膈，隔也。饮食入咽，不得辄下，噎塞膈中，如有阻隔之者，故名膈噎。又其病正在膈间，
食不得下，气反上逆，随复吐出，故又名膈气。反胃者，饮食入胃，全无阻隔，过一二时，
辄复吐出，有反还之意，故曰反胃。甚者朝食暮吐，暮食朝吐，有翻倾之义，故亦名翻胃。
不似噎隔之噎，然后吐，不噎则不吐也。
噎膈之病，有虚有实。实者或痰或血，附着胃脘，与气相搏，翳膜外裹，或复吐出，膈
宽，旋复如初。虚者津枯不泽，气少不充，胃脘干瘪，食涩不下。虚则润养，实则疏瀹，不可不辨也。
饮食下咽，不得入胃为噎。食不下通，气反上逆为塞。东垣乃谓阳气不得出者为塞，阴气不
得降者为噎，岂非谓入食从阴，而气出从阳耶？其文则深，其旨反晦，至谓先用阳药治本，
后用诸塞泻标，吾不知其何谓矣。
子和论膈噎，累累数百言，谓三阳结热，前后闭涩，下既不通，必反上行，所以噎食不下。
夫膈噎，胃病也。始先未必燥结，久之乃有大便秘少，若羊矢之证。此因胃中津气上逆，不得
下行而然，乃胃病及肠，非肠病及胃也，又因河间三乙承气之治，谓噎膈之病，惟宜用下，
结散阳消，其疾自愈。夫脘膈之病，岂下可去？虽仲景有大黄甘草，东垣有通幽润肠等法，
为便秘呕吐者立，然自是食入辄吐之治，非所论于食噎不下也。独其所谓慎勿顿攻，宜先润
养，小着汤丸，累累加用，关扃自透。或用苦酸微涌膈涎，因而治下，药势易行。设或不行
，蜜盐下导，始终勾引，两药相通者，其言甚善。盖痰血在脘，不行不愈，而药过病所，反
伤真气，非徒无益矣。故以小丸累加，适至病所，无过不及，以平为期，则治噎之道也。但
须审是痰是血而行之耳。
膈噎之证，大都年逾五十者，是津液枯槁者居多。若壮年气盛，非血即痰。近见有津液
枯槁之剂，治一少年肥实男子，至死不悟，哀哉。（鹤年。）
先婶传一方云∶用烧酒一斤，浸海蜇花头一斤，入瓷瓶内，埋地数年，则海蜇化为水矣
。取饮半酒杯妙。（鹤年又识。）
膈，即阻隔之意。饮食进入咽喉后，不能随即下行，噎塞于胸膈之中，好像有东西阻挡一样，所以称为膈噎。又因为病位主要在膈间，食物无法下咽，气机反而上逆，随之吐出，因此又被称为膈气。反胃是指饮食进入胃中，完全没有阻隔感，过了一两个时辰后，又重新吐出，有“反还”的意思，所以叫反胃。严重的甚至早晨吃的饭晚上吐出来，晚上吃的饭早晨吐出来，有翻倾的含义，所以也叫做翻胃。这与噎隔不同，噎隔是必须感到噎塞才会呕吐，如果不噎则不吐。
噎膈这种病，有虚证也有实证。实证可能是痰浊或瘀血，附着在胃脘部，与气机相互搏结，外面像被薄膜包裹一样，有时也能吐出，但胸膈暂时宽松，片刻后又恢复原状。虚证则是津液枯竭缺乏滋润，元气不足，导致胃脘干瘪，食物涩滞难下。虚证应当用润养之法，实证应当用疏通疏导之法，这两者不可不加以辨别。
饮食下咽后不能进入胃中，这叫噎；食物不能下行通畅，气机反而上逆，这叫塞。李东垣却说阳气不能外达的叫塞，阴气不能下降的叫噎，这难道是说进食属于阴，而气的运行属于阳吗？他的文字虽然深奥，但主旨反而晦涩难懂。至于他说先用阳药治本，后用各种通泻法治标，我真不知道他这是什么意思。
张子和论述膈噎，连续说了几百字，认为三阳经热邪郁结，前后二便闭塞不通，下面既不通畅，必然反向上行，所以导致食物吞咽不下。其实膈噈是胃病。起初未必有燥屎内结，时间久了才会有大便干少、像羊粪球一样的症状。这是因为胃中的津气和气机上逆，不能下行所致，这是胃病波及到肠，而不是肠病波及到胃。又因为受刘河间使用三乙承气汤治疗的观点影响，认为膈噎之病只宜用攻下法，只要结散阳消，疾病自然痊愈。然而，胃脘和胸膈的疾病，岂是攻下法能去除的？虽然张仲景有大黄甘草汤，李东垣有通幽汤、润肠丸等方剂，但这些是为便秘伴呕吐的患者设立的，自然是针对食入即吐的治疗方法，并不适用于讨论食物噎塞不下的情况。唯独他所说的“千万不要猛烈攻伐，适宜先进行润养，少量服用汤剂或丸药，逐渐增加用量，关窍自然通透”，或者“使用苦味酸味药物轻微涌吐膈间涎沫，借此顺势治疗下部，药势容易通行。如果还不行，再用蜂蜜盐水从下方导引，上下勾连引导，使两种药力相通”，这些话说得很好。大概是因为痰血停留在胃脘，不运行就不会痊愈，但如果药力超过病所，反而会损伤真气，不仅无益反而有害。所以用小丸药逐渐增加剂量，刚好到达病所，不过分也不不及，以平和为准则，这就是治疗噎膈的方法。但必须仔细审察是痰还是瘀血，然后针对性地进行治疗。
膈噎这类病症，大多发生在五十岁以上的人身上，其中多是津液枯槁的情况。如果是青壮年气血旺盛，则不是瘀血就是痰浊。近来见到有人用治疗津液枯槁的方剂，去治疗一个身体肥胖壮实的年轻男子，结果病人至死都不醒悟（指误诊误治），真是悲哀啊。（鹤年注）
先婶流传下来一个方子说：用烧酒一斤，浸泡海蜇头一斤，放入瓷瓶中，埋在地下几年，海蜇就会化为水了。取半酒杯饮用，效果奇妙。（鹤年又记）
Ge (Obstruction) refers to blockage. When food and drink enter the throat but cannot descend immediately, they become stuck in the chest and diaphragm as if obstructed by something; hence it is named Ge Ye (Diaphragmatic Obstruction). Furthermore, since the disease is located primarily between the diaphragm, where food cannot go down, and Qi rebels upward, followed by vomiting, it is also called Ge Qi (Diaphragmatic Qi). Fan Wei (Regurgitation/Stomach Reversal) occurs when food enters the stomach without any sense of obstruction, but after one or two hours, it is vomited back up, having a meaning of "returning," thus it is called Fan Wei. In severe cases, morning meals are vomited in the evening, and evening meals in the morning, implying a flipping-over sensation, so it is also named Fan Wei (Flipping Stomach). This differs from Ge Ye, where vomiting only occurs if there is a sensation of choking; if there is no choking, there is no vomiting.
The disease of Ge Ye can be either Deficiency (Xu) or Excess (Shi). In Excess patterns, phlegm (Tan) or blood stasis (Yu Xue) may adhere to the epigastrium, struggling with Qi, wrapped externally like a membrane; sometimes it can be vomited out, leaving the diaphragm temporarily relaxed, only to return to its original state shortly after. In Deficiency patterns, body fluids are depleted and lack moisture, and Qi is insufficient, causing the stomach to shrink and dry, making food difficult to pass due to friction. Deficiency requires moistening and nourishing, while Excess requires dredging and unblocking; these must not be confused.
When food and drink enter the throat but fail to reach the stomach, it is called Ye (Choking); when food fails to descend smoothly and Qi rebels upward, it is called Sai (Blockage). Li Dongyuan stated that Yang Qi failing to exit constitutes Sai, and Yin Qi failing to descend constitutes Ye. Does this imply that ingested food belongs to Yin, while the movement of Qi belongs to Yang? Although his wording is profound, the underlying principle becomes obscure. He further suggested using Yang-tonifying herbs first to treat the root, followed by various purgative methods to treat the branch; I do not understand what he meant by this.
Zihe discussed Ge Ye at length, stating that heat accumulation in the Three Yang meridians causes blockage in both upper and lower orifices. Since the lower pathway is blocked, Qi must rebel upward, resulting in the inability to swallow food. However, Ge Ye is a disease of the Stomach. Initially, there may not be dryness and accumulation; only after a long time might symptoms such as scanty, hard stools resembling sheep feces appear. This occurs because Stomach fluids and Qi rebel upward instead of descending; thus, it is a Stomach disease affecting the Intestines, not an Intestinal disease affecting the Stomach. Influenced by Liu Hejian’s use of San Yi Cheng Qi Tang (Three Yin Major Yellow and Rhubarb Decoction), some argue that Ge Ye should only be treated with purgatives, believing that once the accumulation dissipates and Yang heat clears, the disease will heal itself. Yet, how can diseases of the epigastrium and diaphragm be cured by purgation? Although Zhang Zhongjing prescribed Da Huang Gan Cao Tang (Rhubarb and Licorice Decoction), and Li Dongyuan developed Tong You Tang (Unblock the Throat Decoction) and Run Chang Wan (Moisten the Intestines Pills), these were established for patients with constipation accompanied by vomiting. They are treatments for immediate regurgitation upon ingestion, not applicable to discussing food sticking and failing to descend. What was particularly commendable was his advice: "Do not attack abruptly; instead, prioritize moistening and nourishing. Administer small doses of decoctions or pills repeatedly until the orifices naturally open." Or, "Use bitter and sour substances to mildly induce vomiting of phlegm-fluids in the diaphragm, thereby facilitating downward treatment, allowing the medicinal force to move easily. If this fails, use honey and salt water to guide from below, connecting upper and lower forces." These words are excellent. Generally, phlegm and blood stasis in the epigastrium will not resolve without movement; however, if the medicinal force exceeds the site of the disease, it will damage True Qi, doing more harm than good. Therefore, using small pills in gradually increasing doses to reach exactly the site of the disease—neither excessive nor insufficient, aiming for balance—is the way to treat Ge Ye. One must carefully distinguish whether the pathogen is phlegm or blood stasis before applying specific treatments.
Cases of Ge Ye mostly occur in individuals over fifty years old, predominantly due to depletion of body fluids. In young adults with robust Qi and Blood, the cause is usually blood stasis or phlegm. Recently, I witnessed a physician using formulas for fluid depletion to treat a young, obese, and robust man, who died without recovering from the misdiagnosis/mistreatment. How tragic! (Recorded by Henian.)
My late aunt passed down a prescription: Soak one jin (approx. 500g) of dried jellyfish head in one jin of distilled liquor (Baijiu), place it in a porcelain jar, and bury it underground for several years until the jellyfish dissolves into water. Take half a wine glass; it is effective. (Recorded again by Henian.)