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26. On the first day, Taiyang (Sun Yang) and Shaoyin (Lesser Yin) diseases occur simultaneously, presenting with headache, dry mouth, thirst, and irritability. On the second day, Yangming (Bright Yang) and Taiyin (Greater Yin) diseases occur, presenting with abdominal fullness, loss of appetite, fever, and delirious speech. On the third day, Shaoyang (Lesser Yang) and Jueyin (Terminal Yin) diseases occur, presenting with deafness, retraction of the scrotum, cold limbs (Jue Ni), inability to take in food or fluids, and unconsciousness or stupor. By the sixth day, vital Qi is exhausted, and life cannot be preserved.

[Note] "Liang Gan" (Simultaneous contraction of exterior and interior meridians) refers to the simultaneous disease of zang-fu organs and their corresponding exterior-interior meridians. On the first day, headache indicates Taiyang; dry mouth, irritability, and thirst indicate Shaoyin. On the second day, fever and delirium indicate Yangming; abdominal fullness and loss of appetite indicate Taiyin. On the third day, deafness indicates Shaoyang; scrotal retraction and cold limbs indicate Jueyin. Pathogens transmitted via meridian transmission cause illness gradually, whereas pathogens causing Liang Gan cause illness rapidly. This is because the pathogenic Yang heat is fierce, and the righteous Qi cannot resist it. Therefore, after three days, the patient cannot take in food or fluids, the Qi of the six fu organs is about to perish, consciousness is lost, and the spirit of the five zang organs has collapsed. The reason for not dying immediately is that the Stomach Qi has not yet completely exhausted. Thus, after another three days, when the Qi is fully exhausted, death occurs. Zhang Jiegu formulated Da Qiang Huo Tang (Great Notopterygium Decoction), using herbs such as Qiang Huo (Notopterygii Rhizoma et Radix), Du Huo (Angelicae Pubescentis Radix), Huang Qin (Scutellariae Radix), and Lian Zi (Coptidis Rhizoma). It uses acrid-sweet properties to disperse the exterior pathogen of Taiyang and bitter-cold properties to clear the heat of Shaoyin. When applied to cases where the exterior and interior conditions are not urgent, this method is indeed appropriate. However, if on the first day there is headache, dry mouth, irritability, and thirst; on the second day, fever, delirium, abdominal fullness, and loss of appetite; and on the third day, deafness, scrotal retraction, cold limbs, inability to eat or drink, and unconsciousness, with such rapid progression, using a mild formula like Da Qiang Huo Tang might cause one to miss the optimal treatment opportunity. One should follow Zhang Zhongjing's principle that treatment must have priority, assess whether the exterior or interior condition is more urgent, and treat according to the syndrome. In this way, survival might still be possible. Therefore, for this syndrome at its onset, if on the first day both exterior and interior are hot, referring to the method for Shaoyin disease occurring on the second or third day with dry mouth and throat, use a heavy dose of Da Cheng Qi Tang (Major Order the Qi Decoction) to purge the fierce Yang pathogen. If both exterior and interior are cold, referring to the method for early-stage Shaoyin disease with fever and deep pulse, use Ma Huang Fu Zi Xi Xin Tang (Ephedra, Aconite, and Asarum Decoction) to resolve the urgency of the Yin pathogen. On the second day, if both exterior and interior are excess syndromes, referring to Yangming disease with delirium, tidal fever, abdominal fullness that occasionally relieves but insufficiently so, use Da Cheng Qi Tang to attack. If both exterior and interior are deficiency syndromes, referring to the combination of three yang meridians with abdominal fullness, heaviness of the body, greasy face, and delirium, use a large dose of Bai Hu Jia Ren Shen Tang (White Tiger Decoction plus Ginseng) to clear. On the third day, if both exterior and interior are hot, referring to the principle "the deeper the cold limbs, the deeper the heat," use Da Cheng Qi Tang to purge. If both exterior and interior are cold, referring to the method for faint pulse nearly imperceptible and cold hands and feet, use Dang Gui Si Ni Jia Wu Zhu Yu Sheng Jiang Tang (Angelica Sinensis Decoction for Cold Limbs plus Evodia and Fresh Ginger) to warm. If treatment is delayed, it will be too late. There are cases among these where patients survive; scholars in later generations should pay close attention to this.