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[Appendix: Bianzhi Huayu Pill]

Regarding the syndrome of Yige (dysphagia and food impaction), medical texts attribute it to various causes: some state it is due to the dryness of the cardia, others to the upward rushing of Chong Qi, others to phlegm-stasis obstruction, and still others to blood stasis. I previously believed this syndrome resulted from the weakness of Middle Qi, which failed to support and suspend the cardia, causing the cardia to contract like an lotus root pore (The cardia connects with the large and small intestines via a continuous flow of Qi; observing stool resembling sheep droppings indicates that both the cardia and the intestines have shrunk). Consequently, phlegm-fluids easily become obstructed, making the upward rushing of Chong Qi even more likely, thus preventing the patient from accepting food. I formerly formulated the "Shen Zhe Peiqi Decoction" (Ginseng and Hematite Decoction to Nourish Qi and Descend Rebellious Qi), imitating the principle of Zhang Zhongjing's "Xuanfu Daizheshi Tang". I heavily used Hematite up to two taels (approx. 75g) to open the stomach and suppress Chong Qi, thereby facilitating bowel movement (patients with this condition often suffer from constipation), while using Ginseng to control the medicinal force, ensuring vigorous Qi transformation and free circulation, naturally supporting and suspending the cardia to widen it. I also assisted with Pinellia, Anemarrhena, Angelica Sinensis, and Asparagus Root to descend Stomach Qi, resolve phlegm, moisten dryness, and generate fluids. This prescription yielded frequent success. However, after long-term use, effectiveness was split evenly between responders and non-responders; some were cured initially but relapsed later, rendering the prescription ineffective upon re-administration. After much deliberation without finding an explanation, I considered it a千古难治之证 (perennially difficult-to-treat syndrome) where complete cure could not be guaranteed.

Later, I treated an elderly man nearing seventy years of age who had been hospitalized for over a month. He could eat, yet never felt completely recovered. Over a year after returning home, he died from his original illness, vomiting pus and blood near death. It then dawned on me that his previous inability to fully recover was due to blood stasis and swelling in the cardia. Had I added blood-breaking herbs at that time, a complete cure might have been achieved. Perhaps because I lacked experience with yige caused by blood stasis, I overlooked it. Later, reading Wu Jutong and Yang Suyuan's discussions on yige, which also emphasized blood stasis, seemed to confirm that the old man indeed had blood stasis. However, regarding this case, I remained hesitant: did he originally have blood stasis, or did it develop later? The reason for my hesitation was the relapse occurring more than a year later. Until early summer of the Xinyou year, when I read Issue 106 of Tianjin "Lu's Medical Journal," which stated that gastric cancer is caused by blood stasis in the stomach, and that treating this condition by combining ancient blood-draining formulas led to frequent cures with no recurrence, my doubts were instantly resolved. Generally, regardless of the cause, 70-80% of such cases involve blood stasis accumulation in the cardia. In severe stasis cases, failure to combine blood-resolving drugs initially prevents cure. In mild cases, using only stomach-opening and anti-reversal drugs may allow gradual dissipation of stasis, leading to recovery, but the root of the stasis remains uncleared, hence the possibility of recurrence.

Ancient formulas for draining blood stasis, such as Didang Tang, Didang Wan, Xiayuxue Tang, and Dahuang Zhechong Wan, are certainly capable of treating the disease. However, I believe that to treat this condition effectively, Chinese and Western medicines must be used together to ensure confidence. Although the aforementioned formulas are effective for blood stasis, they may fail to eliminate tumor growths. Western medicine calls this condition "gastric cancer." The term "cancer" refers to the raised, rock-like appearance of the lesion. If the lesion indeed contains blood stasis, blood-resolving drugs can eliminate it. If it does not contain blood stasis, blood-resolving drugs alone will not work. Just as intestinal mushrooms (intestinal tumors/growths) can form in the intestines, tumors can also form in the stomach. Among drugs that eliminate tumors, the Western medicine "Wobu" (Potassium Iodide) is most effective, standing out among alterative agents. Now, combining Chinese and Western medicines, I propose the following formula for trial.

[Bianzhi Huayu Pill]
Panax Notoginseng Root (30g, fine powder)
Peach Kernel (30g, roasted, fine powder)
Borax (18g, fine powder)
Licorice Root (12g, fine powder)
Western Medicine Potassium Iodide (10 grains)
Pubescent Honeydew Melon Stem (20 grains)

Mix the six ingredients, refine honey to make pills, each weighing 6g (two qian). Take by holding in the mouth to dissolve slowly, swallowing the saliva carefully.

Current proposed method for treating yige: Regardless of the etiology, first administer Shen Zhe Peiqi Decoction for two to three doses, which should enable eating. If subsequent doses show increasing efficacy, after seven to eight doses, add Peach Kernel and Safflower (each several qian) to the original formula, continuing until full recovery. If initial doses are effective but subsequent ones lose incremental efficacy, add Rhizoma Sparganii (2 qian) and Ground Beetle (0.5 qian) to the original formula; additionally, take three or four Bianzhi Huayu Pills daily, dissolved in the mouth. Long-term use should yield results. If the blood stasis has formed an ulcer with un-discharged pus, prescribe Silkworm Chrysalis, Gleditsia Sinensis Thorn, Frankincense, Myrrh, Trichosanthes Root, and Forsythia to dissipate the pathology.

If the pulse presents a slippery quality, Shen Zhe Peiqi Decoction alone will likely cure the condition. After five to six doses, one may take one qian of Panax Notoginseng fine powder washed down with the decoction, and the dregs should also be consumed similarly. Upon recovery, recurrence will naturally cease.

Wang Mengying stated that roasting a newborn mouse on a new tile, grinding it into powder, and taking it with warm wine is extremely effective for yige. This is because mice possess the ability to resolve masses and promote meridian circulation, making them highly effective for yige caused by blood stasis in the cardia.

A patient with yige craved alcohol and drank a potful, after which the illness vanished. Inspection of the pot revealed a large centipede inside. Thus, the cure was attributed not to the alcohol itself, but to the alcohol boiled with the centipede. Skeptics questioned me about this. It is likely because the centipede excels at reducing swelling and ulcers; the patient's yige was caused by an ulcer resulting from blood stasis in the cardia, so drinking centipede-boiled wine brought immediate relief. To use this remedy, boil three whole centipedes in several liang of ash-free wine (white or yellow rice wine, not distilled spirits) and drink.

In summary, regarding drugs that break blood stasis, Leech is supreme. However, it must not be roasted; it must be used raw to be effective. Physicians fear its potency and dare not even use roasted forms, let alone raw. They do not realize that Leech is inherently mild yet possesses excellent blood-stasis-resolving capabilities. If patients do not improve with the aforementioned drugs, it is likely due to firmly consolidated blood stasis. In addition to decoctions and pills, take 1.5g (five fen) of raw Leech fine powder with water, twice daily. If the patient cannot take powder, remove the Ground Beetle from the decoction and add 6g (two qian) of raw Leech.

[Appendix: Original Text from Tang XX's Medical Journal]
Reading Mr. Zhang Xichun's discussion on treating yige in Issue 4 of the magazine, which elucidates profound mysteries and opens new paths for treatment methods, I deeply admire his insightful remarks. Furthermore, reading Dr. Hou XX's (Western Physician) article on Fanwei (regurgitation) in Issue 2 of the Third Middle School Magazine, which states that the most important pathological cause is gastric cancer occurring in the pylorus, obstructing the passage of food into the intestines. Initially, stomach function is strong enough to struggle against the obstruction to transport food to the intestines. Over time, fatigue sets in, function weakens further, the disease progresses, resulting in Fanwei. Note: His citation of Western medicine regarding Fanwei suggests its cause is similar to yige, implying yige treatments could apply; this is indeed a general theory. However, based on my lifelong experience, Fanwei comprises two types: one caused by cancer in the pylorus, and another caused by deficiency-cold in the stomach combined with rebellious Stomach Qi and upward-rushing Chong Qi. For the former (pyloric cancer), treatment principles align with yige. For the latter (stomach deficiency-cold with Qi rebellion), warming and tonifying the Stomach while descending rebellious Qi and suppressing Chong Qi is essential. Moreover, regarding gastric cancer, cancers arising in the cardia are mostly due to blood stasis, whereas those in the pylorus are mostly tumor growths. Blood stasis stems from vascular stagnation, while tumor growths stem from glandular hypertrophy. Treatment approaches should therefore differ in emphasis. It is advisable to add Raw Chicken Gizzard Membrane (3 qian) and Rhizoma Sparganii (2 qian) to Shen Zhe Peiqi Decoction; and add 24g (eight qian) of raw Leech fine powder to Bianzhi Huayu Pill, increasing Western Medicine Potassium Iodide to 15 grains, refining with honey into pills the size of paulownia seeds, taking 9g (three qian) per dose, twice daily. This way, whether the pyloric cancer is a tumor growth (which can be slowly dissolved) or blood stasis (which is also easy to eliminate), it can be addressed. Another simple prescription for yige uses Kelp (60g, washed clean of salt) and Wheat (30g), boiled in nine cups of water until the wheat is soft. Strain and drink a small cup at any time. Additionally, keep two or three pieces of kelp in the mouth to swallow saliva continuously, which is extremely effective. Note: This prescription utilizes the principle of Western Medicine Potassium Iodide. Since Western Potassium Iodide is derived from burning seaweed ash, and Chinese herbs Kelp, Sargassum, and Laminaria all contain the essence of Potassium Iodide. The addition of wheat is because Kelp is salty and cold; long-term use may harm the Spleen and Stomach, so wheat is added to harmonize and tonify them.

If this prescription proves effective, it should also be effective for Fanwei caused by tumor growths in the pylorus.