吴 脉小涩。脘中隐痛。呕恶吞酸。舌绛不多饮。此高年阳气结于上。阴液衰于下。为关格之渐。
当开痞通阳议治。（阳结于上阴衰于下关格）
川连 人参 姜汁 半夏 枳实汁 竹沥
卢 阴阳逆乱。已成关格。议用附子泻心汤。为上热下寒主治。
徐（七八） 老人食入涎涌。吐痰略能咽粥。二便艰少。是阳不转旋上结。阴枯于下便难。极难调治。勿
用腥油 味。脉弦大而搏。议妙香丸。
又 妙香丸仍服。每五日服大半夏汤。
毛 老年形消。不食不便。气冲涌涎。乃关格之症。议用进退黄连汤。
川连 淡干姜 半夏 姜汁 人参 茯苓 附子 生白芍
濮（七十） 七旬有年。纳食脘胀。大便干涩。并不渴饮。痰气凝遏阻阳。久延关格最怕。
川连 枇杷叶 半夏 姜汁 杏仁 枳壳
杜（六四） 老人积劳久虚。因渴饮冷。再伤胃阳。洞泄复加呕吐。不受汤饮食物。上不得入。下不得出。
此为关格难治。
人参 半夏 川连 淡干姜
某 清阳日结。腹窄不能纳谷。阴液渐涸。肠失润。大便难。
桂枝 川连 半夏 姜汁 杏仁 茯苓
毕（五四） 夏间诊视。曾说难愈之 。然此病乃积劳伤阳。年岁未老。精神已竭。古称噎膈反胃。都因
阴枯而阳结也。秋分后复诊。两脉生气日索。交早咽燥。昼日溺少。五液告涸。难任刚燥阳药。
是病谅非医药能愈。大半夏汤加黄连姜汁。
某 脉寸口搏大。按之则涩。形瘦气逆。上不纳食。下不通便。老年积劳内伤。阳结不行。致脘闭
阴枯。腑乏津营。必二便交阻。病名关格。为难治。
人参 枳实 川连 生干姜 半夏 茯苓
苏（五四） 向来翻胃。原可撑持。秋季骤加惊忧。厥阳陡升莫制。遂废食不便。消渴不已。如心热。呕吐
涎沫。五味中喜食酸甘。肝阴胃汁。枯槁殆尽。难任燥药通关。胃属阳土。宜凉宜润。肝为刚脏。
宜柔宜和。酸甘两济其阴。（肝阴胃汁枯）
乌梅肉 人参 鲜生地 阿胶 麦冬汁 生白芍
某 阳明汁干成膈。
梨汁 柿霜 玉竹 天冬 麦冬 甜杏仁 川贝 生白芍 三角胡麻
王（五三） 老年血气渐衰。必得数日大便通爽。然后脘中纳食无阻。此胃汁渐枯。已少胃气下行之
旨。噎症萌矣。病乃操持太过。身中三阳。燔燥烁津所致。故药饵未能全功。议用丹溪法。（烦劳阳亢肺胃津液枯）
麦冬汁 鲜生地汁 柏子仁汁 甜杏仁什 黑芝麻汁 杜苏子汁 松子仁浆
水浸布纸。绞汁滤清。炖自然膏。
马（六十） 劳心劳力经营。向老自衰。平日服饵桂附生姜三十年。病食噎不下膈吐出。此在上焦之
气不化。津液不注于下。初病大便艰涩。按经云。味过辛热。肝阳有余。肺津胃液皆夺。为上燥。
仿嘉言清燥法。
麦冬 麻仁 鲜生地 甜水梨 桑叶 石膏 生甘草
某 脉涩左大。食入为噎。是属液亏。先宜理气。后用润剂。（液亏气滞）
半夏 云茯苓 枇杷叶 枳实 竹沥
程 舌黄微渴。痰多咳逆。食下欲噎。病在肺胃。高年姑以轻剂清降。（肺胃气不降）
鲜枇杷叶 杏仁 郁金 栝蒌皮 山栀 淡香豉
沈 格拒食物。涎沫逆气。自左上升。此老年悒郁所致。必使腑通浊泄。仅可延年。议两通阳明
厥阴之法。（肝郁气逆）
半夏 苦杏仁 茯苓 橘红 竹沥 姜汁
俞 酒热郁伤。脘中食阻而痛。治以苦辛寒。（酒热郁伤肺胃）
小川连 半夏 香豉 枳实 茯苓 姜汁
又 苦辛化燥。噎阻不舒。而大便不爽。治手太阴。
鲜枇杷叶 紫菀 苏子 杏仁 桃仁 郁金
某 忧思郁结。凝痰阻碍。已属噎塞之象。当怡情善调。（忧郁痰阻）
炒半夏（一钱半） 茯苓（五钱） 秫米（三钱） 枳实（一钱炒） 姜汁（三小匙冲）
杨（四七） 脉弦而小涩。食入脘痛格拒。必吐清涎。然后再纳。视色苍。眼筋红黄。昔肥今瘦。云是郁怒
之伤。少火皆变壮火。气滞痰聚日拥。清阳莫展。脘管窄隘。不能食物。噎膈渐至矣。法当苦
以降之。辛以通之。佐以利痰清膈。莫以豆蔻沉香劫津可也。
川黄连 杏仁 桔梗 土栝蒌皮 半夏 橘红 竹沥 姜汁
朱（五二） 未老形衰。纳谷最少。久有心下忽痛。略进汤饮不安。近来常吐清水。是胃阳日薄。噎膈须
防。议用大半夏汤。补腑为宜。（胃阳虚）
人参 半夏 茯苓 白香粳米 姜汁 河水煎
白（五六） 少食颇安。过饱食不肯下。间有冷腻涎沫涌吐而出。此有年胃阳久馁。最多噎膈反胃之
虑。饮以热酒。脘中似乎快爽。显然阳微欲结。所幸二便仍通。浊尚下泄。犹可望安。
熟半夏（姜水炒二两） 茯苓（二两） 生益智仁（一两） 丁香皮（五钱） 新会皮（一两） 淡干姜（一两）
上药净末分量。用香淡豆豉一两洗净煎汁法丸。淡姜汤服三钱。
吕（六十） 劳倦饥饱。皆伤胃阳。年及花甲。最虑噎膈翻胃。此面饭酒肉重浊之物。与病不合。
半夏 姜汁 香豉 土栝蒌皮 杏仁 橘红
冯（六七） 有年阳微。酒湿浓味。酿痰阻气。遂令胃失下行为顺之旨。脘窄不能纳物。二便如昔。病在
上中。议以苦降辛通。佐以养胃。用大半夏汤。
半夏 人参 茯苓 姜汁 川连 枳实
又 胃属腑阳。以通为补。见症脘中窒塞。纳食不易过膈。肤浅见识。以白豆蔻木香沉香麝。冀
获速功。不知老人日衰。愈投泄气。斯冲和再无复振之理。故云岐子九法。后贤立辨其非。夏
季宜用外台茯苓饮加菖蒲。佐以竹沥姜汁。辛滑可矣。
顾（四十） 脉濡缓无力。中年胸胁时痛。继以早食晚吐。此属反胃。乃胃中无阳。浊阴腐壅。议仿仲景
阳明辛热宣通例。
吴萸 半夏 荜茇 淡干姜 茯苓
又 辛热开浊。吐减。行走劳力。即吐痰水食物。阳气伤也。用吴萸理中汤。
尤 脉缓。右关弦。知饥恶食。食入即吐。肢浮。便溏溺少。不渴饮。此胃阳衰微。开合之机已废。老
年噎膈反胃。乃大症也。
人参 茯苓 淡附子 淡干姜 炒粳米 姜汁
又 通胃阳法服。腑病原无所补。只以老年积劳伤阳之质。所服之剂。开肺即是泄气。芩连苦
寒劫阳。姜汁与干姜附子并用。三焦之阳皆通耳。若枳朴仍是泄气。与前义悖矣。
人参 茯苓 淡附子 淡干姜
刘（五四） 脉左小弦。右濡涩。五旬又四。阴阳日衰。劳烦奔走。阳愈伤。致清气欲结。食入脘痛。痰涎涌
逆。皆噎膈反胃见症。其饮酒愈甚。由正气先馁。非酒能致病。
川连 枳实汁 茯苓 半夏 广皮白 黑山栀
姜汁 竹沥
包（六十） 胸脘痞闷。嗳逆。三四日必呕吐粘腻。或黄绿水液。此属反胃。六旬有年。是亦重病。
川连 半夏 枳实 郁金 竹茹 姜汁
陆 脉沉微。阳气大伤。阴浊僭踞。旦食不能暮食。周身掣痛。背胀。病状着难愈之症。（阳虚阴浊凝滞）
人参 附子 干姜 茯苓 泽泻
姚（六二） 腑阳不通降。浊壅为反胃。累遭病反。老年难以恢复。自能潜心安养。望其悠久而已。药不
能愈是病矣。
人参 附子 干姜 公丁香 姜汁和丸
某 积劳有年。阳气渐衰。浊凝瘀阻。脘中常痛。怕成噎膈便塞之症。（阳衰脘痹血瘀）
桃仁 红花 延胡 川楝子 半夏 橘红 郁金汁 栝蒌皮
李 两关脉缓涩。食入气阻。吐涎稍通。前已吐过瘀浊胶粘。此皆久积劳倦。阳气不主旋运。为
噎膈反胃之症。此病最多反复。必须身心安逸。方可却病。徒药无益耳。
半夏 姜汁 桃仁 韭白汁 香豉 栝蒌皮 郁金
某 胃痛。得瘀血去而减。两三年宿病复起。食进痞闷。怕其清阳结而成膈。大意益气佐通。仍
兼血络为治。
人参 半夏 茯苓 新会皮 木香 生益智 当归 桃仁
水法丸。服三钱。
张（三三） 早食暮吐。大便不爽。病在中下。初因劳伤胃痛。痰瘀有形之阻。
半夏 枳实 制大黄 桃仁 韭白汁
经云。三阳结谓之膈。又云一阳发病。其传为膈。仲景云。朝食暮吐。暮食朝吐。宿谷不化。名
曰胃反。丹溪谓噎膈反胃。名虽不同病出一体。多因气血两虚而成。然历观噎膈反
胃之因。实有不同。大抵饮食之际。气忽阻塞。饮食原可下咽。如有物梗塞之状者。名曰噎。
心下格拒。饥不能食。或食到喉间。不能下咽者。名曰膈。食下良久复出。或隔宿吐出者。名
曰反胃。夫噎膈一症。多因喜怒悲忧恐五志过极。或纵情嗜欲。或恣意酒食。以致阳气内
结。阴血内枯而成。治宜调养心脾。以舒结气。填精益血。以滋枯燥。夫反胃乃胃中无阳。
不能容受食物。命门火衰。不能熏蒸脾土。以致饮食入胃。不能运化。而为朝食暮吐。暮食
朝吐。治宜益火之源。以消阴翳。补土通阳以温脾胃。故先生于噎膈反胃。各为立法以治
之。其阳结于上。阴亏于下。而为噎膈者。用通阳开痞。通补胃腑。以及进退黄连。附子泻心
诸法。上热下寒为治。其肝阴胃汁枯槁。及烦劳阳亢。肺胃津液枯而成噎膈者。用酸甘济
阴。及润燥清燥为主。其液亏气滞。及阳衰血瘀而成噎膈者。用理气逐瘀。兼通血络为主。
其胃阳虚而为噎膈反胃。及忧郁痰阻而成者。用通补胃腑。辛热开浊。以及苦降辛通。佐
以利痰清膈为主。其肝郁气逆而为噎膈者。两通厥阴阳明为治。其酒热郁伤肺胃。气不
降而为噎膈者。用轻剂清降。及苦辛寒开肺为主。而先生于噎膈反胃治法。可谓无遗蕴
矣。张景岳云。治噎膈大法。当以脾肾为主。其理甚通。当宗之。又有饮膈热膈。及忧气恚食
寒之膈。其主治各载本门。兹不复赘。（邹滋九）
是证。每因血枯气衰致此。凡香燥消涩之药。久在禁内。案中虽有一二仿用辛热。而亦必
谛审其为阳微浊踞者。其余或苦辛泄滞而兼润养。或酸甘化液而直滋清。或郁闷于气
分。而推扬谷气。或劳伤于血分。而宣通瘀浊。总以调化机关。和润血脉为主。阳气结于上。
阴液衰于下。二语。实为证之确切论也。（姚亦陶）
徐评 果系膈症。百无一生。不必言治。若反胃则古人自有主方。不得泛用通治之品。此老尚
未明也。
案中多用人参。其意以为不食胃虚。不可不用参以补其精气。不知噎膈之症。必有瘀血顽痰
逆气。阻膈胃气。其已成者。百无一治。其未成者。用消瘀去痰降气之药。或可望其通利。若用人
参。虽或一时精气稍旺。而病根益深。永无愈期矣。
吴先生：脉象细小涩滞。胃脘部隐隐作痛。呕吐恶心、吞酸水。舌质深红但饮水不多。这是高龄之人阳气郁结于上焦，阴液亏损于下焦的征兆，是关格病（上下阴阳隔绝不通之重症）的初期表现。
应当采用开痞散结、通阳化气的治法。（针对阳结于上、阴衰于下的关格证）
川黄连 人参 姜汁 半夏 枳实汁 竹沥
卢先生：阴阳之气逆乱失调，已经形成关格病。建议用附子泻心汤治疗。此方主治上热下寒之证。
徐先生（七十八岁）：老年人进食后涎沫涌出，吐痰后勉强能喝粥。大小便困难且量少。这是阳气不能转旋上行而郁结，阴液枯竭于下导致大便难行。极难调理治疗。不要食用腥油腻的食物。脉象弦大且搏指有力。建议服用妙香丸。
又：继续服用妙香丸。每五天服用一次大半夏汤。
毛先生：老年人形体消瘦。不进食且不便秘。气机上冲涌出涎沫。这是关格的症状。建议用进退黄连汤治疗。
川黄连 淡干姜 半夏 姜汁 人参 茯苓 附子 生白芍
濮先生（七十岁）：年过七旬。进食后胃脘胀满。大便干涩。并不口渴想喝水。痰气凝结遏制阳气，日久拖延最怕是发展为关格。
川黄连 枇杷叶 半夏 姜汁 杏仁 枳壳
杜先生（六十四岁）：老人因长期劳累久虚，因为口渴喝冷饮，再次损伤了胃阳。腹泻加重并伴有呕吐。无法接受汤水和食物。上面吃不下，下面排不出。
这属于关格难治之症。
人参 半夏 川黄连 淡干姜
某患者：清阳之气日渐郁结。腹部狭窄不能容纳谷物。阴液逐渐枯竭。肠道失去滋润。大便困难。
桂枝 川黄连 半夏 姜汁 杏仁 茯苓
毕先生（五十四岁）：夏季诊视时曾说此病难以痊愈。然而此病乃是长期劳累损伤阳气，年纪尚轻，精神却已衰竭。古人称之为噎膈反胃，都是因为阴液枯竭而阳气郁结所致。秋分后复诊，两脉生气日渐衰退。交节之时咽干口燥。白天尿少。五脏津液告急枯竭。难以耐受刚烈燥热的阳药。
这个病估计不是医药所能治愈的。用大半夏汤加黄连和姜汁。
某患者：脉象寸口部搏动大而按之则涩。形体消瘦，气机上逆。上面不能纳食，下面不通大便。老年长期劳累内伤，阳气郁结不行，导致胃脘闭塞，阴液枯竭。腑脏缺乏津液营血。必然出现二便阻塞不通。病名叫做关格。属于难治之症。
人参 枳实 川黄连 生干姜 半夏 茯苓
苏先生（五十四岁）：向来患有翻胃（反胃），原本还可以支撑。秋季突然受到惊恐忧虑，厥阳之气陡升无法控制。于是废食不便。消渴不止。像心里发热。呕吐涎沫。五味之中喜欢食用酸甘之物。肝阴和胃汁已经枯槁殆尽。难以耐受燥药来通关。胃属阳土，宜凉宜润。肝为刚脏，宜柔宜和。用酸甘之法共同滋养其阴。（针对肝阴胃汁枯槁）
乌梅肉 人参 鲜生地 阿胶 麦冬汁 生白芍
某患者：阳明经津液干枯而成膈证。
梨汁 柿霜 玉竹 天冬 麦冬 甜杏仁 川贝母 生白芍 三角胡麻
王先生（五十三岁）：老年人气血逐渐衰弱。必须得几天大便通畅爽利，然后胃脘中进食才无阻碍。这是胃汁逐渐枯竭，已经缺少胃气下行的旨意。噎症萌芽了。病因是操持劳碌太过，身体中三阳之火燔灼干燥，烁伤津液所致。所以药物未能完全奏效。建议用朱丹溪的方法。（针对烦劳致阳亢，肺胃津液枯）
麦冬汁 鲜生地汁 柏子仁汁 甜杏仁 黑芝麻汁 杜苏子汁 松子仁浆
用水浸湿布纸，绞取汁液滤清，炖煮成自然膏。
马先生（六十岁）：用心用力的经营劳作，到了老年自然衰老。平日服用桂枝、附子、生姜长达三十年。病表现为食物噎塞不下膈，吐出。这是在上焦的气化功能失常。津液不能注流于下。初病时大便艰涩。按照经文所说。味道过于辛热，导致肝阳有余。肺津胃液都被剥夺。属于上燥证。
仿照嘉言（李中梓或喻昌，此处指代清燥救肺汤类思路）的清燥法。
麦冬 麻仁 鲜生地 甜水梨 桑叶 石膏 生甘草
某患者：脉象涩，左脉大。进食即感噎塞。这是属于津液亏虚。先宜理气。后用润剂。（针对津液亏虚气机阻滞）
半夏 云茯苓 枇杷叶 枳实 竹沥
程先生：舌苔黄微渴。痰多咳嗽气逆。进食后欲发噎。病位在肺胃。高龄暂且用轻剂清热降逆。（针对肺胃气机不降）
鲜枇杷叶 杏仁 郁金 栝蒌皮 山栀 淡香豉
沈先生：格拒食物。涎沫逆气，从左侧上升。这是老年人忧郁所致。必须使腑气通畅，浊邪排泄，仅可延长寿命。建议用两通阳明和厥阴的方法。（针对肝郁气逆）
半夏 苦杏仁 茯苓 橘红 竹沥 姜汁
俞先生：酒热郁结受伤。胃脘中食物阻滞而疼痛。治疗用苦辛寒法。（针对酒热郁伤肺胃）
小川连 半夏 香豉 枳实 茯苓 姜汁
又：苦辛化燥。噎阻不适，而且大便不爽。治疗手太阴肺经。
鲜枇杷叶 紫菀 苏子 杏仁 桃仁 郁金
某患者：忧思郁结。凝痰阻碍。已经属于噎塞的现象。应当调畅情志，善于调理。（针对忧郁痰阻）
炒半夏（一钱半） 茯苓（五钱） 秫米（三钱） 枳实（一钱炒） 姜汁（三小匙冲服）
杨先生（四十七岁）：脉象弦而小涩。进食后胃脘疼痛格拒。必定吐出清稀涎沫。然后再进食。面色苍白。眼筋红黄。以前肥胖现在消瘦。说是由于郁怒所伤。少火都变成了壮火。气滞痰聚日益壅拥。清阳之气不能舒展。胃管狭窄隘细。不能进食。噎膈渐渐形成了。治法应当用苦味以降逆。辛味以通散。佐以利痰清膈。不要用豆蔻沉香等劫夺津液的药。
川黄连 杏仁 桔梗 土栝蒌皮 半夏 橘红 竹沥 姜汁
朱先生（五十二岁）：未老先衰。进食最少。长久以来有心下部突然疼痛。稍微进点汤饮就不安。近来常吐清水。这是胃阳日渐薄弱。需防噎膈。建议用大半夏汤。补益腑脏为宜。（针对胃阳虚）
人参 半夏 茯苓 白香粳米 姜汁 河水煎煮
白先生（五十六岁）：少吃颇觉安稳。吃多了食物不肯下行。间或有冷腻涎沫涌吐而出。这是年老胃阳长久虚弱。最多有噎膈反胃的顾虑。饮用热酒，胃脘中似乎快爽。显然是阳气微弱欲结。所幸二便仍然通畅。浊气尚能下泄。还可望平安。
熟半夏（姜水炒二两） 茯苓（二两） 生益智仁（一两） 丁香皮（五钱） 新会皮（一两） 淡干姜（一两）
将上述药物研净末，按比例分量。用香淡豆豉一两洗净煎汁泛丸。淡姜汤送服三钱。
吕先生（六十岁）：劳倦饥饱，都会损伤胃阳。年届花甲。最担心噎膈翻胃。此时面食酒肉重浊之物，与病情不合。
半夏 姜汁 香豉 土栝蒌皮 杏仁 橘红
冯先生（六十七岁）：年老阳气微弱。酒湿浓味。酿生痰浊阻碍气机。遂令胃失下行为顺的旨意。胃脘狭窄不能纳物。二便如常。病在上中二焦。建议用苦降辛通。佐以养胃。用大半夏汤。
半夏 人参 茯苓 姜汁 川黄连 枳实
又：胃属腑阳，以通为补。见到症状胃脘中窒塞，进食不易过膈。肤浅的见识，用白豆蔻木香沉香麝香，希望获得速效。不知道老人日渐衰弱，越投泄气之药。那么冲和之气再无复兴的道理。所以说岐伯的九法，后贤立辨其非。夏季宜用外台茯苓饮加石菖蒲。佐以竹沥姜汁。辛滑即可。
顾先生（四十岁）：脉象濡缓无力。中年胸胁时常疼痛。继而又早食晚吐。这属于反胃。乃胃中无阳。浊阴腐败壅滞。建议仿照仲景阳明辛热宣通的例子。
吴茱萸 半夏 荜茇 淡干姜 茯苓
又：辛热开浊。呕吐减少。行走劳力，就吐痰水食物。这是阳气受伤。用吴茱萸理中汤。
尤先生：脉缓。右关脉弦。知饥饿但厌恶进食。食入即吐。肢体浮肿。便溏尿少。不渴饮。这是胃阳衰微。开合的机能已经废弃。老年噎膈反胃，是大症。
人参 茯苓 淡附子 淡干姜 炒粳米 姜汁
又：通胃阳的方法服用后。腑病原无所补。只因为是老年长期劳累损伤阳气的体质。所服的药剂，开肺即是泄气。芩连苦寒劫夺阳气。姜汁与干姜附子并用，三焦之阳皆通耳。若枳朴仍是泄气，与前义相悖矣。
人参 茯苓 淡附子 淡干姜
刘先生（五十四岁）：脉左小弦。右濡涩。五十四岁。阴阳日渐衰退。劳烦奔走，阳气更受损伤。导致清气欲结。食入胃脘疼痛。痰涎涌逆。都是噎膈反胃的表现症状。饮酒越多越严重。由正气先虚弱所致，并非酒能致病。
川黄连 枳实汁 茯苓 半夏 广皮白 黑山栀
姜汁 竹沥
包先生（六十岁）：胸脘痞闷。嗳气逆。三四天必呕吐粘腻。或黄绿水液。这属于反胃。六旬有年。也是重病。
川黄连 半夏 枳实 郁金 竹茹 姜汁
陆先生：脉沉微。阳气大伤。阴浊僭越占据。早晨吃饭晚上不能吃。周身掣痛。背胀。病状属于难愈之症。（阳虚阴浊凝滞）
人参 附子 干姜 茯苓 泽泻
姚先生（六十二岁）：腑阳不通降。浊气壅滞成为反胃。屡次遭遇病情反复。老年难以恢复。若能潜心安养。望其长寿而已。药物不能治愈这个病。
人参 附子 干姜 公丁香 姜汁和丸
某患者：长期劳累多年。阳气逐渐衰退。浊凝瘀阻。胃脘中常痛。怕发展成噎膈便塞之症。（阳衰脘痹血瘀）
桃仁 红花 延胡索 川楝子 半夏 橘红 郁金汁 栝蒌皮
李先生：两关脉缓涩。食入气阻。吐涎稍通。之前已吐过瘀浊胶粘之物。这都是长期积累劳倦。阳气不主旋转运化。为噎膈反胃之症。此病最多反复。必须身心安逸，方可祛病。单纯用药无益。
半夏 姜汁 桃仁 韭白汁 香豉 栝蒌皮 郁金
某患者：胃痛。得到瘀血去除而减轻。两三年宿病复发。进食痞闷。怕其清阳结而成膈。大意益气佐通。仍兼通血络为治。
人参 半夏 茯苓 新会皮 木香 生益智 当归 桃仁
水法丸。服三钱。
张先生（三十三岁）：早食暮吐。大便不爽。病在中下。初因劳伤胃痛。痰瘀有形之阻。
半夏 枳实 制大黄 桃仁 韭白汁
经文说：三阳结谓之膈。又说一阳发病，其传变为膈。仲景说：朝食暮吐，暮食朝吐，宿谷不化，名叫胃反。丹溪说噎膈反胃，名称虽不同，病出一体。多因气血两虚而成。然而纵观噎膈反胃的原因，实在有不同。大致在饮食之际，气忽然阻塞。饮食原可下咽，如有物梗塞之状者，名叫噎。心下格拒，饥不能食，或食到喉间，不能下咽者，名叫膈。食下良久复出，或隔宿吐出者，名叫反胃。夫噎膈一症，多因喜怒悲忧恐五志过极。或纵情嗜欲。或恣意酒食。以致阳气内结。阴血内枯而成。治宜调养心脾。以舒结气。填精益血。以滋枯燥。夫反胃乃胃中无阳。不能容受食物。命门火衰。不能熏蒸脾土。以致饮食入胃。不能运化。而为朝食暮吐。暮食朝吐。治宜益火之源。以消阴翳。补土通阳以温脾胃。故先生对于噎膈反胃。各为立法以治之。其阳结于上。阴亏于下。而为噎膈者。用通阳开痞。通补胃腑。以及进退黄连。附子泻心诸法。上热下寒为治。其肝阴胃汁枯槁。及烦劳阳亢。肺胃津液枯而成噎膈者。用酸甘济阴。及润燥清燥为主。其液亏气滞。及阳衰血瘀而成噎膈者。用理气逐瘀。兼通血络为主。其胃阳虚而为噎膈反胃。及忧郁痰阻而成者。用通补胃腑。辛热开浊。以及苦降辛通。佐以利痰清膈为主。其肝郁气逆而为噎膈者。两通厥阴阳明为治。其酒热郁伤肺胃。气不降而为噎膈者。用轻剂清降。及苦辛寒开肺为主。而先生对于噎膈反胃治法。可谓无遗蕴矣。张景岳说：治噎膈大法。当以脾肾为主。其理甚通。当宗之。又有饮膈热膈。及忧气恚食寒之膈。其主治各载本门。兹不复赘。（邹滋九评）
此证。每因血枯气衰导致。凡是香燥消涩的药物。长久在禁忌之内。案中虽然有一二仿用辛热。但也必须审慎其为阳微浊踞者。其余或苦辛泄滞而兼润养。或酸甘化液而直滋清。或郁闷于气分。而推扬谷气。或劳伤于血分。而宣通瘀浊。总以调化机关。和润血脉为主。阳气结于上。阴液衰于下。这两句话。实为确切的论断。（姚亦陶评）
徐评：果系膈症。百无一生。不必言治。若反胃则古人自有主方。不得泛用通治之品。这位老先生尚未明白也。
案中多用人参。其意以为不食胃虚。不可不用参以补其精气。不知噎膈之症。必有瘀血顽痰逆气。阻膈胃气。其已成者。百无一治。其未成者。用消瘀去痰降气之药。或可望其通利。若用人参。虽或一时精气稍旺。而病根益深。永无愈期矣。
Mr. Wu: The pulse is fine, small, and choppy (Se). There is dull pain in the epigastrium. Vomiting, nausea, and acid regurgitation occur. The tongue is crimson (Jiang), but there is little desire to drink. This indicates that in an elderly person, Yang Qi is knotted in the upper Jiao, while Yin fluids are depleted in the lower Jiao. It is the precursor to Guan Ge (a severe condition of obstruction where Upper and Lower do not communicate).
Treatment should focus on opening stagnation and unblocking Yang Qi. (Addressing Guan Ge caused by Yang knotting above and Yin deficiency below)
Coptidis Rhizoma (Chuanlian), Ginseng Radix et Rhizoma (Renshen), Ginger Juice (Jiangzhi), Pinelliae Tuber (Banxia), Immature Bitter Orange Juice (Zhishi Zhi), Bamboo Sap (Zhuli).
Mr. Lu: Yin and Yang Qi are chaotic and reversed, having already formed Guan Ge. It is proposed to use Fuzi Xie Xin Tang (Aconite Decoction for Draining the Epigastrium). This formula treats the pattern of Heat Above and Cold Below.
Mr. Xu (78 years old): In the elderly, after eating, saliva surges upward; after vomiting phlegm, porridge can barely be swallowed. Urination and defecation are difficult and scanty. This is due to Yang Qi failing to rotate and ascending, causing knotting, while Yin fluids are withered below, leading to difficult defecation. It is extremely difficult to regulate and treat. Avoid greasy and fishy foods. The pulse is wiry (Xian), large, and forceful upon pressure. It is proposed to take Miao Xiang Wan (Wonderful Fragrance Pill).
Again: Continue taking Miao Xiang Wan. Take Da Ban Xia Tang (Large Pinellia Decoction) every five days.
Mr. Mao: The elderly patient has emaciation. He does not eat and has constipation. Qi rushes upward, bringing up saliva. This is a symptom of Guan Ge. It is proposed to use Jin Tui Huang Lian Tang (Advance-Retreat Coptis Decoction).
Coptidis Rhizoma (Chuanlian), Dried Ginger (Dan Jiang), Pinelliae Tuber (Banxia), Ginger Juice (Jiangzhi), Ginseng Radix et Rhizoma (Renshen), Poria (Fuling), Aconiti Lateralis Radix Praeparata (Fuzi), Raw White Peony Root (Sheng Baishao).
Mr. Pu (70 years old): Over seventy years of age. After eating, the epigastrium feels distended. Stool is dry and rough. There is no thirst or desire to drink. Phlegm-Qi condenses and obstructs Yang Qi. If prolonged, it is most feared to develop into Guan Ge.
Coptidis Rhizoma (Chuanlian), Loquat Leaf (Pipaye), Pinelliae Tuber (Banxia), Ginger Juice (Jiangzhi), Apricot Seed (Xingren), Bitter Orange Peel (Zhiqiao).
Mr. Du (64 years old): The elderly patient has been deficient due to long-term overwork. Due to thirst from drinking cold water, the Stomach Yang was injured again. Diarrhea worsened and was accompanied by vomiting. He cannot accept soups, drinks, or food. Nothing enters from above, nothing exits from below.
This belongs to the difficult-to-treat category of Guan Ge.
Ginseng Radix et Rhizoma (Renshen), Pinelliae Tuber (Banxia), Coptidis Rhizoma (Chuanlian), Dried Ginger (Dan Jiang).
Certain Patient: Clear Yang Qi is increasingly knotted. The abdomen is narrow and cannot accept grain. Yin fluids are gradually drying up. The intestines lose lubrication. Defecation is difficult.
Cinnamon Twig (Guizhi), Coptidis Rhizoma (Chuanlian), Pinelliae Tuber (Banxia), Ginger Juice (Jiangzhi), Apricot Seed (Xingren), Poria (Fuling).
Mr. Bi (54 years old): During the summer consultation, it was said that this disease is difficult to cure. However, this illness results from long-term labor injuring Yang Qi. Although young in years, the spirit is exhausted. Ancients called this Ye Ge (Dysphagia/Obstruction) and Fan Wei (Regurgitation). All are due to Yin withering and Yang knotting. Upon re-consultation after the Autumn Equinox, the vital energy in both pulses is declining day by day. At the change of seasons, the throat is dry. Daytime urination is scanty. The fluids of the Five Zang organs are告急 (critical depletion). One cannot tolerate harsh, drying Yang-tonifying medicines.
It is likely that this disease cannot be cured by medicine. Use Da Ban Xia Tang (Large Pinellia Decoction) added with Coptidis Rhizoma (Huanglian) and Ginger Juice.
Certain Patient: The pulse at the Cun position is large and forceful, but choppy upon pressure. The body is thin, Qi rebels upward. Above, food is not accepted; below, bowels are not unblocked. Long-term internal injury from labor in old age causes Yang Qi to knot and fail to move, leading to epigastric closure and Yin depletion. The Fu organs lack Jin-Ying fluids. Obstruction of both urine and stool is inevitable. The disease name is Guan Ge. It is difficult to treat.
Ginseng Radix et Rhizoma (Renshen), Immature Bitter Orange (Zhishi), Coptidis Rhizoma (Chuanlian), Raw Dried Ginger (Sheng Ganjiang), Pinelliae Tuber (Banxia), Poria (Fuling).
Mr. Su (54 years old): Previously suffering from Fan Wei (Regurgitation), he could previously manage. In autumn, sudden fright and worry caused Jue Yang Qi to surge uncontrollably. Thus, appetite ceased, bowels were blocked, and Xiao Ke (Wasting-Thirst) persisted. Sensation of heart heat. Vomiting of saliva and foam. Among the five flavors, sour and sweet are preferred. Liver Yin and Stomach juices are nearly exhausted. Harsh drying medicines cannot be tolerated to open the passage. The Stomach is Yang Earth, suitable for cooling and moistening. The Liver is a rigid organ, suitable for softening and harmonizing. Use Sour and Sweet methods to jointly nourish Yin. (Targeting exhaustion of Liver Yin and Stomach juice)
Dark Plum Meat (Wumei Rou), Ginseng Radix et Rhizoma (Renshen), Fresh Rehmanniae Radix (Xian Shengdi), Donkey-Hide Gelatin (Ejiao), Ophiopogonis Juice (Maidong Zhi), Raw White Peony Root (Sheng Baishao).
Certain Patient: Yangming fluid dryness leads to Ge (Obstruction).
Pear Juice (Lizhi), Persimmon Frost (Shishuang), Polygonati Odorati Rhizoma (Yuzhu), Asparagi Tuber (Tiantong), Ophiopogonis Tuber (Maidong), Sweet Apricot Seed (Tian Xingren), Fritillariae Bulbus (Chuanbei), Raw White Peony Root (Sheng Baishao), Triangular Sesame (Sanjiao Huma).
Mr. Wang (53 years old): In the elderly, Blood and Qi gradually decline. Several days of smooth defecation are required before food can enter the epigastrium without obstruction. This indicates that Stomach juices are gradually withering, and the directive of Stomach Qi descending is lacking. Ye (Dysphagia) is budding. The cause is excessive mental exertion, causing the Three Yang fires to scorch and dry up fluids. Therefore, medicinal treatment has not achieved full effect. It is proposed to use Danxi's method. (Targeting fatigue-induced Yang hyperactivity and drying of Lung/Stomach fluids)
Ophiopogonis Juice (Maidong Zhi), Fresh Rehmanniae Juice (Xian Shengdi Zhi), Platycladi Seed Juice (Baizi Ren Zhi), Sweet Apricot Seed (Tian Xingren), Black Sesame Juice (Hei Zhima Zhi), Perilla Seed Juice (Du Suzi Zhi), Pine Kernel Paste (Songzi Ren Jiang).
Soak cloth and paper in water, wring out the juice, filter clear, and stew into a natural paste.
Mr. Ma (60 years old): Mental and physical labor leads to natural decline in old age. For thirty years, he took Guizhi (Cinnamon Twig), Fuzi (Prepared Aconite), and Shengjiang (Fresh Ginger). The disease manifests as food sticking and not passing the diaphragm, then being vomited out. This is due to failure of Qi transformation in the Upper Jiao. Fluids do not flow downward. Initially, defecation was difficult. As the classics state: Excessive pungent and hot flavors lead to excess Liver Yang. Lung fluids and Stomach fluids are deprived. This is Upper Dryness.
Imitate Jiayan's Qing Zao (Clear Dryness) method.
Ophiopogonis Tuber (Maidong), Hemp Seed (Maren), Fresh Rehmanniae Radix (Xian Shengdi), Sweet Water Pear (Tianshui Li), Mulberry Leaf (Sangye), Gypsum (Shigao), Raw Licorice Root (Sheng Gancao).
Certain Patient: Pulse is choppy, Left is large. Food entering causes dysphagia. This belongs to fluid deficiency. First, regulate Qi. Then use moistening agents. (Targeting fluid deficiency with Qi stagnation)
Pinelliae Tuber (Banxia), Cloud Poria (Yun Fuling), Loquat Leaf (Pipaye), Immature Bitter Orange (Zhishi), Bamboo Sap (Zhuli).
Mr. Cheng: Tongue coating is yellow, slight thirst. Phlegm is abundant, coughing with rebellious Qi. After eating, there is a sensation of impending dysphagia. The disease is in the Lung and Stomach. For the elderly, lightly use clearing and descending agents. (Targeting failure of Lung-Stomach Qi descent)
Fresh Loquat Leaf (Xian Pipaye), Apricot Seed (Xingren), Curcuma Aromatica Rhizome (Yujin), Trichosanthis Pericarpium (Gualou Pi), Gardenia Fruit (Shanzhi), Light Fermented Soybean (Dan Xiangchi).
Mr. Shen: Rejection of food. Saliva foam and rebellious Qi rise from the left. This is caused by depression in the elderly. Bowel must be unblocked, turbid pathogens expelled. Only then can life be extended. It is proposed to use the method of simultaneously regulating Yangming and Jueyin meridians. (Targeting Liver depression with Qi rebellion)
Pinelliae Tuber (Banxia), Bitter Apricot Seed (Ku Xingren), Poria (Fuling), Tangerine Peel (Juhong), Bamboo Sap (Zhuli), Ginger Juice (Jiangzhi).
Mr. Yu: Alcohol-heat郁结 (stagnation) injures. Food obstruction in the epigastrium causes pain. Treat with Bitter-Pungent-Cold method. (Targeting alcohol-heat stagnation injuring Lung-Stomach)
Small Coptidis Rhizoma (Xiao Chuanlian), Pinelliae Tuber (Banxia), Fermented Soybean (Xiangchi), Immature Bitter Orange (Zhishi), Poria (Fuling), Ginger Juice (Jiangzhi).
Again: Bitter-Pungent transforms into dryness. Dysphagia is uncomfortable, and defecation is unsatisfactory. Treat the Hand-Taiyin (Lung).
Fresh Loquat Leaf (Xian Pipaye), Aster Tataricus Root (Ziwan), Perilla Seed (Suzi), Apricot Seed (Xingren), Peach Kernel (Taoren), Curcuma Aromatica Rhizome (Yujin).
Certain Patient: Worry and thought cause stagnation. Condensed phlegm obstructs. It has reached the stage of Ye (Dysphagia). Emotions should be regulated, and care taken in lifestyle. (Targeting depression-phlegm obstruction)
Stir-fried Pinelliae Tuber (1.5 qian), Poria (5 qian), Sorghum (3 qian), Stir-fried Immature Bitter Orange (1 qian), Ginger Juice (3 small spoons, mixed in).
Mr. Yang (47 years old): Pulse is wiry, small, and choppy. After eating, epigastric pain and rejection occur. Clear saliva must be vomited before eating again. Complexion is pale. Eye tendons are red and yellow. Formerly fat, now thin. Said to be injury from depression and anger. Mild fire has transformed into vigorous fire. Qi stagnation and phlegm accumulation increase daily. Clear Yang cannot unfold. The esophageal tube narrows. Food cannot pass. Ye Ge (Dysphagia/Obstruction) is gradually forming. The method should use Bitter to descend, Pungent to unblock. Assist with draining phlegm and clearing Ge. Do not use Cardamom or Aquilaria which deplete fluids.
Coptidis Rhizoma (Chuanlian), Apricot Seed (Xingren), Platycodon Root (Jiegeng), Trichosanthis Pericarpium (Tu Gualou Pi), Pinelliae Tuber (Banxia), Tangerine Peel (Juhong), Bamboo Sap (Zhuli), Ginger Juice (Jiangzhi).
Mr. Zhu (52 years old): Premature aging. Minimal food intake. Long-standing sudden pain in the epigastrium. Slight intake of soup/drink causes discomfort. Recently often vomiting clear water. This indicates Stomach Yang is daily declining. Prevention of Ye Ge is necessary. It is proposed to use Da Ban Xia Tang (Large Pinellia Decoction). Tonifying the Fu organ is appropriate. (Targeting Stomach Yang deficiency)
Ginseng Radix et Rhizoma (Renshen), Pinelliae Tuber (Banxia), Poria (Fuling), White Fragrant Rice (Bai Xiang Jingmi), Ginger Juice (Jiangzhi), Decocted in river water.
Mr. Bai (56 years old): Small meals feel comfortable. Overeating causes food to refuse to go down. Occasionally cold, greasy saliva foam is vomited. This is due to long-term weakness of Stomach Yang in old age. There is much concern for Ye Ge and Fan Wei. Drinking hot wine makes the epigastrium feel relieved. Clearly, Yang is weak and about to knot. Fortunately, urination and defecation are still open. Turbidity can still descend. Peace can still be hoped for.
Stir-fried Pinelliae Tuber with Ginger Water (2 liang), Poria (2 liang), Raw Alpinia Oxyphylla Fruit (1 liang), Clove Bark (5 qian), Chenpi (1 liang), Dried Ginger (1 liang).
Grind these pure herbs into powder. Wash 1 liang of Light Fermented Soybean, decoct in water, and use the juice to make pills. Take 3 qian with light ginger soup.
Mr. Lv (60 years old): Labor, fatigue, hunger, and fullness all injure Stomach Yang. At sixty, one most fears Ye Ge and Fan Wei. Heavy, turbid foods like rice, noodles, alcohol, meat, and fish are incompatible with the disease.
Pinelliae Tuber (Banxia), Ginger Juice (Jiangzhi), Fermented Soybean (Xiangchi), Trichosanthis Pericarpium (Tu Gualou Pi), Apricot Seed (Xingren), Tangerine Peel (Juhong).
Mr. Feng (67 years old): In old age, Yang is weak. Alcohol dampness and strong flavors brew phlegm, obstructing Qi. Thus, the Stomach loses its normal function of descending. The epigastrium is narrow and cannot accept food. Urination and defecation are as usual. The disease is in the Upper and Middle Jiao. It is proposed to use Bitter-descending and Pungent-unblocking, assisted by nourishing the Stomach. Use Da Ban Xia Tang (Large Pinellia Decoction).
Pinelliae Tuber (Banxia), Ginseng Radix et Rhizoma (Renshen), Poria (Fuling), Ginger Juice (Jiangzhi), Coptidis Rhizoma (Chuanlian), Immature Bitter Orange (Zhishi).
Again: The Stomach is a Fu organ of Yang, tonification lies in unblocking. Symptoms show epigastric stuffiness, difficulty passing food through the diaphragm. Superficial understanding uses White Cardamom, Costus Root, Aquilaria, Musk, hoping for quick results. Not knowing that the elderly are daily declining, further administration of Qi-draining drugs means the Harmonious Qi will never recover. Thus, it is said that Qibo's Nine Methods were correctly辨析 (analyzed/corrected) by later experts. In summer, waitai Fuling Yin (External Platform Poria Drink) added with Acorus is suitable. Assisted by Bamboo Sap and Ginger Juice. Pungent and slippery is sufficient.
Mr. Gu (40 years old): Pulse is soggy, slow, and powerless. Mid-life chest and hypochondriac pain. Subsequently, morning food evening vomiting. This belongs to Fan Wei (Regurgitation). It is because there is no Yang in the Stomach. Turbid Yin rots and obstructs. It is proposed to imitate Zhang Zhongjing's Yangming Pungent-Hot Unblocking example.
Evodia Fruit (Wuyu), Pinelliae Tuber (Banxia), Pepper Fruit (Bibo), Dried Ginger (Dan Jiang), Poria (Fuling).
Again: Pungent-Hot opens turbidity. Vomiting decreases. Walking and labor cause vomiting of phlegm-water and food. This is Yang Qi injury. Use Wuyu Lizhong Tang (Evodia Lizhong Decoction).
Mr. You: Pulse is slow. Right Guan is wiry. Knows hunger but dislikes food. Vomits immediately after eating. Limbs are edematous. Loose stools, scanty urine. No thirst. This is Stomach Yang decline. The mechanism of opening and closing has failed. Ye Ge and Fan Wei in the elderly are major diseases.
Ginseng Radix et Rhizoma (Renshen), Poria (Fuling), Light Prepared Aconite (Dan Fuzi), Dried Ginger (Dan Jiang), Stir-fried Rice (Chao Jingmi), Ginger Juice (Jiangzhi).
Again: After using the method to unblock Stomach Yang. The Fu organ pathology receives no benefit. Only because the constitution is that of the elderly with long-term labor injuring Yang. The administered formulas, if they open the Lung, are also draining Qi. Scutellaria and Coptis are Bitter-Cold and deplete Yang. Using Ginger Juice with Dried Ginger and Aconite allows the Yang of the Three Jiao to all unblock. If Zhishi and Houpo are still used, they drain Qi, contradicting the previous principle.
Ginseng Radix et Rhizoma (Renshen), Poria (Fuling), Light Prepared Aconite (Dan Fuzi), Dried Ginger (Dan Jiang).
Mr. Liu (54 years old): Pulse Left is small and wiry. Right is soggy and choppy. Fifty-four years old. Yin and Yang decline daily. Labor and running injure Yang further. Leading to Clear Qi wanting to knot. Eating causes epigastric pain. Phlegm-saliva surges and rebels. These are all manifestations of Ye Ge and Fan Wei. Drinking alcohol makes it worse. It is due to righteous Qi being weak first, not that alcohol causes the disease.
Coptidis Rhizoma (Chuanlian), Immature Bitter Orange Juice (Zhishi Zhi), Poria (Fuling), Pinelliae Tuber (Banxia), Tangerine Pith (Guang Pi Bai), Black Gardenia Fruit (Hei Shanzhi).
Ginger Juice (Jiangzhi), Bamboo Sap (Zhuli).
Mr. Bao (60 years old): Chest and epigastric fullness and oppression. Belching and rebellion. Every three or four days, sticky vomit occurs. Or yellow-green watery fluid. This belongs to Fan Wei (Regurgitation). Sixty years old. It is also a serious disease.
Coptidis Rhizoma (Chuanlian), Pinelliae Tuber (Banxia), Immature Bitter Orange (Zhishi), Curcuma Aromatica Rhizome (Yujin), Bamboo Shavings (Zhuru), Ginger Juice (Jiangzhi).
Mr. Lu: Pulse is deep and minute. Yang Qi is greatly injured. Yin turbidity usurps the position. Morning food cannot be eaten at night. Whole body twitching pain. Back distension. The symptoms belong to a difficult-to-cure condition. (Yang deficiency with Yin-turbidity stagnation)
Ginseng Radix et Rhizoma (Renshen), Aconiti Lateralis Radix Praeparata (Fuzi), Dried Ginger (Ganjiang), Poria (Fuling), Alisma Rhizome (Zexie).
Mr. Yao (62 years old): Fu Yang does not descend. Turbidity obstructs, becoming Fan Wei. Repeated illnesses. Elderly find it hard to recover. If one can quietly calm the mind and rest, longevity may be hoped for. Medicine cannot cure this disease.
Ginseng Radix et Rhizoma (Renshen), Aconiti Lateralis Radix Praeparata (Fuzi), Dried Ginger (Ganjiang), Public Clove (Gong Dingxiang), Pills made with Ginger Juice.
Certain Patient: Long-term labor for years. Yang Qi gradually declines. Turbidity condenses, blood stasis obstructs. Frequent pain in the epigastrium. Fear of developing Ye Ge and bowel obstruction. (Yang decline, epigastric bi, blood stasis)
Peach Kernel (Taoren), Safflower (Honghua), Corydalis Rhizome (Yanhu), Toosendan Fruit (Chuanlianzi), Pinelliae Tuber (Banxia), Tangerine Peel (Juhong), Curcuma Juice (Yujin Zhi), Trichosanthis Pericarpium (Gualou Pi).
Mr. Li: Both Guan pulses are slow and choppy. Food entering causes Qi obstruction. Vomiting saliva provides slight relief. Previously vomited sticky turbid blood stasis. All due to long-term accumulated labor and fatigue. Yang Qi fails to rotate and transport. This is a case of Ye Ge and Fan Wei. This disease recurs frequently. Physical and mental peace is required to dispel the disease. Medication alone is useless.
Pinelliae Tuber (Banxia), Ginger Juice (Jiangzhi), Peach Kernel (Taoren), Leek White Juice (Jiu Bai Zhi), Fermented Soybean (Xiangchi), Trichosanthis Pericarpium (Gualou Pi), Curcuma (Yujin).
Certain Patient: Stomach pain. Reduced when blood stasis is removed. Chronic disease from two or three years recurs. Eating causes fullness. Fear that Clear Yang will knot and form Ge. The main idea is to tonify Qi and assist unblocking, still treating the blood collaterals.
Ginseng Radix et Rhizoma (Renshen), Pinelliae Tuber (Banxia), Poria (Fuling), Chenpi (Xinhui Pi), Costus Root (Muxiang), Raw Alpinia Oxyphylla Fruit (Sheng Yizhi), Angelica Sinensis (Danggui), Peach Kernel (Taoren).
Made into pills with water method. Take 3 qian.
Mr. Zhang (33 years old): Morning food evening vomiting. Defecation unsatisfactory. Disease is in Middle and Lower Jiao. Initially due to labor-injury stomach pain.有形 (tangible) obstruction of phlegm and blood stasis.
Pinelliae Tuber (Banxia), Immature Bitter Orange (Zhishi), Processed Rhubarb (Zhi Dahuang), Peach Kernel (Taoren), Leek White Juice (Jiu Bai Zhi).
The Classics say: Knotting of the Three Yang is called Ge. Also: When Yi Yang is affected, it transmits to Ge. Zhongjing says: Morning food evening vomiting, evening food morning vomiting, undigested food remains, named Wei Fan (Stomach Regurgitation). Danxi said Ye Ge and Fan Wei have different names but originate from the same source. Mostly due to dual deficiency of Qi and Blood. However, observing the causes of Ye Ge and Fan Wei, they are indeed different. Generally, during eating, Qi suddenly blocks. Food can originally be swallowed, but feels like something is stuck, named Ye. Epigastric rejection, hungry but cannot eat, or food reaches the throat but cannot swallow, named Ge. Food eaten comes out after a long time, or vomited the next day, named Fan Wei. The syndrome of Ye Ge is mostly due to extreme emotions (Joy, Anger, Worry, Thought, Fear). Or indulging desires. Or excessive alcohol and food. Leading to internal knotting of Yang Qi and internal withering of Yin Blood. Treatment should nourish Heart and Spleen to relax knotted Qi. Fill essence and tonify blood to moisten dryness. Fan Wei is due to no Yang in the Stomach. Cannot accept food. Mingmen Fire is weak. Cannot steam and warm Spleen Earth. Thus, food entering the Stomach cannot be transformed, leading to morning food evening vomiting, evening food morning vomiting. Treatment should benefit the source of Fire to eliminate Yin shadows. Tonify Earth and unblock Yang to warm Stomach and Spleen. Therefore, Mr. Ye established different laws for Ye Ge and Fan Wei. For those with Yang knotting above and Yin deficiency below causing Ye Ge, use unblocking Yang and opening stagnation, tonifying and unblocking the Stomach Fu, as well as Jin Tui Huang Lian Tang and Fuzi Xie Xin Tang methods. Treating Heat Above and Cold Below. For those with Liver Yin and Stomach juice exhaustion, and fatigue-induced Yang hyperactivity causing Lung-Stomach fluid drying leading to Ye Ge, use Sour-Sweet to nourish Yin, and Moistening-Dryness/Clearing-Dryness as main treatments. For those with fluid deficiency Qi stagnation, and Yang decline blood stasis causing Ye Ge, use regulating Qi and driving out stasis, combining with unblocking blood collaterals as main treatments. For Stomach Yang deficiency causing Ye Ge/Fan Wei, and depression-phlegm obstruction causing it, use tonifying and unblocking Stomach Fu, Pungent-Hot opening turbidity, and Bitter-descending Pungent-unblocking, assisting with draining phlegm and clearing Ge as main treatments. For Liver depression Qi rebellion causing Ye Ge, simultaneously regulate Jueyin and Yangming as treatment. For alcohol-heat stagnation injuring Lung-Stomach, Qi not descending causing Ye Ge, use light clearing-descending agents and Pungent-Bitter-Cold opening Lung as main treatments. And Mr. Ye's treatment methods for Ye Ge and Fan Wei can be said to be comprehensive. Zhang Jingyue said: The general law for treating Ye Ge should focus on Spleen and Kidney. The reasoning is very sound. One should follow it. There are also Yin-Ge, Heat-Ge, and Ge caused by worry, anger, food, and cold. Their main treatments are recorded in their respective sections. No further repetition here. (Commentary by Zou Zijiu)
This syndrome is often caused by blood withering and Qi decline. All aromatic-drying and astringent medicines are strictly forbidden. Although a few pungent-hot medicines are imitated in the cases, it must be carefully examined whether it is Yang weakness with turbidity occupation. Others either use Bitter-Pungent to drain stagnation combined with moistening-nourishing, or Sour-Sweet to generate fluids directly nourishing clearly. Or depression in Qi level, promoting grain Qi. Or labor injury in Blood level, circulating turbid stasis. Always focusing on regulating transformation mechanisms and harmonizing/moistening blood vessels. "Yang knotting above, Yin fluid depletion below" are truly accurate statements for this syndrome. (Commentary by Yao Yitao)
Xu's Commentary: If it is truly Ge syndrome, one in a hundred survives. No need to speak of treatment. If it is Fan Wei, ancients had their own main formulas. One must not generally use universal treatment products. This old gentleman has not yet understood.
Many cases use Renshen (Ginseng). The intention is that since the patient does not eat, the Stomach is empty, so Renshen must be used to tonify essence and Qi. Not knowing that Ye Ge syndrome must have blood stasis, stubborn phlegm, and rebellious Qi obstructing Stomach Qi. If already formed, one in a hundred cannot be treated. If not yet formed, using medicines to eliminate stasis, remove phlegm, and descend Qi might hope for unblocking. If Renshen is used, although essence and Qi may temporarily improve slightly, the root of the disease becomes deeper, and there will never be a period of cure.