蒋 色苍形瘦，是体质本属木火，食入脘阻呕沫。经言三阳结，谓之膈。夫三阳皆行津液，而肾实
五液之主。有年肾水衰，三阳热结，腐浊不行，势必上犯，此格拒之由，香岩先生所谓阳结于上，阴衰于下也。
通阳不用辛热，存阴勿以滋腻。一则瘦人虑虚其阴，一则浊沫可导而下。半夏（青盐拌制）、竹茹、蒌霜、
熟地炭、杞子炭、牛膝炭、茯苓、薤白、姜汁。数服渐受粥饮，兼服牛乳数月不吐。
耿 年近古稀，两尺脉微，右关弦迟，气噎梗食，吐出涎沫，气平食入。夫弦为木旺，迟为胃寒。弦迟
在右，胃受肝克，传化失司，治在泄肝温胃，痰水自降。丁香、益智仁煨、苏子霜、茯苓、青皮、砂仁、姜（煨）。
数服痰气两平。
陈 酒客中虚，气阻成噎，必有蒸湿酿痰。脉来迟弱，中脘阳衰，饮米粥亦拒，得热酒辄行，明系阳
微欲结。法宜通阳则胸脘得展，湿痰得降，而运纳有权。潞参、茯神、茯苓、砂仁、丁香、半夏（姜制）、
广皮、姜、枣煎。数服，粥饮不拒矣。后再加干姜（炮淡，二分）、益智仁（生研），数服胸舒而纳食。
某氏 因恼怒曾呕瘀血，已是肝逆。今胸痛吐沫，脉涩尺微，食入反出，火土两衰，蒸化无力，乃脾肾
阳衰候也。然犯辛燥，又虞动血，择其辛温通降者宜之。韭子（炒研）、苏子、沙苑子、砂仁、降香（汁冲）、
茯苓、半夏曲、益智子（煨研），数服食进，痛沫悉止。
钟氏 脾胃阳衰，浊饮不降，食入胀痛，有吐逆反胃之虞。右脉濡涩，左脉弦。宜泄肝浊以通腑阳。
浓朴（姜制，五分）、椒目（六分）、茯苓（三钱）、半夏（姜制，钱半）、苏子（炒研，七分）、枳壳（炒）、
陈皮，加姜，此三因七气汤加法，气降则饮降矣。再服呕胀减，大便得通，嗣用温脾胃，兼辛通降逆。半夏、
砂仁、韭子（炒研）、益智仁（煨研）、茯苓、石见穿、生姜。数服渐纳谷食矣。
丁 中年丧子，悲惋成噎，脘痛吐食。此清阳不旋，逆气不降，宜善自排遣，达观随化，非药石能愈之
。贝母、郁金、茯神、制半夏、栝蒌、韭白汁、姜汁、苏子汁冲服。痛呕俱减。
族某 客冬怫悒吐食，粒米不纳，仅进粥饮。今春怯寒吐沫，二便俱少，脉细涩模糊，浊逆阳微，肝肾
不主吸气。岂容再服萸、地酸腻，阅所服方，竞不识辛通大旨，仿两通厥阴、阳明主治为近理。苏子、杏仁、
川贝、益智、橘白、潞参、茯苓、制半夏、姜汁、韭白汁冲服。数剂涎沫少，粥饮多进，间进牛乳，亦不吐。
用香粳米（炒黄）、九香虫煎汤煨药，更适。转方用大半夏汤，谷食安而大便渐通。
蒋某：面色苍白，形体消瘦，这是体质本属木火偏旺。食物进入胃脘时感到阻塞，并呕吐出泡沫状痰涎。《内经》说：“三阳经气郁结，就称为膈证。”三阳经都运行津液，而肾是五液的主宰。年高者肾水衰退，导致三阳热邪郁结，腐浊之物不能下行，势必上逆侵犯，这就是格拒（饮食难下）的原因，正如香岩先生所说：“阳气郁结于上，阴精衰败于下。”治疗通阳不可用辛热之品，保存阴液不可用滋腻之药。一则因为瘦人容易阴虚，二则腐浊痰沫可以引导其下行。处方：半夏（用青盐拌制）、竹茹、瓜蒌霜、熟地黄炭、枸杞子炭、牛膝炭、茯苓、薤白、姜汁。服用数剂后逐渐能接受粥饮，同时连续数月服用牛奶，不再呕吐。
耿某：年龄接近七十岁，两尺脉微弱，右关脉弦而迟，感觉气噎梗塞，进食困难，吐出涎沫，待气息平稳后方能进食。脉弦表示肝木旺盛，脉迟表示胃中有寒。弦迟脉出现在右关，说明胃受到肝木的克制，传化功能失调，治疗应当疏泄肝气、温补胃阳，痰水自然下降。处方：丁香、煨益智仁、苏子霜、茯苓、青皮、砂仁、煨姜。服用数剂后，痰和气都平复了。
陈某：长期饮酒之人中气虚弱，气机阻滞形成噎膈，必然有湿热蒸酿成痰。脉来迟弱，中脘部位阳气衰微，连喝米粥也拒绝不下，但喝热酒却能通行，这明显是阳气微弱即将郁结的表现。治法应当通阳，使胸脘得以舒展，湿痰得以降下，从而恢复运化纳食的功能。处方：潞党参、茯神、茯苓、砂仁、丁香、姜制半夏、广陈皮、生姜、大枣煎服。服用数剂后，粥饮不再被拒绝了。之后再加炮干姜（淡干姜二分）、生研益智仁，服用数剂后胸部舒畅并能进食。
某氏：因恼怒曾呕吐瘀血，已是肝气上逆。如今胸痛吐沫，脉涩且尺脉微弱，食物吃进去反而吐出，这是火（心/命门）土（脾）两衰，蒸化无力，属于脾肾阳衰的证候。然而若使用辛燥药物，又担心动血，所以选择辛温通降的药物为宜。处方：炒研韭子、苏子、沙苑子、砂仁、降香（汁冲服）、茯苓、半夏曲、煨研益智子，服用数剂后进食增加，疼痛和吐沫全部停止。
钟氏：脾胃阳气衰微，浊饮不能下降，食物进入后胀痛，有呕吐反胃的危险。右脉濡涩，左脉弦。应当疏泄肝浊以通畅腑阳。处方：姜制厚朴（五分）、椒目（六分）、茯苓（三钱）、姜制半夏（钱半）、炒研苏子（七分）、炒枳壳、陈皮，加生姜。这是基于三因七气汤的加减法，气降则饮邪自降。再服药后呕吐腹胀减轻，大便得以通畅，随后改用温补脾胃兼辛通降逆的方法。处方：半夏、砂仁、炒研韭子、煨研益智仁、茯苓、石见穿、生姜。服用数剂后逐渐能进食谷物。
丁某：中年丧子，因悲伤哀怨形成噎膈，胃脘疼痛并吐出食物。这是清阳不升旋转，逆气不降，应当自我排遣情绪，豁达乐观顺应变化，这不是单纯药物能治愈的。处方：贝母、郁金、茯神、制半夏、栝蒌、韭白汁、姜汁、苏子汁冲服。疼痛和呕吐都减轻了。
族中某人：去年冬天抑郁不畅而呕吐食物，一粒米都吃不进，仅能喝粥饮。今年春天怕冷吐沫，大小便都减少，脉象细涩模糊，这是浊气上逆、阳气微弱，肝肾不能主司吸气。哪里还能继续服用山茱萸、熟地等酸腻药物？查看所服的方子，竟然不懂辛通的大旨，仿照两通厥阴、阳明主治的思路较为合理。处方：苏子、杏仁、川贝母、益智仁、橘白、潞党参、茯苓、制半夏、姜汁、韭白汁冲服。服用数剂后涎沫减少，粥饮多进，偶尔喝牛奶也不吐。用炒黄的香粳米和九香虫煎汤来煨药，更为适宜。转方使用大半夏汤，谷食安稳且大便逐渐通畅。
Jiang: His complexion was pale and his body emaciated, indicating a constitution inherently prone to Wood-Fire excess. Food felt obstructed in the epigastrium upon swallowing, accompanied by vomiting of frothy saliva. The Classics state: "Obstruction in the three Yang meridians is termed Ge (Dysphagia)." The three Yang meridians all circulate body fluids, while the Kidney is the master of the five fluids. In advanced age, Kidney Water declines, leading to heat accumulation in the three Yang meridians; putrid turbidity fails to descend and inevitably rebels upward, causing Jue (Rejection/Obstruction). This aligns with Mr. Xiangyan's saying: "Yang Qi is knotted above, Yin Essence is deficient below." To unblock Yang, one must not use acrid-hot herbs; to preserve Yin, one must not use cloying-nourishing herbs. First, emaciated individuals are prone to Yin deficiency; second, putrid froth can be guided downward. Prescription: Banxia (Pinelliae Rhizoma, processed with green salt), Zhuru (Bambusae Caulis in Taeniam), Lou Shuang (Fructus Trichosanthis pulvis), Shudi Tan (Carbonized Radix Rehmanniae Preparata), Qizi Tan (Carbonized Fructus Lycii), Niuxi Tan (Carbonized Radix Achyranthis Bidentatae), Fuling (Poria), Xiebai (Bulbus Allii Macrostemonis), Jiangzhi (Zingiberis Rhizoma Juice). After several doses, he gradually tolerated gruel. Concurrently taking cow's milk for several months resulted in no further vomiting.
Geng: Approaching seventy years of age, his radial pulses at both Chi positions were faint; the pulse at the right Guan position was wiry and slow. He experienced Qi obstruction and food sticking, vomiting saliva, only able to eat after his breath stabilized. A wiry pulse indicates Liver Wood hyperactivity; a slow pulse indicates Stomach Cold. Wiry and slow pulses at the right Guan suggest the Stomach is overacted upon by Liver Wood, leading to dysfunction in transmission and transformation. Treatment should involve draining Liver excess and warming the Stomach, so that Phlegm-Fluid descends naturally. Prescription: Dingxiang (Caryophylli Flos), Yi Zhi Ren Alpiniae Officinarum Semens, roasted; Suzi Fang (Perillae Fructus pulvis), Fuling (Poria), Qingpi (Citri Reticulatae Pericarpium Viride), Sharen (Amomi Fructus), Jiang (Zingiberis Rhizoma), roasted. After several doses, both Phlegm and Qi normalized.
Chen: A chronic wine drinker with Middle Jiao deficiency, Qi obstruction formed dysphagia, inevitably involving steaming dampness transforming into Phlegm. The pulse was slow and weak, indicating decline of Yang Qi in the Zhongwan region. Even rice gruel was rejected, whereas hot wine passed through easily, clearly indicating Yang deficiency approaching knotting. The method should be to unblock Yang, allowing the chest and epigastrium to expand, damp-phlegm to descend, and transportation/nutrition functions to recover. Prescription: Lushen (Codonopsis Radix), Fushen (Poria cum Pinus Radix), Fuling (Poria), Sharen (Amomi Fructus), Dingxiang (Caryophylli Flos), Banxia (Pinelliae Rhizoma, processed with ginger), Guangpi (Citri Reticulatae Pericarpium), Jiang (Zingiberis Rhizoma), Zao (Jujubae Fructus) decocted. After several doses, gruel was no longer rejected. Later, Ganjiang (Zingiberis Radix Preparata, 2 fen) and Yi Zhi Ren (Alpiniae Officinarum Semen, raw and ground) were added. After several doses, the chest felt comfortable and food intake resumed.
Certain Lady:曾因恼怒呕吐瘀血，indicating Liver Qi rebellion. Now she suffers from chest pain and vomiting of froth, with a choppy pulse and faint Chi pulse. Food enters but is immediately vomited out. Fire (Heart/Kidney Yang) and Earth (Spleen) are both deficient, lacking the power of steaming and transformation. This is a syndrome of Spleen-Kidney Yang deficiency. However, using acrid-dry herbs risks disturbing blood; thus, acrid-warm herbs that unblock and descend are chosen. Prescription: Jiu Zi (Allii Tuberosi Semen), fried and ground; Suzi (Perillae Fructus), Shayuan Zi (Astragali Complanati Semen), Sharen (Amomi Fructus), Jiangxiang (Dalbergiae Odoriferae Lignum), juice mixed; Fuling (Poria), Banxia Qu (Pinelliae Fermentatum), Yi Zhi Zi (Alpiniae Officinarum Semen), roasted and ground. After several doses, food intake increased, and pain/froth ceased completely.
Zhong: Spleen-Stomach Yang deficiency, turbid fluid fails to descend. Food intake causes distension and pain, with risk of vomiting and regurgitation. Right pulse is soggy and choppy; left pulse is wiry. Treatment should drain Liver turbidity to unblock Fu-Yang. Prescription: Houpo (Magnoliae Officinalis Cortex), processed with ginger (5 fen); Jiaomu (Zanthoxyli Semen) (6 fen); Fuling (Poria) (3 qian); Banxia (Pinelliae Rhizoma), processed with ginger (1 qian 5 fen); Suzi (Perillae Fructus), fried and ground (7 fen); Zhike (Aurantii Fructus), stir-fried; Chenpi (Citri Reticulatae Pericarpium), plus Ginger. This is an addition to San Yin Qi Qi Tang. When Qi descends, Fluid descends. Subsequent doses reduced vomiting and distension, and bowel movements became patent. Thereafter, warming Spleen-Stomach combined with acrid-unblocking and descending methods were used. Prescription: Banxia (Pinelliae Rhizoma), Sharen (Amomi Fructus), Jiu Zi (Allii Tuberosi Semen), fried and ground; Yi Zhi Ren (Alpiniae Officinarum Semen), roasted and ground; Fuling (Poria), Shijianchuan (Andrographis Herba), Shengjiang (Zingiberis Rhizoma Recens). After several doses, grain food intake gradually improved.
Ding: Lost his son in middle age, sorrow and lamentation led to dysphagia, epigastric pain, and vomiting of food. This is failure of Clear Yang to rotate and rebellious Qi failing to descend. He should manage his emotions well, maintain an open-minded attitude, and adapt to changes; this cannot be cured by medicine alone. Prescription: Beimu (Fritillariae Bulbus), Yujin (Curcumae Radix), Fushen (Poria cum Pinus Radix), Zhi Banxia (Pinelliae Rhizoma, prepared), Gualou (Trichosanthis Fructus), Jiubai Zhi (Allii Tuberosi Bulbus Juice), Jiangzhi (Zingiberis Rhizoma Juice), Suzi Zhi (Perillae Fructus Juice), taken together. Pain and vomiting decreased significantly.
Clansman: Last winter, due to depression, he vomited food and could not swallow even a grain of rice, subsisting only on gruel. This spring, he feared cold and vomited froth; urination and defecation were scant. The pulse was fine, choppy, and indistinct. Turbid Qi rebels upward, Yang Qi is weak, and Liver-Kidney fail to govern inhalation. How can one continue using Cornus and Rehmannia which are sour and cloying? Reviewing his previous prescriptions reveals a lack of understanding of the major principle of acrid-unblocking. I imitated the treatment of simultaneously regulating Jueyin and Yangming, which is more logical. Prescription: Suzi (Perillae Fructus), Xingren (Armeniacae Semen Amarum), Chuanbei (Fritillariae Cirrhosae Bulbus), Yi Zhi (Alpiniae Officinarum Semen), Ju Bai (Citri Reticulatae Pericarpium Album), Lushen (Codonopsis Radix), Fuling (Poria), Zhi Banxia (Pinelliae Rhizoma, prepared), Jiangzhi (Zingiberis Rhizoma Juice), Jiubai Zhi (Allii Tuberosi Bulbus Juice), taken together. After several doses, salivation decreased, and gruel intake increased. Occasional cow's milk was also tolerated without vomiting. Using fragrant glutinous rice (fried yellow) and Jiu Xiang Chong (Aspongopus Chinensis) decoction to simmer the herbs was more suitable. The formula was then changed to Da Ban Xia Tang (Major Pinellia Decoction), resulting in stable food intake and gradual patency of bowels.