膈与噎，其证虽异，而其因相均，其治亦相出入，是以不得区而析之。且余平生于此证，无能治愈，未审
何说何方能中其綮。故今泛然采录，并及奇方，览者勿罪其繁芜而可也。
五膈 五膈气者，谓忧膈，恚膈、气膈、寒膈、热膈也
（按∶此目本出《肘后》）。忧膈之病，胸中气结烦闷，津液不通，饮食不下，羸瘦不为气力。恚膈之为病
（按∶《三因》作思膈），心下苦实满，噫辄酢心，食不消，心下积结，牢在胃中，大小便不利。气膈之为病
（《三因》怒膈），胸胁逆满，咽塞，胸膈不通，恶闻食臭。寒隔之为病（《三因》恐膈），心腹胀满咳逆，
腹上苦冷，雷鸣，绕脐痛，食不消，不能食肥。热膈之为病（《三因》喜膈），脏有热气，五心中热，口中烂
生疮，骨烦四肢重，唇口干燥，身体头面手足或热，腰背皆疼痛，胸痹引背，食不消，不能多食，羸瘦少气及
癖也。此是方家所说五膈形证也。经云∶阳脉结谓
之膈。言忧恚寒热动气伤神，而气之与神并为阳也。伤动阳气，致阴阳不和，而脏腑生病，结于胸膈之间，故称
为膈气。众方说五膈互有不同，但伤动之由有五，故云五膈气。（《病源论》）（按∶此与次五噎并系其形证，
然论膈噎者，以此为祖，故首列之。）
《延年秘 》凡忧膈、气膈、食膈、寒膈、饮膈，五病同药，常以忧愁思虑饮食而得之。（《外台》）
（按∶此出五膈丸主治。）
五噎 夫五噎，谓一曰气噎，二曰忧噎，三曰食噎，四曰劳噎，五曰思噎。虽有五名，皆由阴阳不和，
三焦隔绝，津液不行，忧恚嗔怒所生，谓之五噎。噎者，噎塞不通也。（《病源论》）
气噎候∶此由阴阳不和，脏气不理，寒气塞于胸膈，故气噎塞不通而谓之气噎，令人喘悸胸背痛也。
食噎候∶此由脏气冷而不理，津液涩少而不能传行饮食，故饮食入则噎塞不通，故谓之食噎。胸内痛，
不得喘息，食不下，是故噎也。（同上）
《古今录验》五噎者（三字据《千金》注引补），气噎、忧噎、劳噎、食噎、思噎。气噎者，心悸，上下
不通，噫哕不彻，胸胁苦痛。忧噎者，天阴苦厥逆，心下悸动，手足逆冷。劳噎者，苦气隔，胁下支满，胸中
填塞，令手足逆冷，不能自温。食噎者，食无多少，惟胸中苦塞，常痛，不得喘息。思噎者，心悸动喜忘，目
视 。此皆忧恚嗔怒，寒气上逆胸胁所致。（外台）
病在膻中之下，故名五膈。若在咽嗌，即名五噎。（《三因》）
膈噎胃反之别 夫饮食入于噎间，不能下噎，随即吐出，自噎而转，故曰噎（按∶此以噎为咽义，非
是）。膈是膈膜之膈，非膈截之谓也。饮食下噎，至于膈间，不能下膈，乃徐吐出，自膈而转，故曰膈。翻胃
是饮食已入胃中，不能运化，而下脘又燥结不通，朝食而暮吐，暮食而朝吐，明其自胃中而倒出，故曰翻胃也。
均一吐病，而有上中下之分。（《赤水》）
噎膈者，饥欲得食，但噎塞迎逆于咽喉胸膈之间，在胃口之上，未曾入胃，即带痰涎而出。若一入胃下，
无不消化，不复出矣。惟在年高者有之，少无噎膈翻胃者，饮食倍常（按∶此句殊可疑），尽入于胃矣。但朝
食暮吐，暮食朝吐，或一两时而吐，或积至一日一夜，腹中胀闷不可忍而复吐，原物酸臭不化，此已入胃而反
出，故曰翻胃，男女老少皆有之。（《医贯》）
噎膈反胃二证，丹溪谓其名虽不同，病出一体，若乎似矣，然而实有不同也。盖反胃者，食犹能入，入而
反出，故曰反胃。噎膈者，隔塞不通，食不能下，故曰噎膈。食入反出者，以阳虚不能化也，可补可温，其治
犹易；食不得下
者，以气结不能行也，或开或助，治有两难，此其轻重之有不同也。且凡病反胃者多能食，病噎膈者不能食。故
噎膈之病，病于胸臆上焦；而反胃之病，则病于中下二焦，此其见证之有不同也。所以反胃之治，多宜益火之
源，以助化功；噎膈之治，多宜调养心脾，以舒结气。此其证候既有不同，故延医亦当分类也。（《景岳》）
病由气结（气结生涎、气结伤阴二因，更有死血等数因。）夫阴阳不和则三焦隔绝，三焦隔绝则津液
不利，故令气塞不调理也，是以成噎。此由忧恚所致，忧恚则气结，气结则不宣流使噎。噎者，噎塞不通也。
（《病源论》）
五噎诸气（妇人多有此病），此病不在外，不在内，不属冷，不属热，不是实，不是虚，所以药难取效。
此病缘忧思恚怒，动气伤神，气积于内，气动则诸证悉见，气静疾候稍平，扪之而不得疾之所在，目视之而不知
色之所因，耳听之不知音之所发，故针灸服药皆不获效，此乃神意间病也。顷京师一士人家，有此疾证，劝令静
观内外，将一切用心力事，委之他人，服药方得见效。若不如此，恐不能安。但根据此戒，兼之灼艾膏肓与四花
穴，及服此三药（按∶此三药未考），可以必瘥。孙真人云∶妇人嗜欲多于丈夫，感病倍于男子，加以慈恋爱
憎，嫉妒忧恚，染着坚牢，情不自抑，所以为病根深，疗之为难瘥。（《鸡峰》）
膈气噎塞者，由忧思过甚，气结不通，肺胃虚弱，气留肓膜则结滞于胸膈，故升降否塞。盖喉咙者，气之
所以上下，若气塞不通，则咽喉噎闷，状若梅核，咽纳有妨，故谓之膈气咽喉噎塞也。（《圣济》）
夫五噎者云云，虽五种不同，皆以气为主云云。皆由喜怒不常，忧思过度，恐虑无时，郁而生涎，涎与气搏，升而
不降，逆害饮食，与五膈同，但此在喉嗌，故名五噎。（《三因》）
《素问》云∶阳脉结谓之膈。盖气之与神并为阳也，逸则气神安，劳则气神耗。傥或寒温失宜，食饮乖度，
七情伤感，气神俱扰，使阳气先结，阴气后乱，阴阳不和，脏腑生病，结于胸膈则成膈气，留于咽嗌则成五噎。
其为病也，令人胸膈痞闷，呕逆噎塞，妨碍饮食，胸痛彻背，或胁下支满，或心忡喜忘，咽噎气不舒。（《济生》）
噎膈多起于忧郁，忧郁则气结于胸臆而生痰。久者痰结成块，胶于上焦，道路窄狭，不能宽畅，饮或可下，
食则难下，而病已成矣。好酒之徒，患此者必是顽痰。（《订补指掌》）
噎膈一证，必以忧愁思虑，积劳积郁，或酒色过度，损伤而成。盖忧思过度则气结，气结则施化不行，酒
色过度则伤阴，阴伤则精血枯涸。气不行，则噎膈病于上；精血枯涸，则燥结病于下。且凡人之脏气，胃司受纳，
脾主运化，而肾为水火之宅，化生之本。今既食饮停膈不行，或大便燥结不通，岂非运化失职，血脉不通之为病
乎。而营运血脉之权，其在上者，非脾而何。其在下者，非肾而何。矧少年少见此证，而惟中衰耗伤者多有之，
此其为虚为实，概可知矣。故凡治此者，欲舍根本而言快捷方式，又安望其有成功也。（《景岳》）
五噎五膈，方书皆类一门，而《千金》独以五膈隶之肺脏。究其所因，良由胃虚不能游溢精气于脾，所以
气噎不通。脾衰不能散精上归于肺，所以食膈不下。原其受病，虽有气食忧劳之不同，总缘思虑气郁之所致。
《素问》明言隔塞闭绝，上下不通，暴忧之病也。（《千金方衍义》）
噎之与膈，本同一气，膈病之始，靡不由噎而成。原其大概，不外乎郁，故张鸡峰以为神思间病。其受
病之源，非止一端。尝考五噎之中，独多思噎；五膈之中，独多饮膈。每见多思虑人，每患气噎，经谓思则气结
是也。好热饮人，每患酒膈，丹溪谓之死血是也。然血膈亦非止一端，往往有勇力过甚，血菀于胃，阻碍饮食
成隔者。即如《灵枢》虫为下膈，有此一证。若夫命门火衰，不能温养土脏，食 时乃出者，得非下膈之证乎。
而《素问》又有三阳结渭之膈，言小肠、大肠、膀胱之津血俱结，如厕涩难，下不通而上逆，势所必然。（同上）
病由气血渐亏 膈噎始因酒色过度，继以七情所伤，气血日亏，相火渐炽，几何不致于膈噎。夫血液
渐亏，则火益甚，而脾胃皆失其传化，饮食津液，凝聚而成痰，积于胃口，渐而致于妨碍道路，斯食不能入而
成五膈五噎者是也。（《医统》）
病由三阳结 俗谓噎食一证，在《内经》若无多语，惟曰三阳结谓之膈。三阳者，谓大肠、小肠、膀
胱也。结，谓结热也。小肠热结则血脉燥，大肠热结则后不圊，膀胱热结则津液涸。三阳俱结，则前后 塞，
下既不通，必反上行，此所以噎食不下，纵下而复出也。谓胃为水谷之海，日受其新，以易其陈，一日一便，
乃常度也，今病噎者，三日、五日或五、七日不便，是乖其度也亦明矣。岂非三阳俱结于下，广肠枯涸，所
食之物为咽所拒，纵入太仓，还出咽咙，此阳火不下推而上行也。（《事亲》）
子和论膈噎，累累数百言，谓三阳结热，前后 涩，下既不通，必反上行，所以噎食不下。夫膈噎，胃
病也，始先未必燥结，久之乃有大便秘少若羊矢之证。此因胃中津气上
逆，不得下行而然，乃胃病及肠，非肠病及胃也。（《金匮翼》）
肠胃之为物，最喜润泽，试以羊豕之肚观之，必是滑腻稠粘，如液如脂，如膏如泽，在人胃亦如是，所谓
阴也。膈症之人，其肠胃必枯槁干燥，绝无滑腻稠粘等象，是胃阴亡也。阴亡，地气绝也，地气绝则天气从何
处生乎，故多死。（《四明心法》）
病有气血之别 《发明》曰∶噎者，六腑之所生，阳也气也。塞者，五脏之所生，阴也血也。二者，
皆由阴中伏阳而作也。谨按∶噎为七情所发，或因三焦传化失常所致，此即主于气也。或血液所亏，胃脘干槁，
或血积所致，即皆因于血也。塞由填塞不通之义，故《发明》有治幽门不通，噎塞不便，通幽汤之例。盖阳无
阴不能施化，阴之失位而阳伏其中，传化不变而反上行矣。然人有所击扑坠跌，内致血瘀，忽即吐而食不能纳，
此由气血俱伤所可见也。大抵始因气致者，初当从气治之；由血致者，当从血治之，岂可类用香热之剂反耗气
血耶。但世俗拘泥，不能究乎病情，遂成危证也，悲夫！（《微义》）
病由逆气 古人指噎膈为津液干枯，故水液可行，干物梗涩，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，随气逆从耳。若以津枯而用润下之剂，岂不反益其邪乎。（《医通》）（按∶此说本于《沙篆》。）
脾胃诸证多因液燥 夫气之初病也，其端甚微，或因些少饮食不谨，或外冒风雨，或内感七情，或食味
过浓，偏助阳气，积成膈热。或资禀充实，表密无汗，或性急易怒火炎
上，以致津液不行，清浊相干。气为之病，或痞或痛，不思食，或噫腐气，或吞酸，或嘈杂，或膨满。不求原
本，便认为寒，遽以辛香燥热之剂投之，数帖时暂得快，以为神方，浓味仍前不节，七情反复相仍，旧病被劫
暂开，浊液易于攒聚，或半月，或一月，前证复作。如此延蔓，自气成积，自积成痰，此为痰、为饮，为吞酸之
由也。良工未遇，缪药又行，痰挟瘀血，遂成窠囊，此为痞、为痛呕吐、为噎膈反胃之次第也。饮食汤液，滞泥
不行，渗道蹇涩，大便或秘或溏，下失传化，中焦愈停。医者不察，犹执为冷，翻思前药，随手得快，至此宾
主皆恨药欠燥热， 伺久服，可以温脾壮胃，消积行气，以冀一旦豁然之效。不思胃为水谷之海，多血多气，清
和则能受；脾为消化之气，清和则能运。今反得香热之偏助，气血沸腾。其始也，胃液凝聚无所容受。其久也，
脾气耗散，传化渐迟。其有胃热易饥，急于得食，脾伤不磨，郁积成痛。医者犹曰虚而积寒，非寻常草木可疗，
径以乌、附助佐丹剂，专意服饵。积而久也，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，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，亦曰
反胃。大便秘少，若羊矢然，名虽不同，病出一体。（《局方发挥》）（按∶此论似精而反晦，又与前款所引
《三因》诸说，其意自异。但明以来诸家，多援用之，而其所主，专在膈噎，仍姑存录之。又此误混反胃，辨
见上。）
脉候 戴云∶翻胃（按∶上文曰∶翻胃即膈噎）有四∶血虚，气虚，有热，有痰。血虚者，脉必数而无
力。气虚者，脉必缓而无力。有热者，脉数而有力。有痰者，脉滑数。二者可治。（《钩玄》）
气噎其脉缓涩，食噎其脉短涩。（《奇效》）
脉紧而芤，紧则为寒，芤则为虚，虚寒相搏，脉为阴结而迟，其人则噎。然多有至死脉不变者，以胃中痰饮
湿热胶固，脉常和软，然细察之，必兼弦象也。（《医通》）
脉见微弱缓滑者，可治；若涩数细数沉涩，及尺肤枯涩者，不治。（《百问》）
脉浮缓而滑，沉缓而长，皆可治；弦涩短小，为难医。（《时方妙用》）
脉空虚及兼歇至者，俱不可治。（《绳墨》）
膈病与噎病，虽然症状表现不同，但病因相同，治疗方法也相互关联，因此不能将它们截然分开。况且我平生遇到这类病症，没有能治愈的，不知道什么理论或方剂能切中要害。所以现在广泛采集记录，并包括一些奇特的方子，希望读者不要责怪内容繁杂琐碎即可。
五膈：所谓五膈气，是指忧膈、恚膈（《三因方》称为思膈）、气膈（《三因方》称为怒膈）、寒膈（《三因方》称为恐膈）、热膈这五种。（按：此目原本出自《肘后备急方》）。忧膈的病证，胸中气机郁结烦闷，津液不通畅，饮食难以下咽，身体消瘦且无力。恚膈的病证，心下部感觉苦痛、坚实胀满，经常嗳气且伴有酸水泛至心胸，食物不消化，心下部有积滞结块，牢固地停留在胃中，大小便不通利。气膈的病证，胸胁部逆气胀满，咽喉堵塞，胸膈气机不通，厌恶闻到食物的气味。寒膈的病证，心腹胀满，咳嗽气逆，腹部怕冷，肠鸣音如雷，绕脐疼痛，食物不消化，不能吃油腻肥甘的食物。热膈的病证，脏腑内有热气，五心（两手心、两足心及心口）发热，口腔糜烂生疮，骨骼烦扰，四肢沉重，嘴唇和口舌干燥，身体、头部、面部、手足有时发热，腰背都疼痛，胸痹牵引背部疼痛，食物不消化，不能多吃，身体消瘦、气短以及有癖积。这是医家所说的五膈的症状表现。经典记载：阳脉结滞称为膈。意思是说，忧愁、愤怒、寒冷、热气扰动气机并损伤神志，而气和神都属于阳。阳气受损扰动，导致阴阳不和，从而脏腑生病，结聚在胸膈之间，所以称为膈气。各种方书对五膈的说法互有不同，但致病的原因主要有五种，所以称为五膈气。（《诸病源候论》）（按：这与下面的五噎并列阐述其症状，然而论述膈噎的，以此为源头，所以首先列出。）
《延年秘录》：凡是忧膈、气膈、食膈、寒膈、饮膈，这五种疾病用同样的药物，通常是因为忧愁、思虑、饮食不当而得病。（《外台秘要》）（按：这里出自五膈丸的主治范围。）
五噎：所谓的五噎，指一是气噎，二是忧噎，三是食噎，四是劳噎，五是思噎。虽然有五个名称，都是由阴阳不和，三焦隔绝，津液不行，由忧愁、愤怒、嗔怒所引起，称为五噎。噎，就是噎塞不通的意思。（《诸病源候论》）
气噎候：这是由于阴阳不和，脏气运行不畅，寒气阻塞于胸膈，所以气机噎塞不通而称为气噎，使人出现喘息、心悸、胸背痛等症状。
食噎候：这是由于脏气虚冷而不运行，津液涩少而不能传输饮食，所以饮食入口则噎塞不通，因此称为食噎。胸内疼痛，不能喘息，食物下不去，这就是噎。（同上）
《古今录验》：五噎（“三字”据《千金方》注引补入），即气噎、忧噎、劳噎、食噎、思噎。气噎，表现为心悸，上下气机不通，嗳气呃逆不顺畅，胸胁部苦痛。忧噎，在天阴时痛苦于厥逆，心下部悸动，手足逆冷。劳噎，痛苦于气机阻隔，胁下支撑胀满，胸中填塞感，使手足逆冷，不能自我温暖。食噎，无论吃多少，只是胸中苦于堵塞，经常疼痛，不能喘息。思噎，心悸动，容易健忘，视物模糊。这些都是由于忧愁、愤怒、嗔怒，寒气上逆侵犯胸胁所致。（《外台秘要》）
病位在膻中穴之下，所以称为五膈。如果在咽喉部位，就称为五噎。（《三因极一病证方论》）
膈、噎、翻胃的区别：饮食进入噎间，不能下行通过噎部，随即吐出，从噎部回转，所以称为噎（按：这里以噎为咽的意思，并非正确理解）。膈是膈膜的膈，不是截断的意思。饮食下行通过噎部，到达膈间，不能下行通过膈部，才慢慢吐出，从膈部回转，所以称为膈。翻胃是饮食已经进入胃中，不能运化，而下脘又燥结不通，早上吃的晚上吐，晚上吃的早上吐，明确是从胃中倒出来，所以称为翻胃。同样是呕吐的病，但有上、中、下的区别。（《赤水玄珠》）
噎膈病，饥饿时想要进食，但在咽喉胸膈之间感到噎塞迎逆，在胃口之上，食物未曾进入胃中，就带着痰涎吐出来。如果一旦进入胃里，无不消化的，也不会再吐出来。只有年高的人才有这种病，年轻人没有噎膈翻胃的，饮食加倍（按：这句话很可疑），都能完全进入胃中。只是早上吃晚上吐，晚上吃早上吐，或者一两个时辰后吐，或者积聚到一天一夜，腹中胀闷难以忍受才吐出来，原物酸臭不消化，这是已经入胃而反出，所以称为翻胃，男女老少都有。（《医贯》）
噎膈和反胃两种证候，朱丹溪认为它们名称虽不同，但病源一体，似乎有理，然而实际上是有不同的。大概反胃者，食物还能吃进去，进去后又反出来，所以叫反胃。噎膈者，隔塞不通，食物不能下咽，所以叫噎膈。食物吃进去又反出来的，是因为阳虚不能运化，可以补益温煦，治疗还比较容易；食物不能下咽的，是因为气结不能运行，或者开郁或者辅助，治疗有两难之处，这是轻重不同。而且凡是患反胃的多能进食，患噎膈的不能进食。所以噎膈的病，病在胸臆上焦；而反胃的病，则病在中下二焦，这是见证的不同。所以反胃的治疗，多适宜益火之源，以助运化之功；噎膈的治疗，多适宜调养心脾，以舒展结气。既然证候既有不同，那么延请医生诊治也应当分类。（《景岳全书》）
病因由气结（气结生涎、气结伤阴两个原因，更有死血等几个原因）。阴阳不和则三焦隔绝，三焦隔绝则津液不利，所以令气机壅塞不调理，因此形成噎。这是由忧愁愤怒所致，忧愁愤怒则气结，气结则不宣通流动导致噎。噎，就是噎塞不通。（《诸病源候论》）
五噎诸气（妇女多有此病），此病不在体表，也不在内脏深处，不属于冷，不属于热，不是实证，不是虚证，所以药物难以取效。此病缘于忧愁思虑愤怒，动气伤神，气积聚于体内，气动则各种症状全部显现，气静则疾病症状稍平，触摸却找不到病的所在，观察面色也不知道颜色的成因，听声音也不知道声音的来源，所以针灸服药都不见效，这是神意之间的病。不久前京城一位读书人家里，有此疾病症状，劝他静心观察内外，将一切用心力的事情委托给他人，服药才见效。如果不这样，恐怕不能安宁。只要遵循这个告诫，兼之艾灸膏肓穴与四花穴，以及服用这三种药（按：这三种药未考证），可以必定痊愈。孙真人说：妇人的嗜欲多于丈夫，感病倍于男子，加上慈爱、憎恶、嫉妒、忧愁愤怒，染着坚固牢靠，情感不能自我抑制，所以病根深，治疗难以痊愈。（《鸡峰普济方》）
膈气噎塞，是由于忧思过度，气结不通，肺胃虚弱，气停留于肓膜则结滞于胸膈，所以升降否塞。喉咙是气上下通行的通道，如果气塞不通，则咽喉噎闷，状如梅核，吞咽有困难，所以称为膈气咽喉噎塞。（《圣济总录》）
所谓五噎等等，虽然五种不同，都以气为主等等。都是由喜怒无常，忧思过度，恐惧忧虑无时，郁而生涎，涎与气搏结，升而不降，逆害饮食，与五膈相同，但这病在喉嗌，所以称为五噎。（《三因极一病证方论》）
《素问》说：阳脉结滞称为膈。气和神都属于阳，安逸则气神安宁，劳累则气神耗损。倘若寒温失宜，饮食乖度，七情伤感，气神俱扰，使阳气先结，阴气后乱，阴阳不和，脏腑生病，结于胸膈则成膈气，留于咽嗌则成五噎。它发病时，令人胸膈痞闷，呕逆噎塞，妨碍饮食，胸痛彻背，或胁下支撑胀满，或心悸易忘，咽噎气不舒。（《济生方》）
噎膈多起于忧郁，忧郁则气结于胸臆而生痰。久病则痰结成块，胶着于上焦，道路窄狭，不能宽畅，饮水或许可以下咽，进食则难以下咽，而病已成矣。喜好饮酒的人，患此病的必定是顽痰。（《订补指掌应用方》）
噎膈一证，必由忧愁思虑，积劳积郁，或酒色过度，损伤而成。大概忧思过度则气结，气结则施化不行，酒色过度则伤阴，阴伤则精血枯涸。气不行，则噎膈病在上焦；精血枯涸，则燥结病在下焦。而且凡人的脏气，胃司受纳，脾主运化，而肾为水火之宅，化生之本。现在既然饮食停膈不行，或大便燥结不通，难道不是运化失职，血脉不通造成的病吗？而营运血脉的权力，在上的，不是脾是什么？在下的，不是肾是什么？何况少年少见此证，而惟中年衰退耗损的人多有此病，这其为虚为实，大概可以知道了。所以凡是治疗此病的人，如果想舍弃根本而言求快捷方式，又怎么指望能成功呢？（《景岳全书》）
五噎五膈，方书都归类为一门，而《千金方》唯独将五膈隶属于肺脏。探究其原因，确实是因为胃虚不能游溢精气于脾，所以气噎不通。脾衰不能散精上归于肺，所以食膈不下。推究其患病原因，虽有气、食、忧、劳的不同，总缘于思虑气郁所致。《素问》明确说隔塞闭绝，上下不通，是暴忧之病。（《千金方衍义》）
噎与膈，本属同一气，膈病之初，无不由噎而成。推究其大概，不外乎郁，所以张鸡峰认为是神思间的病。其受病的源头，不止一端。曾考证五噎之中，独多思噎；五膈之中，独多饮膈。常见多思虑的人，每患气噎，经书说思则气结就是这样。喜好热饮的人，每患酒膈，丹溪称之为死血就是这样。然而血膈也不止一端，往往有勇力过甚，血瘀于胃，阻碍饮食成膈的。就像《灵枢》说的虫为下膈，有此一证。至于命门火衰，不能温养土脏，食后乃出的，莫非是下膈的证候吗？而《素问》又有三阳结谓之膈，言小肠、大肠、膀胱的津血俱结，如厕涩难，下不通而上逆，势所必然。（同上）
病因由气血渐亏：膈噎开始因酒色过度，继以七情所伤，气血日亏，相火渐炽，多久会导致膈噎。血液渐亏，则火更甚，而脾胃都失去传化功能，饮食津液，凝聚而成痰，积于胃口，逐渐导致妨碍道路，于是食物不能入而成五膈五噎。（《医统》）
病因由三阳结：俗谓噎食一证，在《内经》中没有多话，只说三阳结谓之膈。三阳，指大肠、小肠、膀胱。结，指结热。小肠热结则血脉燥，大肠热结则大便不通，膀胱热结则津液枯竭。三阳俱结，则前后闭塞，下既不通，必反上行，这就是噎食不下，即使下咽也复出的原因。说胃为水谷之海，每天接受新的，以替换旧的，一日一次排便，是常度，现在患噎病的人，三日、五日或五、七日不便，是违背常度了，这也明确了。难道不是三阳俱结于下，广肠枯涸，所食之物被咽拒绝，即使进入太仓，又从咽咙出来，这是阳火不下推而上行。（《医学入门》）
子和论膈噎，连续数百言，说三阳结热，前后涩滞，下既不通，必反上行，所以噎食不下。夫膈噎，是胃病，起初未必燥结，久了才有大便秘少若羊屎的证候。这是因为胃中津气上逆，不得下行而然，是胃病及肠，非肠病及胃。（《金匮翼》）
肠胃作为物体，最喜欢润泽，试看羊猪的肚子，必定是滑腻稠粘，如液如脂，如膏如泽，在人的胃也是如此，这叫阴。膈症的人，其肠胃必定枯槁干燥，绝无滑腻稠粘等象，这是胃阴亡。阴亡，地气绝，地气绝则天气从何处生呢，所以多死。（《四明心法》）
病有气血之别：《本草发明》说：噎者，六腑所生，阳，气也。塞者，五脏所生，阴，血也。二者，都由阴中伏阳而作。谨按：噎为七情所发，或因三焦传化失常所致，此即主于气。或血液所亏，胃脘干槁，或血积所致，即皆因于血。塞由填塞不通之义，所以《本草发明》有治幽门不通，噎塞不便，用通幽汤的例子。盖阳无阴不能施化，阴之失位而阳伏其中，传化不变而反上行。然而人有被击扑坠跌，内致血瘀，忽然呕吐而食物不能纳入，这是由气血俱伤所可见的。大抵始因气致的，初当从气治；由血致的，当从血治，岂可类用香热之剂反而耗伤气血呢？但世俗拘泥，不能究乎病情，遂成危证，可悲啊！（《格致余论微义》）
病因由逆气：古人指噎膈为津液干枯，所以水液可行，干物梗涩，为槁在上焦，我私下怀疑。如果果真是津枯，为什么食物刚下咽，涎随上涌呢？所以知道膈咽之间，交通之气不得降者，都是冲脉上行，逆气所作。惟气逆，所以水液不能居润下之常，随气逆从耳。如果用津枯而用润下之剂，岂不是反而增加邪气吗？（《医学纲目》）（按：此说本于《沙篆》。）
脾胃诸证多因液燥：气之初病，其端甚微，或因少许饮食不谨，或外冒风雨，或内感七情，或食味过浓，偏助阳气，积成膈热。或资质充实，表密无汗，或性急易怒火炎上，以致津液不行，清浊相干。气为之病，或痞或痛，不思食，或嗳腐气，或吞酸，或嘈杂，或膨满。不求原本，便认为寒，遽以辛香燥热之剂投之，数帖时暂得快，以为神方，浓味仍前不节，七情反复相仍，旧病被劫暂开，浊液易于攒聚，或半月，或一月，前证复作。如此延蔓，自气成积，自积成痰，此为痰、为饮，为吞酸之由。良工未遇，缪药又行，痰挟瘀血，遂成窠囊，此为痞、为痛呕吐、为噎膈反胃之次第。饮食汤液，滞泥不行，渗道蹇涩，大便或秘或溏，下失传化，中焦愈停。医者不察，犹执为冷，翻思前药，随手得快，至此宾主皆恨药欠燥热，伺久服，可以温脾壮胃，消积行气，以冀一旦豁然之效。不思胃为水谷之海，多血多气，清和则能受；脾为消化之气，清和则能运。今反得香热之偏助，气血沸腾。其始也，胃液凝聚无所容受。其久也，脾气耗散，传化渐迟。其有胃热易饥，急于得食，脾伤不磨，郁积成痛。医者犹曰虚而积寒，非寻常草木可疗，径以乌头、附子助佐丹剂，专意服饵。积而久也，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，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，亦曰反胃。大便秘少，若羊矢然，名虽不同，病出一体。（《局方发挥》）（按：此论似精而反晦，又与前款所引《三因》诸说，其意自异。但明以来诸家，多援用之，而其所主，专在膈噎，仍姑存录之。又此误混反胃，辨见上。）
脉候：戴云：翻胃（按：上文曰：翻胃即膈噎）有四：血虚，气虚，有热，有痰。血虚者，脉必数而无力。气虚者，脉必缓而无力。有热者，脉数而有力。有痰者，脉滑数。二者可治。（《脉诀钩玄》）
脉紧而芤，紧则为寒，芤则为虚，虚寒相搏，脉为阴结而迟，其人则噎。然多有至死脉不变者，以胃中痰饮湿热胶固，脉常和软，然细察之，必兼弦象也。（《医学纲目》）
脉见微弱缓滑者，可治；若涩数细数沉涩，及尺肤枯涩者，不治。（《百问直解》）
脉浮缓而滑，沉缓而长，皆可治；弦涩短小，为难医。（《时方妙用》）
Ge (Diaphragm Syndrome) and Ye (Choking Syndrome), although their symptoms differ, share the same etiology and therapeutic approaches are interrelated; thus, they should not be strictly separated. Moreover, throughout my life, I have been unable to cure cases of this syndrome, and I am unsure what theory or formula can hit the mark. Therefore, I now compile records extensively, including unusual formulas, hoping readers will not blame the content for being cumbersome.
Five Ge (Diaphragm Syndromes): The so-called Five Ge Qi refers to You Ge (Worry Ge), Hui Ge (Anger Ge, referred to as Si Ge in *San Yin Fang*), Qi Ge (Qi Ge, referred to as Nu Ge in *San Yin Fang*), Han Ge (Cold Ge, referred to as Kong Ge in *San Yin Fang*), and Re Ge (Heat Ge). (Note: This category originally appeared in *Zhou Hou Bei Ji Fang*). You Ge disease manifests as qi stagnation and oppression in the chest, unsmooth flow of body fluids, difficulty swallowing food, emaciation, and lack of strength. Hui Ge disease manifests as bitter fullness and hardness in the epigastrium, frequent belching with acid reflux to the heart region, indigestion, accumulation and knotting in the epigastrium firmly lodged in the stomach, and obstruction of bowel and bladder movements. Qi Ge disease manifests as rebellious qi and fullness in the chest and hypochondrium, throat obstruction, blockage of the chest-diaphragm area, and aversion to the smell of food. Han Ge disease manifests as abdominal distension and fullness, coughing and rebellious qi, cold sensation in the abdomen, borborygmus, periumbilical pain, indigestion, and inability to consume fatty foods. Re Ge disease manifests as heat in the zang organs, heat in the five centers (palms, soles, and chest), oral ulcers and erosion, bone vexation, heavy limbs, dry lips and mouth, occasional heat in the body, head, face, and extremities, pain in the waist and back, chest bi syndrome radiating to the back, indigestion, inability to eat much, emaciation, shortness of breath, and pi masses. These are the symptom patterns of the Five Ge described by physicians. Classics state: "Obstruction of yang pulses is called Ge." This means that worry, anger, cold, and heat disturb qi and damage shen (spirit); since both qi and shen belong to yang, damage to yang qi leads to yin-yang disharmony, causing zang-fu diseases that knot in the chest-diaphragm region, hence termed Ge Qi. Various formularies differ on the Five Ge, but since there are five causes of disturbance, it is called Five Ge Qi. (*Zhu Bing Yuan Hou Lun*) (Note: This parallels the following Five Ye descriptions; as it is the source for discussions on Ge and Ye, it is listed first.)
*Yan Nian Mi Lu*: You Ge, Qi Ge, Shi Ge (Food Ge), Han Ge, and Yin Ge (Drink Ge) are treated with the same medicine; these illnesses usually arise from worry, thought, and improper diet. (*Wai Tai Mi Yao*) (Note: This refers to the indications for Wu Ge Wan).
Five Ye (Choking Syndromes): The Five Ye are: 1. Qi Ye, 2. You Ye, 3. Shi Ye, 4. Lao Ye, and 5. Si Ye. Although there are five names, they all result from yin-yang disharmony, separation of the San Jiao (Triple Burner), failure of body fluid transmission, and are caused by worry, anger, and resentment, hence called Five Ye. "Ye" means choking and obstruction. (*Zhu Bing Yuan Hou Lun*)
Qi Ye Pattern: This results from yin-yang disharmony and disordered zang qi, with cold qi blocking the chest-diaphragm, causing qi obstruction termed Qi Ye, leading to panting, palpitations, and chest/back pain.
Shi Ye Pattern: This results from cold and disordered zang qi, with scanty and astringent body fluids failing to transport food and drink; thus, food chokes upon entry, termed Shi Ye. Symptoms include chest pain, inability to breathe easily, and inability to swallow food. (Ibid.)
*Gu Jin Lu Yan*: The Five Ye (three characters added according to *Qian Jin Fang* commentary) are Qi Ye, You Ye, Lao Ye, Shi Ye, and Si Ye. Qi Ye presents with palpitations, obstruction of upper and lower qi, incomplete belching/hiccuping, and painful hypochondrium. You Ye presents with suffering from jue-ni (cold reversal) on cloudy days, epigastric palpitations, and cold extremities. Lao Ye presents with suffering from qi obstruction, fullness supporting the hypochondrium, chest filling sensation, cold extremities that cannot self-warm. Shi Ye presents with a bitter feeling of blockage in the chest regardless of food amount, constant pain, and inability to breathe easily. Si Ye presents with palpitations, frequent forgetfulness, and blurred vision. All are caused by worry, anger, resentment, and upward counterflow of cold qi to the chest and hypochondrium. (*Wai Tai Mi Yao*)
Disease located below the Dan Zhong (Conception Vessel 17) point is named Five Ge. If located in the throat, it is named Five Ye. (*San Yin Ji Yi Bing Zheng Fang Lun*)
Distinction between Ge, Ye, and Fan Wei (Reverse Stomach): When food enters the Ye space but cannot pass down, it is immediately vomited out, turning back from the Ye; thus, it is called Ye (Note: Here 'Ye' implies the pharynx, which is not entirely accurate). Ge refers to the diaphragm membrane, not interception. When food passes the Ye but reaches the Ge space and cannot descend further, it is slowly vomited out, turning back from the Ge; thus, it is called Ge. Fan Wei occurs when food has entered the stomach but fails to transform; the lower stomach becomes dry and obstructed, causing morning food to be vomited in the evening and evening food in the morning, clearly reversing from the stomach; thus, it is called Fan Wei. Although all are vomiting disorders, they are distinguished by upper, middle, and lower locations. (*Chi Shui Xuan Zhu*)
In Ye Ge, the patient feels hungry and desires food, but experiences choking and reverse flow in the throat and chest-diaphragm region, above the stomach opening. Food does not enter the stomach but is expelled with saliva/phlegm. Once food enters the stomach, it digests completely and is not regurgitated. This condition mostly affects the elderly; young people do not suffer from Ye Ge or Fan Wei, and even with double the usual diet, food enters the stomach. However, in Fan Wei, morning food is vomited in the evening, evening food in the morning, or after one or two hours, or after accumulating for a day and night until unbearable abdominal distension forces vomiting. The vomitus is sour, foul, and undigested, indicating it came from the stomach; thus, it is Fan Wei, affecting men, women, old, and young. (*Yi Guan*)
Zhu Danxi stated that although Ye Ge and Fan Wei have different names, they stem from the same pathology, which seems plausible, yet they are actually distinct. In Fan Wei, food can enter but is reversed out, hence "Reverse Stomach." In Ye Ge, obstruction prevents food from entering, hence "Ge/Ye." Regurgitation of ingested food is due to yang deficiency failing to transform; it can be tonified and warmed, making treatment relatively easier. Inability to swallow food is due to qi stagnation failing to move; it requires resolving stagnation or assisting movement, making treatment difficult. This indicates a difference in severity. Furthermore, patients with Fan Wei can usually eat, while those with Ye Ge cannot. Thus, Ye Ge pathology is in the upper jiao (chest/diaphragm), whereas Fan Wei pathology is in the middle and lower jiao, representing a difference in manifestation. Therefore, Fan Wei treatment favors warming the source of fire to aid transformation, while Ye Ge treatment favors nourishing the heart and spleen to soothe qi stagnation. Since syndromes differ, medical classification is necessary. (*Jing Yue Quan Shu*)
Etiology involves Qi Knotting (Causes include qi knot generating phlegm, qi knot damaging yin, and blood stasis). Yin-yang disharmony leads to San Jiao separation, causing body fluid obstruction and qi stagnation, resulting in Ye. This is caused by worry and anger; worry/anger knots qi, preventing smooth flow, causing Ye. Ye means choking obstruction. (*Zhu Bing Yuan Hou Lun*)
The Five Ye Qi (common in women) is neither external nor internal, neither cold nor hot, neither excess nor deficiency, making drugs ineffective. It arises from worry, thought, anger disturbing qi and damaging spirit; qi accumulates internally. When qi moves, symptoms appear; when qi calms, symptoms subside. Palpation finds no location, observation reveals no color cause, listening hears no sound origin; thus, acupuncture and herbs fail. This is a disorder of the spirit/mind. A scholar in the capital had this condition; advised to observe internally/externally calmly and delegate mental efforts, he improved with medication. Without this, recovery is unlikely. Following this advice, plus moxibustion on Gao Huang (BL-43) and Si Hua points, and taking three specific medicines (unverified), cure is certain. Sun Simiao said: Women have more desires than men and suffer twice as many diseases due to love, hate, jealousy, worry, and anger, which root deeply and are hard to treat. (*Ji Feng Pu Ji Fang*)
Ge Qi obstruction results from excessive worry/thought knotting qi, weak lung/stomach, qi lingering in the huang-mo (diaphragmatic fat) knotting in the chest-diaphragm, blocking ascending/descending functions. The throat is the passage for qi; if blocked, it feels like a plum pit, hindering swallowing, termed Ge Qi Throat Obstruction. (*Sheng Ji Zong Lu*)
Regarding the Five Ye, though diverse, they are primarily qi-related. Caused by irregular joy/anger, excessive worry/thought, constant fear/anxiety, depression generates phlegm; phlegm and qi contend, rising but not descending, harming food intake. Similar to Five Ge, but located in the throat, hence Five Ye. (*San Yin Ji Yi Bing Zheng Fang Lun*)
*Sù Wèn* states: "Obstruction of yang pulses is called Ge." Qi and shen belong to yang; rest keeps them calm, labor depletes them. Improper temperature regulation, dietary errors, and seven emotions disturb qi and shen, causing yang to knot first and yin to become chaotic later. Yin-yang disharmony leads to zang-fu disease knotting in the chest-diaphragm (Ge Qi) or throat (Five Ye). Symptoms include chest oppression, vomiting/choking, dietary interference, chest pain radiating to back, hypochondriac fullness, palpitations/forgetfulness, and throat qi discomfort. (*Ji Sheng Fang*)
Ye Ge often starts with depression, knotting qi in the chest to generate phlegm. Long-standing phlegm forms masses, adhering to the upper jiao, narrowing passages. Liquids may pass, but solids struggle, establishing the disease. Alcoholics often suffer from stubborn phlegm. (*Ding Bu Zhi Zhang Ying Yong Fang*)
Ye Ge is caused by worry/thought, accumulated labor/depression, or excessive alcohol/sex damaging the body. Excessive worry knots qi, stopping transformation; excessive sex damages yin, drying essence/blood. Qi stagnation causes Ye Ge in the upper jiao; essence/blood dryness causes dryness/knotting in the lower jiao. The stomach receives, the spleen transforms, and the kidney is the root of water/fire. If food stops in the diaphragm or stool is dry, it is failure of transformation and blood vessel obstruction. The power to circulate blood lies in the spleen (upper) and kidney (lower). Young people rarely get this; it affects those with mid-life decline. Thus, deficiency/excess can be inferred. Treatment must address the root, not seek shortcuts. (*Jing Yue Quan Shu*)
While formularies group Five Ye and Ge together, *Qian Jin Fang* assigns Five Ge to the Lung organ. The reason is stomach deficiency failing to transport essence to the spleen (causing Qi Ye obstruction) and spleen deficiency failing to send essence up to the lungs (causing Food Ge obstruction). Despite differences in qi, food, worry, and labor, the root is always thought-depression. *Sù Wèn* explicitly states obstruction and closure are due to sudden worry. (*Qian Jin Fang Yan Yi*)
Ye and Ge share the same qi; Ge often originates from Ye. Generally, it involves depression, so Zhang Jifeng considered it a spiritual disorder. Causes vary. Among Five Ye, Si Ye is common; among Five Ge, Yin Ge is common. Over-thinkers often get Qi Ye ("thought knots qi"). Hot-drink lovers often get Wine Ge (Danxi calls it dead blood). Blood Ge also has various causes, such as excessive exertion causing blood stagnation in the stomach. *Ling Shu* mentions parasites causing lower Ge. Mingmen fire deficiency failing to warm the spleen/stomach causing delayed vomiting might be lower Ge. *Sù Wèn* mentions "Three Yang knotting causes Ge," referring to heat/knotting in Small Intestine, Large Intestine, and Bladder, causing constipation and upward rebellion. (Ibid.)
Etiology: Gradual Deficiency of Qi and Blood. Ye Ge begins with excessive alcohol/sex, followed by seven emotions, daily depletion of qi/blood, and gradual intensification of ministerial fire, leading to Ye Ge. As blood/yin deplete, fire increases, spleen/stomach lose transformation, fluids condense into phlegm, accumulate at the stomach opening, obstruct passages, and prevent food entry, forming Five Ge/Ye. (*Yi Tong*)
Etiology: Three Yang Knotting. Commonly, Ye Shi (choking food) is briefly mentioned in *Nei Jing* as "Three Yang knotting causes Ge." Three Yang refers to Large Intestine, Small Intestine, and Bladder. Knotting refers to heat knotting. Small Intestine heat dries blood vessels; Large Intestine heat causes constipation; Bladder heat dries fluids. All three knotted leads to anterior/posterior blockage; downward obstruction forces upward rebellion, causing choking and regurgitation. The stomach is the sea of water/grain, receiving new to replace old, with daily defecation as normal. Ye patients go 3-7 days without stool, violating norms. This is due to Three Yang knotting below, drying the large intestine, rejecting food at the throat, or forcing it back up from the stomach due to upward-moving yang fire. (*Yi Xue Ru Men*)
He Zi discussed Ye Ge at length, stating Three Yang heat knotting causes blockage, downward obstruction forces upward rebellion, preventing food intake. Ye Ge is a stomach disease; initially not necessarily dry, but later presents with small, sheep-dung-like stools. This is due to stomach fluids/qi rebelling upward instead of descending, meaning stomach disease affects the intestines, not vice versa. (*Jin Kui Yi*)
Intestines and stomach prefer moisture; animal bellies are slippery and viscous. Human stomachs should be similar (yin). Ge patients have dry, withered intestines/stomachs lacking moisture; this is loss of stomach yin. Loss of yin is like the earth dying; without earth, where does heaven (qi) come from? Hence, high mortality. (*Si Ming Xin Fa*)
Distinction between Qi and Blood Pathology: *Ben Cao Fa Ming* states: Ye is generated by six fu organs, yang, and qi. Se (obstruction) is generated by five zang organs, yin, and blood. Both arise from yang hidden within yin. Ye is triggered by seven emotions or san jiao transmission failure, primarily qi-based. Blood deficiency, dry stomach lining, or blood stasis cause blood-based issues. Se implies blockage; *Fa Ming* cites Tong You Tang for pyloric obstruction. Yang cannot transform without yin; yin displacement traps yang, reversing transmission upward. Trauma causing blood stasis leads to sudden vomiting and inability to eat, showing qi/blood injury. Initially qi-based issues should be treated via qi; blood-based via blood. Using aromatic-hot agents indiscriminately consumes qi/blood. Secular rigidity ignores pathology, leading to critical conditions. Sad! (*Ge Zhi Yu Lun Wei Yi*)
Etiology: Rebellious Qi. Ancients attributed Ye Ge to dry fluids, allowing liquids but blocking solids, citing upper jiao withering. I doubt this. If fluids were truly dry, why does saliva surge immediately upon swallowing? Thus, the qi communication between diaphragm and throat fails to descend, driven by Chong Mai upward flow and rebellious qi. Due to rebellion, fluids cannot stay low and moist, following the rebellion. Using lubricating/lowering agents for dryness would worsen the pathogen. (*Yi Xue Gang Mu*) (Note: Based on *Sha Zhao*.)
Spleen/Stomach Syndromes Often Due to Fluid Dryness: Initial qi disease is subtle, caused by slight dietary indiscretion, wind/cold exposure, seven emotions, or rich flavors aiding yang, accumulating into diaphragm heat. Or robust constitution with closed pores, or irritable nature causing fire to rise, stopping fluid transmission and mixing clear/turbid. Qi disease causes stuffiness/pain, anorexia, belching, acid regurgitation, heartburn, or distension. Mistaking this for cold and using aromatic-hot agents brings temporary relief, hailed as miraculous. Continued rich diet and emotional stress allow turbid fluids to gather, causing recurrence. Prolonged, qi becomes mass, mass becomes phlegm, leading to phlegm, fluid retention, and acid regurgitation. Without skilled doctors, wrong meds continue; phlegm mixes with blood stasis forming nests, leading to stuffiness, pain, vomiting, Ye Ge, and Fan Wei sequentially. Dietary fluids stagnate, channels become rough, stool varies, lower transformation fails, middle jiao stops. Doctors mistake this for cold, preferring hot meds to warm spleen/stomach and move qi. They forget the stomach is a sea of blood/qi requiring clarity/harmony to receive; the spleen requires clarity/harmony to transform. Hot meds cause qi/blood boiling. Initially, stomach fluids coagulate and reject intake; later, spleen qi scatters, transformation slows. Stomach heat causes hunger, but spleen damage prevents grinding, causing pain. Doctors call it deficiency-cold, prescribing Aconite/Cinnamon pills. Long-term use consumes blood/qin, drying the stomach lining. Drying near the throat allows liquids but blocks solids (Ye); drying near the stomach allows entry but prevents full digestion, causing regurgitation (Ge/Fan Wei). Constipation resembles sheep dung. Different names, same root. (*Ju Fang Fa Hui*) (Note: This argument seems precise but is obscure, differing from *San Yin*. Ming/Qing doctors cite it, focusing on Ge/Ye. It confuses Fan Wei; see distinction above.)
Pulse Diagnosis: Dai Yun: Fan Wei (note: Fan Wei equals Ge/Ye) has four types: Blood Deficiency, Qi Deficiency, Heat, Phlegm. Blood Deficiency pulse is rapid and forceless. Qi Deficiency pulse is slow and forceless. Heat pulse is rapid and forceful. Phlegm pulse is slippery and rapid. These two [types] are treatable. (*Mai Jue Gou Xuan*)
Qi Ye pulse is slow and choppy; Shi Ye pulse is short and choppy. (*Qi Xiao Liang Fang*)
Tight and hollow pulse: Tight indicates cold, hollow indicates deficiency. Deficiency-cold interaction causes yin-knotting and slow pulse, leading to Ye. However, some die with unchanged pulses because phlegm-fluid-heat dampness in the stomach makes the pulse soft; careful inspection reveals a string-like quality. (*Yi Xue Gang Mu*)
Weak, slow, slippery pulses are treatable; choppy-rapid, fine-rapid, deep-choppy, and dry/rubbery skin at the chi position are untreatable. (*Bai Wen Zhi Jie*)
Floating-slow-slippery and deep-slow-long pulses are treatable; string-choppy-short-small pulses are difficult to treat. (*Shi Fang Miao Yong*)
Empty pulses and intermittent pulses are untreatable. (*Yi Zong Sheng Mo*)