太阳症兼见阳明,名曰太阳阳明合病;太阳症兼见少阳,名曰太阳少阳合病;阳明症兼见少
阳,名曰阳明少阳合病。以上两阳经合病也。若三阳皆见症者,名三阳经合病。夫曰合病,
初起一齐发病之谓。若一经先病,先病之经未解,又见一经起者,名并病。若先起之经病
解,又见一经病起者,名传经病,皆非合病也。若太阳与阳明合病,先治太阳,兼治阳明;
太阳少阳合病,先治太阳,兼治少阳。凡治外感,先重太阳表症,故见太阳症,多用羌活汤
为君。兼阳明症,加葛根;兼少阳症,加柴胡。三阳皆见,三经之药俱用,而太阳之药倍之。
三阳合病,多发春夏秋三时。三阳合病,多下利。按《伤寒论》合病,言太阳有二条,不言合
病,然用方一以KT KT 有汗,用桂枝葛根汤以解肌,一以KT KT 项背强无汗,用葛根汤以发汗,
则暗合阳明合病矣。又明言太阳与阳明合病三条,一以不下利但呕者,葛根加半夏汤;一以
不呕下利者,但用葛根汤;一以喘而胸满者,麻黄汤。其太阳与少阳合病者二条。一以自下
利者,黄芩汤;一以下利兼呕者,黄芩汤加半夏生姜。阳明少阳合病者一条,以下利脉滑而
数者,有宿食,用大承气汤。三阳合病二条,一曰脉浮大,上关上,但欲眠睡,目合则汗,不
立方治;一曰腹满身重,难以转侧,口不仁,面垢,谵语,遗尿,发汗则谵语,下之额上生
汗,手足逆冷,若自汗者,白虎汤主之。前言三阳合病,一见太阳病,重用太阳表症之药,
再视何经有合病,再加某经药治之。此言太阳表邪为重,故以太阳经络而分轻重也。又云合
病并病,要看症之多少轻重,舍少从多,舍轻从重主治,未可尽执经络上分轻重。又见仲景
于太阳阳明合病,见呕加半夏,不加太阳药。太阳阳明合病,见喘满用麻黄汤,不用阳明
药。下文太阳阳明合病,见下利用黄芩汤清少阳,不用太阳药。下利见呕,加半夏、生姜,
不加少阳药。此又在症上分轻重缓急而言。此告戒经络病症,互相参治,方无遗漏。
太阳病证兼见阳明病证,称为太阳阳明合病;太阳病证兼见少阳病证,称为太阳少阳合病;阳明病证兼见少阳病证,称为阳明少阳合病。以上所述均为两条阳经的合病情况。如果三条阳经的病证同时出现,称为三阳经合病。所谓“合病”,是指疾病初起时各经症状同时发作。如果某一经先发病,先病的经络病邪未解,又出现另一经的症状,称为并病(Bingbing, Concurrent Disease)。如果先发的经络病证已解,又出现另一经的病证,称为传经病(Chuanjing Bing, Transmission Disease),这些都不属于合病。若是太阳与阳明合病,应先治疗太阳经,兼顾治疗阳明经;太阳与少阳合病,应先治疗太阳经,兼顾治疗少阳经。凡是治疗外感病,首先要重视太阳经表证,因此见到太阳病证,多以羌活汤(Qianghuo Tang)作为主方。若兼有阳明病证,加用葛根(Puerariae Radix);若兼有少阳病证,加用柴胡(Bupleuri Radix)。若三阳经症状皆现,则三经的药物均使用,而太阳经的药物加倍使用。
三阳合病,多发生在春、夏、秋三个季节。三阳合病,多见下利(Diarrhea)症状。按《伤寒论》(Shanghan Lun, Treatise on Cold Pathogenic Diseases)中关于合病的记载,提到太阳经的情况有两条,虽未明言“合病”,但用药一方针对有汗者,用桂枝葛根汤(Guizhi Gegen Tang)以解肌(Relieve the muscle layer);另一方针对项背强急无汗者,用葛根汤(Gegen Tang)以发汗(Induce sweating),这实际上暗合了阳明合病的治法。又明确论述太阳与阳明合病有三条:一是以下利不呕吐为主,用葛根加半夏汤(Gegen Banxia Tang);一是不呕吐而下利,只用葛根汤;一是气喘且胸部胀满,用麻黄汤(Mahuang Tang)。其中太阳与少阳合病有两条:一是自发下利,用黄芩汤(Huangqin Tang);一是下利兼呕吐,用黄芩汤加半夏生姜(Huangqin Tang with Pinelliae Rhizoma and Zingiberis Rhizoma et Recens)。阳明与少阳合病有一条,以下利、脉象滑数且有宿食(Retained Food)为特征,用大承气汤(Da Chengqi Tang)。三阳合病有两条:一条是脉象浮大,关部尤甚,只想睡觉,闭眼即出汗,此处未列方剂治疗;另一条是腹部胀满、身体沉重、难以翻身转侧、口舌不知味、面部污垢、说胡话(Delirium)、遗尿,若误用发汗法则会导致谵语加重,误用攻下法则会导致额头出汗、手足逆冷,若患者自汗出,则以白虎汤(Baihu Tang)主治。前文所说三阳合病,一见太阳病,就重用太阳经表证的药物,再观察哪一经有合病症状,再加该经的药物进行治疗。这是指出太阳表邪较重,故以太阳经络来区分轻重。又说合病和并病,要看症状的多少和轻重,舍弃少的服从多的,舍弃轻的服从重的来主治,不能仅仅执着于从经络上分轻重。又见张仲景(Zhang Zhongjing)在太阳阳明合病中,见呕吐加半夏,不加太阳药;太阳阳明合病,见喘满用麻黄汤,不用阳明药;下文太阳阳明合病,见下利用黄芩汤清少阳热,不用太阳药;下利见呕吐,加半夏、生姜,不加少阳药。这是在症状上区分轻重缓急而言。这是告诫要经络病症互相参治,才不会有所遗漏。
When Taiyang disease manifestations are accompanied by Yangming disease manifestations, it is termed Taiyang-Yangming Hebing (Combined Disease); when Taiyang disease manifestations are accompanied by Shaoyang disease manifestations, it is termed Taiyang-Shaoyang Hebing; when Yangming disease manifestations are accompanied by Shaoyang disease manifestations, it is termed Yangming-Shaoyang Hebing. The above refer to combined diseases involving two Yang meridians. If disease manifestations of all three Yang meridians appear simultaneously, it is termed San Yang Jing Hebing (Combined Disease of Three Yang Meridians). The term "Hebing" refers to the simultaneous onset of symptoms from different meridians at the beginning of the disease. If one meridian is affected first, and before its pathogen is resolved, symptoms of another meridian appear, it is termed Bingbing (Concurrent Disease). If the initially affected meridian's pathology resolves, and then pathology of another meridian appears, it is termed Chuanjing Bing (Transmission Disease). These do not constitute Hebing. In cases of Taiyang-Yangming Hebing, treatment should prioritize the Taiyang meridian while concurrently addressing the Yangming meridian; in Taiyang-Shaoyang Hebing, treatment should prioritize the Taiyang meridian while concurrently addressing the Shaoyang meridian. Generally, in treating exogenous febrile diseases, priority is given to Taiyang exterior syndromes. Therefore, upon observing Taiyang syndrome, Qianghuo Tang (Notopterygii Rhizoma et Radix Decoction) is often used as the principal formula. If Yangming syndrome is concurrent, Puerariae Radix (Kudzu Root) is added; if Shaoyang syndrome is concurrent, Bupleuri Radix (Thoroughwort Root) is added. If manifestations of all three Yang meridians are present, herbs for all three meridians are employed, with the dosage for Taiyang herbs doubled.
San Yang Hebing frequently occurs during spring, summer, and autumn. It is often characterized by Xiali (Diarrhea). According to *Shanghan Lun* (*Treatise on Cold Pathogenic Diseases*), there are two clauses regarding Taiyang that imply Hebing without explicitly naming it: for those with sweating, Guizhi Gegen Tang (Cinnamon Twig and Kudzu Root Decoction) is used to relieve the muscle layer; for those with stiffness in the nape and back without sweating, Gegen Tang (Kudzu Root Decoction) is used to induce sweating. This implicitly aligns with the treatment of Yangming Hebing. Furthermore, there are three explicit clauses on Taiyang-Yangming Hebing: one where diarrhea is present but no vomiting, treated with Gegen Banxia Tang (Kudzu Root and Pinellia Decoction); one where there is no vomiting but diarrhea, treated solely with Gegen Tang; and one featuring panting and chest fullness, treated with Mahuang Tang (Ephedra Decoction). There are two clauses on Taiyang-Shaoyang Hebing: one presenting spontaneous diarrhea, treated with Huangqin Tang (Scutellaria Decoction); and one with diarrhea accompanied by vomiting, treated with Huangqin Tang plus Pinelliae Rhizoma and Zingiberis Rhizoma et Recens (Fresh Ginger). There is one clause on Yangming-Shaoyang Hebing: characterized by diarrhea, a slippery and rapid pulse, and Su Shi (Retained Food), treated with Da Chengqi Tang (Major Order the Qi Decoction). There are two clauses on San Yang Hebing: one describes a floating and large pulse, prominent at the Guan position, somnolence, and sweating upon closing the eyes, for which no formula is prescribed; the other presents abdominal fullness, body heaviness, difficulty turning over, inability to taste properly, facial greasiness, Shenjing (Delirium), and urinary incontinence. If sweating is induced erroneously, delirium worsens; if purgation is induced erroneously, sweat appears only on the forehead and cold extremities occur. If spontaneous sweating is present, Baihu Tang (White Tiger Decoction) is the primary treatment. The previous text stated that for San Yang Hebing, once Taiyang disease is identified, heavy emphasis is placed on Taiyang exterior herbs, followed by adding herbs for any other concurrent meridians. This emphasizes that when Taiyang exterior pathogen is predominant, severity is distinguished via the Taiyang meridian. Conversely, it is also stated that for Hebing and Bingbing, treatment should be based on the quantity and severity of symptoms, prioritizing the majority over the minority and the severe over the mild, rather than rigidly adhering to meridian hierarchy. Observations of Zhang Zhongjing show that in Taiyang-Yangming Hebing with vomiting, Banxia (Pinelliae Rhizoma) is added without Taiyang-specific herbs; in Taiyang-Yangming Hebing with panting and fullness, Mahuang Tang is used without Yangming-specific herbs; in subsequent Taiyang-Yangming Hebing with diarrhea, Huangqin Tang is used to clear Shaoyang heat without Taiyang herbs; and in diarrhea with vomiting, Banxia and Shengjiang (Zingiberis Rhizoma et Recens) are added without specific Shaoyang herbs. This approach distinguishes severity and urgency based on symptoms. This serves as a warning to integrate meridian and symptom-based treatments to avoid omissions.