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[Li Dongyuan's Discussion] When the throat is blocked and Yang Qi cannot reach the exterior, it is called "Se" (Obstruction); when Yin Qi cannot descend, it is called "Ye" (Choking). The rebellious Qi of Ye-Se interferes between the throat and chest-diaphragm, obstructing the flow of Qi and Blood in all meridians, resulting in symptoms such as an open mouth and staring eyes, with Qi on the verge of exhaustion. Treatment should first employ acrid-sweet herbs with Yang properties to guide Stomach Qi to treat the root cause; simultaneously, herbs that unblock obstructions should be added to drain the branch manifestation.

In cold months, external Yin Qi greatly assists internal Yin Pathogens. In the principal formula, add Wu Zhu Yu (Evodiae Fructus), a herb that is extremely hot, acrid, and bitter, to drain Yin-Cold Qi. In hot months, when Yang Qi is abundant, add Qing Pi (Aurantii Fructus Pericarpium), Chen Pi (Citri Reticulatae Pericarpium), Yi Zhi Ren (Alpiniae Oxyphyllae Fructus), and Huang Bo (Phellodendri Cortex) to disperse Cold Qi and drain rebellious Yin-Fire, or use Xiao Pi Wan (Eliminate Lump Pill) combined with Zi Shen Wan (Nourish Kidney Pill). Zi Shen Wan consists of Huang Bo (Phellodendri Cortex), Zhi Mu (Anemarrhenae Rhizoma), and a small amount of Rou Gui (Cinnamomi Cortex). Alternatively, add Huang Lian (Coptidis Rhizoma) to make separate pills. Take 70-80 pills on an empty stomach after residual food has digested. Wait a short while and then eat rich food to suppress the medication, preventing it from lingering in the Stomach. (All the above methods are modifications of Bu Zhong Yi Qi Tang [Spleen-Qi Boosting Decoction].)

Regarding the treatment of obstruction in the diaphragm and throat, and medication principles for seasonal changes: *Huang Di Zhen Jing* (The Yellow Emperor’s Classic of Acupuncture) states: "Disease of the Stomach manifests as abdominal distension, pain in the epigastrium centered at the heart, radiating upward to support both hypochondria, obstruction of the diaphragm and throat, and difficulty swallowing food. Treat by selecting Zusanli (ST36)." The throat is the gateway for swallowing food; the diaphragm is the domain of the Upper Jiao (Upper Burner), governing the Heart and Lung. "Obstruction" refers to the failure of ascending and descending Qi to communicate. It also states: "When Clear Qi remains below, Sundry Diarrhea (unformed stool with undigested food) occurs." Sundry Diarrhea refers to yellow, porridge-like excrement containing undigested grains. "When Turbid Qi remains above, Distension occurs." Abdominal fullness, constipation, difficult defecation, or hard stools followed by loose stools are all manifestations of this. Turbid Qi remaining above, failing to descend, occurs because the Yin Qi inhaled by the Kidneys and Liver fails to enter, thus food cannot go down. This is caused by Fire from the Chong Mai (Penetrating Vessel) rushing upward, causing the Stomach Meridian to rebel and ascend.

When Clear Qi stays below causing Sundry Diarrhea, it is because on days when Stomach Qi was healthy, it should have ascended to the Heart and Lung to nourish the meridians. Due to irregular diet and physical overexertion, Heart Fire invades the Earth position (Spleen/Stomach), weakening Stomach Qi so it sinks into the Yin level. Consequently, ingested grains fail to ascend and instead descend, becoming Sundry Diarrhea. Severe congestion between the throat and diaphragm preventing communication is caused by rebellious Qi ascending from the Chong Mai. As *Zhen Jing* says: "Stomach disease involves Qi rushing to the hypochondria, diaphragmatic and throat obstruction, and inability to swallow food; treat by selecting Zusanli." *Zhen Jing* further states: "When Clear and Turbid Qi interfere with each other and chaos ensues in the chest, it is called 'Da Huo' (Great Confusion)." Da Huo means confusion and disorder. Failure of Qi to communicate is a critical emergency; if not urgently resolved, various complications will arise.

The Sages have essential methods for treating this: If Yang Qi is insufficient and Yin Qi is excessive, first tonify Yang, then drain Yin. This allows Yang Qi to rise in the Yang aspect before draining Yin. In Spring and Summer, when Yang Qi is in the meridians, benefit the meridians and remove blood stasis from collaterals. In Autumn and Winter, when Yang Qi descends, first treat the Zang-Fu organs. If there are symptoms of Ye (Choking) and Se (Obstruction): Se is governed by the Five Zang Organs, belonging to Yin and Blood; Ye is governed by the Six Fu Organs, belonging to Yang and Qi. Both conditions arise from Yang trapped within Yin. The following seasonal medication principles and treatments are established.

During the three winter months, Yin Qi is outside and Yang Qi is inside. One should assist Yang Qi externally without inducing sweating; internally, eliminate Yin-Fire without causing diarrhea. This is the key principle of secure closure and storage. In deep winter, Water Qi is prosperous; Water prosperity leads to Metal prosperity. The child strengthens the mother; the Lung is the mother of the Kidney. The Yang Qi of the skin and hair is originally weak. Assisted by the winter season, patients often sneeze frequently, run clear nasal discharge, and in severe cold, thick nasal discharge with incessant sneezing. They are more sensitive to wind and cold than normal people, urinate frequently with scant volume, or drink much and urinate much with clear urine. Bowel movements are irregular, insomnia at night is common. In severe cases, phlegm, cough, vomiting, hiccups, and spitting white foam occur, leading to an open mouth, staring eyes, lack of Qi communication, and impending collapse. Treat with Wu Zhu Yu Wan (Evodia Pill).

Wu Zhu Yu Wan: Treats Cold in the upper diaphragm causing obstruction of the diaphragm and throat.
Ingredients: Wu Zhu Yu (Evodiae Fructus), Cao Kou (Amomi Fructus Rotundus), Yi Zhi Ren (Alpiniae Oxyphyllae Fructus) [each 1 qian 2 fen]; Bai Jiang Can (Bombyx Batryticatus) [4 fen]; Chen Pi (Citri Reticulatae Pericarpium), Ren Shen (Ginseng Radix et Rhizoma), Huang Qi (Astragali Radix), Sheng Ma (Cimicifugae Rhizoma) [each 8 fen]; Mai Ya (Hordei Fructus Germinatus) [1 qian 5 fen]; Gan Cao (Glycyrrhizae Radix et Rhizoma), Dang Gui Shen (Angelicae Sinensis Radix) [each 6 fen]; Ban Xia (Pinelliae Rhizoma) [1 qian]; Mu Xiang (Aucklandiae Radix) [2 fen]; Ze Xie (Alismatis Rhizoma), Jiang Huang (Curcumae Longae Rhizoma), Chai Hu (Bupleuri Radix) [each 4 fen]; Qing Pi (Aurantii Fructus Pericarpium) [2 fen].
Preparation and Administration: Grind into powder, mix with steamed dough soaked in decoction, and form pills the size of mung beans. Chew 30 pills finely and swallow with warm water, at any time. Do not drink large amounts of water, lest the medicine move downward too quickly and lose efficacy.

During the three summer months of intense heat, Yang Qi is outside and Yin Qi is inside. If this disease occurs at this time, Heaven assists Righteous Qi to defeat Pathogenic Qi, and it may heal spontaneously without treatment. However, some cases do not heal because Yin Qi is extremely abundant, preventing Righteous Qi from expanding. For example, in cases of diaphragmatic and throat obstruction with severe choking sensation, if previous symptoms manifest, treatment should follow the seasonal timing using Li Ge Wan (Clear Diaphragm Pill) to drain Lung Fire, taken with Huang Qi Bu Zhong Tang (Astragalus Spleen-Qi Boosting Decoction). If the legs are flaccid and cold, walking is unsteady and swaying, arms feel broken and painful with weakness, or there is shortness of breath, rapid breathing, or insufficient respiration, use a decoction of Huang Qi (Astragali Radix), Ren Shen (Ginseng Radix et Rhizoma), Gan Cao (Glycyrrhizae Radix et Rhizoma), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Cang Zhu (Atractylodis Rhizoma), Ze Xie (Alismatis Rhizoma), Zhu Ling (Polyporus), Fu Ling (Poria), and Chen Pi (Citri Reticulatae Pericarpium) to take Zi Shen Wan (Nourish Kidney Pill), 50-60 pills. Between the sixth and seventh lunar months, when Damp-Heat dominates, if shortness of breath prevents speech, add Wu Wei Zi (Schisandrae Chinensis Fructus) and Mai Men Dong (Ophiopogonis Radix). If there is epigastric stuffiness and inability to eat, take Xiao Pi Wan (Eliminate Lump Pill), 70 pills, using the aforementioned Bai Zhu and Cang Zhu decoction, applying careful judgment.

Huang Qi Bu Zhong Tang (Formula see entry "Pi"). Li Ge Wan (Formula see entry "Fan Wei"). Zi Shen Wan (Formula see entry "Lin"). Xiao Pi Wan (Formula see entry "Pi").