医宗金鉴卷九

<<Yi Zong Jin Jian>> Chapter 9

辨合病并病脉证并治篇

Co-exist and developed stages, its pulse and treatment

伤寒有六经之证，有六经之脉，证脉井然不杂，则可直指为某经之病。若两经、三经，阴阳混淆，不可以一经名者；或一经未罢又传一经，二经、三经同病，不归并一经者，则名曰合病。或二经、三经同病，其後归并一经自病者，则名曰并病。论中所着合病、并病，虽单举阳经，未及阴经，然阳经既有合病、并病，则阴经亦必有之可知矣。

For a Shanghan disease, if the person has clear clinic conditions/symptoms, or individual pulse that indicate to each stage, the diagnosis is straight forward. If two or three stages mixed, it is hard to name the stage with the name of only one stage; or if one stage is not over, but the disease has developed into another one, two, or three stages, it is called co-exist stage. If the disease has been in two or more stages, now it develops into only one stage, it is called developed stage. In this book, the examples for the co-exist stage and developed stage are given referring to the Taiyang, Yangming, and Shaoyang stages, does not cite any Yin stages, such as Taiyin, Shaoyin and Jueyin stage. If the Yang stages has the co-exist and developed stages, the Yin stages should also have them.

如太阳病脉反沉，少阴病反发热，是少阴、太阳合病也；阳明病脉迟，太阴病大实痛，是太阴、阳明合病也；少阳病脉细而厥，厥阴病呕而发热，是厥阴、少阳合病也。是虽无合病之名，而确有合病之实。且三阳皆有发热证，三阴皆有下利证，如发热而下利，是阴阳合病也，阴阳合病，若阳盛者属阳经，则下利为实热，即论中所谓太阳、阳明，阳明、少阳，太阳、少阳，合病者是也。

For example, in Taiyang stage, the pulse should be floating, but now it is deep; in Shaoyin stage, the pulse should have no fever, but now the person has fever, indicating the co-exist of Taiyang and Shaoyin stages. In Yangming stage, the pulse should be slow, and in Taiyin stage, the person should have no heavily fullness and pain in the whole stomach, but the person has such conditions now, indicating the co-exist of Yangming and Taiyin stages. In Shaoyang stage, the pulse should be string, but now it is thin and the person has Jue condition; in Jueyin stage, the person has however nausea and fever; indicating the co-exist of Jueyin and Shaoyang stages. Clearly, though it is not called co-exist of the Yin stages, but in clinic they exist. Additionally, it is known that the three Yang stages have fever, and the three Yin stages have diarrhea. If a person has both fever and diarrhea, he has co-exist of Yang and Yin stages. In this case, if the overall condition tends to show the Yang stage, the diarrhea belongs to Shi fever, as indicated in the book as Taiyang-Yangming, Yangming-Shaoyang, Taiyang-Shaoyang co-exist stages.

阴盛者属阴经，则下利为虚寒，即论中所谓少阴下利反发热不死，少阴下利清谷， 里寒外热，不恶寒而面赤者是也。盖阳与阳合，不合於阴，为三阳合病，则不下利而自汗出，乃白虎汤证也；阴与阴合，不合於阳，为三阴合病，则不发热而吐利厥逆，乃四逆汤证也。诚以人之藏府互根，阴阳相合，三阳既有合并之病，则三阴亦有合并之病，不待言矣。

If the condition shows more as Yin stages, the diarrhea belongs to weak Cold, as indicated in the book as Shaoyin diarrhea but with fever; as Shaoyin diarrhea with non-digested food in the stool; as cold inside but surface hot, the person has no chilly but the face is red in color. Usually if a Yang stage co-exists with another Yang stage, not with any Yin stage, it is the Yang co-exist condition. The person has no diarrhea but has sweat, indicating a Baihu Tang condition; if a Yin stage co-exists with another Yin stage, not with any Yang stage, it is Yin co-exist condition, the person has no fever, but nausea, diarrhea and has Jue condition, indicating a Sini Tang condition. This is because in the body, the Zang and Fu[1] organs are linked, associated functionally each other, if the three Yang stage (which is the disorder in the Fu, such as urine bladder – Taiyang; large intestine – Yangming; and gall bladder – Shaoyang) have disorder, the three Yin stage can have disorders at the same time. This is easy to understand.

01 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。

With co-exist of Taiyang and Yangming stage[2], if the person has diarrhea, use Gegen Tang[3]. If he has not diarrhea, but has nausea, use Gegen jia Banxia Tang.

葛根汤方

Gegen Tang[4]

葛根  四两， 麻黄（去节）三两， 桂枝 二两， 芍药  二两， 甘草（炙）二两， 生姜（切）三两，大枣（擘）十二枚

Gegen 60 gram, Mahuang (remove joints in the stem) 45 gram, Guizhi 30 gram, Shaoyao 30 gram, Gancao (processed) 30 gram, Fresh ginger 45 gram, Chinese date 12 badges.

右七味，俰咀，以水一斗，先煮麻黄葛根，减二升，去沫，内诸药，煮取三升，温服一升，覆取微似汗，不须啜粥，馀如桂枝法，将息及禁忌。

Add Mahuang and 2500 ml water into a pot. Bring to boil and keep it in mild boiling until there is about four fifth of liquid remained. Add other herbs in and continue to cook until the liquid in the pot is about 750 ml. Drink one third of the tea, covering the body to get slight sweat. No need to drink rice tea. Other requirement is as the same as for Guizhi Tang.

葛根加半夏汤方

Gegen jia Banxia Tang

於葛根汤内，加半夏半升，馀依葛根汤法。

Add Banxia 124 gram into the Gegen Tang. Cook the same way.

02 太阳与阳明合病，喘而胸满者，不可下，宜麻黄汤。

With co-exist of Taiyang and Yangming stage, if the person has asthma and fullness in the chest, use Mahuang Tang, not bowel-cleansing therapy.

03  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。

With co-exist of Taiyang and Shaoyang stage[5], if the person has diarrhea, use Huangqin Tang; if he has nausea, use Huangqin jia Banxia Shenjiang Tang.

黄芩汤方

Huangqin Tang

黄芩三两， 甘草（炙）二两， 芍药二两， 大枣（擘）十二枚

Huangqin 45 gram, Gancao (processed) 30 gram, Shaoyao 30 gram, Chinese date 12 badges.

右四味，以水一斗，煮取三升，去滓，温服一升，日再服，夜一服。

Add the herbs and 2500 ml water into a herbal pot. Bring to boil and keep in mild boiling until the liquid in the pot is about 750 ml. Collect the herbal tea. Drink one third of the tea, repeat once in the day time, and the last one at night.

黄芩加半夏生姜汤方

Huangqin jia Banxia Shengjiang Tang

於黄芩汤方内，加半夏半升，生姜三两，馀依黄芩汤法

Add 124 gram of Banxia and 45 gram of fresh ginger into the Huangqin Tang above. Cook and drink it the same way.

04 阳明、少阳合病，必下利，其脉不负者为顺也。负者失也，互相克贼，名为负也。脉滑而数者，有宿食也，当下之，宜大承气汤。

With co-exist of Shaoyang and Yangming stage, the person will have diarrhea[6]. The pulse should be big and string[7], indicating a co-responding condition. If the pulse is only string, not big, it suggests the Wood (the Shaoyang, the Liver, the Wood) is combating against the Soil (the Yangming stage, the Stomach, the soil), the disease will be hard to improve. If the pulse is only big, but not string, it suggests the Soil is not under attack by the Wood, the condition being easier to solve. If the pulse is slippery and frequent, it suggests he has old-dead stool in his Stomach. Da Chengqi Tang should be used. [8]

05 三阳合病，脉浮大弦[9]，关上，但欲眠睡，目合则汗。

In co-exist of Taiyang-Shaoyang-Yangming stages, one of the clinic conditions are: the pulse is floating, big and string on the Guan position; the person feels willing to lie down for a sleep and has sweat during the sleep. [10]

06 三阳合病，腹满身重，难以转侧，口不仁，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。

In co-exist of Taiyang-Shaoyang-Yangming stages, one may feel fullness in Stomach, heavy in the body so that it is hard to turn the body, feel strange taste in mouth, has dark-dirty color on the face, Chattering syndrome, leak in the urine, and sweat. In this condition, use Baihu Tang[11]. If the sweat therapy is used, the person will have Chattering syndrome. If the bowel-cleansing therapy is used, he will have sweat on the front head and reverse-developing cold hands and feet.

07 二阳并病，太阳初得病时，发其汗，汗先出不彻，因转属阳明，续自微汗出、不恶寒。若太阳证不罢者，不可下，下之为逆，如此可小发汗。设面色缘缘正赤者，阳气怫郁在表，当解以汗。(宜仍与麻桂各半汤，或桂枝二越婢一汤). 若发汗不彻，不足言，阳气怫郁不得越，当汗不汗，其人躁烦，不知痛处，乍在腹中，乍在四肢，按之不可得，其人短气，但坐，以汗出不彻故也，更发汗则愈。何以知汗出不彻，以脉涩故知也。(当更用大青龙汤或葛根汤).

Taiyang-Yangming developed condition. The person has had Taiyang stage and was given sweat therapy. However, the sweat therapy did not work in full to deplete all Xieqi from the body, so the disease develops to Yangming stage. He then has mild sweat, no chilly. If the Taiyang stage does not fully disappear, the bowel-cleansing therapy should not be used. It is a wrong therapy in this case to use the bowel-cleansing therapy. The herbs need in this case is mild sweat therapy again, especially if the person has pink color on his face[12], suggesting the Yangqi is floating on the body surface. If the sweat is again not to a complete level, the Yangqi cannot be released off, he will feel annoyed/impatience. He also feels pain here and there, but hardly be able to point the exact point of the pain. He may feel the pain sometimes in the stomach, sometimes in arm and legs. He feels not pain when pressing the so claimed pain spot. Because he feels short of breath, he cannot lie down, but sit. All is because the incomplete sweat, that is told by harsh pulse. [13]

08 二阳并病，太阳证罢，但发潮热，手足絷絷汗出，大便难而谵语者，下之则愈，宜大承气汤。

Taiyang-Yangming developed condition. The person has hot wave, continuous mild sweat in the hands and feet, has constipation and Chattering. Bowel-cleansing therapy should be used, use Da Chengqi Tang.  

09 太阳与少阳并病，头项强痛，或眩冒，时如结胸，心下痞僐者，当刺大椎、第一间 (商阳穴),  肺俞、肝俞。慎不可发汗，发汗则谵语。脉弦，五、六日，谵语不止，当刺期门。

Taiyang-Shaoyang developed condition. The person feels some times tight and pain on the neck, some times cloudy-dizziness in head, some times feels similar to a Jiexiong[14], or hard and full in the upper stomach area. Use acupuncture on Dazhui point[15], Shangyang point, Feishu[16] and Ganshu[17] points. Be careful in the use of sweat therapy. The sweat therapy may cause Chattering syndrome. If the person has continuous Chattering syndrome and string pulse for five to six days, acupuncture on Qimen point.

10 太阳少阳并病，心下硬，颈项强而眩者，当刺大椎、肺俞、肝俞，慎勿下之 。

Taiyang-Shaoyang developed condition. The person feels hard on the upper stomach, tight on the neck, head dizziness. Use acupuncture on Dazhu point, Feishu, Ganshu. Be careful not to use bowel-cleansing therapy. [18]

11 太阳少阳并病，而反下之，成结胸，心下硬，下利不止，水浆不下，其人心烦。

Taiyang-Shaoyang developed condition. If the bowel-cleansing therapy is used, it may cause Jiexiong condition. The person will feel hard on the upper stomach, has continuous diarrhea, hard to swallow any food or water and feels annoyed.