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The stomach qi of the Yangming channel follows the normal pattern of descending with every breath. Because it descends with every breath, it constantly utilizes this downward force to transport digested food and drink into the small intestine to convert them into chyle; further transporting the remaining waste into the large intestine to be excreted as feces. This is the natural operation of human Qi transformation (Qi Hua), where a single Qi circulates from the mouth (Feimen) to the anus (Pomen) without obstruction.

However, sometimes stomach qi does not descend but instead rebels upward. Investigating the cause of this pathology, it may be due to an irritable temperament causing Liver and Gallbladder qi to rebel upward and interfere with the Stomach; or it may be due to Kidney deficiency failing to secure, causing Chong vessel qi to rush upward. The Stomach, squeezed by the rebellious Qi of the Liver, Gallbladder, and Chong vessel, loses its downward momentum and rebels upward along with that squeezing force. Once this upward rebellion becomes habitual, its capacity to descend is completely lost. Even when no other pathogenic Qi is squeezing it, it often rebels upward due to extreme accumulation. In such cases, food and drink entering the Stomach cannot be transported downward. Upward, this manifests as distension and fullness; downward, as constipation. This is an inevitable trend.

Treaters who do not understand that the etiology lies in the rebellion and failure to descend of the Stomach organ's qi, administer medicines for reducing distension, but once the medicinal effect wears off, the distension remains. Treating with purgatives brings relief today only for the condition to return tomorrow. Over time, various complicating symptoms emerge: vomiting and hiccuping, dry heaving and counterflow qi, hematemesis and epistaxis, heat and vexation in the chest and diaphragm, dizziness and vertigo of the head and eyes, phlegm-saliva congestion, panting and coughing, palpitations and insomnia. With such complex presenting signs, treatment becomes increasingly difficult. Even if some recognize that the cause lies in rebellious stomach qi failing to descend, using descending herbs such as Banxia (Pinelliae Rhizoma), Suzi (Perillae Fructus), Louren (Trichosanthis Semen), Zhuru (Bambusae Caulis in Taeniam), Houpo (Magnoliae Officinalis Cortex), and Zhishi (Aurantii Fructus Immaturus) proves ineffective.

Based on my decades of experience, having treated countless cases of this syndrome, I know that heavy use of Hematitum (Dai Zhe Shi) is essential for efficacy. Hematitum has six specific advantages for this syndrome: First, its heavy and sinking property guides stomach qi downward. Second, by guiding stomach qi downward, it directs it straight to the intestines to unblock bowel movements. Third, due to its heavy and sinking nature, it calms and anchors the Chong vessel qi to prevent upward rushing. Fourth, its chemical composition is iron oxide, containing Metal energy, which restrains the rampant Wood of the Liver, preventing Liver qi from interfering upward. Fifth, being iron oxide, it guides floating and hyperactive Ministerial Fire downward, thereby eliminating heat/vexation in the chest/diaphragm and dizziness/vertigo. Sixth, while it descends stomach qi and unblocks bowels, and guides fire downward, its nature is not cold-cooling or destructive; it does not damage the Qi aspect at all. As an iron oxide compound, it benefits the Blood aspect (iron oxide corresponds to rust, thus replenishing iron in the blood). Therefore, in treating rebellious stomach qi failing to descend, I often rely solely on heavy doses of Hematitum, achieving immediate results.

In the late spring of Bingyin year, I moved from Cangzhou to Tianjin. A patient surnamed Guo, nearly thirty years old, visited my residence for consultation. He reported chronic feeling of fullness and oppression in the heart/chest region, food stagnation in the stomach refusing to descend, occasional vomiting, and dependency on laxatives for bowel movements. This persisted for over a year despite repeated ineffective treatments. His condition had not worsened significantly, but his body had become emaciated and weak due to reduced dietary intake. His pulse rate was normal, yet all six positions exhibited a stagnant (Yu) quality. I informed him, "This is a case of stomach qi failing to descend. It is easy to treat. Heavy use of Hematitum for a few doses will yield results." I prescribed: Raw Hematitum powder 1 liang, Raw Huai Yam (Dioscoreae Hypoglaucae Rhizoma) and Stir-fried Huai Yam each 7 qian, Quan Danggui (Angelicae Sinensis Radix) 3 qian, Raw Jineijin (Galli Gigerii Endothelium Corneum) 2 qian, Houpo (Magnoliae Officinalis Cortex) and Chaihu (Bupleuri Radix) each 1 qian. I instructed, "Decoct these herbs in water, take one dose daily. Return for prescription adjustment once you have one bowel movement per day."

Mr. Li, a fellow physician from the same county present at the time, also palpated the pulse. Suspecting something, he asked, "In diseases of stomach qi failing to descend, the pulse phenomenon is typically wiry, long, and forceful. Since this case is clearly stomach qi failing to descend, why do all six pulses show stagnation, and feel weak upon deep pressure?" I replied, "An excellent question. There is considerable value in researching this. Generally, the pulse in initial stages of stomach qi failing to descend is wiry, long, and forceful, because the etiology is mostly Chong qi rushing upward, or combined with Liver qi interfering upward. Chong qi rushing upward makes the pulse long and forceful; Liver qi interfering upward makes it wiry and forceful; both present together make it wiry, long, and forceful. However, initially forced by Liver and Chong qi, the Stomach organ's qi changes its normal downward course to rebel upward. Once this rebellion persists for a long time, habit becomes nature. Even without external forcing qi, it rebels upward and fails to descend. The Stomach resides in the Middle Jiao and serves as the hub of post-heaven Qi transformation. Thus, prolonged Stomach dysfunction leads to stagnation of human Qi transformation, and also leads to deficiency of human Qi transformation. Consequently, the pulse presents as both stagnant and deficient. Due to the stagnation, we heavily use Hematitum to guide stomach qi downward, assisted by Houpo to unblock Yang (Ye Tianshi stated: Houpo in large doses breaks Qi, in small doses unblocks Yang), and Jineijin to resolve accumulation, thereby opening the stagnation. Due to the deficiency, we heavily use Huai Yam, half raw and half stir-fried, taking advantage of its ability to tonify the Spleen and nourish the Stomach (if Spleen dampness prevails impairing transportation, use stir-fried Yam to strengthen it; if Stomach fluids are insufficient for digestion, use raw Yam to nourish it). Only then can the patient tolerate the stagnation-opening herbs without injury. We use Danggui for its ability to generate blood, moisten bowels, and tonify deficiency, assisting in opening stagnation. We use Chaihu because human Qi transformation favors ascending on the left and descending on the right. If we only heavily use sedating/descending drugs, we risk hindering natural Qi transformation. Thus, we add a small amount of Chaihu to promote circulation, restoring the normal rhythm of Qi transformation." Mr. Li deeply agreed with my explanation. The patient took this prescription for eight doses consecutively. Bowel movements became once daily, fullness/oppression decreased significantly, and dietary intake increased. We then reduced Hematitum to 6 qian, Chaihu to 5 fen, and added Baizhu (Atractylodis Macrocephalae Rhizoma) 1.5 qian. After ten more doses, he was fully cured. Ten days later, Mr. Li encountered another patient with the same syndrome and identical pulse presentation, who was also cured through heavy use of Hematitum.