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In Shaoyang disease, each meridian has its specific symptoms and corresponding treatments. Whether one is injured by Yang pathogens or Yin pathogens, they are inherently different. Given this, why speak of "Liang Gan" (Double Meridian Infection)?

There is the condition of "Bing Bing" (Concurrent Disease) in Shanghan (Cold Damage). For instance, when Taiyang symptoms have not yet subsided, Yangming or Shaoyang symptoms appear subsequently. This is concurrent disease. If the concurrent transmission is complete, the pathogen enters the interior; if incomplete, it remains in the exterior. This represents Yang meridians joining with Yang meridians. How do we know that Yin meridians do not join with Yin meridians?

There is the condition of "He Bing" (Combined Disease). For example, Taiyang and Yangming occur simultaneously, or Yangming and Shaoyang occur simultaneously, or even all three Yang meridians are combined, leading to spontaneous diarrhea. This represents Yang meridians combining with Yang meridians. How do we know that Yin meridians do not combine with Yin meridians?

There is the condition of "Chuan Jing" (Meridian Transmission). For instance, on the first day, Taiyang is affected; on the second day, Yangming; on the third, Shaoyang; on the fourth, Taiyin; on the fifth, Shaoyin; and on the sixth, Jueyin. However, some diseases remain confined to a single meridian throughout, while others transmit through only one or two meridians before stopping. Some skip meridians during transmission, and some persist beyond their designated time frame. This constitutes transmission from Yang meridians into Yin meridians. If Yin conditions transform into Yang, recovery occurs.

There is also "Zhi Zhong" (Direct Invasion). When the three Yin meridians are invaded, there is no fever throughout the course. This is not transmitted from Yang meridians but rather the Yin meridians are directly afflicted. Thus, it does not correspond with Yang conditions. All such cases—Bing Bing, He Bing, Chuan Jing, and Zhi Zhong—cannot be termed "Liang Gan." True "Liang Gan" refers to one Yin meridian and one Yang meridian being diseased simultaneously. For example:
- Taiyang and Shaoyin both diseased: headache, dry mouth, irritability, and fullness.
- Yangming and Taiyin both diseased: abdominal fullness, body heat, anorexia, and delirium.
- Shaoyang and Jueyin both diseased: deafness, retraction of the testicles, cold limbs, inability to swallow fluids, and unconsciousness.

Although headaches, body heat, and deafness in the three Yang meridians are indeed caused by cold invasion, irritability, fullness, delirium, and testicular retraction in the three Yin meridians are heat syndromes resulting from meridian transmission. These would not be seen upon initial cold invasion. Furthermore, since the heat syndromes of meridian transmission and Liang Gan share similarities, why is it said that for meridian transmission, "even severe fever will not result in death," whereas for Liang Gan, "death is inevitable"? I must clarify this distinction.

Generally, meridian transmission involves pathogens moving from the three Yang meridians to the three Yin meridians, characterized by persistent fever, where pulse and symptoms correspond. In contrast, Liang Gan involves simultaneous invasion of one Yin and one Yang meridian: external cold causes exterior excess, while internal cold causes interior deficiency, resulting in a discrepancy between pulse and symptoms. The example cited by Sizhen—"Taiyang symptoms presenting with Shaoyin pulse, or Shaoyin symptoms presenting with fever"—adequately illustrates this. Hence, I have stated that pathogens in meridian transmission often affect those with excess constitutions, sparing the three Yin meridians initially without grave concern. Conversely, pathogens in Liang Gan affect those with deficient constitutions, immediately involving the three Yin meridians, making death unavoidable upon contact. Although the classics do not explicitly discuss excess and deficiency here, the phrase "inevitable death despite severity" cannot be dismissed as exaggeration. Sizhen’s commentary on the Liang Gan chapter merely aligns textually without fitting clinical reality. Therefore, applying Sizhen’s Taiyang-Shaoyin example to Yangming-Taiyin and Shaoyang-Jueyin yields consistent results, leaving no room for doubt.

Appendix: Sizhen’s Discussion on the Differences Between Shaoyin Symptoms Resembling Taiyang and Taiyang Pulse Resembling Shaoyin

Typically, Taiyang disease presents with a pulse resembling Shaoyin, and Shaoyin disease presents with symptoms resembling Taiyang. This reversal necessitates distinct treatments. Upon deep investigation, both present with a deep pulse and fever. If accompanied by headache, it is diagnosed as Taiyang disease, where the pulse should be floating. A deep pulse instead indicates interior deficiency, chronic cold, and衰竭 of healthy Qi. With body pain present, treatment should prioritize rescuing the interior to strengthen healthy Qi internally and expel pathogens externally. In this context, dried ginger and raw Aconite can induce sweating and resolve the condition. If the interior were not deficient and cold, a floating pulse would appear, indicating a Ma Huang Tang syndrome for Taiyang.

Similarly, with a deep pulse and fever but no headache, it is named Shaoyin disease, which typically lacks fever. The presence of fever here arises from cold pathogens trapped in the exterior, causing skin constriction and heat generation. If the pathogen were interior, there would be no exterior heat. Thus, Ephedra, Asarum, and Aconite are used to release exterior heat and warm the Shaoyin meridian. If the cold pathogen were solely interior, symptoms like vomiting, diarrhea, and cold limbs would appear, indicating a Si Ni Tang syndrome for Shaoyin. From this perspective, superficial exterior pathogens cause milder "reversal" symptoms (fever), while depleted healthy Qi causes more significant "reversal" symptoms (deep pulse). Therefore, Si Ni Tang is considered heavier/more critical than Ma Huang Fu Zi Xi Xin Tang. This demonstrates that cooked Aconite paired with Ephedra provides tonification within dispersion, while raw Aconite paired with dried ginger provides dispersion within tonification. Although Taiyang and Shaoyin may both show deep pulses and fever, the presence or absence of headache dictates different treatments, justifying their joint discussion. Misdiagnosis leads inevitably to death.

According to Sizhen: Taiyang symptoms of headache and fever indicate cold invasion of Taiyang. A deep pulse instead of a floating one indicates Shaoyin pulse, suggesting cold invasion of Shaoyin. Using Si Ni Tang treats Shaoyin, prioritizing interior rescue without worrying about failing to expel Taiyang pathogens. Conversely, Shaoyin symptoms of deep pulse indicate cold invasion of Shaoyin. Fever instead of cold indicates Taiyang symptoms, suggesting cold invasion of Taiyang. Using Ma Huang Fu Zi Xi Xin Tang treats both Taiyang (dispersing exterior heat) and Shaoyin (warming the meridian).

However, if Taiyang symptoms include a floating pulse plus vomiting and diarrhea, should one treat only Taiyang? If Shaoyin presents with a deep pulse and fever without Taiyang symptoms, should one focus solely on Shaoyin? This must be understood. By analogy, if Yangming symptoms include body heat and tidal fever but with a weak pulse, diarrhea, and cold limbs, it becomes a Taiyin condition, requiring Fuzi Lizhong Tang to rescue the interior. If Shaoyang symptoms include alternating chills and fever but with a fine pulse, ascariasis-induced convulsions, irritability, and abdominal pain, it becomes a Jueyin condition, requiring Wuzhuyu Tang to rescue the counterflow.

Yang symptoms with Yang pulses are easy to distinguish. Yang symptoms with Yin pulses represent false symptoms and true pulses. There are also cases of both false symptoms and false pulses, such as extreme Yin causing restlessness (desire to jump into water) with a surging pulse that vanishes under pressure, indicating true interior cold and false exterior heat. Or, a choppy pulse with cold limbs, vomiting, constipation, and hidden heat, representing water resembling fire at extremes, or fire resembling water at extremes. Such cases cannot be equated with Liang Gan. Ultimately, treating the root ensures success; treating the branch ensures failure. Clinicians must exercise caution.

Si Ni Tang (Recovery Decoction)
Fuzi (Aconiti Lateralis Radix Praeparata, 2 qian)
Gancao (Glycyrrhizae Radix et Rhizoma, unspecified amount)
Ganjiang (Zingiberis Rhizoma, 1.5 qian each)
Decoct in water and take orally.

Ma Huang Fu Zi Xi Xin Tang (Ephedra, Aconite, and Asarum Decoction)
Mahuang (Ephedrae Herba, 2 qian each)
Xixin (Asari Radix et Rhizoma, 2 qian each)
Fuzi (Aconiti Lateralis Radix Praeparata, 1 qian)
Decoct in water and take orally.

Li Zhong Tang (Regulate the Middle Decoction)
Renshen (Ginseng Radix, 1 qian each)
Baizhu (Atractylodis Macrocephalae Rhizoma, 1 qian each)
Ganjiang (Zingiberis Rhizoma, 1 qian each)
Gancao (Glycyrrhizae Radix et Rhizoma, 0.8 qian)
Decoct in water and take orally. Add Fuzi if abdominal pain is severe; add Shengjiang (Zingiberis Rhizoma Recens) if vomiting due to cold occurs; add Fuling (Poria, unspecified amount) if urination is difficult; remove Baizhu if Kidney Qi moves.

Wu Zhu Yu Tang (Evodia Decoction)
Wuzhuyu (Evodiae Fructus, 3 qian each)
Shengjiang (Zingiberis Rhizoma Recens, 3 qian each)
Renshen (Ginseng Radix, 1 qian)
Decoct with half a zhong of water and one jujube until reduced to seven-tenths, then take orally.