〔丹〕《局方》治气一门有曰∶治一切气，冷气、滞气、逆气、上气，用安息香丸、丁沉丸、大沉香丸、苏
子丸、匀气散、如神丸、集香丸、白沉香丸、煨姜丸、盐煎散、七气散、温白丸、生姜汤。其治呕吐膈噎也，
用五膈丸、五膈宽中散、膈气散、酒症丸、草豆蔻丸、撞气丸、人参丁香散。其治吞酸也，用丁香煎丸、小理
中丸。其治痰饮也，用倍术丸、消饮丸、温中化痰丸、五套丸。且于各方条下，或曰口苦失味、曰噫酸、曰舌
涩、曰吐清水、曰痞满、曰气急、曰胁下急痛、曰五心中热，口烂生疮。皆是明言热症，何为悉用热药？夫周
流于人之一身以为主者，气也。阳往则阴来，阴往则阳来，一升一降，无有穷已。苟内不伤于七情，外不感于
六淫，其为气也，何病之有？今曰冷气、滞气、逆气、上气，皆是肺受火邪，气得炎上之化，有升无降，熏蒸
清道，甚而至于上焦不纳，中焦不化，下焦不渗，展转变为呕、为吐、为膈、为噎、为痰、为饮、为反胃、为
吞酸。夫治寒以热，治热以寒，此正治之法也。治热用热，治寒用寒，此反佐之法也。详味前方，既非正治，
又非反佐，此愚之所以不能无疑也。谨按《原病式》曰∶诸病呕吐酸，皆属于热；诸积饮痞满中膈，皆属于湿；
诸气逆冲上呕涌，溢食不下，皆属于火；诸坚痞，腹满急痛，吐腥秽，皆属于寒，深契仲景之意。《金匮要略》
曰∶胸痹病，胸背痛，栝蒌薤白汤主之。胸痹，心痛彻背，背痛彻心，栝蒌薤白半夏汤主之。心下痞气，气结
在胸，胁下上逆抢心者，枳实薤白栝蒌桂枝汤主之。呕而心下痞者，半夏泻心汤主之。干呕而利者，黄芩加半
夏生姜汤主之。诸呕吐谷不得入者，小半夏汤主之。呕吐病在膈上者，猪苓汤主之。胃反呕吐者，半夏参蜜汤
主之。食已即吐者，大黄甘草汤主之。胃反吐而渴者，茯苓泽泻汤主之。吐后欲饮者，文蛤汤主之。病似呕不
呕，似哕不哕，心中无奈者，姜汁半夏汤主之。干呕手足冷者，陈皮汤主之。哕逆者，陈皮竹茹汤主之。干呕
下痢者，黄芩汤主之。气冲上者，皂荚丸主之。上气脉浮者，浓朴麻黄汤主之。上气脉沉者，泽泻汤主之。火
逆上气者，麦门冬汤主之。心下有痰饮，胸胁支满，目眩，茯苓桂术汤主之。短气有微饮，当从小便出之，宜
茯苓桂术甘草汤主之；肾气丸亦主之。病者脉伏，其人欲自利，利者反快，虽利心下续坚满者，此为留饮欲去
故也，甘遂半夏汤主之。病悬饮者，十枣汤主之。病溢饮者，当发其汗，宜大青龙汤；又宜小青龙汤主之。心
下有支饮，其人苦冒眩，泽泻汤主之。支饮胸满者，浓朴大黄汤主之。支饮不得息，葶苈大枣泻肺汤主之。呕
家本渴，今反不渴，心中有支饮故也，小半夏汤主之。卒呕吐，心下痞，膈间有水眩悸者，小半夏加茯苓汤主
之。假令瘦人脐下有悸者，吐涎沫而头眩，此水也，五苓散主之。心胸有停痰宿水，自吐出水后，心胸间虚，
气满不能食，消痰气令能食，茯苓饮主之。先渴后呕，为水停心下，此属饮家，半夏汤加茯苓主之。观其微意，
可表者汗之；可下者利之；滞者导之；郁者扬之；热者清之；寒者温之；偏寒偏热者，反佐而行之；挟湿者，
淡以渗之；挟虚者，补而养之。何尝例用辛香燥热之剂？以火济火，实实虚虚，咎将谁执？或曰∶《脉诀》谓热
则生风，冷生气，寒主收引。今冷气上冲矣，气逆矣，气滞矣，非冷而何？吾子引仲景之言而斥其非，然则诸
气、诸饮、诸呕吐、反胃、吞酸等病，将无寒症耶？予曰∶五脏各有火，五志激之，其火随起。若诸寒为病，
必须身犯寒气，口食寒物，乃为病寒，非若诸火病自内作。所以气之病寒者，十无一二。或曰∶其余痰气、呕
吐、吞酸、噎膈、反胃，作热作火，论治于理可通。若病患自言冷气从下而上，非冷而何？予曰∶上升之气，
自肝而出；中挟相火，自下而出。其热为甚，自觉其冷，非真冷也。火极似水，积热之甚，阳亢阴微，故见此
症。冷生气者，出高阳生之谬言也。若病果因于寒，当以去寒之剂治之，何至例用辛香燥热为方，不知权变，
宁不误人。或曰气上升者，皆用黑锡丹、养正丹、养气丹等药，以为镇坠，然服之者随手得效，吾子以为热甚
之病，亦将有误耶？予曰∶相火之外，又有脏腑厥阳之火，五志之动，各有火起。相火者，此经所谓一水不胜
二火之火。斯火也，出于天造。厥阳者，此经所谓一水不胜五火之火，出于人欲。二者之火相扇而动，气之升
也，随火炎上，升而不降，孰能御之？令借丹剂之重坠而降之。气郁为湿痰，丹性热燥湿，痰被劫亦为暂开。
所以清快丹毒，积久偏助狂火，阴血愈耗，其升愈甚。俗人喜温，迷而不悟，被此祸者，滔滔皆是。或曰∶丹
药之重，欲降而升，然如之何则可？予曰∶投以辛凉，行以辛温，制伏肝邪；治以咸寒，佐以甘温，收以苦甘，
和以甘淡，补养阴血，阳自相附，阴阳比和，何升之有？先哲治法，其则不远，吾不赘及。或曰∶诸气诸饮，
与夫呕吐、吞酸、膈噎、反胃等症，《局方》未中肯綮，我知之矣。然则《要略》之方，果足用乎？抑犹有未发
者乎？予曰∶天地之气化无穷，人身之病亦变化无穷，仲景之书，载道者也。医之良者，引例推类，可谓无穷
之用，借令略有加减修合，终难逾越矩度。夫气之初病也，其端甚微，或因些小饮食不谨；或外冒风雨寒暑；
或内感七情；或食味过浓，偏助阳气，积成膈热；或资禀素实表密无汗；或性急易怒，阴火炎上，以致津液不
行，清浊相干。气为之病，或痞或痛，或不思食，或噎噫腐气，或吞酸，或嘈杂，或膨满。不求本原，便认为
寒，遽以辛香燥热之剂投之，数帖暂得快然，以为神方。仍前浓味不节，将理不谨，旧疾被劫暂舒，浊液易于
攒聚，或半月，或一月，前病复作。如此延蔓，自气成积，自积成痰，此为痰、为饮、为吞酸之由也。良工未
遇，谬药已行，痰挟污血，遂成窠囊，于是为痞、为痛、为呕、为噎膈、反胃之次第诸症隆起。饮食汤液，泥
滞不行，渗道蹇涩，大便或秘或溏，下失传化，中焦愈停。医者不察，犹执为冷，翻思前药随手得快，至此宾
主皆恨药欠燥热。 俟久服，脾可以温，胃可以壮，以冀一旦豁然之效。不思胃为水谷之海，多血多气，气清
和则能受。脾为消化之宫，气清和则能运。今得香热之药，偏助气血沸腾。其始也，胃液凝聚，无所容受；其
久也，脾气耗散，传化渐迟。其有胃热易饥，急于得食，脾伤不磨，郁积成痛，医者犹曰虚而积寒，非寻常草
木可疗，妄以乌、附助佐丹剂，专意服饵。积而久也，血液俱耗，胃脘干槁。其槁在上，近咽之下水饮可行，
食物难入，间或可入，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，小若羊屎，然名虽不同，病出一体。《要略》论饮有六∶曰痰饮、悬饮、溢饮、支饮、
留饮、伏饮。分别五脏诸证，治法至矣尽矣。第恨医者不善处治，病者不守禁忌，遂使药助病邪，展转深痼，
去生渐远，深可哀悯。或曰∶《千金》诸方，治膈噎反胃，未尝废姜、桂等剂，何吾子之多言也？予曰∶气之郁
滞，久留清道，非借香热不足以行。然悉有大黄、石膏、竹茹、芒硝、泽泻、前胡、朴硝、茯苓、黄芩、芦根、
栝蒌等药为之佐使，其始则同，其终则异。病邪易伏，故易于安。或曰∶胃脘干槁者，古方果可治乎？将他有
要捷之法，或可补前人之未发者乎？予曰∶古方用人参以补肺，御米以解毒，竹沥以清痰，干姜以养血，粟米
以实胃，蜜水以润燥，姜以去秽，正是此意。张鸡峰亦曰∶噎当是神思间病，惟内观自养，可以治之。此言深
中病情，治法亦为近理。夫噎病主于血干，夫血者阴气也，阴主静，内外两静，则脏腑之火不起，而金水二气
有养，阴血自生，肠胃津液传化合宜，何噎之有。
【丹】《太平惠民和剂局方》在治疗气病的一门中说道：治疗各种气病，包括冷气、滞气、逆气、上气，使用安息香丸、丁沉丸、大沉香丸、苏子丸、匀气散、如神丸、集香丸、白沉香丸、煨姜丸、盐煎散、七气散、温白丸、生姜汤。其治疗呕吐、膈噎（吞咽困难）时，使用五膈丸、五膈宽中散、膈气散、酒症丸、草豆蔻丸、撞气丸、人参丁香散。其治疗吞酸（反酸）时，使用丁香煎丸、小理中丸。其治疗痰饮（体内水液代谢失常形成的病理产物）时，使用倍术丸、消饮丸、温中化痰丸、五套丸。并且在各个方剂的条目下，有的提到口苦味觉丧失、嗳气带酸味、舌苔涩腻、吐出清水、心腹痞满、气急、胁下拘急疼痛、五心烦热（手心、脚心和心口发热）、口腔溃烂生疮等。这些都是明确指出的热证，为什么全都使用热性药物呢？
人体周身运行作为主宰的是气。阳气往则阴气来，阴气往则阳气来，一升一降，没有穷尽。如果内部不被七情（喜、怒、忧、思、悲、恐、惊）所伤，外部不被六淫（风、寒、暑、湿、燥、火）所感，气怎么会生病呢？现在所说的冷气、滞气、逆气、上气，都是肺受到火邪侵袭，气具有炎上的特性，只有上升没有下降，熏蒸清道（呼吸道及上部脏腑），甚至导致上焦不能受纳，中焦不能运化，下焦不能渗泄，进而转变为呕吐、吐食、膈噎、痰饮、反胃、吞酸等症状。
治疗寒证用热药，治疗热证用寒药，这是正治法。治疗热证用热药，治疗寒证用寒药，这是反佐法。仔细品味前面的方剂，既不是正治，也不是反佐，这就是我对此产生怀疑的原因。
谨按刘完素《原病式》所说：各种呕吐、反酸，都属于热；各种积聚、痰饮、痞满、膈间不适，都属于湿；各种气逆冲上、呕吐涌出、饮食不下，都属于火；各种坚硬痞块、腹部胀满急痛、吐出腥秽之物，都属于寒，这深深契合了张仲景的医理。
《金匮要略》说：胸痹病，胸部和背部疼痛，用栝蒌薤白汤主治。胸痹，心痛牵引至背部，背痛牵引至心脏，用栝蒌薤白半夏汤主治。心下部痞塞之气，气结在胸部，胁下之气上逆冲击心脏的，用枳实薤白栝蒌桂枝汤主治。呕吐且心下部痞塞的，用半夏泻心汤主治。干呕且伴有腹泻的，用黄芩加半夏生姜汤主治。各种呕吐食物无法进入的，用小半夏汤主治。呕吐病位在膈以上的，用猪苓汤主治。胃反呕吐的，用半夏参蜜汤主治。吃完就吐的，用大黄甘草汤主治。胃反吐且口渴的，用茯苓泽泻汤主治。呕吐后想喝水的，用文蛤汤主治。病情似呕非呕，似呃逆非呃逆，心中无可奈何的，用姜汁半夏汤主治。干呕且手脚冰冷的，用陈皮汤主治。呃逆的，用陈皮竹茹汤主治。干呕且伴有腹泻的，用黄芩汤主治。气向上冲的，用皂荚丸主治。上气且脉浮的，用浓朴麻黄汤主治。上气且脉沉的，用泽泻汤主治。火邪逆乱导致上气的，用麦门冬汤主治。心下有痰饮，胸部和胁部支撑胀满，头晕目眩的，用茯苓桂术汤主治。短气且有轻微饮邪，应当从小便排出，宜用茯苓桂术甘草汤主治；肾气丸也可主治。病人脉象伏匿，其人想要自利（腹泻），泻后反而感觉爽快，虽然腹泻但心下部继续坚满的，这是留饮欲去的表现，用甘遂半夏汤主治。患悬饮病的，用十枣汤主治。患溢饮病的，应当发汗，宜用大青龙汤；又宜用小青龙汤主治。心下有支饮，其人苦于头昏目眩的，用泽泻汤主治。支饮导致胸满的，用浓朴大黄汤主治。支饮导致呼吸困难的，用葶苈大枣泻肺汤主治。经常呕吐的人本应口渴，现在反而不渴，是因为心中有支饮的缘故，用小半夏汤主治。突然呕吐，心下部痞塞，膈间有水气导致眩晕心悸的，用小半夏加茯苓汤主治。假如瘦人脐下有悸动感的，吐涎沫且头晕的，这是水饮为病，用五苓散主治。心胸有停痰宿水，自行吐出后，心胸间空虚，气满不能进食，消除痰气使其能进食的，用茯苓饮主治。先口渴后呕吐，是水停在心下，这属于饮家，用半夏汤加茯苓主治。观察其中的微意，可表证的用汗法；可下证的用利法；气滞的用导法；气郁的用扬法；热证的用清法；寒证的用温法；偏寒偏热的，用反佐法而行；挟湿的用淡味渗利法；挟虚的用补养法。何曾一概使用辛香燥热的药剂？以火救火，使实证更实，虚证更虚，过错由谁承担？
有人说：《脉诀》说热则生风，冷则生气，寒主收引。现在冷气上冲，气逆，气滞，难道不是冷吗？你引用张仲景的话来指责《局方》的错误，那么各种气病、各种饮病、各种呕吐、反胃、吞酸等病，难道就没有寒证了吗？
我说：五脏各有火，五志激动，火随之而起。如果是各种寒性病，必须身体遭受寒气，口中食用寒物，才是病寒，不像各种火病是从内部产生的。所以气病属于寒的，十个里面没有一两个。
有人说：其余的痰气、呕吐、吞酸、噎膈、反胃，作热作火，从道理上讲得通。但如果病人自己说冷气从下往上冲，难道不是冷吗？
我说：上升的气，从肝而出；中间夹杂着相火，从下而出。其热非常严重，自觉寒冷，并非真正的冷。火极似水，积热甚重，阳亢阴微，所以出现这种症状。“冷生气”的说法，出自高阳生的谬论。如果病果真是因寒引起的，应当用去寒的药剂治疗，何至于一概使用辛香燥热的方剂，不知权变，岂不误人？
有人说：气上升的，都用黑锡丹、养正丹、养气丹等药物，用来镇坠，然而服用的人随手见效，你认为这是热甚的病，也会有误吗？
我说：除了相火之外，还有脏腑厥阳之火，五志的变动，各有火起。相火，是这部经典所说的“一水不胜二火”的火。这种火，出于天造（先天）。厥阳，是这部经典所说的“一水不胜五火”的火，出于人欲（后天欲望）。这两种火相互煽动而发作，气随着火势炎上，只升不降，谁能抵御它？现在借用丹药的重坠之性来降气。气郁结成湿痰，丹药性质热燥湿，痰被劫夺也是暂时开通。所以清除丹毒，日久偏助狂火，阴血更加耗损，气的上升更加厉害。世俗之人喜欢温热，迷惑而不醒悟，遭受此祸害的，比比皆是。
我说：投以辛凉的药物，配合辛温的药物运行，以制伏肝邪；用咸寒的药物治疗，佐以甘温的药物，用苦甘的药物收敛，用甘淡的药物调和，补养阴血，阳气自然依附，阴阳比和，哪里还有上升的呢？先哲的治疗方法，准则不远，我不再赘述。
有人说：各种气病、各种饮病，以及呕吐、吞酸、膈噎、反胃等症状，《局方》没有击中要害，我知道了。但是《金匮要略》的方子，真的足够使用吗？还是有未阐发的地方吗？
我说：天地之气化无穷无尽，人身之病也变化无穷无尽，张仲景的书，记载的是大道。医术高明的人，引例推类，可以说应用无穷，假令略有加减调配，终究难以逾越规矩法度。气初发病时，端倪很微小，或许因为一点饮食不慎；或许外感风雨寒暑；或许内伤七情；或许口味过重，偏助阳气，积成膈热；或许体质素实，腠理密闭无汗；或许性情急躁易怒，阴火炎上，以致津液不行，清浊相干。气为之病，或痞塞或疼痛，或不思饮食，或打嗝腐气，或吞酸，或嘈杂，或膨满。不求根本原因，便认为是寒，急忙用辛香燥热的药剂投喂，几帖暂时感到舒服，便以为是神方。仍然像以前一样饮食浓味不节制，调理不谨慎，旧疾被劫持暂时舒缓，浊液容易聚集，或者半个月，或者一个月，前病复发。如此蔓延，从气变成积，从积变成痰，这就是痰、饮、吞酸的由来。良医未遇，谬药已行，痰挟污血，遂成窠囊（病灶），于是痞、痛、呕、噎膈、反胃等次第诸症隆起。饮食汤液，泥滞不行，渗道蹇涩，大便或者秘结或者溏泄，下失传化，中焦更加停滞。医者不察，还坚持认为是冷，回想前药随手得快，至此宾主都恨药不够燥热。等待久服，脾可以温，胃可以壮，以此期望有一天豁然开朗的效果。不想胃为水谷之海，多血多气，气清和则能受纳。脾为消化之宫，气清和则能运化。现在得到香热之药，偏助气血沸腾。起初，胃液凝聚，无所容受；久了，脾气耗散，传化逐渐迟缓。那些胃热易饥，急于得食，脾伤不磨，郁积成痛的，医者还说虚而积寒，不是寻常草木可疗，妄用乌头、附子辅助丹药，专心服饵。积累久了，血液全部耗损，胃脘干枯槁缩。槁缩在上部，接近咽下的部位，水饮可行，食物难入，偶尔可入，入也不多，名叫噎。槁缩在下部，与胃相近，食物虽可入，难尽入胃，良久复出，名叫膈，也叫反胃。大便秘结，小便像羊屎一样，虽然名字不同，病出一体。《金匮要略》论述饮病有六种：叫痰饮、悬饮、溢饮、支饮、留饮、伏饮。分别五脏各种证候，治疗方法可谓至极尽善了。只是遗憾医者不善于处置治疗，病人不遵守禁忌，致使药助病邪，辗转深固，离生渐远，深可哀悯。
有人说：《千金方》的各种方子，治疗膈噎反胃，未曾废弃姜、桂等药剂，为何您这么多言？
我说：气之郁滞，久留清道，不借香热不足以行气。然而其中都有大黄、石膏、竹茹、芒硝、泽泻、前胡、朴硝、茯苓、黄芩、芦根、栝蒌等药物作为佐使，开始相同，最终不同。病邪容易潜伏，所以容易安宁。
有人说：胃脘干枯槁缩的，古方真的能治吗？有其他要捷的方法，或许可以补充前人未阐发的吗？
我说：古方用人参来补肺，御米（罂粟壳）来解毒，竹沥来清痰，干姜来养血，粟米来实胃，蜜水来润燥，姜来去秽，正是这个意思。张鸡峰也说：噎病应该是神思间的病，只有内观自养，才可以治疗。这话深深切中病情，治疗方法也为近理。夫噎病主要在于血干，血者阴气也，阴主静，内外两静，则脏腑之火不起，而金水二气有养，阴血自生，肠胃津液传化合宜，哪里有噎病呢？
[Dan] The *Taiping Huimin Heji Jufang* (Formulas of the Bureau for Benefiting the People) states in the section on treating Qi disorders: To treat all types of Qi, including Cold Qi, Stagnant Qi, Rebellious Qi, and Ascending Qi, use Anyixiang Wan (Benzoin Pill), Dingchen Wan (Clove and Agarwood Pill), Da Chenxiang Wan (Large Aquilaria Pill), Suzi Wan (Perilla Seed Pill), Yunqi San (Uniform Qi Powder), Rushen Wan (Miracle Pill), Jixiang Wan (Gathered Fragrance Pill), Bai Chenxiang Wan (White Aquilaria Pill), Weijiang Wan (Roasted Ginger Pill), Yanjian San (Salt-Boiled Powder), Qi Qi San (Seven Qi Powder), Wenbai Wan (Warm White Pill), and Shengjiang Tang (Fresh Ginger Decoction). For treating vomiting and Ge Ye (dysphagia/choking sensation), use Wuge Wan (Five Diaphragm Pills), Wuge Kuanzhong San (Five Diaphragm Middle-Widening Powder), Geqi San (Diaphragm Qi Powder), Jiuzheng Wan (Wine-Stasis Pill), Caodoukou Wan (Cardamomum Rotundum Pill), Zhuangqi Wan (Qi-Striking Pill), and Renshen Dingxiang San (Ginseng and Clove Powder). For treating Tun Suan (acid regurgitation), use Dingxiang Jian Wan (Clove Decoction Pill) and Xia Lizhong Wan (Minor Regulate Middle Pill). For treating Tan Yin (Phlegm-Fluids), use Beishu Wan (Double Atractylodes Pill), Xiaoyin Wan (Eliminate Fluids Pill), Wenzhong Huatan Wan (Warm Middle Transform Phlegm Pill), and Wutao Wan (Five-Ring Pill). Furthermore, under the entries of various formulas, it mentions bitter taste with loss of flavor, acid belching, astringent tongue coating, spitting clear water, chest and abdominal fullness/stuffiness, shortness of breath, acute pain under the ribs, heat in the five centers (palms, soles, and chest), and oral ulcers. These are explicitly stated as Heat syndromes. Why are hot medicines used exclusively?
The Qi that circulates throughout the human body as the master is vital. When Yang goes, Yin comes; when Yin goes, Yang comes. One ascends, one descends, without end. If internally not injured by the Seven Emotions (joy, anger, worry, thought, sadness, fear, fright) and externally not affected by the Six Exogenous Pathogens (wind, cold, summerheat, dampness, dryness, fire), how could Qi cause disease? Now, the so-called Cold Qi, Stagnant Qi, Rebellious Qi, and Ascending Qi are all cases where the Lung is affected by Fire pathogenic factors. Since Qi has the nature of flaming upward, it rises but does not descend, steaming the Clear Orifices. In severe cases, this leads to the Upper Jiao failing to receive, the Middle Jiao failing to transform, and the Lower Jiao failing to seep. Consequently, it transforms into vomiting, spitting, Ge (diaphragmatic obstruction), Ye (choking), Phlegm, Fluids, Fanwei (regurgitation), and Tun Suan (acid regurgitation).
Treating Cold with Heat, and treating Heat with Cold, is the method of Direct Treatment (Zheng Zhi). Treating Heat with Heat, and treating Cold with Cold, is the method of Indirect/Supplementary Treatment (Fan Zuo). Carefully examining the aforementioned formulas, they are neither Direct nor Indirect treatments. This is why I harbor doubts.
According to Liu Wansu's *Yuan Bing Shi* (Original Treatise on Disease Mechanisms): All vomiting and acid regurgitation belong to Heat; all accumulations, fluids, stuffiness, and diaphragmatic fullness belong to Dampness; all rebellious Qi rushing upward, vomiting and gushing, inability to swallow food, belong to Fire; all hard masses, abdominal fullness with acute pain, spitting foul-smelling substances, belong to Cold. This deeply aligns with Zhang Zhongjing's intent.
The *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet) states: For Xiong Bi (Chest Bi syndrome) with chest and back pain, Gualou Xiebai Tang (Trichosanthes Rhizome and Macrostemon Stem Decoction) is the primary formula. For Xiong Bi with heart pain radiating to the back and back pain radiating to the heart, Gualou Xiebai Banxia Tang (Trichosanthes Rhizome, Macrostemon Stem, and Pinellia Tuber Decoction) is the primary formula. For Pi Qi (stuffiness qi) below the heart, with Qi knotting in the chest and Qi from the hypochondrium rushing upward striking the heart, Zhishi Xiebai Gualou Guizhi Tang (Aurantium Fructus, Macrostemon Stem, Trichosanthes Rhizome, and Cinnamon Twig Decoction) is the primary formula. For vomiting with Pi (stuffiness) below the heart, Banxia Xiexin Tang (Pinellia Tuber Decoction to Drain the Epigastrium) is the primary formula. For dry heaving with diarrhea, Huangqin Jia Banxia Shengjiang Tang (Scutellaria Root Decoction with Added Pinellia and Fresh Ginger) is the primary formula. For all vomiting where food cannot enter, Xiaobanxia Tang (Minor Pinellia Tuber Decoction) is the primary formula. For vomiting where the pathology is above the diaphragm, Zhuling Tang (Polyporus Decoction) is the primary formula. For Fanwei (regurgitation) with vomiting, Banxia Shenmi Tang (Pinellia Tuber, Ginseng, and Honey Decoction) is the primary formula. For vomiting immediately after eating, Dahuang Gancao Tang (Rhubarb and Licorice Decoction) is the primary formula. For Fanwei vomiting with thirst, Fuling Zexie Tang (Poria and Alisma Decoction) is the primary formula. For wanting to drink after vomiting, Wen Sha Tang (Clam Shell Decoction) is the primary formula. For symptoms resembling vomiting but not quite, resembling hiccup but not quite, with a sense of helplessness in the heart, Jiangzhi Banxia Tang (Ginger Juice and Pinellia Tuber Decoction) is the primary formula. For dry heaving with cold hands and feet, Chenpi Tang (Tangerine Peel Decoction) is the primary formula. For hiccups, Chenpi Zhuru Tang (Tangerine Peel and Bamboo Shavings Decoction) is the primary formula. For dry heaving with diarrhea, Huangqin Tang (Scutellaria Root Decoction) is the primary formula. For Qi rushing upward, Zaojiao Wan (Ziziphus Spinosus Fruit Pill) is the primary formula. For Shang Qi (ascending Qi) with a floating pulse, Nongpu Mahuang Tang (Magnolia Bark and Ephedra Decoction) is the primary formula. For Shang Qi with a deep pulse, Zexie Tang (Alisma Decoction) is the primary formula. For Fire rebellion causing ascending Qi, Maidong Tang (Ophiopogon Decoction) is the primary formula. For Phlegm-Fluids below the heart with chest and hypochondriac distension/fullness and vertigo, Fuling Guizhu Tang (Poria, Cinnamon Twig, and Atractylodes Macrocephala Decoction) is the primary formula. For shortness of breath with slight Fluid retention, which should be expelled via urination, Fuling Guizhu Gancao Tang (Poria, Cinnamon Twig, Atractylodes Macrocephala, and Licorice Decoction) is indicated; Shenqi Wan (Kidney Qi Pill) is also indicated. For patients with a hidden pulse who desire spontaneous diarrhea, feeling relief after defecation, yet continuing to have hardness/fullness below the heart, this indicates Liuyin (Retained Fluids) attempting to exit; Gansui Banxia Tang (Kansui and Pinellia Tuber Decoction) is the primary formula. For Xuan Yin (Hanging Fluids), Shizao Tang (Ten Jujube Decoction) is the primary formula. For Yi Yin (Overflowing Fluids), sweating is indicated; Da Qinglong Tang (Major Green Dragon Decoction) or Xiao Qinglong Tang (Minor Green Dragon Decoction) is indicated. For Zhi Yin (Supporting Fluids) below the heart causing severe vertigo, Zexie Tang (Alisma Decoction) is the primary formula. For Zhi Yin causing chest fullness, Nongpu Dahuang Tang (Magnolia Bark and Rhubarb Decoction) is the primary formula. For Zhi Yin causing difficulty breathing, Tingli Dazao Fei Tang (Descurainia Seed and Jujube Decoction to Drain the Lungs) is the primary formula. Those prone to vomiting should be thirsty; if not, it is due to Zhi Yin in the heart; Xiaobanxia Tang (Minor Pinellia Tuber Decoction) is the primary formula. For sudden vomiting with epigastric stuffiness and vertigo/palpitations due to Water between the diaphragm, Xiaobanxia Jia Fuling Tang (Minor Pinellia Tuber Decoction with Added Poria) is the primary formula. For thin individuals with palpitations below the navel, spitting saliva, and vertigo, this is Water pathology; Wuling San (Five-Ingredient Powder with Poria) is the primary formula. For retained Phlegm and old Water in the heart and chest, after self-vomiting leaves the area empty, Qi-full preventing eating, Xiaotan Qi Ling Nengshi (Eliminate Phlegm Qi to Enable Eating, i.e., Fuling Yin) is used. For thirst followed by vomiting, indicating Water stopping below the heart, belonging to Yin families, Banxia Tang (Pinellia Decoction) with added Fuling is used. Observing the subtle intent: those suitable for release should be sweated; those suitable for purging should be drained; stagnation should be guided; depression should be raised; Heat should be cleared; Cold should be warmed; mixed Cold/Heat should be treated with supplementary methods; Dampness should be leached with bland flavors; Deficiency should be supplemented and nourished. Where did it ever say to uniformly use acrid-aromatic drying-hot agents? Using Fire to save Fire, making excess more excess and deficiency more deficient—who bears the blame?
Some say: The *Mai Jue* (Pulse Secrets) states that Heat generates Wind, Cold generates Qi, and Cold causes contraction. Now Cold Qi rushes up, Qi rebels, Qi stagnates—is it not Cold? You cite Zhang Zhongjing to refute errors, then do all Qi disorders, all Fluid disorders, all vomiting, regurgitation, and acid regurgitation lack Cold syndromes?
I say: Each of the Five Zang organs has its own Fire. When stirred by the Five Desires, Fire arises accordingly. If diseases are caused by Cold, one must physically encounter Cold air or consume Cold foods to become diseased with Cold. This differs from Fire diseases arising from within. Thus, Qi diseases caused by Cold account for less than one or two out of ten.
Some say: It is understandable to discuss Phlegm-Qi, vomiting, acid regurgitation, dysphagia, and regurgitation as Heat/Fire. But if the patient says Cold Qi rushes from below upward, is it not Cold?
I say: Ascending Qi originates from the Liver; it carries Ministerial Fire (Xiang Huo) rising from below. The Heat is extreme, yet the patient feels Cold; this is not true Cold. Extreme Fire resembles Water. Severe accumulated Heat leads to Yang hyperactivity and Yin deficiency, thus presenting these symptoms. "Cold generates Qi" is a fallacy attributed to Gao Yangsheng. If the disease were truly due to Cold, one should use Cold-dispelling agents. Why uniformly use acrid-aromatic drying-hot prescriptions, lacking flexibility, thereby harming people?
Some say: For ascending Qi, drugs like Heixi Dan (Black Tin Pill), Yangzheng Dan (Nourish Righteousness Pill), and Yangqi Dan (Nourish Qi Pill) are used for their heavy, descending properties. Patients recover instantly. Do you think treating such severe Heat diseases with these is erroneous?
I say: Besides Ministerial Fire, there is Jueyang Fire of the Zang-Fu. Movements of the Five Desires each generate Fire. Ministerial Fire is the "One Water unable to overcome Two Fires" mentioned in the classics. This Fire is innate. Jueyang Fire is the "One Water unable to overcome Five Fires," arising from human desires. These two Fires fan each other, causing Qi to rise with the flames, ascending without descending. Who can resist it? Now, using the heavy, descending nature of pills to suppress Qi. Qi stagnation forms Damp-Phlegm; pill properties are hot and drying, temporarily clearing the Phlegm. However, clearing pill toxicity over time excessively aids wild Fire, consuming Yin Blood further, causing Qi to ascend even more. Laypeople prefer warmth, remaining deluded; those suffering this disaster are numerous.
Some say: Pills are heavy; intending to descend but causing ascent, what should be done?
I say: Administer Acrid-Cool agents, move with Acrid-Warm agents to subdue Liver pathogenic factors; treat with Salty-Cold agents, assist with Sweet-Warm agents, astringe with Bitter-Sweet agents, harmonize with Sweet-Bland agents, nourish Yin Blood. Yang will naturally attach, Yin and Yang will harmonize, and there will be no ascending. The methods of ancient sages are close at hand; I need not elaborate.
Some say: Regarding Qi disorders, Fluid disorders, vomiting, acid regurgitation, dysphagia, and regurgitation, I know the *Heji Jufang* misses the mark. But are the formulas from the *Jin Gui Yao Lue* sufficient? Is there anything undeveloped?
I say: The transformation of Heaven and Earth is infinite; diseases of the human body are equally infinite. Zhang Zhongjing's book records the Great Dao. Skilled physicians apply examples and infer categories, finding infinite utility. Even with slight modifications, one cannot exceed the rules. Initially, Qi disorder has subtle signs, perhaps due to minor dietary indiscretion, external exposure to wind/cold/summerheat/dampness, internal emotional injury, overly rich flavors aiding Yang Qi leading to Diaphragm Heat, constitutive robustness with closed pores and no sweat, or irritability causing Yin Fire to flare, obstructing Jin-Ye (body fluids) and mixing Clear and Turbid. Qi becomes diseased, causing Pi (stuffiness), pain, anorexia, belching with rotten odor, acid regurgitation, zaoza (discomfort), or bloating. Seeking no root cause, one assumes Cold and hastily administers acrid-aromatic drying-hot agents. After a few doses, temporary relief is felt, deemed a divine prescription. Yet, continuing rich diets and poor care, the old disease is temporarily suppressed by the harsh agents, allowing Turbid Fluids to accumulate easily. Half a month or a month later, the previous illness returns. This spreads: from Qi to Accumulation (Ji), from Accumulation to Phlegm. This is the origin of Phlegm, Fluids, and acid regurgitation. Without encountering a skilled physician, erroneous medicines are used. Phlegm mixes with turbid blood, forming nest-like pockets (ker nang). Thus, Pi, pain, vomiting, dysphagia, and regurgitation arise sequentially. Food and liquids stagnate, channels become obstructed, bowels become constipated or loose, lower transmission fails, Middle Jiao stagnates further. Physicians fail to observe, insisting on Cold, recalling the quick relief of previous medicines, blaming the drugs for not being hot enough. Waiting for long-term use to warm the Spleen and strengthen the Stomach, hoping for a sudden cure. They forget: The Stomach is the Sea of Water and Grain, abundant in Blood and Qi; only with clear and harmonious Qi can it receive. The Spleen is the Palace of Digestion; only with clear and harmonious Qi can it transport. Now receiving aromatic-hot drugs, excessively agitating Blood and Qi. Initially, Stomach fluids coagulate, unable to receive; eventually, Spleen Qi dissipates, transportation slows. Those with Stomach Heat, easy hunger, and urgency to eat, but with damaged Spleen failing to grind, accumulating pain, are told by physicians to have Deficiency and accumulated Cold, untreatable by ordinary herbs. They recklessly use Aconite (Wutou) and Prepared Aconite Root (Fuzi) to aid pills, focusing on ingestion. Over time, Blood is exhausted, the stomach wall becomes dry and shriveled. If shriveling is upper, near the throat, liquids pass but solids struggle to enter, entering little if at all—this is called Ye (dysphagia). If shriveling is lower, near the stomach, food enters but cannot fully reach the stomach, regurgitating after a long while—this is called Ge (diaphragmatic obstruction) or Fanwei (regurgitation). Constipation occurs, urine resembles sheep dung. Though names differ, the pathology stems from one source. The *Jin Gui Yao Lue* discusses six types of Yin: Tan Yin, Xuan Yin, Yi Yin, Zhi Yin, Liuyin, Fuyin. Differentiating Five Zang syndromes, the treatment methods are perfect. It is only regrettable that physicians fail to treat properly and patients ignore taboos, causing medicine to aid pathogens, deepening the disease, moving further from life, which is deeply pitiable.
Some say: *Qianjin Fang* (Prescriptions Worth a Thousand Gold) uses Ginger and Cinnamon for dysphagia and regurgitation. Why do you speak so much?
I say: Stagnant Qi lingering in the Clear Orifices requires aromatic-hot agents to move. However, these formulas always include Rhubarb, Gypsum, Bamboo Shavings, Mirabilite, Alisma, Peucedanum, Mirabilite, Poria, Scutellaria, Reed Rhizome, and Trichosanthes Rhizome as assistants. They start similarly but end differently. Pathogens are easily subdued, thus easily resolved.
Some say: Can ancient formulas really treat a dry, shriveled stomach wall? Are there quicker methods to supplement predecessors?
I say: Ancient formulas use Ginseng to tonify Lung, Poppy Capsule (Yu Mi) to detoxify, Bamboo Sap to clear Phlegm, Dried Ginger to nourish Blood, Millet to solidify Stomach, Honey Water to moisten dryness, and Ginger to remove filth. This is precisely the intent. Zhang Jifeng also said: Dysphagia is a disorder of the Spirit/Mind; only introspection and self-nurturing can treat it. This deeply hits the pathology, and the method is reasonable. Dysphagia is primarily due to Blood Dryness. Blood is Yin Qi; Yin prefers stillness. Internal and external stillness prevents Zang-Fu Fire from arising. Metal and Water Qi are nourished, Yin Blood generates naturally, and intestinal fluids transform appropriately. How could there be dysphagia?