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Typhoid fever presents with the syndromes of the Six Channels (Liu Jing), as well as the pulses of the Six Channels. If the syndromes and pulses are distinct and non-mixed, one can directly identify it as a disease of a specific channel. However, if two or three channels are involved simultaneously, with Yin and Yang symptoms confused such that it cannot be named after a single channel; or if a disease in one channel has not yet resolved before transmitting to another channel, resulting in simultaneous involvement of two or three channels without merging into a single channel, this is termed "He Bing" (Combined Disease). If two or three channels are involved simultaneously, but subsequently the pathogen merges into one channel to manifest independently, this is termed "Bing Bing" (Consecutive Disease). Although the Treatise only mentions He Bing and Bing Bing for the Yang channels and does not explicitly address the Yin channels, given that He Bing and Bing Bing exist for the Yang channels, it can be inferred that they also exist for the Yin channels. For example: Taiyang disease (Disease of the Taiyang Channel) presenting with a pulse that is unexpectedly deep, and Shaoyin disease (Disease of the Shaoyin Channel) presenting with unexpected fever, constitutes a combined disease of Shaoyin and Taiyang; Yangming disease (Disease of the Yangming Channel) presenting with a slow pulse, and Taiyin disease (Disease of the Taiyin Channel) presenting with severe abdominal pain due to excess, constitutes a combined disease of Taiyang and Yangming; Shaoyang disease (Disease of the Shaoyang Channel) presenting with a fine pulse and cold extremities, and Jueyin disease (Disease of the Jueyin Channel) presenting with vomiting and fever, constitutes a combined disease of Jueyin and Shaoyang. Although these cases lack the name "combined disease," they indeed possess the reality of combined disease. Furthermore, all Three Yang channels have fever syndromes, and all Three Yin channels have diarrhea syndromes. For instance, simultaneous fever and diarrhea constitute a combined disease of Yin and Yang. In a combined disease of Yin and Yang, if Yang is predominant and belongs to the Yang channels, the diarrhea is due to excess-heat; this corresponds to what the Treatise calls combined diseases of Taiyang-Yangming, Yangming-Shaoyang, and Taiyang-Shaoyang. If Yin is predominant and belongs to the Yin channels, the diarrhea is due to deficiency-cold; this corresponds to what the Treatise describes as Shaoyin diarrhea with unexpected fever (indicating survival), Shaoyin diarrhea with undigested food, interior cold with exterior false heat, aversion to cold absent but facial redness present. Generally, when Yang combines with Yang without involving Yin, forming a combined disease of the Three Yang channels, there is no diarrhea but spontaneous sweating, which is a syndrome for Baihu Tang (White Tiger Decoction). When Yin combines with Yin without involving Yang, forming a combined disease of the Three Yin channels, there is no fever but vomiting, diarrhea, and cold extremities, which is a syndrome for Sini Tang (Frigid Extremities Decoction). Indeed, human Zang-Fu organs are mutually rooted, and Yin and Yang interact. Since there are combined diseases of the Three Yang channels, it goes without saying that there are also combined diseases of the Three Yin channels.

In a combined disease of Taiyang and Yangming channels, spontaneous diarrhea will inevitably occur; Gegen Tang (Pueraria Decoction) is the primary formula. In a combined disease of Taiyang and Yangming channels, if there is no diarrhea but only vomiting, Gegen Jia Banxia Tang (Pueraria and Pinellia Decoction) is the primary formula.

[Annotation] When a disease in one channel has not yet resolved before transmitting to another, resulting in simultaneous involvement of two or three channels without merging into a single channel, it is called He Bing (Combined Disease). A combined disease of Taiyang and Yangming refers to the simultaneous occurrence of Taiyang symptoms such as fever, aversion to cold, and anhidrosis, with Yangming symptoms such as irritability, heat, and insomnia. The ascending and descending of Wei Qi (Defensive Qi) and Ying Qi (Nutritive Qi) between the exterior and interior become disordered. Therefore, if there is no diarrhea, there will be upward reversal leading to vomiting. The treatment method requires first resolving the exterior of the Taiyang channel; once the exterior is resolved, the interior of the Yangming channel will naturally harmonize. If diarrhea occurs, Gegen Tang should be used to release the exterior and lift clear Yang, and the diarrhea will stop; if vomiting occurs, Banxia (Pinelliae Rhizoma) should be added to descend rebellious Qi while releasing the exterior, and the vomiting will cease.

[Collected Annotations] Cheng Wuji stated: When pathogenic factors are strong on the exterior, Yang fails to govern the interior, causing interior disharmony. If interior Qi descends without reversing upward, there is only diarrhea without vomiting; if interior Qi reverses upward without descending, there is only vomiting without diarrhea. Therefore, Gegen Tang is used to scatter exterior pathogens, and Banxia is added to direct rebellious Qi downward.

Gegen Tang Formula
Gegen (Puerariae Radix, 4 liang), Mahuang (Ephedrae Herba, processed, 3 liang), Guizhi (Cinnamomi Ramulus, 2 liang), Shaoyao (Paeoniae Radix Alba, 2 liang), Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried, 2 liang), Shengjiang (Zingiberis Rhizoma Recens, sliced, 3 liang), Dazao (Ziziphi Jujubae Fructus, broken open, 12 pieces).
The above seven ingredients are coarsely crushed. Boil in 10 dou of water. First decoct Mahuang and Gegen, reduce by 2 dou, skim off the foam, then add the remaining herbs. Decoct to obtain 3 sheng of liquid. Take 1 sheng warm. Cover with blankets to induce slight sweating. There is no need to drink hot porridge. Other nursing care methods and contraindications follow those of Guizhi Tang.

Gegen Jia Banxia Tang Formula
To the Gegen Tang formula, add Banxia (Pinelliae Rhizoma, half sheng). All other procedures follow the Gegen Tang method.

[Formula Analysis] This formula is essentially Guizhi Tang (Cinnamon Twig Decoction) plus Mahuang and Gegen. Mahuang assists Guizhi to induce sweating from the Ying and Wei levels of the Taiyang channel. Gegen acts as the sovereign herb alongside Guizhi to resolve pathogens in the muscle layer of the Yangming channel. It is named Gegen Tang rather than Guizhi Tang plus Mahuang and Gegen because the emphasis is on the Yangming channel, as vomiting and diarrhea often belong to Yangming pathology. When both Yang channels have urgent exterior conditions, warm administration and covering to induce sweat are necessary, otherwise the exterior will not easily resolve. Whether vomiting or diarrhea occurs, the interior is already disharmonious. Even if hot porridge is consumed, the Stomach cannot transport essence to the skin and hair. Therefore, drinking hot porridge is unnecessary.

[Collected Exegesis] Ke Qin stated: Li Gao designated it as a medicine for the Yangming channel, and Jiegu said: Do not administer it immediately if the pathogen has not entered the Yangming channel. Did these two scholars not read Zhang Zhongjing's works? In essence, both Gegen and Guizhi are agents that resolve the muscle layer and harmonize the interior. Thus, they can be used whether there is sweating or not, and whether there is diarrhea or not, differing from Mahuang which is specialized for releasing the exterior.

Wang Hu stated: The *Waitai Fangyi* asks: The classic states that diarrhea should not be treated with sweating, as sweating leads to abdominal distension. Why is sweating indicated here for diarrhea? The answer is: In Shaoyin disease, diarrhea with undigested food indicates interior deficiency; further sweating would cause Spleen deficiency and distension. Here, the Taiyang disease has not yet resolved; there may still be headache, aversion to wind and cold, etc., indicating the pathogen is still at the exterior, and the pulse is still floating. It has transmitted to the Yangming channel, presenting with thirst, body heat, etc., accompanied by spontaneous diarrhea. One must use this formula to release the Taiyang exterior, because it contains Gegen which can eliminate Yangming pathogens. Therefore, for any condition featuring fever combined with interior signs and a floating pulse, this formula is most suitable.

In a combined disease of Taiyang and Yangming channels, characterized by wheezing and chest fullness, purgation is contraindicated; Mahuang Tang (Ephedra Decoction) is appropriate.

[Annotation] In a combined disease of Taiyang and Yangming, if there is no diarrhea or vomiting, it indicates that the interior Qi is solid and resistant to pathogens. If wheezing and chest fullness occur, it signifies that exterior pathogens are strong and Qi is congested in the chest and lungs. The pathogen is located in the high-level exterior, not constituting a Chest Bind (Jie Xiong); therefore, purgation is contraindicated. Use Mahuang Tang to release the exterior and unblock the Lungs; the wheezing and fullness will resolve spontaneously.

[Collected Annotations] Yu Chang stated: In a combined disease of two channels, medicines for both channels should be used. How can one use only Mahuang Tang? When pathogens from Taiyang and Yangming combine and attack the Stomach, if there is no vomiting, there is diarrhea; thus, Gegen Tang is used. Now, since the pathogen attacks the Lungs, causing wheezing and chest fullness, Mahuang and Xingren (Armeniacae Semen Amarum) are the specific drugs for treating Lung Qi rebellion and wheezing.

Wei Litong stated: In a combined disease of two channels, if symptoms manifest solely in the chest and lungs with wheezing and fullness, this is precisely the harm caused by exterior pathogens of the two channels. Do not mistakenly consider the chest and diaphragm as interior and recklessly apply purgative methods like Da Xianxiong Tang (Major Chest Bind Decoction) or Xiao Xianxiong Tang (Minor Chest Bind Decoction).

In a combined disease of Taiyang and Shaoyang channels, if there is spontaneous diarrhea, administer Huangqin Tang (Scutellaria Decoction); if there is vomiting, Huangqin Jia Banxia Shengjiang Tang (Scutellaria, Pinellia and Ginger Decoction) is the primary formula.

[Annotation] A combined disease of Taiyang and Shaoyang refers to the simultaneous appearance of Taiyang symptoms (fever, aversion to cold) and Shaoyang symptoms (alternating chills and fever). If exterior pathogens are strong, causing vexation and pain in the limbs and joints, Chaihu Guizhi Tang (Bupleurum and Cinnamon Twig Decoction) should be used to resolve the exterior of both channels. Now, with strong interior heat causing spontaneous diarrhea, Huangqin Tang should be used to clear the heat and harmonize the interior. If vomiting occurs, add Banxia and Shengjiang, employing a descending method within the clearing and harmonizing approach.

[Collected Annotations] Cheng Zhi stated: This discusses diarrhea in a combined disease of Taiyang and Shaoyang, indicating the use of the Harmonizing Method. Mentioning Taiyang implies that exterior signs remain. However, since diarrhea is present, it is clear that heat has entered the interior. Therefore, instead of releasing the exterior, the interior is cleared. Cheng Wuji said: In a combined disease of Taiyang and Yangming, diarrhea indicates the pathogen is in the exterior, so Gegen Tang is used; in a combined disease of Yangming and Shaoyang, diarrhea indicates the pathogen is in the interior, so Chengqi Tang can be used. In this case of combined Taiyang and Shaoyang, diarrhea indicates the pathogen is in the half-exterior/half-interior region, making sweating and purgation inappropriate. Therefore, Huangqin and Shaoyao are used to harmonize. Vomiting indicates pathogenic Qi rebelling upward. Thus, Banxia and Shengjiang are added to disperse rebellious Qi.

Wang Hu stated: When a combined disease of Taiyang and Shaoyang leads to diarrhea, the exterior cold pathogens have all transformed into interior heat. Since the interior heat is not excessive accumulation, Huangqin Tang is used to clear the interior heat. Once the interior heat is cleared, the exterior pathogens will naturally harmonize. Therefore, for this condition, not only is Guizhi Tang for Taiyang contraindicated, but Chaihu Tang for Shaoyang is also unnecessary.

Huangqin Tang Formula
Huangqin (Scutellariae Radix, 3 liang), Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried, 2 liang), Shaoyao (Paeoniae Radix Alba, 2 liang), Dazao (Ziziphi Jujubae Fructus, broken open, 12 pieces).
The above four ingredients are boiled in 10 dou of water to obtain 3 sheng of liquid. Strain. Take 1 sheng warm, twice daily and once at night.

Huangqin Jia Banxia Shengjiang Tang Formula
To the Huangqin Tang formula, add Banxia (Pinelliae Rhizoma, half sheng) and Shengjiang (Zingiberis Rhizoma Recens, 3 liang). All other procedures follow the Huangqin Tang method.

[Formula Analysis] Interior heat disharmony causes spontaneous diarrhea. Huangqin clears heat, Gancao harmonizes the middle, and with the assistance of Shaoyao and Dazao, the efficacy is doubled. Once heat is cleared and the interior is harmonized, diarrhea stops.

[Collected Exegesis] Ke Qin stated: Because the heat is not in the half-exterior, Chaihu is not used; because the heat has entered the half-interior, Huangqin and Shaoyao are added. If the Stomach Qi is not weak and deficient, Renshen (Ginseng Radix) is not needed. If vomiting is concurrent, adding Banxia and Shengjiang is appropriate.

In a combined disease of Yangming and Shaoyang channels, diarrhea will inevitably occur. If the pulse is "not negative" (Fu), it is a favorable sign; if "negative," it is unfavorable. Mutual overcoming and robbing is termed "Negative." A slippery and rapid pulse indicates retained food; purgation is indicated, and Da Chengqi Tang (Major Emodi Decoction) is appropriate.

[Annotation] Yangming belongs to Earth, and Shaoyang belongs to Wood (Note: The original text says "Shaoyang belongs to Earth," which is likely a textual error or specific theoretical context, as Shaoyang is typically Wood/Gallbladder and Yangming is Earth/Stomach, with Wood overacting on Earth. The subsequent text clarifies "Wood coming to overcome Earth"). Both channels are偏向 interior, so combined disease inevitably leads to diarrhea. Yangming pulse is large, and Shaoyang pulse is wiry. A pulse that is both large and wiry represents the proper pulse for this combination. Huangqin Tang should be used to clear heat and harmonize Earth, while draining Wood pathogenic factors, stopping the diarrhea. If the pulse is large but not wiry, it means Earth is not affected by Wood, the disease is easy to cure, and it is termed "Favorable" (Shun). If the pulse is wiry but not large, it means Wood is overcoming Earth, the disease is difficult to treat, and it is termed "Negative" (Fu). Now, if the pulse is not large, but wiry, slippery, and rapid, it indicates that the pathology is not due to Wood overcoming Earth, but rather heat-diarrhea caused by retained food. Therefore, Huangqin Tang is not used, but Da Chengqi Tang is used for purgation. In combined Taiyang-Yangming diarrhea, exterior signs predominate, so Gegen Tang is used to release the exterior. In combined Yangming-Shaoyang diarrhea, interior signs predominate, so Da Chengqi Tang is used to purge the interior. In combined Taiyang-Shaoyang diarrhea, half-exterior/half-interior signs predominate, so Huangqin Tang is used to harmonize. If it is not a combined disease, Guizhi Tang and Mahuang Tang respectively manage Taiyang exterior, Wuling San and Didang Tang respectively manage Taiyang interior; Gegen Tang manages Yangming exterior, the three Chengqi formulas manage Yangming interior; Xiao Chaihu Tang manages Shaoyang exterior, and Da Chaihu Tang manages Shaoyang interior. Each has its specific domain.

[Collected Annotations] Zhang Jianshan stated: All combined diseases involve diarrhea, distinguished by external signs. Taiyang disease presents with headache, stiff neck, and back stiffness; Yangming disease presents with eye pain, dry nose, and insomnia; Shaoyang disease presents with hypochondriac pain and deafness. Whenever two-channel syndromes appear simultaneously with diarrhea, it is called combined disease. However, it suffices if each channel shows one or two symptoms; complete manifestation is not required.

Lin Lan stated: This section involves three syndromes internally. Da Chengqi Tang only treats the syndrome of slippery and rapid pulse with retained food, not the previous two syndromes simultaneously. "Not negative" means that although there is diarrhea, the pulse has not become purely wiry. The treatment method is not stated. Tao Hua claimed to have treated it with Xiao Chaihu Tang plus Gegen and Baishao, achieving results effortlessly. "Negative" means the pulse is purely wiry, indicating Spleen failure and only seeing the "ghost thief" pulse (overacting pulse). No treatment is needed. Although both are combined diseases involving Yangming, there is a distinction between pathogen entering the channel versus the Fu organ. How can one generalize to Chengqi Tang during the channel stage?

In a combined disease of the Three Yang channels, the pulse is floating, large, and extends to the Guan position. The patient desires sleep, and sweats when closing the eyes.

[Commentary] The character "Shang" (Up) in "floating, large, Shang Guan" should be "Xian" (Wiry) to conform to the pulse of combined disease of the Three Yang channels in the Treatise. If it were "Shang," there is no precedent in the classics for both Cun pulses governing Three Yang diseases.

[Annotation] A floating, large, and wiry pulse is the pulse for combined disease of the Three Yang channels. Floating, large, and wiry appearing at the Guan position indicates that heat pathogens of the Three Yang channels gather in the Yangming channel. Heat gathering in Yangming should cause vexation and insomnia. Now, the patient only desires sleep, which is drowsiness due to heat overwhelming the Spirit. Drowsiness naturally involves closing the eyes. Heat steaming causes spontaneous sweating. If treatment is appropriate, allowing the pathogen to return to the exterior and resolve, the outcome is good; otherwise, it is unpredictable. It is appropriate to use Chaihu Tang, Guizhi Tang, and Baihu Tang, selecting and combining them according to the specific indications.

[Collected Annotations] Fang Youzhi stated: Taiyang pulse is floating, Yangming pulse is large. The Guan position is the location of Shaoyang. Hence, it is called combined disease of the Three Yang channels.

Wei Litong stated: Diagnosing a floating pulse indicates Taiyang, a large pulse indicates Yangming. If the pulse extends long to the Guan position, it can be known to be wiry. Wiry also indicates Shaoyang. Thus, the meridians of the Three Yang channels are simultaneously affected by pathogens, so the pulses of the Three Yang channels show disease simultaneously. Examining the symptoms again, desiring sleep is not Shaoyin disease, but sleep due to Yang excess overwhelming the Spirit. Sweating upon closing the eyes indicates Yang winning and struggling with Yin, causing sweating.

In a combined disease of the Three Yang channels, the abdomen is full, the body is heavy, turning the side is difficult, the mouth lacks sensation (taste), the face is grimy, there is delirium, and urinary incontinence. Sweating induces delirium; purgation causes sweating on the forehead and cold extremities. If there is spontaneous sweating, Baihu Tang (White Tiger Decoction) is the primary formula.

[Annotation] This continues the previous clause to detail the symptoms and clarify the treatment. Combined disease of the Three Yang channels refers to the combination of Taiyang, Yangming, and Shaoyang diseases. It must include Taiyang symptoms (headache, fever), Yangming symptoms (aversion to heat, insomnia), and Shaoyang symptoms (deafness, alternating chills and fever). Taiyang governs the back, Yangming governs the abdomen, and Shaoyang governs the sides. Now, the entire body is trapped by heat pathogens of the Three Yang channels, hence the heaviness and difficulty in turning. The orifice of the Stomach opens to the mouth; heat pathogens attacking upward cause loss of taste (mouth lacking sensation). Yangming governs the face; heat pathogens steaming outward cause a grimy complexion. Heat binding in the interior causes abdominal fullness; heat flourishing in the Stomach causes delirium. Heat forcing the Bladder causes urinary incontinence; heat steaming the muscle layer causes spontaneous sweating. Although the syndrome belongs to the Three Yang channels, the heat gathers in the Stomach. Therefore, it should be treated primarily as a Yangming heat syndrome. If one releases the exterior via sweating (from Taiyang), fluids are exhausted further, and Stomach heat deepens, worsening delirium. If one purges the interior (from Yangming), Yin is further injured, and Yang has no foundation and dissipates, causing forehead sweating and cold extremities. One must examine whether the patient has not yet undergone sweating or purging, and presents with body heat and spontaneous sweating. Only then is it a Yangming syndrome, and Baihu Tang should be used to clearly clear Stomach heat, urgently rescue fluids, and preserve Yin.

[Collected Annotations] Wang Hu stated: Someone asked how Baihu Tang can resolve heat of the Three Yang channels? The answer is: When the disease reaches spontaneous sweating, the pathogens of Taiyang and Shaoyang have all returned to Yangming. How can one not treat it specifically from Yangming?

Zheng Zhongguang stated: Combined disease of the Three Yang channels involves injury to both exterior and interior. Sweating biased towards attacking Taiyang causes pathogens to merge into Yangming, worsening delirium. Purgation biased towards treating Yangming causes forehead sweating (non-flowing), cold hands and feet, inevitably leading to collapse of Yang. Thus, neither sweating nor purgation is suitable. Only Baihu Tang can resolve the heat of both exterior and interior of Yangming. If there is no spontaneous sweating, the exterior is not yet resolved, and this clause should not be applied alone; it should be treated in conjunction with other syndromes.

In a consecutive disease of Two Yang channels, when Taiyang disease was initially acquired, sweating was induced. The sweat did not come out thoroughly, so the pathogen subsequently transferred to Yangming, presenting with continuous slight sweating and absence of aversion to cold. If Taiyang signs have not ceased, purgation is contraindicated; purgation is adverse. In such cases, mild sweating may be induced. If the face is persistently and purely red, Yang Qi is constrained and depressed in the exterior; it should be resolved and fumigated. If sweating was not thorough, insufficient to describe, Yang Qi is constrained and depressed, unable to diffuse. Because sweating was indicated but not achieved, the person becomes restless and irritable, unaware of the exact location of pain, sometimes in the abdomen, sometimes in the limbs, unable to be pinpointed by pressure. The person experiences shortness of breath and can only sit. This is due to incomplete sweating. Inducing sweating again will lead to recovery. How do we know sweating was incomplete? By the choppy pulse.

[Commentary] The characters "Xun Zhi" (fumigate) under "Dang Jie Zhi" (should resolve) should be "Yi Han" (with sweat) to align with the context.

[Annotation] When a disease in one channel has not yet resolved before transmitting to another, and the simultaneous disease subsequently merges into one channel to manifest independently, it is called Bing Bing (Consecutive Disease). "Two Yang" refers to Taiyang and Yangming. When Taiyang disease was initially acquired, sweating was induced, but the sweat was not thorough. The remaining pathogen transferred to Yangming. If there is continuous slight sweating and aversion to cold transforms into aversion to heat, this marks the Yangming syndrome suitable for purgation. If there is no slight sweating, but aversion to cold persists, the Taiyang exterior has not yet resolved, and purgation is contraindicated (adverse). If sweating has already been induced, but some exterior pathogen remains, Mahuang Guizhi Ge Ban Tang (Mahuang and Guizhi Half-Decoction) or Guizhi Er Yuebi Yi Tang (Guizhi Double and Yuebi Single Decoction) should be used to mildly release the exterior and harmonize it, leading to resolution. "Yuanyuan" means continuously without cessation. "Zheng Chi" means purely red without other colors, referring to the entire face being continuously red. This is due to incomplete sweating, causing Yang Qi to be constrained and unable to diffuse. Hence, the person is restless, short of breath, has a choppy pulse, does not know the pain location, feels pain intermittently in the abdomen and limbs, and cannot find it by pressing. These are all due to pathogenic factors congesting the meridians with no outlet, solely because of incomplete sweating. One should use Da Qinglong Tang (Major Green Dragon Decoction) or Gegen Tang to induce sweating for recovery.

[Commentary] Facial redness: Red malar flush occurring in the afternoon due to exhaustion indicates Yin deficiency with bone-steaming heat. Floating redness due to repelled Yang, accompanied by cold extremities, diarrhea, and faint pulse, indicates Yang deficiency. Deep red color with tidal fever and hard stool indicates interior excess. Pale red color with aversion to cold and anhidrosis indicates exterior excess. Shortness of breath with choppy pulse: Internal causes are mostly Qi and Blood deficiency. If external cause, breath must be coarse. This is shortness of breath due to pathogenic congestion in the chest from incomplete sweating, preventing normal respiration, not shortness of breath from Qi deficiency due to excessive sweating. External cause choppy pulse must be forceful, indicating pathogenic stagnation from incomplete sweating preventing Ying and Wei circulation, not choppy pulse from fluid deficiency due to excessive sweating failing to nourish the vessels.

[Collected Annotations] Wang Kentang stated: Because the disease is Taiyang, sweating is indicated; because it is Yangming, mild sweating is indicated. The word "first" (Xian) has the most sequence, representing the pivot of Zhang Zhongjing's methodology. Purgation uses Da and Xiao Chengqi Tang; sweating uses Mahuang and other formulas.

Cheng Yingmao stated: Once Taiyang transfers to Yangming, it should be treated from Yangming. However, fearing that at the point of transfer, exterior pathogens are not yet fully gone, and interior pathogens take advantage of their shallow depth, the two pathogens contend, and signs appear alternately. This is called consecutive disease. Even if exterior signs are few and interior signs many, it is ultimately Yangming with exterior signs. Taiyang should not have abdominal pain; because the pathogen has no exit and intends to attack inward, the pain location is uncertain.

Lin Lan stated: Incomplete sweating necessarily results in a choppy pulse. Without re-sweating, how will the pathogen leave? Thus, unsweated disease is consecutive disease; sweated disease is transfer to Yangming. Unsweated means Yang Qi is constrained in the exterior; sweated means sweating was incomplete. Incomplete sweating requires re-sweating; transfer requires purgation; unsweated allows mild sweating; constrained allows resolution via sweating. Different pathogenic origins lead to different diseases, hence different treatments.

In a consecutive disease of Two Yang channels, when Taiyang signs cease, only tidal fever occurs, hands and feet sweat continuously, defecation is difficult, and delirium appears. Purgation leads to recovery; Da Chengqi Tang (Major Emodi Decoction) is appropriate.

[Annotation] Consecutive disease of Two Yang channels involves simultaneous Taiyang and Yangming disease. When Taiyang signs cease, everything merges into Yangming. Hence, only tidal fever, continuous sweating of hands and feet, difficult defecation, and delirium occur. These are all signs of Yangming Stomach excess. Therefore, purgation leads to recovery, and Da Chengqi Tang is appropriate.

[Collected Annotations] Yu Chang stated: The two clauses on consecutive disease both involve Taiyang and Yangming. The first clause involves initial entry into Yangming, where Taiyang pathogens are not yet thorough, so sweating is still appropriate. This clause involves entry into Yangming, where Taiyang signs have ceased and everything merges into Yangming, so purgation is appropriate.