天下有奇证，即在常病之中，令人不可捉摸者。族弟成室太早，先吐血，继咳嗽，二年
，始
得诊之；脉数而涩，以温补脾肾，兼理肺气治之，即愈。半年回家，又接考试，病复发，又
半年，始得诊之；身热，时时汗出，咳嗽气急，自言少腹有气上涌，当其涌时，鼻出不及，
从口冲出，其势汹涌，不可吸止，日夜数发，逼迫难堪，诊脉浮弦而数，此有风湿在表也，
先以芳香宣理脾肺，佐以固肾，一剂，得冷汗续续半日，诸证顿瘳；继以温固肝肾之剂调理
之，气病仍复时发，发时或兼咳，或不兼咳，脉象必数疾，而不洪大，及愈，即平调如常人
。但身体日渐疲软，中间疑其风邪从脐入，疑其寒从足心入，用药温补下元，更佐以外治，
莫不暂效，而旋发，再用即无功。所更奇者，教令静坐，吸气稍长，用意深纳，旋即身大寒
热如疟状，初尚以为药力能振动阳气而化疟也；及次日，不寒热矣，身体轻爽倍常，方大喜
。间不半月，又冲发如故，再教纳气，又发寒热如前，殊莫解吸气深纳之何以遂致寒热也?
小便赤涩，大便艰秘，口味初强渐弱，自秋及冬，经余手治，皆用温润镇固之法。间或别延
他医，指为阴虚，稍用凉润，即水泻而气陷不续；又疑有虫，药中佐入百部、雷丸；又思寒
邪深伏下焦，宜用温下，以大黄、牵牛入温补剂中，得下，亦于病无增损也。其后渐觉喉痛
如破，又如肿塞，不能下食。视之，略无红肿之事，但小舌坠下，脉象亦渐细涩少神，知其
肾气不能上朝，督脉萧索，无能为矣。腊月回家，迁延三月，身痿不能起于床矣，终莫得救
挽之术也。冲气虽损病常证，亦未有似此汹涌莫遏者。详述之，以俟高明者之指示焉。
天下存在奇特的病证，这些病证隐藏在常见疾病之中，让人难以捉摸。族弟成家娶妻太早，先出现吐血症状，随后咳嗽，经过两年才得到诊治；诊得脉象数而涩，采用温补脾肾、兼理肺气的方法治疗，病情随即痊愈。半年后回家，又参加科举考试，病情复发，又过了半年才再次诊治；此时身体发热，时常出汗，咳嗽且气急，患者自述少腹部有气向上冲涌，当气上涌时，从鼻子出来不及，便从口中冲出，气势汹涌，无法吸入停止，每天发作数次，令人感到极度逼迫难受，诊得脉象浮弦而数，这是风湿邪气在表的表现，先用芳香宣通调理脾肺的药物，佐以固肾药物，服用一剂后，持续出冷汗半天，所有症状顿时减轻；接着用温补固摄肝肾的药剂进行调理，但气逆之病仍不时复发，发作时有时伴有咳嗽，有时不伴咳嗽，脉象必定数疾，但不洪大，等到病愈后，脉象平调如常人。只是身体日渐疲软，中间怀疑风邪从肚脐进入，怀疑寒邪从脚心进入，用药温补下元，更配合外治法，无不暂时见效，但随即复发，再用同样的方法就无效了。更奇特的是，教导他静坐，吸气稍长，用意深纳气息，随即身体出现像疟疾一样的大寒大热，起初还以为是药力能振动阳气而转化为疟疾；到了第二天，不再寒热了，身体轻爽倍于平常，于是非常高兴。间隔不到半个月，气冲又像以前一样发作，再教导纳气，又出现像以前一样的寒热，实在无法理解为什么吸气深纳会导致寒热呢？小便赤红涩痛，大便艰难秘结，口味起初强盛逐渐减弱，从秋天到冬天，经我手治疗，都使用温润镇固的方法。偶尔另外延请其他医生，诊断为阴虚，稍微使用凉润药物，立即导致水样腹泻且气陷接续不上；又怀疑有寄生虫，在药中佐入百部、雷丸；又想到寒邪深伏在下焦，适宜用温下法，在大黄、牵牛子中加入温补剂中，服药后虽然排便，但对病情也没有增加或减少的影响。其后逐渐感觉喉咙疼痛如同破裂，又像肿胀堵塞，不能进食。查看咽喉，略微没有红肿的现象，只是小舌下垂，脉象也逐渐细涩缺乏神气，知道这是肾气不能上朝，督脉萧索，无能为力的表现。腊月回家，拖延三个月，身体痿软不能起床了，最终没有得到挽救的办法。冲气虽然是虚损病的常见证候，但也未有像这样汹涌不可遏制的。详细叙述此案例，以等待高明者的指示。
There are peculiar syndromes in the world that exist within common diseases, making them elusive and difficult to grasp. A younger male cousin of my clan married too early, first experiencing hemoptysis (coughing up blood), followed by coughing; it took two years before he could be diagnosed. His pulse was rapid and choppy. Treatment with warming and tonifying Spleen and Kidney, combined with regulating Lung Qi, resulted in immediate recovery. Half a year later, upon returning home and taking imperial examinations, the illness relapsed. It took another half year before he could be diagnosed again. At this time, he had a fever, intermittent sweating, coughing, and shortness of breath. He reported that Qi surged upward from his lower abdomen; when this surge occurred, it was insufficient to exit through the nose, so it rushed out through the mouth. The momentum was surging and unstoppable, occurring several times a day, causing unbearable distress. His pulse was floating, wiry, and rapid, indicating Wind-Dampness pathogenic factors at the Exterior. Initially, aromatic herbs were used to diffuse and regulate the Spleen and Lung, assisted by kidney-astringent herbs. After one dose, continuous cold sweat lasted for half a day, and all symptoms suddenly alleviated. Subsequently, decoctions warming and consolidating the Liver and Kidney were used for regulation. However, the Qi-reversal condition still recurred intermittently. During attacks, coughing was sometimes present, sometimes absent, but the pulse was invariably rapid and hurried, though not forceful and large. Upon recovery, the pulse returned to normal like that of a healthy person. Yet, his body became increasingly flaccid and weak. At one point, I suspected the Wind pathogen entered via the umbilicus, or Cold entered via the sole of the foot. Medications warming and tonifying the Lower Yuan, combined with external therapies, provided only temporary relief before recurrence; repeated use proved ineffective. More remarkably, instructing him to sit quietly, breathe deeply, and concentrate on drawing Qi downward immediately triggered severe chills and fever resembling Malaria (Chuanre). Initially, I thought the medicinal power stimulated Yang Qi, transforming into Malaria. By the next day, the chills and fever subsided, and his body felt exceptionally light and refreshed, which brought great joy. However, within half a month, the Qi surge recurred as before. Instructing him to draw Qi again triggered chills and fever as before. It was incomprehensible why deep inhalation would lead to such chills and fever. Urine was red and scanty/difficult to pass; stool was dry and constipated. Taste initially strong then gradually weakened. From autumn to winter, under my treatment, warm, moistening, sedating, and consolidating methods were consistently used. Occasionally, other physicians were consulted, diagnosing Yin Deficiency (Yinxu) and prescribing slightly cooling and moistening herbs, which immediately caused watery diarrhea and sinking Qi unable to continue. Parasites were suspected, so Stemona Root (Baibu, 百部) and Polyporus Umbellatus (Leiwang, 雷丸) were added. It was also considered that Cold pathogen lay deeply hidden in the Lower Jiao, requiring a warming purgative approach; Rhubarb (Dahuang, 大黄) and Morning Glory Seed (Qianniu, 牵牛) were added to warming tonics. Although bowel movements occurred, there was no improvement or worsening of the disease. Later, he gradually felt throat pain as if ruptured or swollen and blocked, unable to swallow food. Examination revealed no significant redness or swelling, but the uvula hung low. The pulse became increasingly fine, choppy, and lacking spirit. This indicated that Kidney Qi could no longer ascend to the upper burner, and the Du Mai (Governing Vessel) was depleted, rendering treatment futile. Returning home in the twelfth lunar month, after three months of delay, his body became emaciated and he could no longer rise from bed. Ultimately, no method of rescue was found. Although Qi reversal is a common syndrome in consumptive diseases, none have been as surging and uncontrollable as this case. Detailed description is provided here, awaiting guidance from experts.