【纲】仲景曰。厥阴之为病。气上撞心。心中疼热。饥而不欲食。食即吐蛔。下之。利不止。
【目】成无己曰。气上撞者。腹中气时时上撞也。此汗吐下后之疾。虽经下之。邪犹在表故也。
痞病气上撞咽候。亦由误汗吐下而生。
魏荔彤曰。此言厥阴病传经热邪为患。历举其症以验之。示误下之禁也。伤寒之邪。传入少阴。
为里中之里。及自少阴传厥阴。又为三阴之极尽处矣。阴尽处受邪。亦无所复传。却由同表里之少
阳为升降之出路。故在阳明有下法。在少阴亦有下法。今阴尽之极。则少阳固无下法。厥阴更无下
法。下之为误可知矣。然邪在少阴。原分寒热。邪在厥阴。亦必分寒热。邪由传经入少阴者为热。
及递传厥阴。不问而知为热矣。惟是厥阴病中。若直中寒邪。亦自少阴起。而入厥阴。是寒热皆由
少阴而来。大足相混也。试先言传经自太阴而来为热邪者。能辨乎此。则由少阴直中而起之寒邪。
自可徐考而识之。厥阴病。得于传经为热邪者。先验其症。首曰消渴。凡热必渴。然寒湿隔阻正气
亦有渴。渴欲饮水。必不能多。未有渴而饮。饮而仍渴。随饮随消随渴者。故随饮随消随渴。则为传
经之热邪。传入厥阴无疑也。少阴居下。厥阴居中。热渐传上。则上焦必受熏灼之害。为消渴。为气
上撞心。为心中疼热。皆少阴之邪热。缘木而升者。竟入肝为病。木火交炽。而诸症见矣。然又有
饥不欲食。食则吐蛔之症者。何也。盖邪从少阴传来。本自三阳传入。病久胃虚。邪热乘之。蛔因
胃气虚。则不能安伏于胃底之下。又热乘之。反浮游于胃口之上。于是胃虚而热。则多饥。蛔在胃
口。故不欲食。食入而食在蛔上则相安。食入而蛔反在食上则必吐蛔。此又厥阴病中旁及之胃病也。
医家或见热症。谓宜下。再见胃病。又谓宜下。漫为下之。大误矣。少阴之传厥阴。其势 日
上矣。治之如法。则邪可从少
阳而散。亦如阳明传少阳。为邪出之门户也。反逆其势而下之。阴性本降。再经误下。利何能止乎。
仲师于厥阴中。首揭不可下之禁。见厥阴病无论为寒为热。俱不可下也。
【纲】仲景曰。病如桂枝症。头不痛。项不强。寸脉微浮。胸中痞硬。气上撞咽喉。不得息者。
此为胸有寒也。当吐之。宜瓜蒂散。
【目】寇宗 曰。此盖未经汗吐下作膈实。故宜吐也。
王肯堂曰。气撞心疼者。厥阴本病也。如气上撞。不吐蛔者。为阳症。若撞咽不得息者。瓜蒂
散吐之。往来寒热者。奔豚。阴拘挛者。阴阳易。卒口噤者。刚痉与汗吐下之后。各有症治方法。
学人详之。
[Outline] Zhang Zhongjing stated: The manifestation of Jueyin disease (Jueyin Disease) is Qi rushing upward to strike the heart, pain and heat in the heart region, a sensation of hunger without desire to eat, and vomiting of roundworms (Ascaris lumbricoides) upon eating. If purgatives are mistakenly used, it will result in unceasing diarrhea.
[Commentary] Cheng Wuji said: "Qi rushing upward" refers to the Qi in the abdomen occasionally rushing upward. This is a condition arising after treatment with sweating, vomiting, or purging methods. Although purging has been applied, the pathogenic factor remains at the exterior level. The symptom of Qi rushing up to the throat in Pi syndrome (Pi Syndrome, characterized by chest fullness and stuffiness) also arises from erroneous use of sweating, vomiting, or purging.
Wei Litong said: This passage discusses the pathology caused by heat pathogens transmitted through the meridians in Jueyin disease. It lists these symptoms for verification and indicates the prohibition against erroneous purging. The pathogen of Shanghan (Cold Damage) transmits into Shaoyin (Shaoyin Disease), becoming the interior of the interior. When it further transmits from Shaoyin to Jueyin, it reaches the extreme end of the three Yin meridians. At this extreme end of Yin, where the pathogen resides, there is no further place for transmission; instead, it finds an outlet for ascending and descending through Shaoyang (Shaoyang Disease), which shares the same exterior-interior relationship with Jueyin. Therefore, while there is a purging method for Yangming (Yangming Disease), there is also one for Shaoyin. Now, at the extreme end of Yin, Shaoyang certainly has no purging method, and Jueyin even less so. It is evident that purging here would be an error. However, when the pathogen is in Shaoyin, it is originally divided into cold and heat patterns; similarly, in Jueyin, one must distinguish between cold and heat. Pathogens entering Shaoyin via transmission are heat patterns; consequently, those progressing to Jueyin are undoubtedly heat patterns as well. Nevertheless, in Jueyin disease, if it is a direct attack by cold pathogens, it naturally originates from Shaoyin and enters Jueyin. Thus, both cold and heat patterns originate from Shaoyin, making them easily confused. One should first learn to distinguish heat pathogens coming from Taiyin (Taiyin Disease). If this can be identified, then cold pathogens originating directly from Shaoyin can be gradually examined and recognized. For Jueyin disease caused by transmitted heat pathogens, the primary symptom to verify is Xiao Ke (Xiao Ke, characterized by excessive thirst and consumption). All heat patterns involve thirst. However, cold-dampness obstructing healthy Qi can also cause thirst, but the desire to drink water will not be large. There is no case where one drinks, still feels thirsty, and experiences immediate consumption and renewed thirst. Therefore, immediate consumption and renewed thirst indicate transmitted heat pathogens entering Jueyin without doubt. Shaoyin is located inferiorly, while Jueyin is central. As heat gradually transmits upward, the Upper Jiao (Upper Burner) inevitably suffers from scorching effects, manifesting as Xiao Ke, Qi rushing up to strike the heart, and pain and heat in the heart region. These are all heat pathogens from Shaoyin rising along the meridians, ultimately entering the Liver to cause disease. Wood and Fire blaze together, resulting in various symptoms. However, there are also symptoms of hunger without desire to eat, and vomiting roundworms after eating. Why is this? Generally, because the pathogen came from Shaoyin, originally transmitted from the Three Yang meridians, prolonged illness leads to deficiency of Stomach Qi. The pathogenic heat takes advantage of this. Due to deficient Stomach Qi, roundworms cannot remain securely hidden at the bottom of the stomach. Furthermore, driven by heat, they float upwards to the upper part of the stomach. Thus, with a deficient and hot Stomach, there is a sensation of frequent hunger. Since the roundworms are at the entrance of the stomach, there is no desire to eat. If food is ingested and lies above the roundworms, they coexist peacefully. But if the roundworms end up above the food, vomiting of roundworms is inevitable. This is another aspect of Jueyin disease involving the Stomach. Physicians might see heat symptoms and suggest purging; seeing Stomach issues, they might again suggest purging. Randomly using purgatives is a major error. The transmission from Shaoyin to Jueyin shows a trend increasingly moving upward. If treated correctly, the pathogen can dissipate through Shaoyang, just as transmission from Yangming to Shaoyang serves as an exit portal for pathogens. To reverse this trend and purge downwards is contrary to nature. Since the nature of Yin is descending, erroneous purging will make it impossible to stop the diarrhea. Zhang Zhongjing first highlights the prohibition against purging in the Jueyin chapter, indicating that regardless of whether Jueyin disease presents as cold or heat, purging is contraindicated.
[Outline] Zhang Zhongjing stated: When the condition resembles Guizhi Tang (Cinnamon Twig Decoction) pattern, but the head does not hurt and the neck is not stiff, with the Cun pulse slightly floating, chest oppression and hardness, Qi rushing up to strike the throat causing difficulty in breathing, this indicates Cold Phlegm-Fluid (Han Yin) in the Chest. It should be treated with emesis, and Gouti San (Melon Sepal Powder) is appropriate.
[Commentary] Kou Zongshi said: This likely results from膈 Shi (Diaphragmatic Excess) without prior treatment via sweating, vomiting, or purging, hence emesis is suitable.
Wang Kentang said: Qi striking and causing heart pain is the fundamental disease of Jueyin. If Qi rushes upward without vomiting roundworms, it is a Yang pattern. If Qi rushes up to the throat causing breathing difficulties, treat with Gouti San for emesis. Alternating chills and fever indicate Ben Tun (Running Piglet Qi). Contraction and spasms of the Yin organs indicate Yin-Yang Yi (Yin-Yang Exchange Disease). Sudden lockjaw indicates Gang Jing (Stiff Spasm). After sweating, vomiting, or purging, there are respective symptom patterns and treatment methods; students should study them in detail.