合并病者,伤寒传经之别名也。或两经同病,或三经同病,名曰合病;若一经病未已,
复连及一经,名曰并病。伤寒书云∶三阳有合病,有并病,三阴无合病,无并病。果尔则太
阴必不与少阴同病乎?少阴必不与厥阴同病乎?且太阴病未瘥,必不至并于少阴,少阴病未瘥
必不至并于厥阴乎?若然,则三阴之证,何以相兼而并见乎?又何以三阳三阴之邪,互相交
错而为病乎?是知合病、并病,有合于阳者,即有合于阴者,有并于阳者,即有并于阴者。
仲景谓三阳合病,闭目则汗,面垢、谵语、遗尿,治用白虎汤。此外合三阳之经,内合阳明
之腑,故用辛凉和解之。若不入腑,白虎将焉用乎?治法不论三阳、三阴,凡两经合病,则
用两经药同治之,三经合病,则用三经药同治之。若一经病未瘥,复并一经,则相其先后、
缓急、轻重而药之,斯无弊耳。然则合、并病者,岂非伤寒传经之别名欤!
直中者,初起不由阳经传入,而径中三阴者也。中太阴,宜用理中汤;中少阴,宜用四
逆汤;中厥阴,宜用白通加猪胆汁汤。大抵脏受寒侵,不温则殆,急投辛热,不可迟缓。
治寒邪中于太阴,呕吐清涎沫,腹中冷痛,或下利清谷,吐蛔虫,脉来沉
干姜 附子 炙甘草(各一钱) 人参(二钱) 白术(二钱)
水煎服。寒甚者,加干姜二钱;渴欲得水,加人参、白术各一钱;当脐有动气,去白术
加肉桂一钱;吐多者,加生姜一钱五分;下利多者,倍加白术;悸者,加茯苓一钱五分;
腹满者,去参、术,加陈皮、半夏、砂仁各八分,附子一钱五分;盖温即是补。
Combined disease (He Bing) and concurrent disease (Bing Bing) are alternative terms for the transmission of meridians in Shanghan (Cold Damage). When two meridians are diseased simultaneously, or three meridians are diseased simultaneously, it is called Combined Disease; if a disease in one meridian has not yet resolved and subsequently involves another meridian, it is called Concurrent Disease. Shanghan texts state: "There are Combined and Concurrent diseases in the Three Yang meridians, but none in the Three Yin meridians." Is this true? Must Taiyin never be diseased concurrently with Shaoyin? Must Shaoyin never be diseased concurrently with Jueyin? Moreover, if Taiyin disease is not cured, must it necessarily involve Shaoyin? If Shaoyin disease is not cured, must it necessarily involve Jueyin? If so, how can the syndromes of the Three Yin meridians appear jointly and simultaneously? And why do pathogens of the Three Yang and Three Yin meridians interweave to cause disease? Thus, we know that there are Combined diseases involving Yang, just as there are those involving Yin; there are Concurrent diseases involving Yang, just as there are those involving Yin. Zhang Zhongjing stated that in Combined disease of the Three Yang meridians, symptoms include sweating when eyes are closed, facial grime, delirium, and urinary incontinence, treated with Baihu Tang (White Tiger Decoction). This is because the exterior combines with the meridians of the Three Yang, and the interior combines with the Fu organs of Yangming; hence, acrid-cool harmonizing methods are used. If the pathogen does not enter the Fu organs, where would Baihu Tang be applicable? In treatment, whether concerning the Three Yang or Three Yin meridians, if two meridians are combined, medications from both meridians are used together; if three meridians are combined, medications from all three are used together. If a disease in one meridian persists and then involves another, one should observe the sequence, urgency, and severity to prescribe medication accordingly, thus avoiding errors. Therefore, are Combined and Concurrent diseases not merely alternative terms for the transmission of Shanghan!
Direct invasion (Zhi Zhong) refers to the initial onset of disease bypassing the Yang meridians and directly attacking the Three Yin meridians. Invasion of Taiyin is suitable for Lizhong Tang (Regulate the Middle Decoction); invasion of Shaoyin is suitable for Sini Tang (Frigid Extremities Decoction); invasion of Jueyin is suitable for Baitong Tang with Pig Bile (Scallion White Decoction with Pig Bile). Generally, when Zang organs are invaded by cold, failure to warm them leads to peril; urgent administration of acrid-hot drugs is required without delay.
For treating cold pathogen invading Taiyin, presenting with vomiting of clear saliva and froth, cold pain in the abdomen, or diarrhea with undigested food, vomiting of roundworms, and a deep pulse, the prescription is as follows: Ganjiang (Dried Ginger), Fuzi (Prepared Aconite Root), Zhi Gancao (Honey-fried Licorice Root) (each 1 qian), Renshen (Ginseng Root) (2 qian), Baizhu (Atractylodes Rhizome) (2 qian). Decoct in water and take orally. For severe cold, add Ganjiang 2 qian; for thirst with desire to drink water, add Renshen and Baizhu each 1 qian; for pulsation at the navel (Dongqi), remove Baizhu and add Rougui (Cinnamon Bark) 1 qian; for frequent vomiting, add Shengjiang (Fresh Ginger) 1.5 qian; for frequent diarrhea, double the dosage of Baizhu; for palpitations, add Fuling (Poria) 1.5 qian; for abdominal fullness, remove Renshen and Baizhu, and add Chenpi (Tangerine Peel), Banxia (Pinellia Tuber), and Sharen (Amomum Fruit) each 0.8 fen, and Fuzi 1.5 qian; essentially, warming constitutes tonification.