噎谓饮食入咽而阻碍不通，梗涩难下，有下者，有不得下者，有吐者，有不吐
者，故别立门。血槁者，地黄、麦门冬、当归煎膏，入韭汁、乳汁、童便、芦根汁、
桃仁泥，和匀，细细呷之。大便秘涩，加桃仁泥、玄明粉，或用人参散。有实积者，
可暂用浓朴丸，亦可用昆布丸。食物下咽，屈曲自膈而下，梗涩作微痛，多是瘀血，
用前膏子药润补之后，以代抵当丸行之。有生姜汁煎方，用生姜汁、白蜜、牛酥各
五两，人参去芦末，百合末各二两，内铜锅中，慢火煎如膏，不拘时候含一匙，如
半枣大，津咽；或煎人参汤，调下一茶匙亦得，此虚而燥者宜之。手巾布裹舂杵头
糠，时时拭齿，治卒噎。刮舂米杵头细糠吞之，或煎汤呷，或炼蜜丸，含咽津亦得。
杵头糠、人参末、石莲绞肉、柿霜、玄明粉等分，舐吃。枇杷叶拭去毛炙，陈皮去
白各一两，生姜半两，水煎分温三服。噎病，喉中如有肉块，食不下，用昆布二两，
洗去咸水，小麦二合，水三大盏煎，候小麦烂熟去滓，每服不拘时，吃一小盏，仍
拣取昆布，不住含三两片咽津极效。噎病声不出，竹皮饮。东垣曰∶堵塞咽喉，阳
气不得出者，曰塞。阴气不得下降者，曰噎。夫噎塞迎逆于咽喉胸膈之间，令诸经
不行，则口开目瞪气欲绝，当先用辛甘气味俱阳之药，引胃气以治其本，加堵塞之
药，以泻其标也。寒月阴气大助阴邪于外，于正药内加吴茱萸，大热大辛苦之味，
以泻阴寒之气。暑月阳盛，则于正药中加青皮、陈皮、益智、黄柏，散寒气泄阴火
之上逆、或以消痞丸合滋肾丸。滋肾丸者，黄柏、知母、微加肉桂，三味是也。或
更加黄连别作丸。二药七八十丸，空心约宿食消尽服之，待少时以美食压之，不令
胃中停留也。以上诸法，悉于补中益气汤加减之。
膈咽不通，并四时换气用药法《黄帝针经》云∶胃病者，腹 胀，胃脘当心而
痛，上肢两胁，膈咽不通，饮食不下，取三里。夫咽者，咽物之门户也。膈者，上
焦心肺之分野。不通者，升降之气上不得下交通。又云∶清气在下，则生餐泄，泄
黄如糜，米谷不化者是也。浊气在上则生 胀，腹中胀满，不得大便，或大便难，
先结后溏皆是也。浊气在上，当降而不降者，乃肾肝吸入之阴气不得下，而反在上
也。胃气逆上，或为呕，或为吐，或为哕者，是阴火之邪上冲，而吸入之气不得，
入故食不下也。此皆气冲之火，逆胃之脉反上而作者也。清气在下则生餐泄者，胃
气未病之日，当上行心肺而经营也，因饮食失节，劳役形体，心火乘于土位，胃
气弱而下陷入阴中，故米谷入而不得升，反降而为餐泄也。膈咽之间，交通之气，
不得表里者，皆冲脉上行逆气所作也。盖胃病者，上肢两胁，膈咽不通，饮食不下，
取三里者是也。《针经》云∶清浊相干，乱于胸中，是为大 ， 者惑也。气不交通，
最为急证，不急去之，诸变生矣。圣人治此有要法，阳气不足，阴气有余，先补其
阳，后泻其阴，是先令阳气升发在阳分，而后泻阴也。春夏之月，阳气在经，当益
其经脉，去其血络。秋冬阳气降伏，当先治其脏腑。若有噎有塞，塞者，五脏之所
生，阴也，血也。噎者，六腑之所生，阳也，气也。二者皆由阴中伏阳而作也。今
立四时用药并治法于后。冬三月，阴气在外，阳气五内，当外助阳气，不得发汗，
内消阴火，勿令泄泻，此闭脏周密之大要也。盛冬乃水旺之时，水旺则金旺，子能
令母实，肺者肾之母，皮毛之阳，元本虚弱，更以冬月助其令，故病者善嚏，鼻流
清涕，寒甚则出浊涕，嚏不止，比常人尤大恶风寒，小便数而欠，或上饮下便，色
清而多，大便不调，夜恶无寐，甚则为痰咳，为呕，为哕，为吐，为唾白沫，以至
口开目瞪，气不交通欲绝者，吴茱萸丸主之。夏三月大暑，阳气在外，阴气在内，
以此病而值此时，是天助正气而锉其邪气，不治而自愈矣。然亦有当愈不愈者，盖
阴气极盛，正气不能伸故耳。且如膈咽不通，咽中如梗，甚者前证俱作，治法当从
时，用利膈丸泻肺火，以黄 补中汤送下。如两足痿厥，行步 怯，欹侧欲倒，臂 如
折，及作痛而无力，或气短气促而喘，或不足以息，以黄 、人参、甘草、白术、
苍术、泽泻、猪苓、茯苓、橘皮等作汤，送下滋肾丸一百五十丸。六七月之间，湿
热之令大行，气短不能言者，加五味子、麦门冬。如心下痞，膨闷食不下，以上件
白术、苍术等汤，送下消痞丸五七十丸，更当审而用之。
【诊】寸口脉浮大，医反下之，此为大逆，浮即无血，大即为寒，寒气相搏，
即为肠鸣，医不知而反与饮水，令汗大出，水得寒气，冷必相搏，其人即噎。寸口
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。
噎，是指饮食咽下时感到阻碍不通，梗塞涩滞难以吞咽。有的能咽下但下行困难，有的完全咽不下，有的会吐出，有的不吐，因此单独设立这一门类。若是血枯津亏所致，可用地黄、麦门冬、当归煎煮成膏，加入韭菜汁、乳汁、童便（儿童尿液）、芦根汁、桃仁泥，混合均匀，细细呷服。若大便秘结涩滞，可加桃仁泥、玄明粉，或使用人参散。若有实邪积滞，可暂时使用浓朴丸，也可使用昆布丸。食物咽下后，曲折经过膈部下行，梗涩并伴有轻微疼痛，多是瘀血所致，在使用上述膏剂润补之后，再用代抵当丸来攻逐瘀血。有一个用生姜汁煎制的方子，用生姜汁、白蜜、牛酥各五两，去芦头的人参末、百合末各二两，放入铜锅中，用慢火煎制成膏状，不限时候含服一匙，如半颗枣大小，待唾液融化后吞下；或者煎煮人参汤，调服一茶匙也可以，此方适宜于虚而燥者。用毛巾或布包裹舂米的杵头糠，时时擦拭牙齿，可治疗突发噎证。刮取舂米杵头的细糠吞服，或煎汤呷服，或炼蜜为丸，含化咽津也可以。将杵头糠、人参末、石莲绞肉、柿霜、玄明粉等分，舔食。枇杷叶刷去毛后炙烤，陈皮去白，各一两，生姜半两，水煎，分三次温服。患噎病，喉中如有肉块堵塞，饮食难下，用昆布二两，洗去咸味，小麦二合，水三大盏煎煮，等到小麦烂熟后去渣，每次服用不拘时候，喝一小盏，仍拣取昆布，不停地含服三两片咽津，效果极佳。患噎病声音发不出，用竹皮饮。李东垣说：咽喉堵塞，阳气不能外达的，称为塞。阴气不能下降的，称为噎。噎塞之气逆乱于咽喉胸膈之间，使诸经气血运行受阻，导致口开目瞪、气息欲绝，应当先用气味俱阳的辛甘药物，引导胃气以治其本，加上通塞的药物，以泻其标。寒冷月份，阴气大盛助长阴邪于外，在正药内加入吴茱萸，这是大热大辛苦味的药物，以泻阴寒之气。暑热月份阳气旺盛，则在正药中加入青皮、陈皮、益智、黄柏，以散寒气、泄上逆之阴火，或者使用消痞丸合滋肾丸。滋肾丸由黄柏、知母组成，微加肉桂，共三味药。或者再加黄连另作丸剂。每次服用七八十丸，空腹约在宿食消化尽后服用，过一会儿用美食压住药力，不让药力在胃中停留。以上各种方法，都在补中益气汤的基础上加减运用。
膈咽不通，以及四季换季时的用药法则，《黄帝针经》说：胃病表现为腹胀，胃脘当心而痛，向上牵引两胁，膈咽不通，饮食不下，应取足三里穴。咽，是吞咽食物的门户。膈，是上焦心肺的分野。不通，是指升降之气在上不得下交通。又说：清气在下，则产生飧泄，大便色黄如糜，米谷不化就是这种情况。浊气在上则产生胀满，腹中胀满，不能大便，或大便困难，先干后稀都是这种情况。浊气在上，应当降而不降，是因为肾肝吸入的阴气不能下行，反而停留在上部。胃气逆上，或呕吐，或反胃，或呃逆，这是阴火之邪上冲，吸入之气不能入，所以饮食不下。这都是气冲之火，逆乱胃脉反向上作祟。清气在下产生飧泄，是因为在胃气未病之时，本该上行至心肺进行营运，因饮食失节、劳役形体，心火乘袭土位，胃气虚弱而下陷于阴中，所以米谷进入后不能上升，反而下降成为飧泄。膈咽之间，交通之气不能通达表里，都是冲脉上行逆气所作。所谓胃病，上引两胁，膈咽不通，饮食不下，取足三里是正确的。《针经》说：清浊相干，扰乱于胸中，这就是大惑证，令人迷惑不解。气不交通，是最危急的病证，如果不急去之，各种变证就会发生。圣人治疗此病有要领，阳气不足，阴气有余，先补其阳，后泻其阴，是先令阳气升发于阳分，然后泻阴。春夏季节，阳气在经脉，应当益其经脉，去除血络中的瘀血。秋冬季节阳气潜藏，应当先治其脏腑。如果有噎有塞，塞，是五脏所生，属阴，属血。噎，是六腑所生，属阳，属气。二者都是由阴中伏阳而发作的。现在列出四季用药及治法如下。冬季三个月，阴气在外，阳气在内，应当外助阳气，不可发汗，内消阴火，勿令泄泻，这是闭藏脏气周密的大要。深冬是水旺之时，水旺则金旺，子能令母实，肺是肾之母，皮毛之阳原本虚弱，再加上冬季助长其令，所以患者容易打喷嚏，鼻流清涕，寒甚则出浊涕，喷嚏不止，比常人更恶风寒，小便频数且量少，或上饮下便，颜色清而量多，大便不调，夜间怕冷无法入睡，严重时则为痰咳，呕吐，呃逆，反胃，吐白沫，以至于口开目瞪，气不交通欲绝，用吴茱萸丸主治。夏季三个月大暑，阳气在外，阴气在内，以此病而值此季节，是天助正气而削弱邪气，不治也能自愈。然而也有该愈却不愈的，这是因为阴气极盛，正气不能伸展的缘故。例如膈咽不通，咽中如有梗物，严重时前述诸证全部出现，治法应当顺应时令，用利膈丸泻肺火，以黄芪补中汤送下。如果两足痿软厥冷，行走怯弱，倾斜欲倒，手臂如折断般疼痛且无力，或气短气促而喘，或呼吸不足以息，用黄芪、人参、甘草、白术、苍术、泽泻、猪苓、茯苓、橘皮等煎汤，送下滋肾丸一百五十丸。六七月之间，湿热之令大行，气短不能言语者，加五味子、麦门冬。如果心下痞满，膨闷饮食不下，用上述白术、苍术等汤，送下消痞丸五七十丸，更应当审慎使用。
【诊】寸口脉浮大，医生反而用下法，这是大逆，浮脉表示无血，大脉表示有寒，寒气相互搏结，即为肠鸣，医生不知道反而给饮水，令大汗出，水得寒气，冷必相互搏结，此人即发生噎证。寸口脉紧而芤，紧脉表示寒，芤脉表示虚，虚寒相互搏结，脉象为阴结而迟，此人则发生噎证。
Yi (Choking/Dysphagia) refers to the obstruction and blockage when food and drink are swallowed, with a sensation of stiffness and difficulty in descending. Some cases allow descent but with difficulty, some do not descend at all, some involve vomiting, and some do not. Therefore, it is established as a separate category. For cases of blood dryness and fluid depletion, prepare a paste by decocting Dihuang (Rehmanniae Radix), Maidong (Ophiopogonis Radix), and Danggui (Angelicae Sinensis Radix). Add juice from Jiucai (Allium tuberosum), milk, Tongbian (Uterine urine/Child's urine), Lugen juice (Phragmitis Rhizoma), and Taoren mud (Persicariae Semen), mix evenly, and sip slowly. If accompanied by constipation and rough stools, add Taoren mud and Xuanningfen (Mirabilite), or use Renshen San (Ginseng Powder). For cases with excess accumulation, Nonghou Wan (Magnolia Bark Pill) can be temporarily used, or Kunbu Wan (Laminaria Pill) may also be employed. When food passes down through the esophagus with a twisting motion below the diaphragm, causing stiffness and slight pain, it is mostly due to blood stasis. After moistening and tonifying with the aforementioned paste medicines, Dai Dandang Wan (Substitute for the Blood-Expelling Pill) should be used to move the stasis. There is a formula decocted with Shengjiang juice (Zingiberis Recensis Juice): take 5 liang each of Shengjiang juice, Baimit (White Honey), and Niusu (Bovine Butter); 2 liang each of Ren Shen Lu mo (Ginseng Radix et Rhizoma, de-stemmed and powdered) and Baihe mo (Lilii Bulbus, powdered). Place in a copper pot and slow-cook into a paste. Take one spoonful at any time, about the size of half a jujube, let it melt in saliva, and swallow; or decoct Renshen Tang (Ginseng Decoction) and mix with one tea spoonful to take. This is suitable for deficiency with dryness. Wrap the head of a rice pestle with coarse bran in a towel or cloth, and wipe teeth frequently to treat sudden Yi. Scrape fine bran from the head of a rice pestle, swallow it directly, decoct it for sipping, or make pills with refined honey to suck and swallow. Equal parts of Chutoukuang (Rice Bran from Pestle Head), Renshen mo (Ginseng Radix et Rhizoma, powdered), Shilian jiaorou (Nelumbinis Semen, mashed), Shishuang (Dried Persimmon Frost), and Xuanningfen (Mirabilite) can be licked and eaten. Pipaye (Loquat Leaf), brushed clean of hairs and roasted, and Chenpi (Citri Reticulatae Pericarpium), peeled, each 1 liang, plus Shengjiang (Zingiberis Rhizoma Recens) 0.5 liang, decocted in water and taken in three warm doses. For Yi disease where a lump feels like meat in the throat and food cannot go down, use 2 liang of Kunbu (Laminaria Thallus), washed to remove saltiness, and 2 he of Xiaomai (Tritici Fructus). Decoct in 3 large cups of water until the wheat is soft and cooked, then strain. Take one small cup at any time without restriction. Still, pick up pieces of Kunbu, keep 2-3 slices in the mouth constantly to dissolve and swallow saliva; this is extremely effective. For Yi disease where voice is lost, use Zhupi Yin (Bamboo Skin Drink). Li Dongyuan said: Obstruction of the throat where Yang Qi cannot emerge is called Sai (Blockage). Where Yin Qi cannot descend is called Yi (Choking). Yi-Sai involves rebellious Qi blocking between the throat and chest/diaphragm, preventing the flow of Qi and Blood in the meridians, leading to open mouth, staring eyes, and near-asphyxiation. One should first use acrid-sweet and purely Yang-flavored herbs to guide Stomach Qi to treat the root, adding unblocking herbs to drain the branch. In cold months, when Yin Qi greatly assists Yin pathogens externally, add Wuzhuyu (Evodiae Fructus), a herb that is hot, acrid, and bitter, to the main prescription to drain Yin-Cold. In summer months when Yang is abundant, add Qingpi (Aurantii Fructus Immaturus), Chenpi (Citri Reticulatae Pericarpium), Yizhi (Alpiniae Oxyphyllae Fructus), and Huangbai (Phellodendri Cortex) to the main prescription to disperse Cold Qi and drain rebellious Yin-Fire, or use Xiaopi Wan (Eliminate Epigastric Distention Pill) combined with Zishen Wan (Tonify Kidney Pill). Zishen Wan consists of Huangbai (Phellodendri Cortex), Zhimu (Anemarrhenae Rhizoma), and a small amount of Rougui (Cinnamomi Ramulus), these three ingredients. Or add Huanglian (Coptidis Rhizoma) separately made into pills. Take 70-80 pills on an empty stomach after residual food has digested, wait a while, then eat good food to suppress the medicine so it does not stay in the Stomach. All the above methods are modifications of Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction).
For obstruction of the Diaphragm and Pharynx, and medication methods according to seasonal changes: The Huangdi Zhenjing (Yellow Emperor's Classic of Acupuncture) states: Diseases of the Stomach manifest as abdominal distension, pain in the epigastrium centered behind the heart, radiating upward to both hypochondria, obstruction of the diaphragm and pharynx, and inability to eat or drink. Treat by selecting Zusanli (ST 36). The pharynx is the gateway for swallowing food. The diaphragm is the domain of the Upper Jiao, Heart, and Lung. Obstruction means the ascending and descending Qi cannot communicate between upper and lower. It also states: Clear Qi sinking below produces Sundxie (Sporadic Diarrhea), characterized by yellow, porridge-like stool with undigested grain. Turbid Qi rising above produces Zhang (Distension), characterized by abdominal fullness, inability to pass stool, difficult stool, or hard stool followed by loose stool. Turbid Qi remaining above fails to descend because the Yin Qi inhaled by the Kidneys and Liver cannot go down and instead stays above. Rebellious Stomach Qi may cause vomiting, regurgitation, or hiccups; this is due to Yin-Fire pathogens rushing upward, preventing inhaled Qi from entering, thus causing inability to eat. These are all caused by Qi-rushing Fire rebelling against the Stomach meridian and moving upward. Clear Qi sinking below producing Sundxie occurs because, before Stomach Qi was diseased, it should have ascended to the Heart and Lung for operation. Due to irregular diet and physical overexertion, Heart Fire attacks the Earth position, weakening Stomach Qi which sinks into the Yin. Thus, ingested grain cannot ascend and instead descends as Sundxie. The communicating Qi between the diaphragm and pharynx failing to connect interior and exterior is caused by rebellious Qi ascending from the Chong Mai (Penetrating Vessel). As stated, for Stomach diseases with hypochondriac radiation, diaphragmatic/pharyngeal obstruction, and inability to eat, selecting Zusanli is correct. The Zhenjing states: When Clear and Turbid interfere with each other and chaos arises in the chest, it is called Da Huo (Great Confusion), causing dizziness and confusion. Lack of Qi communication is an acute emergency; if not treated urgently, various complications will arise. The Sages have essential methods for treating this: when Yang Qi is insufficient and Yin Qi is excessive, first tonify Yang, then drain Yin. This first allows Yang Qi to rise in the Yang aspect, then drains Yin. In spring and summer, when Yang Qi is in the meridians, benefit the meridians and remove blood from collateral vessels. In autumn and winter, when Yang Qi submerges, first treat the Zang-Fu organs. If there is Yi or Sai, Sai originates from the Five Zang organs, belongs to Yin, and relates to Blood. Yi originates from the Six Fu organs, belongs to Yang, and relates to Qi. Both are caused by Yang hidden within Yin. The following details medication and treatment methods for the four seasons. During the three winter months, Yin Qi is external and Yang Qi is internal. One should assist Yang Qi externally without sweating, and dissipate Yin-Fire internally without causing diarrhea. This is the key to keeping the Zang organs closed and secure. In deep winter, Water is prosperous, making Metal prosperous. Since the child makes the mother solid, and Lung is the mother of Kidney, the Yang of skin and hair is originally weak. Assisted by the Winter command, patients often sneeze, run clear nasal discharge, and in severe cold, thick nasal discharge. Persistent sneezing makes them more sensitive to wind and cold than normal. Urination is frequent and scanty, or drinking leads to urination with clear, abundant urine. Bowel movements are irregular. At night, they fear cold and cannot sleep. Severe cases develop phlegm-cough, vomiting, hiccups, regurgitation, spitting white foam, and even open mouth, staring eyes, lack of Qi communication, and near-asphyxiation. Wu Zhu Yu Wan (Evodia Pill) is the primary treatment. During the three summer months of great heat, Yang Qi is external and Yin Qi is internal. If this disease occurs at this time, Heaven assists Righteous Qi to defeat Evil Qi, and it may heal spontaneously without treatment. However, some cases do not heal because Yin Qi is extremely abundant and Righteous Qi cannot expand. For example, in diaphragmatic/pharyngeal obstruction with a lump sensation in the throat, and severe manifestation of previous symptoms, treatment should follow the season. Use Lige Wan (Unblock Diaphragm Pill) to drain Lung Fire, delivered with Huangqi Buzhong Tang (Astragalus Tonify Middle Decoction). If accompanied by flaccidity and cold in both legs, hesitant walking, leaning and falling, arms feeling broken and painful with weakness, shortness of breath, rapid breathing, or suffocation, decoct Huangqi (Astragali Radix), Renshen (Ginseng Radix et Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), Cangzhu (Atractylodis Rhizoma), Zexie (Alismatis Rhizoma), Zhuling (Polyporus), Fuling (Poria), and Ju Pi (Citri Reticulatae Pericarpium) as a decoction, and deliver 150 Zishen Wan (Tonify Kidney Pills). Between the sixth and seventh months, when Damp-Heat commands prevail, and the patient has shortness of breath and inability to speak, add Wuweizi (Schisandrae Fructus) and Maidong (Ophiopogonis Radix). If there is epigastric stuffiness, bloating, and inability to eat, use the aforementioned Baizhu and Cangzhu decoction to deliver 50-70 Xiaopi Wan (Eliminate Epigastric Distention Pills), using this method with caution.
[Diagnosis] If the Cun Kou (Radial Pulse) is floating and large, and the physician incorrectly uses purgation, this is a major contraindication. Floating indicates lack of Blood; Large indicates Cold. When Cold Qi combats, it causes borborygmus (bowel sounds). If the physician, unaware, gives water causing profuse sweating, the water combines with Cold Qi, causing cold combat, resulting in Yi (Choking). If the Cun Kou pulse is tight and hollow (Kou), Tight indicates Cold, Hollow indicates Deficiency. The combination of Deficiency and Cold results in a Yin-knotted and slow pulse, leading to Yi (Choking).