论关隔 论尸厥
天师曰∶开治者，气闭不开而开之也。如关隔之症是也；或如尸厥气闭是也。关隔者，乃上焦有
关，一层关住，而饮食不能下；下焦有关，一层关住，而下不能出。此乃气之郁塞，一时偶得上吐下泻，
不能尽命而死矣。此等症，五脏六腑原未尝有损，偶然触怒，肝气冲于胃口之间，肾气不得上行，肺气
不得下达，以成此症。若言胃病，而胃实未病；若言脾病，而脾实无病也。法当以开郁为主。方用柴胡一钱，
郁金一钱，白芍三钱，茯苓一钱，白芥子一钱，天花粉一钱，苏子一钱，荆芥一钱，甘草五分，水煎
服。（〔批〕和解至圣丹。）此方妙在平常而有至理。盖肝气之郁，必用柴、芍以舒之，然过多则必阻
而不纳。方中以此二味为君，而佐以郁金之寒散，芥子之祛痰，天花粉之散结，甘草之和中，茯苓之去
湿，气味平和，委婉易入，不争不战，相爱相亲，自能到门而款关，不致扣关而坚壁也。
至于尸厥闭气，此中邪气闭，必须用药以开之。开之奈何？不用瓜蒂以探吐，即用皂角以取喷也。
方用瓜蒂七个，水二碗，煎汤一碗、加盐少许灌之，即大吐浓痰数碗而愈。或用皂角刺，研为细末，取鹅
翎管盛药末，吹入疾人鼻中，得打喷嚏，口吐浓痰如黄物者即愈。盖厥症多系热邪，然热邪必然叫号，今
黯然无语，宛似死人，明系阴虚之人，忽中阴邪，不可以治阳厥之法治之，多至不救。不若先以瓜蒂、皂
角取吐，以去其痰涎，人自出声，而后以人参五钱，白薇一钱，茯苓三钱，白术五钱，半夏二钱，治
之自安。（〔批〕开闭至圣丹。）此开治之一法也。
张公曰∶论奇而方妙。中风之症，亦可用瓜蒂散、皂角汤以开之。然必须用人参一两，半夏三钱，
南星三钱，附子一钱，以继之也。否则，徒用瓜蒂、皂角，徒取一时之开关，而终不能留中气之坚固，
虽开关何益哉。
华君曰∶尚有二法未传。一阴阳汤也。法用滚水、凉水各一碗，均之，加炒盐一撮，打百余下，起
泡饮之。凡有上焦欲吐而不能吐者，饮之立吐而愈。
一喷嚏之法未授也。用生半夏三钱，为末，水丸如黄豆大，入鼻孔中，则必喷嚏不已，用水饮之立
止。通治中风不语、尸厥等症，中恶、中鬼俱妙，皆开治之法也。
（关格症，上不得入，下不得出，病在上下二焦，而根实本于中焦。喻嘉言以黄连汤进退法，兼朝
服八味丸，治之甚善，附记于末，以俟临症者之自择。方法详《医门法律·关格条》，兹不赘。李子
永识。）
【背景信息】
书名：石室秘录 作者：陈士铎 朝代：清 章节：开治法 类别：综合
【待处理原文】
论关格 论尸厥
天师说：所谓“开治”，是指气机闭塞不通而采用开通的方法。比如关格这种病症就是这样；或者像尸厥那种气机闭塞的情况也是如此。关格，是指上焦有关隘阻隔，一层封闭，导致饮食无法下行；下焦也有关隘阻隔，一层封闭，导致大小便无法排出。这是由于气机郁结堵塞，一时之间偶然出现上吐下泻，（若不及时救治）就会危及生命。这类病症，五脏六腑原本并没有实质性的损伤，只是偶然受到刺激，肝气冲撞至胃脘部位，肾气不能上行，肺气不能下达，从而形成这种病症。如果说这是胃病，但胃实际上并未生病；如果说这是脾病，但脾实际上也没有生病。治疗法则应当以疏解郁结为主。方剂使用柴胡一钱，郁金一钱，白芍三钱，茯苓一钱，白芥子一钱，天花粉一钱，苏子一钱，荆芥一钱，甘草五分，用水煎服。（〔批注〕和解至圣丹。）这个方子的妙处在于看似平常却蕴含至理。因为肝气的郁结，必须用柴胡、白芍来疏解它，然而用量过多则必然会导致阻滞而不受纳。方中以此二味药为君药，辅以郁金的寒凉散结，白芥子的祛痰，天花粉的消散结节，甘草的调和脾胃，茯苓的去除湿气，药性气味平和，委婉易于吸收，不争不战，相互亲和，自然能够到达病所并打开关隘，不至于强行叩门而导致坚壁清野（拒药于外）。
至于尸厥导致的闭气，这是因为邪气闭塞，必须用药来开通它。如何开通呢？不用瓜蒂来催吐，就用皂角来取嚏。方剂使用瓜蒂七个，水两碗，煎成一碗汤，加入少许盐灌服，就会大量吐出浓稠痰液数碗而痊愈。或者使用皂角刺，研成细末，取鹅毛管盛装药末，吹入病人鼻中，使其打喷嚏，口中吐出如黄色物体般的浓痰，即可痊愈。大概厥症多属于热邪，然而热邪必然会导致呼叫号哭，现在病人沉默不语，宛似死人，明显是阴虚之人，忽然中了阴邪，不可以用治疗阳厥的方法来治疗，否则大多无法挽救。不如先用瓜蒂、皂角催吐，以去除痰涎，人自然会发出声音，然后再用人参五钱，白薇一钱，茯苓三钱，白术五钱，半夏二钱，进行治疗，自会安宁。（〔批注〕开闭至圣丹。）这是开治的一种方法。
张公说：论述奇特而方剂精妙。中风病症，也可以使用瓜蒂散、皂角汤来开通。然而必须随后用人参一两，半夏三钱，天南星三钱，附子一钱，来接续治疗。否则，仅仅使用瓜蒂、皂角，只能暂时取得开关的效果，最终不能保持中气的坚固，虽然打开了关隘又有什么益处呢？
华君说：还有两种方法没有传授。一种是阴阳汤。用法是用滚水和凉水各一碗，混合均匀，加入炒盐一撮，搅拌百余下，起泡后饮用。凡是上焦想要呕吐而不能呕吐的人，饮下后立即呕吐而痊愈。
另一种是喷嚏疗法未传授。使用生半夏三钱，研成粉末，用水泛丸如黄豆大小，放入鼻孔中，就会不停地打喷嚏，用水饮用立即停止。通治中风失语、尸厥等病症，中恶、中鬼都极为巧妙，都是开治的方法。
（关格症，上面不能进食，下面不能排泄，病位在上下二焦，而根源实在中焦。喻嘉言用黄连汤进退法，兼早晨服用八味丸，治疗非常有效，附记在最后，以供临证者自行选择。方法详见《医门法律·关格条》，此处不再赘述。李子永识。）
[Background Information]
Book: *Shishi Milu* (Secrets of the Stone Chamber)
Author: Chen Shiduo
Dynasty: Qing
Chapter: Kai Zhifa (Methods of Opening Treatment)
Category: Comprehensive
[Original Text Processing]
On Guan Ge and Shi Jue
The Heavenly Master said: "Kai Zhi" (Opening Treatment) refers to using methods to open up when Qi mechanism is closed and unresponsive. This is exemplified by the condition of Guan Ge; or similarly, in cases of Shi Jue where Qi mechanism is closed. Guan Ge involves an obstruction in the Upper Jiao (Upper Burner), a layer of blockage that prevents food and drink from descending; and an obstruction in the Lower Jiao (Lower Burner), a layer of blockage that prevents excretion. This results from the stagnation and blockage of Qi. If one experiences sudden vomiting and diarrhea due to this, it can be fatal if not treated. In such conditions, the Five Zang Organs and Six Fu Organs are originally undamaged; they are merely accidentally provoked. The Liver Qi (Liver Qi) rushes to the epigastric region, the Kidney Qi cannot ascend, and the Lung Qi cannot descend, thereby forming this syndrome. If one claims it is a Stomach disease, the Stomach is actually not diseased; if one claims it is a Spleen disease, the Spleen is actually not diseased. The treatment principle should focus primarily on resolving stagnation. The prescription uses Chai Hu (Bupleuri Radix) 1 qian, Yu Jin (Curcumae Radix) 1 qian, Bai Shao (Paeoniae Radix Alba) 3 qian, Fu Ling (Poria) 1 qian, Bai Jie Zi (Sinapis Semen) 1 qian, Tian Hua Fen (Trichosanthis Radix) 1 qian, Su Zi (Perillae Fructus) 1 qian, Jing Jie (Schizonepetae Herba) 1 qian, and Gan Cao (Glycyrrhizae Radix et Rhizoma) 5 fen. Decoct in water and take orally. ([Commentary] Hejie Zhisheng Dan / Supreme Holy Pill for Harmonizing and Resolving). The brilliance of this formula lies in its apparent simplicity containing profound principles. Since Liver Qi stagnation must be soothed with Chai Hu and Bai Shao, excessive use would inevitably cause obstruction and rejection. Therefore, these two herbs serve as the Jun (Emperor) herbs, assisted by the cold and dispersing properties of Yu Jin, the phlegm-resolving action of Bai Jie Zi, the nodule-dispersing effect of Tian Hua Fen, the middle-jiao harmonizing role of Gan Cao, and the dampness-removing function of Fu Ling. The medicinal nature and aroma are mild, gentle, and easy to absorb. They do not contend or fight but act in harmony and affinity, naturally reaching the site of illness and opening the gates, rather than forcing entry which might lead to a fortified refusal.
Regarding Shi Jue causing Qi closure, this is due to pathogenic factors blocking the Qi, requiring medication to open it. How to open it? One may use Gua Di (Cucumeris Fructus) to induce vomiting, or use Zao Jiao (Gleditsiae Sinensis Spina) to induce sneezing. The prescription uses seven Gua Di fruits, two bowls of water, decocted to one bowl of soup, with a little salt added, and administered orally. This will induce the vomiting of several bowls of thick phlegm, leading to recovery. Alternatively, use Zao Jiao Ci (Gleditsiae Sinensis Spina), grind into a fine powder, place the powder in a goose feather tube, and blow it into the patient's nose. Inducing sneezing and the expectoration of thick yellowish phlegm will result in recovery. Generally, Jue syndromes are often associated with Heat Pathogens (Heat Evil); however, heat pathogens typically manifest with shouting or crying. Here, the patient is silent and appears like a corpse, clearly indicating a person with Yin Deficiency who has suddenly been affected by Yin Pathogens (Yin Evil). One cannot treat this with methods for Yang Jue; otherwise, rescue is unlikely. It is better to first use Gua Di and Zao Jiao to induce vomiting and remove saliva and phlegm, allowing the patient to speak again, and then treat with Ren Shen (Ginseng Radix) 5 qian, Bai Wei (Cynanchi Atrati Radix) 1 qian, Fu Ling 3 qian, Bai Zhu (Atractylodis Macrocephalae Rhizoma) 5 qian, and Ban Xia (Pinelliae Rhizoma) 2 qian, which will bring peace. ([Commentary] Kaibi Zhisheng Dan / Supreme Holy Pill for Opening Blockages). This is one method of Kai Zhi.
Master Zhang said: The discussion is unique and the formulas are excellent. For Wind Stroke syndromes, Guadi San (Melon Seed Powder) and Zao Jiao Tang (Soap Pod Decoction) can also be used to open the blockage. However, one must subsequently use Ren Shen 1 liang, Ban Xia 3 qian, Nan Xing (Arisaematis Rhizoma Preparatum) 3 qian, and Fu Zi (Aconiti Lateralis Radix Preparata) 1 qian to follow up. Otherwise, merely using Gua Di and Zao Jiao only temporarily opens the gate, failing to consolidate the Middle Qi (Middle Guardian Qi). What benefit is there in opening the gate without maintaining internal strength?
Master Hua said: There are two other methods not yet transmitted. One is Yinyang Tang (Yin-Yang Decoction). The method involves taking one bowl of boiling water and one bowl of cool water, mixing them evenly, adding a pinch of stir-fried salt, stirring vigorously over a hundred times until bubbles form, and drinking it. For anyone whose Upper Jiao desires to vomit but cannot, drinking this will induce immediate vomiting and cure the condition.
The second is the Sneezing Method, which has not been taught. Use Sheng Ban Xia (Raw Pinelliae Rhizoma) 3 qian, grind into powder, make pills the size of soybeans using water, and insert into the nostrils. This will cause incessant sneezing; drinking water will immediately stop it. This treats Wind Stroke aphasia, Shi Jue, etc., and is also effective for Zhong E (Sudden Malignancy/Toxic Qi Invasion) and Zhong Gui (Ghost Strike/Sudden Fright), all being methods of Kai Zhi.
(Note: Guan Ge syndrome, characterized by inability to intake above and inability to excrete below, involves the Upper and Lower Jiao, but the root lies in the Middle Jiao. Yu Jiayan treated this effectively by adjusting Huanglian Tang (Coptis Decoction) and administering Bawei Wan (Eight-Ingredient Pill) in the morning. I record this at the end for clinicians to choose according to their judgment. The detailed methods are described in *Yimen Falv · Guan Ge Tiao*, so I will not repeat them here. Li Zi Yong notes.)