【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。
【纲】张仲景说：厥阴病的表现是，气向上冲撞心脏，心中感觉疼痛且发热，感到饥饿却不想进食，吃东西就会吐出蛔虫。如果误用泻下法治疗，会导致腹泻不止。
【目】成无己说：所谓“气上撞”，是指腹中的气不时地向上冲撞。这是经过发汗、催吐或泻下之后产生的疾病。虽然已经使用了泻下法，但邪气仍然在表。痞病中出现气上撞咽喉的症状，也是由于误用发汗、催吐或泻下所致。
魏荔彤说：这里说的是厥阴病中由传经而来的热邪为患。列举这些症状来验证，并提示禁止误用泻下法。伤寒的邪气传入少阴，成为里中之里；等到从少阴传入厥阴，又成为了三阴经的尽头。在阴尽之处受邪，也没有地方再传变了，却可以通过与厥阴互为表里的少阳经作为升降的出路。所以在阳明病中有泻下法，在少阴病中也有泻下法。如今到了阴尽的极点，少阳固然没有泻下法，厥阴更没有泻下法，误用泻下显然是错误的。然而，邪气在少阴时，原本就分寒证和热证；邪气在厥阴时，也必须区分寒热。邪气由传经进入少阴的是热证，等到进一步传到厥阴，不用问也知道是热证了。只是在于厥阴病中，如果是直中寒邪，也自然是从少阴开始，而进入厥阴，这样寒证和热证都来自少阴，很容易混淆。试着先分辨从太阴传来的是热邪，如果能辨别这一点，那么从少阴直中而起的寒邪，自然可以慢慢考察并识别出来。厥阴病，如果是通过传经得到的热邪，首先要验证其症状，首见消渴（口渴多饮）。凡是热证必然口渴，但是寒湿阻隔正气也会有口渴，想喝水但一定喝不多。没有那种喝了水后仍然渴，随喝随消、随消随渴的情况。所以，随喝随消随渴，就是传经的热邪，传入厥阴无疑。少阴位于下，厥阴位于中，热邪逐渐上传，则上焦必然受到熏灼的危害，表现为消渴、气上撞心、心中疼热，这些都是少阴的邪热顺着经络上升，最终进入肝脏致病，木火交相炽盛，各种症状就出现了。然而又有饥饿但不想吃饭，吃了饭就吐蛔虫的症状，为什么呢？大概是因为邪气从少阴传来，原本是从三阳经传入，病程久了胃气虚弱，邪热趁虚而入。蛔虫因为胃气虚弱，就不能安稳地潜伏在胃底之下，加上热邪逼迫，反而浮游在胃口的上方。于是胃虚而有热，就会觉得多饥；蛔虫在胃口处，所以不想吃东西。如果吃进去食物，食物在蛔虫上面，两者就相安无事；如果吃进去食物，蛔虫反而在食物上面，就一定会吐出蛔虫。这又是厥阴病中波及到胃部的病症。医生们或者看到热症，认为应该用泻下法；或者看到胃病，又认为应该用泻下法。随意使用泻下法，是大错特错了。少阴传给厥阴，病势日益向上。如果治疗得当，邪气可以从少阳经消散，就像阳明病传给少阳，是邪气外出的门户一样。如果违背这种趋势而强行泻下，阴性的本质是下降的，再经过误下的伤害，腹泻怎么能停止呢？张仲景在厥阴篇中，首先揭示不可泻下的禁令，表明厥阴病无论是寒证还是热证，都不可泻下。
【纲】张仲景说：病情类似桂枝汤证，但头部不痛，颈部不强硬，寸脉微微浮起，胸中痞塞坚硬，气向上冲撞咽喉，导致呼吸不畅的，这是胸中有寒痰（此处“寒”指寒饮/痰浊），应当用涌吐法治疗，适宜用瓜蒂散。
【目】寇宗奭说：这大概是未经过发汗、催吐或泻下，导致膈间实邪壅滞，所以适宜用涌吐法。
王肯堂说：气撞心痛，是厥阴的本病。如果是气向上冲撞，但不吐蛔虫的，属于阳证。如果是气上撞咽喉导致呼吸困难的，用瓜蒂散涌吐。出现往来寒热的，是奔豚病。出现阴部拘挛抽搐的，是阴阳易病。突然出现口噤（牙关紧闭）的，是刚痉。以及发汗、催吐、泻下之后的各种情况，各有相应的症状和治疗方剂，学习者请详细查阅。
[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.