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Zhu Danxi said: When Qi (vital energy) is initially diseased, its onset is very subtle. It may be due to slight dietary indiscretion; or external invasion by the Six Evils (wind, cold, summer-heat, dampness, dryness, fire); or internal injury by the Seven Emotions (joy, anger, worry, pensiveness, sorrow, fear, fright); or excessive richness in taste, which biases and assists Yang Qi, accumulating into Di Re (obstruction heat); or a constitution that is robust with dense exterior pores and no sweating; or an irritable temperament causing Fire to flare upward, leading to stagnation of Body Fluids and interference between Clear and Turbid Qi. Consequently, Qi becomes diseased, manifesting as distension or pain, loss of appetite, belching of putrid gas, acid regurgitation, indigestion, or abdominal fullness. If one does not investigate the root cause but instead administers acrid, aromatic, drying, and hot agents, temporary relief may be achieved. However, if rich food intake remains unregulated and the Seven Emotions continue to interact reciprocally, body fluids easily accumulate. Thus spreading, it progresses from Qi stagnation to accumulation, and from accumulation to Phlegm. This is the origin of Phlegm, Yin (fluid retention), and acid regurgitation. Without encountering a skilled physician and with erroneous medication continuing, Phlegm combines with Blood Stasis, forming "Ke Nang" (nidus-like stubborn lesions). This is the sequence leading to distension, pain, vomiting, Ye Ge (dysphagia/obstruction), Fan Wei (regurgitation/vomiting after eating).

When food and liquids stagnate and fail to move, the channels become obstructed. Stool may be constipated or loose. The lower part loses its function of transmission and transformation, causing further stagnation in the Middle Jiao. One seeks methods to warm the Spleen and strengthen the Stomach, eliminate accumulation, and move Qi, hoping for immediate effect. Yet, one fails to consider that the Stomach is the Sea of Water and Grain, abundant in Blood and Qi; only when clear and harmonious can it receive. The Spleen is the organ of digestion; only when clear and harmonious can it transport. If aromatic and drying agents bias the system, Qi and Blood will boil. Initially, Stomach fluids coagulate and cannot accept nourishment; over time, Spleen Qi dissipates, and transmission slows. Accumulated over a long period, Blood is exhausted, and the gastric region becomes dry and shriveled. If this dryness is located upper, near the throat, water and drinks can pass, but food is difficult to enter; this is named Ye (dysphagia). If the dryness is located lower, near the stomach, food may enter but cannot fully reach the stomach, and is vomited out after a long while; this is named Ge (obstruction), also called Fan Wei (regurgitation). Stool is scanty and hard, resembling sheep droppings.

Ancient formulas used Ren Shen (Ginseng Root) to tonify Lung Qi, Yu Mi (Poppy Seed) to resolve toxicity, Zhu Li (Bamboo Sap) to resolve Phlegm, Dang Gui (Angelicae Sinensis Radix) and Bai Shao (White Peony Root) to nourish Blood, Su Mi (Millet) to solidify the Stomach, honey water to moisten dryness, and Sheng Jiang (Fresh Ginger Rhizome) to remove turbidity. In such cases, pathogenic factors are easily subdued, and the disease resolves naturally. Zhang Jifeng also stated: Ye Ge is a disorder of the spirit and mind; only introspection and quiet cultivation can treat it. This statement deeply hits the mark of the pathology. Ye Ge arises from dryness of Blood. Yin governs stillness; if both interior and exterior are still, the Fire of the Zang-Fu organs will not arise, and the Metal and Water Qi will be nourished. Yin Blood will generate spontaneously, intestinal and gastric fluids will be moist, and transmission and transformation will be appropriate. How could there be Ye Ge?

Zhao Yangkui said: Zhu Danxi’s discussion is profound, but unfortunately lacks clear differentiation. Moreover, he focuses mainly on moistening Blood without directly exploring the source of congenital essence in the Kidney. Therefore, his prescriptions add cow or goat milk to Si Wu Tang (Four Substance Decoction), along with Zhu Li (Bamboo Sap) and Jiu Zhi (Chinese Chives Juice) to transform Phlegm and resolve Stasis. These treat the branch but not the root. The *Nei Jing* states: "Obstruction of the Three Yin meridians is called Ge." The Three Yang meridians are the Large Intestine, Small Intestine, and Bladder. The Large Intestine governs Jin (thin fluids). The Small Intestine governs Ye (thick fluids). Heat obstruction in the Large Intestine leads to depletion of Jin; heat obstruction in the Small Intestine leads to dryness of Ye. The Bladder is the official of the capital, storing fluids; heat obstruction in the Bladder leads to exhaustion of fluids. However, why do the Three Yang meridians result in heat obstruction? All are diseases of the Kidney. The Kidney governs the Five Fluids and controls urination and defecation. Once Kidney Water is dry, Yang Fire becomes dominant, simmering and consuming fluids. Heat obstruction in the Three Yang meridians leads to blockage of both anterior and posterior orifices. Since the lower pathway is blocked, Qi must rebel upward, directly invading the clear pathways and rushing up to Xi Men (the inlet of the throat), causing dysphagia where food cannot go down. Why can water and drinks enter, but food cannot? Food enters Yin and generates Qi in Yang, thereby stirring up the Fire in the stomach opening, making entry difficult. Water belongs to Yin, sharing the same affinity, so it can enter. Vomiting white foam indicates that the ingested water is boiling and rising. Feces resembling sheep droppings indicate that little food was ingested, residues were completely consumed, and the intestines became dry, small, and narrow. This condition mostly affects those over fifty years old, whose innate vitality has ceased, leaving only isolated Yang. Treatment must focus primarily on nourishing Yin. Wang Taipu said: "Food immediately vomited out indicates lack of Water; food vomited after reflux indicates lack of Fire." For lack of Water, strengthen the master of Water; for lack of Fire, benefit the source of Fire. Chu Shizhong said: "Treat upper disorders by addressing the lower; use Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) in large doses, decocted and drunk for a long time, to save one or two out of ten cases." One must also abstain from sexual activity and maintain a bland diet. If one says "warm the Stomach," the Stomach is originally not cold; if one says "tonify the Stomach," the Stomach is originally not deficient. If one says "open depression," acrid and drying herbs merely assist Fire; nothing is better than nourishing Yin, upon which the false flame extinguishes itself.

Regarding Fan Wei (regurgitation), Dong Yuan’s writings state that vomiting has three syndromes: Qi, Accumulation, and Cold. Vomiting from the Upper Jiao stems from Qi; from the Middle Jiao from Accumulation; from the Lower Jiao from Cold. If the pulse is deep and slow, evening meal vomited in the morning, or morning meal vomited in the evening, urination is free, but stool is closed, this is Lower Jiao vomiting. The method should be to open the closure and warm the Cold. From this, we see that Lower Jiao vomiting is due to decline of Ming Men (Gate of Life) Fire, like a pot without fuel at the bottom, unable to steam and rot the water and grain in the Stomach. Abdominal distension forces vomiting. Wang Taipu’s statement that "food vomited after reflux indicates lack of Fire" is correct. One must benefit the source of Fire, first using Ba Wei Wan (Eight-Ingredient Pill) to tonify Ming Men Fire, thereby saving the Mother of Earth (Spleen), and subsequently using Fu Zi Li Zhong Tang (Aconite Decoction to Regulate the Middle) to regulate the Middle Jiao. This ensures complete success.

Li Shicai said: Ye Ge mostly belongs to Heat, while Fan Wei mostly belongs to Cold, but one must not be rigid. If the pulse is large and forceful, treat as Heat; if small and weak, treat as Cold. Yellowish-white and withered complexion indicates Cold and Deficiency; reddish and lustrous complexion indicates Excess Heat. Correlating pulse with symptoms and color with pulse minimizes error. This is why this disease is difficult. One wishes to invigorate the Spleen and resolve Phlegm, fearing that drying agents may harm Body Fluids; one wishes to nourish Blood and generate fluids, fearing that moistening agents may congeal in the Middle Jiao. If Yin Deficiency with Fire Hyperactivity is diagnosed, nourishing Blood is urgent. If Spleen Injury with Yin Excess is diagnosed, warming and tonifying come first. In cases of grief and indignation causing Fire depression and closure, where Spirit is not significantly depleted and the pulse still has force, one should use the purgative methods of Cang Gong and He Jian. Small decoctions and pills should be administered repeatedly until the obstructions penetrate. If Phlegm is abundant in the chest diaphragm and slightly expectorated, treating the lower allows medicinal power to flow easily. If it still does not work, use honey and salt to guide downward, continuously attracting and promoting natural unblocking. These are all distinctions between Empty and Full, Yin and Yang, serving as criteria for clinical judgment.

Fang Yuezhi said: Danxi claimed that elderly patients are incurable. Because in youth, Qi and Blood are not yet deficient; using drugs to劫 (rob/clear) Phlegm and Fire results in no recurrence. In old age, Qi and Blood are already deficient; using drugs to rob Phlegm and Fire may bring temporary relief, but the disease recurs. The reason is that Qi Deficiency fails to transform and generates Phlegm, while Blood Deficiency fails to moisten and generates Fire. Danxi also said this disease must never be treated with acrid and drying herbs, as taking them leads to death; a bland diet is suitable. I once used Xia Tian Gao (Cloud Sky Paste) added to deficiency-tonifying medicines to treat this condition. One patient vomited and had diarrhea to expel accumulated Blood; another did so to expel accumulated Phlegm. Both recovered appetite. However, neither observed dietary restrictions, subsequently consuming rich and sweet foods, leading to relapse. They did not realize that this disease involves Deficiency, and the Spleen and Stomach are still weak; rich and sweet foods are hard to digest, hence the recurrence. After Xia Tian Gao induces vomiting and diarrhea, Ren Shen (Ginseng Root) paste should be used to tonify.

Liu Hejian said: A tight pulse at the Fu Yang position indicates internal dryness abundance and decline of warm Qi. If tight and choppy, Blood has been lost. If Blood is lost in the Upper Wan (epigastrium), the chest diaphragm becomes dry and rough, preventing food entry; if Blood is lost in the Lower Wan, and the Large and Small Intestines are also withered, food cannot descend, making it difficult to treat.

Zhang Zhongjing discussed the pulse and symptoms of Fan Wei: Question: If a patient has a rapid pulse, indicating Heat, which should consume grain and increase thirst, yet vomits instead, why? Master said: Due to sweating, Yang pulses became faint, Diaphragm Qi became deficient, resulting in a rapid pulse. Rapid indicates guest Heat, inability to consume grain, and Cold deficiency in the Stomach. A wiry pulse indicates Deficiency; with no surplus Stomach Qi, morning meal vomited in the evening transforms into Wei Fan (Stomach reversal). Cold is above, but the doctor erroneously purged, causing the pulse to become wiry, thus named Deficiency.

Also said: At Cun Kou (Radial artery), if the pulse is faint and rapid, faint indicates lack of Qi; lack of Ying (Nutrient) Qi leads to Ying Deficiency; Ying Deficiency leads to insufficient Blood; insufficient Blood leads to Cold in the Chest.

These two passages describe the subtlety of pulse and symptomatology by Zhongjing. Generally, Yang excess causes rapidity, Yin excess causes slowness. If Yang Qi is already faint, how can the pulse be rapid? If the pulse is rapid, how can the Stomach be cold? This must be examined to find the cause. Faint Yang leads to Ying Deficiency; Ying Deficiency means it is not guarded by Yang and floats as Guest Heat. Faint Yang leads to Diaphragm Qi Deficiency; Diaphragm Qi Deficiency means it cannot transport Yin, resulting in Cold Stomach. Moreover, if the doctor does not understand and erroneously purges, damaging both Upper and Lower Yang, the pulse changes from Yin to wiry. Due to insufficient Upper Yang, food eaten before noon is not digested; due to insufficient Lower Yang, after dusk, Yang does not enter Yin, and waste is not transported to the Large and Small Intestines. Thus, "no surplus Stomach Qi," leading to Fan Wei and morning meal vomited in the evening. Human pulses follow Heaven and Earth; faint indicates Yang does not transport vigorously, rapid indicates Yin does not gather completely. Yin and Yang deviate from their norms, Ying and Wei are insufficient, leading to Cold in the Chest. Ying and Wei originate from Grain and help digest it; Ying and Wei are not filled without Grain, and Grain is not transformed without Ying and Wei. With Cold in the Chest, the Stomachi cannot receive or discharge Grain. Once Fan Wei syndrome forms, what doubt remains? Note revised by Dong Yi.

Yu Jiayan said: Yang in the Chest is like the Sun in the sky; its relation to the pathway of receiving grain is crucial, as described in this passage. The Chest connects downward to the Spleen and Stomach; if Yang Qi is deficient, Yin Blood must also be deficient. Only mild and harmonizing agents should be used to balance the Zang-Fu organs and nourish Ying and Wei. Pure and refined medicines must be used. Yang in the Kidney is like the axis of the world; its relation to the survival of the life root is particularly significant, as seen in the later passage regarding Si Ni Tang (Frigid Extremities Decoction). The Kidney stores True Yang internally; if Yang escapes outward, Yin Qi becomes extremely abundant. Only fierce and potent agents can push forward and defeat the enemy. To overcome Yin and restore Yang, direct and penetrating methods are required.