掖县任××妻，年五旬，得胃气不降证。
原因 举家人口众多，因其夫在外，家务皆自操劳，恒动肝火，遂得此证。
证候 食后停滞胃中，艰于下行，且时觉有气挟火上冲，口苦舌胀，目眩耳鸣，恒有呃欲呕逆
或恶心，胸膈烦闷，大便六七日始行一次，或至服通利药始通，小便亦不顺利。其脉左部
弦硬，右部弦硬而长，一息搏近五至，受病四年，屡次服药无效。
诊断 此肝火与肝气相并，冲激胃腑，致胃腑之气不能息息下行传送饮食，久之，胃气不但不能
下行，且更转而上逆，是以有种种诸病也。宜治以降胃理冲之品，而以滋阴清火之药辅之。
处方 生赭石（两半轧细） 生怀山药（一两） 生杭芍（六钱） 玄参（六钱）
生麦芽（三钱） 茵陈（二钱） 生鸡内金（二钱黄色的捣） 甘草（钱半）
共煎汤一大盅，温服。
效果 每日服药一剂，三日后大便日行一次，小便亦顺利。上焦诸病亦皆轻减，再诊其脉，颇
见柔和。遂将赭石减去五钱，又加柏子仁五钱，连服数剂，霍然全愈。
天津张××，年三十五岁，得吐血证，年余不愈。
病因 禀性褊急，劳心之余又兼有拂意之事，遂得斯证。
证候 初次所吐甚多，屡经医治，所吐较少，然终不能除根。每日或一次或两次，觉心中有热
上冲，即吐血一两口。因病久身羸弱，卧床不起，亦偶有扶起少坐之时，偶或微喘，幸食
欲犹佳，大便微溏，日行两三次，其脉左部弦长，重按无力，右部大而芤，一息五至。
诊断 凡吐血久不愈者，多系胃气不降，致胃壁破裂，出血之处不能长肉生肌也。再即此脉论
之，其左脉之弦，右脉之大，原现有肝火浮动挟胃气上冲之象，是以其吐血时，觉有热上
逆，至其脉之弦而无力者，病久而气化虚也。大而兼芤者，失血过多也。至其呼吸有时或喘，
大便日行数次，亦皆气化虚而不摄之故。治此证者，当投以清肝、降胃、培养气血、固摄气化之剂。
处方 赤石脂（两半） 生怀山药（一两） 净萸肉（八钱） 生龙骨（六钱捣碎）
生牡蛎（六钱捣碎） 生杭芍（六钱） 大生地黄（四钱） 甘草（二钱） 广三七（二钱）
药共九味，将前八味煎汤送服三七末。
方解 降胃之药莫如赭石，此愚治吐衄恒用之药也。此方中独重用赤石脂者，因赭石为铁养化
合其重坠之力甚大，用之虽善降胃，而其力达于下焦，又善通大便，此证大便不实，赭石
似不宜用；赤石脂之性，重用之亦能使胃气下降，至行至下焦，其粘滞之力又能固涩大便，且
其性能生肌，更可使肠壁破裂出血之处早愈，诚为此证最宜之药也。
效果 将药煎服两剂，血即不吐，喘息已平，大便亦不若从前之勤，脉象亦较前和平，惟心
中仍有觉热之时。遂即原方将生地黄改用一两，又加熟地黄一两，连服三剂，诸病皆愈。
The wife of Ren XX from Yexian, aged fifty, suffered from the syndrome of Stomach Qi failing to descend.
Etiology With a large family and her husband away, she bore all household chores alone, frequently stirring up Liver Fire (Liver Fire), thereby contracting this condition.
Symptoms Food stagnated in the stomach after eating, difficult to move downward, accompanied by a sensation of Qi carrying fire rushing upward. She experienced bitter taste in the mouth, swollen tongue, dizziness, tinnitus, frequent hiccups, urge to vomit, or nausea, and oppression/stuffiness in the chest and diaphragm. Bowel movements occurred only once every six or seven days, or required purgative medicines to become regular; urination was also unsmooth. Her pulse was wiry and hard on the left side, and wiry, hard, and long on the right side, with nearly five beats per breath (slightly rapid rate). Having been ill for four years, multiple courses of medication had failed.
Diagnosis This is caused by Liver Fire merging with Liver Qi, assaulting the Stomach organ, preventing the Stomach Qi from continuously descending to transport food. Over time, Stomach Qi not only fails to descend but reverses upward, causing these various symptoms. Treatment should employ herbs that descend Stomach Qi and regulate Chong Mai (Penetrating Vessel), assisted by herbs that nourish Yin and clear Fire.
Prescription Raw Hematite (Ochre Stone) [Dai Zhe Shi] (15g, finely crushed)
Raw Huai Yam [Shan Yao] (30g)
Raw Hang Peony Root [Bai Shao] (18g)
Scrophularia Root [Xuan Shen] (18g)
Raw Malt [Mai Ya] (9g)
Artemisia Capillaris Herb [Yin Chen] (6g)
Raw Chicken Gizzard Lining [Ji Nei Jin] (6g, yellow variety, crushed)
Licorice Root [Gan Cao] (4.5g)
Decoct together in one large cup of water, take warm.
Outcome Taking one dose daily, after three days, bowel movements became once daily, and urination smoothed out. Upper Jiao (Upper Burner) symptoms alleviated significantly. On re-examination, the pulse showed considerable softness. The dosage of Ochre Stone was reduced by 15g, and Semen Platycladi [Bai Zi Ren] (15g) was added. After several more doses, she recovered completely.
Zhang XX from Tianjin, aged thirty-five, suffered from hematemesis (vomiting blood) for over a year without cure.
Etiology He had an irritable and narrow temperament. Combined with mental exertion and frustrating circumstances, he contracted this condition.
Symptoms The initial episode involved massive bleeding. Although subsequent treatments reduced the volume, it never resolved completely. Once or twice daily, upon feeling heat rushing upward from the heart/chest, he would spit or vomit one or two mouthfuls of blood. Due to chronic illness, his body was emaciated, and he was bedridden, occasionally sitting up. He experienced occasional mild panting. Fortunately, his appetite remained good. His stool was slightly loose, occurring two to three times daily. His pulse was wiry and long on the left, powerless upon heavy pressure; on the right, it was large and hollow (Kou pulse), with five beats per breath.
Diagnosis Chronic hematemesis that fails to heal is often due to Stomach Qi failing to descend, causing rupture of the gastric wall where hemorrhage prevents tissue regeneration. Analyzing the pulse: the wiry left pulse and large right pulse indicate floating Liver Fire accompanying rebellious Stomach Qi, explaining the sensation of heat reversing upward during bleeding. The wiry yet powerless quality indicates Qi deficiency due to chronicity. The large and hollow quality indicates excessive blood loss. Occasional panting and frequent loose stools are due to deficient Qi failing to secure and hold. Treatment requires formulas that clear the Liver, descend Stomach Qi, nourish Qi and Blood, and secure Qi transformation.
Prescription Red Kaolin [Chi Shi Zhi] (15g)
Raw Huai Yam [Shan Yao] (30g)
Processed Cornus Fruit [Yu Rou] (24g)
Raw Dragon Bone [Long Gu] (18g, crushed)
Raw Oyster Shell [Mu Li] (18g, crushed)
Raw Hang Peony Root [Bai Shao] (18g)
Large Rehmannia Root [Sheng Di Huang] (12g)
Licorice Root [Gan Cao] (6g)
Panax Notoginseng Root [San Qi] (6g)
Nine ingredients total. Decoct the first eight ingredients in water and use the decoction to wash down the powder of San Qi.
Formula Analysis Among herbs that descend Stomach Qi, Ochre Stone [Dai Zhe Shi] is unparalleled; I frequently use it for hematemesis and epistaxis. However, this formula uniquely emphasizes Chi Shi Zhi because Ochre Stone is an iron oxide compound with strong heavy-sinking properties. While effective at descending Stomach Qi, its force reaches the Lower Jiao (Lower Burner) and promotes bowel movement. Since this patient’s stool was loose, Ochre Stone was unsuitable. Chi Shi Zhi, when used in high doses, can also descend Stomach Qi. Reaching the Lower Jiao, its sticky/astringent nature secures the bowels. Furthermore, its ability to generate flesh allows ruptured intestinal walls to heal early, making it the most appropriate herb for this case.
Outcome After two doses, bleeding ceased, panting subsided, and bowel movements normalized. The pulse became harmonious, though a sensation of internal heat persisted. In the original formula, Sheng Di Huang was increased to 30g, and Prepared Rehmannia Root [Shu Di Huang] (30g) was added. After three more doses, all symptoms resolved.