反胃脉法
难经云脉格则吐逆(见淋 门)
脉经云紧而滑者吐逆小弱而涩胃反
千金云寸紧尺涩其人胸满不能食而吐吐止者为下之故不能食设言未止者此为胃反故尺为
微涩
金匮云病患脉数数为热当消谷引饮而反吐者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今脉反弦故名曰虚
趺阳脉浮而涩浮则为虚涩则伤脾脾伤则不磨朝食暮吐暮食朝吐宿谷不化名曰胃反脉紧而
涩其病难治
丹溪云胃为水谷之海脾为消化之器清和则健而营运世人以痰饮呕吐诸气多服香热之药偏
助气
血沸腾其始也胃液凝聚其久也脾气耗败传化渐迟又以乌附丹剂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亦曰反胃大便秘小若羊屎然名虽不同病出一体或曰千金治噎膈反胃
未尝废姜桂等药何吾子之多言也予曰气之郁滞久留清道非借香热不足以行然悉有大黄石膏竹
茹芒硝泽泻前胡朴硝茯苓黄芩芦根栝蒌等药为之佐使其始则同其终则异也病邪易伏其病自安
严氏云(三因同)五噎五膈者由喜怒不常七情伤于脾胃郁而生痰痰与气搏升而不降饮食不
下盖
气留于咽嗌者则成五噎结于胸膈者为五膈五噎之名忧思劳食气也五噎之名忧恚寒热气也其病
令人胸膈痞闷呕逆噎塞妨碍饮食治法调顺阴阳化痰下气阴阳平匀气顺痰下则病无由而作矣
按膈噎之证皆由气聚成积自积成痰痰积之久血液俱病以其为病在咽在膈故前人立膈噎二
者之
名三因方又分五噎五膈病状徒有其名为治则一而已故不叙焉又严氏为化痰下气之说夫气之不
下痰之不化必有为病之因苟不治其本而专以香燥之药治其标痰气何由而自下也
反胃病的脉象诊法
《难经》说：脉象呈现格拒之象，则会出现呕吐逆上的症状（参见淋门章节）。
《脉经》说：脉象紧而滑的，是呕吐逆上；脉象小弱而涩的，是胃反病。
《千金方》说：寸脉紧、尺脉涩的人，胸中胀满，不能进食且呕吐。如果呕吐停止，是因为误用攻下法导致不能进食；如果说呕吐未停止，这就是胃反病，所以尺脉微涩。
《金匮要略》说：病人脉数，数脉主热，应当能消化谷物并引水自饮，但却反而呕吐，这是因为发汗过度导致阳气微弱、膈气虚弱，脉象才表现为数。这种数是客热，不能消化谷物，原因是胃中虚冷。脉象弦的，代表虚证，胃气不足，早晨吃的食物晚上吐出，转变为胃反病，寒邪在上部，医生反而使用攻下法，现在脉象反而变弦，所以称为虚证。趺阳脉浮而涩，浮脉主虚，涩脉伤脾，脾受伤则不能磨化水谷，早晨吃的食物晚上吐出，晚上吃的食物早晨吐出，宿食不化，这叫做胃反。脉象紧而涩的，病情难以治愈。
朱丹溪说：胃是水谷汇聚的海，脾是消化的器官，清和则功能健全而运行正常。世人因为痰饮、呕吐等病症，多服用香燥温热之药，偏助气血沸腾。起初导致胃液凝聚，日久则脾气耗败，传化功能逐渐迟缓。又服用乌头、附子及丹药，积久导致血液俱耗，胃脘干枯槁硬。如果干枯部位在上部，靠近咽下，水饮可以下行，但食物难以下咽，即使偶尔能入，量也不多，这叫做“噎”。如果干枯部位在下部，靠近胃部，食物虽然可以进入，但难以完全进入胃中，停留很久后再次吐出，这叫做“膈”，也叫做“反胃”。大便秘结，形状像羊屎一样。名称虽然不同，但病源出自一体。有人说，《千金方》治疗噎膈反胃，未曾废弃姜、桂等药物，为什么您这么多话？我说：气机郁滞长久停留在清道之中，不借助香燥温热之药不足以推动运行，然而（在方剂中）必定有大黄、石膏、竹茹、芒硝、泽泻、前胡、朴硝、茯苓、黄芩、芦根、栝蒌等药物作为辅助，使其初期看似相同，最终效果却不同。病邪容易潜伏，疾病自然安宁。
严氏说（《三因极一病证方论》观点相同）：五噎五膈，是由于喜怒无常，七情损伤脾胃，郁结而生痰，痰与气搏结，升而不降，导致饮食不下。气停留于咽喉处，则形成五噎；结聚于胸膈处，则形成五膈。五噎的名称源于忧思、劳倦、饮食；五噎的名称源于忧怒、寒冷、热气、饮食。这些病症使人胸膈痞闷，呕逆噎塞，妨碍饮食。治疗方法是调顺阴阳，化痰下气。阴阳平匀，气顺痰下，则疾病没有产生的根源了。按：膈噎这类病症，都是由气聚成积，自积生痰，痰积日久，血液都受病变影响。因为病位在咽、在膈，所以前人立下膈、噎两个名称。《三因方》又分为五噎五膈的病状，徒有名称，但治疗方法是一致的罢了，所以不再叙述。另外，严氏提出化痰下气的说法，气不下行、痰不化解，必定有致病的原因。如果不治其根本，而专门用香燥药物治疗其标，痰和气怎么能自行下降呢？
Pulse Diagnosis for Regurgitation (Wei Fan)
The *Nan Jing* (Classic of Difficult Issues) states: When the pulse presents a "Ge" (blocking/resisting) quality, vomiting and upward reversal of Qi occur (see section on Lin Syndrome).
The *Mai Jing* (Pulse Classic) states: A pulse that is tight and slippery indicates vomiting and upward reversal; a pulse that is small, weak, and choppy indicates Wei Fan (stomach reversal).
The *Qian Jin Fang* (Prescriptions Worth a Thousand Gold) states: In a person with a tight cun pulse and a chopchi chi pulse, there is chest fullness, inability to eat, and vomiting. If the vomiting stops, it is due to previous inappropriate purgation leading to an inability to eat; if the vomiting does not stop, this is Wei Fan, hence the chi pulse is described as slightly choppy.
The *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet) states: If a patient has a rapid pulse, which indicates heat and should normally allow for digestion of grains and increased thirst, yet they vomit instead, this is because excessive sweating caused Yang Qi to become weak and Diaphragm Qi to become deficient, resulting in a rapid pulse. This rapidness is due to "Guest Heat," which cannot digest food; the root cause is deficiency-cold in the Stomach. A wiry pulse indicates deficiency, meaning Stomach Qi is insufficient. Food eaten in the morning is vomited in the evening, transforming into Wei Fan. Cold pathogen resides in the upper jiao, but the physician incorrectly used purgatives. Since the pulse is now wiry, it is named "Deficiency." The Fu Yang pulse (radial artery at the ankle) is floating and choppy. Floating indicates deficiency; choppy indicates Spleen injury. When the Spleen is injured, it fails to grind and transform food. Food eaten in the morning is vomited in the evening, and food eaten in the evening is vomited in the morning. Undigested food remains, termed Wei Fan. A pulse that is tight and choppy indicates a difficult-to-treat condition.
Zhu Danxi stated: The Stomach is the sea of water and grain; the Spleen is the organ of digestion. When clear and harmonious, functions are robust and transport is normal. People often take aromatic, hot, and warm medicines for phlegm-fluid retention, vomiting, and other Qi disorders, which excessively agitates the boiling of Qi and Blood. Initially, this causes Stomach fluids to coagulate; over time, Spleen Qi is exhausted, and transformation/transportation gradually slows. Furthermore, taking Aconite (Wu Tou), Prepared Aconite Root (Fu Zi), and alchemical pills depletes both blood and Yin over time, causing the gastric region to become dry and withered. If the withering is in the upper part, near the throat, liquids can pass down, but solids are difficult to enter. Even if some enters, the amount is small; this is called "Ye" (dysphagia/choking). If the withering is in the lower part, near the stomach, food may enter but cannot fully pass into the stomach. It stays for a long time and is then regurgitated; this is called "Ge" (diaphragmatic obstruction), also known as "Fan Wei" (regurgitation). Stool becomes hard and dry, resembling sheep dung. Although the names differ, the disease originates from the same source. Some ask: The *Qian Jin Fang* did not discard Ginger and Cinnamon when treating Ye, Ge, and Fan Wei. Why do you speak so much? I reply: When Qi stagnation lingers in the clear orifices for a long time, aromatic and hot medicines are necessary to move it. However, these must be assisted by herbs such as Rhubarb (Da Huang), Gypsum (Shi Gao), Bamboo Shavings (Zhu Ru), Mirabilite (Mang Xiao), Alisma (Ze Xie), Peucedanum (Qian Hu), Nitrated Potassium (Pu Xiao), Poria (Fu Ling), Scutellaria (Huang Qin), Reed Rhizome (Lu Gen), and Trichosanthes Fruit (Gua Lou). Thus, while the initial approach may seem similar, the final outcome differs. Pathogenic factors are easily subdued, and the body returns to peace.
Yan Shi stated (consistent with *San Yin Fang*): The Five Ye and Five Ge arise from irregular emotions (joy, anger, etc.) injuring the Spleen and Stomach, leading to Qi constraint, phlegm generation, and the struggle between Phlegm and Qi, where Qi rises but does not descend, preventing food intake. When Qi lodges in the throat and epiglottis, it forms the Five Ye; when it knots in the chest and diaphragm, it forms the Five Ge. The term "Five Ye" refers to conditions caused by worry, thought, fatigue, and diet. The term "Five Ye" (in another context/classification) refers to conditions caused by indignation, cold, heat, and diet. These diseases cause chest and diaphragm stuffiness, vomiting, upward reversal, choking, and obstruction of food intake. The treatment method is to regulate Yin and Yang, resolve phlegm, and direct Qi downward. When Yin and Yang are balanced, Qi flows smoothly, and Phlegm descends, leaving no basis for the disease to arise. Note: Ge and Ye syndromes all result from Qi aggregation forming masses, which generate phlegm over time. As the mass persists, both blood and Qi are affected. Because the pathology is located in the throat and diaphragm, predecessors established the distinct names of Ge and Ye. *San Yin Fang* further subdivided them into five types of Ye and five types of Ge based on symptoms. However, these distinctions are merely nominal; the treatment principles remain the same, so they are not detailed here. Furthermore, Yan Shi's theory of resolving phlegm and directing Qi downward implies that if Qi does not descend and Phlegm does not transform, there must be a root cause. If one treats only the branch with aromatic and drying herbs without addressing the root, how can Phlegm and Qi naturally descend?