鼓胀而名蛊者，取若虫侵蚀之义也。然方书有曰∶凡聚虫蛇杂类盛之以器，令相啖
食至尽，余存其一，此名为蛊。最能变化，或随饮食入腹，食人五脏，急者刺痛卒死，
缓者渐深羸瘦，更有误食蜈蚣物中毒，舌退场门外而不收，识者以鸡血涂舌根上即收。
噎膈、翻胃、关格三者，名各不同，病原迥异，治宜区别，不可不辨也。噎之为
病，饮食到口，咽喉之间，咽嗌不下，随即吐出，自噎而转，故曰噎，其槁在于吸门，
吸门者，会厌之间也。病在上焦，多属胃脘枯燥，血液衰少，是阴亏火旺之病也。鬲之
为病，如饮食下咽，至膈不能直下，乃徐吐出，自膈而转，故曰鬲，此膈膜之膈，而非
隔截之隔也。其槁在于贲门，贲门者，胃之上口也，病在中焦，多属忧思恚怒，以致痰
气郁结于上膈，或构难释之苦思，而结脾中之生意者，是怀情之病也。丹溪曰∶惟男子
年高者有之，少无噎膈，其反胃之为病，饮食倍常，食已下膈，而入于胃中，因下脘不
能腐熟化运，或朝食暮吐，或暮食朝吐，或积至日余，胀闷难忍，复吐原物，完谷不
化，自胃之下脘翻倒而出，故名翻胃。其槁在于幽门，幽门者，太仓之下口也。病在下
焦，虽属胃病，而实由命门火衰，肾经虚寒之病也。凡男女老小皆有之。其关格者，粒
米不欲食，渴喜茶水，饮之少顷，即吐出，复求饮复吐，饮之以药，热药入口即出，冷
药过时而出，大小便秘，名曰关格。关者，二便俱秘，下不得出也。格者，吐逆水浆，
上不得入也。惟女人多有此症，是阴阳易位，故上下同病，关无出之由，格无入之
理，急化难从缓治，实者暂通，即补虚者，
峻补为攻，盖由阳气在上中焦，气不升降耳。
噎膈多起于血液枯涸，挟郁而成，盖气郁则结滞，而痰横膈中，所以多吐痰水也。
膈者谓膈在心下，上下不通，若格拒之状，始则结于喉咙，觉有所碍，吐之不出，咽之
不下，由气郁痰搏而然，久则渐妨饮食，而为噎膈也。噎者，饮食之际，气卒阻滞，饮
食不下，而为噎也。
节斋曰∶膈噎翻胃之症，因火而成，其来有渐，病源不一，有因思虑过度，而动脾
火者；有因忿怒过度，而动肝火者；有因久食煎炒，而生胃火者；有因淫欲忘返，而起
肾火者，盖火气炎上，熏蒸津液，成痰，初则痰火未结，咽膈干燥，饮食不得流利，为
膈为噎，久则痰火已结，胃之上脘不开，饮食虽进，停滞膈间，须臾便出，谓之呕吐。
至于胃之下脘不开，饮食虽进，停滞胃中，良久主出，谓之翻胃。丹溪云∶年高者不
治，盖少年气血未虚，用药劫去痰火，病不复生，年老气血已虚，用药劫去痰火，虽得
暂愈，其病复作，所以然者。气虚则不能运化而生痰，血虚则不能滋润而生火也。切不
可用香燥之药，若服之必死，宜薄滋味，盖其症属热而燥，倘药又香燥，则散气耗血，
且浓味则助火生病，不亦益助其病乎，所以并宜忌之。
养葵曰∶噎膈，丹溪谓之得七情六淫，遂有火热炎上之化，多升少降，津液不布，
积而为痰为饮，被劫时，暂得快，不久复作，前药再行，积成其热，血液衰耗，胃脘
干槁，妨碍道路，其槁在上，则近咽之下，水饮可行，食物难食，食亦不多，名之曰
噎。其槁在下，则与胃为近，食虽可入，难尽入胃，良久复出，名之曰膈，亦曰反胃。
大便秘少，若羊矢然，必外避六淫，内节七情，饮食自养，滋血生津，以润肠胃，则金
无畏火之炎，肾有生水之渐，气清血和则脾气运健，而食消传化矣。丹溪之论甚妙，但
噎膈翻胃，分别欠明，独喜其“火热炎上之化，肾有生水之渐”二句，深中病源，惜其
见犹未真，以润血为主，而不直探乎肾中先天之原，故其立方，以四物牛羊乳之类，加
之竹沥、韭汁、化痰化瘀，皆治标而不治本也。岂知《内经》惟曰∶三阳结谓之膈，三
阳者，大肠、小肠、膀胱也。结谓结热也。大肠主律，小肠主液，大肠热结则津涸，小
肠热结则液燥，膀胱为州都之官，津液藏焉。膀胱热结，则津液竭，然而三阳何以致
结热，皆肾之病也。盖肾主五液，肾主二便，与膀胱为一脏一腑，肾水既干，阳火偏
盛，熬煎津液，三阳热结，则前后闭涩，下既不通，必反于上，直犯清道，上冲吸门，
喉咽所以噎食不下也。何为水饮不入，食物难下，盖食入于阴，长气于阳，反引动胃口
之火，故难入水者阴类也。同气相投，故可入口吐白沫者，所饮之水，沸而上腾也。粪
如羊屎者，食入者少，渣滓消尽，肠亦干小而不宽大也。此症多是男子年高五十以外得
之，又必其人不绝色欲，盖老人天真已绝，只有孤阳，大宜养阴为主，王太仆云∶食入
即出，是无水也。食久反出，是无火也。故噎涩大都属热，反胃大都属寒，无水者，壮
水之主，无火者，益火之源。褚侍中云∶上病疗下，直须以六味地黄丸料，大剂煎饮，
久服可挽于十中之一二，又须绝嗜欲，远房帏，薄滋味可也。若曰温胃，胃本不寒，若
曰补胃，胃不虚，若曰开郁，则香燥之品，适以助火，若欲下以承气咸寒，则损胃，津
液愈竭，无如补阴，焰光自灭也。
膈病最难疗治，盖欲健脾理痰，恐燥剂有妨于津液，方欲养血生津，恐润剂有碍于
中州，若泥于舒郁快膈，则辛香助火，胃汁速干，去死不远矣。故东垣谓吐有三证，气
积寒也，上焦吐者，从气，食则暴吐者是也。中焦吐者从积，或先痛后吐，或先吐而
后痛者是也。下焦从寒，脉沉而迟，朝食暮吐，暮食朝吐，小便利，大便秘者是也。法
当通其闭，温其寒，专治下焦，散其寒，徐以中焦药和之而愈。盖命门火衰，釜底无
薪，不能蒸腐，胃中水谷，腹中胀满，不得不吐，所谓食久反出，是无火也。须用益火
之源，先以八味地黄丸，补命门火，以扶脾土之母，徐以附子理中汤，理中焦万举万
全，不知出此，而徒以山楂神曲，平胃化食，适以速其亡也。又老人膈噎之病，由于
血液枯槁，中州失转运之权，而不能荣养乎脏腑，故脉见缓弱而渐沉迟，此正气日渐衰
微之象也。然所以能少延岁月者，以尚存一线中和之气，犹必待油干而灯始尽耳。医
者，自当保其真气，勿使疏泄，润其枯涩，勿使壅塞，常使气能生血，庶能终其天年。
丹溪所以有诸乳诸汁之治也。今人加以化痰破气之药，谓病生于郁结，而骤开之，或得
效于顷刻，终必至干枯委顿而毙。盖阳明多血多气，为水谷之海，能受其新，方易其
陈，非若少壮者，去其陈而已，无余事，必药饵以去其病，静摄以还其元，盖书以为神
思间病，谓养其神，清其思，而后津液归聚于胃中，譬如天朗气清，血水之朝宗者，自
无风波振撼之忧，不观之膈噎之人，其水饮可受，食物难入，缘阴气销亡，不得不求助
于同类耳。
夫反胃本于血液干槁，故莫如养血，养血又莫如滋水，水旺而津液自生，肠胃之传
道，得其职矣。又云∶呕吐属于胃脘虚寒，故莫若辛温，辛温则莫如补火，补火而命门
气暖，胃海之水谷可腐熟矣。故八味六味，诚治反胃之要药，惟赵献可能独窥其秘。
噎病，本于精血枯稿，忧思郁结，津滋血液，不能下润，而噎，故一见饮食便心中
噎塞，机先病也。本无形之真气受病，故其治当以培真气为主。又曰∶本于肾虚，任用
为病，气弱血枯，思虑劳役。而成，气弱则运化不开，血枯则道路闭塞，人之任脉，上
循咽嗌，自胃三脘直下，肾虚则任脉不润丹田，元阳之气，而无温暖蒸腐之功，由是中
焦失传运润下之化，而成噎矣。故其治专以滋阴为主。
得药不反，虽思饮食，切勿便与粥饮，及诸饮食。惟每日人参五钱，陈皮二钱，老
黄米一两，作汤细啜，以泄胃气，觉稍安，渐渐加人参，旬日半月间，方可小试陈米饮
糜粥，盖仓廪未固，不宜便贮米谷，常见即食粥饭者，遂致不救。虚而胃液干，噎食不
下，譬如人吃干物，则梗噎难下，必以茶汤润之乃可，其理易见，用生姜汁，白蜜牛酥
各五两，人参末、百合各二两，重汤煮膏，时进半匙，津下则脾胃渐开，最忌肥甘粘
腻，恐复伤胃也。或少用白鲞牛鸭清汤，以助胃气，又有积血停内，而致者，当消息逐
之，大便涩者难治。痰多者不必治痰，补以化之。口吐白沫者，不治，胸腹嘈痛，如刀
割者死。年高者不治。粪如羊屎者不治。
关格者，《内经》以脉论，而非言病也。自仲景创其论，而诸家俱以关格为病名矣。
如《经》曰∶人迎四盛以上为格阳，寸口四盛以上为关阴，人迎与寸口俱盛四倍以上，
为关格，关格之脉羸，不能极于天地之精气则死，而景岳亦以为人迎独盛者病在三阳之
腑，寸口独盛者，病在三阴之脏，关格者，阴阳偏盛之极，为孤阳之逆候实真阴之败竭
也。论脉论病，议虽不同，而阴阳偏绝，为关为格之害则一顾名求义，便可以得病之情矣。
关则不得小便，甚热之气，热在下焦，闭塞不便也，格则吐逆，甚寒之气，寒在胸
中，遏绝不行也。关格者，谓膈中觉有所碍，欲升不升，欲降不降，欲食不食，寒热
上下不通，此为气之横格也。必用吐提其气之横格，而不必在出痰也。有痰宜吐者，二
陈汤吐之，吐中便有降。有中气虚不运者，补气药中升降之。
关格者，忽然而来乃暴病也。大小便秘，渴饮水谷，少顷则吐，又饮又吐，唇燥
眼珠微红，面赤或不赤，甚者或心痛，或不
痛，自病起粒米不思，滴水不得下胃，饮一杯吐出杯半，数日后，脉亦沉伏，此寒从少
阴肾经而入，阴盛于下，逼阳于上，谓之格阳之症，名曰关格。关格者，不得尽其命而
死矣，须以仲景白通汤，用《内经》寒因热用之法，《经》曰∶若调寒热之逆，冷热必
行，则热药冷服，下咽之后，冷性既除，热性始发，由是病气随愈，呕吵皆除，情且不
违，而致大益，此和人尿猪胆汁咸苦寒之物，于白通汤中，要其气相从，可去拒格之
寒也。服药后脉渐出者，生，脉乍出者，死。陶节庵杀车槌中有反本回阳汤，极妙，
愈后须八味丸常服。又有一种肝火之症，亦呕而不入，但所呕者酸水，或苦水，或青蓝
水，惟大小便不秘，亦能作心痛，此是火郁木郁之症，木郁则达之，火郁则发之，须用
茱连浓煎，细细呷之，再服逍遥散而愈，愈后须以六味调理。
鼓胀病之所以被称为“蛊”，是取像虫子侵蚀身体一样的含义。然而医书中记载：将各种虫蛇杂类聚集在容器中，让它们互相吞食直到全部吃完，最后剩下的一只，这就叫做“蛊”。这种蛊最能变化，有时随饮食进入腹中，吞噬人的五脏，急性的会导致剧烈刺痛突然死亡，慢性的会逐渐深入导致身体消瘦衰弱。更有误食了蜈蚣等有毒物质中毒的，舌头伸出唇外无法收回，有见识的人用鸡血涂抹舌根处即可收回。
噎膈、翻胃、关格这三种病，名称各不相同，病因截然不同，治疗应当加以区别，不可不仔细辨别。所谓“噎”的病，是饮食到了嘴边，在咽喉之间咽不下去，随即吐出，从噎塞而转吐，所以叫噎，其病变部位在于吸门，吸门就是会厌所在的位置。病在上焦，多属于胃脘干燥枯竭，血液衰少，这是阴液亏损、虚火旺盛的病证。“膈”的病，像是饮食咽下后，到达膈膜处不能直接下行，而是慢慢吐出，从膈部回转，所以叫膈，这是指膈膜的膈，而不是阻隔的隔。其病变部位在于贲门，贲门就是胃的上口，病在中焦，多属于忧思愤怒，导致痰气郁结在上膈，或者因为难以解脱的苦思冥想，致使脾中的生机郁结，这是情志致病。“丹溪（朱震亨）说：只有年高的男子才有此病，少年没有噎膈。”至于“反胃”的病，饮食量比平时加倍，吃下去经过膈部进入胃中，因为下脘不能腐熟运化，或者早晨吃的晚上吐出来，或者晚上吃的早晨吐出来，或者积存到一天以后，胀闷难受，又把原物吐出来，食物完谷不化，从胃的下脘翻倒而出，所以名叫翻胃。其病变部位在于幽门，幽门就是太仓（胃）的下口。病在下焦，虽然属于胃病，但实际上是由命门火衰、肾经虚寒引起的病证。男女老少都有此病。至于“关格”的病，一粒米都不想进食，口渴喜欢喝茶水，喝下去不久，就吐出来，想再喝又吐，吃药的话，热药入口即出，冷药过一会儿才出，大小便闭塞不通，名叫关格。“关”是指二便都闭塞，下面排不出来；“格”是指呕吐逆拒水浆，上面进不去。只有女人多有此症，这是阴阳位置颠倒，所以上下同时生病，关没有出的道理，格没有入的道理，病情紧急难以化解，难从缓治，实证暂时通利，虚证则峻补作为攻法，大概是因为阳气在上中焦，气机不升降的缘故。
噎膈多起于血液枯涸，夹杂气郁而成，因为气郁则结滞，痰横亘在膈中，所以多吐痰水。膈是指膈在心下，上下不通，像格拒的样子，开始结于喉咙，觉得有所阻碍，吐不出来，咽不下去，由气郁痰搏结所致，久了逐渐妨碍饮食，成为噎膈。噎，是在饮食之际，气突然阻滞，饮食不下，成为噎。
节斋说：膈噎翻胃的病证，因火而成，其来势缓慢，病源不一，有因思虑过度而动脾火的；有因愤怒过度而动肝火的；有因久吃煎炒食物而生胃火的；有因淫欲忘返而起肾火的，大概火气炎上，熏蒸津液，形成痰，起初痰火未结，咽膈干燥，饮食不得流利，成为膈或噎，久了痰火已结，胃的上脘不开，饮食虽进，停滞在膈间，一会儿就出来，叫做呕吐。至于胃的下脘不开，饮食虽进，停滞在胃中，很久才出来，叫做翻胃。丹溪说：年高者不治，因为少年气血未虚，用药劫去痰火，病不再复发，年老气血已虚，用药劫去痰火，虽然暂时痊愈，但病会复发，之所以这样，是因为气虚则不能运化而生痰，血虚则不能滋润而生火。切不可用香燥的药物，如果服用必然致死，宜清淡饮食，因为此症属热而燥，如果药又是香燥的，就会散气耗血，而且浓味会助火生病，不是更加助长疾病吗，所以都应禁忌。
养葵说：噎膈，丹溪认为是得七情六淫，于是有火热炎上的变化，多升少降，津液不布散，积聚而为痰为饮，被劫持时，暂时感到痛快，不久又发作，前面的药再用，积聚成热，血液衰耗，胃脘干枯槁涩，妨碍道路，其干枯在上，则靠近咽下的地方，水饮可行，食物难食，吃得也不多，名叫噎。其干枯在下，则与胃接近，食虽可入，难尽入胃，很久才复出，名叫膈，也叫反胃。大便秘结少，像羊屎一样，必须外避六淫，内节七情，饮食自养，滋血生津，以润肠胃，那么金（肺）无畏火之炎，肾有生水之渐，气清血和则脾气运化健旺，而食物消化传导正常。丹溪的论述很妙，但噎膈翻胃，区分不够明确，唯独喜欢他“火热炎上之化，肾有生水之渐”这两句，深深切中病源，可惜他的见解还不够真切，以润血为主，而不直探肾中先天之本，所以他立方，用四物汤加牛羊乳之类，加上竹沥、韭汁，化痰化瘀，都是治标而不治本。哪里知道《内经》只说：三阳结谓之膈，三阳，是大肠、小肠、膀胱。结谓结热也。大肠主津，小肠主液，大肠热结则津液枯竭，小肠热结则液燥，膀胱为州都之官，津液藏焉。膀胱热结，则津液竭尽，然而三阳为何致结热，都是肾的病啊。盖肾主五液，肾主二便，与膀胱为一脏一腑，肾水既干，阳火偏盛，熬煎津液，三阳热结，则前后闭涩，下面不通，必反于上，直犯清道，上冲吸门，喉咽所以噎食不下也。为什么水饮不入，食物难下？盖食入于阴，长气于阳，反引动胃口之火，所以难入的是阴类的水。同气相投，所以可以入口吐白沫，所饮之水，沸腾而上腾也。粪如羊屎者，因为食入者少，渣滓消尽，肠也干小而不宽大也。此症多是男子年高五十以外得的，又必须此人不断绝色欲，盖老人天真已绝，只有孤阳，大宜养阴为主，王太仆说：食入即出，是无水也。食久反出，是无火也。所以噎涩大都属热，反胃大都属寒，无水者，壮水之主，无火者，益火之源。褚侍中说：上病疗下，直须以六味地黄丸料，大剂煎饮，久服可挽回十中之一二，又须绝嗜欲，远房帏，薄滋味才可以。如果说温胃，胃本不寒，如果说补胃，胃不虚，如果说开郁，则香燥之品，恰好助火，如果想用承气汤咸寒攻下，则损胃，津液愈竭，不如补阴，焰光自灭也。
膈病最难治疗，大概想健脾理痰，恐怕燥剂有妨于津液，正想养血生津，恐怕润剂有碍于中州（脾胃），如果拘泥于舒郁快膈，则辛香助火，胃汁速干，离死不远了。所以东垣说吐有三证，气积寒也，上焦吐者，从气，食则暴吐者是也。中焦吐者从积，或先痛后吐，或先吐而后痛者是也。下焦从寒，脉沉而迟，朝食暮吐，暮食朝吐，小便利，大便秘者是也。法当通其闭，温其寒，专治下焦，散其寒，徐以中焦药和之而愈。盖命门火衰，釜底无薪，不能蒸腐胃中水谷，腹中胀满，不得不吐，所谓食久反出，是无火也。须用益火之源，先用八味地黄丸，补命门火，以扶脾土之母，徐以附子理中汤，理中焦万举万全，不知出此，而徒以山楂神曲，平胃化食，恰好加速其死亡。又老人膈噎的病，由于血液枯槁，中州失转运之权，而不能荣养脏腑，故脉见缓弱而渐沉迟，这是正气日渐衰微之象。然而之所以能稍延岁月，是因为尚存一线中和之气，犹如油干而灯始尽耳。医者，自然应当保其真气，勿使疏泄，润其枯涩，勿使壅塞，常使气能生血，庶能终其天年。丹溪所以有诸乳诸汁之治也。今人加以化痰破气之药，谓病生于郁结，而骤开之，或得效于顷刻，终必至干枯委顿而毙。盖阳明多血多气，为水谷之海，能受其新，方易其陈，非若少壮者，去其陈而已，无余事，必药饵以去其病，静摄以还其元，盖书以为神思间病，谓养其神，清其思，而后津液归聚于胃中，譬如天朗气清，血水之朝宗者，自无风波振撼之忧，不观之膈噎之人，其水饮可受，食物难入，缘阴气销亡，不得不求助于同类耳。
夫反胃本于血液干槁，故莫如养血，养血又莫如滋水，水旺而津液自生，肠胃之传道，得其职矣。又说：呕吐属于胃脘虚寒，故莫若辛温，辛温则莫如补火，补火而命门气暖，胃海之水谷可腐熟矣。故八味六味，诚治反胃之要药，惟赵献可能独窥其秘。
噎病，本于精血枯稿，忧思郁结，津滋血液，不能下润，而噎，故一见饮食便心中噎塞，机先病也。本无形之真气受病，故其治当以培真气为主。又说：本于肾虚，任用为病，气弱血枯，思虑劳役。而成，气弱则运化不开，血枯则道路闭塞，人之任脉，上循咽嗌，自胃三脘直下，肾虚则任脉不润丹田，元阳之气，而无温暖蒸腐之功，由是中焦失传运润下之化，而成噎矣。故其治专以滋阴为主。
得药不反，虽思饮食，切勿便与粥饮，及诸饮食。惟每日人参五钱，陈皮二钱，老黄米一两，作汤细啜，以泄胃气，觉稍安，渐渐加人参，旬日半月间，方可小试陈米饮糜粥，盖仓廪未固，不宜便贮米谷，常见即食粥饭者，遂致不救。虚而胃液干，噎食不下，譬如人吃干物，则梗噎难下，必以茶汤润之乃可，其理易见，用生姜汁，白蜜牛酥各五两，人参末、百合各二两，重汤煮膏，时进半匙，津下则脾胃渐开，最忌肥甘粘腻，恐复伤胃也。或少用白鲞牛鸭清汤，以助胃气，又有积血停内，而致者，当消息逐之，大便涩者难治。痰多者不必治痰，补以化之。口吐白沫者，不治，胸腹嘈痛，如刀割者死。年高者不治。粪如羊屎者不治。
关格者，《内经》以脉论，而非言病也。自仲景创其论，而诸家俱以关格为病名矣。如《经》曰：人迎四盛以上为格阳，寸口四盛以上为关阴，人迎与寸口俱盛四倍以上，为关格，关格之脉羸，不能极于天地之精气则死，而景岳亦以为人迎独盛者病在三阳之腑，寸口独盛者，病在三阴之脏，关格者，阴阳偏盛之极，为孤阳之逆候实真阴之败竭也。论脉论病，议虽不同，而阴阳偏绝，为关为格之害则一顾名求义，便可以得病之情矣。
关则不得小便，甚热之气，热在下焦，闭塞不便也，格则吐逆，甚寒之气，寒在胸中，遏绝不行也。关格者，谓膈中觉有所碍，欲升不升，欲降不降，欲食不食，寒热上下不通，此为气之横格也。必用吐提其气之横格，而不必在出痰也。有痰宜吐者，二陈汤吐之，吐中便有降。有中气虚不运者，补气药中升降之。
关格者，忽然而来乃暴病也。大小便秘，渴饮水谷，少顷则吐，又饮又吐，唇燥眼珠微红，面赤或不赤，甚者或心痛，或不痛，自病起粒米不思，滴水不得下胃，饮一杯吐出杯半，数日后，脉亦沉伏，此寒从少阴肾经而入，阴盛于下，逼阳于上，谓之格阳之症，名曰关格。关格者，不得尽其命而死矣，须以仲景白通汤，用《内经》寒因热用之法，《经》曰：若调寒热之逆，冷热必行，则热药冷服，下咽之后，冷性既除，热性始发，由是病气随愈，呕吵皆除，情且不违，而致大益，此和人尿猪胆汁咸苦寒之物，于白通汤中，要其气相从，可去拒格之寒也。服药后脉渐出者，生，脉乍出者，死。陶节庵杀车槌中有反本回阳汤，极妙，愈后须八味丸常服。又有一种肝火之症，亦呕而不入，但所呕者酸水，或苦水，或青蓝水，惟大小便不秘，亦能作心痛，此是火郁木郁之症，木郁则达之，火郁则发之，须用茱连浓煎，细细呷之，再服逍遥散而愈，愈后须以六味调理。
The distension disorder named "Gu" (Guzhong, a type of abdominal distension resembling insect erosion) takes its name from the meaning of insects eroding the body. However, medical texts state: When various insects and snakes are gathered in a container to eat each other until none remain, leaving only one survivor, this is called "Gu". This Gu can change most readily; sometimes it enters the abdomen with food or drink, devouring the five Zang organs. In acute cases, it causes severe stabbing pain and sudden death; in chronic cases, it gradually deepens, leading to emaciation and wasting. There are also cases of poisoning from accidentally ingesting centipedes or similar toxic substances, where the tongue protrudes outside the lips and cannot be retracted. Those knowledgeable apply chicken blood to the root of the tongue to retract it.
Yige (Dysphagia), Fanwei (Regurgitation/Reverse Stomach), and Guange (Obstruction and Rejection) are three conditions with different names but vastly different etiologies; their treatments must be distinguished and not confused. The condition of "Ye" (Dysphagia/Choking) occurs when food reaches the mouth but cannot pass down the throat, being immediately vomited up. It starts with choking and turns into vomiting, hence called Ye. Its pathology lies at the Xi Men (Suction Gate), which is the location of the epiglottis. The disease is in the Upper Jiao (Upper Burner) and mostly belongs to dryness and withering of the stomach cavity, with depletion of blood, indicating a disease of Yin deficiency and Fire hyperactivity. The condition of "Ge" (Diaphragm obstruction) is like food swallowed reaching the diaphragm but unable to descend directly, instead slowly vomiting back up from the diaphragm, hence called Ge. This refers to the anatomical diaphragm, not the concept of blockage. Its pathology lies at the Fen Men (Cardia), which is the upper opening of the stomach. The disease is in the Middle Jiao (Middle Burner) and mostly belongs to emotional distress from worry and anger, causing Phlegm and Qi stagnation in the upper diaphragm, or due to bitter mental struggles that knot the vital energy of the Spleen; this is a disease caused by emotional factors. Danxi (Zhu Zhenheng) said: "Only elderly men suffer from this; young people do not have Yige." As for "Fanwei" (Reverse Stomach/Regurgitation), the patient eats double the usual amount. After food passes the diaphragm into the stomach, because the lower Wan (Lower Orifice of the stomach) cannot rot and transform it, morning food may be vomited in the evening, or evening food in the morning, or after accumulating for over a day, causing unbearable bloating and distension, then vomiting the original undigested food. It flips out from the lower Wan of the stomach, hence named Fanwei. Its pathology lies at the You Men (Pylorus), which is the lower opening of the Tai Cang (Stomach). The disease is in the Lower Jiao (Lower Burner); although it belongs to the Stomach, it is actually caused by decline of Mingmen Fire (Gate of Vitality Fire) and deficiency-cold of the Kidney Meridian. Both men and women of all ages can suffer from this. As for "Guange" (Obstruction and Rejection), the patient does not desire to eat even a grain of rice, feels thirsty and prefers tea or water, but drinks little before vomiting it up again. If medicine is taken, hot medicine comes out immediately upon entering, and cold medicine comes out after a while. Urination and defecation are blocked. This is named Guange. "Guan" (Obstruction) means both urination and defecation are blocked, with nothing able to exit below. "Ge" (Rejection) means vomiting and rejecting water and fluids, with nothing able to enter above. Women often have this syndrome. It is a case of Yin and Yang reversing positions, so both upper and lower parts are diseased. Guan has no way out, Ge has no way in. The urgency makes it hard to resolve, and it is difficult to treat slowly. Excess patterns are temporarily unblocked, while deficiency patterns require vigorous tonification as an attacking method. This is likely because Yang Qi is stuck in the Upper and Middle Jiao, failing to ascend and descend.
Yige mostly originates from dried-up Blood, complicated by Qi stagnation. Because Qi stagnation leads to knotting and stagnation, with Phlegm obstructing the Diaphragm, patients often vomit Phlegm and water. "Ge" refers to the Diaphragm located below the Heart, where upper and lower passages are blocked, resembling rejection. Initially, it knots at the throat, feeling obstructed; neither vomitable nor swallowable, caused by Qi stagnation and Phlegm binding. Over time, it gradually hinders eating and drinking, becoming Yige. "Ye" refers to the sudden blockage of Qi during eating, preventing food from going down, resulting in Ye.
Jiezai said: The syndromes of Ge-Ye and Fanwei are caused by Fire, developing gradually with diverse sources. Some arise from excessive thinking stirring Spleen Fire; some from excessive anger stirring Liver Fire; some from long-term consumption of fried foods generating Stomach Fire; some from unchecked sexual desire raising Kidney Fire. Generally, Fire Qi flares upward, steaming Body Fluids to form Phlegm. Initially, Phlegm-Fire is not yet knotted, causing dryness in the throat and diaphragm, making food and drink difficult to flow smoothly, resulting in Ge or Ye. Later, Phlegm-Fire knots, the upper Wan of the Stomach fails to open; although food enters, it stagnates in the Diaphragm and comes out shortly after, called Vomiting. If the lower Wan of the Stomach fails to open, food enters but stagnates in the Stomach, coming out after a long time, called Fanwei. Danxi said: Elderly patients are incurable. Young people have not yet depleted Qi and Blood; using drugs to clear Phlegm-Fire cures the disease without recurrence. Elderly people have already depleted Qi and Blood; clearing Phlegm-Fire brings temporary relief, but the disease returns. This is because Qi deficiency fails to transform and generates Phlegm, while Blood deficiency fails to moisten and generates Fire. One must absolutely avoid aromatic-dry drugs; taking them will surely lead to death. Diet should be bland. Since this syndrome is Heat and Dryness, if the medicine is also aromatic-dry, it scatters Qi and consumes Blood. Moreover, rich flavors aid Fire and cause disease, further exacerbating the condition, so these should all be avoided.
Yangkui said: Danxi attributes Yige to Seven Emotions and Six Evils, leading to transformations of Fire flaring upward, with more ascending than descending. Body Fluids are not distributed, accumulating into Phlegm and Drink. When attacked, there is temporary relief, but it recurs soon. Repeating previous medicines accumulates Heat, depletes Blood, and causes the stomach cavity to become dry and rough, obstructing the pathway. If the dryness is upper, near the throat, water drinks can pass, but solid food is hard to eat and intake is small; this is called Ye. If the dryness is lower, near the stomach, food can enter but not fully reach the stomach, coming out after a long time; this is called Ge, also called Fanwei. Defecation is scanty and resembles sheep droppings. One must avoid external Six Evils, regulate internal Seven Emotions, nourish oneself through diet, nourish Blood and generate Fluids to moisten the intestines and stomach. Then Metal (Lung) will fear no Fire flare, and Kidney will have gradual generation of Water. With clear Qi and harmonious Blood, Spleen Qi transforms robustly, and food digests and transmits normally. Danxi's discussion is excellent, but his distinction between Yige and Fanwei is unclear. I particularly appreciate his phrases "transformation of Fire flaring upward" and "gradual generation of Water by Kidney," which deeply hit the source of the disease. Unfortunately, his insight was not entirely true; focusing mainly on moistening Blood without directly exploring the congenital origin in the Kidney, his prescriptions used Si Wu Tang (Four Substances Decoction) added with cow/sheep milk, bamboo sap, and leek juice to resolve Phlegm and stasis. These treat the branch but not the root. Does he not know that *Neijing* states: "Knotting of the Three Yang meridians is called Ge." The Three Yang are Large Intestine, Small Intestine, and Bladder. Knotting refers to Heat knotting. Large Intestine governs Jin (Fluids), Small Intestine governs Ye (Essence Fluids). Heat knotting in Large Intestine dries Jin; Heat knotting in Small Intestine dries Ye. Bladder is the Official of the Capital, storing Fluids. Heat knotting in Bladder exhausts Fluids. However, why do the Three Yang develop Heat knotting? It is all a disease of the Kidney. The Kidney governs Five Fluids and Two Passages (urination and defecation), paired with the Bladder as Zang-Fu. Once Kidney Water is dry, Yang Fire becomes dominant, boiling and frying Fluids. Heat knotting in the Three Yang causes blockage of front and rear passages. Since the bottom is blocked, Qi rebels upward, directly attacking the Clear Pathways, rushing up to the Xi Men (Suction Gate), causing the throat to choke and food to fail to go down. Why can't water enter and food go down? Food enters Yin and generates Qi in Yang, inadvertently stirring the Fire of the Stomach gate. Therefore, water (Yin category) is hard to enter. Like attracts like, so drinking water causes white foam to be vomited up as the water boils and rises. Feces resembling sheep droppings occur because little food enters, residues are consumed, and the intestines become dry, small, and narrow. This syndrome mostly affects men over fifty who do not abstain from sexual desires. The innate essence of the elderly is exhausted, leaving only isolated Yang. Tonifying Yin is highly appropriate. Wang Taipu said: "Food vomited immediately upon entry indicates lack of Water. Food vomited after a long time indicates lack of Fire." Thus, Ye-Se mostly belongs to Heat, while Fanwei mostly belongs to Cold. For lack of Water, strengthen the Master of Water; for lack of Fire, benefit the Source of Fire. Chu Shizhong said: "Treat upper diseases by lowering; directly use Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) in large doses decocted and drunk. Long-term use can save one or two in ten. Also, one must abandon desires, avoid sexual activity, and eat bland food." If one says warm the Stomach, the Stomach is originally not cold. If one says tonify the Stomach, the Stomach is not deficient. If one says relieve stagnation, aromatic-dry products merely aid Fire. If one tries to purge with Cheng Qi Tang (Salvage the Extremity Decoction) using salty-cold herbs, it damages the Stomach and exhausts Fluids further. Nothing is better than tonifying Yin; the flame extinguishes itself.
Ge disease is hardest to treat. Trying to invigorate the Spleen and resolve Phlegm fears dry agents harming Fluids; trying to nourish Blood and generate Fluids fears moist agents hindering the Middle Jiao. Clinging to soothing stagnation and relieving the diaphragm uses pungent-aromatics that aid Fire, rapidly drying Stomach Juice, bringing one close to death. Therefore, Dongyuan stated there are three types of vomiting related to Qi accumulation and Cold: Upper Jiao vomiting stems from Qi; sudden vomiting after eating is the sign. Middle Jiao vomiting stems from Accumulation; either pain precedes vomiting or vomiting precedes pain. Lower Jiao vomiting stems from Cold; pulse is deep and slow, morning food vomited in evening, evening food in morning, urination is free, defecation is blocked. The method should be to unblock obstruction, warm Cold, specifically treat the Lower Jiao, scatter Cold, and slowly harmonize with Middle Jiao medicines to achieve cure. Since Mingmen Fire declines, there is no firewood under the pot to steam and rot food and water in the Stomach, causing abdominal fullness and necessitating vomiting. This is what is meant by "food vomited after a long time indicates lack of Fire." One must benefit the Source of Fire, first using Ba Wei Di Huang Wan (Eight-Ingredient Pill with Rehmannia) to tonify Mingmen Fire, supporting the Mother of Spleen Earth, then slowly using Fu Zi Li Zhong Tang (Aconite Decoction to Regulate the Middle) to regulate the Middle Jiao. Without this approach, merely using Hawthorn and Medicated Leaven to calm the Stomach and digest food merely accelerates death. Furthermore, the Ge-Ye disease in the elderly stems from dried-up Blood, loss of transport function in the Middle Jiao, inability to nourish Zang-Fu organs, presenting with a slow, weak pulse gradually becoming deep and slow, indicating daily decline of Righteous Qi. The reason they can prolong life slightly is that a thread of Harmonious Qi remains, like a lamp burning out only after the oil is gone. Physicians must preserve True Qi, prevent leakage, moisten dryness without causing congestion, ensuring Qi generates Blood, so as to complete their natural lifespan. This is why Danxi advocated treatments with various milks and juices. Modern physicians add Phlegm-resolving and Qi-breaking drugs, claiming the disease arises from stagnation and suddenly opening it. Although effective momentarily, it ultimately leads to withered collapse and death. The Yangming Meridian has abundant Blood and Qi, serving as the Sea of Food and Fluids, accepting new and exchanging old. Unlike the young and strong who simply eliminate waste, here one must use medicine to remove disease and quiet cultivation to restore Yuan Qi. Books describe this as a disorder of Spirit and Thought, stating that nourishing the Spirit and clearing Thoughts allows Fluids to gather in the Stomach. Like clear weather, when Blood and Water return to their source, there is no fear of stormy waves. Observe Yige patients: they can accept water drinks but find solid food hard to enter. This is because Yin Qi is consumed, forcing reliance on similar substances.
Fanwei fundamentally stems from dried-up Blood, so nothing is better than nourishing Blood; nourishing Blood is best achieved by nourishing Water. When Water is abundant, Fluids naturally generate, and the transmission functions of the intestines and stomach perform their duties properly. It is also said: Vomiting belongs to deficiency-cold of the stomach cavity, so nothing is better than Pungent-Warmth; Pungent-Warmth is best achieved by tonifying Fire. Tonifying Fire warms Mingmen Qi, allowing food and water in the Sea of the Stomach to be rotted and transformed. Thus, Ba Wei (Eight-Ingredient) and Liu Wei (Six-Ingredient) pills are indeed key medicines for treating Fanwei, uniquely understood by Zhao Xianke.
Ye disease fundamentally stems withered Essence and Blood, sorrowful thoughts and stagnation. Fluids and Blood cannot moisten downward, causing Ye. Thus, seeing food causes a sensation of choking in the heart; the mechanism is diseased beforehand. The formless True Qi is diseased, so treatment should focus on cultivating True Qi. It is also said: It fundamentally stems from Kidney deficiency, misuse leading to disease, weak Qi and dried Blood from worry and labor. Weak Qi fails to transform, dried Blood blocks pathways. The Ren Mai (Conception Vessel) of the human body ascends along the throat and descends straight down from the three Wans of the Stomach. Kidney deficiency causes Ren Mai to fail to moisten the Dantian; Yuan Yang Qi lacks the function of warming and steaming/rotting. Consequently, the Middle Jiao loses its transforming, transporting, and moistening descent functions, forming Ye. Therefore, treatment focuses exclusively on nourishing Yin.
If medicine prevents regurgitation, even if the patient desires food, do not immediately give porridge, drinks, or any food. Only use daily 5 qian of Renshen (Ginseng Radix et Rhizoma), 2 qian of Chenpi (Citri Reticulatae Pericarpium), and 1 liang of Lao Huang Mi (Old Yellow Rice), decocted as soup to sip slowly, to vent Stomach Qi. When feeling slightly relieved, gradually increase Renshen. After ten days to half a month, one can cautiously try old rice gruel. Since the granary is not yet secure, it is inappropriate to store grain immediately. Often, those who eat porridge and rice immediately lead to untreatable conditions. Deficiency with dry Stomach Fluids, food choking and not going down, is like a person eating dry things, causing blockage and difficulty swallowing; it must be moistened with tea water to proceed, a principle easily seen. Use 5 liang each of Sheng Jiang Zhi (Fresh Ginger Juice), Bai Mi (White Honey), Niu Su (Cow Butter/Suet), and 2 liang each of Renshen Mo (Ginseng Powder) and Bai He (Lilii Bulbus). Simmer over double-boiling to make an ointment. Advance half a spoon occasionally. Once Fluids descend, Spleen and Stomach gradually open. Most taboo are rich, sweet, sticky, and greasy foods, fearing further damage to the Stomach. A small amount of Bai Xiang Niu Ya Qing Tang (White Fish, Beef, and Duck Clear Soup) can be used to assist Stomach Qi. There are also cases caused by accumulated Blood stasis internally, which should be gradually expelled. Difficult stool is hard to treat. For excessive Phlegm, there is no need to treat Phlegm directly; tonification resolves it. Vomiting white foam is incurable. Chest and abdominal burning pain like knife cutting is fatal. Elderly patients are incurable. Feces resembling sheep droppings are incurable.
Guange, discussed in *Neijing*, refers to pulse diagnosis, not disease. Since Zhang Zhongjing created his theory, all schools considered Guange a disease name. As *Jing* states: "Ren Ying pulse four times fuller indicates Ge Yang; Cun Kou pulse four times fuller indicates Guan Yin. If both Ren Ying and Cun Kou are more than four times fuller, it is Guange. The Guange pulse is emaciated; unable to exhaust the essence Qi of Heaven and Earth, death ensues." Jingyue also believed that exclusive fullness of Ren Ying indicates disease in the Three Yang Fu organs; exclusive fullness of Cun Kou indicates disease in the Three Yin Zang organs. Guange represents extreme excess of Yin and Yang, a rebellious sign of isolated Yang and actual exhaustion of True Yin. Although discussions on pulse vs. disease differ, the harm of Yin-Yang partial severance leading to Guan and Ge is the same. Seeking meaning from the name reveals the nature of the disease.
Guan means inability to urinate, caused by intense Heat Qi, Heat in the Lower Jiao blocking passage. Ge means vomiting and rebellion, caused by intense Cold Qi, Cold in the Chest blocking flow. Guange refers to a sensation of obstruction in the Diaphragm, wanting to ascend but unable, wanting to descend but unable, wanting to eat but unable, with Cold and Heat not communicating between upper and lower. This is horizontal blocking of Qi. One must use emesis to lift the horizontal blocking of Qi, not necessarily to expel Phlegm. If Phlegm is present and suitable for emesis, use Er Chen Tang (Two-Aged Decoction) to induce vomiting; within vomiting lies descending. If Middle Qi is deficient and fails to transport, use Qi-tonifying drugs with ascending-descending properties.
Guange arrives suddenly and is an acute disease. Constipation of both urine and stool, thirst for water and food, vomiting shortly after drinking, repeated drinking and vomiting, dry lips, slightly red eyeballs, flushed or unflushed face, severe cases may have chest pain or no pain. From onset, no desire for even a grain of rice, not a drop of water can enter the stomach. Drink one cup, vomit half. After several days, the pulse becomes deep and hidden. This Cold enters from the Shaoyin Kidney Meridian; Yin excess below forces Yang upward, called Ge Yang syndrome, named Guange. Guange leads to premature death. One must use Zhang Zhongjing's Bai Tong Tang (White Connecting Decoction), applying the *Neijing* method of "treating Cold with Hot." *Jing* states: "To regulate reversal of Cold and Heat, Cold and Hot must act accordingly." Thus, take hot medicine cold. After swallowing, the cold nature dissipates, and the hot nature begins to act. Consequently, pathogenic Qi heals, and vomiting ceases. This does not violate feelings and brings great benefit. Adding Human Urine and Pig Gallbladder Bile (salty, bitter, cold substances) to Bai Tong Tang seeks harmony of Qi to remove the rejecting Cold. If the pulse gradually emerges after taking medicine, survival; if the pulse suddenly appears and disappears, death. Tao Jie'an's *Sha Che Chui* contains Fan Ben Hui Yang Tang (Return to Root and Restore Yang Decoction), extremely excellent. After recovery, continuously take Ba Wei Wan (Eight-Ingredient Pill). Another type of Liver Fire syndrome also presents with vomiting without retention, but vomits sour water, bitter water, or green-blue water. Urination and defecation are not blocked, but can cause chest pain. This is Fire Stagnation and Wood Stagnation syndrome. For Wood stagnation, disperse it; for Fire stagnation, vent it. Use Zhu Lian (Coptidis Rhizoma and Evodiae Fructus) decocted strongly, sipped slowly, then take Xiao Yao San (Free and Easy Wanderer Powder) to cure. After recovery, regulate with Liu Wei (Six-Ingredient Pill).