噎枯在上。咽喉壅塞。饮虽可入。食不能下。隔枯在下胸臆痞闷。食虽可入。至胃复出
。或食下而眼白口开。气不能顺。或食入而当心刺痛。须臾吐出。食出痛止。
五隔五噎由喜怒太过。七情伤于脾胃。郁而生痰。痰与气搏。升而不降。饮食不下。盖
留于
咽嗌者。则成五噎。结于胃膈者。则为五隔。(思忧喜怒悲)其病令人胸膈痞闷。呕逆噎塞。
妨碍饮食。治法宜调阴阳。化痰下气。阴阳平匀。气顺痰下。则病无由作矣。
按七情所伤。痰与气搏。故食不下若瘀血阻碍。则食下作痛。或反胃而吐出。总由脾胃
虚伤。血液枯槁。不能运化五谷。膈间受病。故通名为膈也。
积虚成损。积损成痨。经年不愈。谓之久虚。有五劳六极七伤之分。五劳应五脏。曲运
神机
则劳心尽力谋虑则劳肝。意外过思则劳脾。预事而忧则劳肺。矜持志节则劳肾。六极应六腑
。血极则面枯发落。善忘筋极则拘挛转筋。爪黯甲痛。肉极则体瘦肉削。倦怠嗜卧。气极则
喘嗽少气皮枯毛焦。骨极则面垢齿浮腰酸脊痛。精极则目暗耳鸣。遗溺茎弱。七伤者。推原
劳极之由。如久视伤血。久卧伤气。久坐伤肉。久立伤骨。久行伤筋。房劳思虑伤心肾。心
主血。肾主精。精竭血燥。气衰火旺蒸疰日久。则痨生焉。
痨瘵既久。元气必伤。热毒痰瘀变幻生虫。在肝为毛虫。食人筋膜在心为羽虫。食人血
脉在
脾为裸虫。食人肌肉。在肺为介虫。食人肤膏。在肾为鳞虫。食人骨髓。其症蒸热咳嗽。胸
闷背痛。两目不明。四肢无力。腰膝酸疼。卧不能寐。或面色 白。或两颊时红。常怀忿怒
。梦与鬼交。若虫蚀肺系。咯血吐痰。喉疮声哑。思食无厌。皮枯毛落。良可悲悯。惟补虚
扶元。杀虫以绝其根。纵不获生。可绝其传疰也 验病法。用乳香焚熏病者之手。令其仰掌
以帛覆之。熏之良久。手背生毛。长至寸许。白而黄者可治。红者则难。青黑者死。若熏之
良久无毛者。非传尸也
初服黑虎丹 下诸痨虫。从大便中出。
真牛黄。阿魏(各一钱)真雷丸。南木香(各五钱)雄鸡肫皮(洗净炙干二钱)共研细末。用
使君子(去壳)研末二两。加前药七钱。将飞罗白面打糊丸如梧子大听用。
次服小红丸
锦纹大黄(为末一两)加前药末七钱。炼蜜丸如黍米大。外用朱砂为衣。听用。
三服打虫化积丸
大黄(为末五两五钱)槟榔(三两)黑丑(头末三两五钱) 用面糊丸如梧子大。听用。
初服起。于四更时。用砂糖水化吞黑虎丹。若壮盛者服二钱五分虚弱者服二钱。二次五
更时
服小红丸。白糖水化吞。如壮盛者服四十丸。虚弱者服三十五丸。三次天明服化积丸。用片
糖化水吞之。壮盛者服三钱五分。虚弱者服三钱。虫下为验。视其虫黄白者治。青黑者不治
。如无虫。过二三日再服。至若收功常服地黄丸补其血气。如服后泻不止者。宜服异功散。
噎证病位在上，表现为咽喉部壅塞阻滞。虽然饮水可以进入，但进食却无法下行。隔证病位在下，表现为胸膈部位痞闷胀满。虽然食物可以进入，但到达胃部后又反吐出来。有的患者在进食后出现眼睛发直、口角张开，气机不能顺畅运行；或者食物入口后在心窝处产生刺痛，片刻之后吐出，食物吐出后疼痛停止。
五噎和五隔的成因，多由喜怒等情绪过度，导致七情内伤脾胃，气机郁结而生痰，痰浊与气机相互搏结，导致气机升而不降，饮食无法下行。若病邪留滞于咽喉部位，则形成五噎；若结聚于胃膈部位，则形成五隔。（其病因涉及思、忧、喜、怒、悲等情志）。这些病症会导致患者胸膈痞闷、呕吐逆气、噎塞不通，妨碍正常饮食。治疗方法应当调理阴阳，化痰并降逆下气。当阴阳平衡协调，气机顺畅、痰浊下降时，疾病自然不再发作。
按语：七情所伤，导致痰与气相互搏结，所以食物难以咽下；若有瘀血阻碍，则食物咽下时会感到疼痛，或者发生反胃而吐出。这总归是由于脾胃虚弱受损，血液枯槁，不能运化五谷精微，膈间受到病变影响，所以统称为“膈”病。
积虚而成损，积损而成痨（劳瘵），经年不愈，称为久虚。其中有五劳、六极、七伤的区分。五劳对应五脏：用心思谋划过多则劳伤心神，深谋远虑则劳伤肝气，意外之事过度思虑则劳伤脾气，预先担忧则劳伤肺气，矜持节操意志则劳伤肾精。六极对应六腑：血极则面色枯槁、头发脱落，善忘；筋极则拘挛、转筋，指甲暗淡、甲痛；肉极则身体消瘦、倦怠嗜卧；气极则喘咳、少气，皮肤干枯、毛发焦黄；骨极则面色垢浊、牙齿浮痛、腰酸脊痛；精极则视力昏暗、耳鸣、遗尿、阴茎萎弱。七伤则是推究劳极的缘由，如久视伤血，久卧伤气，久坐伤肉，久立伤骨，久行伤筋，房事劳累及思虑过度损伤心肾。心主血，肾主精，精竭血燥，气衰火旺，蒸灼日久，则生痨病。
痨瘵日久，元气必然受损。热毒、痰浊、瘀血变幻生成虫邪。在肝为毛虫，食人筋膜；在心为羽虫，食人血脉；在脾为裸虫（无毛之虫），食人肌肉；在肺为介虫（有壳之虫），食人肤膏；在肾为鳞虫，食人骨髓。其症状表现为蒸热咳嗽、胸闷背痛、两眼不明、四肢无力、腰膝酸疼、卧床不能入睡。有的面色㿠白，有的两颊时常发红，常怀忿怒，梦见与鬼交合。如果虫蚀肺系，则咯血吐痰，喉部生疮声音嘶哑，思食无厌，皮肤干枯毛发脱落，实在令人悲悯。治疗唯有补虚扶元，杀虫以绝其根，即使不能获救，也可阻断其传染。
验病方法：用乳香焚烧熏烤患者的手，令其手掌向上，用布覆盖，熏烤良久，若手背生出毛发，长约一寸左右，颜色白而黄的可以治愈，红色的难治，青黑色的必死。如果熏烤良久没有长毛的，不是传尸痨病。
初服黑虎丹，以排出诸种痨虫，从大便中排出。
配方：真牛黄、阿魏（各一钱），真雷丸、南木香（各五钱），雄鸡肫皮（洗净炙干二钱）。共研为细末，使用使君子（去壳）研成的粉末二两，加入前述药末七钱，用飞罗白面打糊，制成梧桐子大小的丸剂，备用。
次服小红丸。
配方：锦纹大黄（研末一两），加入前述药末七钱，炼蜜为丸，如黍米大小，外用朱砂为衣，备用。
三服打虫化积丸。
配方：大黄（研末五两五钱），槟榔（三两），黑丑（头末三两五钱）。用面糊为丸，如梧桐子大小，备用。
服药次序：初次服药，在四更天时，用砂糖水化开吞服黑虎丹。若体质壮盛者服用二钱五分，虚弱者服用二钱。第二次在五更天时，服用小红丸，用白糖水化开吞服。若体质壮盛者服用四十丸，虚弱者服用三十五丸。第三次在天明时分，服用化积丸，用片糖化水吞服。若体质壮盛者服用三钱五分，虚弱者服用三钱。以排出虫体为见效标志。观察排出的虫，黄白色的可治，青黑色的不治。如果没有虫排出，过两三天再服。至于收功阶段，常服地黄丸以补益气血。如果服药后腹泻不止，宜服用异功散。
Yi (choking) is located in the upper part, manifesting as congestion and obstruction in the throat. Although drinking water can enter, food cannot go down. Ge (blocking) is located in the lower part, manifesting as fullness and stuffiness in the chest and diaphragm. Although food can enter, it is regurgitated after reaching the stomach. Some patients experience staring eyes and open mouth after eating, with qi failing to flow smoothly; or they experience stabbing pain at the heart center upon swallowing food, which is vomited out after a moment, with the pain stopping once the food is expelled.
The Five Yis and Five Ges are caused by excessive emotions such as joy and anger, where the Seven Emotions injure the Spleen and Stomach. Qi stagnation generates phlegm, which contends with qi, causing qi to ascend but not descend, preventing food intake. If the pathogen remains in the throat and esophagus, it becomes Five Yis; if it knots in the stomach and diaphragm, it becomes Five Ges. (Involving emotions of worry, thought, joy, anger, and grief). These conditions cause chest and diaphragm fullness, vomiting and counterflow, choking and blockage, hindering diet. The treatment method should regulate Yin and Yang, resolve phlegm, and direct qi downward. When Yin and Yang are balanced, qi flows smoothly, and phlegm descends, the disease will not arise.
Note: Injury from the Seven Emotions causes phlegm and qi to contend, so food cannot be swallowed; if blood stasis obstructs, food causes pain upon swallowing, or leads to regurgitation. This is generally due to deficiency and injury of the Spleen and Stomach, with withered blood unable to transform the five grains. Disease in the diaphragm region is thus collectively named "Ge".
Accumulated deficiency becomes Sun (damage), accumulated damage becomes Lao (consumption). Unhealed for years is called long-term deficiency. It is divided into Five Labors, Six Extremes, and Seven Injuries. Five Labors correspond to the Five Zang organs: mental exertion labors the Heart; planning and strategizing labors the Liver; excessive thinking about unexpected matters labors the Spleen; worrying about future events labors the Lungs; maintaining moral integrity labors the Kidneys. Six Extremes correspond to the Six Fu organs: Blood extreme manifests as withered complexion and hair loss, forgetfulness; Sinew extreme manifests as spasms and cramps, dark nails and nail pain; Flesh extreme manifests as emaciation, fatigue, and desire to lie down; Qi extreme manifests as wheezing, coughing, shortness of breath, dry skin, and scorched hair; Bone extreme manifests as dirty complexion, floating teeth, sore waist, and back pain; Essence extreme manifests as dim vision, tinnitus, enuresis, and weak penis. Seven Injuries trace the causes of labor and extremes: prolonged viewing injures blood; prolonged lying injures qi; prolonged sitting injures flesh; prolonged standing injures bones; prolonged walking injures sinews; sexual excess and overthinking injure the Heart and Kidneys. The Heart governs blood, and the Kidneys govern essence. Exhausted essence and dry blood, with deficient qi and flourishing fire, steaming for a long time, generate Lao disease.
After Lao disease persists for a long time, Yuan Qi (Original Qi) must be injured. Heat toxins, phlegm turbidity, and blood stasis transform into parasites. In the Liver, they are Hair Parasites, eating sinews and fascia; in the Heart, they are Feather Parasites, eating blood vessels; in the Spleen, they are Naked Parasites, eating muscle tissue; in the Lungs, they are Shell Parasites, eating skin fat; in the Kidneys, they are Scale Parasites, eating bone marrow. Symptoms include steaming fever, coughing, chest tightness, back pain, unclear vision, limb weakness, soreness and pain in the waist and knees, inability to sleep when lying down. Some have a sallow white complexion, some have red cheeks at times, often feeling angry, dreaming of intercourse with ghosts. If parasites erode the lung system, there is hemoptysis and expectoration, throat ulcers, hoarseness, insatiable appetite, withered skin, and falling hair, which is truly pitiable. Treatment requires tonifying deficiency and supporting Yuan Qi, killing parasites to cut off the root. Even if survival is not achieved, transmission can be prevented.
Diagnostic test: Burn frankincense to fumigate the patient's hand. Have the patient hold their palm upward, cover it with cloth, and fumigate for a long time. If hair grows on the back of the hand, about one cun long, white and yellow indicates curability; red indicates difficulty; blue-black indicates death. If no hair grows after long fumigation, it is not a transmissive corpse parasite disease.
First, take Heihu Dan (Black Tiger Pill) to expel various Lao parasites via stool.
Formula: Real Niuhuang (Calculus Bovis), Awei (Ferulae Resina) (each 1 qian); Real Leiyuan (Polyporus Umbellatus), Nanmuxiang (Lithospermi Radix et Rhizoma) (each 5 qian); Xiongji Zhunpi (Gallus gallus domesticus Gizzard Skin) (washed, dried by roasting, 2 qian). Grind into fine powder. Use 2 liang of Shijunzi (Quisqualis Fructus) kernel powder. Add 7 qian of the aforementioned powder. Make pills with flour paste, size of Sophora japonica seeds. Set aside.
Second, take Xiaohong Wan (Little Red Pill).
Formula: Jinwen Dahuang (Rhei Radix et Rhizoma) powder (1 liang). Add 7 qian of the previous powder. Make pills with refined honey, size of millet seeds. Coat with Zhusha (Cinnabaris). Set aside.
Third, take Dachong Huaji Wan (Worm-Beating and Mass-Resolving Pill).
Formula: Dahuang (Rhei Radix et Rhizoma) powder (5 liang 5 qian); Binglang (Arecae Semen) (3 liang); Heiqiu (Momordicae Semen Preparatum) head powder (3 liang 5 qian). Make pills with flour paste, size of Sophora japonica seeds. Set aside.
Administration: First dose: At the fourth watch (4 AM–6 AM), dissolve Heihu Dan in sugar water and swallow. For robust patients, 2.5 qian; for weak patients, 2 qian. Second dose: At the fifth watch (6 AM–8 AM), take Xiaohong Wan dissolved in white sugar water. For robust patients, 40 pills; for weak patients, 35 pills. Third dose: At dawn, take Huaji Wan dissolved in rock sugar water. For robust patients, 3.5 qian; for weak patients, 3 qian. Expulsion of worms is the sign of efficacy. Observe the worms: yellow-white are treatable; blue-black are untreatable. If no worms are passed, repeat after two to three days. For recovery, commonly take Dihuang Wan (Rehmannia Pill) to tonify blood and qi. If diarrhea persists after taking these medicines, take Yigong San (Extraordinary Efficacy Powder).