大意
王太仆曰。食入反出。是谓无火。张洁古曰。下焦吐者因于寒。合是两说而并衡之。其为真火衰微。不能腐
熟水谷则一也。（汇补）
内因
病由悲愤气结。思虑伤脾。或先富后贫之失精。或先贵后贱之脱营。抑郁无聊。而寄情诗酒。或艳冶当前。
而纵饮高歌。皆能酿成痰火。妨碍饷道而食反出。（汇补）
外候
或食已则吐。或再食则吐。或朝食暮吐。或暮食朝吐。心胸痞闷。往来寒热。或大便不实。或嗳腐噫酸。（丹溪）
反胃分辨
有损伤胃气而吐者。有脾不运化而吐者。有中焦积热者。有下焦虚寒者。脉大有力。当作热治。脉小无力。
当作寒医。色之黄白而枯者为虚寒。色之红赤而泽者为实热。（士材）
脉法
趺阳脉浮而涩。虚而微。弦而迟。小而滑者。均为反胃。右尺濡弱者。亦成反胃。
治法
治宜开胃顺气以调上。培脾扶土以和中。壮火回阳以温下。其他如化痰抑肝镇坠诸药。酌而用之。
用药
主以二陈汤。加藿香、蔻仁、木香、砂仁、香附、苏梗。消食。加神曲、麦芽。助脾。加人参、白术。抑肝。加
沉香、白芍。温中。加炮姜、益智。壮火。加肉桂、丁香。甚用附子理中汤。或八味丸。反胃。用伏龙肝水煎药以补土。
糯米汁以泽脾。代赭以镇逆。乌铭以抑肝。若服药初愈者。切不便与粥。复伤胃家。惟以人参五钱、陈皮一钱、老黄米
一两。作汤细啜。旬日之后。方可食粥。否则仓廪未固。卒至不救。
反胃选方
二陈汤（方见痰症） 理中汤（方见中寒） 八味丸 六君子汤（二方见中风）
木香调气散
白豆蔻 丁香 木香（各二钱） 檀香（一钱半） 藿香（八分） 砂仁（四钱） 甘草（八分）
为末。每服二钱。加盐少许。沸汤下。
滋血润肠汤（统旨） 治血枯。及死血在膈。饮食不下反出。便燥。
当归（三钱） 白芍 生地（各一钱半） 红花 桃仁 大黄（煨） 枳壳（各一钱）
水煎。入韭汁服。
滋阴清膈散 治阴火上冲而食反出。
当归 白芍 黄柏 黄连（各一钱半） 黄芩 山栀 生地（各一钱） 甘草（三分）
水煎。入童便、竹沥服。
九伯饼 治反胃饮食不下。下即吐痰涎。
南星（姜汁制炮七次） 人参（各三钱） 半夏（姜汁洗七次） 枯矾 枳实（麸炒七次） 浓朴（姜炒）
甘草（各五钱） 木香（四钱） 豆豉（一两）
为末。老米打糊为饼。如钱大。瓦上焙干。露过。每服一饼。细嚼。以姜煎平胃散下。此方加阿魏三钱神效。
附子散
用大附一只。坐砖上。四面着火。渐逼干。淬入姜汁中。又根据前火逼干。复淬之。约姜汁尽碗许。捣为末。将
粟米饮下一钱。
金桃酒 治反胃吐酸。
古铜四钱。敲如米大。再入核桃肉一斤。与前同研烂。用烧酒一斤。和铜挑匀。入瓶内。封口。隔水慢火煮
一时。取出埋地下一二时。每日空心服一盏。如病重者。午后再服。
[General Principle]
Wang Bing (styled Taipu) stated: "Food entering and then being vomited back up is termed 'Fireless' (referring to the deficiency of Mingmen True Fire)." Zhang Yuansu (styled Jiegu) stated: "Vomiting from the Lower Jiao is caused by Cold." Synthesizing and weighing these two statements, their root cause is identical: the decline of True Fire, resulting in the inability to rot and cook water and grain. (From *Zhengzhi Huibu*)
[Internal Causes]
Disease arises from grief and anger causing Qi stagnation, excessive worry injuring the Spleen, or the loss of Essence due to a transition from wealth to poverty, and the depletion of Ying Blood due to a fall from nobility to lowliness. Depressed and bored, one may find solace in poetry and wine; or facing beauty, one may indulge in drinking and singing loudly. All these can brew Phlegm-Fire, obstructing the pathway of nourishment and causing food to be vomited back. (From *Zhengzhi Huibu*)
[External Manifestations]
Some vomit immediately after eating, some vomit upon eating again, some vomit in the evening what was eaten in the morning, and some vomit in the morning what was eaten in the evening. There is chest and epigastric fullness and oppression, alternating chills and fever, loose stools, or belching with a putrid odor and acid regurgitation. (From Zhu Danxi)
[Differentiation of Fanwei (Reverse Stomach)]
There are cases of vomiting due to injury of Stomach Qi, cases due to the Spleen's failure to transport and transform, cases due to accumulated Heat in the Middle Jiao, and cases due to Deficiency-Cold in the Lower Jiao. If the pulse is large and forceful, treat as Heat. If the pulse is small and weak, treat as Cold. A sallow or white complexion that is dry indicates Deficiency-Cold; a ruddy or red complexion that is lustrous indicates Excess-Heat. (From Li Shicai)
[Pulse Diagnosis]
The Fuyang pulse (pulse at the dorsum pedis, reflecting Stomach Qi) that is floating and choppy, or deficient and faint, or wiry and slow, or small and slippery, all indicate Fanwei. A Rouruo (soft and weak) pulse at the Right Chi position (reflecting Kidney and Mingmen) also leads to Fanwei.
[Therapeutic Principles]
Treatment should focus on opening the Stomach and smoothing Qi to regulate the Upper Jiao, tonifying the Spleen and supporting Earth to harmonize the Middle Jiao, and strengthening Fire and restoring Yang to warm the Lower Jiao. Other herbs such as those for resolving Phlegm, suppressing the Liver, and anchoring rebellious Qi should be used according to discretion.
[Herbal Medication]
The main formula is Erchen Tang (Two-Aged Decoction), added with Huoxiang (Patchouli Herb), Kouren (Cardamom Seed), Muxiang (Aucklandiae Radix), Sharen (Amomi Fructus), Xiangfu (Cyperi Rhizoma), and Sugeng (Perillae Caulis). For digesting food, add Shenqu (Massa Medicata Fermentata) and Maiya (Hordei Fructus Germinatus). To assist the Spleen, add Renshen (Ginseng Radix) and Baizhu (Atractylodis Macrocephalae Rhizoma). To suppress the Liver, add Chenxiang (Aquilaria Lignum) and Baishao (Paeoniae Radix Alba). To warm the Middle, add Paojiang (Prepared Ginger) and Yizhiren (Alpiniae Oxyphyllae Semen). To strengthen Fire, add Rougui (Cinnamomi Cortex) and Dingxiang (Caryophylli Flos). In severe cases, use Fuzi Lizhong Tang (Aconite Root Decoction to Regulate the Middle) or Bawei Wan (Eight-Ingredient Pill). For Fanwei, decoct herbs in water boiled with Fulonggan (Calcined Coeli Terra) to tonify Earth, use Nuomici juice (Glutinous Rice Juice) to moisten the Spleen, Dai Zhe Shi (Ochre) to anchor rebellion, and Wumei/Wuzhuyu (actually Wuhua/Seppia Gladius, here referring to Hai Piao Xiao - Sepiae Endoconcha) to restrain the Liver. If the patient has just recovered from medication, porridge must strictly be avoided to prevent re-injuring the Stomach Qi. Instead, decoct 5 qian of Renshen, 1 qian of Chenpi (Citri Reticulatae Pericarpium), and 1 liang of Lao Huangmi (Old Yellow Rice) into a thin soup and sip slowly. After ten days, porridge may be introduced. Otherwise, if the Granaries (Spleen and Stomach function) are not yet solid, rescue will ultimately be impossible.
[Selected Formulas for Fanwei]
Erchen Tang (See Tan Zheng chapter) Lizhong Tang (See Zhong Han chapter) Bawei Wan Liujunzi Tang (See Fengzhong chapter)
Muxiang Tiaoqi San (Aucklandiae Radix Powder to Regulate Qi)
Baidoukou (Cardamomi Fructus), Dingxiang (Caryophylli Flos), Muxiang (Aucklandiae Radix) (2 qian each), Tanxiang (Santalum Album Lignum) (1.5 qian), Huoxiang (Agastaches Herba) (0.8 fen), Sharen (Amomi Fructus) (4 qian), Gancao (Glycyrrhizae Radix et Rhizoma) (0.8 fen).
Grind into powder. Take 2 qian per dose, add a little salt, and take with boiling water.
Zixue Runchang Tang (Nourishing Blood and Moistening Intestines Decoction) (From *Tongzhi*)
Treats Blood exhaustion and fixed blood stasis in the Diaphragm, where food cannot go down but comes back up, accompanied by dry stool.
Danggui (Angelicae Sinensis Radix) (3 qian), Baishao (Paeoniae Radix Alba), Shengdi (Rehmanniae Radix) (1.5 qian each), Honghua (Carthami Flos), Taoren (Persicae Semen), Dahuang (Rhei Radix et Rhizoma, baked), Zhike (Aurantii Fructus Immaturus) (1 qian each).
Decoct in water, add Jiuzhi (Allium Tuberosum Juice), and take.
Ziyin Qingge San (Yin-Nourishing and Diaphragm-Clearing Powder)
Treats Food reflux caused by Yin Fire rushing upward.
Danggui (Angelicae Sinensis Radix), Baishao (Paeoniae Radix Alba), Huangbai (Phellodendri Cortex), Huanglian (Coptidis Rhizoma) (1.5 qian each), Huangqin (Scutellariae Radix), Shanzhi (Gardeniae Fructus), Shengdi (Rehmanniae Radix) (1 qian each), Gancao (Glycyrrhizae Radix et Rhizoma) (0.3 fen).
Decoct in water, add Tongbian (Child Urine) and Zhuli (Bambusa Textilis Sap) and take.
Jiubo Bing (Jiu Bo Cake)
Treats Fanwei where food cannot go down and phlegm-saliva is vomited immediately after ingestion.
Nanxing (Arisaematis Rhizoma, processed with Ginger Juice and fried seven times), Renshen (Ginseng Radix) (3 qian each), Banxia (Pinelliae Rhizoma, washed with Ginger Juice seven times), Kufan (Alumen), Zhishi (Aurantii Fructus Immaturus, bran-fried seven times), Houpo (Magnoliae Officinalis Cortex, ginger-fried), Gancao (Glycyrrhizae Radix et Rhizoma) (5 qian each), Muxiang (Aucklandiae Radix) (4 qian), Douchi (Sojae Semen Praeparatum) (1 liang).
Grind into powder, make into cakes using Old Rice paste, size of a coin, bake on tile until dry, and expose to dew. Take one cake per dose, chew thoroughly, and swallow with Pingwei San (Regulate the Stomach Powder) decocted with Ginger. Adding 3 qian of Awei (Asafoetida) to this formula yields miraculous effects.
Fuzi San (Aconite Root Powder)
Take one large Fuzi (Aconiti Lateralis Radix Praeparata), place it on a brick, and apply fire around it until gradually dried. Quench it in Ginger Juice. Repeat the firing and quenching process until approximately one bowl of Ginger Juice is consumed. Grind into powder. Take 1 qian with Millet Drink.
Jintao Jiu (Golden Peach Wine)
Treats Fanwei with acid regurgitation.
Ancient Copper (4 qian), crushed to rice-grain size. Mix with 1 jin of Walnut Meat (Hetao Ren). Grind together until smooth. Add 1 jin of Shaojiu (Distilled Liquor), mix evenly with the copper, seal in a bottle, and simmer in water over low heat for one shichen (two hours). Remove and bury in the ground for one to two hours. Take one cup on an empty stomach daily. For severe cases, take another cup after noon.