论关隔 论尸厥
天师曰∶开治者，气闭不开而开之也。如关隔之症是也；或如尸厥气闭是也。关隔者，乃上焦有
关，一层关住，而饮食不能下；下焦有关，一层关住，而下不能出。此乃气之郁塞，一时偶得上吐下泻，
不能尽命而死矣。此等症，五脏六腑原未尝有损，偶然触怒，肝气冲于胃口之间，肾气不得上行，肺气
不得下达，以成此症。若言胃病，而胃实未病；若言脾病，而脾实无病也。法当以开郁为主。方用柴胡一钱，
郁金一钱，白芍三钱，茯苓一钱，白芥子一钱，天花粉一钱，苏子一钱，荆芥一钱，甘草五分，水煎
服。（〔批〕和解至圣丹。）此方妙在平常而有至理。盖肝气之郁，必用柴、芍以舒之，然过多则必阻
而不纳。方中以此二味为君，而佐以郁金之寒散，芥子之祛痰，天花粉之散结，甘草之和中，茯苓之去
湿，气味平和，委婉易入，不争不战，相爱相亲，自能到门而款关，不致扣关而坚壁也。
至于尸厥闭气，此中邪气闭，必须用药以开之。开之奈何？不用瓜蒂以探吐，即用皂角以取喷也。
方用瓜蒂七个，水二碗，煎汤一碗、加盐少许灌之，即大吐浓痰数碗而愈。或用皂角刺，研为细末，取鹅
翎管盛药末，吹入疾人鼻中，得打喷嚏，口吐浓痰如黄物者即愈。盖厥症多系热邪，然热邪必然叫号，今
黯然无语，宛似死人，明系阴虚之人，忽中阴邪，不可以治阳厥之法治之，多至不救。不若先以瓜蒂、皂
角取吐，以去其痰涎，人自出声，而后以人参五钱，白薇一钱，茯苓三钱，白术五钱，半夏二钱，治
之自安。（〔批〕开闭至圣丹。）此开治之一法也。
张公曰∶论奇而方妙。中风之症，亦可用瓜蒂散、皂角汤以开之。然必须用人参一两，半夏三钱，
南星三钱，附子一钱，以继之也。否则，徒用瓜蒂、皂角，徒取一时之开关，而终不能留中气之坚固，
虽开关何益哉。
华君曰∶尚有二法未传。一阴阳汤也。法用滚水、凉水各一碗，均之，加炒盐一撮，打百余下，起
泡饮之。凡有上焦欲吐而不能吐者，饮之立吐而愈。
一喷嚏之法未授也。用生半夏三钱，为末，水丸如黄豆大，入鼻孔中，则必喷嚏不已，用水饮之立
止。通治中风不语、尸厥等症，中恶、中鬼俱妙，皆开治之法也。
（关格症，上不得入，下不得出，病在上下二焦，而根实本于中焦。喻嘉言以黄连汤进退法，兼朝
服八味丸，治之甚善，附记于末，以俟临症者之自择。方法详《医门法律·关格条》，兹不赘。李子
永识。）
[Background Information]
Book: *Shishi Milu* (Secrets of the Stone Chamber)
Author: Chen Shiduo
Dynasty: Qing
Chapter: Kai Zhifa (Methods of Opening Treatment)
Category: Comprehensive
[Original Text Processing]
On Guan Ge and Shi Jue
The Heavenly Master said: "Kai Zhi" (Opening Treatment) refers to using methods to open up when Qi mechanism is closed and unresponsive. This is exemplified by the condition of Guan Ge; or similarly, in cases of Shi Jue where Qi mechanism is closed. Guan Ge involves an obstruction in the Upper Jiao (Upper Burner), a layer of blockage that prevents food and drink from descending; and an obstruction in the Lower Jiao (Lower Burner), a layer of blockage that prevents excretion. This results from the stagnation and blockage of Qi. If one experiences sudden vomiting and diarrhea due to this, it can be fatal if not treated. In such conditions, the Five Zang Organs and Six Fu Organs are originally undamaged; they are merely accidentally provoked. The Liver Qi (Liver Qi) rushes to the epigastric region, the Kidney Qi cannot ascend, and the Lung Qi cannot descend, thereby forming this syndrome. If one claims it is a Stomach disease, the Stomach is actually not diseased; if one claims it is a Spleen disease, the Spleen is actually not diseased. The treatment principle should focus primarily on resolving stagnation. The prescription uses Chai Hu (Bupleuri Radix) 1 qian, Yu Jin (Curcumae Radix) 1 qian, Bai Shao (Paeoniae Radix Alba) 3 qian, Fu Ling (Poria) 1 qian, Bai Jie Zi (Sinapis Semen) 1 qian, Tian Hua Fen (Trichosanthis Radix) 1 qian, Su Zi (Perillae Fructus) 1 qian, Jing Jie (Schizonepetae Herba) 1 qian, and Gan Cao (Glycyrrhizae Radix et Rhizoma) 5 fen. Decoct in water and take orally. ([Commentary] Hejie Zhisheng Dan / Supreme Holy Pill for Harmonizing and Resolving). The brilliance of this formula lies in its apparent simplicity containing profound principles. Since Liver Qi stagnation must be soothed with Chai Hu and Bai Shao, excessive use would inevitably cause obstruction and rejection. Therefore, these two herbs serve as the Jun (Emperor) herbs, assisted by the cold and dispersing properties of Yu Jin, the phlegm-resolving action of Bai Jie Zi, the nodule-dispersing effect of Tian Hua Fen, the middle-jiao harmonizing role of Gan Cao, and the dampness-removing function of Fu Ling. The medicinal nature and aroma are mild, gentle, and easy to absorb. They do not contend or fight but act in harmony and affinity, naturally reaching the site of illness and opening the gates, rather than forcing entry which might lead to a fortified refusal.
Regarding Shi Jue causing Qi closure, this is due to pathogenic factors blocking the Qi, requiring medication to open it. How to open it? One may use Gua Di (Cucumeris Fructus) to induce vomiting, or use Zao Jiao (Gleditsiae Sinensis Spina) to induce sneezing. The prescription uses seven Gua Di fruits, two bowls of water, decocted to one bowl of soup, with a little salt added, and administered orally. This will induce the vomiting of several bowls of thick phlegm, leading to recovery. Alternatively, use Zao Jiao Ci (Gleditsiae Sinensis Spina), grind into a fine powder, place the powder in a goose feather tube, and blow it into the patient's nose. Inducing sneezing and the expectoration of thick yellowish phlegm will result in recovery. Generally, Jue syndromes are often associated with Heat Pathogens (Heat Evil); however, heat pathogens typically manifest with shouting or crying. Here, the patient is silent and appears like a corpse, clearly indicating a person with Yin Deficiency who has suddenly been affected by Yin Pathogens (Yin Evil). One cannot treat this with methods for Yang Jue; otherwise, rescue is unlikely. It is better to first use Gua Di and Zao Jiao to induce vomiting and remove saliva and phlegm, allowing the patient to speak again, and then treat with Ren Shen (Ginseng Radix) 5 qian, Bai Wei (Cynanchi Atrati Radix) 1 qian, Fu Ling 3 qian, Bai Zhu (Atractylodis Macrocephalae Rhizoma) 5 qian, and Ban Xia (Pinelliae Rhizoma) 2 qian, which will bring peace. ([Commentary] Kaibi Zhisheng Dan / Supreme Holy Pill for Opening Blockages). This is one method of Kai Zhi.
Master Zhang said: The discussion is unique and the formulas are excellent. For Wind Stroke syndromes, Guadi San (Melon Seed Powder) and Zao Jiao Tang (Soap Pod Decoction) can also be used to open the blockage. However, one must subsequently use Ren Shen 1 liang, Ban Xia 3 qian, Nan Xing (Arisaematis Rhizoma Preparatum) 3 qian, and Fu Zi (Aconiti Lateralis Radix Preparata) 1 qian to follow up. Otherwise, merely using Gua Di and Zao Jiao only temporarily opens the gate, failing to consolidate the Middle Qi (Middle Guardian Qi). What benefit is there in opening the gate without maintaining internal strength?
Master Hua said: There are two other methods not yet transmitted. One is Yinyang Tang (Yin-Yang Decoction). The method involves taking one bowl of boiling water and one bowl of cool water, mixing them evenly, adding a pinch of stir-fried salt, stirring vigorously over a hundred times until bubbles form, and drinking it. For anyone whose Upper Jiao desires to vomit but cannot, drinking this will induce immediate vomiting and cure the condition.
The second is the Sneezing Method, which has not been taught. Use Sheng Ban Xia (Raw Pinelliae Rhizoma) 3 qian, grind into powder, make pills the size of soybeans using water, and insert into the nostrils. This will cause incessant sneezing; drinking water will immediately stop it. This treats Wind Stroke aphasia, Shi Jue, etc., and is also effective for Zhong E (Sudden Malignancy/Toxic Qi Invasion) and Zhong Gui (Ghost Strike/Sudden Fright), all being methods of Kai Zhi.
(Note: Guan Ge syndrome, characterized by inability to intake above and inability to excrete below, involves the Upper and Lower Jiao, but the root lies in the Middle Jiao. Yu Jiayan treated this effectively by adjusting Huanglian Tang (Coptis Decoction) and administering Bawei Wan (Eight-Ingredient Pill) in the morning. I record this at the end for clinicians to choose according to their judgment. The detailed methods are described in *Yimen Falv · Guan Ge Tiao*, so I will not repeat them here. Li Zi Yong notes.)