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In cases of *Lianggan* (Simultaneous Affection by Cold on Exterior and Interior), on the first day, the Taiyang (Greater Yang) and Shaoyin (Lesser Yin) meridians are simultaneously affected as exterior and interior respectively. Symptoms such as headache, fever, and aversion to cold indicate that the pathogenic factor is in the exterior; symptoms such as dry mouth and thirst indicate that the pathogenic factor is in the interior.

On the second day, the Yangming (Bright Yang) and Taiyin (Greater Yin) meridians are simultaneously affected. Symptoms such as body heat, eye pain, nasal dryness, and insomnia indicate that the pathogenic factor is in the exterior; symptoms such as abdominal fullness and loss of appetite indicate that the pathogenic factor is in the interior.

On the third day, the Shaoyang (Lesser Yang) and Jueyin (Terminal Yin) meridians are simultaneously affected. Symptoms such as deafness, hypochondriac pain, alternating chills and fever, and vomiting indicate that the pathogenic factor is in the exterior; symptoms such as mental restlessness and abdominal fullness, retraction of the scrotum, cold limbs, and inability to take food or fluids indicate that the pathogenic factor is in the interior.

In all cases of *Lianggan*, whether occurring within three days or six days, the Ying (Nutritive) and Wei (Defensive) Qi cease to circulate, and the Zang-Fu organs become obstructed. The patient falls into a coma and loses consciousness, the Stomach Qi is exhausted, and death ensues. Although this condition is critical, the physician cannot remain passive. Emergency measures akin to rescuing someone from drowning or putting out a fire are indispensable. However, one must carefully examine the syndrome to distinguish between urgency and slackness. If the symptoms involve the Three Yang meridians—such as headache, body heat, deafness, hypochondriac pain, aversion to cold, and vomiting—the pathogen is in the exterior and must be resolved externally. If the symptoms involve the Three Yin meridians—such as abdominal fullness, thirst, scrotal retraction, and delirium—the pathogen is in the interior and must be harmonized internally. If the pathogen enters from the exterior and the exterior symptoms are more severe than the interior ones, treatment should primarily target the exterior while concurrently regulating the interior. If the invasion occurs due to deficiency, and the Yuan Qi (Original Qi) is unable to sustain itself, immediate attention should be paid solely to preserving the root cause. One must not attack the pathogen; rather, if the Yuan Yang (Original Yang) is preserved, even a formidable enemy will dissipate on its own, offering a glimmer of hope. Given the highly variable nature of this syndrome, rigid prescriptions for treatment are inappropriate.

Commentary: My disciple Qian Zhen stated: *Lianggan* refers to simultaneous disease of the exterior and interior, seemingly implying an external contraction, but in reality, it does not always fit this definition strictly. It is precisely because both internal and external aspects are injured that it is termed *Lianggan*. Currently, we observe cases where the Shaoyin meridian fails internally first, followed by the Taiyang meridian externally; this is *Lianggan* caused by indulgence in desires. When the Taiyin meridian is injured internally, and the Yangming meridian is subsequently re-infected externally, this is *Lianggan* caused by overexertion, fatigue, and irregular diet. When the Jueyin meridian experiences Qi rebellion within the Zang organs, and the Shaoyang meridian becomes diseased in the Fu organs, this is *Lianggan* caused by imprudent emotional responses, tendon fatigue, and blood deterioration. People know *Lianggan* as a type of Shanghan (Cold Damage), but they do not realize that in *Lianggan* associated with Cold Damage, both internal and external systems are besieged, making the illness severe. However, the severity of the injury varies, and the outcome depends on the physician's knowledge, determining life or death. Some argue that *Lianggan* syndromes are rare; this is likely due to limited clinical exposure and a lack of deep understanding of their principles. Regarding treatment, the key lies in identifying the etiology and addressing the root. These words are most pertinent to this disease, truly revealing insights previously unexpressed, and sufficiently guiding those lost in confusion. They must be recorded.