（附∶变质化瘀丸）
噎膈之证，方书有谓贲门枯干者，有谓冲气上冲者，有谓痰瘀者，有谓血瘀者。愚向谓此证系中气衰弱，
不能撑悬贲门，以致贲门缩如藕孔（贲门与大小肠一气贯通，视其大便若羊矢，其贲门大小肠皆缩小可知），
痰涎遂易于壅滞，因痰涎壅滞冲气更易于上冲，所以不能受食。向曾拟参赭培气汤一方，仿仲景旋复代赭石
汤之义，重用赭石至八钱，以开胃镇冲，即以下通大便（此证大便多艰），而即用人参以驾驭之，俾气化
旺而流通，自能撑悬贲门使之宽展，又佐以半夏、知母、当归、天冬诸药，以降胃、利痰、润燥、生津，
用之屡见效验。迨用其方既久，效者与不效者参半，又有初用其方治愈，及病又反复再
服其方不效者。再三踌躇，不得其解，亦以为千古难治之证，原
不能必其全愈也。后治一叟，年近七旬，住院月余，已能饮食，而终觉不脱然。迨其回家年余，仍以旧证病
故，濒危时吐出脓血若干，乃恍悟从前之不能脱然者，系贲门有瘀血肿胀也，当时若方中加破血之药，或
能全愈。盖愚于瘀血致噎之证，素日未有经验，遂至忽不留心。后读吴鞠通、杨素园论噎膈，亦皆注重瘀血
之说，似可为从前所治之叟亦有瘀血之确征。而愚于此案，或从前原有瘀血，或以后变为瘀血，心中仍有游
移。何者？以其隔年余而后反复也。迨辛酉孟夏阅天津《卢氏医学报》百零六期，谓胃癌由于胃瘀血，治此
证者兼用古下瘀血之剂，屡屡治愈，又无再发之 ，觉胸中疑团顿解。盖此证无论何因，其贲门积有瘀血者
十之七八。其瘀之重者，非当时兼用治瘀血之药不能愈。其瘀之轻者，但用开胃降逆之药，瘀血亦可些
些消散，故病亦可愈，而究之瘀血之根蒂未净，是以有再发之 也。
古下瘀血之方，若抵当汤、抵当丸、下瘀血汤、大黄 虫丸诸方，可谓能胜病矣。而愚意以为欲治此证，
必中、西之药并用，始觉有把握。盖以上诸方治瘀血虽有效，以消瘤赘恐难见效。西医名此证为胃癌，所
谓癌者因其处起凸若山之有岩也。其中果函有瘀血，原可用消瘀血之药消之。若非函有瘀血，但用消瘀血之
药，即不能消除。夫人之肠中可生肠蕈，肠蕈即瘤赘也。肠中可生瘤赘，即胃中亦可生瘤赘。而消瘤赘之药，
惟西药沃剥即沃度加HT 谟最效，此其在变质药中独占优胜之品也。今愚合中、西药品，拟得一方于下，以备试用。
【变质化瘀丸】
旱三七（一两细末） 桃仁（一两炒熟细末） 硼砂（六钱细末） 粉甘草（四钱细末）
西药沃剥（十瓦） 百布圣（二十瓦）
上药六味调和，炼蜜为丸，二钱重。服时含化，细细咽津。
今拟定治噎膈之法∶无论其病因何如，先服参赭培气汤两三剂，必然能进饮食。若以后愈服愈见效，
七八剂后，可于原方中加桃仁、红花各数钱，以服至全愈为度。若初服见效，继服则不能递次见效者，可于
原方中加三棱二钱， 虫钱半；再于汤药之外，每日口含化服变质化瘀丸三丸或四丸，久久当有效验。若其
瘀血已成溃疡，而脓未尽出者，又宜投以山甲、皂刺、乳香、没药、花粉、连翘诸药，以消散之。
此证之脉若见滑象者，但服参赭培气汤必愈。而服过五六剂
后，可用药汤送服三七细末一钱，煎渣服时亦如此。迨愈后自无再发之 矣。
王孟英谓，以新生小鼠新瓦上焙干，研末，温酒冲服，治噎
膈极有效。盖鼠之性能消 瘕，善通经络，故以治血瘀贲门成噎膈者极效也。
有一人患噎膈，偶思饮酒，饮尽一壶而脱然病愈。验其壶中，有蜈蚣一条甚巨，因知其病愈非由于饮酒，
实由于饮煮蜈蚣之酒也。闻其事者质疑于愚。此盖因蜈蚣善消肿疡，患者必因贲门瘀血成疮致噎，故饮
蜈蚣酒而顿愈也。欲用此方者，可用无灰酒数两（白酒黄酒皆可不宜用烧酒）煮全蜈蚣三条饮之。
总论破瘀血之药，当以水蛭为最。然此物忌炙，必须生用之方有效。乃医者畏其猛烈，炙者犹不敢用，
则生者无论矣。不知水蛭性原和平，而具有善化瘀血之良能。若服以上诸药而病不愈者，想系瘀血凝结甚固，
当于服汤药、丸药之外，每用生水蛭细末五分，水送服，日两次。若不能服药末者，可将汤药中 虫减
去，加生水蛭二钱。
【附录】唐××登医志原文∶读杂志第四期张锡纯君论治噎膈，阐发玄微，于此证治法别开径面，卓
见名言，实深钦佩。及
又读侯××（西医）反胃论（见第三中学第二期杂志中），谓病原之最重要者，乃幽门之发生胃癌，妨碍
食物入肠之道路。初时胃力尚佳，犹能努力排除障碍，以输运食物于肠。久而疲劳，机能愈弱，病势益
进，乃成反胃。按∶其引西医之论反胃，言其原因同于噎膈，可以治噎膈之法治之，固属通论。然即愚
生平经验以来，反胃之证原有两种，有因幽门生癌者；有因胃中虚寒兼胃气上逆、冲气上冲者。其幽门生癌
者，治法原可通于噎膈。若胃中虚寒兼气机冲逆者，非投以温补胃府兼降逆镇冲之药不可。且即以胃中生
癌论，贲门所生之癌多属瘀血，幽门所生之癌多属瘤赘。瘀血由于血管凝滞，瘤赘由于腺管肥大。治法亦宜各
有注重，宜于参赭培气汤中加生鸡内金三钱，三棱二钱；于变质化瘀丸中加生水蛭细末八钱，再将西药沃剥改
作十五瓦，蜜为丸，桐子大，每服三钱。日服两次。而后幽门所生之癌，若为瘤赘，可徐消，即为瘀血亦不难
消除。又治噎膈便方，用昆布二两洗净盐，小麦二合，用水三大盏，煎至小麦烂熟，去渣，每服不拘时饮一
小盏；仍取昆布不住口含两三片咽津，极效。按此方即用西药沃度加HT 谟之义也。盖西药之沃度加HT 谟原由
海草烧灰制出，若中药昆布、海藻、海带皆含有沃度加HT 谟之原质者也。其与小麦同煮服者，因昆布味咸性
凉，久服之恐与脾胃不宜，故加小麦以调补脾胃也。
此方果效，则人之幽门因生瘤赘而反胃者，用之亦当有效也。
【附：变质化瘀丸】
关于噎膈这一病证，医书中有的认为是贲门干枯所致，有的认为是冲气上逆所致，有的认为是痰瘀阻滞，有的认为是血瘀所致。我过去认为此证是由于中气衰弱，无法支撑悬挂贲门，导致贲门收缩如同藕孔一般（贲门与大小肠之气相互贯通，观察其大便若羊屎状，可知其贲门及大小肠皆已缩小），痰涎因此容易壅滞，进而使得冲气更容易上逆，所以患者不能进食。过去我曾拟定“参赭培气汤”一方，仿照张仲景“旋复代赭石汤”的意旨，重用赭石至八钱，以开胃并镇摄冲气，借以下通大便（此证患者大便多艰涩），同时用人参来驾驭药力，使气化旺盛而流通，自然能支撑悬挂贲门使其宽展，又辅以半夏、知母、当归、天冬等药物，以降胃气、利痰浊、润燥结、生津液，使用此方屡次见效。然而长期使用该方后，有效者与无效者各占一半，还有起初服用该方治愈，后来病情反复再服却无效的情况。经过再三斟酌，不得其解，也认为这是千古难治之证，原本就不能保证完全痊愈。
后来治疗一位老人，年近七十，住院月余，已经能够饮食，但始终觉得不能完全摆脱病痛。待他回家一年多后，仍因旧病去世，临终时吐出脓血若干。此时我才恍然醒悟，从前之所以不能完全脱然痊愈，是因为贲门有瘀血肿胀。当时如果在方中加入破血药物，或许能完全治愈。大概是因为我对于瘀血导致噎膈的病症，平日缺乏经验，以至于疏忽未加留意。后来阅读吴鞠通、杨素园论述噎膈的文章，也都注重瘀血的说法，这似乎可以作为从前所治那位老人确有瘀血的确凿证据。但对于此案，我心中仍有犹豫：究竟是原来就有瘀血，还是后来变为瘀血？为什么呢？因为间隔了一年多才复发。直到辛酉年孟夏（初夏）阅读天津《卢氏医学报》第一百零六期，文中称胃癌是由于胃中瘀血所致，治疗此证兼用古方下瘀血之剂，屡屡治愈，且无复发之虞，使我心中的疑团顿时解开。大概此证无论起因如何，其贲门积有瘀血者十之七八。瘀血严重的，当时若不兼用治疗瘀血的药物，则不能痊愈；瘀血轻微的，仅用开胃降逆的药物，瘀血也可逐渐消散，故病亦可愈，但究其根本，瘀血的根蒂并未清除干净，所以会有复发。
古代下瘀血的方剂，如抵当汤、抵当丸、下瘀血汤、大黄䗪虫丸等方，可以说能胜任治病了。但我认为想要治疗此证，必须中西药并用，才觉得有把握。因为上述各方治疗瘀血虽有效，但要消除肿瘤赘生物恐怕难以见效。西医将此证称为胃癌，所谓“癌”，是因为患处突起如山岩之有岩石。其中如果确实含有瘀血，原可用消瘀血的药物来消除它。如果不是含有瘀血，单用消瘀血的药物，就不能消除。人的肠中可以生肠蕈，肠蕈即肿瘤赘生物。肠中可以生肿瘤赘生物，那么胃中也可以生肿瘤赘生物。而消除肿瘤赘生物的药物，唯有西药“沃剥”（碘化钾）最效，这是在变质药中独占优胜的品种。现在我结合中西药品，拟定下方一个，以备试用。
【变质化瘀丸】
旱三七（一两，研成细末） 桃仁（一两，炒熟，研成细末） 硼砂（六钱，研成细末） 粉甘草（四钱，研成细末）
西药沃剥（十瓦） 百布圣（二十瓦）
以上六味药调和，炼蜜为丸，每丸重二钱。服用时含在口中慢慢化开，细细咽下津液。
现在拟定治疗噎膈的方法：无论病因如何，先服用参赭培气汤两三剂，必然能够进食。如果以后越服越见效，七八剂后，可以在原方中加入桃仁、红花各数钱，一直服用到痊愈为止。如果初服见效，继服则不能依次见效的，可以在原方中加入三棱二钱，䗪虫半钱；除了在汤药之外，每日口含化服变质化瘀丸三丸或四丸，久而久之应当有效验。如果其瘀血已成溃疡，而脓液未尽排出的，又适宜投用穿山甲、皂角刺、乳香、没药、天花粉、连翘等药物，以消散之。
此证的脉象若见滑象的，只服用参赭培气汤必能痊愈。而在服用过五六剂后，可用药汤送服三七细末一钱，煎煮药渣服用时也如此。等到痊愈后自然不会再复发。
王孟英曾说，用新生小鼠在新瓦上焙干，研成粉末，温酒冲服，治疗噎膈极有效。大概老鼠的性能能消除癥瘕，善于通经络，所以用于治疗血瘀导致贲门形成噎膈的患者极有效。
有一人患噎膈，偶然想喝酒，喝完一壶酒后病痛完全解除。检查他的酒壶，发现里面有一条很大的蜈蚣，因此知道他的病愈并非由于饮酒，实在是由于饮用了煮过蜈蚣的酒。听到这件事的人向我质疑。这大概是因为蜈蚣善于消肿疡，患者必定是因为贲门瘀血成疮导致噎膈，所以饮用蜈蚣酒而顿时痊愈。想要使用此方的人，可以用无灰酒数两（白酒黄酒皆可，不宜用烧酒）煮全蜈蚣三条饮用。
总论破瘀血的药物，当以水蛭为最。然而此物忌讳炙烤，必须生用才有效。但是医者畏惧其猛烈，连炙过的都不敢用，更不用说生用的了。不知道水蛭本性原本平和，且具有善于化瘀血的良能。如果服用上述诸药而病不愈，想必是瘀血凝结非常牢固，应当在服用汤药、丸药之外，每次用水蛭细末五分，水送服，每日两次。如果不能服药末的人，可以将汤药中的䗪虫减去，加入生水蛭二钱。
【附录】唐××登医志原文：读杂志第四期张锡纯君论治噎膈，阐发玄微，于此证治法别开径面，卓见名言，实深钦佩。及又读侯××（西医）反胃论（见第三中学第二期杂志中），谓病原之最重要者，乃幽门之发生胃癌，妨碍食物入肠之道路。初时胃力尚佳，犹能努力排除障碍，以输运食物于肠。久而疲劳，机能愈弱，病势益进，乃成反胃。按：其引西医之论反胃，言其原因同于噎膈，可以治噎膈之法治之，固属通论。然即愚生平经验以来，反胃之证原有两种，有因幽门生癌者；有因胃中虚寒兼胃气上逆、冲气上冲者。其幽门生癌者，治法原可通于噎膈。若胃中虚寒兼气机冲逆者，非投以温补胃府兼降逆镇冲之药不可。且即以胃中生癌论，贲门所生之癌多属瘀血，幽门所生之癌多属瘤赘。瘀血由于血管凝滞，瘤赘由于腺管肥大。治法亦宜各有注重，宜于参赭培气汤中加生鸡内金三钱，三棱二钱；于变质化瘀丸中加生水蛭细末八钱，再将西药沃剥改作十五瓦，蜜为丸，桐子大，每服三钱。日服两次。而后幽门所生之癌，若为瘤赘，可徐消，即为瘀血亦不难消除。又治噎膈便方，用昆布二两洗净盐，小麦二合，用水三大盏，煎至小麦烂熟，去渣，每服不拘时饮一小盏；仍取昆布不住口含两三片咽津，极效。按此方即用西药沃度加HT谟之义也。盖西药之沃度加HT谟原由海草烧灰制出，若中药昆布、海藻、海带皆含有沃度加HT谟之原质者也。其与小麦同煮服者，因昆布味咸性凉，久服之恐与脾胃不宜，故加小麦以调补脾胃也。
[Appendix: Bianzhi Huayu Pill]
Regarding the syndrome of Yige (dysphagia and food impaction), medical texts attribute it to various causes: some state it is due to the dryness of the cardia, others to the upward rushing of Chong Qi, others to phlegm-stasis obstruction, and still others to blood stasis. I previously believed this syndrome resulted from the weakness of Middle Qi, which failed to support and suspend the cardia, causing the cardia to contract like an lotus root pore (The cardia connects with the large and small intestines via a continuous flow of Qi; observing stool resembling sheep droppings indicates that both the cardia and the intestines have shrunk). Consequently, phlegm-fluids easily become obstructed, making the upward rushing of Chong Qi even more likely, thus preventing the patient from accepting food. I formerly formulated the "Shen Zhe Peiqi Decoction" (Ginseng and Hematite Decoction to Nourish Qi and Descend Rebellious Qi), imitating the principle of Zhang Zhongjing's "Xuanfu Daizheshi Tang". I heavily used Hematite up to two taels (approx. 75g) to open the stomach and suppress Chong Qi, thereby facilitating bowel movement (patients with this condition often suffer from constipation), while using Ginseng to control the medicinal force, ensuring vigorous Qi transformation and free circulation, naturally supporting and suspending the cardia to widen it. I also assisted with Pinellia, Anemarrhena, Angelica Sinensis, and Asparagus Root to descend Stomach Qi, resolve phlegm, moisten dryness, and generate fluids. This prescription yielded frequent success. However, after long-term use, effectiveness was split evenly between responders and non-responders; some were cured initially but relapsed later, rendering the prescription ineffective upon re-administration. After much deliberation without finding an explanation, I considered it a千古难治之证 (perennially difficult-to-treat syndrome) where complete cure could not be guaranteed.
Later, I treated an elderly man nearing seventy years of age who had been hospitalized for over a month. He could eat, yet never felt completely recovered. Over a year after returning home, he died from his original illness, vomiting pus and blood near death. It then dawned on me that his previous inability to fully recover was due to blood stasis and swelling in the cardia. Had I added blood-breaking herbs at that time, a complete cure might have been achieved. Perhaps because I lacked experience with yige caused by blood stasis, I overlooked it. Later, reading Wu Jutong and Yang Suyuan's discussions on yige, which also emphasized blood stasis, seemed to confirm that the old man indeed had blood stasis. However, regarding this case, I remained hesitant: did he originally have blood stasis, or did it develop later? The reason for my hesitation was the relapse occurring more than a year later. Until early summer of the Xinyou year, when I read Issue 106 of Tianjin "Lu's Medical Journal," which stated that gastric cancer is caused by blood stasis in the stomach, and that treating this condition by combining ancient blood-draining formulas led to frequent cures with no recurrence, my doubts were instantly resolved. Generally, regardless of the cause, 70-80% of such cases involve blood stasis accumulation in the cardia. In severe stasis cases, failure to combine blood-resolving drugs initially prevents cure. In mild cases, using only stomach-opening and anti-reversal drugs may allow gradual dissipation of stasis, leading to recovery, but the root of the stasis remains uncleared, hence the possibility of recurrence.
Ancient formulas for draining blood stasis, such as Didang Tang, Didang Wan, Xiayuxue Tang, and Dahuang Zhechong Wan, are certainly capable of treating the disease. However, I believe that to treat this condition effectively, Chinese and Western medicines must be used together to ensure confidence. Although the aforementioned formulas are effective for blood stasis, they may fail to eliminate tumor growths. Western medicine calls this condition "gastric cancer." The term "cancer" refers to the raised, rock-like appearance of the lesion. If the lesion indeed contains blood stasis, blood-resolving drugs can eliminate it. If it does not contain blood stasis, blood-resolving drugs alone will not work. Just as intestinal mushrooms (intestinal tumors/growths) can form in the intestines, tumors can also form in the stomach. Among drugs that eliminate tumors, the Western medicine "Wobu" (Potassium Iodide) is most effective, standing out among alterative agents. Now, combining Chinese and Western medicines, I propose the following formula for trial.
[Bianzhi Huayu Pill]
Panax Notoginseng Root (30g, fine powder)
Peach Kernel (30g, roasted, fine powder)
Borax (18g, fine powder)
Licorice Root (12g, fine powder)
Western Medicine Potassium Iodide (10 grains)
Pubescent Honeydew Melon Stem (20 grains)
Mix the six ingredients, refine honey to make pills, each weighing 6g (two qian). Take by holding in the mouth to dissolve slowly, swallowing the saliva carefully.
Current proposed method for treating yige: Regardless of the etiology, first administer Shen Zhe Peiqi Decoction for two to three doses, which should enable eating. If subsequent doses show increasing efficacy, after seven to eight doses, add Peach Kernel and Safflower (each several qian) to the original formula, continuing until full recovery. If initial doses are effective but subsequent ones lose incremental efficacy, add Rhizoma Sparganii (2 qian) and Ground Beetle (0.5 qian) to the original formula; additionally, take three or four Bianzhi Huayu Pills daily, dissolved in the mouth. Long-term use should yield results. If the blood stasis has formed an ulcer with un-discharged pus, prescribe Silkworm Chrysalis, Gleditsia Sinensis Thorn, Frankincense, Myrrh, Trichosanthes Root, and Forsythia to dissipate the pathology.
If the pulse presents a slippery quality, Shen Zhe Peiqi Decoction alone will likely cure the condition. After five to six doses, one may take one qian of Panax Notoginseng fine powder washed down with the decoction, and the dregs should also be consumed similarly. Upon recovery, recurrence will naturally cease.
Wang Mengying stated that roasting a newborn mouse on a new tile, grinding it into powder, and taking it with warm wine is extremely effective for yige. This is because mice possess the ability to resolve masses and promote meridian circulation, making them highly effective for yige caused by blood stasis in the cardia.
A patient with yige craved alcohol and drank a potful, after which the illness vanished. Inspection of the pot revealed a large centipede inside. Thus, the cure was attributed not to the alcohol itself, but to the alcohol boiled with the centipede. Skeptics questioned me about this. It is likely because the centipede excels at reducing swelling and ulcers; the patient's yige was caused by an ulcer resulting from blood stasis in the cardia, so drinking centipede-boiled wine brought immediate relief. To use this remedy, boil three whole centipedes in several liang of ash-free wine (white or yellow rice wine, not distilled spirits) and drink.
In summary, regarding drugs that break blood stasis, Leech is supreme. However, it must not be roasted; it must be used raw to be effective. Physicians fear its potency and dare not even use roasted forms, let alone raw. They do not realize that Leech is inherently mild yet possesses excellent blood-stasis-resolving capabilities. If patients do not improve with the aforementioned drugs, it is likely due to firmly consolidated blood stasis. In addition to decoctions and pills, take 1.5g (five fen) of raw Leech fine powder with water, twice daily. If the patient cannot take powder, remove the Ground Beetle from the decoction and add 6g (two qian) of raw Leech.
[Appendix: Original Text from Tang XX's Medical Journal]
Reading Mr. Zhang Xichun's discussion on treating yige in Issue 4 of the magazine, which elucidates profound mysteries and opens new paths for treatment methods, I deeply admire his insightful remarks. Furthermore, reading Dr. Hou XX's (Western Physician) article on Fanwei (regurgitation) in Issue 2 of the Third Middle School Magazine, which states that the most important pathological cause is gastric cancer occurring in the pylorus, obstructing the passage of food into the intestines. Initially, stomach function is strong enough to struggle against the obstruction to transport food to the intestines. Over time, fatigue sets in, function weakens further, the disease progresses, resulting in Fanwei. Note: His citation of Western medicine regarding Fanwei suggests its cause is similar to yige, implying yige treatments could apply; this is indeed a general theory. However, based on my lifelong experience, Fanwei comprises two types: one caused by cancer in the pylorus, and another caused by deficiency-cold in the stomach combined with rebellious Stomach Qi and upward-rushing Chong Qi. For the former (pyloric cancer), treatment principles align with yige. For the latter (stomach deficiency-cold with Qi rebellion), warming and tonifying the Stomach while descending rebellious Qi and suppressing Chong Qi is essential. Moreover, regarding gastric cancer, cancers arising in the cardia are mostly due to blood stasis, whereas those in the pylorus are mostly tumor growths. Blood stasis stems from vascular stagnation, while tumor growths stem from glandular hypertrophy. Treatment approaches should therefore differ in emphasis. It is advisable to add Raw Chicken Gizzard Membrane (3 qian) and Rhizoma Sparganii (2 qian) to Shen Zhe Peiqi Decoction; and add 24g (eight qian) of raw Leech fine powder to Bianzhi Huayu Pill, increasing Western Medicine Potassium Iodide to 15 grains, refining with honey into pills the size of paulownia seeds, taking 9g (three qian) per dose, twice daily. This way, whether the pyloric cancer is a tumor growth (which can be slowly dissolved) or blood stasis (which is also easy to eliminate), it can be addressed. Another simple prescription for yige uses Kelp (60g, washed clean of salt) and Wheat (30g), boiled in nine cups of water until the wheat is soft. Strain and drink a small cup at any time. Additionally, keep two or three pieces of kelp in the mouth to swallow saliva continuously, which is extremely effective. Note: This prescription utilizes the principle of Western Medicine Potassium Iodide. Since Western Potassium Iodide is derived from burning seaweed ash, and Chinese herbs Kelp, Sargassum, and Laminaria all contain the essence of Potassium Iodide. The addition of wheat is because Kelp is salty and cold; long-term use may harm the Spleen and Stomach, so wheat is added to harmonize and tonify them.
If this prescription proves effective, it should also be effective for Fanwei caused by tumor growths in the pylorus.