成 气上冲者腹里气时时上冲也此汗吐下后之疾虽经下之邪犹在表故也痞病气上冲咽喉亦由误汗吐下而生又有病
如桂枝证胸中痞气上冲咽喉不得息瓜蒂散盖未经汗吐下作膈实故宜吐也厥阴气上撞心易病气上冲尤宜消息按条而施治焉
气撞心疼吐蛔者厥阴本病也如气上冲不吐蛔者为阳证若冲咽不得息者瓜蒂散吐之往来寒热者奔脉阴拘挛者阴阳易
卒口噤者刚痉与汗吐下之后各有证治方法学人详之厥阴本病方论已见前条
病如桂枝证头不痛项不强寸脉微浮胸中痞硬气上冲咽喉不得息者胸有寒也当吐之宜瓜蒂散
瓜蒂（炒黄） 赤小豆（各一分）上研为细末取一钱用豉一合汤七合先渍之须臾煎成稀糜去渣取汁相和温顿服不吐
少少加得快吐乃止诸亡血虚家不可与服
活 瓜蒂散每服一钱匕药下便卧欲吐且忍之良久不吐取三钱匕汤二合和服以手指探之便吐不吐复稍增之以吐为度
若吐少病不除明日如前法再吐之不可令人虚也如药力过时不吐饮热汤一升以助药力吐讫便可食无须更服若服药过多者
饮水解之
奔豚气上冲胸腹痛往来寒热奔豚汤主之（方论见杂病积聚门）
阴阳易少腹里急引阴中拘挛热上冲胸头重不欲举眼中生花者宜烧 散（论见阴阳易）
气上冲胸口噤不得语欲作刚痉者宜葛根汤（论见杂病痉门）
烧针令其汗针处被寒核起而赤者必发奔豚气从少腹上冲心者灸其核各一壮与桂枝加桂汤
桂枝（二两半） 芍药 生姜（各一两半） 甘草（一两） 大枣（六枚）上 咀每服五钱水煎温服（桂枝加桂以能泄奔豚气也）
动气发汗则气上冲正在心端（论见动气）太阳下后其气上冲者以桂枝汤方用前法若不上冲者不可与之伤寒吐下后心
下逆满气上冲胸头眩脉沉紧若发汗则动经身为振摇者茯苓白术甘草汤（方见振摇）伤寒吐下后发汗虚烦脉甚微八九日心
下痞硬胁下痛气上冲咽喉眩冒经脉动惕者久而成痿
附
活 李根汤 治气上冲正在心端
半夏 当归 芍药 生姜 茯苓 桂枝 黄芩 甘草 甘李根白皮（各等分）上 咀每服五钱水煎温服
成无己注：气上冲，是指腹中的气时时向上冲逆。这是发汗、催吐、泻下之后产生的病证，虽然经过攻下，但邪气仍在表分，所以会出现这种情况。痞证中气上冲至咽喉，也是由于误用汗、吐、下法所致。又有病情类似桂枝汤证，但胸中痞塞，气上冲咽喉导致呼吸不畅的，应用瓜蒂散，这是因为未经过汗、吐、下治疗而形成的膈实之证，所以适宜用涌吐法。厥阴经的气上撞心，以及容易出现的病理性气上冲，尤其应当仔细斟酌，按照条文来施治。
如果是气撞心痛并吐出蛔虫的，这是厥阴经的本病。如果气上冲但不吐蛔虫的，属于阳证。若气冲至咽喉导致呼吸困难的，应用瓜蒂散涌吐。出现往来寒热的，是奔豚病；出现阴部拘挛的，是阴阳易病；突然口噤不能言语的，是刚痉。这些在汗、吐、下法之后各有相应的证治方法，学者们应详细研究。厥阴本病的方论已在前面条文中见到。
病情类似桂枝汤证，但头不痛、项不强，寸脉微浮，胸中痞塞坚硬，气上冲咽喉导致呼吸不畅的，这是胸中有寒饮。应当用涌吐法，适宜用瓜蒂散。
瓜蒂（炒黄）和赤小豆（各一分），研成细末。取一钱药末，用香豉一合、水七合，先浸泡片刻，煎成稀粥状，去渣取汁，与药末混合，温服一次顿下。如果不吐，稍微增加剂量，以快吐为度停止。凡是失血或体质虚弱的人，不可服用。
活人书注：瓜蒂散每次服用一钱匕，药下后便躺下，想吐时且忍耐它，很久不吐，取三钱匕药末，用二合汤调和服用，用手指探喉催吐。如果还不吐，再稍加剂量，以吐为限度。如果吐得少，病未除，第二天按前法再吐一次，不可让人体虚。如果药力过时仍不吐，喝热汤一升以助药力。吐完后就可以进食，不需要再服药。如果服药过多，饮水解毒。
奔豚病，气上冲胸腹，疼痛，往来寒热，主用奔豚汤（方论见杂病积聚门）。
阴阳易病，少腹里急，牵引阴中拘挛，热气上冲胸部，头重不欲举，眼中生花，适宜用烧裈散（论见阴阳易）。
气上冲胸口，口噤不能言语，欲作刚痉的，适宜用葛根汤（论见杂病痉门）。
用烧针令其出汗，针处受寒，起核而色红的，必定引发奔豚病，气从少腹上冲心，应在红核上各灸一壮，并给予桂枝加桂汤。
桂枝（二两半）、芍药、生姜（各一两半）、甘草（一两）、大枣（六枚）。上药切碎，每服五钱，水煎温服。（桂枝加桂汤能泄奔豚之气。）
动气证，若发汗则气上冲，正在心端（论见动气）。太阳病下之后，其气上冲的，用桂枝汤，方用前法。若不上冲的，不可与之。伤寒吐下后，心下逆满，气上冲胸，头眩，脉沉紧，若再发汗则动摇经脉，身体振摇的，用茯苓白术甘草汤（方见振摇）。伤寒吐下后发汗，虚烦，脉甚微，八九日心下痞硬，胁下痛，气上冲咽喉，眩晕冒昧，经脉跳动惕然不安的，日久会形成痿证。
附方：
Cheng Wuji's Commentary: Qi rushing upward refers to the qi in the abdomen rushing upward intermittently. This is a disease occurring after sweating, vomiting, or purging; although purging has been performed, the pathogenic factor remains in the exterior, hence this occurs. In the Pi syndrome (fullness obstruction), qi rushing up to the throat also arises from erroneous use of sweating, vomiting, or purging. There are cases where the condition resembles the Guizhi Tang (Cinnamon Twig Decoction) pattern, but with chest fullness and obstruction, and qi rushing up to the throat causing difficulty in breathing; the Gualou San (Thistle Powder) should be used. This is because it is a case of diaphragmatic excess formed without prior sweating, vomiting, or purging, so the emetic method is appropriate. For Jueyin channel qi rushing against the heart, and pathological qi rushing upward, one must carefully deliberate and treat according to the specific clauses.
If there is qi rushing causing heart pain accompanied by vomiting of roundworms, this is the primary disease of the Jueyin channel. If qi rushes upward but does not involve vomiting roundworms, it belongs to a Yang pattern. If the rush reaches the throat and causes respiratory distress, Gualou San should be used for emesis. Cases presenting with alternating chills and fever are Ben Tun (Rushing Pig) disease; those with contraction and cramping of the yin organs are Yin-Yang Yi (Yin-Yang Exchange) disease; sudden lockjaw and inability to speak indicate Gang Jing (Stiff Spasm). Each of these has specific diagnostic and treatment methods following sweating, vomiting, or purging; students should study them in detail. The formulas and discussions for the primary diseases of the Jueyin channel have already appeared in previous clauses.
When the condition resembles the Guizhi Tang pattern, but there is no headache or stiffness of the neck, the cun pulse is slightly floating, the chest is full and hard, and qi rushes up to the throat causing respiratory distress, this indicates cold-fluid retention in the chest. Emesis should be induced using Gualou San.
Gualou (Thistle Fruit, processed until yellow) and Chi Xiaodou (Red Adzuki Bean, each 1 fen) are ground into a fine powder. Take 1 qian of the powder, mix with 1 he of Xiangchi (Fermented Soybean Paste) and 7 he of water. Soak briefly, then boil into a thin porridge. Strain and take the decoction, mixing it with the powder. Take warm in one dose. If vomiting does not occur, slightly increase the dose. Stop when vigorous vomiting occurs. Patients with blood loss or deficiency constitution must not take this.
Linggui Zhongjing's Commentary: For Gualou San, take 1 qian bi per dose. After taking the medicine, lie down. If you feel the urge to vomit, endure it for a long time. If vomiting does not occur, take 3 qian bi of the powder mixed with 2 he of soup, and induce vomiting by stimulating the throat with a finger. If still no vomiting, slightly increase the dose. Stop when vomiting occurs. If vomiting is insufficient and the disease persists, repeat the method the next day. Do not cause excessive weakness. If the medicinal power passes without inducing vomiting, drink 1 sheng of hot water to assist the medicinal effect. After vomiting, food can be taken; no further doses are needed. If too much medicine is taken, drink water to detoxify.
Ben Tun disease presents with qi rushing up to the chest and abdomen, pain, and alternating chills and fever; Bentun Tang is the main formula (see Miscellaneous Diseases Accumulation section).
Yin-Yang Yi disease presents with urgency and tightness in the lower abdomen,牵引 (pulling) and cramping of the yin organs, heat rushing up to the chest, heaviness of the head making lifting difficult, and visual disturbances (seeing flowers); Shao Kun San (Burned Underwear Powder) is appropriate (see Yin-Yang Yi discussion).
Qi rushing up to the chest and throat, lockjaw, and inability to speak, indicating impending Gang Jing (Stiff Spasm), should be treated with Gegen Tang (Kudzu Root Decoction) (see Miscellaneous Diseases Spasm section).
Using burning needles to induce sweating, if the needle site is exposed to cold and develops nodules that turn red, Ben Tun 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, 2 liang 5 qian), Shaoyao (Peony Root), Shengjiang (Fresh Ginger, each 1 liang 5 qian), Gancao (Licorice Root, 1 liang), Dazao (Jujube, 6 pieces). Cut the herbs. Take 5 qian per dose, decoct in water, and take warm. (Guizhi Jia Gui Tang can drain the qi of Ben Tun.)
Dongqi (Moving Qi) syndrome: If sweating is induced, qi rushes upward, stopping exactly at the heart end (see Dongqi discussion). After purging in Taiyang disease, if qi rushes upward, use Guizhi Tang with the previous method. If qi does not rush upward, do not use it. After vomiting and purging in Cold Damage, if there is rebellious fullness below the heart, qi rushing up to the chest, dizziness, and a deep, tight pulse, inducing sweating again will disturb the channels, causing body tremors; Fuling Baizhu Gancao Tang (Poria, Atractylodes, and Licorice Decoction) is indicated (see Tremors section). After vomiting, purging, and sweating in Cold Damage, if there is deficiency irritability, a very faint pulse, and after eight or nine days, fullness and hardness below the heart, pain under the ribs, qi rushing up to the throat, dizziness, and palpitations/tremors of the meridians, this may eventually lead to Wei syndrome (Flaccidity Syndrome).
Supplementary Formula:
Linggui Zhongjing: Li Gen Tang (Li Root Decoction), treats qi rushing upward stopping exactly at the heart end.
Banxia (Pinellia Tuber), Danggui (Angelica Sinensis), Shaoyao (Peony Root), Shengjiang (Fresh Ginger), Fuling (Poria), Guizhi (Cinnamon Twig), Huangqin (Scutellaria Root), Gancao (Licorice Root), Ganli Gen Bapi (White Bark of Prunus Serrulata Root, equal parts). Cut the herbs. Take 5 qian per dose, decoct in water, and take warm.