伤寒动气者。乃筑筑然动于腹中者是也。脏气不治。随脏所至。发泄于脐之四旁。跳动
筑筑然。谓之动气。难经曰。肝内证。脐左有动气。按之牢若痛。心内证。脐上有动气。按
之
不
左
之
可
热
则
。头眩心悸。是下之而动肺气者也。动气在下不可发汗。发汗则无汗。心中大烦。骨节苦痛
。目晕恶寒。食则反吐。谷不得下。是发汗而动肾气者也。动气在下不可下。下之则腹满。
猝起头眩。食则下清谷。心下痞。是下之为动肾气者也。其脾内证。当脐有动气。经特曰脐
之四旁。动气不可汗下而独不言脾。盖当脐有动气者。以脾主中州。为胃以行津液。发汗吐
下。耗损津液必先动脾。其余四脏动气发动。妄有汗下犹先动脾。脾家发动气者。讵可动之
也。所以特不言之也。伤寒所以必看外证为当者。盖不在脉之可见。必待问之可得也。发汗
吐下者。务要审谛。举此动气。类可知矣。
歌括云。奔豚动气数般方。左右高低细揣量。去术理中并用桂。不堪汗下例中详。动气
者。
气
脐
非问证何以知之。然则调理伤寒。贵于纤悉问证。动气诸药。详见不可汗不可下条例中。太
阳病下之后。气上冲者桂枝汤。若不上冲不可与也。若从腹上冲于心。桂枝加桂汤。发汗后
脐下悸者。欲作奔豚也。茯苓桂甘大枣汤。动气通用理中汤去术加桂。盖桂利小便。泄奔豚
故
眩
盖以误汗动经。故以白术闭其汗也。奔豚动气。脉沉弱。肢体冷。可与养正丹。动气证治论
。用柴胡桂枝汤。
伤寒病中出现动气症状的，是指腹部中有筑筑然跳动的感觉。这是脏气失调，随着病邪所在脏腑的位置，发泄于脐部四周，出现跳动且伴有筑筑然的感觉，这被称为动气。《难经》说：肝的内证，表现为脐左侧有动气，按压时感觉坚硬且疼痛；心的内证，表现为脐上有动气，按压时感觉坚实且疼痛；肺的内证，表现为脐右侧有动气，按压时感觉坚实且疼痛；肾的内证，表现为脐下有动气，按压时感觉坚实且疼痛。
如果误用下法而损伤肺气，会出现头眩、心悸等症状。动气位于下部（指肾）不可发汗，若发汗则会导致无汗、心中极度烦躁、骨节剧烈疼痛、目眩恶寒、进食后反而呕吐、食物无法下行。这是因发汗而动摇了肾气。动气位于下部不可攻下，若攻下则会导致腹部胀满、突然起身时头晕眼花、进食后排泄未消化的食物、心下痞塞。这是因攻下而动摇了肾气。
脾的内证，表现为当脐处有动气。经文特别指出是脐之四旁有动气，却唯独没有提及脾脏。这是因为当脐处有动气者，由于脾主中州，负责为胃传输津液，发汗、催吐、攻下等方法耗损津液，必定首先动摇脾脏。其余四脏动气发动，若妄用汗法或下法，也必先动摇脾脏。既然脾家已经发动了动气，怎么还能再扰动它呢？所以经文特意不言及脾。
伤寒病之所以必须详细询问外在证候才是正确的，是因为这些情况往往不在脉象上直接可见，必须通过问诊才能得知。使用发汗、催吐、攻下等治法，务必审慎仔细。列举出这种动气的情况，其他类似情况就可以类推了。
歌诀说：“奔豚与动气有多种方剂，需仔细权衡左右高低的位置。去除白术的理中汤配合桂枝使用，不可发汗和攻下的情况在条例中有详细说明。”动气并非仅在脐部，如果不是通过问诊如何能知道呢？因此调理伤寒，贵在细致地询问证候。治疗动气的各种药物，详见于“不可汗”、“不可下”的条例中。
太阳病经过攻下之后，如果气向上冲逆的，用桂枝汤；如果气不向上冲逆的，则不可给予此方。如果气从腹部向上冲至心脏部位，用桂枝加桂汤。发汗后脐下悸动的，是想要发作奔豚症，用茯苓桂枝甘草大枣汤。动气通用的方剂是理中汤去掉白术加上桂枝。因为桂枝能通利小便，宣泄奔豚之气。
如果是因误用汗法动摇经脉，导致眩晕，可以用白术来固表止汗。奔豚与动气，若脉象沉弱、肢体寒冷，可以与养正丹。关于动气的证治论述，可用柴胡桂枝汤。
In Taiyang disease (Sun Yang Disease), the manifestation of "moving qi" refers to a throbbing sensation within the abdomen. This occurs due to dysfunction of the zang organs, where the pathological qi follows the affected organ and manifests around the umbilicus, presenting as throbbing with a "zhuzhu" (pounding) sensation, termed "moving qi". The *Nan Jing* (Classic of Difficult Issues) states: For internal liver syndrome, there is moving qi on the left side of the umbilicus, which feels firm and painful upon pressure; for internal heart syndrome, there is moving qi above the umbilicus, which feels firm upon pressure; for internal lung syndrome, there is moving qi on the right side of the umbilicus, which feels firm upon pressure; for internal kidney syndrome, there is moving qi below the umbilicus, which feels firm upon pressure.
If purgation is incorrectly applied, damaging Lung Qi, symptoms such as dizziness and palpitations may occur. When moving qi is located in the lower region (referring to the Kidney), sweating therapy is contraindicated. If sweating is induced, it leads to anhidrosis, severe mental restlessness, severe pain in the bone joints, dizziness with aversion to cold, vomiting after eating, and inability to retain food. This indicates that sweating has disturbed Kidney Qi. Purgation is also contraindicated when moving qi is in the lower region. If purgation is used, it results in abdominal fullness, sudden dizziness upon rising, passage of undigested food after eating, and epigastric stuffiness. This indicates that purgation has disturbed Kidney Qi.
For internal spleen syndrome, there is moving qi directly at the umbilicus. The classic text specifically mentions moving qi around the four sides of the umbilicus but omits the Spleen. This is because the Spleen governs the central region and transports fluids for the Stomach. Therapies such as sweating, vomiting, and purging deplete body fluids and inevitably disturb the Spleen first. Even if other four zang organs' moving qi is activated, improper use of sweating or purging will still disturb the Spleen first. Since the Spleen's qi is already activated, how can it be further disturbed? Therefore, the text deliberately does not mention the Spleen.
In Taiyang disease, it is essential to carefully inquire about external syndromes because these conditions are not always visible in the pulse and must be confirmed through inquiry. When employing sweating, vomiting, or purging therapies, one must exercise extreme caution. By understanding this case of moving qi, similar cases can be inferred by analogy.
The verse states: "There are various formulas for Ben Tun (Rushing Pig) and moving qi; carefully assess their positions on the left, right, high, and low. Li Zhong Tang (Regulate the Middle Decoction) without Bai Zhu combined with Gui Zhi is used; details on contraindications for sweating and purging are explained in the relevant regulations." Moving qi is not limited to the umbilical area; without inquiry, how could it be known? Therefore, in managing Taiyang disease, meticulous inquiry into symptoms is paramount. The specific herbs for treating moving qi are detailed in the sections regarding contraindications for sweating and purging.
After purgation in Taiyang disease, if Qi rushes upward, Gui Zhi Tang (Cinnamon Twig Decoction) should be administered. If Qi does not rush upward, this formula is contraindicated. If Qi rushes from the abdomen up to the heart region, Gui Zhi Jia Gui Tang (Cinnamon Twig Decoction plus Cinnamon Twig) is indicated. After sweating, if there is palpitation below the umbilicus, it suggests impending Ben Tun (Rushing Pig Syndrome); Fu Ling Gui Gan Da Zao Tang (Poria, Cinnamon Twig, Licorice, and Jujube Decoction) is prescribed. For general treatment of moving qi, Li Zhong Tang (Regulate the Middle Decoction) without Bai Zhu (Atractodis Rhizoma) plus Gui Zhi (Cinnamon Twig) is commonly used. Gui Zhi promotes urination and dissipates Ben Tun.
If dizziness arises from erroneous sweating disturbing the meridians, Bai Zhu (Atractodis Rhizoma) can be used to secure the exterior and stop sweating. For Ben Tun and moving qi presenting with a deep and weak pulse and cold limbs, Yang Zheng Dan (Yang-Protecting Pill) may be given. Regarding the discussion on the syndrome and treatment of moving qi, Chai Hu Gui Zhi Tang (Bupleurum and Cinnamon Twig Decoction) can be utilized.