【脉】 涩小，血不足；大而弱，气不足。
【因】 血虚（血，阴血也。主静，内外两静，火则不能生焉），脏腑之火起，气
虚（气，肺
金生水，制火则不起），脏腑之火炽。而或因金水二气不养，或阴血不生，肠胃津涸，传化
失宜；或因痰膈妨碍升降，气不交通，皆食入复出，谓之膈噎。即翻胃也，噎病也。
大概因血液俱耗，胃脘亦槁。在上近咽之下，水饮可行，食物难入，间或可食，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，亦名翻胃，
大便秘少如羊矢。名虽不同，病本一也。
张论 三阳结谓之膈。三阳，大肠、小肠、膀胱也。结者，结热也。小肠结热，
则血脉燥；
大肠结热，则后不通；膀胱结热，则津液涸。三阳既结，则前后闭，则反而上行，此所以噎
食不下，纵下而复出也。宜先润养，因而治下。或涎痰上阻，用苦酸微微涌之。
【证】 《三因》有五噎∶
气噎者，心悸，上下不通，噫哕不彻，胸背痛。
忧噎者，遇天阴寒，手足厥冷，不能自温。
劳噎者，气上膈，胁下支满，胸中填塞，故背痛。
思噎者，心怔悸，喜忘，目视KT KT 。
食噎者，食无多少，胸中苦塞痛，不得喘息。
五膈
忧膈者，胸中气结，津液不通，饮食不下，羸瘦短气。
思膈者，中脘食满，噫则酸心，饮食不消，大便不利。
怒膈者，胸膈逆满，噎塞不通，呕则筋急，恶闻食臭。
喜膈者，五心烦热，口舌生疮，四肢倦重，身常发热，胸痛引背，食少。
恐膈者，心腹胀满，咳嗽气逆，腹中苦冷雷鸣，绕痛，不能食。
【治法】 宜以润养津血，降火散结，万药万全。
有人血耗，便如羊矢，病反胃半年，脉涩而不匀，不大便八九日。先以甘蔗汁煎六君
子汤加附子、大黄与之，伺便润，令以牛乳服之。
方 四物汤 加陈皮（去白） 红花（酒浸） 驴尿（防其成虫）
秘方 治膈噎。
童便 牛羊乳 韭汁 竹沥 甘蔗汁（解酒毒）
气虚加四君；血虚加四物。
胡荽丹 治反胃气。
乌鸡（一只，令净）
胡荽子入鸡，缝之，煮熟食之，渐尽。不得，再一只鸡妙也。
【病因】 血虚（血，即阴血。性质主静，若内外环境都保持安静，火邪就不能妄动），脏腑之火兴起；气虚（气，肺金生水，能制约火邪使其不妄动），导致脏腑之火炽盛。或者因为肺金与肾水二气不能滋养，或阴血无法生成，致使肠胃津液枯竭，传导消化功能失常；或者因为痰浊阻滞妨碍了气机的升降，气机不通畅，最终导致食物吃进去又吐出来，这称为膈噎。也就是翻胃、噎病。大抵是因为血液耗损，胃脘部也干枯萎缩。病变部位在上，靠近咽喉下方，饮水可以下行，但食物难以进入，偶尔能吃一点，但吃得很少，这种情况叫做“噎”。病变部位在下，靠近胃部，食物虽然能进入，但难以完全进入胃中，过很久又会吐出来，这种情况叫做“膈”，也叫翻胃，大便干燥稀少，形状像羊粪蛋一样。名称虽然不同，但疾病的根本是一样的。
张景岳论述：三阳经热结称为膈。三阳，指大肠、小肠、膀胱。所谓“结”，是指热邪结聚。小肠热结，则血脉燥涩；大肠热结，则大便不通；膀胱热结，则津液枯竭。三阳经既已热结，则大小便闭塞，气机反而向上逆行，这就是为什么吞咽困难、饮食不下，即使勉强咽下也会吐出来的原因。治疗应当先润养津液，然后顺势通利下部。如果有涎痰上阻，可用苦味和酸味药物轻微催吐。
【证候】 《三因极一病证方论》中有五噎：
气噎，表现为心悸，上下气机不通，嗳气呃逆不畅，胸背疼痛。
忧噎，遇到阴天寒冷时，手足厥冷，无法自行温暖。
劳噎，气机上逆至膈部，胁下胀满支撑感，胸中填塞感，因此背痛。
思噎，心中怔忡悸动，容易遗忘，视物模糊不清。
食噎，无论进食多少，胸中都感觉苦涩堵塞疼痛，呼吸困难不得喘息。
五膈：
忧膈，胸中气机郁结，津液不通，饮食难以下咽，身体消瘦，气息短促。
思膈，中脘部感觉食物积满，嗳气时反酸烧心，饮食不消化，大便不通利。
怒膈，胸膈部气逆胀满，噎塞不通，呕吐时筋脉拘急，厌恶闻到食物的气味。
喜膈，五心烦热，口舌生疮，四肢倦怠沉重，身体经常发热，胸痛牵引背部，食欲减退。
恐膈，心腹胀满，咳嗽气逆，腹部怕冷且肠鸣音重，环绕肚脐疼痛，无法进食。
【治法】 适宜采用滋润养护津血、降火散结的方法，用药需万全周全。
有一位患者血液耗损，大便像羊粪蛋一样干结，患反胃症半年，脉象涩而不均匀，八九日不大便。先用甘蔗汁煎煮六君子汤，加入附子、大黄给患者服用，等待大便变润后，让患者服用牛乳。
方剂：四物汤，加陈皮（去白）、红花（酒浸）、驴尿（防止形成虫积）。
秘方：治疗膈噎。
童便（健康男童的小便）、牛羊乳、韭菜汁、竹沥、甘蔗汁（可解酒毒）。
气虚者加用四君子汤；血虚者加用四物汤。
胡荽丹：治疗反胃气逆。
乌鸡一只（处理干净），将胡荽子装入鸡腹内，缝合，煮熟后食用，逐渐吃完。如果不够，再吃一只鸡效果更好。
[Pulse] A choppy and small pulse indicates insufficient Yin blood; a large and weak pulse indicates insufficient Qi.
[Etiology] Blood deficiency (Blood refers to Yin blood, which is characterized by stillness; if both internal and external environments are tranquil, Fire cannot arise). The Fire of the Zang-Fu organs flares up. Qi deficiency (Qi involves Lung Metal generating Kidney Water, which controls Fire so it does not flare up), leading to blazing Fire in the Zang-Fu organs. Alternatively, due to the failure of Lung Metal and Kidney Water to nourish each other, or the inability to generate Yin blood, the fluids of the intestines and stomach become depleted, and transportation and transformation functions become disordered. Or, phlegm obstruction hinders the ascending and descending movements of Qi, causing Qi circulation to be blocked. All these result in food being regurgitated after ingestion, known as Ge-Ye (Dysphagia and Obstruction). This is also referred to as Fan-Wei (Reversal Stomach) or Ye-Bing (Choking Disease). Generally, it is caused by the depletion of blood and the withering of the stomach cavity. When the lesion is located upper, near the lower throat, liquids can pass down, but solid food finds it difficult to enter; occasionally some food may be taken, but the amount is small. This is named "Ye" (Choking). When the lesion is located lower, near the stomach, although food can enter, it cannot fully reach the stomach and is vomited out after a long time. This is named "Ge" (Obstruction), also called Fan-Wei, accompanied by dry, scanty stools resembling sheep dung. Although the names differ, the root of the disease is the same.
Zhang's Discussion: "Jie" (Knotting/Constriction) of the Three Yang meridians is called Ge. The Three Yang refer to the Large Intestine, Small Intestine, and Bladder. "Jie" refers to the knotting of Heat. If Heat knots in the Small Intestine, the blood vessels become dry; if Heat knots in the Large Intestine, defecation is obstructed; if Heat knots in the Bladder, body fluids are depleted. Once the Three Yang are knotted, both urination and defecation are closed off, causing Qi to rebel and move upward. This is why swallowing is difficult, food cannot go down, and even if forced down, it comes back up. Treatment should first moisten and nourish, then treat the lower jiao accordingly. If saliva and phlegm obstruct upwards, use bitter and sour substances to induce mild vomiting.
[Symptoms] According to *San Yin Fang*, there are five types of Ye:
Qi-Ye: Palpitations, blockage of Qi movement above and below, incomplete belching and hiccuping, chest and back pain.
You-Ye (Worry-Ye): Cold hands and feet when encountering cloudy or cold weather, unable to warm oneself.
Lao-Ye (Labor-Ye): Qi rebelling upwards to the diaphragm, distension and fullness under the ribs, sensation of filling in the chest, hence back pain.
Si-Ye (Pensive-Ye): Heart palpitations, forgetfulness, blurred vision.
Shi-Ye (Food-Ye): Regardless of the amount eaten, there is bitter obstruction and pain in the chest, difficulty breathing.
Five types of Ge:
You-Ge (Worry-Ge): Qi knotting in the chest, unblocked fluids, inability to swallow food, emaciation, and shortness of breath.
Si-Ge (Pensive-Ge): Fullness of food in the epigastrium, acid reflux upon belching, indigestion, and constipation.
Nu-Ge (Anger-Ge): Rebellious Qi causing fullness in the chest and diaphragm, choking and obstruction, tendon spasms during vomiting, aversion to the smell of food.
Xi-Ge (Joy-Ge): Five-palm heat, mouth and tongue ulcers, heavy and fatigued limbs, constant low-grade fever, chest pain radiating to the back, and poor appetite.
Kong-Ge (Fear-Ge): Abdominal distension and fullness, coughing with rebellious Qi, cold sensation in the abdomen with loud borborygmi, circumumbilical pain, and inability to eat.
[Therapeutic Methods] It is appropriate to use methods that moisten and nourish Yin and blood, descend Fire, and dissipate knots. Medication must be comprehensive and safe.
Case: A patient suffered from blood depletion, with stools like sheep dung, suffering from Fan-Wei for half a year. The pulse was choppy and irregular, with no bowel movement for eight or nine days. First, administer Liu Jun Zi Tang (Six Gentlemen Decoction) decocted with cane juice, added with Fu Zi (Aconite Root) and Da Huang (Rhubarb Root). Wait for the stool to soften, then have the patient drink cow's milk.
Formula: Si Wu Tang (Four Substances Decoction), add Chen Pi (Tangerine Peel, white part removed), Hong Hua (Safflower, soaked in wine), and Donkey Urine (to prevent parasite formation).
Secret Recipe: Treats Ge-Ye.
Tong Bian (Child's urine), Cow/Sheep Milk, Chive Juice, Zhu Li (Bamboo Sap), Cane Juice (resolves alcohol toxicity).
For Qi deficiency, add Si Jun Zi Tang (Four Gentlemen Decoction); for Blood deficiency, add Si Wu Tang (Four Substances Decoction).
Hu Sui Dan: Treats Fan-Wei Qi rebellion.
Black-bone Chicken (one whole, cleaned thoroughly).
Fill the chicken with Hu Sui Zi (Coriander Seeds), sew it up, cook until done, and eat it gradually until finished. If one is insufficient, eating another chicken is advisable.