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Guan-ge (Obstruction and Rejection) is a syndrome where the upper part manifests as rejection, preventing food and drink from entering, while the lower part manifests as closure, blocking the excretion of urine and feces. This is a sign of Yin-Yang imbalance with excess in one aspect, and also a syndrome of Yin-Yang separation and extinction. When Yang is in excess, it rebels upward; after prolonged rebellion, Yin follows it upward. Due to this upward rebellion, fluids cannot be accepted; due to restlessness and agitation, there is only egress without ingress, only ascending without descending. Thus, Yin and Yang separate and extinguish. The patient presents with sweating on the head and coldness in the four limbs, the pulse disappears, and death ensues.

If this were not the case, Zhu Danxi stated: "When the upper orifices are open, the water from the lower orifices will flow out." Why then, when the upper part is more open, does the lower part fail to discharge? However, *Suwen* states: "Without Yang, Yin cannot be generated; without Yin, Yang cannot be transformed." Now, since Yang is in excess and Yin follows it, there is Yang without Yin, which is evident. The classics further state: "The Upper Jiao governs reception, and the Lower Jiao governs excretion." It also says: "The Sanjiao is the official of drainage, through which water passages flow." Now, since the upper part fails to receive and the lower part fails to excrete, the fire of the Sanjiao is completely exhausted. How could it be possible for the head not to sweat while Yang does not rebel upward, and for the limbs not to be cold while Yin does not descend into extinction? Bian Que said that such conditions lead to death before one's natural lifespan is fulfilled; later kidney-focused physicians described it as a condition with nine deaths to one survival, making treatment indeed difficult.

I alone pondered that Yin-extinction and Yang-extinction are indeed incurable. However, if one seeks a method of rescue before they are completely exhausted, unless there is a way to restore Yang above and retrieve Yin below, how can there be any benefit? Thus, I realized that Zhang Zhongjing's Baitong Decoction uses purely Yang herbs like Shengjiang (Dried Ginger) and Fuzi (Prepared Aconite Root). Fearing that Yang might extinguish at the top, it employs purely Yin substances like Renao (Human Urine) and Zhudanshi (Pig Gallbladder Stone/Bile) to guide it, fearing that Yin might extinguish at the bottom, so that Yin and Yang may coordinate and harmonize. This is an excellent therapeutic method. Later, Xue Ji (Zijie'an) expanded upon this and established Huiyang Fanben Decoction, also aiming for balance through mutual assistance of Yin and Yang. It adds Huanglian (Coptis Rhizome) and Laccha (Aged Tea) to clear heat, uses Jiang (Ginger) and Fu (Aconite) as counter-agents, and employs Renshen (Ginseng Radix) and Wuweizi (Schisandra Fruit) to restore body fluids and Yuan Qi, preventing separation and extinction. This is a method beyond methods. When Yao Jisheng (Jiayan) appeared, he established Huanglian Tuijin Decoction, adjusting for the bias of Yin and Yang through advancement and retreat. He also utilized Shiwu Wan (Eight-Ingredient Pill with Rehmannia) to restore the root of Yin and Yang, thereby establishing life. One might say that thought has reached its limit and the path seems closed. If students can integrate and understand this, then for the syndrome of Guan-ge, perhaps one can emerge from ten thousand deaths to find one life, saving countless premature deaths.

Note: The vomiting and rebellion of Ge syndrome differ from ordinary vomiting and rebellion. Generally, in ordinary vomiting and rebellion, urination remains smooth, allowing Yang Qi to nourish downward, and Yin Qi remains attached, preventing upper collapse. The urinary blockage of Guan syndrome differs from ordinary urinary difficulty. Generally, in ordinary urinary difficulty, there is no upper vomiting and rebellion; even if Yin Qi cannot transform, Yang Qi has not yet separated, preventing lower collapse. Only in Ge syndrome is Yin extinct at the top, so administering hot herbs makes the heat more intense; one must use Yin herbs to assist it to avoid rejection. Only in Guan syndrome is Yang extinct at the bottom, so administering Yin herbs leads to cold extremities; one must use Yang herbs to retrieve it to restore Qi transformation. This is a disease of both Yin and Yang, requiring herbs that mutually assist Yin and Yang for rescue, which is the profound gate.

Clinical observation shows that patients with urinary blockage invariably suffer unbearable abdominal distension and fullness. In Guan syndrome, however, there is only an urgent sensation of needing to void, without distension or fullness. This indicates that Yang Qi is depleted and Yin Qi is simultaneously exhausted. At this time, severe vomiting and rebellion accompanied by chest fullness or pain occur due to the upward rushing of Yin Qi. Initially, there is no excess pathogenic factor. Furthermore, the Kidney governs the two lower orifices and manages Water and Fire. Now, Qi fails to descend and be stored, and the root is about to extinguish. Shiwu Wan guides the floating fire back to its source and restores True Yin; is this not another crucial point?

Huanglian Tuijin Decoction
Chuan Huanglian (Stir-fried with Ginger Juice), Paojiang (Prepared Ginger), Banxia (Pinellia Tuber), Chuan Niuxi (Cyathulae Radix stir-fried with Salt Water), Baishao (White Peony Root stir-fried with Wine, each 1 qian), Renshen (Ginseng Radix, 1.5 qian), Dazao Rou (Date Flesh, 3 pieces), Tongbian (Child's Urine, half small cup).
Decoct in water. If Yang deficiency with cold limbs, add Shufuzi (Prepared Aconite Root) 1 qian, reduce Huanglian by 0.5 qian. If Yin deficiency with restlessness and thirst, add Maimendong (Ophiopogon Tuber) 1 qian, remove Banxia.

Baitong Decoction
Congbai (Scallion White, 2 stems), Shufuzi (Prepared Aconite Root, 3 qian), Ganjiang (Dried Ginger, 1.5 qian).
Decoct in water, add Renao (Human Urine) and Zhudanche (Pig Gallbladder Bile).

Huiyang Fanben Decoction (See Yin Syndrome Treatise)