某 长夏吐食，症属翻胃，服四君异功加炮姜、桂、附，不应。予谓五脏以守为补，六腑以通为补，
此不易之经训。四君异功本脾药，非胃药，胃腑宣通则和，一与守中，必致壅逆，白术、炮姜皆守剂，且阳
土喜柔 ，忌刚燥劫液，久吐则胃阴伤，须辛通使胃气下行则效。韭子（炒研）、杏仁、豆蔻衣、半夏、砂
仁、太子参、姜汁粉、栝蒌仁。戒毋谷食，暂用面食，盖谷性阴而滞，面性阳而通，加意调养可痊。
毕 嗜饮翻胃，面食颇安，谷食则越宿倾吐无余。此胃阳衰，酒食化痰，瘀浊不降故也。用通阳泄浊法，制
半夏、茯苓、益智仁、干姜、陈皮、吴萸、砂仁。惜不能戒酒，故时发时愈云。
下不得出为关，二便俱闭也。上不得入为格，水浆吐逆也。下关上格，中焦气不升降。乃阴阳离绝之危候。
景岳以此为阳亢阴竭，元海无根。症见粒米不能下咽，渴饮茶汤，少顷即吐，复饮复吐，热药入口随出，冷
药过时亦出，大小便俱阻。关无出之由，格无入之理，急症难从缓治。《内经》以阴气太盛，则阳不能荣，
故曰关；阳气太盛，则阴弗能荣，故曰格∶阴阳俱盛，不得相荣，故曰关格。关格者不得尽期而死，因是症气逆
于上，津涸于下，与噎膈反胃同，而势较骤，最忌燥热劫阴，法宜甘润滋液，生脉散加甜杏仁、玉竹等。
或甘酸化阴。参、麦、阿胶、地黄、白芍、乌梅、牛膝等。如脉洪大者先降火，山栀、犀角、竹茹、黄连等。
沉滑者先豁痰，大半夏汤。兼虚弦者先和阴，甘露
饮去茵陈、黄芩。喘满者先降逆，降气汤去桂。阳结者先通痞，用半夏泻心汤加减。液虚者主通润，一阴煎。真
阴素亏者滋化源，大营煎。气血两不足者填虚损，大补元煎。尝治一老人，吐欲死，便不通，上格下关，用参、
苓、归、芍、山药、牛膝、麦冬、百合等。吐止，用炒粳米汤，浓煨三阴煎调理，便通获愈，可以审所治矣。
某患者，在长夏季节出现呕吐食物症状，病症属于翻胃（指饮食入胃后，停留时间较长才吐出，或朝食暮吐、暮食朝吐的病证）。服用四君子汤、异功散并加入炮姜、桂枝、附子治疗后，未见效果。我认为五脏以固守为补益，六腑以通畅为补益，这是不可改变的经典训诫。四君子汤和异功散本是调理脾脏的药物，并非调理胃腑的药物。胃腑需要宣通才能调和，一旦使用守中（固守中焦）的方法，必然导致气机壅滞上逆。白术、炮姜都属于守剂，而且阳土（胃）喜欢柔和，忌讳刚燥之药劫伤津液。长期呕吐会导致胃阴受损，必须用辛味通降的药物使胃气下行才能见效。处方：韭子（炒后研碎）、杏仁、豆蔻衣、半夏、砂仁、太子参、姜汁粉、栝蒌仁。嘱咐患者禁止食用谷物，暂时改用面食，因为谷物的性质属阴且黏滞，面食的性质属阳且通畅，注意调养可以痊愈。
毕姓患者，因嗜酒导致翻胃，吃面食感觉舒适，但吃谷物则隔夜全部吐出。这是因为胃阳衰弱，酒食化痰，瘀浊之气不能下降所致。采用通阳泄浊的治疗方法，处方：制半夏、茯苓、益智仁、干姜、陈皮、吴茱萸、砂仁。可惜患者不能戒酒，所以病情时好时坏。
下窍不通叫“关”，大小便都闭塞。上窍拒纳叫“格”，水浆入口即吐。下关上格，说明中焦气机不升不降。这是阴阳离绝的危重征象。张景岳认为这是阳亢盛而阴枯竭，元气之海无根。症状表现为米粒不能咽下，口渴想喝茶汤，片刻后即吐出，再喝再吐，热药入口随即吐出，冷药过一会儿也吐出，大小便都阻塞。关证没有排出的途径，格证没有摄入的道理，急症难以从缓治。《内经》认为阴气太盛，阳气就不能荣养，所以叫关；阳气太盛，阴气就不能荣养，所以叫格；阴阳都偏盛，不能相互荣养，所以叫关格。患关格病的人活不到自然寿命期限就会死亡，因为这个病症气逆于上，津液枯竭于下，与噎膈、反胃病相同，但病情发展更迅猛，最忌讳燥热之药劫伤阴液，治法适宜用甘润滋液之法，如生脉散加甜杏仁、玉竹等。或者用甘酸化阴之法，如人参、麦冬、阿胶、地黄、白芍、乌梅、牛膝等。如果脉象洪大，先清降火热，如山栀、犀角、竹茹、黄连等。脉象沉滑，先豁除痰浊，用大半夏汤。兼见虚弦脉，先调和阴分，用甘露饮去掉茵陈、黄芩。气喘胸满，先降逆气，用降气汤去掉桂枝。阳结者先通痞塞，用半夏泻心汤加减。津液虚弱者主以通润，用一阴煎。真阴素来亏损者滋养化源，用大营煎。气血两虚不足者填补虚损，用大补元煎。我曾治疗一位老人，呕吐欲死，大便不通，上格下关，用人参、茯苓、当归、白芍、山药、牛膝、麦冬、百合等药。呕吐停止后，用炒粳米汤，浓煎三阴煎进行调理，大便通畅后痊愈，可以据此审视治疗方法了。
A patient presented with vomiting of food during the late summer season, a condition classified as Fan Wei (Reversal Stomach, characterized by delayed vomiting of ingested food). Treatment with Si Jun Zi Tang (Four Gentlemen Decoction) and Yi Gong San (Extraordinary Efficacy Powder), augmented with Pao Jiang (Roasted Ginger), Gui Zhi (Cinnamon Twig), and Fu Zi (Aconite Root), proved ineffective. I stated that for the Five Zang Organs, preservation is tonification; for the Six Fu Organs, unblocking is tonification. This is an immutable classic principle. Si Jun Zi Tang and Yi Gong San are primarily spleen-regulating formulas, not stomach-regulating ones. The stomach fu organ requires free flow to achieve harmony; employing methods that "guard the center" will inevitably lead to qi stagnation and rebellion. Bai Zhu (Atractylodis Macrocephalae Rhizoma) and Pao Jiang are both "preservative" agents. Furthermore, the Yang Earth (Stomach) prefers softness and abhors harsh, dry substances that consume fluids. Chronic vomiting damages Stomach Yin; therefore, acrid and descending herbs must be used to guide Stomach Qi downward to achieve efficacy. Prescription: Jiu Zi (Allii Tuberosi Semen, stir-fried and powdered), Xing Ren (Prunus Armeniaca Seed), Dou Kou Yi (Cardamomi Fructus Pericarpium), Ban Xia (Pinelliae Rhizoma), Sha Ren (Amomi Fructus), Tai Zi Shen (Pseudostellariae Radix), Jiang Zhi Fen (Ginger Juice Powder), Gua Lou Ren (Trichosanthis Semen). The patient was instructed to avoid grain foods and temporarily consume wheat noodles, as grains are yin in nature and cloying/stagnant, whereas wheat noodles are yang in nature and promoting flow. With careful regulation, recovery is possible.
Patient Bi suffered from Fan Wei due to excessive alcohol consumption. Wheat noodles provided relief, but grain foods resulted in complete vomiting of the previous day's intake overnight. This indicates Spleen-Stomach Yang deficiency, where alcohol and food generate phlegm, and turbid stasis fails to descend. The treatment method was to unblock Yang and drain turbidity. Prescription: Zhi Ban Xia (Prepared Pinelliae Rhizoma), Fu Ling (Poria), Yi Zhi Ren (Alpiniae Oxyphyllae Fructus), Gan Jiang (Zingiberis Rhizoma), Chen Pi (Citri Reticulatae Pericarpium), Wu Zhu Yu (Evodiae Fructus), Sha Ren (Amomi Fructus). Regrettably, the patient could not abstain from alcohol, so the condition relapsed intermittently.
Inability to expel waste from below is called Guan (Obstruction), involving blockage of both urination and defecation. Inability to accept intake from above is called Ge (Refusal), involving regurgitation of liquids. When Guan and Ge occur simultaneously, it signifies failure of the Middle Jiao Qi mechanism to ascend and descend. This is a critical sign of Yin-Yang separation. Zhang Jingyue attributed this to Hyperactive Yang and Exhausted Yin, with the Yuan Sea (Kidney Essence) lacking root. Symptoms include inability to swallow even a grain of rice, thirst for tea or water, vomiting shortly after drinking, repeated cycles of drinking and vomiting, expulsion of hot medicines immediately upon entry, and expulsion of cold medicines after a delay. Both urine and stool are obstructed. Guan has no outlet, Ge has no inlet. Acute conditions cannot be treated slowly. The *Nei Jing* states: Excessive Yin prevents Yang from nourishing, hence Guan; Excessive Yang prevents Yin from nourishing, hence Ge; when both Yin and Yang are excessive and fail to mutually nourish, it is called Guan Ge. Patients with Guan Ge do not survive their natural lifespan because Qi rebels upward while Body Fluids dry up below. Although similar to Ye Ge (Dysphagia) and Fan Wei, the progression is more rapid. Harsh, hot, fluid-consuming herbs are strictly contraindicated. The appropriate method is sweet-moistening to nourish fluids, such as Sheng Mai San (Generate the Pulse Powder) plus Tian Xing Ren (Sweet Apricot Seed) and Yu Zhu (Polygonati Odorati Rhizoma). Alternatively, use sweet-acid to transform into Yin, such as Ren Shen (Ginseng Radix), Mai Dong (Ophiopogonis Tuber), E Jiao (Donkey-Hide Gelatin), Di Huang (Rehmanniae Radix), Bai Shao (Paeoniae Radix Alba), Wu Mei (Mume Fructus), Niu Xi (Achyranthis Bidentatae Radix). If the pulse is洪大 (Hóng Dà - Surging and Large), first clear and descend Fire, using Shan Zhi (Gardeniae Fructus), Xi Jiao (Rhinocerotis Cornu), Zhu Ru (Bambusae Caulis in Taenia), Huang Lian (Coptidis Rhizoma). If the pulse is 沉滑 (Chén Huá - Deep and Slippery), first resolve Phlegm, using Da Ban Xia Tang (Major Pinellia Decoction). If accompanied by Xu Xuan (Deficient and Wiry) pulse, first harmonize Yin, using Gan Lu Yin (Sweet Dew Drink) minus Yin Chen (Artemisiae Scopariae Herba) and Huang Qin (Scutellariae Radix). If there is panting and fullness, first direct rebellious Qi downward, using Jiang Qi Tang (Direct Qi Downward Decoction) minus Gui Zhi (Cinnamon Twig). For Yang Knotting, first unblock stagnation, using Ban Xia Xie Xin Tang (Pinellia Decoction to Drain the Epigastrium) with modifications. For Fluid Deficiency, prioritize moistening and unblocking, using Yi Yin Jian (First Yin Decoction). For constitutional True Yin Deficiency, nourish the source of transformation, using Da Ying Jian (Great Camp Decoction). For simultaneous Qi and Blood Deficiency, fill the deficiency, using Da Bu Yuan Jian (Great Tonify Origin Decoction). I once treated an elderly man who was vomiting to the point of death and had constipation, presenting with Upper Ge and Lower Guan. He was prescribed Ren Shen (Ginseng Radix), Fu Ling (Poria), Dang Gui (Angelicae Sinensis Radix), Bai Shao (Paeoniae Radix Alba), Shan Yao (Dioscoreae Rhizoma), Niu Xi (Achyranthis Bidentatae Radix), Mai Dong (Ophiopogonis Tuber), Bai He (Lilii Bulbus), etc. After vomiting ceased, he was treated with fried Coix Seed Soup and thickly simmered San Yin Jian (Three Yins Decoction) for regulation. His bowels moved, and he recovered. This illustrates how to examine treatments.