天津盛××，年五旬，得噎膈证。
病因 处境恒多不顺，且又秉性褊急，易动肝火，遂得斯证。
证候 得病之初期，觉饮食有不顺时，后则常常如此，始延医为调治，服药半年，更医十余人
皆无效验。转觉病势增剧，自以为病在不治，已停药不服矣。适其友人何××劝其求愚为之延医，
其六脉细微无力，强食饼干少许，必嚼成稀糜方能下咽，咽时偶觉龃龉即作呕吐，带出痰涎若干。惟饮
粳米所煮稠汤尚无阻碍，其大便燥结如羊矢，不易下行。
诊断 杨素园谓∶“此病与失血异证同源，血之来也暴，将胃壁之
膜冲开则为吐血；其来也缓，不能冲开胃膜，遂瘀于上脘之处，
致食管窄隘即成噎膈。”至西人则名为胃癌，所谓癌者，如山石之有岩，其形凸出也。此与杨
氏之说正相符合，其为瘀血致病无疑也。其脉象甚弱者，为其进食甚少气血两亏也。至其便结如羊
矢，亦因其饮食甚少，兼胃气虚弱不输送下行之故也。此宜化其瘀血兼引其血下行，而更辅以培养气血之品。
处方 生赭石（一两轧细） 野台参（五钱） 生怀山药（六钱） 天花粉（六钱）
天冬（四钱） 桃仁（三钱去皮捣） 红花（二钱） 土鳖虫（五枚捣碎） 广三七（二钱捣细）
药共九味，将前八味煎汤一大盅，送服三七末一半，至煎渣再服时，再送服其余一半。
方解 方中之义，桃仁、红花、土鳖虫、三七诸药，所以消其瘀血也。重用生赭石至一两，所
以引其血下行也。用台参、山药者，所以培养胃中之气化，不使因服开破之药而有伤损也。用天冬
、天花粉者，恐其胃液枯槁，所瘀之血将益干结，故借其凉润之力以滋胃液，且即以防台参之因补生热也。
效果 将药服至两剂后，即可进食，服至五剂，大便如常。因将赭石改用八钱，又服数剂，饮
食加多，仍觉胃口似有阻碍不能脱然。俾将三七加倍为四钱，仍分两次服下，连进四剂，
自大便泻下脓血若干，病遂全愈。
帮助 按噎膈之证，有因痰饮而成者，其胃口之间生有痰囊（即喻氏《寓意草》中所谓窠囊），本方
去土鳖虫、三七，加清半夏四钱，数剂可愈。有因胃上脘枯槁痿缩致成噎膈者，本方去土鳖虫、三七，将
赭石改为八钱，再加当归、龙眼肉、枸杞子各五钱，多服可愈。有因胃上脘生瘤赘以致成噎膈者（
“论胃病噎膈治法及反胃治法”中曾详论），然此证甚少，较他种噎膈亦甚难治，盖瘤赘之生，恒
有在胃之下脘成反胃者，至生于胃之上脘成噎膈者，则百中无一二也。
天津有一位姓盛的先生，五十岁左右，患上了噎膈病。
病因：他生活境遇常常不顺心，且性格急躁偏狭，容易动肝火，因此得了这个病。
证候：在发病初期，感觉饮食吞咽有些不顺畅，后来就经常这样，才开始请医生调理治疗，服药半年，换了十几个医生，都没有效果。病情反而加重，他自己认为病已无法治愈，已经停药不吃了。正好他的朋友何先生劝他找我诊治。诊脉发现其六脉细微无力，勉强吃几块饼干，必须嚼成稀烂的糊状才能咽下，咽下时偶尔觉得有阻碍就会呕吐，吐出一些痰涎。只有喝用粳米煮的浓稠米汤还没有阻碍，大便干燥结硬像羊粪蛋一样，不容易排下来。
诊断：杨素园曾说：“这个病与失血证虽然表现不同，但根源相同。如果是急性的出血，猛烈冲击冲开了胃壁的膜，就会变成吐血；如果是缓慢的瘀滞，不能冲开胃膜，就瘀积在上脘部位，导致食管狭窄，就成了噎膈。”至于西医则称之为胃癌，所谓“癌”，就像山石上有岩石突起一样，形状是凸出的。这与杨氏的说法正相符合，这无疑是瘀血致病造成的。脉象非常微弱，是因为进食很少，气血两亏的缘故。至于大便干结像羊粪蛋，也是因为他饮食很少，加上胃气虚弱，不能输送下行所致。这种情况应该化解瘀血并引导血液下行，同时辅以培养气血的药物。
处方：生赭石（一两，轧细） 野台参（五钱） 生怀山药（六钱） 天花粉（六钱） 天冬（四钱） 桃仁（三钱，去皮捣碎） 红花（二钱） 土鳖虫（五枚，捣碎） 广三七（二钱，捣细）。
共九味药，将前八味煎成一碗大汤，送服一半的三七末；等到煎药渣再服用时，再送服剩下的一半三七末。
方解：方中桃仁、红花、土鳖虫、三七等药物，是用来消除瘀血的。重用生赭石至一两，是用来引导血液下行的。使用台参、山药，是为了培养胃中的气化功能，防止因服用攻破类药物而损伤正气。使用天冬、天花粉，是担心胃液枯竭，导致瘀积的血更加干结，所以借助它们的凉润之力来滋养胃液，并且借此防止台参因补益而生热。
效果：服药两剂后，就可以进食了；服到五剂，大便恢复正常。于是将赭石的用量改为八钱，又服了几剂，饮食量增加，但仍感觉胃口处似乎仍有阻碍，不能完全通畅。让患者将三七加倍至四钱，仍分两次服用，连续进服四剂，大便泻下了一些脓血，病于是完全痊愈。
帮助：按噎膈这一病症，有的是因为痰饮形成的，其胃口之间生有痰囊（即喻嘉言《寓意草》中所谓的窠囊），本方去掉土鳖虫、三七，加入清半夏四钱，服几剂可以痊愈。有的是因为胃的上脘干枯萎缩导致的噎膈，本方去掉土鳖虫、三七，将赭石改为八钱，再加当归、龙眼肉、枸杞子各五钱，多服可以痊愈。有的是因为胃的上脘长了赘生物（肿瘤）导致的噎膈（在“论胃病噎膈治法及反胃治法”中曾详细论述过），然而这种病例很少，比其他种类的噎膈也很难治疗。大概赘生物生长在胃的下脘会导致反胃，而生长在胃的上脘导致噎膈的，一百个里面也找不出一两个。
Mr. Sheng from Tianjin, aged fifty, suffered from **Yige** (Dysphagia and food retention).
Etiology: His living circumstances were often unfavorable, and his temperament was narrow-minded and irritable, prone to stirring up **Liver Fire** (hyperactivity of Liver Yang or heat due to emotional stagnation), which led to this disease.
Symptoms: In the early stage of the illness, he felt some difficulty in swallowing food, which later became frequent. He only then sought medical treatment, taking medicine for half a year and consulting more than ten physicians without effect. The condition worsened, and he believed it was incurable, so he stopped taking medication. Fortunately, his friend Mr. He advised him to seek my consultation. Examination revealed that all six pulses were fine, thready, and weak. When he forced himself to eat a few crackers, they had to be chewed into a thin paste before swallowing; occasionally, he felt an obstruction during swallowing, leading to vomiting with some phlegm-saliva. However, drinking thick rice gruel made from **Jingmi** (Oryza sativa var. glutinosa) caused no obstruction. His stool was dry and hard like sheep droppings, difficult to pass.
Diagnosis: Yang Suyuan stated: "This disease shares the same root as **Shixue** (Hemorrhage), though the manifestations differ. If bleeding is sudden and violent, it bursts open the membrane of the stomach wall, resulting in hematemesis; if it is slow, failing to burst the gastric membrane, it stasises in the upper epigastrium, causing narrowing of the esophagus, thus forming Yige." Western medicine calls this **Stomach Cancer** (Gastric Carcinoma). The term 'cancer' refers to something protruding like rock on a mountain, with a convex shape. This aligns perfectly with Yang's theory; undoubtedly, this is caused by **Blood Stasis** (stagnation of blood circulation). The pulse is very weak because of minimal food intake leading to deficiency of both Qi and Blood. The stool being hard like sheep droppings is also due to minimal dietary intake and the weakness of **Stomach Qi** (digestive energy), which fails to transport downward. Treatment should focus on resolving blood stasis and guiding blood downward, supplemented by herbs that nourish Qi and Blood.
Prescription: **Sheng Zhe Shi** (Raw Oolithum, 1 liang, finely crushed); **Ye Taishen** (Wild Codonopsis pilosula, 5 qian); **Sheng Huai Shanyao** (Fresh Dioscorea opposita, 6 qian); **Tianhuafen** (Trichosanthis Radix, 6 qian); **Tiandong** (Asparagi Radix, 4 qian); **Taoren** (Persicae Semen, 3 qian, skin removed and crushed); **Honghua** (Carthami Flos, 2 qian); **Tubei Chong** (Eupolyphaga Steleophaga, 5 pieces, crushed); **Guang Sanqi** (Notoginseng Radix et Rhizoma, 2 qian, finely crushed).
There are nine ingredients in total. Decoct the first eight ingredients to make one large cup of decoction, and take half of the **Sanqi** powder with it. When the dregs are decocted for the second dose, take the remaining half of the **Sanqi** powder with it.
Formula Analysis: **Taoren**, **Honghua**, **Tubei Chong**, and **Sanqi** in the formula are used to eliminate blood stasis. A heavy dose of **Sheng Zhe Shi** (1 liang) is used to guide blood downward. **Taishen** and **Shanyao** are used to cultivate the transformation and transportation function of Stomach Qi, preventing damage from the use of dispersing and breaking herbs. **Tiandong** and **Tianhuafen** are used because there is a fear that the depletion of Stomach fluids will cause the stasised blood to become even drier and harder; thus, their cooling and moistening properties are borrowed to nourish Stomach fluids, and simultaneously to prevent **Taishen** from generating heat due to its tonifying nature.
Effect: After taking two doses, he could eat food. After five doses, his bowel movements returned to normal. Therefore, the dose of **Zhe Shi** was reduced to 8 qian, and after taking a few more doses, food intake increased. However, he still felt an obstruction in the stomach area that did not completely resolve. The dose of **Sanqi** was doubled to 4 qian, taken in two divided doses. After four consecutive doses, he passed some pus and blood in his stool, and the disease was completely cured.
Assistance: Regarding Yige, some cases are caused by **Phlegm-Fluid** (retention of pathological fluid). There may be phlegm cysts formed between the stomach entrance (referred to as 'nest cysts' in Yu Jia Yan's *Yuyi Cao*). For such cases, remove **Tubei Chong** and **Sanqi** from this formula, add **Qing Banxia** (Pinelliae Rhizoma Praeparatum cum Alumine et Zingibere, 4 qian), and it can be cured after a few doses. Some cases are caused by atrophy and shrinkage of the upper epigastrium due to dryness. For these, remove **Tubei Chong** and **Sanqi**, change **Zhe Shi** to 8 qian, and add **Danggui** (Angelicae Sinensis Radix), **Longyanrou** (Longan Arillus), and **Gouqizi** (Lycii Fructus), each 5 qian. Taking it for a long time can lead to recovery. Some cases are caused by growths (tumors) in the upper epigastrium (discussed in detail in "Discussion on Treatment Methods for Stomach Diseases, Yige, and Fanwei"). However, this type is rare and much harder to treat than other types of Yige. Generally, growths in the lower epigastrium cause Fanwei (regurgitation/vomiting), while those in the upper epigastrium causing Yige occur in less than one or two out of a hundred cases.