痰膈，因七情伤于脾胃，郁而生痰，痰与气搏，升而不降，遂成噎膈。其病令人胸膈痞
饮食辄噎，不得下入胃中，必反上逆而呕，与痰俱出。治法宜调阴阳，化痰下气，阴阳平均，气顺痰下，病斯已矣。
《和剂》四七汤 治喜怒忧思悲恐惊之气，结成痰涎，状如破絮，或如梅核，
之间，咯不出，咽不下，此七情所为也。中脘痞闷，气不舒快，或痰饮呕逆恶心，并皆治之
半夏（制，二钱） 茯苓（一钱六分） 紫苏叶（八分） 浓朴（姜制，一钱二分）
水一盏，生姜七片，红枣二枚，煎至八分，不拘时服。
丁沉透膈汤（《和济》） 治脾胃不和，痰逆恶心，或时呕吐，饮食不进，十膈五
噎，痞塞不通，并皆治之。
人参 砂仁 香附（各一两） 青皮 木香 肉豆蔻 白豆蔻 丁香（各半两）
浓朴（各七钱五分） 草果 半夏 神曲（各二钱半） 甘草（一两五钱） 麦芽（五
每服四钱，水一盏，姜三片，枣一枚，不拘时热服。
涤痰丸
半夏曲 枯矾 皂角（炙，刮去皮弦子） 元明粉 白茯苓 枳壳（各等分）
上为末，霞天膏如丸，量人虚实用之。
丹溪治一少年，食后必吐出数口，却不尽出，膈上时作声，面色如平人。病不在脾胃，
而在膈间。其得病之由，乃因大怒未止，辄食面，故有此证。想其怒甚则血菀于上，积在膈间，
碍气升降，津液因聚，为痰为饮，与血相搏而动，故作声也。用二陈加香附、韭汁、萝卜子
二日，以瓜蒂散、败酱吐之；再一日又吐，痰中见血一盏；次日复吐，见血一盅而愈。
一中年人，中脘作痛，食已乃吐，面紫霜色，两关脉涩，乃血病也。因跌仆后，中脘即
痛，投以生新血推陈血之剂，吐血片碗许而愈。
一中年妇人反胃，以四物加带白陈皮、留尖去皮桃仁、生甘草、酒红花，浓煎，入驴尿
，以防生虫，与数十帖而安。
一人咽膈间，常觉有物闭闷，饮食妨碍，脉涩稍沉，形色如常，以饮热酒所致。遂用生
韭汁每服半盏，日三服，至二斤而愈。
一人食必屈曲下膈，梗涩微痛，脉右甚涩而关沉，左却和，此污血在胃脘之口，气因郁
而为痰，必食物所致。询其去腊，日饮KT 剁酒三盏，遂以生韭汁冷冻饮料细呷之，尽半斤而愈。
一贫叟病噎膈，食入即吐，胸中刺痛，或令取韭汁入盐梅卤少许细呷，得入渐加，忽吐
此亦仲景治胸痹用薤白，取其辛温能散胃脘痰涎恶血之义也。愚谓此不独辛温散结之义
，盖亦咸能润下，而酸味最能开膈胃，止呕吐，品味不杂而意旨周密，殊可取也。
一妇年及五十，身材略瘦小，勤于女工，得噎膈证半年矣，饮食绝不进，而大便燥结不行者
十数日，小腹隐隐然疼痛，六脉皆沉伏。以生桃仁七个，令细嚼，杵生韭汁一盏送下。片时
许，病者云∶胸中略作宽舒。以四物六钱，加栝蒌仁一钱，桃仁泥半钱，酒蒸大黄一钱，酒
红花一分，煎成止药一盏，取新温羊乳汁一盏，合而服之。半日后下宿粪若干，明日腹中痛
止，渐可进稀粥而少安。后以四物出入加减，合羊乳汁服五六十帖而安。
江应宿治一老妇年近七旬，患噎膈，胃脘干燥，属血虚有热，投五汁汤，二十余日而愈。其
方芦根汁、藕汁、甘蔗汁、牛羊乳、生姜汁少许，余各半盏，重汤煮温，不拘时徐徐服。
滋血润肠汤 治血枯及死血在膈，饮食不下，大便燥结。
当归（酒洗，三钱） 芍药（煨） 生地黄（各一钱半） 红花（酒洗） 桃仁（去皮尖，
炒） 大黄（酒煨） 枳壳（麸炒，各一钱）
水一盅半，煎七分，入韭菜汁半酒盏，食前服。
秦川剪红丸（《良方》）
雄黄（另研） 木香（各五钱） 槟榔 三棱（煨） 蓬术（煨） 贯仲（去毛） 干漆
（炒烟尽） 陈皮（各一两） 大黄（一两半）
上面和丸梧子大，每五十丸，食前米饮送下，吐出瘀血，及下虫为效。
痰膈，是由于七情（喜、怒、忧、思、悲、恐、惊）损伤脾胃，气机郁结而生痰，痰与气相互搏结，气机上升而不能下降，从而形成噎膈（吞咽困难，饮食难下）。此病使人胸膈部痞闷堵塞，饮食刚入口即发生哽噎，不能下行入胃，必然反逆向上而呕吐，并与痰涎一同吐出。治疗方法应当调和阴阳，化痰降气，待阴阳平衡，气顺痰消，疾病即可痊愈。
《和剂局方》的四七汤，治疗因喜怒忧思悲恐惊等情绪之气，凝结成痰涎，形状像破旧的棉絮，或者像梅核卡在喉咙之间，咳不出来，咽不下去，这是由七情内伤所致。伴有中脘部痞闷胀满，气机不舒畅，或者痰饮上逆导致呕吐恶心，这些症状都适用此方。
半夏（制，二钱） 茯苓（一钱六分） 紫苏叶（八分） 厚朴（姜制，一钱二分）
加水一盏，生姜七片，红枣二枚，煎煮至八分量的药液，不限时间服用。
丁沉透膈汤（出自《和济局方》），治疗脾胃不和，痰气上逆恶心，时常呕吐，饮食不进，十种膈证和五种噎证，胸膈痞塞不通，都适用此方。
人参 砂仁 香附（各一两） 青皮 木香 肉豆蔻 白豆蔻 丁香（各半两）
厚朴（各七钱五分） 草果 半夏 神曲（各二钱半） 甘草（一两五钱） 麦芽（五钱）
每次服用四钱，加水一盏，生姜三片，红枣一枚，不限时间热服。
涤痰丸
半夏曲 枯矾 皂角（炙，刮去皮及内膜） 元明粉 白茯苓 枳壳（各等分）
以上药物研为细末，用霞天膏（一种胶类制剂）作为粘合剂制成丸药，根据患者体质的虚实酌情使用。
朱丹溪治疗一名少年，进食后必定吐出几口食物，但不能完全吐出，膈间时常发出声响，面色如常人无异。病位不在脾胃，而在膈间。他得病的原因，是因为大怒之后未平息，就吃面食，所以出现这个病症。推测其怒气极盛时，血液郁积于上部，积聚在膈间，阻碍气机的升降，津液因此聚集成痰成饮，与血相搏动而产生声音。使用二陈汤（燥湿化痰，理气和中）加入香附、韭菜汁、萝卜子，两天后，用瓜蒂散催吐；又过一天再次催吐，痰中带出一盏血；第二天再次催吐，吐出一盅血而痊愈。
一名中年人，中脘部疼痛，吃完饭后才呕吐，面色呈紫霜色，左右关脉涩，这是血瘀的病证。因为跌打损伤后，中脘立即疼痛，投以生新血、推陈血的药剂，吐血约一碗许而痊愈。
一名中年妇女患反胃（食入即吐），用四物汤（补血调血）加入带白的陈皮、留尖去皮的桃仁、生甘草、酒洗红花，浓煎，加入驴尿，以防生虫，服用几十帖后安宁。
一人感觉咽喉膈间常觉有物闭塞闷痛，饮食受阻，脉象涩且稍沉，神色形态如常，这是饮用热酒所致。于是用生韭菜汁，每次半盏，每日三次服用，直到喝了两斤而痊愈。
一人进食必须弯腰屈曲才能通过膈部，梗涩且微痛，右脉甚涩而关脉沉，左脉却平和，这是污血停留在胃脘之口，气机因郁结而为痰，必定是食物所致。询问得知去年腊月，每天饮用甜酒三盏，于是用生韭菜汁冷冻饮料细细呷服，喝完半斤而痊愈。
一位贫穷的老翁患噎膈，食物吃进去立刻吐出，胸中刺痛，有人让他取韭菜汁加入少许盐梅卤细细呷服，能够咽下并逐渐增加剂量，忽然吐出大量瘀血。这也是张仲景治疗胸痹（胸部憋闷疼痛）使用薤白，取其辛温能消散胃脘痰涎恶血的含义。我认为这不仅有辛温散结的意义，而且咸味能润下，酸味最能开通膈胃，止住呕吐，品味不杂乱而意旨周密，非常值得采纳。
一位年近五十的妇女，身材略瘦小，勤于女红，患噎膈证半年了，饮食完全不能进，大便干燥秘结不通已有十多天，小腹隐隐作痛，六脉皆沉伏。用生桃仁七个，令其细嚼，用生韭菜汁一盏送服。片刻之后，病人说：胸中略微感到宽舒。再用四物汤六钱，加栝蒌仁一钱，桃仁泥半钱，酒蒸大黄一钱，酒红花一分，煎成药液一盏，取新鲜温热的羊乳汁一盏，混合服用。半天后排出宿便若干，第二天腹中疼痛停止，渐渐可以吃稀粥而稍感安宁。后来用四物汤出入加减，配合羊乳汁服用五六十帖而痊愈。
江应宿治疗一位年近七十的老妇人，患噎膈，胃脘干燥，属于血虚有热，投以五汁汤，二十多日后痊愈。其方为芦根汁、藕汁、甘蔗汁、牛乳、羊乳、生姜汁少许，其余各半盏，隔水加热温服，不限时间慢慢服用。
滋血润肠汤，治疗血枯及死血（瘀血）在膈，饮食不下，大便干燥秘结。
当归（酒洗，三钱） 芍药（煨） 生地黄（各一钱半） 红花（酒洗） 桃仁（去皮尖，炒） 大黄（酒煨） 枳壳（麸炒，各一钱）
加水一盅半，煎至七分，加入韭菜汁半酒盏，饭前服用。
秦川剪红丸（出自《良方》）
雄黄（单独研磨） 木香（各五钱） 槟榔 三棱（煨） 蓬术（煨） 贯众（去毛） 干漆（炒至烟尽） 陈皮（各一两） 大黄（一两半）
以上药物研末和匀制成梧桐子大小的丸药，每次五十丸，饭前米汤送下，以吐出瘀血及排出虫体为见效。
Tan Ge (Phlegm Obstruction), caused by the Seven Emotions (Joy, Anger, Worry, Thought, Sorrow, Fear, Fright) damaging the Spleen and Stomach, leading to Qi stagnation and Phlegm formation. Phlegm and Qi contend with each other, rising but not descending, thus forming Ye Ge (Dysphagia/Obstruction). This condition causes chest and diaphragm fullness and blockage; food is immediately obstructed upon entry, cannot descend into the Stomach, and inevitably regurgitates upward as vomiting, mixed with Phlegm. The treatment method should harmonize Yin and Yang, resolve Phlegm and direct Qi downward. When Yin and Yang are balanced, Qi flows smoothly and Phlegm descends, and the disease will be cured.
Si Qi Tang (Four-Seven Decoction) from *He Ji Ju Fang* treats Phlegm-drool congealed by Qi of joy, anger, worry, thought, sorrow, fear, and fright. It resembles broken cotton or a plum pit stuck in the throat, unable to be coughed out or swallowed down, caused by the Seven Emotions. It also treats epigastric fullness and oppression, Qi discomfort, or Phlegm-fluid retention causing nausea and vomiting.
Ban Xia (Prepared Pinellia Rhizome, 2 qian) Fu Ling (Poria, 1.6 qian) Zi Su Ye (Perilla Leaf, 0.8 qian) Hou Po (Magnolia Bark, processed with Ginger, 1.2 qian)
Add one cup of water, seven slices of Sheng Jiang (Fresh Ginger), two Hong Zao (Jujube), decoct until eight-tenths remain. Take at any time.
Ding Chen Tou Ge Tang (Cardamom and Clove Diaphragm-Penetrating Decoction) from *He Ji Ju Fang* treats disharmony of the Spleen and Stomach, Phlegm-rebellion with nausea, occasional vomiting, inability to eat, ten types of Ge syndrome and five types of Ye syndrome, chest and diaphragm blockage. All these conditions are treated by this formula.
Ren Shen (Ginseng Root) Sha Ren (Amomum Fruit) Xiang Fu (Cyperus Rhizome) [each 1 liang] Qing Pi (Green Tangerina Peel) Mu Xiang (Costus Root) Rou Dou Kou (Nutmeg) Bai Dou Kou (Tsaoko Cardamom) Ding Xiang (Clove Bud) [each 0.5 liang]
Hou Po (Magnolia Bark) [each 0.75 liang] Cao Guo (Black Cardamom) Ban Xia (Pinellia Rhizome) Shen Qu (Medicated Leaven) [each 2.5 qian] Gan Cao (Licorice Root, 1.5 liang) Mai Ya (Malt, 5 qian)
Take 4 qian per dose, add one cup of water, three slices of Ginger, one Jujube. Take hot at any time.
Di Tan Wan (Phlegm-Washing Pill)
Ban Xia Qu (Pinellia Fermented Paste) Ku Fan (Alum) Zao Jiao (Gleditsia Spine) [roasted, skin and membrane scraped off] Yuan Ming Fen (Mirabilite) Bai Fu Ling (White Poria) Zhi Ke (Aurantium Fruit) [each equal parts]
Grind all into powder, use Xia Tian Gao (a gelatinous paste) as a binder to make pills. Use according to the patient's deficiency or excess.
Zhu Danxi treated a young man who vomited several mouthfuls after eating, but not completely. There was sound made in the diaphragm area, while his complexion appeared normal. The disease was not in the Spleen and Stomach, but in the diaphragm. The cause was excessive anger followed immediately by eating noodles. It is presumed that extreme anger caused blood to stagnate upwards, accumulating in the diaphragm, obstructing the ascending and descending of Qi. Body fluids gathered to form Phlegm and Fluids, which contended with blood, creating sound. He used Er Chen Tang (Two-Cured Decoction) plus Xiang Fu (Cyperus Rhizome), Jiu Cai Zhi (Chinese Chive Juice), and Luo Bo Zi (Radish Seed). After two days, he induced vomiting using Gua Di San (Melon Sepal Powder); another day later, vomiting again resulted in one cup of blood in the phlegm; the next day, vomiting again resulted in one bowl of blood, and he was cured.
A middle-aged man suffered pain in the Zhong Wan (CV12) region, vomiting only after eating. His face had a purple-frost color, and the pulse at both Guan positions was choppy (Se). This is a Blood disease. Following a fall, Zhong Wan pain occurred immediately. He was given a formula to generate new blood and eliminate old blood. Vomiting about a bowl of blood led to recovery.
A middle-aged woman suffered from Fan Wei (Regurgitation/Vomiting after eating). She was treated with Si Wu Tang (Four-Material Decoction) plus Chen Pi (Citrus Peel with white pith), Tao Ren (Peach Seed, tip retained, skin removed), Sheng Gan Cao (Raw Licorice Root), and Hong Hua (Safflower washed with wine). Decocted strongly, with Donkey Urine added to prevent worm infestation. After dozens of doses, she recovered.
A man felt a constant obstruction and stuffiness in the throat and diaphragm, hindering diet. The pulse was choppy and slightly deep, but his appearance was normal. This was caused by drinking hot wine. He was prescribed raw Chinese Chive Juice, half a cup per dose, three times daily. After consuming two jin (approx. 1 kg), he was cured.
A man required bending forward to swallow food through the diaphragm, experiencing slight pain and roughness. The right pulse was very choppy and the Guan position was deep, while the left pulse was harmonious. This indicated stagnant blood at the entrance of the Stomach, with Qi stagnation transforming into Phlegm, likely caused by food. Inquiry revealed he drank sweet wine three cups daily last December. He was instructed to sip frozen raw Chinese Chive Juice slowly. After finishing half a jin, he was cured.
A poor elderly man suffered from Ye Ge (Dysphagia), vomiting immediately after eating, with stabbing pain in the chest. Someone advised him to sip Chinese Chive Juice mixed with a little salted plum brine. He could swallow it gradually increasing the amount, then suddenly vomited a large amount of stagnant blood. This aligns with Zhang Zhongjing’s use of Xie Bai (Macrostemon Rhizome) for Xiong Bi (Chest Bi/Pain), utilizing its acrid-warm nature to disperse Stomach Phlegm and bad blood. I believe this not only has the meaning of acrid-warm dispersal of knots, but also salty flavors moisten and direct downward, while sour flavors best open the diaphragm and Stomach and stop vomiting. The flavor profile is simple yet the intent is thorough, making it highly worthy of adoption.
A woman near fifty, slightly thin and small, diligent in needlework, suffered from Ye Ge for half a year. She could not eat anything, and her stool was dry and constipated for over ten days. Her lower abdomen had dull pain, and all six pulses were deep and hidden. She chewed seven raw Tao Ren (Peach Seeds) finely and swallowed them with one cup of raw Jiu Cai Zhi (Chinese Chive Juice). After a short while, she reported slight relief in the chest. Then, Si Wu Tang (6 qian) was combined with Gua Lou Ren (Trichosanthes Seed, 1 qian), Tao Ren Paste (0.5 qian), Jiu Zheng Da Huang (Wine-processed Rhubarb, 1 qian), and Jiu Hong Hua (Wine-processed Safflower, 0.1 fen). Decocted to one cup, mixed with one cup of fresh warm Sheep Milk. Half a day later, she passed accumulated feces. The next day, abdominal pain ceased, and she could gradually consume thin porridge and feel better. Later, Si Wu Tang was modified and taken with Sheep Milk for 50-60 doses until recovery.
Jiang Yingsu treated an elderly woman near seventy suffering from Ye Ge, with dryness in the Stomach region, attributed to Blood deficiency with Heat. He administered Wu Zhi Tang (Five-Juice Decoction). She recovered after more than twenty days. The formula consists of Lu Gen Zhi (Reed Rhizome Juice), Ou Zhi (Lotus Root Juice), Gan Zhe Zhi (Sugarcane Juice), Niu Nai (Cow Milk), Yang Nai (Sheep Milk), and a little Sheng Jiang Zhi (Ginger Juice). The first four juices are half a cup each; boil gently in double boiler until warm. Take slowly at any time.
Zi Xue Run Chang Tang (Blood-Nourishing and Intestine-Moistening Decoction) treats Blood exhaustion and Dead Blood (Stagnant Blood) in the diaphragm, inability to eat, and dry constipation.
Dang Gui (Angelica Sinensis, washed with wine, 3 qian) Shao Yao (Peony Root, roasted) Sheng Di Huang (Rehmannia Root, prepared) [each 1.5 qian] Hong Hua (Safflower, washed with wine) Tao Ren (Peach Seed, skin and tip removed, stir-fried) Da Huang (Rhubarb Root, wine-roasted) Zhi Ke (Bitter Orange Fruit, bran-fried) [each 1 qian]
Add one and a half cups of water, decoct to seven-tenths. Add half a wine cup of Jiu Cai Zhi (Chinese Chive Juice). Take before meals.
Qinchuan Jian Hong Wan (Qinchuan Blood-Cutting Pill) from *Liang Fang*
Xiong Huang (Realgar, ground separately) Mu Xiang (Costus Root) [each 5 qian] Bing Lang (Areca Seed) San Leng (Knotweed Rhizome, roasted) Peng Ze (Curcuma Rhizome, roasted) Guan Zhong (Dryopteris Frond) Gan Xi (Dried Lacquer) [stir-fried until smoke ceases] Chen Pi (Aged Tangerina Peel) [each 1 liang] Da Huang (Rhubarb Root, 1.5 liang)
Grind all into powder and mix to make pills the size of a walnut seed. Take 50 pills before meals with Rice Drink. Efficacy is indicated by vomiting stagnant blood and expelling worms.