噎膈反胃，多因于内伤，忧郁失志，及恣意酒食，纵情劳役，以致阳气内结，阴血内
枯而
成也。经云∶三阳结谓之膈，三阳，手太阳小肠、手阳明大肠、足太阳膀胱也。盖小肠热结
，则小水短少，而火气不泄；大肠热结，则大解不利，而郁热难除；膀胱热结，则津液不充
，而道路蹇涩；三阳并结，则前后之气不行。下既不行，则火邪上逆。气火上逆，则痰涎愈
生。痰涎生则往来之气愈阻，而呕逆噎膈之证起矣。且也重伤之以七情，更感之以六气。或
不戒炙爆肥腻之物；或妄投辛香燥热之剂，遂使火邪愈炽，津液枯，痰涎愈结，病情愈深，
岂易
疗哉？须分上中下三焦以治之。夫咽嗌梗塞，气不顺行，水饮可行，食物难入，其槁在吸门
，名之曰膈。其或食下则胃脘作痛。烦闷不安，须臾吐出，食出而安，其槁在贲门，名之曰
噎。噎者属上焦，其或食虽可下，良久复出。槁在幽门，名曰反胃，亦曰胃反，此属中焦
。其或朝食暮吐，暮食朝吐，所出完谷，小便赤，大便难，或如羊矢，其槁在阑门，亦名反
胃。上属下焦。然壮者犹或可治，当用透膈疏气，化痰清火，健胃和脾之剂。经又曰∶噎膈
多生于血干，反胃亦生于脾弱。东垣曰∶脾、阴也，血亦阴也，阴主静，内外两静，则脏腑
之火何由而生？金水二脏有养，阴血自生，肠胃津液传化合宜，噎膈反胃之有哉？
噎膈（吞咽困难、胸膈阻塞）和反胃（食入即吐或朝食暮吐），多因内伤所致，如忧郁失志，以及恣意饮酒饮食，纵情劳役，导致阳气在内结聚，阴血在内枯竭而形成。经典记载说：三阳经气结滞称为膈证，所谓三阳，是指手太阳小肠经、手阳明大肠经、足太阳膀胱经。大概小肠热结，则小便短少，而火气不得宣泄；大肠热结，则大便不利，而郁积之热难以清除；膀胱热结，则津液不充盛，而通道艰涩不畅；三阳经气并结，则前后二便之气机不通。下部既不通畅，则火邪上逆。气火向上冲逆，则痰涎更加滋生。痰涎产生则往来气机更加阻滞，于是呕吐、逆气、噎膈的病症就产生了。况且又重伤于七情（喜、怒、忧、思、悲、恐、惊），更感受六气（风、寒、暑、湿、燥、火）之邪。或者不戒除炙烤爆裂肥腻之物；或者妄用辛香燥热的药剂，致使火邪更加炽盛，津液枯竭，痰涎更加凝结，病情日益深重，难道容易治疗吗？必须分上、中、下三焦来治疗。咽喉梗塞，气机不顺行，水饮可以下行，食物难以下咽，其病变部位在吸门（会厌处），名为膈证。有的进食后胃脘作痛，烦闷不安，片刻后吐出，食物吐出后则安宁，其病变部位在贲门（胃上口），名为噎证。噎证属于上焦。有的虽然食物可以咽下，但良久之后又复出，其病变部位在幽门（胃下口），名为反胃，也称为胃反，此属中焦。有的早晨吃晚上吐，晚上吃早晨吐，吐出的食物是完谷（未消化的食物），小便赤黄，大便困难，或者像羊屎一样干结，其病变部位在阑门（大小肠交界处），也名为反胃。这属于下焦。然而身体强壮者或许还可以治疗，应当使用透膈疏气、化痰清火、健胃和脾的方剂。经典又说：噎膈多生于血枯，反胃也生于脾弱。李东垣说：脾属阴，血也属阴，阴主静，内外都安静，那么脏腑之火从何而生？如果肺金和肾水两脏得到滋养，阴血自然生成，肠胃津液传输化合适宜，怎么会有噎膈反胃呢？
Yige (dysphagia with chest obstruction) and Fanwei (regurgitation of food, either immediately after eating or morning/evening vomiting), are mostly caused by internal injury, such as depression and loss of will, as well as indulgence in alcohol and diet, and excessive labor, leading to the internal accumulation of Yang Qi and the internal depletion of Yin Blood. The Classics state: "Accumulation in the Three Yang meridians is called Ge syndrome." The so-called Three Yang refer to the Hand-Taiyang Small Intestine Meridian, the Hand-Yangming Large Intestine Meridian, and the Foot-Taiyang Bladder Meridian. Generally, if there is heat accumulation in the Small Intestine, urine becomes scanty, and Fire Qi cannot be vented; if there is heat accumulation in the Large Intestine, defecation is difficult, and stagnant heat is hard to eliminate; if there is heat accumulation in the Bladder, body fluids are insufficient, and pathways become obstructed and rough; when the Qi of the Three Yang meridians accumulates together, the Qi mechanism of the anterior and posterior orifices fails to circulate. Since the lower part does not flow smoothly, Fire Evil rebels upward. When Qi and Fire rebel upward, phlegm-saliva is further generated. Once phlegm-saliva is produced, the circulating Qi mechanism becomes more obstructed, thus giving rise to symptoms of vomiting, rebellious Qi, Yige, and Fanwei. Moreover, severe injury from the Seven Emotions (Joy, Anger, Worry, Pensiveness, Sorrow, Fear, Fright) combined with contraction of the Six Qi (Wind, Cold, Summer-heat, Dampness, Dryness, Fire). Or failure to abstain from roasted, fried, and fatty foods; or reckless administration of acrid, aromatic, dry, and hot agents, causing Fire Evil to become even more blazing, body fluids to wither, and phlegm-saliva to coagulate further, making the condition deeper and harder to treat. Treatment must differentiate between the Upper, Middle, and Lower Jiao (Triple Burner). If there is blockage in the throat and epiglottis, Qi does not move smoothly, water and drinks can pass, but food is difficult to enter, the lesion is at Xi Men (the glottis/epiglottis area), named Ge syndrome. If pain occurs in the epigastrium after swallowing food, accompanied by restlessness and discomfort, followed by vomiting after a moment, with relief after vomiting, the lesion is at Ben Men (the cardia/gastric inlet), named Ye syndrome. Ye syndrome belongs to the Upper Jiao. If food can be swallowed but regurgitates after a long time, the lesion is at You Men (the pylorus/gastric outlet), named Fanwei, also called Weifan, which belongs to the Middle Jiao. If food eaten in the morning is vomited in the evening, or food eaten in the evening is vomited in the morning, with undigested food expelled, red urine, difficult defecation, or stool resembling sheep droppings, the lesion is at Lan Men (the junction of the small and large intestines), also named Fanwei, belonging to the Lower Jiao. However, those with strong constitution may still be treatable, using formulas that penetrate the diaphragm, soothe Qi, resolve phlegm, clear fire, strengthen the stomach, and harmonize the spleen. The Classics further state: "Yige often arises from blood dryness, and Fanwei also arises from spleen weakness." Li Dongyuan said: "The Spleen is Yin, and Blood is also Yin. Yin governs stillness. If both internal and external states are still, how would Fire of the Zang-Fu organs arise? If the Metal (Lung) and Water (Kidney) organs are nourished, Yin Blood will naturally generate, and the transmission and transformation of gastrointestinal fluids will be appropriate, thus preventing Yige and Fanwei."