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Taiyang (Greater Yang) and Shaoyang (Lesser Yang) diseases occur simultaneously, presenting with stiffness and pain in the head and neck, sometimes accompanied by dizziness or vertigo. The symptoms occasionally resemble Jie Xiong (Chest Binding Syndrome, where pathogenic heat and fluid retention bind in the chest and diaphragm), with a sensation of fullness and hardness in the epigastrium. In such cases, acupuncture should be applied to the first interspace of the Dazhui (GV14) acupoint, Feishu (BL13), and Ganshu (BL18). Sweating therapy must be strictly avoided; if sweating is induced erroneously, it will lead to delirium and a wiry pulse. If delirium persists for five to six days, Qimen (LR14) acupoint should be needled.

When Taiyang and Shaoyang diseases coexist, with epigastric hardness, stiff neck, and dizziness, Dazhui (GV14), Feishu (BL13), and Ganshu (BL18) should be needled. Purging therapy must not be used. If Taiyang and Shaoyang diseases are treated erroneously with purging, Jie Xiong (Chest Binding Syndrome) forms, characterized by epigastric hardness, incessant diarrhea, inability to take even fluids, and mental restlessness.

Commentary: When the pathogen resides in Shaoyang (Lesser Yang), it may enter the Fu organs of Yangming (Greater Yang) or the Zang organs of Taiyin (Greater Yin). If it is about to enter Yangming but the exterior syndrome has not yet resolved, premature purging results in Jie Xiong (Chest Binding Syndrome). If it is about to enter Taiyin, erroneous purging results in Pi (Stagnation Syndrome, characterized by epigastric fullness and obstruction without pain). This etiology is fundamentally the same as that of Jie Xiong and Pi syndromes in Taiyang disease.

Regarding Jie Xiong (Chest Binding Syndrome), Da Xian Xiong Tang (Major Downward Draining Decoction) is the primary formula. Regarding Pi (Stagnation Syndrome), Ban Xia Xie Xin Tang (Pinellia Decoction to Drain the Epigastrium) is the primary formula.

The defining characteristics of Taiyin (Greater Yin) disease include abdominal fullness, vomiting, inability to eat, worsening spontaneous diarrhea, and occasional spontaneous abdominal pain. If purging is applied erroneously, it will inevitably cause binding and hardness below the chest.

Commentary: Taiyin Spleen governs damp earth. Its meridian originates at the tip of the great toe, ascends along the medial malleolus into the abdomen, passes through the diaphragm, flanks the throat, and connects to the root of the tongue. Taiyin is the chief of the three Yin meridians. If Taiyang disease does not resolve, Ying (Nutritive Qi) and Wei (Defensive Qi) become internally stagnant, transmitting to Yangming and then Shaoyang; after four days, it must transmit to the Taiyin meridian. If the patient’s visceral Yin is naturally robust, transmission from the meridian to the Zang organ can occur regardless of the number of days. Once the pathogen enters the Zang organ, warming the interior is required; exterior-releasing methods alone cannot cure it. Zhang Zhongjing established chapters on Taiyin and Shaoyin diseases to discuss interior syndromes resulting from pathogen entry into the Zang organs, rather than merely referring to meridian syndromes occurring on the fourth, fifth, or sixth day.

Regarding Taiyin disease: If the exterior cold has not resolved, Gui Zhi Tang (Cinnamon Twig Decoction) is the primary formula. If the exterior is unresolved but interior cold is urgent, Si Ni Tang (Frigid Extremities Decoction) is administered first, followed by Gui Zhi Tang (Cinnamon Twig Decoction). If the exterior is resolved but there is excess cold in the interior, Si Ni Tang (Frigid Extremities Decoction) is used. If there is cold in the interior and deficient heat above, Huang Lian Tang (Coptis Decoction) is used. If the exterior is unresolved and the interior is deficient, Gui Zhi Jia Shao Yao Tang (Cinnamon Twig Decoction with Added Paeonia) is used. If the exterior is unresolved and the interior is excess, Gui Zhi Jia Da Huang Tang (Cinnamon Twig Decoction with Added Rheum) is used. If exterior cold stagnates generating internal damp-heat, Yin Chen Hao Tang (Artemisiae Scopariae Decoction) is used. If exterior dampness stagnates generating internal stasis-heat, Ma Huang Lian Qiao Chi Xiao Dou Tang (Ephedra, Forsythia, and Red Bean Decoction) is used. If both exterior and interior present stasis-heat, Zhi Zi Bai Pi Tang (Gardeniae Cortex Phellodendri Decoction) is used.