经义
人迎一盛，病在少阳，二盛病在太阳，三盛病在阳明，四盛以上为格阳。寸口一盛，病在厥阴，二盛病在
少阴，三盛病在太阴，四盛以上为关阴。人迎与寸口俱盛，四倍以上，为关格。关格之脉羸不能极于天地之精
气则死矣。（《素问》）
五脏不和，则九窍不通；六腑不和，则留结为痈。邪在六腑，则阳脉不和；阳脉不和，则气留之；气留之，
则阳脉盛矣。邪在五脏，则阴脉不和；阴脉不和，则血留之；血留之，则阴脉盛矣。阴气太盛，则阳气不得相
荣也，故曰格。阳气太盛，则阴气不得相荣也，故曰关。阴阳俱盛，不得相荣也，故曰关格。关格者，不得尽
其命而死矣。○上鱼为溢，为外关内格。入尺为覆，为内关外格。（《难经》）
哲言
寸口脉浮而大，浮为虚，大为实；在尺为关，在寸为格；关则不得小便，格则吐逆。○心脉洪大而长，上
微头小者，则汗出；下微本大者，则关格不通，不得尿。头无汗者可治，有汗者死。○趺阳脉伏而涩，伏则吐逆，
水谷不化，涩则食不得入，名曰关格。（张仲景）
关则不得小便，格则吐逆。关者甚热之气，格者甚寒之气。是关者无出之由，格者无入之理。寒在胸中，
遏绝不入；热在下焦，填塞不出。（张洁古）
关格者，谓膈中觉有所碍，欲升不升，欲降不降，欲食不食，此为气之横格。（戴复庵）
走哺，由下不通，浊气上冲，而饮食不得入。关格，由上下阴阳之气倒置，上不得入，下不得出。（《医阶辨证》）
关格一证，在《内经》本言脉体，以明阴阳离绝之故。自秦越人以尺寸言关格，已失本经之意矣。又仲景
曰∶在尺为关，在寸为格；关则不得小便，格则吐逆。故后世自叔和、东垣以来，无不以此相传，而竞置关格
一证于乌有矣。再至丹溪，则曰此证多死。寒在上，热在下，脉两寸俱盛四倍以上，法当吐以提其气之横格。
愚谓两寸俱盛四倍，又安得为寒在上耶？且脉大如此，则浮豁无根，其虚可知，又堪吐乎？谬而谬又，莫此为
甚！夫《内经》云人迎寸口，既非尺寸之谓，而曰吐逆者，特隔食一证耳；
曰不得小便者，特癃闭一证耳。二证自有本条，其与关格何涉？数子且然，况其他乎？○《经》曰∶人迎四盛
以上为格阳；寸口四盛以上为关阴；人迎与寸口俱盛，四倍以上，为关格。此关格之证，以脉言，不以病言也。
今人患此颇多，而人多不知，但其两手之脉，浮弦数极，大至四倍以上者，便是此证。其病必虚里跳动，而气
喘不已；此之喘状，多无咳嗽，但觉胸膈舂舂，似胀非胀，似短非短，微劳则喘甚，多言亦喘甚，甚至遍身振
振，慌张不定。此必情欲之伤，以致元气无根，孤阳离剧之候也，多不可治。（张景岳）
按∶《内经》所言，人迎与寸口俱盛，四倍以上为关格。是以阳经取决于人迎，阴经取决于寸口也。越人
云∶上鱼为溢，为外关内格；入尺为覆，为内关外格。仲景亦谓在尺为关，在寸为格；关则不得小便，格则
吐逆。皆以阳分取决于寸口，阴分取决于尺内也。《难经》又言∶上部有脉，下部无脉，其人当吐不吐者死；
仲景又有趺阳脉伏而涩，伏则吐逆，水谷不化，涩则食不得入，名曰关格。则知关格之脉证不一也。而马仲化
释《内经》，谓关格之义，非隔食、癃闭之证。张介宾直将越人、仲景之言，一概非之，独执人迎在颈，为阳
明之表脉，遂诋东垣、丹溪皆仍叔和《脉经》左为人迎、右为气口之谬。呜呼！《内经》固为圣经，确宜遵从，
而越人、仲景之书，未尝不为圣经也。盖人迎气口，所以分表里之阴阳；寸口尺内，所以分上下之阴阳也。人
一身表里上下之气化，皆肺所司，血脉皆心所主，故凡气血之盛衰，靡不变见于气口，气口实为肺经之一脉，
不过分其部位，以候他脏之气耳。即如仲景所指趺阳少阴，虽主于足，然未尝不于关尺推之；则《内经》所言
人迎气口，候之左右亦无不可也。故释《内经》之关格，但当言是表里阴阳痞绝之候，不当与上吐下闭之关格
混同立论则可；若言上吐下闭，当称隔食癃闭，不得名为关格则不可。或言关格之证，其脉未必皆然则可；若
言关格之脉，必无在
尺在寸之分则不可。（《张氏医通》）
关格之为病，世多不得其解，不知《内经》分人迎、寸口，其言早已明析。人迎统三阳，寸口统三阴；统
三阳者胃也，统三阴者肺也。阳曰格，言其阻；阴曰关，言其闭。经未明言，所患何证，犹为难测。仲景为解
曰∶关则不得小便，格则吐逆，则明显易解矣。阳明主纳水谷，三阳同阻于阳明，水谷何由入？太阴主调水道，
三阴同闭于太阴，水道何由调？治者不从肺胃求责，或以为阳反在下，阴反在上；或以为阳格乎阴，阴拒乎阳；
或谓阴阳不交，各造其偏，均未得谛当也。○关格一证，前本仲景之说为解，其实仲景所言，但关格中之一病
耳。谓吐逆不得小便，为非关格，不可也。以为遂足以尽关格之病，亦不可也。阴阳本自贯通，关格则阴阳各
聚于一区。《内经》言脉不言证，其所包者广可知。故凡阴阳两不相顾，而病多分见者，皆关格之类也。○阴
病救阴，阳病救阳，阴阳同病，则阴阳同救。阴阳皆病，而分见者，其将何以措手乎？由是言之，吐逆不得小
便，但为关格之先兆。他如干霍乱之欲吐不得吐，欲泻不得泻，或一身而寒热各半，或一病而阴阳混淆者，皆
关格之类，而不得为真关格。真关格者，无药可医，不得尽期而死。（《医参》）
补编
关格虽有数种，然总由肝郁为病，以肝主疏泄故也。治用逍遥散，加山栀、车前以降逆，柴胡以升木郁，
乃和解之意。（陈士铎）
关格者，暴病也。大小便秘，渴饮呕吐，唇燥面赤，脉息沉伏，此寒从少阴而入，阴盛于下，逼阳于上。
须以白通汤，寒因热用，和人尿、猪胆咸苦之物于温热药中，其气相从，可去拒格之寒也。服药脉渐出者生，
乍出者死。（《赵氏医贯》）
《内经》曰∶病久则传化，上下不并，良医弗为。此正指关格而言也。不并犹言不交也，阳在上者不能下，
阴在下者不能上，则天地不交，而运化之机缄穷矣。欲降其阳则阴伤，欲升其阴则阳
败，故古人立方，不治其寒热，而以通达窍者宜之。（《见闻录》）
关格所伤，根本已甚，药饵固不可废。如精虚者，当补其精；气虚者，当益其气。然必须远居别室，静养
澄心，假以岁月，斯可保全。若不绝谢人事，但靠药饵，终无济也。（张景岳）
关格之证，自《灵》、《素》以及《难经》、仲景脉法，皆深言之，然无其方也。后世以无成方根据傍，其
中元言奥义，总不参研，空存其名久矣。惟云岐子述其阴阳反背之状，传其所试九方。其谓阴阳易位，病名关
格。胸膈以上，阳气常在，则热为主病；身半以下，阴气常在，则寒为主病。胸中有寒，以热药治之；丹田有
热，以寒药治之。若胸中寒热兼有，以主客之法治之。治主当缓，治客当急。此从《伤寒论》胸中有寒，丹田
有热立说，实非关格本证。所引《内经》运气治主客之法，亦属无据。至于《灵》、《素》、《难经》、《金
匮》之文，绝不体会，所定诸方，浑入后人恶劣窠臼。方中小疵，杂用二陈、五苓、枳壳、浓朴、槟榔、木香
是也。方中大疵，杂用片脑、麝香、附子、皂角、牵牛、大黄、朴硝是也。夫阴阳不交，各造其偏，而谓阴反
在上阳反在下，可乎？九死一生之证，而以霸术劫夺其阴阳，可乎？仲景之以趺阳为诊者，正欲人调其营卫，
不偏阴偏阳，一味冲和无忤，听胃气之自为敷布，得协于平也。岂一蹴所能几耶？故不问其关于何而开，格于
何而通，一惟求之于中，握枢而运。治吐逆之格，由中而渐透于上；治不溲之关，由中而渐透于下；治格而且
关，由中而渐透于上下。姑立进退黄连汤一方，要未可为中人道也。○黄连汤者，仲景治伤寒之方也；以其胃
中有邪气，阻遏阴阳升降之机，而不交于中土，于是阴不得升，而独治于下，为下寒，腹中痛；阳不得降，而
独治于上，为胸中热，欲呕吐，与此汤以升降阴阳固然矣。而湿家下之，舌上如苔者，丹田有热，胸中有寒，
亦用此汤何耶？盖伤寒分表、里、中三治，表里之邪俱盛，则从中而和之，故有小柴胡之和法。饮入胃中，听
胃气之升者，
带柴胡出表；胃气之降者，带黄芩入里，一和而表里之邪尽服，不相扦格矣。至于丹田胸中之邪，则在于上下，
而不为表里，即变柴胡汤为黄连汤，和其上下。饮入胃中，亦听胃气之上下敷布，故不问其上热下寒，上寒下
热，皆可治之也。夫表里之邪，则用柴胡、黄芩；上下之邪，则用桂枝、黄连。表里之邪，则用生姜以散之；
上下之邪，则用干姜以开之。仲景圣法昭然矣。昌欲进退其上下之法，求之于中，握枢而运，以渐透于上下。
格则吐逆，进而用此方为宜。盖太阳主开，太阳不开，则胸间窒塞，食不得入，入亦复出，以桂枝为太阳经药，
和营卫而行阳道，故能开之也。至于五志厥阳之火上入，桂枝又不可用矣，用之则以火济火，头有汗而阳脱矣。
其关则不得小便，退之之法，从胃气以透入阴分，桂枝亦在所不取。但胃之关门已闭，少阴主阖，少阴之气不
上，胃之关门必不开。《经》曰∶肾气独沉。又曰∶肾气不衡。夫真气之在肾中，犹权衡也，有权有衡，则关
门时开时阖。有权无衡，则关门有阖无开矣，小溲亦何从而出耶？是则肾气丸，要亦退之之中所有事矣。肾气
交于胃，则关门开，交于心，则厥阳之火随之下伏，有不得不用之时矣。○凡治关格病，不知批 导 ，但冀
止呕利溲，亟治其标，技穷力竭，无益反损，医之罪也。○凡治关格病，不参人迎、趺阳、太冲，独持寸口，
已属疏略。若并寸口阴阳之辨懵然，医之罪也。○凡治关格病，不辨脉之阳虚阳实，阴虚阴实，而进退其治，
肓人适路，不辨东西，医之罪也。○凡治关格病，不从王道，辄投霸术，逞己之能，促人之死，医之罪也。（《医门法律》）
附方
进退黄连汤 黄连姜汁炒一钱五分、干姜炮一钱五分、人参人乳拌蒸一钱五分、桂枝一钱、半夏姜制一钱
五分、大枣二枚。进法∶用本方六味俱不制，水三茶盏，煎一盏半，温服。退法∶不用桂枝，黄连减半，或
加肉桂五分，如上逐味制熟，煎服法同。
朝服八味丸三钱，半饥服煎剂。
资液救焚汤 治五志厥阳之火。生地黄取汁二钱、麦门冬取汁二钱、人参人乳拌蒸一钱五分、胡麻仁炒研一
钱、柏子仁炒七分、甘草炙一钱、五味子四分、紫石英敲碎一钱、阿胶一钱、寒水石敲碎一钱、滑石敲碎一钱、
犀角磨汁三分、生姜汁三匙。上除四汁、阿胶，其八味用水四茶杯，缓火煎至一杯半；去渣、入四汁、阿胶，
再煎至胶烊化；斟出，调牛黄五厘。日中分二、三次热服。空朝先服八味丸三钱。
[Classic Discourse]
When the Renying pulse is one times larger than the Cunkou pulse, the disease is in Shaoyang (Lesser Yang); two times larger, the disease is in Taiyang (Greater Yang); three times larger, the disease is in Yangming (Yang Brightness); four times larger or more, it is called Ge Yang (Rebellious Yang). When the Cunkou pulse is one time larger than the Renying pulse, the disease is in Jueyin (Terminal Yin); two times larger, the disease is in Shaoyin (Lesser Yin); three times larger, the disease is in Taiyin (Greater Yin); four times larger or more, it is called Guan Yin (Closed Yin). If both the Renying and Cunkou pulses are vigorous and four times larger or more, it is called Guan Ge (Guan-Ge syndrome). The Guan Ge pulse is emaciated and cannot sustain the essence and Qi of Heaven and Earth, leading to death. (From *Su Wen*)
When the Five Zang organs are not in harmony, the Nine Orifices will be obstructed; when the Six Fu organs are not in harmony, Qi stagnation leads to accumulation and formation of carbuncles. Evil invading the Six Fu organs causes disharmony of the Yang pulses; disharmony of the Yang pulses causes Qi stagnation; Qi stagnation leads to an excess of Yang pulses. Evil invading the Five Zang organs causes disharmony of the Yin pulses; disharmony of the Yin pulses causes Blood stagnation; Blood stagnation leads to an excess of Yin pulses. When Yin Qi is excessively excessive, Yang Qi cannot mutually nourish and harmonize, hence it is called "Ge" (Rebellion/Obstruction). When Yang Qi is excessively excessive, Yin Qi cannot mutually nourish and harmonize, hence it is called "Guan" (Closure). When both Yin and Yang Qi are excessive and cannot mutually nourish and harmonize, it is called Guan Ge. Those suffering from Guan Ge will die as their lifespan is exhausted. ○ A pulse extending to the fish border (Yuchi) is called Yi pulse, representing Wai Guan Nei Ge (External Closure Internal Rebellion). A pulse extending into the Chi position is called Fu pulse, representing Nei Guan Wai Ge (Internal Closure External Rebellion). (From *Nan Jing*)
[Philosophical Discourses]
The Cunkou pulse is floating and large; floating indicates deficiency, large indicates excess. When seen at the Chi position, it is Guan; when seen at the Cun position, it is Ge. Guan results in inability to urinate; Ge results in vomiting and reflux. ○ The Heart pulse is洪大 (Hongda/Vigorous and Large) and long; if the head is slightly small and the root large, sweating occurs; if the lower part is slightly large, Guan Ge obstruction occurs, and urination is impossible. If the head has no sweat, it is treatable; if there is sweat, it is fatal. ○ The Duyang pulse is Fu (Deep) and Se (Choppy); Fu indicates vomiting and reflux with undigested food and drink; Se indicates inability to swallow food, a condition named Guan Ge. (Zhang Zhongjing)
Guan refers to inability to urinate; Ge refers to vomiting and reflux. Guan is caused by extremely hot Qi causing blockage; Ge is caused by extremely cold Qi causing obstruction. Thus, Guan has no outlet, and Ge has no entry. Cold retained in the chest prevents entry; Heat accumulated in the Lower Jiao prevents exit. (Zhang Jiegu)
Guan Ge syndrome refers to a sensation of obstruction in the Diaphragm, where rising is impeded, descending is blocked, and appetite is lost. This is due to Qi transverse obstruction. (Dai Fuan)
Zoubu (Running Back/Nausea) arises from lower obstruction, with turbid Qi rushing upward, preventing food intake. Guan Ge arises from the inversion of Upper and Lower Yin and Yang Qi, where nothing can enter above and nothing can exit below. (*Yi Jie Bian Zheng*)
The term Guan Ge in *Nei Jing* originally referred to pulse morphology to illustrate the separation of Yin and Yang. Since Qin Yueren (Bian Que) interpreted Guan Ge using Cun and Chi positions, he deviated from the original meaning of the Classic. Furthermore, Zhang Zhongjing stated: Pulse at Chi is Guan (urinary retention); pulse at Cun is Ge (vomiting/reflux). Consequently, later physicians from Wang Shuhe and Li Dongyuan onwards transmitted this view, completely neglecting the true nature of Guan Ge syndrome. Later, Zhu Danxi claimed this syndrome is mostly fatal, attributing it to Cold above and Heat below, with both Cun pulses exceeding four times normal size, suggesting emesis to lift the transverse Qi. I argue that if both Cun pulses are four times larger, how can it be Cold above? Moreover, such a large pulse indicates floating, hollow, and rootless qualities, revealing severe deficiency; how can emesis be used? Error upon error, none is greater than this! The Renying and Cunkou mentioned in *Nei Jing* do not refer to Cun and Chi positions; vomiting specifically refers to Dysphagia (Yishi); urinary retention specifically refers to Long Bi (Strangury). These conditions have their own distinct categories and are unrelated to Guan Ge. If these masters erred, what of others? ○ *Nei Jing* states: Renying four times larger is Ge Yang; Cunkou four times larger is Guan Yin; both four times larger is Guan Ge. This definition of Guan Ge is based on pulse, not symptoms. Many people suffer from this now but do not recognize it; if both hands show floating, wiry, rapid, and large pulses (four times normal), it is this syndrome. Symptoms must include palpitation of Xuli (Vitalis) and incessant asthma; this asthma usually lacks cough, but feels like chest pounding, distension without fullness, shortness without suffocation, worsening with slight exertion or speech, even whole-body tremors and panic. This is likely due to emotional/lust injury causing rootless Yuan Qi and extreme separation of solitary Yang, mostly untreatable. (Zhang Jingyue)
Commentary: *Nei Jing* states Guan Ge when Renying and Cunkou are four times larger, determining Yang meridians by Renying and Yin meridians by Cunkou. Yueren said: Extending to Yuchi is Yi (Wai Guan Nei Ge); entering Chi is Fu (Nei Guan Wai Ge). Zhongjing also said: Chi is Guan (urinary retention); Cun is Ge (vomiting). These determine Yang by Cunkou and Yin by Chi. *Nan Jing* adds: Pulse above, no pulse below, expecting vomit but unable to vomit is fatal. Zhongjing added: Duyang Fu and Se indicates vomiting/undigested food (Fu) and inability to eat (Se), named Guan Ge. Thus, Guan Ge pulses/symptoms vary. Ma Zhonghua explained *Nei Jing*, stating Guan Ge is not Dysphagia or Strangury. Zhang Jiabin rejected Yueren and Zhongjing entirely, insisting Renying is on the neck (Yangming surface pulse), criticizing Dongyuan and Danxi for following Shuhe's left-right Renying/Qikou error. Alas! *Nei Jing* is sacred and should be followed, but Yueren and Zhongjing's works are also sacred. Renying/Qikou distinguish Surface/Interior Yin-Yang; Cunkou/Chi distinguish Upper/Lower Yin-Yang. Lung governs Qi transformation of Surface/Interior/Upper/Lower; Heart governs Blood vessels. Thus, Qi/Blood changes manifest at Qikou (Lung meridian pulse), merely differentiating locations to inspect other Zang. Just as Zhongjing uses Duyang/Shaoyin (foot pulses) inferred from Guan/Chi, interpreting Renying/Qikou at left/right is also acceptable. Therefore, explaining *Nei Jing*'s Guan Ge should only describe it as Surface/Interior Yin-Yang blockage/separation, not conflating it with Vomiting/Urinary Retention Guan Ge. However, calling Vomiting/Retention "Guan Ge" is incorrect; they should be named Dysphagia and Strangury. It is acceptable to say Guan Ge pulses may not always be so; it is unacceptable to say Guan Ge pulses never differentiate between Chi and Cun. (*Zhang Shi Yi Tong*)
Guan Ge is misunderstood by many, ignoring *Nei Jing*'s clear distinction of Renying/Cunkou. Renying governs Three Yang; Cunkou governs Three Yin. Three Yang are governed by Stomach; Three Yin by Lung. "Ge" implies obstruction; "Guan" implies closure. The Classic does not specify symptoms, making it hard to predict. Zhongjing clarified: Guan is urinary retention; Ge is vomiting. This makes it clear. Yangming Stomach receives food/water; if Three Yang are blocked at Yangming, how does food enter? Taiyin Spleen regulates waterways; if Three Yin are closed at Taiyin, how are waterways regulated? Treating without focusing on Lung/Stomach—whether assuming Yang inverted below/Yin above, or Yang blocking Yin/Yin rejecting Yang, or Yin-Yang non-interaction—is inaccurate. ○ Previous interpretations relied on Zhongjing, but his description is only one aspect of Guan Ge. Saying vomiting/retention is NOT Guan Ge is wrong; saying it EXHAUSTS all Guan Ge pathology is also wrong. Yin-Yang should be connected; Guan Ge isolates them. *Nei Jing* discusses pulse, not symptoms, implying broad scope. Thus, any condition where Yin-Yang ignore each other and symptoms appear separately belongs to Guan Ge category. ○ Treat Yin disease by saving Yin; Yang disease by saving Yang; both by saving both. If Yin-Yang are diseased and separate, how to handle? Thus, vomiting/retention is merely a precursor. Other examples: Gan Huoluan (Dry Cholera) wanting to vomit/diarrhea but unable, half-body cold/half-hot, or mixed Yin-Yang pathology—all are Guan Ge-like, but not True Guan Ge. True Guan Ge is incurable and fatal before expected term. (*Yi Can*)
[Supplement]
Although Guan Ge has varieties, it generally stems from Liver Qi Stagnation, as Liver governs free flow. Treatment uses Xiaoyao San, adding Zhizi and Cheqianzi to direct rebellious Qi downward, and Chaihu to raise Liver Qi depression, embodying Harmonizing method. (Chen Shiduo)
Guan Ge is an acute disease. Constipation, thirst, vomiting, dry lips, red face, deep-hidden pulse indicate Cold entering Shaoyin, Yin excess below forcing Yang above. Must use Baitong Tang, applying Cold with Heat method, mixing human urine and pig gallbladder bile (salty/bitter) into warm medicine to align Qi and remove obstructing Cold. Pulse gradually appearing indicates life; suddenly appearing indicates death. (*Zhao Shi Yi Guan*)
*Nei Jing* says: Long illness transforms, Upper/Lower do not interact, even good doctors fail. This refers to Guan Ge. "No interaction" means non-communication; Yang above cannot descend, Yin below cannot ascend, Heaven/Earth do not interact, and transformation mechanism stops. Descending Yang injures Yin; Ascending Yin damages Yang. Thus ancients prescribed formulas not treating Cold/Heat directly, but unblocking orifices. (*Jianwen Lu*)
Guan Ge severely damages the root; medication is essential. Essence deficiency requires tonifying essence; Qi deficiency requires benefiting Qi. However, one must live apart, cultivate mind and body quietly over years to preserve health. Without cutting off worldly affairs, relying solely on medicine is futile. (Zhang Jingyue)
Guan Ge is discussed deeply in *Ling Shu*, *Su Wen*, *Nan Jing*, and Zhongjing's pulse methods, yet no specific formula exists. Later generations, lacking established formulas, ignored profound meanings, keeping only the name. Yun Qizi described Yin-Yang reversal and transmitted nine tested formulas. He stated Yin-Yang position swap is Guan Ge: Upper chest Yang constant = Heat dominant; Lower body Yin constant = Cold dominant. Chest Cold treated with Hot meds; Dantian Heat treated with Cold meds. Mixed Cold/Heat in chest uses Master/Guest method. Slow treatment for Master, urgent for Guest. This derives from *Shang Han Lun* (Chest Cold/Dantian Heat) but is not true Guan Ge. Its reference to *Nei Jing* luck/master-guest methods is baseless. It ignores *Ling/Su/Nan/Jin Gui* texts, incorporating poor later formulas. Minor flaws: mixing Er Chen, Wu Ling, Zhi Ke, Hou Po, Bing Lang, Mu Xiang. Major flaws: mixing Bing Pian, She Xiang, Fu Zi, Zao Jiao, Qian Niu, Da Huang, Xiao Ming. Can Yin-Yang imbalance be treated by claiming Yin above/Yang below? Can a near-fatal case be treated with coercive methods seizing Yin-Yang? Zhongjing used Duyang pulse to guide regulating Ying-Wei, avoiding Yin/Yang bias, allowing Stomach Qi to distribute naturally for balance. This is not achieved instantly. Thus, regardless of where Guan/Ge opens/closes, seek resolution in the Middle, grasp the pivot, and operate. Treat Ge (vomiting) by penetrating upward from Middle; treat Guan (retention) by penetrating downward from Middle; treat both by penetrating up/down from Middle. Tentatively establish Jin Tui Huang Lian Tang. This is insufficient for those on the right path. ○ Huang Lian Tang is Zhongjing's Shang Han formula. Stomach evil blocks Yin-Yang升降 (ascending/descending) at Middle Earth, causing Yin to stay below (Cold abdomen/pain) and Yang to stay above (Hot chest/vomiting). This formula regulates Yin-Yang. But why use it for dampness patients misused purgatives with tongue coating, Dantian heat/chest cold? Shang Han treats Surface/Interior/Middle. When Surface/Interior evil are strong, harmonize from Middle (Xiao Chai Hu Tang). Medicine enters Stomach; ascending Qi carries Chai Hu out (Surface); descending Qi carries Huang Qin in (Interior). One harmonization clears Surface/Interior without conflict. For Dantian/Chest evil (Upper/Lower, not Surface/Interior), change Chai Hu Tang to Huang Lian Tang to harmonize Upper/Lower. Medicine enters Stomach; Qi distributes up/down. Thus, Upper Heat/Lower Cold or vice versa are treatable. Surface/Interior evil use Chai Hu/Huang Qin; Upper/Lower evil use Gui Zhi/Huang Lian. Surface/Interior use Sheng Jiang to disperse; Upper/Lower use Gan Jiang to open. Zhongjing's holy method is clear. I propose adjusting Upper/Lower methods via Middle, grasping pivot, penetrating up/down. For Ge (vomiting), advance with this formula. Taiyang governs opening; if Taiyang fails to open, chest stuffiness prevents eating/ejection. Gui Zhi (Taiyang herb) harmonizes Ying-Wei, moves Yang Dao, thus opens. However, if Five Emotions/Jue Yang Fire rise, Gui Zhi is contraindicated (adding fire to fire, head sweat, Yang collapse). For Guan (retention), retreat method penetrates Yin via Stomach Qi; Gui Zhi is excluded. But Stomach gate is closed; Shaoyin governs closing; if Shaoyin Qi doesn't ascend, Stomach gate won't open. *Nei Jing*: Kidney Qi sinks alone; Kidney Qi unbalanced. True Qi in Kidney is like a scale; with weight and beam, gate opens/closes. With weight but no beam, gate only closes, no urine. Thus, Shen Qi Wan is necessary in retreat. Kidney Qi interacting with Stomach opens gate; interacting with Heart subdues Jue Yang Fire. There are times for its use. ○ Treating Guan Ge without guiding/directing, hoping only to stop vomiting/diurese, urgently treating branch, exhausting skill, harming patient, is doctor's fault. ○ Treating Guan Ge ignoring Renying/Duyang/Taichong, holding only Cunkou, is negligence. Ignoring Cunkou Yin-Yang differentiation is doctor's fault. ○ Not distinguishing Pulse Yang Deficiency/Excess, Yin Deficiency/Excess to adjust treatment, like blind man walking, is doctor's fault. ○ Treating Guan Ge not via Kingly Way but Hegemonic Methods, showing off skill, hastening death, is doctor's fault. (*Yi Men Fa Lv*)
[Attached Formulas]
**Jin Tui Huang Lian Tang (Advance-Retreat Coptis Decoction)**
Huang Lian (Stir-fried with Ginger Juice) 1.5 qian; Gan Jiang (Roasted) 1.5 qian; Ren Shen (Steamed with Human Milk) 1.5 qian; Gui Zhi 1 qian; Ban Xia (Processed with Ginger) 1.5 qian; Da Zao 2 pieces.
Advance Method: Use all six ingredients unprocessed. Water 3 tea cups, decoct to 1.5 cups, take warm.
Retreat Method: Omit Gui Zhi, halve Huang Lian, or add Rou Gui 0.5 qian. Process ingredients thoroughly as above, decoct and take same as above.
Take Ba Wei Wan 3 qian in morning, take decoction when half-hungry.
**Zi Ye Jiao Fen Tang (Fluid-Nourishing Fire-Saving Decoction)**
Treats Five Emotions Jue Yang Fire.
Sheng Di Huang (Juice) 2 qian; Mai Men Dong (Juice) 2 qian; Ren Shen (Steamed with Human Milk) 1.5 qian; Hu Ma Ren (Stir-fried & ground) 1 qian; Bai Zi Ren (Stir-fried) 0.7 fen; Gan Cao (Roasted) 1 qian; Wu Wei Zi 0.4 fen; Zi Shi Ying (Crushed) 1 qian; E Jiao 1 qian; Han Shui Shi (Crushed) 1 qian; Hua Shi (Crushed) 1 qian; Xi Jiao (Ground juice) 0.3 fen; Sheng Jiang Jiang (Ginger Juice) 3 spoons.
Except for the four juices and E Jiao, decoct the other eight ingredients in 4 tea cups of water with slow fire to 1.5 cups. Remove dregs, add four juices and E Jiao, decoct until E Jiao melts. Pour out, mix in Niu Huang 0.05 fen. Take hot, divided into 2-3 doses during midday. Take Ba Wei Wan 3 qian on empty stomach in morning.