食不能下者，胃脘膈也。（全文见水肿。）一阳发病，少气，善咳善泄，其传为膈。（全文见诊病传变。王注云∶三焦
内结中热，故膈塞不便。）
〔《素》〕三阳结谓之膈。（王注云∶小肠结则血脉燥，膀胱热则津液竭，故膈塞不便。）
运气 膈食皆属湿。经云∶太阴所至，为积饮痞膈是也。
〔世〕治翻胃痛而吐，诸气不入者。黄牛鼻绳各姓者七个，长七寸，烧存性，为末，作三服，用好酒调下，饭汤调
亦得。
鲫鱼散
大鲫鱼一个，去肠留胆，纳绿矾末填满缝口，以炭火炙黄为末。每服一钱，陈米饮调下，日三服。
〔《山》〕翻胃。细炒棠梨叶，去刺为末，酒下。又方，松木节为末，酒下。
〔《灵》〕黄帝曰∶气为上膈者，食饮入而还出，余已知之矣。虫为下膈，下膈者，食 时乃出，（ 时，周
时也。）余未得其意，愿卒闻之？岐伯曰∶喜怒不适，食饮不节，寒温不时，则寒汁流于肠中。流于肠中则虫寒，
虫寒则积聚，守于下管，则肠胃充郭，卫气不营，邪气居之。（肠胃充郭则卫气不营，故邪气得以居之也。）
人食则虫上食，虫上食则下管虚，下管虚则邪气胜之，积聚以留，（邪气原因卫虚而居下脘，今虫上而下管虚，则邪气乘
虚胜之，
而积聚以留也。）留则痈成，痈成则下管约。（下管约，故食入则痛，至 时乃复出也。）其痈在管内者，即内
而痛深。其痈在脘外者，则痈外而痛浮，痈上皮热。黄帝曰∶刺之奈何？岐伯曰∶微按其痈，观气所行，先浅刺其傍，
稍内益深，
还而刺之，毋过三行，察其沉浮，以为深浅。已刺必熨，令热入中，日使热内，邪气益衰，（详此剌痈非所刺也。但剌后
熨之，
使热气入于积所，则邪免衰去，卫气复盛也。）大痈乃溃。伍以参禁，以除其内，恬 无为，乃能行气，后以咸苦，化谷
乃下矣。
灸刺 膈食有四∶
其一取胃。经云∶虫为下膈，按其痈刺之者，是其一法也。
其二取太阴。经云∶太阴根于隐白，结于太仓。太阴为开，开折则仓廪无所输，膈洞。膈洞者，取之太阴，
视有余不足。故开折者，气不足而生病者是也。盖膈洞者，经谓之食不化，下嗌还出也。
其三取胃。经云∶胃病若膈咽不通，饮食不下，取之三里是也。又云∶饮食不下，膈塞不通，邪在胃脘。
在上脘，则刺抑而下之；在下脘，则散而去之是也。
其四取手少阴。经云∶手少阴之别，名曰通里。去脘一寸半，其病实则支膈，取之掌后一寸，别走太阳者
是也。
〔《撮》〕翻胃∶劳宫（一分）。中脘（灸，泻之）。心 （一分，沿皮向外一寸半，补之。）
〔《玉》〕翻胃吐食∶中魁（中指第三节，灸泻之。）中脘（寸半）。腕骨（一分泻之，灸）。
〔东〕吐食不化∶上脘 中脘 下脘。
〔《甲》〕食饮不化，入腹还出，下脘主之。又法∶三里 阴陵泉 不应，取下穴∶中脘 天枢 又法∶中脘 脾
中魁 三里 又法∶腋聚毛下宛宛中（五十壮。）石关（五十壮。）
〔《东》〕今日食，明日吐。心 （沿皮，寸半）。膈 （沿皮，寸半）。胸堂（七壮。即膻中）。巨阙 胃
脘（寸半。各灸五十壮。）又翻胃∶商丘 通谷 巨阙 然谷 隐白 阳陵泉 内庭 膈关
〔《甲》〕背痛恶寒，脊强俯仰难，食不下，呕吐多痰，鬲关主之。
〔丹〕切不可用香燥之药，服之必死，宜薄滋味。
〔《脉》〕寸口脉微而数，微则无气，无气则荣虚，荣虚则血不足，血不足则胸中冷。跗阳脉浮而涩，浮
则为虚，涩则伤脾，脾伤则不磨，朝食暮吐，暮食朝吐，完谷不化，名曰胃反。脉紧而涩，其病难治。脉弦者
虚也，胃气无余，朝食暮吐，变为胃反。寒在于上，医反下之，令脉反弦，故名曰虚。
脾脉微急为膈中，食饮入而还出涎沫。（全文见虚实法。）
〔《素》〕胃脉 而散者，当病食痹。（脉要精微论 至真要论云∶食痹而吐。）
肾脉微缓为洞，洞者食不化，下嗌还出。（全文见治虚实法。）
进食困难无法下咽的，属于胃脘膈证。（全文参见水肿篇。）一阳经发病，表现为气短，容易咳嗽和腹泻，其传变可发展为膈证。（全文参见诊病传变篇。王冰注解说：三焦内部结聚中焦之热，所以导致膈塞不通、大便不利。）
《素问》记载：三阳经邪气结聚称为膈证。（王冰注解说：小肠结滞则血脉干枯，膀胱有热则津液枯竭，因此导致膈塞不通、大便不利。）
运气学说认为，膈食（噎膈与反胃）都属于湿邪致病。经文说：太阴湿土之气所至，会出现积饮、痞满和膈塞，说的就是这个道理。
世俗医方治疗翻胃（反胃）、胃痛且呕吐，各种药物都无法进入体内的情况。取黄牛鼻绳各七个（需注明来源或特定部位，原文“各姓者”疑为衍文或特定指代，此处直译），长七寸，烧存性（烧至保留药性），研成细末，分三次服用，用优质黄酒调服，用米汤调服也可以。
鲫鱼散方：
大鲫鱼一条，去内脏但保留鱼胆，将绿矾末填满缝好口，用炭火烤黄后研成细末。每次服用一钱，用陈年米饮调服，每日三次。
《山居方》治疗翻胃：细炒棠梨叶，去掉刺后研成细末，用酒送服。另一方法，用松木节研成细末，用酒送服。
《灵枢》黄帝问道：气逆导致上膈证，饮食入胃后立即吐出，我已经知道了。虫积导致下膈证，下膈证的特点是食物停留一段时间后才会吐出，（“时”指周时，即一段时间），我不明白其中的机理，希望能听您详细讲解？岐伯回答说：喜怒情绪失调，饮食不节制，寒温不适，会导致寒汁流注于肠中。流注于肠中则使寄生虫受寒，寄生虫受寒则积聚停滞，守在下管（下脘），导致肠胃胀满，卫气不能正常运行，邪气占据其间。（肠胃胀满则卫气不能运行，所以邪气得以占据。）人进食时寄生虫向上觅食，寄生虫向上则下管空虚，下管空虚则邪气乘虚而入，积聚停滞留存，（邪气原本因卫气虚弱而居于下脘，现在虫向上食而下管空虚，则邪气乘虚胜之，从而积聚留存。）停留久了则形成痈脓，痈脓形成则下管约束狭窄。（下管约束狭窄，所以食物入胃则疼痛，过了一段时间才吐出。）如果痈在管内，则向内疼痛深重；如果痈在脘外，则向外疼痛浅浮，皮肤表面发热。黄帝问：如何针刺治疗？岐伯说：轻轻按压痈处，观察气血运行的方向，先在旁边浅刺，逐渐加深，来回针刺，不超过三次，根据痈的深浅决定进针深度。针刺后必须配合熨法，使热气深入体内，每天让热气内入，邪气日益衰退，（详细看此刺痈并非直接刺痈本身，而是刺后熨之，使热气进入积聚之处，则邪气衰减去除，卫气恢复旺盛。）大痈最终溃破。配合五行相克禁忌，以清除体内邪气，保持心境恬淡无为，才能使气机运行，随后用咸味和苦味的药物，化解谷食使其下行。
针灸治疗膈食有四种方法：
其一取胃经。经文说：虫积导致下膈，通过按压痈处进行针刺，这是其中一种方法。
其二取足太阴脾经。经文说：足太阴脾经起于隐白穴，结于太仓（中脘）。太阴主开，开阖失常则仓廪（脾胃）无法正常输布，出现膈洞（胸膈洞泄）。膈洞证，应取足太阴经，视其有余或不足而定补泻。所谓开阖失常，是气不足而生病的情况。大概膈洞证，经文中称为食不化，食物咽下后又吐出。
其三取足阳明胃经。经文说：胃病若出现膈咽不通，饮食不下，应取足三里穴。又说：饮食不下，膈塞不通，邪气在胃脘。如果在上脘，则针刺以抑制并引导下行；如果在下脘，则疏散并祛除邪气。
其四取手少阴心经。经文说：手少阴心经的络穴名叫通里，距离腕横纹一寸半，其病症实证表现为支撑膈部不适，应取掌后一寸处的穴位，别走太阳经的是该络穴。
《撮要》治疗翻胃：劳宫穴（刺一分）。中脘穴（灸，泻法）。心俞穴（刺一分，沿皮向外斜刺一寸半，补法）。
《玉机》治疗翻胃吐食：中魁穴（中指第三节，灸，泻法）。中脘穴（一寸半深）。腕骨穴（刺一分泻法，也可灸）。
《甲乙经》治疗食饮不化，入腹后又吐出，由下脘穴主治。又一种方法：取足三里、阴陵泉，若无反应，取下穴：中脘、天枢。又一种方法：中脘、脾俞、中魁、足三里。又一种方法：腋毛下宛宛中处（灸五十壮）。石关穴（灸五十壮）。
东垣治疗今日吃明日吐：心俞穴（沿皮刺，一寸半）。膈关穴（沿皮刺，一寸半）。胸堂穴（即膻中，灸七壮）。巨阙穴、胃脘俞穴（一寸半深。各灸五十壮）。又治翻胃：商丘、通谷、巨阙、然谷、隐白、阳陵泉、内庭、膈关。
《甲乙经》治疗背痛恶寒，脊背僵硬俯仰困难，饮食不下，呕吐多痰，由膈关穴主治。
丹溪指出：切不可使用香燥的药物，服用必死，宜清淡饮食。
《脉诀》论述：寸口脉微而数，微则无气，无气则营血虚弱，营血虚弱则血不足，血不足则胸中寒冷。跗阳脉浮而涩，浮则为虚，涩则伤脾，脾受伤则不能磨化水谷，朝食暮吐，暮食朝吐，完谷不化，名为胃反。脉紧而涩，病情难治。脉弦者为虚证，胃气无余，朝食暮吐，变为胃反。寒邪在上，医生反而用攻下法，导致脉反弦，故名为虚。
脾脉微急为膈中证，饮食入胃后又吐出涎沫。（全文参见虚实法篇。）
Those who cannot swallow food belong to the category of Weiwan Ge (Stomach Epigastrium Diaphragm Syndrome). (For the full text, see the Edema chapter.) When a Yang channel is affected, it manifests as shortness of breath, frequent coughing, and diarrhea; its transmission can develop into Ge syndrome (Diaphragm Syndrome/Obstruction). (For the full text, see Diagnosis of Disease Transmission. Wang Bing's commentary states: Heat accumulates internally in the Sanjiao [Triple Burner], causing obstruction and difficulty in bowel movements.)
The *Suwen* records: Accumulation in the three Yang channels is called Ge syndrome. (Wang Bing's commentary states: Stagnation in the Small Intestine leads to dry blood vessels; heat in the Bladder leads to exhaustion of body fluids, thus causing obstruction and difficulty in bowel movements.)
According to the theory of Six Qi (Yunqi), both Ge Shi (Dysphagia and Regurgitation) are attributed to Dampness. The classic states: "When Taiyin [Spleen] arrives, it causes accumulation of fluids, distension, and diaphragmatic obstruction."
Secular prescriptions for Fanwei (Regurgitation), stomach pain, vomiting, and inability to retain any substances: Take seven pieces of ox nose rope (specific origin noted as 'ge xing zhe', likely a textual variant or specific requirement), each seven cun long. Calcine them until they retain their medicinal properties (burn to charcoal but keep efficacy), grind into powder, divide into three doses, and take with fine yellow wine. Taking with rice soup is also acceptable.
**Crucian Carp Powder Formula:**
Take one large crucian carp, remove internal organs but keep the gallbladder, fill the cavity with Alum powder, sew the mouth shut, and roast over charcoal fire until yellow. Grind into powder. Take one qian per dose, mixed with aged rice water, three times daily.
From *Shanju Fang* for Fanwei: Stir-fry pear leaf (*Bretschneidera sinensis*) finely, remove thorns, grind into powder, and take with wine. Another method: Grind pine wood nodes into powder and take with wine.
In the *Lingshu*, the Yellow Emperor asked: "Qi rebellion causing Upper Ge syndrome results in food and drink being vomited immediately after ingestion; I understand this. Parasites causing Lower Ge syndrome result in food being vomited only after a period of time ('shi' refers to a cycle/time). I do not understand the mechanism and wish to hear it fully." Qibo replied: "Improper emotional responses, irregular diet, and exposure to cold or heat cause cold juices to flow into the intestines. Flowing into the intestines chills the parasites; chilled parasites accumulate and stay in the Lower Guan (Lower Epigastrium/Xiawan), causing fullness in the intestines and stomach. This prevents the Defensive Qi (Wei Qi) from circulating, allowing pathogenic factors to reside there. (Fullness in the intestines and stomach prevents Wei Qi circulation, so pathogens occupy the space.) When a person eats, parasites move upward to feed. Upward movement of parasites empties the Lower Guan. Emptiness in the Lower Guan allows pathogens to prevail, leading to stagnation and accumulation. (Pathogens originally resided in the Lower Epigastrium due to deficient Wei Qi; now that parasites move up and the Lower Guan becomes empty, pathogens take advantage of the deficiency to accumulate.) Prolonged stagnation forms an abscess. Once the abscess forms, the Lower Guan becomes constricted. (Constriction of the Lower Guan causes pain upon eating, and food is vomited out after a period of time.) If the abscess is inside the lumen, the pain is deep internally. If the abscess is outside the epigastrium, the pain is superficial externally, and the skin overlying it feels hot. The Yellow Emperor asked: 'How should acupuncture be performed?' Qibo said: 'Gently press the abscess to observe the direction of Qi flow. First, prick shallowly around it, then gradually deepen. Prick repeatedly, no more than three times. Observe the depth of the lesion to determine needle insertion depth. After needling, apply moxibustion/warming therapy to drive heat inward. Daily application of heat inward will cause pathogenic factors to decline. (Note: Needling the abscess here does not mean pricking the abscess directly. Rather, needling followed by warming drives heat into the area of accumulation, causing pathogens to decline and Wei Qi to recover.) The large abscess will eventually suppurate. Combine with Five Elements prohibitions to eliminate internal pathogens. Maintain tranquility and non-action to allow Qi to circulate. Subsequently, use salty and bitter herbs to transform grain and facilitate downward movement.'"
There are four acupuncture approaches for treating Ge Shi:
1. **Target the Stomach Channel:** The classic states: "Parasites cause Lower Ge; pressing the abscess and needling is one method."
2. **Target the Taiyin Channel:** The classic states: "The Taiyin channel originates at Yinbai and terminates at Taicang (Zhongwan). Taiyin governs opening; if opening fails, the granary [Spleen/Stomach] cannot transport, leading to Ge Dong (Diaphragmic Hole/Leakage). For Ge Dong, treat the Taiyin channel, assessing excess or deficiency. Failure of opening indicates disease caused by Qi deficiency. Ge Dong is described in classics as food not digesting and regurgitating after swallowing."
3. **Target the Stomach Channel (again):** The classic states: "If Stomach disease presents with obstruction in the throat and epigastrium and inability to eat, treat Zusanli (ST36)." It also states: "Inability to eat and diaphragmatic obstruction indicate pathogens in the Stomach Epigastrium. If in the Upper Epigastrium, needle to suppress and guide downward; if in the Lower Epigastrium, disperse and eliminate pathogens."
4. **Target the Shaoyin Channel of Hand:** The classic states: "The Luo-connecting vessel of the Hand Shaoyin Heart channel is named Tongli, located 1.5 cun above the wrist crease. In excess conditions, it causes support/stiffness in the diaphragm. Treat the point 1 cun behind the palm, which connects to the Taiyang channel."
From *Cuoyao*: For Fanwei: Laogong (PC8) - puncture 1 fen. Zhongwan (CV12) - moxa, reducing method. Xinshu (BL15) - puncture 1 fen, oblique outward 1.5 cun, tonifying method.
From *Yuji*: For Fanwei vomiting: Zhongkui (acupoint on middle finger) - moxa, reducing method. Zhongwan (CV12) - 1.5 cun. Wangu (SI4) - puncture 1 fen reducing, or moxa.
Dongyuan for vomiting undigested food: Shangwan (CV13), Zhongwan (CV12), Xiawan (CV10).
From *Jia Yi Jing*: For undigested food/drink vomiting after entering the abdomen, Xiawan (CV10) is the primary point. Alternative methods: Zusanli (ST36), Yinlingquan (SP9). If no response, use lower points: Zhongwan (CV12), Tianshu (ST25). Another method: Zhongwan (CV12), Pizhong (EX-BA3), Zhongkui, Zusanli (ST36). Another method: Area under axillary hair (Moxa 50 Zhu). Shiguan (KI18) (Moxa 50 Zhu).
Dongyuan for "eating today, vomiting tomorrow": Xinshu (BL15) - oblique 1.5 cun. Gegan (BL18) - oblique 1.5 cun. Xiongzhong (CV17, i.e., Danzhong) - Moxa 7 Zhu. Jueque (CV14), Weiwanyu (BL21) - 1.5 cun deep. Moxa 50 Zhu each. Another Fanwei prescription: Shangqiu (SP5), Tonggu (BL65), Jueque (CV14), RanGu (KI2), Yinbai (SP1), Yanglingquan (GB34), Neiting (ST44), Gegan (BL18).
From *Jia Yi Jing*: For back pain, aversion to cold, stiff spine difficult to bend or extend, inability to eat, vomiting profuse phlegm, Gegan (BL18) is the primary point.
Danxi warns: Absolutely do not use aromatic-drying drugs; doing so will lead to death. Diet should be bland and mild.
From *Mai Jue*: Cun Kou pulse is faint and rapid. Faint indicates lack of Qi; lack of Qi leads to Ying-Blood deficiency; Ying-Blood deficiency leads to insufficient Blood; insufficient Blood causes cold in the chest. Fu Yang pulse is floating and choppy. Floating indicates deficiency; choppy indicates Spleen injury. Spleen injury impairs grinding/digestion. Morning food vomited in evening, evening food vomited in morning, undigested grains expelled, named Weifan (Stomantic Reflux). Tight and choppy pulse indicates difficult-to-treat disease. Wiry pulse indicates deficiency; surplus-free Stomach Qi; morning food vomited in evening, transforming into Weifan. Cold in the upper jiao treated incorrectly with purgatives leads to wiry pulse, hence named deficiency.
Spleen pulse slightly urgent indicates Ge Zhong (Diaphragmatic Middle); food/drink enters and regurgitates with saliva/froth. (For full text, see Deficiency-Excess Methods.)
From *Suwen*: Stomach channel pulse that is hurried and scattered indicates Shi Bi (Food Obstruction). (*Mai Yao Jing Wei Lun* and *Zhi Yao Da Zheng Lun* state: Shi Bi with vomiting.)
Kidney pulse slightly slow indicates Dong syndrome. Dong syndrome manifests as undigested food regurgitating after swallowing. (For full text, see Treating Deficiency-Excess Methods.)