【内伤噎隔之症】饮食之间，渐觉难下，或下咽稍急，即噎胸前。如此旬月，日甚一
日，渐至每食必噎，只食稀粥，不食干粮，此内伤噎隔之症也。
【内伤噎隔之因】平素忧愁郁结，五志之火皆动，日夜煎熬，津液干涸，或膏粱浓味
，辛辣炙 ，恣意不谨，积热消阴，二者皆成噎隔反胃之因也。
【内伤噎隔之脉】多见沉涩；左寸沉涩，心血枯；左关沉涩肝血竭；尺脉沉涩肾水虚；
右关沉涩脾阴绝；胃脉沉涩胃汁干；胃汁干兮肠亦结。
【内伤噎隔之治】宜生津养胃，二母二冬汤，虚者生脉散，加养血之药；若凝窒已久
，痰涎聚结于胃脘，不可用凝滞之药，先用清痰清火，开豁化痰，《金匮》麦门冬汤，冲竹沥、姜汁
、芦
几次，如大肠结硬，略加玄明粉；津液干枯，承气不可用；若膏粱积热，本元旺者，承气汤或
二母二冬汤
知母 贝母 麦门冬 天门冬
家秘痰多，暂加青黛、海石；肠枯，暂加当归、芍药；气凝痰滞，暂加半夏、香附，以
行本方之滞，此不得已，暂服二三剂可也。
生脉散 见前肺嗽。
四顺饮 见前肺嗽。
《金匮》麦门冬汤
麦门冬 半夏 人参 粳米 甘草 橘红
承气汤
枳壳 浓朴 大黄 甘草
桢按∶膈气呕吐，噎隔呕吐，同一呕吐也，而其原不同，其治天壤。夫方书所谓膈气呕
吐者，即《内经》气为上膈之一条也；所谓噎隔呕吐者，即《内经》三阳结为隔之一条也。
膈气呕吐，有寒有热者也；噎隔呕吐，有热无寒者也。
噎隔外感者易治，以其暂得燥热，不过清之。内伤者难治，以其阴精内竭，一时难复。
然尚有轻重，初病者，痰涎未起，可用滋阴；久病者，必强其饮食，以致吐干胃汁，若误投
燥热，燥极反见湿象，必至痰涎上涌，热极反见寒象，必至冷气上冲，如是则滋阴凝滞不服
，详论首卷总论中，细玩则得之矣。第一要饮食得法，一起忌食干粮辛辣，竟吃酥粥牛乳，
及淡腐浆等，小口慢咽渐润，胃管开通，然后咽下；若吃荤腥，但可慢火煮烂，竟吃浓汁，
切不可吃有形硬块，治以养阴滋血汤等。夫医者止论用药，谁知治隔症，反在饮食得法，例
如饮食伤胃，必要饮食小心；劳动损伤，必要咽津静养，方可挽回也。
【内伤噎隔的症状表现】在饮食过程中，逐渐感觉吞咽困难，或者吞咽稍急时，食物就会哽阻在胸前。像这样经过一个月左右，病情一天比一天加重，逐渐发展到每顿饭都会发生哽噎，只能喝稀粥，不能吃干粮，这就是内伤噎隔的症状。
【内伤噎隔的病因】平时忧愁郁结，导致五志之火（喜、怒、忧、思、恐所化之热）皆动，日夜煎熬身体，致使津液干涸；或者是长期食用肥甘厚味、辛辣炙烤之物，饮食不节制，造成积热消耗阴精。这两种情况都会成为形成噎隔和反胃的原因。
【内伤噎隔的脉象】多见沉涩脉；左寸脉沉涩，表示心血枯竭；左关脉沉涩，表示肝血耗尽；尺脉沉涩，表示肾水虚弱；右关脉沉涩，表示脾阴断绝；胃脉沉涩，表示胃汁干枯；胃汁干枯则肠道也会结滞不通。
【内伤噎隔的治疗】应当生津养胃，使用二母二冬汤；体质虚弱的用生脉散，加入养血药物；如果气机凝滞已久，痰涎聚结于胃脘部，不可使用滋腻停滞的药物，应先用清化痰火、开豁化痰的方法，《金匮要略》中的麦门冬汤，冲服竹沥、姜汁、芦根汁，服用几次后，如果大肠结硬，稍微加入玄明粉；如果津液干枯，承气汤不可用；如果是膏粱积热且本元旺盛者，可用承气汤或二母二冬汤（方药组成：知母、贝母、麦门冬、天门冬）。朱丹溪家传秘法：痰多时，暂时加入青黛、海浮石；肠燥枯涩时，暂时加入当归、芍药；气凝痰滞时，暂时加入半夏、香附，以行本方之滞，这是不得已而为之，暂服二三剂即可。
生脉散 见前文肺嗽章节。
四顺饮 见前文肺嗽章节。
《金匮要略》麦门冬汤（方药组成：麦门冬、半夏、人参、粳米、甘草、橘红）
承气汤（方药组成：枳壳、浓朴、大黄、甘草）
桢按语：膈气呕吐与噎隔呕吐，虽然都是呕吐症状，但其病因不同，治疗方法也天差地别。所谓方书中提到的“膈气呕吐”，即《内经》中“气为上膈”的一条论述；所谓“噎隔呕吐”，即《内经》中“三阳结为隔”的一条论述。膈气呕吐，有寒证也有热证；噎隔呕吐，只有热证没有寒证。
噎隔由外感引起者容易治疗，因为只是暂时受到燥热影响，不过是用清热法治疗。内伤者难治，因为其阴精内部枯竭，一时难以恢复。
然而还有轻重之分，初病者，痰涎尚未生成，可以使用滋阴法；久病者，必然因强行进食而导致吐出干竭的胃汁，如果误投燥热药物，燥极反而出现湿象，必然导致痰涎上涌；热极反而出现寒象，必然导致冷气上冲。像这样，滋阴药会凝滞不服，详细论述见首卷总论中，仔细研读就能明白。第一要点是饮食要有规律，一开始就要忌食干粮和辛辣，完全吃酥粥、牛乳以及淡腐浆等，小口慢咽逐渐滋润，使胃管开通，然后才能咽下；如果吃荤腥，只能用慢火煮烂，只喝浓汁，千万不要吃有形硬块，治疗用养阴滋血汤等。医生只谈论用药，谁知道治疗噎隔症，反而在于饮食得法。例如饮食伤胃，一定要小心饮食；劳动损伤，一定要吞咽津液静养，才可以挽回。
[Symptoms of Internal Injury Yige] During eating and drinking, one gradually feels difficulty in swallowing. Or, if swallowing is slightly hurried, food gets stuck in the chest. After about a month like this, the condition worsens day by day, eventually leading to choking with every meal. The patient can only consume thin porridge and cannot eat dry food. This is the symptom pattern of internal injury Yige (dysphagia and regurgitation).
[Etiology of Internal Injury Yige] Usually, due to chronic worry and depression, the fire of the Five Emotions (heat generated from joy, anger, worry, thought, and fear) becomes active, simmering day and night, causing the drying up of body fluids. Alternatively, long-term consumption of rich, fatty, sweet foods, spicy items, and roasted or grilled dishes, without dietary restraint, leads to accumulated heat that consumes Yin essence. Both of these factors contribute to the formation of Yige and regurgitation.
[Pulse Patterns of Internal Injury Yige] The pulse is predominantly deep and choppy (Chen Se). A deep and choppy pulse at the Left Cun position indicates exhaustion of Heart Blood; a deep and choppy pulse at the Left Guan position indicates depletion of Liver Blood; a deep and choppy pulse at the Chi position indicates deficiency of Kidney Water; a deep and choppy pulse at the Right Guan position indicates severance of Spleen Yin; a deep and choppy pulse at the Stomach position indicates dryness of Stomach Juice. When Stomach Juice is dry, the Intestines also become obstructed.
[Treatment of Internal Injury Yige] The treatment should focus on generating fluids and nourishing the Stomach, using Er Mu Er Dong Tang (Two Mothers and Two Winter Decoction). For those with deficiency, Sheng Mai San (Generate the Pulse Powder) should be used, added with blood-nourishing herbs. If Qi stagnation has persisted for a long time and phlegm-saliva has accumulated in the epigastrium, cloying and stagnating herbs must not be used. Instead, clear phlegm and fire, and open up to resolve phlegm using Maidong Tang (Ophiopogon Decoction) from *Jin Gui Yao Lue*, mixed with Zhuli (Bamboo Sap), Jiangzhi (Ginger Juice), and Lugen juice. After several doses, if the Large Intestine is hard and obstructed, add a small amount of Xuanmingfen (Mirabilite). If body fluids are dried up, Chengqi Tang (Purgative Decoction) is contraindicated. If there is accumulated heat from rich foods and the Root Yuan (Original Vitality) is robust, Chengqi Tang or Er Mu Er Dong Tang may be used.
*Er Mu Er Dong Tang* ingredients: Zhi Mu (Anemarrhenae Rhizoma), Bei Mu (Fritillariae Bulbus), Maidong (Ophiopogonis Radix), Tiandong (Asparagi Radix).
Zhu Danxi's secret formula: If there is excessive phlegm, temporarily add Qingdai (Indigo Naturalis) and Haishi (Aragonitum); if the intestines are dry, temporarily add Danggui (Angelicae Sinensis Radix) and Shaoyao (Paeoniae Radix); if Qi is stagnant and phlegm is obstructive, temporarily add Banxia (Pinelliae Rhizoma) and Xiangfu (Cyperi Rhizoma) to move the stagnation of the main formula. This is a last resort; take for two or three doses only.
Sheng Mai San see previous section on Lung Cough.
Si Shun Yin see previous section on Lung Cough.
*Jin Gui* Maidong Tang (Ophiopogon Decoction): Maidong (Ophiopogonis Radix), Banxia (Pinelliae Rhizoma), Renshen (Ginseng Radix), Jingmi (Oriza Sativa Granum), Gancao (Glycyrrhizae Radix et Rhizoma), Juhong (Citri Reticulatae Pericarpium Rubrum).
Chengqi Tang (Purgative Decoction): Zhiqiao (Aurantii Fructus), Houpo (Magnoliae Officinalis Cortex), Dahuang (Rhei Radix et Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma).
Commentary by Zhen: Geqi vomiting and Yige vomiting are both types of vomiting, but their origins differ, and their treatments are worlds apart. What formularies refer to as "Geqi vomiting" corresponds to the line in *Nei Jing* stating "Qi causes Upper Ge"; what they refer to as "Yige vomiting" corresponds to the line in *Nei Jing* stating "The binding of the Three Yangs causes Ge". Geqi vomiting involves both cold and heat patterns; Yige vomiting involves only heat, with no cold.
Yige caused by external contraction is easier to treat because it is merely temporary exposure to dryness-heat, which can be cleared. Internal injury cases are difficult to treat because the Yin essence is internally exhausted and cannot be restored quickly.
However, there are degrees of severity. In early stages, when phlegm-saliva has not yet formed, Yin-nourishing methods can be used. In chronic cases, forced feeding often leads to the vomiting of dry stomach juices. If mistaken treatment with drying-heat herbs is administered, extreme dryness may paradoxically manifest as dampness, leading to surging phlegm-saliva; extreme heat may paradoxically manifest as cold, leading to the upward rush of cold Qi. In such scenarios, Yin-nourishing herbs will cause stagnation and intolerance. Detailed discussions are found in the General Discussion of Volume One; careful study will reveal the principles. The primary requirement is proper diet. Initially, avoid dry food and spicy items; consume only soft porridge, milk, and light fermented bean curd liquids. Swallow slowly in small sips to gradually moisten and open the esophagus before swallowing. If consuming meat, cook it thoroughly over low heat and consume only the rich broth; absolutely avoid solid, hard chunks. Treat with Yangyin Zixue Tang (Nourish Yin and Nourish Blood Decoction) etc. Physicians usually discuss medication alone, but who knows that treating Yige depends more on dietary regulation? For example, if the Stomach is injured by diet, one must be cautious with food intake; if injured by labor, one must swallow saliva and rest quietly to recover.