反胃与噎膈同理,但噎膈上脘下脘全闭,故食不能入而反胃,上脘不闭,惟下脘闭耳,故朝食而暮
吐,暮食而朝吐也。盖胃虽能纳谷,而脾虚不能消化,下行无路,则逆而上涌,此自然之理也。法宜温
中燥湿,降逆开结为主,宜以姜苓半夏汤主之。如中焦虚寒,下焦无火者,以吴茱萸汤主之。
姜苓半夏汤
人参(三钱) 半夏(三钱) 生姜(三钱) 茯苓(三钱) 白蜜(半杯) 河水扬之二
百四十遍,煎大半杯,入白蜜,温服。若肝气不能疏泄,加桂枝、阿胶疏木清风,至利水滑肠之法,
根据噎膈诸方,无有异也。
吴茱萸汤(方见头痛)
不能食者,胃中元气虚也。然有虚冷虚热之异,虚冷者,胃阳败则湿胜其燥,虽食而不能消化,其证
面黄白,身常恶寒,大便溏秘无常是也。虚热者,胃阴竭则燥胜其湿,不食而常觉饱闷,其证面黄赤,
身常恶热,大便燥结不通是也。谷劳一证,其人怠惰嗜卧,肢体烦重,腹满善饥而不能食,食已则发,
谷气
不行使然也。如胃虚冷不能食者,以消食丸主之。如胃虚热不能食者,以资生丸主之。如谷劳不能食,
以沉香汤,椒姜大麦汤主之。
消食丸
麦 (一升) 神曲(一升) 干姜(四两炮) 乌梅(四两焙) 茯苓(五两)
用蜜为丸,每服十五丸,日再。加至四十丸。
资生丸
白术(三两,米泔水浸用山黄土拌九蒸晒去土切片焙干) 橘皮(二两) 山楂(二两蒸)
神曲(二两炒) 茯苓(一两五钱,人乳拌饭上蒸晒干) 人参(三两,人乳浸透饭锅上蒸透) 白豆蔻
(五钱微炒) 扁豆(一两炒) 莲肉(一两去心炒) 山药(一两半炒) 芡实(一两半炒) 薏仁
(二两炒) 上为末,炼蜜丸,每服二钱,细嚼,淡盐汤下。
沉香汤
沉香(一钱) 枳实(二钱) 人参(三钱) 茯苓(三钱) 半夏(三钱姜制) 杏仁(三钱)
甘草(二钱) 陈皮(三钱) 白术(三钱土炒) 生姜(三钱) 水煎大半杯,温服。
椒姜大麦汤
大麦芽(一升炒) 川椒(一两炒) 干姜(三两) 共捣末,每服方寸匕,日三服。
Regurgitation (Fanwei) shares the same pathogenesis as Dysphagia and Obstruction (Yige), but in Dysphagia and Obstruction, both the upper orifice of the stomach (Shangwan) and the lower orifice of the stomach (Xiawan) are completely blocked, thus food cannot enter. In Regurgitation, the upper orifice is not blocked, only the lower orifice is blocked; therefore, food eaten in the morning is vomited in the evening, and food eaten in the evening is vomited in the morning. Generally, although the Stomach can receive food, Spleen deficiency fails to digest it. With no way to descend, the contents reverse and surge upward, which is a natural principle. The treatment method should primarily focus on warming the Middle Jiao, drying dampness, descending rebellious Qi, and opening accumulations. Jiangling Banxia Tang (Ginger, Poria, and Pinellia Decoction) is indicated as the primary formula. If there is deficiency-cold in the Middle Jiao and lack of fire in the Lower Jiao, Wuzhuyu Tang (Evodia Decoction) is indicated.
Jiangling Banxia Tang (Ginger, Poria, and Pinellia Decoction)
Renshen (Ginseng Radix et Rhizoma, 3 qian), Banxia (Pinelliae Rhizoma Preparatum, 3 qian), Shengjiang (Zingiberis Rhizoma Recens, 3 qian), Fuling (Poria, 3 qian), Baimi (White Honey, half cup). Stir river water two hundred and forty times, decoct until slightly more than half a cup remains, add White Honey, and take warm. If Liver Qi fails to disperse and drain, add Guizhi (Cinnamomi Ramulus) and Ejiao (Asini Corii Colla) to soothe the Liver Wood and clear wind. Regarding methods for promoting urination and lubricating the intestines, based on various formulas for Dysphagia and Obstruction, there is no difference.
Wuzhuyu Tang (Evodia Decoction) (See formula under Headache)
Inability to eat is caused by deficiency of Yuan Qi (Primordial Qi) in the Stomach. However, there are differences between deficiency-cold and deficiency-heat. In deficiency-cold, Stomach Yang fails, allowing dampness to overcome dryness; although food is consumed, it cannot be digested. Symptoms include a sallow-white complexion, constant aversion to cold, and irregular bowel movements alternating between loose stools and constipation. In deficiency-heat, Stomach Yin is exhausted, allowing dryness to overcome dampness; one feels full and stifled even without eating. Symptoms include a sallow-red complexion, constant aversion to heat, and dry, obstructed stool. Gu Lao (Grain Labor/Exhaustion due to Dietary Mismanagement) is characterized by lethargy and a desire to lie down, heaviness and discomfort in the limbs, abdominal fullness with frequent hunger but inability to eat, and exacerbation after eating. This is caused by the failure of Grain Qi to circulate. For inability to eat due to Stomach deficiency-cold, Xiaoshi Wan (Digestive Pill) is indicated. For inability to eat due to Stomach deficiency-heat, Zisheng Wan (Life-Nourishing Pill) is indicated. For inability to eat due to Gu Lao, Chenxiang Tang (Aquilaria Decoction) and Jiaojing Damai Tang (Sichuan Pepper, Ginger, and Barley Decoction) are indicated.
Xiaoshi Wan (Digestive Pill)
Maiya (Hordei Fructus Germinatus, 1 sheng), Shenqu (Massa Medicata Fermentata, 1 sheng), Ganjiang (Zingiberis Rhizoma, 4 liang, processed), Wumei (Mume Fructus, 4 liang, baked), Fuling (Poria, 5 liang). Form pills with honey. Take fifteen pills per dose, twice daily. Increase up to forty pills.
Zisheng Wan (Life-Nourishing Pill)
Baizhu (Atractylodis Macrocephalae Rhizoma, 3 liang, soaked in rice wash water, mixed with mountain yellow earth, steamed and sun-dried nine times, earth removed, sliced, and dried), Jupi (Citri Reticulatae Pericarpium, 2 liang), Shanzha (Crataegi Fructus, 2 liang, steamed), Shenqu (Massa Medicata Fermentata, 2 liang, stir-fried), Fuling (Poria, 1.5 liang, mixed with human milk, steamed over rice, dried), Renshen (Ginseng Radix et Rhizoma, 3 liang, soaked in human milk, steamed thoroughly over rice pot), Baixudoukou (Cardamomi Rotundus Fructus, 5 qian, lightly stir-fried), Bian Dou (Dolichoris Lablab Semen Album, 1 liang, stir-fried), Lianrou (Nelumbinis Semen, 1 liang, heart removed, stir-fried), Shanyao (Dioscoreae Rhizoma, 1.5 liang, stir-fried), Qianshi (Euryales Semen, 1.5 liang, stir-fried), Yiren (Coicis Semen, 2 liang, stir-fried). Grind into powder, form pills with refined honey. Take 2 qian per dose, chew thoroughly, and swallow with light salt water.
Chenxiang Tang (Aquilaria Decoction)
Chenxiang (Aquilariae Lignum Resinatum, 1 qian), Zhishi (Aurantii Fructus Immaturus, 2 qian), Renshen (Ginseng Radix et Rhizoma, 3 qian), Fuling (Poria, 3 qian), Banxia (Pinelliae Rhizoma Preparatum, 3 qian, prepared with ginger), Xingren (Armeniacae Semen Amarum, 3 qian), Gancao (Glycyrrhizae Radix et Rhizoma, 2 qian), Chenpi (Citri Reticulatae Pericarpium, 3 qian), Baizhu (Atractylodis Macrocephalae Rhizoma, 3 qian, stir-fried with soil), Shengjiang (Zingiberis Rhizoma Recens, 3 qian). Decoct in water until slightly more than half a cup remains, and take warm.
Jiaojing Damai Tang (Sichuan Pepper, Ginger, and Barley Decoction)
Damaiye (Hordei Fructus Germinatus, 1 sheng, stir-fried), Chuanjiao (Zanthoxyli Pericarpium, 1 liang, stir-fried), Ganjiang (Zingiberis Rhizoma, 3 liang). Pound together into powder. Take one fangcun bi (square-inch spoonful) per dose, three times daily.