大意
王太仆曰。食入反出。是谓无火。张洁古曰。下焦吐者因于寒。合是两说而并衡之。其为真火衰微。不能腐
熟水谷则一也。（汇补）
内因
病由悲愤气结。思虑伤脾。或先富后贫之失精。或先贵后贱之脱营。抑郁无聊。而寄情诗酒。或艳冶当前。
而纵饮高歌。皆能酿成痰火。妨碍饷道而食反出。（汇补）
外候
或食已则吐。或再食则吐。或朝食暮吐。或暮食朝吐。心胸痞闷。往来寒热。或大便不实。或嗳腐噫酸。（丹溪）
反胃分辨
有损伤胃气而吐者。有脾不运化而吐者。有中焦积热者。有下焦虚寒者。脉大有力。当作热治。脉小无力。
当作寒医。色之黄白而枯者为虚寒。色之红赤而泽者为实热。（士材）
脉法
趺阳脉浮而涩。虚而微。弦而迟。小而滑者。均为反胃。右尺濡弱者。亦成反胃。
治法
治宜开胃顺气以调上。培脾扶土以和中。壮火回阳以温下。其他如化痰抑肝镇坠诸药。酌而用之。
用药
主以二陈汤。加藿香、蔻仁、木香、砂仁、香附、苏梗。消食。加神曲、麦芽。助脾。加人参、白术。抑肝。加
沉香、白芍。温中。加炮姜、益智。壮火。加肉桂、丁香。甚用附子理中汤。或八味丸。反胃。用伏龙肝水煎药以补土。
糯米汁以泽脾。代赭以镇逆。乌铭以抑肝。若服药初愈者。切不便与粥。复伤胃家。惟以人参五钱、陈皮一钱、老黄米
一两。作汤细啜。旬日之后。方可食粥。否则仓廪未固。卒至不救。
反胃选方
二陈汤（方见痰症） 理中汤（方见中寒） 八味丸 六君子汤（二方见中风）
木香调气散
白豆蔻 丁香 木香（各二钱） 檀香（一钱半） 藿香（八分） 砂仁（四钱） 甘草（八分）
为末。每服二钱。加盐少许。沸汤下。
滋血润肠汤（统旨） 治血枯。及死血在膈。饮食不下反出。便燥。
当归（三钱） 白芍 生地（各一钱半） 红花 桃仁 大黄（煨） 枳壳（各一钱）
水煎。入韭汁服。
滋阴清膈散 治阴火上冲而食反出。
当归 白芍 黄柏 黄连（各一钱半） 黄芩 山栀 生地（各一钱） 甘草（三分）
水煎。入童便、竹沥服。
九伯饼 治反胃饮食不下。下即吐痰涎。
南星（姜汁制炮七次） 人参（各三钱） 半夏（姜汁洗七次） 枯矾 枳实（麸炒七次） 浓朴（姜炒）
甘草（各五钱） 木香（四钱） 豆豉（一两）
为末。老米打糊为饼。如钱大。瓦上焙干。露过。每服一饼。细嚼。以姜煎平胃散下。此方加阿魏三钱神效。
附子散
用大附一只。坐砖上。四面着火。渐逼干。淬入姜汁中。又根据前火逼干。复淬之。约姜汁尽碗许。捣为末。将
粟米饮下一钱。
金桃酒 治反胃吐酸。
古铜四钱。敲如米大。再入核桃肉一斤。与前同研烂。用烧酒一斤。和铜挑匀。入瓶内。封口。隔水慢火煮
一时。取出埋地下一二时。每日空心服一盏。如病重者。午后再服。
【大意】
王冰（号太仆）说：食物吃进去又反吐出来，这被称为“无火”（指命门真火衰微）。张元素（字洁古）说：下焦呕吐是因为寒邪。将这两种说法综合权衡来看，其根本原因都是真火衰微，不能腐熟消化水谷。（出自《证治汇补》）
【内因】
疾病由悲伤、愤怒导致气机郁结，思虑过度损伤脾气，或者先富裕后贫穷导致精气耗损，或者先尊贵后卑贱导致营血脱失。心情抑郁无聊，寄托情感于诗歌和美酒；或者面对艳丽景色，纵情饮酒高歌。这些情况都能酿成痰火，阻碍饮食通道，导致食物反吐而出。（出自《证治汇补》）
【外候】
有的刚吃完就吐，有的再吃就吐，有的早晨吃的晚上吐，有的晚上吃的早晨吐。心胸部位痞塞闷胀，忽冷忽热，或者大便不成形，或者嗳气带有腐败气味、泛酸。（出自朱丹溪）
【反胃分辨】
有因损伤胃气而呕吐的，有因脾脏不运化而呕吐的，有中焦积热的，有下焦虚寒的。脉象大且有力，应当按热证治疗；脉象小且无力，应当按寒证医治。面色黄白且干枯的为虚寒，面色红赤且有光泽的为实热。（出自李士材）
【脉法】
趺阳脉（足背动脉，候脾胃之气）浮而涩，或虚而微，或弦而迟，或小而滑，均属于反胃。右尺部脉（候肾与命门）濡弱的，也会形成反胃。
【治法】
治疗宜开胃顺气以调理上焦，培补脾土以调和中部，壮火回阳以温煦下焦。其他如化痰、抑肝、镇逆等药物，酌情使用。
【用药】
主方用二陈汤，加藿香、豆蔻仁、木香、砂仁、香附、紫苏梗。若需消食，加神曲、麦芽；若需助脾，加人参、白术；若需抑肝，加沉香、白芍；若需温中，加炮姜、益智仁；若需壮火，加肉桂、丁香。病情严重者用附子理中汤，或八味丸。治疗反胃，用伏龙肝（灶心土）的水煎药以补益脾土，糯米汁滋润脾阴，代赭石以镇降逆气，乌贼骨（海螵蛸）以抑制肝气。如果服药初愈时，切忌立即喝粥，以免再次损伤胃气。只能用五钱人参、一钱陈皮、一两老黄米煮汤细细饮用。十几天之后，才可以吃粥。否则仓廪（脾胃功能）未稳固，最终可能导致无法救治。
【反胃选方】
二陈汤（方剂见痰症章节） 理中汤（方剂见中寒章节） 八味丸 六君子汤（两个方剂见中风章节）
木香调气散
白豆蔻、丁香、木香（各二钱），檀香（一钱半），藿香（八分），砂仁（四钱），甘草（八分）。
研为细末。每次服用二钱，加少许盐，用沸水冲服。
滋血润肠汤（出自《医统正脉全书·统旨》）
治疗血枯，以及死血瘀阻膈间，饮食不下反而吐出，大便干燥。
当归（三钱），白芍、生地（各一钱半），红花、桃仁、大黄（煨制）、枳壳（各一钱）。
水煎，加入韭菜汁服用。
滋阴清膈散
治疗阴火上冲导致食物反吐。
当归、白芍、黄柏、黄连（各一钱半），黄芩、山栀、生地（各一钱），甘草（三分）。
水煎，加入童便（健康儿童的尿液）、竹沥服用。
九伯饼
治疗反胃饮食不下，吃下去即吐出痰涎。
南星（用姜汁制并炮制七次）、人参（各三钱），半夏（用姜汁洗七次），枯矾、枳实（麸炒七次），浓朴（姜炒），甘草（各五钱），木香（四钱），豆豉（一两）。
研为细末，用老米糊做成饼，大小如铜钱，在瓦上焙干，露置过夜。每次服用一饼，细细咀嚼，用生姜煎煮的平胃散送服。此方加阿魏三钱，效果极佳。
附子散
取一个大附子，放在砖上，四面点火，逐渐烘烤至干，淬入姜汁中。再像前面那样用火烘烤至干，再次淬入姜汁。大约消耗姜汁一碗左右，捣碎研为细末。用粟米饮送服一钱。
金桃酒
治疗反胃吐酸。
古铜四钱，敲碎如米粒大小，再放入核桃肉一斤，与前物一同研烂。用烧酒一斤，调和均匀，装入瓶内，封口。隔水用慢火煮一个时辰（两小时），取出埋入地下约一至两个小时。每天空腹服用一盏。如果病情严重者，中午后再服一次。
[General Principle]
Wang Bing (styled Taipu) stated: "Food entering and then being vomited back up is termed 'Fireless' (referring to the deficiency of Mingmen True Fire)." Zhang Yuansu (styled Jiegu) stated: "Vomiting from the Lower Jiao is caused by Cold." Synthesizing and weighing these two statements, their root cause is identical: the decline of True Fire, resulting in the inability to rot and cook water and grain. (From *Zhengzhi Huibu*)
[Internal Causes]
Disease arises from grief and anger causing Qi stagnation, excessive worry injuring the Spleen, or the loss of Essence due to a transition from wealth to poverty, and the depletion of Ying Blood due to a fall from nobility to lowliness. Depressed and bored, one may find solace in poetry and wine; or facing beauty, one may indulge in drinking and singing loudly. All these can brew Phlegm-Fire, obstructing the pathway of nourishment and causing food to be vomited back. (From *Zhengzhi Huibu*)
[External Manifestations]
Some vomit immediately after eating, some vomit upon eating again, some vomit in the evening what was eaten in the morning, and some vomit in the morning what was eaten in the evening. There is chest and epigastric fullness and oppression, alternating chills and fever, loose stools, or belching with a putrid odor and acid regurgitation. (From Zhu Danxi)
[Differentiation of Fanwei (Reverse Stomach)]
There are cases of vomiting due to injury of Stomach Qi, cases due to the Spleen's failure to transport and transform, cases due to accumulated Heat in the Middle Jiao, and cases due to Deficiency-Cold in the Lower Jiao. If the pulse is large and forceful, treat as Heat. If the pulse is small and weak, treat as Cold. A sallow or white complexion that is dry indicates Deficiency-Cold; a ruddy or red complexion that is lustrous indicates Excess-Heat. (From Li Shicai)
[Pulse Diagnosis]
The Fuyang pulse (pulse at the dorsum pedis, reflecting Stomach Qi) that is floating and choppy, or deficient and faint, or wiry and slow, or small and slippery, all indicate Fanwei. A Rouruo (soft and weak) pulse at the Right Chi position (reflecting Kidney and Mingmen) also leads to Fanwei.
[Therapeutic Principles]
Treatment should focus on opening the Stomach and smoothing Qi to regulate the Upper Jiao, tonifying the Spleen and supporting Earth to harmonize the Middle Jiao, and strengthening Fire and restoring Yang to warm the Lower Jiao. Other herbs such as those for resolving Phlegm, suppressing the Liver, and anchoring rebellious Qi should be used according to discretion.
[Herbal Medication]
The main formula is Erchen Tang (Two-Aged Decoction), added with Huoxiang (Patchouli Herb), Kouren (Cardamom Seed), Muxiang (Aucklandiae Radix), Sharen (Amomi Fructus), Xiangfu (Cyperi Rhizoma), and Sugeng (Perillae Caulis). For digesting food, add Shenqu (Massa Medicata Fermentata) and Maiya (Hordei Fructus Germinatus). To assist the Spleen, add Renshen (Ginseng Radix) and Baizhu (Atractylodis Macrocephalae Rhizoma). To suppress the Liver, add Chenxiang (Aquilaria Lignum) and Baishao (Paeoniae Radix Alba). To warm the Middle, add Paojiang (Prepared Ginger) and Yizhiren (Alpiniae Oxyphyllae Semen). To strengthen Fire, add Rougui (Cinnamomi Cortex) and Dingxiang (Caryophylli Flos). In severe cases, use Fuzi Lizhong Tang (Aconite Root Decoction to Regulate the Middle) or Bawei Wan (Eight-Ingredient Pill). For Fanwei, decoct herbs in water boiled with Fulonggan (Calcined Coeli Terra) to tonify Earth, use Nuomici juice (Glutinous Rice Juice) to moisten the Spleen, Dai Zhe Shi (Ochre) to anchor rebellion, and Wumei/Wuzhuyu (actually Wuhua/Seppia Gladius, here referring to Hai Piao Xiao - Sepiae Endoconcha) to restrain the Liver. If the patient has just recovered from medication, porridge must strictly be avoided to prevent re-injuring the Stomach Qi. Instead, decoct 5 qian of Renshen, 1 qian of Chenpi (Citri Reticulatae Pericarpium), and 1 liang of Lao Huangmi (Old Yellow Rice) into a thin soup and sip slowly. After ten days, porridge may be introduced. Otherwise, if the Granaries (Spleen and Stomach function) are not yet solid, rescue will ultimately be impossible.
[Selected Formulas for Fanwei]
Erchen Tang (See Tan Zheng chapter) Lizhong Tang (See Zhong Han chapter) Bawei Wan Liujunzi Tang (See Fengzhong chapter)
Muxiang Tiaoqi San (Aucklandiae Radix Powder to Regulate Qi)
Baidoukou (Cardamomi Fructus), Dingxiang (Caryophylli Flos), Muxiang (Aucklandiae Radix) (2 qian each), Tanxiang (Santalum Album Lignum) (1.5 qian), Huoxiang (Agastaches Herba) (0.8 fen), Sharen (Amomi Fructus) (4 qian), Gancao (Glycyrrhizae Radix et Rhizoma) (0.8 fen).
Grind into powder. Take 2 qian per dose, add a little salt, and take with boiling water.
Zixue Runchang Tang (Nourishing Blood and Moistening Intestines Decoction) (From *Tongzhi*)
Treats Blood exhaustion and fixed blood stasis in the Diaphragm, where food cannot go down but comes back up, accompanied by dry stool.
Danggui (Angelicae Sinensis Radix) (3 qian), Baishao (Paeoniae Radix Alba), Shengdi (Rehmanniae Radix) (1.5 qian each), Honghua (Carthami Flos), Taoren (Persicae Semen), Dahuang (Rhei Radix et Rhizoma, baked), Zhike (Aurantii Fructus Immaturus) (1 qian each).
Decoct in water, add Jiuzhi (Allium Tuberosum Juice), and take.
Ziyin Qingge San (Yin-Nourishing and Diaphragm-Clearing Powder)
Treats Food reflux caused by Yin Fire rushing upward.
Danggui (Angelicae Sinensis Radix), Baishao (Paeoniae Radix Alba), Huangbai (Phellodendri Cortex), Huanglian (Coptidis Rhizoma) (1.5 qian each), Huangqin (Scutellariae Radix), Shanzhi (Gardeniae Fructus), Shengdi (Rehmanniae Radix) (1 qian each), Gancao (Glycyrrhizae Radix et Rhizoma) (0.3 fen).
Decoct in water, add Tongbian (Child Urine) and Zhuli (Bambusa Textilis Sap) and take.
Jiubo Bing (Jiu Bo Cake)
Treats Fanwei where food cannot go down and phlegm-saliva is vomited immediately after ingestion.
Nanxing (Arisaematis Rhizoma, processed with Ginger Juice and fried seven times), Renshen (Ginseng Radix) (3 qian each), Banxia (Pinelliae Rhizoma, washed with Ginger Juice seven times), Kufan (Alumen), Zhishi (Aurantii Fructus Immaturus, bran-fried seven times), Houpo (Magnoliae Officinalis Cortex, ginger-fried), Gancao (Glycyrrhizae Radix et Rhizoma) (5 qian each), Muxiang (Aucklandiae Radix) (4 qian), Douchi (Sojae Semen Praeparatum) (1 liang).
Grind into powder, make into cakes using Old Rice paste, size of a coin, bake on tile until dry, and expose to dew. Take one cake per dose, chew thoroughly, and swallow with Pingwei San (Regulate the Stomach Powder) decocted with Ginger. Adding 3 qian of Awei (Asafoetida) to this formula yields miraculous effects.
Fuzi San (Aconite Root Powder)
Take one large Fuzi (Aconiti Lateralis Radix Praeparata), place it on a brick, and apply fire around it until gradually dried. Quench it in Ginger Juice. Repeat the firing and quenching process until approximately one bowl of Ginger Juice is consumed. Grind into powder. Take 1 qian with Millet Drink.
Jintao Jiu (Golden Peach Wine)
Treats Fanwei with acid regurgitation.
Ancient Copper (4 qian), crushed to rice-grain size. Mix with 1 jin of Walnut Meat (Hetao Ren). Grind together until smooth. Add 1 jin of Shaojiu (Distilled Liquor), mix evenly with the copper, seal in a bottle, and simmer in water over low heat for one shichen (two hours). Remove and bury in the ground for one to two hours. Take one cup on an empty stomach daily. For severe cases, take another cup after noon.