26. 一日太阳少阴病, 头痛口干渴而烦. 二日阳明太阴病, 满不欲食
身热谵. 三日少阳厥阴病, 耳聋囊缩厥逆寒, 水浆不入神昏冒, 六日
气尽命难全.
【注】两感者, 脏腑表里同病也. 一日, 头痛、 太阳也; 口干烦渴,
少阴也. 二日, 身热谵语, 阳明也; 腹满不欲食, 太阴也. 三日, 耳
聋,少阳也; 囊缩而厥, 厥阴也. 传经之邪其为病也渐, 两感之邪其
为病也速. 盖因阳邪酷烈, 正不能御, 所以三日后水浆不入, 六腑之
气欲绝, 昏不知人, 五脏之神已败, 而不即死者, 赖有胃气未尽耳,
故又三日其气乃尽而死. 张洁古制大羌活汤, 以羌, 独, 芩, 连辈,
辛甘以散太阳之表, 苦寒以清少阴之热, 施之于表里不急者, 固为得
法也. 若夫一日则头痛口干烦渴, 二日则身热谵语腹满不欲食, 三日
则耳聋囊缩而厥, 水浆不入, 昏不知人, 传变如此迅速, 恐用大羌活
汤平缓之剂, 反失机宜, 当遵仲景治有先后之说, 审其表里孰急, 随
证治之, 犹或可活. 故于此证初病, 一日表里俱热者, 根据少阴病得之
二,三日, 口燥咽干之法, 用大承气汤重剂以泻阳邪之烈; 表里俱寒
者, 根据少阴病始得之, 反发热脉沉之法, 用麻黄附子细辛汤, 以解阴
邪之急. 二日表里俱实者, 根据阳明病谵语有潮热, 腹满时减, 减不足
言之法, 用大承气汤攻之; 表里虚者, 根据三阳合病, 腹满身重, 面垢
谵语之法, 用大剂白虎加人参汤清之. 三日表里热者, 根据厥深热亦深
之法, 用大承气汤下之; 表里寒者, 根据脉微欲绝手足厥寒之法, 用当
归四逆加吴茱萸生姜汤温之. 缓则不及事矣, 其间颇有得生者, 后之
学者其留意焉.
26. 第一天出现太阳病和少阴病，症状为头痛、口干、口渴且心烦。第二天出现阳明病和太阴病，症状为腹部胀满、不想进食、身体发热、说胡话。第三天出现少阳病和厥阴病，症状为耳聋、阴囊收缩、四肢厥冷且寒战，无法进水进食，神志昏迷恍惚，到了第六天正气耗尽，生命难以保全。
【注】所谓“两感”，是指脏腑的表里两经同时发病。第一天，头痛属于太阳经；口干、心烦口渴属于少阴经。第二天，身体发热、说胡话属于阳明经；腹部胀满、不想进食属于太阴经。第三天，耳聋属于少阳经；阴囊收缩且四肢厥冷属于厥阴经。循经传变的邪气致病过程是渐进的，而两感之邪致病过程迅速。这是因为阳热邪气酷烈，正气不能抵御，所以三天后出现水浆不入（无法进食饮水），六腑之气将要断绝，神志昏迷不省人事，五脏的神气已经败坏，之所以没有立即死亡，是因为胃气尚未完全耗尽，因此再过三天，其气彻底耗尽而死。张洁古制定了大羌活汤，使用羌活、独活、黄芩、黄连等药物，以辛甘之性发散太阳经在表的邪气，以苦寒之性清解少阴经的热邪，应用于表里病情不急迫的情况，固然符合法度。但是如果第一天就出现头痛、口干、心烦口渴，第二天就出现身体发热、说胡话、腹部胀满、不想进食，第三天就出现耳聋、阴囊收缩且四肢厥冷、无法进食饮水、神志昏迷不省人事，病情传变如此迅速，恐怕使用大羌活汤这样药性平缓的方剂，反而会错失治疗时机，应当遵循张仲景关于治疗有先后顺序的理论，审察表证和里证哪个更急迫，随证进行治疗，或许还有救活的可能。所以对于此证初起，第一天表里都热的情况，参照少阴病得之二三日口燥咽干的方法，使用大承气汤重剂来泻除阳热邪气的猛烈之势；表里都寒的情况，参照少阴病初起反而发热、脉沉的方法，使用麻黄附子细辛汤，来解除阴寒邪气的急迫。第二天表里都实证的情况，参照阳明病说胡话且有潮热、腹部胀满但有时减轻、减轻的程度不足以形容（指胀满严重）的方法，使用大承气汤攻下；表里都虚证的情况，参照三阳合病出现腹部胀满、身体沉重、面部油垢、说胡话的方法，使用大剂量白虎加人参汤清解。第三天表里都热的情况，参照“厥深者热亦深”（四肢厥冷越厉害，内热越深重）的方法，使用大承气汤攻下；表里都寒的情况，参照脉微细欲绝、手足厥冷的方法，使用当归四逆加吴茱萸生姜汤温补。如果用药迟缓就来不及处理了，其中颇有能存活下来的案例，后来的学者务必留意。
26. On the first day, Taiyang (Sun Yang) and Shaoyin (Lesser Yin) diseases occur simultaneously, presenting with headache, dry mouth, thirst, and irritability. On the second day, Yangming (Bright Yang) and Taiyin (Greater Yin) diseases occur, presenting with abdominal fullness, loss of appetite, fever, and delirious speech. On the third day, Shaoyang (Lesser Yang) and Jueyin (Terminal Yin) diseases occur, presenting with deafness, retraction of the scrotum, cold limbs (Jue Ni), inability to take in food or fluids, and unconsciousness or stupor. By the sixth day, vital Qi is exhausted, and life cannot be preserved.
[Note] "Liang Gan" (Simultaneous contraction of exterior and interior meridians) refers to the simultaneous disease of zang-fu organs and their corresponding exterior-interior meridians. On the first day, headache indicates Taiyang; dry mouth, irritability, and thirst indicate Shaoyin. On the second day, fever and delirium indicate Yangming; abdominal fullness and loss of appetite indicate Taiyin. On the third day, deafness indicates Shaoyang; scrotal retraction and cold limbs indicate Jueyin. Pathogens transmitted via meridian transmission cause illness gradually, whereas pathogens causing Liang Gan cause illness rapidly. This is because the pathogenic Yang heat is fierce, and the righteous Qi cannot resist it. Therefore, after three days, the patient cannot take in food or fluids, the Qi of the six fu organs is about to perish, consciousness is lost, and the spirit of the five zang organs has collapsed. The reason for not dying immediately is that the Stomach Qi has not yet completely exhausted. Thus, after another three days, when the Qi is fully exhausted, death occurs. Zhang Jiegu formulated Da Qiang Huo Tang (Great Notopterygium Decoction), using herbs such as Qiang Huo (Notopterygii Rhizoma et Radix), Du Huo (Angelicae Pubescentis Radix), Huang Qin (Scutellariae Radix), and Lian Zi (Coptidis Rhizoma). It uses acrid-sweet properties to disperse the exterior pathogen of Taiyang and bitter-cold properties to clear the heat of Shaoyin. When applied to cases where the exterior and interior conditions are not urgent, this method is indeed appropriate. However, if on the first day there is headache, dry mouth, irritability, and thirst; on the second day, fever, delirium, abdominal fullness, and loss of appetite; and on the third day, deafness, scrotal retraction, cold limbs, inability to eat or drink, and unconsciousness, with such rapid progression, using a mild formula like Da Qiang Huo Tang might cause one to miss the optimal treatment opportunity. One should follow Zhang Zhongjing's principle that treatment must have priority, assess whether the exterior or interior condition is more urgent, and treat according to the syndrome. In this way, survival might still be possible. Therefore, for this syndrome at its onset, if on the first day both exterior and interior are hot, referring to the method for Shaoyin disease occurring on the second or third day with dry mouth and throat, use a heavy dose of Da Cheng Qi Tang (Major Order the Qi Decoction) to purge the fierce Yang pathogen. If both exterior and interior are cold, referring to the method for early-stage Shaoyin disease with fever and deep pulse, use Ma Huang Fu Zi Xi Xin Tang (Ephedra, Aconite, and Asarum Decoction) to resolve the urgency of the Yin pathogen. On the second day, if both exterior and interior are excess syndromes, referring to Yangming disease with delirium, tidal fever, abdominal fullness that occasionally relieves but insufficiently so, use Da Cheng Qi Tang to attack. If both exterior and interior are deficiency syndromes, referring to the combination of three yang meridians with abdominal fullness, heaviness of the body, greasy face, and delirium, use a large dose of Bai Hu Jia Ren Shen Tang (White Tiger Decoction plus Ginseng) to clear. On the third day, if both exterior and interior are hot, referring to the principle "the deeper the cold limbs, the deeper the heat," use Da Cheng Qi Tang to purge. If both exterior and interior are cold, referring to the method for faint pulse nearly imperceptible and cold hands and feet, use Dang Gui Si Ni Jia Wu Zhu Yu Sheng Jiang Tang (Angelica Sinensis Decoction for Cold Limbs plus Evodia and Fresh Ginger) to warm. If treatment is delayed, it will be too late. There are cases among these where patients survive; scholars in later generations should pay close attention to this.