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Pulse Diagnosis for Regurgitation (Wei Fan)

The *Nan Jing* (Classic of Difficult Issues) states: When the pulse presents a "Ge" (blocking/resisting) quality, vomiting and upward reversal of Qi occur (see section on Lin Syndrome).

The *Mai Jing* (Pulse Classic) states: A pulse that is tight and slippery indicates vomiting and upward reversal; a pulse that is small, weak, and choppy indicates Wei Fan (stomach reversal).

The *Qian Jin Fang* (Prescriptions Worth a Thousand Gold) states: In a person with a tight cun pulse and a chopchi chi pulse, there is chest fullness, inability to eat, and vomiting. If the vomiting stops, it is due to previous inappropriate purgation leading to an inability to eat; if the vomiting does not stop, this is Wei Fan, hence the chi pulse is described as slightly choppy.

The *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet) states: If a patient has a rapid pulse, which indicates heat and should normally allow for digestion of grains and increased thirst, yet they vomit instead, this is because excessive sweating caused Yang Qi to become weak and Diaphragm Qi to become deficient, resulting in a rapid pulse. This rapidness is due to "Guest Heat," which cannot digest food; the root cause is deficiency-cold in the Stomach. A wiry pulse indicates deficiency, meaning Stomach Qi is insufficient. Food eaten in the morning is vomited in the evening, transforming into Wei Fan. Cold pathogen resides in the upper jiao, but the physician incorrectly used purgatives. Since the pulse is now wiry, it is named "Deficiency." The Fu Yang pulse (radial artery at the ankle) is floating and choppy. Floating indicates deficiency; choppy indicates Spleen injury. When the Spleen is injured, it fails to grind and transform food. Food eaten in the morning is vomited in the evening, and food eaten in the evening is vomited in the morning. Undigested food remains, termed Wei Fan. A pulse that is tight and choppy indicates a difficult-to-treat condition.

Zhu Danxi stated: The Stomach is the sea of water and grain; the Spleen is the organ of digestion. When clear and harmonious, functions are robust and transport is normal. People often take aromatic, hot, and warm medicines for phlegm-fluid retention, vomiting, and other Qi disorders, which excessively agitates the boiling of Qi and Blood. Initially, this causes Stomach fluids to coagulate; over time, Spleen Qi is exhausted, and transformation/transportation gradually slows. Furthermore, taking Aconite (Wu Tou), Prepared Aconite Root (Fu Zi), and alchemical pills depletes both blood and Yin over time, causing the gastric region to become dry and withered. If the withering is in the upper part, near the throat, liquids can pass down, but solids are difficult to enter. Even if some enters, the amount is small; this is called "Ye" (dysphagia/choking). If the withering is in the lower part, near the stomach, food may enter but cannot fully pass into the stomach. It stays for a long time and is then regurgitated; this is called "Ge" (diaphragmatic obstruction), also known as "Fan Wei" (regurgitation). Stool becomes hard and dry, resembling sheep dung. Although the names differ, the disease originates from the same source. Some ask: The *Qian Jin Fang* did not discard Ginger and Cinnamon when treating Ye, Ge, and Fan Wei. Why do you speak so much? I reply: When Qi stagnation lingers in the clear orifices for a long time, aromatic and hot medicines are necessary to move it. However, these must be assisted by herbs such as Rhubarb (Da Huang), Gypsum (Shi Gao), Bamboo Shavings (Zhu Ru), Mirabilite (Mang Xiao), Alisma (Ze Xie), Peucedanum (Qian Hu), Nitrated Potassium (Pu Xiao), Poria (Fu Ling), Scutellaria (Huang Qin), Reed Rhizome (Lu Gen), and Trichosanthes Fruit (Gua Lou). Thus, while the initial approach may seem similar, the final outcome differs. Pathogenic factors are easily subdued, and the body returns to peace.

Yan Shi stated (consistent with *San Yin Fang*): The Five Ye and Five Ge arise from irregular emotions (joy, anger, etc.) injuring the Spleen and Stomach, leading to Qi constraint, phlegm generation, and the struggle between Phlegm and Qi, where Qi rises but does not descend, preventing food intake. When Qi lodges in the throat and epiglottis, it forms the Five Ye; when it knots in the chest and diaphragm, it forms the Five Ge. The term "Five Ye" refers to conditions caused by worry, thought, fatigue, and diet. The term "Five Ye" (in another context/classification) refers to conditions caused by indignation, cold, heat, and diet. These diseases cause chest and diaphragm stuffiness, vomiting, upward reversal, choking, and obstruction of food intake. The treatment method is to regulate Yin and Yang, resolve phlegm, and direct Qi downward. When Yin and Yang are balanced, Qi flows smoothly, and Phlegm descends, leaving no basis for the disease to arise. Note: Ge and Ye syndromes all result from Qi aggregation forming masses, which generate phlegm over time. As the mass persists, both blood and Qi are affected. Because the pathology is located in the throat and diaphragm, predecessors established the distinct names of Ge and Ye. *San Yin Fang* further subdivided them into five types of Ye and five types of Ge based on symptoms. However, these distinctions are merely nominal; the treatment principles remain the same, so they are not detailed here. Furthermore, Yan Shi's theory of resolving phlegm and directing Qi downward implies that if Qi does not descend and Phlegm does not transform, there must be a root cause. If one treats only the branch with aromatic and drying herbs without addressing the root, how can Phlegm and Qi naturally descend?