病两感于寒者，一日则太阳与少阴表里俱病，凡头痛发热恶寒者邪在表，口干而渴者邪在里。
二日则阳明与太阴表里俱病，身热目痛、鼻干不眠者邪在表，腹满不欲食者邪在里。三日则少阳与
厥阴表里俱病，耳聋胁痛、寒热而呕者邪在表，烦满、囊缩而厥、水浆不入邪在里。凡两感者，或
三日，或六日，营卫不行，脏腑不通，昏不知人，胃气乃尽，故当死也。若此两感，虽为危证，然
不忍坐视，其于拯溺救焚之计所不可免，但当细察其证，亦自有缓急可辨。若三阳之头痛身热，耳
聋胁痛，恶寒而呕，此在表者，不得不解于外。其三阴之腹满口渴，囊缩谵语，此在里者，不得不
和其中。若其邪自外入，而外甚于里者，必当以外为主治，而兼调其内。若其邪因虚袭，而元气不
支者，速宜单顾根本，不可攻邪，但使元阳不败，则强敌亦将自解，其庶几乎有，可望也。此证变
态非常，故不可凿言方治。
按∶门人钱祯曰∶两感者，本表里之同病，似若皆以外感为言也，而实有未必尽然者，正以外
内俱伤，便是两感。今见有少阴先溃于内，而太阳继之于外者，即纵情肆欲之两感也。太阴受伤于
里，而阳明重感于表者，即劳倦竭力，饮食不调之两感也。厥阴气逆于脏，少阳复病于腑者，即七
情不慎，疲筋败血之两感也。人知两感为伤寒，而不知伤寒之两感，内外俱困，病斯剧矣。但伤有
重轻，医有知不知，则死生系之。或谓两感证之不多见者，盖亦见之不广，而义有未达耳。其于治
法，亦在乎知其由而救其本也。此言最切此病，诚发人之未发，深足指迷，不可不录。
患两感于寒的病证，第一天太阳经与少阴经表里同时受病，凡是出现头痛、发热、恶寒的症状，说明邪气在体表；出现口干且口渴的症状，说明邪气在体内。
第二天阳明经与太阴经表里同时受病，身体发热、眼睛疼痛、鼻干、无法安睡的症状，说明邪气在体表；腹部胀满、不想进食的症状，说明邪气在体内。
第三天少阳经与厥阴经表里同时受病，耳聋、胁肋疼痛、忽冷忽热并伴有呕吐的症状，说明邪气在体表；心烦腹胀、阴囊收缩、四肢厥冷、水米难进的症状，说明邪气在体内。
凡是两感的病证，或者三天，或者六天，营气和卫气运行停滞，脏腑气机不通畅，神志昏迷不省人事，胃气耗尽，所以会导致死亡。像这样的两感病证，虽然属于危重证候，但医者不忍心坐视不管，挽救溺水和救火般的急救措施是不可免除的，只是应当仔细审查其证候，自然有轻重缓急可以辨别。如果是三阳经的头痛身热、耳聋胁痛、恶寒呕吐，这些是在体表的病邪，不得不从外部解除。如果是三阴经的腹部胀满、口渴、阴囊收缩、胡言乱语，这些是在体内的病邪，不得不调和内部。如果邪气从外侵入，且外表症状比内部严重的，必须以治疗外部为主，兼以调理内部。如果是因为正气虚弱而遭受邪气侵袭，且元气支撑不住的，应当迅速单独顾护根本，不可攻伐邪气，只要使元阳不致败坏，那么强大的敌人也将自行消散，这样或许还有希望。这种病证的变态非常复杂，所以不能死板地规定方剂治疗方法。
按语：门人钱祯说：两感病证，本来是表里同病，似乎都是指外感而言，但实际上未必完全如此，正是因为内外都受到损伤，才称为两感。现在见到有少阴经先在内部溃败，然后太阳经继而在外部受病的，这就是纵情肆欲导致的两感。太阴经在内部受伤，然后阳明经再次在外部感受邪气的，这就是劳倦竭力、饮食不调导致的两感。厥阴经气机逆乱于脏，少阳经又在腑发病的，这就是七情不慎、筋脉疲劳、血液败坏导致的两感。人们只知道两感是伤寒的一种，却不知道伤寒中的两感，内外都困顿，病情就会非常严重。但是伤害有轻重之分，医生有无知识之别，这就关系到生死存亡。有人说两感证不多见，大概也是见得不够广泛，且对其义理没有透彻理解罢了。对于治疗方法，也在于知道病因从而救治根本。这些话最切合此病，确实是启发他人未曾想到的见解，足以指引迷津，不可不记录下来。
In cases of *Lianggan* (Simultaneous Affection by Cold on Exterior and Interior), on the first day, the Taiyang (Greater Yang) and Shaoyin (Lesser Yin) meridians are simultaneously affected as exterior and interior respectively. Symptoms such as headache, fever, and aversion to cold indicate that the pathogenic factor is in the exterior; symptoms such as dry mouth and thirst indicate that the pathogenic factor is in the interior.
On the second day, the Yangming (Bright Yang) and Taiyin (Greater Yin) meridians are simultaneously affected. Symptoms such as body heat, eye pain, nasal dryness, and insomnia indicate that the pathogenic factor is in the exterior; symptoms such as abdominal fullness and loss of appetite indicate that the pathogenic factor is in the interior.
On the third day, the Shaoyang (Lesser Yang) and Jueyin (Terminal Yin) meridians are simultaneously affected. Symptoms such as deafness, hypochondriac pain, alternating chills and fever, and vomiting indicate that the pathogenic factor is in the exterior; symptoms such as mental restlessness and abdominal fullness, retraction of the scrotum, cold limbs, and inability to take food or fluids indicate that the pathogenic factor is in the interior.
In all cases of *Lianggan*, whether occurring within three days or six days, the Ying (Nutritive) and Wei (Defensive) Qi cease to circulate, and the Zang-Fu organs become obstructed. The patient falls into a coma and loses consciousness, the Stomach Qi is exhausted, and death ensues. Although this condition is critical, the physician cannot remain passive. Emergency measures akin to rescuing someone from drowning or putting out a fire are indispensable. However, one must carefully examine the syndrome to distinguish between urgency and slackness. If the symptoms involve the Three Yang meridians—such as headache, body heat, deafness, hypochondriac pain, aversion to cold, and vomiting—the pathogen is in the exterior and must be resolved externally. If the symptoms involve the Three Yin meridians—such as abdominal fullness, thirst, scrotal retraction, and delirium—the pathogen is in the interior and must be harmonized internally. If the pathogen enters from the exterior and the exterior symptoms are more severe than the interior ones, treatment should primarily target the exterior while concurrently regulating the interior. If the invasion occurs due to deficiency, and the Yuan Qi (Original Qi) is unable to sustain itself, immediate attention should be paid solely to preserving the root cause. One must not attack the pathogen; rather, if the Yuan Yang (Original Yang) is preserved, even a formidable enemy will dissipate on its own, offering a glimmer of hope. Given the highly variable nature of this syndrome, rigid prescriptions for treatment are inappropriate.
Commentary: My disciple Qian Zhen stated: *Lianggan* refers to simultaneous disease of the exterior and interior, seemingly implying an external contraction, but in reality, it does not always fit this definition strictly. It is precisely because both internal and external aspects are injured that it is termed *Lianggan*. Currently, we observe cases where the Shaoyin meridian fails internally first, followed by the Taiyang meridian externally; this is *Lianggan* caused by indulgence in desires. When the Taiyin meridian is injured internally, and the Yangming meridian is subsequently re-infected externally, this is *Lianggan* caused by overexertion, fatigue, and irregular diet. When the Jueyin meridian experiences Qi rebellion within the Zang organs, and the Shaoyang meridian becomes diseased in the Fu organs, this is *Lianggan* caused by imprudent emotional responses, tendon fatigue, and blood deterioration. People know *Lianggan* as a type of Shanghan (Cold Damage), but they do not realize that in *Lianggan* associated with Cold Damage, both internal and external systems are besieged, making the illness severe. However, the severity of the injury varies, and the outcome depends on the physician's knowledge, determining life or death. Some argue that *Lianggan* syndromes are rare; this is likely due to limited clinical exposure and a lack of deep understanding of their principles. Regarding treatment, the key lies in identifying the etiology and addressing the root. These words are most pertinent to this disease, truly revealing insights previously unexpressed, and sufficiently guiding those lost in confusion. They must be recorded.