王 左尺独大，肾液不充，肾阳不安其位，尺脉以大为虚，经所谓阴衰于下者是也。右
手三
部俱弦，食入则痛，经所谓阳结于上者是也。有阴衰而累及阳结者，有阳结而累及阴衰者。
此证形体长大，五官俱露，木火通明之象。凡木火太旺者，其阴必素虚，古所谓瘦人多火，
又所谓瘦人之病，虑虚其阴。凡噎症治法，必究阴衰阳结，何者为先，何者为后，何者为轻
，何者为重？此症既系阴虚为本，阳结为标，何得妄投大黄十剂之多？虽一时暂通阳结，其如
阴虚而愈虚，何业医者岂不知数下亡阴乎？且云歧子九法，大半皆攻，喻嘉言痛论其非，医
者
岂未之见耶？愚谓因怒停食，名之食膈，或可一时暂用，亦不得恃行数用，今议五汁饮果实
之甘寒，牛乳血肉之变化，降胃阴以和阳结治其标，大用专翕膏峻补肝肾之阴，以救阴衰治
其本，再能痛戒恼怒，善保太和，犹可望愈。
真大生地（四斤） 人参（四斤） 杭白芍（四斤） 清提麦冬（四斤） 阿胶（四斤） 蔡龟胶
（四
斤） 山萸肉（二斤） 鳖甲（四斤） 芡实（二斤） 沙苑蒺藜（四斤） 海参（四斤） 鲍鱼（四斤
）猪脊髓（一斤） 羊腰子（三十二对） 鸡子黄（六十四个） 云苓块（四斤） 乌骨鸡（一对）
牡蛎（四斤） 莲子（四斤） 桂圆肉（二斤） 白蜜（四斤）
取尽汁久火煎炼成膏。
李 五十四岁 大凡噎症由于半百之年，阴衰阳结，古来纷纷议论，各疏所长，俱未定
宗。大
抵偏于阳结而阴衰者，宜通阳气，如旋复代赭汤，进退黄连汤之类。偏于阴衰而阳结者，重
在阴衰，断不可见一毫香燥，如丹溪之论是也。又有食膈宜下，痰膈宜导，血膈宜通，络气
膈宜宣。肝呕吐太过而伤胃液者，宜牛转草复其液。老僧寡妇，强制太过，精气结而成骨，
横处幽门，宜鹅血以化之。厨役受秽浊之气伤肺，酒肉胜食而伤胃，宜化清气，不可胜数。
按∶此症脉沉数有力而渴，面色苍而兼红，甫过五旬，须发皆白，其为平日用心太过，重伤
其阴，而又伏火无疑。用玉女煎法。
真大熟地（六钱） 石膏（八钱） 牛膝（三钱） 炙甘草（三钱） 麦冬（六钱） 白粳米（
一撮） 知母（二钱） 旋复花（三钱，新绛纱包）
每早服牛乳一茶碗。
张 六十三岁 老年阳结，又因久饮怒郁，肝旺克土，气上阻咽，致成噎食。按∶阳气
不虚不结，断非破气可疗，议一面通补胃阳，一面镇守肝阴法。
洋参（二钱） 茯苓块（四钱） 桂枝（六钱） 代赭石（一两二钱， ） 半夏（一两） 旋复
花（五钱，包） 生姜（六钱）
七帖。
二十日 阳脉已起，恐过涸其液，议进阴药，退阳药。
洋参（四钱） 桂枝（三钱） 白芍（六钱，炒） 旋复花（六钱） 茯苓（三钱） 炙甘草（三
钱） 代赭石（一两， ） 半夏（六钱） 姜汁（每杯冲三小匙）
二十五日 前日脉数，因退阳进阴，今日脉缓而痰多，仍须进阳，俾中焦得运，以复其
健顺之体。
洋参（二钱） 桂枝（六钱） 焦白芍（三钱） 半夏（一两二钱） 茯苓（八钱） 代赭石（一
两六钱） 旋复花（六钱，包） 生姜（五大片）
二帖。
傅 五十五岁 先因酒楼中饮酒，食烧小猪响皮，甫下咽，即有家人报知朋友凶信，随
即下
楼寻车，车夫不知去向，因步行四五里，寻至其友救难未遇。又步行四里，又未遇。渴急饮
冰冻乌梅汤三碗，然后买车返家，心下隐隐微痛，一月后痛有加，延医调治，一年不效。次
年五月饮水一口，胃中痛如刀割，干饭不下咽，已月余矣。闰五月初八，计一粒不下已十日
，骨瘦如柴，面赤如赭，脉沉洪有力，胃中痛处，高起如桃大，按之更痛。余曰∶此食膈也
，当下之。因用大承气汤，加牵牛，作三碗，一碗痛至少腹，三碗痛至肛门，大痛不可忍，
又不得下。于是又作半剂，服一碗，外加蜜导法，始下如鸭蛋，黑而有毛，坚不可破。次日
先吃烂面半碗，又次日饮粥汤，三日食粥，五日吃干饭矣。下后所用者，五汁饮也。
杨 四十六岁 先因微有痰饮咳嗽，误补于前，误下于后，津液受伤，又因肝郁性急，
致成噎食，不食而大便燥，六脉弦数，治在阴衰。
炙甘草（三钱） 大生地（六钱） 生阿胶（三钱化） 丹皮（三钱） 麦冬（三钱） 麻仁（三
钱） 郁金（八分）
服七帖而效，又于前方加∶
鳖甲（四钱） 杞子（三钱） 服十七八帖而大效，进食如常。惟余痰饮，后以外台茯苓饮
散，减广皮、枳实，收全功。
王姓患者，左侧尺脉独大，这是肾阴液不足的表现，导致肾阳不能安守其位。尺脉以大为虚象，正如经典所说“阴衰于下”。右手三部脉均呈弦象，进食时感到疼痛，这正是经典所说的“阳结于上”。有因阴衰而累及阳结的，也有因阳结而累及阴衰的。此患者形体高大，五官显露，呈现木火通明的征象。凡是木火过旺的人，其阴气必然素来虚弱，古人所谓“瘦人多火”，又说“瘦人的疾病，要顾虑其阴气亏损”。凡治疗噎症（吞咽困难），必须探究是阴衰在先还是阳结在先，何者为轻，何者为重？此症既然以阴虚为本，阳结为标，怎么能妄用大黄多达十剂呢？虽然暂时通畅了阳结，但会使阴虚更加严重，难道医生不知道多次攻下会亡失阴液吗？况且《歧伯九法》中大多属于攻伐之法，喻嘉言曾痛斥其非，医生难道没有见过吗？我认为如果是因愤怒导致停食，名为食膈（饮食停滞之膈证），或许可以暂时使用，但也绝不能依赖频繁攻下。现在议定使用五汁饮和果实的甘寒之品，以及牛乳这类血肉有情之品，以降胃阴来调和阳结，治其标；重用专翕膏峻补肝肾之阴，以救阴衰，治其本。若能再戒除恼怒，善于保养太和之气，还望有望痊愈。
真大生地（四斤） 人参（四斤） 杭白芍（四斤） 清提麦冬（四斤） 阿胶（四斤） 蔡龟胶（四斤） 山萸肉（二斤） 鳖甲（四斤） 芡实（二斤） 沙苑蒺藜（四斤） 海参（四斤） 鲍鱼（四斤） 猪脊髓（一斤） 羊腰子（三十二对） 鸡子黄（六十四个） 云苓块（四斤） 乌骨鸡（一对） 牡蛎（四斤） 莲子（四斤） 桂圆肉（二斤） 白蜜（四斤）
取尽药汁，久火煎炼成膏。
李姓患者，五十四岁。大凡噎症发生于五十岁以后，多是阴衰阳结所致。古来对此纷纷议论，各抒己见，都未确立统一宗旨。大致偏于阳结而兼有阴衰者，宜通阳气，如旋复代赭汤、进退黄连汤之类。偏于阴衰而兼有阳结者，重点在于阴衰，绝对不可使用丝毫香燥药物，如丹溪的论述就是如此。又有食膈宜用下法，痰膈宜用导法，血膈宜用通法，络气膈宜用宣法。肝气呕吐太过而损伤胃液者，宜用牛转草（反刍）之理以恢复其津液。老僧寡妇，克制情欲太过，精气凝结而成骨，横亘在幽门处，宜用鹅血来化解它。厨役受秽浊之气伤肺，酒肉过量伤胃，宜化清气，此类情况不可胜数。
按：此症脉沉数有力且口渴，面色苍中带红，刚过五十岁，须发皆白，可知平日用心过度，重伤阴液，且有伏火无疑。采用玉女煎法。
真大熟地（六钱） 石膏（八钱） 牛膝（三钱） 炙甘草（三钱） 麦冬（六钱） 白粳米（一撮） 知母（二钱） 旋复花（三钱，新绛纱包）
每早服牛乳一茶碗。
张姓患者，六十三岁。老年阳气结滞，又因长期饮酒、愤怒抑郁，导致肝旺克脾土，气机上逆阻塞咽喉，致使形成噎食。按：阳气不虚则不结，绝非破气之法可疗，议定一面通补胃阳，一面镇守肝阴的方法。
洋参（二钱） 茯苓块（四钱） 桂枝（六钱） 代赭石（一两二钱，先煎） 半夏（一两） 旋复花（五钱，包煎） 生姜（六钱）
七帖。
二十日：阳脉已起，恐过度耗竭其津液，议进滋阴药，退温阳药。
洋参（四钱） 桂枝（三钱） 白芍（六钱，炒） 旋复花（六钱） 茯苓（三钱） 炙甘草（三钱） 代赭石（一两，先煎） 半夏（六钱） 姜汁（每杯冲入三小匙）
二十五日：前日脉数，因退阳进阴，今日脉缓而痰多，仍须进温阳药，使中焦得以运化，以恢复其健顺之体。
洋参（二钱） 桂枝（六钱） 焦白芍（三钱） 半夏（一两二钱） 茯苓（八钱） 代赭石（一两六钱，先煎） 旋复花（六钱，包煎） 生姜（五大片）
二帖。
傅姓患者，五十五岁。先前因为在酒楼饮酒，吃烧小猪响皮，刚咽下，就有家人报知朋友凶信，随即下楼寻车，车夫不知去向，于是步行四五里，寻至其友家救难未果。又步行四里，也未遇到。口渴急饮冰冻乌梅汤三碗，然后买车回家，心下隐隐微痛，一个月后疼痛加剧，延医调治，一年无效。次年五月，饮水一口，胃中痛如刀割，干饭无法咽下，已月余矣。闰五月初八，计算一粒食物不下已达十日，骨瘦如柴，面赤如赭石，脉沉洪有力，胃中痛处，高起如桃子大小，按压更痛。我说：这是食膈（饮食停滞之膈证），应当用下法。于是用大承气汤，加牵牛子，作三碗药，一碗服下后痛至少腹，三碗服下后痛至肛门，大痛不可忍受，却又不得大便。于是又做半剂，服下一碗，外加蜜导法，才排出如鸭蛋大小的粪便，黑色且有毛，坚硬不可打破。次日先吃烂面半碗，又次日饮粥汤，三日食粥，五日吃干饭了。下法之后所用的是五汁饮。
杨姓患者，四十六岁。先前因为微有痰饮咳嗽，之前误补，之后误下，导致津液受伤，又因肝郁性急，致使形成噎食，不进食而大便干燥，六脉弦数，治疗关键在于阴衰。
炙甘草（三钱） 大生地（六钱） 生阿胶（三钱，烊化） 丹皮（三钱） 麦冬（三钱） 麻仁（三钱） 郁金（八分）
服七帖见效，又在前方基础上加：
Wang, Left side. The left Chi pulse alone is large, indicating that the Kidney Yin fluids are insufficient, causing the Kidney Yang to be unsettled in its position. A large Chi pulse signifies deficiency; as the Classics state, "Yin declines below." The three positions of the right hand all present a Wiry (Xian) pulse, and pain occurs upon swallowing, which corresponds to the Classic's description of "Yang knotting above." There are cases where Yin decline affects Yang knotting, and cases where Yang knotting affects Yin decline. This patient has a tall stature with prominent facial features, presenting the image of Wood and Fire being bright. Whenever Wood and Fire are excessively vigorous, the Yin must have been deficient since early times; as the ancients said, "Thin people often have fire," and again, "In diseases of thin people, one must worry about Yin deficiency." In treating Yige (Dysphagia), one must investigate whether Yin decline or Yang knotting comes first, which is light and which is heavy. Since this case takes Yin deficiency as the root and Yang knotting as the branch, how can one recklessly administer Rhubarb (Dahuang) for ten doses? Although it temporarily unblocks the Yang knotting, it makes the Yin deficiency even more severe. Does the physician not know that frequent purging destroys Yin? Moreover, the Nine Methods of Qizi are mostly attacking methods, and Yu Jiayan severely criticized them. Has the physician not seen this? I believe that if food stagnation is caused by anger, named Shige (Food Obstruction), it might be used temporarily, but one must not rely on frequent purging. Now, I propose using Wu Zhi Yin (Five Juice Drink) and the sweet-cold nature of fruits, along with Niu Nai (Cow's Milk), a substance of blood and flesh, to descend Stomach Yin and harmonize the Yang knotting to treat the branch. Use Zhuan Xi Gao (Special Absorption Paste) heavily to tonify the Liver and Kidney Yin vigorously to save the Yin decline and treat the root. If one can also strictly avoid anger and carefully preserve Taihe (Great Harmony), there is still hope for recovery.
True Large Sheng Di Huang (Rehmanniae Radix, 4 jin) Ren Shen (Ginseng Radix et Rhizoma, 4 jin) Hang Bai Shao (Paeoniae Radix Alba, 4 jin) Qing Ti Mai Dong (Ophiopogonis Radix, 4 jin) E Jiao (Colla Corii Asini, 4 jin) Cai Gui Jiao (Colla Testudinis, 4 jin) Shan Yu Rou (Corni Fructus, 2 jin) Bie Jia (Carapax et Plastrum Testudinis, 4 jin) Qian Shi (Euryales Semen, 2 jin) Sha Yuan Ji Li (Astragali Complanati Semen, 4 jin) Hai Shen (Holothuria, 4 jin) Bao Yu (Abalone, 4 jin) Zhu Ji Sui (Porcine Medulla Spinalis, 1 jin) Yang Yao Zi (Ovis Cervix, 32 pairs) Ji Zi Huang (Ovi Ovum Vitellus, 64 pieces) Yun Ling Kuai (Poria, 4 jin) Wu Gu Ji (Gallus Gallus Domesticus Var. nigricans, 1 pair) Mu Li (Concha Ostreae, 4 jin) Lian Zi (Nelumbinis Semen, 4 jin) Gui Yuan Rou (Longan Arillus, 2 jin) Bai Mi (Mellis, 4 jin)
Extract all juices and decoct over long fire until it becomes a paste.
Li, 54 years old. Generally, Yige occurring after fifty years of age is due to Yin decline and Yang knotting. Since ancient times, there have been many discussions, each advocating their own strengths, yet no unified doctrine has been established. Roughly, those biased towards Yang knotting with some Yin decline should use methods to unblock Yang Qi, such as Xuan Fu Dai Zhe Tang (Inula and Hematite Decoction) or Tui Jin Huang Lian Tang (Advance-Retreat Coptis Decoction). Those biased towards Yin decline with some Yang knotting focus heavily on Yin decline; absolutely do not use any aromatic-dry substances, as discussed by Danxi. Furthermore, Shige (Food Obstruction) should be treated with purging, Tan Ge (Phlegm Obstruction) with guiding, Xue Ge (Blood Obstruction) with promoting circulation, and Luo Qi Ge (Collateral-Qi Obstruction) with diffusing. When Liver Qi vomiting is excessive and damages Stomach fluids, one should use the principle of ruminating cattle to restore fluids. For old monks and widows who suppress desires too much, essence and Qi condense into bone, obstructing the幽门 (Pylorus); Goose Blood should be used to resolve it. Cooks injured by foul air affecting the Lung, and by excessive wine and meat injuring the Stomach, should use methods to transform clear Qi; such cases are countless.
Note: This patient's pulse is deep, rapid, and forceful, with thirst. The complexion is pale yet reddish. Having just passed fifty, with white hair and beard, it is evident that mental exertion was excessive, severely damaging Yin, and latent Fire is undoubtedly present. Use the method of Yu Nu Jian (Jade Woman Decoction).
True Large Shu Di Huang (Prepared Rehmanniae Radix, 6 qian) Shi Gao (Gypsum Fibrosum, 8 qian) Niu Xi (Achyranthis Bidentatae Radix, 3 qian) Zhi Gan Cao (Prepared Glycyrrhizae Radix et Rhizoma, 3 qian) Mai Dong (Ophiopogonis Radix, 6 qian) Bai Jing Mi (Oryza Sativa, a pinch) Zhi Mu (Anemarrhenae Rhizoma, 2 qian) Xuan Fu Hua (Inulae Flos, 3 qian, wrapped in Xin Jiang Sha)
Take one tea bowl of Cow's Milk every morning.
Zhang, 63 years old. Elderly Yang knotting, further complicated by long-term drinking, anger, and depression, leading to Liver excess overcoming Spleen/Earth, with Qi blocking upward at the throat, resulting in Yishi (Dysphagia). Note: Yang does not knot unless it is deficient; breaking Qi methods are definitely not curative. Propose a method of simultaneously tonifying and unblocking Stomach Yang while stabilizing Liver Yin.
Yang Shen (American Ginseng Radix, 2 qian) Fu Ling Kuai (Poria, 4 qian) Gui Zhi (Cinnamomi Ramulus, 6 qian) Dai Zhe Shi (Limonitum, 1 liang 2 qian, decocted first) Ban Xia (Pinelliae Rhizoma, 1 liang) Xuan Fu Hua (Inulae Flos, 5 qian, wrapped) Sheng Jiang (Zingiberis Rhizoma Recens, 6 qian)
Seven doses.
20th Day: The Yang pulse has risen. Fear of exhausting fluids further, propose advancing Yin-nourishing herbs and retreating Yang-warming herbs.
Yang Shen (American Ginseng Radix, 4 qian) Gui Zhi (Cinnamomi Ramulus, 3 qian) Bai Shao (Paeoniae Radix Alba, 6 qian, stir-fried) Xuan Fu Hua (Inulae Flos, 6 qian) Fu Ling (Poria, 3 qian) Zhi Gan Cao (Prepared Glycyrrhizae Radix et Rhizoma, 3 qian) Dai Zhe Shi (Limonitum, 1 liang, decocted first) Ban Xia (Pinelliae Rhizoma, 6 qian) Jiang Zhi (Zingiberis Rhizoma Recens Juice, 3 small spoons per cup)
25th Day: The previous day the pulse was rapid. Due to retreating Yang and advancing Yin, today the pulse is slow with much phlegm. Still need to advance Yang herbs so that the Middle Jiao can transport, restoring its healthy and smooth function.
Yang Shen (American Ginseng Radix, 2 qian) Gui Zhi (Cinnamomi Ramulus, 6 qian) Jiao Bai Shao (Paeoniae Radix Alba, 3 qian, charred) Ban Xia (Pinelliae Rhizoma, 1 liang 2 qian) Fu Ling (Poria, 8 qian) Dai Zhe Shi (Limonitum, 1 liang 6 qian, decocted first) Xuan Fu Hua (Inulae Flos, 6 qian, wrapped) Sheng Jiang (Zingiberis Rhizoma Recens, 5 large slices)
Two doses.
Fu, 55 years old. Previously, after drinking at a restaurant and eating roasted pork skin, immediately upon swallowing, family informed him of a friend's death. He went downstairs to find a cart, but the driver was missing, so he walked 4-5 li to his friend's house to help but failed. Walked another 4 li, still unsuccessful. Thirsty, he drank three bowls of iced Plum Soup, then bought a cart to return home. His epigastrium had a dull, slight pain. After one month, the pain increased. Medical treatment lasted one year without effect. In May of the next year, after drinking one mouthful of water, stomach pain felt like knife-cutting; dry rice could not be swallowed. It had been over a month. On the 8th day of the leap fifth month, he had not taken a single grain of food for ten days. Emaciated, face red like ochre, pulse deep, surging, and forceful. The painful area in the stomach protruded like a peach, more painful upon pressure. I said: This is Shige (Food Obstruction), it must be purged. Therefore, I used Da Cheng Qi Tang (Major Order the Qi Decoction) plus Qian Niu Zi (Semen Pharbitidis), made into three bowls. After one bowl, pain reached the lower abdomen; after three bowls, pain reached the anus. Severe pain was unbearable, yet no stool passed. So, half a dose was prepared again; after taking one bowl, combined with Honey Suppository method, stool resembling a duck egg, black and hairy, hard and unbreakable, was finally passed. The next day, half a bowl of soft noodles were eaten; the following day, rice soup was drunk; on the third day, rice porridge was eaten; on the fifth day, dry rice was eaten. After purging, Wu Zhi Yin (Five Juice Drink) was used.
Yang, 46 years old. Previously, due to slight Phlegm-Fluid cough, mistaken tonification earlier, and mistaken purging later, damaged the Jin-Ye (Body Fluids). Further, due to Liver depression and irritability, Yishi (Dysphagia) formed. Not eating leads to dry stools. All six pulses are Wiry and Rapid. Treatment focuses on Yin decline.
Zhi Gan Cao (Prepared Glycyrrhizae Radix et Rhizoma, 3 qian) Da Sheng Di Huang (Raw Rehmanniae Radix, 6 qian) Sheng E Jiao (Raw Colla Corii Asini, 3 qian, melted) Dan Pi (Moutan Cortex, 3 qian) Mai Dong (Ophiopogonis Radix, 3 qian) Ma Ren (Cannabis Seed, 3 qian) Yu Jin (Curcumae Radix, 8 fen)
After seven doses, efficacy was seen. Added to the previous formula:
Bie Jia (Carapax et Plastrum Testudinis, 4 qian) Qi Zi (Lycii Fructus, 3 qian)
After seventeen to eighteen doses, great efficacy was achieved, and eating returned to normal. Only residual Phlegm-Fluid remained. Later, Waitai Fu Ling Yin San (External Platform Poria Drink Powder) was used, removing Guang Pi (Tangerine Peel) and Zhi Shi (Immature Bitter Orange), completing the cure.