【歌】噎膈生于血液干，或因气火或因痰。近于咽嗌名为噎，水饮能吞食物艰。胃脘之间成膈证，食虽能
进下关难。要参脉症求虚实，勿泥辛香概作寒。
【论】丹溪云∶噎病生于血干。盖胃为水谷之海，脾为消化之器，清和则健运，能为诸经行其津液，稍有
不行，则留滞壅塞，而噎膈之病作矣。世人皆遵局方，但有呕吐者，便用香燥热药，偏助其火，不思此病原因
燥结枯槁而成，复用香燥热药治之，其谬甚矣！其始，胃液凝聚，其久也，脾气耗败，传化渐迟。乌、附、丹
毒服之积久，血液俱耗，胃脘干槁。其槁在上，近咽之下，水饮可行，食物难入，间或可入，入亦不多，名之
曰“噎”。其槁在下，与胃为近，食虽可入，难尽入胃，良久复出，名之曰“膈”，渐成反胃，小便秘，大便
如羊粪，名虽不同，病出一体。
夫血，阴也。阴主静，内外两静，则脏腑之火不起，金水二气有养，阴血自生，肠胃津润传化合宜，何
噎之有？世人概用香燥热药者，不知此理也。子和引《内经》三阳结为膈立论，力辨世人热药之误，可谓明矣！
又有以承气治之，
失之太峻也。盖咽有因火气冲逆，食不得入者，脉数大。有因痰饮阻滞者，脉结滑。有七情郁结者，脉沉涩。
有因瘀血积滞，盖阳无阴不能失化，阴失位，阳伏其中，传化不变而反上行，其脉芤涩。因气者，从气治；因
血者，从血治；因痰者，导之；因火者，壮水制之，岂专以辛香燥剂乎！若脾胃阳火衰微，不能运化者，暂以
辛温药开其结滞，仍以益阴养胃为主。若概以局方辛香燥热之药以火济火，重耗其津液，则大便闭结，幽门不
通，上冲吸门，而噎膈转甚矣。此千古之弊也！
达按∶前证多起于忧郁，忧郁则气结于胸臆而生痰，久则痰结成块，胶于上焦，道路狭窄，不能宽畅，饮
或可下，食则难入，而病已成矣。好酒之徒患此者，必是顽痰，盖酒能发火，火能成痰，痰因火煎，胶结不开，
阻塞道路，水饮下咽，亦觉痛涩。若以血槁治，投当归、地黄等药，血未必润，反助其痰，病何由愈！若黑瘦
之人，真阴素虚，常觉内热，又不嗜酒，或过服香燥热药者，当以血槁治。
痰气
喜怒七情伤于脾胃，郁而生痰，痰与气搏，升而不降，饮食不下，气留于咽嗌者，快气饼子、四七汤主之。
痰郁者，化痰丸。关格者，必用吐以提其气。若横格，不必在乎出痰也。有痰亦宜吐，涌痰汤。其关格者，详
本条内。
快气饼子
治气郁不快，食下则胸膈噎塞疼痛。
莱菔子（炒，二两） 紫苏子（一两） 橘红（一两） 白豆蔻（一两） 白茯苓（一两）
上为细末，炼蜜和姜汁为饼子，时时噙嚼之。
四七汤
治七情气郁，结聚痰涎，状如破絮，或如梅核在咽喉之间，咯不出，咽不下。并治中脘痞满，痰涎壅盛，
上气喘急。妇人有孕恶阻，亦宜服之。
半夏（一钱半） 白茯苓（一钱三分） 苏梗（一钱） 浓朴（一钱）
上锉，一剂，生姜七片，大枣一枚，水二钟，煎八分服。
化痰丸（方见痰证。）
涌痰汤
甘草（一两） 桔梗（一两） 瓜蒂（五钱） 枳壳（五钱） 陈皮（五钱）
上，用水十碗，煎至五碗，去渣，连连饮尽，浸浮其痰，发一恶心，即大吐。得宽后，可服参苓白术散
调理，不致复发矣。
火
上焦火盛冲逆，食不得下而呕者，和中桔梗汤加竹茹、枇杷叶，渴者，去半夏，加麦冬。大便燥结者，人
参利膈丸微下。血少阴虚，火盛不得眠，食入反出者，朱砂安神丸。
和中桔梗汤（方见呕。）
人参利膈丸
治胸中不利，痰咳喘满，和脾开滞，推陈致新，治噎膈之圣药。
木香（一两） 槟榔（一两） 人参（一两） 当归（一两） 藿香（一两） 甘草（一两） 枳实
（一两） 大黄（酒浸，一两） 浓朴（姜制，一两）
上为细末，水丸，温水送下五十丸，如桐子大。仍用猪胆导之，得通便佳。
朱砂安神丸（方见惊悸。）
虚
血气槁弱而成噎塞者，养血汤，或润血饮子。脾虚，中气不足，八珍汤加橘皮、竹茹、枇杷叶。
养血汤
当归（二钱） 生地黄（二钱） 玄参（二钱） 阿胶（二钱） 知母（二钱） 红花（五分，酒洗） 桃
仁（五分，研泥）
上锉，一剂，水二盏，煎八分，加生白蜜二匙服。
润血饮子（增）
治血槁成噎。
水一钟，入阿胶一两，化开，煎至七分，加竹沥半盏，人乳一盏，蜜五匙，徐徐服之。
瘀血
瘀血则脉涩，桃仁承气汤下之。
桃仁承气汤（方见本条下。）
【歌诀】噎膈病的发生源于血液干枯，有时是因为气火，有时是因为痰湿。病变部位靠近咽喉的称为“噎”，此时喝水尚能吞咽，但进食困难。病变部位在胃脘部的称为“膈”，食物虽然能进入，但在下咽时感到艰难。诊治时必须参合脉象和症状来辨别虚实，不要拘泥于辛香药物而一概当作寒证治疗。
【论述】朱丹溪说：噎病是由于血液干枯引起的。胃是水谷汇聚的海，脾是消化的器官，只有清和之气才能健运，从而为各条经络输送津液。如果稍有阻滞不通，就会留滞壅塞，导致噎膈病发生。世人都遵循《局方》的做法，只要有呕吐症状，就使用香燥热药，这反而偏助了体内的火邪。人们没有考虑到此病的原因本是燥结枯槁而成，如果再使用香燥热药来治疗，错误就非常严重了！起初，胃液凝聚；日久，脾气耗败，传导消化逐渐迟缓。乌头、附子、丹砂等毒性药物长期服用，会耗竭血液，导致胃脘干燥枯槁。如果枯槁发生在上部，靠近咽喉下方，水饮可以下行，食物难以进入，偶尔能进一点，进去的量也不多，这就叫做“噎”。如果枯槁发生在下部，靠近胃部，食物虽然可以进入，但难以全部进入胃中，很久之后又会吐出，这就叫做“膈”，逐渐演变成反胃，小便短少便秘，大便像羊粪球一样，名称虽然不同，但病根出自同一本源。
血属于阴。阴主静，内外保持安静，脏腑之火就不会妄动，肺金肾水二气得到滋养，阴血自然生成，肠胃津液滋润，传导消化适宜，哪里会有噎病呢？世人一概使用香燥热药，是不懂这个道理。张子和引用《内经》中“三阳结为膈”的理论立论，极力辩驳世人误用热药的弊端，可以说是非常明察了！又有人用承气汤来治疗，这就失之过于峻猛了。大概有的患者因为火气冲逆，导致食物无法入喉，其脉象数大；有的因为痰饮阻滞，其脉象结滑；有的因为七情郁结，其脉象沉涩；有的因为瘀血积滞，由于阳无阴不能转化，阴失其位，阳气潜伏其中，传导变化停滞反而向上逆行，其脉象芤涩。因气致病者，从气治；因血致病者，从血治；因痰致病者，疏导它；因火致病者，壮水制火，难道能专门使用辛香燥剂吗！如果脾胃阳气衰微，不能运化，暂时使用辛温药开通结滞，但仍应以益阴养胃为主。如果一概使用《局方》中的辛香燥热药物以火济火，严重耗伤津液，就会导致大便闭结，幽门不通，气机上冲吸门，从而使噎膈病情加重。这是千古以来的弊病啊！
皇甫中按语：上述病症多起于忧郁，忧郁则气结于胸臆而生痰，日久痰结成块，胶着于上焦，使道路狭窄，不能宽畅，饮水或许可以下行，进食则难以下咽，此时病已形成。喜好饮酒的人患此病，必定是顽痰，因为酒能生火，火能炼痰，痰因火煎熬，胶结不开，阻塞道路，水饮下咽也会觉得疼痛涩滞。如果用治血枯的方法，投用当归、地黄等药物，血液未必能得到滋润，反而助长痰湿，病怎么能痊愈呢！如果是形体黑瘦之人，真阴素来虚弱，常觉内热，又不嗜酒，或者过服香燥热药的人，才应当用治血枯的方法。
痰气
喜怒等七情损伤脾胃，郁结而生痰，痰与气搏结，升而不降，饮食不下，气停留于咽喉，可用快气饼子、四七汤主治。
痰郁者，用化痰丸。关格证者，必须用吐法以提举气机。若是横格证，不必在乎排出痰涎。有痰也宜用吐法，用涌痰汤。关于关格证，详见本条内容。
快气饼子
治疗气郁不快，进食后胸膈噎塞疼痛。
莱菔子（炒，二两） 紫苏子（一两） 橘红（一两） 白豆蔻（一两） 白茯苓（一两）
以上研为细末，用炼蜜调和姜汁制成饼子，时时含嚼。
四七汤
治疗七情气郁，结聚痰涎，感觉像破絮，或者像梅核卡在咽喉之间，咳不出来，咽不下去。并治疗中脘痞满，痰涎壅盛，上气喘急。妇女怀孕恶阻，也适宜服用。
半夏（一钱半） 白茯苓（一钱三分） 苏梗（一钱） 浓朴（一钱）
以上切碎，一剂药，加生姜七片，大枣一枚，水二钟，煎至八分，服用。
涌痰汤
甘草（一两） 桔梗（一两） 瓜蒂（五钱） 枳壳（五钱） 陈皮（五钱）
以上用水十碗，煎至五碗，去渣，连续饮尽，浸浮其痰，引发恶心，随即大吐。吐后感觉宽松，可服用参苓白术散调理，以免复发。
火
上焦火盛冲逆，食物无法下行而呕吐者，用和中桔梗汤加竹茹、枇杷叶；口渴者，去掉半夏，加麦冬。大便燥结者，用人参利膈丸轻微通下。血少阴虚，火盛导致失眠，食物吃下后反出者，用朱砂安神丸。
人参利膈丸
治疗胸中不利，痰咳喘满，和脾开滞，推陈致新，是治疗噎膈的圣药。
木香（一两） 槟榔（一两） 人参（一两） 当归（一两） 藿香（一两） 甘草（一两） 枳实（一两） 大黄（酒浸，一两） 浓朴（姜制，一两）
以上研为细末，用水泛丸，温水送服五十丸，大小如梧桐子。仍用猪胆汁导便，得以通便为佳。
虚
血气干枯衰弱而成噎塞者，用养血汤，或润血饮子。脾虚，中气不足，用八珍汤加橘皮、竹茹、枇杷叶。
养血汤
当归（二钱） 生地黄（二钱） 玄参（二钱） 阿胶（二钱） 知母（二钱） 红花（五分，酒洗） 桃仁（五分，研泥）
以上切碎，一剂药，水二盏，煎至八分，加生白蜜两匙服用。
润血饮子（新增）
治疗血枯成噎。
取水一钟，加入阿胶一两，化开后，煎至七分，加竹沥半盏，人乳一盏，蜂蜜五匙，慢慢服用。
桃仁承气汤（方剂见本条下。）
[Song] Yige (Dysphagia and Obstruction) arises from the dryness of blood, sometimes due to Qi fire or phlegm. When the lesion is near the throat, it is called "Ye" (Dysphagia); water can be swallowed, but food is difficult to ingest. When the lesion is in the epigastrium, it is called "Ge" (Obstruction); although food can enter, swallowing is difficult. One must examine the pulse and symptoms to determine deficiency or excess, and not rigidly treat all cases with acrid-aromatic herbs as cold syndromes.
[Discussion] Zhu Danxi stated: Ye disease arises from blood dryness. The Stomach is the sea of water and grain, and the Spleen is the organ of digestion. Only when the Qi is clear and harmonious can it function vigorously, transporting body fluids to the meridians. If there is any stagnation, it leads to retention and obstruction, causing Yige. People generally follow the *Ju Fang* (Prescriptions of the Bureau of Taiping Imperial Medical Institute), using aromatic, drying, and hot medicines whenever vomiting occurs. This inadvertently aids the fire. They fail to consider that this disease originates from dryness, coagulation, and withering; using aromatic, drying, and hot medicines to treat it is a grave error! Initially, stomach fluids coagulate; over time, Spleen Qi is exhausted, and transformation and transportation gradually slow down. Long-term consumption of toxic substances like Aconitum Radix Preparata (Wutou), Aconitum Lateralis Radix Preparata (Fuzi), and Cinnabaris (Dansha) depletes the blood, leading to dryness and withering of the epigastrium. If the withering is in the upper part, near the lower throat, water drinks can pass, but food is hard to enter; occasionally some enters, but the amount is small. This is called "Ye". If the withering is in the lower part, near the Stomach, food can enter but cannot fully pass into the Stomach; after a long while, it is regurgitated. This is called "Ge", which gradually becomes Fanwei (Regurgitation). Urine becomes scanty and constipated, and stool resembles sheep dung. Although the names differ, the pathology stems from the same source.
Blood belongs to Yin. Yin governs stillness. If both internal and external states are tranquil, the fire of the Zang-Fu organs will not flare up, allowing Lung Metal and Kidney Water energies to nourish each other, naturally generating Yin blood. With moist intestines and stomach and appropriate transformation and transportation, how could Ye occur? People who indiscriminately use aromatic, drying, and hot medicines do not understand this principle. Zhang Zihe cited the *Neijing* theory that "binding of the Three Yang causes Ge" to establish his argument, strongly refuting the errors of using hot medicines by laypeople, which was indeed insightful! Others use Chengqi Tang (Gut-Draining Decoction) for treatment, which is too harsh. Generally, if the cause is Qi fire rushing upward, preventing food intake, the pulse is rapid and large. If caused by phlegm-fluid retention, the pulse is knotted and slippery. If caused by emotional depression, the pulse is deep and choppy. If caused by blood stasis accumulation, since Yang cannot transform without Yin, and Yin loses its position while Yang lies dormant within, transformation ceases and Qi rebels upward, resulting in a knotted and choppy pulse. For cases due to Qi, treat the Qi; for cases due to Blood, treat the Blood; for cases due to Phlegm, guide it out; for cases due to Fire, strengthen Water to control it. How can one rely solely on acrid-aromatic drying agents? If Spleen and Stomach Yang fire is weak and unable to transform, temporarily use acrid-warm medicines to open blockages, but the primary approach should still be nourishing Yin and benefiting the Stomach. If one indiscriminately uses the acrid-aromatic, drying, and hot medicines from the *Ju Fang* to add fire to fire, severely depleting body fluids, it leads to constipation, obstruction of the幽门 (Pylorus), rebellion of Qi to the吸门 (Glottis), and worsening of Yige. This has been a malpractice for millennia!
Huangfu Zhong notes: The aforementioned conditions often originate from melancholy. Melancholy causes Qi to knot in the chest, generating phlegm. Over time, phlegm forms lumps, adhering to the Upper Jiao, narrowing the pathways and preventing smooth flow. Drinking may go down, but eating is difficult, and the disease is established. Those who love alcohol and suffer from this condition likely have stubborn phlegm, as alcohol generates fire, and fire refines phlegm. Phlegm, scorched by fire, becomes sticky and obstructive. Even drinking water feels painful and astringent upon swallowing. If treated as blood dryness by administering herbs like Danggui (Angelicae Sinensis Radix) and Dihuang (Rehmanniae Radix), the blood may not be moistened, but rather the phlegm aggravated, so how could the disease heal? However, for individuals who are thin and dark-complexioned, with inherent deficiency of True Yin, constant sensation of internal heat, no habit of drinking alcohol, or those who have overused acrid-aromatic hot medicines, treatment should focus on blood dryness.
Phlegm-Qi
Joy, anger, and other Seven Emotions injure the Spleen and Stomach, leading to depression and phlegm formation. Phlegm and Qi contend, rising but not descending, preventing food intake, with Qi lingering in the throat. Treat with Kuaqi Bingzi (Qi-Swiftness Pills) or Siqi Tang (Four-Emotions Decoction).
For Phlegm Depression, use Huatan Wan (Phlegm-Resolving Pill).
For Guange (Constriction and Obstruction), emesis must be used to lift the Qi.
For Hengge (Horizontal Obstruction), there is no need to focus on expelling phlegm. If phlegm exists, emesis is also suitable, using Yongtan Tang (Phlegm-Gushing Decoction). See the specific section for details on Guange.
Kuaqi Bingzi (Qi-Swiftness Pills)
Treats Qi depression and discomfort, with chest and diaphragm obstruction and pain after eating.
Radish Seed (Lai Fuzi, stir-fried, 2 liang) Perilla Seed (Zi Su Zi, 1 liang) Exocarpium Citri Reticulatae (Ju Hong, 1 liang) White Cardamom (Bai Dou Kou, 1 liang) Poria (Bai Fu Ling, 1 liang)
Grind into fine powder. Mix with refined honey and ginger juice to form pills. Chew slowly and frequently.
Siqi Tang (Four-Emotions Decoction)
Treats Qi depression due to Seven Emotions, with accumulated phlegm-saliva feeling like broken cotton or a plum pit stuck in the throat, impossible to cough up or swallow. Also treats epigastric fullness, abundant phlegm-saliva, and upper asthma. Suitable for pregnant women with morning sickness.
Pinellia Rhizome (Banxia, 1.5 qian) Poria (Bai Fu Ling, 1.3 qian) Perilla Stem (Su Geng, 1 qian) Magnolia Bark (Nong Po, 1 qian)
Cut into pieces. For one dose, add 7 slices of fresh ginger and 1 jujube. Add 2 zhong of water, decoct to 0.8 zhong, and take.
Huatan Wan (Phlegm-Resolving Pill) (Formula see Phlegm Syndrome section.)
Yongtan Tang (Phlegm-Gushing Decoction)
Licorice Root (Gancao, 1 liang) Platycodon Root (Jiegeng, 1 liang) Melon Seed (Guadi, 5 qian) Bitter Orange (Zhiqiao, 5 qian) Tangerine Peel (Chenpi, 5 qian)
Add 10 bowls of water, decoct to 5 bowls. Strain and drink continuously to induce floating of phlegm. Induce nausea to cause severe vomiting. After relief, take Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) for regulation to prevent recurrence.
Fire
When Upper Jiao fire is excessive and rebellious, preventing food descent and causing vomiting, use Hezhong Jiegeng Tang (Harmonize Middle Jiao and Platycodon Decoction) plus Bamboo Shavings (Zhuru) and Loquat Leaf (Pipaye). If thirsty, remove Banxia and add Ophiopogon Root (Maidong). For dry constipation, use Renli Ligewan (Ginseng and Throat-Unblocking Pills) for mild purgation. For blood deficiency and Yin deficiency with excessive fire causing insomnia and regurgitation of food, use Zhusha Anshen Wan (Cinnabar-Calming Spirit Pills).
Hezhong Jiegeng Tang (Formula see Vomiting section.)
Renli Ligewan (Ginseng and Throat-Unblocking Pills)
Treats chest discomfort, phlegm-cough, asthma, and fullness. Harmonizes Spleen, opens stagnation, eliminates old and promotes new. It is a sacred medicine for treating Yige.
Costus Root (Muxiang, 1 liang) Areca Seed (Binglang, 1 liang) Ginseng Root (Renshen, 1 liang) Angelica Root (Danggui, 1 liang) Agastache Herb (Huoxiang, 1 liang) Licorice Root (Gancao, 1 liang) Immature Bitter Orange (Zhishi, 1 liang) Rhubarb (Dahuang, wine-soaked, 1 liang) Magnolia Bark (Nong Po, ginger-processed, 1 liang)
Grind into fine powder. Make water pills. Take 50 pills with warm water, size of wutong seeds. Still use pig bile suppository to facilitate bowel movement; achieving soft stool is ideal.
Zhusha Anshen Wan (Cinnabar-Calming Spirit Pills) (Formula see Palpitations section.)
Deficiency
For Yige caused by dryness and weakness of Qi and Blood, use Yangxue Tang (Nourish Blood Decoction) or Runxue Yinzi (Moisten Blood Infusion). For Spleen deficiency and insufficient Middle Qi, use Bazhen Tang (Eight-Treasures Decoction) plus Chenpi (Tangerine Peel), Zhuru (Bamboo Shavings), and Pipaye (Loquat Leaf).
Yangxue Tang (Nourish Blood Decoction)
Angelica Root (Danggui, 2 qian) Rehmannia Root (Sheng Dihuang, 2 qian) Scrophularia Root (Xuanshen, 2 qian) Donkey-Hide Gelatin (Ejiao, 2 qian) Anemarrhena Rhizome (Zhimu, 2 qian) Safflower (Honghua, 5 fen, wine-rinsed) Peach Kernel (Taoren, 5 fen, ground to paste)
Cut into pieces. For one dose, add 2 zhan of water, decoct to 0.8 zhan. Add 2 spoons of raw white honey and take.
Runxue Yinzi (Moisten Blood Infusion) (Added)
Treats Yige caused by blood dryness.
Take 1 zhong of water, add 1 liang of Ejiao, dissolve, and decoct to 0.7 zhong. Add half a zhan of bamboo sap, 1 zhan of human milk, and 5 spoons of honey. Take slowly.
Blood Stasis
Blood stasis presents with a choppy pulse. Use Taochengqi Tang (Peach Kernel and Gut-Draining Decoction) to purge.
Taochengqi Tang (Peach Kernel and Gut-Draining Decoction) (Formula see below this section.)