庞氏曰。凡三阴无合病。惟三阳有合病十四证。其三阴三阳相
并而病者。即两感是也。雍曰。合病十四证。已见三阳经。今重列于
下。非惟便于检按。亦相附参考易明。庶无瘥矣。
仲景曰。太阳与阳明合病者。必自下利。葛根汤主之。
又曰。太阳与阳明合病。不下利。但呕者。葛根加半夏汤主之。
又曰。太阳与阳明合病。喘而胸满者。不可下。宜麻黄汤。
仲景问曰。何缘得阳明病。答曰。太阳病。若发汗。若下。若利小
便。亡其津液。胃中干燥。因转属阳明。不更衣。大便难者。此阳明病
也。雍曰。无太阳证者。宜调胃承气汤。凡转属之法。与合病微不同。
且如太阳阳明合病。必须解两经之邪。故仲景不舍葛根麻黄二汤。
若转属阳明。可以少俟太阳证衰。即以调胃承气汤专攻阳明。一举
而两得之。盖太阳为既往。则当日衰。阳明为方来。则当日盛故也。
又曰。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。朱氏曰。若太阳证不罢。不可下。
宜桂枝麻黄各半汤小发其汗。雍曰。若太阳不罢者。宜少俟一日。又
不罢。则根据朱氏法。
又曰。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。可小发汗。设面色缘缘正赤者。阳气怫郁在表。当解之熏之。
（一作蒸）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。以脉涩故知之。雍
曰。宜桂枝麻黄各半汤。
问曰。太阳阳明合病并病。二者之证。何以别之。朱氏曰。脉浮
大而长。头疼腰痛。肌热鼻干目疼者。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。雍
曰。合病。脉浮大而长者。未必恶寒。其脉浮紧而长。无汗者。当恶寒
也。皆宜桂枝麻黄各半汤。有下症者。自宜前法。
仲景曰。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。刺期门。雍曰。仲景言少阳不可发汗。故并病
亦不可汗也。
又曰。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。雍曰。仲景曰。太阳病转入少阳。脉沉迟者。与小柴胡
汤。庞氏曰。脉紧者。小柴胡汤。少加牡蛎。大抵少阳多宜和解。故宜
小柴胡汤。太阳和解。亦宜用之。
又曰。太阳少阳并病。太阳病不解。转入少阳者。胁下硬满。干
呕不能食。往来寒热。尚未可吐下。脉沉紧者。与小柴胡汤。庞氏曰。
脉紧者。小柴胡加桂枝。胁下硬满。加牡蛎。
又曰。阳明少阳合病。必下利。其脉不负者顺也。负者失也。互
相克贼。名为负也。雍曰。宜理中汤。下利而厥者。宜四逆汤。其脉不
弦者。为顺。脉弦者。阳明土负也。急泻邱墟阳陵泉。以泄少阳木。急
灸三里。以补阳明土也。
仲景曰。三阳合病。腹满身重。难以转侧。口不仁。面垢。谵语。
下之。则额上生汗。手足厥冷。若自汗出者。白虎汤主之。
又曰。三阳合病。脉浮大。上关上。但欲眠睡。目合则汗。庞氏
曰。不言弦者。隐于长大也。常氏云。可桂枝柴胡各半汤。雍曰。即柴
胡桂枝汤也。
问曰。仲景言本太阳病。因医下之。腹满时痛。转属太阴者。此
为两感乎。为合病乎。雍曰。非也。合病虽亦有转属者。要之两阳俱
作也。两感则表里阴阳俱病矣。难经曰。人之有尺。犹木之有根。枝
叶虽枯槁。根本将自生。两感则根叶皆将枯。无自而生矣。合病太阳
太阴。虽名一阴一阳。而实非相为表里之经。互相有生救。谓如太阳
虽病。而少阴不受病。太阴虽病。而阳明不受病。正类枝叶虽枯槁。
根本自生之象。是以不为两感。况本非邪气传注。医误下之。移太阳
之疾。入于太阴。非两经俱作之证甚明。是以仲景用桂枝加芍药汤、
桂枝加大黄汤也。
庞氏说：凡是三阴经没有合病的情况。只有三阳经有十四种合病的证候。如果是三阴和三阳同时受邪而发病，那就是两感病。郭雍说：十四种合病证候，已经在三阳经中列出。现在重新列在下面，不仅为了方便查阅，也便于相互参照，容易理解，这样就不会出现差错。
张仲景说：太阳经与阳明经合病的人，必然会出现自发性腹泻，用葛根汤主治。
又说：太阳经与阳明经合病，如果没有腹泻，只是呕吐的，用葛根加半夏汤主治。
又说：太阳经与阳明经合病，出现气喘且胸部胀满的，不可使用泻下法，适宜用麻黄汤。
张仲景问：为什么会得阳明病？回答说：患太阳病时，如果发汗、如果攻下、如果利小便，导致津液耗损，胃中干燥，因而转化为阳明病。如果不解大便，大便困难的，这就是阳明病。郭雍说：如果没有太阳经症状的，适宜用调胃承气汤。凡是转属的方法，与合病略有不同。比如太阳阳明合病，必须解除两经的病邪，所以张仲景不舍弃葛根汤和麻黄汤这两方。如果是转属阳明，可以稍微等待太阳经症状消退后，就用调胃承气汤专门攻治阳明病，一举两得。这是因为太阳经属于既往之邪，当日就会衰退；阳明经属于新近之邪，当日就会旺盛的缘故。
又说：二阳并病（指太阳与阳明两经先后发病），太阳经的症状已经消失，只出现定时发热（潮热）、手足出汗、大便困难且胡言乱语（谵语）的，用泻下法就可以痊愈，适宜用大承气汤。朱氏说：如果太阳经的症状没有消失，不可使用泻下法，适宜用桂枝麻黄各半汤轻微发汗。郭雍说：如果太阳经症状没有消失，适宜再等待一天。如果还没有消失，就按照朱氏的方法处理。
又说：二阳并病，在太阳经刚得病的时候，医生发了汗，但汗出得不透彻，因而病邪转属到阳明经。随后病人自然有微汗出，不怕冷。如果太阳经的症状还没有消失，不可使用泻下法，误用泻下法是逆治。像这种情况，可以轻微发汗。如果病人面色持续通红，这是阳气郁结在体表，应当用解表熏蒸的方法治疗。（另一种说法是蒸法）。如果发汗不透彻，不足以说明问题。阳气郁结不能宣越，本该出汗却不出汗，病人烦躁不安，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。病人呼吸短促，只能坐着，这都是因为汗出不透彻的缘故。再次发汗就会痊愈。怎么知道汗出不透彻呢？从脉象涩滞就可以知道。郭雍说：适宜用桂枝麻黄各半汤。
问：太阳阳明合病与并病，这两种证候，如何区别？朱氏说：脉象浮大而长，头痛腰痛，肌肉发热，鼻干目疼的，是合病。太阳经刚得病时，医生发了汗，但汗出不透彻，因而病邪转属到阳明经，随后自然有微汗出，不怕冷的，是并病。郭雍说：合病，脉象浮大而长的，未必怕冷。如果脉象浮紧而长，无汗的，应当怕冷。这些都适宜用桂枝麻黄各半汤。如果有可下之症，自然适宜用前面的方法。
张仲景说：太阳经与少阳经并病，出现头项强痛，或者头晕目眩，有时像结胸证那样，心下部痞塞硬满的，应当针刺大椎穴第一间隙、肺俞穴、肝俞穴。千万不可发汗，发汗就会导致胡言乱语，脉象弦。过了五六天，胡言乱语不止，应当针刺期门穴。郭雍说：张仲景说少阳经不可发汗，所以并病也不可发汗。
又说：太阳少阳并病，心下部硬满，颈项强直且眩晕的，应当针刺大椎穴、肺俞穴、肝俞穴。千万不要使用泻下法。郭雍说：张仲景说：太阳病转入少阳，脉象沉迟的，用小柴胡汤。庞氏说：脉象紧的，用小柴胡汤，稍加牡蛎。大体上少阳病多适宜和解，所以适宜用小柴胡汤。太阳病和解，也适宜使用此方。
又说：太阳少阳并病，太阳病未解，病邪转入少阳的，胁下硬满，干呕不能进食，寒热往来，还不可以使用吐法或下法。脉象沉紧的，用小柴胡汤。庞氏说：脉象紧的，用小柴胡汤加桂枝。胁下硬满的，加牡蛎。
又说：阳明少阳合病，必然出现腹泻。脉象不虚弱的为顺证。虚弱的为逆证，互相克制贼害，称为“负”。郭雍说：适宜用理中汤。腹泻且四肢厥冷的，适宜用四逆汤。脉象不弦的，为顺证。脉象弦的，是阳明土气虚弱（被少阳木气克制）。急需泻邱墟穴、阳陵泉穴，以泄少阳木气；急需灸三里穴，以补益阳明土气。
张仲景说：三阳合病，腹部胀满，身体沉重，难以翻身侧卧，口舌麻木不知五味（口不仁），面部污垢，胡言乱语。如果使用泻下法，就会导致额头出汗，手足冰冷。如果是自汗出的，用白虎汤主治。
又说：三阳合病，脉象浮大，关部以上明显，只想睡觉，闭上眼睛就出汗（盗汗）。庞氏说：不说脉弦，是因为隐含在脉象长大之中。常氏说：可以用桂枝柴胡各半汤。郭雍说：就是柴胡桂枝汤。
问：张仲景说原本患太阳病，因为医生误用泻下法，导致腹部胀满、时而疼痛，病邪转属太阴经，这算是两感病吗？还是合病？郭雍说：不是。合病虽然也有转属的情况，但总之是两阳经同时发病。两感则是表里阴阳两经都发病了。《难经》说：人的尺脉，就像树木的树根。枝叶虽然枯萎，树根自然会生长。两感病则是根和叶都将枯萎，无法自行生长了。合病涉及太阳和太阴，虽然名为一阴一阳，但实际上并不是互为表里的经络，而是互相有生救的关系。比如说太阳虽然发病，但少阴不受病；太阴虽然发病，但阳明不受病。正像枝叶虽然枯萎，树根依然生长的景象。所以不算作两感病。况且本来不是邪气传注，是医生误用下法，将太阳的疾病移入太阴，显然不是两经同时发病的证候。因此张仲景使用桂枝加芍药汤、桂枝加大黄汤。
Pang stated: There are no combined diseases (He Bing) involving only the three Yin meridians. There are fourteen types of combined diseases involving the three Yang meridians. When the three Yin and three Yang meridians are simultaneously affected, it is called Liang Gan (Double Contraction). Guo Yong stated: The fourteen types of combined diseases have already been listed in the chapters on the three Yang meridians. They are re-listed below for convenience of reference and easier understanding through cross-referencing, thereby avoiding errors.
Zhang Zhongjing stated: In cases where the Taiyang (Greater Yang) and Yangming (Yang Brightness) meridians present with a combined disease, spontaneous diarrhea will inevitably occur. Gegen Tang (Kudzu Decoction) is the primary treatment.
He further stated: In cases where the Taiyang and Yangming meridians present with a combined disease, if there is no diarrhea but only vomiting, Gegen Jia Banxia Tang (Kudzu Decoction with Pinellia) is the primary treatment.
He further stated: In cases where the Taiyang and Yangming meridians present with a combined disease, characterized by wheezing and chest fullness, purgation (Xia Fa) is contraindicated. Mahuang Tang (Ephedra Decoction) is appropriate.
Zhang Zhongjing asked: What is the cause of acquiring a Yangming disease? The answer is: If a patient suffering from a Taiyang disease undergoes sweating therapy, purgation, or diuresis, their body fluids (Jin Ye) are depleted. This leads to dryness in the Stomach, causing the condition to transform into a Yangming disease. If the patient fails to defecate and experiences difficulty in bowel movements, this constitutes a Yangming disease. Guo Yong stated: If there are no symptoms of the Taiyang meridian, Tiaowei Chengqi Tang (Regulate the Stomach and Order the Qi Decoction) is appropriate. The method of transformation (Zhuan Shu) differs slightly from that of combined disease. For instance, in a Taiyang-Yangming combined disease, one must resolve the pathogenic factors of both meridians; therefore, Zhang Zhongjing did not discard Gegen Tang and Mahuang Tang. However, if the condition has transformed into a Yangming disease, one may wait briefly for the Taiyang symptoms to subside, then use Tiaowei Chengqi Tang to specifically attack the Yangming pathology, achieving two goals with one action. This is because the Taiyang aspect represents past pathology, which wanes on that day, while the Yangming aspect represents emerging pathology, which peaks on that day.
He further stated: In Er Yang Bing Bing (Concurrent Disease of Two Yangs), when the Taiyang symptoms have ceased, but tidal fever (Chao Re), sweating of the hands and feet, difficulty in bowel movements, and delirium (Chan Yu) are present, purgation will lead to recovery. Dachengqi Tang (Major Order the Qi Decoction) is appropriate. Zhu stated: If Taiyang symptoms have not ceased, purgation is contraindicated. Guizhi Mahuang Ge Ban Tang (Guizhi and Mahuang Half-Dose Decoction) should be used to induce slight sweating. Guo Yong stated: If Taiyang symptoms have not ceased, it is appropriate to wait another day. If they still persist, follow Zhu's method.
He further stated: In Er Yang Bing Bing, when the Taiyang disease was first contracted, sweating therapy was administered, but the sweat was not thorough. Consequently, the pathology transferred to the Yangming meridian. Subsequently, the patient exhibits slight spontaneous sweating and aversion to cold has ceased. If Taiyang symptoms have not yet ceased, purgation is contraindicated; using it would be an adverse reaction. In such cases, slight sweating should be induced. If the patient's face is persistently red, this indicates Yang Qi stagnation at the exterior. It should be treated with resolution and fumigation (or steaming). If sweating was not thorough, mere insufficiency does not suffice. Yang Qi stagnates and cannot vent. Although sweating should occur, it does not. The patient becomes restless and irritable, unable to pinpoint the pain location, which shifts between the abdomen and limbs, and cannot be elicited by pressure. The patient suffers from shortness of breath and can only sit upright. This is due to incomplete sweating. Re-inducing sweating will lead to recovery. How do we know the sweating was incomplete? We know it from the choppy pulse (Se Mai). Guo Yong stated: Guizhi Mahuang Ge Ban Tang is appropriate.
Question: How to distinguish between Taiyang-Yangming He Bing (Combined Disease) and Bing Bing (Concurrent Disease)? Zhu stated: A pulse that is floating, large, and long, accompanied by headache, lower back pain, muscle heat, dry nose, and eye pain, indicates He Bing. If, upon initial contraction of Taiyang disease, sweating therapy was administered but was not thorough, leading to transfer to Yangming, followed by slight spontaneous sweating and absence of aversion to cold, this indicates Bing Bing. Guo Yong stated: In He Bing, a floating, large, and long pulse does not necessarily imply aversion to cold. If the pulse is floating, tight, and long, with no sweating, aversion to cold should be present. Both conditions are appropriate for Guizhi Mahuang Ge Ban Tang. If there are indications for purgation, the previous methods should be used.
Zhang Zhongjing stated: In Taiyang-Shaoyang Bing Bing (Concurrent Disease of Taiyang and Shaoyang), presenting with stiffness and pain in the head and neck, dizziness or vertigo, occasional sensation similar to Jie Xiong (Chest Binding), and epigastric hardness and fullness, acupuncture at the first interspace of the Dazhui (GV14), Feishu (BL13), and Ganshu (BL18) points is indicated. Sweating therapy must be strictly avoided. Inducing sweating will lead to delirium and a wiry pulse (Xian Mai). If delirium persists after five to six days, Qimen (LR14) should be needled. Guo Yong stated: Zhang Zhongjing stated that Shaoyang should not be treated with sweating; thus, concurrent disease also prohibits sweating.
He further stated: In Taiyang-Shaoyang Bing Bing, presenting with epigastric hardness, stiff neck, and dizziness, acupuncture at Dazhui, Feishu, and Ganshu is indicated. Purgation must strictly be avoided. Guo Yong stated: Zhang Zhongjing said: If Taiyang disease transfers to Shaoyang and the pulse is deep and slow, Xiaochaihu Tang (Minor Bupleurum Decoction) is given. Pang stated: If the pulse is tight, Xiaochaihu Tang with added Oyster Shell (Muli) is used. Generally, Shaoyang diseases are best treated with harmonization, making Xiaochaihu Tang appropriate. Harmonizing Taiyang disease also suits its use.
He further stated: In Taiyang-Shaoyang Bing Bing, if Taiyang disease remains unresolved and transfers to Shaoyang, presenting with hardness and fullness in the hypochondrium, dry retching, inability to eat, and alternating chills and fever, emesis and purgation are not yet applicable. If the pulse is deep and tight, Xiaochaihu Tang is given. Pang stated: If the pulse is tight, Xiaochaihu Tang with added Cinnamon Twig (Guizhi) is used. For hardness and fullness in the hypochondrium, add Oyster Shell (Muli).
He further stated: In Yangming-Shaoyang He Bing, diarrhea will inevitably occur. If the pulse is "not negative" (Fu), it is a favorable prognosis. If "negative," it is unfavorable. Mutual overcoming and attacking is termed "Fu." Guo Yong stated: Lizhong Tang (Center Regulating Decoction) is appropriate. If diarrhea is accompanied by cold extremities (Jue), Sini Tang (Four Reversal Decoction) is appropriate. A pulse that is not wiry indicates favorability. A wiry pulse indicates that Yangming Earth is being overcome (by Shaoyang Wood). Urgent drainage of Qiuxu (GB40) and Yanglingquan (GB34) is needed to drain Shaoyang Wood. Urgent moxibustion of Zusanli (ST36) is needed to tonify Yangming Earth.
Zhang Zhongjing stated: In San Yang He Bing (Combined Disease of Three Yangs), presenting with abdominal fullness, heaviness of the body, difficulty in turning over, numbness of the mouth (Kou Bu Ren), facial grease, and delirium. If purgation is used, sweating on the forehead and cold extremities will result. If there is spontaneous sweating, Baihu Tang (White Tiger Decoction) is the primary treatment.
He further stated: In San Yang He Bing, the pulse is floating and large, prominent at the Guan position above. The patient desires sleep and sweats when closing the eyes. Pang stated: The absence of a wiry description implies it is hidden within the large and long qualities. Chang stated: Guizhi Chaihu Ge Ban Tang (Guizhi and Bupleurum Half-Dose Decoction) can be used. Guo Yong stated: This is Chaihu Guizhi Tang (Bupleurum and Cinnamon Twig Decoction).
Question: Zhang Zhongjing stated that originally suffering from Taiyang disease, due to physician-induced purgation, resulting in abdominal fullness and intermittent pain, transferring to Taiyin. Is this Liang Gan (Double Contraction) or He Bing (Combined Disease)? Guo Yong stated: No. Although He Bing may involve transformation, it fundamentally involves simultaneous onset of two Yang meridians. Liang Gan involves simultaneous disease of both interior and exterior, Yin and Yang. The Nan Jing states: The Chi pulse of a person is like the root of a tree. Even if branches and leaves wither, the root will regenerate. In Liang Gan, both root and leaves wither, and regeneration is impossible. He Bing involving Taiyang and Taiyin, though named one Yin and one Yang, does not actually involve meridians that are exterior-interior pairs, but rather mutually generating and rescuing relationships. For example, if Taiyang is diseased, Shaoyin is not; if Taiyin is diseased, Yangming is not. This resembles withered branches and leaves while the root remains alive. Thus, it is not considered Liang Gan. Moreover, it is not due to pathogenic transmission, but physician error in purgation, moving Taiyang pathology into Taiyin. It is clearly not a simultaneous disease of two meridians. Therefore, Zhang Zhongjing uses Guizhi Jia Shaoyao Tang (Guizhi Decoction with Added Peony Root) and Guizhi Jia Dahuang Tang (Guizhi Decoction with Added Rhubarb).