（内经与伤寒序例皆谓之两感于寒）
【因】身受阴寒之气。口食生冷之物。表里俱伤者为两感。其病多发于夏令夜间。
因人多贪凉。喜食冰水瓜果故耳。
【证】头疼体痛。身重恶寒。目瞑嗜卧。少气懒言。手足微冷。虽身热亦不渴。下
利清谷。甚则两脚筋吊。舌苔白而嫩滑。甚或灰而淡白。或灰黑腻苔。舌质嫩滑湿润。
【脉】沉而迟。甚则沉微。沉为邪陷。迟为寒凝。微则阳气欲绝。此朱丹溪所谓表
里皆寒。难分经络。无热可散。温补自解。不急治。去生甚远是也。
【治】素问谓两感于寒者必死。不治。仲景谓两感病俱作。治有先后。朱南阳谓宜
先救里。以四逆汤。后救
表。以桂枝汤。然就余所验。禀有虚实。感有浅深。虚而感之深者必死。实而感之浅者可治
。法当先温其里。附子理中汤加公丁香（二十支）煨肉果（钱半）。俟里温阳回。则下利
止而手足转温。若犹头身俱痛。恶寒筋急者。则以桂枝加附子汤。温通阳气以解表。表
解而胃口不开者。则以香砂二陈汤。温运中阳以健胃。其病自愈。
【秀按】两感伤寒。夏月最多。后贤皆名曰中寒。世俗又谓之吊脚痧。多死于挑痧
及香散痧药。目击心伤。俞君参用丹溪南阳两家治法。确是对症良方。然则两感证亦有
可治之道。不可遽必其死也。
【廉勘】两感伤寒一症。俞氏求原固确。惟救里救表。其间先后缓急。当消息之。
如下利不止。肢冷筋吊者。则先救里。若下利尚微。足筋不吊。而头身剧痛。发热恶寒
者。宜先解表。随证权变可也。
（《内经》与《伤寒论·序例》中都将这种情况称为“两感于寒”。）
【病因】身体感受阴寒之气，口中食用生冷食物，导致表里同时受伤，这叫做两感。这种病多发生在夏季的夜间。因为人们大多贪凉，喜欢喝冰水、吃瓜果的缘故。
【症状】头痛，身体疼痛，身体沉重，怕冷，眼睛闭合想睡觉，气短懒言，手脚微微发冷，虽然身体发热但并不口渴，腹泻且排出未消化的食物，严重的时候双脚筋脉拘挛吊起，舌苔白而嫩滑，严重时呈灰色或淡白色，或者是灰黑色腻苔，舌质嫩滑湿润。
【脉象】脉沉而迟，严重时脉沉微。沉表示邪气内陷，迟表示寒凝滞，微表示阳气即将衰竭。这就是朱丹溪所说的表里皆寒，难以区分是哪条经络受病，没有热邪可以发散，通过温补自然能解除，如果不紧急治疗，离死亡就很远了。
【治法】《素问》说两感于寒的病必定死亡，无法治疗。张仲景说两感病同时发作，治疗要有先后顺序。朱南阳主张应该先救里，用四逆汤；后救表，用桂枝汤。然而根据我的临床验证，人的体质有虚实之分，感邪有浅深之别。体质虚弱且感邪深的必定死亡，体质充实且感邪浅的可以治愈。治法应当先温补里阳，用附子理中汤加公丁香（二十支）、煨肉豆蔻（一钱半）。等到里阳温暖、阳气回复，那么腹泻就会停止，手脚转暖。如果仍然头痛身痛，怕冷且筋脉拘急，就用桂枝加附子汤，温通阳气以解表。表证解除但胃口不开，就用香砂二陈汤，温运中焦阳气以健胃。这样病自然痊愈。
【秀按语】两感伤寒在夏季最多见，后世医家都称之为中寒，世俗又称之为吊脚痧。很多人死于挑痧和使用香散类痧药。目睹此景，心中悲伤。俞君参考了朱丹溪和朱南阳两家的治法，确实是对症的良方。既然这样，两感证也有可治的方法，不能立刻断定其必死无疑。
【廉勘语】两感伤寒这一病症，俞氏追溯本源确实准确。只是在救里和救表的先后缓急上，应当斟酌权衡。如下利不止，四肢冰冷，筋脉拘挛吊起的，则先救里。如果下利尚轻微，足部筋脉不吊起，而头部身体剧烈疼痛，发热恶寒的，宜先解表。随证灵活变通即可。
(The *Neijing* and the *Preface to Examples* in the *Shanghan Lun* both refer to this condition as "Lianggan Yu Han" (Simultaneous contraction of exterior and interior by cold pathogens).)
[Etiology] The body is exposed to Yin-cold qi, and raw or cold foods are ingested, causing simultaneous injury to both the exterior and interior; this is called Lianggan. This disease frequently occurs at night during summer. This is because people often seek coolness and enjoy drinking iced water or eating fruits.
[Symptoms] Headache, body pain, heaviness of the body, aversion to cold, closing of eyes with drowsiness, shortness of breath and reluctance to speak, slight coldness of the hands and feet, fever without thirst, diarrhea with undigested food, and in severe cases, tendon spasms pulling up the legs. The tongue coating is white, tender, and slippery; in severe cases, it may be gray, pale white, or gray-black and greasy. The tongue body is tender, slippery, and moist.
[Pulse] Deep and slow; in severe cases, deep and faint. Deep indicates pathogen sinking inward; slow indicates cold stagnation; faint indicates impending depletion of Yang qi. This corresponds to what Zhu Danxi described as "cold in both exterior and interior," making it difficult to distinguish which meridians are affected, with no heat to dissipate; resolution comes through warming and tonification. If not treated urgently, death is imminent.
[Treatment] The *Suwen* states that Lianggan Yu Han is invariably fatal and incurable. Zhang Zhongjing stated that when Lianggan diseases occur simultaneously, treatment must follow a specific sequence. Zhu Nanyang advocated first rescuing the interior using Sini Tang (Four Reversal Decoction), followed by rescuing the exterior using Guizhi Tang (Cinnamon Twig Decoction). However, based on my clinical experience, constitution varies between deficiency and excess, and pathogenic depth varies. Cases involving deficiency with deep pathogen invasion are invariably fatal, while those involving excess with shallow invasion are treatable. The method should prioritize warming the interior using Fuzi Lizhong Tang (Aconite and Atractylodes Macrocephala Decoction) added with Gong Dingxiang (Syzygium aromaticum flower bud, 20 pieces) and Wei Rouguo (Nutmeg, roasted, 1.5 qian). Once the interior is warmed and Yang qi returns, diarrhea will cease and hands and feet will warm. If headache and body pain persist, along with aversion to cold and tendon stiffness, use Guizhi Jia Fuzi Tang (Cinnamon Twig Decoction plus Aconite Root) to warm and unblock Yang qi to release the exterior. If the exterior is resolved but appetite remains poor, use Xiangsha Erchen Tang (Aucklandia and Amomum Decoction with Two Aged Chen Decoction) to warm and transport Middle Jiao Yang qi to strengthen the stomach. The disease will then resolve spontaneously.
[Commentary by Xiu] Lianggan Shanghan is most common in summer. Later physicians have named it Zhonghan (Cold Stroke), while the lay public calls it Diaojiao Sha (Foot-Hanging Sha). Many die due to bloodletting (Tiaosha) or the use of aromatic Sha medicines. Witnessing this causes heartbreak. Mr. Yu’s integration of the treatments from Zhu Danxi and Zhu Nanyang constitutes effective prescriptions for these symptoms. Thus, Lianggan Zheng also has treatable pathways and should not be immediately deemed fatal.
[Review by Lian] Regarding the syndrome of Lianggan Shanghan, Mr. Yu’s tracing of its origin is indeed accurate. However, regarding the sequence and urgency of rescuing the interior versus the exterior, careful consideration is required. If diarrhea is incessant, limbs are cold, and tendons are spasming, rescue the interior first. If diarrhea is mild, leg tendons are not spasming, but there is severe headache and body pain with fever and aversion to cold, release the exterior first. Adapt flexibly according to the presentation.