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(The *Neijing* and the *Preface to Examples* in the *Shanghan Lun* both refer to this condition as "Lianggan Yu Han" (Simultaneous contraction of exterior and interior by cold pathogens).)

[Etiology] The body is exposed to Yin-cold qi, and raw or cold foods are ingested, causing simultaneous injury to both the exterior and interior; this is called Lianggan. This disease frequently occurs at night during summer. This is because people often seek coolness and enjoy drinking iced water or eating fruits.

[Symptoms] Headache, body pain, heaviness of the body, aversion to cold, closing of eyes with drowsiness, shortness of breath and reluctance to speak, slight coldness of the hands and feet, fever without thirst, diarrhea with undigested food, and in severe cases, tendon spasms pulling up the legs. The tongue coating is white, tender, and slippery; in severe cases, it may be gray, pale white, or gray-black and greasy. The tongue body is tender, slippery, and moist.

[Pulse] Deep and slow; in severe cases, deep and faint. Deep indicates pathogen sinking inward; slow indicates cold stagnation; faint indicates impending depletion of Yang qi. This corresponds to what Zhu Danxi described as "cold in both exterior and interior," making it difficult to distinguish which meridians are affected, with no heat to dissipate; resolution comes through warming and tonification. If not treated urgently, death is imminent.

[Treatment] The *Suwen* states that Lianggan Yu Han is invariably fatal and incurable. Zhang Zhongjing stated that when Lianggan diseases occur simultaneously, treatment must follow a specific sequence. Zhu Nanyang advocated first rescuing the interior using Sini Tang (Four Reversal Decoction), followed by rescuing the exterior using Guizhi Tang (Cinnamon Twig Decoction). However, based on my clinical experience, constitution varies between deficiency and excess, and pathogenic depth varies. Cases involving deficiency with deep pathogen invasion are invariably fatal, while those involving excess with shallow invasion are treatable. The method should prioritize warming the interior using Fuzi Lizhong Tang (Aconite and Atractylodes Macrocephala Decoction) added with Gong Dingxiang (Syzygium aromaticum flower bud, 20 pieces) and Wei Rouguo (Nutmeg, roasted, 1.5 qian). Once the interior is warmed and Yang qi returns, diarrhea will cease and hands and feet will warm. If headache and body pain persist, along with aversion to cold and tendon stiffness, use Guizhi Jia Fuzi Tang (Cinnamon Twig Decoction plus Aconite Root) to warm and unblock Yang qi to release the exterior. If the exterior is resolved but appetite remains poor, use Xiangsha Erchen Tang (Aucklandia and Amomum Decoction with Two Aged Chen Decoction) to warm and transport Middle Jiao Yang qi to strengthen the stomach. The disease will then resolve spontaneously.

[Commentary by Xiu] Lianggan Shanghan is most common in summer. Later physicians have named it Zhonghan (Cold Stroke), while the lay public calls it Diaojiao Sha (Foot-Hanging Sha). Many die due to bloodletting (Tiaosha) or the use of aromatic Sha medicines. Witnessing this causes heartbreak. Mr. Yu’s integration of the treatments from Zhu Danxi and Zhu Nanyang constitutes effective prescriptions for these symptoms. Thus, Lianggan Zheng also has treatable pathways and should not be immediately deemed fatal.

[Review by Lian] Regarding the syndrome of Lianggan Shanghan, Mr. Yu’s tracing of its origin is indeed accurate. However, regarding the sequence and urgency of rescuing the interior versus the exterior, careful consideration is required. If diarrhea is incessant, limbs are cold, and tendons are spasming, rescue the interior first. If diarrhea is mild, leg tendons are not spasming, but there is severe headache and body pain with fever and aversion to cold, release the exterior first. Adapt flexibly according to the presentation.