天津张××，年四十五岁，得冲气上冲兼奔豚证。
病因 初秋之时，患赤白痢证，医者两次用大黄下之，其痢愈而变为此证。
证候 每夜间当丑寅之交，有气起自下焦挟热上冲，行至中焦觉闷而且热，心中烦乱，迟十数
分钟其气上出为呃，热即随之消矣。其脉大致近和平，惟两尺稍浮，按之不实。
诊断 此因病痢时，连服大黄下之，伤其下焦气化，而下焦之冲遂挟肾中之相火上冲也。其在
丑寅之交者，阳气上升之时也。宜用仲师桂枝加桂汤加减治之。
处方 桂枝尖（四钱） 生怀山药（一两） 生芡实（六钱捣碎） 清半夏（四钱水洗三次）
生杭芍（四钱） 生龙骨（四钱捣碎） 生牡蛎（四钱捣碎） 生麦芽（三钱）
生鸡内金（二钱黄色的捣） 黄柏（二钱） 甘草（二钱）
共煎汤一大盅，温服。
效果 将药煎服两剂，病愈强半，遂即原方将桂枝改用三钱，又
加净萸肉、甘枸杞各四钱，连服三剂全愈。
帮助 凡气之逆者可降，郁者可升，惟此证冲气挟相火上冲，则升降皆无所施。桂枝一药而
升降之性皆备，凡气之当升者遇之则升，气之当降者遇之则降，此诚天生使独而为不可思议
之妙药也。山药、芡实，皆能补肾，又皆能敛戢下焦气化；龙骨、牡蛎，亦收敛之品，然敛正
气而不敛邪气，用于此证初无收敛过甚之虞，此四药并用，诚能于下焦之气化培养而
镇安之也。用芍药、黄柏者，一泻肾中之相火，一泻肝中之相火，且桂枝性热，二药性凉，凉
热相济，方能奏效。用麦芽、鸡内金者，所以运化诸药之力也。用甘草者，欲以缓肝之急，不使
肝木助气冲相火上升也。至于服药后病愈强半，遂减轻桂枝加萸肉、枸杞者，俾肝肾壮旺自能扫除病根。
Zhang XX from Tianjin, aged forty-five, suffered from a syndrome of Chong Qi (Penetrating Vessel Qi) rushing upward combined with Ben Tun (Rushing Pig).
Etiology: In early autumn, he contracted dysentery characterized by both red and white discharge. The physician twice administered Dahuang (Rhei Radix et Rhizoma) for purgation. Although the dysentery resolved, this condition developed subsequently.
Symptoms: Every night during the transition between Chou hour (01:00–03:00) and Yin hour (03:00–05:00), Qi rises from the Lower Jiao (Lower Burner), carrying heat upward. Upon reaching the Middle Jiao (Middle Burner), he experiences chest oppression and heat, along with mental restlessness. After more than ten minutes, the Qi erupts upward as hiccups, and the heat dissipates accordingly. His pulse is generally near normal, except that the Chi positions (Kidney positions) on both wrists are slightly floating and feel empty upon deep pressure.
Diagnosis: This occurred because continuous purgation with Dahuang during dysentery damaged the Qi transformation function of the Lower Jiao, causing the Chong Mai (Penetrating Vessel) in the Lower Jiao to carry the Minister Fire (Xiang Huo) from the Kidneys upward. The occurrence during the Chou-Yin transition corresponds to the time when Yang Qi naturally rises. It is appropriate to treat this using Zhang Zhongjing’s Guizhi Jia Gui Tang (Cinnamon Twig Plus Cinnamon Decoction) with modifications.
Prescription: Guizhi Jian (Tips of Cinnamomi Ramulus, 4 qian), Sheng Huai Shanyao (Raw Dioscoreae Hypoglaucae Rhizoma, 1 liang), Sheng Qianshi (Raw Euryales Semen, 6 qian, crushed), Qing Banxia (Clear Pinelliae Rhizoma, 4 qian, washed three times), Sheng Hangshao (Raw Paeoniae Radix Alba, 4 qian), Sheng Longgu (Raw Ostreae Concha, 4 qian, crushed), Sheng Muli (Raw Ostreae Concha, 4 qian, crushed), Sheng Maiya (Raw Hordei Fructus Germinatus, 3 qian), Sheng Jineijin (Raw Gavis Stomach Linings, 2 qian, yellow variety, crushed), Huangbai (Phellodendri Cortex, 2 qian), Gancao (Glycyrrhizae Radix et Rhizoma, 2 qian).
Decoct together in a large bowl of water and take warm.
Outcome: After taking two doses, the illness improved significantly. The original prescription was then used again, but with Guizhi reduced to 3 qian, and adding Jing Yurou (Clean Corni Fructus) and Gan Gouqi (Sweet Lycii Fructus), each 4 qian. After three consecutive doses, full recovery was achieved.
Commentary: Generally, rebellious Qi can be directed downward, and stagnant Qi can be dispersed upward. However, in this case, where Chong Qi carries Minister Fire upward, neither descending nor ascending methods alone are effective. Guizhi (Cinnamomi Ramulus) uniquely possesses both ascending and descending properties; Qi that should ascend ascends upon encountering it, and Qi that should descend descends upon encountering it. This is truly a miraculous herb endowed by nature. Shanyao (Dioscoreae Hypoglaucae Rhizoma) and Qianshi (Euryales Semen) both tonify the Kidneys and can consolidate and restrain the Qi transformation of the Lower Jiao. Longgu (Ostreae Concha) and Muli (Ostreae Concha) are also astringents, but they consolidate righteous Qi without trapping pathogenic factors; thus, there is little risk of excessive astringency when used initially for this syndrome. These four herbs combined effectively nourish and pacify the Qi transformation in the Lower Jiao. Shaoyao (Paeoniae Radix Alba) and Huangbai (Phellodendri Cortex) are used to drain the Minister Fire from the Kidneys and Liver, respectively. Since Guizhi is hot in nature, these two cool herbs provide thermal balance, which is essential for efficacy. Maiya (Hordei Fructus Germinatus) and Jineijin (Gavis Stomach Linings) are used to facilitate the digestion and distribution of the other herbs’ actions. Gancao (Glycyrrhizae Radix et Rhizoma) is used to soothe Liver tension, preventing Liver Wood from assisting the rebellious Qi and Minister Fire in rising. Regarding the reduction of Guizhi and the addition of Yurou (Corni Fructus) and Gouqi (Lycii Fructus) after significant improvement: this aims to strengthen the Liver and Kidneys so that their robustness can naturally eradicate the root of the disease.