阳明胃气以息息下行为顺。为其息息下行也，实时时借其下行之力，传送所化饮食达于小肠，以化乳糜；
更传送所余渣滓，达于大肠，出为大便。此乃人身气化之自然，自飞门以至魄门，一气营运而无所窒碍者也。
乃有时胃气不下行而转上逆，推其致病之由，或因性急多怒，肝胆气逆上干；或因肾虚不摄，冲中气
逆上冲，而胃受肝胆冲气之排挤，其势不能下行，转随其排挤之力而上逆。迨至上逆习为故常，其下行
之能力尽失，即无他气排挤之时，亦恒因蓄极而自上逆。于斯饮食入胃不能传送下行，上则为胀满，下则为便
结，此必然之势也。而治之者，不知其病因在胃府之气上逆不下降，乃投以消胀之药，药力歇而胀满依然。
治以通便之剂，今日通而明日如故，久之兼证歧出，或为呕哕，或为呃、为逆，或为吐衄，或胸膈烦热，或头
目眩晕，或痰涎壅滞，或喘促咳嗽，或惊悸不寐，种种现证头绪纷繁，则治之愈难。即间有知其致病之由在
胃气逆而不降者，而所用降胃之药若半夏、苏子、蒌仁、竹茹、浓朴、枳实诸品，亦用之等于不用也。
而愚数十年经验以来，治此证者不知凡几，知欲治此证非重用赭石不能奏效也。盖赭石对于此证，其特长
有六∶其重坠之力能引胃气下行，一也，既能引胃气下行，更能引胃气直达肠中以通大便，二也；因其饶有
重坠之力，兼能镇安冲气使不上冲，三也；其原质系铁养化合，含有金气，能制肝木之横恣，使其气不上
干，四也；为其原质系铁养化合，更能引浮越之相火下行，而胸膈烦热、头目眩晕自除，五也；其力能降胃
通便，引火下行，而性非寒凉开破，分毫不伤气分，因其为铁养化合转能有益于血分（铁养化协议于铁锈故
能补血中之铁锈），六也。是以愚治胃气逆而不降之证，恒但重用赭石，即能随手奏效也。
丙寅季春，愚自沧州移居天津。有郭××者，年近三旬，造寓求诊。自言心中常常满闷，饮食停滞胃
中不下，间有呕吐之时，大便非服通利之品不行，如此者年余，屡次服药无效，至今病未增剧，因饮食减少
则身体较前羸弱矣。诊其脉，至数如常，而六部皆有郁象。因晓之曰∶“此胃气不降之证也，易治耳。但
重用赭石数剂即可见效也。”为疏方，用生赭石细末一两，生怀山药、炒
怀山药各七钱，全当归三钱，生鸡内金二钱，浓朴、柴胡各一
钱。嘱之曰∶“此药煎汤日服一剂，服至大便日行一次再来换方。”
时有同县医友李××在座，亦为诊其脉，疑而问曰∶“凡胃气不降之病，其脉之现象恒弦长有力。
今此证既系胃气不降，何其六脉皆有郁象，而重按转若无力乎？”答曰∶“善哉问也，此中颇有可研究之
价值。盖凡胃气不降之脉，其初得之时，大抵皆弦长有力，以其病因多系冲气上冲，或更兼肝气上干。冲气上
冲，脉则长而有力；肝气上干，脉则弦而有力；肝冲并见，脉则弦长有力也。然其初为肝气冲气之所迫，其胃
府之气不得不变其下行之常而上逆，迨其上逆既久，因习惯而成自然，即无他气冲之干之，亦恒上逆而不能
下行。夫胃居中焦，实为后天气化之中枢。故胃久失其职，则人身之气化必郁，亦为胃久失其职，则人
身之气化又必虚，是以其脉之现象亦郁而且虚也。为其郁也，是以重用赭石以引胃气下行，而佐以浓朴以通
阳（叶天士谓浓朴多用则破气，少用则通阳），鸡内金以化积，则郁者可开矣。为其虚也，是以重用山药生、
熟各半，取其能健脾兼能滋胃（脾湿胜不能健运，宜用炒山药以健之，胃液少不能化食，宜用生山药以滋之），
然后能受开郁之药，而无所伤损。用当归者，取其能生血兼能润便补虚，即以开郁也。用柴胡者，因人身之
气化左宜升、右宜降，但重用镇降之药，恐有妨于气化之自然，故少加柴胡以宣通之，所以还其气化之常
也。”李××闻之，深韪愚言。后其人连服此药八剂，大便日行一次，满闷大减，饮食加多。遂将赭石改
用六钱，柴胡改用五分，又加白术钱半。连服十剂全愈。阅旬日，李××遇有此证，脉亦相同，亦重用赭石治愈。
阳明经的胃气以每一呼吸都向下运行作为顺常。正因为胃气每一呼吸都向下运行，所以能随时借助这股下行的力量，将消化后的饮食输送到小肠，转化为乳糜；再将剩余的糟粕输送到大肠，排出成为大便。这是人体气化运行的自然规律，从口腔（飞门）到肛门（魄门），一气周流运转而没有阻碍。
然而有时胃气不向下运行反而向上逆乱，推究其致病的原因，可能是因为性情急躁易怒，导致肝胆之气上逆干扰胃腑；也可能是因为肾虚不能固摄，导致冲脉之气上冲，胃受到肝胆冲气的排挤，势必要向下运行的能力丧失，转而随着排挤的力量向上逆乱。等到这种上逆习以为常，其下行的能力完全丧失，即使没有其他气机的排挤，也常常因为蓄积至极而从上面逆乱。在这种情况下，饮食进入胃中不能传送下行，向上则表现为胀满，向下则表现为便秘，这是必然的趋势。
而治疗的人，不知道病因在于胃腑之气上逆而不下降，于是投用消除胀满的药物，药力消退后胀满依旧。用通便的药剂治疗，今天通了明天又恢复原状，久而久之兼证纷纷出现，有的呕吐呃逆，有的干呕、气逆，有的吐血鼻衄，有的胸膈烦热，有的头目眩晕，有的痰涎壅滞，有的气喘咳嗽，有的惊悸失眠，各种现症头绪纷繁，治疗起来更加困难。即便偶尔有人知道致病原因在于胃气上逆不降，但所用降胃的药物如半夏、苏子、瓜蒌仁、竹茹、厚朴、枳实等品，用起来也等于没用。
而我几十年的经验以来，治疗这类病症不知有多少例，深知要治疗此证非重用代赭石不能见效。大概代赭石对此证的特长有六点：它沉重坠降的力量能引导胃气下行，这是一点；既然能引导胃气下行，更能引导胃气直达肠道以通大便，这是第二点；因为它富有沉重坠降的力量，兼能镇安冲气使其不上冲，这是第三点；它的原质是氧化铁化合物，含有金气，能制约肝木的横恣，使肝气不向上干扰，这是第四点；因为其原质是氧化铁化合物，更能引导浮越的相火下行，从而胸膈烦热、头目眩晕自然消除，这是第五点；它的力量能降胃通便，引火下行，且性质并非寒凉开破，丝毫不损伤气分，因为它作为氧化铁化合物转化后反而有益于血分（氧化铁协议于铁锈，故能补血中的铁元素），这是第六点。因此我治疗胃气上逆不降的病症，常常只重用代赭石，就能随手奏效。
丙寅年季春三月，我从沧州移居天津。有个叫郭某某的人，年纪近三十岁，来到寓所求诊。他自己说心中常常感到闷塞，饮食停滞在胃中不下行，偶尔有呕吐的时候，大便不服用通利药物就不能排便，像这样持续了一年多，屡次服药无效，至今病情没有加剧，但因为饮食减少身体比以前消瘦虚弱了。诊察他的脉搏，至数正常，但六部脉都有郁结之象。于是告诉他：“这是胃气不降的病症，容易治疗。只要重用代赭石服用几剂就可以见效。”于是为他开具处方，用生代赭石细末一两，生怀山药、炒怀山药各七钱，全当归三钱，生鸡内金二钱，厚朴、柴胡各一钱。嘱咐他说：“这药煎汤每天服用一剂，服到大便每天一次再来换方。”
当时同县的医友李某某也在座，也为他诊脉，疑惑地问：“凡是胃气不降的病，其脉象通常弦长有力。现在这个病既然是胃气不降，为什么六脉都有郁结之象，而且重按反而显得无力呢？”回答说：“问得好啊，这里面很有研究的价值。大凡胃气不降的脉象，初得之时，大多都是弦长有力，因为其病因多系冲气上冲，或者更兼肝气上干。冲气上冲，脉象就长而有力；肝气上干，脉象就弦而有力；肝气和冲气并见，脉象就弦长有力。然而起初是因为肝气冲气所逼迫，胃腑之气不得不改变其下行的常态而上逆，等到其上逆既久，因习惯而成自然，即使没有其他气机的冲撞干扰，也常常上逆而不能下行。胃居中焦，实际上是后天化气的中枢。所以胃长久失职，人身的气化必然郁结，也因为胃长久失职，人身的气化又必然虚弱，因此其脉象的表现也是郁结而且虚弱的。因为它是郁结的缘故，所以重用代赭石来引导胃气下行，并佐以厚朴来通阳（叶天士说厚朴多用则破气，少用则通阳），鸡内金来化解积滞，那么郁结就可以打开了。因为它是虚弱的缘故，所以重用山药生熟各半，取它既能健脾又能滋胃（脾湿胜不能健运，宜用炒山药来健运它；胃液少不能化食，宜用生山药来滋润它），然后才能承受开郁的药物，而不受损伤。用当归，是取它能生血兼能润便补虚，以此来辅助开郁。用柴胡，是因为人身的气化左边宜升、右边宜降，但如果只重用镇降的药物，恐怕妨碍气化的自然规律，所以少加柴胡来宣通它，以此恢复气化的常态。”李某某听了，深深赞同我的话。后来这个人连续服用此药八剂，大便每天一次，闷塞大减，饮食增多。于是将代赭石改为六钱，柴胡改为五分，又加白术一钱半。连续服用十剂痊愈。过了十天，李某某遇到有此证的患者，脉象也相同，也重用代赭石治愈。
The stomach qi of the Yangming channel follows the normal pattern of descending with every breath. Because it descends with every breath, it constantly utilizes this downward force to transport digested food and drink into the small intestine to convert them into chyle; further transporting the remaining waste into the large intestine to be excreted as feces. This is the natural operation of human Qi transformation (Qi Hua), where a single Qi circulates from the mouth (Feimen) to the anus (Pomen) without obstruction.
However, sometimes stomach qi does not descend but instead rebels upward. Investigating the cause of this pathology, it may be due to an irritable temperament causing Liver and Gallbladder qi to rebel upward and interfere with the Stomach; or it may be due to Kidney deficiency failing to secure, causing Chong vessel qi to rush upward. The Stomach, squeezed by the rebellious Qi of the Liver, Gallbladder, and Chong vessel, loses its downward momentum and rebels upward along with that squeezing force. Once this upward rebellion becomes habitual, its capacity to descend is completely lost. Even when no other pathogenic Qi is squeezing it, it often rebels upward due to extreme accumulation. In such cases, food and drink entering the Stomach cannot be transported downward. Upward, this manifests as distension and fullness; downward, as constipation. This is an inevitable trend.
Treaters who do not understand that the etiology lies in the rebellion and failure to descend of the Stomach organ's qi, administer medicines for reducing distension, but once the medicinal effect wears off, the distension remains. Treating with purgatives brings relief today only for the condition to return tomorrow. Over time, various complicating symptoms emerge: vomiting and hiccuping, dry heaving and counterflow qi, hematemesis and epistaxis, heat and vexation in the chest and diaphragm, dizziness and vertigo of the head and eyes, phlegm-saliva congestion, panting and coughing, palpitations and insomnia. With such complex presenting signs, treatment becomes increasingly difficult. Even if some recognize that the cause lies in rebellious stomach qi failing to descend, using descending herbs such as Banxia (Pinelliae Rhizoma), Suzi (Perillae Fructus), Louren (Trichosanthis Semen), Zhuru (Bambusae Caulis in Taeniam), Houpo (Magnoliae Officinalis Cortex), and Zhishi (Aurantii Fructus Immaturus) proves ineffective.
Based on my decades of experience, having treated countless cases of this syndrome, I know that heavy use of Hematitum (Dai Zhe Shi) is essential for efficacy. Hematitum has six specific advantages for this syndrome: First, its heavy and sinking property guides stomach qi downward. Second, by guiding stomach qi downward, it directs it straight to the intestines to unblock bowel movements. Third, due to its heavy and sinking nature, it calms and anchors the Chong vessel qi to prevent upward rushing. Fourth, its chemical composition is iron oxide, containing Metal energy, which restrains the rampant Wood of the Liver, preventing Liver qi from interfering upward. Fifth, being iron oxide, it guides floating and hyperactive Ministerial Fire downward, thereby eliminating heat/vexation in the chest/diaphragm and dizziness/vertigo. Sixth, while it descends stomach qi and unblocks bowels, and guides fire downward, its nature is not cold-cooling or destructive; it does not damage the Qi aspect at all. As an iron oxide compound, it benefits the Blood aspect (iron oxide corresponds to rust, thus replenishing iron in the blood). Therefore, in treating rebellious stomach qi failing to descend, I often rely solely on heavy doses of Hematitum, achieving immediate results.
In the late spring of Bingyin year, I moved from Cangzhou to Tianjin. A patient surnamed Guo, nearly thirty years old, visited my residence for consultation. He reported chronic feeling of fullness and oppression in the heart/chest region, food stagnation in the stomach refusing to descend, occasional vomiting, and dependency on laxatives for bowel movements. This persisted for over a year despite repeated ineffective treatments. His condition had not worsened significantly, but his body had become emaciated and weak due to reduced dietary intake. His pulse rate was normal, yet all six positions exhibited a stagnant (Yu) quality. I informed him, "This is a case of stomach qi failing to descend. It is easy to treat. Heavy use of Hematitum for a few doses will yield results." I prescribed: Raw Hematitum powder 1 liang, Raw Huai Yam (Dioscoreae Hypoglaucae Rhizoma) and Stir-fried Huai Yam each 7 qian, Quan Danggui (Angelicae Sinensis Radix) 3 qian, Raw Jineijin (Galli Gigerii Endothelium Corneum) 2 qian, Houpo (Magnoliae Officinalis Cortex) and Chaihu (Bupleuri Radix) each 1 qian. I instructed, "Decoct these herbs in water, take one dose daily. Return for prescription adjustment once you have one bowel movement per day."
Mr. Li, a fellow physician from the same county present at the time, also palpated the pulse. Suspecting something, he asked, "In diseases of stomach qi failing to descend, the pulse phenomenon is typically wiry, long, and forceful. Since this case is clearly stomach qi failing to descend, why do all six pulses show stagnation, and feel weak upon deep pressure?" I replied, "An excellent question. There is considerable value in researching this. Generally, the pulse in initial stages of stomach qi failing to descend is wiry, long, and forceful, because the etiology is mostly Chong qi rushing upward, or combined with Liver qi interfering upward. Chong qi rushing upward makes the pulse long and forceful; Liver qi interfering upward makes it wiry and forceful; both present together make it wiry, long, and forceful. However, initially forced by Liver and Chong qi, the Stomach organ's qi changes its normal downward course to rebel upward. Once this rebellion persists for a long time, habit becomes nature. Even without external forcing qi, it rebels upward and fails to descend. The Stomach resides in the Middle Jiao and serves as the hub of post-heaven Qi transformation. Thus, prolonged Stomach dysfunction leads to stagnation of human Qi transformation, and also leads to deficiency of human Qi transformation. Consequently, the pulse presents as both stagnant and deficient. Due to the stagnation, we heavily use Hematitum to guide stomach qi downward, assisted by Houpo to unblock Yang (Ye Tianshi stated: Houpo in large doses breaks Qi, in small doses unblocks Yang), and Jineijin to resolve accumulation, thereby opening the stagnation. Due to the deficiency, we heavily use Huai Yam, half raw and half stir-fried, taking advantage of its ability to tonify the Spleen and nourish the Stomach (if Spleen dampness prevails impairing transportation, use stir-fried Yam to strengthen it; if Stomach fluids are insufficient for digestion, use raw Yam to nourish it). Only then can the patient tolerate the stagnation-opening herbs without injury. We use Danggui for its ability to generate blood, moisten bowels, and tonify deficiency, assisting in opening stagnation. We use Chaihu because human Qi transformation favors ascending on the left and descending on the right. If we only heavily use sedating/descending drugs, we risk hindering natural Qi transformation. Thus, we add a small amount of Chaihu to promote circulation, restoring the normal rhythm of Qi transformation." Mr. Li deeply agreed with my explanation. The patient took this prescription for eight doses consecutively. Bowel movements became once daily, fullness/oppression decreased significantly, and dietary intake increased. We then reduced Hematitum to 6 qian, Chaihu to 5 fen, and added Baizhu (Atractylodis Macrocephalae Rhizoma) 1.5 qian. After ten more doses, he was fully cured. Ten days later, Mr. Li encountered another patient with the same syndrome and identical pulse presentation, who was also cured through heavy use of Hematitum.