动气者。筑筑然动于脐旁上下左右。甚者连及虚里心胁。而浑身振动也。此病由于妄汗妄下。气血大
亏。以致肾气不纳。鼓动于下而作也。或由其人少阴素亏。因
病而发。恒见于瘦薄虚弱之人。方书都以理中汤去白术、加肉桂、倍茯苓治之。以
伐肾邪。恐未切当。盖奔豚属水邪。而动气属肾虚。不若八味饮加五味、胡桃。直培
根本。以收纳肾气。多服自效。
邵评∶动气由于土虚不能制水。水气凝结而成。肾中虚气。逆乘土位也。若虚里
穴。在乳下。其动应衣。宗气泄也。大虚之症。治当大补。盖由妄汗妄下。伤其正气。
其人肾气本虚。素有动气在于上焦。因之而发。肾真不纳。治以补肾纳气为主。
理中汤补脾土。去白术。嫌滞气也。加桂、苓。泄水以伐肾邪。然动气一症。是肾气
亏乏。气少收纳。非肾中水邪上逆。与奔豚不同。宜补肾气。不宜伐肾邪。故用八
味饮以补肾真。加五味子、胡桃。敛纳肾气为治。
又评∶奔豚与动气。其因各异。辨治极当。
凡伤寒至发动气。必肾气大亏。水火并衰。其见证。六脉迟软。舌润不渴。脐腹冷如
冰。暖炉昼夜不舍。饱则动缓。饥则动甚。于此可知其虚。非大剂八味多服不除。寒甚。加炮姜。若止少
阴水亏。动气亦不甚。必有舌干口渴脉数可凭。宜都气饮。加胡桃肉以纳之。左归饮加减亦可。
邵评∶阴亏虚热见症。脉象与阳虚者。自是不同。都气饮、六味丸加五味子。以补
阴纳气壮水之剂。此言伤寒之发动气者。
杂症虚。亦发动气。宜照本病施治。如怯弱痢疾之类。
邵评∶杂症之有动气。总由脾肾两虚。参合其所患之本病。而辨别治之。
Dongqi (Abdominal Pulsation) manifests as a throbbing sensation moving up, down, left, and right around the navel. In severe cases, it extends to the Xuliri (Precordial Region/Heart Base) and hypochondrium, causing tremors throughout the body. This condition arises from improper use of sweating or purgative methods, leading to a severe deficiency of Qi and Blood, resulting in the failure of Kidney Qi to grasp and retain, causing stirring and movement below. Alternatively, it may be triggered by illness in individuals with pre-existing deficiency of the Shaoyin (Lesser Yin) channel. It is commonly seen in emaciated and weak individuals. Medical texts generally treat this with Lizhong Tang (Regulate the Middle Decoction), removing Baizhu (Atractylodis Macrocephalae Rhizoma), adding Rougui (Cinnamomi Cortex), and doubling the dosage of Fuling (Poria). The intent is to attack the pathogenic factor of the Kidney. However, this may not be entirely appropriate. Ben Tun (Running Piglet) belongs to Water Pathogen, whereas Dongqi belongs to Kidney Deficiency. It is better to use Bawei Yin (Eight-Ingredient Replenishing Pill / Jin Gui Shen Qi Wan) added with Wuweizi (Schisandrae Fructus) and Hutaoren (Walnut Seed) to directly cultivate the root and grasp the Kidney Qi; long-term administration will yield efficacy.
Shao's Commentary: Dongqi occurs because Spleen Earth is deficient and cannot control Kidney Water, causing Water Qi to coagulate. The deficient Qi within the Kidney rebels and attacks the position of the Earth (Spleen/Stomach). If referring to the Xuliri acupoint located below the breastbone, where the pulsation causes clothing to move, this indicates leakage of Zong Qi (Gathering Qi) and represents a critical deficiency syndrome; treatment should focus on massive tonification. This results from improper sweating and purging damaging the Righteous Qi; the patient's Kidney Qi was originally deficient, and pre-existing Dongqi in the Upper Jiao (Upper Burner) is thus triggered. The Kidney's True Qi fails to grasp; treatment should prioritize tonifying the Kidney and grasping Qi. Lizhong Tang tonifies Spleen Earth; Baizhu is removed to avoid stagnating Qi; Rougui and Fuling are added to drain Water and attack the Kidney pathogen. However, Dongqi is characterized by a lack of Kidney Qi and insufficient grasping ability, not by the rebellion of Kidney Water Pathogen upwards, which differs from Ben Tun. It is suitable to tonify Kidney Qi rather than attack the Kidney pathogen. Therefore, Bawei Yin is used to tonify Kidney True Qi, and Wuweizi and Hutaoren are added to astringe and grasp Kidney Qi for treatment.
Further Commentary: Ben Tun and Dongqi have different etiologies; distinguishing and treating them is highly appropriate.
Whenever Taiyang Disease (Exogenous Cold Damage) progresses to induce Dongqi, it implies a severe deficiency of Kidney Qi and simultaneous decline of Water and Fire. Clinical manifestations include slow and soft pulses in all six positions, a moist tongue without thirst, and an umbilical and abdominal coldness like ice, requiring heat sources day and night. The pulsation slows after full meals and intensifies during hunger, revealing its deficiency nature. Without large doses of Bawei Yin administered over time, it cannot be cured. If cold signs are severe, Paojiang (Prepared Ginger) is added. If there is only a deficiency of Water in the Shaoyin channel, Dongqi is not severe; there must be symptoms such as a dry tongue, thirst, and rapid pulse to rely upon. Duiqi Yin (All-Inclusive Decoction) added with Hutaoren (Walnut Seed) to grasp Qi is suitable. Zuoi Yin (Left-Restoring Decoction) with modifications can also be used.
Shao's Commentary: Symptoms of Yin deficiency with empty heat present pulse characteristics naturally different from those of Yang deficiency. Duiqi Yin and Liuwei Wan (Six-Ingredient Rehmannia Pill) added with Wuweizi are formulas that tonify Yin, grasp Qi, and strengthen Water to control Fire. This refers to Dongqi induced by Taiyang Disease.
Deficiency syndromes in miscellaneous diseases can also induce Dongqi; treatment should follow the management of the primary disease, such as in cases of asthenic dysentery.
Shao's Commentary: Dongqi appearing in miscellaneous diseases is fundamentally due to dual deficiency of Spleen and Kidney; differentiation and treatment must be combined with the underlying disease.