反胃一证，《金匮》无 条。但于呕吐篇中，发奥义四段。其脉其证，皆主阳气衰微立说，但隐而不露，今特发明，
导入中寒门后，以见人身阳气所关之重。又见胸中阳气，与肾中真阳，差等不同，而治寒病之机，了然心目矣。
问曰∶病患脉数，数为热，当消谷引饮；而反吐者，何也？师曰∶以发其汗，令阳微膈气虚，脉乃数；数为客热，
不能消谷，胃中虚冷故也。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。
此条仲景形容脉证之变态，最为微妙。凡脉阳盛则数，阴盛则迟。其人阳气既微，何得脉反数？脉既数，何得胃反
冷？此不可不求其故也。盖脉之数，由于误用辛温发散，而遗其客热。胃之冷，由于阳气不足，而生其内寒。医不达权
通变，见其脉数，反以寒剂泻其无过，致上下之阳俱损，其脉遂从阴而变为弦。上之阳不足，日中已前所食，亦不消化。
下之阳不足，日暮已后，阳亦不入于阴，而糟粕不输于大小肠。从口入者，惟有从口出而已，故曰胃气无余。言胃中之
阳气，所存无几，所以反胃，而朝食暮吐也。
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。
此条颛论脉理，虽不言证，隐纬上条反胃之证，不重举耳。人身之脉，阳法天而健，阴法地而翕，两相和合，不刚
不柔，不疾不徐，冲和纯粹，何病之有哉？今微则阳不健运，数则阴不静翕，阴阳两乖其度，荣卫不充而胸中冷，又不
啻上条客热已也。夫荣卫之气，出入脏腑，流布经络，本生于谷，复消磨其谷，是荣卫非谷不充，谷非荣卫不化，胸中
既冷，胃必不能出纳其谷，证成反胃。又何疑乎？
趺阳脉浮而涩，浮则为虚，涩则伤脾；脾伤则不磨食，朝食暮吐，暮食朝吐，宿谷不化，名曰胃反。脉紧而涩，其
病难治。
脾气运动，则脉不涩；胃气坚固，则脉不浮。今脉浮是胃气虚，不能腐熟水谷；脉涩是脾血伤，不能消磨水谷。所
以阳时食入，阴时反出；阴时食入，阳时反出。盖两虚不相参合，故莫由转输下入大小肠也。河间谓趺阳脉紧，内燥盛
而湿气衰。故为难治。可见浮脉病成必变紧脉也，况紧而见涩，其血已亡乎？上脘亡血，膈间干涩，食不得入；下脘亡
血，必并大小肠皆枯，食不得下，故难治也。
呕而脉弱，小便复利，身有微热，见厥者难治，四逆汤主之。（十五）
呕则谷气不资于脉，故脉弱，弱则阳气虚不能充于内外。下焦虚，则小便冷自利；上焦虚，则浊气升上，逼迫其阳
于外。外虽假热，内实真寒，证成厥逆，所出之阳，顷刻决离而不返矣，治之诚难也。惟四逆一汤，胜阴回阳，差有可
用耳。呕证而兼厥逆下利，乃阴寒之极。阳气衰微，可知反胃之呕，乃关格之呕。阴阳两病，殊不与下利厥逆相杂。不
知《金匮》缘何重录《伤寒论》中厥阴证一条，入在反胃一门，岂其误以呕与反胃为同证耶？医学之不明，自昔已
然，可慨也已。兹并辨明，以见胸中之阳，与肾中之阳大不同也。胸中之阳，如天之有日，其关系荣卫纳谷之道，最为
扼要，前三条所云是也。盖胸中下连脾胃，其阳气虚者，阴血亦必虚，但宜用冲和之剂，以平调脏腑，安养荣卫，舍纯
粹以精之药不可用也。肾中之阳，如断鳌立极，其关系命根存亡之机，尤为宏巨，后一条所云是也。盖肾中内藏真阳，
其阳外亡者，阴气必极盛。惟从事刚猛之剂，以摧锋陷阵，胜阴复阳，非单刀直入之法，不可行也。如是而读此四章，
庶几用法之权衡，因误编而愈益明矣。
反胃这一病证，《金匮要略》中没有专门的条文。但在呕吐篇中，阐发了四个深奥的道理。其脉象和症状，都是基于阳气衰微立论的，只是含蓄不露，现在特意加以阐明，将其归入中寒门之后，以显示人身阳气的重要性。同时也看出胸中的阳气与肾中的真阳，性质不同，而治疗寒病的机理，便在心目中清晰明了了。
问：病人脉数，数脉主热，应当消谷善饥、多饮；反而呕吐，这是为什么？老师说：因为发汗过度，导致阳气微弱、膈气虚，脉才表现为数；这种数是客热（外来的或暂时的热邪），不能消化食物，是因为胃中虚冷所致。脉弦的，是虚证，胃气没有余留，早晨吃晚上吐，变为胃反；寒邪在上焦，医生反而用攻下法，使脉变成弦，所以名叫虚。
这条条文张仲景形容脉证的变态，最为微妙。凡是脉阳盛则数，阴盛则迟。这个人阳气既然微弱，为什么脉反而数？脉既然数，为什么会有胃反冷？这不可不求其原因。大概脉数，是由于误用辛温发散药，而遗留了客热。胃冷，是由于阳气不足，而生内寒。医生不懂权变通融，见其脉数，反而用寒凉药泻其无过之热，导致上下阳气都受损，脉遂从阴变为弦。上焦阳不足，中午以前吃的食物，也不能消化。下焦阳不足，傍晚以后，阳气也不入于阴，而糟粕不能输送到大肠小肠。从口进入的食物，只有从口吐出而已，所以说胃气无余。意思是胃中的阳气，所存无几，所以反胃，朝食暮吐。
寸口脉微而数，微则无气，无气则营血虚，营血虚则血不足，血不足则胸中冷。
这条条专门论述脉理，虽然不说症状，但隐含了上一条反胃的症状，只是不再重复列举罢了。人身的脉，阳法天而健运，阴法地而收敛，两者和谐配合，不刚不柔，不快不慢，冲和纯粹，有什么病呢？现在脉微则阳不健运，脉数则阴不静敛，阴阳两乖其度，营卫不充而胸中冷，又不止是上一条的客热了。夫营卫之气，出入脏腑，流布经络，本生于水谷，又消磨水谷，是营卫非水谷不充，水谷非营卫不化，胸中既冷，胃必不能纳食出食，证成反胃。又有什么可怀疑的呢？
趺阳脉浮而涩，浮则为虚，涩则伤脾；脾伤则不磨食，朝食暮吐，暮食朝吐，宿谷不化，名曰胃反。脉紧而涩，其病难治。
脾气运动，则脉不涩；胃气坚固，则脉不浮。现在脉浮是胃气虚，不能腐熟水谷；脉涩是脾血伤，不能消磨水谷。所以在阳时食入，在阴时反出；在阴时食入，在阳时反出。大概两虚不相参合，所以无法转输下入大肠小肠。河间认为趺阳脉紧，内燥盛而湿气衰。所以为难治。可见浮脉病成必变紧脉也，何况紧而见涩，其血已亡乎？上脘亡血，膈间干涩，食不得入；下脘亡血，必并大小肠皆枯，食不得下，故难治也。
呕而脉弱，小便复利，身有微热，见厥者难治，四逆汤主之。（十五）
呕则谷气不资于脉，故脉弱，弱则阳气虚不能充于内外。下焦虚，则小便冷自利；上焦虚，则浊气升上，逼迫其阳于外。外虽假热，内实真寒，证成厥逆，所出之阳，顷刻决离而不返矣，治之诚难也。惟四逆一汤，胜阴回阳，差有可用耳。呕证而兼厥逆下利，乃阴寒之极。阳气衰微，可知反胃之呕，乃关格之呕。阴阳两病，殊不与下利厥逆相杂。不知《金匮》缘何重录《伤寒论》中厥阴证一条，入在反胃一门，岂其误以呕与反胃为同证耶？医学之不明，自昔已然，可慨也已。兹并辨明，以见胸中之阳，与肾中之阳大不同也。胸中之阳，如天之有日，其关系荣卫纳谷之道，最为扼要，前三条所云是也。盖胸中下连脾胃，其阳气虚者，阴血亦必虚，但宜用冲和之剂，以平调脏腑，安养荣卫，舍纯粹以精之药不可用也。肾中之阳，如断鳌立极，其关系命根存亡之机，尤为宏巨，后一条所云是也。盖肾中内藏真阳，其阳外亡者，阴气必极盛。惟从事刚猛之剂，以摧锋陷阵，胜阴复阳，非单刀直入之法，不可行也。如是而读此四章，庶几用法之权衡，因误编而愈益明矣。
The syndrome of Fanwei (Regurgitation) is not explicitly detailed in the *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet). However, four profound principles are expounded in the chapter on Vomiting. Both its pulse and symptoms are based on the theory of declining Yang Qi (Vital Energy), yet these are presented implicitly. Here, they are specifically elucidated and placed after the section on Middle Jiao Cold to highlight the critical importance of Yang Qi in the human body. It also demonstrates that the Yang Qi in the chest differs from the True Yang in the Kidneys, making the mechanism for treating cold diseases clear in mind and eye.
Question: The patient has a rapid pulse. A rapid pulse indicates Heat, which should lead to efficient digestion of food and increased thirst; why does regurgitation occur instead? The Master said: This is due to excessive sweating, which caused Yang Qi to become weak and Diaphragm Qi to be deficient, resulting in a rapid pulse. This rapidness represents Guest Heat (transient or external heat), which cannot digest food, because the Stomach is deficient and cold. A wiry pulse indicates deficiency; there is no surplus of Stomach Qi. Food eaten in the morning is vomited in the evening, transforming into Weifan (Stomantic Regurgitation). Cold is located in the Upper Jiao, but the physician incorrectly used purgatives, causing the pulse to become wiry; thus it is named "Deficiency."
This passage by Zhang Zhongjing describes the variations of pulses and symptoms with utmost subtlety. Generally, an excess of Yang results in a rapid pulse, while an excess of Yin results in a slow pulse. If a person's Yang Qi is already weak, how can the pulse be rapid? If the pulse is rapid, how can there be stomach cold and regurgitation? One must seek the cause. The rapidity of the pulse stems from the misuse of acrid-warm dispersing agents, leaving behind Guest Heat. The coldness of the stomach stems from insufficient Yang Qi generating internal cold. The physician, failing to understand flexibility and adaptation, seeing the rapid pulse, wrongly used cold medicines to purge non-existent heat, damaging both upper and lower Yang. Consequently, the pulse changed from Yin characteristics to a wiry quality. Insufficiency of Yang in the Upper Jiao means food consumed before noon cannot be digested. Insufficiency of Yang in the Lower Jiao means that after dusk, Yang does not enter Yin, and waste products are not transported to the Large and Small Intestines. What enters the mouth only exits through the mouth; hence, it is said that Stomach Qi has no surplus. This means the Yang Qi within the Stomach is barely preserved, leading to Fanwei, where food eaten in the morning is vomited in the evening.
At the Cun Kou (Radial Artery at the wrist), the pulse is faint and rapid. Faint indicates lack of Qi; lack of Qi leads to Ying Deficiency (Nutritive Qi Deficiency); Ying Deficiency leads to Blood insufficiency; Blood insufficiency leads to coldness in the Chest.
This clause focuses solely on pulse theory. Although it does not explicitly state symptoms, it implicitly contains the symptoms of Fanwei mentioned in the previous clause, merely omitting repetition. The pulses of the human body: Yang follows Heaven and moves vigorously; Yin follows Earth and gathers/contracts. When harmonized, they are neither rigid nor soft, neither fast nor slow, possessing a balanced purity. How could disease exist? Now, a faint pulse indicates Yang fails to move vigorously; a rapid pulse indicates Yin fails to gather quietly. Both Yin and Yang deviate from their proper degrees, Ying and Wei (Defensive Qi) are insufficient, leading to coldness in the chest. This is worse than the Guest Heat mentioned in the previous clause. The Qi of Ying and Wei enters and exits the Zang-Fu organs and flows through the meridians. They originate from Grain (food) and help metabolize it. Thus, Ying and Wei require Grain to be sufficient, and Grain requires Ying and Wei to be transformed. Since the chest is cold, the Stomach certainly cannot receive and discharge grain, forming the syndrome of Fanwei. Is there any doubt?
At the Zu Yang (Dorsalis Pedis Artery), the pulse is floating and choppy. Floating indicates deficiency; choppy indicates Spleen injury. When the Spleen is injured, it cannot grind food. Food eaten in the morning is vomited in the evening, and food eaten in the evening is vomited in the morning. Undigested old grain remains, named Weifan. If the pulse is tight and choppy, the disease is difficult to treat.
When Spleen Qi moves, the pulse is not choppy; when Stomach Qi is firm, the pulse is not floating. Currently, a floating pulse indicates Stomach Qi deficiency, unable to rot and ripen water and grain; a choppy pulse indicates Spleen Blood injury, unable to digest and break down water and grain. Therefore, food entering during Yang hours is expelled during Yin hours; food entering during Yin hours is expelled during Yang hours. Because two deficiencies do not interact, there is no way to transport downward into the Large and Small Intestines. He Jian believed that a tight Zu Yang pulse indicates abundant internal dryness and deficient dampness. Hence, it is difficult to treat. It can be seen that a floating pulse, once the disease forms, must change to a tight pulse. Moreover, if tightness appears with choppy texture, Blood has been lost. If Blood is lost in the Shang Wan (Upper Orifice), dryness and chappedness in the diaphragm prevent food entry; if Blood is lost in the Xia Wan (Lower Orifice), the Large and Small Intestines will also wither, preventing food descent; thus, it is difficult to treat.
Vomiting accompanied by a weak pulse, free urination, slight fever, and appearance of Jue (Cold Extremities) is difficult to treat; Si Ni Tang (Frigid Extremities Decoction) should be administered. (15)
Vomiting prevents Grain Qi from nourishing the pulse, hence the pulse is weak. Weakness indicates Yang Qi deficiency, unable to fill the interior and exterior. Lower Jiao deficiency causes cold urine and spontaneous flow; Upper Jiao deficiency causes turbid Qi to rise, forcing Yang outward. Although there is apparent heat externally, internally there is true cold. The syndrome becomes Jue Ni (Reversal Cold), and the outgoing Yang separates instantly and does not return; treatment is indeed difficult. Only Si Ni Tang can overcome Yin and restore Yang, offering some hope. Vomiting combined with Jue Ni and diarrhea represents extreme Yin-Cold. Yang Qi decline is evident. It can be known that vomiting in Fanwei is actually Guan Ge (Obstruction and Reversal) vomiting. Yin and Yang pathologies are distinctly different from diarrhea and Jue Ni. It is unclear why the *Jingui Yaolue* re-recorded a Jue Yin Syndrome clause from the *Shanghan Lun* and placed it in the Fanwei category. Did it mistakenly consider vomiting and Fanwei as the same syndrome? The obscurity of medicine has existed since ancient times, which is lamentable. Here, distinctions are clarified to show that the Yang Qi in the chest is vastly different from the Yang Qi in the Kidneys. The Yang Qi in the chest is like the sun in the sky; its relationship to the pathways of Ying, Wei, and grain intake is most crucial, as stated in the first three clauses. The chest connects downward to the Spleen and Stomach; if Yang Qi is deficient, Yin Blood must also be deficient. One should only use mild and harmonizing formulas to balance the Zang-Fu and nourish Ying and Wei. Medicines that are purely pure and refined should not be used. The Yang Qi in the Kidneys is like cutting a turtle shell to establish the foundation; its relationship to the life root and survival is particularly grand, as stated in the last clause. The Kidneys store True Yang internally; if this Yang escapes outward, Yin Qi must be extremely abundant. Only fierce and potent medicines can charge forward, overcome Yin, and restore Yang. Without a direct approach, this method cannot be executed. Reading these four chapters in this manner, one may understand the weighing of therapeutic methods, becoming even clearer despite the erroneous compilation.