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*The Famous Doctors' Medical Cases* records: A monk in Jiangzhou suffered from **Yige** (dysphagia/obstruction of the esophagus) and could not eat. He instructed his disciple to open his chest and throat after his death to see what was inside. The disciple did so and found an object, resembling a fish but with two heads, which he placed in a bowl. At that time, the temple was harvesting indigo plants to make indigo dye, and the disciple took some indigo paste and put it into the bowl; the creature subsequently dissolved into water. Since then, people have used indigo to treat **Yige**, often with good effect. Chen Wuyue, in *San Yin Ji Yi Bing Zheng Fang Lun* (Treatise on the Causes and Manifestations of All Diseases), believed this was actually a **Jia** (abdominal mass/lump), not comparable to the five types of **Ye** (choking/dysphagia). Later generations therefore used indigo to treat **Yige**, which is incorrect. It is likely that some cases of **Yige** are caused by the formation of a **Jia**; indigo can treat such conditions, but it cannot be applied universally to all cases of **Yige**.

Commentary: *Xu Mingyi Leian* (Continued Cases of Famous Doctors) records: A monk in Wuchang suffered from epigastric pain, and his disciple suffered from the same condition. After the master died, he left instructions to dissect and examine his heart. Indeed, a fine bone was found in the heart region, seven or eight cun long, shaped like a hairpin, which was inserted into a vase for offering before the master's spirit tablet. Coincidentally, a distinguished guest arrived and killed a goose; the disciple used this bone to pick out something from the goose's throat. Any place touched by the goose's blood dissolved. The disciple drank goose blood for several days, and his stomach ailment was completely cured. This incident is similar to the story of the monk in Jiangzhou. According to *Bencao* (Materia Medica), goose blood treats **Yige**, **Gexie** (regurgitation), and **Fanwei** (vomiting of undigested food). Zhang Shiweng detailed this method in *Yitong*. The monk's stomach pain resulting in the growth of a bone is likely also a type of **Yige**. If so, the efficacy of goose blood is indeed superior to that of indigo.

In the commentary on *Yong Yao Jing Shi Yi Fu* by Jiang Yi of the Ming Dynasty, it is stated: **Yige** and **Fanwei** have always been feared by both doctors and patients as incurable conditions. I obtained this prescription, and nine out of ten treatments were effective; it is as precious as grain during a famine or fur coats in deep winter. Thus, I composed a song to record it: "Who knows Stone Piercer? Green leaves with deep veins and serrated edges, width less than an inch but length doubled, round stems hugging each other connected. In autumn, yellow flowers bloom with five fine petals, bearing flat seeds gathered like needles. The perennial root grows about three cun high, spring shoots emerge alongside the older stalks. Bitter and pungent in flavor, neutral in nature, entering the Lung organ, it penetrates intestines and stomach to break hard accumulations. Harvest flowers and leaves, crush to extract juice, assisted by cane syrup and white wine. Drinking this for **Yige** transforms phlegm immediately, restoring swallowing function first." Commentary: *Shi Da Chuan* (Stone Piercer) is rarely mentioned in *Bencao*, its functions being recorded only starting from *Bencao Gangmu Shiyi*. However, few people recognize it; even if they do, they may not believe in it or be willing to take it. I believe that for early-stage **Yezheng** (dysphagia), there is no better choice than *Qige San* (Open the Diaphragm Powder) from *Yixue Xinyu*. There is also a secret recipe for **Yige** paste, which Cheng Yanxuan in *Yishu* considers as effective as a divine pill. (Formula: Human milk, cow milk, Reed rhizome juice, Ginseng juice, Longan aril juice, Cane juice, Pear juice, equal parts of these seven ingredients, with a small amount of Ginger juice, stewed over water into a paste, mixed with a little refined honey, taken slowly and frequently.) As for Gu Songyuan's *Ge Zai Zao Dan* (Diaphragm Regeneration Pill), it is claimed to save critical conditions (see "Current Books Section"). With these prescriptions, why seek obscure medicines?

Regarding the syndrome of **Yige**, the discussion by Yang Suyuan, Prefect of Dingzhou, is the most detailed and accurate, appearing in Wang Mengying's *Gujin Yi'an Anxuan*. It is recorded here in full.

Historically, this syndrome was discussed together with **Fanwei**. Actually, **Fanwei** involves eating and then vomiting it back up, which is distinctly different from **Yige**, where nothing can be swallowed. Even within **Ye** and **Ge**, there is a distinction: **Ye** implies the ability to swallow initially but with a sensation of obstruction in the throat; **Ge** implies complete inability to swallow. Regarding etiology, ancients divided it into five causes: sorrow, qi stagnation, anger, food retention, and cold. There were also classifications of Drink-**Ge**, Heat-**Ge**, Phlegm-**Ge**, and Worm-**Ge**, leading to much confusion. Ye Tianshi believed it was due to the exhaustion of Yin fluids below and the binding of Yang Qi above, causing narrowing of the esophagus. This theory is based on *Neijing* and is well-founded. Xu Huixi attributed it to blood stasis and stubborn phlegm obstructing the Stomach Qi with rebellious Qi, stating that once formed, there is no cure. His reasoning is also profound. However, if it is due to Yin exhaustion and Qi binding, why do patients with consumptive diseases die from Yin exhaustion without seeing Yang binding? If it is said that Yin exhaustion combined with worry and overthinking leads to Yang Qi binding and thus **Yige**, then those who suffer from this are mostly heavy drinkers and arrogant men, while those who never experience worry do not get it. This argument is untenable. While it seems reasonable that blood stasis, stubborn phlegm, and rebellious Qi block Stomach Qi, *Bencao* lists numerous herbs for moving blood, resolving phlegm, and descending Qi. Why would there be no treatment? This second argument is also untenable.

There is a practitioner in my hometown who treated this by tying the patient to a pillar in the scorching sun, prying open their mouth, pressing down the tongue, revealing a tumor-like mass blocking the esophagus in the throat, and cutting it off with a sharp blade. This caused significant bleeding, leaving the patient exhausted until recovery after several days. Due to the danger, most dare not try it. Another rogue, suffering from this in old age, hated his fate and used a wisteria stem to probe his throat violently to hasten death, vomiting several sheng of blood, which miraculously cured him. Although these two methods are not exemplary, it clearly shows that there is indeed a tangible object blocking the esophagus, not just a functional narrowing.

Another case from Xian County involved a patient near death who instructed his wife to cut open his throat to remove the object. After he died, she followed instructions and found an object in the throat, neither bone nor flesh, extremely tough and uncuttable by knife or axe. She threw it onto a tree in the garden, where it remained intact for a year. One day, her son saw something sticky among the grass, moving vividly. Upon close inspection, it was his father's throat object. He stared at it for half a day, and it eventually dissolved. He collected the grass, decocted it for others with **Yige**, who recovered after three doses. He became famous for treating **Yige** for over ten years until the grass ceased to grow. This proves that there originally existed specific medicines for this syndrome in the world.

I speculate that this syndrome arises from excessive Liver Qi ascending and failure of Lung Qi to descend. (Wang Mengying commented: "A brief judgment, truly unmatched insight.") Blood following the Qi ascends and stagnates, eventually forming a tangible object over time. This shares the same origin but has a different course as hemorrhagic syndromes. Hemorrhage comes suddenly and exits as hematemesis; this syndrome develops slowly and remains trapped as **Yige**. Decoctions enter the stomach, passing beyond the site of the disease, and thus cannot remove tangible objects, rendering them ineffective. Specific medicines for this syndrome must act specifically on the throat and possess the power to resolve blood stasis and unbind knots.

Previously, a bookseller from Jinxian suffered from this and begged me for a prescription. I was at a loss. Recalling that dew from leek leaves effectively treats **Jinkou Li** (dysentery with inability to eat), I thought this might offer a parallel approach. The man knew medicine himself and was delighted. He decocted *Qianjin Weijing Tang* (Thousand Gold Reed Shoot Decoction), added half the amount of leek dew, and sipped it frequently. He recovered in a few days. (Wang Mengying commented: "Excellent prescription.")