二阳并病。太阳初得病时。发其汗。汗先出不彻。因转属阳明。续自微汗出。不恶寒。若太阳病证不罢者。
不可下。下之为逆。如此可发小汗。设面色缘缘正赤者。阳气怫郁在表。当解之熏之。若发汗不彻。不足
言。阳气怫郁不得越。当汗不汗。其人躁烦。不知痛处。乍在腹中。乍在四肢。按之不可得。其人短气。但坐
以汗出不彻故也。更发汗则愈。何以知汗出不彻。以脉涩故知也。
二阳。太阳阳明也。并病者。谓太阳虽受邪。虽已传入阳明。而太阳仍未罢。两经俱病也。此条虽云二
阳并病。其创法之意。盖示人以两经之邪。有偏盛于太阳者。治法亦当以太阳为主。未可轻治阳明也。自太阳
初得病时。至汗出不恶寒句。是言太阳转入阳明之故。即传经之义也。乃一条之总义。自若太阳病证不罢者。
至可小发汗句。是汗不彻而太阳未罢之轻者。此段为客。面色缘缘正赤句至末。方是主。谓太阳之邪正盛而未解。
其初入阳明之邪。尚轻而
可忽。当以太阳表证为主治也。意谓太阳初得病时。发其汗。汗先出不彻。其邪不得尽去。因而转为阳明。
邪既转属阳明。随即有自微汗出不恶寒之阳明见证。非若太阳证之身热恶寒无汗也。即阳明篇首之身热汗自出。
不恶寒反恶热之义也。若邪已转属阳明。而太阳病证尚有不罢者。是表证犹未尽除。邪气未归阳明之里。
胃邪未实。为不可下。下之为逆。如此等未尽之表邪。不过因汗出不彻耳。其邪去多留少。可小小发其汗。
邪当自解。设若病患之面色缘缘然正赤而浮现于面者。乃阳气为寒邪所闭。怫郁于表。当汗解之。或熏之取汗。
此虽同一汗出不彻之证。其留邪甚多。一如全未解散之太阳表邪。若前所谓发汗不彻。可小发汗之说。
又不足言矣。此因阳气怫郁。为寒邪所束。怫郁于皮肤腠理之间。不得发越。乃当汗不汗。致令人郁闷烦躁也。
不知痛处者。谓所受寒邪。若但在太阳之表。则如伤寒首条。有身疼腰痛骨节疼痛之证。其痛处自有定在。
此因寒邪虽在太阳。已曾转属阳明。而阳明之经已在肌肉之分。且腹中四肢。皆阳明胃经之所属也。是以素
问太阴阳明论中。有四肢皆禀气于胃之语。阳明篇中。即有脉浮大而短气。腹都满之证。盖因太阳邪气初转阳明。
在经在腑。未有定所。故觉乍在腹中。乍在四肢。按之不可得。其人气短耳。即素问离合真邪论所谓此邪新客。
溶溶未有定处也。见证如此。虽太阳初转阳明。而太阳表证正盛。阳明不足论也。但坐以汗出不彻之故。更发其
汗则愈矣。然何以知其汗出不彻乎。夫脉者。气血流行之动处也。寒伤营血。不得汗泄。阳气郁滞。血脉不快于
流行则涩。此以脉涩。故知之也。
二阳并病。太阳证罢。但发潮热。手足 汗出。大便难而谵语者。下之则愈。宜大承气汤。
太阳阳明并病。与上条同义。但上文则太阳证多而未解。虽有阳明证而犹未可下。当专以太阳主治而宜汗。此条
则言太阳证已罢。但有潮热手足汗出。大便难而谵语等阳明胃实诸证。应以阳明为治而当下。皆示人以辨证施
治之法也。
太阳与少阳并病。头项强痛。或眩冒。时如结胸。心下痞硬者。当刺大椎第一间。肺俞肝俞。慎不可发汗。
发汗则谵语。脉弦。五六日谵语不止。当刺期门。
头项强痛。太阳证也。眩冒。少阳肝胆病也。足少阳之脉。起于目锐 。足厥阴之脉。上入颃颡。连目系。
邪热在少阳。肝胆脏腑相连。热邪在络。上侵目系。故眩冒也。或眩冒者。或时眩冒也。时如结胸者。时或如结胸之
状。而实非结胸也。少阳之脉。下颊车。合缺盆以下胸中。邪在少阳。故时如结胸而心下痞硬也。况胸又属太阳
者乎。邪在太阳则当汗。邪在少阳则禁汗。太阳与少阳并病。亦不可汗。既不可汗。则两经郁经之邪无可解之法。
故当刺大椎第一间。及肺俞肝俞。又叮咛之曰。慎不可发汗。发汗则谵语。与少阳篇禁例无异也。大椎者。背脊共
二十一节。最上之第一节骨上。即百劳穴也。肺俞者。第三椎两旁各一寸半之二穴也。肝俞者。第九椎下两旁各
一寸半之二穴也。刺大椎者。所以泄头项强痛之邪也。刺五分。留三呼。泻五吸。刺肺俞者。泄肺气以开皮毛也。
寒邪客于皮毛。皮毛者。肺之合也。然泄肺气而开皮毛。本当以麻黄汤发汗。乃为正治。因太少并病不可发汗。
故刺之以泄皮毛而代麻黄汤之汗也。可刺三分。留七呼。刺肝俞者。泻少阳之邪也。可刺三分。留六吸。凡此三刺。
皆可泄两经之气。解太少之邪者也。故邪在少阳。慎不可发汗。发汗则里虚邪陷而谵语矣。谵语则邪犯阳明。
脉当洪大而不弦。弦者。少阳肝胆之邪也。脉弦而五六日谵语不止。是木邪盛而未欲解也。故当刺肝经之募穴期
门。以泄其邪。所谓随其实而泻之也。
辨误 条辨不知胸属太阳。及少阳之脉亦下胸中。而以胸为阳明部分。固谬。又疑云肝与胆合。
刺肝俞以泻少阳。肺与膀胱。非合也。以肺主气。故刺之以通膀胱之气化欤。不知太阳之表邪在外。膀胱之
气化在里。通其在里之气化。岂能即解在外之表邪。其说更谬。尚论不加揆度。遂取其论以为说。云膀胱
不与肺合。然肺主气。刺肺俞以通其气。斯膀胱之气化行而邪自不能留矣。呜呼。以智者而亦蹈前人之
辙迹。其亦以盲引盲之谓乎。嘻。
太阳少阳并病。心下硬。颈项强而眩者。当刺大椎肺俞肝俞。慎勿下之。
此即上文之证治也。以上文但言不可发汗。而未言不可下。故此条又重申不可下之禁也。
太阳少阳并病而反下之。成结胸心下硬。下利不止。水浆不下。其人心烦。
上文所谓时如结胸。乃其本证。非误下之变。故不过时常如结胸之状。而心下痞硬。乃似结胸而非结胸也。
此因太少两经并病。皆不可下。以不可下者而反下之。遂成结胸心下硬。又因误下之虚。中气不守而下利不止。
邪陷胸中而水浆不下矣。其人心烦者。误下之后。阳邪陷膈。故作虚烦也。然其证已剧。而仲景不立治法。致
方氏疑为脱简。而尚论云。并病即不误下。已如结胸心下痞硬矣。况误下乎。比太阳误下之结胸。殆有甚焉。
且其人心烦。似不了之语。以太阳经结胸证悉具。烦躁者亦死。意者此谓其人心烦者死乎。愚恐未必尽皆死证也。
夫三阳经之烦证不一。皆非死证。惟烦躁并见者为重耳。以烦属阳而躁属阴也。所以三阴之手足厥而烦躁者多死。
而三阳篇中。如汗不出而烦躁者。为邪气不得外泄之表实。故用大青龙汤之汗剂。如发汗若下之。病仍不解而
烦躁者。为阳虚阴盛之里虚证。故以茯苓四逆汤温之。唯结胸证悉具而烦躁者死。盖以太阳误下。邪已陷入而
为结胸。且诸证悉具。烦躁则
阴极阳亡。所以死也。此虽亦以反下而成结胸。其人虽心烦而未躁。或有治法。未可知也。当于仲景
诸烦证中。约略寻讨其活法可也。
二阳并病。太阳初得病时。发其汗。汗先出不彻。因转属阳明。续自微汗出。不恶寒。若太阳病证不罢者。
不可下。下之为逆。如此可发小汗。设面色缘缘正赤者。阳气怫郁在表。当解之熏之。若发汗不彻。不足
言。阳气怫郁不得越。当汗不汗。其人躁烦。不知痛处。乍在腹中。乍在四肢。按之不可得。其人短气。但坐
以汗出不彻故也。更发汗则愈。何以知汗出不彻。以脉涩故知也。
【白话译文】
二阳并病，即太阳病与阳明病同时存在。在太阳病（太阳经受邪所致的病证）刚发生时，使用发汗法治疗，但汗出得不透彻。因此病邪转而归属于阳明（阳明经受邪所致的病证）。随后病人出现持续不断的微微出汗，且不害怕寒冷。如果此时太阳病的症状还没有完全消失，就不可使用泻下法。误用泻下法属于逆治（违背治疗原则的错误治法）。像这种情况，可以采用轻微的发汗法。假如病人面色连续不断地呈现纯正的红色，这是阳气被郁闭在体表所致，应当采用解表发汗或熏蒸取汗的方法。如果是发汗不彻底，导致阳气郁闭不能宣发，本该发汗却未能汗出，病人就会感到烦躁不安，不知道疼痛的具体位置，有时在腹部，有时在四肢，按压又找不到痛点。病人还会感到呼吸短促，这完全是因为汗出不透彻的缘故。再次给予发汗治疗就会痊愈。怎么知道是汗出不透彻呢？通过脉象涩滞就可以知道。
二阳，指的是太阳和阳明。并病，是指太阳虽然受了邪气，虽然已经传入阳明，但太阳的病证仍未解除，两经同时发病。这一条虽然说是二阳并病，但其立法用意，大概是告诉人们，两经的邪气有偏盛于太阳的情况，治疗方法也应当以太阳为主，不可以轻易治疗阳明。从“太阳初得病时”到“汗出不恶寒”这几句，是说太阳转入阳明的原因，也就是传经的含义，这是一条的总义。从“若太阳病证不罢者”到“可小发汗”这几句，是说汗出不透而太阳未解的较轻情况，这一段为次要内容。“面色缘缘正赤”直到结尾，才是主要内容。意思是太阳的邪气正盛而未解除，初入阳明的邪气尚轻且可忽略，应当以治疗太阳表证为主。意思是说，太阳刚得病时，发汗后汗出不透，邪气不能完全去除，因而转为阳明。邪气既然转属阳明，随即就有自己微微出汗、不恶寒的阳明见证，不像太阳证那样身体发热、怕冷、无汗。也就是阳明篇首所说的身体发热、自然出汗、不怕冷反而怕热的含义。如果邪气已经转属阳明，而太阳病的症状还有未解除的，说明表证还没有完全清除，邪气没有归入阳明的里部，胃中邪气未实，所以不可使用泻下法，误用泻下法就是逆治。像这种未尽的表邪，不过是因汗出不透彻罢了。邪气去得多留得少，可以稍微发一点汗，邪气自然会解除。假如病人的面色连续不断地纯正发红并浮现于面部，这是阳气被寒邪闭塞，郁滞在体表，应当通过发汗来解除，或者用熏蒸的方法取汗。这虽然同样是汗出不透的证候，但留存的邪气很多，就像完全没有解散的太阳表邪一样，前面所说的“发汗不透彻，可小发汗”的说法，就不够用了。这是因为阳气被郁闭，被寒邪束缚，郁滞在皮肤腠理之间，不能发散，本该发汗却没有汗出，导致人郁闷烦躁。不知道疼痛部位的原因，是说所受寒邪，如果只在太阳的表层，就像伤寒首条所说，有身体疼痛、腰痛、骨节疼痛的症状，疼痛的部位自有定处。这里是因为寒邪虽然在太阳，已经曾转属阳明，而阳明的经脉已经在肌肉的层次，而且腹部和四肢，都是阳明胃经所属的范围。所以在《素问·太阴阳明论》中有“四肢都禀受胃气”的话，在阳明篇中，就有脉浮大和呼吸短促、腹部胀满的症状。大概是因为太阳邪气初转阳明，在经在腑，没有固定的所在，所以感觉有时在腹部，有时在四肢，按压又找不到。这个人只是呼吸短促罢了。也就是《素问·离合真邪论》所说的“这个邪气是新近客居的，流动而没有固定位置”。见证如此，虽然太阳初转阳明，但太阳表证正盛，阳明病不足以谈论。只是因为汗出不透彻的缘故，再次发汗就会痊愈。然而怎么知道是汗出不透彻呢？脉，是气血运行的动态表现。寒邪伤及营血，不能通过汗液排泄，阳气郁滞，血脉流行不畅所以脉象涩滞。这就是通过脉涩来判断的原因。
二阳并病。太阳证罢。但发潮热。手足 汗出。大便难而谵语者。下之则愈。宜大承气汤。
【白话译文】
二阳并病。太阳病的症状已经消失。只出现定时发热（潮热）、手脚出汗、大便困难并且胡言乱语（谵语）的情况，使用泻下法就会痊愈，适宜使用大承气汤。
太阳阳明并病。与上条同义。但上文则太阳证多而未解。虽有阳明证而犹未可下。当专以太阳主治而宜汗。此条
则言太阳证已罢。但有潮热手足汗出。大便难而谵语等阳明胃实诸证。应以阳明为治而当下。皆示人以辨证施
治之法也。
【白话译文】
太阳阳明并病，与上一条意义相同。但上一条是说太阳证多且未解除，虽然有阳明证但仍然不可使用泻下法，应当专门以治疗太阳为主，适宜使用发汗法。这一条则是说太阳证已经解除，只有潮热、手脚出汗、大便困难、胡言乱语等阳明胃家实证的各种症状，应当以治疗阳明为主，适宜使用泻下法。这都是向人们展示辨证施治的方法。
太阳与少阳并病。头项强痛。或眩冒。时如结胸。心下痞硬者。当刺大椎第一间。肺俞肝俞。慎不可发汗。
发汗则谵语。脉弦。五六日谵语不止。当刺期门。
【白话译文】
太阳与少阳并病（太阳经与少阳经同时发病），出现头颈部僵硬疼痛，或者头晕目眩，有时感觉像结胸（一种胸胁苦满、心下痞硬的病证），胃脘部痞塞坚硬，应当针刺大椎穴的第一间隙，以及肺俞穴、肝俞穴。千万不要发汗。如果发汗，会导致胡言乱语，脉象呈弦象。如果过了五六天胡言乱语仍不停止，应当针刺期门穴。
头项强痛。太阳证也。眩冒。少阳肝胆病也。足少阳之脉。起于目锐 。足厥阴之脉。上入颃颡。连目系。
邪热在少阳。肝胆脏腑相连。热邪在络。上侵目系。故眩冒也。或眩冒者。或时眩冒也。时如结胸者。时或如结胸之
状。而实非结胸也。少阳之脉。下颊车。合缺盆以下胸中。邪在少阳。故时如结胸而心下痞硬也。况胸又属太阳
者乎。邪在太阳则当汗。邪在少阳则禁汗。太阳与少阳并病。亦不可汗。既不可汗。则两经郁经之邪无可解之法。
故当刺大椎第一间。及肺俞肝俞。又叮咛之曰。慎不可发汗。发汗则谵语。与少阳篇禁例无异也。大椎者。背脊共
二十一节。最上之第一节骨上。即百劳穴也。肺俞者。第三椎两旁各一寸半之二穴也。肝俞者。第九椎下两旁各
一寸半之二穴也。刺大椎者。所以泄头项强痛之邪也。刺五分。留三呼。泻五吸。刺肺俞者。泄肺气以开皮毛也。
寒邪客于皮毛。皮毛者。肺之合也。然泄肺气而开皮毛。本当以麻黄汤发汗。乃为正治。因太少并病不可发汗。
故刺之以泄皮毛而代麻黄汤之汗也。可刺三分。留七呼。刺肝俞者。泻少阳之邪也。可刺三分。留六吸。凡此三刺。
皆可泄两经之气。解太少之邪者也。故邪在少阳。慎不可发汗。发汗则里虚邪陷而谵语矣。谵语则邪犯阳明。
脉当洪大而不弦。弦者。少阳肝胆之邪也。脉弦而五六日谵语不止。是木邪盛而未欲解也。故当刺肝经之募穴期
门。以泄其邪。所谓随其实而泻之也。
【白话译文】
头颈部僵硬疼痛，是太阳证。头晕目眩，是少阳肝胆的病。足少阳胆经的经脉，起于眼外角。足厥阴肝经的经脉，向上进入鼻咽部，连接眼球后的脉络。邪热在少阳，肝胆脏腑相连，热邪在经络，向上侵犯目系，所以出现头晕目眩。“或眩冒”，意思是有时会出现头晕目眩。“时如结胸”，意思是有时感觉像结胸的样子，但实际上并不是结胸。少阳经脉，下行经过颊车，汇合于缺盆，向下进入胸中。邪气在少阳，所以有时感觉像结胸且胃脘部痞塞坚硬。况且胸部又属于太阳经管辖的范围吗？邪气在太阳应当发汗，邪气在少阳禁止发汗。太阳与少阳并病，也不可以发汗。既然不可以发汗，那么两经郁滞的邪气就没有其他解除的方法，所以应当针刺大椎穴的第一间隙，以及肺俞穴、肝俞穴。又反复叮嘱说：千万不要发汗。发汗就会导致胡言乱语，这与少阳篇中的禁忌例子没有区别。大椎穴，背部脊柱共有二十一节，在最上面第一节骨的上方，也就是百劳穴。肺俞穴，在第三椎骨两旁各一寸半的两个穴位。肝俞穴，在第九椎骨下方两旁各一寸半的两个穴位。针刺大椎穴，是为了宣泄头颈部僵硬疼痛的邪气。进针五分，留针三次呼吸的时间，施行泻法五次吸气的时间。针刺肺俞穴，是为了宣泄肺气以开通皮毛。寒邪客居在皮毛，皮毛是肺的外合。然而宣泄肺气而开通皮毛，本来应当用麻黄汤发汗，这才是正确的治法。因为太阳和少阳并病不可发汗，所以通过针刺来宣泄皮毛的邪气，代替麻黄汤的发汗作用。可以进针三分，留针七次呼吸的时间。针刺肝俞穴，是为了泻除少阳的邪气。可以进针三分，留针六次吸气的时间。凡是这三种针刺，都可以宣泄两经的气机，解除太阳和少阳的邪气。所以邪气在少阳，千万不要发汗。发汗会导致体内虚弱、邪气内陷而出现胡言乱语。胡言乱语说明邪气侵犯了阳明，脉象应当洪大而不是弦。弦脉，是少阳肝胆的邪气表现。脉象弦且过了五六天胡言乱语仍不停止，这是木（肝胆）邪气旺盛且尚未解除的表现。所以应当针刺肝经的募穴期门，以宣泄邪气，这就是所谓的“随着邪气的实处而进行泻法”。
辨误 条辨不知胸属太阳。及少阳之脉亦下胸中。而以胸为阳明部分。固谬。又疑云肝与胆合。
刺肝俞以泻少阳。肺与膀胱。非合也。以肺主气。故刺之以通膀胱之气化欤。不知太阳之表邪在外。膀胱之
气化在里。通其在里之气化。岂能即解在外之表邪。其说更谬。尚论不加揆度。遂取其论以为说。云膀胱
不与肺合。然肺主气。刺肺俞以通其气。斯膀胱之气化行而邪自不能留矣。呜呼。以智者而亦蹈前人之
辙迹。其亦以盲引盲之谓乎。嘻。
【白话译文】
辨析错误：有的条辨作者不知道胸部属于太阳经，以及少阳经脉也下行进入胸中，却把胸部当作阳明经的部分，这当然是错误的。又有人怀疑说：肝与胆相合，针刺肝俞穴来泻除少阳邪气；肺与膀胱不相合。因为肺主气，所以针刺它来通达膀胱的气化功能吗？他们不知道太阳的表邪在体外，膀胱的气化功能在体内。通达体内的气化功能，怎么能立即解除体外的表邪呢？这种说法更加荒谬。尚论（指清代医家张隐庵的《伤寒论集注》中的观点）不加推敲揣测，就采纳别人的论述作为自己的说法，说膀胱不与肺相合，但是肺主气，针刺肺俞穴来通调其气，这样膀胱的气化功能运行起来，邪气自然就不能留住了。唉！以聪明才智的人也会重蹈前人的覆辙，这大概就是所谓的盲人引路吧。唉！
太阳少阳并病。心下硬。颈项强而眩者。当刺大椎肺俞肝俞。慎勿下之。
【白话译文】
太阳少阳并病，出现胃脘部痞塞坚硬，颈部僵硬且头晕目眩的情况，应当针刺大椎穴、肺俞穴、肝俞穴。千万不要使用泻下法。
此即上文之证治也。以上文但言不可发汗。而未言不可下。故此条又重申不可下之禁也。
【白话译文】
这就是上一条所述的证候和治疗。因为上一条只说了不可发汗，而没有说不可泻下，所以这一条又重申了禁止泻下的规定。
太阳少阳并病而反下之。成结胸心下硬。下利不止。水浆不下。其人心烦。
【白话译文】
太阳少阳并病反而使用了泻下法，导致形成结胸证，胃脘部痞塞坚硬，腹泻不止，连水和流质食物都无法咽下，病人心中烦躁。
上文所谓时如结胸。乃其本证。非误下之变。故不过时常如结胸之状。而心下痞硬。乃似结胸而非结胸也。
此因太少两经并病。皆不可下。以不可下者而反下之。遂成结胸心下硬。又因误下之虚。中气不守而下利不止。
邪陷胸中而水浆不下矣。其人心烦者。误下之后。阳邪陷膈。故作虚烦也。然其证已剧。而仲景不立治法。致
方氏疑为脱简。而尚论云。并病即不误下。已如结胸心下痞硬矣。况误下乎。比太阳误下之结胸。殆有甚焉。
且其人心烦。似不了之语。以太阳经结胸证悉具。烦躁者亦死。意者此谓其人心烦者死乎。愚恐未必尽皆死证也。
夫三阳经之烦证不一。皆非死证。惟烦躁并见者为重耳。以烦属阳而躁属阴也。所以三阴之手足厥而烦躁者多死。
而三阳篇中。如汗不出而烦躁者。为邪气不得外泄之表实。故用大青龙汤之汗剂。如发汗若下之。病仍不解而
烦躁者。为阳虚阴盛之里虚证。故以茯苓四逆汤温之。唯结胸证悉具而烦躁者死。盖以太阳误下。邪已陷入而
为结胸。且诸证悉具。烦躁则
阴极阳亡。所以死也。此虽亦以反下而成结胸。其人虽心烦而未躁。或有治法。未可知也。当于仲景
诸烦证中。约略寻讨其活法可也。
【白话译文】
上文所说的“有时像结胸”，是原本的症状，不是误用泻下法导致的变证。所以只是经常感觉像结胸的样子，而胃脘部痞塞坚硬，是类似结胸但实际上不是结胸。这是因为太阳和少阳两经并病，都不可使用泻下法。对不可下证的病人反而使用泻下法，于是形成了结胸证，胃脘部痞塞坚硬。又因为误用泻下法导致正气虚弱，中气不能固守而腹泻不止。邪气陷入胸中，导致水和流质食物无法咽下。病人心中烦躁，是因为误用泻下法后，阳邪陷入膈部，所以产生虚烦。然而病情已经很严重，而张仲景没有设立治疗方法，导致方有执等人怀疑是竹简脱落缺失。而尚论（张隐庵）说：并病即使不误用泻下法，也已经像结胸、胃脘部痞塞坚硬了，何况是误用泻下法呢？比起太阳经误用泻下法形成的结胸，恐怕还要严重。而且“病人心中烦躁”这句话，似乎没有说完。因为太阳经结胸证全部具备，出现烦躁症状的也会死亡。猜想这里是不是说病人心中烦躁的就会死亡呢？我担心未必全都是死证。三阳经的烦证有多种，都不是死证。只有烦躁并见的才属于重症。因为烦属于阳，躁属于阴。所以三阴经的手足厥冷且烦躁的病人大多死亡。而在三阳篇中，比如不出汗而烦躁的，是邪气不能向外发泄的表实证，所以使用大青龙汤这样的发汗剂；比如发汗或泻下后，病仍未解除且烦躁的，是阳气虚弱阴气盛的里虚证，所以用茯苓四逆汤来温补。只有结胸证全部具备且出现烦躁症状的才会死亡。大概是因为太阳经误用泻下法，邪气已经陷入并形成结胸，而且各种症状全部具备，如果出现烦躁，就是阴气极盛阳气亡失，所以死亡。这里虽然也是因为误用泻下法而形成结胸，病人虽然心中烦躁但没有躁动，或许还有治疗方法，这也是不可知的。应当在张仲景的各种烦证中，大致寻找其救治的方法即可。
Two-Yang Concurrent Disease. When the Taiyang disease (disease syndrome caused by pathogenic invasion of the Taiyang meridian) is first contracted, diaphoresis (sweating therapy) is applied, but the sweat does not come out thoroughly. Consequently, the condition transfers to the Yangming (disease syndrome caused by pathogenic invasion of the Yangming meridian). Subsequently, there is continuous slight sweating and aversion to cold ceases. If the Taiyang disease symptoms have not yet resolved, purgation (downward-draining therapy) must not be used; using it constitutes a contraindicated treatment (adverse method). In such cases, mild diaphoresis may be employed. If the patient's face exhibits a persistent, bright red color, this indicates that Yang Qi is constrained and stagnant at the exterior. It should be treated with methods to resolve the exterior, such as fumigation to induce sweating. If diaphoresis was insufficient, leading to constrained Yang Qi unable to vent, and sweating should have occurred but did not, the patient will experience restlessness and irritability (Zaofan), unaware of the specific location of pain, which shifts between the abdomen and the four limbs, and cannot be pinpointed by palpation. The patient also suffers from shortness of breath, solely due to incomplete sweating. Re-administering diaphoresis will lead to recovery. How do we know the sweating was incomplete? We know this because the pulse is choppy (Se).
"Two-Yang" refers to Taiyang and Yangming. "Concurrent disease" means that although Taiyang has been invaded by pathogens and has transferred to Yangming, the Taiyang symptoms have not yet ceased; both meridians are diseased. Although this clause mentions Two-Yang concurrent disease, its legislative intent is to show people that when pathogens in both meridians are predominantly in Taiyang, the treatment should focus on Taiyang, and one should not lightly treat Yangming. From "when Taiyang disease is first contracted" to "sweating without aversion to cold," this explains the cause of Taiyang transferring to Yangming, i.e., the meaning of transmission through meridians, which is the general principle of this clause. From "If Taiyang disease symptoms have not yet ceased" to "may mildly induce sweating," this describes the milder case where sweating was incomplete and Taiyang has not resolved; this section is secondary. From "face exhibits persistent bright red color" to the end is the main content. It means that Taiyang pathogens are abundant and unresolved, while the newly transferred Yangming pathogens are light and negligible; thus, treatment should focus on Taiyang exterior symptoms. The idea is: when Taiyang disease is first contracted, if sweating is incomplete, pathogens cannot be fully expelled, leading to transformation into Yangming. Once pathogens transfer to Yangming, symptoms such as spontaneous slight sweating and lack of aversion to cold appear, unlike Taiyang symptoms of fever, aversion to cold, and anhidrosis. This aligns with the meaning in the Yangming chapter: fever, spontaneous sweating, no aversion to cold, but aversion to heat. If pathogens have transferred to Yangming but Taiyang symptoms remain unresolved, it means the exterior syndrome is not fully cleared, pathogens have not entered the interior of Yangming, and the Stomach is not full of pathogens; therefore, purgation is contraindicated, and using it is adverse. Such residual exterior pathogens are merely due to incomplete sweating. Since most pathogens have left and few remain, mild diaphoresis can resolve them spontaneously. If the patient's face shows a persistent, bright red flush, it is because Yang Qi is blocked by cold pathogens and constrained at the exterior. It should be resolved via diaphoresis or fumigation. Although this is also a case of incomplete sweating, the retained pathogens are numerous, similar to completely unresolved Taiyang exterior pathogens. Thus, the previous statement about "mildly inducing sweating for incomplete sweating" is insufficient. This is because Yang Qi is constrained by cold pathogens, stagnating between the skin and interstices, unable to vent. Sweating should have occurred but did not, causing depression and irritability. The reason for not knowing the pain location is that if cold pathogens were only in the Taiyang exterior, as stated in the first clause of Shanghan, there would be body ache, lower back pain, and joint pain with fixed locations. Here, although cold pathogens are in Taiyang, they have transferred to Yangming. The Yangming meridian is in the muscle layer, and the abdomen and four limbs belong to the Yangming Stomach meridian. As stated in *Suwen: Taiyin Yangming Lun*, "the four limbs all receive Qi from the Stomach." In the Yangming chapter, there are symptoms of floating and large pulse, shortness of breath, and abdominal fullness. Generally, when Taiyang pathogens initially transfer to Yangming, whether in the meridian or fu-organ, their location is indefinite, hence the sensation of pain shifting between the abdomen and limbs, unfindable by palpation. The patient simply has shortness of breath, as described in *Suwen: Lihe Zhenye Lun*: "This pathogen has recently invaded and has no fixed location." Given these manifestations, although Taiyang has just transferred to Yangming, the Taiyang exterior syndrome is vigorous, and Yangming is negligible. It is solely due to incomplete sweating; re-inducing sweating will cure it. However, how do we know sweating was incomplete? The pulse is the dynamic movement of Qi and Blood circulation. Cold pathogens injure Ying-Blood, preventing excretion via sweat. Yang Qi becomes stagnant, and blood vessels flow sluggishly, resulting in a choppy pulse. Thus, we know this from the choppy pulse.
Two-Yang Concurrent Disease. If Taiyang symptoms have ceased, but there is tidal fever (Chaore), sweating of the hands and feet, difficulty in defecation, and delirious speech (Shanyu), purgation will cure it. Da Chengqi Tang (Great Order the Qi Decoction) is appropriate.
Taiyang-Yangming concurrent disease shares the same meaning as the previous clause. However, in the previous clause, Taiyang symptoms were predominant and unresolved; although Yangming symptoms existed, purgation was still contraindicated, and treatment should focus exclusively on Taiyang via diaphoresis. In this clause, Taiyang symptoms have ceased, leaving only Yangming Stomach excess syndromes such as tidal fever, hand and foot sweating, difficulty in defecation, and delirious speech. Treatment should focus on Yangming via purgation. Both illustrate the method of syndrome differentiation and treatment.
Taiyang-Shaoyang Concurrent Disease. Symptoms include stiffness and pain in the head and neck, dizziness and vertigo (Xuanmao), occasional feeling resembling Jie Xiong (Chest Binding), and epigastric hardness. Acupoints Dazhui (GV14), Feishu (BL13), and Ganshu (BL18) should be needled. Diaphoresis must be strictly avoided. Inducing sweating will cause delirious speech and a wiry pulse (Xianmai). If delirious speech persists for five to six days, Qimen (LR14) should be needled.
Stiffness and pain in the head and neck are Taiyang symptoms. Dizziness and vertigo are Shaoyang Liver-Gallbladder diseases. The Foot-Shaoyang Gallbladder Meridian originates at the outer canthus. The Foot-Jueyin Liver Meridian ascends to the nasopharynx and connects to the eye system. Pathogenic heat in Shaoyang affects the connected Liver and Gallbladder organs; heat pathogens in the collaterals invade the eye system upward, causing dizziness. "Or dizziness" means occasional dizziness. "Occasionally resembling Chest Binding" means occasionally feeling like Chest Binding, but actually not being Chest Binding. The Shaoyang meridian descends past Jiache, converges at Quepen, and enters the chest. Pathogens in Shaoyang cause occasional Chest Binding-like sensations and epigastric hardness. Moreover, the chest also belongs to Taiyang. Pathogens in Taiyang require diaphoresis; pathogens in Shaoyang prohibit diaphoresis. In Taiyang-Shaoyang concurrent disease, diaphoresis is also contraindicated. Since diaphoresis is impossible, there is no other way to resolve the constrained pathogens in both meridians. Therefore, Dazhui (first interspace), Feishu, and Ganshu should be needled. It is repeatedly emphasized: strictly avoid diaphoresis. Inducing sweating causes delirious speech, consistent with the prohibitions in the Shaoyang chapter. Dazhui is located above the first vertebra of the twenty-one vertebral segments of the spine, also known as Bailao. Feishu consists of two points, each 1.5 cun lateral to the third thoracic vertebra. Ganshu consists of two points, each 1.5 cun lateral to the ninth thoracic vertebra. Needling Dazhui expels pathogens causing head and neck stiffness. Insertion depth: 0.5 cun; retain needles for three exhalations; apply reducing method for five inhalations. Needling Feishu expels Lung Qi to open the skin and hair. Cold pathogens lodge in the skin and hair, which are the exterior correspondence of the Lung. Although expelling Lung Qi and opening the skin/hair normally requires Ma Huang Tang (Ephedra Decoction) for diaphoresis, since diaphoresis is contraindicated in Taiyang-Shaoyang concurrent disease, needling is used to expel pathogens from the skin/hair, substituting for the sweating effect of Ma Huang Tang. Insertion depth: 0.3 cun; retain needles for seven exhalations. Needling Ganshu drains Shaoyang pathogens. Insertion depth: 0.3 cun; retain needles for six inhalations. These three needleings all vent Qi from both meridians and resolve Taiyang-Shaoyang pathogens. Thus, when pathogens are in Shaoyang, diaphoresis must be strictly avoided. Inducing sweating leads to interior deficiency and pathogen sinking, causing delirious speech. Delirious speech indicates pathogens have invaded Yangming; the pulse should be flooding (Hongmai) rather than wiry. A wiry pulse indicates Shaoyang Liver-Gallbladder pathogens. A wiry pulse with persistent delirious speech after five to six days indicates Wood (Liver-Gallbladder) pathogens are abundant and unresolved. Therefore, Qimen, the Front-Mu point of the Liver meridian, should be needled to drain pathogens, following the principle of "draining according to excess."
Correction of Errors: Some commentators do not know that the chest belongs to Taiyang and that the Shaoyang meridian also descends into the chest, erroneously considering the chest part of Yangming, which is definitely wrong. Others suspect that since Liver and Gallbladder are paired, needling Ganshu drains Shaoyang; but Lung and Bladder are not paired. Since Lung governs Qi, perhaps needling it promotes Bladder Qi transformation? They fail to realize that Taiyang exterior pathogens are external, while Bladder Qi transformation is internal. Promoting internal Qi transformation cannot immediately resolve external exterior pathogens; this argument is even more absurd. Shanglun (Zhang Yin'an) did not scrutinize this and adopted this theory, stating that although Bladder and Lung are not paired, since Lung governs Qi, needling Feishu promotes Qi flow, allowing Bladder Qi transformation to proceed so pathogens cannot remain. Alas! Even wise people tread the tracks of predecessors; this is indeed "the blind leading the blind." Sigh.
Taiyang-Shaoyang Concurrent Disease. Epigastric hardness, neck stiffness, and dizziness require needling Dazhui, Feishu, and Ganshu. Purgation must be strictly avoided.
This repeats the syndrome and treatment from above. The previous clause only mentioned avoiding diaphoresis, not purgation. This clause reiterates the prohibition against purgation.
Taiyang-Shaoyang Concurrent Disease treated with purgation instead results in Chest Binding with epigastric hardness, incessant diarrhea, inability to take in fluids, and mental restlessness.
The previously mentioned "occasionally resembling Chest Binding" was the original syndrome, not a complication of erroneous purgation. Thus, it was merely a sensation resembling Chest Binding with epigastric hardness, similar to but not actual Chest Binding. Because both Taiyang and Shaoyang concurrent diseases prohibit purgation, using purgation on such cases leads to Chest Binding and epigastric hardness. Furthermore, due to deficiency caused by erroneous purgation, Middle Qi fails to secure, causing incessant diarrhea. Pathogens sink into the chest, preventing intake of fluids. Mental restlessness occurs because, after erroneous purgation, Yang pathogens sink into the Diaphragm, causing deficiency-related restlessness. However, the condition is severe, and Zhang Zhongjing did not establish a treatment method, leading Fang Youzhi to suspect missing bamboo slips. Shanglun stated: In concurrent disease, even without erroneous purgation, symptoms resemble Chest Binding and epigastric hardness; how much worse with erroneous purgation? This is likely more severe than Chest Binding caused by erroneous purgation in Taiyang. Moreover, "mental restlessness" seems like an unfinished sentence. In Taiyang Chest Binding, when all symptoms are present, restlessness and agitation indicate death. Perhaps this implies that mental restlessness alone indicates death? I fear not all such cases are fatal. Restlessness syndromes in the Three Yang meridians vary and are not necessarily fatal. Only simultaneous restlessness and agitation are critical, as restlessness belongs to Yang and agitation to Yin. Thus, patients with cold extremities and agitation in the Three Yin meridians often die. In the Three Yang chapters, sweating absence with restlessness indicates exterior excess where pathogens cannot vent externally, treated with Da Qinglong Tang (Major Green Dragon Decoction). Post-sweating or post-purgation persistence of restlessness indicates interior deficiency with Yang deficiency and Yin excess, treated with Fuling Sini Tang (Poria and Aconite Decoction). Only Chest Binding with all symptoms present plus restlessness indicates death, because erroneous purgation in Taiyang allows pathogens to sink into Chest Binding, and with all symptoms present, restlessness signifies extreme Yin and loss of Yang, leading to death. Although this case also involves Chest Binding due to erroneous purgation, if the patient has mental restlessness but no agitation, there might be a treatment method, though unknown. One should roughly search for curative methods among Zhang Zhongjing's various restlessness syndromes.