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Wang Haizang stated: Pathogenic factors from Heaven (external pathogens) affect the body and harm the Five Zang organs. From this, it is known that simultaneous internal and external infection leads to disease in both the Fu and Zang organs. If one attempts to release the exterior via sweating, the interior may be compromised; if one attempts to purge the interior, the exterior may be damaged. Since the exterior and interior cannot be treated simultaneously, it is said that "Lianggan" (simultaneous transmission of two meridians) is incurable. However, individuals vary in their constitutional strength (deficiency or excess), and pathogenic invasion varies in depth. Those with deficiency constitution and deep invasion will inevitably die; those with robust constitution and shallow invasion may still be treatable. Although there are cases where treatment fails and death occurs, there are none who survive without treatment. I have occasionally used Da Qianghuo Tang (Great Notopterygia Decoction), saving two or three out of ten patients. Therefore, I established this formula for benevolent physicians to use. Note: The treatment method for this formula is detailed later.

Zhao Sizhen stated: Zhang Zhongjing regarded Lianggan as a fatal syndrome but subsequently discussed treatment priorities, advocating releasing the exterior first and purging the interior second. Successive practitioners likely did this because they could not bear to watch patients die and hoped for a slight chance of survival. *Huangdi Yishu* (The Book of Life) states: One should first rescue the interior with Sini Tang (Frigid Extremities Decoction) and then release the exterior with Guizhi Tang (Cinnamon Twig Decoction). This ignores what Zhang Zhongjing said: When Taiyang and Shaoyin are diseased simultaneously, headache indicates Taiyang pathogenic excess at the exterior, while dry mouth and thirst indicate Shaoyin pathogenic excess at the interior. When Yangming and Taiyin are diseased simultaneously, fever and delirium indicate Yangming pathogenic excess at the exterior, while anorexia and abdominal fullness indicate Taiyin pathogenic excess at the interior. When Shaoyang and Jueyin are diseased simultaneously, deafness indicates Shaoyang pathogenic excess at the exterior, while retraction of the genitals and cold extremities indicate Jueyin pathogenic excess at the interior. For the Three Yang diseases (headache, fever, deafness), releasing the exterior alone is already difficult; for the Three Yin diseases (abdominal fullness, dry mouth/thirst, genital retraction, cold extremities), is it acceptable not to purge the interior? *Huangdi Yishu* cites the example of diarrhea and body pain requiring interior rescue due to deficiency-cold, yet applies this to heat-excess syndromes characterized by irritability, thirst, abdominal fullness, delirium, and genital retraction. Is this reasonable? What Zhang Zhongjing referred to as "releasing the exterior" involves Gegen (Kudzu Root) and Mahuang (Ephedra); what he referred to as "purging the interior" involves Tiaowei Chengqi Tang (Harmonizing the Stomach and Regulating the Qi Decoction). In contrast, *Huangdi Yishu* defines "rescuing the interior" as using Sini Tang and "rescuing the exterior" as using Guizhi Tang. To equate "rescue" with "purge" is contradictory. Using Sini Tang in such cases would be adding fire to fire; how would symptoms like abdominal fullness, delirium, and genital retraction be resolved? How would the Zang-Fu organs become unblocked? How would Ying and Wei Qi circulate? Death within six days would follow immediately. Alas, although Lianggan is considered incurable, the principle of medication lies in supporting healthy Qi and eliminating pathogenic factors, tonifying deficiency, and reducing excess. Physicians must have a consistent methodology in mind.