【歌】翻胃多因气血虚，脉来不足命多殂。是痰是火宜消降，数滑而沉可验之。更有寒郁并气滞，脉来沉
伏与沉迟。
【论】翻胃成于噎膈，病而致于翻胃，则已危矣。或朝
食而暮吐，或暮食而朝吐，其吐必尽所食，日日如此，不变易者是也。至于吐无时者，呕吐也。空哕而无所出
者，虚呕也。大抵此病由血槁不能荣润肠胃，故上不得纳，下不得便，如肠结若羊粪者死。然血虚者，则脉数
而无力；气虚者，则脉缓而无力；气血两虚者，口中多出沫，但沫大出者必死。亦有热甚者，则脉数而有力；
有痰阻者，则脉滑而有力；因气滞者，其脉沉而伏，因寒郁者，其脉沉而迟，皆非血气衰竭，故可治。学人须
审其虚实而断之，斯无失也。
【脉】翻胃噎膈，寸紧尺涩。紧芤或弦，虚寒之厄。关沉有痰，浮涩脾积。浮弱气虚，涩小血弱。若涩而
沉，七情所搏。
虚
虚而不能荣润大肠，故便难。盖幽门不通，上冲吸门，食不能纳，年老者难治，年少者犹可保全，四物汤
加桃仁、红花、麻仁、枳壳，结甚者，暂加熟大黄以导其滞，量人虚实用之。中年人，四物汤加童便、韭汁、
牛、羊乳、竹沥姜汁。气虚者，参苓白术散。气虚有火兼痰者，七圣汤。阴虚火上冲者，四物汤加知母、黄柏、
姜汁、竹沥。若饮食少思，大便不实，胸膈痞闷，吞酸嗳腐，食不化而反出，是为脾胃虚寒，即王太仆所谓∶
食入反出，是无火也。用六君子汤加炮干姜，白豆蔻、黄连、制吴茱萸，如不应，用八味丸补命门火以生脾土。
四物汤（方见血证。）
参苓白术散
治脾胃虚弱，饮食不进，呕吐泄泻。
人参（二钱，去芦） 茯苓（二钱，去皮） 白术（二钱，土炒） 干山药（二钱，炒） 甘草） 二
钱，炙） 白扁豆（去皮，姜汁浸，炒，一钱五分） 莲肉（炒，
一钱） 砂仁（炒，一钱） 桔梗（炒，一钱） 薏苡仁（一钱）
上为细末，每服二钱，枣子煎汤调下。七圣汤
治翻胃呕吐。
半夏（一钱） 黄连（一钱） 白豆蔻（一钱） 人参（一钱） 白茯苓（一钱） 竹茹（一钱） 生姜（三片）
上锉，一剂，水二钟，煎八分，空心热服。
六君子汤（方见脾胃。）
八味丸
即六味丸加肉桂、附子。（方见虚损。）
实
胃中有火，不能停食者，即王太仆所谓∶食不得入，是有火也。二陈汤加竹沥、姜汁、炒黄连、山栀。便
结者，四物汤加桃仁、红花、枳实、黄芩。痰阻者，二陈加枳壳、栝蒌仁、竹沥、姜汁，或用化痰丸。气逆
者，脉浮而洪，食已暴吐，气上冲胸发痛，用木香调气散。气滞者，脉沉而伏，二陈汤加木香、砂仁、青皮、
枳壳。食与气相假成积者，其脉浮而匿，其症或先痛而后吐，或先吐而后痛，治法当以小毒药去其积，槟榔、
木香行其气。下焦有寒者，其脉沉而迟，其症朝食暮吐，暮食朝吐，小便清，大便闭而不通，治法当以通其闭
塞，温其寒气。大便渐通，复以中焦药和之，不令大便秘结而自愈也。
二陈汤（方见痰证。）
化痰丸（方见痰证。）
木香调气散
白豆蔻（二两） 丁香（二两） 木香（二两） 檀香（二两） 藿香叶（八两） 炙甘草（八两） 砂仁（四两）
上为末，每服二钱，入盐少许，沸汤点服。
一方
治翻胃之要药。
韭汁（二两） 牛乳（一盏） 生姜（半两，取汁） 竹沥（半盏） 童便（一盏）
上五味，和匀顿服，或入煎剂中同服尤佳。
一方治翻胃极效，用螃蟹洗净，入水中，蟹背上水要高三、四指，以香油一小盏入水中，将两指捻白面撒
水上，蟹脐内白沫即出，次日去蟹，留水晒干为末，每服五分，淡烧酒下。
[Song] Fanwei (Revolving Stomach) is mostly caused by deficiency of Qi and Blood; when the pulse is insufficient, prognosis is poor with high mortality. If the etiology involves Phlegm or Fire, methods of resolving and descending should be employed; a rapid, slippery, and deep pulse can verify this. Additionally, there are cases of Cold stagnation and Qi stagnation, where the pulse presents as deep and hidden or deep and slow.
[Discussion] Fanwei develops from Yige (Dysphagia); once the disease progresses to Fanwei, it becomes critical. In some cases, food eaten in the morning is vomited in the evening, or food eaten in the evening is vomited in the morning; the vomitus consists entirely of the ingested food, occurring daily without change, which characterizes Fanwei. Vomiting that occurs at irregular times is simply termed "Ou" (Vomiting). Dry retching without expulsion of matter is termed "Xu Ou" (Deficiency Vomiting). Generally, this disease arises from dryness and depletion of Blood, failing to nourish and moisten the intestines and stomach, resulting in an inability to accept food above and pass stool below. If the stool resembles sheep dung (dry and hard), it indicates a fatal condition. However, those with Blood deficiency present with a rapid but forceless pulse; those with Qi deficiency present with a slow but forceless pulse; those with both Qi and Blood deficiency produce excessive saliva in the mouth, and if saliva flows profusely, death is inevitable. There are also cases of intense Heat, presenting with a rapid and forceful pulse; cases of Phlegm obstruction, presenting with a slippery and forceful pulse; cases of Qi stagnation, presenting with a deep and hidden pulse; and cases of Cold stagnation, presenting with a deep and slow pulse. These are not signs of Qi and Blood exhaustion, thus they are treatable. Practitioners must carefully distinguish between excess and deficiency to avoid error.
[Pulse Diagnosis] In Fanwei and Yige, the Cun (Inch) position is tight and the Chi (Cubit) position is choppy. A tight, hollow, or wiry pulse indicates the calamity of Deficiency-Cold. A deep pulse at the Guan (Bar) position indicates Phlegm; a floating and choppy pulse indicates Spleen accumulation. A floating and weak pulse indicates Qi deficiency; a choppy and small pulse indicates Blood weakness. If the pulse is choppy and deep, it is often due to constraint by the Seven Emotions.
Deficiency Pattern: Yin-Blood deficiency fails to nourish the Large Intestine, leading to difficult defecation. This is generally because the pylorus is obstructed, causing Qi to rush upward to the glottis, preventing food intake. Elderly patients are difficult to treat, while younger patients may still recover. Use Siwu Tang (Four Substances Decoction) plus Tao Ren (Peach Kernel), Hong Hua (Safflower), Hema Ren (Hemp Seed), and Zhike (Aurantium Fruit). For severe impaction, temporarily add Shu Dahuang (Prepared Rhubarb) to guide out stagnation, adjusting dosage according to the patient's deficiency or excess. For middle-aged patients, use Siwu Tang plus Tongbian (Child's Urine), Jiu Zhi (Leek Juice), Niu Nai (Cow Milk), Yang Nai (Sheep Milk), Zhu Li (Bamboo Sap), and Jiang Zhi (Ginger Juice). For Qi deficiency, use Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder). For Qi deficiency with Fire and Phlegm, use Qisheng Tang (Seven Sages Decoction). for Yin deficiency with flaming-up Fire, use Siwu Tang plus Zhimu (Anemarrhena Rhizome), Huangbai (Phellodendron Bark), Jiang Zhi, and Zhu Li. If appetite is poor, stools are loose, chest and diaphragm feel full and stifled, acid regurgitation and belching of rotten food occur, and food is digested poorly then regurgitated, this is Spleen-Stomach Deficiency-Cold. As Wang Taipu stated: "Food enters and comes back out; this is lack of Fire." Use Liujunzi Tang (Six Gentlemen Decoction) plus Pao Ganjiang (Prepared Ginger Rhizome), Baidoukou (Cardamom), Huanglian (Coptis Rhizome), and Zhi Wuzhuyu (Processed Evodia Fruit). If ineffective, use Bawei Wan (Eight-Ingredient Pill) to tonify Mingmen Fire to generate Spleen Earth. Siwu Tang (Formula see Blood Syndromes chapter).
Shenling Baizhu San
Treats Spleen-Stomach weakness, loss of appetite, vomiting, and diarrhea.
Renshen (2 qian, remove rhizome) Fuling (2 qian, remove bark) Baizhu (2 qian, stir-fried with soil) Shanyao (2 qian, stir-fried) Gancao (2 qian, honey-fried) Bian Dou (remove skin, soak in ginger juice, stir-fried, 1.5 qian) Lian Rou (stir-fried, 1 qian) Sharen (stir-fried, 1 qian) Jiegeng (stir-fried, 1 qian) Yiyiren (1 qian)
Grind into fine powder. Take 2 qian per dose, mixed with decoction of Jujube.
Qisheng Tang
Treats Fanwei and vomiting.
Banxia (1 qian) Huanglian (1 qian) Baidoukou (1 qian) Renshen (1 qian) Fuling (1 qian) Zhuru (1 qian) Shengjiang (3 slices)
Cut into pieces. One dose with 2 zhong of water, decoct to 0.8 zhong. Take hot on an empty stomach.
Liujunzi Tang (Formula see Spleen-Stomach chapter).
Bawei Wan
Is Liuwei Wan (Six-Ingredient Pill with Rehmannia) plus Rougui (Cinnamon Bark) and Fuzi (Aconite Root). (Formula see Deficiency Damage chapter).
Excess Pattern: Fire in the Stomach prevents food retention, as Wang Taipu stated: "Food cannot enter; this is due to Fire." Use Erchen Tang (Two Aged Ingredients Decoction) plus Zhu Li, Jiang Zhi, Chao Huanglian (Stir-fried Coptis), and Shanzhi (Gardenia Fruit). For constipation, use Siwu Tang plus Tao Ren, Hong Hua, Zhishi (Immature Aurantium), and Huangqin (Scutellaria Root). For Phlegm obstruction, use Erchen Tang plus Zhike, Gualou Ren (Trichosanthes Seed), Zhu Li, and Jiang Zhi, or Huatan Wan (Phlegm-Resolving Pill). For rebellious Qi, with a floating and surging pulse, sudden vomiting after eating, and Qi rushing to the chest causing pain, use Muxiang Tiaoqi San (Costus Regulating Qi Powder). For Qi stagnation, with a deep and hidden pulse, use Erchen Tang plus Muxiang (Costus Root), Sharen, Qingpi (Young Aurantium Peel), and Zhike. When food and Qi combine to form accumulation, the pulse is floating and concealed; symptoms include pain before vomiting or vomiting before pain. The treatment method should use mild toxic drugs to remove accumulation, using Binglang (Areca Seed) and Muxiang to move Qi. For Cold in the Lower Jiao, the pulse is deep and slow; symptoms include morning food evening vomiting, evening food morning vomiting, clear urine, and closed/unpassing stool. The treatment should open the blockage and warm the Cold. Once stool gradually passes, use Middle Jiao harmonizing medicines to prevent re-constipation, leading to spontaneous recovery.
Erchen Tang (Formula see Phlegm Syndromes chapter).
Huatan Wan (Formula see Phlegm Syndromes chapter).
Muxiang Tiaoqi San
Baidoukou (2 liang) Dingxiang (2 liang) Muxiang (2 liang) Tanxiang (2 liang) Huoxiang Ye (8 liang) Zhigancao (8 liang) Sharen (4 liang)
Grind into powder. Take 2 qian per dose, add a little salt, and take with boiling water.
Another Formula
Key medicine for treating Fanwei.
Jiu Zhi (2 liang) Niu Nai (1 zhan) Shengjiang (half liang, extract juice) Zhu Li (half zhan) Tongbian (1 zhan)
Mix the five ingredients evenly and take in one dose, or add to a decoction for better efficacy.
Another highly effective formula for Fanwei: Wash a crab clean, place it in water so that the water level is three to four fingers high above the crab's back. Pour a small zhan of Sesame Oil into the water. Dip two fingers in white flour and sprinkle it on the water surface. White foam will emerge from the crab's umbilicus. Remove the crab the next day, leave the water, dry it in the sun, and grind into powder. Take 5 fen per dose, washed down with light rice wine.