生于郁结，而骤开之，或得效于顷刻，终必至于就毙。余阅历数十载，见年少无此患，年老有此证，其为气血
之亏，水火之弱，上焦之枯，肠胃之燥，已明效大验。治此者，不急求脾肾根本而补救之，反从事于开关，诡
异以为快捷方式，医亦愚矣！（《会心录》）
噎隔，多因五志过极，或纵情嗜欲，或恣意酒食，以致阳气内结，阴血内枯而成。治宜调养心脾，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，以致饮食入胃，不
能运化，而为朝食暮吐，暮食朝吐。治宜益火之原，以消阴翳；补土通阳，以温脾胃。故噎隔反胃，各为立法
以治之。其阳气结于上，阴液亏于下，而为噎隔者，用通阳开痞、通补胃府，以及进退黄连附子泻心诸法，上
热下寒为治。其肝阴胃汁枯槁及烦劳阳亢，肺胃津衰而成噎隔者，用酸甘济阴，及润燥清燥为主。其液亏气滞，
及阳衰血瘀而成者，用理气逐瘀，兼通血络为主。其胃阳虚，及忧郁痰阻而成者，用通补胃腑，辛热开浊，以
及苦降辛通，佐以利痰清隔为主。其肝郁气逆而成者，两通厥阴阳明为治。其酒热郁伤肺胃，气不降而成者，
用轻剂清降，及苦辛寒开肺为治。○是证每因血枯气衰所致，凡香燥消涩之药，久在禁内。案中虽有一二仿用
辛热，而亦必谛审其为阳微浊踞者。其余或苦辛泄滞，而兼润养；或酸甘化液，而直滋清；或郁闷于气分，而
推扬谷气；或劳伤于血分，而宣通淤浊，总以调化机关，和润血脉为主。“阳气结于上，阴液衰于下”
二语，实为是证之确论也。（《临证指南》）
古方治噎隔，多以止吐之剂，不思∶吐，湿证也，宜燥；噎隔，燥证也，宜润。《经》云∶三阳结谓之隔。结，结热也，热
甚则物干。凡噎隔，不出“胃脘干槁”四字。槁在上脘，水饮可行，食物难入；槁在下脘，食虽可入，久而复
出。胃既槁矣，复以燥药投之，不愈益其燥乎？是以大、小半夏二汤，在噎隔门为禁剂也。予尝用启隔散以
开其关，佐以四君子汤，调理脾胃，挟郁者参用逍遥散。虽然，药逍遥而人不逍遥，亦无益也。张鸡峰云∶此
乃神思间病，法当内观静养。斯言深中病情，然其间有挟虫、挟血、挟痰、挟食而为患者，又当按法兼治，不
可忽也。（《医学心悟》）
咽嗌闭塞，胸膈满闷，似属气滞；然有服耗气药过多，中气不运而致者，又当补气。大便燥热，结如羊
矢，似属血热；然有服通利药过多，血液衰竭而致者，又当补血。（刘宗浓）
噎隔，古方多以热剂治之，殊不知隔噎之证，断乎无寒。或谓隔噎因于气郁，故用辛热以散之；不思气
郁者，因气虚而郁，非实也。气既因虚而郁，郁久成热，若再用辛热耗气，则是虚者益虚，热者益热，其何以
为救治之道哉！（徐春甫）
此证之所以疑难者∶方欲健脾理痰，恐燥剂妨于津液；方欲养血生津，恐润剂碍于中州。审其阴伤火
旺者，当以养血为亟；脾伤阴盛者，当以温补为先。更有忧恚盘礴，火郁闭结，神犹未衰，脉犹有力，当以仓
公、河间之法下之，关扃自通。（《医宗必读》）
古人指噎隔为津液干枯，故水液可行；干物梗塞，为槁在上焦。愚窃疑之，若果津枯，何以食才下咽，
涎随上涌乎？故知膈咽之间，交通之气不得降者，皆冲脉上行，逆气所作也。惟气逆故水液不能居润下之常，
随气而上逆耳。若用润下之剂，岂不反益其逆乎？宜六君子汤加减为是。○大抵噎隔之人，体肥痰逆者可治，枯
津衰者，多不可治。○反胃初愈，切不可与粥饮。每日与独参汤，少加炒陈米，不时煎服，旬日后方可小
试稀糜。往往即食饭者，多致复病而危。（张路玉）
三阳结而服润剂，如未吐涎则可；若涎涌而食不下，润药不
能润肠，反滋其液，是速其毙也。如欲服药，究竟以六君为是。脾喜燥而恶湿，胃液不行，肠如何润？○粪如
羊矢者，为三阳结，治在肠。大便溏而食哽者，治在胃。（许宣治）
过饮热酒，多成隔证，今人皆知，而所以然之理未达也。盖隔有二种∶一者上脘之艰于纳；一者下脘之艰
于出耳。然人之胃中，全是一团冲和之气，所以上脘清阳居多，不觉其热，下脘浊阴居多，不觉其寒。实时令
大热，而胃中之气，不变为热，时令大寒，而胃中之气，不变为寒，气惟冲和。故但能容食，不能化食，必藉
脾中之阳气入胃，而运化之机始显，此身中自然之造化也。曲 之性，极能升腾，日饮沸酒不辍，势必将下
脘之气，转升于上、中二脘，而幽门之口，闭而不通者有之。且热酒从喉而入，日将上脘泡灼，渐有腐熟之象，
而生气不存，窄隘有加，止能纳水，不能纳谷者有之。此其所以多成隔证也。（喻嘉言）
梅核隔者，喉中如有物，膈间作痛，死血居多。治宜昆布、当归、桃仁、韭汁、童便，甚者加大黄。有
因痰结者，宜涤痰丸。《医鉴》谓或结于咽喉，时觉有所妨碍，吐之不出，咽之不下，由于气郁痰结而然者，
正指此也。然此证总属有形之物，非血即痰。若气则无形，其非梅核隔可知矣。（沈金鳌）
年满六旬者难治。粪如羊矢者不治。大吐白沫者不治。胸腹嘈痛如刀割者死。不绝酒色，及忧恚者危。（《证治汇补》）
脉候
血虚者，左脉无力。气虚者，右脉无力。痰凝者，寸关沉滑而大。气滞者，寸关沉伏而涩。火气冲逆者，
脉来数大。瘀血积滞者，脉来芤涩。小弱而涩者反胃，紧滑而革者噎隔。（《证治汇补》）
选案
倪庆云，病隔气，粒米不入，始吐清水，次吐绿水，次吐黑水，次吐臭水，呼吸将绝。余曰∶尽今一昼夜，
先服理中汤六剂，
来早转方，一剂全安。渠家曰∶病已至此，滴水不入，安能服药六剂乎？既有妙方，何不即投，必先与理中汤，
然后乃用，何也？余曰∶《金匮》有云∶病患噫气不除者，旋复代赭石汤主之。吾于此病，分别用之者有二∶
一者以黑水为胃底之水，臭水为肠中之水，此水且出，则胃中之津液久已不存，不敢用半夏以燥其胃也。一者
以将绝之气，止存一丝，以代赭坠之，恐其立断。必先以理中分理阴阳，使气易于降下，然后代赭得以奏 。
进药三剂，病者言内气稍接，但恐太急，俟明日再服，后旦转方为妥。次早余持前药一盏，勉令服之；曰∶吾
即立地转方，顷刻见效，再有何说？乃用旋复花一味煎汤，调代赭石末二匙与之，药才入口，其气已转入丹田
矣。病者因脱衣触冷复呕，与前药立止。饥甚食粥六盏，复呕，与前药立止。又因怒复呕，与前药立止。后不
复呕，但困倦之极，服补药二十剂，丸药一斤，将息二月，始能出户，方悔从前少服理中二剂耳。（喻嘉言）
罗景思，患噎隔三月，渐致滴水难入，已将入木。予见其目珠尚觉活动，不忍坐观，与法制元明粉泡水一
匙，俟其润下，又进一匙，连进数匙，喉间有声，自辰至未，服下一盏，腹内响动，少顷二便忽通，试与米饮
半盏不吐，但觉胸腹火热难过，此在先多服温补诸药之害。再与黄连、生地、元参、花粉、天冬、丹皮、
甘草、银花二剂，胸腹松快，食饮无妨。徐以六味加归、芍调理而愈。○项苇庵臬台请致后，偶有怫郁，二
便不通，食不下咽，诸医议虚议实，俱莫奏功。余按其胃脉沉伏而实，乃曰∶三阳热结，前后闭塞，下既不通，
所以噎食不下，当用河间法，下以承气。医咸咋舌。余曰∶项老先生，干系不小，诸君若有妙论，何不担承？
又复默然。项君曰∶羊叔子岂是鸩人，吾当服华仲药耳。余亦欣然与饮，竟获全安。○王子久，患噎隔，诸开
关法，无隙可乘。予用悉尼一枚，剖作四棱，纳入巴豆十二粒，皮纸封裹，外加泥团煨红，取起剔去巴豆，将
梨捣汁与饮，少顷即便走气，
上下宽舒，随以八仙糕粉数分，和米饮与之，渐渐气回。再与回天饮一服，徐又少与糕粉米饮，两日后，令啜
稀粥，调理三月而痊。○刘梅溪，始患消渴，服地黄汤颇效；久而噎塞，改用开郁之剂，二证齐甚。吐皆饮食
宿物带痰涎而出，饥渴之极，毫不能下，小便点滴成膏，粪如羊矢，六脉全无，意谓消噎合并，当水源涸绝，
何以痰涎宿秽，吐出愈多？此必心脾之郁未能畅达耳。以归脾汤去白术、木香，加茱萸、黄连、二冬、菖蒲，
一服吐止脉出。易以回天饮，二十服而瘳。（程华仲）
张文仲，患反胃，每食羹粥诸物，须臾吐出，御医不能疗，疲困欲绝。忽一卫士云∶驴溺极验。遂服二合，
止吐一半；再服，食粥便定。次日奏知宫中，五六人患此证者，服之俱瘥。此物稍有毒，服时不可过多，须热
饮之，病深者七日效。（《本事方》）
朱彦真，病酒隔，呕逆不食，每日惟饮热酒一、二觥，少顷即作酸呕出，膈间大痛，杂治经年不效。良由
平昔好饮热酒所致。此即丹溪所谓好饮热酒，死血留于胃口之候。授以人参散，方用人参一两，煎成加麝香半
分，冰片三厘，三剂便能进食。盖冰麝善散胃口之痰与瘀血耳。改服柏子仁汤，半月而安。二方出自云岐，人
多未识。○秦伯源，噎隔呕逆，形神枯槁，情志郁抑。门人邹恒友，令用啄木鸟入麝香熬膏，时嗅其气，以通
其结；内服逍遥散加香、砂，以散其郁，数剂患除。陈君用噎隔，亦用此法治愈。又一农人患噎隔，呕涎如赤
豆水，此属血瘀于内，方用桂苓饮加当归、桃仁、丹皮、牛膝，用黑糖 虫浆调服，下溏黑如污泥。盖农人努
力受伤，血郁于内，但攻其积血，呕逆自已。（《张氏医通》）
附方
启隔散 通治噎隔开关之剂，屡效。沙参、丹参、茯苓、川贝母、杵头糠、郁金、砂仁壳、荷叶蒂。
治隔气开关方 用荔枝一个去核，蜒蝣一条，将冰片数厘，糁蜒蝣上，仍将荔枝肉包好，放在壳内，用线
扎定。令病患含在口
中，有冷涎水渗出，徐徐咽下；时许蜒化，连壳吐去。服一次可进饮食，勿使病者知，恐嫌秽也。
又方 此证由于肠枯血燥，故粪如羊矢者不治。此方生血润肠最妙。牛乳、羊乳、人乳。不拘分量，可以常服。
元霜 用黑铅一斤，烊成薄饼，中穿一孔，以绳系之。将醋半瓮，以铅饼悬瓮中，离醋寸许，瓮口用皮
纸箬子札紧，砖石压之，放阴处。数日取起，饼上有霜拭下。每铅一斤，取霜二两。治噎隔每服五分，白汤送
下。治痰火咳嗽，每服三分。
秘传隔噎膏 效如神丹，须心平气和，勿求速 。人乳、牛乳、芦根汁、人参汁、龙眼肉汁、蔗汁、梨
汁、姜汁。七味等分，惟姜汁少许，隔汤熬成膏，微下炼蜜，徐徐频服。
（程杏轩）此病生于气机郁结，若骤然强行开通，或许能顷刻见效，但最终必然导致死亡。我阅历数十载，见年轻人没有这种病患，而老年人有此证候，这气血的亏虚、水火之气的衰弱、上焦的枯槁、肠胃的干燥，已是明效大验。治疗此病的人，不急于求取脾肾的根本进行补救，反而从事于开关通窍，标新立异以求快捷方式，这也太愚昧了！（出自《会心录》）
噎隔（吞咽困难及胸膈阻塞），多因七情过极，或纵情嗜欲，或恣意饮酒饮食，以致阳气在内结聚，阴血在内枯竭而成。治疗应当调养心脾，以舒展结聚之气；填精益血，以滋润枯燥。反胃（食物入胃后停留一段时间再吐出），乃胃中无阳，不能容纳接受食物，命门火衰，不能熏蒸脾土，以致饮食进入胃中，不能运化，从而出现早晨吃晚上吐，晚上吃早晨吐的症状。治疗应当益补火的根源，以消除阴寒之邪；补益脾土以通阳，以温煦脾胃。所以噎隔和反胃，各自制定法则来治疗。其阳气结聚于上，阴液亏损于下，而形成噎隔的，用通阳开痞、通补胃腑，以及进退黄连附子泻心汤等法，以上热下寒为治则。其肝阴胃汁干枯及烦劳阳亢，肺胃津液衰少而成噎隔的，用酸甘济阴，以及润燥清燥为主。其津液亏损气机阻滞，以及阳衰血瘀而成的，用理气逐瘀，兼通血络为主。其胃阳虚，以及忧郁痰阻而成的，用通补胃腑，辛热开浊，以及苦降辛通，佐以利痰清隔为主。其肝郁气逆而成的，两通厥阴经和阳明经为治。其酒热郁伤肺胃，气机不降而成的，用轻剂清降，以及苦辛寒开肺为治。○此证每因血枯气衰所致，凡是香燥消涩的药物，长久以来都在禁忌之列。案中虽然有一两处仿用辛热药物，但也必须审慎判断是否为阳气微弱、浊邪踞留者。其余或者苦辛泄滞，而兼润养；或者酸甘化液，而直接滋清；或者郁闷在气分，而推扬谷气；或者劳伤在血分，而宣通淤浊，总以调化机关，和润血脉为主。“阳气结于上，阴液衰于下”这两句话，实在是此证的确论。（出自《临证指南》）
古方治疗噎隔，多以止吐的药剂，却不思考：呕吐，是湿证，宜用燥药；噎隔，是燥证，宜用润药。《内经》说：三阳经气结聚称为隔。结，是结热，热甚则物体干枯。凡噎隔，不出“胃脘干槁”这四个字。槁在上脘，水饮可行，食物难入；槁在下脘，食物虽可入，久后复出。胃既然干枯了，再用燥药投喂，不是更加增加它的干燥吗？因此大半夏汤、小半夏汤，在噎隔门类中属于禁用的药剂。我曾使用启隔散来开通关隘，佐以四君子汤，调理脾胃，挟有郁结的参用逍遥散。虽然如此，药用了逍遥散而人并不逍遥，也没有益处。张鸡峰说：这是神思之间的病，法当内观静养。这话深深切中病情，然而其中有的挟虫、挟血、挟痰、挟食而为患者，又应当按法兼治，不可忽视。（出自《医学心悟》）
咽嗌闭塞，胸膈满闷，似乎属于气滞；然而有服用耗气药过多，中气不运转而导致的，又应当补气。大便燥热，结如羊屎，似乎属于血热；然而有服用通利药过多，血液衰竭而导致的，又应当补血。（刘宗浓）
噎隔，古方多以热剂治疗，殊不知隔噎之证，断然没有寒证。有人说隔噎因为气郁，所以用辛热药来散之；却不思考气郁者，是因为气虚而郁，并非实证。气既因虚而郁，郁久成热，若再用辛热耗气，那么就是虚者更虚，热者更热，这怎么作为救治之道呢！（徐春甫）
此证之所以疑难的原因在于：正想健脾理痰，恐怕燥剂妨碍津液；正想养血生津，恐怕润剂碍于中州（脾胃）。审察其阴伤火旺者，应当以养血为急务；脾伤阴盛者，应当以温补为先。更有忧恚盘礴，火郁闭结，神气尚未衰退，脉象尚有力道，应当以仓公、河间的方法攻下，关扃自然通畅。（出自《医宗必读》）
古人指噎隔为津液干枯，所以水液可行；干物梗塞，为槁在上焦。我私下怀疑，如果真是津枯，为什么食物才刚咽下，涎液随之上涌呢？所以知道膈咽之间，交通的气机不得下降的，都是冲脉上行，逆气所作。只有气逆，所以水液不能居润下的常态，随气而上逆罢了。如果用润下的药剂，岂不是反而增加其逆气吗？适宜六君子汤加减为是。○大抵噎隔之人，体肥痰逆者可治，枯津衰者，大多不可治。○反胃初愈，切不可给粥饮。每日给独参汤，少加炒陈米，不时煎服，十日后才可以小试稀糜。往往立即吃饭的，多导致复发而危险。（张路玉）
三阳经气结聚而服用润剂，如果没有吐涎还可以；如果涎涌且食不下，润药不能润肠，反而滋生其液，这是加速其死亡。如果想要服药，究竟以六君子汤为是。脾喜燥而恶湿，胃液不行，肠道如何润？○粪如羊屎的，是三阳经气结聚，治在肠。大便溏而食哽的，治在胃。（许宣治）
过量饮用热酒，多成为隔证，今人皆知，但所以然的道理未通达。盖隔有两种：一者是上脘难以纳食；一者是下脘难以出食。然而人的胃中，全是一团冲和之气，所以上脘清阳居多，不觉其热，下脘浊阴居多，不觉其寒。即使时令大热，而胃中之气，不变为热，时令大寒，而胃中之气，不变为寒，气惟冲和。所以只能容受食物，不能消化食物，必藉脾中的阳气进入胃中，而运化的机制才显现，这是身体中自然的造化。曲蘖的性质，极能升腾，日饮沸酒不停，势必将下脘之气，转升于上、中二脘，而幽门的口，闭而不通的有之。且热酒从喉而入，日将上脘泡灼，渐有腐熟之象，而生气不存，窄隘有加，只能够纳水，不能纳谷的有之。这就是为什么多成为隔证的原因。（喻嘉言）
梅核隔（感觉喉中有异物感），喉中如有物，膈间作痛，死血居多。治疗适宜昆布、当归、桃仁、韭汁、童便，严重的加大黄。有因痰结的，适宜涤痰丸。《医鉴》说或者结于咽喉，时觉有所妨碍，吐之不出，咽之不下，由于气郁痰结而然的，正是指此。然而此证总属有形之物，非血即痰。如果是气则无形，它不是梅核隔可知了。（沈金鳌）
年满六十岁者难治。粪如羊屎的不治。大吐白沫的不治。胸腹嘈痛如刀割的死。不绝酒色，及忧恚的危。（《证治汇补》）
脉候
血虚者，左脉无力。气虚者，右脉无力。痰凝者，寸关沉滑而大。气滞者，寸关沉伏而涩。火气冲逆者，脉来数大。瘀血积滞者，脉来芤涩。小弱而涩的是反胃，紧滑而革的是噎隔。（《证治汇补》）
选案
倪庆云，患隔气，粒米不入，开始吐清水，接着吐绿水，接着吐黑水，接着吐臭水，呼吸将绝。我说：尽这一昼夜，先服理中汤六剂，
明天早上转方，一剂全安。他家的人说：病已至此，滴水不入，怎么能服药六剂呢？既有妙方，为什么不立即投用，必须先给理中汤，然后才用，为什么呢？我说：《金匮要略》说：病患噫气不除的，旋复代赭石汤主之。我对此病，分别使用的理由有二：
一是以黑水为胃底之水，臭水为肠中之水，这些水都出来了，那么胃中的津液久已不存在，不敢用半夏来燥其胃。一是以将绝之气，只存一丝，用代赭石坠之，恐怕其立刻断绝。必须先以理中汤分理阴阳，使气易于降下，然后代赭石才能奏效。
进药三剂，病人说内气稍接，但恐怕太急，等到明天再服，后早转方为妥。次早我拿着前药一盏，勉强让他服下；说：我就立即转方，顷刻见效，还有什么话说？于是用旋复花一味煎汤，调代赭石末二匙给他，药才入口，其气已转入丹田矣。病人因为脱衣触冷又呕，给前药立即停止。饥甚食粥六盏，又呕，给前药立即停止。又因为怒又呕，给前药立即停止。后来不再呕，只是困倦之极，服补药二十剂，丸药一斤，将息二月，始能出户，才后悔从前少服理中汤二剂。（喻嘉言）
罗景思，患噎隔三月，渐致滴水难入，即将入木（指棺材，比喻病重将死）。我看见他目珠尚觉活动，不忍坐视不管，与法制元明粉泡水一匙，等他润下，又进一匙，连进数匙，喉间有声，自辰时至未时，服下一盏，腹内响动，少顷二便忽通，试给米饮半盏不吐，只觉胸腹火热难过，这是在先前多服温补诸药的害处。再给黄连、生地、元参、花粉、天冬、丹皮、甘草、银花二剂，胸腹松快，食饮无妨。慢慢用六味地黄丸加归、芍调理而愈。○项苇庵臬台请辞后，偶有怫郁，二便不通，食不下咽，诸医议论虚实，都没有功效。我按他的胃脉沉伏而实，就说：三阳热结，前后闭塞，下既不通，所以噎食不下，应当用河间的方法，下以承气汤。医生们都咋舌。我说：项老先生，关系不小，诸位如果有妙论，为什么不担承？又沉默不语。项君说：羊叔子难道是毒人的人，我应当服用华仲的药。我也欣然与他饮，竟获全安。○王子久，患噎隔，各种开关法，无隙可乘。我用悉尼（梨的一种）一枚，剖作四棱，纳入巴豆十二粒，皮纸封裹，外加泥团煨红，取起剔去巴豆，将梨捣汁与饮，少顷即便走气，
上下宽舒，随即用八仙糕粉数分，和米饮给他，渐渐气回。再给回天饮一服，慢慢又少给糕粉米饮，两日后，令啜稀粥，调理三月而痊。○刘梅溪，开始患消渴，服地黄汤颇有效；久而噎塞，改用开郁之剂，二证齐甚。吐皆饮食宿物带痰涎而出，饥渴之极，毫不能下，小便点滴成膏，粪如羊屎，六脉全无，心想消噎合并，当水源涸绝，为什么痰涎宿秽，吐出愈多？这一定是心脾之郁未能畅达耳。用归脾汤去白术、木香，加茱萸、黄连、二冬、菖蒲，一服吐止脉出。换以回天饮，二十服而瘳。（程华仲）
张文仲，患反胃，每食羹粥诸物，须臾吐出，御医不能疗，疲困欲绝。忽然一个卫士说：驴溺极验。于是服二合，止吐一半；再服，食粥便定。次日奏知宫中，五六人患此证者，服之俱瘥。此物稍有毒，服时不可过多，须热饮之，病深者七日效。（《本事方》）
朱彦真，病酒隔，呕逆不食，每日惟饮热酒一、二觥，少顷即作酸呕出，膈间大痛，杂治经年无效。良由平昔好饮热酒所致。这就是丹溪所说的好饮热酒，死血留于胃口之候。授以人参散，方用人参一两，煎成加麝香半分，冰片三厘，三剂便能进食。盖冰麝善散胃口之痰与瘀血耳。改服柏子仁汤，半月而安。二方出自云岐，人多未识。○秦伯源，噎隔呕逆，形神枯槁，情志郁抑。门人邹恒友，令用啄木鸟入麝香熬膏，时嗅其气，以通其结；内服逍遥散加香、砂，以散其郁，数剂患除。陈君用噎隔，亦用此法治愈。又一农人患噎隔，呕涎如赤豆水，此属血瘀于内，方用桂苓饮加当归、桃仁、丹皮、牛膝，用黑糖 虫浆调服，下溏黑如污泥。盖农人努力受伤，血郁于内，但攻其积血，呕逆自已。（《张氏医通》）
附方
启隔散 通治噎隔开关之剂，屡效。沙参、丹参、茯苓、川贝母、杵头糠、郁金、砂仁壳、荷叶蒂。
治隔气开关方 用荔枝一个去核，蜒蝣一条，将冰片数厘，糁蜒蝣上，仍将荔枝肉包好，放在壳内，用线扎定。令病患含在口中，有冷涎水渗出，徐徐咽下；时许蜒化，连壳吐去。服一次可进饮食，勿使病者知，恐嫌秽也。
又方 此证由于肠枯血燥，故粪如羊屎者不治。此方生血润肠最妙。牛乳、羊乳、人乳。不拘分量，可以常服。
元霜 用黑铅一斤，烊成薄饼，中穿一孔，以绳系之。将醋半瓮，以铅饼悬瓮中，离醋寸许，瓮口用皮纸箬子札紧，砖石压之，放阴处。数日取起，饼上有霜拭下。每铅一斤，取霜二两。治噎隔每服五分，白汤送下。治痰火咳嗽，每服三分。
秘传隔噎膏 效如神丹，须心平气和，勿求速效。人乳、牛乳、芦根汁、人参汁、龙眼肉汁、蔗汁、梨汁、姜汁。七味等分，惟姜汁少许，隔汤熬成膏，微下炼蜜，徐徐频服。
(Cheng Xingxuan) This disease arises from Qi stagnation. If one attempts to forcibly open the obstruction suddenly, it may yield immediate results, but ultimately leads to death. In my decades of experience, I have observed that young people do not suffer from this condition, whereas elderly people do. The deficiency of Qi and Blood, the weakness of Water and Fire (Kidney Yin and Yang), the withering of the Upper Jiao, and the dryness of the intestines and stomach are evident and verified facts. Those who treat this disease fail to urgently seek the root in the Spleen and Kidney for remediation; instead, they engage in opening orifices, seeking shortcuts through unconventional methods. Such physicians are indeed foolish! (From *Huixin Lu*)
Yige (Dysphagia and chest/epigastric obstruction) is mostly caused by extreme excess of the Five Emotions, indulgence in desires, or excessive consumption of alcohol and food, leading to the internal accumulation of Yang Qi and the internal depletion of Yin Blood. Treatment should focus on nourishing the Heart and Spleen to soothe stagnant Qi; replenishing Essence and Blood to moisten dryness. Fanwei (Regurgitation/Vomiting after a delay) occurs when there is no Yang in the Stomach to receive food, and the Fire of the Gate of Life (Mingmen) is deficient, failing to warm the Earth of the Spleen. Consequently, food entering the Stomach cannot be transformed, resulting in vomiting in the evening what was eaten in the morning, or in the morning what was eaten in the evening. Treatment should involve benefiting the source of Fire to eliminate Yin shadows; tonifying Earth to unblock Yang, thereby warming the Spleen and Stomach. Thus, Yige and Fanwei require distinct therapeutic principles. For cases where Yang Qi is knotted above and Yin fluids are deficient below causing Yige, use methods to unblock Yang and dissipate痞 (fullness), unblock and tonify the Stomach Fu, and employ variations of Huanglian Fuzi Xiexin Tang, treating upper heat and lower cold. For cases where Liver Yin and Stomach Juice are withered due to mental fatigue and hyperactive Yang, or where Lung and Stomach Jinye (fluids) are depleted, use Sour-Sweet to nourish Yin, and primarily moisten dryness. For cases where fluid deficiency causes Qi stagnation, or Yang deficiency leads to Blood stasis, use methods to regulate Qi and expel stasis, combined with unblocking blood collaterals. For cases of Stomach Yang deficiency and melancholy-phlegm obstruction, use methods to unblock and tonify the Stomach Fu, acrid-hot to open turbidity, bitter-descending and acrid-unblocking, assisted by promoting phlegm resolution and clearing obstruction. For cases caused by Liver depression and rebellious Qi, treat by simultaneously unblocking the Jueyin and Yangming meridians. For cases where wine-heat injures the Lung and Stomach, preventing Qi descent, use mild agents to clear and descend, and bitter-acrid-cold to open the Lung. ○This condition is often caused by Blood withering and Qi declining. Aromatic, drying, and astringent herbs are long prohibited. Although some cases in records imitate the use of acrid-hot herbs, it must be carefully examined whether it is due to minute Yang and turbid pathogen retention. Otherwise, either bitter-acrid to drain stagnation while combining with moistening, or sour-sweet to generate fluids while directly nourishing and clearing, or pushing up Grain Qi if depression is in the Qi level, or circulating turbidity if injury is in the Blood level. The general principle is to regulate transformation mechanisms and harmonize/moisten blood vessels. "Yang Qi knots above, Yin fluids decline below" is truly an accurate conclusion for this condition. (From *Linzheng Zhinan*)
Ancient formulas for treating Yige mostly used anti-emetic agents, failing to consider: Vomiting is a Dampness syndrome, suitable for drying agents; Yige is a Dryness syndrome, suitable for moistening agents. The *Classic* states: Knotting of the Three Yang meridians is called Ge (Obstruction). Knotting refers to accumulated heat; excessive heat causes objects to dry out. All Yige falls under the four characters "Stomach Guan withered and dry." If withered in the Upper Guan, water drinks can pass, but solid food enters with difficulty; if withered in the Lower Guan, food can enter but is vomited out later. Since the Stomach is already withered, administering drying drugs only increases the dryness. Therefore, Da Banxia Tang and Xiao Banxia Tang are prohibited in the category of Yige. I once used Qige San to open the obstruction, assisted by Sijunzi Tang to regulate the Spleen and Stomach, and Xiaoyao San for those with depression. However, even if the medicine is Xiaoyao (soothing), if the person is not at ease, it is of no benefit. Zhang Jifeng said: This is a disorder of the spirit and mind; the method should be introspection and quiet rest. This statement hits the pathology deeply. However, some cases involve parasites, blood, phlegm, or food retention, which must be treated concurrently according to their specific laws and cannot be ignored. (From *Yixue Xinwu*)
Throat and epiglottis closure, chest and diaphragm fullness, seem to belong to Qi stagnation; however, some are caused by excessive consumption of Qi-consuming drugs leading to failure of Middle Qi movement, requiring Qi tonification. Dry and hot stool, shaped like sheep dung, seems to belong to Blood heat; however, some are caused by excessive consumption of purgative drugs leading to Blood exhaustion, requiring Blood tonification. (Liu Zongnong)
Ancient formulas mostly treated Yige with hot agents, unaware that Yige certainly has no Cold syndrome. Some say Yige is due to Qi depression, so acrid-hot herbs are used to disperse it; yet they fail to realize that Qi depression stems from Qi deficiency, not excess. Since Qi is depressed due to deficiency, prolonged depression generates heat. Using acrid-hot drugs to consume Qi further depletes the deficient and intensifies the heat, offering no way for rescue! (Xu Chunfu)
The difficulty of this condition lies in: When intending to strengthen the Spleen and resolve phlegm, one fears drying agents will damage Jinye (fluids); when intending to nourish Blood and generate fluids, one fears moistening agents will obstruct the Middle Jiao (Spleen/Stomach). For Yin injury with fire flourishing, nourishing Blood is urgent; for Spleen injury with Yin excess, warming and tonifying comes first. In cases of deep sorrow and anger, fire depression and closure, where Spirit is not yet exhausted and Pulse is still forceful, one should use the methods of Cang Gong and He Jian to purge, allowing the obstruction to naturally open. (From *Yizong Bidu*)
Ancients pointed to Yige as Jinye withering, allowing water to pass, while dry solids are blocked, indicating withering in the Upper Jiao. I privately doubt this: if Jinye were truly withered, why does saliva surge immediately upon swallowing food? Thus, I know that the Qi facilitating communication between the diaphragm and throat fails to descend because of Chong Mai ascending and rebellious Qi acting. Only due to rebellious Qi does fluid fail to follow its normal downward-moistening course, rising with the Qi instead. Using descending-moistening drugs would only exacerbate rebellion. Six Junzi Tang with modifications is appropriate. ○Generally, Yige patients with obesity and phlegm-rebellion are treatable; those with withered fluids and decline are mostly untreatable. ○After initial recovery from Fanwei, porridge and drinks must strictly be avoided. Daily administration of Dushen Tang with a little fried aged rice, decocted and taken frequently, allows testing thin gruel only after ten days. Often, eating rice immediately leads to relapse and danger. (Zhang Luyu)
If Three Yang knotting is treated with moistening agents, it is acceptable if no saliva is vomited; if saliva surges and food cannot enter, moistening drugs cannot moisten the intestines but instead generate more fluid, accelerating death. If medication is desired, Six Junzi Tang is ultimately best. The Spleen likes dryness and dislikes dampness; if Stomach fluids do not circulate, how can the intestines be moistened? ○Stool like sheep dung indicates Three Yang knotting, treatment focuses on the Intestines. Loose stool with food sticking indicates treatment focuses on the Stomach. (Xu Xuanzhi)
Excessive drinking of hot wine often leads to Ge syndrome, known to moderns, but the underlying mechanism is not understood. Ge has two types: one is difficulty in receiving food in the Upper Guan; the other is difficulty in expelling food from the Lower Guan. The Stomach contains a mass of harmonious Qi. Thus, the Upper Guan has mostly clear Yang, feeling no heat; the Lower Guan has mostly turbid Yin, feeling no cold. Even in extreme summer heat, Stomach Qi does not become hot; in extreme winter cold, Stomach Qi does not become cold; Qi remains harmonious. It can receive food but not digest it, relying on Spleen Yang entering the Stomach to activate digestion, which is natural creation. Qu (ferment) nature rises vigorously. Daily boiling wine forces Lower Guan Qi to rise to Upper and Middle Guan, potentially closing the Youmen (pylorus). Hot wine entering the throat daily scorches the Upper Guan, creating a putrefied appearance, destroying vital Qi, narrowing the passage, allowing only water but not grain. This is why it often becomes Ge syndrome. (Yu Jiayan)
Meihe Ge (Plum-pit sensation in throat), feeling of an object in the throat, pain in the diaphragm, mostly due to fixed blood (stasis). Treatment suits Kelp, Angelica Sinensis, Peach Kernel, Leek Juice, and Child's Urine; severe cases add Rhubarb. Cases due to phlegm knotting suit Tidan Wan. *Yijian* states: obstruction in the throat, feeling of hindrance, unable to spit out or swallow down, due to Qi depression and phlegm knotting, precisely refers to this. However, this condition always involves tangible pathogens, either blood or phlegm. Qi is intangible, so it is clearly not Meihe Ge. (Shen Jin'ao)
Patients over sixty years old are difficult to treat. Stool like sheep dung is untreatable. Profuse vomiting of white foam is untreatable. Chest and abdominal burning pain like knife-cutting is fatal. Continuing sexual activity/alcohol and experiencing sorrow/anger is critical. (*Zhengzhi Huibu*)
Pulse Diagnosis
Blood deficiency: Left pulse is weak. Qi deficiency: Right pulse is weak. Phlegm condensation: Cun and Guan pulses are deep, slippery, and large. Qi stagnation: Cun and Guan pulses are deep, hidden, and choppy. Rebellious Fire Qi: Pulse is rapid and large. Blood stasis retention: Pulse is hollow and choppy. Small, weak, and choppy indicates Fanwei; tight, slippery, and革 (leather-like) indicates Yige. (*Zhengzhi Huibu*)
Selected Cases
Ni Qingyun suffered from Ge Qi, unable to eat a grain of rice, initially vomiting clear water, then green water, then black water, then foul-smelling water, breathing nearly ceased. I said: Within this day and night, first take six doses of Lizhong Tang. Tomorrow morning change the formula, one dose will fully recover. His family said: The illness is this severe, not even a drop of water can enter, how can he take six doses? If there is a miraculous formula, why not administer it immediately, insisting on Lizhong Tang first? I said: *Jinkui Yaolue* states: For patients with persistent belching, Xuanfu Daizhe Shi Tang is indicated. My reasoning for using different approaches here is twofold: First, black water is bottom-stomach water, foul water is intestinal water; since these waters are exiting, Stomach Jinye has been absent for a long time, so I dare not use Banxia to dry the Stomach. Second, the dying Qi retains only a thread; using Daizhe Shi to sink it might cause immediate severance. One must first use Lizhong Tang to differentiate and regulate Yin and Yang, making Qi easier to descend, so Daizhe Shi can take effect. After three doses, the patient said internal Qi slightly connected, but feared rushing, suggesting waiting until tomorrow. Next morning, I brought a cup of the previous medicine, urging him to drink; I said: I will change the formula immediately, effects will be instant, what else is there to say? So I used Xuanfu flower decoction alone, mixed with two spoonfuls of Daizhe Shi powder. As soon as the medicine entered his mouth, his Qi turned into the Dantian. The patient vomited again due to removing clothes and touching cold; giving the previous medicine stopped it immediately. Hungry, he ate six bowls of porridge, vomited again; giving the previous medicine stopped it immediately. Angry, he vomited again; giving the previous medicine stopped it immediately. Later, no more vomiting, only extreme fatigue. Took twenty doses of tonic medicine and one jin of pills, recuperated for two months before leaving the house, only then regretting taking only two fewer doses of Lizhong Tang initially. (Yu Jiayan)
Luo Jingsi suffered from Yige for three months, gradually unable to swallow even a drop of water, nearing death. Seeing his eyes still moving, I could not watch idly. Gave him one spoonful of prepared Yuanming Powder dissolved in water, waiting for it to moisten and descend, then another spoonful, continuing several spoonfuls. Sound in the throat, from Chen hour to Wei hour, consumed one cup. Abdomen rumbled, shortly after bowels and bladder opened. Tested with half a cup of rice drink, no vomiting, only felt heat and discomfort in chest and abdomen, harm from previously taking many warming and tonifying drugs. Gave two doses of Huanglian, Shengdi, Yuanshen, Huafen, Tiandong, Danpi, Gancao, Yinhua. Chest and abdomen relaxed, eating and drinking fine. Gradually regulated with Liuwei Dihuang Wan plus Danggui and Shaoyao, recovered. ○Xiang Weian, after resigning, occasionally experienced frustration, constipation and urinary retention, inability to swallow food. Physicians debated deficiency vs. excess, all ineffective. Palpating his Stomach pulse, deep, hidden, and excess, I said: Three Yang heat knotting, front and back blocked. Lower not unblocked, hence Yige and inability to eat. Should use He Jian's method, purge with Chengqi Tang. Doctors gaped. I said: Old Gentleman Xiang is important. If you have brilliant theories, why not take responsibility? They fell silent. Mr. Xiang said: Would Yang Shuzi poison people? I will take Dr. Hua Zhong's medicine. I happily administered it, and he fully recovered. ○Wang Zijiu suffered from Yige, no opening methods worked. I used one pear, cut into four wedges, inserted twelve grains of Ban Dou (Croton seed), wrapped in paper, mud-coated and roasted red. Removed Ban Dou, mashed pear into juice and drank. Shortly after, Qi moved, upper and lower expanded. Then gave a few fen of Baxian Cake powder mixed with rice drink, Qi gradually returned. Another dose of Huitian Yin, slowly more cake powder and rice drink. Two days later, allowed thin gruel, regulated for three months, cured. ○Liu Meixi initially suffered from Xiaoke (Wasting-Thirst), Di Huang Tang was effective; later developed Yige, switched to Qi-opening agents, both conditions severe. Vomit contained leftover food and phlegm-saliva, extreme hunger and thirst, unable to swallow anything, urine drops like paste, stool like sheep dung, six pulses absent. Thought Wasting-Thirst and Yige combined, water source dried up, why so much phlegm and waste vomited? Must be Heart and Spleen depression not smoothly expressed. Used Guipi Tang minus Baizhu and Muxiang, plus Zhuyu, Huanglian, Er Dong, Changpu. One dose stopped vomiting, pulse appeared. Changed to Huitian Yin, twenty doses cured. (Cheng Huazhong)
Zhang Wenzhong suffered from Fanwei, vomiting soup and porridge shortly after eating. Imperial physicians could not cure, exhausted and near death. Suddenly a guard said: Donkey urine is very effective. Took two he, vomiting stopped by half; took again, porriage settled. Next day reported to the palace, five or six people with this condition took it and recovered. This substance is slightly toxic, do not take too much, must drink hot. Deep illness shows effect in seven days. (*Benshi Fang*)
Zhu Yanzhen suffered from Wine Ge, vomiting and refusal to eat, drinking only one or two cups of hot wine daily, shortly after vomiting acidic bile, severe diaphragm pain, miscellaneous treatments for years ineffective. Caused by habitual drinking of hot wine. This is Danxi's description of hot wine drinkers having fixed blood remaining in the Stomach gate. Prescribed Renshen San: Ren Shen 1 liang, decocted, add She Xiang (Musk) 0.5 fen, Bing Pian (Borneol) 3厘. Three doses allowed eating. Borneol and Musk disperse phlegm and blood stasis in the Stomach gate. Changed to Baizi Ren Tang, peaceful in half a month. These two formulas come from Yunqi, rarely known. ○Qin Boyuan, Yige with vomiting, emaciated body and spirit, depressed mood. Student Zou Hengyou ordered using Woodpecker with Musk boiled into ointment, sniffed occasionally to open knots; internally took Xiaoyao San plus Chenpi and Sharen to disperse depression, several doses cured. Mr. Chen also cured Yige with this method. Another farmer suffered Yige, vomiting saliva like red bean water, belonging to internal blood stasis. Formula: Guiling Yin plus Danggui, Taoren, Danpi, Niuxi, mixed with Black Sugar and Scorpion paste, passed loose black stool like mud. Farmer injured by labor, blood depressed inside; attacking accumulated blood stopped vomiting. (*Zhangshi Yitong*)
Attached Formulas
Qige San: Universal formula for opening Yige, frequently effective. Shashen, Danshen, Fuling, Chuanbeimu, Chutoukuang, Yujin, Sharenqiao, Hetiedi.
Treating Ge Qi Opening Formula: Use one lychee pitted, one millipede. Sprinkle a few cents of Bing Pian on the millipede, wrap lychee meat, place in shell, tie with thread. Let patient hold in mouth, cold saliva渗出, swallow slowly; after some time millipede dissolves, spit out shell. One dose allows eating, do not let patient know, fearing disgust.
Another Formula: This condition due to intestinal dryness and Blood dryness, thus stool like sheep dung is untreatable. This formula best generates Blood and moistens intestines. Cow milk, Sheep milk, Human milk. Any amount, can be taken regularly.
Yuan Shuang: Use 1 jin of black lead, melt into thin cake, pierce hole in center, tie with string. Half jar of vinegar, suspend lead cake in vinegar, inch away from surface. Seal jar mouth with paper and leaves, press with bricks/stones, place in shade. After several days, take up, wipe frost from cake. Per 1 jin lead, obtain 2 liang frost. For Yige, take 5 fen, send down with plain water. For Phlegm-Fire cough, take 3 fen.
Secretly Transmitted Ge-Yige Paste: Effective as divine pill, requires calm mind, do not seek quick results. Human milk, Cow milk, Lugan juice, Renshen juice, Longyanrou juice, Zhe juice, Li juice, Jiang juice. Seven ingredients equal parts, except small amount of Jiang juice. Decoct over water into paste, add refined honey, take frequently and slowly.