（二）
肿胀症。以疏凿饮子舟车丸为禁剂。济生肾气丸。胀症亦须慎用。
食不得入。昔医名噎。食虽入咽。及带痰涎吐出为膈。朝食暮吐暮食朝吐。名翻胃。丹
溪主血液俱耗。噎为上稿。膈为下稿。以四物汤。加甘蔗汁芦根汁牛乳之类为主。薛立斋谓
怫郁伤脾。以逍遥散左金丸归脾汤六君子汤之类。与六八味丸间服。赵养葵充其说。而归于
治肾。以内经谓肾乃胃之关。关门不利。升降息矣。关即气交之中天之枢也。故肾旺则胃阴
充。胃阴充则能食。以大剂六味汤八味汤为主。时贤高鼓峰杨乘六宗其法。而变通之。专取
阳明。
以六味汤。去丹泽伏苓。加甘草枸杞生地当归。总使一派甘润之药。以养胃阴。胃阴上
济。则贲门宽展。而饮食进。胃阴下达。则幽门阑门滋润。而二便通。十余剂可愈。入镜经。
主内经三阳结谓之隔一语。大变其法。以隔食之人。五七日不大便。陈物不去。则新物不纳。
以三一承气汤节次下之。后用芝麻饮啜之则愈。此数法。皆从金匮大半夏汤中甘润蜜水得来。
而却遗去仲景以半夏为主而降冲脉之逆。人参为辅而生既亡之液之义。学人必于此而得其梧
机。而又审其寒热虚实而施治。则于噎膈之道。思过半矣。至于食入反出。是中焦土寒。下
焦火虚。以附子理中汤香砂六君子汤。加干姜八味地黄丸。间服多效。○若食不得入。必以
黄连黄苓人参干姜汤为主。泻心汤亦妙。○瘀血在膈。饮热汤及食椒姜而呃者。宜加桃仁红
花之类。○吴茱萸汤。不论噎膈反胃皆可用。唯以呕而胸满为的证。干呕吐涎沫头痛。亦为
的证。脉浮缓而滑。沉缓而长。皆可治。弦涩短小。为难医。
（二）
肿胀病。疏凿饮子、舟车丸属于禁忌使用的方剂。济生肾气丸治疗胀病时也须谨慎使用。
食物无法咽下，古代医生称之为“噎”。食物虽然进入咽喉，但随即带着痰涎吐出，称为“膈”。早晨吃晚上吐，或晚上吃早晨吐，称为“翻胃”（反胃）。朱丹溪主张这是血液与阴液俱耗所致，“噎”是上焦干枯，“膈”是下焦干枯。以四物汤（补血调血的基础方），加入甘蔗汁、芦根汁、牛乳等甘润之品作为主方。薛立斋认为这是由于情志怫郁损伤了脾气，主张使用逍遥散、左金丸、归脾汤、六君子汤等方剂，并与六味丸、八味丸交替服用。赵养葵充实了这一理论，最终归结为治疗肾脏。依据《黄帝内经》所说“肾乃胃之关”，如果关门不利，升降之气就会停止。“关”即气交之中天的枢纽。所以肾气旺盛则胃中阴液充足，胃阴充足则能进食。以大剂量六味地黄汤、八味地黄汤为主方。当代贤者高鼓峰、杨乘六遵循这一法则并加以变通，专门取法阳明经。
采用六味地黄汤，去掉牡丹皮、茯苓、泽泻，加入甘草、枸杞、生地、当归，总使药物呈现一派甘润的性质，以滋养胃阴。胃阴上济，则贲门宽展，饮食得以进入；胃阴下达，则幽门、阑门得到滋润，二便通畅。服用十余剂即可痊愈。叶天士（叶氏）依据《黄帝内经》“三阳结谓之隔”这句话，彻底改变了治疗方法。对于噎食之人，若五到七天不大便，陈积之物不去，则新物无法纳入。使用三一承气汤分阶段攻下，之后用芝麻饮饮用则可痊愈。这些方法，都是从《金匮要略》大半夏汤中甘润蜜水的治法得来，但却遗漏了张仲景以半夏为主药以降冲脉之逆气，以人参为辅药以生已亡之津液的深意。学习者必须在此领悟其关键机理，并且审察疾病的寒热虚实而施治，那么对于噎膈病的诊治，就掌握了一半以上的要领了。至于食物吃进去又反吐出来，这是中焦土寒，下焦火虚。使用附子理中汤、香砂六君子汤，配合干姜、八味地黄丸交替服用，多有效验。○如果食物完全无法咽下，必须以黄连、黄芩、人参、干姜汤（辛开苦降法）为主方。泻心汤也很妙。○如果有瘀血在膈间，喝热汤及吃椒姜后出现呃逆的，适宜加入桃仁、红花之类活血化瘀药。○吴茱萸汤，不论噎膈还是反胃都可以使用，唯独以呕吐且胸满为确切的证候，干呕、吐涎沫、头痛，也是确切证候。脉象浮缓而滑，沉缓而长，都可以治疗。脉象弦涩短小，则难治。
(2)
Edema and distension disorders. Shuozao Yinzi (Boat-Rowing Decoction) and Zhouche Wan (Cart-and-Wheel Pill) are contraindicated. Jisheng Shenqi Wan (Kidney-Qi Pill for Sicknesses by the Sage) must also be used with caution in treating distension disorders.
Inability to swallow food was termed "Ye" (Dysphagia/Choking) by ancient physicians. If food enters the throat but is immediately vomited up along with phlegm and saliva, it is termed "Ge" (Regurgitation). Vomiting what was eaten in the morning in the evening, or what was eaten in the evening in the morning, is termed "Fanwei" (Reverse Stomach/Regurgitation). Zhu Danxi advocated that this condition results from the depletion of both blood and yin fluids. "Ye" refers to dryness in the upper jiao, while "Ge" refers to dryness in the lower jiao. The primary treatment involves Siwu Tang (Four Substances Decoction), supplemented with sweet substances such as sugarcane juice, reed rhizome juice, and cow's milk. Xue Lizhai attributed this to emotional stagnation injuring the spleen qi, recommending formulas such as Xiaoyao San (Free and Easy Wanderer Powder), Zuojin Wan (Left Metal Pill), Guipi Tang (Restore the Spleen Decoction), and Liujunzi Tang (Six Gentlemen Decoction), administered alternately with Liuwei Wan (Six-Ingredient Pill with Rehmannia) or Bawei Wan (Eight-Ingredient Pill). Zhao Yangkui expanded upon this theory, ultimately attributing the root cause to kidney pathology. Citing the *Huangdi Neijing* (Yellow Emperor's Inner Canon): "The Kidney is the gate of the Stomach." If the gate functions improperly, the ascending and descending movements of qi cease. This "gate" corresponds to the pivot of heaven within the intersection of qi. Therefore, when kidney qi is robust, stomach yin fluids are sufficient; when stomach yin is sufficient, one can eat. The main treatment employs large doses of Liuwei Dihuang Tang (Six-Ingredient Rehmannia Decoction) and Bawei Dihuang Tang (Eight-Ingredient Rehmannia Decoction). Contemporary scholars such as Gao Gufeng and Yang Chengliu followed this methodology and adapted it, focusing specifically on the Yangming channel.
The prescription uses Liuwei Dihuang Tang, removing Mudanpi (Cortex Moutan), Fuling (Poria), and Zexie (Rhizoma Alismatis), and adding Gancao (Radix Glycyrrhizae), Gouqi (Fructus Lycii), Shengdi (Radix Rehmanniae Preparata), and Danggui (Radix Angelicae Sinensis). The goal is to employ a regimen of moistening and sweet-natured herbs to nourish stomach yin. When stomach yin ascends to nourish the upper part, the cardia relaxes and expands, allowing food intake; when stomach yin descends to nourish the lower part, the pylorus and ileocecal valve become moistened, facilitating the passage of stool and urine. Recovery can be expected after approximately ten doses. Ye Tianshi (Ye Gui), interpreting the *Neijing* statement "When the three yang channels are knotted, it is called Ge," radically altered this approach. For patients with dysphagia who have not had a bowel movement for five to seven days, accumulated waste prevents the acceptance of new food. Treatment involves administering Sanyi Chengqi Tang (Three-One Purging Decoction) in stages to purge accumulation, followed by Sesame Drink until recovery. These methods are derived from the moistening honey-water principle found in Banxia Xiexin Tang (Banxia Heart-Purging Decoction) in the *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet), yet they overlook Zhang Zhongjing's intent: using Banxia (Rhizoma Pinelliae) as the chief herb to descend rebellious Chong vessel qi, and Renshen (Radix Ginseng) as the assistant to generate lost fluids. Practitioners must grasp this key mechanism here and apply treatment based on an assessment of cold, heat, deficiency, and excess. In doing so, they will master more than half of the principles regarding the treatment of Ye and Ge. As for food being ingested and then regurgitated, this indicates cold in the middle jiao (spleen/stomach earth) and deficiency fire in the lower jiao. Attuzi Lizhong Tang (Aconite Center-Regulating Decoction) and Xiangsha Liujunzi Tang (Aromatic-Amomum Six Gentlemen Decoction), taken alternately with Ganjiang (Rhizoma Zingiberis) and Bawei Dihuang Wan (Eight-Ingredient Rehmannia Pill), often prove effective. ○ If food cannot enter at all, the primary formula should be Huanglian Huangqin Renshen Ganjiang Tang (Coptis, Scutellaria, Ginseng, and Ginger Decoction), which utilizes a bitter-cold and acrid-warm combination to open and purge; Xiexin Tang (Heart-Purging Decoction) is also excellent. ○ If there is blood stasis in the diaphragm region, and hiccups occur after drinking hot liquids or eating pepper and ginger, herbs such as Taoren (Semen Persicae) and Honghua (Flos Carthami) should be added to invigorate blood and resolve stasis. ○ Wuzhuyu Tang (Evodia Decoction) can be used for both Ye/Ge and Fanwei, specifically indicated for symptoms of vomiting accompanied by chest fullness, or dry heaving, spitting of clear saliva, and headache. A pulse that is floating, moderate, and slippery, or deep, moderate, and long, indicates treatability. A pulse that is wiry, choppy, short, and small indicates a difficult prognosis.