素问三十三篇曰。有温病者。汗出辄复热。而脉躁疾。不为汗
衰。狂言。不能食。岐伯曰。病名阴阳交。交者死也。人所以汗出者。
皆生于谷。谷生于精。今邪气交争于骨肉而得汗者。是邪却而精胜
也。精胜则当能食而不复热。复热者。邪气也。汗者。精气也。今汗出
而辄复发热者。是邪胜也。不能食者。精无俾也。汗而热留者。其寿
可立而倾也。
又曰。热论曰。汗出而脉尚躁盛者死。今脉不与汗相应。此不胜
其病也。其死明矣。狂言者。是失志。失志者。死。今见三死。不见一
生。虽愈。必死也。雍曰。汗出辄复热。一死。脉尚盛。二死。狂言失
志。三死也。
灵枢二十三篇曰。热病已得汗。而脉尚躁盛者。此阴脉之极也。
死。其得汗而脉静者。生。雍曰。此二证。脉经皆以为阴阳交。疑以得
汗者为交。不得汗者非交也。
又曰。热病已得汗。而脉尚躁。且复热。勿肤刺。喘甚者死。
脉经曰。热病。阴阳交者死。
又曰。热病。烦已而汗。脉当静。
又曰。太阳病。已得汗。脉反躁盛者。是阴阳交。死。复得汗。脉
静者。生。
又曰。热病阴阳交者。热烦心躁。太阴寸口脉两部尚躁盛。是阴
阳交。死。得汗脉静者。生。雍曰。以上二证。与前同。灵枢不言阴阳
交。此言阴阳交为异。脉经所载皆古书。此二证莫知所出也。
又曰。热病。阳进阴退。头独汗出者。死。阴进阳退。腰以下至足
汗出者。死。阴阳俱进。汗出已。热如故。亦死。阴阳俱退。汗出已。寒
不止。鼻口气冷。亦死。以上十证。并见脉经阴阳交部。
又曰。热病所谓并阴者。热病已汗。因得泄。是谓并阴。故治。
（一作活）
又曰。热病所谓并阳者。热病已得汗。脉尚躁盛。火热汗出。虽
不汗出。若衄（庞氏云和而衄）者。是谓并阳。故治。雍曰。并阴阳二
证。诸书无所见。亦类阴阳交。故脉经继之于其后。
阴阳交论曰。伤寒两感阴阳交二证。皆出于素问。仲景发明两
感。而不及阴阳交。王叔和载阴阳交。而不及两感。后世因仲景而明
两感之证。独阴阳交多所未解。予考阴阳交之证。大抵伤寒脉不为
汗解者。皆阴阳交也。何以不为汗解。曰。独阴独阳之病。一汗则解。
阴兼阳阳兼阴之病。一汗不能解。盖汗解其阴。阳脉不得退。汗解其
阳。阴脉不得退。此所以不为汗衰也。然则阴兼阳阳兼阴者。何病
也。余悉索之。则两感之证似之。一日太阳与少阴俱病。二日阳明与
太阴俱病。皆阴兼阳。阳兼阴也。阴阳相兼而病。故其病名曰交。是
以太阳汗解。而少阴未得解。阳明汗解。而太阴未得解者。岂非因其
相交而不为汗衰乎。观二证之言。初若不相同。合二证阴阳之理。则
无异也。故素问言两感。本非病名。至阴阳交。则曰病名阴阳交。盖
两感言其始感。阴阳交者。着其名也。故阴阳交之证。有曰复得汗。
脉静者生。是邪气再出而复生也。仲景亦曰。发表攻里。本自不同。
岂非再乎。故遇斯病者。当参二证而治之。然则仲景发明两感。而不
及阴阳交。叔和载阴阳交而不言两感。意岂异乎。更俟贤哲明之。
《素问》第三十三篇说：有一种温病，出汗后随即又发热，脉象躁动急疾，不因出汗而减弱，出现胡言乱语，不能进食。岐伯说：这种病名叫“阴阳交”，所谓“交”是指死证。人之所以出汗，都是因为水谷精微化生的缘故，水谷精微又源于先天之精。现在邪气与正气在骨肉之间交争，能够出汗的，是邪气退却而精气胜的表现。精气胜则应当能进食且不再发热。再次发热的，是邪气作祟；汗出的，是精气外泄。现在出汗后随即又发热，这是邪气胜而精气败。不能进食，说明精气得不到补充。出汗后热势仍留滞不退，寿命可以立刻倾覆（指死亡）。
又说：《热论》中说：出汗后脉象仍然躁动旺盛的，主死。现在的脉象与汗出情况不相适应，这是正气不胜病邪。其死亡是显而易见的。胡言乱语，是神志丧失；神志丧失，主死。现在见到三种死证，见不到一种生机，即使暂时看似痊愈，最终也必死无疑。郭雍说：出汗后随即又发热，这是一死；脉象仍然盛大，是二死；胡言乱语、神志丧失，是三死。
《灵枢》第二十三篇说：热病已经出汗，但脉象仍然躁动旺盛的，这是阴脉衰竭到了极点，主死。如果出汗后脉象平静的，主生。郭雍说：这两种证候，《脉经》都将其归为“阴阳交”。我怀疑出汗的为“交”，不出汗的非“交”。
又说：热病已经出汗，但脉象仍然躁动，并且再次发热，不要针刺皮肤（此处原文可能有误或指特定禁忌），气喘严重的，主死。
又说：热病，烦躁停止后出汗，脉象应当平静。
又说：太阳病，已经出汗，脉象反而躁动旺盛的，这是阴阳交，主死。如果再次出汗，脉象平静的，主生。
又说：热病属于阴阳交的，表现为热盛心烦躁动，太阴和寸口两部脉象仍然躁动旺盛，这是阴阳交，主死。如果出汗后脉象平静的，主生。郭雍说：以上两种证候，与前文相同。《灵枢》未提及“阴阳交”，这里提及“阴阳交”有所不同。《脉经》所载皆出自古书，但这两种证候不知出处。
又说：热病中所谓的“并阴”，是指热病已经出汗，接着又发生腹泻，这叫做“并阴”，因此可以治疗。（另一种说法是“活”）
又说：热病中所谓的“并阳”，是指热病已经出汗，脉象仍然躁动旺盛，火热迫津外泄而出汗，即使没有出汗，如果出现鼻衄（庞氏说：调和后出现鼻衄），这叫做“并阳”，因此可以治疗。郭雍说：“并阴”和“并阳”这两种证候，在其他书中未见记载，也类似“阴阳交”，所以《脉经》将其附记在后面。
《阴阳交论》说：伤寒中的“两感”和“阴阳交”两种证候，都出自《素问》。张仲景阐明了“两感”，但未涉及“阴阳交”；王叔和记载了“阴阳交”，但未涉及“两感”。后世因为张仲景而明白了“两感”的证候，唯独对“阴阳交”大多未能理解。我考证“阴阳交”的证候，大抵上伤寒脉象不因汗解的，都属于“阴阳交”。为什么不因汗解呢？回答是：单纯的阴病或单纯的阳病，一次发汗就能解除；阴兼阳或阳兼阴的病，一次发汗不能解除。因为发汗解除了阴分之邪，阳脉却无法消退；发汗解除了阳分之邪，阴脉却无法消退。这就是不因汗解的原因。那么，阴兼阳、阳兼阴的是什么病呢？我仔细搜寻，发现“两感”的证候与此相似。第一天太阳与少阴同时发病，第二天阳明与太阴同时发病，都是阴兼阳、阳兼阴。阴阳相互兼夹而发病，所以病名叫“交”。因此，太阳病通过发汗解除，而少阴病未能解除；阳明病通过发汗解除，而太阴病未能解除，这难道不是因为它们相互交错而不因汗解吗？观察这两种证候的描述，起初似乎不相同，但结合阴阳之理来看，则没有差异。所以《素问》说的“两感”，本来不是病名；至于“阴阳交”，则明确说是病名“阴阳交”。大概“两感”说的是初始感受，“阴阳交”则是确定了它的名称。所以关于“阴阳交”的证候，有说再次出汗、脉象平静的就生，这是邪气再次外出而恢复生机。张仲景也说：“发表攻里，本自不同。”这难道不是指再次治疗吗？所以遇到这种病，应当参考这两种证候来治疗。然而，张仲景阐明了“两感”而未涉及“阴阳交”，王叔和记载了“阴阳交”而未提“两感”，他们的意图难道有差异吗？更期待贤哲加以阐明。
Chapter 33 of the *Suwen* (Plain Questions) states: There is a type of warm disease where, after sweating, fever returns immediately, the pulse is rapid and restless, and does not diminish due to sweating. The patient speaks deliriously and cannot eat. Qibo said: This disease is named "Yin-Yang Jiao" (Yin-Yang Intercalation/Conflict), and "Jiao" indicates a fatal outcome. The reason humans sweat is that sweat is generated from grain (food/nutrients), which in turn originates from essence (Jing). Now, when pathogenic factors contend with healthy qi in the muscles and bones, and sweating occurs, it signifies that the pathogen is retreating and the essence is prevailing. If the essence prevails, the patient should be able to eat and not have recurrent fever. Recurrent fever indicates the presence of pathogenic factors; sweat represents the loss of essence. Now, if sweating is followed immediately by fever, it means the pathogen is prevailing over the essence. Inability to eat means the essence has no support (cannot be replenished). If heat remains after sweating, life can be lost instantly.
It also states: The *Relun* (Discourse on Heat Diseases) says: If the pulse remains rapid and vigorous after sweating, death ensues. Currently, the pulse does not correspond with the sweating, indicating that the body cannot overcome the disease. Death is thus evident. Delirious speech indicates the loss of Zhi (Will/Shen); loss of Zhi leads to death. Seeing three signs of death and no sign of life, even if there is temporary improvement, death is inevitable. Guo Yong stated: Recurrent fever after sweating is the first sign of death; a still vigorous pulse is the second; delirious speech and loss of Zhi are the third.
Chapter 23 of the *Lingshu* (Spiritual Pivot) states: In heat diseases, if sweating has occurred but the pulse remains rapid and vigorous, this is the extreme depletion of Yin pulses, leading to death. If the pulse becomes calm after sweating, survival is indicated. Guo Yong stated: These two conditions are both classified as "Yin-Yang Jiao" in the *Maijing* (Pulse Classic). I suspect that sweating constitutes "Jiao," while non-sweating does not.
It further states: In heat diseases, if sweating has occurred but the pulse remains rapid, and fever recurs, do not needle the skin. If panting is severe, death ensues.
The *Maijing* states: In heat diseases, those classified as Yin-Yang Jiao die.
It also states: In heat diseases, if irritability ceases and sweating occurs, the pulse should become calm.
It further states: In Taiyang disease, if sweating has occurred but the pulse becomes rapidly vigorous instead, this is Yin-Yang Jiao, leading to death. If sweating occurs again and the pulse becomes calm, survival is indicated.
It also states: In heat diseases classified as Yin-Yang Jiao, there is intense heat, vexation, and restlessness. If both the Taiyin and Cun Kou (inch position at radial artery) pulses remain rapid and vigorous, this is Yin-Yang Jiao, leading to death. If the pulse becomes calm after sweating, survival is indicated. Guo Yong stated: These two conditions are identical to those mentioned earlier. The *Lingshu* does not mention "Yin-Yang Jiao," whereas this text does, marking a difference. The *Maijing* cites ancient texts, but the source of these two conditions is unknown.
It further states: What is referred to in heat diseases as "Bing Yin" (Merging with Yin) is when, after sweating in a heat disease, diarrhea subsequently occurs. This is called "Bing Yin," and treatment is possible (another version reads "Huó" - survival/life).
It also states: What is referred to as "Bing Yang" (Merging with Yang) in heat diseases is when, after sweating, the pulse remains rapid and vigorous, or fire-heat forces sweat out. Even if no sweat occurs, if nasal bleeding (bi-ni) happens (according to Pang Shi, harmonizing then causing nasal bleeding), this is called "Bing Yang," and treatment is possible. Guo Yong stated: The conditions of "Bing Yin" and "Bing Yang" are not found in other books but resemble "Yin-Yang Jiao," so the *Maijing* appended them afterwards.
The *Yin-Yang Jiao Lun* (Treatise on Yin-Yang Jiao) states: Both "Liang Gan" (Double Exposure) and "Yin-Yang Jiao" in cold damage originate from the *Suwen*. Zhang Zhongjing elucidated "Liang Gan" but did not address "Yin-Yang Jiao." Wang Shuhe recorded "Yin-Yang Jiao" but did not address "Liang Gan." Later generations understood "Liang Gan" through Zhang Zhongjing, but "Yin-Yang Jiao" remained largely misunderstood. I have examined the condition of "Yin-Yang Jiao" and generally concluded that in cold damage, if the pulse does not resolve with sweating, it belongs to "Yin-Yang Jiao." Why does it not resolve? The answer is: Diseases of pure Yin or pure Yang can be resolved with one sweating episode. However, diseases where Yin combines with Yang or Yang combines with Yin cannot be resolved with one sweating episode. Sweating resolves the Yin aspect, but the Yang pulse cannot recede; sweating resolves the Yang aspect, but the Yin pulse cannot recede. This is why it does not diminish with sweating. So, what are diseases where Yin combines with Yang and vice versa? Upon searching thoroughly, I find they resemble "Liang Gan." On the first day, Taiyang and Shaoyin are diseased simultaneously; on the second day, Yangming and Taiyin are diseased simultaneously. These are cases of Yin combining with Yang and Yang combining with Yin. Because Yin and Yang combine in the disease, it is named "Jiao" (Intercalation/Intersection). Therefore, Taiyang may resolve via sweating, but Shaoyin does not; Yangming may resolve via sweating, but Taiyin does not. Is this not because their intersection prevents resolution via sweating? Observing the descriptions of these two conditions, they initially seem different, but integrating them with Yin-Yang theory reveals no difference. Thus, the "Liang Gan" mentioned in the *Suwen* was originally not a disease name, whereas "Yin-Yang Jiao" is explicitly named as such. "Liang Gan" refers to the initial exposure, while "Yin-Yang Jiao" specifies the pathological state. Regarding "Yin-Yang Jiao," it is said that if sweating occurs again and the pulse becomes calm, the patient survives, indicating the pathogen is exiting again and life is restored. Zhang Zhongjing also said: "Releasing the exterior and purging the interior are fundamentally different." Does this not refer to a subsequent treatment? Therefore, when encountering this disease, one should consider both conditions for treatment. However, Zhang Zhongjing elucidated "Liang Gan" without mentioning "Yin-Yang Jiao," and Wang Shuhe recorded "Yin-Yang Jiao" without mentioning "Liang Gan." Could their intentions differ? I await clarification from worthy sages.