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Those who cannot swallow food belong to the category of Weiwan Ge (Stomach Epigastrium Diaphragm Syndrome). (For the full text, see the Edema chapter.) When a Yang channel is affected, it manifests as shortness of breath, frequent coughing, and diarrhea; its transmission can develop into Ge syndrome (Diaphragm Syndrome/Obstruction). (For the full text, see Diagnosis of Disease Transmission. Wang Bing's commentary states: Heat accumulates internally in the Sanjiao [Triple Burner], causing obstruction and difficulty in bowel movements.)

The *Suwen* records: Accumulation in the three Yang channels is called Ge syndrome. (Wang Bing's commentary states: Stagnation in the Small Intestine leads to dry blood vessels; heat in the Bladder leads to exhaustion of body fluids, thus causing obstruction and difficulty in bowel movements.)

According to the theory of Six Qi (Yunqi), both Ge Shi (Dysphagia and Regurgitation) are attributed to Dampness. The classic states: "When Taiyin [Spleen] arrives, it causes accumulation of fluids, distension, and diaphragmatic obstruction."

Secular prescriptions for Fanwei (Regurgitation), stomach pain, vomiting, and inability to retain any substances: Take seven pieces of ox nose rope (specific origin noted as 'ge xing zhe', likely a textual variant or specific requirement), each seven cun long. Calcine them until they retain their medicinal properties (burn to charcoal but keep efficacy), grind into powder, divide into three doses, and take with fine yellow wine. Taking with rice soup is also acceptable.

**Crucian Carp Powder Formula:**
Take one large crucian carp, remove internal organs but keep the gallbladder, fill the cavity with Alum powder, sew the mouth shut, and roast over charcoal fire until yellow. Grind into powder. Take one qian per dose, mixed with aged rice water, three times daily.

From *Shanju Fang* for Fanwei: Stir-fry pear leaf (*Bretschneidera sinensis*) finely, remove thorns, grind into powder, and take with wine. Another method: Grind pine wood nodes into powder and take with wine.

In the *Lingshu*, the Yellow Emperor asked: "Qi rebellion causing Upper Ge syndrome results in food and drink being vomited immediately after ingestion; I understand this. Parasites causing Lower Ge syndrome result in food being vomited only after a period of time ('shi' refers to a cycle/time). I do not understand the mechanism and wish to hear it fully." Qibo replied: "Improper emotional responses, irregular diet, and exposure to cold or heat cause cold juices to flow into the intestines. Flowing into the intestines chills the parasites; chilled parasites accumulate and stay in the Lower Guan (Lower Epigastrium/Xiawan), causing fullness in the intestines and stomach. This prevents the Defensive Qi (Wei Qi) from circulating, allowing pathogenic factors to reside there. (Fullness in the intestines and stomach prevents Wei Qi circulation, so pathogens occupy the space.) When a person eats, parasites move upward to feed. Upward movement of parasites empties the Lower Guan. Emptiness in the Lower Guan allows pathogens to prevail, leading to stagnation and accumulation. (Pathogens originally resided in the Lower Epigastrium due to deficient Wei Qi; now that parasites move up and the Lower Guan becomes empty, pathogens take advantage of the deficiency to accumulate.) Prolonged stagnation forms an abscess. Once the abscess forms, the Lower Guan becomes constricted. (Constriction of the Lower Guan causes pain upon eating, and food is vomited out after a period of time.) If the abscess is inside the lumen, the pain is deep internally. If the abscess is outside the epigastrium, the pain is superficial externally, and the skin overlying it feels hot. The Yellow Emperor asked: 'How should acupuncture be performed?' Qibo said: 'Gently press the abscess to observe the direction of Qi flow. First, prick shallowly around it, then gradually deepen. Prick repeatedly, no more than three times. Observe the depth of the lesion to determine needle insertion depth. After needling, apply moxibustion/warming therapy to drive heat inward. Daily application of heat inward will cause pathogenic factors to decline. (Note: Needling the abscess here does not mean pricking the abscess directly. Rather, needling followed by warming drives heat into the area of accumulation, causing pathogens to decline and Wei Qi to recover.) The large abscess will eventually suppurate. Combine with Five Elements prohibitions to eliminate internal pathogens. Maintain tranquility and non-action to allow Qi to circulate. Subsequently, use salty and bitter herbs to transform grain and facilitate downward movement.'"

There are four acupuncture approaches for treating Ge Shi:
1. **Target the Stomach Channel:** The classic states: "Parasites cause Lower Ge; pressing the abscess and needling is one method."
2. **Target the Taiyin Channel:** The classic states: "The Taiyin channel originates at Yinbai and terminates at Taicang (Zhongwan). Taiyin governs opening; if opening fails, the granary [Spleen/Stomach] cannot transport, leading to Ge Dong (Diaphragmic Hole/Leakage). For Ge Dong, treat the Taiyin channel, assessing excess or deficiency. Failure of opening indicates disease caused by Qi deficiency. Ge Dong is described in classics as food not digesting and regurgitating after swallowing."
3. **Target the Stomach Channel (again):** The classic states: "If Stomach disease presents with obstruction in the throat and epigastrium and inability to eat, treat Zusanli (ST36)." It also states: "Inability to eat and diaphragmatic obstruction indicate pathogens in the Stomach Epigastrium. If in the Upper Epigastrium, needle to suppress and guide downward; if in the Lower Epigastrium, disperse and eliminate pathogens."
4. **Target the Shaoyin Channel of Hand:** The classic states: "The Luo-connecting vessel of the Hand Shaoyin Heart channel is named Tongli, located 1.5 cun above the wrist crease. In excess conditions, it causes support/stiffness in the diaphragm. Treat the point 1 cun behind the palm, which connects to the Taiyang channel."

From *Cuoyao*: For Fanwei: Laogong (PC8) - puncture 1 fen. Zhongwan (CV12) - moxa, reducing method. Xinshu (BL15) - puncture 1 fen, oblique outward 1.5 cun, tonifying method.

From *Yuji*: For Fanwei vomiting: Zhongkui (acupoint on middle finger) - moxa, reducing method. Zhongwan (CV12) - 1.5 cun. Wangu (SI4) - puncture 1 fen reducing, or moxa.

Dongyuan for vomiting undigested food: Shangwan (CV13), Zhongwan (CV12), Xiawan (CV10).

From *Jia Yi Jing*: For undigested food/drink vomiting after entering the abdomen, Xiawan (CV10) is the primary point. Alternative methods: Zusanli (ST36), Yinlingquan (SP9). If no response, use lower points: Zhongwan (CV12), Tianshu (ST25). Another method: Zhongwan (CV12), Pizhong (EX-BA3), Zhongkui, Zusanli (ST36). Another method: Area under axillary hair (Moxa 50 Zhu). Shiguan (KI18) (Moxa 50 Zhu).

Dongyuan for "eating today, vomiting tomorrow": Xinshu (BL15) - oblique 1.5 cun. Gegan (BL18) - oblique 1.5 cun. Xiongzhong (CV17, i.e., Danzhong) - Moxa 7 Zhu. Jueque (CV14), Weiwanyu (BL21) - 1.5 cun deep. Moxa 50 Zhu each. Another Fanwei prescription: Shangqiu (SP5), Tonggu (BL65), Jueque (CV14), RanGu (KI2), Yinbai (SP1), Yanglingquan (GB34), Neiting (ST44), Gegan (BL18).

From *Jia Yi Jing*: For back pain, aversion to cold, stiff spine difficult to bend or extend, inability to eat, vomiting profuse phlegm, Gegan (BL18) is the primary point.

Danxi warns: Absolutely do not use aromatic-drying drugs; doing so will lead to death. Diet should be bland and mild.

From *Mai Jue*: Cun Kou pulse is faint and rapid. Faint indicates lack of Qi; lack of Qi leads to Ying-Blood deficiency; Ying-Blood deficiency leads to insufficient Blood; insufficient Blood causes cold in the chest. Fu Yang pulse is floating and choppy. Floating indicates deficiency; choppy indicates Spleen injury. Spleen injury impairs grinding/digestion. Morning food vomited in evening, evening food vomited in morning, undigested grains expelled, named Weifan (Stomantic Reflux). Tight and choppy pulse indicates difficult-to-treat disease. Wiry pulse indicates deficiency; surplus-free Stomach Qi; morning food vomited in evening, transforming into Weifan. Cold in the upper jiao treated incorrectly with purgatives leads to wiry pulse, hence named deficiency.

Spleen pulse slightly urgent indicates Ge Zhong (Diaphragmatic Middle); food/drink enters and regurgitates with saliva/froth. (For full text, see Deficiency-Excess Methods.)

From *Suwen*: Stomach channel pulse that is hurried and scattered indicates Shi Bi (Food Obstruction). (*Mai Yao Jing Wei Lun* and *Zhi Yao Da Zheng Lun* state: Shi Bi with vomiting.)

Kidney pulse slightly slow indicates Dong syndrome. Dong syndrome manifests as undigested food regurgitating after swallowing. (For full text, see Treating Deficiency-Excess Methods.)