论
《内经》曰∶三阳结，谓之膈。子和云∶三阳者，大小肠膀胱也。结，谓热结也。小肠热结则血脉燥，大肠热结则
不能圊，膀胱热结则津液涸，三阳既结则前后闭塞，下既不通必反而上行，所以噎食不下，纵下而复出也。此阳火不下
降而上行也，故经又曰少阳所至为呕涌，溢食不下，此理明矣。又先哲论膈噎反胃，大率以血液干槁。其或咽喉窒塞，
食不能下，其槁在吸门；或食下则胃脘当心而痛，须臾吐出，食出痛止，其槁在贲门，此皆上焦之膈噎也。其或食物可
不，良久复出，其槁在幽门，此中焦之膈噎也。其或朝食暮吐，暮食朝吐，其槁在阑门，大小肠之间，此下焦之膈噎也。
虽然，亦有斯须轻病而为医所误者，丹溪论之详矣。谓夫气之初病，其端甚微，或因些少饮食不谨，或外胃风雨，内伤
七情，或食味过浓，偏助阳气，积成膈热，或资禀充实，表密无汗，或性急易怒，相火上炎，以致津液不行，清浊相干，
惟气之为病，或痞或痛，或不思食，或噫腐吞酸，或嘈杂痞闷。医者不求其本，便认为寒，遽以辛香燥热之剂投之，时
暂得快，以为神方。浓味仍前不节，七情反复相侵，旧病被劫暂开，浊液易于 聚，或半月，或一月，前证复作。如此
蔓延，自气成积，自积成痰，此为痰为饮为吞酸之由也。良工未遇，谬药又行，痰挟瘀血，遂成窠囊，此为痞为痛为呕
吐膈噎反胃之次第也。医者犹谓虚而积寒，非寻常草木可疗，竟以乌、附助佐丹剂，专意服饵。积而久也，血液俱耗，
胃脘干槁。其槁在上，近咽之下，水饮可行，食物难入，间或可入，食亦不多，名之曰噎。其槁在下，与胃为近，食虽
可下，难尽入胃，良久复出，名之曰膈，亦曰反胃，大便秘，小若羊屎。然名虽不同，病出一体。又曰∶噎病生于血干，
血阴也，阴主静，内外两静则脏腑之火不起，而金水二脏有养，阴血自生，肠胃津液传化合宜，何噎之有。医者当知此
意，不可妄以燥热之剂，以火济火，则何以异刺人而杀之也，慎之慎之！
脉法
《脉经》曰∶寸紧尺涩，其人胸满不能食而吐，吐止者为下之，故不能食。误言未止者，此为反胃，故尺为微涩也。
（误一作设。）
寸口脉紧而芤，紧则为寒，芤则为虚，虚寒相搏，脉为阴结而迟，其人则噎。关上脉数，其人则吐。
脉弦者虚也，胃气无余，朝食暮吐，暮食朝吐，变为胃反。寒在于上，医反下之，令脉反弦，故名曰虚。
趺阳脉浮而涩，浮则为虚，涩则伤脾，脾伤则不磨，朝食暮吐，暮食朝吐，宿谷不化，名曰胃反，脉紧而涩，其病
难治。
脉涩而小，血不足；脉大而弱，气不足。
方法
丹溪曰∶大率属血虚、气虚、有痰。
戴氏曰∶气虚者，脉必缓而无力。血虚者，脉必数而无力。痰者，寸关脉必沉，或伏而大。有气滞结者，寸关沉而
涩。
张鸡峰曰∶噎当是神思间病，惟内观以自养可安。此言深中病情。
屎如羊屎者，不治。（大肠无血故也。）年高者，不治。（年五十余，则不可治矣。）
戴氏曰∶气血俱虚者，则口中多出沫。但见沫大出者，必死不治。
治法，用童便、韭汁、竹沥、姜汁、牛羊乳（一本有驴屎），气虚入四君子汤，血虚入四物汤。切不可用香燥药，宜
薄滋味。
一法，用黄连三钱（姜汁炒），山楂肉二钱，保和丸二钱，同为末，糊丸麻子大，胭脂胚子为衣，人参汤入竹沥，下
五十丸。
一方，用马匏儿烧存性，陈米汤调服。（即野田瓜，北方多有。原本书马剥儿，误也。）
一云，马匏儿烧存性一钱，好枣肉四枚，平胃散二钱，温酒调服，食即可下，然后随病源调理。
一方，用吴茱萸、黄连、贝母、栝蒌子、牛转草，丸服。
一方，用韭汁二两，牛乳一盏，生姜半两捣汁，和匀顿服，效。
有气结者，用开导之剂。有阴火上炎者，作阴虚治。有积血者，当消息去之，韭汁能下膈上瘀血。
古方用人参以补肺，御米以解毒，竹沥以清痰，干姜以养血，粟米以实胃，蜜以润燥，姜以去秽。有治寒者，必为
当时有实因于寒者用之也，挟寒者间或有之。今人悉因痰气，久误于医，传变而成，其无寒也明矣。
（以上丹溪方法凡十一条）
栝蒌实丸（局方） 治膈噎，胸膈痞，痛彻背胁，喘急妨闷。
栝蒌实（去壳别研） 枳壳（去穣麸炒） 半夏（汤泡七次） 桔梗（炒，各一两）
上为细末，姜汁米糊为丸，如梧桐子大，每服五十丸，生姜汤送下。
宽中进食丸（东垣） 滋形气，喜饮食。（方见内伤门。）
人参利膈丸（东垣） 治膈噎，胸中不利，大便结燥，痰嗽喘满，脾胃壅滞。推陈致新，治膈气之圣药也。
木香 槟榔（各七钱五分） 人参 当归 藿香 甘草 枳实（麸炒黄，各一两） 大黄（酒湿蒸熟） 浓朴（姜
制，一两）
上为细末，滴水为丸，如梧桐子大，每服五十丸，温水下。
（丹溪活套）云∶凡膈噎反胃，悉用二陈汤加姜汁、竹沥、童便、韭汁之类为主治。如胸中觉有热闷，本方加土炒
黄连、黄芩、栝蒌仁、桔梗之类。如血虚瘦弱之人，本方合四物汤，少加杏仁泥、红花，童便、韭汁之类仍不可缺。如
饮酒人，本方加砂糖、驴屎入内服。如朝食暮吐，暮食朝吐，或食下须臾即吐者，此胃可容受而脾不能传送也，或大小
肠秘结不通，食返而上奔也，本方加酒蒸大黄、桃仁之类以润之。脾不磨者，本方多加麦 面、神曲之类以助化之。如
气虚肥白人膈噎者，本方合四君子汤，亦加竹沥、姜汁为要药也。有因七情郁结成气噎者，本方加香附、抚芎、木香、
槟榔、栝蒌仁、砂仁之类。凡膈噎，大便燥结，用大黄，乃急则治其标之剂也。仍用四物汤加童便、韭汁，多饮牛羊乳
为上策也。但不可以人乳代之，盖人乳内有饮食烹饪之火及七情之火存于中，故不可代服也。
（祖传方）
润肠膏 治膈噎，大便燥结，饮食良久复出，及朝食暮吐、暮食朝吐者，其功甚捷。
新取葳灵仙（四两，捣汁，四、五月开花者） 生姜（四两，捣汁） 真麻油（二两） 白砂蜜（四两，煎沸，掠
出上沫）
上四味，同入银石器内搅匀，慢火煎，候如 ，时时以箸挑食之。一料未愈，再服一料决效。
大力夺命丸 治膈噎不下食及翻胃等证。
杵头糠 牛转草（各半斤） 糯米（一斤）
上为细末，取黄母牛口中涎沫为丸，如龙眼大，入锅中，慢火煮熟食之，加沙糖二、三两入内丸尤佳。
一方 治噎膈久不纳谷者。
隔年炊饭干（不拘多少）
上一味，以急流顺水煎煮糜烂，取浓汁时时与之。待能食后，以调脾进食、生血顺气之药调治而安。
（医案）
苏溪金贤九里，年五十三，夏秋间得噎证,胃脘痛，食不下，或食下良久复出，大便燥结，人黑瘦殊甚，求予治。
诊其脉，右手关前弦滑而洪，关后略沉小，左三部俱沉弦，尺带芤。予曰∶此中气不足，木来侮土，上焦湿热郁结成痰，
下焦血少，故大便燥结。阴火上冲吸门，故食不下。用四物以生血，用四君子以补气，用二陈以祛痰，三合成剂，加姜
炒黄连、炒枳实、栝蒌仁，少加砂仁。又间服润肠丸，或服丹溪坠痰丸。半年，服前药百余帖，病全安。
梅林骆氏妇，予妻婶也，年四十九，身材略瘦小，勤于女工，得膈噎证半年矣，饮食绝不进，而大便结燥不行者十
数日，小腹隐隐然疼痛，求予治。诊之，六脉皆沉伏。予以生桃仁七个令细嚼，杵生韭汁一盏送下。片时许，病者云∶
胸中略见宽舒。以四物汤六钱，加栝蒌仁一钱，桃仁泥半钱，酒蒸大黄一钱，酒红花一分，煎成正药一盏，取新温羊乳
汁一盏，合而服之。半日后，下宿粪若干。明日腹中痛渐止，渐可进稀粥而少安。后以四物汤出入加减，合羊乳汁，服
五、六十帖而安。
论
《黄帝内经》说：三阳经气结滞，称为膈证。刘河间（刘完素）说：三阳指的是小肠、大肠和膀胱。结，是指热邪结聚。小肠热结则血脉干枯，大肠热结则不能排便，膀胱热结则津液枯竭，三阳既已结滞，则大小便闭塞不通，下部既然不通，气机必然反而上行，所以出现吞咽困难、食物无法下咽，即使勉强咽下也会立即吐出的症状。这是阳气之火不下降反而上行的缘故，所以经文又说：少阳之气所致病症表现为呕吐涌逆、饮食不下，这个道理是很明显的。另外，先贤论述膈噎反胃，大都是因为血液干枯枯槁。如果咽喉部堵塞，食物不能下行，这种干枯发生在吸门；或者食物咽下后胃脘部当心处疼痛，片刻之后吐出，食物吐出后疼痛停止，这种干枯发生在贲门，这都属于上焦的膈噎证。如果食物可以咽下，但过很久又吐出来，这种干枯发生在幽门，这属于中焦的膈噎证。如果早晨吃的食物晚上吐出，晚上吃的食物早晨吐出，这种干枯发生在阑门，即大小肠之间，这属于下焦的膈噎证。
虽然如此，也有病情轻微却因医生误治而加重的情况，朱丹溪对此论述得很详细。他说：气病初起时，征兆很微小，可能是因为少许饮食不慎，或外受风雨侵袭，内伤七情，或因口味过重，偏助阳气，积结成膈热；或因体质充实，表密无汗；或因性格急躁易怒，相火上炎，导致津液运行不畅，清浊之气相互干扰。仅仅是气机为病，可能出现痞满或疼痛，或不思饮食，或嗳气腐臭吞酸，或嘈杂痞闷。医生不探究病因根本，就认为是寒证，急忙使用辛香燥热的药物投服，暂时感到舒适，便以为是神方。然而浓味饮食依然不加节制，七情反复侵扰，旧病被劫持暂开，浊液易于积聚，或者半个月，或者一个月，前证再次发作。这样蔓延发展，自气成积，自积成痰，这就是形成痰饮、吞酸的原因。良医未遇，谬药又行，痰挟瘀血，遂成窠囊，这就是形成痞满、疼痛、呕吐、膈噎、反胃的次第过程。医生还认为是虚寒积滞，不是寻常草木药物所能治疗的，竟然使用乌头、附子辅助丹药，专心服用。久而久之，血液耗损，胃脘干枯枯槁。如果干枯在上部，靠近咽喉之下，水饮尚可通行，食物难以进入，偶尔能进入，吃得也不多，命名为噎。如果干枯在下部，靠近胃部，食物虽可咽下，但难以全部进入胃中，过很久又吐出来，命名为膈，也称为反胃，大便干燥，小便像羊屎一样。虽然名称不同，但病源出自一体。又说：噎病生于血干，血属阴，阴主静，内外两静则脏腑之火不起，而肺金肾水二脏得到滋养，阴血自然生成，肠胃津液传输化合适宜，哪里有噎病呢？医生应当明白这个意思，不可妄用燥热之剂，以火济火，这与刺人杀人有什么区别呢？务必谨慎！
脉法
《脉经》说：寸脉紧尺脉涩，其人胸满不能进食且呕吐，呕吐停止的是因为误用攻下法，所以不能进食。如果说呕吐未止，这是反胃，所以尺脉微涩。（“误”一作“设”。）
寸口脉紧而芤，紧则为寒，芤则为虚，虚寒相搏，脉象为阴结而迟，其人则出现噎证。关上脉数，其人则呕吐。
脉弦者表示虚，胃气无余，朝食暮吐，暮食朝吐，变为胃反。寒邪在上，医生反而用攻下法，令脉象反见弦象，所以名为虚。
趺阳脉浮而涩，浮则为虚，涩则伤脾，脾伤则不能磨化食物，朝食暮吐，暮食朝吐，宿谷不化，名为胃反，脉紧而涩，其病难治。
脉涩而小，表示血不足；脉大而弱，表示气不足。
方法
朱丹溪说：大率属于血虚、气虚、有痰。
戴氏说：气虚者，脉必缓而无力。血虚者，脉必数而无力。痰证者，寸关脉必沉，或伏而大。有气滞结者，寸关脉沉而涩。
张鸡峰说：噎证大概是心神思维间的疾病，只有内观修养才能安宁。这话深深切中病情。
大便像羊屎一样的，不治。（因为大肠无血。）年高者，不治。（年龄五十多岁，就不可治了。）
戴氏说：气血俱虚者，则口中多出涎沫。只要见到涎沫大量涌出，必定死亡不治。
治疗方法，使用童便、韭菜汁、竹沥、姜汁、牛羊乳（另一版本有驴屎），气虚加入四君子汤，血虚加入四物汤。切不可使用香燥药，宜清淡饮食。
一种方法，使用黄连三钱（姜汁炒），山楂肉二钱，保和丸二钱，同为细末，糊丸如麻子大，胭脂胚子为衣，人参汤送服竹沥，每次服五十丸。
一方，使用马匏儿烧存性，陈米汤调服。（即野田瓜，北方多有。原书作马剥儿，是误字。）
一说，马匏儿烧存性一钱，好枣肉四枚，平胃散二钱，温酒调服，食物即可下咽，然后随病源调理。
一方，使用韭汁二两，牛乳一盏，生姜半两捣汁，和匀顿服，有效。
有气结者，用开导之剂。有阴火上炎者，按阴虚治疗。有积血者，当斟酌去除，韭汁能消除膈上瘀血。
古方用人参以补肺，御米以解毒，竹沥以清痰，干姜以养血，粟米以实胃，蜜以润燥，姜以去秽。有治寒的，一定是当时确实有实因于寒的情况才使用的，挟寒者间或有之。今人全因痰气，久误于医，传变而成，其中没有寒邪是显而易见的。
（以上丹溪方法共十一条）
栝蒌实（去壳别研） 枳壳（去穣麸炒） 半夏（汤泡七次） 桔梗（炒，各一两）
上为细末，姜汁米糊为丸，如梧桐子大，每服五十丸，生姜汤送下。
宽中进食丸（东垣） 滋养形气，促进食欲。（方见内伤门。）
人参利膈丸（东垣） 治疗膈噎，胸中不利，大便结燥，痰嗽喘满，脾胃壅滞。推陈致新，是治疗膈气的圣药。
木香 槟榔（各七钱五分） 人参 当归 藿香 甘草 枳实（麸炒黄，各一两） 大黄（酒湿蒸熟） 浓朴（姜制，一两）
上为细末，滴水为丸，如梧桐子大，每服五十丸，温水送下。
（丹溪活套）说：凡膈噎反胃，全用二陈汤加姜汁、竹沥、童便、韭汁之类为主治。如胸中觉有热闷，本方加土炒黄连、黄芩、栝蒌仁、桔梗之类。如血虚瘦弱之人，本方合四物汤，少加杏仁泥、红花，童便、韭汁之类仍不可缺。如饮酒人，本方加砂糖、驴屎入内服。如朝食暮吐，暮食朝吐，或食下须臾即吐者，这是胃可容受而脾不能传送也，或大小肠秘结不通，食返而上奔也，本方加酒蒸大黄、桃仁之类以润之。脾不磨者，本方多加麦面、神曲之类以助化之。如气虚肥白人患膈噎者，本方合四君子汤，亦加竹沥、姜汁为要药也。有因七情郁结成气噎者，本方加香附、抚芎、木香、槟榔、栝蒌仁、砂仁之类。凡膈噎，大便燥结，用大黄，乃急则治其标之剂也。仍用四物汤加童便、韭汁，多饮牛羊乳为上策也。但不可以人乳代之，盖人乳内有饮食烹饪之火及七情之火存于中，故不可代服也。
（祖传方）
润肠膏 治疗膈噎，大便燥结，饮食良久复出，及朝食暮吐、暮食朝吐者，其功效甚捷。
新取葳灵仙（四两，捣汁，四、五月开花者） 生姜（四两，捣汁） 真麻油（二两） 白砂蜜（四两，煎沸，掠出上沫）
上四味，同入银石器内搅匀，慢火煎，候如稀粥状，时时以筷子挑食之。一料未愈，再服一料决效。
上为细末，取黄母牛口中涎沫为丸，如龙眼大，入锅中，慢火煮熟食之，加沙糖二、三两入内丸尤佳。
隔年炊饭干（不拘多少）
上一味，以急流顺水煎煮糜烂，取浓汁时时与之。待能食后，以调脾进食、生血顺气之药调治而安。
（医案）
苏溪金贤九里，年五十三，夏秋间得噎证，胃脘痛，食不下，或食下良久复出，大便燥结，人黑瘦殊甚，求予治。
诊其脉，右手关前弦滑而洪，关后略沉小，左三部俱沉弦，尺带芤。我说：这是中气不足，木来侮土，上焦湿热郁结成痰，下焦血少，故大便燥结。阴火上冲吸门，故食不下。用四物汤以生血，用四君子汤以补气，用二陈汤以祛痰，三合成剂，加姜炒黄连、炒枳实、栝蒌仁，少加砂仁。又间服润肠丸，或服丹溪坠痰丸。半年，服前药百余帖，病全安。
梅林骆氏妇，予妻婶也，年四十九，身材略瘦小，勤于女工，得膈噎证半年矣，饮食绝不进，而大便结燥不行者十数日，小腹隐隐然疼痛，求予治。诊之，六脉皆沉伏。我以生桃仁七个令细嚼，杵生韭汁一盏送下。片时许，病者云：胸中略见宽舒。以四物汤六钱，加栝蒌仁一钱，桃仁泥半钱，酒蒸大黄一钱，酒红花一分，煎成正药一盏，取新温羊乳汁一盏，合而服之。半日后，下宿粪若干。明日腹中痛渐止，渐可进稀粥而少安。后以四物汤出入加减，合羊乳汁，服五、六十帖而安。
Discussion
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: "Obstruction of the three Yang meridians is termed Ge (Diaphragm obstruction)." Liu Hejian (Liu Wansu) stated: The three Yang refer to the Small Intestine, Large Intestine, and Bladder. "Jie" (knot/obstruction) refers to heat accumulation. Heat accumulation in the Small Intestine causes dryness of the blood vessels; heat accumulation in the Large Intestine leads to inability to defecate; heat accumulation in the Bladder depletes body fluids. Once the three Yang are obstructed, both urination and defecation become blocked. Since the lower orifices are not unblocked, the Qi mechanism must reverse and ascend, resulting in difficulty swallowing and food refusal, or if swallowed, immediate regurgitation. This is due to Yang fire failing to descend and instead ascending. Hence, the classic also states: "Manifestations of Shaoyang (Lesser Yang) include vomiting, gurgling, overflow, and inability to eat," which clarifies this principle. Furthermore, ancient sages discussed Ge, Ye (choking), and Fanwei (regurgitation), generally attributing them to dryness and withering of the blood. If there is blockage in the throat preventing food from descending, the withering occurs at the Xi Men (Inlet Gate); if pain occurs in the epigastrium upon swallowing, followed by regurgitation after a moment, with pain ceasing upon expulsion, the withering occurs at the Fen Men (Receiving Gate). These are all upper Jiao (Upper Burner) cases of Ge and Ye. If food can be swallowed but regurgitated after a long time, the withering occurs at the You Men (Pyloric Gate), representing middle Jiao Ge and Ye. If morning food is vomited in the evening, and evening food in the morning, the withering occurs at the Lan Men (Barrier Gate), between the Large and Small Intestines, representing lower Jiao Ge and Ye.
Nevertheless, there are cases of mild illness exacerbated by medical error, as Zhu Danxi discussed in detail. He stated: At the onset of Qi disorders, signs are subtle. They may arise from slight dietary indiscretion, external invasion of wind and rain, internal injury from the Seven Emotions, excessive richness in taste reinforcing Yang Qi and accumulating into Diaphragmatic Heat, robust constitution with tight pores and no sweating, or an irritable temperament causing Ministerial Fire to flare upward. This leads to impaired fluid circulation and interference between clear and turbid Qi. Pure Qi disorders may manifest as fullness or pain, loss of appetite, belching with sour regurgitation, or dyspepsia with stifling sensation. Physicians who fail to seek the root cause often diagnose Cold and hastily administer pungent, aromatic, drying, and hot agents. Temporary relief leads them to regard these as miraculous prescriptions. However, continued indulgence in rich foods and repeated emotional invasions allow the old disease to temporarily subside only for turbid fluids to accumulate easily. Within half a month or a month, previous symptoms recur. Such progression transforms Qi stagnation into accumulation, and accumulation into Phlegm, giving rise to Phlegm-Dampness and acid regurgitation. Without encountering skilled physicians and amidst erroneous medication, Phlegm combines with Stasis-Blood to form nests/cysts. This sequence leads to fullness, pain, vomiting, Ge, Ye, and Fanwei. Physicians still attribute it to deficiency-cold accumulation, believing ordinary herbs cannot treat it, and thus prescribe Aconite (Wutou) and Prepared Aconite Root (Fuzi) alongside elixirs, focusing on their consumption. Over time, blood is depleted, and the stomach lining becomes dry and withered. If the withering is upper, near the throat below the pharynx, water and drinks may pass, but solid food enters with difficulty, and even then, intake is small; this is named Ye (Choking). If the withering is lower, near the stomach, food may enter but cannot fully reach the stomach, regurgitating after a long time; this is named Ge (Diaphragm Obstruction), also called Fanwei (Regurgitation), accompanied by dry stool and urine resembling sheep droppings. Although names differ, the pathology originates from one source. It is said: Ye arises from dry blood. Blood belongs to Yin, and Yin governs stillness. When both internal and external conditions are still, organ-fire does not rise, allowing Lung Metal and Kidney Water to nourish each other, Yin-blood generates naturally, and gastrointestinal fluids transmit and transform appropriately, leaving no room for Ye. Physicians must understand this and must not recklessly use drying-hot agents to add fire to fire; otherwise, how is this different from stabbing someone to death? Be extremely cautious!
Pulse Diagnosis
The *Mai Jing* (Classic of Pulse Diagnosis) states: "Cun pulse tight and Chi pulse choppy indicate chest fullness, inability to eat, and vomiting. If vomiting stops, it was caused by improper purgation, leading to inability to eat. If vomiting does not stop, it is Fanwei, hence the Chi pulse is slightly choppy." (Note: "Wu" [mistake] is alternatively read as "She" [suppose].)
If the Cun Kou pulse is tight and hollow, tight indicates Cold, and hollow indicates Deficiency. The combination of Deficiency and Cold results in a Yin-knotted and slow pulse, causing Ye. If the Guan pulse is rapid, vomiting occurs.
A wiry pulse indicates Deficiency; lack of Stomach Qi leads to morning food being vomited in the evening, and evening food in the morning, transforming into Fanwei. Cold resides above, but the physician incorrectly uses purgatives, causing the pulse to become wiry, hence named Deficiency.
The Fu Yang pulse floating and choppy indicates floating as Deficiency and choppy as Spleen injury. Spleen injury impairs digestion, leading to morning food vomited in the evening, and evening food in the morning, with undigested grain remaining, named Fanwei. If the pulse is tight and choppy, the disease is difficult to treat.
A choppy and small pulse indicates insufficient Blood; a large and weak pulse indicates insufficient Qi.
Methods
Zhu Danxi stated: Generally, it belongs to Blood Deficiency, Qi Deficiency, or presence of Phlegm.
Dai Shi stated: In Qi Deficiency, the pulse is necessarily slow and forceless. In Blood Deficiency, the pulse is necessarily rapid and forceless. In Phlegm disorders, the Cun and Guan pulses are necessarily deep, or hidden and large. In cases of Qi stagnation and knotting, the Cun and Guan pulses are deep and choppy.
Zhang Jifeng stated: Ye is likely a disorder of the mind and spirit, curable only through introspection and self-nourishment. This statement deeply hits the mark of the condition.
Stool resembling sheep droppings indicates incurability (due to lack of Blood in the Large Intestine). Advanced age indicates incurability (over fifty years old, it is untreatable).
Dai Shi stated: In combined Qi and Blood Deficiency, excessive saliva appears in the mouth. If saliva flows profusely, death is inevitable and untreatable.
Treatment methods involve using Child’s Urine, Leek Juice, Bamboo Sap, Ginger Juice, and Cattle/Sheep Milk (another version includes Donkey Dung). For Qi Deficiency, add Si Jun Zi Tang (Four Gentlemen Decoction); for Blood Deficiency, add Si Wu Tang (Four Substances Decoction). Pungent-drying herbs must strictly be avoided; diet should be bland.
One method uses Huang Lian (Coptis Rhizome) 3 qian (stir-fried with ginger juice), Shan Zha Rou (Hawthorn Flesh) 2 qian, and Bao He Wan (Preserve Harmony Pill) 2 qian. Pulverize together, make pills with paste similar to hemp seeds, coat with Red Dye Embryo, and take 50 pills with Ginseng Decoction mixed with Bamboo Sap.
Another prescription uses Ma Bao Er (wild melon) calcined until carbonized, taken with aged rice soup. (This refers to wild field melons, common in the North. The original text mistakenly wrote Ma Bo Er.)
Another says: Calcined Ma Bao Er 1 qian, four good dates flesh, Ping Wei San (Peace the Middle Powder) 2 qian, mixed with warm wine. Food can then go down, followed by regulation according to the disease source.
Another prescription uses Wu Zhu Yu (Evodia Fruit), Huang Lian (Coptis Rhizome), Bei Mu (Fritillaria Bulb), Gua Lou Zi (Trichosanthes Seed), and Niu Zhuan Cao (Ophiopogon Tuber), taken as pills.
Another prescription uses 2 liang of Leek Juice, 1 zhan of Cow Milk, and juice from half a liang of fresh Ginger, mixed and taken in one dose. Effective.
For Qi knotting, use opening and guiding agents. For Ministerial Fire flaring upward, treat as Yin Deficiency. For accumulated Blood stasis, remove it judiciously; Leek Juice can eliminate upper diaphragm stasis.
Ancient formulas used Ren Shen (Ginseng Root) to tonify Lung, Yu Mi (Poppy Seed) to detoxify, Zhu Li (Bamboo Sap) to clear Phlegm, Gan Jiang (Dried Ginger) to nourish Blood, Su Mi (Millet) to strengthen Stomach, Honey to moisten dryness, and Ginger to remove foulness. Treatments for Cold were used only when there was a definite excess Cold etiology; cases involving Cold are occasional. Modern cases mostly stem from Phlegm and Qi, prolonged medical errors, and transformation, clearly lacking Cold.
(Above are eleven methods from Danxi.)
Gua Lou Shi Wan (Hospital Formula): Treats Ge and Ye, chest and diaphragm fullness, pain radiating to back and ribs, asthma and suffocation.
Gua Lou Shi (Trichosanthes Fruit, shell removed and ground separately), Zhi Ke (Aurantium Peel, pulp removed and stir-fried with bran), Ban Xia (Pinellia Tuber, soaked in boiling water seven times), Jie Geng (Platycodon Root, stir-fried), each 1 liang.
Pulverize into fine powder, make pills with Ginger Juice and Rice Paste, size of Sophora seeds. Take 50 pills per dose, washed down with Ginger Decoction.
Kuan Zhong Jin Shi Wan (Dong Yuan): Nourishes form and Qi, promotes appetite. (Formula seen in Internal Injury section.)
Ren Shen Li Ge Wan (Dong Yuan): Treats Ge and Ye, chest discomfort, dry constipation, Phlegm cough with asthma/fullness, Spleen-Stomach congestion. Eliminates stale matter and generates new; it is the sacred medicine for treating Diaphragmatic Qi.
Mu Xiang (Costus Root), Bing Lang (Areca Seed), each 7.5 qian; Ren Shen (Ginseng Root), Dang Gui (Angelica Sinensis Root), Huo Xiang (Patchouli Herb), Gan Cao (Licorice Root), Zhi Shi (Immature Bitter Orange, stir-fried with bran until yellow), Da Huang (Rhubarb Root and Rhizome, steamed with wine), Hou Po (Magnolia Bark, processed with ginger), each 1 liang.
Pulverize into fine powder, make pills with drops of water, size of Sophora seeds. Take 50 pills per dose, washed down with warm water.
(Danxi Flexible Methods) states: For all Ge, Ye, and Fanwei, primarily use Er Chen Tang (Two-Cured Decoction) added with Ginger Juice, Bamboo Sap, Child’s Urine, Leek Juice, etc. If heat stifling is felt in the chest, add Tu Chao Huang Lian (Earth-fried Coptis), Huang Qin (Scutellaria Root), Gua Lou Ren (Trichosanthes Seed), Jie Geng (Platycodon Root), etc. For those with Blood Deficiency and emaciation, combine with Si Wu Tang (Four Substances Decoction), add small amounts of Xing Ren Ni (Apricot Seed Paste) and Hong Hua (Carthamus Flower), while Child’s Urine and Leek Juice remain indispensable. For drinkers, add Rock Sugar and Donkey Dung to the base formula. For morning food vomited in the evening, or immediate regurgitation after eating, this indicates the Stomach can receive but the Spleen cannot transport, or Large/Small Intestine constipation causes food to rush upward; add Jiu Zheng Da Huang (Wine-processed Rhubarb) and Tao Ren (Peach Seed) to moisten. For Spleen failure to digest, add more Mai Mian (Wheat Flour) and Shen Qu (Medicated Leaven) to aid digestion. For Qi-deficient, obese individuals with Ge, combine with Si Jun Zi Tang (Four Gentlemen Decoction), adding Bamboo Sap and Ginger Juice as essential drugs. For Qi-Ye caused by Seven Emotions depression, add Xiang Fu (Cyperus Rhizome), Fu Xiong (Ligusticum Rhizome), Mu Xiang (Costus Root), Bing Lang (Areca Seed), Gua Lou Ren (Trichosanthes Seed), Sha Ren (Amomum Fruit), etc. For all Ge with dry constipation, Da Huang (Rhubarb) is used as an urgent measure to treat the branch. Still, use Si Wu Tang (Four Substances Decoction) with Child’s Urine and Leek Juice; drinking abundant Cattle/Sheep Milk is the best strategy. Human Milk must not be substituted, as it contains fire from cooking and emotions within, making it unsuitable for substitution.
(Ancestral Prescriptions)
Run Chang Gao (Intestine-Moistening Ointment): Treats Ge and Ye, dry constipation, delayed regurgitation, and morning/evening vomiting. Its effect is very swift.
Fresh Ling Xiao Xian (Salvia Miltiorrhiza, 4 liang, juiced, flowering in April-May), Fresh Sheng Jiang (Ginger, 4 liang, juiced), True Ma You (Sesame Oil, 2 liang), Bai Sha Mi (White Sand Honey, 4 liang, boiled and skimmed).
Mix the four ingredients evenly in a silver or ceramic vessel, simmer slowly until thick like porridge. Taste frequently with chopsticks. If one course is ineffective, take another course for certain efficacy.
Da Li Duo Ming Wan (Great Strength Life-Seizing Pill): Treats Ge and Ye with inability to eat and Fanwei.
Chu Tou Kang (Rice Husk), Niu Zhuan Cao (Ophiopogon Tuber), each half jin; Nuomi (Glutinous Rice, 1 jin).
Pulverize into fine powder. Use saliva from a yellow cow to make pills the size of longan fruits. Cook slowly in a pot until done and eat. Adding 2-3 liang of rock sugar to the pills is especially good.
Another Prescription: Treats long-standing Ge/Ye unable to accept grain.
Ge Nian Chui Fan Gan (Dried Leftover Rice from Previous Year, any amount).
Boil this single ingredient in fast-flowing water until mushy, take the thick juice, and give frequently. After ability to eat returns, regulate with Spleen-tonifying, appetite-promoting, Blood-generating, and Qi-smoothing herbs to achieve recovery.
(Medical Case)
Jin Xianjiuli from Suxi, aged 53, contracted Ye syndrome in summer-autumn, with epigastric pain, inability to eat, or delayed regurgitation after eating, dry constipation, severe dark emaciation, sought my treatment.
Palpating his pulse: Right Guan anterior was wiry, slippery, and surging; posterior slightly deep and small. Left three positions were all deep and wiry, Chi position hollow. I said: This is Middle Qi insufficiency, Wood insulting Earth, Upper Jiao damp-heat condensing into Phlegm, Lower Jiao Blood deficiency causing dry constipation. Ministerial Fire rushing up to the Xi Men causes inability to eat. Use Si Wu Tang (Four Substances Decoction) to generate Blood, Si Jun Zi Tang (Four Gentlemen Decoction) to tonify Qi, Er Chen Tang (Two-Cured Decoction) to dispel Phlegm. Combine these three into one formula, add Ginger-stir-fried Huang Lian (Coptis), Stir-fried Zhi Shi (Immature Bitter Orange), Gua Lou Ren (Trichosanthes Seed), and a little Sha Ren (Amomum Fruit). Also intermittently take Run Chang Wan (Intestine-Moistening Pill) or Danxi’s Zhui Tan Wan (Phlegm-Descending Pill). Over half a year, taking over a hundred doses of the aforementioned medicines, the disease completely resolved.
Mrs. Luo from Meilin, my wife’s aunt, aged 49, slightly short and thin, diligent in needlework, suffered from Ge-Ye for half a year. She refused all food and drink, had dry constipation for ten-plus days, and dull lower abdominal pain. Sought my treatment. Palpation revealed all six pulses were deep and hidden. I had her chew seven raw Tao Ren (Peach Seeds) finely, washed down with one zhan of freshly crushed Leek Juice. After a short while, she reported slight relief in the chest. I prescribed Si Wu Tang (Four Substances Decoction) 6 qian, plus Gua Lou Ren (Trichosanthes Seed) 1 qian, Tao Ren Ni (Peach Seed Paste) 0.5 qian, Jiu Zheng Da Huang (Wine-processed Rhubarb) 1 qian, Jiu Hong Hua (Wine Carthamus) 0.1 fen. Decoct to obtain one zhan of proper medicine. Mix with one zhan of fresh warm Sheep Milk and take together. Half a day later, passage of stored feces occurred. Next day, abdominal pain gradually ceased, and she could gradually consume thin congee with some relief. Later, adjusting Si Wu Tang (Four Substances Decoction) and combining with Sheep Milk, taking 50-60 doses resulted in recovery.