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Cheng Wuji's Commentary: Qi rushing upward refers to the sensation of qi in the abdomen surging upward intermittently. This is a condition occurring after emesis or purgation; although purgation has been used, the pathogenic factor remains in the exterior, hence this manifestation. In the case of Pi syndrome (epigastric fullness and stuffiness), when qi rushes upward to the throat, it is also caused by erroneous application of sweating, vomiting, or purging methods. There are cases where the symptoms resemble those of Guizhi Tang (Cinnamon Twig Decoction) syndrome, with epigastric fullness and qi rushing upward to the throat causing dyspnea; in such cases, Gualou San (Thistle Powder) should be used. This occurs due to excess phlegm-fluid retention in the diaphragm without prior sweating, vomiting, or purging, thus warranting emetic therapy. For Jueyin disease (disease of the Liver and Pericardium channels) characterized by qi striking the heart, and pathological qi surging upward, careful consideration is required, and treatment should be administered according to specific textual guidelines.

If there is qi-striking pain in the heart accompanied by vomiting of roundworms, this is a primary Jueyin disease. If qi surges upward but without vomiting roundworms, it belongs to Yang syndromes. If the surge reaches the throat causing respiratory obstruction, Gualou San (Thistle Powder) should be used for emesis. If there are alternating chills and fever, it is Ben Tun (Rushing Pig) disease; if there is spasmodic contraction in the genitalia, it is Yin-Yang Yi (Yin-Yang Exchange) disease; if sudden lockjaw occurs, it is Gang Jing (Stiff Spasm). Each of these conditions following sweating, vomiting, or purging has its own therapeutic method; students should consult detailed references. The formulas and discussions for primary Jueyin diseases have been presented in previous articles.

When the condition resembles Guizhi Tang (Cinnamon Twig Decoction) syndrome, but without headache or stiff neck, with a slightly floating pulse at the Cun position, epigastric fullness and hardness, and qi rushing upward to the throat causing dyspnea, this indicates cold-phlegm in the chest. Emesis is indicated, preferably using Gualou San (Thistle Powder).

Gualou (Thistle Fruit, *Momordicae Fructus*), roasted until yellow; Chi Xiaodou (Red Adzuki Bean, *Vigna angularis*): each one fen. Grind both into a fine powder. Take one qian of the powder, mix with one he of Xiangchi (Fermented Soybean, *Sojae Semen Praeparatum*) and seven ge of water. Soak the Xiangchi first, then boil until a thin porridge consistency is reached. Strain and take the decoction, mixing it with the powder. Take warm in one dose. If no vomiting occurs, increase the dosage slightly. Stop when vigorous vomiting is achieved. Do not administer to patients with blood loss or those with deficiency constitution.

Huoren Shu Commentary: For Gualou San (Thistle Powder), administer one qian bi per dose. After ingestion, lie down. If the urge to vomit arises, endure it for a while. If no vomiting occurs after a long time, mix three qian bi of powder with two ge of soup and induce vomiting by stimulating the throat with a finger. If still no vomiting, slightly increase the dose. Continue until vomiting occurs.

If the initial vomiting is insufficient and the pathogen remains, repeat the emetic procedure the next day as before, ensuring not to cause excessive depletion. If the drug's effect passes without vomiting, drink one sheng of hot water to assist the medicinal power. After vomiting, food may be consumed; further doses are unnecessary. If too much medicine is taken, drink water to counteract it.

Ben Tun (Rushing Pig) disease, characterized by qi rushing to the chest, abdominal pain, and alternating chills and fever, is primarily treated with Bentong Tang (Rushing Pig Decoction) (see Miscellaneous Diseases - Accumulation section).

Yin-Yang Yi (Yin-Yang Exchange) disease, characterized by urgency and tightness in the lower abdomen, spasmodic contraction of the genitalia, heat rushing to the chest, heavy head unwilling to lift, and visual disturbances (seeing spots), is treated with Shao Kun San (Burnt Underwear Powder) (see Yin-Yang Exchange section).

When qi rushes to the chest and throat, causing lockjaw and inability to speak, indicating impending Gang Jing (Stiff Spasm), Gegen Tang (Kudzu Decoction) is appropriate (see Miscellaneous Diseases - Spasm section).

If burning needle therapy is used to induce sweating, and the needle site becomes cold, forming a nodule that turns red, Ben Tun (Rushing Pig) disease will inevitably develop, with qi rushing from the lower abdomen to the heart. Moxibustion should be applied to each nodule (one moxa cone per nodule), followed by Guizhi Jia Gui Tang (Cinnamon Twig Decoction with Added Cinnamon Twig).

Guizhi (Cinnamon Twig, *Ramulus Cinnamomi Cassiae*, 2 liang 5 qian); Shaoyao (Peony Root, *Radix Paeoniae Alba*, 1 liang 5 qian); Shengjiang (Fresh Ginger, *Rhizoma Zingiberis Recens*, 1 liang 5 qian); Gancao (Licorice Root, *Radix Glycyrrhizae Uralensis*, 1 liang); Dazao (Jujube, *Fructus Jujubae*, 6 pieces). Chop the above five ingredients. Take 5 qian per dose, decoct in water, and take warm. (The addition of Guizhi in Guizhi Jia Gui Tang enables it to drain/subdue the Ben Tun [Rushing Pig] qi.)

In Dong Qi (Moving Qi) syndrome, if sweating is induced, qi will rush upward, centering on the heart area (see Moving Qi section). In Taiyang disease, if qi surges upward after purgation, use Guizhi Tang (Cinnamon Twig Decoction) with the previously described method. If qi does not surge upward, do not administer it. After vomiting and purging in Shanghan (Cold Damage), if there is rebellious fullness below the heart, qi rushing to the chest, dizziness, and a deep, tight pulse, inducing sweating will disturb the meridians, causing body tremors; treat with Fuling Baizhu Gancao Tang (Poria, Atractylodes, and Licorice Decoction) (see Tremor section). After vomiting, purging, and subsequent sweating in Shanghan, if deficiency-heat irritability appears with a very faint pulse, and after eight or nine days, epigastric fullness and hardness, hypochondriac pain, qi rushing to the throat, dizziness, and palpitations/tremors of the meridians occur, prolonged neglect will lead to Wei syndrome (flaccidity syndrome).

Appendix:

Huoren Shu: Ligen Tang (Li Root Decoction), treats qi rushing upward centering on the heart.

Banxia (Pinellia Tuber, *Rhizoma Pinelliae Ternatae*); Danggui (Angelica Sinensis Root, *Radix Angelicae Sinensis*); Shaoyao (Peony Root, *Radix Paeoniae Alba*); Shengjiang (Fresh Ginger, *Rhizoma Zingiberis Recens*); Fuling (Poria, *Sclerotium Polypori); Guizhi (Cinnamon Twig, *Ramulus Cinnamomi Cassiae*); Huangqin (Scutellaria Root, *Radix Scutellariae*); Gancao (Licorice Root, *Radix Glycyrrhizae Uralensis*); Ganli Gen Bapi (White Bark of Li Root, *Cortex Pruni Salicinae*). All in equal parts. Chop the above nine ingredients. Take 5 qian per dose, decoct in water, and take warm.