王 痰隔中焦，食入脘痛，口沃清水，呕吐粘痰。大便坚结，肠液枯也。时多空嗳，胃失降也。拟化痰
和胃，降气润肠法。
旋复花（盐水炒） 代赭石 杏仁 半夏 橘红 栝蒌皮 瓦楞子
苏子 白芥子 莱菔子 姜汁 地栗汁
胡 气郁中焦，得食则呕，已延匝月，虑成膈证。
川连（吴萸炒） 白术 半夏 藿香 陈皮 焦六曲 香附 茯苓 郁金 白蔻仁
张 营阴虚，故内热少寐。气火逆，故咽喉哽塞。拟四物以养其阴，四七以理其气。
大生地（砂仁拌） 苏梗 茯苓 当归 川朴 北沙参 白芍 半夏 枣仁 姜竹茹 枇杷叶
陈 营虚火亢，胃枯食噎。心膈至咽，如火之焚，有时呱呱作声，此气火郁结使然也。病关情志，非徒药
饵可瘳，宜自怡悦，庶几可延。
旋复花 代赭石 沙参 黑山栀 茯苓 川贝 焦六曲 麦冬 杏仁 竹茹 枇杷叶
复 气火上逆，咽喉不利，胸痛食噎，膈症已成。况年逾六旬，长斋三十载，胃液枯槁，欲求濡润胃阴，
饮食无碍，还望怡情自适。
前方加西洋参、半夏。
丁 脉形弦硬。春令见此，是即但弦无胃。纳食哽痛，大便坚燥，已见木火亢逆，胃汁肠液干枯，治之不易。
旋复花 杏仁 火麻仁 桃仁 苏子 青果 荸荠 芦根
复 前方润燥以舒郁结，今拟下气化痰之剂。
麦冬 半夏 杏仁 橘红 川贝 茯苓 竹茹 芦根 荸荠 海蜇 枇杷叶
渊按∶两方清润可喜，洵属名家。
秦 痰气阻于胸中，故痰多而胸闷，纳食或呕，两太阳胀痛。清气不升，浊气不降。久延不已，恐成膈症。
半夏 橘红 赤苓 吴萸汁炒川连 党参 泽泻 藿香 旋复花 枳壳 川贝 蔻仁 肉桂 大腹皮 冬术 生姜
来复丹一钱，药汁送下。
陈 丧子悲伤，气逆发厥，左脉沉数不利，是肝之气郁，血少不泽也。右关及寸滑搏，为痰为火，肺胃
之气失降，肝木之火上逆，将水谷津液蒸酿为痰，阻塞气道，故咽喉胸膈若有阻碍，
纳食有时呕噎也。夫五志过极，多从火化，哭泣无泪，目涩昏花，皆属阳亢而阴不上承。目前治法，不外顺
气降火，复入清金平木。
苏子 茯苓 半夏 枳实 杏仁 川贝 竹茹 沙参 橘红 麦冬 海蜇 荸荠
此方系四七、温胆、麦冬三汤加减，降气化痰，生津和胃。病起肝及肺胃，当从肺肝胃为主。
秦 七情郁结，痰气凝聚。胸膈不利，时或呕逆。症将半载，脾胃大虚。前用四七、二陈，降气化痰，
今参入理中，兼培中土，当顾本也。
四七汤合二陈汤。理中汤加丁香、木香、蔻仁。
徐 气郁于胸为膈，气滞于腹为臌。饮食不纳，形肉顿瘦。
阴气凝聚，阳气 没。脉细如丝。姑与培土、通阳、化气一法。
党参 肉桂 白术 大腹皮 熟附子 泽泻 茯苓 来复丹
渊按∶伤胃则膈，伤脾则臌。膈多郁火，臌多阳衰。肺金治节不行，肝木起而克贼。
周 胸痛吐清水，自幼酒湿蕴蓄胃中，阳气不宣，浊气凝聚。
遽述前年又得暴喘上气，额汗淋漓，发作数次。今又增心嘈若饥，此皆胃病。用小半夏汤。
半夏 茯苓 陈皮 竹茹 生姜
渊按∶暴喘额汗，肺肾亦病，不独胃也。
复 停饮生痰，呕吐酸水，胸中板痛。前用小半夏汤，所以蠲其饮也。今风邪伤肺，咳嗽内热。拟金
沸草散宣风降气，仍寓祛痰蠲饮，肺胃兼治之方。
金沸草 半夏 陈皮 茯苓 款冬花 杏仁 荆芥 前胡 竹茹 枇杷叶
赵 气水郁结成痰，咽噎碍食，食入辄呕清水米粒。病在胃之上脘。降气化痰之药，须择不燥者为宜。
栝蒌仁 半夏曲 川贝 橘红 丁香 蛤壳（青黛三分，同研包） 白蜜 枇杷叶 竹茹 芦根 生姜汁（冲服）
复 诸逆冲上，皆属于火。食入即吐是有火也。
川连 半夏 苏梗 制大黄 竹茹 枇杷叶
渊按∶《内经》病机十九条，都有不尽然者，注者不敢违背，随文敷衍，贻误后学。其实是是非非，
明眼自能别白。即如诸逆冲上之证，不属于火者甚多，未可一概论也。读经者知之。
祝 胃阳虚则水饮停，脾阳虚则谷不化。腹中漉漉，胸胁胀满，纳食辄呕酸水清涎，或嗳腐气。
法以温导，崇土利水。
炮姜 陈皮 苍术 半夏 熟附子 白术 党参 泽泻 枳实 栝蒌仁 蔻仁 谷芽
沈 食下则饱胀，作酸呕吐，病属反胃。胃脉浮按则紧，沉按则弦。弦者木侮土，紧者寒在中。
党参 干姜 半夏 陈皮 茯苓 丁香 焦六曲 荜茇 蔻仁 陈香橼
许 吐血后呃逆，迄今一月。舌白腻，右脉沉滑，左脉细弱。其呃之气自少腹上冲，乃瘀血挟痰浊阻于
肺胃之络，下焦冲脉相火上逆，鼓动其痰，则呃作矣。酌方必有济，幸勿躁急为嘱。
半夏 茯苓 陈皮 当归 郁金 丁香 柿蒂 姜汁 藕汁 水红花子
东垣滋肾丸一钱，陈皮、生姜泡汤下。阴寒呃者用肉桂五分，坎 二条，沉香六分，分两服。
渊按∶所谓气呃、痰呃是也。与虚寒不同。
某 疟后痰气阻滞胃脘，清阳不升。作呃，纳食辄呕，防成膈症。且与仲景化痰镇逆再商。
旋复花 代赭石 淡干姜 法半夏 赤苓 制香附 丁香 柿蒂
秦 纳食辄呕清水涎沫米粒，病在胃也。曾经从高坠下，胁肋肩膊时痛，是兼有瘀伤留于肺胃之络，
故呕有臭气。拟化瘀和胃，降逆止呕为治。
旋复花 归须 广郁金 杏仁 半夏 炒丹皮 茯苓 焦楂肉 橘红 蔻仁
渊按∶佐韭、姜、藕三汁更妙。
复 止呕必以和胃，气升必须降纳。
半夏 茯苓 白术 蔻仁 藿香 陈皮 老桂木 神曲 干姜 沉香 伏龙肝
李 寒热咳嗽，一载有余，咳痰带血。饮食沃噎，胸膈阻窒，又成噎膈。此必兼挟气郁而成。今且和
胃降气，冀其血止噎减为妙。
旋复花 半夏 杏仁 丹皮 橘红 茯苓 郁金 栝蒌霜 蔻仁 竹茹 枇杷叶
陈 卒然心痛，纳食哽塞，粥饮犹可。此心气郁结，防变膈证。
栝蒌仁 薤白头 旋复花 川贝母 茯神 半夏 桔梗 远志肉 竹茹
朱 脉滑大，食入哽噎不下，舌腻，此属痰膈，大肠燥火凝结。拟清痰火，佐以宣通。
旋复花 麦冬 六神曲 黑山栀 赤苓 半夏 豆豉 陈皮 杏仁 竹茹 海蜇 荸荠 枇杷叶
吴 情志郁结，阳明津液内枯，少阴之气上逆。少腹气上冲咽，咽喉觉胀，纳食哽噎。拟温养津液，
以降浊阴之气。
旋复花 代赭石 苁蓉干 枸杞子 橘红 茯苓 川贝 半夏 沉香 鸡冠 地栗
盛 气郁痰凝，胸中失旷，背寒脊痛，纳少哽噎。甚则吐出。膈症之根。
旋复花 桂枝 栝蒌皮 杏仁 竹茹 代赭石 薤白头 半夏 茯苓
又 诸恙仍然，痰稍易出。
桂枝 栝蒌皮 干姜 薤白头 陈皮 杏仁 旋复花 生鹿角 竹茹 枇杷叶
又 服温通阳气之药，呕出寒痰甚多，未始不美，惟纳食哽噎之势未除。仍以温通，再观动静。
川熟附 桂枝 薤白头 半夏 陈皮 杏仁 桃仁 栝蒌仁 姜汁 韭菜根汁
又 上焦吐者从乎气，中焦吐者因乎积。此纳食哽噎，少顷则吐出数口，且多清水粘痰，是有
痰积在中焦也。然究属膈症之根。
川熟附 半夏 瓦楞子 陈皮 苏子 莱菔子 旋复花 白芥子 桃仁 荜茇
高 坤土阳微湿胜，腹中不和。用平胃、理中合剂。
平胃散合理中汤。加延胡者，因有瘀凝也。
某 叠进温中运湿，腹中呱呱有声，朝食则安，暮食则滞，卧则筋惕肉 ，时吐酸水。中土阳微，
下焦阴浊之气上逆，病属反胃。温中不效，法当益火之源，舍时从症，用茅术附子理中合真
武法。
附子理中加茯苓、陈皮、生姜。
渊按∶水谷不化精微而生酸痰，肝木失于濡润，筋惕肉 ，是肝有燥火也。徒事温燥无益。
张 胃汁干枯，肠脂燥涸，上焦饮食尽生为痰，不生津血。纳食则吐，痰随吐出。膈症之根渐深，
高年静养为宜。
鲜苁蓉（一两） 青盐半夏（三钱） 茯苓 当归 陈皮 沉香 枳壳
又 津枯气结噎膈，苁蓉丸是主方。
照前方加炒香柏子仁、陈海蛰、地栗。每日用柿饼一枚，饭上蒸软，随意嚼咽。
盛 背为阳位，心为阳脏。心之下，胃之上也。痰饮窃踞于胃之上口，则心阳失其清旷，而背常恶寒，
纳食哽噎，是为膈症之根。盖痰饮为阴以碍阳故也。
熟附子 桂枝 杏仁 神曲 薤白头 栝蒌皮 旋复花 蔻仁 豆豉 丁香 竹茹 枇杷叶
渊按∶温中化饮，降逆润肠，不失古人法度。惟豆豉一味不解是何意思。
孔 先曾呕血，胃中空虚，寒饮停留，阳气不通，水谷不化，食入呕吐酸水，谷食随之而出。脉细肢
寒，阳微已甚。证成翻胃，虑延脾败难治。
熟附子 干姜 丁香 橘饼 苁蓉干 九香虫 二陈汤（其中甘草炙黑）
渊按∶噎膈反胃从呕血而起者甚多。盖血虽阴物，多呕则胃阳伤而不复，不能运水谷而化精微，失
其顺下之职，始则病反胃，久则肠液枯槁而为膈证矣。
严 噎膈、反胃，胃脘之病也。上焦主纳，中焦司运，能纳
而不能运，故复吐出。朝食暮吐，责其下焦无阳。拟化上焦之
痰，运中焦之气，益下焦之火，俾得三焦各司其权，而水谷熟腐，自无反出之恙。然不易矣。
旋复花 代赭石 熟附子 茯苓 枳壳 沉香 半夏 新会皮 益智仁 淡苁蓉 地栗 陈鸡冠 海蛰
仁渊曰∶噎膈证，昔张鸡峰谓神思问病，而有不尽然者。过于谋虑忧思，脾阴伤而肝火起，固有是证。
而得之呕血过多，或餐凉食冷者不少，是皆脾胃阳伤也。胃阳伤则不化而失其顺降，
脾阳伤则不运而失其升腾，饮食到胃，精微不化气血津液而变酸水痰涎。中土既失温和松燥，肝胆失其条达，
郁结不舒，横克脾胃，气结而为痛，逆升而为吐，将稼穑甘味化为木火酸苦之味呕
出，胸膈稍快。明日再积再呕，久之中焦之气日伤，津液日竭，胃管之口缩小，纳食哽嗌作痛。胃气既失
顺降，二肠自少灌溉，渣滓留滞不行，加以肝胆郁结之火日加煽灼，大便自然燥而不
通，甚至经旬始通。通下如羊矢黑粒者，不可治矣。夫噎膈固属难治，而古人治此者亦少精妙之方。云岐子
九方，劫霸攻克，固不足道。《局方》过于香燥。近惟喻嘉言黄连汤进退之议，深中
窍要。此外如丹溪五汁安中饮、左金丸等，尚可取法。若大便不通，断不可以硝、黄硬下。要知阳明气降，
始二肠津液流润，不通自通矣。若夫反胃，即噎膈之根。古人谓食不得入是有火，食
入反出是无火。盖肝胆相火，郁于胸中，清旷之地，变为燎原之场，胃口被灼，气不得降，致食不能下。
此不独噎膈，噤口痢亦是此意。若噎膈证如此，则五液被焚，不可为矣。至食入反出，
虽属无火，乃中宫失温运之职，升降不灵，木火更从而为患，与火不生土，土虚阳衰之无火大异，未可以温
燥从事。仲景论胸中有寒，丹田有热，与此相近。喻氏黄连汤，即仿其意为之进退。
治此者能想明孰寒孰热、孰虚孰实，得其机巧，则为良工矣。
王姓患者：痰浊阻滞中焦，进食后胃脘疼痛，口中流出大量清稀唾液，呕吐粘稠痰液。大便干结坚硬，这是肠道津液枯竭的表现。时常空自嗳气，这是胃气失于下降所致。拟采用化痰和胃、降气润肠的治疗方法。
旋复花（盐水炒制） 代赭石 杏仁 半夏 橘红 栝蒌皮 瓦楞子 苏子 白芥子 莱菔子 姜汁 地栗汁
胡姓患者：气机郁滞于中焦，进食即呕吐，病程已延续一个月，担心发展为噎膈证。
川黄连（吴茱萸炒制） 白术 半夏 藿香 陈皮 焦六曲 香附 茯苓 郁金 白蔻仁
张姓患者：营阴亏虚，所以体内发热、睡眠减少。气火逆乱，所以咽喉有哽塞感。拟用四物汤以滋养其阴，四七汤以调理其气。
大生地（砂仁拌炒） 苏梗 茯苓 当归 川朴 北沙参 白芍 半夏 枣仁 姜竹茹 枇杷叶
陈姓患者：营血虚弱而火气亢盛，胃阴枯槁导致饮食哽噎。从心膈至咽喉，感觉如火烧灼，有时发出呱呱的声音，这是气火郁结所致。病情与情志有关，不仅仅依靠药物就能治愈，应当自我愉悦心情，或许还能延缓病情。
旋复花 代赭石 沙参 黑山栀 茯苓 川贝 焦六曲 麦冬 杏仁 竹茹 枇杷叶
复诊（某患者）：气火上逆，咽喉不利，胸痛且饮食哽噎，膈症已经形成。况且年过六十，长期吃斋三十年，胃液干枯，想要滋润胃阴，使饮食无碍，还希望保持心情愉悦自在。
前方加入西洋参、半夏。
丁姓患者：脉象弦硬。春季出现这种脉象，是只有弦脉而没有胃气的表现。进食时哽痛，大便干结燥硬，已经见到肝木火气亢逆，胃汁和肠液干枯，治疗不易。
旋复花 杏仁 火麻仁 桃仁 苏子 青果 荸荠 芦根
复诊：前方通过润燥来舒展郁结，现在拟定下气化痰的方剂。
麦冬 半夏 杏仁 橘红 川贝 茯苓 竹茹 芦根 荸荠 海蜇 枇杷叶
渊按：这两个方子清润得当，确实属于名家手笔。
秦姓患者：痰气阻滞于胸中，所以痰多且胸闷，进食有时呕吐，两侧太阳穴胀痛。清气不升，浊气不降。拖延日久不止，恐怕会发展成膈症。
半夏 橘红 赤苓 吴萸汁炒川连 党参 泽泻 藿香 旋复花 枳壳 川贝 蔻仁 肉桂 大腹皮 冬术 生姜
来复丹一钱，用药汁送服。
陈姓患者：因丧子之痛悲伤过度，气逆导致昏厥，左脉沉数而不流利，这是肝气郁结，血少不能濡养的表现。右关及寸部脉滑搏有力，为痰为火，肺胃之气失于下降，肝木之火上逆，将水谷津液蒸酿成痰，阻塞气道，所以咽喉胸膈感觉若有阻碍，进食有时呕吐哽噎。五志过极，大多化火，哭泣无泪，眼睛干涩昏花，都属于阳亢而阴不上承。目前治法，不外乎顺气降火，进而清金平木。
苏子 茯苓 半夏 枳实 杏仁 川贝 竹茹 沙参 橘红 麦冬 海蜇 荸荠
此方是四七汤、温胆汤、麦冬饮三个方剂的加减，具有降气化痰、生津和胃的功效。病起于肝，涉及肺胃，当以肺、肝、胃为主进行治疗。
秦姓患者：七情郁结，痰气凝聚。胸膈不畅，时而呕吐逆气。症状持续半年，脾胃大虚。前医用四七汤、二陈汤，降气化痰，现在参入理中汤，兼培补中土，应当顾护根本。
四七汤合二陈汤。理中汤加丁香、木香、蔻仁。
徐姓患者：气郁于胸导致膈症，气滞于腹导致臌胀。饮食无法接纳，形体肌肉突然消瘦。
阴气凝聚，阳气埋没。脉细如丝。暂用培土、通阳、化气的方法。
党参 肉桂 白术 大腹皮 熟附子 泽泻 茯苓 来复丹
渊按：伤胃则成膈，伤脾则成臌。膈症多因郁火，臌胀多因阳衰。肺金的治节功能不行，肝木就会起来克制它。
周姓患者：胸痛并吐出清水，自幼酒湿蕴蓄在胃中，阳气不宣发，浊气凝聚。
忽然叙述前年又得了暴喘上气，额头汗淋漓，发作数次。现在又增加心中嘈杂似饥的感觉，这都是胃病。用小半夏汤。
半夏 茯苓 陈皮 竹茹 生姜
复诊：停饮生痰，呕吐酸水，胸中板滞疼痛。前用小半夏汤，是为了消除水饮。现在风邪伤肺，咳嗽伴有内热。拟用金沸草散宣散风邪、降气，仍包含祛痰蠲饮之意，是肺胃兼治的方子。
金沸草 半夏 陈皮 茯苓 款冬花 杏仁 荆芥 前胡 竹茹 枇杷叶
赵姓患者：气与水郁结形成痰，咽部哽噎妨碍进食，进食后立即呕吐清水米粒。病位在胃的上脘。降气化痰的药物，必须选择不燥烈的为宜。
栝蒌仁 半夏曲 川贝 橘红 丁香 蛤壳（青黛三分，同研包煎） 白蜜 枇杷叶 竹茹 芦根 生姜汁（冲服）
复诊：各种气逆冲上的症状，都归属于火。食入即吐是有火的表现。
川黄连 半夏 苏梗 制大黄 竹茹 枇杷叶
渊按：《内经》病机十九条，都有不完全正确的地方，注释者不敢违背，只是随文敷衍，贻误后学。其实是非分明，明眼人自然能辨别清楚。就像“诸逆冲上”这一条，不属于火的证候很多，不可以一概而论。读经的人要知晓这一点。
祝姓患者：胃阳虚则水饮停留，脾阳虚则谷物不消化。腹中漉漉有声，胸胁胀满，进食就呕吐酸水清涎，或者嗳出腐臭气味。
治法以温导为主，崇土利水。
炮姜 陈皮 苍术 半夏 熟附子 白术 党参 泽泻 枳实 栝蒌仁 蔻仁 谷芽
沈姓患者：食物下咽则饱胀，泛酸呕吐，病属反胃。胃脉浮取则紧，沉取则弦。弦脉代表木侮土，紧脉代表寒在中焦。
党参 干姜 半夏 陈皮 茯苓 丁香 焦六曲 荜茇 蔻仁 陈香橼
许姓患者：吐血后呃逆，至今一个月。舌苔白腻，右脉沉滑，左脉细弱。呃逆的气自少腹上冲，这是瘀血挟带痰浊阻滞于肺胃之络，下焦冲脉相火上逆，鼓动其痰，则呃逆发作。斟酌处方必有疗效，希望不要急躁。
半夏 茯苓 陈皮 当归 郁金 丁香 柿蒂 姜汁 藕汁 水红花子
东垣滋肾丸一钱，用陈皮、生姜泡汤送下。如果是阴寒呃逆，用肉桂五分，坎炁二条，沉香六分，分两次服用。
某患者：疟疾后痰气阻滞胃脘，清阳不升。发生呃逆，进食就呕吐，防止发展成膈症。暂且参考仲景的化痰镇逆方再行商议。
旋复花 代赭石 淡干姜 法半夏 赤苓 制香附 丁香 柿蒂
秦姓患者：进食就呕吐清水涎沫米粒，病在胃。曾经从高处置坠下，胁肋肩膊时常疼痛，这是兼有瘀伤留滞于肺胃之络，所以呕吐物有臭味。拟化瘀和胃，降逆止呕为治疗方法。
旋复花 归须 广郁金 杏仁 半夏 炒丹皮 茯苓 焦楂肉 橘红 蔻仁
复诊：止呕必须以和胃为主，气升必须降纳。
半夏 茯苓 白术 蔻仁 藿香 陈皮 老桂木 神曲 干姜 沉香 伏龙肝
李姓患者：寒热咳嗽，一年有余，咳痰带血。饮食沃噎，胸膈阻窒，又成了噎膈。这必定兼挟气郁而成。现在暂且和胃降气，希望血止噎减为妙。
旋复花 半夏 杏仁 丹皮 橘红 茯苓 郁金 栝蒌霜 蔻仁 竹茹 枇杷叶
陈姓患者：突然心痛，进食哽塞，喝粥饮水还可以。这是心气郁结，防止变为膈证。
栝蒌仁 薤白头 旋复花 川贝母 茯神 半夏 桔梗 远志肉 竹茹
朱姓患者：脉滑大，食入哽噎不下，舌苔腻，这属于痰膈，大肠燥火凝结。拟清痰火，佐以宣通。
旋复花 麦冬 六神曲 黑山栀 赤苓 半夏 豆豉 陈皮 杏仁 竹茹 海蜇 荸荠 枇杷叶
吴姓患者：情志郁结，阳明津液内枯，少阴之气上逆。少腹气上冲至咽喉，咽喉感觉胀，进食哽噎。拟温养津液，以降浊阴之气。
旋复花 代赭石 苁蓉干 枸杞子 橘红 茯苓 川贝 半夏 沉香 鸡冠 地栗
盛姓患者：气郁痰凝，胸中失旷，背寒脊痛，进食少且哽噎。严重时吐出。这是膈症的根源。
旋复花 桂枝 栝蒌皮 杏仁 竹茹 代赭石 薤白头 半夏 茯苓
又诊：各种病症仍然存在，痰稍微容易咳出。
桂枝 栝蒌皮 干姜 薤白头 陈皮 杏仁 旋复花 生鹿角 竹茹 枇杷叶
又诊：服用温通阳气的药物，呕出很多寒痰，未尝不是好事，只是进食哽噎之势未除。仍以温通为主，再观察动静。
川熟附 桂枝 薤白头 半夏 陈皮 杏仁 桃仁 栝蒌仁 姜汁 韭菜根汁
又诊：上焦呕吐源于气，中焦呕吐源于积。这里进食哽噎，片刻后吐出几口，且多为清水粘痰，这是有痰积在中焦。然而究其本质，仍属膈症的根源。
川熟附 半夏 瓦楞子 陈皮 苏子 莱菔子 旋复花 白芥子 桃仁 荜茇
高姓患者：坤土阳微湿胜，腹中不和。用平胃散、理中汤合剂。
平胃散合理中汤。加延胡索，是因为有瘀凝。
某患者：连续进服温中运湿药，腹中呱呱有声，早晨进食则安适，晚上进食则停滞，躺卧时筋惕肉瞤，时而呕吐酸水。中土阳微，下焦阴浊之气上逆，病属反胃。温中无效，治法应当益火之源，舍时从症，用茅术附子理中汤合真武汤法。
附子理中汤加茯苓、陈皮、生姜。
渊按：水谷不化精微而生酸痰，肝木失去濡润，筋惕肉瞤，这是肝有燥火。单纯使用温燥没有益处。
张姓患者：胃汁干枯，肠脂燥涸，上焦饮食全部生为痰，不生津血。进食则吐，痰随呕吐而出。膈症的根源渐深，高龄宜静养为宜。
鲜苁蓉（一两） 青盐半夏（三钱） 茯苓 当归 陈皮 沉香 枳壳
又诊：津枯气结导致的噎膈，苁蓉丸是主方。
照前方加入炒香柏子仁、陈海蛰、地栗。每日用柿饼一枚，饭上蒸软，随意嚼咽。
盛姓患者：背部为阳位，心为阳脏。心的下方，胃的上方。痰饮窃踞于胃的上口，则心阳失去清旷，而背部常恶寒，进食哽噎，这是膈症的根源。因为痰饮属阴而阻碍阳气。
熟附子 桂枝 杏仁 神曲 薤白头 栝蒌皮 旋复花 蔻仁 豆豉 丁香 竹茹 枇杷叶
渊按：温中化饮，降逆润肠，不失古人法度。只是豆豉一味不解是何意思。
孔姓患者：先前曾呕血，胃中空虚，寒饮停留，阳气不通，水谷不化，食入呕吐酸水，谷食随之而出。脉细肢寒，阳微已甚。证成翻胃，担心拖延下去脾败难治。
熟附子 干姜 丁香 橘饼 苁蓉干 九香虫 二陈汤（其中甘草炙黑）
渊按：噎膈反胃从呕血而起的情况很多。血虽属阴物，但多呕则胃阳受伤而不能恢复，不能运化水谷而化生精微，失去其顺下的职能，起初病为反胃，久则肠液枯槁而为膈证。
严姓患者：噎膈、反胃，是胃脘的疾病。上焦主纳，中焦司运，能纳而不能运，所以反复吐出。朝食暮吐，责之于下焦无阳。拟化上焦之痰，运中焦之气，益下焦之火，使得三焦各司其职，而水谷熟腐，自然无反出的毛病。但这并不容易。
旋复花 代赭石 熟附子 茯苓 枳壳 沉香 半夏 新会皮 益智仁 淡苁蓉 地栗 陈鸡冠 海蛰
仁渊曰：噎膈证，过去张鸡峰认为是神思问病（心理因素致病），但有不完全正确的地方。过于谋虑忧思，脾阴伤而肝火起，固然有此证。而因呕血过多，或餐凉食冷者也不少，这些都是脾胃阳伤。胃阳伤则不化而失其顺降，脾阳伤则不运而失其升腾，饮食到胃，精微不化气血津液而变酸水痰涎。中土既失温和松燥，肝胆失其条达，郁结不舒，横克脾胃，气结而为痛，逆升而为吐，将稼穑甘味化为木火酸苦之味呕出，胸膈稍快。明日再积再呕，久之中焦之气日伤，津液日竭，胃管之口缩小，纳食哽嗌作痛。胃气既失顺降，二肠自少灌溉，渣滓留滞不行，加以肝胆郁结之火日加煽灼，大便自然燥而不通，甚至经旬始通。通下如羊矢黑粒者，不可治矣。夫噎膈固属难治，而古人治此者亦少精妙之方。云岐子九方，劫霸攻克，固不足道。《局方》过于香燥。近惟喻嘉言黄连汤进退之议，深中窍要。此外如丹溪五汁安中饮、左金丸等，尚可取法。若大便不通，断不可以硝、黄硬下。要知阳明气降，始二肠津液流润，不通自通矣。若夫反胃，即噎膈之根。古人谓食不得入是有火，食入反出是无火。盖肝胆相火，郁于胸中，清旷之地，变为燎原之场，胃口被灼，气不得降，致食不能下。此不独噎膈，噤口痢亦是此意。若噎膈证如此，则五液被焚，不可为矣。至食入反出，虽属无火，乃中宫失温运之职，升降不灵，木火更从而为患，与火不生土，土虚阳衰之无火大异，未可以温燥从事。仲景论胸中有寒，丹田有热，与此相近。喻氏黄连汤，即仿其意为之进退。
治此者能想明孰寒孰热、孰虚孰实，得其机巧，则为良工矣。
Patient Wang: Phlegm turbidity obstructs the middle jiao (middle burner), causing epigastric pain after eating, profuse flow of clear saliva from the mouth, and vomiting of sticky phlegm. Stool is hard and dry, indicating depletion of intestinal fluids. Frequent empty belching indicates failure of stomach qi to descend. The proposed treatment method is to resolve phlegm, harmonize the stomach, direct rebellious qi downward, and moisten the intestines.
*Imperatae Radix Rhizoma* (prepared with salt water) *Ostreae Concha* *Armeniacae Semen Amarum* *Pinelliae Tuber* *Citri Reticulatae Pericarpium* *Trichosanthis Pericarpium* *Arcae Concha* *Perillae Fructus* *Sinapis Albi Semen* *Raphani Fructus* *Zingiberis Rhizoma Recens Juice* *Dioscoreae Hypoglaucae Tuber Juice*
Patient Hu: Qi stagnation in the middle jiao, vomiting immediately after eating, the condition has persisted for a month, concern that it may develop into dysphagia (Yi Ge).
*Coptidis Rhizoma* (stir-fried with *Evodiae Fructus*) *Atractylodis Macrocephalae Rhizoma* *Pinelliae Tuber* *Agastachis Herba* *Citri Reticulatae Pericarpium* *Fritillariae Thunbergii Bulb* (charred) *Cyperi Rhizoma* *Poria* *Curcumae Longae Rhizoma* *Amomi Fructus Rotundus*
Patient Zhang: Ying (nutritive) yin deficiency causes internal heat and insomnia. Rebellious qi and fire cause a sensation of obstruction in the throat. The proposed treatment uses Si Wu Tang (Four Substances Decoction) to nourish yin, and Si Qi Tang (Seven Emotions Decoction) to regulate qi.
*Rehmanniae Radix Preparata* (mixed with *Amomi Fructus Rotundus*) *Perillae Caulis* *Poria* *Angelicae Sinensis Radix* *Magnoliae Officinalis Cortex* *Glehniae Radix* *Paeoniae Radix Alba* *Pinelliae Tuber* *Ziziphi Jujubae Semen* *Zingiberis Rhizoma Recens cum Bamboo Juice* *Loquat Leaf*
Patient Chen: Ying blood deficiency with hyperactive fire, dryness of stomach yin causing food dysphagia. From the heart diaphragm to the throat, there is a burning sensation like fire, sometimes accompanied by gurgling sounds; this is due to the constraint of qi and fire. The illness is related to emotional states and cannot be cured solely by medication; one should maintain a joyful mood to potentially prolong life.
*Imperatae Radix Rhizoma* *Ostreae Concha* *Glehniae Radix* *Gardeniae Fructus* (blackened) *Poria* *Fritillariae Cirrhosae Bulbus* *Fritillariae Thunbergii Bulb* (charred) *Ophiopogonis Radix* *Armeniacae Semen Amarum* *Bambusae Caulis in Taenias Succus* *Loquat Leaf*
Follow-up: Rebellious qi and fire are ascending, causing throat discomfort, chest pain, and food dysphagia; dysphagia (Ge Zheng) has already formed. Moreover, at over sixty years old and having been a vegetarian for thirty years, stomach fluids are depleted. To moisten stomach yin and facilitate eating, maintaining emotional comfort is essential.
Add *Panax Quinquefolius Radix* and *Pinelliae Tuber* to the previous prescription.
Patient Ding: The pulse is wiry and stiff. Appearing in spring, this indicates a wiry pulse without stomach qi. Pain and obstruction upon swallowing, and hard, dry stool indicate hyperactivity of liver wood and fire, with depletion of stomach juice and intestinal fluids. Treatment will be difficult.
*Imperatae Radix Rhizoma* *Armeniacae Semen Amarum* *Hemp Seed* *Peach Kernel* *Perillae Fructus* *Canarium Fruit* *Dioscorea Hypoglauca* *Reed Rhizome*
Follow-up: The previous formula moistened dryness to relieve constraint. Now, a formula to direct qi downward and resolve phlegm is prescribed.
*Ophiopogonis Radix* *Pinelliae Tuber* *Armeniacae Semen Amarum* *Citri Reticulatae Pericarpium* *Fritillariae Cirrhosae Bulbus* *Poria* *Bambusae Caulis in Taenias Succus* *Reed Rhizome* *Dioscorea Hypoglauca* *Ezeis Concha* *Loquat Leaf*
Note by Yuan: These two formulas are pleasantly moistening and clearly belong to a master physician.
Patient Qin: Phlegm and qi obstruct the chest, causing excessive phlegm and chest tightness. Eating sometimes induces vomiting, and bilateral temporal regions are distended and painful. Clear qi fails to ascend, turbid qi fails to descend. If prolonged, it may develop into dysphagia.
*Pinelliae Tuber* *Citri Reticulatae Pericarpium* *Poria* (*Coptidis Rhizoma* stir-fried with *Evodiae Fructus* juice) *Codonopsis Radix* *Alismatis Rhizoma* *Agastachis Herba* *Imperatae Radix Rhizoma* *Aurantii Fructus Immaturus* *Fritillariae Cirrhosae Bulbus* *Amomi Fructus Rotundus* *Cinnamomi Cortex* *Arecae Pericarpium* *Atractylodis Rhizoma* *Zingiberis Rhizoma Recens*
*Lai Fu Dan* (1 qian), taken with decoction juice.
Patient Chen: Grief from the loss of a son caused qi rebellion leading to fainting. The left pulse is deep, rapid, and unsmooth, indicating liver qi stagnation and insufficient blood to nourish. The right Guan and Cun positions show slippery and forceful pulses, indicating phlegm and fire. Lung and stomach qi fail to descend; liver wood fire ascends, steaming fluids into phlegm, blocking airways. This causes a sensation of obstruction in the throat and chest diaphragm, with occasional vomiting and dysphagia upon eating. Extreme emotions often transform into fire. Crying without tears and dry, blurry vision indicate hyperactive yang with yin failing to ascend. Current treatment involves smoothing qi and directing fire downward, followed by clearing metal to pacify wood.
*Perillae Fructus* *Poria* *Pinelliae Tuber* *Aurantii Fructus Immaturus* *Armeniacae Semen Amarum* *Fritillariae Cirrhosae Bulbus* *Bambusae Caulis in Taenias Succus* *Glehniae Radix* *Citri Reticulatae Pericarpium* *Ophiopogonis Radix* *Ezeis Concha* *Dioscorea Hypoglauca*
This formula is a modification of Si Qi Tang, Wen Dan Tang, and Mai Dong Yin. It directs qi downward, resolves phlegm, generates fluids, and harmonizes the stomach. Since the disease originates in the liver and involves lung and stomach, treatment should focus on these three organs.
Patient Qin: Seven emotions constrained, phlegm and qi condensed. Chest diaphragm discomfort, occasional vomiting and rebellion. Symptoms have lasted half a year, spleen and stomach are severely deficient. Previous use of Si Qi Tang and Er Chen Tang directed qi downward and resolved phlegm. Now, Li Zhong Tang is added to tonify the middle earth, focusing on treating the root.
Si Qi Tang combined with Er Chen Tang. Li Zhong Tang plus *Saussureae Involucratae Capitulum*, *Costi Rhizoma*, *Amomi Fructus Rotundus*.
Patient Xu: Qi constraint in the chest leads to dysphagia; qi stagnation in the abdomen leads to abdominal distension. Food is not accepted, and flesh rapidly wastes away.
Yin qi condenses, yang qi is buried. Pulse is fine as a silk thread. Temporarily use methods to tonify earth, unblock yang, and transform qi.
*Codonopsis Radix* *Cinnamomi Cortex* *Atractylodis Macrocephalae Rhizoma* *Arecae Pericarpium* *Aconiti Lateralis Radix Preparata* *Alismatis Rhizoma* *Poria* *Lai Fu Dan*
Note by Yuan: Injury to the stomach leads to dysphagia; injury to the spleen leads to distension. Dysphagia often involves constrained fire; distension often involves yang deficiency. When the governing function of lung metal fails, liver wood attacks it.
Patient Zhou: Chest pain and vomiting of clear fluid. Since childhood, alcohol-dampness has accumulated in the stomach, yang qi is not disseminated, and turbid qi condenses.
Suddenly recalling an episode last year of sudden asthma and rising qi, with profuse sweating on the forehead, occurring several times. Now, epigastric discomfort resembling hunger is added. All these are stomach diseases. Use Xiao Ban Xia Tang.
*Pinelliae Tuber* *Poria* *Citri Reticulatae Pericarpium* *Bambusae Caulis in Taenias Succus* *Zingiberis Rhizoma Recens*
Note by Yuan: Sudden asthma and forehead sweating indicate lung and kidney involvement, not just the stomach.
Follow-up: Retained fluids generate phlegm, vomiting sour fluid, and board-like chest pain. Previously, Xiao Ban Xia Tang was used to eliminate retained fluids. Now, wind pathogen injures the lung, causing cough and internal heat. Jin Fei Cao San is proposed to disperse wind and direct qi downward, still containing elements to dispel phlegm and eliminate fluids, treating both lung and stomach.
*Sparganii Rhizoma* *Pinelliae Tuber* *Citri Reticulatae Pericarpium* *Poria* *Farfarae Flos* *Armeniacae Semen Amarum* *Schizonepetae Spica* *Peucedani Radix* *Bambusae Caulis in Taenias Succus* *Loquat Leaf*
Patient Zhao: Qi and water constrain to form phlegm, causing throat obstruction and difficulty eating. Eating immediately induces vomiting of clear fluid and rice grains. The disease is located in the upper part of the stomach. Medications to direct qi downward and resolve phlegm should be chosen for their non-drying nature.
*Trichosanthis Semen* *Pinelliae Fermentatum* *Fritillariae Cirrhosae Bulbus* *Citri Reticulatae Pericarpium* *Illicii Fructus* *Meretrix Shell* (mixed with 3 fen of *Indigo Naturalis*, wrapped for decoction) *White Honey* *Loquat Leaf* *Bambusae Caulis in Taenias Succus* *Reed Rhizome* *Zingiberis Rhizoma Recens Juice* (taken by mixing)
Follow-up: All rebellious upward movements belong to fire. Vomiting immediately after eating indicates fire.
*Coptidis Rhizoma* *Pinelliae Tuber* *Perillae Caulis* *Rhei Radix et Rhizoma* (processed) *Bambusae Caulis in Taenias Succus* *Loquat Leaf*
Note by Yuan: The Nineteen Pathogenesis Statements in *Nei Jing* are not entirely accurate. Commentators dare not contradict them, merely elaborating on the text, which misleads later learners. Truth and falsehood are clear to discerning eyes. For instance, many cases of "rebellious upward movements" do not belong to fire and cannot be generalized. Readers of classics should be aware of this.
Patient Zhu: Stomach yang deficiency leads to retention of fluids; spleen yang deficiency leads to indigestion of grain. Gurgling in the abdomen, distension and fullness in chest and hypochondrium, vomiting sour fluid and clear saliva upon eating, or belching foul odor.
The method is warming and guiding, strengthening earth and promoting urination.
*Zingiberis Rhizoma Preparata* *Citri Reticulatae Pericarpium* *Atractylodis Rhizoma* *Pinelliae Tuber* *Aconiti Lateralis Radix Preparata* *Atractylodis Macrocephalae Rhizoma* *Codonopsis Radix* *Alismatis Rhizoma* *Aurantii Fructus Immaturus* *Trichosanthis Semen* *Amomi Fructus Rotundus* *Oryzae Fructus Germinatus*
Patient Shen: Fullness and bloating after eating, acid regurgitation and vomiting, classified as regurgitation (Fan Wei). Stomach pulse is tight when lightly pressed, wiry when deeply pressed. Wiry indicates wood insulting earth; tight indicates cold in the center.
*Codonopsis Radix* *Zingiberis Rhizoma Preparata* *Pinelliae Tuber* *Citri Reticulatae Pericarpium* *Poria* *Illicii Fructus* *Fritillariae Thunbergii Bulb* (charred) *Piperis Kadsurae Fructus* *Amomi Fructus Rotundus* *Citri Exocarpium*
Patient Xu: Hiccups after hematemesis, lasting one month. Tongue coating is white and greasy; right pulse is deep and slippery, left pulse is fine and weak. The qi for hiccups rushes up from the lower abdomen, indicating blood stasis mixed with turbid phlegm obstructing the collaterals of lung and stomach. Ministerial fire from the lower jiao chong vessel rebels upward, stirring phlegm, causing hiccups. The prescribed formula will surely help; do not be anxious.
*Pinelliae Tuber* *Poria* *Citri Reticulatae Pericarpium* *Angelicae Sinensis Radix* *Curcumae Longae Rhizoma* *Illicii Fructus* *Diospyroi Fructus* *Zingiberis Rhizoma Recens Juice* *Nelumbinis Nelumbo Nuciferae Semen* *Polygoni Multiflori Caulis*
Zi Shui Wan (Nourish Kidney Pill) by Dong Yuan, 1 qian, taken with decoction of *Citri Reticulatae Pericarpium* and *Zingiberis Rhizoma Recens*. For yin-cold hiccups, use *Cinnamomi Cortex* 5 fen, *Uterus Porci* 2 strips, *Aquilariae Lignum Resinatum* 6 fen, divided into two doses.
Note by Yuan: This refers to qi hiccups and phlegm hiccups, different from deficiency-cold hiccups.
Unknown Patient: After malaria, phlegm and qi obstruct the stomach, clear yang fails to ascend. Hiccups occur, vomiting upon eating, preventing development into dysphagia. Referencing Zhang Zhongjing’s phlegm-resolving and rebellion-directing formula for discussion.
*Imperatae Radix Rhizoma* *Ostreae Concha* *Zingiberis Rhizoma Siccatum* (light) *Pinelliae Tuber* *Poria* *Cyperi Rhizoma* (processed) *Illicii Fructus* *Diospyroi Fructus*
Patient Qin: Vomiting clear fluid, saliva, and rice grains upon eating indicates stomach disease. A previous fall from height caused intermittent pain in ribs, shoulders, and arms, indicating residual blood stasis in lung and stomach collaterals, hence the foul odor in vomit. The treatment is to resolve stasis, harmonize the stomach, direct rebellion downward, and stop vomiting.
*Imperatae Radix Rhizoma* *Rosae Multiflorae Radix* *Curcumae Longae Rhizoma* *Armeniacae Semen Amarum* *Pinelliae Tuber* *Moutan Cortex* (stir-fried) *Poria* *Crataegi Fructus* (charred) *Citri Reticulatae Pericarpium* *Amomi Fructus Rotundus*
Note by Yuan: Adding juices from garlic sprouts, ginger, and lotus root would be even better.
Follow-up: To stop vomiting, one must harmonize the stomach; to raise qi, one must direct it downward.
*Pinelliae Tuber* *Poria* *Atractylodis Macrocephalae Rhizoma* *Amomi Fructus Rotundus* *Agastachis Herba* *Citri Reticulatae Pericarpium* *Cinnamomi Ramulus* *Saccharomyces* *Zingiberis Rhizoma Preparata* *Aquilariae Lignum Resinatum* *Dragon's Blood* (Fulong Gan)
Patient Li: Alternating chills and fever with cough for over a year, coughing up blood-streaked sputum. Food feels stuck, chest diaphragm blocked, developing into dysphagia. This must involve qi constraint. Currently, harmonize the stomach and direct qi downward, hoping for cessation of bleeding and reduction of dysphagia.
*Imperatae Radix Rhizoma* *Pinelliae Tuber* *Armeniacae Semen Amarum* *Moutan Cortex* *Citri Reticulatae Pericarpium* *Poria* *Curcumae Longae Rhizoma* *Trichosanthis Pulvis* *Amomi Fructus Rotundus* *Bambusae Caulis in Taenias Succus* *Loquat Leaf*
Patient Chen: Sudden heart pain, food dysphagia, but porridge and drinks are acceptable. This is heart qi constraint, preventing progression to dysphagia.
*Trichosanthis Semen* *Allii Macrostemonis Bulbus* *Imperatae Radix Rhizoma* *Fritillariae Thunbergii Bulbus* *Poria Cum Pinode* *Pinelliae Tuber* *Platycodonis Radix* *Polygalae Radix* *Bambusae Caulis in Taenias Succus*
Patient Zhu: Pulse is slippery and large, food dysphagia, tongue coating is greasy. This belongs to phlegm dysphagia, with dryness-fire congealing in the large intestine. The proposal is to clear phlegm-fire and assist in unblocking.
*Imperatae Radix Rhizoma* *Ophiopogonis Radix* *Saccharomyces* *Gardeniae Fructus* (blackened) *Poria* *Pinelliae Tuber* *Glycine Soja* (fermented) *Citri Reticulatae Pericarpium* *Armeniacae Semen Amarum* *Bambusae Caulis in Taenias Succus* *Ezeis Concha* *Dioscorea Hypoglauca* *Loquat Leaf*
Patient Wu: Emotional constraint, dryness of yangming fluids internally, rebellion of shaoyin qi. Qi rushes from lower abdomen to throat, throat feels distended, food dysphagia. The proposal is to warm and nourish fluids to direct turbid yin downward.
*Imperatae Radix Rhizoma* *Ostreae Concha* *Cibotii Rhizoma* (dried) *Lycii Fructus* *Citri Reticulatae Pericarpium* *Poria* *Fritillariae Cirrhosae Bulbus* *Pinelliae Tuber* *Aquilariae Lignum Resinatum* *Phasianus Crest* *Dioscorea Hypoglauca*
Patient Sheng: Qi constraint and phlegm condensation, chest emptiness, back cold and spine pain, reduced intake with dysphagia. Severe cases result in vomiting. This is the root of dysphagia.
*Imperatae Radix Rhizoma* *Cinnamomi Ramulus* *Trichosanthis Pericarpium* *Armeniacae Semen Amarum* *Bambusae Caulis in Taenias Succus* *Ostreae Concha* *Allii Macrostemonis Bulbus* *Pinelliae Tuber* *Poria*
Second visit: Symptoms persist, phlegm is slightly easier to expectorate.
*Cinnamomi Ramulus* *Trichosanthis Pericarpium* *Zingiberis Rhizoma Preparata* *Allii Macrostemonis Bulbus* *Citri Reticulatae Pericarpium* *Armeniacae Semen Amarum* *Imperatae Radix Rhizoma* *Cervi Cornu Degelatinatum* *Bambusae Caulis in Taenias Succus* *Loquat Leaf*
Third visit: After taking warming and unblocking yang medicines, much cold phlegm was vomited, which is not bad. However, the trend of food dysphagia remains. Continue with warming and unblocking, observe changes.
*Aconiti Lateralis Radix Preparata* *Cinnamomi Ramulus* *Allii Macrostemonis Bulbus* *Pinelliae Tuber* *Citri Reticulatae Pericarpium* *Armeniacae Semen Amarum* *Peach Kernel* *Trichosanthis Semen* *Zingiberis Rhizoma Recens Juice* *Chinese Chives Root Juice*
Fourth visit: Vomiting from the upper jiao relates to qi; vomiting from the middle jiao relates to accumulation. Here, food dysphagia followed by vomiting a few mouthfuls after a short time, mostly clear fluid and sticky phlegm, indicates phlegm accumulation in the middle jiao. Ultimately, it is still the root of dysphagia.
*Aconiti Lateralis Radix Preparata* *Pinelliae Tuber* *Arcae Concha* *Citri Reticulatae Pericarpium* *Perillae Fructus* *Raphani Fructus* *Imperatae Radix Rhizoma* *Sinapis Albi Semen* *Peach Kernel* *Piperis Kadsurae Fructus*
Patient Gao: Earth yang is weak with dampness prevailing, abdominal discomfort. Use Ping Wei San and Li Zhong Tang combined.
Ping Wei San combined with Li Zhong Tang. Added *Cyperi Rhizoma* due to blood stasis.
Unknown Patient: After continuous administration of warming middle and transforming dampness medicines, gurgling sounds in the abdomen, comfort after morning meals but stagnation after evening meals, muscle twitching while lying down, occasional vomiting of sour fluid. Middle earth yang is weak, turbid yin qi from lower jiao rebels upward, disease is regurgitation. Warming middle is ineffective; the method should be to benefit the source of fire, disregarding season for symptoms, using Mao Zhu Fu Zi Li Zhong Tang combined with Zhen Wu Tang method.
Fu Zi Li Zhong Tang plus *Poria*, *Citri Reticulatae Pericarpium*, *Zingiberis Rhizoma Recens*.
Note by Yuan: Water and grain failing to transform into essence produce sour phlegm; liver wood loses nourishment, causing muscle twitching, indicating liver dryness-fire. Purely using warming and drying is useless.
Patient Zhang: Stomach juice is dry, intestinal fat is parched, food in upper jiao transforms entirely into phlegm, failing to generate fluids and blood. Vomiting upon eating, phlegm follows vomiting. The root of dysphagia deepens; advanced age requires quiet rest.
*Fresh Cibotii Rhizoma* (1 liang) *Qing Yan Ban Xia* (3 qian) *Poria* *Angelicae Sinensis Radix* *Citri Reticulatae Pericarpium* *Aquilariae Lignum Resinatum* *Aurantii Fructus Immaturus*
Second visit: For dysphagia due to fluid depletion and qi constraint, Cong Rong Wan is the main formula.
To the previous formula, add fried fragrant *Platycladi Semen*, aged *Ezeis Concha*, and *Dioscorea Hypoglauca*. Daily, steam one date cake on rice until soft, chew and swallow as desired.
Patient Sheng: The back is the position of yang, the heart is the organ of yang. Below the heart is the stomach. When phlegm-fluids occupy the upper opening of the stomach, heart yang loses its clarity, causing back coldness and food dysphagia; this is the root of dysphagia. Phlegm-fluids are yin and obstruct yang.
*Aconiti Lateralis Radix Preparata* *Cinnamomi Ramulus* *Armeniacae Semen Amarum* *Saccharomyces* *Allii Macrostemonis Bulbus* *Trichosanthis Pericarpium* *Imperatae Radix Rhizoma* *Amomi Fructus Rotundus* *Glycine Soja* (fermented) *Illicii Fructus* *Bambusae Caulis in Taenias Succus* *Loquat Leaf*
Note by Yuan: Warming middle, resolving fluids, directing rebellion downward, and moistening intestines align with ancient methods. The purpose of *Glycine Soja* (fermented) is unclear.
Patient Kong: Previous hematemesis left the stomach empty, cold fluids retained, yang qi blocked, water and grain undigested. Eating induces vomiting of sour fluid, with food following. Pulse is fine, limbs cold, yang deficiency is severe. Condition becomes regurgitation, fear of spleen failure if prolonged.
*Aconiti Lateralis Radix Preparata* *Zingiberis Rhizoma Preparata* *Illicii Fructus* *Citrus Reticulata* (preserved) *Cibotii Rhizoma* (dried) *Stink Bug* *Er Chen Tang* (with charred licorice)
Note by Yuan: Many cases of dysphagia and regurgitation start with hematemesis. Although blood is yin, frequent vomiting damages stomach yang, preventing recovery and the transformation of water and grain into essence. Loss of descending function initially causes regurgitation; long-term depletion of intestinal fluids leads to dysphagia.
Patient Yan: Dysphagia and regurgitation are diseases of the stomach. Upper jiao governs reception, middle jiao governs transport. Reception without transport causes repeated vomiting. Morning food, evening vomiting blames lack of yang in lower jiao. Proposal: Resolve phlegm in upper jiao, move qi in middle jiao, benefit fire in lower jiao, so that three jiaos perform their duties, food digests properly, and no regurgitation occurs. This is difficult.
*Imperatae Radix Rhizoma* *Ostreae Concha* *Aconiti Lateralis Radix Preparata* *Poria* *Aurantii Fructus Immaturus* *Aquilariae Lignum Resinatum* *Pinelliae Tuber* *Xin Hui Pi* (Newhui Tangerine Peel) *Alpiniae Oxyphyllae Fructus* *Cibotii Rhizoma* (light) *Dioscorea Hypoglauca* *Chicken Comb* (aged) *Ezeis Concha*
Ren Yuan says: Dysphagia, as Zhang Jifeng claimed, is often attributed to mental distress, but this is not always true. Overthinking injures spleen yin and raises liver fire, certainly causing such symptoms. However, many cases arise from excessive hematemesis or consuming cold foods/drinks, all damaging spleen and stomach yang. Stomach yang damage leads to failure to digest and lose descending function; spleen yang damage leads to failure to transport and lose ascending function. Food entering the stomach fails to transform into qi, blood, and fluids, instead becoming sour fluid and phlegm. Middle earth loses warmth and looseness; liver and gallbladder lose smoothness, constraint builds, attacking spleen and stomach. Qi constrains causing pain, rebels causing vomiting. Sweet flavors transform into sour/bitter wood/fire flavors and are vomited, bringing slight relief to chest/diaphragm. Accumulation and vomiting continue daily; over time, middle jiao qi is injured, fluids depleted, gastric opening narrows, eating causes pain. With loss of stomach qi descent, intestines lack irrigation, residue stagnates. Plus, liver/gallbladder constraint fire intensifies, causing dry, obstructed stool, possibly only passing after ten days. Stool like sheep droppings black granules is untreatable. Dysphagia is indeed difficult to treat, and ancient masters rarely had exquisite formulas. Yun Qi Zi’s Nine Formulas are too harsh. *Ju Fang* is too aromatic and drying. Recently, Yu Jiayan’s modifications of Huang Lian Tang hit the key point. Others like Danxi’s Wu Zhi An Zhong Yin and Zuo Jin Wan are also worth learning from. If stool is obstructed, never forcibly purge with Nux and Rhei. Know that when yangming qi descends, intestinal fluids flow, and obstruction resolves naturally. Regurgitation is the root of dysphagia. Ancients said "food cannot enter" is fire; "food enters and comes out" is no fire. Gallbladder/liver ministerial fire constrained in chest turns clear space into a prairie fire, scorching stomach gate, qi cannot descend, food cannot go down. This applies not only to dysphagia but also to anorectic dysentery. If dysphagia reaches this stage, five fluids are burned, untreatable. As for "food enters and comes out," although no fire, it is loss of middle palace warming/transport function, lifting/lowering dysfunction, wood/fire causing trouble, very different from fire failing to generate earth or earth deficiency/yang decline. Cannot simply use warming/drying. Zhang Zhongjing discussed "cold in chest, heat in dantian," similar to this. Yu’s Huang Lian Tang imitates this idea.
Those treating this must understand cold/hot, deficiency/excess, grasp the subtleties, and become skilled physicians.