膈证乃七情所伤，郁结不舒而成，最难调理，因失意之由，非药石所能治也。盖思则气
结则脾不运而胃亦不生发，胃不生发，则肺失所养，肺与大肠为表里，肺无养则大肠不行，
大肠与胃皆属阳明，为出入相应之腑，大肠不出，则胃亦不纳，不出不纳，则两阳明真气不
行，下焦虚寒矣，中焦元气不到，致后天之胃气不行，浊火填塞胸中而否隔矣。用补肾起脾
之味，如山药、小茴、磁石、归身、白芍、甘草、生地、北五味之属调之，或可小安。然必
意气欣乐，神思爽达，则真气生而可愈。
膈证有气膈，血膈、痰膈之别。气膈开关，用乌药、小茴；血膈用当归、桃仁、乌药、
沉香；痰膈用半夏、附子。可医者理脾温肺，如劳役甚者，补中益气汤加附子、制乌药一分。大
便如羊屎者，阳陷于阴分而阳气将绝也，亦用补中益气汤以提之。气膈随吃随吐，或食未几
即变痰涎而出，火在胃中而丹田真火不足也。丹田之火为少火，火在下化谷为气、少火生气
也；火在胃为邪火，邪火传速，故煎熬水谷而成痰。盖火在丹田，
乃能生土，腐熟水谷，变化气血；若火在胃中则丹田寒，火乘土位则不
杀谷，或吐或成痰。补骨脂、沉香能降火，小茴通真气，乌药理浊气，芡实入肾，人参入肺
。血膈时吐时止，胸前作痛，且连背心，血积胸中，气行则血行，宜用气药，枳壳、沉香、
芎、归，行气导血。痰膈，痰涎稠粘，痰积胸中，宜用痰药，二陈汤、槟榔、枳壳顺气降痰
。前药俱加生姜。膈气中焦无火，惟热在上焦，不用小茴温暖，安能开其胸膈？
验案
一人饮食能进，遇子时则吐泻。盖其人必苦忧思，思则脾气郁结，不能散精于肺，下输
膀胱
，故津液直入大肠而泻也。吐者脾不健运，不能传化幽门，宿食积于胃中，子时阳升冲动陈
垢，故吐也。宜扶脾为主，用人参、茯苓、山药各一钱，炙甘草五分，附子、制乌药三分，
一人年五十五，胸前微痛，无休息时，六脉俱无胃气，惟脾脉略缓。盖胸中受气于丹田
，时时心下微痛，乃丹田阳气不到胸也，膈气无疑。脾脉微缓，调理脾胃，犹可迁延。保元汤加
一女喉间常起噎鲠，饮食难消，舌上干燥，胸前痛如有所伤，两腿无力，面上肉紧六年
矣。方用六味汤加白芷、细辛各八分。
膈证是由于七情（喜、怒、忧、思、悲、恐、惊）受到损伤，气机郁结不舒展而形成的，最难调理。因为这是由于失意引起的，不是单纯依靠药物所能治愈的。大概思虑过度会导致气机结滞，脾脏不能运化，胃气也不能生发；胃气不生发，肺脏就失去滋养；肺与大肠互为表里，肺脏得不到滋养则大肠传导功能失常；大肠与胃都属于阳明经，是出入相应的腑，大肠不能排出糟粕，胃也就不能受纳食物；既不能排出又不能受纳，那么两阳明经的真气就不能运行，导致下焦虚寒；中焦元气无法到达，致使后天之本的胃气停滞，浊气和火邪填塞胸中，从而形成痞塞阻隔之证。使用能够补肾并提升脾气的药物，如山药、小茴香、磁石、当归身、白芍、甘草、生地黄、北五味子等来调治，或许可以稍微缓解。然而必须心情愉悦，神思清爽通达，这样真气才能生发，疾病才可痊愈。
膈证有气膈、血膈、痰膈的区别。对于气膈，宜用乌药、小茴香以开通气机；对于血膈，用当归、桃仁、乌药、沉香；对于痰膈，用半夏、附子。病情尚可治疗者，应调理脾胃、温养肺脏，如果是劳役过度严重者，可用补中益气汤加入附子、制乌药一分。大便像羊屎一样干结的，是阳气陷入阴分且阳气即将衰竭的表现，也使用补中益气汤来提升阳气。气膈表现为随吃随吐，或者进食不久即变为痰涎吐出，这是火在胃中而丹田真火不足所致。丹田之火称为少火，火在下焦能腐熟水谷化为气，即“少火生气”；火在胃中则为邪火，邪火传变迅速，所以煎熬水谷而成痰。如果火在丹田，就能生助脾土，腐熟水谷，变化气血；若火在胃中，则丹田寒冷，火占据土位而不能消化谷物，导致呕吐或生成痰饮。补骨脂、沉香能降火，小茴香能通利真气，乌药能理顺浊气，芡实入肾，人参入肺。血膈表现为时而吐血时而停止，胸前疼痛，且牵连背心，这是血液积聚在胸中，气行则血行，适宜使用理气药，如枳壳、沉香、川芎、当归，以行气引导血液运行。痰膈表现为痰涎稠厚粘腻，痰积在胸中，适宜使用化痰药，如二陈汤、槟榔、枳壳，以顺气降痰。上述药物均加入生姜。膈气病在中焦无火，只有热在上焦，如果不使用小茴香温暖中焦，怎么能打开胸膈的闭塞呢？
验案
有一人饮食尚能进服，但每到子时（夜间11点至凌晨1点）就发生呕吐和腹泻。大概是因为此人深受忧愁思虑之苦，思虑导致脾气郁结，不能将精微物质散布于肺，向下输送到膀胱，所以津液直接流入大肠而导致腹泻。呕吐是因为脾脏健运功能失常，不能传递转化食物通过幽门，宿食积存在胃中，子时阳气升发冲动陈旧的积垢，所以发生呕吐。适宜以扶护脾胃为主，用人参、茯苓、山药各一钱，炙甘草五分，附子、制乌药三分。
另一人五十五岁，胸前轻微疼痛，没有休息的时候，六脉都缺乏胃气，只有脾脉略微缓和。大概胸中的气来源于丹田，时时感到心下轻微疼痛，是丹田阳气不能到达胸部，确属膈气无疑。脾脉微弱缓和，调理脾胃，还可以拖延时日。使用保元汤加味。
还有一人喉间经常感觉噎塞梗阻，饮食难以消化，舌面干燥，胸前疼痛如同受伤，双腿无力，面部肌肉紧绷，这种情况持续六年了。方剂使用六味地黄丸加白芷、细辛各八分。
Ge syndrome (Diaphragm Syndrome) is caused by injury from the seven emotions (joy, anger, worry, thought, sadness, fear, fright), resulting in stagnation and lack of free flow. It is extremely difficult to regulate because it stems from emotional distress, which cannot be cured by medicine alone. Generally, excessive thinking leads to Qi stagnation; when the Spleen fails to transport, the Stomach fails to generate. When the Stomach fails to generate, the Lung loses its nourishment. The Lung and Large Intestine are exterior-interior related; if the Lung lacks nourishment, the Large Intestine's transmission function fails. The Large Intestine and Stomach both belong to the Yangming channel and are fu organs corresponding in entry and exit. If the Large Intestine does not expel waste, the Stomach cannot accept food. If there is neither expulsion nor acceptance, the true Qi of the two Yangming channels cannot circulate, leading to deficiency-cold in the Lower Jiao. If the Yuan Qi of the Middle Jiao cannot reach, the postnatal Stomach Qi stagnates, causing turbid fire to fill the chest and resulting in obstruction and blockage (Pi Ge). Treatment involves using herbs that tonify the Kidney and raise the Spleen, such as Dioscoreae Rhizoma (Shanyao), Foeniculi Fructus (Xiaohui), Magnetitum (Cishi), Angelicae Sinensis Radix (Guishen), Paeoniae Radix Alba (Baishao), Glycyrrhizae Radix et Rhizoma Preparatum (Gancao), Rehmanniae Radix Recens (Shengdi), and Schisandrae Fructus (Bei Wuwei), to regulate the condition, which may provide slight relief. However, one must maintain a joyful spirit and clear mind so that true Qi can arise and recovery can occur.
Ge syndrome is categorized into Qi Ge (Qi Obstruction), Blood Ge (Blood Obstruction), and Phlegm Ge (Phlegm Obstruction). For Qi Ge, use Linderae Radix (Wuyao) and Foeniculi Fructus (Xiaohui) to open the orifice. For Blood Ge, use Angelicae Sinensis Radix (Danggui), Persicae Semen (Taoren), Linderae Radix (Wuyao), and Aquilariae Lignum Resinatum (Chenxiang). For Phlegm Ge, use Pinelliae Tuber (Banxia) and Aconiti Lateralis Radix Preparata (Fuzi). In cases where treatment is feasible, regulate the Spleen and warm the Lung. For severe cases due to overwork, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with added Aconiti Lateralis Radix Preparata (Fuzi) and prepared Linderae Radix (Zhi Wuyao) in a proportion of one part. If stools resemble sheep dung, it indicates Yang sinking into the Yin level and impending exhaustion of Yang; treat with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) to lift the Yang. Qi Ge presents as immediate vomiting after eating, or food turning into phlegm-saliva shortly after ingestion; this is due to fire in the Stomach combined with insufficient true fire in the Dantian. The fire in the Dantian is called "Lesser Fire" (Shaohuo); located in the lower body, it roasts grains into Qi ("Lesser Fire generates Qi"). Fire in the Stomach is "Evil Fire," which spreads rapidly, thus frying grains into phlegm. If fire is in the Dantian, it generates Earth (Spleen/Stomach), roasts grains, and transforms Qi and Blood. If fire is in the Stomach, the Dantian becomes cold; fire occupying the Earth position fails to digest grains, leading to vomiting or phlegm formation. Psoraleae Fructus (Buguzhi) and Aquilariae Lignum Resinatum (Chenxiang) descend fire; Foeniculi Fructus (Xiaohui) unblocks true Qi; Linderae Radix (Wuyao) regulates turbid Qi; Euryales Semen (Qianshi) enters the Kidney; Ginseng Radix et Rhizoma (Renshen) enters the Lung. Blood Ge presents with intermittent hematemesis, pain in the chest radiating to the back; blood accumulates in the chest. Since Qi movement drives Blood movement, use Qi-moving herbs like Aurantii Fructus (Zhike), Aquilariae Lignum Resinatum (Chenxiang), Chuanxiong Rhizoma (Xiong), and Angelicae Sinensis Radix (Gui) to move Qi and guide Blood. Phlegm Ge presents with thick, sticky phlegm-saliva accumulating in the chest; use phlegm-resolving herbs like Er Chen Tang (Two-Cured Decoction), Arecae Semen (Binglang), and Aurantii Fructus (Zhike) to smooth Qi and descend phlegm. Add fresh ginger to all preceding prescriptions. In Ge Qi, there is no fire in the Middle Jiao, only heat in the Upper Jiao; without warming with Foeniculi Fructus (Xiaohui), how can the chest diaphragm be opened?
Case Record
One patient could eat but experienced vomiting and diarrhea every Zi hour (11 PM–1 AM). This person likely suffered from sorrow and excessive thinking. Thinking causes Spleen Qi stagnation, preventing the dispersion of essence to the Lung and downward transmission to the Bladder. Consequently, fluids enter the Large Intestine directly, causing diarrhea. Vomiting occurs because the Spleen fails to transport and transform, unable to pass food through the pylorus; old food accumulates in the Stomach. At Zi hour, Yang rises and stirs up old residues, causing vomiting. Treatment should focus on supporting the Spleen, using Ginseng Radix et Rhizoma (Renshen), Poria (Fuling), and Dioscoreae Rhizoma (Shanyao) each 1 qian, roasted Glycyrrhizae Radix et Rhizoma (Zhi Gancao) 0.5 qian, Aconiti Lateralis Radix Preparata (Fuzi), and prepared Linderae Radix (Zhi Wuyao) each 0.3 qian.
Another patient, aged 55, had slight chest pain with no respite. All six pulses lacked Stomach Qi, except the Spleen pulse which was slightly slow. The chest receives Qi from the Dantian; constant slight epigastric pain indicates Dantian Yang failing to reach the chest, confirming Ge Qi. The slightly slow Spleen pulse suggests that regulating the Spleen and Stomach allows for prolonged survival. Use Baoyuan Tang (Protect the Origin Decoction) with additions.
A third patient often felt choking and obstruction in the throat, difficulty digesting food, dry tongue, chest pain resembling injury, weak legs, and tight facial skin for six years. Prescribe Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) plus Angelicae Dahuricae Radix (Baizhi) and Asari Radix et Rhizoma (Xixin) each 0.8 fen.