朱丹溪曰∶气之初病也，其端甚微，或因此小饮食不谨；或外冒六淫；或内感七情；或食味过浓，
偏助阳气，积成膈热；或资禀充实，表密无汗；或性急易怒，火炎上，以致津液不行，清浊相干。气为之病，
或痞或痛，不思饮食，或噫腐气，或吞酸，或糟杂，或膨满。不思原本，遂以辛香燥热之剂投之，临时得
快，浓味仍前不节，七情反复相因，溺液易于攒聚，如此蔓延，自气成积，自积成痰，此为痰、为饮、
为吞酸之由也。良工未遇，谬药又行，痰挟淤血，遂为窠囊，此为痞、为痛、呕吐、为噎、为膈、反胃之
次第也。
饮食汤液滞泥不行，渗道蹇涩，大便或秘或溏，下失传化，中焦愈停，求可以温脾壮胃、消积行气，以
冀一旦之效。不思胃为水谷之海，多血多气，清和则能受；脾为消化之脏，清和则能运，若香燥偏助，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。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，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，大便秘少，若羊矢然。
古方用人参以补肺，御米以解毒，竹沥以消痰，归、芍以养血，粟米以实胃，蜜水以润燥，姜以去秽，
病邪易伏，其病自安。张鸡峰亦曰∶噎是神思间病，惟内观静养可以治之。此言深中病情。夫噎病生于血
干，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，肠胃津润传化合宜，何噎之有？
赵养葵曰∶丹溪之论其妙，惜其分别欠明，且以润血为
主，而不直探乎肾中先天之源。故其立方，以四物中牛羊乳之类，加之竹沥、韭汁，化痰化淤，皆治标而
不治本也。《内经》曰∶三阴结，谓之膈。三阳者，大肠、小肠、膀胱也。大肠主津。小肠主液。大肠热
结则津涸，小肠热结则液燥。膀胱为州都之官，津液藏焉，膀胱热结则津液竭。然而三阳何以致结热，
皆肾之病也。肾主五液，又肾主大小便，肾水既干，阳火偏盛，煎熬津液，三阳热结则前后闭塞。下既不通，
必反于上，直犯清道，上冲吸门，喉咽所以噎食不下也。何为水饮可入，食物难下？盖食入于阴，长气于阳，
反引动胃口之火，故难入；水者阴类也，同气相投，故可入。口吐白沫者，所饮之水，沸而上腾也。粪如
羊矢者，食入者少，渣滓消尽，肠亦干小而不宽也。此症多是年高五十于外，其天真已绝，只有孤阳，治之
唯以养阴为主。王太仆曰∶食入即出，是无水也；食入反出，是无火也。无水者壮水之主，无火者益火
之源，褚侍中云∶上病疗下，直须六味地黄料，大剂煎饮久服，可挽十中之一二。又须远绝房帏，薄滋味可
也。若曰温胃，胃本不寒；若曰补胃，胃本不虚。若曰开郁，香燥之品适以助火，无如补阴，光焰自灭。
反胃，东垣书谓吐有三症，气、积、寒也。上焦吐者从气，中焦吐者从积，下焦吐者从寒。若脉沉迟，
暮食朝吐，朝食暮吐，小便利，大便闭，此下焦吐也，法当通其闭，温其寒。观此，可见下焦吐乃命门火衰，
釜底无薪，不能蒸腐胃中水谷，腹中胀满，不得不吐也。王太仆所谓食入反出，是无火也是矣。须益火之源
，先以八味丸补命门火，以救脾土之母，徐以附子理中汤理中焦，万举万全。
李士材曰，噎寒大都属热，反胃大都属寒，然亦不可拘也，脉大有力当作热治，脉小无力当作寒医。
色之黄白而枯
者为寒虚，色之红赤而泽者为实热。以脉合症，以色合脉，庶乎无误，此症之所以疑难者。方欲健脾理痰
，恐燥剂有妨于津液，
方欲养血生津，恐润剂有凝于中州。审其阴虚火旺者，当以养血为亟；脾伤阴盛者，当以温补为先。更
有忧恚盘礴，火郁闭结，神不大衰，脉犹有力，当以仓公。河间之法下之。小小汤丸，累累加用，关扃自透
。膈间痰盛，微微涌出，因而治下，药势易行。设或不行，蜜盐下导，始终勾引，自然
宣通。此皆虚实阴阳之辨，临症之权衡也。
方约之曰∶丹溪云年高者不治。盖少年气血未虚，用药劫去痰火，病不复生；年高气血已虚，用药劫
去痰火，虽得暂愈，其病复作。所以然者，气虚不能运化而生痰，血虚不能滋润而生火也。丹溪又云此症切
不可用香燥药，服之必死，宜薄滋味。予尝用霞天膏加于补虚药中治此症，一人则吐泻以去积血，一人则
吐泻以去积痰，俱获病安思食。然二人俱不能节戒，随啖肥甘，终不能免。殊不知此症挟虚，脾胃尚弱，肥甘
难化，故复病也。霞天膏吐泻后，又宜用人参炼膏补之。
刘河间曰∶趺阳脉紧，内燥盛而温气衰。又紧而见涩，其血已亡。上脘亡血，膈间干涩，食不得入；
下脘亡血，又并大小肠皆枯，食不得下，故难治也。
张仲景反胃脉症，问曰∶病患脉数，数为热、当消谷引饮，而反吐者，何也？师曰∶以其发汗，令阳脉
微，膈气虚，脉乃数，数为客热，不能消谷，胃中虚冷也。脉弦者虚也，胃气无余，朝食暮吐，变为胃反。
寒在于上，医反下之，令脉反弦，故名曰虚。
又曰∶寸口脉微而数，微则无气，无气则荣虚，荣虚则血不足，血不足则胸中冷。
此二条，仲景形容脉证之微妙。凡阳盛则数，阴盛则迟，其人阳气既微，何得脉反数？脉既数，何
得胃反冷？此不可不察，求其故也。阳气微则荣虚，荣虚则不为阳守而浮为客热。阳气微则膈气虚，膈
气虚则亦不能运阴而为胃冷。况医不知而反下之，致上下之阳俱损，其脉遂从阴而变为弦。因是上之阳不
足，日中已前所食，亦不消化；下之阳不足，日暮已后，阳亦不入于阴，而糟粕亦不输于大小肠。故曰胃气
无余，所以反胃而朝食暮吐也。盖人身之脉法天地，微则阳不健运，数则阴不尽翁，阴阳两乖其度，荣卫不
充而胸中冷。荣卫本生于谷，能复消磨其谷，是荣卫非谷不充，谷非荣卫不化，胸中既冷，胃必不能出纳其
谷，证成反胃，又何疑乎？东逸改注。
喻嘉言曰∶胸中之阳，如天之有日，其关系纳谷之道，最为扼要，此条所云是也。盖胸中下连脾胃，其阳
气虚者，阴血亦必虚，但宜用冲和之剂，以平调脏腑，安养荣卫，舍纯粹以精之药不可用也。肾中之阳如断
鳖立极，其关系命根存亡之机，尤为宏矩，后条四逆汤等是也。盖肾中内藏真阳，其阳外亡者，阴气必极盛，
惟从事刚猛之剂，以推锋陷阵。胜阴复阳，非单刀直入之法，不可行也。
朱丹溪说：气机初病时，其征兆非常细微，或许是因为饮食不慎；或许是外感六淫邪气；或许是内伤七情；或许是口味过重，偏助阳气，积聚成膈热；或许是体质充实，腠理致密无汗；或许是性情急躁易怒，火气炎上，导致津液运行不畅，清浊之气相互干扰。气机因此发病，出现痞塞或疼痛，不想进食，或者嗳出腐臭之气，或者吞酸，或者食物混杂不化，或者腹部胀满。如果不探究根本原因，就投用辛香燥热的药物，暂时得到缓解，但浓味饮食依然没有节制，七情反复相因，体液容易积聚，这样蔓延发展，从气滞变成积块，从积块变成痰饮，这就是产生痰、饮、吞酸的原因。如果没有遇到良医，又误用药物，痰挟带淤血，遂形成窠囊（顽固病灶），这就是出现痞塞、疼痛、呕吐、噎膈、反胃的次第过程。
饮食汤液停滞泥阻不行，渗道蹇涩，大便或者秘结或者溏泄，下部失去传导变化功能，中焦更加停聚。寻求能够温脾壮胃、消积行气的方法，以期望获得一时的疗效。却不思考胃是水谷之海，多血多气，清和才能受纳；脾是消化的脏器，清和才能运化。如果香燥药物偏助，气血就会沸腾。起初，胃液凝聚，无法容纳受纳；时间久了，脾气耗散，传化逐渐迟缓。积累久了，血液全部耗损；胃脘干枯槁硬。如果干枯在上部，靠近咽喉之下，水饮可以下行，食物难以进入，名叫噎；如果干枯在下部，靠近胃部，食物虽然可以进入，但难以完全进入胃中，很久之后又吐出来，名叫膈，也叫反胃，大便秘结量少，像羊屎一样。
古方用人参来补肺，御米来解毒，竹沥来消痰，当归、白芍来养血，粟米来实胃，蜜水来润燥，生姜来去秽，病邪容易潜伏，疾病自然安宁。张鸡峰也说：噎膈是神思之间的病，只有内观静养才可以治疗。这话深深切中病情。夫噎膈病生于血干，阴主静，内外都静，那么脏腑之火就不会起，而金水二气得到滋养，阴血自然生成，肠胃津润，传化适宜，哪里有噎膈呢？
赵养葵说：丹溪的论述很精妙，可惜区分不够明确，而且以润血为主，而不直接探求肾中先天之源。所以他立方的时候，在四物汤中加入牛羊乳之类，加上竹沥、韭汁，化痰化瘀，都是治标不治本。《内经》说：三阴结，叫做膈。三阳者，是大肠、小肠、膀胱。大肠主津。小肠主液。大肠热结则津液枯竭，小肠热结则液燥。膀胱为州都之官，津液藏焉，膀胱热结则津液竭尽。然而三阳为何会导致热结，都是肾的病。肾主五液，又肾主大小便，肾水既已干涸，阳火偏盛，煎熬津液，三阳热结则前后闭塞。下部既然不通，必然反逆于上，直犯清道，上冲吸门，喉咽所以噎食不下。为什么水饮可入，食物难下？盖食物入于阴，长气于阳，反而引动胃口之火，所以难入；水是阴类，同气相投，所以可入。口吐白沫的，是所饮之水，沸腾而上腾。粪便如羊屎的，是吃进去的少，渣滓消尽，肠也干小而不宽。此症多是年过五十之外的人，其天真之气已绝，只有孤阳，治疗唯有以养阴为主。王太仆说：食入即出，是无水；食入反出，是无火。无水者壮水之主，无火者益火之源。褚侍中说：上病疗下，直须六味地黄料，大剂煎饮久服，可挽回十分之一二。还必须远离房事，淡薄滋味即可。如果说温胃，胃本来不寒；如果说补胃，胃本来不虚。如果说开郁，香燥之品恰好助火，不如补阴，光焰自灭。
反胃，东垣书中说呕吐有三症，气、积、寒。上焦吐者从气，中焦吐者从积，下焦吐者从寒。如果脉沉迟，暮食朝吐，朝食暮吐，小便通利，大便闭结，这是下焦吐，法当通其闭，温其寒。看此，可见下焦吐乃是命门火衰，釜底无薪，不能蒸腐胃中水谷，腹中胀满，不得不吐。王太仆所谓食入反出，是无火，也是对的。须益火之源，先用八味丸补命门火，以救脾土之母，慢慢用附子理中汤理中焦，万举万全。
李士材说，噎膈大都属热，反胃大都属寒，但也不可拘泥，脉大有力当作热治，脉小无力当作寒医。面色黄白而枯者为寒虚，面色红赤而泽者为实热。以脉合症，以色合脉，才几乎没有错误，这就是此症之所以疑难的原因。方欲健脾理痰，恐怕燥剂有妨于津液；方欲养血生津，恐怕润剂有凝于中州。审其阴虚火旺者，应当以养血为急；脾伤阴盛者，应当以温补为先。更有忧恚盘礴，火郁闭结，神不大衰，脉犹有力，应当用仓公、河间之法下之。小小汤丸，累累加用，关扃自透。膈间痰盛，微微涌出，因而治下，药势易行。设或不行，蜜盐下导，始终勾引，自然宣通。这都是虚实阴阳的辨别，临症的权衡。
方约之说：丹溪说年高者不治。因为少年气血未虚，用药劫去痰火，病不复生；年高气血已虚，用药劫去痰火，虽得暂愈，其病复作。所以如此，是因为气虚不能运化而生痰，血虚不能滋润而生火。丹溪又说此症切不可用香燥药，服之必死，宜薄滋味。我曾有用霞天膏加入补虚药中治此症，一人则吐泻以去积血，一人则吐泻以去积痰，都获得病安思食。然而二人俱不能节戒，随即啖食肥甘，最终不能免病。殊不知此症挟虚，脾胃尚弱，肥甘难化，所以复病。霞天膏吐泻后，又宜用人参炼膏补之。
刘河间说：趺阳脉紧，内燥盛而温气衰。又紧而见涩，其血已亡。上脘亡血，膈间干涩，食不得入；下脘亡血，又并大小肠皆枯，食不得下，故难治。
张仲景论反胃脉症，问曰：病患脉数，数为热，当消谷引饮，而反吐者，何也？师曰：以其发汗，令阳脉微，膈气虚，脉乃数，数为客热，不能消谷，胃中虚冷也。脉弦者虚也，胃气无余，朝食暮吐，变为胃反。寒在于上，医反下之，令脉反弦，故名曰虚。
又说：寸口脉微而数，微则无气，无气则荣虚，荣虚则血不足，血不足则胸中冷。
这两条，仲景形容脉证之微妙。凡阳盛则数，阴盛则迟，其人阳气既微，何得脉反数？脉既数，何得胃反冷？此不可不察，求其故也。阳气微则荣虚，荣虚则不为阳守而浮为客热。阳气微则膈气虚，膈气虚则亦不能运阴而为胃冷。况医不知而反下之，致上下之阳俱损，其脉遂从阴而变为弦。因是上之阳不足，日中已前所食，亦不消化；下之阳不足，日暮已后，阳亦不入于阴，而糟粕亦不输于大小肠。故曰胃气无余，所以反胃而朝食暮吐也。盖人身之脉法天地，微则阳不健运，数则阴不尽翁，阴阳两乖其度，荣卫不充而胸中冷。荣卫本生于谷，能复消磨其谷，是荣卫非谷不充，谷非荣卫不化，胸中既冷，胃必不能出纳其谷，证成反胃，又何疑乎？东逸改注。
喻嘉言说：胸中之阳，如天之有日，其关系纳谷之道，最为扼要，此条所云是也。盖胸中下连脾胃，其阳气虚者，阴血亦必虚，但宜用冲和之剂，以平调脏腑，安养荣卫，舍纯粹以精之药不可用也。肾中之阳如断鳖立极，其关系命根存亡之机，尤为宏矩，后条四逆汤等是也。盖肾中内藏真阳，其阳外亡者，阴气必极盛，惟从事刚猛之剂，以推锋陷阵。胜阴复阳，非单刀直入之法，不可行也。
Zhu Danxi said: When Qi (vital energy) is initially diseased, its onset is very subtle. It may be due to slight dietary indiscretion; or external invasion by the Six Evils (wind, cold, summer-heat, dampness, dryness, fire); or internal injury by the Seven Emotions (joy, anger, worry, pensiveness, sorrow, fear, fright); or excessive richness in taste, which biases and assists Yang Qi, accumulating into Di Re (obstruction heat); or a constitution that is robust with dense exterior pores and no sweating; or an irritable temperament causing Fire to flare upward, leading to stagnation of Body Fluids and interference between Clear and Turbid Qi. Consequently, Qi becomes diseased, manifesting as distension or pain, loss of appetite, belching of putrid gas, acid regurgitation, indigestion, or abdominal fullness. If one does not investigate the root cause but instead administers acrid, aromatic, drying, and hot agents, temporary relief may be achieved. However, if rich food intake remains unregulated and the Seven Emotions continue to interact reciprocally, body fluids easily accumulate. Thus spreading, it progresses from Qi stagnation to accumulation, and from accumulation to Phlegm. This is the origin of Phlegm, Yin (fluid retention), and acid regurgitation. Without encountering a skilled physician and with erroneous medication continuing, Phlegm combines with Blood Stasis, forming "Ke Nang" (nidus-like stubborn lesions). This is the sequence leading to distension, pain, vomiting, Ye Ge (dysphagia/obstruction), Fan Wei (regurgitation/vomiting after eating).
When food and liquids stagnate and fail to move, the channels become obstructed. Stool may be constipated or loose. The lower part loses its function of transmission and transformation, causing further stagnation in the Middle Jiao. One seeks methods to warm the Spleen and strengthen the Stomach, eliminate accumulation, and move Qi, hoping for immediate effect. Yet, one fails to consider that the Stomach is the Sea of Water and Grain, abundant in Blood and Qi; only when clear and harmonious can it receive. The Spleen is the organ of digestion; only when clear and harmonious can it transport. If aromatic and drying agents bias the system, Qi and Blood will boil. Initially, Stomach fluids coagulate and cannot accept nourishment; over time, Spleen Qi dissipates, and transmission slows. Accumulated over a long period, Blood is exhausted, and the gastric region becomes dry and shriveled. If this dryness is located upper, near the throat, water and drinks can pass, but food is difficult to enter; this is named Ye (dysphagia). If the dryness is located lower, near the stomach, food may enter but cannot fully reach the stomach, and is vomited out after a long while; this is named Ge (obstruction), also called Fan Wei (regurgitation). Stool is scanty and hard, resembling sheep droppings.
Ancient formulas used Ren Shen (Ginseng Root) to tonify Lung Qi, Yu Mi (Poppy Seed) to resolve toxicity, Zhu Li (Bamboo Sap) to resolve Phlegm, Dang Gui (Angelicae Sinensis Radix) and Bai Shao (White Peony Root) to nourish Blood, Su Mi (Millet) to solidify the Stomach, honey water to moisten dryness, and Sheng Jiang (Fresh Ginger Rhizome) to remove turbidity. In such cases, pathogenic factors are easily subdued, and the disease resolves naturally. Zhang Jifeng also stated: Ye Ge is a disorder of the spirit and mind; only introspection and quiet cultivation can treat it. This statement deeply hits the mark of the pathology. Ye Ge arises from dryness of Blood. Yin governs stillness; if both interior and exterior are still, the Fire of the Zang-Fu organs will not arise, and the Metal and Water Qi will be nourished. Yin Blood will generate spontaneously, intestinal and gastric fluids will be moist, and transmission and transformation will be appropriate. How could there be Ye Ge?
Zhao Yangkui said: Zhu Danxi’s discussion is profound, but unfortunately lacks clear differentiation. Moreover, he focuses mainly on moistening Blood without directly exploring the source of congenital essence in the Kidney. Therefore, his prescriptions add cow or goat milk to Si Wu Tang (Four Substance Decoction), along with Zhu Li (Bamboo Sap) and Jiu Zhi (Chinese Chives Juice) to transform Phlegm and resolve Stasis. These treat the branch but not the root. The *Nei Jing* states: "Obstruction of the Three Yin meridians is called Ge." The Three Yang meridians are the Large Intestine, Small Intestine, and Bladder. The Large Intestine governs Jin (thin fluids). The Small Intestine governs Ye (thick fluids). Heat obstruction in the Large Intestine leads to depletion of Jin; heat obstruction in the Small Intestine leads to dryness of Ye. The Bladder is the official of the capital, storing fluids; heat obstruction in the Bladder leads to exhaustion of fluids. However, why do the Three Yang meridians result in heat obstruction? All are diseases of the Kidney. The Kidney governs the Five Fluids and controls urination and defecation. Once Kidney Water is dry, Yang Fire becomes dominant, simmering and consuming fluids. Heat obstruction in the Three Yang meridians leads to blockage of both anterior and posterior orifices. Since the lower pathway is blocked, Qi must rebel upward, directly invading the clear pathways and rushing up to Xi Men (the inlet of the throat), causing dysphagia where food cannot go down. Why can water and drinks enter, but food cannot? Food enters Yin and generates Qi in Yang, thereby stirring up the Fire in the stomach opening, making entry difficult. Water belongs to Yin, sharing the same affinity, so it can enter. Vomiting white foam indicates that the ingested water is boiling and rising. Feces resembling sheep droppings indicate that little food was ingested, residues were completely consumed, and the intestines became dry, small, and narrow. This condition mostly affects those over fifty years old, whose innate vitality has ceased, leaving only isolated Yang. Treatment must focus primarily on nourishing Yin. Wang Taipu said: "Food immediately vomited out indicates lack of Water; food vomited after reflux indicates lack of Fire." For lack of Water, strengthen the master of Water; for lack of Fire, benefit the source of Fire. Chu Shizhong said: "Treat upper disorders by addressing the lower; use Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) in large doses, decocted and drunk for a long time, to save one or two out of ten cases." One must also abstain from sexual activity and maintain a bland diet. If one says "warm the Stomach," the Stomach is originally not cold; if one says "tonify the Stomach," the Stomach is originally not deficient. If one says "open depression," acrid and drying herbs merely assist Fire; nothing is better than nourishing Yin, upon which the false flame extinguishes itself.
Regarding Fan Wei (regurgitation), Dong Yuan’s writings state that vomiting has three syndromes: Qi, Accumulation, and Cold. Vomiting from the Upper Jiao stems from Qi; from the Middle Jiao from Accumulation; from the Lower Jiao from Cold. If the pulse is deep and slow, evening meal vomited in the morning, or morning meal vomited in the evening, urination is free, but stool is closed, this is Lower Jiao vomiting. The method should be to open the closure and warm the Cold. From this, we see that Lower Jiao vomiting is due to decline of Ming Men (Gate of Life) Fire, like a pot without fuel at the bottom, unable to steam and rot the water and grain in the Stomach. Abdominal distension forces vomiting. Wang Taipu’s statement that "food vomited after reflux indicates lack of Fire" is correct. One must benefit the source of Fire, first using Ba Wei Wan (Eight-Ingredient Pill) to tonify Ming Men Fire, thereby saving the Mother of Earth (Spleen), and subsequently using Fu Zi Li Zhong Tang (Aconite Decoction to Regulate the Middle) to regulate the Middle Jiao. This ensures complete success.
Li Shicai said: Ye Ge mostly belongs to Heat, while Fan Wei mostly belongs to Cold, but one must not be rigid. If the pulse is large and forceful, treat as Heat; if small and weak, treat as Cold. Yellowish-white and withered complexion indicates Cold and Deficiency; reddish and lustrous complexion indicates Excess Heat. Correlating pulse with symptoms and color with pulse minimizes error. This is why this disease is difficult. One wishes to invigorate the Spleen and resolve Phlegm, fearing that drying agents may harm Body Fluids; one wishes to nourish Blood and generate fluids, fearing that moistening agents may congeal in the Middle Jiao. If Yin Deficiency with Fire Hyperactivity is diagnosed, nourishing Blood is urgent. If Spleen Injury with Yin Excess is diagnosed, warming and tonifying come first. In cases of grief and indignation causing Fire depression and closure, where Spirit is not significantly depleted and the pulse still has force, one should use the purgative methods of Cang Gong and He Jian. Small decoctions and pills should be administered repeatedly until the obstructions penetrate. If Phlegm is abundant in the chest diaphragm and slightly expectorated, treating the lower allows medicinal power to flow easily. If it still does not work, use honey and salt to guide downward, continuously attracting and promoting natural unblocking. These are all distinctions between Empty and Full, Yin and Yang, serving as criteria for clinical judgment.
Fang Yuezhi said: Danxi claimed that elderly patients are incurable. Because in youth, Qi and Blood are not yet deficient; using drugs to劫 (rob/clear) Phlegm and Fire results in no recurrence. In old age, Qi and Blood are already deficient; using drugs to rob Phlegm and Fire may bring temporary relief, but the disease recurs. The reason is that Qi Deficiency fails to transform and generates Phlegm, while Blood Deficiency fails to moisten and generates Fire. Danxi also said this disease must never be treated with acrid and drying herbs, as taking them leads to death; a bland diet is suitable. I once used Xia Tian Gao (Cloud Sky Paste) added to deficiency-tonifying medicines to treat this condition. One patient vomited and had diarrhea to expel accumulated Blood; another did so to expel accumulated Phlegm. Both recovered appetite. However, neither observed dietary restrictions, subsequently consuming rich and sweet foods, leading to relapse. They did not realize that this disease involves Deficiency, and the Spleen and Stomach are still weak; rich and sweet foods are hard to digest, hence the recurrence. After Xia Tian Gao induces vomiting and diarrhea, Ren Shen (Ginseng Root) paste should be used to tonify.
Liu Hejian said: A tight pulse at the Fu Yang position indicates internal dryness abundance and decline of warm Qi. If tight and choppy, Blood has been lost. If Blood is lost in the Upper Wan (epigastrium), the chest diaphragm becomes dry and rough, preventing food entry; if Blood is lost in the Lower Wan, and the Large and Small Intestines are also withered, food cannot descend, making it difficult to treat.
Zhang Zhongjing discussed the pulse and symptoms of Fan Wei: Question: If a patient has a rapid pulse, indicating Heat, which should consume grain and increase thirst, yet vomits instead, why? Master said: Due to sweating, Yang pulses became faint, Diaphragm Qi became deficient, resulting in a rapid pulse. Rapid indicates guest Heat, inability to consume grain, and Cold deficiency in the Stomach. A wiry pulse indicates Deficiency; with no surplus Stomach Qi, morning meal vomited in the evening transforms into Wei Fan (Stomach reversal). Cold is above, but the doctor erroneously purged, causing the pulse to become wiry, thus named Deficiency.
Also said: At Cun Kou (Radial artery), if the pulse is faint and rapid, faint indicates lack of Qi; lack of Ying (Nutrient) Qi leads to Ying Deficiency; Ying Deficiency leads to insufficient Blood; insufficient Blood leads to Cold in the Chest.
These two passages describe the subtlety of pulse and symptomatology by Zhongjing. Generally, Yang excess causes rapidity, Yin excess causes slowness. If Yang Qi is already faint, how can the pulse be rapid? If the pulse is rapid, how can the Stomach be cold? This must be examined to find the cause. Faint Yang leads to Ying Deficiency; Ying Deficiency means it is not guarded by Yang and floats as Guest Heat. Faint Yang leads to Diaphragm Qi Deficiency; Diaphragm Qi Deficiency means it cannot transport Yin, resulting in Cold Stomach. Moreover, if the doctor does not understand and erroneously purges, damaging both Upper and Lower Yang, the pulse changes from Yin to wiry. Due to insufficient Upper Yang, food eaten before noon is not digested; due to insufficient Lower Yang, after dusk, Yang does not enter Yin, and waste is not transported to the Large and Small Intestines. Thus, "no surplus Stomach Qi," leading to Fan Wei and morning meal vomited in the evening. Human pulses follow Heaven and Earth; faint indicates Yang does not transport vigorously, rapid indicates Yin does not gather completely. Yin and Yang deviate from their norms, Ying and Wei are insufficient, leading to Cold in the Chest. Ying and Wei originate from Grain and help digest it; Ying and Wei are not filled without Grain, and Grain is not transformed without Ying and Wei. With Cold in the Chest, the Stomachi cannot receive or discharge Grain. Once Fan Wei syndrome forms, what doubt remains? Note revised by Dong Yi.
Yu Jiayan said: Yang in the Chest is like the Sun in the sky; its relation to the pathway of receiving grain is crucial, as described in this passage. The Chest connects downward to the Spleen and Stomach; if Yang Qi is deficient, Yin Blood must also be deficient. Only mild and harmonizing agents should be used to balance the Zang-Fu organs and nourish Ying and Wei. Pure and refined medicines must be used. Yang in the Kidney is like the axis of the world; its relation to the survival of the life root is particularly significant, as seen in the later passage regarding Si Ni Tang (Frigid Extremities Decoction). The Kidney stores True Yang internally; if Yang escapes outward, Yin Qi becomes extremely abundant. Only fierce and potent agents can push forward and defeat the enemy. To overcome Yin and restore Yang, direct and penetrating methods are required.