《黄帝内经》“两感于寒”与《伤寒论》“两感”辨析

梳理《黄帝内经》“两感于寒”内涵的历史演变，提出《黄帝内经》“两感于寒”证实为少阴虚衰情况下太阳、少阴两经同时感受寒邪，属于一种危重证候，与《伤寒论》太阳、少阴两感证有明显的区别。《伤寒论》“两感”证有“狭义两感”与“广义两感”之分。“狭义两感”即特指表里两经之感邪；而“广义两感”则认为，只要是两经感邪，不管疾病是如何发病及传变，皆为“两感”之范畴，不仅涉及互为表里两经的合病，而且亦包括其他两经合病及并病的相关内容，甚至同一经的经腑同病亦可被纳入“两感”。参照《伤寒论》对“两感”的治法，提出《黄帝内经》“两感于寒”可先用四逆汤或通脉四逆汤救里，根据病情决定是否再用桂枝汤等解表。

Analysis of the Syndrome of "Two Infected with Cold Pathogen" in The Yellow Emperor's Inner Classic and "Two Infected with Pathogen" in Treatise on Cold Damage

Summarize the historical evolution of the connotation of "two infected with cold pathogen" in The Yellow Emperor's Inner Classic, and propose that the "two infected with cold pathogen" in The Yellow Emperor's Inner Classic is the condition where Taiyang and Shaoyin meridians simultaneously infect cold pathogen when Shaoyin is deficient. This belongs to a critical syndrome, and is significantly different from the "two infected with pathogen" syndromes of Taiyang and Shaoyin meridians proposed in Treatise on Cold Damage. The "two infected with pathogen" in Treatise on Cold Damage has narrow meaning and broad meaning. The narrow meaning specifically refers to the infection of pathogen in both the external and internal meridians; while the broad meaning proposes that despite how the disease occurs and spreads, as long as the two meridians are infected with pathogen, it belongs to the category of "two infected with pathogen". The broad meaning not only involves complex diseases of both the external and internal meridians, but also includes related contents of complex and combination diseases of other two meridians, and even the same meridian-mediated meridian-organ diseases. Referring to the treatment of "two infected with pathogen" in Treatise on Cold Damage, it is proposed that the "two infected with cold pathogen" in The Yellow Emperor's Inner Classic can be first treated with Sini decoction or Tongmai Sini decoction for the interior, and then decide whether to use Guizhi decoction, etc, to relieve external symptoms based on the condition.