噎膈者，阳衰土湿，上下之窍闭也。盖脾主升清，胃主降浊，清气升则下窍豁达而莫壅，浊气降则
上窍清空而无碍，一自中气虚败，湿土堙塞，脾陷则清气不升，是以下窍涩结而不出，胃逆则浊气不降，是
以上窍郁塞而不纳。且脾陷则肝木无疏泄之权，故便溺艰涩而水瘀不行。胃逆则胆火有浮升之势，故痰涎滞
塞而食噎不下。出纳之无灵，缘脾胃之不运，而脾胃之不运，实中气之虚败致之也。以苓桂半夏汤主之。
苓桂半夏汤
茯苓（三钱） 泽泻（三钱） 甘草（二钱） 桂枝（三钱） 半夏（三钱） 干姜（三钱） 生
姜
（三钱） 芍药（三钱） 水煎大半杯，温服。如上脘不开，宜重用半夏以降胃气。痰盛者，加茯苓、橘皮行
其瘀浊，生姜取汁，多用益善。如痰饮极旺，用瓜蒂
散吐之。如胸胁痛楚，当以甘草缓其迫急，芍药泄其木邪，柴胡、鳖甲散其结郁。若兼风木枯燥加阿胶、
当归，滋木清风，其痛自瘥。如大便燥结，宜以干姜、砂仁温中破滞，益脾阳而开肠窍；以桂枝达木
郁而行疏泄；干涩难下者，重用肉苁蓉以滑肠窍，白蜜亦佳；木枯血燥，不能疏泄，加阿胶、当归滋
其风木。如小便红涩，宜苓泽桂枝，泄湿疏木，以通前窍。甚者用猪苓汤加桂枝。猪苓滑泽，泄湿燥土，
桂枝、阿胶，疏木清风，水道自利。
噎膈（吞咽困难、胸膈阻塞的病证），是由于阳气衰微、脾土湿气阻滞，导致上下的窍道闭塞。因为脾主升发清气，胃主通降浊气，清气上升则下窍通畅而无壅塞，浊气下降则上窍清空而无阻碍。一旦中气虚弱败坏，湿土壅塞，脾脏下陷则清气不能上升，所以下窍涩滞结聚而排泄不出；胃气上逆则浊气不能下降，所以上窍郁塞而不能纳食。并且脾脏下陷则肝木失去疏泄的权力，所以大小便艰涩而水液瘀滞不行。胃气上逆则胆火有浮越上升的趋势，所以痰涎停滞堵塞而食物噎阻不下。出纳功能失灵，根源在于脾胃运化失常，而脾胃运化失常，实际上是由中气虚弱败坏导致的。用苓桂半夏汤主治。
苓桂半夏汤
茯苓（三钱） 泽泻（三钱） 甘草（二钱） 桂枝（三钱） 半夏（三钱） 干姜（三钱） 生姜（三钱） 芍药（三钱） 用水煎取大半杯，温服。如果上脘不开，应当重用半夏以降胃气。痰多者，加茯苓、橘皮以行其瘀浊，生姜取汁，多用有益。如果痰饮极盛，用瓜蒂散催吐。如果胸胁疼痛，应当用甘草缓解其迫急，芍药疏泄肝木之邪，柴胡、鳖甲消散其结聚郁滞。如果兼有风木枯燥，加阿胶、当归，滋养肝木清风，疼痛自然痊愈。如果大便燥结，宜用干姜、砂仁温中破滞，补益脾阳而开通肠窍；用桂枝通达木郁而行疏泄；干涩难下者，重用肉苁蓉以滑利肠窍，白蜜也很好；如果木枯血燥，不能疏泄，加阿胶、当归滋养风木。如果小便红赤涩痛，宜用茯苓、泽泻、桂枝，泄湿疏木，以通前阴窍道。严重的用猪苓汤加桂枝。猪苓滑利渗湿，泄湿燥土，桂枝、阿胶，疏木清风，水道自然通利。
Yige (dysphagia and food impaction) refers to the obstruction of the upper and lower orifices caused by the decline of Yang qi and the dampness stagnation of the Spleen Earth. The Spleen governs the ascending of clear Qi, while the Stomach governs the descending of turbid Qi. When clear Qi ascends, the lower orifice remains open and unobstructed; when turbid Qi descends, the upper orifice remains clear and unimpeded. Once the Middle Qi becomes deficient and fails, damp Earth blocks the flow. If the Spleen sinks, clear Qi cannot ascend, resulting in the lower orifice becoming astringent and knotted with no excretion; if the Stomach rebels, turbid Qi cannot descend, resulting in the upper orifice becoming stagnant and blocked with no intake. Furthermore, when the Spleen sinks, Liver Wood loses its power of free flow and drainage, causing difficult urination and defecation with water stasis failing to move. When the Stomach rebels, Gallbladder Fire has a tendency to float and rise, causing phlegm-saliva to stagnate and block, preventing food from going down. The failure of intake and excretion stems from the dysfunction of the Spleen and Stomach transportation, which is actually caused by the deficiency and failure of Middle Qi. Linggui Banxia Tang (Poria, Cinnamon Twig, and Pinellia Decoction) is used as the primary treatment.
Linggui Banxia Tang (Poria, Cinnamon Twig, and Pinellia Decoction)
Fuling (Poria, 3 qian), Zexie (Rhizoma Alismatis, 3 qian), Gancao (Radix Glycyrrhizae, 2 qian), Guizhi (Ramulus Cinnamomi, 3 qian), Banxia (Rhizoma Pinelliae, 3 qian), Ganjiang (Rhizoma Zingiberis Preparatum, 3 qian), Shengjiang (Rhizoma Zingiberis Recens, 3 qian), Shaoyao (Radix Paeoniae Alba, 3 qian). Decoct in water, take half cup warm. If the Upper Wan (upper part of the stomach) does not open, heavy use of Banxia (Rhizoma Pinelliae) is appropriate to direct Stomach Qi downward. For abundant phlegm, add Fuling (Poria) and Jupi (Pericarpium Citri Reticulatae) to move turbidity; extract juice from Shengjiang (Rhizoma Zingiberis Recens), more is better. If phlegm-fluid retention is extremely vigorous, Gouti San (Melon Seed Powder) should be used to induce vomiting. If there is pain in the chest and hypochondrium, Gancao (Radix Glycyrrhizae) should be used to relieve urgency, Shaoyao (Radix Paeoniae Alba) to drain Liver Wood pathogen, and Chaihu (Radix Bupleuri) and Biejia (Carapax et Plastrum Testudinis) to dissipate knotting and stagnation. If accompanied by dryness of Wind-Wood, add Ejiao (Colla Corii Asini) and Danggui (Radix Angelicae Sinensis) to nourish Wood and clear wind, and the pain will heal itself. If stool is dry and constipated, Ganjiang (Rhizoma Zingiberis Preparatum) and Sharen (Fructus Amomi Rotundus) should be used to warm the middle and break stagnation, benefiting Spleen Yang and opening the intestinal orifice; Guizhi (Ramulus Cinnamomi) to reach Wood stagnation and promote drainage; for dryness and difficulty in passing, heavy use of Rongzhuang (Cortex Cistanches) to lubricate the intestinal orifice is recommended, and Baimi (Mell) is also good; if Wood is dry and Blood is parched, unable to drain, add Ejiao (Colla Corii Asini) and Danggui (Radix Angelicae Sinensis) to nourish Wind-Wood. If urine is red and astringent, Fuling (Poria), Zexie (Rhizoma Alismatis), and Guizhi (Ramulus Cinnamomi) should be used to drain dampness and soothe Wood to open the anterior orifice. In severe cases, Zhuling Tang (Polyporus Decoction) plus Guizhi (Ramulus Cinnamomi) is used. Zhuling (Polyporus) is slippery and moistening, draining dampness and drying Earth; Guizhi (Ramulus Cinnamomi) and Ejiao (Colla Corii Asini) soothe Wood and clear wind, allowing the water passages to flow freely.