【纲】仲景曰。本太阳病。初得时。发其汗。汗先出不彻。因转属阳明也。伤寒转属阳明者。其人 然微汗出也。
太阳与少阳并病。脉弦。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。若谵语不止者。刺期门。太阳少阳并病。心下硬。头项强而痛者。当刺大椎肺俞肝俞。慎勿下之。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。
【目】许叔微曰。问。三阳有合病并病。何之。答曰。脉浮大而长。头疼腰痛。肌热目疼鼻干
者。合病也。太阳初得病时。发其汗。汗先出不彻。因转属阳明。续自微汗出。不恶寒者。并病也。
三阳皆有合病。惟三阴无合病。不可不知。
李 曰。并者。催并逼迫之意。始初二阳合病。后一阳气盛。一阳气衰。并归一经独重。初症亦
不解罢。阳明并太阳者。太阳症未解。阳明症又至。麻黄汤合升麻。如太阳症重。加太阳经药。阳
明症重。加阳明经药。后仿此。少阳并太阳者。太阳症未解。少阳症又至。麻黄汤合小柴胡汤。头
痛项强眩冒。如结胸状者。亦宜通用九味羌活汤。少阳并阳明者。为木克土。难治。小柴胡汤合升
麻葛根汤。或柴胡升麻汤救之。是并病在表者皆可汗。若太阳症罢。乃入胃腑者。谓
之传经症。非并病也。宜酌量攻下。古云。三阴无合病。然三阴亦自有相合并者。但非两感。必
无阴经与阳经相合为病之理。
陶华曰。太阳阳明并病者。如本太阳病发汗。则汗出不彻。因转属阳明。续自微汗出不恶寒。
是并归阳明也。太阳症尚在。桂枝麻黄合半汤。太阳症也。大小承气。则是阳明症也。
柯琴曰。并病与合病异。合则一时并见。并则以次相乘。如太阳之头项强痛未罢。递见脉强眩
冒心下痞硬。是与少阳并病。更见谵语。即三阳并病矣。太阳阳明并病。太阳症未罢者。从太阳而
小发汗。太阳病已罢者。从阳明而下之。其机于恶寒发热而分也。然阳明之病在胃家实。太阳阳明
合病。喘而胸满者。不可下。恐胃家未实耳。
【纲】张仲景说：原本是太阳病，在刚发病时，使用发汗法治疗，但汗出得不透彻，因此病邪转属到阳明经。伤寒病转属阳明的表现是，病人濈然（连续不断）地微微出汗。
太阳病与少阳病并病，脉象弦，头项部僵硬疼痛，有时出现头晕目眩，有时感觉像结胸证那样，心下部痞塞硬满的，应当针刺大椎穴第一间隙、肺俞穴和肝俞穴。千万不要发汗，如果发汗就会导致谵语（胡言乱语）。如果谵语不止，应当针刺期门穴。太阳病与少阳病并病，心下部硬满，头项部僵硬且疼痛的，应当针刺大椎穴、肺俞穴和肝俞穴。千万不要用攻下法。太阳病与少阳病并病，反而用了攻下法，就会形成结胸证，表现为心下部硬满，腹泻不止，水浆无法入口，此时人心烦意乱。
【目】许叔微说：有人问，三阳经有合病和并病，有什么区别？回答说：脉象浮大而长，头痛腰痛，肌肉发热，眼睛疼痛，鼻子干燥的，这是合病。太阳病刚发病时，使用发汗法，但汗出不透彻，因此转属阳明，随后持续微微出汗，且不恶寒的，这是并病。
李说：“并”字有催逼、逼迫的意思。起初是二阳经合病，后来某一阳气盛，另一阳气衰，病气并入一经而独重，初起的症状也没有解除。阳明并太阳者，是指太阳病症未解，阳明病症又至。可用麻黄汤合升麻，如太阳症重，加太阳经药；阳明症重，加阳明经药，后续仿照此例。少阳并太阳者，是指太阳病症未解，少阳病症又至。可用麻黄汤合小柴胡汤。出现头痛项强、眩晕冒昧，像结胸状的情况，也适宜通用九味羌活汤。少阳并阳明者，属于木克土，难治。可用小柴胡汤合升麻葛根汤，或用柴胡升麻汤救治。这种在表的并病都可以用汗法。如果太阳症已罢，病邪进入胃腑的，称为传经症，不是并病。适宜斟酌情况使用攻下法。古语说三阴无合病，然而三阴经也有相互合并的情况，但这并非两感证，必定没有阴经与阳经相合为病的道理。
陶华说：太阳阳明并病，比如原本是太阳病，发汗后汗出不透彻，因此转属阳明，随后持续微微出汗且不恶寒，这就是病气并入阳明。太阳症仍在，可用桂枝麻黄各半汤，这是针对太阳症的；大小承气汤，则是针对阳明症的。
柯琴说：并病与合病不同。合病是同时出现，并病是依次相乘。如太阳病的头项强痛未罢，接着出现脉强、眩晕、心下痞硬，这是与少阳并病；如果再出现谵语，就是三阳并病了。太阳阳明并病，太阳症未罢的，从太阳经用小发汗法；太阳病已罢的，从阳明经用攻下法。其关键在于通过恶寒发热来区分。然而阳明病在于胃家实，太阳阳明合病出现喘而胸满的，不可攻下，恐怕胃家尚未结实。
[General Principle] Zhang Zhongjing stated: If it was originally a Taiyang disease (Disease of the Taiyang Channel), and at the onset, diaphoresis (sweating method) was applied, but the sweat was not thorough, the pathogen may transfer to the Yangming channel. In cases where Shanghan (Cold Damage) transfers to Yangming, the patient exhibits continuous, slight sweating (Ji Ran Wei Han Chu).
When Taiyang and Shaoyang diseases occur simultaneously (Bing Bing), with a wiry pulse (Xian Mai), stiffness and pain in the head and neck, occasional dizziness or vertigo, and sensations resembling Jie Xiong (Chest Binding Syndrome) with epigastric fullness and hardness, one should needle the first interspace of the Dazhui (GV14) point, Feishu (BL13), and Ganshu (BL18). Diaphoresis must be strictly avoided; inducing sweat may lead to delirious speech (Zhen Yu). If delirium persists, Qimen (LR14) should be needled. In cases of Taiyang and Shaoyang simultaneous disease presenting with epigastric hardness, stiffness, and pain in the head and neck, Dazhui (GV14), Feishu (BL13), and Ganshu (BL18) should be needled. Purging methods must be strictly avoided. If purgatives are incorrectly used for Taiyang and Shaoyang simultaneous disease, it results in Jie Xiong syndrome, characterized by epigastric hardness, incessant diarrhea, inability to take food or fluids, and mental restlessness.
[Detailed Commentary] Xu Shuwei said: When asked about the difference between He Bing (Combined Disease) and Bing Bing (Simultaneous Disease) among the Three Yang channels, the answer is as follows: A floating and large pulse, headache, lower back pain, muscle heat, eye pain, and nasal dryness indicate He Bing. If Taiyang disease is treated with diaphoresis at onset, but the sweat is not thorough, leading to a transfer to Yangming, followed by continuous slight sweating and absence of aversion to cold, this is Bing Bing.
He Bing occurs in all Three Yang channels, whereas Bing Bing does not occur in the Three Yin channels; this distinction must be understood.
Li [Gao] explained that "Bing" implies forcing or pressing together. Initially, there is a combined disease of two Yang channels. Later, if one Yang qi becomes excessive and the other deficient, the pathology consolidates into one channel, becoming predominant, while initial symptoms remain unresolved. For Yangming combining with Taiyang, where Taiyang symptoms persist and Yangming symptoms emerge, Mahuang Tang (Ephedra Decoction) combined with Shengma (Cimicifugae Rhizoma) may be used. If Taiyang symptoms are heavier, add herbs for the Taiyang channel; if Yangming symptoms are heavier, add herbs for the Yangming channel, following this pattern. For Shaoyang combining with Taiyang, where Taiyang symptoms persist and Shaoyang symptoms emerge, Mahuang Tang combined with Xiaochaihu Tang (Minor Bupleurum Decoction) is appropriate. For symptoms such as headache, neck stiffness, dizziness, and a sensation resembling chest binding, Jiwei Qianghuo Tang (Nine-Ingredient Notopterygia Decoction) is also suitable. For Shaoyang combining with Yangming, representing Wood overacting on Earth, the condition is difficult to treat. Xiaochaihu Tang combined with Shengma Gegen Tang (Cimicifuga and Pueraria Decoction) or Chaihu Shengma Tang may be used. Such simultaneous diseases in the exterior can be treated with diaphoresis. However, if Taiyang symptoms have resolved and the pathogen has entered the stomach fu organ, it is termed a transmitted disease (Chuan Jing Zheng), not a simultaneous disease, and purging should be considered cautiously. Ancient texts state that Three Yin channels do not have He Bing, yet they can have internal combinations, though these are not Liang Gan (Double Invasion) patterns, and there is no principle of Yin and Yang channels combining to form disease.
Tao Hua stated: In Taiyang-Yangming simultaneous disease, if an original Taiyang disease is treated with diaphoresis resulting in incomplete sweating, causing a transfer to Yangming, followed by continuous slight sweating and absence of aversion to cold, the pathology has consolidated into Yangming. If Taiyang symptoms persist, Guizhi Mahuang Banxia Tang (Modified Cinnamon Twig and Ephedra Half-Dose Decoction) addresses the Taiyang aspect, while Da Chengqi Tang (Major Order the Qi Decoction) or Xiao Chengqi Tang (Minor Order the Qi Decoction) addresses the Yangming aspect.
Ke Qin stated: Simultaneous disease differs from combined disease. Combined disease presents simultaneously, whereas simultaneous disease progresses sequentially. For instance, if Taiyang symptoms of head and neck stiffness persist, followed by a strong pulse, dizziness, and epigastric fullness/hardness, it is a combination with Shaoyang. If delirium subsequently appears, it becomes a simultaneous disease of all three Yang channels. In Taiyang-Yangming simultaneous disease, if Taiyang symptoms persist, mild diaphoresis targeting Taiyang is indicated; if Taiyang symptoms have resolved, purging targeting Yangming is indicated. The differentiation lies in the presence or absence of aversion to cold and fever. However, Yangming disease involves excess in the stomach-intestines. In Taiyang-Yangming combined disease presenting with wheezing and chest fullness, purging is contraindicated, as the stomach-intestine excess may not yet be established.