族弟初得病。头痛口干烦渴。第三日。予往视之。则已耳聋囊缩。昏冒不知人。厥逆。水浆
不下矣。予曰。速治后事。是谓两感证。不可治矣。越三日死。
论曰。仲景论伤寒两感云。凡伤于寒。热虽甚不死。若两感于寒而病者必死。又曰两感病俱
作。治有先后。发表攻里。本自不同。既云必死。又云治有先后。何也。大抵此病。表里双传。脏腑
俱病。患此者十无一生。故云必死。然仲景岂以己见而重诬后人哉。故有发表攻里之说。以勉后
人。恐万世后遇大圣而得之。不欲绝望于后人。仲景之心仁矣。
有市人李九妻。患腹痛。身体重。不能转侧。小便遗失。或作中湿治。予曰。非是也。三阳
合病证。仲景云。见阳明篇第十证。三阳合病。腹满。身重难转侧。口不仁。面垢。谵语。遗尿
不可汗。汗则谵语。下则额上汗出。手足逆冷。乃三投白虎汤而愈。
从军王武经病。始呕吐。俄为医者下之。已八九日。而内外发热。予诊之曰。当行白虎加人
参汤。或云既吐复下。是里虚矣。白虎可行乎。予曰。仲景云见太阳篇二十八证。若下后。七八
日不解。热结在里。表里俱热者。白虎加人参汤。证相当也。盖吐者为其热在胃脘。而脉致令虚
大。三投而愈。
论曰。仲景称伤寒若吐下后七八日不解。热结在里。表里俱热者。人参白虎汤主之。又云伤
寒脉浮无汗。发热不解。不可与白虎汤。又云脉滑。为表有热。里有寒。白虎汤主之。国朝林亿
校正。谓仲景此法必表里
字差矣。是大不然。大抵白虎能除伤寒中 。表里发热。故前后证或云表里俱热。或云表热里寒。
皆可服之。宜也。中一证。称表不解不可服者。以其宜汗发热。此全是伤寒麻黄与葛根汤证。安
可行白虎。林但见所称表里不同。便谓之差。是亦不思不精之过也。
族弟刚生病时，出现头痛、口干、心烦口渴的症状。到了第三天，我去探望他，发现他已经耳聋、阴囊收缩、神志昏迷不省人事，四肢厥冷，连水浆都无法咽下。我说：“赶快处理后事吧，这叫做两感证，是无法治愈的。”过了三天，他果然去世了。
论述说：张仲景在论述伤寒两感证时说：“凡是感受寒邪，虽然发热严重但不会死亡；如果是两感于寒而发病的，必定死亡。”又说：“两感病同时发作，治疗有先后顺序，解表与攻里，原本就是不同的方法。”既然说必定死亡，又说治疗有先后顺序，这是为什么呢？大抵这种病，表里双传，脏腑都受病，患此病的人十个中没有能活下来的，所以说必定死亡。然而张仲景难道是以自己的偏见来诬蔑后人吗？所以提出了解表攻里的说法，以此来勉励后人，恐怕万世之后遇到圣人来治愈它，不想让后人对病人绝望。张仲景的心地真是仁慈啊。
有个叫李九的市井百姓的妻子，患有腹痛，身体沉重，不能翻身侧卧，小便失禁。有人当作中湿证来治疗。我说：“不是这样的。这是三阳合病证。张仲景说，见阳明篇第十证。三阳合病，腹部胀满，身体沉重难以转侧，口中味觉失灵（口不仁），面部污垢，胡言乱语（谵语），小便失禁。不可发汗，发汗则会导致胡言乱语；不可攻下，攻下则会导致额头出汗，手足逆冷。”于是投用白虎汤三次而痊愈。
从军官员王武经患病，起初呕吐，不久被医生用了泻下法。已经过了八九天，内外都发热。我诊察后说：“应当使用白虎加人参汤。”有人说：“既然已经吐过又泻过，这是里虚了，白虎汤能用吗？”我说：“张仲景说，见太阳篇第二十八证。如果经过泻下后，七八天病情未解，热邪结聚在里，表里都发热的，用白虎加人参汤。症状相符。大概呕吐是因为热邪在胃脘，导致脉象虚大。服用三次而痊愈。”
论述说：张仲景称伤寒如果在吐下之后，七八天病情未解，热邪结聚在里，表里都发热的，用人参白虎汤主治。又说：“伤寒脉浮，无汗，发热不退，不可给予白虎汤。”还说：“脉滑，表示表有热，里有寒，用白虎汤主治。”本朝林亿校正时，认为张仲景这里的“表里”二字写错了。这完全不对。大抵白虎汤能清除伤寒中的表里发热，所以前后的证候有的说“表里俱热”，有的说“表热里寒”，都可以服用，是适宜的。其中一证提到“表不解不可服”，是因为那适宜用发汗法治疗发热，那完全是伤寒麻黄汤与葛根汤的证候，怎么可以用白虎汤呢？林亿只是看到所称的表里不同，就说是文字错误，这也是不加思考、不够精审的过失。
The younger brother of my clan fell ill initially with headache, dry mouth, irritability, and excessive thirst. On the third day, I went to visit him and found that he had already suffered from deafness, retraction of the scrotum, coma with loss of consciousness, cold extremities (Jue Ni), and an inability to swallow even water or gruel. I said, "Hurry and make arrangements for funeral affairs; this is called Liang Gan Syndrome (Two-Yin Simultaneous Infection), which is incurable." Three days later, he died.
In commentary: Zhang Zhongjing discussed Liang Gan in Shanghan Lun, stating, "Generally, injury by cold, even if accompanied by severe heat, does not lead to death. However, if one contracts cold on both exterior and interior simultaneously (Liang Gan), death is inevitable." He also stated, "When Liang Gan occurs, symptoms manifest simultaneously; treatment has a sequence, distinguishing between releasing the exterior and purging the interior, which are originally different methods." If it is said that death is inevitable, yet there is a sequence of treatment, why is this? Broadly speaking, this disease involves simultaneous transmission to both exterior and interior, affecting all zang-fu organs. Ten out of ten patients die, hence it is said to be inevitably fatal. Yet, did Zhang Zhongjing merely use his own opinion to mislead future generations? Therefore, he mentioned releasing the exterior and purging the interior to encourage successors, hoping that after ten thousand years, a sage might arise to cure it, unwilling to cause despair among later practitioners. Zhang Zhongjing's heart was truly benevolent.
A merchant named Li Jiu's wife suffered from abdominal pain, heaviness of the body, inability to turn over, and urinary incontinence. Some treated it as dampness striking the middle (Zhong Shi). I said, "This is incorrect. It is San Yang He Bing Syndrome (Combined Disease of the Three Yangs). Zhang Zhongjing states, see Chapter 10 of the Yangming section. In Combined Disease of the Three Yangs, there is abdominal fullness, heaviness of the body making turning difficult, dysfunction of taste in the mouth (Kou Bu Ren), facial greasiness/dirtiness, delirium, and urinary incontinence. Sweating is contraindicated; if sweating is induced, delirium will occur. Purging is contraindicated; if purging is performed, sweat will appear only on the forehead, and the hands and feet will become cold." She was treated with three doses of Baihu Tang (White Tiger Decoction) and recovered.
Wang Wu Jing, a military officer, initially vomited. Soon after, a physician administered purgatives. Eight or nine days passed, and internal and external heat manifested. Upon pulse diagnosis, I said, "Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng) should be used." Someone objected, "Since vomiting and purging have already occurred, the interior is deficient. Can Baihu Tang be used?" I replied, "Zhang Zhongjing states, see Chapter 28 of the Taiyang section. If after purging, the condition remains unresolved after seven or eight days, with heat consolidated in the interior and both exterior and interior presenting heat, Baihu Jia Renshen Tang is indicated. The symptoms match. Vomiting indicates heat in the stomach region, causing the pulse to appear deficient and large. After three doses, she recovered."
In commentary: Zhang Zhongjing stated that if, after emesis or purging in Shanghan, the condition remains unresolved after seven or eight days, with heat consolidated in the interior and both exterior and interior presenting heat, Renshen Baihu Tang should govern. He also stated, "In Shanghan, if the pulse is floating, there is no sweat, and fever persists, Baihu Tang must not be given." Furthermore, he stated, "If the pulse is slippery, indicating heat in the exterior and cold in the interior, Baihu Tang governs." During the Song Dynasty, Lin Yi, in his correction of the text, claimed that Zhang Zhongjing's mention of "exterior and interior" contained errors. This is entirely incorrect. Broadly, Baihu Tang can eliminate heat in both exterior and interior in Shanghan. Thus, prior texts may say "heat in both exterior and interior" or "heat in exterior and cold in interior"; both are indications for its use. The specific clause stating "if the exterior is not resolved, do not take it" refers to cases where sweating is appropriate for fever; those are purely Shaoyin or Taiyang patterns suitable for Mahuang Tang or Gegen Tang. How could Baihu Tang be used there? Lin Yi merely saw the discrepancy in the description of exterior/interior and concluded it was a textual error, which is an oversight due to lack of deep thought and precision.