合病者。两经三经一时并受。见证齐发。不似传经之以此传彼也。其证与前三阳篇之表里证同。其当
汗当下。不可汗下皆同。以其并感齐发。无先后之不齐。故谓之合。并病者。此经传入彼经。遂至两经俱
病。非若传经之此经传入彼经。邪既传入彼经。而此经之证随罢也。谓之并者。一经病而并及他经亦病。
故谓之并。然伤寒论中。惟三阳有合并病。三阴证中无之。盖因太阳皆属汗证。阳明多下症。而少阳全不可
汗下。其治法迥殊。不可淆乱。故立法森严。精详审辨。倘治法一差。变证立至。非若三阴证之阴寒相似。
理中四逆辈可通用也。故立合病并病之条。以见两经三经之病。偏多偏少。何重何轻。当以何者主治。何者
当禁。如太阳证当汗。而与少阳合并。则禁汗。如阳明当下而太阳证未罢。则仍当汗而禁
下。又如三阳合并。有少阳证在内。则汗下皆禁。若太少证俱罢。则仍可下之类也。然合病并病。
非三阳经诸证之外。更别有合并病也。其合并之义。即所以申明三阳传变之中。又有两经三经齐病。
非传非变者。更有一经病。并及他经亦病。遂至两经皆病者之分别也。总之中风伤寒。有一定之例。
一曰传经。乃以此传彼。彼病而此罢也。设有未罢。不可但治受传之经。如太阳未罢不可下。少阳未
罢不可汗下之类也。二曰合病。乃两经三经一时并感。见证齐发也。三曰并病。乃一经受病。传入
他经。而本经之证仍未罢。彼此皆病也。至若变证。非天然自感之病。皆误治失治所致。乃人事所召。
即坏病也。又不在定例中矣。夫伤寒论中之合并二义。自当各因其证治。分隶三阳条下。如当汗之
并病。及用麻黄汤之合病。自当隶于太阳篇中。如用葛根汤。及葛根半夏汤之合病。当隶于太阳阳明
篇中。用大承气。及白虎汤之合并病。当隶于阳明中篇。如用黄芩汤。及黄芩半夏生姜汤。至刺大椎。
刺肺俞肝俞。刺期门之合并病。当隶于少阳篇中为是。旧因王叔和编次之时。杂乱于三阳篇中。不使
各归本属。而成氏注本。又不正其失。一任其颠倒错乱。以后注家。虽议论繁多。而绝不及此。致尚
论另立一门。后之学人。遂疑为三阳诸证之外。又有合并二病。未免多歧之惑。今若仍散归诸篇。恐
于丛杂之中。读者模糊阅过。未能专悉其义。故仍喻氏之旧而发明其意。庶令阅者专而易晓。与各
归本篇无异矣。倘得其理爽然。又何求焉。
辨误 方氏条辨云。合之为言相配偶也。轻重齐。多少等。谓之合。以阳明切近太阳。所以合也。
其说如此。岂少阳与
太阳仅多阳明之一间。遂无合病邪。若是。则下文太阳与少阳之合病何来。喻氏遂因之而广其说云。两经之证。
各见一半。如日月之合璧。王者之合圭璧。界限中分。不偏多偏少。愚谓日月遥相对照。光满而为望。日月同
处东北甲地。两相并合。全晦而为合朔。究未必中分各为一半也。至于圭璧。则有桓圭信圭躬圭谷璧蒲璧之不同。
谓之五瑞。九峰蔡氏云。古者天子锡诸侯以命圭。圭头斜锐。其冒下斜。刻大小长短广狭如之。诸侯来朝。
天子以刻处冒其圭头。察其同异。以辨其伪。故周礼天子执冒以朝诸侯。即周书顾命所谓上宗奉同冒者是也。
岂中分一半之谓乎。且二璧之形。圜而中虚。亦未必中分其半也。然合病之两经受邪。亦偏多偏少。故有麻黄承
气黄芩白虎诸汤。偏于一经之治。并未中分其半。况更有三经合病者乎。窃未敢以为然也。至并病条下。方氏又
云。并。犹合也。云彼此相兼合。而有轻重多寡之不同。谓之并。以少阳间阳明。去太阳远。故但兼并也。窃谓
太阳行身之背。少阳行身之侧。阳明行身之前。何间之有。亦何远之有。岂有不能合。而但兼并之理耶。若果如
是。则但当有太阳与少阳之并病。不当有太阳与少阳之合病矣。何合并皆有太少之条乎。喻氏又因兼并之说。而
曰两经之症。连串为一。如索贯然。即兼并之义也。遂有秦并六国之喻。殊足惑乱人意。若曰如秦并六国。则六
经病证。皆当并入一经矣。岂止两经兼并而已哉。嗟嗟。仲景之立法也何精。后人之注释也何晦。仲景之为后
世虑也何深。后人之读其书也何浅。呜呼。道之不明也。有以夫。
合病，是指两经或三经同时感受邪气，症状一齐发作，不像传经那样从此经传到彼经。其临床表现与前三阳篇中的表证和里证相同，应当发汗的就要发汗，应当攻下的就要攻下，不可发汗和攻下的也都一样。因为它们是同时感受邪气而一齐发病，没有先后次序的差异，所以称为“合”。
并病，是指此经的病邪传入彼经，导致两经都生病，不像传经那样，邪气既已传入彼经，此经的症状就随即消失。所谓“并”，是指一经生病而波及他经，使他经也生病，所以称为“并”。然而，《伤寒论》中只有三阳经有合并病，三阴证中没有。这是因为太阳病多属汗证，阳明病多属下证，而少阳病完全不可用汗法和下法，它们的治疗方法截然不同，不能混淆。因此立法严谨，精细详审地加以辨析。如果治疗方法稍有差错，变证就会立刻出现，不像三阴证那样都是阴寒之证，理中汤、四逆汤等方剂可以通用。所以设立合病和并病的条文，是为了说明两经或三经患病时，哪经偏重、哪经偏轻，哪个为主治、哪个当禁忌。例如太阳证应当发汗，但如果与少阳合并，则禁止发汗；例如阳明证应当攻下，但如果太阳证未罢，则仍应当发汗而禁止攻下；又如三阳合并，其中有少阳证在内，则发汗和攻下都在禁忌之列。如果太阳和少阳的证候都已消除，则可以攻下之类。然而，合病和并病，并不是在三阳经各种证候之外，另外还有一种合并病。其“合并”的含义，就是要在申明三阳传变的过程中，区分出那种并非传经、也非变证，而是有一经生病，波及他经也生病，从而导致两经都生病的情况。总之，中风和伤寒是有固定法则的：第一是传经，即从此经传到彼经，彼经生病而此经症状消失。如果有未消失的情况，不能只治疗受传的经，如太阳证未罢不可攻下，少阳证未罢不可发汗和攻下之类。第二是合病，即两经或三经同时感受邪气，症状一齐发作。第三是并病，即一经受病，传入他经，而本经的症状仍未消失，彼此都生病。至于变证，不是天然自感的疾病，都是误治或失治所致，是人祸招致的，也就是坏病，这就不在固定的法则之中了。《伤寒论》中的合并二义，自然应当根据各自的证候治疗，分别归属于三阳各篇之下。如应当发汗的并病，以及使用麻黄汤的合病，自然应当归属于太阳篇中；如使用葛根汤及葛根半夏汤的合病，应当归属于太阳阳明篇中；使用大承气汤及白虎汤的合并病，应当归属于阳明篇中；如使用黄芩汤及黄芩半夏生姜汤，以及针刺大椎穴、肺俞穴、肝俞穴、期门穴的合并病，应当归属于少阳篇中才是正确的。过去因为王叔和在编次时，将这些内容杂乱地放在三阳篇中，不使它们各自回归本属，而成无己的注本又不纠正这一失误，任由其颠倒错乱。后来的注家虽然议论繁多，却绝口不提此事，致使尚志钧另立一门。后世的学人，于是怀疑在三阳诸证之外，又有合并这两种病，未免产生多种歧义的困惑。现在如果仍然散乱地归入各篇，恐怕在丛杂之中，读者会模糊读过，未能专门透彻地理解其含义。所以现在还是遵循喻嘉言旧例来阐明其意，希望让读者专注且容易理解，与各篇回归本篇无异。如果能得其理而豁然开朗，还有什么可求的呢？
辨误：方有执在《伤寒论条辨》中说：“合”的意思就是配偶，轻重相等，多少一致，称为“合”。因为阳明经切近太阳经，所以叫合。他的说法如此，难道少阳与太阳之间仅仅隔着阳明经，就没有合病了吗？如果是这样，那么下文太阳与少阳的合病是从哪里来的呢？喻昌于是顺着这个说法扩大解释，说两经的症状，各见一半，像日月相合璧，王者相合圭璧，界限从中分开，不偏多也不偏少。我认为日月遥相对照，光满盈而为望日（满月）；日月同处东北甲地，两相并合，全晦暗而为合朔（新月），终究未必是一半对一半。至于圭璧，则有桓圭、信圭、躬圭、谷璧、蒲璧等不同，称为五瑞。九峰的蔡沈说，古时候天子赏赐诸侯以命圭，圭头斜锐，下面斜刻，大小长短广狭都依此制作。诸侯来朝见，天子用刻处覆盖其圭头，观察其异同，以辨别真伪。所以《周礼》中天子的执冒用来朝见诸侯，即《周书·顾命》所说的上宗奉同冒。这难道是中间分开一半的意思吗？况且两块璧的形状，圆形而中间空虚，也未必是分成两半。然而合病的两经受邪，也是偏多偏少，所以有麻黄汤、承气汤、黄芩汤、白虎汤等方剂，是偏向治疗一经的，并没有中分其半。何况还有三经合病的情况呢？我私下不敢苟同这种观点。到了并病条下，方有执又说：“并”，就像“合”一样，意思是彼此相互兼合，而有轻重多寡的不同，称为“并”。因为少阳介于阳明之间，距离太阳远，所以只是兼并。我认为太阳行于身背，少阳行于身侧，阳明行于身前，有什么间隔呢？又有什么遥远呢？哪有不能合，而只是兼并的道理呢？如果果真是这样，那就应当只有太阳与少阳的并病，不应当有太阳与少阳的合病了。为什么合并病中都有太阳和少阳的条文呢？喻昌又顺着兼并的说法，说两经的症状，连串为一，像绳索贯穿一样，这就是兼并的意义。于是有了秦兼并六国的比喻，这足以惑乱人心。如果说像秦兼并六国，那么六经病证，都应当并入一经了，岂止是两经兼并而已呢？唉！张仲景的立法是多么精妙，后人的注释是多么晦涩，张仲景为后世考虑得多么深远，后人读他的书又是多么浅薄。呜呼！道的不明朗，是有原因的啊。
He Bing (Combined Disease) refers to the simultaneous contraction of pathogenic factors by two or three meridians, with symptoms appearing all at once. This differs from Chuan Jing (Transmitted Disease), where the disease transmits from one meridian to another. The clinical manifestations are identical to the exterior and interior syndromes described in the first three chapters concerning the Yang meridians. Treatments that require sweating should be applied; treatments that require purgation should be applied; those contraindicated for both sweating and purgation follow the same rule. This is because the pathogenic factors are contracted simultaneously and manifest together, without any sequence or disparity. Hence, it is called "He" (Combination).
Bing Bing (Concurrent Disease) occurs when the pathogen from one meridian transmits to another, resulting in disease in both meridians. This differs from Chuan Jing, where, once the pathogen has transmitted to the other meridian, the symptoms of the original meridian cease. The term "Bing" implies that disease in one meridian extends to affect another, causing illness in both. Thus, it is called "Bing". However, in the *Shanghan Lun* (Treatise on Cold Damage), combined diseases exist only within the Three Yang meridians and not in the Three Yin syndromes. This is because Taiyang diseases primarily involve sweating therapies, Yangming diseases primarily involve purgative therapies, while Shaoyang diseases are strictly contraindicated for both sweating and purgation. Their treatment methods are vastly different and must not be confused. Therefore, the legislation is rigorous, with precise and detailed differentiation. If the treatment method deviates even slightly, altered syndromes (Bian Zheng) will arise immediately. This contrasts with Three Yin syndromes, which are uniformly cold-deficiency patterns where formulas like Lizhong Tang (Central Restoring Decoction) and Sini Tang (Reversed Cold Decoction) can be used generally. Thus, the clauses on He Bing and Bing Bing were established to clarify situations where two or three meridians are diseased: determining which meridian is predominant or minor, which takes primary treatment priority, and which is contraindicated. For instance, if a Taiyang syndrome requiring sweating combines with Shaoyang, sweating is prohibited. If a Yangming syndrome requiring purgation exists but the Taiyang syndrome has not resolved, sweating should still be employed while purgation is prohibited. Furthermore, if all Three Yang meridians are involved and Shaoyang symptoms are present, both sweating and purgation are prohibited. Conversely, if both Taiyang and Shaoyang symptoms have resolved, purgation may then be employed.
However, He Bing and Bing Bing do not refer to a separate category of disease existing outside the various syndromes of the Three Yang meridians. The meaning of "combined" is to distinguish cases within the transmission and alteration of the Three Yang meridians where two or three meridians are diseased simultaneously—cases that are neither simple transmission nor altered syndromes, but rather instances where disease in one meridian extends to others, resulting in concurrent illness. In summary, Wind Strike and Cold Damage follow fixed principles: First is Chuan Jing (Transmission), where disease moves from one meridian to another, the new meridian becomes diseased, and the old meridian's symptoms cease. If the old symptoms persist, one must not treat only the receiving meridian; for example, if Taiyang symptoms persist, purgation is forbidden; if Shaoyang symptoms persist, both sweating and purgation are forbidden. Second is He Bing (Combined Disease), where two or three meridians contract pathogens simultaneously, and symptoms appear together. Third is Bing Bing (Concurrent Disease), where one meridian contracts disease, transmits to another, yet the original meridian's symptoms remain unresolved, resulting in illness in both.
Altered Syndromes (Bian Zheng) are not naturally occurring diseases but result from misdiagnosis or mistreatment, being consequences of human error, also known as Huai Bing (Ruined Disease); these fall outside fixed rules. The concepts of combination in the *Shanghan Lun* should naturally be categorized under the respective Three Yang chapters based on their specific syndromes and treatments. For example, concurrent diseases requiring sweating, or combined diseases treated with Mahuang Tang (Ephedra Decoction), belong in the Taiyang chapter. Combined diseases treated with Gegen Tang (Kudzu Decoction) or Gegen Banxia Tang (Kudzu and Pinellia Decoction) belong in the Taiyang-Yangming chapter. Combined diseases treated with Dachengqi Tang (Major Order the Qi Decoction) or Baihu Tang (White Tiger Decoction) belong in the Yangming chapter. Combined diseases treated with Huangqin Tang (Scutellaria Decoction) or Huangqin Banxia Shengjiang Tang (Scutellaria, Pinellia, and Fresh Ginger Decoction), or those involving acupuncture at Dazhui (GV14), Feishu (BL13), Ganshu (BL18), and Qimen (LR14), belong correctly in the Shaoyang chapter. Previously, due to Wang Shuhe’s compilation, these were杂乱ly placed among the Three Yang chapters without returning them to their proper归属. Cheng Wuji’s commentary failed to correct this error, allowing the disorder to persist. Later commentators, despite numerous discussions, never addressed this issue, leading Shang Zhilun to establish a separate category. Consequently, later students suspected that beyond the various syndromes of the Three Yang meridians, there existed two additional types of combined diseases, causing confusion. If these are now scattered back into the chapters, readers might skim over them amidst the complexity and fail to grasp their specific meanings. Therefore, following Yu Jia Yan’s precedent, I elucidate their intent so that readers may focus and understand easily, effectively restoring them to their proper chapters. If the logic is clear, what else could be sought?
Correction of Errors: Fang Youzhi, in his *Shanghan Lun Tiaobian*, stated: "He" means pairing or matching, where severity is equal and quantity is balanced. Because Yangming is adjacent to Taiyang, they combine. Such reasoning implies that between Shaoyang and Taiyang, separated only by Yangming, no combined disease could exist. If so, where does the subsequent clause regarding Taiyang-Shaoyang combined disease come from? Yu Chang expanded on this, stating that in combined diseases, each meridian presents half the symptoms, like the moon and sun forming a jade disk (Hebi), or kings joining jade tablets (He Gui), with boundaries split evenly, neither side dominant. I argue that when the moon and sun are opposite, light is full (Wang/Full Moon); when they are together in the northeast, they merge completely into darkness (Heshuo/New Moon). It is not necessarily an even split. Regarding jade tablets, there are Huan Gui, Xin Gui, Gong Gui, Gu Bi, and Pu Bi, known as the Five Rui (Jade Emblems). Cai Shen of Jiufeng noted that anciently, the Son of Heaven bestowed life-jade upon feudal lords. The tip was slanted and sharp, carved to specific dimensions. When lords came to court, the Emperor would place the 'Mao' (cover) over the jade tip to check for authenticity. Thus, the Zhou Li describes the Emperor using the Mao to receive lords, corresponding to the Shangshu Gu Ming mentioning the High Minister presenting the Tong Mao. Is this a division into halves? Moreover, the shape of bi (jade disks) is round with a hollow center, certainly not divided in half. Since combined diseases involve pathogens affecting two meridians with varying degrees of dominance, treatments like Mahuang Tang, Chengqi Tangs, Huangqin Tang, and Baihu Tang target specific meridians, not splitting them equally. How much less so for three-meridian combinations? I cannot accept this view.
Regarding Bing Bing, Fang Youzhi added: "Bing" is like "He," meaning mutual inclusion with differences in severity and quantity. Because Shaoyang lies between Yangming and far from Taiyang, it merely annexes. I contend that Taiyang runs along the back, Shaoyang along the sides, and Yangming along the front. What interval exists? What distance? How can there be a principle of mere annexation without combination? If true, there should only be Taiyang-Shaoyang concurrent disease, not combined disease. Why do both categories contain Taiyang-Shaoyang clauses? Yu Chang further elaborated on annexation, likening the connection of symptoms to beads on a string, citing Qin’s unification of the Six States as an analogy. This is confusing. If it were like Qin annexing the Six States, all Six Meridian syndromes should merge into one, not just two. Alas! Zhang Zhongjing’s legislation was exquisite; later commentaries are obscure. Zhang’s foresight for posterity was profound; later readers’ understanding is shallow. Woe! The obscurity of the Dao has its causes.