治胸膈满闷，其脉大而弦，按之似有力，非真有力，此脾胃真气外泄，冲脉逆气上干之证，
慎勿作实证治之。若用开通之药，凶危立见。服此汤数剂后脉见柔和，即病有转机，多服自
愈。
野台参（五钱） 生赭石（轧细,五钱） 生芡实（五钱） 生山药（五钱） 萸肉（去净核,五钱） 清半夏（二钱） 茯苓
（二钱）
服药数剂后，满闷见轻，去芡实加白术二钱。
脉之真有力者，皆有洪滑之象。洪者如波涛叠涌，势作起伏；滑者指下滑润，累
累如贯珠。此脉象弦直，既无起伏之势，又无贯珠之形，虽大而有力，实非真有力之象。
和缓者脾胃之正脉，弦长者肝胆之正脉。然脾胃属土，其脉象原宜包括金、木、水、火诸脏
腑，故六部之脉皆有和缓，乃为正象。今其脉弦而有力，乃肝木横恣，侵侮脾土之象，故知
其脾胃虚也。
冲脉上隶阳明，故冲气与胃气原相贯通。今因胃气虚而不降，冲气即易于上干。此时脾胃气
化不固，既有外越之势，冲气复上干而排挤之，而其势愈外越，故其脉又兼大也。
一媪，年过六旬，胸腹满闷，时觉有气自下上冲，饮食不能下行。其子为书贾，且知医。曾
因卖书至愚书校，述其母病证，且言脉象大而弦硬。为拟此汤，服一剂满闷即减，又服数
剂全愈。
一人，年近五旬，心中常常满闷，呕吐痰水。时觉有气起自下焦，上冲胃口。其
脉弦硬而长，右部尤甚，此冲气上冲，并迫胃气上逆也。问其大便，言甚干燥。遂将方中赭
石改作一两，又加知母、生牡蛎各五钱，浓朴、苏子各钱半，连服六剂全愈。
附录:
直隶盐山李××来函∶
天津王媪，得病月余，困顿已极，求治于弟。诊其脉，六部皆弦硬有力，更粗大异常，询其病，则胸膈满闷，食已
即吐，月余以来，未得一饭不吐，且每日大便两三次，所便少许有如鸡矢，自云心中之难受，莫可言喻，不如即早与世
长辞，脱此苦恼。细思胸膈满闷，颇似实证者；，然而脉象弦硬粗大，无一点柔和之象，遂忆镇摄汤下注云，治胸膈满闷，
其脉大而弦，按之有力，此脾胃真气外泄，冲脉逆气上干之证，慎勿以实证治之云云。即抄镇摄汤原方予之。服一剂，
吐即见减，大便次数亦见减，脉遂有柔和之象。四五剂，即诸病全愈。以后遇此等脉象，即按此汤加减治之，无不效如
桴鼓。
治疗胸膈部胀满憋闷，脉象大而弦，重按似乎有力，但并非真正的有力。这是脾胃的真气向外泄漏，冲脉的逆气向上干犯所导致的证候，千万不要当作实证来治疗。如果使用疏通开泄的药物，危险和凶险的情况会立刻出现。服用此汤药几剂后，如果脉象变得柔和，说明病情有了转机，继续多服自然会痊愈。
野台参（五钱） 生赭石（轧细，五钱） 生芡实（五钱） 生山药（五钱） 山茱萸肉（去净核，五钱） 清半夏（二钱） 茯苓（二钱）
服药几剂后，如果胀满憋闷减轻，去掉芡实，加入白术二钱。
脉象真正有力的，都有洪大滑利的征象。洪大的脉象像波涛层层涌起，气势起伏不定；滑利的脉象在指下感觉滑润，连续不断如同串联的珍珠。这种脉象弦直，既没有起伏的气势，也没有串联珍珠的形状，虽然看起来大且有力，实际上并不是真正有力的脉象。
和缓的脉象是脾胃的正脉，弦长的脉象是肝胆的正脉。然而脾胃属土，其脉象原本应当包容金、木、水、火各脏腑的特点，所以六部脉象都有和缓之象，才是正常的表现。现在脉象弦而有力，这是肝木横逆肆意，侵犯欺凌脾土的征象，因此知道其脾胃虚弱。
冲脉隶属于阳明胃经，所以冲气与胃气原本是贯通的。现在因为胃气虚弱而不能下降，冲气就容易向上干犯。此时脾胃的气化功能不固，既有向外越出的趋势，冲气又向上干犯并排挤它，导致其外越的趋势更加严重，所以脉象又兼见大脉。
有一位老妇人，年龄超过六十岁，胸腹部胀满憋闷，时常觉得有气从下面向上冲撞，饮食不能下行。她的儿子是书商，并且懂得医术。曾经因为卖书来到我的书房校对书籍，叙述他母亲的病证，并且说脉象大而弦硬。我为她开了这个汤药，服用一剂后胀满憋闷就减轻了，又服用几剂后完全痊愈。
有一位男子，年龄接近五十岁，心中常常感到胀满憋闷，呕吐痰涎和水液。时常觉得有气从下焦升起，向上冲撞胃口。他的脉象弦硬而长，右部尤其明显，这是冲气上冲，并且逼迫胃气上逆所致。询问他的大便情况，他说非常干燥。于是将方中的赭石改为一两，又加入知母、生牡蛎各五钱，厚朴、苏子各钱半，连续服用六剂后完全痊愈。
附录：
直隶盐山李××来信：
天津的王老太婆，患病一个多月，困顿疲惫到了极点，向我求治。诊察她的脉象，六部脉都弦硬有力，而且异常粗大。询问她的病情，则是胸膈部胀满憋闷，吃完东西就吐，一个多月以来，没有一顿饭不是吃完就吐的，并且每天大便两三次，排泄物很少，形状像鸡屎，她自己说心中的难受，无法用言语形容，不如早点离开人世，摆脱这种苦恼。仔细思考胸膈部胀满憋闷，很像是实证；然而脉象弦硬粗大，没有一点柔和的迹象，于是想起镇摄汤下方的注释中说：“治疗胸膈部胀满憋闷，脉象大而弦，重按有力，这是脾胃真气向外泄漏，冲脉逆气向上干犯的证候，千万不要以实证来治疗”等等。于是抄写镇摄汤的原方给她服用。服用一剂后，呕吐就明显减少，大便次数也减少了，脉象随即出现了柔和的迹象。四五剂后，各种病症全部痊愈。以后遇到这种脉象，就按照这个汤药加减治疗，无不效验如击鼓应声般迅速。
Treats fullness and oppression in the chest and diaphragm, with a pulse that is large and wiry; upon deep pressure it seems forceful, but this is not true forcefulness. This is a syndrome of leakage of the true qi of the Spleen and Stomach outward, and rebellious Qi of the Chong vessel (Penetrating Vessel) invading upward. Do not treat it as an Excess syndrome. If opening and draining herbs are used, danger and critical conditions will appear immediately. After taking several doses of this decoction, if the pulse becomes soft and harmonious, it indicates a turning point in the illness; continuing to take it will lead to self-healing.
Yetaishen (Codonopsis Radix, Wild Type, 5 qian) Shengzheshi (Hematitum, Raw, finely crushed, 5 qian) Shengqianshi (Euryales Semen, Raw, 5 qian) Shengshanyao (Dioscoreae Rhizoma, Raw, 5 qian) Yurou (Corni Fructus, pips removed completely, 5 qian) Qingbanxia (Pinelliae Rhizoma Preparatum, Cleaned, 2 qian) Fuling (Poria, 2 qian)
After taking several doses, if the fullness and oppression lighten, remove Qianshi and add Baizhu (Atractylodis Macrocephalae Rhizoma) 2 qian.
Truly forceful pulses all exhibit the characteristics of Hong (Surging) and Hua (Slippery). "Hong" resembles waves surging one after another, with momentum rising and falling; "Hua" feels slippery under the fingers, continuous like pearls strung together. This pulse is wiry and straight, lacking both the rising and falling momentum and the shape of strung pearls. Although it appears large and forceful, it is actually not a truly forceful pulse.
The soft and harmonious pulse is the normal pulse of the Spleen and Stomach; the wiry and long pulse is the normal pulse of the Liver and Gallbladder. However, since the Spleen belongs to Earth, its pulse should originally encompass the characteristics of the Metal, Wood, Water, and Fire organs. Therefore, having a soft and harmonious quality in all six positions is the correct manifestation. Now, the pulse is wiry and forceful, which is a sign of Liver Wood acting recklessly and encroaching upon/insulting Spleen Earth; thus, we know the Spleen and Stomach are deficient.
The Chong vessel (Penetrating Vessel) is subordinate to the Yangming (Stomach) channel, so the Qi of the Chong vessel and the Stomach Qi are originally connected. Now, because Stomach Qi is deficient and fails to descend, the Qi of the Chong vessel easily invades upward. At this time, the transformation and transportation of the Spleen and Stomach are unstable, showing a tendency to escape outward; the rebellious Qi of the Chong vessel further invades upward and pushes against it, making the outward escaping tendency even more severe, hence the pulse also exhibits largeness.
An elderly woman, over sixty years old, suffered from fullness and oppression in the chest and abdomen, often feeling Qi rushing upward from below, preventing food and drink from descending. Her son was a bookseller and knew medicine. He once came to my study while selling books to have books proofread, described his mother's symptoms, and stated her pulse was large, wiry, and hard. I prescribed this decoction for her. After one dose, the fullness and oppression decreased; after several more doses, she was completely cured.
A man, nearly fifty years old, often felt fullness and oppression in the heart region, vomiting phlegm and water. He often felt Qi rising from the Lower Jiao (Lower Burner) and rushing upward to the stomach entrance. His pulse was wiry, hard, and long, especially prominent on the right side. This indicates rebellious Qi of the Chong vessel ascending and forcing Stomach Qi to rebel upward. Asking about his bowel movements, he said they were very dry. Thus, I changed the Zheshi in the formula to 1 liang, added Zhimu (Anemarrhenae Rhizoma) and Shengmuli (Ostreae Concha, Raw), each 5 qian, Houpo (Magnoliae Officinalis Cortex), and Suzi (Perillae Fructus), each 1.5 qian. After continuously taking six doses, he was completely cured.
Appendix:
Letter from Li XX of Yanshan, Zhili:
Old Madam Wang in Tianjin had been ill for over a month, extremely exhausted and debilitated, seeking treatment from me. Palpating her pulse, all six positions were wiry, hard, and forceful, and exceptionally coarse and large. Inquiring about her illness, she reported fullness and oppression in the chest and diaphragm, vomiting immediately after eating. For over a month, no meal went down without being vomited up. She also had bowel movements two or three times daily, with scanty excrement resembling chicken droppings. She claimed the discomfort in her heart was indescribable, and she would rather die early to escape this suffering. Upon careful consideration, the chest and diaphragm fullness resembled an Excess syndrome; however, the pulse was wiry, hard, coarse, and large, lacking any hint of softness. I then recalled the note under ZhenShe Tang (Sedation and Suppression Decoction): "Treats fullness and oppression in the chest and diaphragm, with a pulse that is large and wiry, forceful upon pressure. This is a syndrome of leakage of the true qi of the Spleen and Stomach outward, and rebellious Qi of the Chong vessel invading upward. Do not treat it as an Excess syndrome." I copied the original prescription of ZhenShe Tang and gave it to her. After one dose, vomiting decreased significantly, bowel movement frequency also decreased, and the pulse began to show softness. After four or five doses, all illnesses were completely cured. Since then, whenever encountering such pulse patterns, I treat them by modifying this decoction, achieving efficacy as immediate as a drumstick striking a drum.