《素问·腹中论》帝曰∶有病膺肿颈痛,胸满腹胀,此为何病?何以得之?岐伯曰∶名厥逆。帝曰∶治
之奈何?岐伯曰∶灸之则喑,石之则狂,须其气并,乃可治也。帝曰∶何以然?岐伯曰∶阳气重上,有余于
上,灸之则阳气入阴,入则喑;石之则阳气虚,虚则狂;须其气并而治之,可使全也。
此因阳气重叠上逆,故名厥逆。其阳逆者,本由阴气不固,如再以火灸之,逼之入阴,则气耗散而火邪
伤肺,则失音而喑也;石者,砭法,乃更泄其气,气泄则阳虚,而心神无主则昏狂,然非有余实火之狂,其病
危矣,故不可用灸砭之法。盖厥者阴阳格逆,必须俟其二气归并,而阴阳渐和,乃可调之,庶使全其生也。
《素问·病能论》帝曰∶有病厥者,诊右脉沉而紧,左脉浮而迟,不知病主安在?岐伯曰∶冬诊之,右
脉固当沉紧,此应四时,左脉浮而迟,此逆四时,在左当主病在肾,颇关在肺,当腰痛也。帝曰∶何以言之?
岐伯曰∶少阴脉贯肾络肺,今得肺脉,肾为之病,故肾为腰痛之病也。
冬令阳气归藏,沉紧之脉,应时令而无病也。今左脉浮迟,是逆时令,逆在左,故知病在左,以肾水亏而
阳浮动,为厥病也。肾脉络肺,故关于肺,浮乃肺之脉象也,而主病在肾虚,腰为肾府,故必腰痛也。
黄帝问道:有的人出现胸膺部肿胀、颈部疼痛,胸部胀满、腹部膨隆,这是什么病?是怎么得的呢?岐伯回答说:名叫厥逆。黄帝问:怎么治疗呢?岐伯说:如果用艾灸治疗会导致失音,如果用砭石放血治疗会导致发狂,必须等到阴阳之气相并调和之后,才可以进行治疗。黄帝问:为什么这样呢?岐伯说:这是因为阳气重迭上逆,有余于上部。如果施以艾灸,会使阳气陷入阴分,陷入则导致失音;如果使用砭石泄气,会使阳气更虚,虚极则导致心神无主而发狂;必须等待其阴阳之气相并调和后再进行治疗,才能使疾病痊愈。
这正是因为阳气重叠上逆,所以名叫厥逆。这种阳气的上逆,根本原因在于阴气不固。如果再使用火灸之法,逼迫阳气入于阴分,就会导致气机耗散,火邪损伤肺脏,从而引起失音喑哑;所谓的“石”,是指砭石疗法,这会进一步泄夺正气,气泄则阳气虚弱,心神失去主宰就会昏乱发狂。但这并非实火导致的狂证,病情已经非常危重,所以不可采用灸法和砭法。大概厥证的本质是阴阳格拒逆乱,必须等待阴阳二气归并调和,使阴阳逐渐和谐,然后才能调理,这样才能保全生命。
《素问·病能论》中记载:黄帝问道:有人患厥病,诊察时发现右脉沉而紧,左脉浮而迟,不知道病症主要在哪里?岐伯回答说:如果在冬季诊察,右脉本来应当沉紧,这是顺应四时变化的正常脉象;左脉浮而迟,这是违背四时变化的异常脉象。左脉异常,说明病位主要在肾,同时也与肺有关,患者应当伴有腰痛的症状。黄帝问:为什么这样说呢?岐伯回答说:足少阴肾经贯穿肾脏并联络肺脏,现在诊得肺的脉象(浮迟),说明肾脏发生了病变,因此肾虚是导致腰痛的原因。
冬季阳气应当潜藏,脉象沉紧是顺应时令的正常表现,并无疾病。现在左脉呈现浮迟之象,这是违背时令的表现。脉象逆乱在左侧,所以知道病位在左侧(肾属水,位于下焦及左侧对应关系,此处指病机涉及肝肾或左脉候肝肾等理论,原文意指左脉异常对应肾)。这是由于肾水亏虚而导致阳气浮动,形成了厥病。因为肾脉络通于肺,所以病情牵连到肺,浮脉是肺的脉象特征,但根本病因在于肾虚。腰为肾之府,所以必然会出现腰痛的症状。
Huangdi asked: There is a condition characterized by swelling of the chest and neck, fullness in the chest, and distension of the abdomen. What disease is this? How did it arise? Qibo replied: It is named Jue Ni (Jue-Ni, reversal counterflow). Huangdi asked: How should it be treated? Qibo replied: If moxibustion is applied, aphonia (loss of voice) will result; if Bian Shi (stone lancet therapy) is used, mania will ensue. One must wait until the Qi merges harmoniously before treatment can proceed. Huangdi asked: Why is this so? Qibo replied: This occurs because Yang Qi is heavy and reverses upward, being excessive in the upper body. If moxibustion is applied, Yang Qi enters the Yin aspect; entering Yin leads to aphonia. If stone lancets are used to drain, Yang Qi becomes deficient; deficiency leads to mania. Treatment must await the merging of Qi to ensure recovery.
This condition is named Jue Ni precisely because Yang Qi overlaps and reverses upward. The root cause of this Yang reversal is the failure of Yin Qi to secure itself. If fire moxibustion is further applied, forcing Yang into Yin, Qi will dissipate, and Fire pathogenic factors will damage the Lung, resulting in aphonia. "Stone" refers to Bian Shi (lancet therapy), which further drains Qi. When Qi is drained, Yang becomes deficient, and without the master control of the Heart Spirit (Shen), confusion and mania occur. However, this is not mania caused by excess real fire; the condition is critical. Therefore, moxibustion and Bian Shi methods are contraindicated. Generally, Jue syndrome involves the rejection and reversal of Yin and Yang. One must wait for the two Qi to merge and for Yin and Yang to gradually harmonize before regulating the body, thereby preserving life.
In *Su Wen: Bing Neng Lun*, Huangdi asked: A patient suffers from Jue syndrome. Palpation reveals a deep and tight pulse on the right side, and a floating and slow pulse on the left side. I do not know where the primary pathology lies. Qibo replied: If diagnosed in winter, the right pulse being naturally deep and tight corresponds to the four seasons and is normal. The left pulse being floating and slow violates the seasonal norms. Abnormality in the left pulse indicates the pathology is primarily in the Kidney, closely related to the Lung, and the patient likely suffers from lower back pain. Huangdi asked: Why do you say so? Qibo replied: The Shaoyin (Lesser Yin) channel penetrates the Kidney and connects with the Lung. Now that a Lung pulse pattern is obtained, it indicates disease in the Kidney; thus, Kidney deficiency is the cause of the lower back pain.
During winter, Yang Qi returns to storage. A deep and tight pulse conforms to the season and indicates no disease. The current floating and slow pulse on the left violates the seasonal norm. The violation is on the left, indicating the pathology is on the left (associated with the Kidney/Water). This is due to Kidney Water deficiency causing Yang to float and ascend, resulting in Jue syndrome. Since the Kidney channel connects to the Lung, the pathology involves the Lung. Floating is the pulse image of the Lung, but the primary pathology lies in Kidney deficiency. The waist is the residence of the Kidney; therefore, lower back pain must occur.