逆气象阳。(全文见五脏。)凡气逆,必见象阳症,面赤脉洪,当以法降其逆乃愈,若以
气象阳盛,而用寒药攻之,则不救矣。气上冲心,咽不得息,治法见伤寒厥阴病条。
〔垣〕如秋冬之月,胃脉四道为冲脉所逆,并胁下少肠脉二道而反上行,病名曰厥逆。经曰∶
逆气上行,满脉去形,七神昏绝,离去其形而死矣。其证气上冲咽不得息,喘息有声不得卧,于
调中益气加吴茱萸半钱或一钱,观厥气多少用之。如夏月有此症,为大热也。盖此症随四时为寒
热温凉,宜以酒黄连、酒黄柏、酒知母各等分为细末,熟汤为丸,如桐子大,每服二百丸,白
汤空心下,仍多饮热汤,服毕,少时便以美饮食压之,使不得胃中停留,直至下焦,以泻冲脉之
邪也。
寒气厥逆,赤丸主之。
茯苓 桂心(各四两) 细辛(一两) 乌头 附子(各二两) 射罔(如大枣,一两)
上六味为末,纳真珠为色,蜜丸如麻子大。先食,酒饮下三丸,日三夜一,服不知稍增之,
以知为度。(一方用半夏四两,不用桂。)
逆气五脏皆有∶
一曰心小肠。经云∶诸逆冲上,皆属于火。又云∶少腹控睾,引腰脊,上冲心,邪在小肠,
取之肓原以散之,刺太阴以予之,取厥阴以下之,取巨虚下廉以去之,按其所过之经以调之是也。
二曰胃。经云∶胃为气逆是也,胃逆有呕有吐有哕,故刺呕吐,取中脘三里也。刺哕,取乳
下黑根尽处,及脐下三寸,皆大验也。治各有本门。
三曰肺大肠。经云∶肺苦气上逆,急食苦以泄之。又云∶腹中常鸣,气上冲胸,喘不能久立,
邪在大肠,刺肓之原,巨虚下廉是也。其肺逆曰咳喘,取天突、人迎泄之也。治亦各有门。
四曰肝。经云∶肝气逆则耳聋不聪, 肿,取血者是也。
五曰肾。即奔豚气逆,香港脚冲心之类是也。治亦各有门。
六曰肾。经云∶督脉别络生病,从少腹上冲心而痛,不得前后,为冲疝是也。(治见疝门。)
〔《玉》〕肾气冲心∶关元(二寸半,补。) 带脉(一分,沿皮向外二寸半,泻。)
〔《摘》〕腹有逆气,上冲心腹,胀满不得息∶气冲(右脐下七寸,两旁相去远二寸,
动脉应手,灸七壮,忌针。)三里立愈。
运气厥逆有三∶
一曰风火。经云∶少阳司天,火气下临,风行于地,厥逆,膈不通是也。
二曰寒。经云∶水郁之发,善厥逆是也。
三曰湿。经云∶太阴司天,湿气下临,厥逆是也。
逆气的表现类似于阳证。(全文详见“五脏”章节。)凡是气机逆乱,必定出现类似阳证的征象,如面色发红、脉象洪大,应当采用降逆的方法治疗才能痊愈;如果误认为这是阳气亢盛,而使用寒凉药物攻伐,则会导致病情恶化无法救治。气向上冲至心胸部位,咽喉阻塞导致呼吸不畅,治疗方法参见《伤寒论》厥阴病条文。
〔李东垣〕在秋冬季节,胃经的四条经脉被冲脉之气所逆乱,并与胁下及小肠的两条经脉一起反而向上逆行,这种病症名为“厥逆”。《内经》说:逆气上行,充斥脉道,使形体与神志分离,七神昏绝,脱离形体而死。其症状表现为气上冲咽喉导致呼吸不畅,喘息有声不能平卧。可在调中益气汤中加入吴茱萸半钱或一钱,根据厥气的轻重酌情使用。如果是夏季出现此症,属于大热之证。因为此症随四季气候变化而有寒热温凉的不同,适宜用酒黄连、酒黄柏、酒知母各等分研为细末,用熟水泛丸,如梧桐子大小,每次服用二百丸,空腹时用白开水送服,随后多喝热汤,服药完毕后,稍后用美味饮食压住药力,使其不滞留于胃中,直达下焦,以泻除冲脉的邪气。
寒气导致的厥逆,用赤丸主治。
茯苓、桂心(各四两)、细辛(一两)、乌头、附子(各二两)、射罔(如大枣大小,一两)。
以上六味药研成粉末,加入真珠粉调色,用蜂蜜制成如麻子大小的丸剂。饭前服用,用酒送服三丸,白天三次,夜间一次,若服药后无效可逐渐增加剂量,以见效为度。(另一处方用半夏四两,不用桂心。)
气逆涉及五脏:
第一是心与小肠。经文说:各种气逆冲上的症状,都归属于火。又说:少腹牵引睾丸,牵连腰脊,气上冲心脏,病邪在小肠,应取肓原穴以消散病邪,针刺太阴经以补益,取厥阴经以降逆,取巨虚下廉穴以祛除病邪,按压其所经过的经脉以调理,就是这种方法。
第二是胃。经文说:胃气上逆即是此症,胃气上逆会有呕吐、吐食、呃逆等症状,所以治疗呕吐,取中脘穴和足三里穴。治疗呃逆,取乳下黑根尽头处,以及脐下三寸处,都有显著疗效。具体治法各有专门章节。
第三是肺与大肠。经文说:肺脏苦于气机上逆,急用苦味食物来泄降肺气。又说:腹部常鸣响,气上冲胸部,气喘不能久立,病邪在大肠,应刺肓之原穴,即巨虚下廉穴。肺脏气逆表现为咳嗽气喘,取天突穴、人迎穴进行泻法治疗。治法也各有专门章节。
第四是肝。经文说:肝气上逆会导致耳聋不聪、肿胀,应取血分穴位治疗。
第五是肾。即奔豚气上逆,脚气冲心之类的病症。治法也各有专门章节。
第六是肾(此处指督脉相关病变)。经文说:督脉的别络发生病变,从少腹上冲心脏并疼痛,大小便不通,称为冲疝。(治法见疝气章节。)
〔《玉机微义》〕肾气冲心:关元穴(深刺二寸半,用补法),带脉穴(浅刺一分,沿皮向外斜刺二寸半,用泻法)。
〔《针灸摘英》〕腹部有逆气,上冲心腹,胀满导致呼吸不畅:气冲穴(位于右脐下七寸,两旁相距约二寸,动脉应手,灸七壮,忌用针刺),足三里穴(灸之立即痊愈)。
运气厥逆有三种:
第一是风火。经文说:少阳司天之年,火气下行,风气行于地,导致厥逆,膈部气机不通。
第二是寒。经文说:水气郁结发作时,容易发生厥逆。
第三是湿。经文说:太阴司天之年,湿气下行,导致厥逆。
The manifestation of rebellious Qi resembles Yang syndromes. (For the full text, see "Zang-Fu Organs".) Whenever Qi rebels, it must present symptoms resembling Yang syndromes, such as a red face and a surging pulse. It should be treated with methods to descend the rebellion to achieve recovery. If one mistakenly assumes this is an excess of Yang Qi and uses cold-natured herbs to attack it, the condition will become incurable. When Qi rushes upward to the heart and chest, causing throat obstruction and difficulty in breathing, the treatment method can be found in the section on Jueyin Disease in Shanghan Lun.
[Li Dongyuan] In autumn and winter months, the four meridians of the Stomach are rebelled against by the Chong Mai (Penetrating Vessel), merging with the two meridians under the hypochondrium and small intestine, reversing their flow to move upward. This disease is named Jue Ni (Cold Reversal). The Classics state: "Rebellious Qi moves upward, filling the vessels and separating from the form; the Seven Spirits become confused and extinct, leaving the form to die." Its symptoms include Qi rushing up to the throat causing respiratory distress, wheezing with audible sounds, and inability to lie flat. One may add Wu Zhu Yu (Evodiae Fructus) half a qian or one qian to Tiao Zhong Yi Qi Tang, adjusting the dosage according to the severity of the Jue Qi. If this syndrome occurs in summer, it indicates severe heat. Since this syndrome varies in cold, heat, warmth, and coolness with the seasons, it is appropriate to use equal parts of Jiu Huang Lian (Scutellariae Radix prepared with wine), Jiu Huang Bo (Phellodendri Cortex prepared with wine), and Jiu Zhi Mu (Anemarrhenae Rhizoma prepared with wine), ground into fine powder, and formed into pills with cooked water, sized like paulownia seeds. Take 200 pills each time on an empty stomach with plain warm water, followed by drinking plenty of hot soup. Immediately after taking the medicine, consume delicious food to suppress the medicinal action, preventing it from lingering in the Stomach, so that it reaches the Lower Jiao (Lower Burner) to drain the pathogenic factors from the Chong Mai.
For Jue Ni caused by Cold Qi, Chi Wan (Red Pill) is the primary treatment.
Fu Ling (Poria), Gui Xin (Cinnamomi Ramulus), each 4 liang; Xi Xin (Asari Radix et Rhizoma), 1 liang; Wu Tou (Aconiti Radix), Fu Zi (Aconiti Lateralis Radix Praeparata), each 2 liang; She Wang (Ephedrae Herba processed with toxic additives), size of a large date, 1 liang.
Grind the above six ingredients into powder, mix with real pearl powder for color, and make honey pills the size of sesame seeds. Take before meals, washed down with wine, three pills at a time, three times during the day and once at night. If ineffective, gradually increase the dose until the desired effect is achieved. (Another prescription uses Ban Xia (Pinelliae Rhizoma) 4 liang, without Gui Xin.)
Qi rebellion involves five Zang organs:
First, Heart and Small Intestine. The Classics say: "All rebellious Qi rushing upward belongs to Fire." It also says: "When the lower abdomen pulls to the testicles, drawing pain to the waist and spine, and Qi rushes up to the heart, the pathogen is in the Small Intestine. Puncture the Yuan source point (Huangyuan) to dissipate it, needle the Taiyin meridian to tonify it, take the Jueyin meridian to descend it, take Ju Xu Xia Lian (ST37) to remove it, and press the meridians it passes through to regulate it."
Second, Stomach. The Classics say: "Stomach Qi rebelling is this condition." Stomach Qi rebellion presents as vomiting, regurgitation, or hiccups. Therefore, for treating vomiting, select Zhong Wan (CV12) and Zu San Li (ST36). For treating hiccups, select the end of the black root under the nipple and the point three cun below the umbilicus; both are highly effective. Specific treatments are detailed in their respective sections.
Third, Lung and Large Intestine. The Classics say: "The Lung suffers from Qi rebelling upward; urgently eat bitter substances to drain it." It also says: "Constant ringing in the abdomen, Qi rushing up to the chest, wheezing unable to stand for long periods; the pathogen is in the Large Intestine. Pierce the Yuan source of the Hu (Sanjiao), which is Ju Xu Xia Lian (ST37)." Lung Qi rebellion manifests as cough and asthma; select Tian Tu (CV22) and Ren Ying (LI18) to drain it. Treatments are also detailed in respective sections.
Fourth, Liver. The Classics say: "Liver Qi rebelling causes deafness and lack of clarity, swelling; select blood points."
Fifth, Kidney. This refers to Ben Tun Qi (Rushing Pig Qi) rebelling upward, or Jiao Qi (Foot Sickness) rushing to the heart, etc. Treatments are detailed in respective sections.
Sixth, Kidney (referring to Du Mai pathology). The Classics say: "Disease arising from the collateral branches of the Du Mai (Governor Vessel) causes Qi to rush from the lower abdomen up to the heart with pain, and inability to pass stool or urine; this is called Chong Shan (Rushing Hernia)." (Treatment seen in the Hernia section.)
[From *Yu Ji Wei Yi*] Kidney Qi rushing to the heart: Guan Yuan (CV4) (depth 2.5 cun, tonification method); Dai Mai (GB26) (superficial insertion 1 fen, oblique outward 2.5 cun, sedation method).
[From *Zhen Jiu Zhai Ying*] Abdominal rebellious Qi rushing to the heart and abdomen, causing distension and inability to breathe: Qi Chong (ST30) (located seven cun below the right umbilicus, two sides apart about two cun, pulsating artery felt; moxibustion seven zhuang, contraindicated for needling); Zu San Li (ST36) (moxabustion leads to immediate recovery).
There are three types of Yun Qi (Luck/Qi Movement) Jue Ni:
First, Wind and Fire. The Classics say: "When Shaoyang governs the year, Fire Qi descends upon the earth, Wind Qi moves on the ground, leading to Jue Ni and obstruction of the Diaphragm."
Second, Cold. The Classics say: "When Water Qi is depressed and erupts, it easily causes Jue Ni."
Third, Dampness. The Classics say: "When Taiyin governs the year, Dampness Qi descends upon the earth, causing Jue Ni."