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Yellow Emperor asked: In cases of Lianggan (simultaneous contraction of exterior and interior meridians by cold pathogen), what are the corresponding pulse and clinical manifestations? Qibo replied: In cases of Lianggan, on the first day, the Taiyang (Greater Yang) and Shaoyin (Lesser Yin) meridians are affected simultaneously, resulting in headache, fever, dry mouth, and vexation with fullness; on the second day, the Yangming (Yang Brightness) and Taiyin (Greater Yin) meridians are affected simultaneously, resulting in abdominal fullness, generalized fever, anorexia, and delirium; on the third day, the Shaoyang (Lesser Yang) and Jueyin (Terminal Yin) meridians are affected simultaneously, resulting in deafness, retraction of the genitals, and cold extremities, inability to take food or fluids, unconsciousness, leading to death on the sixth day. It is also stated that external pathogenic qi from heaven damages the five zang organs when contracted, indicating that simultaneous exterior-interior contraction involves both fu and zang organs. If one attempts to release the exterior, the interior is compromised; if one attempts to purge the interior, the exterior is compromised. Since neither exterior nor interior can be treated independently, death ensues. For those with shallow contraction, treatment may still be possible, using Chonghe Lingbao Yin (Harmonizing and Spiritual Elixir Decoction) or Da Qianghuo Tang (Major Notopterygium Decoction). Subsequently, observe the syndromes: if interior syndrome is urgent, use Da Chaihu Tang (Major Bupleurum Decoction) or Tiaowei Chengqi Tang (Regulating the Stomach and Directing Downward Decoction) for mild purgation; if exterior syndrome is urgent, use Chaige Jieji Tang (Bupleurum and Kudzu Muscle-Releasing Decoction) or Xiao Chaihu Tang (Minor Bupleurum Decoction) for mild release. If there is diarrhea, body pain, cold extremities, and a deep pulse, indicating transmission of pathogen to yin meridians, use Sini Tang (Frigid Extremities Decoction) or Lizhong Tang (Regulate the Middle Decoction) for warming supplementation based on severity.

Foot-Taiyang Bladder Meridian: Headache, neck stiffness, pain in the spine, lower back, and knees, aversion to cold with spasms, fever without sweating indicates Exterior Excess syndrome; treat according to the principal formula. If slight fever and delirium occur after onset, with difficult urination and heat binding in the bladder, Gui Ling Yin (Cinnamon Twig and Polyporus Decoction) is indicated. If urination is clear but there is lower abdominal urgency and distension, it is Blood Stasis syndrome. If stool is black, with thirst for water but reluctance to swallow, Tao Ren Chengqi Tang (Peach Kernel Directing Downward Decoction) should be used to expel black blood. If heat is severe with sweating stopping at the neck, thirst for water, and difficult urination, jaundice will certainly develop; Yinchen Wuling San (Artemisia Capillaris and Five-Ingredient Powder with Poria) is indicated. After sweating, if there is thirst, nasal congestion, unresolved exterior syndrome, vexation, closing eyes, and epistaxis flowing freely, the disease resolves; if not, induce mild sweating again.

Foot-Yangming Stomach Meridian: Eye pain, dry nose, insomnia, fever with slight aversion to cold, spontaneous sweating, dry tongue, and slightly surging-long pulse belong to the primary disease of Yangming Exterior syndrome. If the tongue coating is white and slippery, Ge Gen Tang (Kudzu Decoction) added with Chai Hu (Bupleuri Radix) and Huang Qin (Scutellariae Radix) is used; if ineffective, Sheng Di Huang Qin Lian Tang (Rehmannia, Scutellaria, and Coptis Decoction) is used. Later, if there is extreme thirst and yellow tongue coating, it belongs to the meridian syndrome, using Rushen Baihu Tang (Divine White Tiger Decoction); if thirst is severe, double the dose of Shi Gao (Gypsum Fibrosum), add Tian Hua Fen (Trichosanthis Radix), Huang Lian (Coptidis Rhizoma), and Zhu Ye (Bambusae Folium). Tidal fever, spontaneous sweating, tossing covers, constipation, passing foul flatus, or spontaneous passage of foul watery stool, chest oppression, and yellow tongue coating indicate Yangming secondary disease; Da Chaihu Tang is used. If ineffective, Liu Yi Shun Qi Tang (Six-Ethyl Regulating Qi Decoction) is used. If the tongue coating is black, dry, and prickly like thorns, heavily use Da Huang (Rhei Radix et Rhizoma) and Mang Xiao (Natrii Sulfas); if ineffective, add more; failure to use them leads to death. If exterior is not cleared and interior is severe, Da Chaihu Tang is used. If heat is severe, San Huang Shigao Tang (Three Yellows and Gypsum Decoction) is used. If eyes are red, San Huang Juseng Tang (Three Yellows and Sesame Decoction) is used.

Foot-Shaoyang Gallbladder Meridian: Deafness, hypochondriac pain, dry retching, bitter taste, alternating chills and fever, slight aversion to cold, scanty sweating, white tongue coating, and floating-wiry pulse indicate Shaoyang meridian disease. The gallbladder has no direct exit or entry, residing in the half-exterior half-interior region; sweating, vomiting, and purging are prohibited. Use Chaihu Shuangjie Yin (Bupleurum Dual-Solving Decoction) for harmonization. Later, if there is fever, deafness, chest fullness, vomiting, thirst, yellow tongue coating, spontaneous diarrhea, and wiry pulse, it is secondary disease; only Xiao Chaihu Tang added with Huang Lian, Zhu Ru (Bambusae Caulis in Taenia), and Zhi Shi (Aurantii Fructus Immaturus) is suitable. Add Da Huang if bowel and urinary passages are obstructed with little output.

Foot-Taiyin Spleen Meridian: Abdominal fullness, dry throat, yellow tongue coating, warm hands and feet, jaundice, difficult urination, constipation, abdominal pain, and deep-forceful pulse indicate primary disease; Gui Zhi Da Huang Tang (Cinnamon Twig and Rhubarb Decoction) is used for purgation. Later, if head sweat stops at the neck, thirst, red urine, solid stool, jaundice of body and eyes, and deep-solid pulse indicate secondary disease; Yinchen Da Huang Tang (Artemisia Capillaris and Rhubarb Decoction) is used. If there is no thirst, vomiting, free bowel movements, clear long urine, pink-red tongue, deep-weak pulse, and cold extremities, Jiawei Lizhong Tang (Modified Regulate the Middle Decoction) is indicated. Or, if initially yang syndrome, due to excessive purgation in a weak constitution, causing deficiency pathogens to transmit to yin meridians with complete cold symptoms, Lizhong Tang is used for warming supplementation.

Foot-Shaoyin Kidney Meridian: Dry mouth and throat, yellow edges and black center tongue coating, constipation or watery stool, and deep-forceful pulse indicate heat pathogen transmitting to Shaoyin primary disease; Tiaowei Chengqi Tang is used for mild purgation. Later, if there is delirium, constipation, hard pain around the umbilicus, vexation, extreme thirst, and rapid-deep pulse, it indicates heat pathogen transmitting to Shaoyin secondary disease; Da Chengqi Tang (Major Directing Downward Decoction) is used for urgent purgation. If heat pathogen transmits to the Chong vessel affecting the blood level, causing reckless blood movement, upward reversal causes hematemesis, downward pressure causes hematochezia. External signs include coma, delirium, dry tongue without coating resembling a roasted pig kidney, deep-choppy or surging-rapid pulse; Sheng Di Huang Lian E Jiao Tang (Rehmannia, Coptis, and Donkey-Hide Gelatin Decoction) or Gui Di Yang Rong Tang (Angelica and Rehmannia Nourishing Nutrient Decoction) are indicated. All above are due to heat pathogen transmitting to kidney, exhausting water, not true yin syndrome. If there is aversion to cold, cold extremities, curling up without thirst, vomiting/diarrhea, abdominal pain, heavy body, and deep-slow pulse, it belongs to zang cold; Huiyang Jiuji Tang (Restore Yang Rescue Emergency Decoction) is used for warming supplementation.

Foot-Jueyin Liver Meridian: Chest and abdominal fullness, extreme thirst drinking water, delirium, vexation, constipation or watery stool, dry tongue, yellow-black-dry coating, and deep-forceful pulse indicate heat pathogen transmitting to Jueyin primary disease; Liu Yi Shun Qi Tang is used for purgation. Later, if previous symptoms persist but hands and feet become cold or suddenly warm, this is "deep heat leads to deep cold" (reversal cold), not true cold. Deep-forceful pulse indicates secondary disease; Da Chengqi Tang is used for urgent purgation. If there is salivation, cold extremities exceeding elbows and knees, no thirst, lower abdominal pain, and deep-slow pulse, this is true yin syndrome of this meridian; Huiyang Jiuji Tang and Zhuyu Sini Tang (Evodia and Frigid Extremities Decoction) are urgently needed for warming.

Among the six meridians, only Shaoyin Kidney Meridian is ambiguous and difficult to clarify, with all pulses being deep. Deep and forceful indicates yang; use Da Huang and Mang Xiao for purgation. Deep and weak indicates yin; use Fu Zi (Aconiti Lateralis Radix Preparata), Jiang (Zingiberis Rhizoma), and Gui (Cinnamomi Ramulus) for warming supplementation. A difference of a hair leads to a thousand miles error; killing happens in the flip of a hand. One must carefully consider externally observed signs concurrently. Twelve syndromes such as "yang syndrome resembling yin" and "yin syndrome resembling yang" are discussed separately in ancient texts, making them hardest for beginners to analyze. (Hong) desiring ease of understanding for later generations, these have been compiled into two discussions. Although largely similar with minor differences, the temperature and weight of medications require careful clinical observation.