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(Cheng Xingxuan) This disease arises from Qi stagnation. If one attempts to forcibly open the obstruction suddenly, it may yield immediate results, but ultimately leads to death. In my decades of experience, I have observed that young people do not suffer from this condition, whereas elderly people do. The deficiency of Qi and Blood, the weakness of Water and Fire (Kidney Yin and Yang), the withering of the Upper Jiao, and the dryness of the intestines and stomach are evident and verified facts. Those who treat this disease fail to urgently seek the root in the Spleen and Kidney for remediation; instead, they engage in opening orifices, seeking shortcuts through unconventional methods. Such physicians are indeed foolish! (From *Huixin Lu*)

Yige (Dysphagia and chest/epigastric obstruction) is mostly caused by extreme excess of the Five Emotions, indulgence in desires, or excessive consumption of alcohol and food, leading to the internal accumulation of Yang Qi and the internal depletion of Yin Blood. Treatment should focus on nourishing the Heart and Spleen to soothe stagnant Qi; replenishing Essence and Blood to moisten dryness. Fanwei (Regurgitation/Vomiting after a delay) occurs when there is no Yang in the Stomach to receive food, and the Fire of the Gate of Life (Mingmen) is deficient, failing to warm the Earth of the Spleen. Consequently, food entering the Stomach cannot be transformed, resulting in vomiting in the evening what was eaten in the morning, or in the morning what was eaten in the evening. Treatment should involve benefiting the source of Fire to eliminate Yin shadows; tonifying Earth to unblock Yang, thereby warming the Spleen and Stomach. Thus, Yige and Fanwei require distinct therapeutic principles. For cases where Yang Qi is knotted above and Yin fluids are deficient below causing Yige, use methods to unblock Yang and dissipate痞 (fullness), unblock and tonify the Stomach Fu, and employ variations of Huanglian Fuzi Xiexin Tang, treating upper heat and lower cold. For cases where Liver Yin and Stomach Juice are withered due to mental fatigue and hyperactive Yang, or where Lung and Stomach Jinye (fluids) are depleted, use Sour-Sweet to nourish Yin, and primarily moisten dryness. For cases where fluid deficiency causes Qi stagnation, or Yang deficiency leads to Blood stasis, use methods to regulate Qi and expel stasis, combined with unblocking blood collaterals. For cases of Stomach Yang deficiency and melancholy-phlegm obstruction, use methods to unblock and tonify the Stomach Fu, acrid-hot to open turbidity, bitter-descending and acrid-unblocking, assisted by promoting phlegm resolution and clearing obstruction. For cases caused by Liver depression and rebellious Qi, treat by simultaneously unblocking the Jueyin and Yangming meridians. For cases where wine-heat injures the Lung and Stomach, preventing Qi descent, use mild agents to clear and descend, and bitter-acrid-cold to open the Lung. ○This condition is often caused by Blood withering and Qi declining. Aromatic, drying, and astringent herbs are long prohibited. Although some cases in records imitate the use of acrid-hot herbs, it must be carefully examined whether it is due to minute Yang and turbid pathogen retention. Otherwise, either bitter-acrid to drain stagnation while combining with moistening, or sour-sweet to generate fluids while directly nourishing and clearing, or pushing up Grain Qi if depression is in the Qi level, or circulating turbidity if injury is in the Blood level. The general principle is to regulate transformation mechanisms and harmonize/moisten blood vessels. "Yang Qi knots above, Yin fluids decline below" is truly an accurate conclusion for this condition. (From *Linzheng Zhinan*)

Ancient formulas for treating Yige mostly used anti-emetic agents, failing to consider: Vomiting is a Dampness syndrome, suitable for drying agents; Yige is a Dryness syndrome, suitable for moistening agents. The *Classic* states: Knotting of the Three Yang meridians is called Ge (Obstruction). Knotting refers to accumulated heat; excessive heat causes objects to dry out. All Yige falls under the four characters "Stomach Guan withered and dry." If withered in the Upper Guan, water drinks can pass, but solid food enters with difficulty; if withered in the Lower Guan, food can enter but is vomited out later. Since the Stomach is already withered, administering drying drugs only increases the dryness. Therefore, Da Banxia Tang and Xiao Banxia Tang are prohibited in the category of Yige. I once used Qige San to open the obstruction, assisted by Sijunzi Tang to regulate the Spleen and Stomach, and Xiaoyao San for those with depression. However, even if the medicine is Xiaoyao (soothing), if the person is not at ease, it is of no benefit. Zhang Jifeng said: This is a disorder of the spirit and mind; the method should be introspection and quiet rest. This statement hits the pathology deeply. However, some cases involve parasites, blood, phlegm, or food retention, which must be treated concurrently according to their specific laws and cannot be ignored. (From *Yixue Xinwu*)

Throat and epiglottis closure, chest and diaphragm fullness, seem to belong to Qi stagnation; however, some are caused by excessive consumption of Qi-consuming drugs leading to failure of Middle Qi movement, requiring Qi tonification. Dry and hot stool, shaped like sheep dung, seems to belong to Blood heat; however, some are caused by excessive consumption of purgative drugs leading to Blood exhaustion, requiring Blood tonification. (Liu Zongnong)

Ancient formulas mostly treated Yige with hot agents, unaware that Yige certainly has no Cold syndrome. Some say Yige is due to Qi depression, so acrid-hot herbs are used to disperse it; yet they fail to realize that Qi depression stems from Qi deficiency, not excess. Since Qi is depressed due to deficiency, prolonged depression generates heat. Using acrid-hot drugs to consume Qi further depletes the deficient and intensifies the heat, offering no way for rescue! (Xu Chunfu)

The difficulty of this condition lies in: When intending to strengthen the Spleen and resolve phlegm, one fears drying agents will damage Jinye (fluids); when intending to nourish Blood and generate fluids, one fears moistening agents will obstruct the Middle Jiao (Spleen/Stomach). For Yin injury with fire flourishing, nourishing Blood is urgent; for Spleen injury with Yin excess, warming and tonifying comes first. In cases of deep sorrow and anger, fire depression and closure, where Spirit is not yet exhausted and Pulse is still forceful, one should use the methods of Cang Gong and He Jian to purge, allowing the obstruction to naturally open. (From *Yizong Bidu*)

Ancients pointed to Yige as Jinye withering, allowing water to pass, while dry solids are blocked, indicating withering in the Upper Jiao. I privately doubt this: if Jinye were truly withered, why does saliva surge immediately upon swallowing food? Thus, I know that the Qi facilitating communication between the diaphragm and throat fails to descend because of Chong Mai ascending and rebellious Qi acting. Only due to rebellious Qi does fluid fail to follow its normal downward-moistening course, rising with the Qi instead. Using descending-moistening drugs would only exacerbate rebellion. Six Junzi Tang with modifications is appropriate. ○Generally, Yige patients with obesity and phlegm-rebellion are treatable; those with withered fluids and decline are mostly untreatable. ○After initial recovery from Fanwei, porridge and drinks must strictly be avoided. Daily administration of Dushen Tang with a little fried aged rice, decocted and taken frequently, allows testing thin gruel only after ten days. Often, eating rice immediately leads to relapse and danger. (Zhang Luyu)

If Three Yang knotting is treated with moistening agents, it is acceptable if no saliva is vomited; if saliva surges and food cannot enter, moistening drugs cannot moisten the intestines but instead generate more fluid, accelerating death. If medication is desired, Six Junzi Tang is ultimately best. The Spleen likes dryness and dislikes dampness; if Stomach fluids do not circulate, how can the intestines be moistened? ○Stool like sheep dung indicates Three Yang knotting, treatment focuses on the Intestines. Loose stool with food sticking indicates treatment focuses on the Stomach. (Xu Xuanzhi)

Excessive drinking of hot wine often leads to Ge syndrome, known to moderns, but the underlying mechanism is not understood. Ge has two types: one is difficulty in receiving food in the Upper Guan; the other is difficulty in expelling food from the Lower Guan. The Stomach contains a mass of harmonious Qi. Thus, the Upper Guan has mostly clear Yang, feeling no heat; the Lower Guan has mostly turbid Yin, feeling no cold. Even in extreme summer heat, Stomach Qi does not become hot; in extreme winter cold, Stomach Qi does not become cold; Qi remains harmonious. It can receive food but not digest it, relying on Spleen Yang entering the Stomach to activate digestion, which is natural creation. Qu (ferment) nature rises vigorously. Daily boiling wine forces Lower Guan Qi to rise to Upper and Middle Guan, potentially closing the Youmen (pylorus). Hot wine entering the throat daily scorches the Upper Guan, creating a putrefied appearance, destroying vital Qi, narrowing the passage, allowing only water but not grain. This is why it often becomes Ge syndrome. (Yu Jiayan)

Meihe Ge (Plum-pit sensation in throat), feeling of an object in the throat, pain in the diaphragm, mostly due to fixed blood (stasis). Treatment suits Kelp, Angelica Sinensis, Peach Kernel, Leek Juice, and Child's Urine; severe cases add Rhubarb. Cases due to phlegm knotting suit Tidan Wan. *Yijian* states: obstruction in the throat, feeling of hindrance, unable to spit out or swallow down, due to Qi depression and phlegm knotting, precisely refers to this. However, this condition always involves tangible pathogens, either blood or phlegm. Qi is intangible, so it is clearly not Meihe Ge. (Shen Jin'ao)

Patients over sixty years old are difficult to treat. Stool like sheep dung is untreatable. Profuse vomiting of white foam is untreatable. Chest and abdominal burning pain like knife-cutting is fatal. Continuing sexual activity/alcohol and experiencing sorrow/anger is critical. (*Zhengzhi Huibu*)

Pulse Diagnosis
Blood deficiency: Left pulse is weak. Qi deficiency: Right pulse is weak. Phlegm condensation: Cun and Guan pulses are deep, slippery, and large. Qi stagnation: Cun and Guan pulses are deep, hidden, and choppy. Rebellious Fire Qi: Pulse is rapid and large. Blood stasis retention: Pulse is hollow and choppy. Small, weak, and choppy indicates Fanwei; tight, slippery, and革 (leather-like) indicates Yige. (*Zhengzhi Huibu*)

Selected Cases
Ni Qingyun suffered from Ge Qi, unable to eat a grain of rice, initially vomiting clear water, then green water, then black water, then foul-smelling water, breathing nearly ceased. I said: Within this day and night, first take six doses of Lizhong Tang. Tomorrow morning change the formula, one dose will fully recover. His family said: The illness is this severe, not even a drop of water can enter, how can he take six doses? If there is a miraculous formula, why not administer it immediately, insisting on Lizhong Tang first? I said: *Jinkui Yaolue* states: For patients with persistent belching, Xuanfu Daizhe Shi Tang is indicated. My reasoning for using different approaches here is twofold: First, black water is bottom-stomach water, foul water is intestinal water; since these waters are exiting, Stomach Jinye has been absent for a long time, so I dare not use Banxia to dry the Stomach. Second, the dying Qi retains only a thread; using Daizhe Shi to sink it might cause immediate severance. One must first use Lizhong Tang to differentiate and regulate Yin and Yang, making Qi easier to descend, so Daizhe Shi can take effect. After three doses, the patient said internal Qi slightly connected, but feared rushing, suggesting waiting until tomorrow. Next morning, I brought a cup of the previous medicine, urging him to drink; I said: I will change the formula immediately, effects will be instant, what else is there to say? So I used Xuanfu flower decoction alone, mixed with two spoonfuls of Daizhe Shi powder. As soon as the medicine entered his mouth, his Qi turned into the Dantian. The patient vomited again due to removing clothes and touching cold; giving the previous medicine stopped it immediately. Hungry, he ate six bowls of porridge, vomited again; giving the previous medicine stopped it immediately. Angry, he vomited again; giving the previous medicine stopped it immediately. Later, no more vomiting, only extreme fatigue. Took twenty doses of tonic medicine and one jin of pills, recuperated for two months before leaving the house, only then regretting taking only two fewer doses of Lizhong Tang initially. (Yu Jiayan)

Luo Jingsi suffered from Yige for three months, gradually unable to swallow even a drop of water, nearing death. Seeing his eyes still moving, I could not watch idly. Gave him one spoonful of prepared Yuanming Powder dissolved in water, waiting for it to moisten and descend, then another spoonful, continuing several spoonfuls. Sound in the throat, from Chen hour to Wei hour, consumed one cup. Abdomen rumbled, shortly after bowels and bladder opened. Tested with half a cup of rice drink, no vomiting, only felt heat and discomfort in chest and abdomen, harm from previously taking many warming and tonifying drugs. Gave two doses of Huanglian, Shengdi, Yuanshen, Huafen, Tiandong, Danpi, Gancao, Yinhua. Chest and abdomen relaxed, eating and drinking fine. Gradually regulated with Liuwei Dihuang Wan plus Danggui and Shaoyao, recovered. ○Xiang Weian, after resigning, occasionally experienced frustration, constipation and urinary retention, inability to swallow food. Physicians debated deficiency vs. excess, all ineffective. Palpating his Stomach pulse, deep, hidden, and excess, I said: Three Yang heat knotting, front and back blocked. Lower not unblocked, hence Yige and inability to eat. Should use He Jian's method, purge with Chengqi Tang. Doctors gaped. I said: Old Gentleman Xiang is important. If you have brilliant theories, why not take responsibility? They fell silent. Mr. Xiang said: Would Yang Shuzi poison people? I will take Dr. Hua Zhong's medicine. I happily administered it, and he fully recovered. ○Wang Zijiu suffered from Yige, no opening methods worked. I used one pear, cut into four wedges, inserted twelve grains of Ban Dou (Croton seed), wrapped in paper, mud-coated and roasted red. Removed Ban Dou, mashed pear into juice and drank. Shortly after, Qi moved, upper and lower expanded. Then gave a few fen of Baxian Cake powder mixed with rice drink, Qi gradually returned. Another dose of Huitian Yin, slowly more cake powder and rice drink. Two days later, allowed thin gruel, regulated for three months, cured. ○Liu Meixi initially suffered from Xiaoke (Wasting-Thirst), Di Huang Tang was effective; later developed Yige, switched to Qi-opening agents, both conditions severe. Vomit contained leftover food and phlegm-saliva, extreme hunger and thirst, unable to swallow anything, urine drops like paste, stool like sheep dung, six pulses absent. Thought Wasting-Thirst and Yige combined, water source dried up, why so much phlegm and waste vomited? Must be Heart and Spleen depression not smoothly expressed. Used Guipi Tang minus Baizhu and Muxiang, plus Zhuyu, Huanglian, Er Dong, Changpu. One dose stopped vomiting, pulse appeared. Changed to Huitian Yin, twenty doses cured. (Cheng Huazhong)

Zhang Wenzhong suffered from Fanwei, vomiting soup and porridge shortly after eating. Imperial physicians could not cure, exhausted and near death. Suddenly a guard said: Donkey urine is very effective. Took two he, vomiting stopped by half; took again, porriage settled. Next day reported to the palace, five or six people with this condition took it and recovered. This substance is slightly toxic, do not take too much, must drink hot. Deep illness shows effect in seven days. (*Benshi Fang*)

Zhu Yanzhen suffered from Wine Ge, vomiting and refusal to eat, drinking only one or two cups of hot wine daily, shortly after vomiting acidic bile, severe diaphragm pain, miscellaneous treatments for years ineffective. Caused by habitual drinking of hot wine. This is Danxi's description of hot wine drinkers having fixed blood remaining in the Stomach gate. Prescribed Renshen San: Ren Shen 1 liang, decocted, add She Xiang (Musk) 0.5 fen, Bing Pian (Borneol) 3厘. Three doses allowed eating. Borneol and Musk disperse phlegm and blood stasis in the Stomach gate. Changed to Baizi Ren Tang, peaceful in half a month. These two formulas come from Yunqi, rarely known. ○Qin Boyuan, Yige with vomiting, emaciated body and spirit, depressed mood. Student Zou Hengyou ordered using Woodpecker with Musk boiled into ointment, sniffed occasionally to open knots; internally took Xiaoyao San plus Chenpi and Sharen to disperse depression, several doses cured. Mr. Chen also cured Yige with this method. Another farmer suffered Yige, vomiting saliva like red bean water, belonging to internal blood stasis. Formula: Guiling Yin plus Danggui, Taoren, Danpi, Niuxi, mixed with Black Sugar and Scorpion paste, passed loose black stool like mud. Farmer injured by labor, blood depressed inside; attacking accumulated blood stopped vomiting. (*Zhangshi Yitong*)

Attached Formulas
Qige San: Universal formula for opening Yige, frequently effective. Shashen, Danshen, Fuling, Chuanbeimu, Chutoukuang, Yujin, Sharenqiao, Hetiedi.
Treating Ge Qi Opening Formula: Use one lychee pitted, one millipede. Sprinkle a few cents of Bing Pian on the millipede, wrap lychee meat, place in shell, tie with thread. Let patient hold in mouth, cold saliva渗出, swallow slowly; after some time millipede dissolves, spit out shell. One dose allows eating, do not let patient know, fearing disgust.
Another Formula: This condition due to intestinal dryness and Blood dryness, thus stool like sheep dung is untreatable. This formula best generates Blood and moistens intestines. Cow milk, Sheep milk, Human milk. Any amount, can be taken regularly.
Yuan Shuang: Use 1 jin of black lead, melt into thin cake, pierce hole in center, tie with string. Half jar of vinegar, suspend lead cake in vinegar, inch away from surface. Seal jar mouth with paper and leaves, press with bricks/stones, place in shade. After several days, take up, wipe frost from cake. Per 1 jin lead, obtain 2 liang frost. For Yige, take 5 fen, send down with plain water. For Phlegm-Fire cough, take 3 fen.
Secretly Transmitted Ge-Yige Paste: Effective as divine pill, requires calm mind, do not seek quick results. Human milk, Cow milk, Lugan juice, Renshen juice, Longyanrou juice, Zhe juice, Li juice, Jiang juice. Seven ingredients equal parts, except small amount of Jiang juice. Decoct over water into paste, add refined honey, take frequently and slowly.