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As the proverb says: Wind disease, Lao disease (consumptive disease), Gu distension (abdominal distension with fluid accumulation), and Ge syndrome (obstruction of the esophagus/stomach). Once any of these four conditions occurs, it is difficult to treat. Alas, illness is indeed painful, but why does it reach such a dire state? I shall elaborate on "Ge" syndrome.

In the human body, from the pharynx to the chest is called Upper Ge; from the chest to the heart region is Middle Ge; from the stomach to the liver is Lower Ge. Upper Ge inherits the Qi of the Upper Jiao (Upper Burner) and governs reception. Middle Ge inherits the Qi of the Middle Jiao and governs the decomposition and ripening of food. Lower Ge inherits the Qi of the Lower Jiao and governs excretion. The reason humans can survive lies in these functions of reception, digestion, and excretion. It is like the ceaseless movement of the heavens and the growth, transformation, storage, and collection on earth. Only when cold and heat are appropriately regulated can one follow the seasonal commands to distribute vitality. If there is premature loss leading to excessive dryness and elevation, clouds and rain will not be distributed, resulting in solitary Yang dominating and water sources drying up. If there is excessive dampness leading to low and oppressive stagnation, heavy miasma will block, causing stagnant Yin to become bleak, and vital energy will be exhausted.

Therefore, at the beginning of Ge syndrome, the pathology is in the Upper Jiao. If the throat is obstructed, eating causes choking. This indicates pathogenic factors invading the Upper Jiao, where Earth Qi fails to ascend and Heaven Qi fails to descend, presenting signs akin to severe drought. At this stage, food can still be forced down to settle. Subsequently, if the Middle Jiao is invaded, although food is eaten, it remains stuck in the middle epigastrium without descending; forcing it down causes pain. After some time, phlegm and water are vomited. Stomach fluids fail to be stored, Liver Fire takes advantage of this weakness, causing the taste to turn sour. Since Spleen Yin is exhausted, intake occurs without digestion. Heaven Qi descends even less, and Earth Qi ascends even less, resulting in a sensation of fullness and obstruction. At this point, food can no longer be forced down to settle. Finally, if the Lower Jiao is invaded, morning meals are vomited in the evening, and evening meals are vomited in the morning. Fire Qi gradually diminishes, leaving solitary Yin. Yin and Yang fail to mutually support each other. Fluids of the Five Zang organs are exhausted, and the Six Fu organs lose their source for ascending and descending. Both reception and excretion cease. Where then are the Heaven and Earth Qi? Ultimately, death occurs due to the cessation of food intake.

Is there truly no way to treat this via the collaterals? The answer is: Initially, one must distinguish which of the Seven Emotions (Joy, Anger, Worry, Thought, Sadness, Fear, Fright) is predominant. Subsequently, one must examine the extent of Qi and Blood exhaustion, and the dominance of Water and Fire. The key lies in tonifying Middle Qi, regulating Qi stagnation, and opening Phlegm obstruction. Heat is cleared; Cold is warmed, bringing the body into balance. Furthermore, observe the depth of pathology in the Upper, Middle, and Lower Jiao, and adjust treatment accordingly. How can one say it is untreatable? The only difficulty lies in the patients themselves, who do not realize that death is imminent, instead repeatedly tormenting themselves, inevitably leading to exhaustion of marrow and fluids, yet never repenting. What can be done about them?

Note: "Ye" (choking) is located in the pharynx. "Ge" (obstruction) is between the heart and stomach. "Fan" (regurgitation/vomiting upwards) involves food moving directly from below upwards. Yue Ren (Bian Que) stated that the Heart and Lung are above the diaphragm, the Upper Jiao is below the heart, the Lower Ge is the upper orifice of the stomach, the Middle Jiao is at the Zhongwan point of the stomach, and the Lower Jiao is below the umbilicus. The *Neijing* states that the left Cun position corresponds to the Liver and Diaphragm, while the right Cun position corresponds to the Spleen and Stomach. Thus, it is clear that the Diaphragm belongs to the area below the heart. My reasoning upward and downward is not based on anatomical form, but on functional utility. Just as the Three Jiao are the pathways for water and grain, and the starting and ending points of Qi, the descriptions of "like mist," "like foam," and "like drainage" are also based on function. Moreover, the *Neijing* mentions only "Ge" and does not separately discuss "Ye" and "Fan," using "Ge" to encompass the Upper, Middle, and Lower Jiao. Is there any doubt about this? However, its subtlety lies in its association with the Liver. Generally, Ge syndrome often arises from Liver injury due to depression and anger. Depression generates Heat, which gradually consumes and dries up Blood. Yang Qi of the Heart and Lung cannot circulate freely, and Yin fluids of the Intestines and Stomach cannot descend and settle. This is the origin of Ge syndrome. If patients and practitioners seek the cause from this perspective, they will have grasped more than half of the solution.

Kaiyu Decoction (Open Stagnation Decoction): Treats early-stage Ge syndrome with Fire symptoms.
Gardeniae Fructus (Stir-baked until black), Shenqu (Fermented Wheat Mass, stir-baked), Platycodonis Radix (Jiegeng), Cyperi Rhizoma (Xiangfu, vinegar-fried), Fritillariae Thunbergii Bulbus (Chuanbeimu, heart removed and ground), Poria (Fuling), Citri Reticulatae Pericarpium (Guangpi) (each 1 qian), Ligusticum Chuanxiong Rhizoma (Fuxiong) (0.5 qian). Add one slice of Ginger and three lotus leaf stalk bases. Decoct in water.

Yuanzhi Decoction: For second-line use.
Polygalae Radix (Yuanzhi, processed with Licorice), Poria Cum Radix (Fushen), Paeoniae Radix Alba (Baishao, stir-fried with wine), Pinelliae Rhizoma Preparatum (Shubanxia), Citri Reticulatae Pericarpium (Guangpi) (each 1 qian), Ziziphi Spinosae Semen (Zaoren) (1.5 qian), Ginseng Radix et Rhizoma (Renshen) (2 qian), Uncariae Ramulus cum Uncis (Gouteng) (3 qian). Add five flesh fruits of Longan Arillus and one slice of Ginger. Decoct in water. Add Gardeniae Fructus if Heat is present; add Zingiberis Rhizoma Preparatum (Paojiang) if Cold is present; add Aucklandiae Radix (Muxiang) if Qi stagnation is present; add Salviae Miltiorrhizae Radix (Danshen) and Biota Seed (Baiziren) if Dryness is present. This formula treats the Middle Jiao. If the pathology is in the Lower Jiao, adjust according to Bawei Wan (Eight-Ingredient Pill).