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The nine formulas for Guan Ge (Obstruction and Rejection) by Yun Qi Zi are recorded here for reference. When prescribing formulas in clinical practice, taking these as a warning and modifying them is also a method of teacher-student transmission.

Baizi Ren Tang (Biota Seed Decoction): Renshen (Ginseng Radix), Banxia (Pinelliae Rhizoma), Baifuling (Poria with Hostwood), Chenpi (Citri Reticulatae Pericarpium), Baizi Ren (Biotae Semen), Gancao (Licorice Root, honey-fried), Shexiang (Musk, a small amount, separately ground). The above herbs are decocted with Shengjiang (Fresh Ginger Rhizome), Shexiang is added, mixed evenly, and taken orally. Adding Yuliren (Prunus Li Thun Seed) is even better. Commentary: This formula uses Liujunzi Tang (Six Gentlemen Decoction), removing Baizhu (Atractylodis Macrocephalae Rhizoma) to prevent stagnation in the middle jiao, adding Baizi Ren and Yuliren for moistening and purging downward, and adding a small amount of Shexiang to open the orifices. It is not without a certain painstaking effort. However, it ultimately fails to understand the principle of disease formation. It does not know how to handle the pathology with ease like "a blade moving through an empty space." Attempting to use Shexiang to open the orifices merely serves to close them further.

Renshen San (Ginseng Powder): Renshen, Shexiang, Pian Nao (Borneol, each a small amount). Ground into powder, taken with Gancao Tang (Licorice Decoction). Commentary: This formula frequently uses Borneol and Musk, which dissipate true Qi. Once the medicinal qi passes the chest, the Da Qi (Great Qi), Zong Qi (Pectoral Qi), and Gu Qi (Grain Qi) become chaotic, and the vital energy is completely exhausted. How can it cure the disease?

Ji Ji Wan (Both Sides Achieved Pill): Treats Guan Ge with deep and fine pulse, and cold extremities. Shufu Zi (Prepared Aconite Root, soaked in child's urine), Renshen (each 1 qian), Shexiang (a small amount). The above are ground into powder, made into pills the size of paulownia seeds using paste, coated with Shexiang. Take seven pills per dose, washed down with Dengxin Tang (Juncus Decoction). Commentary: The formula description states that a deep and fine pulse with cold extremities indicates entirely the failure of Kidney Qi to ascend and the closure of the "gate." While Renshen and Fuzi are certainly necessary, if the treatment focuses solely on tonifying Yang without Yin to coordinate it, how can the state of Ji Ji (both sides achieved/interaction of Water and Fire) be reached? Moreover, using Shexiang as a coating causes the medicinal qi to scatter, preventing it from descending. Even if the medicine reaches the gate, opens it, and allows temporary urination, the condition of Ge (Rejection) will inevitably worsen.

Binglang Yiqi Tang (Areca Nut and Qi-Boosting Decoction): Treats Guan Ge occurring after labor, due to Qi deficiency and failure of movement. Binglang (Arecae Semen, used in large amounts), Renshen, Baizhu, Danggui (Angelicae Sinensis Radix), Huangqi (Astragali Radix), Chenpi, Shengma (Cimicifugae Rhizoma), Gancao, Chaihu (Bupleuri Radix), Zhike (Aurantii Fructus Immaturus), Shengjiang. Decoct and take. Commentary: This formula uses Buzhong Yiqi Tang (Middle-Boosting and Qi-Supplementing Decoction) plus Binglang and Zhike, stating that Binglang should be used in large amounts. The intention is that the ascending action of Buzhong Yiqi Tang combined with the descending action of Binglang will unblock Guan Ge. However, ascending crosses the boundary of Ge, and descending crosses the boundary of Guan; both are bound to fail.

Mutong Erchen Tang (Akebia and Two-Aged Herb Decoction): Treats urinary obstruction following heart-spleen pain, caused by Phlegm obstructing the middle jiao and Qi stagnation in the lower jiao. Mutong (Akebiae Caulis), Chenpi (removed white part), Baifuling, Banxia (processed with ginger), Gancao, Zhike. Decoct with Shengjiang and take. After taking, induce vomiting gently. If still obstructed, take Jiawei Xiaowei Dan (Modified Small Stomach Pill) or Jiawei Kongyan Dan (Modified Controlling Phlegm Pill). Commentary: This again adds Mutong and Zhike to Erchen Tang, similar to the method of adding Binglang and Zhike to Buzhong Yiqi Tang. However, Guan Ge cases are mostly due to Fire, rarely due to Phlegm. Just as one rejoices when a cloud covers the scorching sun, one might think clearing Phlegm solves the problem. But can the Fire disaster in the human body be entirely resolved by劫 (robbing/clearing) Phlegm? Furthermore, if Phlegm obstruction is not severe, it does not lead to Guan Ge. Guan Ge patients are emaciated and cannot withstand the depletion of essence and Qi from Heaven and Earth; this clearly indicates daily depletion of Yin Essence and hyperactivity of Yang Fire. To treat this by focusing on Phlegm is misguided. And to administer harsh medicines like Xiaowei Dan and Kongyan Dan—what kind of talk is this!

Daoqi Qingli Tang (Guiding Qi and Clearing-Purging Decoction): Treats Guan Ge with vomiting/reversal and obstruction of both stool and urine. Zhuling (Polyporus), Zexie (Alismatis Rhizoma), Baizhu, Renshen, Huoxiang (Patchouli Herb), Baizi Ren, Banxia, Chenpi, Gancao, Mutong, Zhizi (Gardeniae Fructus), Baifuling, Binglang, Zhike, Dahuang (Rhei Radix et Rhizoma), Houpo (Magnoliae Officinalis Cortex), Shexiang, Heiqianniu (Pharbitidis Semen). Decoct with Shengjiang and take, concurrently taking Muxiang Hezhong Wan (Costus Harmonizing Middle Pill). If vomiting does not stop, moxa Qihai (CV6) and Tianshu (ST25). If still obstructed, use Honey Suppository. Commentary: This formula gathers various purgative and draining herbs, with a small addition of Renshen and Baizhu to guide Qi, claiming efficacy everywhere. But for a patient with faint breath, is there any Qi left to stimulate and open long-standing obstruction? As soon as the medicine enters the stomach, it immediately increases vomiting and reversal. To say that if vomiting persists, one should moxa Qihai and Tianshu, adding fire therapy—is this bearable? For constipation, honey suppositories are used; what is used for urinary retention? It is truly annoying and laughable!

Jiawei Maren Wan (Modified Hemp Seed Pill): Treats Guan Ge with obstruction of both stool and urine. Dahuang (1 liang), Shaoyao (Paeoniae Radix), Houpo, Danggui, Xingren (Armeniacae Semen Amarum), Maren (Cannabis Fructus), Binglang, Muxiang (Aucklandiae Radix), Zhike (each 5 qian). Ground into powder, made into honey pills, taken with warm water. Commentary: This formula focuses exclusively on promoting bowel movements. I fear that before the bowels are cleared, the Stomach Qi will be damaged first, leading to further inability to ingest food. Even if the bowels move normally, the Guan Ge condition remains unchanged. One dose will triple the exhaustion, and continuous use will be incurable.

Zaojiao San (Soap Pod Powder): Treats Guan Ge with obstruction of both stool and urine lasting three to five days. Da Zaojiao (Gleditsiae Sinensis Spine, charred but retaining nature). Ground into powder, taken with rice soup. Also, boil 1 liang of pork lard, and consume both the juice and fat. Additionally, take Bazheng San (Eight-Herb Rectification Powder) with added Binglang, Zhike, Poxiao (Natrii Sulfas), Taoren (Persicae Semen), Dengxincao (Junci Medulis Herba), and Chagen (Camelliae Sinensis Root). Commentary: These methods only address the branch symptom of opening the bowels and bladder, failing to seek the root of Guan Ge. Does one realize that Zaojiao powder entering the stomach feels like thousands of needles piercing? Even obese people cannot endure it, let alone emaciated patients. Following this with animal fats cannot save them from the harsh depletion, especially with the addition of Taoren and Poxiao to exacerbate the harm.

Da Chengqi Tang (Major Order the Qi Decoction) (Formula seen in Volume 4): Commentary: This is a formula for treating excess conditions of the Stomach in Shanghan (Cold Damage). Using it for Guan Ge is acting against reason and nature, treating human life as worthless grass and millet; nothing is more serious than this.

These nine formulas do not understand the principles of disease formation and blindly attempt to gain therapeutic success. Adding harsh drugs to Liujunzi Tang or Buzhong Yiqi Tang can be excused. However, adding harsh drugs to Erchen Tang, Bazheng San, or Chengqi Tangs is indefensible. As for Pian Nao (Borneol), Shexiang, and Zaojiao, even acute diseases dare not use them lightly, let alone terminal cases. Their skills become poorer as they apply them; thus, they belong to the class of those who are unlearned and merely book-smart.

Jin Tui Huanglian Tang Formula (Self-prescribed, formula discussion seen previously): Huanglian (Scutellariae Radix, stir-fried with ginger juice), Ganjiang (Zingiberis Rhizoma, processed), Renshen (steamed with human milk, 1.5 qian), Guizhi (Cinnamomi Ramulus, 1 qian), Banxia (processed with ginger, 1.5 qian), Dazao (Jujubae Fructus, two pieces). Advancing Method: Use all seven herbs of this formula without special processing. Add three tea cups of water, decoct until half remains, and take warm. Retreating Method: Do not use Guizhi. Reduce Huanglian by half, or add Rougui (Cinnamomi Cortex, 0.5 qian). Process each herb thoroughly as described above, decoct and take similarly. However, take Cui Shi Bawei Wan (Cui’s Eight-Ingredient Pill, 3 qian) on an empty stomach in the morning, and take the decoction when half-hungry.

Cui Shi Bawei Wan (Cui’s Eight-Ingredient Pill) (Formula seen in Volume 2)

Ziye Jiufen Tang (Fluid-Nourishing and Fire-Extinguishing Decoction) (Self-prescribed): Treats the Fire of Jue Yang arising from the Five Emotions. Shengdihuang (Rehmanniae Radix Recens, 2 qian, juice extracted), Maimendong (Ophiopogonis Radix, 2 qian, juice extracted), Renshen (1.5 qian, steamed with human milk), Zhigancao (Honey-fried Licorice Root), Zhen E'jiao (Donkey-hide Gelatin), Huma Ren (Sesami Semen, fried and ground, 1 qian), Baizi Ren (fried, 0.7 qian), Wuweizi (Schisandrae Fructus, 0.4 qian), Zishiyang (Hematitum), Hanshui Shi (Calcitum), Huashi (Talcum, each 1 qian; these three must be crushed and ground into powder), Shengxizhi (Rhinocerotis Cornu Cortex Fresh Juice, 0.3 qian), Shengjiangzhi (Fresh Ginger Juice, two tea spoons). Except for the four juices and E'jiao, the other eight herbs are decocted with four tea cups of mountain spring water over slow heat until one and a half cups remain. Strain, add the four juices and E'jiao, heat slightly again until the gelatin melts, pour out, and mix with 0.05 qian of Niuhuang (Bovis Calculus) fine powder. Take hot in two or three doses during midday. In the morning on an empty stomach, first take Cui Shi Bawei Wan (3 qian).

I had no choice but to tentatively propose these two formulas as models for treating Guan Ge. Since pathological changes have no fixed formulas, the doctor's mental flexibility and adaptation should also be unbound. Initially, this is not meant to fix the eyesight of learners, nor is it merely talking to the deaf.