病源五肺气者，谓忧膈恚膈气膈寒膈热膈也，忧膈之为病，胸中气结烦闷，津液不通，
饮食不下，羸瘦不为气力，恚膈之为病，心下苦实满，噫辄酢心，食不消，心下积结，牢在
胃中，大小便不利，气膈之为病，胸胁逆满噎塞，胸膈不通，噫闻食臭，寒膈之为病，心腹
胀满，咳逆，腹上苦冷，雷鸣绕脐痛，食不消，不能食肥，热膈之为病，脏有热气，五心中
热口中烂生疮，胸烦四肢重，唇口干燥，身体头面手足或热，腰背疼痛，胸痹引背，食不消，
不能多食，羸瘦少气及癖也，此是方家所说五膈形证也，经云，阳脉结谓之膈，言忧恚寒热，
动气伤神，而气之与神并为阳也，伤动阳气，致阴阳不和，而腑脏生病，结于胸膈之间，故
称为膈气，众方说五膈互有不同，但伤动之由有五，故云五膈气。（出第十三卷中）
备急膈中之患，名曰膏肓，汤丸径过，针灸不及，所以作丸含之，令气势得相熏染，有
五膈要丸方。
麦门冬（十分去心） 椒（六分汗） 远志 附子（炮） 干姜 人参 桂心 细辛（各
六分
）甘草（十分炙）
上九味捣筛，以蜜和丸，如弹子。以一枚着牙齿间含，稍稍咽汁，日三，主短气胸满，
心下坚，冷气，此病有十许方，率皆相类，此丸最效，五膈者，谓忧膈气膈恚膈热膈寒膈也。
忌
张文仲五膈丸方。
吴茱萸 曲 杏仁（去皮尖） 干姜 蜀椒（汗） 好豉（熬）
上六味等分捣筛，蜜和丸如梧子。饮服七丸，日三。忌生冷。（此方出隐居效验备急肘
后同出第三卷中）
延年秘录凡忧膈气膈食膈寒膈饮膈，五病同药，常以忧愁思虑食饮而得之，若寒食食生
菜，便发其病，苦心满不得气息，引脊痛如刺之状，食则心下坚，大如粉絮，大痛欲吐，吐
则瘥，饮食不得下，甚者乃手足冷，上气咳逆喘息气短，疗以九物五膈丸方。
麦门冬（去心） 蜀椒（汗各三两） 远志（三两去心） 甘草（五两炙） 附子（一
两炮）
干姜（三两） 人参（四两） 桂心（三两） 细辛（三两）（通按此即前五膈要丸一味不
差）
右药捣筛蜜和，微使淖，置有盖器中，先食服大如弹子丸一丸，置喉中稍咽之，喉中胸
中当热，药力稍尽，复含一丸日三四夜一二服，服药七日愈，二十日平复，若不能含者，可
一大丸作二小丸，尽服之，唯夏月合乃益麦门冬甘草人参耳，其余不异神良，椒当以铜器熬
于火上，使极热，下置地，纳椒器中熟搅之，须臾汗出，便捣协议处，椒力有热，亦去其毒，
非
古今录验大五膈丸，疗膈中游气，上下无常处，脏有虚冷，气迫咽喉，胸满气逆，胁有
邪气，食已气满，羸瘦着床骨立，往来寒热腹中不调，或下痢呕逆咳嗽，骨肉销尽服之令人
能食，长肌肉，强筋骨，利五脏，好颜色补不足益气力方。
细辛 桂心 黄芩 食茱萸 浓朴（炙各三分） 杏仁（三十枚去尖） 干姜 川椒（汗）
远志（各三分去心） 小草 芍药 附子（炮） 当归（各二分） 黄连（二分）
上十四味捣筛，蜜和服如梧子二丸。日三，不知加之，以知为度。忌猪肉冷水生葱菜等
又五膈丸，疗忧膈气膈食膈寒膈饮膈，异病同药，神方。
人参 附子（炮） 远志（去心） 桂心 细辛（各四分） 干姜 蜀椒（各五分汗）
上七味捣筛，以蜜和服如弹丸，着牙下 咀咽之，若病剧者，日三夜再，并疗诸毒风注
气腹中百病皆应，当得真新好药，即可中病耳，神秘妙方不传。忌生葱生菜猪肉冷水等物。
（通
又疗邪气呕逆吸气五膈为病，五脏俱虚，则受风冷，五脏有邪，呼吸不足，阴注于内，
阳结于外，阴阳错乱，语言无常，膈中左右，状如结气，喉咽不利，气出不入，此血气衰微，
脏
蜀椒（一升汗） 干姜（二两） 桂心（二两） 芍药（一两半） 半夏（洗） 细辛 茯
苓（各
一两） 前胡（一两半）
上八物捣筛，蜜和服如弹丸一枚，喉中稍稍吞之，可增至三丸，或冷则加远志一两佳。
日再。忌羊肉饧生葱生菜醋物。
又疗胸痛达背，膈中烦满，结气忧愁，饮食不下，药悉主之，宜丸方。
制半夏（一分） 甘草（炙） 远志（去心各四分） 干姜 桂心 细辛 椒（去目汗）
附
子（炮各二分）
上八味捣筛，以蜜和为丸，先饭酒若粳米饮服如梧子五丸，日三，稍增至十丸。忌海藻
菘菜羊肉饧猪肉冷水生葱生菜。（并出第十八卷中）
经心录五膈丸，疗寒冷则心痛，咽中如有物，吐之不出，咽之不入，食饮少方。
干姜（三两） 麦门冬（二两去心） 附子（一两炮） 细辛（二两） 蜀椒（一两汗）
远
志（一两去心） 甘草（一两炙） 人参（二两） 食茱萸（二两） 桂心（三两）（通按
此方即前五
膈丸多食茱
上十味蜜和为丸如梧子。服五丸，日二。忌猪肉冷水海藻菘菜生葱生菜。（千金同出第
二卷中）
[Background Information]
Book: *Waitai Miyao* (Essential Prescriptions Worth a Thousand Gold for Emergencies)
Author: Wang Tao
Dynasty: Tang Dynasty, Tianbao 11th Year
Chapter: Eight Formulas for Five Ge (Obstruction)
Category: Formulas
[Translation]
Regarding the etiology of disease, the so-called "Five Ge" refers to You Ge (Sorrow Obstruction), Hui Ge (Resentment Obstruction), Qi Ge (Qi Obstruction), Han Ge (Cold Obstruction), and Re Ge (Heat Obstruction).
You Ge (Sorrow Obstruction) manifests as stagnation of Qi in the chest causing irritability and oppression, unobstructed flow of body fluids being impaired, difficulty in swallowing food and drink, emaciation, and lack of strength.
Hui Ge (Resentment Obstruction) manifests as a bitter sensation of fullness and hardness in the epigastrium (heart below), frequent belching with acid reflux to the heart region, indigestion, accumulation and knotting in the epigastrium firmly lodged in the stomach, and difficulty in urination and defecation.
Qi Ge (Qi Obstruction) manifests as rebellious Qi causing fullness and distension in the chest and hypochondrium, choking and blockage, inability of Qi to pass freely through the chest and diaphragm, and belching accompanied by the odor of food.
Han Ge (Cold Obstruction) manifests as abdominal and epigastric distension and fullness, coughing and rebellious Qi, cold pain in the abdomen, borborygmus (rumbling sounds) around the umbilicus with pain, indigestion, intolerance to fatty and rich foods.
Re Ge (Heat Obstruction) manifests as heat in the Zang organs, heat in the five centers (both palms, both soles, and the precordium), erosion and sores in the mouth, chest irritability, heaviness in the four limbs, dry lips and oral cavity, occasional heat in the body, head, face, hands, and feet, pain in the waist and back, angina pectoris radiating to the back, indigestion, inability to eat large amounts, emaciation, shortness of breath, and the presence of masses (Pi Ji).
These are the morphological signs and symptoms of the Five Ge as described in medical formularies. The Classics state: "When Yang pulses are knotted, it is called Ge." This means that sorrow, resentment, cold, and heat disturb Qi and damage Shen (Spirit). Since Qi and Shen both belong to Yang, damaging and disturbing Yang Qi leads to Yin-Yang disharmony, causing disease in the Fu and Zang organs, which then knots between the chest and diaphragm; thus, it is called Qi Ge. Various formularies differ in their descriptions of the Five Ge, but since there are five causes of disturbance, they are termed the Five Qi Ge. (From Volume 13)
To urgently treat patients suffering from Ge obstruction, where the condition is severe enough to be termed "Gohuang" (incurable/deep-seated), where decoctions and pills cannot reach directly, and acupuncture cannot penetrate, pills designed for holding in the mouth are prepared so that the medicinal energy can permeate and infuse.
There is the Essential Pill for Five Ge Formula.
* *Ophiopogonis Radix* (Maidong, 10 parts, heart removed)
* *Zanthoxyli Fructus* (Huajiao/Sichuan Pepper, 6 parts, processed to remove toxicity/sweat)
* *Polygalae Radix* (Yuanzhi)
* *Aconiti Lateralis Radix Praeparata* (Fuzi, processed)
* *Zingiberis Rhizoma* (Ganjiang/Dried Ginger)
* *Ginseng Radix* (Renshen)
* *Cinnamomi Ramulus* (Guixin/Cinnamon Twig)
* *Asari Radix* (Xixin) (each 6 parts)
* *Glycyrrhizae Radix et Rhizoma* (Gancao/Licorice, 10 parts, honey-fried)
The above nine ingredients are crushed, sifted, and mixed with honey to form pills the size of a bullet. Take one pill, hold it between the teeth, and slowly swallow the juice three times a day. It treats shortness of breath, chest fullness, hardness in the epigastrium, and cold Qi. There are more than ten formulas for this disease, all largely similar, but this pill is the most effective. The Five Ge refer to You Ge, Qi Ge, Hui Ge, Re Ge, and Han Ge.
Contraindications: None specified in this excerpt (typically implies avoiding raw/cold/greasy foods during treatment).
Zhang Wenzhong's Five Ge Pill Formula.
* *Evodiae Fructus* (Wuzhuyu)
* *Medicated Leaven* (Qu)
* *Prunus Armeniaca Semen* (Xingren/Apricot Seed, skin and tip removed)
* *Zingiberis Rhizoma* (Ganjiang/Dried Ginger)
* *Zanthoxyli Fructus* (Shujiao/Sichuan Pepper, processed to remove toxicity/sweat)
* *Sojae Semen Praeparatum* (Haoshi/Fermented Soybean, roasted)
The above six ingredients are taken in equal parts, crushed, sifted, and mixed with honey to form pills the size of a wu zi (small seed). Take seven pills with warm water, three times a day. Avoid raw and cold foods. (This formula appears in *Yinju Xiaoyan*, *Beiji Zhoubhou Fang*, same as Volume 3).
*Yannian Milu* states: For You Ge, Qi Ge, Shi Ge (Food Obstruction), Han Ge, and Yin Ge (Fluid Obstruction), the five diseases use the same medicine. They are often caused by sorrow, worry, and improper diet. If cold food or raw vegetables are eaten, the disease may flare up. Symptoms include bitter fullness in the heart/chest, inability to breathe smoothly, pain in the spine like stabbing, hardness in the epigastrium after eating the size of cotton fluff, severe pain inducing vomiting, relief upon vomiting, inability of food and drink to descend, and in severe cases, cold hands and feet, rebellious Qi, coughing, wheezing, and shortness of breath. Treat with the Nine-Ingredient Five Ge Pill Formula.
* *Ophiopogonis Radix* (Maidong, heart removed)
* *Zanthoxyli Fructus* (Shujiao/Sichuan Pepper, processed to remove toxicity/sweat, each 3 liang)
* *Polygalae Radix* (Yuanzhi, 3 liang, heart removed)
* *Glycyrrhizae Radix et Rhizoma* (Gancao/Licorice, 5 liang, honey-fried)
* *Aconiti Lateralis Radix Praeparata* (Fuzi, 1 liang, processed)
* *Zingiberis Rhizoma* (Ganjiang/Dried Ginger, 3 liang)
* *Ginseng Radix* (Renshen, 4 liang)
* *Cinnamomi Ramulus* (Guixin/Cinnamon Twig, 3 liang)
* *Asari Radix* (Xixin, 3 liang)
(Note: Tong An notes this formula is identical to the previous Essential Pill for Five Ge, with no difference in ingredients.)
Crush the above medicines, sift them, mix with honey until slightly moist and sticky, and place in a covered container. Before meals, take one pill the size of a bullet, place it in the throat, and swallow slowly. The throat and chest should feel hot. When the medicinal effect begins to fade, take another pill. Take 3-4 times daily and 1-2 times at night. Recovery occurs in seven days, and full restoration in twenty days. If unable to hold it in the mouth, divide one large pill into two small ones and swallow completely. Only in summer should the dosage of Maidong, Gancao, and Renshen be increased; otherwise, it remains unchanged. Shen Liang adds: Process Sichuan pepper in a copper vessel over fire until extremely hot, then place on the ground, put the pepper in a container, stir thoroughly until sweat appears, then crush and use. This retains the hot nature while removing toxicity.
*Gujin Lu Yan* Da Wu Ge Wan (Great Five Ge Pill) treats wandering Qi in the Ge obstruction, moving unpredictably up and down, deficiency-cold in the Zang organs, Qi pressing against the throat, chest fullness, rebellious Qi, pathogenic Qi in the hypochondrium, fullness after eating, emaciation with visible ribs, alternating chills and fever, irregular bowel movements, diarrhea, vomiting, coughing. Taking this allows the patient to eat, gain muscle, strengthen bones and tendons, benefit the Zang organs, improve complexion, tonify deficiencies, and boost Qi and strength.
* *Asari Radix* (Xixin)
* *Cinnamomi Ramulus* (Guixin/Cinnamon Twig)
* *Scutellariae Radix* (Huangqin)
* *Zanthoxyli Fructus* (Shizhuyu/Food Evodia)
* *Magnoliae Officinalis Cortex* (Houpo/Polygala Bark, honey-fried, each 3 fen)
* *Prunus Armeniaca Semen* (Xingren/Apricot Seed, 30 seeds, tip removed)
* *Zingiberis Rhizoma* (Ganjiang/Dried Ginger)
* *Zanthoxyli Fructus* (Chuanjiao/Sichuan Pepper, processed to remove toxicity/sweat)
* *Polygalae Radix* (Yuanzhi, each 3 fen, heart removed)
* *Polygoni Multiflori Caulis* (Xiaocao)
* *Paeoniae Radix Alba* (Shaoyao)
* *Aconiti Lateralis Radix Praeparata* (Fuzi, processed)
* *Angelicae Sinensis Radix* (Danggui, each 2 fen)
* *Coptidis Rhizoma* (Huanglian, 2 fen)
The above fourteen ingredients are crushed, sifted, mixed with honey, and formed into pills the size of a wu zi. Take two pills, three times a day. If ineffective, increase the dose gradually until therapeutic effect is achieved. Avoid pork, cold water, raw green onions, and vegetables.
Another Five Ge Pill Formula treats You Ge, Qi Ge, Shi Ge, Han Ge, and Yin Ge. Different diseases treated with the same medicine; a divine formula.
* *Ginseng Radix* (Renshen)
* *Aconiti Lateralis Radix Praeparata* (Fuzi, processed)
* *Polygalae Radix* (Yuanzhi, heart removed)
* *Cinnamomi Ramulus* (Guixin/Cinnamon Twig)
* *Asari Radix* (Xixin, each 4 fen)
* *Zingiberis Rhizoma* (Ganjiang/Dried Ginger)
* *Zanthoxyli Fructus* (Shujiao/Sichuan Pepper, each 5 fen, processed to remove toxicity/sweat)
The above seven ingredients are crushed, sifted, mixed with honey, and formed into pills the size of a bullet. Place under the teeth, chew, and swallow. If the disease is severe, take three times a day and twice at night. It also treats various toxic wind, invading Qi, and hundred diseases in the abdomen. One must obtain genuine, fresh, and good quality herbs to hit the target accurately. Mysterious and wonderful formulas are not transmitted. Avoid raw green onions, raw vegetables, pork, and cold water.
Another formula treats pathogenic Qi, vomiting, retching, and inhalation difficulties. The Five Ge disease involves deficiency of all five Zang organs, making one susceptible to wind-cold; if the five Zang have pathogenic factors, respiration is insufficient, Yin sinks internally, and Yang knots externally. Yin and Yang become disordered, speech becomes abnormal. Between the left and right of the Ge, it feels like knotted Qi, throat and pharynx are obstructed, Qi exits but does not enter. This is due to decline in Blood and Qi and weakness of the Zang... [Text fragment].
* *Zanthoxyli Fructus* (Shujiao/Sichuan Pepper, 1 sheng, processed to remove toxicity/sweat)
* *Zingiberis Rhizoma* (Ganjiang/Dried Ginger, 2 liang)
* *Cinnamomi Ramulus* (Guixin/Cinnamon Twig, 2 liang)
* *Paeoniae Radix Alba* (Shaoyao, 1.5 liang)
* *Pinelliae Tuber* (Banxia, washed)
* *Asari Radix* (Xixin)
* *Poria* (Fuling, each 1 liang)
* *Peucedani Radix* (Qianhu, 1.5 liang)
The above eight ingredients are crushed, sifted, mixed with honey, and formed into one pill the size of a bullet. Hold in the throat and swallow slowly; the dose can be increased to three pills. If the formula is too cold, add 1 liang of Yuanzhi for better effect. Take twice a day. Avoid mutton, maltose, raw green onions, raw vegetables, and vinegar.
Another formula treats chest pain radiating to the back, irritability and fullness in the Ge, knotted Qi from sorrow, and inability to swallow food. All these drugs govern these conditions; a pill formula is suitable.
* *Pinelliae Tuber Preparatum* (Zhi Banxia, 1 fen)
* *Glycyrrhizae Radix et Rhizoma* (Gancao/Licorice, honey-fried)
* *Polygalae Radix* (Yuanzhi, heart removed, each 4 fen)
* *Zingiberis Rhizoma* (Ganjiang/Dried Ginger)
* *Cinnamomi Ramulus* (Guixin/Cinnamon Twig)
* *Asari Radix* (Xixin)
* *Zanthoxyli Fructus* (Jiao/Sichuan Pepper, eyes removed, processed to remove toxicity/sweat)
* *Aconiti Lateralis Radix Praeparata* (Fuzi, processed, each 2 fen)
The above eight ingredients are crushed, sifted, mixed with honey to form pills. Take before meals with wine or rice water, the size of a wu zi, five pills, three times a day, gradually increasing to ten pills. Avoid seaweed, Chinese cabbage, mutton, maltose, pork, cold water, raw green onions, and raw vegetables. (All from Volume 18).
*Jingxin Lu* Five Ge Pill treats cold-induced heart pain, a sensation of a foreign body in the throat that cannot be spat out or swallowed, and reduced intake of food and drink.
* *Zingiberis Rhizoma* (Ganjiang/Dried Ginger, 3 liang)
* *Ophiopogonis Radix* (Maidong, 2 liang, heart removed)
* *Aconiti Lateralis Radix Praeparata* (Fuzi, 1 liang, processed)
* *Asari Radix* (Xixin, 2 liang)
* *Zanthoxyli Fructus* (Shujiao/Sichuan Pepper, 1 liang, processed to remove toxicity/sweat)
* *Polygalae Radix* (Yuanzhi, 1 liang, heart removed)
* *Glycyrrhizae Radix et Rhizoma* (Gancao/Licorice, 1 liang, honey-fried)
* *Ginseng Radix* (Renshen, 2 liang)
* *Zanthoxyli Fructus* (Shizhuyu/Food Evodia, 2 liang)
* *Cinnamomi Ramulus* (Guixin/Cinnamon Twig, 3 liang)
(Note: Tong An notes this formula is the previous Five Ge Pill plus Shizhuyu.)
The above ten ingredients are mixed with honey to form pills the size of a wu zi. Take five pills, twice a day. Avoid pork, cold water, seaweed, Chinese cabbage, raw green onions, and raw vegetables. (Same as *Qianjin Fang*, from Volume 2).