太阳与阳明合病。喘而胸满者。不可下。宜麻黄汤主之。
胸中为阳之位。喘而胸满者。病发于阳而盛于阳也。邪在阳则可汗。在阴则可下。此以阳邪
盛于阳位。故不可下之以虚其里。里虚则邪且陷矣。而宜麻黄汤汗之以疏其表。表疏则邪自解矣。
合病者。两经同病。邪气盛者。其伤必多。甚则遍及三阳也。
太阳与阳明合病者。必自下利。葛根汤主之。太阳与阳明合病。不下利。但呕者。葛根加半夏汤主之。
伤寒之邪。在上则为喘满。入里则为下利。两阳合病。邪气盛大。不特充斥于上。抑且浸
淫于里。故曰必
自下利。其不下利者。则必上逆而呕。晰而言之。合病下利者。里气得热而下行也。不下利但呕
者。里气得热而上行也。夫邪盛于外而之内者。仍当先治其邪。葛根汤合用桂枝麻黄而加葛根。
所以解经中两阳相合之邪。其不下利而但呕者。则加半夏以下逆气。而葛根解外。法所不易矣。
葛根汤方
葛根（四两） 生姜（三两切） 甘草（二两炙） 芍药（二两） 桂枝（二两去皮）
麻黄（三两去节汤炮去黄汁焙干称） 大枣（十二枚擘）
上七味。以水一斗。先煮葛根、麻黄减二升。去上沫。纳诸药。煮取三升。去滓。温服一升。覆取微
似汗。不须啜粥。余如桂枝法将息及禁忌。
葛根加半夏汤方
于葛根汤内加半夏半升。洗。
太阳与少阳合病。自下利者。与黄芩汤。若呕者。黄芩加半夏生姜汤主之。
少阳居表里之间。视阳明为较深。其热气尤易内侵。是以太阳与少阳合病。亦自下利。而治法
则不同矣。太阳阳明合病者。其邪近外。驱之使从外出为易。太阳少阳合病者。其邪近里。
治之使从里和为易。故彼用葛根。而此与黄芩也。夫热气内淫。黄芩之苦。可以清之。肠胃得热而不固。芍药之
酸。甘草之甘。可以固之。若呕者。热上逆也。故加半夏、生姜。以散逆气。而黄芩之清里。
亦法所不易矣。
黄芩汤方
黄芩（三两） 甘草（二两炙） 芍药（二两） 大枣（十二枚擘）
上四味。以水一斗。煮取三升。去滓。温服一升。日再。夜一服。
黄芩加半夏生姜汤方
于黄芩汤内加半夏半升。生姜三两。余根据前法。
三阳合病。腹满身重。难以转侧。口不仁而面垢。谵语遗尿。发汗则谵语。下之则额上生汗。
手足逆冷。若自汗出者。白虎汤主之。此条叔和隶阳明篇中。
三阳合病。脉浮大。上关上。但欲眠睡。目合则汗。此条隶少阳篇中。
三阳合病。视诸合病邪气为较大矣。而太阳之腑膀胱。阳明之腑胃。少阳之腑胆。热邪盛满
自经入腑。故腹满身重。口不仁而面垢。谵语遗尿。及但欲眠睡。目合则汗。皆为里为热之征也
。夫里而不表。故不可汗。汗之则津亡。胃燥而谵语。热而不实。复不可下。下之则中伤气竭。而额上生汗。手足
逆冷。若自汗出句。顶腹满身重四句来。谓有腹满身重等证而自汗出者。则虽三阳合病。而邪聚于
阳明者较太阳为多。故宜白虎汤清而解之。若不自汗出者。则太阳为多。白虎不可与矣。脉浮大。上
关上者。病盛于阳经。故脉亦盛于阳位也。但欲眠睡者。热胜而神昏也。目合则汗者。胆热则液泄
也。此条盖补上条之所未备。而热之聚于少阳者。视太阳阳明较多矣。设求治法。岂白虎汤所能尽哉
。
白虎汤方
石膏（一斤） 知母（六两） 甘草（二两） 粳米（六合）
上先煮石膏数十沸。再投药米。米熟汤成。温服。
太阳经与阳明经同时发病。出现气喘且胸部胀满的症状，不可使用泻下法，适宜用麻黄汤主治。
胸中属于阳气所在的位置。气喘且胸部胀满，说明病发于阳分且在阳分邪气亢盛。邪气在阳分则可用发汗法，在阴分则可用泻下法。此处因为阳邪亢盛于阳位，所以不能用泻下法以免使里气虚弱。如果里气虚弱，邪气就会内陷。因此适宜用麻黄汤发汗以疏通表邪，表邪疏通后，病邪自然解除。
所谓合病，是指两经同时发病。邪气亢盛的，损伤必然较多，严重时甚至会波及三阳经。
太阳经与阳明经合病，必定会出现自发性腹泻，用葛根汤主治。太阳经与阳明经合病，如果不腹泻，只是呕吐的，用葛根加半夏汤主治。
伤寒的病邪，停留在上部就会导致气喘和胸满，侵入内部就会导致腹泻。两阳经合病，邪气盛大，不仅充斥于上部，而且逐渐浸淫于内部，所以说必定会出现自发性腹泻。那些不腹泻的，就一定会向上逆乱而呕吐。详细来说，合病导致腹泻的，是因为里气受热而下行；不腹泻只是呕吐的，是因为里气受热而上行。既然邪气盛于外部并影响内部，仍应当先治疗外邪。葛根汤结合了桂枝汤和麻黄汤的功效并加入葛根，用来解除两阳经相合之邪。对于不腹泻只是呕吐的情况，则加入半夏以降逆气，而葛根用于解表，这是治疗方法中不可改变的原则。
葛根汤方：
葛根（四两） 生姜（三两，切片） 甘草（二两，炙烤） 芍药（二两） 桂枝（二两，去皮）
麻黄（三两，去节，用水煮后去掉黄色泡沫，焙干后称量） 大枣（十二枚，掰开）
以上七味药，用水一斗，先煮葛根、麻黄，水量减少二升时，去掉上面的浮沫，再加入其他药物，煮取三升药液，去掉药渣，温服一升，服药后覆盖衣被使身体微微出汗，不需要喝热粥，其余调养方法和禁忌参照桂枝汤的方法。
太阳经与少阳经合病，出现自发性腹泻的，给予黄芩汤。如果伴有呕吐的，用黄芩加半夏生姜汤主治。
少阳经位于表里之间，比阳明经病位较深，其热气更容易向内侵犯。因此太阳经与少阳经合病，也会出现自发性腹泻，但治疗方法却不同。太阳经与阳明经合病，邪气靠近体表，驱使其从外出比较容易；太阳经与少阳经合病，邪气靠近体内，使其从内部调和比较容易。所以前者用葛根汤，后者用黄芩汤。热气内侵，黄芩的苦味可以清泄它；肠胃受热而不固摄，芍药的酸味、甘草的甜味可以固护它。如果有呕吐，是热气上逆，所以加入半夏、生姜来散除逆气，而黄芩清里的作用，也是治疗方法中不可改变的原则。
黄芩汤方：
黄芩（三两） 甘草（二两，炙烤） 芍药（二两） 大枣（十二枚，掰开）
以上四味药，用水一斗，煮取三升药液，去掉药渣，温服一升，每天两次，晚上一次。
黄芩加半夏生姜汤方：
在黄芩汤中加入半夏半升，生姜三两，其余依照前面的方法。
三阳经合病，出现腹部胀满、身体沉重、难以翻身侧卧、口舌麻木不知五味且面色污垢、胡言乱语、小便失禁等症状。如果误用发汗法，会导致胡言乱语加重；如果误用泻下法，会导致额头出汗、手足逆冷。如果出现自汗出的症状，用白虎汤主治。这一条原文被王叔和编入阳明病篇中。
三阳经合病，脉象浮大，关部以上明显，只想睡觉闭目，眼睛闭合时就出汗。这一条原文被王叔和编入少阳病篇中。
三阳经合病，相比其他的合病，邪气更为盛大。太阳经的腑是膀胱，阳明经的腑是胃，少阳经的腑是胆，热邪亢盛充满，从经脉传入腑脏，所以出现腹部胀满、身体沉重、口舌麻木不知五味且面色污垢、胡言乱语、小便失禁，以及只想睡觉、眼睛闭合就出汗，这些都是里热证的征象。因为病位在里而不在表，所以不可发汗，发汗则津液亡失，胃燥热而导致胡言乱语；热邪存在但未形成实结，也不可泻下，泻下则中气受伤、元气衰竭，导致额头出汗、手足逆冷。“若自汗出”一句，承接“腹满身重”等四句而来，意思是说有腹满身重等症状且伴有自汗出的，虽然属于三阳合病，但邪气聚集在阳明经的比太阳经多，所以适宜用白虎汤清热解表。如果不自汗出，则太阳经受邪较多，就不能使用白虎汤了。脉象浮大，关部以上明显的，说明病势盛于阳经，所以脉象也在阳位显得盛大。只想睡觉，是因为热盛导致神志昏蒙。眼睛闭合就出汗，是因为胆热导致津液外泄。这一条大概是补充上一条所未完备的内容，显示热邪聚集在少阳经的，比太阳、阳明经更多。如果要寻求治疗方法，难道仅靠白虎汤就能解决吗？
白虎汤方：
石膏（一斤） 知母（六两） 甘草（二两） 粳米（六合）
先将石膏煮沸数十次，再投入其他药物和米，米熟汤成，温服。
Taiyang (Sun) and Yangming (Yang Brightness) meridians suffer from simultaneous disease. When panting and chest fullness occur, purgation is contraindicated; Mahuang Tang (Ephedra Decoction) is indicated.
The chest is the residence of Yang Qi. Panting with chest fullness indicates that the pathogen originates in the Yang aspect and flourishes there. When the pathogen is in the Yang aspect, diaphoresis (sweating method) is applicable; when in the Yin aspect, purgation is applicable. Here, because Yang pathogens are excessive in the Yang position, purgation must not be used to avoid emptying the interior. If the interior becomes deficient, the pathogen will sink inward. Therefore, it is appropriate to use Mahuang Tang to induce sweating and disperse the exterior. Once the exterior is dispersed, the pathogen resolves naturally.
"Simultaneous disease" (He Bing) refers to two meridians being diseased at the same time. When pathogens are excessive, the damage is necessarily greater, and in severe cases, it may extend to all three Yang meridians.
When Taiyang and Yangming meridians suffer from simultaneous disease, spontaneous diarrhea inevitably occurs; Gegen Tang (Kudzu Root Decoction) is indicated. When Taiyang and Yangming meridians suffer from simultaneous disease, if there is no diarrhea but only vomiting, Gegen Jia Banxia Tang (Gegen Tang with Added Pinellia) is indicated.
Pathogens of Cold Damage (Shang Han), if remaining in the upper part, cause panting and fullness; if entering the interior, they cause diarrhea. In simultaneous disease of two Yang meridians, pathogens are abundant, filling not only the upper part but also gradually infiltrating the interior; hence, spontaneous diarrhea is inevitable. Those who do not have diarrhea will inevitably experience upward rebellion leading to vomiting. Specifically, diarrhea in simultaneous disease results from interior Qi moving downward due to heat; vomiting without diarrhea results from interior Qi moving upward due to heat. Since pathogens are excessive externally and affect the interior, treatment should first address the external pathogens. Gegen Tang combines the effects of Guizhi Tang (Cinnamon Twig Decoction) and Mahuang Tang, adding Kudzu Root to resolve pathogens combining in the two Yang meridians. For cases without diarrhea but with vomiting, Pinellia is added to direct rebellious Qi downward, while Kudzu Root resolves the exterior; this principle remains unchangeable.
**Gegen Tang Formula:**
Kudzu Root (Puerariae Radix, 4 liang), Fresh Ginger (Zingiberis Rhizoma Recens, 3 liang, sliced), Licorice Root (Glycyrrhizae Radix et Rhizoma, 2 liang, honey-fried), White Peony Root (Paeoniae Radix Alba, 2 liang), Cinnamon Twig (Cinnamomi Ramulus, 2 liang, bark removed), Ephedra Stem (Ephedrae Herba, 3 liang, nodes removed, boiled in water to remove yellow foam, dried before weighing), Jujube (Zizyphi Fructus, 12 pieces, split).
Take these seven ingredients, add ten dou of water, first boil Kudzu Root and Ephedra until the volume reduces by two dou, skim off the foam on top, then add the remaining herbs. Boil until three sheng of liquid remain, strain, and take one sheng warm. Cover with blankets to achieve a slight sweat. No porridge needs to be consumed afterward. Rest and dietary restrictions follow the guidelines for Guizhi Tang.
**Gegen Jia Banxia Tang Formula:**
Add Pinellia Tuber (Pinelliae Rhizoma, half sheng), washed, to Gegen Tang.
When Taiyang and Shaoyang (Lesser Yang) meridians suffer from simultaneous disease, resulting in spontaneous diarrhea, Huangqin Tang (Scutellaria Decoction) is administered. If vomiting occurs, Huangqin Jia Banxia Shengjiang Tang (Huangqin Tang with Added Pinellia and Fresh Ginger) is indicated.
Shaoyang resides between the exterior and interior, deeper than Yangming, making its heat more prone to invading inward. Thus, simultaneous disease of Taiyang and Shaoyang also causes spontaneous diarrhea, but the treatment differs. In simultaneous disease of Taiyang and Yangming, pathogens are closer to the exterior, making it easier to drive them out outwardly. In simultaneous disease of Taiyang and Shaoyang, pathogens are closer to the interior, making it easier to harmonize them from within. Hence, the former uses Gegen Tang, while the latter uses Huangqin Tang. Heat invading inward can be cleared by the bitter property of Scutellaria Root (Huangqin); the sour property of White Peony Root and the sweet property of Licorice Root can secure the intestines and stomach heated by pathogens. If vomiting occurs, it indicates heat rebelling upward, so Pinellia and Fresh Ginger are added to scatter rebellious Qi, while Scutellaria clears the interior; this method is indispensable.
**Huangqin Tang Formula:**
Scutellaria Root (Scutellariae Radix, 3 liang), Licorice Root (Glycyrrhizae Radix et Rhizoma, 2 liang, honey-fried), White Peony Root (Paeoniae Radix Alba, 2 liang), Jujube (Zizyphi Fructus, 12 pieces, split).
Take these four ingredients, add ten dou of water, boil until three sheng remain, strain, and take one sheng warm. Take twice daily and once at night.
**Huangqin Jia Banxia Shengjiang Tang Formula:**
Add Pinellia Tuber (Pinelliae Rhizoma, half sheng) and Fresh Ginger (Zingiberis Rhizoma Recens, 3 liang) to Huangqin Tang. Follow the previous method for the rest.
In simultaneous disease of the three Yang meridians, symptoms include abdominal fullness, body heaviness, difficulty turning over, numbness of the mouth and face (loss of taste/sensation), facial grease, delirium, and urinary incontinence. Diaphoresis would worsen delirium; purgation would cause sweating on the forehead and cold extremities. If spontaneous sweating occurs, Baihu Tang (White Tiger Decoction) is indicated. This clause was categorized by Wang Shuhe into the Yangming chapter.
In simultaneous disease of the three Yang meridians, the pulse is floating and large, prominent above the Guan position; the patient desires sleep, and sweating occurs upon closing the eyes. This clause was categorized by Wang Shuhe into the Shaoyang chapter.
Simultaneous disease of the three Yang meridians involves larger pathogenic factors than other simultaneous diseases. The Fu organs of Taiyang (Bladder), Yangming (Stomach), and Shaoyang (Gallbladder) are filled with excess heat transferring from the channels to the Fu organs. Thus, abdominal fullness, body heaviness, oral numbness, facial grease, delirium, urinary incontinence, desire for sleep, and sweating upon eye closure are all signs of interior heat. Since the pathology is interior rather than exterior, diaphoresis is contraindicated; inducing sweat depletes fluids, causing stomach dryness and worsening delirium. Although heat exists, it is not solidified, so purgation is also contraindicated; purging damages middle Qi and exhausts Yuan Qi, leading to forehead sweating and cold extremities. The phrase "if spontaneous sweating occurs" follows the description of abdominal fullness and body heaviness. It means that if these symptoms accompany spontaneous sweating, although it is a three-Yang simultaneous disease, the pathogen concentrates more in Yangming than in Taiyang. Therefore, Baihu Tang is suitable to clear and resolve the heat. If there is no spontaneous sweating, Taiyang involvement is predominant, and Baihu Tang is contraindicated. A floating and large pulse, prominent above the Guan position, indicates disease flourishing in the Yang meridians, hence the pulse is also vigorous at the Yang position. Desire for sleep indicates mental confusion due to excessive heat. Sweating upon closing the eyes indicates fluid leakage due to Gallbladder heat. This clause supplements the previous one, showing that heat concentrates more in Shaoyang than in Taiyang or Yangming. If seeking treatment, could Baihu Tang alone suffice?
**Baihu Tang Formula:**
Gypsum Fibrosum (Shigao, 1 jin), Anemarrhenae Rhizoma (Zhimu, 6 liang), Licorice Root (Glycyrrhizae Radix et Rhizoma, 2 liang), Rice (Oryzae Semen, 6 he).
First boil Gypsum for dozens of boils, then add the other herbs and rice. Cook until the rice is tender and the decoction is ready. Take warm.