表里合病必下利
太阳（汗）与阳明合病必自下利葛根汤主之不下利但呕者葛根加半夏汤主之太阳（和）与少阳合
病自下利者与黄芩汤若呕者黄芩加半汤生姜汤主之阳明与少阳合病必下利脉滑而数者有宿食也当下之宜大承气汤（俱详
下利）
并病
二阳（汗）并病太阳出汗不彻因转属阳明自汗不恶寒太阳证不罢面赤躁烦短气者更发汗则愈二阳（下）并病
太阳证罢潮热谵语者下之则愈（论见谵语）太阳（刺）少阳并病项强眩冒心下硬如结胸者刺胸俞肝俞（论见项强）
合并两经俱病并则一经证罢而并归于一经也太阳与阳明合病有三证其邪凑有浅深之殊故用药有汗下和解之异治见
各条三阳合病有二证其一证用白虎汤其一证无治法后人用小柴胡白虎之类盖此二证俱有三阳之候故不可汗下二阳并病
有二证表未解者汗之表已解有里证者下之太阳与少阳并病有三证其一由误下以致心下硬成结胸其一项强如柔痉状心下
硬如结胸刺肺俞肝俞慎勿发汗汗则谵语不止宜刺期门其一心下硬项强而眩者刺大椎肺俞不宜下也
合病
太阳（汗）与阳明合病胸满而喘者不可下麻黄汤太阳（解肌）与阳明合病自下利葛根汤不下利但呕者葛根加
半夏（或曰由太阳表未罢而阳明里又至两阳合病热甚于表乘虚渐攻于里故下也其不下利而呕者邪气虽攻里未入于胃但气
逆而呕故加半夏以止呕逆庞氏曰外证必头痛腰疼肌热目疼鼻干也脉浮大太阳受病也长者阳明也头腰太阳也肌目鼻阳明
也）
太阳与少阳合病自下利者与黄芩汤若呕者黄芩加半夏汤（或曰此表实里虚热入攻里故自下利若兼痰饮则呕也）
阳明少阳合病必下利脉长者为顺脉眩者为负负者克贼也脉滑而数者有宿食大承气汤（或曰阳明土少阳木其脉弦者木
乘土也不弦者不负也负者必死若滑而数者有宿食非负也故宜下）
三阳合病腹满身重难以转侧口不仁面垢谵语遗尿不可汗下若自汗者白虎汤三阳合病脉浮大见关上但欲眠目合则汗
小柴胡白虎汤（或曰此二证俱有三阳之证此不可汗下）
并病
二阳（解肌）并病太阳初得时汗之不彻转属阳明续自微汗不恶寒大柴胡汤若太阳证不罢不可下可少发汗设面
色缘缘正赤阳气怫郁在表汗之不彻其人烦躁短气不知痛处宜更发汗则愈葛根汤二阳（下）并病太阳证罢潮热手足汗大便
难谵语者大承气汤太阳少阳并病反下之成结胸心下硬下利不止水浆不下心烦生姜泻心汤小陷胸汤太阳（刺）与少阳并项
强痛或眩冒时如结胸心下痞硬刺大椎第一间肺俞肝俞不可汗汗则谵语不止刺期门太阳少阳并病心下硬项强而眩者刺大
椎肺俞慎勿下
赵 愚尝疑合病并病之难明也久矣姑释之盖合病者二阳经或三经同受病之病不传者也并病者一阳经先受病又过
一
经病之传者也且如太阳阳明并病一证若并而未尽是传未通尚有表证仲景所谓太阳证不罢面色赤阳气怫郁在表不得越烦
躁气短是也犹当汗之以各半汤若并之已尽是谓传过仲景所谓太阳证罢潮热手足汗出大便硬而谵语者是也法当下之以承
气汤是知传则入腑不传则不入腑所以仲景论太阳阳明合病止出三证如前太阳阳明并病则言其有传变如此也又如阳经互
相合病皆自下利仲景于太阳阳明合病则主以葛根汤太阳少阳合病主以黄芩汤少阳阳明合病主以承气汤至于太阳少阳并
病其证头项强痛眩冒如结胸心下痞硬当刺大椎肺俞肝俞不可汗下太阳阳明并病已见上论但三阳合病仲景无背恶寒语句
虽别有口燥渴心烦背微恶寒者乃属太阳证而非三阳合病也活人言三阳合病背恶寒者非也三阳若与三阴合病即是两感所
以三阴无合病例也
张 夫并者乃催并督并之义非吞并相就之理然催并系去声吞并之并乃上声史记曰始皇初并天下即此理也夫并之
理
乃前病未解后病已至有逼相并之义故曰并病也经曰太阳与少阳并病头项强痛或眩冒云云如果并作一家则仲景不具两经
之证而言也其非并字明矣
又曰或云三阳合病有太阳阳明有正阳阳明有少阳阳明似乎重出予曰各有所指不过表里之分耳夫三阳合病在表三阳
阳明病在里事在两途即非重出在表者宜解散以痊安在里者非攻下则不可然表里证治迥各不同惟编目有似乎重出
【表里合病必下利】
太阳经与阳明经同时发病（合病），必然出现自发性腹泻，应当用葛根汤治疗。如果没有腹泻但出现呕吐症状的，应当用葛根加半夏汤治疗。
太阳经与少阳经同时发病（合病），出现自发性腹泻的，应当用黄芩汤治疗；如果伴有呕吐的，应当用黄芩加半夏生姜汤治疗。
阳明经与少阳经同时发病（合病），必然出现腹泻。如果脉象滑而数，说明体内有积食，应当采用攻下法，适宜使用大承气汤。（以上关于下利的详细论述见“下利”章节）
【并病】
太阳经与阳明经先后发病（并病）：太阳经受邪后发汗不彻底，导致病邪转入阳明经。此时患者自汗出、不怕冷，但太阳经的症状尚未完全消失，表现为面部发红、烦躁不安、呼吸短促，应当再次发汗才能痊愈。
太阳经与阳明经先后发病（并病）：太阳经的症状已经消失，出现定时发热（潮热）、说胡话（谵语）的，应当采用攻下法才能痊愈。（相关论述见“谵语”章节）
太阳经与少阳经先后发病（并病）：出现颈项强直、头晕目眩、心下部僵硬如同结胸证的症状，应当针刺胸俞穴和肝俞穴。（相关论述见“项强”章节）
【合并病辨析】
所谓合并两经同时发病叫“合病”，指一经的症状消退后并入另一经的叫“并病”。
太阳经与阳明经合病有三种证型，因为邪气侵袭有浅深不同，所以治疗方法有发汗、攻下、和解的区别，具体治法见各相关条目。
三阳经（太阳、阳明、少阳）合病有两种证型：一种证型用白虎汤治疗；另一种证型没有特定的固定治法，后人多采用小柴胡汤或白虎汤等方剂。这是因为这两种证型都具备三阳经的症状表现，所以既不能单纯发汗也不能单纯攻下。
二阳经（太阳、阳明）并病有两种证型：表证未解的应当发汗；表证已解而有里实证的应当攻下。
太阳经与少阳经并病有三种证型：第一种是由于误用攻下法导致心下部僵硬形成结胸证；第二种是颈项强直如同柔痉状，心下部僵硬如同结胸证，应当针刺肺俞穴和肝俞穴，切记不可发汗，否则会导致说胡话不止，适宜针刺期门穴；第三种是心下部僵硬、颈项强直且眩晕的，应当针刺大椎穴和肺俞穴，不宜使用攻下法。
【合病详解】
太阳经与阳明经合病，若出现胸部胀满而气喘的，不可攻下，应当用麻黄汤。
太阳经与阳明经合病，若出现自发性腹泻的，用葛根汤；若无腹泻但呕吐的，用葛根加半夏汤。（或者解释为：由太阳表证未罢，阳明里证又至，两阳合病，热势盛于体表，乘虚逐渐攻入体内，所以导致腹泻。若不腹泻而呕吐，是因为邪气虽攻入体内但未进入胃腑，只是气机上逆而呕吐，所以加半夏以止呕逆。庞氏说：外证必然头痛、腰痛、肌肉发热、眼睛疼痛、鼻子干燥。脉象浮大是太阳经受病，脉象长是阳明经受病。头腰属太阳，肌肉、眼睛、鼻子属阳明。）
太阳经与少阳经合病，若出现自发性腹泻的，用黄芩汤；若伴有呕吐的，用黄芩加半夏汤。（或者解释为：这是表实里虚，热邪侵入攻里，所以自发性腹泻。如果兼有痰饮则会出现呕吐。）
阳明经与少阳经合病，必然出现腹泻。脉象长的是顺证，脉象眩晕的是逆证（负者克贼也）。脉象滑而数的，说明有积食，宜用大承气汤攻下。（或者解释为：阳明属土，少阳属木，脉象弦是木乘土，不弦则不算相克。相克的必然死亡，如果是滑而数且有积食，则不属于相克，所以适宜攻下。）
三阳经合病，出现腹部胀满、身体沉重、难以翻身转侧、口舌麻木不知滋味、面色垢秽、说胡话、遗尿等症状，不可发汗也不可攻下。如果伴有自汗出的，用白虎汤。三阳经合病，脉象浮大见于关部，只想睡觉、闭眼时出汗的，用小柴胡汤或白虎汤。（或者解释为：这两种证型都具备三阳经的症状，所以不可发汗攻下。）
【并病详解】
太阳经与阳明经并病（解肌法）：太阳经初得病时发汗不彻底，病邪转入阳明经，继续轻微自汗出、不怕冷，用大柴胡汤。如果太阳经症状未消失，不可攻下，可以少量发汗。假如面色通红，阳气郁滞在体表，发汗不彻底，导致其人烦躁、呼吸短促、不知道疼痛具体位置，应当再次发汗才能痊愈，用葛根汤。
太阳经与阳明经并病（攻下法）：太阳经症状消失，出现潮热、手足出汗、大便困难、说胡话的，用大承气汤。
太阳经与少阳经并病，如果误用攻下法，会形成结胸证，心下部僵硬，腹泻不止，水浆难进，心烦意乱，用生姜泻心汤或小陷胸汤。
太阳经与少阳经并病，出现颈项强痛或头晕目眩，有时像结胸证，心下部痞塞坚硬，应当针刺大椎第一间穴、肺俞穴、肝俞穴，不可发汗，发汗会导致说胡话不止，应当针刺期门穴。
太阳经与少阳经并病，心下部僵硬、颈项强直且眩晕的，应当针刺大椎穴和肺俞穴，切记不可攻下。
赵嗣真曾长久怀疑合病和并病的概念难以明白，姑且解释一下：所谓合病，是指两条阳经或三条阳经同时受病，病情不传变。所谓并病，是一条阳经先受病，然后又传给另一条经，是病情的传变。
例如太阳与阳明并病的一种证型，如果并而未尽，说明传变未通，还有表证，即仲景所说的“太阳证不罢，面色赤，阳气怫郁在表，不得越，烦躁，气短”，这种情况仍然应当用桂枝麻黄各半汤发汗。如果并之已尽，说明已经传过，即仲景所说的“太阳证罢，潮热，手足汗出，大便硬而谵语”，这种情况下法则应当用承气汤攻下。由此可知，传变则入腑，不传变则不入腑。所以仲景论述太阳阳明合病只列出三种证型如前所述；论述太阳阳明并病则强调其有传变的特点。
又如阳经互相合病，都会出现自发性腹泻。仲景对于太阳阳明合病主用葛根汤，太阳少阳合病主用黄芩汤，少阳阳明合病主用承气汤。至于太阳少阳并病，其症状是头项强痛、眩晕、像结胸证、心下部痞塞坚硬，应当针刺大椎、肺俞、肝俞穴，不可发汗攻下。太阳阳明并病已在上面论述过。但是三阳合病，仲景没有提到背恶寒的语句。虽然另有口燥渴、心烦、背部微恶寒的情况，那属于太阳证，而不是三阳合病。《活人书》说三阳合病有背恶寒，这是不对的。三阳经如果与三阴经合病，就是两感证，所以三阴经没有合病的病例。
张元素认为，“并”字乃是催促、督责的意思，不是吞并、凑合的道理。然而“催并”的并读去声，“吞并”的并读上声。《史记》说秦始皇初并天下，就是这个道理。“并”的原理是前面的病未解，后面的病已至，有逼迫相并的含义，所以叫并病。经文说“太阳与少阳并病，头项强痛或眩冒”等等，如果真的是并作一家，那么仲景就不会分别列举两经的症状了。这足以证明它不是简单的“并”字含义。
又说：有人问，三阳合病中有太阳阳明，有正阳阳明，有少阳阳明，似乎重复了。我说：各自有所指代，不过是表里的区别罢了。三阳合病在表，三阳阳明病在里，事情在两途，即非重复。在表的适宜解散以痊愈，在里的非攻下不可。既然表里证治截然不同，只是在编目上似乎有重复。
[Combined Disease of Exterior and Interior Must Present with Diarrhea]
When the Taiyang (Taiyang Channel) and Yangming (Yangming Channel) channels are simultaneously affected (He Bing), spontaneous diarrhea will inevitably occur; Gegen Tang (Kudzu Decoction) should be administered. If there is no diarrhea but vomiting occurs, Gegen Jia Banxia Tang (Gegen plus Pinellia Decoction) should be administered.
When the Taiyang (Taiyang Channel) and Shaoyang (Shaoyang Channel) channels are simultaneously affected (He Bing), if spontaneous diarrhea occurs, Huangqin Tang (Scutellaria Decoction) should be administered; if accompanied by vomiting, Huangqin Jia Banxia Shengjiang Tang (Huangqin plus Pinellia and Fresh Ginger Decoction) should be administered.
When the Yangming (Yangming Channel) and Shaoyang (Shaoyang Channel) channels are simultaneously affected (He Bing), diarrhea will inevitably occur. If the pulse is slippery and rapid, it indicates retained food stagnation; purgative therapy should be employed, and Dachengqi Tang (Major Order the Qi Decoction) is appropriate. (For detailed discussions on diarrhea, see the "Diarrhea" section.)
[Bing Bing - Sequential Affection of Channels]
Taiyang (Taiyang Channel) and Yangming (Yangming Channel) sequential affection: After sweating treatment for Taiyang channel pathogen, if not thorough, the pathogen transfers to the Yangming channel. The patient presents with spontaneous sweating, aversion to cold has ceased, yet Taiyang symptoms persist, manifesting as facial redness, restlessness, shortness of breath. Re-sweating therapy should be applied to achieve cure.
Taiyang (Taiyang Channel) and Yangming (Yangming Channel) sequential affection: When Taiyang symptoms have resolved, presenting with tidal fever and delirium, purgative therapy should be applied to achieve cure. (See "Delirium" section for related discussion.)
Taiyang (Taiyang Channel) and Shaoyang (Shaoyang Channel) sequential affection: Manifesting with neck stiffness, dizziness, and epigastric hardness resembling Jie Xiong (Chest Binding Syndrome). Acupuncture at Xionshu (BL-17) and Ganshu (BL-18) points should be performed. (See "Neck Stiffness" section for related discussion.)
[Analysis of Combined and Sequential Affections]
Simultaneous affection of two channels is called He Bing (Combined Disease); when symptoms of one channel resolve and merge into another, it is called Bing Bing (Sequential Affection).
Taiyang and Yangming He Bing presents in three patterns. Due to differences in the depth of pathogen invasion, treatments vary between sweating, purging, and harmonizing. Refer to respective sections for specific treatments.
San Yang (Three Yang Channels: Taiyang, Yangming, Shaoyang) He Bing presents in two patterns: one pattern is treated with Baihu Tang (White Tiger Decoction); the other lacks a fixed standard treatment, with later practitioners often using Xiaochaihu Tang (Minor Order the Qi Decoction) or Baihu Tang. This is because both patterns exhibit signs of all three Yang channels, thus neither simple sweating nor purging is appropriate.
Er Yang (Two Yang Channels: Taiyang, Yangming) Bing Bing presents in two patterns: if exterior syndrome is unresolved, sweating therapy is indicated; if exterior is resolved and interior excess exists, purging therapy is indicated.
Taiyang and Shaoyang Bing Bing presents in three patterns:
1. Caused by erroneous purging leading to epigastric hardness forming Jie Xiong (Chest Binding Syndrome).
2. Neck stiffness resembling Rou Jing (Soft Spasm), with epigastric hardness like Jie Xiong. Acupuncture at Feishu (BL-13) and Ganshu (BL-18) is indicated. Sweating must be strictly avoided, otherwise delirium will persist; Qimen (LR-14) acupuncture is suitable.
3. Epigastric hardness, neck stiffness, and dizziness. Dazhui (GV-14) and Feishu (BL-13) acupuncture is indicated. Purging is contraindicated.
[Detailed Explanation of He Bing]
Taiyang and Yangming He Bing, if presenting with chest fullness and wheezing, cannot be purged; Mahuang Tang (Ephedra Decoction) should be used.
Taiyang and Yangming He Bing, if presenting with spontaneous diarrhea, use Gegen Tang (Kudzu Decoction); if no diarrhea but vomiting occurs, use Gegen Jia Banxia Tang (Gegen plus Pinellia Decoction). (Alternatively explained: Taiyang exterior remains unresolved while Yangming interior pathogen arrives. Heat from combined Yang pathogens is intense on the exterior and attacks the interior via deficiency, causing diarrhea. If no diarrhea but vomiting occurs, the pathogen attacks the interior but has not entered the Stomach, causing Qi rebellion and vomiting; thus Banxia (Pinellia) is added to stop vomiting. Pang Shi stated: Exterior signs necessarily include headache, lower back pain, muscle heat, eye pain, and nasal dryness. Floating-large pulse indicates Taiyang disease; long pulse indicates Yangming disease. Head and waist belong to Taiyang; muscles, eyes, and nose belong to Yangming.)
Taiyang and Shaoyang He Bing, if presenting with spontaneous diarrhea, use Huangqin Tang (Scutellaria Decoction); if accompanied by vomiting, use Huangqin Jia Banxia Tang (Huangqin plus Pinellia Decoction). (Alternatively explained: This is exterior excess and interior deficiency, with heat invading and attacking the interior, causing spontaneous diarrhea. If phlegm-fluid retention is present, vomiting occurs.)
Yangming and Shaoyang He Bing inevitably presents with diarrhea. A long pulse is a favorable sign (Shun); dizziness indicates an unfavorable sign (Fu/Negative), representing overcoming and harming. A slippery and rapid pulse indicates retained food; Dachengqi Tang (Major Order the Qi Decoction) should be used for purging. (Alternatively explained: Yangming belongs to Earth, Shaoyang to Wood. A string-like pulse indicates Wood overacting on Earth; without string-like quality, it is not overcoming. Overcoming leads to death. If slippery and rapid with retained food, it is not overcoming, hence purging is suitable.)
San Yang (Three Yang Channels) He Bing presents with abdominal fullness, body heaviness, difficulty turning, numbness of the mouth and face, greasy complexion, delirium, and urinary incontinence. Neither sweating nor purging is allowed. If spontaneous sweating occurs, Baihu Tang (White Tiger Decoction) should be used. San Yang He Bing with floating-large pulse seen at Guan position, somnolence, and sweating upon closing eyes, treat with Xiaochaihu Tang (Minor Order the Qi Decoction) or Baihu Tang (White Tiger Decoction). (Alternatively explained: Both patterns exhibit San Yang signs; thus sweating and purging are contraindicated.)
[Detailed Explanation of Bing Bing]
Taiyang and Yangming Bing Bing (Muscle-Releasing Method): Initial Taiyang disease treated with sweating was incomplete, transferring to Yangming. Continued mild spontaneous sweating and absence of aversion to cold indicate Dachengqi Tang (Major Order the Qi Decoction) [Note: Text says Da Chai Hu Tang here]. If Taiyang symptoms persist, purging is contraindicated; slight sweating may be attempted. If the face is entirely red, Yang Qi is constrained on the exterior due to incomplete sweating, causing restlessness, shortness of breath, and unknown pain locations. Re-sweating with Gegen Tang (Kudzu Decoction) is required.
Taiyang and Yangming Bing Bing (Purgative Method): When Taiyang symptoms resolve, presenting with tidal fever, sweating on hands and feet, difficult defecation, and delirium, Dachengqi Tang (Major Order the Qi Decoction) should be used.
Taiyang and Shaoyang Bing Bing, if erroneously purged, forms Jie Xiong (Chest Binding Syndrome), with epigastric hardness, incessant diarrhea, inability to take fluids, and irritability. Shengjiang Xiexin Tang (Fresh Ginger Decoction to Drain the Epigastrium) or Xiaoxianzhong Tang (Minor Trap-in-the-Center Decoction) should be used.
Taiyang and Shaoyang Bing Bing, presenting with neck stiffness and pain, or dizziness, sometimes resembling Jie Xiong (Chest Binding Syndrome), with epigastric stuffiness and hardness. Acupuncture at Dazhui (GV-14), Feishu (BL-13), and Ganshu (BL-18) is indicated. Sweating is contraindicated; if done, delirium will persist. Qimen (LR-14) acupuncture is indicated.
Taiyang and Shaoyang Bing Bing, with epigastric hardness, neck stiffness, and dizziness. Acupuncture at Dazhui (GV-14) and Feishu (BL-13) is indicated. Purging must be strictly avoided.
Zhao Sizhen long doubted the clarity of He Bing and Bing Bing concepts. Let us explain: He Bing refers to simultaneous affliction of two or three Yang channels without transmission. Bing Bing refers to prior affliction of one Yang channel followed by transmission to another.
For example, in Taiyang-Yangming Bing Bing, if the merging is incomplete, transmission is blocked, and exterior signs remain (as Zhongjing described: "Taiyang signs unresoved, facial redness, Yang Qi constrained on exterior, unable to vent, restlessness, shortness of breath"). In this case, Ge Ban Tang (Half-Half Decoction) should still be used for sweating. If merging is complete, transmission has occurred (as Zhongjing described: "Taiyang signs resolved, tidal fever, hand/foot sweating, hard stool, delirium"). In this case, Chengqi Tang (Order the Qi Decoction) should be used for purging. Thus, transmission enters the Fu organs; non-transmission does not. Therefore, Zhongjing lists only three patterns for Taiyang-Yangming He Bing as above, while describing Taiyang-Yangming Bing Bing emphasizes its transmissive nature.
Furthermore, mutual He Bing among Yang channels invariably presents with spontaneous diarrhea. Zhongjing uses Gegen Tang for Taiyang-Yangming He Bing, Huangqin Tang for Taiyang-Shaoyang He Bing, and Chengqi Tang for Shaoyang-Yangming He Bing. For Taiyang-Shaoyang Bing Bing, symptoms include head/neck stiffness, dizziness, resemblance to Jie Xiong, and epigastric stuffiness/hardness; acupuncture at Dazhui, Feishu, Ganshu is indicated, avoiding sweating and purging. Taiyang-Yangming Bing Bing is discussed above. However, for San Yang He Bing, Zhongjing does not mention aversion to cold on the back. Although cases exist with dry mouth/thirst, irritability, and slight back aversion to cold, these belong to Taiyang signs, not San Yang He Bing. *Huoren Shu* states San Yang He Bing includes back aversion to cold, which is incorrect. If San Yang combines with San Yin, it becomes Liang Gan (Double Cold), so San Yin has no He Bing cases.
Zhang Yuansu argued that "Bing" implies urging or supervising, not swallowing or merging. "Cu Bing" (urging) is pronounced with a departing tone, while "Tun Bing" (swallowing) is pronounced with an upper tone. *Records of the Grand Historian* states Qin Shi Huang initially "Bing" (unified/conquered) the world, illustrating this principle. The logic of "Bing" is that the previous illness is unresolved while the new illness arrives, creating a sense of coercion and combination, hence "Bing Bing". The classic states "Taiyang and Shaoyang Bing Bing, head/neck stiffness or dizziness," etc. If they were truly merged into one entity, Zhongjing would not list signs of both channels separately. This proves it is not merely the character "Bing".
Another view: Some ask if San Yang He Bing involving Taiyang-Yangming, Zheng Yang Yangming, and Shaoyang-Yangming is repetitive. I reply: Each has specific reference, differing only by exterior/interior distinction. San Yang He Bing is exterior; San Yang Yangming disease is interior. They are distinct paths, not repetitive. Exterior conditions require dispersing resolution; interior conditions require purging. Since exterior and interior treatments differ significantly, they only appear repetitive in indexing.