吐而不已，至每食必吐，名反胃。胃脘枯槁，梗涩难入，饮食噎塞，迎逆于咽
喉之间，名噎。噎塞迎逆于胸膈之间，名膈。（过此乃得入胃。）《医贯》谓∶噎膈年高者有
之，噎则水饮可入，食物难入，入亦不多。膈则食虽可入，亦不能多，良久复出。
二者皆难于纳，勉强吞下，终带痰涎，或白沫酸水，或如酱汁者而出。反胃非不能
纳，（原能多食。）乃不能容受，朝食暮吐，暮食朝吐，或一二时而吐，或积至一日夜，
腹中胀闷不安而吐，（亦有食已即出者。）原物酸馊不化，男女老少皆有之。丹溪谓∶得之
七情六淫，遂有火热炎上之化，多升少降，津液不行，积为痰饮。被劫时（以热药劫治
也）暂得快，（津液得辛热暂行散。）不久复作，前药再行，积成其热。血液衰耗，胃脘干
枯，大便秘少，如羊矢然。（火盛粪干坚小，又肠亦干小，故屎不润不大也。）必外
避六淫，内节七
情，饮食自养，滋血生津，以润肠胃。则金无畏火之炎，肾有生水之渐，脾气健运，
而食积传化矣。王太仆云∶食入即出，是无水也，（噎膈反胃皆有之。）食久反出，是无火
也。（反胃有之，噎膈无此。）无水者壮水之主，六味主之，无火者益火之原，八味主之。
（并见虚损。）火逆冲上，食不得入，脉洪数有力者，滋阴清膈饮，加枇杷叶二钱，芦根
一两。又有一种，肝火郁而不伸，亦呕不纳食，亦心痛，但所呕者酸苦青蓝水，大
小便多不秘，（亦有乍秘乍泄者。）用吴茱萸、黄连浓煎，细细呷之，再服逍遥散（见郁，）
愈后六味丸（详郁门。）痰饮阻隔，食才下，便为痰涎裹住吐出者，以八神来复丹控其痰
涎（见痰饮。）血槁者，地黄、麦冬、当归煎膏，入韭汁、乳香、童便、芦根汁、桃仁泥，
细呷之。大便秘涩，加桃仁泥、玄明粉。但食物下咽，觉屈曲自膈而下，梗涩微痛，
多是瘀血，用前药后，以代抵当丸（见血）行之。瘀血在膈间，阻碍饮食，代抵当丸，
芥子大三钱，去枕仰卧，细细咽之，令搜尽停积，天明利下恶物，将息自愈。五灵
脂为末，黄犬胆汁和丸，龙眼大，每服一丸，好黄酒温服三次，亦行瘀之妙剂也。
有虫者，秦川剪红丸取之。此丸亦取瘀血噎病。喉中如有肉块，是食滞于此不下
也，麦昆煎。童便、（降火。）竹沥、（行痰。）姜汁、（佐竹沥。）韭汁、（行血。
）人乳、牛乳、
（补虚润燥。）芦根汁、（止呕。）茅根汁、（凉血。）甘蔗汁、（和胃。）驴尿，（杀虫。）
仍入烧酒、米醋、蜜
各少许，和匀，隔汤顿温服。得药不吐，切不可便与粥饭食物，每日用人参五钱，
陈皮一钱，作汤细啜，数日后方可饮陈米汤及粥糜。张子和曰∶《内经》谓三阳结为
膈，三阳，手足太阳，小肠经膀胱经也。结，谓结热也。小肠结热则血脉燥，
膀胱热结则津液涸，二便秘塞，下既不通，必反上行，所以噎食不下。经又曰∶少
阳所至为呕涌，食不下。又云∶肝移寒于心，为狂膈中。盖阳气与寒相搏，故膈食，
中不通，非独专于寒也。医者不察，妄用热药，人言可下，退阳养阴，张眼吐舌，
恐伤元气。惟刘河间三一承气汤，（见大便不通。）独超千古。假如久 ，慎勿陡攻，纵得
攻开，必虑后患。宜先润养，小作汤丸，累累加之，关扃自透。其或涎痰上阻，
轻用酸苦微涌，因而治下，药势易行。设或不行，蜜、盐下导，始终勾引，两药相
通，结散阳消，饮食自下。一官病此十年，大便涩燥，小便黄赤，予以四生丸，下
三十行，燥矢肠垢，何啻数升。其人昏困一二日，频以冰水呷之，渐投乳酪芝
麻饮，数日外，大啜饮食而愈。有极力 呼，气喉损破，气并胃管，（喉破，气不能从喉管行，
故从胃管行。）壅塞致吐，法在不治，牛喉管焙干服之。酒客多噎膈，饮热酒者尤多，以
热伤津液，咽管干涩，（观其口舌干涩可知。）食不得入也。
呕吐不止，直到每次进食都必然呕吐，这称为反胃。胃脘部干枯萎缩，食物梗涩难以下咽，饮食噎塞，逆阻于咽喉之间，这称为噎。噎塞逆阻于胸膈之间，这称为膈。（食物必须经过此处才能进入胃中。）《医贯》中说：年高之人常有噎膈病，噎证时饮水可以进入，但食物难以下咽，即使能进也不多吃。膈证时食物虽然可以进入，但也吃不多，过很久又会吐出。这两种情况都难以纳食，勉强吞下后，最终吐出的多带有痰涎，或是白沫酸水，或是像酱汁一样的东西。反胃并非不能纳食（原本能吃很多），而是不能容纳受纳，表现为早晨吃的晚上吐，晚上吃的早上吐，或者过一两个时辰就吐，或者积聚到一天一夜，因腹中胀闷不安而呕吐，（也有刚吃完就吐出来的。）吐出的是原物，味道酸馊且不消化，男女老少都可能得此病。朱丹溪说：此病源于七情内伤和六淫外感，导致火热炎上的变化，气机多升少降，津液运行不畅，积聚成为痰饮。被误用热药强行治疗时（以热药劫治），暂时感到舒适（津液得辛热之性暂时散开），但不久又发作，之前的药物再次使用，反而积成了热邪。血液衰耗，胃脘干枯，大便秘结量少，形状像羊屎一样。（因为火盛导致粪便干坚细小，肠道也干小，所以大便不润滑且量不大。）治疗必须在外避开六淫邪气，在内节制七情欲望，通过饮食自我调养，滋养血液、生津液，以滋润肠胃。这样肺金就不畏惧火的刑克，肾有生水的基础，脾气健运，食物积滞得以传化。王太仆说：食物吃下去立刻吐出，这是无水（阴亏）的表现（噎膈和反胃都有这种情况）；食物吃很久才反出来，这是无火（阳虚）的表现（只有反胃有这种情况，噎膈没有）。无水的用壮水之主的方法，用六味地黄丸主治；无火的用益火之源的方法，用八味丸主治。（这两类方剂也见于虚损病的论述中。）如果是火气上逆冲撞，食物无法进入，脉象洪数有力的，用滋阴清膈饮，加枇杷叶二钱，芦根一两。还有一种情况，是肝火郁结而不能舒展，也会呕吐且不纳食，同时伴有心痛，但所呕吐的是酸苦青蓝色的水，大小便大多不通畅（也有时而便秘时而泄泻的）。用吴茱萸、黄连浓煎，细细呷服，之后再服用逍遥散（见郁证章节），痊愈后服用六味丸（详见郁证门）。如果是痰饮阻隔，食物刚咽下，就被痰涎裹住吐出，用八神来复丹来控制痰涎（见痰饮章节）。如果是血枯干燥，用地黄、麦冬、当归煎膏，加入韭汁、乳香、童便、芦根汁、桃仁泥，细细呷服。如果大便秘涩，加桃仁泥、玄明粉。但如果食物下咽后，感觉曲折地从膈间下行，梗涩微痛，多是瘀血所致，在用前面的药物治疗后，用代抵当丸（见血证章节）来行瘀。如果瘀血在膈间，阻碍饮食，用代抵当丸，取芥子大三钱，患者去枕仰卧，细细咽下，令其搜尽停积的瘀血，天亮后排出恶物，静养即可自愈。也可以用五灵脂研末，用黄犬胆汁和丸，如龙眼大，每次服一丸，用好黄酒温服三次，这也是行瘀的妙剂。如果有虫积者，用秦川剪红丸驱除。这个丸药也能治疗瘀血引起的噎病。如果喉中感觉如有肉块，是食物停滞于此不下，用麦昆煎。童便（降火）、竹沥（行痰）、姜汁（佐助竹沥）、韭汁（行血）、人乳、牛乳（补虚润燥）、芦根汁（止呕）、茅根汁（凉血）、甘蔗汁（和胃）、驴尿（杀虫），仍加入烧酒、米醋、蜂蜜各少许，调和均匀，隔水炖温服。服药后如果不吐，切不可立即给予粥饭食物，每天用人参五钱，陈皮一钱，煮汤细细啜饮，几天后才可饮用陈米汤及粥糜。张子和说：《内经》说三阳结为膈，三阳指的是手足太阳经，即小肠经和膀胱经。结，是指结热。小肠结热则血脉干燥，膀胱热结则津液枯竭，二便闭塞，下面不通，必然反向上行，所以导致噎食不下。经文又说：少阳之气至则为呕吐涌逆，食物不下。又说：肝将寒邪移于心，会导致狂症和膈中病。这是因为阳气与寒邪相搏结，所以导致膈食，中焦不通，并不单单是因为寒邪。医生不仔细考察，妄用热药，人们说可以攻下，却退阳养阴，导致病人瞪眼吐舌，恐怕损伤元气。只有刘河间的三一承气汤（见大便不通章节），独超千古。假如病程长久，切勿突然猛攻，纵然攻开了，也必须顾虑后患。应该先润养，少量制作汤丸，逐渐增加剂量，关窍自然通透。如果涎痰上阻，轻微使用酸苦之药微促涌吐，进而治疗下部，药势容易通行。如果仍然不行，用蜜、盐导下，始终勾引引导，两药相通，结聚消散，阳气消退，饮食自然下行。有一位官员患此病十年，大便涩燥，小便黄赤，我给他用四生丸，下了三十次，排出的燥屎肠垢，何止几升。那人昏困了一两天，频繁地呷饮冰水，逐渐投喂乳酪芝麻饮，几天后，大量进食饮食而痊愈。有人极力呼喊，导致气喉破损，气体并入胃管（喉部破损，气体不能从喉管走，所以从胃管走），壅塞导致呕吐，这种方法属于不治之症，可用牛喉管焙干后服用。嗜酒的人多患噎膈，喝热酒的人尤其多，因为热邪损伤津液，咽管干涩（看他的口舌干涩就知道了），导致食物不得入。
Vomiting continuously until every meal is inevitably vomited is called Fanwei (Rebellious Stomach). When the stomach cavity is withered and atrophic, causing food to be obstructed and difficult to swallow, with dietary intake blocked and reversing in the throat, it is called Ye (Choking). When this obstruction and reversal occur in the chest and diaphragm region, it is called Ge (Diaphragmatic Obstruction). (Food must pass through this area to enter the stomach.) The *Yi Guan* states: Elderly people often suffer from Ye and Ge. In Ye syndrome, water can be swallowed but solid food is difficult to enter, and even if it does, not much is consumed. In Ge syndrome, although food can enter, the amount is small, and after a long time, it is vomited back up. Both conditions make swallowing difficult; when forced down, the vomitus eventually contains phlegm-drool, or white foam and sour fluid, or substances resembling sauce juice. Fanwei is not characterized by an inability to take in food (the patient originally could eat much), but by an inability to retain it. It manifests as eating in the morning and vomiting in the evening, or eating in the evening and vomiting in the morning, or vomiting after one or two hours, or accumulating for a day and night before vomiting due to abdominal distension and discomfort. (There are also cases where food is expelled immediately after eating.) The vomitus consists of the original food, which is sour, rancid, and undigested. This condition affects men, women, the old, and the young alike. Zhu Danxi stated that this disease arises from emotional disturbances (Seven Emotions) and external pathogenic factors (Six Excesses), leading to transformations of fire and heat blazing upward. Qi mechanism rises more than it descends, body fluids fail to circulate, and accumulate into phlegm-fluids. When treated erroneously with hot herbs to forcibly dissipate pathogens, there may be temporary relief (as body fluids temporarily disperse due to acrid-hot properties), but the condition soon recurs. Repeated use of such drugs accumulates heat. Blood consumption leads to dryness and atrophy of the stomach cavity, and constipation with scanty stools resembling sheep dung. (Because excessive fire causes dry, hard, small feces, and the intestines become dry and narrow, the stool lacks lubrication and volume.) Treatment requires avoiding the Six Excesses externally, regulating the Seven Emotions internally, nourishing oneself through diet, tonifying blood and generating fluids to moisten the intestines and stomach. Thus, Metal (Lung) will not fear the inflammation of Fire, Kidney will have the gradual generation of Water, Spleen Qi will be robust and transformative, and food stagnation will be transmitted and digested. Wang Tai said: Food entering and immediately exiting indicates a lack of Water (Yin deficiency), which occurs in both Ye/Ge and Fanwei. Food remaining for a long time before being vomited indicates a lack of Fire (Yang deficiency), which occurs only in Fanwei, not in Ye/Ge. For those lacking Water, strengthen the master of Water using Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia); for those lacking Fire, benefit the source of Fire using Bawei Wan (Eight-Ingredient Pill). (These are also discussed under Deficiency Damage.) If rebellious fire rushes upward and food cannot enter, with a flooding, rapid, and forceful pulse, use Ziyin Qingge Yin (Nourish Yin and Clear Diaphragm Decoction), adding 2 qian of Loquat Leaf and 1 liang of Reed Rhizome. Another type involves Liver Fire constrained and unable to extend, causing vomiting and refusal of food, accompanied by heart pain. However, the vomitus is sour, bitter, green-blue fluid, and bowel/bladder movements are mostly unobstructed (though sometimes alternating between constipation and diarrhea). Use Evodia and Coptis decocted strongly, sipped slowly, followed by Xiaoyao San (Free and Easy Wanderer Powder), and after recovery, Liuwei Wan (see Depression chapter). If Phlegm-Fluids obstruct, and food is swallowed only to be wrapped and vomited out by phlegm, use Bashen Laifu Dan (Eight-God Restoration Pill) to control phlegm (see Phlegm-Fluid chapter). If Blood is withered/dry, decoct Rehmannia, Ophiopogon, and Angelica into a paste, add Chive Juice, Frankincense, Child's Urine, Reed Rhizome Juice, and Peach Kernel Paste, sipping slowly. If large bowels are dry and obstructed, add Peach Kernel Paste and Mirabilite. However, if upon swallowing, food feels twisted descending from the diaphragm, with slight pain and obstruction, it is mostly Blood Stasis. After using the aforementioned medicines, use Daididang Wan (Substitute Dangui Pill) to move stasis (see Blood chapter). If Blood Stasis is in the diaphragm, obstructing food intake, use Daididang Wan: take 3 qian of Mustard Seed, lie supine without a pillow, and swallow slowly to search out and eliminate accumulated stasis. By dawn, foul matter will be discharged, and rest will lead to self-healing. Alternatively, grind Trogopterorus (Wulingzhi) into powder, mix with bile of a yellow dog to form pills the size of a longan fruit. Take one pill three times daily with warm good yellow wine; this is also an excellent formula for moving stasis. If parasites are present, use Qinchuan Jianhong Wan to expel them. This pill also treats Ye disease caused by blood stasis. If a meat-like lump is felt in the throat, it is food stagnating there and not descending; use Maikun Decoction. Child's urine (to descend fire), Bamboo Sap (to move phlegm), Ginger Juice (to assist bamboo sap), Chive Juice (to move blood), Human Milk, Cow Milk (to tonify deficiency and moisten dryness), Reed Rhizome Juice (to stop vomiting), Imperata Rhizome Juice (to cool blood), Sugarcane Juice (to harmonize stomach), and Donkey Urine (to kill parasites). Add small amounts of distilled spirits, rice vinegar, and honey, mix well, and take warm after steaming in water. If the medicine is taken without vomiting, do not immediately give porridge or food. Daily, decoct 5 qian of Ginseng and 1 qian of Tangerine Peel, sip the soup slowly. Only after several days should aged rice water and soft porridge be allowed. Zhang Zihe said: The *Neijing* states that "Three Yang knotting leads to Ge." Three Yang refers to Hand and Foot Taiyang meridians, i.e., Small Intestine and Bladder meridians. Knotting means heat accumulation. Heat accumulation in the Small Intestine dries blood vessels; heat accumulation in the Bladder depletes body fluids. Constipation and urinary retention mean the lower pathways are blocked, forcing rebellion upward, thus causing inability to swallow food. The classics also state: "Arrival of Shaoyang leads to vomiting and gurgling, inability to eat." And: "Liver transferring cold to Heart leads to mania and Ge." This is because Yang Qi combats Cold, causing Ge obstruction. Middle Jiao blockage is not solely due to Cold. Physicians who fail to investigate often recklessly use hot herbs. People say purgatives can be used, yet they suppress Yang to nourish Yin, causing patients to stare with tongue protruding, fearing damage to Yuan Qi. Only Liu Hejian's Sanyi Chengqi Tang (Three-One Purging Decoction) stands supreme across ages. If the disease has persisted for a long time, do not attack abruptly. Even if opened by purging, worry about subsequent complications. First, moisten and nourish; prepare small decoctions and pills, increasing dosage gradually, so the closure naturally penetrates. If saliva-phlegm obstructs above, mildly use sour-bitter herbs to induce slight vomiting, then treat below; drug action will proceed easily. If still ineffective, use honey and salt to guide downward, maintaining mutual attraction between the two drugs. As knots scatter and Yang dissipates, food and drink will descend naturally. An official suffered from this for ten years, with dry, obstructed bowels and yellow-red urine. I administered Sisheng Wan (Four-Life Pill), resulting in thirty evacuations of dry feces and intestinal filth, exceeding several sheng. The patient was confused and fatigued for one to two days, frequently sipping ice water, gradually receiving milk curd and sesame drink. After several days, he resumed normal eating and recovered. Some individuals shout with great effort, damaging the airway and larynx, causing gas to merge into the stomach tube (since the larynx is broken, gas cannot pass through the laryngeal tube, so it goes through the stomach tube), leading to obstruction and vomiting. This method is considered incurable; however, dried ox trachea can be taken. Wine drinkers often suffer from Ge; those drinking hot wine are especially prone, as heat damages body fluids, drying the esophagus (evident from dry mouth and tongue), preventing food entry.