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The distension disorder named "Gu" (Guzhong, a type of abdominal distension resembling insect erosion) takes its name from the meaning of insects eroding the body. However, medical texts state: When various insects and snakes are gathered in a container to eat each other until none remain, leaving only one survivor, this is called "Gu". This Gu can change most readily; sometimes it enters the abdomen with food or drink, devouring the five Zang organs. In acute cases, it causes severe stabbing pain and sudden death; in chronic cases, it gradually deepens, leading to emaciation and wasting. There are also cases of poisoning from accidentally ingesting centipedes or similar toxic substances, where the tongue protrudes outside the lips and cannot be retracted. Those knowledgeable apply chicken blood to the root of the tongue to retract it.

Yige (Dysphagia), Fanwei (Regurgitation/Reverse Stomach), and Guange (Obstruction and Rejection) are three conditions with different names but vastly different etiologies; their treatments must be distinguished and not confused. The condition of "Ye" (Dysphagia/Choking) occurs when food reaches the mouth but cannot pass down the throat, being immediately vomited up. It starts with choking and turns into vomiting, hence called Ye. Its pathology lies at the Xi Men (Suction Gate), which is the location of the epiglottis. The disease is in the Upper Jiao (Upper Burner) and mostly belongs to dryness and withering of the stomach cavity, with depletion of blood, indicating a disease of Yin deficiency and Fire hyperactivity. The condition of "Ge" (Diaphragm obstruction) is like food swallowed reaching the diaphragm but unable to descend directly, instead slowly vomiting back up from the diaphragm, hence called Ge. This refers to the anatomical diaphragm, not the concept of blockage. Its pathology lies at the Fen Men (Cardia), which is the upper opening of the stomach. The disease is in the Middle Jiao (Middle Burner) and mostly belongs to emotional distress from worry and anger, causing Phlegm and Qi stagnation in the upper diaphragm, or due to bitter mental struggles that knot the vital energy of the Spleen; this is a disease caused by emotional factors. Danxi (Zhu Zhenheng) said: "Only elderly men suffer from this; young people do not have Yige." As for "Fanwei" (Reverse Stomach/Regurgitation), the patient eats double the usual amount. After food passes the diaphragm into the stomach, because the lower Wan (Lower Orifice of the stomach) cannot rot and transform it, morning food may be vomited in the evening, or evening food in the morning, or after accumulating for over a day, causing unbearable bloating and distension, then vomiting the original undigested food. It flips out from the lower Wan of the stomach, hence named Fanwei. Its pathology lies at the You Men (Pylorus), which is the lower opening of the Tai Cang (Stomach). The disease is in the Lower Jiao (Lower Burner); although it belongs to the Stomach, it is actually caused by decline of Mingmen Fire (Gate of Vitality Fire) and deficiency-cold of the Kidney Meridian. Both men and women of all ages can suffer from this. As for "Guange" (Obstruction and Rejection), the patient does not desire to eat even a grain of rice, feels thirsty and prefers tea or water, but drinks little before vomiting it up again. If medicine is taken, hot medicine comes out immediately upon entering, and cold medicine comes out after a while. Urination and defecation are blocked. This is named Guange. "Guan" (Obstruction) means both urination and defecation are blocked, with nothing able to exit below. "Ge" (Rejection) means vomiting and rejecting water and fluids, with nothing able to enter above. Women often have this syndrome. It is a case of Yin and Yang reversing positions, so both upper and lower parts are diseased. Guan has no way out, Ge has no way in. The urgency makes it hard to resolve, and it is difficult to treat slowly. Excess patterns are temporarily unblocked, while deficiency patterns require vigorous tonification as an attacking method. This is likely because Yang Qi is stuck in the Upper and Middle Jiao, failing to ascend and descend.

Yige mostly originates from dried-up Blood, complicated by Qi stagnation. Because Qi stagnation leads to knotting and stagnation, with Phlegm obstructing the Diaphragm, patients often vomit Phlegm and water. "Ge" refers to the Diaphragm located below the Heart, where upper and lower passages are blocked, resembling rejection. Initially, it knots at the throat, feeling obstructed; neither vomitable nor swallowable, caused by Qi stagnation and Phlegm binding. Over time, it gradually hinders eating and drinking, becoming Yige. "Ye" refers to the sudden blockage of Qi during eating, preventing food from going down, resulting in Ye.

Jiezai said: The syndromes of Ge-Ye and Fanwei are caused by Fire, developing gradually with diverse sources. Some arise from excessive thinking stirring Spleen Fire; some from excessive anger stirring Liver Fire; some from long-term consumption of fried foods generating Stomach Fire; some from unchecked sexual desire raising Kidney Fire. Generally, Fire Qi flares upward, steaming Body Fluids to form Phlegm. Initially, Phlegm-Fire is not yet knotted, causing dryness in the throat and diaphragm, making food and drink difficult to flow smoothly, resulting in Ge or Ye. Later, Phlegm-Fire knots, the upper Wan of the Stomach fails to open; although food enters, it stagnates in the Diaphragm and comes out shortly after, called Vomiting. If the lower Wan of the Stomach fails to open, food enters but stagnates in the Stomach, coming out after a long time, called Fanwei. Danxi said: Elderly patients are incurable. Young people have not yet depleted Qi and Blood; using drugs to clear Phlegm-Fire cures the disease without recurrence. Elderly people have already depleted Qi and Blood; clearing Phlegm-Fire brings temporary relief, but the disease returns. This is because Qi deficiency fails to transform and generates Phlegm, while Blood deficiency fails to moisten and generates Fire. One must absolutely avoid aromatic-dry drugs; taking them will surely lead to death. Diet should be bland. Since this syndrome is Heat and Dryness, if the medicine is also aromatic-dry, it scatters Qi and consumes Blood. Moreover, rich flavors aid Fire and cause disease, further exacerbating the condition, so these should all be avoided.

Yangkui said: Danxi attributes Yige to Seven Emotions and Six Evils, leading to transformations of Fire flaring upward, with more ascending than descending. Body Fluids are not distributed, accumulating into Phlegm and Drink. When attacked, there is temporary relief, but it recurs soon. Repeating previous medicines accumulates Heat, depletes Blood, and causes the stomach cavity to become dry and rough, obstructing the pathway. If the dryness is upper, near the throat, water drinks can pass, but solid food is hard to eat and intake is small; this is called Ye. If the dryness is lower, near the stomach, food can enter but not fully reach the stomach, coming out after a long time; this is called Ge, also called Fanwei. Defecation is scanty and resembles sheep droppings. One must avoid external Six Evils, regulate internal Seven Emotions, nourish oneself through diet, nourish Blood and generate Fluids to moisten the intestines and stomach. Then Metal (Lung) will fear no Fire flare, and Kidney will have gradual generation of Water. With clear Qi and harmonious Blood, Spleen Qi transforms robustly, and food digests and transmits normally. Danxi's discussion is excellent, but his distinction between Yige and Fanwei is unclear. I particularly appreciate his phrases "transformation of Fire flaring upward" and "gradual generation of Water by Kidney," which deeply hit the source of the disease. Unfortunately, his insight was not entirely true; focusing mainly on moistening Blood without directly exploring the congenital origin in the Kidney, his prescriptions used Si Wu Tang (Four Substances Decoction) added with cow/sheep milk, bamboo sap, and leek juice to resolve Phlegm and stasis. These treat the branch but not the root. Does he not know that *Neijing* states: "Knotting of the Three Yang meridians is called Ge." The Three Yang are Large Intestine, Small Intestine, and Bladder. Knotting refers to Heat knotting. Large Intestine governs Jin (Fluids), Small Intestine governs Ye (Essence Fluids). Heat knotting in Large Intestine dries Jin; Heat knotting in Small Intestine dries Ye. Bladder is the Official of the Capital, storing Fluids. Heat knotting in Bladder exhausts Fluids. However, why do the Three Yang develop Heat knotting? It is all a disease of the Kidney. The Kidney governs Five Fluids and Two Passages (urination and defecation), paired with the Bladder as Zang-Fu. Once Kidney Water is dry, Yang Fire becomes dominant, boiling and frying Fluids. Heat knotting in the Three Yang causes blockage of front and rear passages. Since the bottom is blocked, Qi rebels upward, directly attacking the Clear Pathways, rushing up to the Xi Men (Suction Gate), causing the throat to choke and food to fail to go down. Why can't water enter and food go down? Food enters Yin and generates Qi in Yang, inadvertently stirring the Fire of the Stomach gate. Therefore, water (Yin category) is hard to enter. Like attracts like, so drinking water causes white foam to be vomited up as the water boils and rises. Feces resembling sheep droppings occur because little food enters, residues are consumed, and the intestines become dry, small, and narrow. This syndrome mostly affects men over fifty who do not abstain from sexual desires. The innate essence of the elderly is exhausted, leaving only isolated Yang. Tonifying Yin is highly appropriate. Wang Taipu said: "Food vomited immediately upon entry indicates lack of Water. Food vomited after a long time indicates lack of Fire." Thus, Ye-Se mostly belongs to Heat, while Fanwei mostly belongs to Cold. For lack of Water, strengthen the Master of Water; for lack of Fire, benefit the Source of Fire. Chu Shizhong said: "Treat upper diseases by lowering; directly use Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) in large doses decocted and drunk. Long-term use can save one or two in ten. Also, one must abandon desires, avoid sexual activity, and eat bland food." If one says warm the Stomach, the Stomach is originally not cold. If one says tonify the Stomach, the Stomach is not deficient. If one says relieve stagnation, aromatic-dry products merely aid Fire. If one tries to purge with Cheng Qi Tang (Salvage the Extremity Decoction) using salty-cold herbs, it damages the Stomach and exhausts Fluids further. Nothing is better than tonifying Yin; the flame extinguishes itself.

Ge disease is hardest to treat. Trying to invigorate the Spleen and resolve Phlegm fears dry agents harming Fluids; trying to nourish Blood and generate Fluids fears moist agents hindering the Middle Jiao. Clinging to soothing stagnation and relieving the diaphragm uses pungent-aromatics that aid Fire, rapidly drying Stomach Juice, bringing one close to death. Therefore, Dongyuan stated there are three types of vomiting related to Qi accumulation and Cold: Upper Jiao vomiting stems from Qi; sudden vomiting after eating is the sign. Middle Jiao vomiting stems from Accumulation; either pain precedes vomiting or vomiting precedes pain. Lower Jiao vomiting stems from Cold; pulse is deep and slow, morning food vomited in evening, evening food in morning, urination is free, defecation is blocked. The method should be to unblock obstruction, warm Cold, specifically treat the Lower Jiao, scatter Cold, and slowly harmonize with Middle Jiao medicines to achieve cure. Since Mingmen Fire declines, there is no firewood under the pot to steam and rot food and water in the Stomach, causing abdominal fullness and necessitating vomiting. This is what is meant by "food vomited after a long time indicates lack of Fire." One must benefit the Source of Fire, first using Ba Wei Di Huang Wan (Eight-Ingredient Pill with Rehmannia) to tonify Mingmen Fire, supporting the Mother of Spleen Earth, then slowly using Fu Zi Li Zhong Tang (Aconite Decoction to Regulate the Middle) to regulate the Middle Jiao. Without this approach, merely using Hawthorn and Medicated Leaven to calm the Stomach and digest food merely accelerates death. Furthermore, the Ge-Ye disease in the elderly stems from dried-up Blood, loss of transport function in the Middle Jiao, inability to nourish Zang-Fu organs, presenting with a slow, weak pulse gradually becoming deep and slow, indicating daily decline of Righteous Qi. The reason they can prolong life slightly is that a thread of Harmonious Qi remains, like a lamp burning out only after the oil is gone. Physicians must preserve True Qi, prevent leakage, moisten dryness without causing congestion, ensuring Qi generates Blood, so as to complete their natural lifespan. This is why Danxi advocated treatments with various milks and juices. Modern physicians add Phlegm-resolving and Qi-breaking drugs, claiming the disease arises from stagnation and suddenly opening it. Although effective momentarily, it ultimately leads to withered collapse and death. The Yangming Meridian has abundant Blood and Qi, serving as the Sea of Food and Fluids, accepting new and exchanging old. Unlike the young and strong who simply eliminate waste, here one must use medicine to remove disease and quiet cultivation to restore Yuan Qi. Books describe this as a disorder of Spirit and Thought, stating that nourishing the Spirit and clearing Thoughts allows Fluids to gather in the Stomach. Like clear weather, when Blood and Water return to their source, there is no fear of stormy waves. Observe Yige patients: they can accept water drinks but find solid food hard to enter. This is because Yin Qi is consumed, forcing reliance on similar substances.

Fanwei fundamentally stems from dried-up Blood, so nothing is better than nourishing Blood; nourishing Blood is best achieved by nourishing Water. When Water is abundant, Fluids naturally generate, and the transmission functions of the intestines and stomach perform their duties properly. It is also said: Vomiting belongs to deficiency-cold of the stomach cavity, so nothing is better than Pungent-Warmth; Pungent-Warmth is best achieved by tonifying Fire. Tonifying Fire warms Mingmen Qi, allowing food and water in the Sea of the Stomach to be rotted and transformed. Thus, Ba Wei (Eight-Ingredient) and Liu Wei (Six-Ingredient) pills are indeed key medicines for treating Fanwei, uniquely understood by Zhao Xianke.

Ye disease fundamentally stems withered Essence and Blood, sorrowful thoughts and stagnation. Fluids and Blood cannot moisten downward, causing Ye. Thus, seeing food causes a sensation of choking in the heart; the mechanism is diseased beforehand. The formless True Qi is diseased, so treatment should focus on cultivating True Qi. It is also said: It fundamentally stems from Kidney deficiency, misuse leading to disease, weak Qi and dried Blood from worry and labor. Weak Qi fails to transform, dried Blood blocks pathways. The Ren Mai (Conception Vessel) of the human body ascends along the throat and descends straight down from the three Wans of the Stomach. Kidney deficiency causes Ren Mai to fail to moisten the Dantian; Yuan Yang Qi lacks the function of warming and steaming/rotting. Consequently, the Middle Jiao loses its transforming, transporting, and moistening descent functions, forming Ye. Therefore, treatment focuses exclusively on nourishing Yin.

If medicine prevents regurgitation, even if the patient desires food, do not immediately give porridge, drinks, or any food. Only use daily 5 qian of Renshen (Ginseng Radix et Rhizoma), 2 qian of Chenpi (Citri Reticulatae Pericarpium), and 1 liang of Lao Huang Mi (Old Yellow Rice), decocted as soup to sip slowly, to vent Stomach Qi. When feeling slightly relieved, gradually increase Renshen. After ten days to half a month, one can cautiously try old rice gruel. Since the granary is not yet secure, it is inappropriate to store grain immediately. Often, those who eat porridge and rice immediately lead to untreatable conditions. Deficiency with dry Stomach Fluids, food choking and not going down, is like a person eating dry things, causing blockage and difficulty swallowing; it must be moistened with tea water to proceed, a principle easily seen. Use 5 liang each of Sheng Jiang Zhi (Fresh Ginger Juice), Bai Mi (White Honey), Niu Su (Cow Butter/Suet), and 2 liang each of Renshen Mo (Ginseng Powder) and Bai He (Lilii Bulbus). Simmer over double-boiling to make an ointment. Advance half a spoon occasionally. Once Fluids descend, Spleen and Stomach gradually open. Most taboo are rich, sweet, sticky, and greasy foods, fearing further damage to the Stomach. A small amount of Bai Xiang Niu Ya Qing Tang (White Fish, Beef, and Duck Clear Soup) can be used to assist Stomach Qi. There are also cases caused by accumulated Blood stasis internally, which should be gradually expelled. Difficult stool is hard to treat. For excessive Phlegm, there is no need to treat Phlegm directly; tonification resolves it. Vomiting white foam is incurable. Chest and abdominal burning pain like knife cutting is fatal. Elderly patients are incurable. Feces resembling sheep droppings are incurable.

Guange, discussed in *Neijing*, refers to pulse diagnosis, not disease. Since Zhang Zhongjing created his theory, all schools considered Guange a disease name. As *Jing* states: "Ren Ying pulse four times fuller indicates Ge Yang; Cun Kou pulse four times fuller indicates Guan Yin. If both Ren Ying and Cun Kou are more than four times fuller, it is Guange. The Guange pulse is emaciated; unable to exhaust the essence Qi of Heaven and Earth, death ensues." Jingyue also believed that exclusive fullness of Ren Ying indicates disease in the Three Yang Fu organs; exclusive fullness of Cun Kou indicates disease in the Three Yin Zang organs. Guange represents extreme excess of Yin and Yang, a rebellious sign of isolated Yang and actual exhaustion of True Yin. Although discussions on pulse vs. disease differ, the harm of Yin-Yang partial severance leading to Guan and Ge is the same. Seeking meaning from the name reveals the nature of the disease.

Guan means inability to urinate, caused by intense Heat Qi, Heat in the Lower Jiao blocking passage. Ge means vomiting and rebellion, caused by intense Cold Qi, Cold in the Chest blocking flow. Guange refers to a sensation of obstruction in the Diaphragm, wanting to ascend but unable, wanting to descend but unable, wanting to eat but unable, with Cold and Heat not communicating between upper and lower. This is horizontal blocking of Qi. One must use emesis to lift the horizontal blocking of Qi, not necessarily to expel Phlegm. If Phlegm is present and suitable for emesis, use Er Chen Tang (Two-Aged Decoction) to induce vomiting; within vomiting lies descending. If Middle Qi is deficient and fails to transport, use Qi-tonifying drugs with ascending-descending properties.

Guange arrives suddenly and is an acute disease. Constipation of both urine and stool, thirst for water and food, vomiting shortly after drinking, repeated drinking and vomiting, dry lips, slightly red eyeballs, flushed or unflushed face, severe cases may have chest pain or no pain. From onset, no desire for even a grain of rice, not a drop of water can enter the stomach. Drink one cup, vomit half. After several days, the pulse becomes deep and hidden. This Cold enters from the Shaoyin Kidney Meridian; Yin excess below forces Yang upward, called Ge Yang syndrome, named Guange. Guange leads to premature death. One must use Zhang Zhongjing's Bai Tong Tang (White Connecting Decoction), applying the *Neijing* method of "treating Cold with Hot." *Jing* states: "To regulate reversal of Cold and Heat, Cold and Hot must act accordingly." Thus, take hot medicine cold. After swallowing, the cold nature dissipates, and the hot nature begins to act. Consequently, pathogenic Qi heals, and vomiting ceases. This does not violate feelings and brings great benefit. Adding Human Urine and Pig Gallbladder Bile (salty, bitter, cold substances) to Bai Tong Tang seeks harmony of Qi to remove the rejecting Cold. If the pulse gradually emerges after taking medicine, survival; if the pulse suddenly appears and disappears, death. Tao Jie'an's *Sha Che Chui* contains Fan Ben Hui Yang Tang (Return to Root and Restore Yang Decoction), extremely excellent. After recovery, continuously take Ba Wei Wan (Eight-Ingredient Pill). Another type of Liver Fire syndrome also presents with vomiting without retention, but vomits sour water, bitter water, or green-blue water. Urination and defecation are not blocked, but can cause chest pain. This is Fire Stagnation and Wood Stagnation syndrome. For Wood stagnation, disperse it; for Fire stagnation, vent it. Use Zhu Lian (Coptidis Rhizoma and Evodiae Fructus) decocted strongly, sipped slowly, then take Xiao Yao San (Free and Easy Wanderer Powder) to cure. After recovery, regulate with Liu Wei (Six-Ingredient Pill).