经云∶三阳结谓之膈。一阳发病，其传为膈。丹溪谓噎应反胃，多由气血两虚而成。噎
膈多由喜、怒、悲、忧、恐五志过枉，或纵情嗜欲，恣意酒食，致伤气内结，阴血内枯而成。治
当调养心脾，以舒结气，填精益血，以滋枯燥。
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。
噎膈之症多因火，熏蒸津液成痰阻。七情妄动五脏伤，阴血渐槁无生所。咽喉通塞不能
食，病起贲门上焦膈。中膈饮食得水入，食下半日又吐出。下膈饮食如平人，朝食暮吐浑无
力。治主加味二陈汤，韭汁牛乳服之适。血虚四物气四君（子汤），痰饮沥贝栝蒌应。瘀血归
尾桃韭汁，气急槟术沉香吞。便结大黄合四物，桃仁苏子蒌麻仁。反胃为轻噎膈重，三阳
热结精血空。薄味勤药静养之，香草之品切忌用。
陈曰∶按经云味过辛热，肝阳有余，肺津胃液皆夺为上燥，阳气结于上，阴气衰于下，为关格。
附子泻心汤
附子 黄芩 川连 大黄 大半夏汤 半夏 人参 白蜜 加黄连 姜汁 进退黄
连汤 人参 川连 桂枝 枳实 竹沥 枇杷叶 杏仁 干姜 茯苓 半夏 姜汁
肝阴伤胃汁枯
陈参曰∶酸甘济阴，胃属阳土，宜凉宜润。肝为刚脏，用柔则和，酸甘两济其阴。
人参 乌梅 生地 阿胶 杏仁 玉竹 川贝 天冬 麦冬 白芍 胡麻 梨汁 柿霜
烦劳阳亢，肝胃津液枯
清燥救肺汤 生地 麦冬 黑芝麻 杏仁 柏仁 白苏子 松子
为汁，熬膏，末，丹溪法。
胃阳虚
陈参曰∶胃气下行为顺。积劳伤阳，治宜通补清利，苦降辛通，利痰清膈。
大半夏汤 半夏 人参 白蜜《外台》 茯苓饮 贝前吴萸理中汤 即理中汤加吴萸
益智 新会 栝蒌 杏仁 竹茹 茯苓 附子 枳实 豆豉 粳米 竹沥 姜汁 川连 郁金 丁香皮
忧郁痰阻
川连 茯苓 半夏 杏仁 橘皮 栝蒌 姜汁 竹沥 桔梗 枳实
肝郁气逆 并通厥阴阳明。
半夏 茯苓 姜汁 杏仁 橘皮 竹沥
液亏气滞
半夏 枳实 枇杷叶 茯苓 竹沥
肺胃气不降
陈曰∶轻剂清降，苦辛寒开肺。
杏仁 郁金 栝蒌 枇杷叶 山栀 豆豉
酒热郁伤肺胃
川连 枳实 豆豉 紫菀 桃仁 白苏子 半夏 杏仁 郁金 茯苓 姜汁 枇杷叶
阳衰脘痹血瘀
桃仁 红花 延胡 半夏 郁金 蒌仁 橘皮 人参 茯苓 益智 归身 姜汁
制军 枳实 川连 韭白汁
《黄帝内经》记载：三阳经气郁结，称为“膈”。少阳一经发病，其传变可发展为“膈”证。朱丹溪认为，“噎”应当对应“反胃”，多由气血两虚所致。“噎膈”多因喜、怒、悲、忧、恐五种情志过度偏颇，或纵情声色欲望、肆意饮酒进食，导致气机内结、阴血内枯而成。治疗应当调养心脾，以舒展郁结之气；填精益髓、补血滋阴，以滋润枯燥之体。
“反胃”是由于胃中阳气不足，不能容纳受纳食物；命门火衰，不能温煦熏蒸脾土，从而导致早晨吃的食物晚上吐出，晚上吃的食物早晨吐出。治疗适宜补益命门之火以消除阴寒之邪，补益脾胃（土）以通阳，温暖脾胃。
“噎膈”病症多因火热之邪，熏蒸津液形成痰浊阻滞。七情妄动损伤五脏，阴血逐渐干枯失去生化之源。咽喉通道阻塞无法进食，病起于贲门及上焦膈部。若为“中膈”，饮食饮水尚可进入，但食后约半天又吐出；若为“下膈”，饮食如常人一般，但出现朝食暮吐且浑身无力。治疗主要以加味二陈汤为主，配合服用韭菜汁和牛乳适宜。若属血虚，用四物汤；若属气虚，用四君子汤；若有痰饮，选用贝母、竹沥、栝蒌、川贝等药。若有瘀血，选用当归尾、桃仁、韭菜汁；若气急，选用槟榔、白术、沉香吞服。若大便干结，大黄合用四物汤，再加桃仁、苏子、栝蒌、麻仁。反胃病轻而噎膈病重，皆因三阳热结、精血空虚所致。饮食宜清淡薄味，勤服药物，静养身心，切忌使用香燥之品。
陈氏按语说：据《内经》记载，口味过于辛热，导致肝阳有余，肺津胃液都被耗夺，形成上部燥热，阳气结聚于上，阴气衰弱于下，这就形成了“关格”证。
附子泻心汤：附子、黄芩、黄连、大黄。
大半夏汤：半夏、人参、白蜜，加入黄连、姜汁。
进退黄连汤：人参、黄连、桂枝、枳实、竹沥、枇杷叶、杏仁、干姜、茯苓、半夏、姜汁。
肝阴受伤，胃汁枯竭：
陈参曰：酸甘化阴，胃属阳土，宜凉宜润。肝为刚脏，用柔则调和，酸甘两法共同济助其阴。
方药：人参、乌梅、生地、阿胶、杏仁、玉竹、川贝、天冬、麦冬、白芍、胡麻、梨汁、柿霜。
烦劳导致阳亢，肝胃津液枯竭：
清燥救肺汤：生地、麦冬、黑芝麻、杏仁、柏仁、白苏子、松子，制成汁、熬膏或研末，这是朱丹溪的方法。
胃阳虚：
陈参曰：胃气以下行为顺。积劳损伤阳气，治疗适宜通补清利，苦降辛通，利痰清膈。
大半夏汤：半夏、人参、白蜜（出自《外台秘要》）。
茯苓饮：贝母、前胡、吴茱萸、理中汤（即理中汤加吴茱萸、益智仁、新会皮）、栝蒌、杏仁、竹茹、茯苓、附子、枳实、豆豉、粳米、竹沥、姜汁、黄连、郁金、丁香皮。
忧郁导致痰阻：
黄连、茯苓、半夏、杏仁、橘皮、栝蒌、姜汁、竹沥、桔梗、枳实。
肝郁气逆：
并治厥阴、阳明经。
半夏、茯苓、姜汁、杏仁、橘皮、竹沥。
肺胃气不降：
陈氏曰：用轻剂清降，苦辛寒开宣肺气。
杏仁、郁金、栝蒌、枇杷叶、山栀、豆豉。
酒热郁伤肺胃：
黄连、枳实、豆豉、紫菀、桃仁、白苏子、半夏、杏仁、郁金、茯苓、姜汁、枇杷叶。
阳衰脘痹血瘀：
桃仁、红花、延胡索、半夏、郁金、栝蒌仁、橘皮、人参、茯苓、益智仁、当归身、姜汁、制军（大黄）、枳实、黄连、韭白汁。
The *Classic of Internal Medicine* states: When the Qi of the three Yang meridians becomes knotted, it is called "Ge" (Obstruction). When disease originates in one Yang meridian, its transmission may develop into "Ge" syndrome. Zhu Danxi stated that "Ye" (Choking) should correspond to "Fanwei" (Regurgitation), which is mostly caused by deficiency of both Qi and Blood. "Ye Ge" (Choking and Obstruction) is mostly caused by excessive deviation of the five emotions—joy, anger, sorrow, worry, and fear—or by indulging in desires and consuming alcohol and food recklessly, leading to internal knotting of Qi and withering of Yin Blood internally. Treatment should focus on nourishing the Heart and Spleen to soothe knotted Qi, and replenishing Essence and Blood to moisten dryness.
"Fanwei" (Regurgitation) occurs because there is insufficient Yang in the Stomach, preventing it from receiving and containing food; the fire of the Gate of Vitality (Mingmen) is declining and cannot warm and steam the Spleen Earth, resulting in vomiting food eaten in the morning at night, or food eaten at night in the morning. Treatment is suitable for tonifying the source of Fire to eliminate shadows of Yin, and tonifying Earth to unblock Yang, thereby warming the Stomach and Spleen.
The symptoms of "Ye Ge" are mostly due to Fire, which steams body fluids into Phlegm causing obstruction. Wild movements of the seven emotions damage the five Zang organs, and Yin Blood gradually withers without a source of generation. The throat becomes blocked, making eating impossible; the disease arises at the cardia and the upper Jiao diaphragm. In "Middle Ge," food and water can enter, but are vomited out half a day later. In "Lower Ge," diet is like that of a healthy person, but morning food is vomited at night, accompanied by general weakness. Treatment primarily uses Modified Erchen Decoction, taken suitably with leek juice and cow's milk. If blood deficiency, use Siwu Decoction; if Qi deficiency, use Sijunzi Decoction; if Phlegm-fluid retention, use Fritillaria, Zhuli (Bamboo Sap), Trichosanthes, and Chuanbei (Fritillaria cirrhosa). If blood stasis, use Dangguiwei (Tail of Angelica sinensis), Taoren (Peach Kernel), and leek juice; if Qi urgency, use Binglang (Areca Seed), Baizhu (Atractylodes macrocephala), and Chenxiang (Aquilaria wood) swallowed. If stool is constipated, combine Dahuang (Rhubarb) with Siwu Decoction, adding Taoren, Suzi (Perilla Seed), Trichosanthes, and Mahuangren (Hemp Seed). Fanwei is mild, while Ye Ge is severe, both due to heat knotting in the three Yang meridians and emptiness of Essence and Blood. Diet should be light and bland, medication should be taken diligently, and rest should be observed; aromatic and drying herbs must be strictly avoided.
Chen's commentary notes: According to the classics, if flavors are excessively pungent and hot, Liver Yang becomes excessive, and Lung Jin (Fluids) and Stomach Ye (Juices) are depleted, leading to upper dryness. Yang Qi knots above, while Yin Qi declines below, forming "Guan Ge" (Closed and Obstructed) syndrome.
Fuzi Xie Xin Tang (Attapirte Decoction for Draining the Epigastrium): Fuzi (Prepared Aconite Lateral Root), Huangqin (Scutellaria Root), Chuanlian (Coptis Rhizome), Dahuang (Rhubarb Root and Rhizome).
Dabanzhong Tang (Major Pinellia Decoction): Banxia (Pinellia Tuber), Renshen (Ginseng Radix et Rhizoma), Baimi (White Honey), added with Huanglian (Coptis Rhizome) and Jiangzhi (Fresh Ginger Juice).
Jintui Huanglian Tang (Advance-Retreat Coptis Decoction): Renshen, Chuanlian, Guizhi (Cinnamon Twig), Zhishi (Immature Bitter Orange), Zhuli (Bamboo Sap), Pipaye (Loquat Leaf), Xingren (Apricot Seed), Ganjiang (Dried Ginger), Fuling (Poria), Banxia, Jiangzhi.
Liver Yin injured, Stomach Juice dried up:
Chen Shen said: Sour and sweet generate Yin. The Stomach belongs to Yang Earth, suitable for cooling and moistening. The Liver is a rigid organ; using soft methods brings harmony. Sour and sweet jointly nourish its Yin.
Herbs: Renshen, Wumei (Dark Plum), Shengdi (Rehmannia Root), Ejiao (Donkey-Hide Gelatin), Xingren, Yuzhu (Polygonatum Odoratum Rhizome), Chuanbei (Fritillaria Cirrhosa Bulb), Tiandong (Asparagus Root), Maidong (Ophiopogon Tuber), Baishao (White Peony Root), Huma (Sesame Seed), Lizhi (Pear Juice), Shishuang (Persimmon Frost).
Fatigue leads to Yang hyperactivity, Liver and Stomach Jin-Ye dried up:
Qingzao Jiufei Tang (Clear Dryness Rescue Lung Decoction): Shengdi, Maidong, Heihima (Black Sesame Seed), Xingren, Bairén (Prunus Armeniaca Seed), Baizuizi (White Perilla Seed), Songzi (Pine Nut), processed into juice, boiled paste, or powder. This is the method of Danxi.
Stomach Yang Deficiency:
Chen Shen said: Stomach Qi descending smoothly is favorable. Accumulated fatigue damages Yang; treatment should facilitate unblocking, tonifying, clearing, and draining, using bitter descent and pungent unblocking to benefit Phlegm and clear the Diaphragm.
Dabanzhong Tang: Banxia, Renshen, Baimi (from *Waitai Mi Yao*).
Fuling Yin: Beimu (Fritillaria Thunbergii Bulb), Qianhu (Peucedani Radix), Wuyu (Evodia Fruit), Lizhong Tang (which is Lizhong Tang plus Wuyu, Yizhi (Alpinia Oxyphylla Fruit), Xinhui (Tangerine Peel), Gualou (Trichosanthes Fruit), Xingren, Zhuru (Bamboo Shavings), Fuling, Fuzi, Zhishi, Douchi (Fermented Soybean), Jingmi (Rice), Zhuli, Jiangzhi, Chuanlian, Yujin (Curcuma Longa Rhizome), Dingxiangpi (Clove Bark).
Melancholy leading to Phlegm obstruction:
Chuanlian, Fuling, Banxia, Xingren, Jupi (Tangerine Peel), Gualou, Jiangzhi, Zhuli, Jiegeng (Platycodon Root), Zhishi.
Liver Depression with Qi Rebellion:
Also treating Jueyin and Yangming meridians.
Banxia, Fuling, Jiangzhi, Xingren, Jupi, Zhuli.
Fluid Deficiency with Qi Stagnation:
Banxia, Zhishi, Pipaye, Fuling, Zhuli.
Lung and Stomach Qi failing to descend:
Chen said: Use light agents to clear and descend, bitter-pungent-cold to open the Lung.
Xingren, Yujin, Gualou, Pipaye, Shanzhi (Gardenia Fruit), Douchi.
Wine-heat stagnating and injuring Lung and Stomach:
Chuanlian, Zhishi, Douchi, Ziwan (Aster Root), Taoren, Baizuizi, Banxia, Xingren, Yujin, Fuling, Jiangzhi, Pipaye.
Yang decline, Epigastric Bi, Blood Stasis:
Taoren, Honghua (Carthamus Flower), Yanhu (Corydalis Rhizome), Banxia, Yujin, Louren (Trichosanthes Seed), Jupi, Renshen, Fuling, Yizhi, Guishen (Angelica Sinensis Root Body), Jiangzhi, Zhijun (Prepared Rhubarb), Zhishi, Chuanlian, Jiubaiji (Leek White Juice).