典藏书目

The *Pathogenesis* states that treating vomiting involves three pathogens: Qi (vital energy), Accumulation (stagnation of food or phlegm), and Cold. All should be differentiated according to the Triple Burner (San Jiao, the functional system of upper, middle, and lower jiao). Vomiting from the Upper Burner stems from Qi. Qi belongs to the Yang of Heaven. The pulse is floating and surging. Symptoms include violent vomiting immediately after eating, thirst with desire for water, dry and constipated stool, Qi rushing upward to the chest causing pain. The treatment method should be to descend Qi and harmonize the Middle Jiao. Vomiting from the Middle Burner stems from Accumulation, which can be Yin or Yang. Food and Qi intertwine to form an accumulation causing pain. The pulse is floating and subtle/restrained. Symptoms may present as pain followed by vomiting, or vomiting followed by pain. The treatment method should use slightly toxic drugs to remove the accumulation, employing Areca Seed (Binglang) and Costus Root (Muxiang) to move Qi. Vomiting from the Lower Burner stems from Cold, corresponding to the Earthly Yin. The pulse is deep and slow. Symptoms include vomiting food eaten in the morning in the evening, or food eaten in the evening in the morning; clear urine, and constipation with blockage. The treatment method should use potent drugs to open the blockage and warm the cold Qi. Once the stool gradually becomes unblocked, use medicines for the Middle Burner to harmonize, ensuring the stool does not become dry again, and it will heal itself.

Commentary: This method divides vomiting into three treatments. The Upper Burner is Yang, and Yang governs Heat. The Lower Burner is Yin, and Yin governs Cold. The Middle Burner is the boundary where Cold and Heat are mixed, containing both Yin and Yang. This is a general principle. Generally, because those with pathology above vomit violently immediately after eating, and those below vomit only after food has stayed for a long time, the distinction between "immediate" and "delayed" serves as the basis for distinguishing Cold and Heat. It is difficult to simply distinguish Cold and Heat solely by location. Wang Bing said: "Food cannot enter indicates Fire; food enters but comes back out indicates no Fire." This agrees with the above. Furthermore, the *Yuan Bing Shi* states: "Vomiting and overflowing, inability to eat, is due to Fire Qi flaring upward, excessive heat in the Stomach and Diaphragm, leading to abnormal transmission and transformation."

Zhu Danxi said: Some say the stomach lining is dry and withered; can this treatment be used? I say: Ancient formulas use Ginseng (Renshen) to tonify Lung, Rice (Jingmi) to detoxify, Bamboo Sap (Zhuli) to clear Phlegm, Dried Ginger (Ganjiang) to nourish Blood, Millet (Sumi) to solidify the Stomach, and Honey (Fengmi) to moisten dryness. This embodies exactly this intent. Zhang Jifeng also said: Dysphagia (Ye) should be considered a disease of the spirit/mind; only introspection and self-nurturing can cure it. This statement deeply hits the nature of the disease, and the treatment method is reasonable. Dysphagia arises from dry Blood. Blood is Yin Qi, and Yin governs stillness. If internal and external conditions are still, the Fire of the Zang-Fu organs does not arise, and the Qi of Metal (Lung) and Water (Kidney) prevails. Yin Blood naturally generates, intestinal and gastric fluids moisten, and transmission functions are appropriate. How could there be dysphagia? Extending this logic, I once formulated a prescription to treat a middle-aged woman using Si Wu Tang (Four Substances Decoction) added with White Tangerina Peel (Baichenpi - peel left with tips removed), Peach Kernel (Taoren), Raw Licorice Root (Sheng Gancao), and Safflower (Honghua) soaked in wine. It was decocted strongly and drunk with Donkey Urine (Lv Niao) to prevent potential parasite growth. After dozens of doses, she recovered. Also, a craftsman from Taizhou, only thirty years old, diligent in work, widowed, and fond of alcohol, had a pale complexion. His pulse was choppy; when pressed heavily, it was large but powerless. I advised him to resign from his duties and stay at a farmhouse, taking fresh, warm cow's milk, sipping it slowly. Each time he finished one cup, five to seven times a day, consuming no other food. Gradually increasing to eight or nine times a day. After half a month, his stool became moist; after more than a month, he recovered. If he felt dry mouth, he drank a little Sugarcane Juice because the Alcohol Toxicity had not cleared. Someone else asked: Why do ancient formulas for dysphagia always mention Cold? I say: Ancient physicians created formulas specifically for the diseases prevalent at that time. The actual condition was indeed caused by Cold, so they were effective. It was not meant to be a fixed rule. However, nowadays, people contracting this illness mostly suffer from long-standing Phlegm and Qi stagnation, transformed by medical treatments, clearly lacking Cold.

Carefully noted: Regurgitation (Fan Wei) initially may arise from irregular diet causing Phlegm-Fluid retention, or from excessive emotional stress causing deficiency in the Spleen and Stomach. Ancient formulas did not investigate the cause, labeling all as Cold, and treated them with aromatic, drying, and hot drugs. These drugs can only drive out Cold pathogens and move stagnant Qi; how can they dispel dietary and Phlegm accumulations? They may even intensify the Fire of emotions and consume the Yin of the Spleen and Stomach. Thus, drugs assist the pathogen, making the condition increasingly entrenched. Mr. Danxi explained this in detail. Treating this disease: Throat obstruction and chest fullness seem like Qi stagnation, but some result from excessive consumption of Qi-consuming drugs leading to failure of Middle Qi movement; these require Qi tonification for natural movement. Dry stool resembling sheep droppings seems like Blood Heat, but some result from excessive purgative drugs depleting Blood, causing further constriction; these require Blood tonification and moistening for natural passage. Some have Fire rebelling upward, preventing food intake, with a surging, forceful, and rapid pulse; or Phlegm-Fluid obstruction with a knotted and choppy pulse; these require clearing Phlegm and draining Heat, so the Fire descends naturally. Some have decline of Spleen-Stomach Yang Qi, with a deep, thin, and faint pulse; these require aromatic-warming drugs to warm Qi, primarily focusing on nourishing Yin and benefiting the Stomach, unlike the *Ju Fang* which focuses solely on drying and acrid-hot properties. As for those who do not observe dietary restrictions, consume rich flavors, engage in sexual excess, and the elderly without Blood, they cannot be cured.