关者，不得小便，格者，吐逆，上下俱病者也。
〔《难》〕邪在六腑，则阳脉不和，阳脉不和，则气留之，气留之则阳脉盛矣。邪在五脏，则阴脉不和，
阴脉不和，则血留之，血留之则阴脉盛矣。阴气太盛，则阳气不得相营也，故曰格。（阴盛阳不得营，故寸口大三
四倍于人迎。）阳气太盛，则阴气不得相营也，故曰关。（阳盛阴不得营，故人迎大三四倍于寸口。）阴阳
俱盛，不得相营也，故曰关格。关格者，不得尽其命而死矣。（三十七难）
〔洁〕关则不得小便，格则吐逆。关者，甚热之气；格者，甚寒之气。是关无出之由，故曰关也；格无入
之理，故曰格也。寒在胸中，遏绝不入，热在下焦，填塞不便。
〔云〕阴阳易位，病名关格。胸膈上阳气常在，则热为主病。身半已下阴气常在，则寒为主。病寒反在胸
中，舌上白胎，而水浆不下，故曰格，格则吐逆。热在丹田，小便不通，故曰关，关则不得小便。胸中有寒，
以热药治之。丹田有热，以寒药治之。若胸中寒热兼有，以主客之法治之。治主当缓，治客当急。尺寸反者死，
阴阳交者死，关格者不得尽其命而死矣。
〔丹〕必用吐，提其气之横格，不必在出痰也。有痰，以二陈汤吐之，吐中便有降。有中虚气不运者，补
气药中升降之。
〔孙〕奉职赵令仪女，忽吐逆，大小便不通，烦乱，四肢渐冷，无脉。凡一日半，与大承气汤一剂。至夜
半渐得大便通，脉渐和，翌日乃安。此关格之病，极为难治，垂死而活者，惟此一人耳。
〔孙〕治大小便不通，关格不利。烧皂角细研，粥饮下三钱，立通。
〔《外》〕关格胀满，大小便不通。独头蒜烧热去皮，纸裹纳下部，气立通。
〔仲〕寸口脉浮而大，浮为虚，大为实，在尺为关，在寸为格，关则不得小便，格则吐逆。
〔《脉》〕下微本大者，则为关格不通，不得尿。头无汗者可治，有汗者死。（成注云∶下微谓脉沉
之而微也，本大谓关后脉大也。）
Guan (Obstruction) refers to the inability to urinate, while Ge (Rejection) refers to vomiting and regurgitation; this condition involves simultaneous pathology in both the upper and lower jiao.
[Nan Jing] When pathogenic factors invade the fu organs, the yang pulses become discordant. Discordance of the yang pulses leads to qi stagnation, and qi stagnation results in an excess of the yang pulses. When pathogenic factors invade the zang organs, the yin pulses become discordant. Discordance of the yin pulses leads to blood stasis, and blood stasis results in an excess of the yin pulses. When yin qi is excessively strong, yang qi cannot circulate and nourish it mutually, hence it is called Ge (Rejection). (Excess of yin with yang unable to circulate manifests as the Cun Kou pulse being three to four times larger than the Ying Chang pulse.) When yang qi is excessively strong, yin qi cannot circulate and nourish it mutually, hence it is called Guan (Obstruction). (Excess of yang with yin unable to circulate manifests as the Ying Chang pulse being three to four times larger than the Cun Kou pulse.) When both yin and yang pulses are excessive and cannot circulate mutually, it is called Guan Ge (Obstruction and Rejection). Those suffering from Guan Ge will die before their natural lifespan is completed. (From Nan Jing, Chapter 37)
[Li Dongyuan] Guan means inability to urinate, and Ge means vomiting and regurgitation. Guan is caused by extreme heat qi; Ge is caused by extreme cold qi. Because Guan has no outlet, it is called Guan; because Ge has no entry, it is called Ge. Cold resides in the chest and middle jiao, obstructing and preventing food intake; heat fills the lower jiao, blocking bowel movements and urination.
[Hua Shou] When yin and yang shift positions, the disease is named Guan Ge. If yang qi constantly resides above the chest and diaphragm, heat is the primary pathogenesis. If yin qi constantly resides below the midpoint of the body, cold is the primary pathogenesis. If cold pathogen resides in the chest, accompanied by a white tongue coating and inability to swallow fluids or food, this is called Ge, which causes vomiting and regurgitation. If heat pathogen resides in the Dan Tian (lower jiao), causing urinary obstruction, this is called Guan, which causes inability to urinate. For cold in the chest, treat with hot-natured herbs. For heat in the Dan Tian, treat with cold-natured herbs. If both cold and heat exist in the chest, apply the method of treating the principal and secondary pathogens. Treating the principal should be gradual, while treating the secondary should be urgent. Death occurs if the Chi and Cun pulses are reversed, if yin and yang pulses intersect chaotically, and those with Guan Ge will die before their natural lifespan is completed.
[Zhu Danxi] Emetic therapy must be used to lift the qi that is horizontally obstructed; it is not necessary to expel phlegm. If phlegm is present, use Er Chen Tang (Two-Aged Decoction) for emesis; within the act of vomiting lies the mechanism of descending. For cases of deficiency of middle qi with failure of qi movement, add herbs that ascend and descend qi to tonifying qi formulas.
[Sun Yiqi] The daughter of Zhao Lingyi, a Fengzhi official, suddenly experienced vomiting and regurgitation, obstruction of both stool and urine, restlessness, gradual coldness of the four limbs, and absence of pulse. After one and a half days, one dose of Da Cheng Qi Tang (Major Order the Yang Decoction) was administered. By midnight, bowel movement gradually became unobstructed, the pulse gradually normalized, and she was stable the next day. This case of Guan Ge is extremely difficult to treat; among those near death who were revived, this was the only one.
[Sun Yiqi] To treat obstruction of stool and urine and unfavorable Guan Ge: burn Jie Jiao (Gleditsia Sinensis Fruit), grind finely, and administer three qian with congee water for immediate relief.
[Wai Tai Mi Yao] For Guan Ge with distension and fullness, and obstruction of stool and urine: take a single-head garlic clove, heat it until hot, peel it, wrap it in paper, and insert it into the lower orifice (anus); qi flow will immediately resume.
[Zhang Zhongjing] The Cun Kou pulse is floating and large. Floating indicates deficiency, and large indicates excess. When this pulse pattern appears at the Chi position, it is Guan; when it appears at the Cun position, it is Ge. Guan leads to inability to urinate, and Ge leads to vomiting and regurgitation.
[Mai Jing] When the pulse is faint upon deep pressure but large at the root (or Guan position), it indicates Guan Ge obstruction with inability to pass urine. If there is no sweat on the head, it is treatable; if there is sweat on the head, it is fatal. (Cheng Wuji notes: "Faint upon deep pressure" refers to the pulse feeling faint when pressed deeply; "Large at the root" refers to the pulse being large behind the Guan position.)