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The *Jingui Yaolue* states: Women may feel as if there is a piece of roasted meat stuck in their throat; this is treated with Banxia Houpo Tang (Pinellia and Magnolia Bark Decoction). (This is also known as Siqi Tang, Four-Seven Decoction.)

The Upper Jiao (Upper Burner) belongs to Yang and is governed by Wei Qi (Defensive Qi). It values free flow and detests obstruction and stagnation. Stagnation causes Jin Ye (Body Fluids) to fail to circulate, accumulating into Tan Xie (Phlegm-Saliva). The Gallbladder meridian uses the throat as its pathway; the Gallbladder governs decision-making, and its Qi belongs to Ministerial Fire. When affected by Seven Emotions (Seven Affects), if one fails to make a clear decision, the Fire becomes stagnant and cannot be dispersed. When Fire is stagnant, its flaming nature does not reach upward; when the flaming nature does not reach upward, the Qi becomes obstructed like trapped flame, gathering with Phlegm-Saliva in the chest. Thus, the sensation is as if a piece of roasted meat is stuck. The *Qianjin Fang* describes it as chest fullness, hardness below the heart, and a feeling in the throat as if a piece of roasted meat were present, which cannot be spat out nor swallowed. Although the symptoms vary slightly, they are all caused by stagnation. Using Banxia (Pinellia Rhizome) and other herbs merely serves to disperse stagnation and resolve phlegm.

The *Neijing* states: For Wood stagnation, promote its free flow; for Fire stagnation, vent it; for Earth stagnation, purge it; for Metal stagnation, drain it; for Water stagnation, control it. However, to regulate Qi, excess should be controlled because that is what it fears; this is what is meant by "purging." To "promote free flow" means to ensure smooth passage; one should use light and ascending agents to lift and unblock it. To "vent" means to ascend and release; one should use ascending and releasing agents to induce sweating and disperse it. To "purge" means to attack downward; one should use salty and cold agents to attack and remove it. To "drain" means to open up; one should use dispersing and vomiting-inducing agents to涌 (urge) and drain it. To "control" means to restrain; one should use bitter and cold agents to subdue and restrain it. These all discuss the stagnation of the Six Qi (Wind, Cold, Summerheat, Dampness, Dryness, Fire). As for the stagnation of the Five Wills (Five Emotions), the above methods are not suitable. The *Neijing* says: One who was once noble but became lowly, though not struck by external pathogens, develops disease from within, named Tuo Ying (Depletion of Ying); one who was once rich but became poor, is named Shi Jing (Loss of Jing). Also, women whose emotions are unsatisfied, leading to depression and lack of comfort, resulting in amenorrhea or irregular menstruation, fever, and cough. Nuns, widows, and others with various ailments must have their root causes identified and treated accordingly.

Zhao Yangkui stated: "Yu" (Stagnation) implies suppression and blockage. The five methods in the *Neijing* refer to stagnation caused by the invasion of the Five External Pathogenic Factors, and should not be interpreted solely as emotional depression. Sorrow is a disease of the Seven Emotions, but it is included within the scope. Zhu Danxi stated: When Qi and Blood are harmonious, no disease arises; once there is Fu Yu (Depression/Stagnation), various diseases arise. He formulated the theory of the Six Types of Stagnation and established Yueju Wan (Yueju Pill) to treat stagnation, using Xiangfu (Cyperus Rhizome), Fuxiong (Ligusticum Chuanxiong Rhizome), and Cangzhu (Atractylodes Rhizome) as the main agents to open stagnation and benefit Qi. He believed that Qi stagnation leads to Dampness retention; Dampness retention generates Heat stagnation; Heat stagnation generates Phlegm stagnation; Phlegm stagnation impedes Blood flow; Blood stagnation leads to Food retention. These six factors interact to cause disease. Since this theory emerged, the principles of the *Neijing* began to become obscure, and the intent of the *Neijing* became even more obscured due to errors in annotations. Consequently, the understanding of stagnation diseases has remained unclear for a long time. Generally, the East generates Wood; Wood represents the vitalizing Qi, wherein Fire Qi attaches to Wood. If Wood stagnates, Earth stagnates; if Earth stagnates, Metal also stagnates; if Metal stagnates, Water also stagnates. This mutual influence among the Five Elements is the natural order. Because of this interdependence, I use one formula to treat Wood stagnation, and all other stagnations heal consequently; this is Xiaoyao San (Free and Easy Wanderer Powder). In severe cases, Zuojin Wan (Zuojin Pill) is added to the formula. Huanglian (Coptis Rhizome) treats Heart Fire; Wu Zhuyu (Evodia Fruit) has a fishy odor, and Liver Qi also has a fishy odor. Like attracts like, thereby assisting Metal to control Wood. This is why it is called Zuojin (Assisting Metal).

For symptoms such as alternating chills and fever, resembling malaria but not quite so; aversion to cold and heat; vomiting with acid regurgitation and epigastric discomfort; chest pain and hypochondriac pain; lower abdominal distension and stuffiness; dizziness and night sweats; Xiaoyao San (Free and Easy Wanderer Powder) is used with modifications. This is a formula targeted at these symptoms, and it is invariably effective. If the patient recovers after one dose but relapses shortly after, or half a day or a day later, and the relapses become more frequent and severe, this is likely a false presentation of upper Heat and lower Cold. This formula should not be administered again. Instead, warming and tonifying formulas should be used. For Yang deficiency, Sijunzi Tang (Four Gentlemen Decoction) is combined with warming herbs; for Yin deficiency, Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) is prepared as a decoction with warming herbs. In severe cases, the method of "treating heat with cold" (Han Yin Re Yong) is employed, where a small amount of cold medicine follows the hot medicine, using the technique of "probing with hot medicine taken cold." Otherwise, rejection may occur, causing harm rather than benefit.

Shiwan stated: Stagnation syndromes often originate from frustrated thoughts and wills, causing Qi to be diseased first; thus, Yueju Wan and Siqi Tang were established. If stagnation persists for a long time, Fire pathogenic factors consume Blood; can herbs like Cangzhu (Atractylodes Rhizome) and Xiangfu (Cyperus Rhizome) be taken for a long time? Therefore, Xiaoyao San (Free and Easy Wanderer Powder) and Guipi Tang (Restore the Spleen Decoction) were subsequently devised. However, stagnation syndromes mostly affect women. As stated in the *Neijing*, diseases of the Two Yang meridians originating from the Heart and Spleen, as well as endless thinking and unfulfilled desires, can all cause illness. The manifestations vary: some have fever and headache; some have wheezing, coughing, and Qi deficiency; some have amenorrhea or irregular menstruation; some have mania, epilepsy, and loss of mental clarity; some have hemorrhage due to flaming Fire; some have bone-steaming consumption; some develop carbuncles and parasites. Treatment methods generally revolve around Xiaoyao San (Free and Easy Wanderer Powder), Guipi Tang (Restore the Spleen Decoction), Zuojin Wan (Zuojin Pill), Jiangqi Tang (Descend Qi Decoction), Wuchen Tang (Wu Chen Decoction), and Qi Qi Tang (Seven Qi Decoction). One must investigate whether the condition is new or chronic, and whether it is excess or deficiency, to select and modify the formulas accordingly.

[Diagnosis] Pulse signs of stagnation are often deep and hidden (Chen Fu), knotted (Jie), rapid with pauses (Cu), deep (Chen), or choppy (Se). If stagnation is in the Liver and Kidney, the pulse appears on the left side; if in the Heart and Spleen, it appears on the right side. If Qi, Blood, Food Retention, or Phlegm-Fluids remain stagnant within, the pulse will inevitably become choppy and intermittent. However, as long as the pulse possesses Shen (Spirit/Vitality), there is no harm. What is meant by Shen is Wei Qi (Stomach Qi). Although stagnation pulses are often deep, hidden, knotted, or rapid, they do not constitute a major threat. The concern lies in pulses that are firm, hard, wiry, strong, and discordant. Deep, hidden, knotted, and rapid pulses indicate that Qi can still be dispersed; once Qi flows freely, harmony is restored. If the pulse is firm, hard, wiry, and strong, Zheng Qi (Upright Qi) has already been damaged, and there is no Qi left to disperse. Even with tonification, efficacy is difficult to achieve, let alone the misuse of Qi-depleting drugs. Therefore, stagnation syndromes presenting with wiry and strong pulses often evolve into deficiency consumptive diseases.

Yi Silan treated a woman suffering from general fatigue, yawning, dry mouth, and inability to eat for a month; she could barely swallow a few grains when forced. Some treated her for Blood deficiency, others for Qi weakness, and some recognized Fire but did not identify its source. Medications were mixed and chaotic, worsening her condition. Her symptoms mildly improved in winter, but in the following summer, all illnesses returned. She became emaciated with visible bones. The Three Jiao pulses were surging and large, extending upwards; the Spleen and Lung pulses were faint and deep; other parts of the pulse were peaceful. This was a Lung Fire disease. Zhi Zi Ren (Gardenia Seed) was soaked in Ginger Juice overnight, stir-fried until black, and ground into an extremely fine powder. It was taken with a decoction of Renshen (Ginseng Root), Maidong (Ophiopogon Tuber), and Wumei (Mume Fruit). After two doses, she felt hungry and desired food. Within ten days, her body regained normal strength. Later, due to infertility from prolonged illness, everyone assumed Blood deficiency and prescribed Renshen (Ginseng Root) and Huangqi (Astragalus Root). Half a month later, she experienced chest and diaphragmatic fullness, and her appetite decreased sharply. It took over three months for her menstruation to start, passing dark, foul-smelling discharge, intermittently flowing, unable to pass smoothly, causing extreme suffering. Yi Silan then used Siwu Tang (Four Substances Decoction) replacing Shudi (Prepared Rehmannia Root), adding Chenpi (Tangerine Peel), Sugen (Perilla Stem), Huangqin (Scutellaria Root), Shanzhi (Gardenia Fruit), Qingpi (Green Tangerine Peel), and Zhike (Bitter Orange Fruit) for more than ten doses. She conceived within one month.