气逆者,气自腹中时时上冲也。盖因太阳病,下之,表邪乘虚传里,里不受邪,则气逆上行,
仍在表也,当复汗之。厥阴客热,气上冲心,此热在里而气上也。若病如虚羸少气,气逆欲吐者,
又动气发汗而气上冲者,此正气虚而气逆也,当根据法调治之。脉沉紧者,不可汗。
太阳病,下之后其气上冲者,可与桂枝汤;不上冲者,不可与之。病如桂枝证,头不痛,项不
强,寸脉浮微,胸中痞硬,气上冲咽喉不得息,此为胸中寒,瓜蒂散吐之;脉微者,不可吐。吐则
心口逆满,气上冲胸,起则头眩,脉沉紧,发汗则动经,身为振摇,茯苓白术桂枝甘草汤。
动气,发汗,气上冲者,李根汤。病后虚羸少气,气逆,吐者,竹叶石膏汤。
短气者,呼吸短促而不能相续也。《千金方》云少气不足以息也。《金匮要略》
曰∶短气不足以息者,实。大抵心腹胀满而短气者,邪在里而为实。心腹濡满而气短者,邪在表而
为虚。又有停水心下,亦令短气,随证攻治,无不愈矣。
短气潮热,腹满而喘,此为外欲解而里欲实,大柴胡汤,小承气汤。
风湿相搏,汗出短气,小便不利,恶风不欲去衣,其邪在表,甘草附子汤。
食少饮多,水停心下,短气,小半夏汤。
身凉干呕,短气汗出,不恶寒,此表解里有水,十枣汤。
误下太阳,短气烦躁,心中懊 ,便为结胸,大陷胸汤及丸。
气逆,是指气从腹中不时向上冲逆。这通常是因为太阳病(太阳经受邪所致的病证),误用攻下法,导致表邪乘虚传入体内,里气不能承受邪气,于是气逆上行;若邪气仍在体表,应当再次使用发汗法治疗。厥阴经受客热侵袭,气上冲至心部,这是热邪在里而气机上逆。如果病人身体虚弱消瘦、气息短少,且气逆想呕吐,这是因为误动气机并误用发汗法导致气上冲,属于正气虚弱而气逆,应当根据法则进行调理治疗。脉象沉紧的,不可使用发汗法。
太阳病,经过攻下治疗后,如果气机上冲,可以给予桂枝汤;如果不气上冲,则不可给予。病情类似桂枝汤证,但头部不痛,项部不强硬,寸脉浮而微弱,胸中痞塞坚硬,气上冲咽喉导致呼吸不畅,这是胸中有寒饮,应用瓜蒂散催吐;脉象微弱的,不可催吐。若催吐后出现心口逆满、气上冲胸,起身时头晕目眩,脉象沉紧,此时若再发汗则会扰动经络,导致身体震颤摇动,应使用茯苓白术桂枝甘草汤。因动气而误用发汗,导致气上冲的,使用李根汤。病后身体虚弱消瘦、气息短少、气逆且呕吐的,使用竹叶石膏汤。
短气,是指呼吸短促而不能连续接续。《千金方》说这是“少气不足以息”。《金匮要略》说:“短气不足以息的,属于实证。”大抵心腹胀满而短气的,是邪气在里而表现为实证。心腹部柔软胀满而气短的,是邪气在表而表现为虚证。又有水饮停聚在心下(胃脘部),也会导致短气,随证攻治,没有不痊愈的。
短气伴有潮热,腹部胀满且喘息,这是表邪欲解而里邪欲实,使用大柴胡汤或小承气汤。风湿相互搏结,出汗且短气,小便不利,怕风不想脱衣,邪气在表,使用甘草附子汤。饮食少而饮水多,水饮停聚在心下,导致短气,使用小半夏汤。身体凉爽、干呕、短气且出汗,不怕冷,这是表邪已解而里有水饮,使用十枣汤。误用攻下法治疗太阳病,导致短气烦躁,心中烦闷懊恼,形成结胸证,使用大陷胸汤或丸剂。
Qi Rebellion refers to the sensation of Qi rushing upward from the abdomen from time to time. This is generally caused by a Taiyang disease (disease pattern resulting from pathogenic invasion of the Taiyang channel), where inappropriate purgation allows exterior pathogens to transmit inward due to deficiency. If the interior cannot accept the pathogen, Qi rebels and moves upward. If the pathogen remains in the exterior, sweating therapy should be reapplied. When Jueyin channel receives external heat, Qi rushes up to the heart; this indicates heat residing in the interior with rebellious Qi movement. If the patient presents with emaciation resembling consumptive weakness, shortness of breath, and rebellious Qi with nausea/vomiting, it results from disturbing Qi and improper sweating leading to upward rebellion; this is due to deficiency of righteous Qi and rebellious Qi, and treatment should follow standard protocols for regulation. If the pulse is deep and tight, sweating is contraindicated.
In Taiyang disease, after purgation, if Qi rebels upward, Guizhi Tang (Cinnamon Twig Decoction) may be administered; if Qi does not rebel upward, it should not be given. If the condition resembles a Guizhi Tang syndrome but without headache or neck stiffness, and the cun pulse is floating and slightly weak, with chest oppression and hardness, and Qi rebelling up to the throat causing difficulty in breathing, this is cold-phlegm obstructing the chest, treated with Gualian San (Melon Seed Powder) to induce vomiting. If the pulse is faint, vomiting induction is contraindicated. If vomiting induces fullness and rebellion at the epigastrium, Qi rushing to the chest, dizziness upon standing, and a deep-tight pulse, subsequent sweating would disturb the collaterals, causing body tremors; Puling Baizhu Guizhi Gancao Tang (Poria, Atractodes, Cinnamon Twig, and Licorice Decoction) is indicated. For cases where "Dongqi" (pulsating qi masses) leads to Qi rebellion after improper sweating, Ligen Tang (Li Root Decoction) is used. For post-illness emaciation, shortness of breath, Qi rebellion, and vomiting, Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction) is prescribed.
Shortness of Breath (Duan Qi) refers to rapid, shallow respiration that cannot be sustained continuously. The *Qianjin Fang* states this as "insufficient Qi failing to sustain respiration." The *Jin Gui Yao Lue* states: "Shortness of breath with inability to sustain respiration indicates Excess." Generally, abdominal distension/fullness accompanied by shortness of breath indicates an Excess pattern with pathogens in the interior. Soft abdominal fullness with shortness of breath indicates a Deficiency pattern with pathogens in the exterior. Additionally, fluid retention in the epigastrium can also cause shortness of breath; treating according to the specific presentation ensures recovery.
Shortness of breath with tidal fever, abdominal fullness, and wheezing indicates that exterior pathogens are resolving while interior pathogens are becoming excess; Da Chai Hu Tang (Major Bupleurum Decoction) or Xiao Cheng Qi Tang (Minor Order the Qi Decoction) is used. When Wind-Dampness combats each other, presenting with sweating, shortness of breath, dysuria, aversion to wind, and reluctance to remove clothing, the pathogen is in the exterior; Gancao Fuzi Tang (Licorice and Prepared Aconite Decoction) is indicated. With poor appetite, excessive drinking, fluid retention in the epigastrium, and shortness of breath, Xiao Banxia Tang (Minor Pinellia Decoction) is used. With cool body, dry retching, shortness of breath, sweating, and no aversion to cold, the exterior is resolved but water resides in the interior; Shizao Tang (Ten Jujube Decoction) is prescribed. Inappropriate purgation of Taiyang disease leading to shortness of breath, irritability, and mental restlessness results in Jie Xiong (Chest Binding); Da Xian Xiong Tang or Wan (Major Draining the Chest Decoction/Pills) is used.