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Ge syndrome (Diaphragm Syndrome) is caused by injury from the seven emotions (joy, anger, worry, thought, sadness, fear, fright), resulting in stagnation and lack of free flow. It is extremely difficult to regulate because it stems from emotional distress, which cannot be cured by medicine alone. Generally, excessive thinking leads to Qi stagnation; when the Spleen fails to transport, the Stomach fails to generate. When the Stomach fails to generate, the Lung loses its nourishment. The Lung and Large Intestine are exterior-interior related; if the Lung lacks nourishment, the Large Intestine's transmission function fails. The Large Intestine and Stomach both belong to the Yangming channel and are fu organs corresponding in entry and exit. If the Large Intestine does not expel waste, the Stomach cannot accept food. If there is neither expulsion nor acceptance, the true Qi of the two Yangming channels cannot circulate, leading to deficiency-cold in the Lower Jiao. If the Yuan Qi of the Middle Jiao cannot reach, the postnatal Stomach Qi stagnates, causing turbid fire to fill the chest and resulting in obstruction and blockage (Pi Ge). Treatment involves using herbs that tonify the Kidney and raise the Spleen, such as Dioscoreae Rhizoma (Shanyao), Foeniculi Fructus (Xiaohui), Magnetitum (Cishi), Angelicae Sinensis Radix (Guishen), Paeoniae Radix Alba (Baishao), Glycyrrhizae Radix et Rhizoma Preparatum (Gancao), Rehmanniae Radix Recens (Shengdi), and Schisandrae Fructus (Bei Wuwei), to regulate the condition, which may provide slight relief. However, one must maintain a joyful spirit and clear mind so that true Qi can arise and recovery can occur.

Ge syndrome is categorized into Qi Ge (Qi Obstruction), Blood Ge (Blood Obstruction), and Phlegm Ge (Phlegm Obstruction). For Qi Ge, use Linderae Radix (Wuyao) and Foeniculi Fructus (Xiaohui) to open the orifice. For Blood Ge, use Angelicae Sinensis Radix (Danggui), Persicae Semen (Taoren), Linderae Radix (Wuyao), and Aquilariae Lignum Resinatum (Chenxiang). For Phlegm Ge, use Pinelliae Tuber (Banxia) and Aconiti Lateralis Radix Preparata (Fuzi). In cases where treatment is feasible, regulate the Spleen and warm the Lung. For severe cases due to overwork, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with added Aconiti Lateralis Radix Preparata (Fuzi) and prepared Linderae Radix (Zhi Wuyao) in a proportion of one part. If stools resemble sheep dung, it indicates Yang sinking into the Yin level and impending exhaustion of Yang; treat with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) to lift the Yang. Qi Ge presents as immediate vomiting after eating, or food turning into phlegm-saliva shortly after ingestion; this is due to fire in the Stomach combined with insufficient true fire in the Dantian. The fire in the Dantian is called "Lesser Fire" (Shaohuo); located in the lower body, it roasts grains into Qi ("Lesser Fire generates Qi"). Fire in the Stomach is "Evil Fire," which spreads rapidly, thus frying grains into phlegm. If fire is in the Dantian, it generates Earth (Spleen/Stomach), roasts grains, and transforms Qi and Blood. If fire is in the Stomach, the Dantian becomes cold; fire occupying the Earth position fails to digest grains, leading to vomiting or phlegm formation. Psoraleae Fructus (Buguzhi) and Aquilariae Lignum Resinatum (Chenxiang) descend fire; Foeniculi Fructus (Xiaohui) unblocks true Qi; Linderae Radix (Wuyao) regulates turbid Qi; Euryales Semen (Qianshi) enters the Kidney; Ginseng Radix et Rhizoma (Renshen) enters the Lung. Blood Ge presents with intermittent hematemesis, pain in the chest radiating to the back; blood accumulates in the chest. Since Qi movement drives Blood movement, use Qi-moving herbs like Aurantii Fructus (Zhike), Aquilariae Lignum Resinatum (Chenxiang), Chuanxiong Rhizoma (Xiong), and Angelicae Sinensis Radix (Gui) to move Qi and guide Blood. Phlegm Ge presents with thick, sticky phlegm-saliva accumulating in the chest; use phlegm-resolving herbs like Er Chen Tang (Two-Cured Decoction), Arecae Semen (Binglang), and Aurantii Fructus (Zhike) to smooth Qi and descend phlegm. Add fresh ginger to all preceding prescriptions. In Ge Qi, there is no fire in the Middle Jiao, only heat in the Upper Jiao; without warming with Foeniculi Fructus (Xiaohui), how can the chest diaphragm be opened?

Case Record
One patient could eat but experienced vomiting and diarrhea every Zi hour (11 PM–1 AM). This person likely suffered from sorrow and excessive thinking. Thinking causes Spleen Qi stagnation, preventing the dispersion of essence to the Lung and downward transmission to the Bladder. Consequently, fluids enter the Large Intestine directly, causing diarrhea. Vomiting occurs because the Spleen fails to transport and transform, unable to pass food through the pylorus; old food accumulates in the Stomach. At Zi hour, Yang rises and stirs up old residues, causing vomiting. Treatment should focus on supporting the Spleen, using Ginseng Radix et Rhizoma (Renshen), Poria (Fuling), and Dioscoreae Rhizoma (Shanyao) each 1 qian, roasted Glycyrrhizae Radix et Rhizoma (Zhi Gancao) 0.5 qian, Aconiti Lateralis Radix Preparata (Fuzi), and prepared Linderae Radix (Zhi Wuyao) each 0.3 qian.

Another patient, aged 55, had slight chest pain with no respite. All six pulses lacked Stomach Qi, except the Spleen pulse which was slightly slow. The chest receives Qi from the Dantian; constant slight epigastric pain indicates Dantian Yang failing to reach the chest, confirming Ge Qi. The slightly slow Spleen pulse suggests that regulating the Spleen and Stomach allows for prolonged survival. Use Baoyuan Tang (Protect the Origin Decoction) with additions.

A third patient often felt choking and obstruction in the throat, difficulty digesting food, dry tongue, chest pain resembling injury, weak legs, and tight facial skin for six years. Prescribe Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) plus Angelicae Dahuricae Radix (Baizhi) and Asari Radix et Rhizoma (Xixin) each 0.8 fen.