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Vomiting continuously until every meal is inevitably vomited is called Fanwei (Rebellious Stomach). When the stomach cavity is withered and atrophic, causing food to be obstructed and difficult to swallow, with dietary intake blocked and reversing in the throat, it is called Ye (Choking). When this obstruction and reversal occur in the chest and diaphragm region, it is called Ge (Diaphragmatic Obstruction). (Food must pass through this area to enter the stomach.) The *Yi Guan* states: Elderly people often suffer from Ye and Ge. In Ye syndrome, water can be swallowed but solid food is difficult to enter, and even if it does, not much is consumed. In Ge syndrome, although food can enter, the amount is small, and after a long time, it is vomited back up. Both conditions make swallowing difficult; when forced down, the vomitus eventually contains phlegm-drool, or white foam and sour fluid, or substances resembling sauce juice. Fanwei is not characterized by an inability to take in food (the patient originally could eat much), but by an inability to retain it. It manifests as eating in the morning and vomiting in the evening, or eating in the evening and vomiting in the morning, or vomiting after one or two hours, or accumulating for a day and night before vomiting due to abdominal distension and discomfort. (There are also cases where food is expelled immediately after eating.) The vomitus consists of the original food, which is sour, rancid, and undigested. This condition affects men, women, the old, and the young alike. Zhu Danxi stated that this disease arises from emotional disturbances (Seven Emotions) and external pathogenic factors (Six Excesses), leading to transformations of fire and heat blazing upward. Qi mechanism rises more than it descends, body fluids fail to circulate, and accumulate into phlegm-fluids. When treated erroneously with hot herbs to forcibly dissipate pathogens, there may be temporary relief (as body fluids temporarily disperse due to acrid-hot properties), but the condition soon recurs. Repeated use of such drugs accumulates heat. Blood consumption leads to dryness and atrophy of the stomach cavity, and constipation with scanty stools resembling sheep dung. (Because excessive fire causes dry, hard, small feces, and the intestines become dry and narrow, the stool lacks lubrication and volume.) Treatment requires avoiding the Six Excesses externally, regulating the Seven Emotions internally, nourishing oneself through diet, tonifying blood and generating fluids to moisten the intestines and stomach. Thus, Metal (Lung) will not fear the inflammation of Fire, Kidney will have the gradual generation of Water, Spleen Qi will be robust and transformative, and food stagnation will be transmitted and digested. Wang Tai said: Food entering and immediately exiting indicates a lack of Water (Yin deficiency), which occurs in both Ye/Ge and Fanwei. Food remaining for a long time before being vomited indicates a lack of Fire (Yang deficiency), which occurs only in Fanwei, not in Ye/Ge. For those lacking Water, strengthen the master of Water using Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia); for those lacking Fire, benefit the source of Fire using Bawei Wan (Eight-Ingredient Pill). (These are also discussed under Deficiency Damage.) If rebellious fire rushes upward and food cannot enter, with a flooding, rapid, and forceful pulse, use Ziyin Qingge Yin (Nourish Yin and Clear Diaphragm Decoction), adding 2 qian of Loquat Leaf and 1 liang of Reed Rhizome. Another type involves Liver Fire constrained and unable to extend, causing vomiting and refusal of food, accompanied by heart pain. However, the vomitus is sour, bitter, green-blue fluid, and bowel/bladder movements are mostly unobstructed (though sometimes alternating between constipation and diarrhea). Use Evodia and Coptis decocted strongly, sipped slowly, followed by Xiaoyao San (Free and Easy Wanderer Powder), and after recovery, Liuwei Wan (see Depression chapter). If Phlegm-Fluids obstruct, and food is swallowed only to be wrapped and vomited out by phlegm, use Bashen Laifu Dan (Eight-God Restoration Pill) to control phlegm (see Phlegm-Fluid chapter). If Blood is withered/dry, decoct Rehmannia, Ophiopogon, and Angelica into a paste, add Chive Juice, Frankincense, Child's Urine, Reed Rhizome Juice, and Peach Kernel Paste, sipping slowly. If large bowels are dry and obstructed, add Peach Kernel Paste and Mirabilite. However, if upon swallowing, food feels twisted descending from the diaphragm, with slight pain and obstruction, it is mostly Blood Stasis. After using the aforementioned medicines, use Daididang Wan (Substitute Dangui Pill) to move stasis (see Blood chapter). If Blood Stasis is in the diaphragm, obstructing food intake, use Daididang Wan: take 3 qian of Mustard Seed, lie supine without a pillow, and swallow slowly to search out and eliminate accumulated stasis. By dawn, foul matter will be discharged, and rest will lead to self-healing. Alternatively, grind Trogopterorus (Wulingzhi) into powder, mix with bile of a yellow dog to form pills the size of a longan fruit. Take one pill three times daily with warm good yellow wine; this is also an excellent formula for moving stasis. If parasites are present, use Qinchuan Jianhong Wan to expel them. This pill also treats Ye disease caused by blood stasis. If a meat-like lump is felt in the throat, it is food stagnating there and not descending; use Maikun Decoction. Child's urine (to descend fire), Bamboo Sap (to move phlegm), Ginger Juice (to assist bamboo sap), Chive Juice (to move blood), Human Milk, Cow Milk (to tonify deficiency and moisten dryness), Reed Rhizome Juice (to stop vomiting), Imperata Rhizome Juice (to cool blood), Sugarcane Juice (to harmonize stomach), and Donkey Urine (to kill parasites). Add small amounts of distilled spirits, rice vinegar, and honey, mix well, and take warm after steaming in water. If the medicine is taken without vomiting, do not immediately give porridge or food. Daily, decoct 5 qian of Ginseng and 1 qian of Tangerine Peel, sip the soup slowly. Only after several days should aged rice water and soft porridge be allowed. Zhang Zihe said: The *Neijing* states that "Three Yang knotting leads to Ge." Three Yang refers to Hand and Foot Taiyang meridians, i.e., Small Intestine and Bladder meridians. Knotting means heat accumulation. Heat accumulation in the Small Intestine dries blood vessels; heat accumulation in the Bladder depletes body fluids. Constipation and urinary retention mean the lower pathways are blocked, forcing rebellion upward, thus causing inability to swallow food. The classics also state: "Arrival of Shaoyang leads to vomiting and gurgling, inability to eat." And: "Liver transferring cold to Heart leads to mania and Ge." This is because Yang Qi combats Cold, causing Ge obstruction. Middle Jiao blockage is not solely due to Cold. Physicians who fail to investigate often recklessly use hot herbs. People say purgatives can be used, yet they suppress Yang to nourish Yin, causing patients to stare with tongue protruding, fearing damage to Yuan Qi. Only Liu Hejian's Sanyi Chengqi Tang (Three-One Purging Decoction) stands supreme across ages. If the disease has persisted for a long time, do not attack abruptly. Even if opened by purging, worry about subsequent complications. First, moisten and nourish; prepare small decoctions and pills, increasing dosage gradually, so the closure naturally penetrates. If saliva-phlegm obstructs above, mildly use sour-bitter herbs to induce slight vomiting, then treat below; drug action will proceed easily. If still ineffective, use honey and salt to guide downward, maintaining mutual attraction between the two drugs. As knots scatter and Yang dissipates, food and drink will descend naturally. An official suffered from this for ten years, with dry, obstructed bowels and yellow-red urine. I administered Sisheng Wan (Four-Life Pill), resulting in thirty evacuations of dry feces and intestinal filth, exceeding several sheng. The patient was confused and fatigued for one to two days, frequently sipping ice water, gradually receiving milk curd and sesame drink. After several days, he resumed normal eating and recovered. Some individuals shout with great effort, damaging the airway and larynx, causing gas to merge into the stomach tube (since the larynx is broken, gas cannot pass through the laryngeal tube, so it goes through the stomach tube), leading to obstruction and vomiting. This method is considered incurable; however, dried ox trachea can be taken. Wine drinkers often suffer from Ge; those drinking hot wine are especially prone, as heat damages body fluids, drying the esophagus (evident from dry mouth and tongue), preventing food entry.