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Mr. Sheng from Tianjin, aged fifty, suffered from **Yige** (Dysphagia and food retention).

Etiology: His living circumstances were often unfavorable, and his temperament was narrow-minded and irritable, prone to stirring up **Liver Fire** (hyperactivity of Liver Yang or heat due to emotional stagnation), which led to this disease.

Symptoms: In the early stage of the illness, he felt some difficulty in swallowing food, which later became frequent. He only then sought medical treatment, taking medicine for half a year and consulting more than ten physicians without effect. The condition worsened, and he believed it was incurable, so he stopped taking medication. Fortunately, his friend Mr. He advised him to seek my consultation. Examination revealed that all six pulses were fine, thready, and weak. When he forced himself to eat a few crackers, they had to be chewed into a thin paste before swallowing; occasionally, he felt an obstruction during swallowing, leading to vomiting with some phlegm-saliva. However, drinking thick rice gruel made from **Jingmi** (Oryza sativa var. glutinosa) caused no obstruction. His stool was dry and hard like sheep droppings, difficult to pass.

Diagnosis: Yang Suyuan stated: "This disease shares the same root as **Shixue** (Hemorrhage), though the manifestations differ. If bleeding is sudden and violent, it bursts open the membrane of the stomach wall, resulting in hematemesis; if it is slow, failing to burst the gastric membrane, it stasises in the upper epigastrium, causing narrowing of the esophagus, thus forming Yige." Western medicine calls this **Stomach Cancer** (Gastric Carcinoma). The term 'cancer' refers to something protruding like rock on a mountain, with a convex shape. This aligns perfectly with Yang's theory; undoubtedly, this is caused by **Blood Stasis** (stagnation of blood circulation). The pulse is very weak because of minimal food intake leading to deficiency of both Qi and Blood. The stool being hard like sheep droppings is also due to minimal dietary intake and the weakness of **Stomach Qi** (digestive energy), which fails to transport downward. Treatment should focus on resolving blood stasis and guiding blood downward, supplemented by herbs that nourish Qi and Blood.

Prescription: **Sheng Zhe Shi** (Raw Oolithum, 1 liang, finely crushed); **Ye Taishen** (Wild Codonopsis pilosula, 5 qian); **Sheng Huai Shanyao** (Fresh Dioscorea opposita, 6 qian); **Tianhuafen** (Trichosanthis Radix, 6 qian); **Tiandong** (Asparagi Radix, 4 qian); **Taoren** (Persicae Semen, 3 qian, skin removed and crushed); **Honghua** (Carthami Flos, 2 qian); **Tubei Chong** (Eupolyphaga Steleophaga, 5 pieces, crushed); **Guang Sanqi** (Notoginseng Radix et Rhizoma, 2 qian, finely crushed).

There are nine ingredients in total. Decoct the first eight ingredients to make one large cup of decoction, and take half of the **Sanqi** powder with it. When the dregs are decocted for the second dose, take the remaining half of the **Sanqi** powder with it.

Formula Analysis: **Taoren**, **Honghua**, **Tubei Chong**, and **Sanqi** in the formula are used to eliminate blood stasis. A heavy dose of **Sheng Zhe Shi** (1 liang) is used to guide blood downward. **Taishen** and **Shanyao** are used to cultivate the transformation and transportation function of Stomach Qi, preventing damage from the use of dispersing and breaking herbs. **Tiandong** and **Tianhuafen** are used because there is a fear that the depletion of Stomach fluids will cause the stasised blood to become even drier and harder; thus, their cooling and moistening properties are borrowed to nourish Stomach fluids, and simultaneously to prevent **Taishen** from generating heat due to its tonifying nature.

Effect: After taking two doses, he could eat food. After five doses, his bowel movements returned to normal. Therefore, the dose of **Zhe Shi** was reduced to 8 qian, and after taking a few more doses, food intake increased. However, he still felt an obstruction in the stomach area that did not completely resolve. The dose of **Sanqi** was doubled to 4 qian, taken in two divided doses. After four consecutive doses, he passed some pus and blood in his stool, and the disease was completely cured.

Assistance: Regarding Yige, some cases are caused by **Phlegm-Fluid** (retention of pathological fluid). There may be phlegm cysts formed between the stomach entrance (referred to as 'nest cysts' in Yu Jia Yan's *Yuyi Cao*). For such cases, remove **Tubei Chong** and **Sanqi** from this formula, add **Qing Banxia** (Pinelliae Rhizoma Praeparatum cum Alumine et Zingibere, 4 qian), and it can be cured after a few doses. Some cases are caused by atrophy and shrinkage of the upper epigastrium due to dryness. For these, remove **Tubei Chong** and **Sanqi**, change **Zhe Shi** to 8 qian, and add **Danggui** (Angelicae Sinensis Radix), **Longyanrou** (Longan Arillus), and **Gouqizi** (Lycii Fructus), each 5 qian. Taking it for a long time can lead to recovery. Some cases are caused by growths (tumors) in the upper epigastrium (discussed in detail in "Discussion on Treatment Methods for Stomach Diseases, Yige, and Fanwei"). However, this type is rare and much harder to treat than other types of Yige. Generally, growths in the lower epigastrium cause Fanwei (regurgitation/vomiting), while those in the upper epigastrium causing Yige occur in less than one or two out of a hundred cases.