《金匮要略》云∶发汗令阳微，膈气虚，脉乃数，数为客热，不能消谷，胃中虚冷，
其气无余，朝食暮吐，变为胃反。又云∶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，宿食不化，名曰胃反。《伤寒论》太阳病，吐后汗
出，不恶寒发热，关脉细数，欲食冷食，朝食暮吐。注以晨食入胃，胃虚不能克化，
至暮胃气行里，与邪相搏，则食反出也。《巢氏病源》亦曰∶荣卫俱虚，血气不足，
停水积饮在胃脘，即脏冷，脏冷则脾不磨，而宿食不化，其气逆而成反胃，则朝食
暮吐，甚则食已即吐。王太仆注《内经》亦曰∶食不得入，是有火也；食入反出，
是无火也。由是后世悉以胃虚为寒，而惟用辛香大热之剂以复其阳。虽有脉数，为
邪热不杀谷者，亦用之。殊不思壮火散气，其大热之药，果能复气乎。丹溪谓膈噎
反胃之病，得之七情六淫，遂有火热炎上之化，多升少降，津液不布，积而为痰为
饮，被劫时暂得快，七情饮食不节，其证复作，前药再行，积成其热，血液衰耗，
胃脘干槁，其槁在上，近咽之下，水饮可行，食物难入，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
秘少若羊矢。然必外避六淫，内节七情，饮食自养，滋血生津，以润肠胃，则金无
畏火之炎，肾有生水之渐，气清血和则脾气健运，而食消磨传送行矣。此论膈噎之
久病者也。然而亦有病未久，而食入即反出之不已与膈噎形状同者，何以言之？
《内经》谓厥阴之复，呕吐，饮食不入，入而复出，甚则入脾，食痹而吐。王注食痹
者，食已心下痛，阴阴然不可忍也，吐出乃止，此胃气逆而不下行也。又胃脉 散，
当病食痹。又肺病传之肝，曰肝痹，胁痛出食。与夫《金匮要略》复有肝中寒、心
中风、厥阴之为病，三者皆食入则吐，则必又从其病由之邪而治也。大抵反胃亦必
如前条治吐，分气、积、寒三法可也。奈后世概用调气之剂，制一方名十膈散，治
十般膈气，今人守之为良方，略古圣贤而勿论。夫治病之道，非中其邪，而病岂能
愈乎。予试以昔尝求邪而得验者明之。一男子壮年，食后必吐出数口，却不尽出，
膈上时作声，面色如平人，知其病不在脾胃而在膈间，问其得病之由，乃因大怒未
止，辄吃面，实时有此证。料之以怒甚则血菀于上，积在膈间，有碍气之升降，津
液因聚为痰为饮，与气相搏而动，故作声也。用二陈汤加香附、韭汁、莱菔子服二
日，以瓜蒂散、酸浆吐之，再一日又吐，痰中见血一盏，次日复吐，见血一钟，其
病即愈。一中年人中脘作痛，食已则吐，面紫霜色，两关脉涩，知其血病也。问之
乃云跌仆后中脘即痛，投以生新推陈血剂，吐出停血碗许，则痛不作而食亦不出矣。
咽喉闭塞，胸膈膨满，似属气滞，暂宜香砂宽中丸，开导结散而已。然服耗气药过
多，中气不运而致者，当补气而使自运，补气运脾汤。李绛疗反胃呕吐无常，粥饮入
口即吐，困倦无力垂死者，以上党人参三大两，劈破，水一大升，煮取四合，热顿
服。大便燥结如羊矢，闭久不通，似属血热，止可清热润养，小着汤丸，累累加之，
关扃自透。（滋血润肠汤，姜汁炙大黄，人参利膈丸，玄明粉少加甘草。）然服通利药过多，致
血液耗竭而愈结者，当补血润血而使自行。有因火逆冲上，食不得入，其脉洪大有力而数者，
滋阴清膈散，加枇杷叶二钱，芦根一两。或痰饮阻滞而脉结涩者，二陈汤入竹沥、
姜汁。痰多，食饮才下，便为痰涎裹住不得下者，以来复丹控其痰涎，自制涤痰丸，
半夏曲、枯矾、皂角火炙刮去皮弦子、玄明粉、白茯苓、枳壳各等分，霞天膏和丸。
有因脾胃阳火内衰，其脉沉微而迟者，以辛香之药温其气，却宜丁沉透膈汤、五膈
宽中散、嘉禾散之类，仍以益阴之药佐之。瘀血在膈间，阻碍气道而成者居多，以
代抵当丸作芥子大，取三钱，去枕仰卧，细细咽之，令其搜逐停积，至天明利下恶
物，却好将息自愈。五灵脂治净为细末，黄犬胆汁和丸，如龙眼大。每服一丸，好
酒半盏温服，不过三服效，亦行瘀血之剂也。亦有虫者，以秦川剪红丸取之，此丸
亦取瘀血。《本事方》芫花丸，治积聚停饮痰水生虫，久则成反胃及变为胃痈。其说
在《灵枢》及《巢氏病源》。有实积而无内热者，古方浓朴丸、万病紫菀丸，当如方
服之，能取下虫物。治反胃，用新汲水一大碗，留半碗，将半碗水内细细浇香油，
铺满水面上，然后将益元散一贴，轻轻铺满香油面上，须臾自然沉水底，此即阴阳
升降之道也。用匙搅匀服，却将所留水半碗荡药碗漱口令净，吐既止，却进末子凉
膈散，通其大小便，未效再进一帖益元及凉膈即效也。此方极验。童便（降火）、竹沥（行痰）、
韭汁（行血）、人乳汁、牛乳汁（补虚润燥）、芦根汁（止呕）、茅根汁（凉血）、姜汁（佐竹沥
行痰）、甘蔗汁（和胃）、驴尿（杀虫）、仍入烧酒、米醋、蜜各少许和匀，隔汤顿温服。自
制通肠丸，大黄（酒浸）、滑石（飞研），各二两，陈皮（去白）、浓朴（姜制），各一两半，人参、当归、贯众
（去毛）、干漆（炒烟尽），各一两，木香、槟榔各七钱半，三棱（煨）、蓬术（煨）、川芎、薄荷、玄明粉、
雄黄、桃仁泥、甘草各五钱，俱各另取细末，用竹沥、童便、韭汁、人乳、驴尿、芦根汁、茅根
汁、甘蔗汁、烧酒、米醋、蜜各二杯，姜汁一杯，隔汤煮浓，和丸如芥子大。每服三钱，
去枕仰卧，唾津咽下，通利止后服。服此丸及前诸汁后，得药不反，切不可便与粥
饭及诸饮食，每日用人参五钱，陈皮二钱，作汤细啜，以扶胃气，觉稍安，渐渐加
人参，旬日半月间，方可小试陈仓米饮及糜粥。仓廪未固，不宜便贮米谷，常见即
食粥饭者，遂致不救。又有反胃，因叫呼极力，破损气喉，气喉破漏，气壅胃管，
胃受气亦致反胃，法在不治，或用牛喉管焙燥服之。张子和十膈五噎浪分支派 ，病
派之分，自巢氏始，病失其本，亦自巢氏始，何则？老子曰∶少则得，多则惑。且
俗谓噎食一症，在《内经》原无多语，惟曰三阳结谓之膈。三阳者，大肠、小肠、
膀胱也。结谓结热也。小肠结热则血脉燥，大肠结热则后不圊，膀胱结热则津液涸，
三阳俱结则前后秘涩。下既不通，必反上行，此所以噎食不下，纵下而复出也。谓
胃为水谷之海，日受其新，以易其陈，一日一便，乃常度也。今病噎者，三五七日
不便，乖其度也。岂非三阳俱结于下，大肠枯涸，所食之物为咽所拒，纵入太仓，
还出喉咙，此阳火不下推而上行也。经曰∶少阳所至，为呕，涌溢食不下。又气厥
论云∶肝移寒于心，为狂，膈中。注阳与寒相搏，故膈食而中不通，此膈热与寒为
之也，非独专于寒也。六节藏象云∶人迎四盛以上为格阳。王太仆云∶阳盛之极，
故膈拒而食不入。《正理论》云∶格则吐逆，故膈亦当为格，后世强分为五噎，后又
别为十膈五噎，其派既多，其惑滋甚，人之溢食，初未必遽然也。初或伤酒食，或
胃热欲吐，或胃风欲吐，医氏不察本原，火里烧姜，汤中煮桂，丁香未已，豆蔻继
之，荜茇未已，胡椒继之。虽曰和胃，胃本不寒。虽曰补胃，胃本不虚。设如伤饮，
止可逐饮。设如伤食，止可逐食。岂可言虚，便将热补。素热之人，三阳必结，三
阳既结，食必上潮。医者犹云胃寒不纳，烧针着艾，三阳转结。分明一句，到了难
从。不过抽薪退热，最为紧要。扬汤止沸，愈急愈增。岁月弥深，为医所误。
人言可下，退阳养阴，张眼吐舌，恐伤元气，止在冲和。闭塞不通，肠宜通畅，
是以肠鸣，肠既不通，遂成噎病。或曰忧恚气结，亦可下乎。予曰忧恚盘礴，便同
火郁，太仓公见此皆下，法废以来，千年不复。今代刘河间治膈气噎食用承气三乙
汤，独超近代。今予不恤，姑示后人。用药之时，更详轻重。假如秘久，慎勿顿攻。
总得攻开，必虑后患。宜先润养，小着汤丸，累累加之，关扃自透。其或咽噎，上
阻痰涎，轻用苦酸，微微涌出。因而治下，药势易行，设或不行，蜜盐下导，始终
勾引，两药相通，结散阳消，饮食自下。莫将巴豆，耗却天真，液燥津枯，留毒不
去。人言此病，曾下夺之，从下夺来，转虚转痞。此为巴豆，非大黄、牵牛之过也。
箕城一酒官，病呕吐，逾年不愈，皆以胃寒治之，丁香、半夏、青、陈、姜、附，
种种燥热，烧锥燎艾，莫知其数，或少愈，或复剧，且十年大便涩燥，小便赤黄，
予视之曰，诸痿喘呕，皆属于上。王太仆云∶上谓上焦也。火气炎上之气，谓皆热
甚而为呕。以四生丸下三十行，燥粪肠垢何啻如斗，其人昏困一二日，频以冰水呷
之，渐投凉乳酪、芝麻饮，时时咽之。数日后大啜饮食，精神气血如昔，继生三子，
至五十岁。
【诊】寸口脉微而数，微则无气，无气则荣虚，荣虚则血不足，血不足则胸中
冷。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，完
谷不化，名曰胃反。脉紧而涩，其病难治。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，令脉反弦，故名曰虚。胃脉 而散者，当病食痹。
（至真要论云∶食痹而吐。）肾脉微缓为洞，洞者食不化，下嗌还出。沉缓而无力，或大而弱，
为气虚。数而无力，或涩小，为血虚。数而有力为热。寸关沉，或伏、或大而滑数，
是痰。寸关脉沉而涩，是气。反胃之脉，沉细散乱，不成条道，沉浮则有，中按则
无，必死不治。更参面色，不欲黄白，亦不欲纯白，皆恶候也。年高病久，元气败
坏，手足寒冷，粪如羊矢，沫大出者，皆不治。
《金匮要略》说：发汗导致阳气微弱，膈间气虚，脉象变得数（快速），数脉代表客热（外来的或暂时的热邪），不能消化谷物，胃中虚冷，胃气枯竭，早晨吃的食物晚上吐出，演变为胃反病。又说：趺阳脉（足背动脉）浮而涩，浮脉表示气虚，涩脉表示脾受伤，脾受伤则不能磨化水谷，早晨吃晚上吐，晚上吃早上吐，宿食不消化，称为胃反。《伤寒论》太阳病，呕吐后出汗，不恶寒也不发热，关脉细数，想吃冷食，早晨吃晚上吐。注解说：早晨进食入胃，因胃虚不能腐熟消化，到了傍晚胃气行于里，与邪气相搏结，食物就反吐出来。《巢氏病源》也说：营卫俱虚，血气不足，停水积饮在胃脘，导致脏腑寒冷，脏腑寒冷则脾不能磨化，宿食不消化，气机上逆而成反胃，表现为早晨吃晚上吐，严重时吃完立刻吐。王太仆（王冰）注释《内经》时说：食物进不去，是有火；食物进去又吐出来，是无火。因此后世都认为是胃虚寒，只用辛香大热的药物来恢复阳气。即使有脉数，是邪热不能杀谷（消化食物）的情况，也使用这些药。殊不知壮火散气，那些大热的药物，真的能恢复元气吗？朱丹溪说：膈噎反胃病，源于七情六淫，于是产生火热炎上的变化，多升少降，津液不布散，积聚成为痰饮，被劫持时暂时感到痛快，但七情饮食不节制，病症复发，前面的药再次使用，积聚成热，血液衰耗，胃脘干枯槁缩。如果干枯在上部，靠近咽喉之下，水饮可以下行，食物难以下咽，即使进入也不多，称为噎。如果干枯在下部，靠近胃部，食物虽然可以进入，但难以完全进入胃中，很久之后又吐出来，称为膈，也称为反胃。大便干结少如羊屎。然而必须外避六淫，内节七情，饮食自养，滋血生津，以滋润肠胃，那么肺（金）就不畏惧火的炎症，肾就有生水（阴液）的渐增，气清血和则脾气健运，食物就能消磨传送了。这是论述膈噎的久病患者。然而也有病不久，而食物进去就反复吐出不止，且症状与膈噎形状相同的，怎么说呢？《内经》说厥阴之复，呕吐，饮食不入，进去又出来，严重时传入脾，食痹而吐。王注解释食痹者，食物吃完心下痛，隐隐作痛不可忍受，吐出来才停止，这是胃气上逆而不下行。另外胃脉芤而散，应当患食痹。还有肺病传至肝，称为肝痹，胁痛并吐出食物。以及《金匮要略》中提到的肝中寒、心中风、厥阴之为病，这三种情况都是食物进去就吐，那么必须根据病因邪气来治疗。大抵反胃也像前面治疗呕吐一样，分气、积、寒三种治法即可。无奈后世一概使用调气药剂，制定一方名为十膈散，治疗十般膈气，今人坚守它为良方，忽略古圣贤的道理而不加讨论。治病之道，如果不针对邪气，病怎么能痊愈呢？我试着用过去求邪而见效的案例来说明。一个壮年男子，饭后必吐出几口，但不全吐，膈上时常发出声音，面色如常人，知道病不在脾胃而在膈间，询问得病原因，是因为大怒未止，随即吃面，当时就出现此证。推测是因为大怒则血郁于上，积聚在膈间，阻碍气的升降，津液因此聚为痰饮，与气相搏而动，所以发声。用二陈汤加香附、韭汁、莱菔子服用两天，再用瓜蒂散、酸浆催吐，第二天又吐，痰中带血一盏，次日再吐，见血一钟，病即痊愈。一个中年人中脘疼痛，吃完就吐，面色紫霜色，两关脉涩，知道是血病。询问得知是跌打损伤后中脘即痛，投以生新推陈的血剂，吐出碗许停血，则痛不作而食物也不再吐出了。咽喉闭塞，胸膈膨满，似乎属于气滞，暂宜用香砂宽中丸，开导结散而已。但如果服用耗气药过多，导致中气不运而致的，应当补气使其自然运转，用补气运脾汤。李绛治疗反胃呕吐无常，粥饮入口即吐，困倦无力垂死的人，用上党人参三大两，劈破，水一大升，煮取四合，热顿服。大便燥结如羊屎，闭久不通，似乎属于血热，只可清热润养，小着汤丸，逐渐增加剂量，关扃自然通透。（滋血润肠汤，姜汁炙大黄，人参利膈丸，玄明粉少加甘草。）但如果服用通利药过多，导致血液耗竭而更加结滞的，应当补血润血使其自行通畅。有因火逆冲上，食物不得入，其脉洪大有力而数的，用滋阴清膈散，加枇杷叶二钱，芦根一两。或者痰饮阻滞而脉结涩的，二陈汤加入竹沥、姜汁。痰多，饮食刚下，就被痰涎裹住不得下行的，以来复丹控制其痰涎，自制涤痰丸，半夏曲、枯矾、皂角火炙刮去皮弦子、玄明粉、白茯苓、枳壳各等分，霞天膏和丸。有因脾胃阳火内衰，其脉沉微而迟的，用辛香之药温其气，却适宜丁沉透膈汤、五膈宽中散、嘉禾散之类，仍以益阴之药佐助。瘀血在膈间，阻碍气道而成的居多，用代抵当丸做成芥子大，取三钱，去枕仰卧，细细咽下，令其搜逐停积，到天明排出恶物，恰好将息自愈。五灵脂治净为细末，黄犬胆汁和丸，如龙眼大。每服一丸，好酒半盏温服，不过三服有效，也是行瘀血的药剂。也有虫积的，用秦川剪红丸攻取，此丸也是取瘀血。《本事方》芫花丸，治疗积聚停饮痰水生虫，久则成反胃及变为胃痈。这种说法在《灵枢》及《巢氏病源》中有记载。有实积而无内热的，古方浓朴丸、万病紫菀丸，应当按方服用，能取下虫物。治疗反胃，用新汲水一大碗，留半碗，将半碗水内细细浇香油，铺满水面上，然后将益元散一贴，轻轻铺满香油面上，须臾自然沉水底，这就是阴阳升降之道。用匙搅匀服，却将所留水半碗荡药碗漱口令净，吐既止，却进末子凉膈散，通其大小便，未效再进一帖益元及凉膈即效也。此方极验。童便（降火）、竹沥（行痰）、韭汁（行血）、人乳汁、牛乳汁（补虚润燥）、芦根汁（止呕）、茅根汁（凉血）、姜汁（佐竹沥行痰）、甘蔗汁（和胃）、驴尿（杀虫），仍入烧酒、米醋、蜜各少许和匀，隔汤顿温服。自制通肠丸，大黄（酒浸）、滑石（飞研），各二两，陈皮（去白）、浓朴（姜制），各一两半，人参、当归、贯众（去毛）、干漆（炒烟尽），各一两，木香、槟榔各七钱半，三棱（煨）、蓬术（煨）、川芎、薄荷、玄明粉、雄黄、桃仁泥、甘草各五钱，俱各另取细末，用竹沥、童便、韭汁、人乳、驴尿、芦根汁、茅根汁、甘蔗汁、烧酒、米醋、蜜各二杯，姜汁一杯，隔汤煮浓，和丸如芥子大。每服三钱，去枕仰卧，唾津咽下，通利止后服。服此丸及前诸汁后，得药不反，切不可便与粥饭及诸饮食，每日用人参五钱，陈皮二钱，作汤细啜，以扶胃气，觉稍安，渐渐加人参，旬日半月间，方可小试陈仓米饮及糜粥。仓廪未固，不宜便贮米谷，常见即食粥饭者，遂致不救。又有反胃，因叫呼极力，破损气喉，气喉破漏，气壅胃管，胃受气亦致反胃，法在不治，或用牛喉管焙燥服之。张子和十膈五噎浪分支派，病派之分，自巢氏始，病失其本，亦自巢氏始，何则？老子曰∶少则得，多则惑。且俗谓噎食一症，在《内经》原无多语，惟曰三阳结谓之膈。三阳者，大肠、小肠、膀胱也。结谓结热也。小肠结热则血脉燥，大肠结热则后不圊，膀胱结热则津液涸，三阳俱结则前后秘涩。下既不通，必反上行，此所以噎食不下，纵下而复出也。谓胃为水谷之海，日受其新，以易其陈，一日一便，乃常度也。今病噎者，三五七日不便，乖其度也。岂非三阳俱结于下，大肠枯涸，所食之物为咽所拒，纵入太仓，还出喉咙，此阳火不下推而上行也。经曰∶少阳所至，为呕，涌溢食不下。又气厥论云∶肝移寒于心，为狂，膈中。注阳与寒相搏，故膈食而中不通，此膈热与寒为之也，非独专于寒也。六节藏象云∶人迎四盛以上为格阳。王太仆云∶阳盛之极，故膈拒而食不入。《正理论》云∶格则吐逆，故膈亦当为格，后世强分为五噎，后又别为十膈五噎，其派既多，其惑滋甚，人之溢食，初未必遽然也。初或伤酒食，或胃热欲吐，或胃风欲吐，医氏不察本原，火里烧姜，汤中煮桂，丁香未已，豆蔻继之，荜茇未已，胡椒继之。虽曰和胃，胃本不寒。虽曰补胃，胃本不虚。设如伤饮，止可逐饮。设如伤食，止可逐食。岂可言虚，便将热补。素热之人，三阳必结，三阳既结，食必上潮。医者犹云胃寒不纳，烧针着艾，三阳转结。分明一句，到了难从。不过抽薪退热，最为紧要。扬汤止沸，愈急愈增。岁月弥深，为医所误。人言可下，退阳养阴，张眼吐舌，恐伤元气，止在冲和。闭塞不通，肠宜通畅，是以肠鸣，肠既不通，遂成噎病。或曰忧恚气结，亦可下乎。予曰忧恚盘礴，便同火郁，太仓公见此皆下，法废以来，千年不复。今代刘河间治膈气噎食用承气三乙汤，独超近代。今予不恤，姑示后人。用药之时，更详轻重。假如秘久，慎勿顿攻。总得攻开，必虑后患。宜先润养，小着汤丸，累累加之，关扃自透。其或咽噎，上阻痰涎，轻用苦酸，微微涌出。因而治下，药势易行，设或不行，蜜盐下导，始终勾引，两药相通，结散阳消，饮食自下。莫将巴豆，耗却天真，液燥津枯，留毒不去。人言此病，曾下夺之，从下夺来，转虚转痞。此为巴豆，非大黄、牵牛之过也。箕城一酒官，病呕吐，逾年不愈，皆以胃寒治之，丁香、半夏、青、陈、姜、附，种种燥热，烧锥燎艾，莫知其数，或少愈，或复剧，且十年大便涩燥，小便赤黄，予视之曰，诸痿喘呕，皆属于上。王太仆云∶上谓上焦也。火气炎上之气，谓皆热甚而为呕。以四生丸下三十行，燥粪肠垢何啻如斗，其人昏困一二日，频以冰水呷之，渐投凉乳酪、芝麻饮，时时咽之。数日后大啖饮食，精神气血如昔，继生三子，至五十岁。
【诊】寸口脉微而数，微则无气，无气则荣虚，荣虚则血不足，血不足则胸中冷。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，完谷不化，名曰胃反。脉紧而涩，其病难治。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，令脉反弦，故名曰虚。胃脉芤而散者，当病食痹。（至真要论云∶食痹而吐。）肾脉微缓为洞，洞者食不化，下嗌还出。沉缓而无力，或大而弱，为气虚。数而无力，或涩小，为血虚。数而有力为热。寸关沉，或伏、或大而滑数，是痰。寸关脉沉而涩，是气。反胃之脉，沉细散乱，不成条道，沉浮则有，中按则无，必死不治。更参面色，不欲黄白，亦不欲纯白，皆恶候也。年高病久，元气败坏，手足寒冷，粪如羊矢，沫大出者，皆不治。
The *Jingui Yaolue* states: Sweating causes Yang to become weak, Qi in the Diaphragm (Diaphragm area) to become deficient, and the pulse to become rapid (Shu). A rapid pulse indicates exogenous heat (Ke Re), which cannot digest grain. The Stomach is cold and deficient, its Qi is exhausted; food eaten in the morning is vomited in the evening, evolving into Fan Wei (Gastric Regurgitation). It also states: The Fuyang pulse (pulse at the dorsum of the foot) is floating and choppy. Floating indicates deficiency; choppy indicates Spleen injury. When the Spleen is injured, it cannot grind and transform; food eaten in the morning is vomited in the evening, and food eaten in the evening is vomited in the morning, with undigested food remaining, known as Fan Wei. In Taiyang disease (Disease of the Taiyang Channel) from the *Shanghan Lun*, after vomiting and sweating, there is no aversion to cold or fever, the Guan pulse (radial artery at the wrist) is fine and rapid, the patient desires cold food, and food eaten in the morning is vomited in the evening. The commentary notes: Food enters the Stomach in the morning, but due to Stomach deficiency, it cannot be decomposed and transformed. By evening, when Stomach Qi moves inward, it clashes with pathogenic factors, causing the food to be regurgitated. The *Chao Shi Bing Yuan* also states: Ying and Wei are both deficient, Blood and Qi are insufficient, water retention and fluid accumulation occur in the Epigastrium, leading to Cold in the Zang organs. When the Zang organs are cold, the Spleen cannot grind, and undigested food remains. Qi rebels upward, forming Fan Wei, manifesting as morning eating and evening vomiting; in severe cases, immediate vomiting occurs after eating. Wang Taipu (Wang Bing) annotated the *Neijing*: "Food cannot enter, this is Fire; food enters and comes back out, this is lack of Fire." Thus, later generations all considered it Stomach deficiency-Cold, using only pungent, aromatic, and strongly hot agents to restore Yang. Even when the pulse is rapid due to pathogenic heat failing to digest grain, these agents were still used. They failed to realize that strong fire dissipates Qi; can such strongly hot medicines truly restore Qi? Zhu Danxi stated: Diseases of Ge Ye (Throat Obstruction) and Fan Wei arise from the Seven Emotions and Six Exogenous Pathogens, leading to transformations of Fire-Heat flaming upward. There is more ascending than descending, Body Fluids are not distributed, accumulating into Phlegm and Fluid Retention. Although temporarily relieved by being "robbed" (perhaps referring to purging or harsh treatment), irregular emotions and diet cause the symptoms to recur. Using previous medications again accumulates Heat, depletes Blood, and causes the Stomach lining to become dry and atrophic. If the atrophy is upper, near the throat, fluids can pass, but food is difficult to swallow and intake is small; this is called Ye (Dysphagia). If the atrophy is lower, near the Stomach, food can enter but cannot fully reach the Stomach, and re-emerges after a long time; this is called Ge (Obstruction) or Fan Wei. Stool is dry and scant, resembling sheep droppings. However, one must avoid the Six Exogenous Pathogens externally, regulate the Seven Emotions internally, nourish oneself through diet, nourish Blood and generate Body Fluids to moisten the Intestines and Stomach. Then, Metal (Lung) will not fear the inflammation of Fire, Kidney will have the gradual generation of Water (Yin), Qi will be clear and Blood harmonious, the Spleen will transport and transform vigorously, and food will be digested and transmitted. This discusses chronic cases of Ge Ye. However, there are also cases where the disease is not chronic, yet food enters and repeatedly comes out, with shapes similar to Ge Ye. Why is this? The *Neijing* states: Revolt of Jueyin causes vomiting, food and drink do not enter, if they enter they come back out; in severe cases, it transmits to the Spleen, causing Shi Bi (Food Impediment) and vomiting. Wang's annotation explains Shi Bi: After eating, pain occurs below the heart, dull and unbearable until vomiting stops; this is Stomach Qi rebelling upward and not descending. Additionally, if the Stomach pulse is Kou (hollow) and scattered, one should suffer from Shi Bi. If Lung disease transmits to the Liver, it is called Gan Bi (Liver Impediment), with hypochondriac pain and vomiting of food. As for the *Jingui Yaolue* mentioning Gan Zhong Han (Cold in the Liver), Xin Zhong Feng (Wind Strike to the Heart), and Bing of Jueyin, all three involve vomiting after food entry; thus, treatment must follow the pathogenic factor. Generally, treating Fan Wei is like treating vomiting in the previous section, dividing into methods for Qi, Accumulation, and Cold. Unfortunately, later generations uniformly used Qi-regulating formulas, creating one formula named Shige San (Ten Obstructions Powder) to treat ten types of Obstruction Qi. Modern people guard it as a good prescription, ignoring ancient sages without discussion. The way of treating disease is: unless the pathogen is addressed, how can the disease heal? I will illustrate with past cases where seeking the pathogen proved effective. A young man always vomited a few mouthfuls after meals, but not all; sounds were often made above the diaphragm, his complexion was normal. Knowing the disease was not in the Spleen/Stomach but in the Diaphragm, I asked the cause. He replied that after a great anger subsided, he ate noodles, and immediately developed this symptom. I deduced that extreme anger causes Blood to stagnate upward, accumulating in the Diaphragm, hindering the ascent and descent of Qi. Body Fluids gathered into Phlegm and Fluid Retention, clashing with Qi and moving, hence the sound. I prescribed Erchen Tang (Two-Aged Decoction) with Xiangfu (Cyperus Rhizome), Jiuzhi (Chinese Chive Juice), and Laifuzi (Radish Seed) for two days, then induced vomiting with Gouti San (Melon Seed Powder) and Suanjiang (Sour Plum Liquid). On the second day, he vomited again, with blood mixed in the Phlegm (one cup); the next day, he vomited again, seeing blood (one bell measure), and the disease was cured. A middle-aged man had pain in the Zhongwan point (CV12), vomiting after eating, with a purple-frost complexion and choppy pulses at both Guan positions, indicating a Blood disease. He reported pain in Zhongwan after a fall. I administered a formula to generate new Blood and eliminate old stasis; he vomited about a bowl of stagnant blood, after which the pain ceased and food was no longer vomited. Throat closure and chest/diaphragm distension seem to belong to Qi stagnation; temporarily use Xiangsha Kuanzhong Wan (Fragrant Sand Broad-Middle Pill) to open and disperse knots. However, if caused by excessive consumption of Qi-consuming drugs leading to failure of Middle Qi to move, one should tonify Qi to allow natural movement, using Buzhi Yunchi Tang (Tonify Qi and Transport Spleen Decoction). Li Jiang treated Fan Wei with unpredictable vomiting, where porridge and drinks were vomited immediately upon entry, leaving the patient exhausted and near death, by using three taels of Shangdang Ginseng, split, boiled in one sheng of water to yield four he, taken hot in one dose. Dry stool resembling sheep droppings, blocked for a long time, seems to belong to Blood Heat; only clear Heat and moisten/nourish, using small decoctions/pills, gradually increasing dosage, so the gates naturally open. (Zixue Runchang Tang, Ginger-processed Dahuang, Renshen Lige Wan, Xuanningfen with a little Gancao.) However, if excessive use of purgatives leads to exhaustion of Blood and increased constipation, one should nourish and moisten Blood to allow natural passage. If due to Fire rebelling upward, preventing food entry, with a surging, forceful, and rapid pulse, use Ziyin Qingge San (Nourish Yin Clear Obstruction Powder), adding Pipaye (Loquat Leaf) 2 qian and Lugeng (Reed Rhizome) 1 liang. Or if obstructed by Phlegm-Fluid with a knotted/choppy pulse, use Erchen Tang with Zhuli (Bamboo Sap) and Jiangzhi (Ginger Juice). If there is much Phlegm, and food/drink is immediately wrapped by Phlegm-saliva preventing descent, use Laifu Dan to control Phlegm-saliva, and self-made Tidan Wan (Eliminate Phlegm Pill): Banxiaqu (Pinellia Fermented Paste), Kubai (Calcined Alum), Zaorao (Gleditsia Sinensis, fire-roasted, skin/strings/seeds removed), Xuanningfen (Mirabilite), Baifuling (Poria), Zhike (Aurantium Fructus) in equal parts, mixed with Xiatiangao (Gelatin) into pills. If due to decline of Spleen/Stomach Yang-Fire internally, with a deep, minute, and slow pulse, use pungent-aromatic drugs to warm Qi; Dingchen Touge Tang (Cloves and Amber Penetrating Obstruction Decoction), Wuge Kuanzhong San (Five Obstructions Broad-Middle Powder), Jiahe San (Harvest Abundance Powder) etc. are suitable, assisted by Yin-nourishing drugs. Most cases of Fan Wei are formed by Blood Stasis in the Diaphragm blocking the Qi pathway. Use Daididang Wan (Substitute Resisting Dang Decoction) made mustard-seed sized, take 3 qian, lie supine without pillow, swallow slowly to search and expel accumulated stasis. By dawn, foul matter is discharged, and recovery follows with proper care. Wulingzhi (Trogopterus Dung), purified and powdered, mixed with Yellow Dog Gallbladder juice into pills the size of a longan. Take one pill per dose, warm with half a cup of good wine; effective within three doses; this is also a Blood-moving agent. For parasitic cases, use Qinchuan Jianhong Wan to expel them; this pill also targets Blood Stasis. Yanhua Wan (Genkwa Flower Pill) from *Ben Shi Fang* treats accumulation, retained fluid, Phlegm-fluid generating worms; over time becoming Fan Wei or transforming into Wei Yong (Stomach Abscess). This theory is found in *Lingshu* and *Chao Shi Bing Yuan*. For solid accumulation without internal Heat, ancient formulas Nongpo Wan (Magnolia Bark Pill) and Wanbing Ziwan Wan (Myriad Disease Aster Pill) should be taken as directed to expel parasites. To treat Fan Wei, take one large bowl of fresh well-water, reserve half a bowl. Slowly pour sesame oil into the remaining half bowl, covering the surface. Place one packet of Yi Yuan San (Benefit Origin Powder) gently on the oil surface; soon it sinks to the bottom. This illustrates the Dao of Yin-Yang ascending and descending. Stir evenly with a spoon and take. Rinse the medicine bowl with the reserved half bowl of water and swallow. Once vomiting stops, administer Mazi Liangge San (Hemp Seed Cool Obstruction Powder) to unblock bowel and bladder movements. If ineffective, administer another packet of Yi Yuan and Liangge San, which will be effective. This prescription is extremely reliable. Tongbian (Child Urine) [clears Fire], Zhuli (Bamboo Sap) [moves Phlegm], Jiuzhi (Chinese Chive Juice) [moves Blood], Renru (Human Milk), Niuru (Cow Milk) [tonifies deficiency and moistens dryness], Lugengzhi (Reed Rhizome Juice) [stops vomiting], Maogenzhi (Imperata Rhizome Juice) [cools Blood], Jiangzhi (Ginger Juice) [assists Zhuli in moving Phlegm], Zhuganzhi (Sugar Cane Juice) [harmonizes Stomach), Lvniao (Donkey Urine] [kills parasites]. Mix with small amounts of Shaojiu (Burning Wine), Micu (Rice Vinegar), and Mi (Honey), warm over water and take in one dose. Self-made Tongchang Wan: Dahuang (wine-soaked), Huashi (flying powder) each 2 liang; Chenpi (peeled), Houpo (ginger-processed) each 1.5 liang; Renshen, Danggui, Guanzhong (de-haired), Ganqi (stir-fried until smoke ceases) each 1 liang; Muxiang, Binglang each 7.5 qian; Sanleng (roasted), Pengzi (roasted), Chuanxiong, Bohe, Xuanningfen, Xionghuang, Taoren paste, Gancao each 5 qian. All separately finely powdered. Mix with 2 cups each of Zhuli, Tongbian, Jiuzhi, Renru, Lvniao, Lugengzhi, Maogenzhi, Zhuganzhi, Shaojiu, Micu, Mi, and 1 cup Jiangzhi. Boil thick over water, mix into pills the size of mustard seeds. Take 3 qian per dose, lie supine without pillow, swallow with saliva. Stop taking after bowels/unblocking cease. After taking this pill and the aforementioned juices, if the medicine does not cause regurgitation, do not immediately give porridge or other foods. Daily, take 5 qian Renshen and 2 qian Chenpi as a decoction, sip slowly to support Stomach Qi. When feeling slightly better, gradually increase Renshen. Only after 10 days to half a month can one cautiously try aged rice water and soft porridge. If the granary is not secure, one should not store grain; commonly, those who eat porridge/rice immediately lead to untreatable conditions. Another type of Fan Wei results from shouting with great effort, damaging the Qi throat. Leakage of the Qi throat causes Qi to block the Stomach tube; the Stomach receiving Qi also leads to Fan Wei. This is considered untreatable by law, or one may use roasted ox trachea. Zhang Zihe's "Ten Ge Five Ye" branches are arbitrary. The division of disease categories began with Chao Yuanfang; the loss of the disease's root also began with him. Why? Laozi said: "Less is gain, more is confusion." The common term "Ye Shi" (Dysphagia) has little mention in the *Neijing*, only stating "Three Yang knotting is called Ge." Three Yang refers to Large Intestine, Small Intestine, and Bladder. Knotting means knotting Heat. Small Intestine knotting Heat dries Blood vessels; Large Intestine knotting Heat prevents defecation; Bladder knotting Heat dries Body Fluids. If all Three Yang knot, front and back become blocked. Since the lower does not unblock, it must rebel upward; this is why food cannot go down, and even if it goes down, it comes back out. The Stomach is the Sea of Water and Grain, receiving new daily to replace the old, with one bowel movement daily as the norm. Now, patients with Ye do not have a bowel movement for 3, 5, or 7 days, deviating from the norm. Is it not because the Three Yang are knotted below, the Large Intestine is withered, the ingested food is rejected by the pharynx, and even if entering the Tai Cang (Stomach), it returns out the throat? This is Yang Fire not pushing downward but rising upward. The Classics state: "Where Shaoyang arrives, there is vomiting, gushing overflow, and food cannot descend." The *Qijue Lun* says: "Liver transfers Cold to Heart, causing Mania and Ge in the middle." Commentary: Yang and Cold clash, causing Ge-food and middle obstruction; this Ge-Heat and Cold cause it, not solely Cold. The *Liujie Zangxiang* states: "Renying four-fold excess and above is Ge Yang." Wang Taipu said: "Extreme Yang excess causes Ge rejection and food not entering." The *Zhengli Lun* states: "Ge implies vomiting and rebellion, so Ge should also be Ge." Later generations forcibly divided it into Five Ye, then Ten Ge and Five Ye. With many branches, confusion increases. Human food overflow does not happen suddenly. Initially, it may be due to alcohol/food injury, Stomach Heat wanting to vomit, or Stomach Wind wanting to vomit. Physicians fail to examine the origin, roasting ginger in fire, boiling cinnamon in soup, continuing with Dingxiang (Clove), Doukou (Cardamom), Bibo (Long Pepper), Hujiao (Pepper). Although claiming to harmonize the Stomach, the Stomach is originally not Cold. Although claiming to tonify the Stomach, the Stomach is originally not Deficient. If injured by fluids, one should only expel fluids. If injured by food, one should only expel food. How can one speak of deficiency and use hot tonification? Those prone to Heat will surely have Three Yang knotting. Once knotted, food must surge upward. Physicians still say Stomach Cold fails to receive, burning needles and moxa, causing further Three Yang knotting. A clear statement becomes hard to follow. Extracting firewood to remove heat is most crucial. Stirring boiling water to stop boiling makes it worse. Years deepen, misled by physicians. People say purging is possible, retreating Yang to nourish Yin, opening eyes and sticking out tongue, fearing damage to Yuan Qi, stopping at harmony. Blockage and non-unblocking, Intestines should be patent, hence borborygmus. Since Intestines are not unblocked, Ye disease forms. Someone asks: Can忧恚 (worry/anger) Qi knotting be purged? I say: Worry/anger stagnation is like Fire Depression. Tai Cang Gong saw this and purged all. Since laws were abandoned, a thousand years have passed without restoration. In modern times, Liu Hejian treats Ge Qi and Ye Shi using Chengqi San Yi Tang (Major Order Three Yi Decoction), surpassing modern practitioners. I do not mind, briefly showing this to posterity. When using drugs, detail severity. If constipated for a long time, do not attack abruptly. Although needing to open, consider after-effects. First moisten and nourish, use small decoctions/pills, gradually increase, gates will open. If throat obstruction, upper blockage by Phlegm-saliva, lightly use bitter/sour to induce slight vomiting. Then treat below, drug power moves easily. If it doesn't work, honey/salt guides downward, connecting start and end, two drugs communicate, knots scatter, Yang dissipates, food/drink descends naturally. Do not use Badou (Croton Seed), consuming true nature, drying fluids and withering Jin, leaving toxins. People say this disease, once purged, became deficient and bloated from purging. This is Badou's fault, not Dahuang or Qianniue's. An official in Jicheng suffered vomiting for over a year, treated as Stomach Cold with Dingxiang, Banxia, Qingpi, Chenpi, Jiang, Fuzi, various drying-hot drugs, burning cones and moxa, countless times. Sometimes slightly better, sometimes worse. For ten years, stool was astringent and dry, urine red-yellow. I examined him and said: "All Wei, panting, and vomiting belong to Upper." Wang Taipu said: "Upper refers to Upper Jiao." Fire-Heat Qi flaming upward causes all to vomit due to extreme Heat. Use Sisheng Wan (Four Generations Pill) to purge thirty times; dry feces and intestinal filth exceeded a bushel. The person was confused and tired for one or two days, frequently sipping ice water, gradually administering cool yogurt and sesame drink, swallowing occasionally. After several days, ate and drank largely, spirit and Qi/Blood returned to normal, subsequently had three children, lived to fifty.
[Diagnosis] Cun Kou pulse is minute and rapid. Minute means no Qi; no Qi means Ying deficiency; Ying deficiency means Blood insufficiency; Blood insufficiency means Cold in the Chest. Fuyang pulse is floating and choppy. Floating indicates deficiency; choppy indicates Spleen injury. Spleen injury means it cannot grind; morning eating/evening vomiting, evening eating/morning vomiting, undigested grain, known as Fan Wei. Tight and choppy pulse, the disease is difficult to treat. String-taut pulse indicates deficiency; Stomach Qi is exhausted; morning eating/evening vomiting, transforming into Fan Wei. Cold is above, but physicians wrongly purged, making the pulse string-taut, hence named Deficiency. Kou and scattered Stomach pulse indicates Shi Bi. (*Zhiyao Lun* states: Shi Bi and vomiting.) Minute and slow Kidney pulse indicates Dong (Cave/Hole); Dong means food not digested, going down the throat and coming back out. Deep, slow, and forceless, or large and weak, indicates Qi deficiency. Rapid and forceless, or choppy and small, indicates Blood deficiency. Rapid and forceful indicates Heat. Deep at Cun/Guan, or hidden, or large and slippery-rapid, indicates Phlegm. Deep and choppy at Cun/Guan indicates Qi. Fan Wei pulse: deep, fine, scattered, lacking direction; present at floating/sinking, absent at moderate pressure; fatal and untreatable. Further check complexion: not yellow-white, nor pure white; all are bad omens. Elderly with long-term disease, Yuan Qi ruined, cold hands/feet, stool like sheep droppings, profuse frothy discharge; all untreatable.