第十四章．治膈食方

Chapter 14. Herbs for food-block condition.

参赭培气汤

Shenzhe Peiqi Tang (Shen here means herb Renshen in Chinese; Zhe means herb Daizheshi; Pai means to nourish; Qi means energy).

治膈食（“论胃病噎膈治法及反胃治法”宜参看）。
This formula is used to treat Food-block condition. It can also be called a Food-block condition, in which the food cannot come down to the stomach for digestion.  

潞党参（六钱） 天门冬（四钱） 生赭石（八钱，轧细） 清半夏（三钱） 淡苁蓉（四钱） 知母（五钱）当归身（三钱） 柿霜饼（五钱，服药后含化徐徐咽之）
Dangshen 18 gram, Tianmendong 12 gram, Daizhshi 24 gram (grind into powder), Banxia 9 gram, Roucongrong 12 gram, Zhimu 15 gram, Danggui (body part) 9 gram, Shishuangbing 15 gram (hold in mouth after drinking the herbal tea from other ingredients).

人之一身，自飞门以至魄门，一气主之，亦一气悬之。故人之中气充盛，则其贲门（胃之上口）宽展，自能容受水谷，下通幽门（胃之下口）以及小肠、大肠，出为二便，病何由而作？若中气衰惫，不能撑悬于内，则贲门缩小，以及幽门、小肠、大肠皆为之紧缩。观膈证之病剧者，大便如羊矢，固因液短，实亦肠细也。况中气不旺，胃气不能息息下降，而冲气转因胃气不降，而乘虚上干，致痰涎亦随逆气上并，以壅塞贲门。夫此时贲门已缩如藕孔，又加逆气痰涎以壅塞其间，又焉能受饮食以下达乎？故治此证者，当以大补中气为主，方中之人参是也。以降逆安冲为佐，以清痰理气为使，方中之赭石、半夏、柿霜是也。又虑人参性热、半夏性燥，故又加知母、天冬、当归、柿霜、以清热润燥、生津生血也。用苁蓉者，以其能补肾，即能敛冲，冲气不上冲，则胃气易于下降。且患此证者，多有便难之虞，苁蓉与当归、赭石并用，其润便通结之功，又甚效也。若服数剂无大效，当系贲门有瘀血，宜加三棱、桃仁各二钱。
In the body, the Qi distributes from the Feimen (throat) to the Pomen (the pylorus) as a whole unit. If the Qi is sufficient and strong, the cardia (the upper opening of the stomach) is broad, so as to accept the food. The pylorus as well as the small intestine and large intestine all are relax to allow the food passing to become stool eventually. If the middle Qi is weak, unable to hold the inner openings open, the pylorus would be narrow, and the cardia and the small intestine and large intestine all are tight. It can be seen in the severe case of the Gezheng patients, the stool is as sheep stool. It can be due to insufficient liquid in the digestive system, but it is actually due to the narrow of the intestine. In addition, if the middle Qi is insufficient, the Stomach Qi cannot fall down to pass food. The Chongqi would rush up to attack the upper part of the body, which makes the phlegm-saliva rush reverse up to block the cardia. At this time, the carida is already be narrow, the additional block from the phlegm would block it further more. How could it be able to accept food down? For this reason, the Food-block condition should be treated with urgent supply of the middle Qi, as the use of Renshen in the formula. The Daizheshi, Banxia, and Shishuangbing work to reverse the Chongqi, and to clear the phlegm. The Zhimu, Tianmendong, Danggui and Shishuangbing are used to clear Fire, Wet the dryness, to produce more liquid and to produce more blood, so as to prevent the possible Fire side effect from the Renshen, and the Dryness of the Banxia. The herb Roucongrong can nourish the Kidney, so to restrain the reversed Qi. If the ChongQi is not rushing up, the Stomach Qi would be easy to fall. Patients with this Food-block condition usually have difficulty in bowel movement. The use of Roucongrong and the Danggui and Daizheshi could promote the bowel movement. It works fast and well. If, after several doses, there is no major improvement, it suggests the presence of blood stagnation in the cardia. Herb Sanlen and Ezhu should be added.

仲景《伤寒论》有旋复代赭石汤，原治伤寒发汗，若吐若下解后，心下痞硬，噫气不除者。周扬俊、喻嘉言皆谓治膈证甚效。拙拟此方，重用赭石，不用旋复花者，因旋复花《神农本草经》原言味咸，今坊间所鬻旋复花，苦而不咸，用之似无效验。惟邑武帝台为汉武帝筑台望海之处，地多咸卤，周遭所产旋复花，大于坊间鬻者几一倍。其味咸而兼辛，以治膈食甚效。

In the book 《Shan Han Lun》, there is a formula called Xuanfu Daizheshi Tang. It is used to solve the hard and block feeling in the stomach area and continuous hiccup, which is caused by an improper use of the sweat therapy, vomiting therapy or bowel cleansing therapy. Mr. Zhou Yangjun and Mr. Yu Jiayan both claimed it works well for the Food-block condition. Here in my formula, the herb Daizheshi, but not the Xuanfuhua, is used, since the Xufuha in the book 《Shennong Bencao Jing》is said to be salty in taste, but the Xuanfuhua in the market now is bitter rather than salty in taste, so as it may not work. Only the Xuanfuha produced in a special place of China…. it is bigger than the ordinary one, and it is salty and also with a spicy taste, works for the Food-block condition.

或问：《神农本草经》旋复花，未言苦亦未言辛。药坊之苦者，既与《神农本草经》之气味不合，岂武帝台之辛者，独与《神农本草经》之气味合乎？答曰：古人立言尚简，多有互文以见义者。《神农本草经》为有文本后第一书，其简之又简可知。故读《神农本草经》之法，其主治未全者，当于气味中求之；其气味未全者，即可于主治中求之。旋复花《神农本草经》载其主结气，胁下满，惊悸、除水、去五脏间寒热，补中下气。三复《神农本草经》主治之文，则复花当为平肝降气之要药，应借辛味，以镇肝木，其味宜咸而兼辛明矣。至于苦味，性多令人涌吐，是以旋复花不宜兼此味也。其味不至甚苦，亦可斟酌加入也。
(not translated) 

一叟，年六十余得膈证，向愚求方。自言犹能细嚼焦脆之物，用汤水徐徐送下，然一口咽之不顺，即呕吐不能再食，且呕吐之时，带出痰涎若干。诊其脉关后微弱，关前又似滑实，知其上焦痰涎壅滞也。用此汤加邑武帝台所产旋复花二钱，连服四剂而愈。
A man, 60 years of old, had such Food-block condition, and asked my help. He said he can chew the charcoal and fragile food in mouth and swallow it with the help from water. If one swallow does not pass down, he would vomit and could not have more eating. When he vomited, there was phlegm in the stuff out. His pulse was weak in the Chi position, and slippery and sthenic in the Chong position. It was considered to be due to the filling of the phlegm in the Upper Jao of the body, which blocks the cardia. He was given this herbal formula, as well as Xuanfuhua 6 grams. Continuous six doses solved his problem.

一人，年四十六，素耽叶子戏，至废寝食。初觉有气上冲咽喉，浸至妨碍饮食，时或呕吐不能下行。其脉弦长而硬，左右皆然。知系冲气挟胃气上冲。治以此汤，加武帝台旋复花二钱、生芡实四钱，降其冲逆之气而收敛之，连服十剂而愈。
A man, 46 years of old, indulged in opera, so as miss his diet and sleep. In the beginning, he felt a reversed Qi up to press his throat. Later, the rushing Qi affected his eating. He felt hard to swallow or had vomit. His pulse was string, long and hard on both sides. It was considered to be due to the Chongqi brings the Stomach Qi to rush up. This formula was given, with addition of Xuanfuha 6 gram, to reverse the up-rushing Qi. After tens of doses, the condition was improved.

族家姑，年五旬有六，初觉饮食有碍，后浸增重，惟进薄粥，其脉弦细无力。盖生平勤俭持家，自奉甚薄，劳心劳力又甚过。其脉之细也，因饮食菲薄而气血衰，其脉之弦也，因劳心过度而痰饮盛也。姑上有两姊，皆以此疾逝世，气同者其病亦同，惴惴自恐不愈。愚毅然以为可治，投以此汤，加白术二钱、龙眼肉三钱，连服十余剂全愈。
My aunt-in-law, 56 years of old, felt hard to swallow in the beginning. Later she could only drink water-like soup. Her pulse was thin and asthenic. She worked very hard usually but cared her self very little in the diet and the rest. Her thin pulse was due to poor diet to supply the Qi and blood. Her string pulse was due to the overwhelming of phlegm-water caused by over work in mind. She had two sisters. Both died to the same condition. She therefore felt feared. However, I told her that her condition can be improved. She was given this formula, plus Baizhu 6 gram, Longyanrou 9 gram. Continuously tens of doses solved the problem.

堂侄女，年四十八岁，素羸弱多病。因自理家务，劳心过度，恒彻夜不寐。于癸卯夏日得膈证。时愚远出，遂延他医调治，屡次无效。及愚旋里，病势已剧。其脉略似滑实，重按无力。治以此汤，加龙眼肉五钱，两剂见轻，又服十余剂全愈。
My niece-in-law, 48 years of old, was weak and sick for a long time. For hard labor house work and over work in mind, she could not fall sleep at all. In a summer, she got this Food-block condition. At that time, I was far away in other cities. She was so sent to other doctor for help, without any improvement. After I came back, her condition became severe. Her pulse was as slippery and sthenic, but weak when press harder. I used this formula to her, with addition of Longyanrou 15 gram. After two doses, her condition was much improved and after tens of doses, the condition was completely solved.  

奉天北镇县萧叟，年六十七岁，得膈证延医治不愈。迁延五六月，病浸加剧，饮水亦间有难下之时。来院求为延医。其脉弦长有力，右部尤甚。知其冲气上冲过甚，迫其胃气不下降也。询其大便，干燥不易下，多日不行，又须以药通之。投以参赭培气汤，赭石改用一两。数剂后，饮食见顺，脉亦稍和，觉胃口仍有痰涎杜塞。为加清半夏三钱，连服十剂，饮食大顺，脉亦复常，大便亦较易。遂减赭石之半，又服数剂，大便一日两次。遂去赭石、柿霜饼、当归、知母，加于术三钱，数剂后自言，觉胃中消化力稍弱，此时痰涎已清，又觉胃口似有疙瘩，稍碍饮食之路。遂将于术改用六钱，又加生鸡内金（捣细）二钱，佐于术以健运脾胃，即借以消胃口之障碍，连服十余剂全愈。
A man, who lived in Baizhen city, Fengtian province, and who was 67 years of old, got this Food-block condition. He tried to visit doctors but no effect. His condition was lasted for 5 or 6 months and it became worse and worse. He could even feel hard to swallow water. His pulse was string, long and strong, especially on the right side. It is known that his condition was due to the up-rushing of the Chongqi, which presses the Stomach Qi not fall. His stool was dry and hard to pass. It was once every more days and need some conducting therapy for the bowel movement. He was given this Shenzhe Paiqi Tang, with the Daizheshi changed to 30 gram. After several doses, the diet was much easier and the pulse was slight calm down too, but he still feel some block feeling in the upper stomach. So, the Daizheshi was reduced to half amount. The formula was continued for several doses. His stool became twince a day. So, the Daizheshi, Shishuanbing, Danggui and Zhimu were removed, but Baizhu 9 gram was added in. After several doses, she daid she felt poor ability to digest food. At this time, the phlegm has been cleared. She felt as a mass on the stomach, which block the pass of the food to digest. So, the Baizhu was increased to 18 gram, with addition of Jineijin 6 gram to help the function of Baizhu in digestion. After tens of doses, the condition was completely solved.

友人吴××治姜姓叟，年六十余，得膈食证。屡次延医调治，服药半载，病转增进。吴××投以参赭培气汤，为其脉甚弦硬，知其冲气上冲，又兼血液枯少也，遂加生芡实以收敛冲气，龙眼肉以滋润血液，一剂能进饮食，又连服七八剂，饮食遂能如常。
My friend, Mr. Wu, had treated a man, who was 60 years of old and had this Food-block condition. The patient has visited various doctors without any help but worse. Mr. Wu prescribed him this Shenzhe Paiqi Tang. For his pulse was string and hard, knowing it is due to Chongqi rushing up, together with weakness in the blood, he added herb Qianshi to restrain the up-rushing Chongqi, the herb Longyanrou to nourish the blood. After one dose, the patient could eat. After seven to eight doses, the diet became normal.

附录：
Appendix:

奉天义县马××来函：
Letter from Mr. Ma, Yi city, Fengtian province.

去岁（乙丑）舍侄××患膈食，延医延医，年余无效。及病至垂危，诸医束手无策，有旧戚赠一良方，言系《衷中参西录》所载之方，名参赭培气汤，服之立见功效。连服十剂，其病全愈。
Last year, my nephew got the Food-block condition. He visited various doctors for about one year, without help. His condition became worse. One of my relatives introduced me a formula, it was said from the book 《Zhongzhogn Canxi Lu》 and called Shenzhe Paiqi Tang. After drinking the herbal tea, the condition was improved right away. After tens of doses, the condition was completely solved.

奉天法库县万××来函：
Letter from Faku city, Fengtian province:

邱××之女，年十五，天癸已至，因受惊而经闭。两阅月，发现心热、心跳、膨胀等证，经医治疗未效，更添翻胃吐食、便燥、自汗等证。又经两月，更医十数，病益剧。适友人介绍为之诊视，脉浮数而濡，尺弱于寸，面色枯槁，肢体消瘦，不能起床；盖两月间食入即吐，或俟半日许亦必吐出，不受水谷之养，并灼热耗阴，无怪其支离若是也。思之再四，此必因受惊气乱而血亦乱，遂至遏其生机，且又在童年，血分未充，即不能应月而潮，久之不下行，必上逆，气机亦即上逆，况冲为血海，隶属阳明，阳明有升无降，冲血即随之上逆，瘀而不行，以至作灼作胀。其心跳者，为上冲之气血所扰也。其出汗吐食者，为上冲之气血所迫也。其津液因汗吐过多而消耗，所以大便干燥也。势非降逆、滋阴，镇心、解瘀之药并用不可。

The daughter of Mr. Qiu was 15 years of old. She supposed to start menstruation, but due to scare, the menstruation stopped. After two months, she felt heart hot, palpitation, bloating feeling, etc. After visiting doctor, there was no improvement, but felt vomiting, constipation, and sweat. After another two months visiting tens of doctors, the disease was much worse. She was introduced by my friend to come to me. Her pulse was floating, frequent and ru. The pulse in the Chi position is weaker than the Chong position. She was pale and withered in the face, and thin and too slim on the body shape. She could not get up the bed, since for the past two months, she vomited the movement finished eating, or vomited sometime later after eating. No strange that she was so withered, since her body could not be nourished by food, and the inside Fire still burning her body Yin. I have considered again and again, and thought that her condition was due to scare that disturbed his Qi and blood, which prevented the body functions. She was in young age, there was no enough blood yet to allow the menstruation. After a long time, the blood does not pass down as menstruation, it would reverse up to cause reverse of the Body Qi too. The Chong meridian was the sea of blood, which belongs to the Yangming meridian too. The Yangming had rising but no falling, so the Chongqi had also only rising but no falling. The blood is stagnated, so to cause burning sensation and floating sense. The palpitation is due to the rushing-up of the Qi and Blood; the sweat and vomiting were also due to the press by the reversed Qi and Blood. The constipation is due the over loss of body liquid after vomiting and bowel cleansing therapy. For the treatment, it is needed to use the herbs to suppress the reversed Qi; to nourish the Yin; to calm the heart; and to cleanse the stagnation.

查参赭镇气汤及参赭培气汤二方，实为治斯证之津梁，爰即二方加减，赭石两半，当归、净萸肉、龙骨、牡蛎各五钱，白芍、肉苁蓉、党参、天冬、生鸡内金各三钱，磨取铁锈之水煎服。一剂病似觉甚，病家哗然，以为药不对证，欲另延医。惟介绍人主持甚力，勉又邀生再诊，此中喧变生固未之知也。既诊脉如故，决无病进之象。后闻有如此情形，生亦莫解。
Check the literature, the Shenzhe Zhenqi Tang and Shenzhe Paiqi Tang are the main formula for her condition. So used these two formulas with modification, in which the Daizheshi was 45 gram, Danggui 15 gram, Shanyurou 15 gram, Longgu 15 gram, and Muli 15 gram, Baishao 9 gram, Roucongrong 9 gram, Dangshen 9 gram, Tianmendong 9 gram, and Jineijin 9 gram. The herbs were cooked in cutler water. After one dose, the condition appeared worse, and the family was very nervous. They thought it was a wrong treatment and considered to change doctor. Only because the person who referred me to them insisted, the family reluctantly allowed me to continue. At that time, her pulse was the same, so I knew the condition was not worse. Later, I met such condition again, but still do not know why.

因反复思之，恍悟：此必胃虚已极，兼胃气上逆过甚，遽投以如此重剂，其胃虚不能运化，气逆更多冲激，想有一番瞑眩，故病似加重也。于斯将原方减半，煎汤一盅，又分两次温服下，并送服柿霜三钱。其第一次服，仍吐药一半，二次即不吐，服完此剂后，略进薄粥，亦未吐，病家始欢然相信。又连服三剂，汗与吐均止，心跳膨胀亦大见轻。惟灼热犹不甚减，遂去净萸肉、龙骨、牡蛎，加生地、玄参各四钱，服五剂后，灼热亦愈强半。如此加减服之，一月后遂能起床矣。嘱其仍守服原方，至诸病全愈后可停药勿服，月事至期亦当自至也。

After consideration for a while, I suddenly realized: this must was due to too weak of her stomach. Along with the reversing up of the stomach Qi, and the use of the large amount of herbs, the stomach is too weak to handle the healing pushing effect, so that the the herbal Qi might cause a rebound effect to the body, and so she felt as dizziness, appearing as the disease became worse. So, I reduced the previous herbs to half doses. The cooked herbal tea was asked to drink for two separated times, with addition of the Shishuangbing 9 gram. After the first drinking, she vomited half of the herbs, but no vomit after the second drink. After finish the drinking, she could eat little bit soup without vomit. The family became glad. After additional three doses, the sweat and the vomit both stopped, and the heart beating feeling was much improved, though the burning sensation was the same. From the formula, Shanyurou, Longgu and Muli were removed, and Xuanshen 12 gram, Shengdi 12 gram were added. After five doses, the burning sensation was also cured for half. With such modification for one month, she could get up the bed. She was asked to continue the herbs until the whole condition was totally cured. Her menstruation would then turn normal.