14. 胸满热烦栀子豉, 痞硬冲喉瓜蒂平, 发热恶寒肢烦痛, 微呕支结
柴桂宁. 郁郁微烦呕不止, 心下痛硬大柴攻. 误下柴胡证仍在, 复与
柴胡振汗生.
【注】上言其禁, 恐失宜也； 此言其可, 贵变通也. 胸满烦热, 太阳
少阳轻邪也, 宜栀子豉汤涌之. 胸满痞硬, 气上冲喉不得息者, 太阳
,少阳重邪也, 宜瓜蒂散吐之. 发热恶寒, 四肢烦疼微呕, 心下支结,
太阳, 少阳表证也, 宜柴胡桂枝汤, 微汗两解之. 郁郁微烦, 呕不止,
心下痛硬, 少阳, 阳明表里证也, 宜大柴胡汤缓攻两解之. 误下不致
变逆, 柴胡证仍在者, 复与柴胡汤以和解之, 若解则必蒸蒸振汗出而
解,以下后虚故也. 详太阳、少阳篇.
15. 合病两三经同病, 并病传归并一经. 二阳合病满喘发, 自痢葛根
呕半同. 太少痢芩呕加半, 明少弦负顺长生, 滑数宿食大承气, 三阳
合病腹膨膨, 口燥身重而谵语, 欲眠合目汗蒸蒸, 遗尿面垢参白虎,
浮大汗下禁当应. 二阳并病汗不彻, 面赤怫郁大青龙, 表罢潮热手足
汗,便难谵语大承攻. 太少头项痛眩冒, 心下痞硬如结胸, 禁汗吐下
惟宜刺, 谵惊不食痢多凶.
【注】一经未罢, 又传一经, 二经, 三经同病, 而不归并一经者, 谓
之合病. 二经, 三经同病, 而后归并一经自病者, 谓之并病. 二阳,
谓太阳, 阳明也. 太阳则有头痛, 发热, 恶寒, 无汗, 阳明则有肌热
,恶热, 心烦, 不眠之证, 相合同病也. 满喘, 谓二阳合病当下痢不
下痢, 更加胸满而喘, 宜麻黄汤发之. 自痢, 谓二阳合病当有之证,
宜葛根汤也. 呕半, 谓二阳合病, 不下痢但加呕者, 宜葛根汤加半夏
也.同, 谓二证同用葛根一方也. 太少, 谓太阳, 少阳合病也. 太阳
则有头痛发热, 恶寒无汗; 少阳则有寒热往来, 口苦耳聋, 目眩胸胁
痛之证, 相合同病也. 痢芩, 谓太阳, 少阳合病当自下痢, 宜与黄芩
汤也. 呕加半, 谓太阳, 少阳合病不自痢, 但加呕者, 宜黄芩汤加半
夏也. 若不呕痢而见太阳, 少阳之证, 非合病也; 宜用柴胡桂枝汤两
解之. 明少, 谓阳明, 少阳两经之证同见下痢合病也. 弦负, 弦为少
阳木脉, 木胜则土负, 负则死也. 顺长生, 长为阳明土脉, 土盛则本
不能灾为顺, 顺则生也. 滑数, 谓阳明, 少阳合病, 下痢粘秽者, 脉
必滑数, 是宿食也, 宜大承气汤; 呕酸苦者, 宜大柴胡汤. 三阳, 谓
太阳、 阳明, 少阳合病也. 腹膨膨, 谓腹胀满也. 口燥, 谓口中干燥
也.身重, 谓身重难转侧也. 谵语, 谓妄乱言也. 欲眠, 谓喜睡也.
合目汗蒸蒸, 谓合目出热汗也. 遗尿, 谓失尿不知也. 面垢, 谓面似
有油垢也. 此皆三阳热盛, 津液枯竭之证, 设使脉浮, 禁不可汗, 脉
大亦不可下, 惟宜用白虎加人参, 益气生津清热可也. 若未经汗下,
津液未伤, 三阳合病, 轻证惟宜柴葛解肌汤, 清解三阳可也. 二阳,
谓太阳阳明并病也. 汗不彻, 谓邪在太阳, 发汗未彻, 又传阳明也.
面赤, 谓邪犹怫郁于太阳, 阳明之表, 未并阳明之腑, 宜大青龙汤解
两经之热也. 表罢, 谓太阳证罢也. 潮热, 手足汗, 大便难, 谵语,
谓已归并阳明腑也, 宜大承气汤, 攻阳明实热也. 太少, 谓太阳, 少
阳并病也. 头颈强痛, 目眩昏冒, 心下痞硬, 如结胸证, 谓太阳少阳
二经之证尚未归并, 其邪未定-禁不可汗下, 惟宜刺大椎、肝腧, 肺
腧,以泻其热也. 若误发汗, 则必发谵语. 若误吐下, 则必心烦而惊,
水浆不入, 下痢不止. 变此恶候, 命多凶也. 义详合病并病篇.
14. 胸部胀满、烦热，用栀子豉汤；胸脘痞硬、气上冲咽喉者，用瓜蒂散平抑。发热、恶寒、四肢烦痛、轻微呕吐、心下支撑结聚，用柴胡桂枝汤调和安宁。郁郁微烦、呕吐不止、心下疼痛且硬，用大柴胡汤攻下。误用下法后，若柴胡证仍在，再次给予柴胡汤，患者会战栗出汗而病愈。
【注】上文讲的是禁忌，是担心治疗不当；这里讲的是可行的方法，贵在灵活变通。胸部胀满、烦热，是太阳、少阳的轻浅邪气，适宜用栀子豉汤涌吐。胸部胀满、痞硬，气上冲咽喉导致呼吸不畅的，是太阳、少阳的重邪，适宜用瓜蒂散吐之。发热、恶寒、四肢烦疼、轻微呕吐、心下支撑结聚，是太阳、少阳的表证，适宜用柴胡桂枝汤，通过微汗来两经同解。郁郁微烦、呕吐不止、心下疼痛且硬，是少阳、阳明的表里证，适宜用大柴胡汤缓攻以两解。误用下法但未导致逆证，柴胡证仍在的，再次给予柴胡汤以和解，如果病解则必然蒸蒸振汗而出而痊愈，这是因为下法之后正气虚弱所致。详见太阳、少阳篇。
15. 合病是两三经同时发病，并病是病邪传变归并于一经。二阳合病出现腹部胀满、喘息或自利，葛根汤为主方，兼呕加半夏。太少合病自利用黄芩汤，兼呕加半夏；脉弦为负（预后不良），脉长为顺（预后良好可生）；脉滑数属宿食，用大承气汤。三阳合病腹胀满，口干燥、身体沉重且胡言乱语，想睡觉闭目时出热汗，遗尿、面色如蒙油垢，用人参白虎汤；若脉浮忌大汗，脉大忌攻下。二阳并病发汗不彻底，面赤怫郁用大青龙汤；表证罢去后出现潮热、手足汗出、大便难、谵语，用大承气汤攻下。太少并病见头项痛、眩晕昏冒，心下痞硬如结胸状，禁止汗、吐、下法，只宜针刺；若出现谵语、惊悸、不食、下痢多凶险。
【注】一经的病未罢，又传给另一经，二经、三经同时发病，而不归并于一经的，称为合病。二经、三经同时发病，而后归并于一经自病的，称为并病。二阳，指太阳和阳明。太阳则有头痛、发热、恶寒、无汗的症状，阳明则有肌热、恶热、心烦、不眠的症状，相合同病。腹满喘促，指二阳合病当下利或不下利，再加上胸满而喘，适宜用麻黄汤发汗。自利，指二阳合病应当有的症状，适宜用葛根汤。呕加半夏，指二阳合病，不下利但加上呕吐的，适宜用葛根汤加半夏。同，指上述两种情况都使用葛根汤一方。太少，指太阳和少阳合病。太阳则有头痛发热、恶寒无汗；少阳则有寒热往来、口苦耳聋、目眩胸胁痛的症状，相合同病。下利用黄芩汤，指太阳、少阳合病应当自下利，适宜给予黄芩汤。呕加半夏，指太阳、少阳合病不自利，但加上呕吐的，适宜用黄芩汤加半夏。如果不呕不利而见到太阳、少阳的症状，不是合病，适宜用柴胡桂枝汤两解。明少，指阳明、少阳两经的症状同见下利的合病。弦负，弦脉为少阳木脉，木胜则土负，负则死。顺长生，长脉为阳明土脉，土盛则本不能受灾为顺，顺则生。滑数，指阳明、少阳合病，下利粘秽的，脉必滑数，这是宿食，适宜用大承气汤；呕吐酸苦的，适宜用大柴胡汤。三阳，指太阳、阳明、少阳合病。腹膨膨，指腹胀满。口燥，指口中干燥。身重，指身体沉重难以转侧。谵语，指胡言乱语。欲眠，指喜欢睡觉。合目汗蒸蒸，指闭目时出热汗。遗尿，指失禁不知。面垢，指面色像有油垢。这些都是三阳热盛、津液枯竭的症状，假如脉浮，严禁不可发汗，脉大也不可以攻下，只适宜用白虎加人参汤，益气生津清热即可。如果未经过汗下，津液未伤，三阳合病轻证，只适宜用柴葛解肌汤，清解三阳即可。二阳，指太阳阳明并病。汗不彻，指邪在太阳，发汗不彻底，又传入阳明。面赤，指邪气仍怫郁于太阳、阳明之表，未并入阳明之腑，适宜用大青龙汤解两经之热。表罢，指太阳证已罢。潮热、手足汗、大便难、谵语，指已归并阳明腑，适宜用大承气汤，攻下阳明实热。太少，指太阳、少阳并病。头颈强痛、目眩昏冒、心下痞硬，如结胸证，指太阳、少阳二经的症状尚未归并，其邪未定，禁止不可汗下，只适宜针刺大椎、肝俞、肺俞，以泻其热。如果误发汗，则必定发谵语。如果误用吐下，则必定心烦而惊，水浆不入，下痢不止。出现这些恶候，性命多凶险。义理详见合病并病篇。
14. Chest fullness with heat and vexation: treat with Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction). Chest fullness, epigastric stiffness, and Qi rushing to the throat causing dyspnea: treat with Goudi San (Melon Seed Powder) to induce vomiting. Fever, aversion to cold, vexatious pain in the limbs, slight vomiting, and "Zhi Jie" (supporting knotting below the heart): treat with Chaihu Guizhi Tang (Bupleurum and Cinnamon Twig Decoction) to harmonize. Depressed mild vexation, incessant vomiting, pain and hardness below the heart: treat with Da Chaihu Tang (Major Bupleurum Decoction) for gentle purgation. If the Chaihu syndrome persists after erroneous purgation, administer Chaihu Tang again; the patient will experience shaking sweating and recover.
[Note] The preceding text discusses contraindications to prevent inappropriate treatment; this section discusses permissible methods, emphasizing flexibility. Chest fullness and vexatious heat indicate light pathogenic factors of Taiyang and Shaoyang; Zhizi Chi Tang is suitable to induce vomiting. Chest fullness, epigastric stiffness, and Qi rushing to the throat causing respiratory difficulty indicate heavy pathogenic factors of Taiyang and Shaoyang; Goudi San is suitable to induce vomiting. Fever, aversion to cold, vexatious limb pain, slight vomiting, and supporting knotting below the heart are exterior syndromes of Taiyang and Shaoyang; Chaihu Guizhi Tang is suitable to resolve both via mild sweating. Depressed mild vexation, incessant vomiting, and pain/hardness below the heart are interior-exterior syndromes of Shaoyang and Yangming; Da Chaihu Tang is suitable for gentle purgation to resolve both. If erroneous purgation does not cause adverse reactions and the Chaihu syndrome persists, re-administer Chaihu Tang to harmonize. Recovery will manifest as steaming shaking sweat due to post-purgation deficiency. See Taiyang and Shaoyang chapters for details.
15. He Bing (Combined Disease) involves two or three meridians affected simultaneously; Bing Bing (Consecutive Disease) involves transmission merging into one meridian. Er Yang (Two Yangs) combined disease presenting with abdominal fullness, wheezing, or spontaneous diarrhea: Gegen Tang (Kudzu Decoction) is primary; add Banxia (Pinellia Tuber) if vomiting occurs. Tai Shao (Taiyang-Shaoyang) combined disease with spontaneous diarrhea: Huangqin Tang (Scutellaria Decoction); add Banxia if vomiting. Pulse Xian (Wiry) indicates unfavorable prognosis (Fu), while Chang (Long) indicates favorable prognosis (Sheng/Chang Sheng). Pulse Hua Shuo (Slippery-Rapid) indicates retained food: Dachengqi Tang (Major Order to Yield Decoction). San Yang (Three Yangs) combined disease presents with abdominal distension, dry mouth, heavy body, delirium, desire to sleep with eyes closed accompanied by steaming hot sweat, enuresis, and greasy facial complexion: Renshen Baihu Tang (Ginseng White Tiger Decoction). If pulse is Fu (Floating), profuse sweating is prohibited; if pulse is Da (Large), purgation is prohibited. Er Yang consecutive disease with incomplete sweating and flushed face indicating pathogenic stagnation: Da Qinglong Tang (Major Green Dragon Decoction). After exterior resolution, tidal fever, sweaty hands/feet, difficult defecation, and delirium indicate Yangming Fu excess: Dachengqi Tang for purgation. Tai Shao consecutive disease with head/neck pain, dizziness, epigastric stiffness resembling Jie Xiong (Chest Binding): prohibit sweating, vomiting, and purgation; only acupuncture is suitable. Delirium, fright, anorexia, and diarrhea indicate poor prognosis.
[Note] When a syndrome in one meridian has not resolved and transmits to another, affecting two or three meridians without merging into one, it is called He Bing. When two or three meridians are affected but subsequently merge into one meridian's independent pathology, it is called Bing Bing. Er Yang refers to Taiyang and Yangming. Taiyang presents with headache, fever, aversion to cold, and anhidrosis; Yangming presents with muscle heat, aversion to heat, mental restlessness, and insomnia. Abdominal fullness and wheezing in Er Yang He Bing require Mahuang Tang (Ephedra Decoction) for sweating if no diarrhea; Gegen Tang if spontaneous diarrhea occurs; Gegen Tang plus Banxia if vomiting occurs without diarrhea. Tai Shao refers to Taiyang and Shaoyang. Taiyang presents with headache, fever, aversion to cold, anhidrosis; Shaoyang presents with alternating chills and fever, bitter taste, deafness, vertigo, and hypochondriac pain. Spontaneous diarrhea in Tai Shao He Bing requires Huangqin Tang; add Banxia if vomiting occurs without diarrhea. If neither vomiting nor diarrhea is present, it is not He Bing; use Chaihu Guizhi Tang to resolve both. Ming Shao refers to Yangming and Shaoyang combined disease with diarrhea. Xian (Wiry) pulse indicates Wood overacting on Earth (unfavorable/Fu leading to death); Chang (Long) pulse indicates Earth flourishing (favorable/Sheng leading to life). Slippery-rapid pulse with sticky/foul diarrhea indicates retained food: Dachengqi Tang. Sour/bitter vomiting indicates Da Chaihu Tang. San Yang refers to Taiyang, Yangming, and Shaoyang combined disease. "Peng Peng" describes abdominal distension. "Kou Zao" is dry mouth. "Shen Zhong" is heaviness of the body making turning difficult. "Zhan Yu" is delirious speech. "Yu Mian" is somnolence. "He Mu Han Zheng Zheng" is steaming hot sweat when closing eyes. "Yi Niao" is enuresis. "Mian Gou" is a greasy facial appearance. These are signs of excessive Three Yang heat and depletion of Jin Ye (Body Fluids). If pulse is Floating, sweating is strictly prohibited; if Large, purgation is prohibited. Use Baibu Jia Renshen Tang (White Tiger Plus Ginseng Decoction) to tonify Qi, generate fluids, and clear heat. If no prior sweating/purgation and fluids are intact, mild San Yang He Bing may be treated with Chaige Jieji Tang (Bupleurum and Kudzu Relieving Muscle Decoction) to clear and resolve Three Yang. Er Yang Bing Bing refers to Taiyang-Yangming consecutive disease. "Han Bu Che" means incomplete sweating from Taiyang transmitting to Yangming. Flushed face indicates pathogenic stagnation at the exterior of Taiyang/Yangming, not yet entering Yangming Fu; use Da Qinglong Tang. "Biao Ba" means Taiyang exterior syndrome has ceased. Tidal fever, sweaty extremities, difficult stool, and delirium indicate merger into Yangming Fu; use Dachengqi Tang to purge Yangming Excess Heat. Tai Shao Bing Bing refers to Taiyang-Shaoyang consecutive disease. Head/neck stiffness, vertigo, epigastric stiffness resembling Jie Xiong indicates symptoms have not merged; pathogen is unsettled. Prohibit sweating, vomiting, purgation; only acupuncture at Dazhui (GV14), Ganshu (BL18), Feishu (BL13) to drain heat is suitable. Erroneous sweating causes delirium; erroneous vomiting/purgation causes mental restlessness, fright, inability to swallow, and persistent diarrhea. These adverse conditions indicate fatal prognosis. See He Bing and Bing Bing chapters for detailed principles.