太阳与阳明合病。喘而胸满者。不可下。麻黄汤主之。
太阳阳明合病者。谓太阳阳明两经皆有见证也。以两经见证之中。有喘而胸满之证。是太阳之表邪偏重于阳明
也。岂方氏所谓轻重齐。多少等。及喻氏两经各见一半乎。夫喘者。肺邪盛满之所致也。寒邪入腠而肺主
皮毛。皮毛为肺之合。肺脏受邪。故气满而喘也。所以伤寒首条。即曰头痛发热。身疼腰痛。恶风无汗而喘者。
麻黄汤主之。盖麻黄为辛散肺气之专药。杏仁为滑利肺气之要药。汤中惟桂枝为解散卫邪之太阳经药耳。仲景以
手太阴药。治足太阳病者。皆以肺主皮毛故也。且胸为太阳之部位。脉要精微论云。背者。胸之府也。足太阳之经
脉凡四行。皆在背而行于督脉之两旁。痹论云。卫气循皮肤之中。分肉之间。熏于肓膜。散于胸腹。营卫皆统于
太阳。故胸属太阳。胸满者。太阳表邪未解。将入里而犹未入也。以阳明病而心下硬满者。尚不可攻。攻之遂利不
止者死。况太阳阳明合病乎。此以太阳表症未罢。攻之恐邪陷变逆。故曰不可下。而以麻黄汤专发太阳之寒邪也。
此条当自太阳伤寒例中遗出。
太阳与阳明合病者。必自下利。葛根汤主之。
太阳阳明合病。虽与前条同义。然上条之邪在胸膈。犹未犯胃。此曰必下利。则邪已内侵而犯胃矣。盖以太阳之郁
邪。既在营卫。而阳明之热邪。又盛于肌肉之间。两经之邪热并盛。不待全陷而热邪内逼。胃中之真气不守而必下
利矣。然虽下利。而其邪犹在于表。未可责之于里。既非误下之后。胃气未虚。断不可以协热下利之法治之。当仍以
两经之表证为急。故以葛根汤主之。盖以麻黄桂枝解太阳营卫之邪。加入葛根。以解散阳明肌肉之经邪。早解其
表。即所以杜其入里之途也。
辨误 尚论谓葛根汤。即桂枝汤加葛根。不用麻黄者是也。其说恐非。当云中风自汗者。用桂枝加葛根汤。
伤寒无汗者。用有麻黄之葛根汤。乃为活法。阳明篇首有汗出恶风者。太阳阳明中风也。故用桂枝加葛根汤。
无汗恶风者。太阳阳明伤寒也。故用葛根汤。葛根汤乃桂枝麻黄之合剂而加葛根者。桂枝加葛根汤乃桂枝
全汤而加葛根者也。此但曰葛根汤。而不曰桂枝加葛根汤。岂非用麻黄者乎。然下文葛根加半夏汤已有麻黄。
此条之葛根汤。已不待言矣。况前有麻黄者。但称葛根汤。无麻黄者。即名之曰桂枝加葛根汤矣。又何庸辨乎。
太阳与阳明合病。不下利。但呕者。葛根加半夏汤主之。
如前太阳与阳明合病。不下利而但呕者。是郁热之表邪内攻。不下走而上逆也。呕则邪在胸中而犯胃口。
故于两经解表之葛根汤。加入辛温蠲饮之半夏。以滑利胸膈之邪也。
葛根加半夏汤方
葛根（四两） 麻黄（三两去节） 桂枝（二两） 芍药（二两） 甘草（二两） 生姜（三两）
大枣（十二枚） 半夏（半斤）
上八味。以水一斗。先煮葛根麻黄减二升。去白沫。内诸药。煮取三升。去滓。温服一升。覆取微似汗。
太阳与少阳合病。自下利者。与黄芩汤。若呕者。黄芩加半夏生姜汤。
太少两阳经之证。并见而为合病。太阳虽在表。而少阳逼处于里。已为半表半里。以两经之热邪内攻。
令胃中之水谷下奔。故自下利。当用黄芩撤其热。而以芍药敛其阴。甘草大枣。和中而缓其津液之下奔也。
若呕者。是邪不下走而上逆。邪在胃口。胸中气逆而为呕也。故加半夏之辛滑。生姜之辛散。为蠲饮
治呕之专剂也。
黄芩汤方
黄芩（三两） 芍药（二两） 甘草（二两） 大枣（十二枚）
上四味。以水一斗。煮取三升。去滓。温服一升。日再。夜一服。若呕者。加半夏半升。生姜三两。
黄芩加半夏生姜汤（即附前方服法内）
阳明少阳合病。必下利。其脉不负者。顺也。负者。失也。互相克贼。名为负也。脉滑而数者。有宿食也。
当下之。宜大承气汤。
阳明者。胃土也。少阳者。肝胆木也。两经俱感。二经之证并见。热邪链接。逼近于里。里受外迫。土受
木刑。胃土不守。水谷下奔。故必下利。而其脉不负者。为顺而无害。若负者。则为丧失之败证矣。所谓负者。
即胜负之负也。以木土克贼之证。而胃家之真气无损。则其脉虽或数或大。而其冲和浑浓之气仍在。是木虽
克土而土不受伤。故为顺而无害。是谓有胃气者生也。若土受木克。胃土之气伤败。其脉或弦细劲急而悬绝。
或如新张弓弦。或如循刀刃。如按琴瑟。或右寸关弦细短促而不可按。或微细而结代之类。是中土已坏而呃
忒。手足逆冷。青黄尘垢之色必现。为真气丧失之死证。所以谓之相克贼。名为负也。素问阴阳别论云。
脉有阴阳。凡阳有五。五五二十五阳。所谓阴者。真藏也。见
则为败。败必死也。所谓阳者。胃脘之阳也。三阳在头。三阴在手。所谓一也。愚按经义。盖以胃脘之阳。
为二十五阳之主。其后天生和长养之气。皆由此出。谓之三阳在头者。言三阳经之胃脉。在结喉两旁各一寸半
之动脉。名曰人迎。三阴经之胃脉。在右手鱼际后一寸之寸口脉。名曰气口。即手太阴肺脉也。故曰肺朝百脉。
经云。气口独为五脏主者。以胃为水谷之海。五脏六腑之大源。五味入口。藏于肠胃。以养五脏气。气口者。
脉之大会。五脏六腑之气。皆变现于气口也。此二脉者。皆同一胗候胃气之脉。故曰所谓一也。若存冲和浑
浓之气。则为不负而顺。若无胃气冲和。即为真藏之脉而失矣。若其脉滑而数者。滑则有力而流利。乃胃实
气旺之象。为顺而不负之脉。滑数则热邪盛于里。气食实于胃。故为有宿食停留。视其舌苔黄黑而浓。按其
胃脘及绕脐硬痛者。是少阳阳明之经邪。皆归阳明之腑矣。故当下之。宜大承气汤。
三阳合病。脉浮大。上关上。但欲眠睡。目合则汗。
成氏以浮属太阳。大为阳明。其说虽是。而不知浮大之脉。但见于关上。盖指阳明脉浮大而言也。观下
文见证。皆属阳明。即可知矣。更以关脉独候少阳之气而曰胆热则睡。岂右关亦候肝胆邪。其说尤未尽善。
素问脉要精微论云。附上。左外以候肝。内以候膈。右外以候胃。内以候脾。关上者。指关脉而言也。仲景
辨脉篇中。称尺脉曰尺中。关脉曰关上。寸脉曰寸口。内经则但言尺中寸口而不言关。盖言尺泽曰尺中。
鱼际曰寸口。尺寸之中。则为上下之半。故谓之关。所以全部内经。但有尺脉寸口而不及关也。至平人气象
论中。于尺寸则 言之。而并不言关也。今言脉浮大而上关上者。谓关脉之浮大。上出关上也。然左肝虽
候肝。而少阳胆经。乃肝之合也。故少阳受邪。浮大于左。右关
候脾胃。故邪入阳明而右关浮大也。其不言左右而但言脉浮大上关上者。乃该左右而合言之。以见邪自太阳而
来。与少阳热邪。阳明热邪。三经郁热之气并蒸。令人蒙昧昏冒。故但欲眠睡也。目合则汗者。即阳明
中风条下所谓脉但浮者。必盗汗出之义也。此本阳明中风。故脉浮大。中风本阳浮阴弱。原多自汗。而目合
则卫气内入。不能司其开阖。毛孔不闭。所以汗出也。此条三阳合病。在太阳则当汗解。在阳明又当攻下。
惟少阳受邪。汗之则谵语。下之则悸而惊。所以汗下皆禁。然三阳俱受邪。何以独重少阳而禁汗下乎。仲景云。
伤寒中风有柴胡证。但见一证便是。不必悉具。盖言若见少阳一证。即当以少阳为主故也。然则仲景不言
治法。其终何以施治乎。曰浮大之脉独见于关上。且言眠睡。目合则汗。皆为阳明见证。是邪热独盛于阳明矣。
舍汗下和解之法。其惟下文之同治乎。
三阳合病。腹满身重。难以转侧。口不仁而面垢。谵语遗尿。发汗则谵语。下之则额上生汗。手足逆冷。若
自汗者。白虎汤主之。
腹满身重。即阳明篇所谓其身必重。腹满而喘。及腹满痛之类也。难以转侧。口不仁而面垢者。灵枢经脉篇云。
足少阳之脉。是动则病口苦善太息。心胁痛。不能转侧。甚则面有微尘。身无膏泽。至真要大论阳明在泉
及阳明司天。民病喜呕。呕有苦。善太息。心胁痛。不能转侧。甚则面有微尘。身无膏泽。至真要大论阳明在泉。
及阳明司天。民病喜呕。呕有苦。善太息。心胁痛。不能反侧。甚则嗌干面尘。身无膏泽。此皆阳明燥金司气。
少阳肝胆受邪之应也。然胃开窍于口。灵枢云。胃和则口能知五味矣。此所云口不仁。是亦阳明胃家之病也。谵语。
邪热在胃也。惟遗尿则邪在足太阳之里。热在下焦。故膀胱不摄而妄出也。以三阳合病而见证如此之剧。既有少阳
并受之邪。汗下皆在所禁。
汗之则犯少阳之戒。故谵语。病至谵语遗尿。正气已自不守。若下之则胃阳丧失。而额上生汗矣。何也。
头为诸阳之所聚。而阳明行身之前。额则阳明之部位也。素问阳明脉解云。四肢者。诸阳之本也。太阴阳明论云。
四肢皆禀气于胃。误下而胃阳丧亡。致邪气入阴而手足厥冷。故汗下皆在所禁也。若虽见前三阳诸证而
又自汗者。知太少之邪已减。独归并于阳明之里。即阳明篇首所谓身热汗自出。又所谓阳明病法多汗者是也。
邪热在里。既不须汗。又不堪下。故以白虎汤主之。
太阳经与阳明经同时发病。出现气喘且胸部胀满的症状，禁止使用泻下法，应以麻黄汤为主治方剂。
所谓太阳与阳明合病，是指太阳经和阳明经同时出现各自的证候。在两经证候中，若出现气喘和胸部胀满，说明是太阳表的邪气偏重于影响阳明经。这哪里像方有执所说的轻重相等、多少相同，或者喻嘉言所说的两经各见一半呢？喘症，是由于肺脏邪气盛满所致。寒邪侵入腠理，而肺主皮毛，皮毛是肺的外合部位，肺脏受邪，所以气机壅满而发喘。因此，《伤寒论》首条就说：“头痛发热，身体疼痛，腰痛，恶风，无汗而喘者，用麻黄汤主治。”这是因为麻黄是辛散肺气专有的药物，杏仁是滑利肺气的重要药物，汤剂中只有桂枝是解散卫分邪气的太阳经药。张仲景用手太阴肺经的药物来治疗足太阳膀胱经的病，都是因为肺主皮毛的缘故。而且胸廓属于太阳经的部位，《脉要精微论》说：“背是胸的府库。”足太阳经脉共有四条，都在背部运行，位于督脉的两旁。《痹论》说：“卫气在皮肤之中、肌肉纹理之间运行，熏蒸于肓膜，散布于胸腹。”营气和卫气都统属于太阳经，所以胸廓属于太阳。胸部胀满，说明太阳表邪尚未解除，将要入里但还未完全入里。如果是阳明病出现心下硬满，尚且不可攻下，如果攻下导致腹泻不止会死亡，何况是太阳与阳明合病呢？这是因为太阳表证未罢，攻下恐怕导致邪气内陷变逆，所以说不可用泻下法，而应用麻黄汤专门发散太阳经的寒邪。这一条应当是从太阳伤寒例中遗漏出来的。
太阳与阳明合病，虽然与前一条义理相同，但前一条的邪气在胸膈，尚未侵犯胃腑；这里说必然腹泻，说明邪气已经内侵并侵犯了胃腑。因为太阳的郁滞邪气既在营卫之间，而阳明的热邪又在肌肉之间炽盛，两经的邪热并盛，不必等到完全陷入体内，热邪就会向内逼迫，导致胃中的真气不能固守而必然发生腹泻。然而虽然有腹泻，但邪气仍然在表，不可以从里证去责备，既然不是误用泻下之后，胃气并未虚弱，绝对不可以用治疗协热下利的方法来处置。仍应当以两经的表证为急务，所以用葛根汤主治。其中麻黄、桂枝解散太阳营卫之邪，加入葛根，以解散阳明肌肉层面的经邪，尽早解除表邪，这就是杜绝邪气入里的途径。
辨误：尚论派认为葛根汤就是桂枝汤加葛根，不用麻黄，这种说法是对的。但这种观点恐怕不对。应该说：中风自汗者，用桂枝加葛根汤；伤寒无汗者，用含有麻黄的葛根汤，这才是灵活的方法。阳明篇开头提到有汗出恶风者，是太阳阳明中风，所以用桂枝加葛根汤；无汗恶风者，是太阳阳明伤寒，所以用葛根汤。葛根汤是桂枝汤和麻黄汤的合剂再加上葛根；桂枝加葛根汤则是完整的桂枝汤加上葛根。这里只说葛根汤，而不说桂枝加葛根汤，难道不是用了麻黄吗？然而下文提到的葛根加半夏汤已有麻黄，这一条的葛根汤，自然不用说也有麻黄了。况且前面有麻黄的，只称为葛根汤；没有麻黄的，就命名为桂枝加葛根汤了，又有什么需要争辩的呢？
像前面说的太阳与阳明合病，不下利而只是呕吐，这是郁热的表邪向内攻冲，不向下走而是向上逆乱。呕吐说明邪气在胸中并侵犯胃口，所以在两经解表的葛根汤中，加入辛温祛除饮邪的半夏，以滑利胸膈的邪气。
葛根加半夏汤方
葛根（四两） 麻黄（三两，去节） 桂枝（二两） 芍药（二两） 甘草（二两） 生姜（三两）
大枣（十二枚） 半夏（半斤）
以上八味药，用水一斗，先煮葛根和麻黄，减少二升水，去掉表面的白沫，再加入其他药物，煮取三升药液，去掉药渣，温服一升，服药后覆盖衣被使微微出汗。
太阳与少阳合病，出现自发性腹泻的，给予黄芩汤；如果有呕吐症状的，给予黄芩加半夏生姜汤。
太阳和少阳这两条阳经的证候并见，称为合病。太阳虽在表，但少阳处于半表半里的位置。由于两经的热邪向内攻冲，导致胃中的水谷向下奔注，所以出现自发性腹泻。应当用黄芩清除热邪，用芍药收敛阴气，甘草和大枣调和脾胃并减缓津液的向下奔注。
如果有呕吐，说明邪气不向下走而是向上逆乱，邪气在胃口，胸中气机逆乱而导致呕吐。所以加入半夏的辛滑，生姜的辛散，作为祛除饮邪和治疗呕吐的专用方剂。
黄芩汤方
黄芩（三两） 芍药（二两） 甘草（二两） 大枣（十二枚）
以上四味药，用水一斗，煮取三升药液，去掉药渣，温服一升，每日两次，夜间一次服用。如果有呕吐，加入半夏半升，生姜三两。
黄芩加半夏生姜汤（即附在前面的服药方法内）
阳明与少阳合病，必然出现腹泻。脉象不负者为顺证，负者为逆证。互相克贼，称为负。脉象滑而数的，是有宿食停滞。应当用泻下法，适宜用大承气汤。
阳明属胃土，少阳属肝胆木。两经同时感受邪气，两经的证候并见，热邪连接，逼近体内。体内受到外部逼迫，土受到木的克制，胃土不能固守，水谷向下奔注，所以必然腹泻。如果脉象不负，就是顺证而无危害。如果负，就是丧失正气的败证。所谓的“负”，就是胜负的负。在木克土的证候中，如果胃家的真气没有受损，那么脉象虽然可能数或大，但冲和浓厚的胃气仍然存在，这是木虽克土但土未受伤，所以是顺证而无危害，这叫作有胃气则生。如果土受到木克，胃土之气伤败，脉象或弦细劲急而悬绝，或像新拉开的弓弦，或像触摸刀刃，或像抚摸琴瑟，或右寸关脉弦细短促而不可按压，或微细而结代之类，这是中土已坏，会出现呃逆、手足逆冷、面色青黄尘垢等表现，是真气丧失的死证。所以叫作相克贼，名为负。《素问·阴阳别论》说：“脉有阴阳，凡阳有五，五五二十五阳。所谓阴，是指真脏脉。出现真脏脉就是败象，败必死。所谓阳，是指胃脘之阳。三阳脉在头，三阴脉在手，说的是同一个道理。”我按经文意义理解，大概是以胃脘之阳为二十五阳之主，其后天生长养育之气，都由此而出。所谓三阳在头，是说三阳经的胃脉，在结喉两旁各一寸半的动脉，名叫人迎。三阴经的胃脉，在右手鱼际后一寸的寸口脉，名叫气口，也就是手太阴肺脉。所以说肺朝百脉。经书说：“气口独为五脏主”，是因为胃是水谷之海，五脏六腑的大源，五味入口，藏于肠胃，以滋养五脏之气。气口是脉的大会，五脏六腑之气，都显现于气口。这两条脉，都是同一诊候胃气的脉，所以说所谓一也。如果存有冲和浓厚的胃气，就是不负而顺；如果没有胃气的冲和，就是真脏脉而失掉了。如果脉象滑而数，滑则有力而流利，是胃实气旺的现象，是顺而不负的脉。滑数表示热邪盛于里，气食实于胃，所以是有宿食停留。观察舌苔黄黑而浓，按压胃脘及绕脐部硬痛，这是少阳阳明经邪，都归并于阳明腑了。所以应当用泻下法，适宜用大承气汤。
成无己认为浮脉属太阳，大脉属阳明，这种说法虽然有理，但他不知道浮大之脉，只见于关上。这大概是指阳明脉浮大而言。看下面的证候，都属于阳明，就可以知道了。再根据关脉单独候察少阳之气，说胆热则嗜睡，难道右关也候察肝胆邪气吗？这种说法尤其不够完善。《素问·脉要精微论》说：“附上，左外以候肝，内以候膈，右外以候胃，内以候脾。关上者，指关脉而言。”张仲景《辨脉篇》中，称尺脉为尺中，关脉为关上，寸脉为寸口。《内经》则只说尺中、寸口而不说关。大概说尺泽曰尺中，鱼际曰寸口，尺寸之中，则为上下之半，所以谓之关。所以全部《内经》，只有尺脉、寸口而没有涉及关脉。到了《平人气象论》中，对于尺寸则言之，而并不说关。现在说脉浮大而上关上，是指关脉的浮大，上出关上也。然而左肝虽候肝，而少阳胆经，乃是肝之外合。所以少阳受邪，浮大于左侧；右关候脾胃，所以邪入阳明而右关浮大。这里不说左右而只说脉浮大上关上，是包括左右而合而言之，以显示邪气来自太阳，与少阳热邪、阳明热邪，三经郁热之气并蒸，令人蒙昧昏冒，所以只想睡觉。闭上眼睛就出汗，就是阳明中风条下所谓“脉但浮者，必盗汗出”的意思。这本来是阳明中风，所以脉浮大。中风本是阳浮阴弱，原多自汗，而闭上眼睛时卫气内入，不能司管开阖，毛孔不闭，所以出汗。这条三阳合病，在太阳当用汗法解表，在阳明又当用攻下法，惟独少阳受邪，发汗则谵语，攻下则心悸惊悸。所以汗法和下法都禁忌。然而三阳都受邪，为什么唯独重视少阳而禁忌汗下呢？张仲景说：“伤寒中风有柴胡证，但见一证便是，不必悉具。”大概是说如果见到少阳的一个证候，就应当以少阳为主。既然如此，张仲景不言治法，最终如何施治呢？回答说：浮大之脉独见于关上，且说嗜睡、闭目出汗，都是阳明见证，这说明邪热独盛于阳明。舍弃汗法、下法、和解法，大概就是下文所说的同治之法吧。
三阳合病，腹部胀满，身体沉重，难以翻身，口不知味而面部污垢，谵语，遗尿。发汗则谵语加重，攻下则额上出汗，手足逆冷。如果自汗出的，用白虎汤主治。
腹部胀满、身体沉重，就是阳明篇所谓“其身必重”、“腹满而喘”及“腹满痛”之类的症状。难以翻身，口不知味而面部污垢，《灵枢·经脉篇》说：“足少阳之脉，是动则病口苦善太息，心胁痛，不能转侧，甚则面有微尘，身无膏泽。”《至真要大论》关于阳明在泉及阳明司天，百姓患病喜欢呕吐，呕有苦味，善太息，心胁痛，不能转侧，甚则面部像有微尘，身体没有光泽。《至真要大论》关于阳明在泉及阳明司天，百姓患病喜欢呕吐，呕有苦味，善太息，心胁痛，不能反侧，甚则咽干面尘，身体没有光泽。这些都是阳明燥金主气，少阳肝胆受邪的反应。然而胃开窍于口，《灵枢》说：“胃和则口能知五味矣。”这里所说的口不知味，也是阳明胃家的病。谵语，是邪热在胃。惟独遗尿，说明邪气在足太阳之里，热在下焦，所以膀胱不能摄纳而妄出。以三阳合病而出现如此严重的证候，既有少阳并受的邪气，汗法和下法都在禁忌之列。
发汗则触犯少阳的禁忌，所以谵语。病到谵语遗尿，正气已经不能固守，如果攻下则胃阳丧失，而额上出汗。为什么呢？头部是诸阳汇聚的地方，而阳明行于身前，额部则是阳明的部位。《素问·阳明脉解》说：“四肢者，诸阳之本也。”《太阴阳明论》说：“四肢皆禀气于胃。”误用下法导致胃阳丧亡，致使邪气入阴而手足厥冷。所以汗法和下法都在禁忌之列。如果虽然见到前三阳的各种证候而又自汗出的，知道太阳、少阳的邪气已经减轻，独自归并于阳明的里证，就是阳明篇开头所谓“身热汗自出”，又说“阳明病法多汗”的情况。邪热在里，既不需要发汗，又不堪攻下，所以用白虎汤主治。
Taiyang (Greater Yang) and Yangming (Yang Brightness) simultaneous disease. When there is panting and chest fullness, purgation is contraindicated; Mahuang Tang (Ephedra Decoction) should be administered as the primary treatment.
Simultaneous disease of Taiyang and Yangming refers to the presence of manifestations from both meridians simultaneously. Among the manifestations of these two meridians, the presence of panting and chest fullness indicates that the exterior pathogenic factor of Taiyang is biased towards affecting Yangming. How could it be like Fang Youzhi's assertion that the severity is equal and the quantity is the same, or Yu Jiayan's theory that each meridian presents half of the symptoms? Panting is caused by the excess and fullness of pathogenic factors in the Lung. Cold pathogenic factors invade the couli (interstices), and the Lung governs the skin and hair; the skin and hair are the external correspondence of the Lung. When the Lung organ is affected by pathogens, qi becomes stagnant and panting occurs. Therefore, the first clause of Shanghan Lun states: "Headache, fever, body pain, lower back pain, aversion to wind, anhidrosis, and panting should be treated with Mahuang Tang." This is because Mahuang (Ephedrae Herba) is a specific herb for acridly dispersing Lung qi, Xingren (Armeniacae Semen Amarum) is a key herb for lubricating Lung qi, and among the herbs in the decoction, only Guizhi (Cinnamomi Ramulus) is a Taiyang meridian herb for dissipating Wei (Defensive) pathogenic factors. Zhang Zhongjing uses Hand-Taiyin Lung meridian herbs to treat Foot-Taiyang Bladder meridian diseases because the Lung governs the skin and hair. Moreover, the chest belongs to the region of the Taiyang meridian. The Treatise on Essential Requirements for Pulse Diagnosis states: "The back is the mansion of the chest." There are four courses of the Foot-Taiyang meridian, all running along the back on both sides of the Du meridian. The Treatise on Bi Syndrome states: "Wei Qi circulates within the skin and between muscle textures, steaming into the Huang membrane and scattering into the chest and abdomen." Ying (Nutritive) and Wei Qi are both governed by the Taiyang meridian; thus, the chest belongs to Taiyang. Chest fullness indicates that the Taiyang exterior pathogenic factor has not yet resolved and is about to enter the interior but has not fully done so. In Yangming disease, if there is hardness and fullness below the heart, attacking with purgatives is still contraindicated; if attacked, leading to unceasing diarrhea, death ensues. How much more so in simultaneous disease of Taiyang and Yangming? Because the Taiyang exterior syndrome has not ceased, attacking with purgatives might cause the pathogen to sink inward and lead to adverse changes; therefore, it is stated that purgation is contraindicated, and Mahuang Tang should be used to specifically disperse the cold pathogen of the Taiyang meridian. This clause should have been omitted from the examples of Taiyang Cold Damage.
Simultaneous disease of Taiyang and Yangming inevitably leads to spontaneous diarrhea; Gegen Tang (Puerariae Decoction) should be administered as the primary treatment.
Although simultaneous disease of Taiyang and Yangming shares the same principle as the previous clause, in the previous clause, the pathogen was in the chest and diaphragm and had not yet invaded the Stomach. Here, stating that it inevitably leads to diarrhea indicates that the pathogen has invaded internally and affected the Stomach. Since the stagnant pathogen of Taiyang is already in the Ying and Wei levels, and the heat pathogen of Yangming is flourishing between the muscles, the heat pathogens of both meridians are excessively strong. Without waiting for them to fully sink inward, the heat pathogen forces inward, causing the true Qi of the Stomach to fail to hold fast, inevitably resulting in diarrhea. However, although there is diarrhea, the pathogen remains at the exterior level and should not be blamed on the interior level. Since it is not after mistaken purgation and the Stomach Qi is not yet deficient, one must absolutely not treat it using methods for協熱下利 (diarrhea with accompanying heat). One should still prioritize the exterior syndromes of both meridians; therefore, Gegen Tang is administered. Mahuang and Guizhi dissipate the pathogen in the Ying and Wei of Taiyang, and adding Gegen (Puerariae Radix) dissipates the meridian pathogen in the muscles of Yangming. Resolving the exterior early is precisely the way to block the path to entering the interior.
Correction of Misunderstandings: The Shanglun school asserts that Gegen Tang is simply Guizhi Tang (Cinnamon Twig Decoction) with added Gegen, without Mahuang, which is correct. However, this view is likely incorrect. It should be stated: For Wind Strike with spontaneous sweating, use Guizhi Jia Gegen Tang (Cinnamon Twig Decoction with Added Pueraria); for Cold Damage without sweating, use Gegen Tang containing Mahuang. This is the flexible method. At the beginning of the Yangming chapter, those with sweating and aversion to wind have Taiyang-Yangming Wind Strike, so they use Guizhi Jia Gegen Tang. Those without sweating and with aversion to wind have Taiyang-Yangming Cold Damage, so they use Gegen Tang. Gegen Tang is a combination of Guizhi Tang and Mahuang Huang Tang (Ephedra, Cinnamon Twig, and Licorice Decoction) plus Gegen; Guizhi Jia Gegen Tang is the complete Guizhi Tang plus Gegen. Here, it is called only Gegen Tang, not Guizhi Jia Gegen Tang; does this not imply the use of Mahuang? However, the subsequent Gegen Jia Banxia Tang (Pueraria and Pinellia Decoction) already contains Mahuang, so the Gegen Tang in this clause naturally implies the presence of Mahuang as well. Furthermore, previously, those with Mahuang were called only Gegen Tang, while those without Mahuang were named Guizhi Jia Gegen Tang. What is there left to debate?
Simultaneous disease of Taiyang and Yangming, without diarrhea but with vomiting only, should be treated with Gegen Jia Banxia Tang (Pueraria and Pinellia Decoction).
As mentioned before, in simultaneous disease of Taiyang and Yangming, if there is no diarrhea but only vomiting, it means the stagnant heat exterior pathogen attacks inward, not flowing downward but reversing upward. Vomiting indicates the pathogen is in the chest and invades the stomach opening. Therefore, in the Gegen Tang which resolves the exterior of both meridians, Banxia (Pinelliae Rhizoma) is added for its acrid-warm property to dispel fluid retention, thereby lubricating the pathogen in the chest and diaphragm.
Gegen Jia Banxia Tang Formula
Gegen (4 liang), Mahuang (3 liang, remove nodes), Guizhi (2 liang), Shaoyao (2 liang), Gancao (2 liang), Shengjiang (3 liang), Dazao (12 pieces), Banxia (0.5 jin).
These eight ingredients are boiled in 1 dou of water. First boil Gegen and Mahuang until reduced by 2 sheng, remove the white foam, then add the remaining herbs. Boil to obtain 3 sheng of liquid, strain, and take 1 sheng warm. Cover the patient to induce a slight sweat.
Simultaneous disease of Taiyang and Shaoyang with spontaneous diarrhea should be treated with Huangqin Tang (Scutellaria Decoction). If there is vomiting, Huangqin Jia Banxia Shengjiang Tang (Scutellaria, Pinellia, and Ginger Decoction) should be given.
The syndromes of the Taiyang and Shaoyang (Lesser Yang) meridians appearing together constitute simultaneous disease. Although Taiyang is at the exterior, Shaoyang is situated semi-interiorly, constituting the semi-exterior semi-interior level. Due to the heat pathogens of both meridians attacking inward, the water and grain in the Stomach rush downward, causing spontaneous diarrhea. Huangqin (Scutellariae Radix) should be used to withdraw the heat, and Shaoyao (Paeoniae Radix Alba) to astringe the Yin. Gancao (Glycyrrhizae Radix) and Dazao (Ziziphi Jujubae Fructus) harmonize the middle and slow the downward rushing of fluids.
If there is vomiting, it indicates the pathogen does not flow downward but reverses upward; the pathogen is at the stomach opening, and Qi in the chest reverses causing vomiting. Therefore, Banxia is added for its acrid-lubricating property, and Shengjiang (Zingiberis Rhizoma Recens) for its acrid-dispersing property, forming a specific agent for dispelling fluid retention and treating vomiting.
Huangqin Tang Formula
Huangqin (3 liang), Shaoyao (2 liang), Gancao (2 liang), Dazao (12 pieces).
These four ingredients are boiled in 1 dou of water to obtain 3 sheng of liquid. Strain and take 1 sheng warm, twice daily and once at night. If vomiting occurs, add Banxia (0.5 sheng) and Shengjiang (3 liang).
Huangqin Jia Banxia Shengjiang Tang (See administration instructions attached above).
Simultaneous disease of Yangming and Shaoyang inevitably leads to diarrhea. If the pulse is "not negative" (Fu), it is a favorable condition; if "negative," it is unfavorable. Mutual overacting is called "negative." A slippery and rapid pulse indicates retained food. Purging should be applied, and Da Chengqi Tang (Major Order the Qi Decoction) is suitable.
Yangming corresponds to Stomach Earth, and Shaoyang corresponds to Liver-Gallbladder Wood. Both meridians are affected, and their syndromes appear together. Heat pathogens link up, approaching the interior. The interior is pressured from outside, and Earth is punished by Wood. The Stomach Earth fails to hold, and water and grain rush downward, inevitably causing diarrhea. If the pulse is "not negative," it is favorable and harmless. If "negative," it is a failing syndrome of lost vitality. The term "negative" refers to defeat. In cases of Wood overacting on Earth, if the true Qi of the Stomach is undamaged, although the pulse may be rapid or large, the harmonious and thick Qi remains. This means Wood overacts on Earth but Earth is not injured, so it is favorable and harmless. This is called "having Stomach Qi leads to life." If Earth is overacted upon by Wood, and the Qi of Stomach Earth is damaged and failing, the pulse may be wiry, fine, forceful, urgent, and suspended, or like a newly strung bowstring, or like touching a blade, or like plucking a zither string, or the right Cun and Guan positions may be wiry, fine, short, and abrupt, unpressable, or micropulse, fine, knotted, and intermittent. This indicates the Middle Earth is ruined, accompanied by hiccups, cold extremities, and a dusty yellow-green complexion, representing a fatal syndrome of lost true Qi. Thus, it is called mutual overacting, named "negative." The Treatise on the Differences of Yin and Yang in Suwen states: "Pulses have Yin and Yang. Of Yang, there are five; five times five make twenty-five Yang. What is called Yin is the Zang-organ revealing itself. To reveal is failure; failure leads to death. What is called Yang is the Yang of the Epigastrium. Three Yang pulses are at the head, Three Yin pulses are at the hand; this refers to the same principle." I interpret the scriptural meaning as regarding the Yang of the Epigastrium as the master of the twenty-five Yangs. All post-natal growth and nourishing Qi emanate from here. "Three Yang at the head" refers to the Stomach pulses of the Three Yang meridians, located at the arterial pulse 1.5 cun lateral to the Adam's apple, named Renying (Human Welcome). The Stomach pulses of the Three Yin meridians are at the Cun Kou (Inlet) pulse, 1 cun posterior to the Thenar eminence on the right hand, named Qikou, which is also the Hand-Taiyin Lung pulse. Hence, it is said that the Lung directs all pulses. The classics state: "Qikou alone serves as the master of the Five Zang organs" because the Stomach is the Sea of Water and Grain, the great source of the Five Zang and Six Fu organs. The five flavors enter the mouth, store in the intestines and stomach, and nourish the Qi of the Five Zang organs. Qikou is the grand meeting of pulses; the Qi of the Five Zang and Six Fu organs manifests at Qikou. These two pulses are essentially the same pulse for assessing Stomach Qi; hence, it is said "what is called one." If harmonious and thick Qi exists, it is "not negative" and favorable; if the harmonious Qi of Stomach is absent, it becomes a Zang-revealing pulse and is lost. If the pulse is slippery and rapid, slippery indicates strength and smoothness, a sign of Stomach excess and vigorous Qi, a favorable and "not negative" pulse. Slippery and rapid indicate heat pathogens flourishing in the interior and food stagnation in the Stomach, thus indicating retained food. Observing a thick yellow-black tongue coating and hardness/pain upon palpation of the epigastrium and around the umbilicus indicates that the meridian pathogens of Shaoyang and Yangming have all converged into the Yangming Fu organs. Therefore, purging should be applied, and Da Chengqi Tang is suitable.
Simultaneous disease of the Three Yangs, with a floating and large pulse extending to the Guan position, drowsiness, and sweating when closing the eyes.
Cheng Wuji considers floating to belong to Taiyang and large to belong to Yangming. While this reasoning has merit, he fails to realize that the floating and large pulse appears only at the Guan position. This likely refers to the Yangming pulse being floating and large. Looking at the subsequent manifestations, they all belong to Yangming, which confirms this. Furthermore, relying on the Guan pulse to exclusively monitor Shaoyang Qi and claiming gallbladder heat causes sleepiness—does the right Guan also monitor Liver-Gallbladder pathogens? This view is particularly incomplete. The Treatise on Essential Requirements for Pulse Diagnosis in Suwen states: "Above the middle, the left exterior monitors the Liver, interior monitors the Diaphragm; the right exterior monitors the Stomach, interior monitors the Spleen. 'Guan Shang' refers to the Guan pulse." In Zhang Zhongjing's Chapter on Differentiating Pulses, Chi pulse is called Chi Zhong, Guan pulse is called Guan Shang, and Cun pulse is called Cun Kou. The Neijing mentions only Chi Zhong and Cun Kou, not Guan. Generally, Chi Ze is called Chi Zhong, Yu Ji is called Cun Kou. The middle of Cun and Chi is the halfway point up and down, hence called Guan. Therefore, the entire Neijing mentions only Chi and Cun pulses, excluding Guan. In the Treatise on the Phenomena of Healthy People, discussions on Cun and Chi exist, but Guan is not mentioned. Now, saying "pulse floating and large extending to Guan Shang" means the floating and large quality of the Guan pulse extends beyond the Guan position. Although the left side monitors the Liver, the Shaoyang Gallbladder meridian is the external correspondence of the Liver. Thus, when Shaoyang is affected, floating and large qualities appear on the left. The right Guan monitors Spleen and Stomach; thus, when pathogens enter Yangming, floating and large qualities appear on the right Guan. Not specifying left or right but stating "pulse floating and large extending to Guan Shang" encompasses both sides collectively, showing that pathogens coming from Taiyang, combined with Shaoyang heat pathogens and Yangming heat pathogens, cause the Qi of stagnant heat in the three meridians to steam together, leading to mental confusion and drowsiness, hence the desire to sleep. Sweating when closing the eyes is the meaning of "if the pulse is merely floating, there will surely be nocturnal sweating" found under the Yangming Wind Strike clause. This is originally Yangming Wind Strike, hence the pulse is floating and large. Wind Strike inherently involves floating Yang and weak Yin, often presenting with spontaneous sweating. When eyes are closed, Wei Qi enters inward and cannot control opening and closing, pores do not close, hence sweating. In this case of simultaneous disease of the Three Yangs, Taiyang requires diaphoresis, Yangming requires purgation, but Shaoyang pathology contraindicates both; diaphoresis leads to delirium, purgation leads to palpitations and fright. So both diaphoresis and purgation are forbidden. However, since all Three Yangs are affected, why is emphasis placed solely on Shaoyang to forbid diaphoresis and purgation? Zhang Zhongjing states: "In Cold Damage and Wind Strike, if Chaihu syndrome is present, seeing even one symptom suffices; it is not necessary for all to be present." This implies that if even one Shaoyang symptom is seen, treatment should focus on Shaoyang. Given this, Zhang Zhongjing does not specify a treatment method; how is therapy ultimately applied? The answer is: The floating and large pulse appears exclusively at the Guan position, and drowsiness and sweating upon closing the eyes are Yangming manifestations. This indicates heat pathogens are exclusively flourishing in Yangming. Abandoning diaphoresis, purgation, and harmonizing methods, the treatment likely refers to the joint treatment mentioned in the following text.
Simultaneous disease of the Three Yangs, with abdominal fullness, heaviness of the body, difficulty turning over, insensitivity of the mouth, facial dirtiness, delirium, and urinary incontinence. Diaphoresis leads to delirium; purgation leads to sweating on the forehead and cold extremities. If there is spontaneous sweating, Baihu Tang (White Tiger Decoction) should be administered.
Abdominal fullness and body heaviness refer to what is described in the Yangming chapter as "the body must feel heavy," "abdominal fullness with panting," and "abdominal fullness and pain." Difficulty turning over, insensitivity of the mouth, and facial dirtiness: The Treatise on the Meridians in Ling Shu states: "When the Foot-Shaoyang meridian moves, it causes bitter taste, frequent sighing, pain in the heart and hypochondrium, inability to turn over, and in severe cases, a face resembling dust and lack of luster in the body." The Treatise on the True and Required Great Principles regarding Yangming ruling the interior and Yangming governing the year states that people suffer from liking to vomit, bitter vomiting, frequent sighing, pain in the heart and hypochondrium, inability to turn over, and in severe cases, a face resembling dust and lack of luster. Regarding Yangming ruling the interior and Yangming governing the year, people suffer from liking to vomit, bitter vomiting, frequent sighing, pain in the heart and hypochondrium, inability to reverse sides, dry throat, dusty face, and lack of luster in the body. These are all responses to Yangming Dry Metal ruling the Qi and Shaoyang Liver-Gallbladder being affected by pathogens. However, the Stomach opens into the mouth. The Ling Shu states: "When the Stomach is harmonious, the mouth can perceive the five flavors." The insensitivity of the mouth mentioned here is also a disease of the Yangming Stomach. Delirium indicates heat pathogens in the Stomach. Only urinary incontinence indicates the pathogen is in the interior of the Foot-Taiyang meridian, with heat in the Lower Jiao, causing the Bladder to fail to retain urine. Given such severe manifestations in simultaneous disease of the Three Yangs, with Shaoyang pathogens also involved, both diaphoresis and purgation are contraindicated.
Diaphoresis violates the prohibition for Shaoyang, leading to delirium. By the time delirium and urinary incontinence occur, the righteous Qi is already failing to hold. If purgation is applied, Stomach Yang is lost, leading to sweating on the forehead. Why? The head is the gathering place of all Yang meridians, and Yangming runs along the front of the body; the forehead is the region of Yangming. The Treatise on Solving the Meaning of the Yangming Pulse in Suwen states: "The four limbs are the root of all Yang." The Treatise on Taiyin and Yangming states: "The four limbs receive Qi from the Stomach." Mistaken purgation leads to the loss of Stomach Yang, causing pathogens to enter Yin and resulting in cold extremities. Thus, both diaphoresis and purgation are contraindicated. If, despite seeing the aforementioned Three Yang symptoms, there is spontaneous sweating, it indicates that the pathogens of Taiyang and Shaoyang have diminished and merged exclusively into the interior of Yangming. This corresponds to "body heat with spontaneous sweating" and "Yangming disease typically involves much sweating" mentioned at the beginning of the Yangming chapter. With heat pathogens in the interior, neither diaphoresis nor purgation is needed or tolerated; therefore, Baihu Tang is administered.