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The *Ling Shu* (Spiritual Pivot) states: When Yin Qi is excessively abundant, Yang Qi cannot circulate within it; this is called "Guan" (Obstruction). When Yang Qi is excessively abundant, Yin Qi cannot circulate within it; this is called "Ge" (Rejection). When both Yin and Yang Qi are excessively abundant and cannot mutually coordinate their circulation, this is called "Guan Ge" (Obstruction and Rejection). Patients suffering from Guan Ge often die before their natural lifespan is exhausted.

When the positions of Yin and Yang are reversed, the disease is named Guan Ge, which is mostly incurable. However, if it is caused by the lingering of pathogenic factors, it may still be treatable. A white coating on the tongue accompanied by the inability to swallow food or fluids is termed "Ge"; Ge manifests as vomiting and regurgitation. Heat accumulating in the Dantian (Lower Abdomen) with an inability to urinate is termed "Guan"; Guan results in urinary retention. In such cases, inducing vomiting must be used to lift the stagnant Qi and resolve the obstruction, regardless of whether phlegm is expelled. Salt water can be used to induce vomiting, and a decoction of *Adansonia digitata* seed powder (Ya Zao Tang) can be used to bathe the lower abdomen and genitals. Alternatively, applying hot salt to the umbilicus is also excellent. If phlegm-dampness is present and vomiting is indicated, *Er Chen Tang* (Two-Cured Decoction) can be used to induce vomiting. The process of vomiting inherently involves the regulation of Qi ascent and descent. For patients with deficiency of Middle Qi leading to poor transportation, Qi-tonifying herbs should be combined with agents that regulate Qi movement. First, use *Si Jun Zi Tang* (Four Gentlemen Decoction) replacing Ren Shen (Ginseng Root) with Ren Shen Lu (Ginseng Stalk) to induce vomiting, followed by regulation using *Ren Shen San* (Ginseng Powder) and *Bai Zi Ren Tang* (Biota Seed Decoction).

If the pulse is deep and fine, with cold extremities, *Ji Ji Wan* (Already Interpenetrating Pill) is indicated. If Qi deficiency after overwork leads to poor Qi movement, *Bu Zhong Yi Qi Tang* (Tonify the Middle and Augment the Qi Decoction) added with Mu Xiang (Aucklandiae Radix) and Bing Lang (Arecae Semen) is indicated. After heart-spleen pain, if urinary retention occurs, it is due to phlegm obstructing the Middle Jiao and Qi stagnation in the Lower Jiao. Use *Er Chen Tang* added with Mu Tong (Akebiae Caulis) and Zhi Ke (Aurantii Fructus), followed by induced vomiting after administration. For cold in the Upper Jiao and heat in the Lower Jiao, *Huang Lian Tang* (Coptis Decoction) is used, substituting Gui Zhi (Cinnamon Twig) with Rou Gui (Cinnamon Bark). For heat in the Upper Jiao and cold in the Lower Jiao, *Sheng Liao Ba Wei Wan* (Raw-Ingredient Eight-Ingredient Pill) added with Niu Xi (Achyranthis Bidentatae Radix) and Che Qian (Plantaginis Semen) is indicated. In Guan Ge with urinary retention, if there is no sweat on the head, the condition is treatable; if there is sweat on the head, it indicates death.

Shi Wen stated: According to the *Nei Jing* (Inner Canon), when both the Ren Ying pulse (carotid artery) and Cun Kou pulse (radial artery) are four times larger than normal, this constitutes Guan Ge. This implies that Yang meridians are determined by the Ren Ying pulse, and Yin meridians by the Cun Kou pulse. The *Nan Jing* (Classic of Difficult Issues) states: Pulse qi extending upward beyond the大鱼际 (Thenar eminence) is called "Yi" (Overflow), manifesting as external Guan and internal Ge. Pulse qi extending downward beyond the Chi position is called "Fu" (Cover), manifesting as internal Guan and external Ge. Zhang Zhongjing also stated that pulse at the Chi position indicates Guan, and at the Cun position indicates Ge. Guan results in urinary retention, and Ge results in vomiting and regurgitation. These views determine Yang aspects by the Cun Kou pulse and Yin aspects by the Chi position. Thus, the *Nan Jing* further states: If there is a pulse in the upper part but none in the lower part, the patient should vomit; if they do not vomit, they will die. Zhang Zhongjing also described the Fu Yang pulse (dorsalis pedis artery) as deep and choppy; a deep pulse leads to vomiting and regurgitation with undigested food and drink, while a choppy pulse prevents food intake; this is named Guan Ge. From this, we know that the pulse and symptoms of Guan Ge are not uniform. Ma Zhonghua, in his explanation of the *Nei Jing*, argued that the meaning of Guan Ge does not refer to conditions like food blockage or urinary retention. However, Zhang Jiebin, in his *Lei Jing* (Classified Classic), directly refuted the statements of Bian Que (Yue Ren) and Zhang Zhongjing, insisting solely that the Ren Ying point is located in the neck and represents the exterior pulse of the Yangming Meridian. He thereby criticized Li Dongyuan and Zhu Danxi for adhering to the erroneous view in Wang Shuhe's *Mai Jing* (Pulse Classic) that the left side is Ren Ying and the right side is Qi Kou. Alas! While the *Nei Jing* is undoubtedly a sacred text that must be followed, the works of Yue Ren and Zhang Zhongjing are also worthy of being considered sacred texts. Generally, Ren Ying and Qi Kou are used to distinguish the Yin-Yang of the interior and exterior, while Cun Kou and Chi are used to distinguish the Yin-Yang of the upper and lower parts. The Qi transformation of the entire body's interior, exterior, upper, and lower regions is governed by the Lung, and blood vessels are controlled by the Heart. Therefore, any changes in the abundance or deficiency of Qi and Blood inevitably manifest in the Qi Kou pulse. Qi Kou is essentially a pulse of the Lung Meridian, merely divided into different locations to observe the Qi of other Zang-Fu organs. Just as Zhang Zhongjing pointed out, although the Fu Yang and Shao Yin pulses primarily correspond to the foot, they can also be deduced from the Guan and Chi positions. Therefore, observing Ren Ying and Qi Kou on the left and right sides as described in the *Nei Jing* is also acceptable. Medical practice values flexibility and comprehensiveness; if one holds to the mean without knowing how to adapt to circumstances, it is akin to sticking rigidly to one side. Thus, when explaining Guan Ge in the *Nei Jing*, one should only describe it as a sign of the severance of Yin-Yang between the interior and exterior, and should not conflate it with the Guan Ge characterized by upper vomiting and lower closure. It is incorrect to claim that upper vomiting and lower closure should be called food blockage and urinary retention and not Guan Ge. It is acceptable to say that the pulse in Guan Ge cases may not always be uniform; however, it is incorrect to claim that Guan Ge pulses necessarily lack differentiation between the Chi and Cun positions. Consider Zhang Zhongjing's mention that a deep and choppy Fu Yang pulse also governs Guan Ge, or examples where a faint upper pulse with a small head indicates sweating, and a faint lower pulse with a large root indicates Guan Ge obstruction. The principles are clear in these instances.