表里合病必下利
太阳（汗）与阳明合病必自下利葛根汤主之不下利但呕者葛根加半夏汤主之太阳（和）与少阳合
病自下利者与黄芩汤若呕者黄芩加半汤生姜汤主之阳明与少阳合病必下利脉滑而数者有宿食也当下之宜大承气汤（俱详
下利）
并病
二阳（汗）并病太阳出汗不彻因转属阳明自汗不恶寒太阳证不罢面赤躁烦短气者更发汗则愈二阳（下）并病
太阳证罢潮热谵语者下之则愈（论见谵语）太阳（刺）少阳并病项强眩冒心下硬如结胸者刺胸俞肝俞（论见项强）
合并两经俱病并则一经证罢而并归于一经也太阳与阳明合病有三证其邪凑有浅深之殊故用药有汗下和解之异治见
各条三阳合病有二证其一证用白虎汤其一证无治法后人用小柴胡白虎之类盖此二证俱有三阳之候故不可汗下二阳并病
有二证表未解者汗之表已解有里证者下之太阳与少阳并病有三证其一由误下以致心下硬成结胸其一项强如柔痉状心下
硬如结胸刺肺俞肝俞慎勿发汗汗则谵语不止宜刺期门其一心下硬项强而眩者刺大椎肺俞不宜下也
合病
太阳（汗）与阳明合病胸满而喘者不可下麻黄汤太阳（解肌）与阳明合病自下利葛根汤不下利但呕者葛根加
半夏（或曰由太阳表未罢而阳明里又至两阳合病热甚于表乘虚渐攻于里故下也其不下利而呕者邪气虽攻里未入于胃但气
逆而呕故加半夏以止呕逆庞氏曰外证必头痛腰疼肌热目疼鼻干也脉浮大太阳受病也长者阳明也头腰太阳也肌目鼻阳明
也）
太阳与少阳合病自下利者与黄芩汤若呕者黄芩加半夏汤（或曰此表实里虚热入攻里故自下利若兼痰饮则呕也）
阳明少阳合病必下利脉长者为顺脉眩者为负负者克贼也脉滑而数者有宿食大承气汤（或曰阳明土少阳木其脉弦者木
乘土也不弦者不负也负者必死若滑而数者有宿食非负也故宜下）
三阳合病腹满身重难以转侧口不仁面垢谵语遗尿不可汗下若自汗者白虎汤三阳合病脉浮大见关上但欲眠目合则汗
小柴胡白虎汤（或曰此二证俱有三阳之证此不可汗下）
并病
二阳（解肌）并病太阳初得时汗之不彻转属阳明续自微汗不恶寒大柴胡汤若太阳证不罢不可下可少发汗设面
色缘缘正赤阳气怫郁在表汗之不彻其人烦躁短气不知痛处宜更发汗则愈葛根汤二阳（下）并病太阳证罢潮热手足汗大便
难谵语者大承气汤太阳少阳并病反下之成结胸心下硬下利不止水浆不下心烦生姜泻心汤小陷胸汤太阳（刺）与少阳并项
强痛或眩冒时如结胸心下痞硬刺大椎第一间肺俞肝俞不可汗汗则谵语不止刺期门太阳少阳并病心下硬项强而眩者刺大
椎肺俞慎勿下
赵 愚尝疑合病并病之难明也久矣姑释之盖合病者二阳经或三经同受病之病不传者也并病者一阳经先受病又过一
经病之传者也且如太阳阳明并病一证若并而未尽是传未通尚有表证仲景所谓太阳证不罢面色赤阳气怫郁在表不得越烦
躁气短是也犹当汗之以各半汤若并之已尽是谓传过仲景所谓太阳证罢潮热手足汗出大便硬而谵语者是也法当下之以承
气汤是知传则入腑不传则不入腑所以仲景论太阳阳明合病止出三证如前太阳阳明并病则言其有传变如此也又如阳经互
相合病皆自下利仲景于太阳阳明合病则主以葛根汤太阳少阳合病主以黄芩汤少阳阳明合病主以承气汤至于太阳少阳并
病其证头项强痛眩冒如结胸心下痞硬当刺大椎肺俞肝俞不可汗下太阳阳明并病已见上论但三阳合病仲景无背恶寒语句
虽别有口燥渴心烦背微恶寒者乃属太阳证而非三阳合病也活人言三阳合病背恶寒者非也三阳若与三阴合病即是两感所
以三阴无合病例也
张 夫并者乃催并督并之义非吞并相就之理然催并系去声吞并之并乃上声史记曰始皇初并天下即此理也夫并之理
乃前病未解后病已至有逼相并之义故曰并病也经曰太阳与少阳并病头项强痛或眩冒云云如果并作一家则仲景不具两经
之证而言也其非并字明矣
又曰或云三阳合病有太阳阳明有正阳阳明有少阳阳明似乎重出予曰各有所指不过表里之分耳夫三阳合病在表三阳
阳明病在里事在两途即非重出在表者宜解散以痊安在里者非攻下则不可然表里证治迥各不同惟编目有似乎重出
【表里合病必下利】
太阳经与阳明经同时发病（合病），必然出现自发性腹泻，应使用葛根汤治疗。如果没有腹泻但伴有呕吐症状的，应使用葛根加半夏汤治疗。
太阳经与少阳经同时发病（合病），出现自发性腹泻的，应使用黄芩汤；如果伴有呕吐的，应使用黄芩加半夏生姜汤治疗。（注：此处原文为“黄芩加半汤生姜汤”，据《伤寒论》及医理校正为黄芩加半夏生姜汤）。
阳明经与少阳经同时发病（合病），必然出现腹泻。若脉象滑而数，说明体内有积滞食物，应当采用攻下法，适宜使用大承气汤。（以上情况详见“下利”章节）
【并病】
太阳经与阳明经先后发病（并病）：太阳经受邪后发汗不彻底，导致病邪转入阳明经。此时患者自汗出、不怕冷，但太阳经的症状尚未完全消失，表现为面部发红、烦躁不安、呼吸短促，此时应再次发汗以治愈。
太阳经与阳明经先后发病（并病）：太阳经的症状已经消失，出现定时发热（潮热）、胡言乱语（谵语），此时应采用攻下法以治愈。（相关论述见“谵语”章节）
太阳经与少阳经先后发病（并病）：表现为颈项强直、头晕目眩、心下部僵硬如同结胸证，应针刺胸俞穴和肝俞穴。（相关论述见“项强”章节）
【合并两经俱病辨析】
所谓“并病”，是指一经的症状消退后，病邪并入另一经。
太阳经与阳明经合病有三种证型，由于邪气侵袭有深浅不同，因此治疗方法有发汗、攻下、和解的区别，具体治法见各条文。
三阳经（太阳、阳明、少阳）合病有两种证型。其中一种证型使用白虎汤治疗；另一种证型没有特定的固定治法，后人多使用小柴胡汤或白虎汤等方剂。这是因为这两种证型都具备三阳经的症状表现，所以不可单纯使用发汗或攻下法。
二阳经（太阳、阳明）并病有两种证型：表证未解的，应用发汗法；表证已解而有里证的，应用攻下法。
太阳经与少阳经并病有三种证型：其一，因误用攻下法导致心下部僵硬，形成结胸证；其二，表现为颈项强直如柔痉状，心下部僵硬如结胸证，应针刺肺俞穴和肝俞穴，切记不可发汗，否则会导致胡言乱语不止，适宜针刺期门穴；其三，心下部僵硬、颈项强直且眩晕者，应针刺大椎穴和肺俞穴，不宜使用攻下法。
【合病详细论述】
太阳经与阳明经合病，表现为胸部胀满且气喘的，不可使用攻下法，应使用麻黄汤。
太阳经与阳明经合病，出现自发性腹泻的，使用葛根汤；若无腹泻但伴有呕吐的，使用葛根加半夏汤。（或者认为：由太阳表证未罢，阳明里证又至，两阳合病，热势盛于体表，乘虚逐渐攻入体内，故导致腹泻。若不下利而呕吐，是因为邪气虽攻入体内但未入胃，仅是气逆而呕，故加半夏以止呕逆。庞氏曰：外证必有头痛、腰痛、肌肉发热、眼睛疼痛、鼻子干燥。脉象浮大为太阳受病之象，脉长则为阳明之象。头腰属太阳，肌肉、眼睛、鼻子属阳明。）
太阳经与少阳经合病，出现自发性腹泻的，使用黄芩汤；若伴有呕吐的，使用黄芩加半夏生姜汤。（或者认为：此乃表实里虚，热邪入里攻伐，故自下利；若兼有痰饮则呕吐。）
阳明经与少阳经合病，必然出现腹泻。脉象长者为顺证，脉象眩晕者为逆证（负），逆证意味着相克贼害。若脉象滑而数，说明有积滞食物，应使用大承气汤攻下。（或者认为：阳明属土，少阳属木，脉弦者为木乘土，若不弦则不为逆。逆者必死，若滑而数则有宿食，非逆证，故宜攻下。）
三阳经合病，表现为腹部胀满、身体沉重、难以翻身转侧、口舌麻木不知滋味、面色垢秽、胡言乱语、遗尿，不可使用发汗或攻下法。若伴有自汗出的，使用白虎汤。
三阳经合病，脉象浮大见于关上，嗜睡、闭眼时出汗，可使用小柴胡汤或白虎汤。（或者认为：这两个证型都具备三阳经的症状，不可发汗或攻下。）
【并病详细论述】
太阳经与阳明经并病（解肌法）：太阳经初得病时发汗不彻底，病邪转入阳明经，继续轻微自汗出、不怕冷，使用大柴胡汤。若太阳经症状未消除，不可攻下，可少量发汗。若患者面色通红，阳气怫郁在表，发汗不彻底，导致其人烦躁、呼吸短促、不知疼痛部位，应再次发汗，使用葛根汤。
太阳经与阳明经并病（攻下法）：太阳经症状消失，出现潮热、手足出汗、大便困难、胡言乱语，使用大承气汤。
太阳经与少阳经并病，若误用攻下法，形成结胸证，心下部僵硬，腹泻不止，水浆难进，心烦意乱，使用生姜泻心汤或小陷胸汤。
太阳经与少阳经并病，表现为颈项强痛或头晕目眩，时而感觉像结胸证，心下部痞塞坚硬，应针刺大椎第一间穴、肺俞穴、肝俞穴，不可发汗，否则会导致胡言乱语不止，应针刺期门穴。
太阳经与少阳经并病，心下部僵硬、颈项强直且眩晕者，应针刺大椎穴和肺俞穴，切记不可攻下。
赵嗣真曾怀疑合病与并病的概念难以阐明已久，姑且解释如下：所谓合病，是两阳经或三阳经同时受病，病邪不传变；所谓并病，是一阳经先受病，又传至另一经，是病邪传变的过程。例如太阳与阳明并病的一种证型，若并而未尽，说明传变未通，尚有表证，即仲景所说的“太阳证不罢，面色赤，阳气怫郁在表，不得越，烦躁，气短”，此时仍当用发汗法，可用桂枝麻黄各半汤。若并之已尽，说明传变已过，即仲景所说的“太阳证罢，潮热，手足汗出，大便硬而谵语”，此时法当用攻下法，用承气汤。由此可知，传变则入腑，不传变则不入腑。所以仲景论述太阳与阳明合病只列出三种证型如上；论述太阳与阳明并病则强调其有传变的特点。又如阳经互相合病，皆自下利，仲景对于太阳阳明合病主以葛根汤，太阳少阳合病主以黄芩汤，少阳阳明合病主以承气汤。至于太阳少阳并病，其证候为头项强痛、眩晕、如结胸、心下痞硬，当刺大椎、肺俞、肝俞，不可汗下。太阳阳明并病已在上文论述。但三阳合病中，仲景无“背恶寒”的语句。虽然另有“口燥渴、心烦、背微恶寒”者，那属于太阳证而非三阳合病。成无己（活人）说三阳合病有背恶寒，这是不对的。三阳若与三阴合病，即是两感证，所以三阴经没有合病的病例。
张元素认为，“并”字乃是催促、督责之意，并非吞并、凑合之理。然而，“催并”的“并”读去声，“吞并”的“并”读上声。《史记》记载：“始皇初并天下”，即为此理。“并”的道理，是前病未解，后病已至，有逼迫相并的含义，故称为并病。经文说：“太阳与少阳并病，头项强痛或眩冒……”如果真的是并作一家，那么仲景就不会分别列举两经的症状了，这就明确了“并”字的含义并非简单的合并。
又说：有人问，三阳合病中有太阳阳明、正阳阳明、少阳阳明，似乎重复。我说：各有指代，不过是表里的区别罢了。三阳合病在表，三阳阳明病在里，事情在两途，即非重复。在表的宜用解散法以求痊愈，在里的非攻下不可。既然表里证治截然不同，只是编目时看起来似乎重复。
[Table-Interior Combined Disease Must Present with Diarrhea]
When the Taiyang (Taiyang Channel) and Yangming (Yangming Channel) channels are affected simultaneously (Combined Disease), spontaneous diarrhea will inevitably occur; Gegen Tang (Kudzu Root Decoction) should be administered. If there is no diarrhea but vomiting occurs, Gegen Jia Banxia Tang (Gegen Decoction with Added Pinellia) should be administered.
When the Taiyang (Taiyang Channel) and Shaoyang (Shaoyang Channel) channels are affected simultaneously (Combined Disease), if spontaneous diarrhea occurs, Huangqin Tang (Scutellaria Decoction) should be used; if vomiting accompanies it, Huangqin Jia Banxia Shengjiang Tang (Huangqin Decoction with Added Pinellia and Fresh Ginger) should be administered. (Note: The original text says "Huangqin Jia Ban Tang Shengjiang Tang", corrected here to Huangqin Jia Banxia Shengjiang Tang based on Shanghan Lun and medical logic).
When the Yangming (Yangming Channel) and Shaoyang (Shaoyang Channel) channels are affected simultaneously (Combined Disease), diarrhea will inevitably occur. If the pulse is slippery and rapid, it indicates retained food stagnation; purgative therapy should be employed, and Dachengqi Tang (Major Order the Qi Decoction) is appropriate. (For details on these conditions, see the section on "Diarrhea").
[Bing Disease - Sequential Involvement]
Taiyang (Taiyang Channel) and Yangming (Yangming Channel) Bing Disease: After treating Taiyang channel pathogen with sweating method, if the sweat was incomplete, the pathogen transfers to the Yangming channel. At this time, the patient sweats spontaneously, has no aversion to cold, but Taiyang symptoms have not completely resolved. Manifestations include facial redness, irritability, shortness of breath. In this case, sweating therapy should be applied again to cure.
Taiyang (Taiyang Channel) and Yangming (Yangming Channel) Bing Disease: When Taiyang symptoms have ceased, tidal fever (periodic fever) and delirium appear. Purgative therapy should be employed to cure. (See the section on "Delirium" for related discussions).
Taiyang (Taiyang Channel) and Shaoyang (Shaoyang Channel) Bing Disease: Manifesting as neck stiffness, dizziness, and hardness in the epigastrium resembling Jie Xiong (Chest Binding Syndrome), acupuncture at Xiongyu (BL-17) and Ganshu (BL-18) points should be performed. (See the section on "Neck Stiffness" for related discussions).
[Analysis of Simultaneous and Sequential Channel Involvement]
"Bing Disease" refers to a condition where symptoms of one channel cease, and the pathogen merges into another channel.
Taiyang and Yangming Combined Disease has three syndromes. Due to differences in the depth of pathogen invasion, treatment methods vary between sweating, purging, and harmonizing. Specific treatments are found in respective clauses.
San Yang (Taiyang, Yangming, Shaoyang) Combined Disease has two syndromes. One syndrome uses Baihu Tang (White Tiger Decoction); the other has no fixed specific treatment, and later practitioners often use Xiaochaihu Tang (Minor Order the Qi Decoction) or Baihu Tang. This is because both syndromes exhibit signs of all three Yang channels, so pure sweating or purging methods are contraindicated.
Er Yang (Taiyang, Yangming) Bing Disease has two syndromes: If the exterior syndrome is unresolved, sweating therapy should be used; if the exterior is resolved and interior syndrome exists, purging therapy should be used.
Taiyang and Shaoyang Bing Disease has three syndromes: First, mistaken purging leads to hardness in the epigastrium forming Jie Xiong Syndrome. Second, manifestations include neck stiffness resembling Rou Jing (Soft Spasm) and hardness in the epigastrium like Jie Xiong; acupuncture at Feishu (BL-13) and Ganshu (BL-18) points is indicated. Sweating must be strictly avoided, otherwise delirium will persist; Qimen (LR-14) point should be acupunctured. Third, hardness in the epigastrium, neck stiffness, and dizziness indicate acupuncture at Dazhui (GV-14) and Feishu (BL-13) points; purging is inappropriate.
[Detailed Discussion on Combined Disease]
Taiyang and Yangming Combined Disease presenting with chest fullness and wheezing should not be purged; Mahuang Tang (Ephedra Decoction) should be used.
Taiyang and Yangming Combined Disease presenting with spontaneous diarrhea uses Gegen Tang; if no diarrhea but vomiting occurs, Gegen Jia Banxia Tang (Gegen Decoction with Added Pinellia) is used. (Alternatively: Since Taiyang exterior is unresolved and Yangming interior pathogen arrives, the heat of two Yangs is strong on the exterior and attacks the interior due to deficiency, causing diarrhea. If vomiting occurs without diarrhea, the pathogen attacks the interior but has not entered the Stomach, causing only Qi rebellion and vomiting; thus Banxia is added to stop vomiting. Pang Shi stated: Exterior symptoms must include headache, lower back pain, muscle heat, eye pain, and nasal dryness. A floating and large pulse indicates Taiyang involvement; a long pulse indicates Yangming. Head and lower back belong to Taiyang; muscles, eyes, and nose belong to Yangming.)
Taiyang and Shaoyang Combined Disease presenting with spontaneous diarrhea uses Huangqin Tang (Scutellaria Decoction); if vomiting occurs, Huangqin Jia Banxia Shengjiang Tang (Huangqin Decoction with Added Pinellia and Fresh Ginger) is used. (Alternatively: This is exterior excess and interior deficiency, with heat entering and attacking the interior, causing spontaneous diarrhea; if phlegm-fluid retention is present, vomiting occurs.)
Yangming and Shaoyang Combined Disease inevitably presents with diarrhea. A long pulse is favorable; dizziness with a certain pulse quality is unfavorable ("Fu"), indicating mutual overcoming and harm. If the pulse is slippery and rapid, it indicates retained food stagnation, and Dachengqi Tang (Major Order the Qi Decoction) should be used for purging. (Alternatively: Yangming belongs to Earth, Shaoyang to Wood. A wiry pulse indicates Wood overcoming Earth; if not wiry, it is not unfavorable. Unfavorable cases result in death. If slippery and rapid, it indicates retained food, not an unfavorable pattern, hence purging is suitable.)
San Yang Combined Disease presents with abdominal fullness, body heaviness, difficulty turning over, numbness of the mouth/tongue, greasy complexion, delirium, and urinary incontinence. Sweating and purging are contraindicated. If spontaneous sweating occurs, Baihu Tang (White Tiger Decoction) should be used.
San Yang Combined Disease with a floating and large pulse visible at the Guan position, somnolence, and sweating upon closing the eyes can be treated with Xiaochaihu Tang (Minor Order the Qi Decoction) or Baihu Tang (White Tiger Decoction). (Alternatively: These two syndromes both possess San Yang signs; sweating and purging are contraindicated.)
[Detailed Discussion on Bing Disease]
Taiyang and Yangming Bing Disease (Muscle-Releasing Method): When Taiyang disease is first acquired and sweating is incomplete, the pathogen transfers to Yangming. Continued mild spontaneous sweating and absence of aversion to cold indicate Dachengqi Tang (Major Order the Qi Decoction) or potentially Da Chaihu Tang (Major Order the Qi Decoction? Note: Text says Da Chaihu Tang). If Taiyang symptoms do not cease, purging is contraindicated; slight sweating may be attempted. If the face is uniformly red, Yang Qi is constrained in the exterior, and incomplete sweating causes irritability, shortness of breath, and unknown pain locations, sweating therapy should be reapplied using Gegen Tang (Kudzu Root Decoction).
Taiyang and Yangming Bing Disease (Purgative Method): When Taiyang symptoms cease, tidal fever, sweating of hands and feet, difficult defecation, and delirium indicate Dachengqi Tang (Major Order the Qi Decoction).
Taiyang and Shaoyang Bing Disease: Mistaken purging leads to Jie Xiong Syndrome, hardness in the epigastrium, incessant diarrhea, inability to take fluids, and irritability. Shengjiang Xiexin Tang (Fresh Ginger Decoction to Drain the Epigastrium) or Xiao Xianxiong Tang (Minor Chest-Binding Decoction) should be used.
Taiyang and Shaoyang Bing Disease presenting with neck stiffness and pain, or dizziness, feeling like Jie Xiong Syndrome, with epigastric stuffiness and hardness, requires acupuncture at Dazhui (GV-14), Feishu (BL-13), and Ganshu (BL-18) points. Sweating is contraindicated; otherwise, delirium will persist. Qimen (LR-14) point should be acupunctured.
Taiyang and Shaoyang Bing Disease presenting with hardness in the epigastrium, neck stiffness, and dizziness requires acupuncture at Dazhui (GV-14) and Feishu (BL-13) points. Purging must be strictly avoided.
Zhao Sizhen had long doubted the clarity of Combined and Bing diseases. He explained: Combined Disease refers to two or three Yang channels being affected simultaneously without transmission; Bing Disease refers to one Yang channel being affected first, then transmitting to another, representing disease progression. For example, in Taiyang-Yangming Bing Disease, if the merging is incomplete, transmission is not thorough, and exterior signs remain (as described by Zhang Zhongjing: "Taiyang signs not ceased, face red, Yang Qi constrained in exterior, unable to vent, irritability, shortness of breath"). Sweating therapy with Ge Ban Tang (Ge Gen Tang combined with Gui Zhi Tang?) or similar formulas should still be used. If merging is complete, transmission has passed (as described by Zhang Zhongjing: "Taiyang signs ceased, tidal fever, hand/foot sweating, hard stool, delirium"). Purgative therapy with Chengqi Tang should be used. Thus, transmission enters the Fu organs; non-transmission does not. Therefore, Zhang Zhongjing lists only three syndromes for Taiyang-Yangming Combined Disease as above, while discussing Taiyang-Yangming Bing Disease emphasizes its transmissive nature. Furthermore, when Yang channels combine, they all present with spontaneous diarrhea. Zhang Zhongjing treats Taiyang-Yangming Combined Disease with Gegen Tang, Taiyang-Shaoyang Combined Disease with Huangqin Tang, and Shaoyang-Yangming Combined Disease with Chengqi Tang. Regarding Taiyang-Shaoyang Bing Disease, symptoms include head/neck stiffness, dizziness, Jie Xiong-like sensation, and epigastric stuffiness; acupuncture at Dazhui, Feishu, Ganshu is indicated, and sweating/purging are contraindicated. Taiyang-Yangming Bing Disease is discussed above. However, in San Yang Combined Disease, Zhang Zhongjing does not mention "aversion to cold on the back." Although "dry mouth/thirst, irritability, slight aversion to cold on the back" exists, that belongs to Taiyang syndrome, not San Yang Combined Disease. Cheng Wuji (Huoren) stated that San Yang Combined Disease includes aversion to cold on the back, which is incorrect. If San Yang combines with San Yin, it becomes Liang Gan (Dual Cold), so San Yin has no Combined Disease cases.
Zhang Yuansu argued that "Bing" implies urging or supervising, not swallowing or merging. However, "Cu Bing" (urge merge) uses the falling tone, while "Tun Bing" (swallow merge) uses the level tone. The Records of the Grand Historian states: "The First Emperor initially merged the world," illustrating this principle. The logic of "Bing" is that the previous illness is unresolved, and the new illness arrives, creating a sense of coercion and merging, hence "Bing Disease." The classic states: "Taiyang and Shaoyang Bing Disease, head/neck stiffness or dizziness..." If they were truly merged into one entity, Zhang Zhongjing would not list symptoms of both channels separately, clarifying that "Bing" does not mean simple combination.
Furthermore, some ask: In San Yang Combined Disease, there are Taiyang-Yangming, Zheng Yang-Yangming, and Shaoyang-Yangming, which seems repetitive. I reply: Each has specific indications, differing only by exterior vs. interior. San Yang Combined Disease is in the exterior; San Yang Yangming Disease is in the interior. They are distinct paths, not repetitive. Exterior conditions require dispersing methods for recovery; interior conditions require purging. Since exterior and interior treatments are vastly different, they only appear repetitive in the index.