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The concept of "Guan Ge" (Obstruction and Rejection) varies in interpretation, yet each has its rationale. The *Classic of Internal Medicine* (*Neijing*) states: Cun Kou (the collective term for the Cun, Guan, and Chi positions on the radial artery) governs the interior, (Cun Kou originally belongs to the Lung meridian, associated with Zang organs, used to inspect internal conditions.) Ren Ying (located beside the Adam's apple, belonging to the Stomach meridian, associated with Fu organs, used to inspect exterior conditions) governs the exterior. The two should correspond, with equal magnitude. In spring and summer, Ren Ying is slightly larger; in autumn and winter, Cun Kou is slightly larger; this is called a healthy person. (This explanation is found in the chapter on Four Diagnostic Methods.) If Ren Ying is one-fold larger than Qi Kou, (meaning one times larger than Qi Kou. The following follows this pattern.) the disease is in the Foot Shaoyang Gallbladder Meridian; if Ren Ying is one-fold larger and restless, the disease is in the Hand Shaoyang Sanjiao Meridian. If two-fold larger, the disease is in the Foot Taiyang Bladder Meridian; if two-fold larger and restless, the disease is in the Hand Taiyang Small Intestine Meridian. If three-fold larger, the disease is in the Foot Yangming Stomach Meridian; if three-fold larger and restless, the disease is in the Hand Yangming Large Intestine Meridian. If four-fold larger, and both large and rapid, (Rapid means restless.) it is named Yi Yang (Overflowing Yang), (Yang qi is excessive and overflowing.) manifesting as Wai Ge (Exterior Rejection), (Rejecting food and drink, preventing entry.) If Cun Kou is one-fold larger, the disease is in the Foot Jueyin Liver Meridian; if one-fold larger and restless, the disease is in the Hand Jueyin Pericardium Meridian. If two-fold larger, the disease is in the Foot Shaoyin Kidney Meridian; if two-fold larger and restless, the disease is in the Hand Shaoyin Heart Meridian. If three-fold larger, the disease is in the Foot Taiyin Spleen Meridian; if three-fold larger and restless, the disease is in the Hand Taiyin Lung Meridian. If four-fold larger, and both large and rapid, it is named Yi Yin (Overflowing Yin), manifesting as Nei Guan (Interior Obstruction), (Urination is blocked.) All these cases are fatal and incurable. If both Ren Ying and Cun Kou are more than four times larger than normal, it is named Guan Ge, and a short life expectancy can be predicted. (Note: These descriptions focus on restlessness and rapidity, establishing a theory based on Heat patterns, serving as illustrative examples. Observing another passage stating: "One must carefully examine cold and heat to verify Zang-Fu diseases," it is known that this syndrome involves both Cold and Heat.) It is also stated that when the five Zang organs are not harmonious, the seven orifices (eyes, ears, mouth, nose) become blocked, (Qi mechanism is obstructed.) When the six Fu organs are not harmonious, pathogens remain and knot to form abscesses. Therefore, if pathogens are in the Fu organs, the Yang meridians are disharmonious; disharmony leads to Qi stagnation and Yang excess. Excessive Yang makes the Yin meridians unfavorable; (These two sentences should follow the statement in the *Classic of Difficult Issues* (*Nanjing*): "If pathogens are in the Zang organs, the Yin meridians are unfavorable," connecting to "unfavorable leads to blood stasis and Yin excess," contrasting with the preceding text about pathogens in Fu organs. The current text says "excessive Yang makes Yin unfavorable" to illustrate the interconnection of Yin and Yang and the transmission of meridians, a common feature in ancient texts.) Unfavorable Yin leads to blood stasis and Yin excess. Excessive Yin prevents Yang from nourishing it, (When Qi and Blood are harmonious, they flourish; now blood flow is impaired, and pathogens gather in Yin meridians, so Yang cannot communicate with them.) thus it is called Guan Yang (Closing Yang). (Meaning closing the gate to prevent Yang from entering.) Excessive Yang prevents Yin from nourishing it, thus it is called Ge Yin (Rejecting Yin). (Repelling Yin so it cannot enter.) When both Yin and Yang are excessive and cannot nourish each other, it is called Guan Ge, leading to death before the natural lifespan ends. According to the classics, when Yin-Yang pathogens are either excessively dominant or mutually excessive, their meridians become disharmonious, manifesting in Ren Ying and Cun Kou as described above. Later generations only palpate Cun Kou, so Qin Yue (Bian Que) considered pulse overflowing from Cun to Yu Ji (fish belly) as Yi Pulse, (Yang is rejected by Yin, pulse overflows from Cun to Yu Ji.), manifesting as Wai Guan Nei Ge (Exterior Obstruction, Interior Rejection); (Exterior Yang is rejected by Interior Yin, unable to descend, like being closed off.) Pulse covering from Chi towards the arm as Fu Pulse, (Yin is rejected by Yang, pulse covers from Chi upwards. Fu means retreat or cover.), manifesting as Nei Guan Wai Ge (Interior Obstruction, Exterior Rejection). (Yin is rejected and cannot ascend, like being closed off.) Zhang Zhongjing stated that if Cun Kou pulse is floating and large, Floating indicates deficiency, (Internal deficiency of righteous Qi causes external floating.) Large indicates excess. (Pathogenic excess.) Located at Chi, it is Guan (Obstruction); located at Cun, it is Ge (Rejection). Guan results in inability to urinate; Ge results in vomiting and reflux. (This agrees with Bian Que. Bian Que spoke of pulse length and surplus; Zhongjing spoke of pulse magnitude and surplus; both indicate pathogenic excess.) He also stated that if the deep pulse is minute but the Chi position is relatively large, (Deep refers to the deep pressure level; Ben refers to Chi. Deep pulse is minute, only Chi is slightly large.) it is Guan Ge obstruction, inability to urinate, (Deep and minute indicates Yin deficiency; Chi large indicates Cold pathogen excess. Deficiency-Cold without Yang fails to transform fluids, hence urine cannot exit. The mention of food rejection is omitted for brevity.) If the head has no sweat, it is treatable; if there is sweat, it is fatal. (Yang collapse.) He also stated that if the Zu Yang (Dazu) pulse is hidden and choppy, (Hidden means Qi does not move; Choppy means Blood does not flow, unable to perform intake/output and transformation.) Hidden pulse leads to vomiting and reflux, undigested food and water; Choppy pulse leads to inability to ingest food, (Blood dryness, stomach wall withered.) named Guan Ge. (Inability to urinate is not mentioned, also for brevity. The previous two points discussed Chi and Cun; this one discusses Zu Yang.) Examining these two schools of thought, each has its logic, extending the未尽 (unfinished) meaning of the *Neijing*. Another view attributed to Qi Bo's son states that Guan Ge is the reversal of Yin and Yang positions. Yang should be upper, Yin lower, which is the fixed position. Now, Cold is in the chest, tongue has white coating, and fluids cannot pass down; Heat is in the Dantian, and urination is blocked; this is called Guan Ge. Upper Cold is treated with Hot methods; Lower Heat is treated with Cold methods. If Cold and Heat coexist, treat the primary and secondary factors separately; treating the primary should be gradual, treating the secondary urgent. This is another perspective. From this argument, it is clear that when Yang extremity is at the top and Yin extremity is at the bottom, causing blockage and lack of interaction, one should regulate Yin and Yang, turning Pi (Stagnation) into Tai (Peace). Zhang Jingyue further argued that the *Neijing* states Ren Ying exceeding four times is having Yang without Yin; Cun Kou exceeding four times is having Yin without Yang; both exceeding four times is Yang extremity at the top (no Yang in Lower Jiao) and Yin extremity at the bottom (no Yin in Upper Jiao), representing Yin-Yang separation. This often results from alcohol and sexual excess damaging Essence and Qi, causing Yang to fly upward and Yin to drain downward, resulting in floating, rootless, scattered, large, and restless pulses, indicating impending collapse. Whenever six pulses are wiry or like leather, exceptionally洪大 (Surging-Large), and restless/rapid, where pulse movement causes body tremors, and there is pulsation at Xu Li (below the nipple) and beside the umbilicus, beating vigorously corresponding to the pulse, accompanied by slight panting, worsening with movement, and limb weakness: if diagnosed as Xu Sun (Deficiency Damage), there are typically no cough or hemoptysis symptoms; if diagnosed as Tan Huo (Phlegm-Fire), there are no excess Heat fever symptoms. This represents true Yin exhaustion and Yuan Hai (Sea of Origin) lacking roots, a critical condition. Those who cannot eat or urinate have their own primary syndromes; what does this have to do with Guan Ge? Although his theory differs from predecessors, the reasoning is profound. (Note: Previous experts focused on symptoms of vomiting/reflux and urinary retention without specifying a fixed pulse; Jingyue specified large/rapid pulses without focusing on vomiting/retention symptoms. Treatment can proceed according to either theory.)