天津陈××，年五十六岁，得反胃吐食证，半年不愈。
病因 初因夏日多食瓜果致伤脾胃，廉于饮食，后又因处境不顺心多抑郁，致成反胃之证。
证候 食后消化力甚弱，停滞胃中不下行，渐觉恶心，久之，则觉有气自下上冲，即将饮食
吐出。屡经医诊视，服暖胃降气之药稍愈，仍然反复，迁延已年余矣。身体羸弱，脉弦长，
按之不实，左右皆然。
诊断 此证之饮食不能消化，固由于脾胃虚寒，然脾胃虚寒者，食后恒易作泄泻，此则食不
下行而作呕吐者，因其有冲气上冲，并迫其胃气上逆也。当以温补脾胃之药为主，而以降胃
镇冲之药辅之。
处方 生怀山药（一两） 白术（三钱炒） 干姜（三钱） 生鸡内金（三钱黄色的捣）
生赭石（六钱轧细） 炙甘草（二钱）
共煎汤一大盅，温服。
效果 将药煎服后，觉饮食下行不复呕吐，翌日头午，大便下两次，再诊其脉不若从前之
弦长，知其下元气化不固，不任赭石之镇降也。遂去赭石加赤石脂五钱（用头煎和次煎之汤，分两次送服
）、苏子二钱，日煎服一剂，连服十剂霍然全愈。盖赤石脂为末送服，
可代赭石以降胃镇冲，而又有固涩下焦之力，故服后不复滑泻也。
天津徐氏妇，年近三旬，得胃脘疼闷证。
病因 本南方人，久居北方，远怀乡里，归宁不得，常起忧思，
因得斯证。
证候 中焦气化凝郁，饮食停滞艰于下行，时欲呃逆，又苦不能上达，甚则蓄极绵绵作疼。
其初病时，惟觉气分不舒，服药治疗三年，病益加剧，且身形亦渐羸弱，呼吸短气，口无津液，时
常作渴，大便时常干燥，其脉左右皆弦细，右脉又兼有牢意。
诊断 《内经》谓脾主思，此证乃过思伤脾以致脾不升胃不降也。为其脾气不上升，是以口无
津液，呃逆不能上达；为其胃气不降，是以饮食停滞，大便干燥。治之者当调养其脾胃，俾
还其脾升胃降之常，则中焦气化舒畅，疼胀自愈，饮食加多而诸病自除矣。
处方 生怀山药（一两） 大甘枸杞（八钱） 生箭 （三钱）
生鸡内金（三钱黄色的捣） 生麦芽（三钱） 玄参（三钱） 天花粉（三钱）
天冬（三钱） 生杭芍（二钱） 桂枝尖（钱半） 生姜（三钱）
大枣（三枚掰开）
共煎汤一大盅，温服。
方解 此方以山药、枸杞、黄 、姜、枣培养中焦气化，以麦芽升脾（麦芽生用善升），以鸡
内金降胃（鸡内金生用善降），以桂枝升脾兼以降胃（气之当升者遇之则升，气之当降者遇之则降），又
用玄参，花粉诸药，以调剂姜、桂、黄 之温热，则药性归于和平，可以久服无弊。
复诊 将药连服五剂，诸病皆大轻减，而胃疼仍未脱然，右脉仍有牢意。度其疼处当有
瘀血凝滞，拟再于升降气化药中加消瘀血之品。
处方 生怀山药（一两） 大甘枸杞（八钱） 生箭 （三钱） 玄参（三钱）
天花粉（三钱） 生麦芽（三钱） 生鸡内金（二钱黄色的捣）
生杭芍（二钱） 桃仁（二钱去皮炒捣） 广三七（二钱轧细）
药共十味，将前九味煎汤一大盅，送服三七末一半，至煎渣再服时，仍送服其余一半。
效果 将药连服四剂，胃中安然不疼，诸病皆愈，身形渐强壮。脉象已如常人，将原方再服数剂以善其后。
天津的陈先生，五十六岁，患有反胃吐食证，半年未愈。
病因：起初因为夏天多吃瓜果导致脾胃受伤，饮食减少，后来又因处境不顺心而多抑郁，最终形成反胃之证。
证候：进食后消化力很弱，食物停滞在胃中不能下行，逐渐感到恶心，时间久了，就觉得有气从下往上冲，随即把饮食吐出。多次经过医生诊治，服用暖胃降气的药物后稍有好转，但仍然反复发作，拖延了一年多。身体消瘦虚弱，脉象弦长，按下去不实，左右手脉象都一样。
诊断：此证饮食不能消化，固然由于脾胃虚寒，但是脾胃虚寒的人，饭后常常容易腹泻，这里却是食物不下行而作呕吐，是因为有冲气上冲，并且迫使胃气上逆。应当以温补脾胃的药物为主，而以降胃镇冲的药物为辅。
处方：生怀山药（一两）、白术（三钱，炒）、干姜（三钱）、生鸡内金（三钱，黄色的，捣碎）、生赭石（六钱，轧细）、炙甘草（二钱）。
共煎汤一大盅，温服。
效果：将药煎服后，感觉饮食下行不再呕吐，第二天上午，大便排了两次，再诊脉，不像从前那样弦长，知道是下元气化不固，承受不住赭石的镇降作用。于是去掉赭石，加入赤石脂五钱（用头煎和次煎的药汤，分两次送服）、苏子二钱，每天煎服一剂，连续服用十剂，霍然全愈。大概赤石脂研末送服，可以代替赭石以降胃镇冲，而且又有固涩下焦的作用，所以服药后不再滑泻。
天津徐氏妇人，年纪近三十岁，患有胃脘疼闷证。
病因：本是南方人，久居北方，远离家乡，回娘家不得，常起忧思，因此得了这个病。
证候：中焦气化凝滞郁结，饮食停滞难以下行，时常想要呃逆，又痛苦于不能上达，严重时积蓄至极，绵绵作痛。刚发病时，只觉得气分不舒，服药治疗三年，病情日益加剧，而且身形也逐渐消瘦虚弱，呼吸短气，口中没有津液，时常口渴，大便时常干燥，其脉象左右皆弦细，右脉又兼有牢脉之意。
诊断：《内经》说脾主思，此证乃是过思伤脾，导致脾不升、胃不降。因为脾气不上升，所以口中没有津液，呃逆不能上达；因为胃气不降，所以饮食停滞，大便干燥。治疗者应当调养其脾胃，使其恢复脾升胃降的常态，那么中焦气化舒畅，疼痛胀满自然痊愈，饮食增多而诸病自除。
处方：生怀山药（一两）、大甘枸杞（八钱）、生黄芪（三钱）、生鸡内金（三钱，黄色的，捣碎）、生麦芽（三钱）、玄参（三钱）、天花粉（三钱）、天冬（三钱）、生杭芍（二钱）、桂枝尖（钱半）、生姜（三钱）、大枣（三枚，掰开）。
共煎汤一大盅，温服。
方解：此方以山药、枸杞、黄芪、姜、枣培养中焦气化，以麦芽升脾（麦芽生用善于升提），以鸡内金降胃（鸡内金生用善于降逆），以桂枝升脾兼以降胃（当升的气遇到它则升，当降的气遇到它则降），又用玄参、花粉等药，来调剂姜、桂、黄芪的温热之性，使药性归于平和，可以久服无弊。
复诊：将药连续服用五剂，诸病都大大减轻，但胃疼仍未完全消除，右脉仍有牢脉之意。推测疼痛处可能有瘀血凝滞，打算再在升降气化的药物中加入消瘀血的物品。
处方：生怀山药（一两）、大甘枸杞（八钱）、生黄芪（三钱）、玄参（三钱）、天花粉（三钱）、生麦芽（三钱）、生鸡内金（二钱，黄色的，捣碎）、生杭芍（二钱）、桃仁（二钱，去皮炒捣）、广三七（二钱，轧细）。
药共十味，将前九味煎汤一大盅，送服一半三七末，等到煎渣再服时，仍送服剩下的一半。
效果：将药连续服用四剂，胃中安然不疼，诸病皆愈，身形逐渐强壮。脉象已如常人，将原方再服数剂以善其后。
Mr. Chen from Tianjin, aged fifty-six, suffered from Fanwei (regurgitation and vomiting) for half a year without recovery.
Etiology: Initially, excessive consumption of melons and fruits in summer injured the Spleen and Stomach, leading to reduced appetite. Subsequently, due to unfavorable circumstances and frequent depression, he developed Fanwei (regurgitation and vomiting).
Symptoms: Digestive power after eating was very weak; food stagnated in the Stomach and failed to descend. Gradually, nausea was felt. Over time, a sensation of Qi rushing upward from below arose, causing the immediate vomiting of food and drink. After multiple medical consultations and taking medicines to warm the Stomach and direct Qi downward, there was slight improvement, but the condition remained recurrent, dragging on for over a year. The body was emaciated and weak. The pulse was wiry and long, empty upon pressure, identical on both sides.
Diagnosis: The inability to digest food in this case is indeed due to Deficiency-Cold of the Spleen and Stomach. However, patients with Deficiency-Cold of the Spleen and Stomach often experience diarrhea after meals. Here, food fails to descend and causes vomiting because of Chong Qi (Penetrating Vessel Qi) rushing upward, forcing Stomach Qi to rebel upward. Treatment should primarily use medicines to warm and tonify the Spleen and Stomach, assisted by medicines to direct Stomach Qi downward and calm the Chong Qi.
Prescription: Raw Huai Shan Yao (Dioscoreae Hypoglaucae Rhizoma, 1 liang), Bai Zhu (Atractylodis Macrocephalae Rhizoma, 3 qian, stir-fried), Gan Jiang (Zingiberis Rhizoma, 3 qian), Raw Ji Nei Jin (Galli Gigerii Endothelium Corneum, 3 qian, yellow variety, crushed), Raw Zhe Shi (Haematitum, 6 qian, finely ground), Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma Preparata, 2 qian).
Decoct together in a large cup of water, take warm.
Effect: After decocting and taking the medicine, the patient felt that food descended normally and vomiting ceased. On the morning of the next day, he had two bowel movements. Upon re-examining the pulse, it was no longer wiry and long as before, indicating that the Qi transformation of the Lower Jiao was unstable and could not withstand the heavy descending action of Zhe Shi (Haematitum). Therefore, Zhe Shi (Haematitum) was removed, and Chi Shi Zhi (Kaolinitum, 5 qian) and Su Zi (Perillae Fructus, 2 qian) were added. Chi Shi Zhi (Kaolinitum) was taken as powder with the decoction of the first and second brews, divided into two doses. One dose was decocted daily, taken continuously for ten doses, resulting in complete recovery. Chi Shi Zhi (Kaolinitum) powder, when taken orally, can substitute for Zhe Shi (Haematitum) to direct Stomach Qi downward and calm Chong Qi (Penetrating Vessel Qi), while also possessing the power to consolidate and astringe the Lower Jiao. Hence, slippery diarrhea did not recur after administration.
Mrs. Xu from Tianjin, nearly thirty years old, suffered from Weiwann Tengmen (pain and fullness in the epigastrium).
Etiology: Originally from the South, she had lived in the North for a long time, far from her hometown, unable to return home to visit her parents. Frequent worry and thought led to this condition.
Symptoms: Qi transformation in the Middle Jiao was stagnant and constrained. Food stagnation made descent difficult. There was frequent desire for hiccup, yet suffering from the inability to reach upwards. In severe cases, accumulation reached its limit, causing continuous dull pain. At the onset of the disease, she only felt discomfort in the Qi aspect. After three years of medicinal treatment, the condition worsened, and her physique gradually became emaciated and weak. She experienced shortness of breath, lack of saliva in the mouth, frequent thirst, and constipation. The pulse was wiry and fine on both sides, with the right pulse additionally exhibiting characteristics of a Firm pulse (Lao Mai).
Diagnosis: The *Nei Jing* states that the Spleen governs thought. This case results from excessive thought injuring the Spleen, leading to failure of Spleen Qi to ascend and Stomach Qi to descend. Because Spleen Qi fails to ascend, there is a lack of saliva and hiccups cannot reach upwards; because Stomach Qi fails to descend, food stagnates and stool becomes dry. Treatment should regulate and nourish the Spleen and Stomach, restoring their normal functions of ascending and descending respectively. Then, Qi transformation in the Middle Jiao will become smooth, pain and distension will heal spontaneously, food intake will increase, and all diseases will be eliminated.
Prescription: Raw Huai Shan Yao (Dioscoreae Hypoglaucae Rhizoma, 1 liang), Da Gan Gou Qi (Lycii Fructus, 8 qian), Raw Huang Qi (Astragali Radix, 3 qian), Raw Ji Nei Jin (Galli Gigerii Endothelium Corneum, 3 qian, yellow variety, crushed), Raw Mai Ya (Hordei Fructus Germinatus, 3 qian), Xuan Shen (Scrophulariae Radix, 3 qian), Tian Hua Fen (Trichosanthis Radix, 3 qian), Tian Dong (Asparagi Radix, 3 qian), Raw Hang Shao (Paeoniae Radix Alba, 2 qian), Gui Zhi Jian (Ramulus Cinnamomi, 1.5 qian), Sheng Jiang (Zingiberis Rhizoma Recens, 3 qian), Da Zao (Jujubae Fructus, 3 pieces, split open).
Decoct together in a large cup of water, take warm.
Formula Analysis: This formula uses Huai Shan Yao (Dioscoreae Hypoglaucae Rhizoma), Gou Qi (Lycii Fructus), Huang Qi (Astragali Radix), Sheng Jiang (Zingiberis Rhizoma Recens), and Da Zao (Jujubae Fructus) to cultivate Qi transformation in the Middle Jiao. Mai Ya (Hordei Fructus Germinatus) ascends Spleen Qi (raw Mai Ya has a strong ascending property); Ji Nei Jin (Galli Gigerii Endothelium Corneum) descends Stomach Qi (raw Ji Nei Jin has a strong descending property); Gui Zhi (Ramulus Cinnamomi) ascends Spleen Qi and simultaneously descends Stomach Qi (Qi that should ascend rises upon encountering it; Qi that should descends falls upon encountering it). Additionally, Xuan Shen (Scrophulariae Radix) and Tian Hua Fen (Trichosanthis Radix) are used to moderate the warming and heating properties of Sheng Jiang (Zingiberis Rhizoma Recens), Gui Zhi (Ramulus Cinnamomi), and Huang Qi (Astragali Radix), bringing the medicinal nature to a state of peace, allowing for long-term use without adverse effects.
Follow-up Visit: After taking the medicine continuously for five doses, all symptoms were significantly alleviated, but epigastric pain had not completely disappeared, and the right pulse still exhibited Firmness (Lao). It was surmised that blood stasis might be stagnating at the site of pain. It was planned to add herbs that eliminate blood stasis to the Qi-regulating and descending/ascent-promoting formula.
Prescription: Raw Huai Shan Yao (Dioscoreae Hypoglaucae Rhizoma, 1 liang), Da Gan Gou Qi (Lycii Fructus, 8 qian), Raw Huang Qi (Astragali Radix, 3 qian), Xuan Shen (Scrophulariae Radix, 3 qian), Tian Hua Fen (Trichosanthis Radix, 3 qian), Raw Mai Ya (Hordei Fructus Germinatus, 3 qian), Raw Ji Nei Jin (Galli Gigerii Endothelium Corneum, 2 qian, yellow variety, crushed), Raw Hang Shao (Paeoniae Radix Alba, 2 qian), Tao Ren (Persicae Semen, 2 qian, peeled, stir-fried, crushed), Guang San Qi (Notoginseng Radix et Rhizoma, 2 qian, finely ground).
Ten ingredients in total. Decoct the first nine ingredients in a large cup of water. Take half of the powdered Guang San Qi (Notoginseng Radix et Rhizoma) with the decoction. When taking the decoction of the dregs again, take the remaining half of the powder.
Effect: After taking the medicine continuously for four doses, the stomach became peaceful and pain-free. All diseases were cured, and the physique gradually strengthened. The pulse returned to normal. Several more doses of the original formula were taken to ensure complete recovery.