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[Song] Yige (Dysphagia and Obstruction) arises from the dryness of blood, sometimes due to Qi fire or phlegm. When the lesion is near the throat, it is called "Ye" (Dysphagia); water can be swallowed, but food is difficult to ingest. When the lesion is in the epigastrium, it is called "Ge" (Obstruction); although food can enter, swallowing is difficult. One must examine the pulse and symptoms to determine deficiency or excess, and not rigidly treat all cases with acrid-aromatic herbs as cold syndromes.

[Discussion] Zhu Danxi stated: Ye disease arises from blood dryness. The Stomach is the sea of water and grain, and the Spleen is the organ of digestion. Only when the Qi is clear and harmonious can it function vigorously, transporting body fluids to the meridians. If there is any stagnation, it leads to retention and obstruction, causing Yige. People generally follow the *Ju Fang* (Prescriptions of the Bureau of Taiping Imperial Medical Institute), using aromatic, drying, and hot medicines whenever vomiting occurs. This inadvertently aids the fire. They fail to consider that this disease originates from dryness, coagulation, and withering; using aromatic, drying, and hot medicines to treat it is a grave error! Initially, stomach fluids coagulate; over time, Spleen Qi is exhausted, and transformation and transportation gradually slow down. Long-term consumption of toxic substances like Aconitum Radix Preparata (Wutou), Aconitum Lateralis Radix Preparata (Fuzi), and Cinnabaris (Dansha) depletes the blood, leading to dryness and withering of the epigastrium. If the withering is in the upper part, near the lower throat, water drinks can pass, but food is hard to enter; occasionally some enters, but the amount is small. This is called "Ye". If the withering is in the lower part, near the Stomach, food can enter but cannot fully pass into the Stomach; after a long while, it is regurgitated. This is called "Ge", which gradually becomes Fanwei (Regurgitation). Urine becomes scanty and constipated, and stool resembles sheep dung. Although the names differ, the pathology stems from the same source.

Blood belongs to Yin. Yin governs stillness. If both internal and external states are tranquil, the fire of the Zang-Fu organs will not flare up, allowing Lung Metal and Kidney Water energies to nourish each other, naturally generating Yin blood. With moist intestines and stomach and appropriate transformation and transportation, how could Ye occur? People who indiscriminately use aromatic, drying, and hot medicines do not understand this principle. Zhang Zihe cited the *Neijing* theory that "binding of the Three Yang causes Ge" to establish his argument, strongly refuting the errors of using hot medicines by laypeople, which was indeed insightful! Others use Chengqi Tang (Gut-Draining Decoction) for treatment, which is too harsh. Generally, if the cause is Qi fire rushing upward, preventing food intake, the pulse is rapid and large. If caused by phlegm-fluid retention, the pulse is knotted and slippery. If caused by emotional depression, the pulse is deep and choppy. If caused by blood stasis accumulation, since Yang cannot transform without Yin, and Yin loses its position while Yang lies dormant within, transformation ceases and Qi rebels upward, resulting in a knotted and choppy pulse. For cases due to Qi, treat the Qi; for cases due to Blood, treat the Blood; for cases due to Phlegm, guide it out; for cases due to Fire, strengthen Water to control it. How can one rely solely on acrid-aromatic drying agents? If Spleen and Stomach Yang fire is weak and unable to transform, temporarily use acrid-warm medicines to open blockages, but the primary approach should still be nourishing Yin and benefiting the Stomach. If one indiscriminately uses the acrid-aromatic, drying, and hot medicines from the *Ju Fang* to add fire to fire, severely depleting body fluids, it leads to constipation, obstruction of the幽门 (Pylorus), rebellion of Qi to the吸门 (Glottis), and worsening of Yige. This has been a malpractice for millennia!

Huangfu Zhong notes: The aforementioned conditions often originate from melancholy. Melancholy causes Qi to knot in the chest, generating phlegm. Over time, phlegm forms lumps, adhering to the Upper Jiao, narrowing the pathways and preventing smooth flow. Drinking may go down, but eating is difficult, and the disease is established. Those who love alcohol and suffer from this condition likely have stubborn phlegm, as alcohol generates fire, and fire refines phlegm. Phlegm, scorched by fire, becomes sticky and obstructive. Even drinking water feels painful and astringent upon swallowing. If treated as blood dryness by administering herbs like Danggui (Angelicae Sinensis Radix) and Dihuang (Rehmanniae Radix), the blood may not be moistened, but rather the phlegm aggravated, so how could the disease heal? However, for individuals who are thin and dark-complexioned, with inherent deficiency of True Yin, constant sensation of internal heat, no habit of drinking alcohol, or those who have overused acrid-aromatic hot medicines, treatment should focus on blood dryness.

Phlegm-Qi
Joy, anger, and other Seven Emotions injure the Spleen and Stomach, leading to depression and phlegm formation. Phlegm and Qi contend, rising but not descending, preventing food intake, with Qi lingering in the throat. Treat with Kuaqi Bingzi (Qi-Swiftness Pills) or Siqi Tang (Four-Emotions Decoction).
For Phlegm Depression, use Huatan Wan (Phlegm-Resolving Pill).
For Guange (Constriction and Obstruction), emesis must be used to lift the Qi.
For Hengge (Horizontal Obstruction), there is no need to focus on expelling phlegm. If phlegm exists, emesis is also suitable, using Yongtan Tang (Phlegm-Gushing Decoction). See the specific section for details on Guange.

Kuaqi Bingzi (Qi-Swiftness Pills)
Treats Qi depression and discomfort, with chest and diaphragm obstruction and pain after eating.
Radish Seed (Lai Fuzi, stir-fried, 2 liang) Perilla Seed (Zi Su Zi, 1 liang) Exocarpium Citri Reticulatae (Ju Hong, 1 liang) White Cardamom (Bai Dou Kou, 1 liang) Poria (Bai Fu Ling, 1 liang)
Grind into fine powder. Mix with refined honey and ginger juice to form pills. Chew slowly and frequently.

Siqi Tang (Four-Emotions Decoction)
Treats Qi depression due to Seven Emotions, with accumulated phlegm-saliva feeling like broken cotton or a plum pit stuck in the throat, impossible to cough up or swallow. Also treats epigastric fullness, abundant phlegm-saliva, and upper asthma. Suitable for pregnant women with morning sickness.
Pinellia Rhizome (Banxia, 1.5 qian) Poria (Bai Fu Ling, 1.3 qian) Perilla Stem (Su Geng, 1 qian) Magnolia Bark (Nong Po, 1 qian)
Cut into pieces. For one dose, add 7 slices of fresh ginger and 1 jujube. Add 2 zhong of water, decoct to 0.8 zhong, and take.

Huatan Wan (Phlegm-Resolving Pill) (Formula see Phlegm Syndrome section.)

Yongtan Tang (Phlegm-Gushing Decoction)
Licorice Root (Gancao, 1 liang) Platycodon Root (Jiegeng, 1 liang) Melon Seed (Guadi, 5 qian) Bitter Orange (Zhiqiao, 5 qian) Tangerine Peel (Chenpi, 5 qian)
Add 10 bowls of water, decoct to 5 bowls. Strain and drink continuously to induce floating of phlegm. Induce nausea to cause severe vomiting. After relief, take Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) for regulation to prevent recurrence.

Fire
When Upper Jiao fire is excessive and rebellious, preventing food descent and causing vomiting, use Hezhong Jiegeng Tang (Harmonize Middle Jiao and Platycodon Decoction) plus Bamboo Shavings (Zhuru) and Loquat Leaf (Pipaye). If thirsty, remove Banxia and add Ophiopogon Root (Maidong). For dry constipation, use Renli Ligewan (Ginseng and Throat-Unblocking Pills) for mild purgation. For blood deficiency and Yin deficiency with excessive fire causing insomnia and regurgitation of food, use Zhusha Anshen Wan (Cinnabar-Calming Spirit Pills).

Hezhong Jiegeng Tang (Formula see Vomiting section.)

Renli Ligewan (Ginseng and Throat-Unblocking Pills)
Treats chest discomfort, phlegm-cough, asthma, and fullness. Harmonizes Spleen, opens stagnation, eliminates old and promotes new. It is a sacred medicine for treating Yige.
Costus Root (Muxiang, 1 liang) Areca Seed (Binglang, 1 liang) Ginseng Root (Renshen, 1 liang) Angelica Root (Danggui, 1 liang) Agastache Herb (Huoxiang, 1 liang) Licorice Root (Gancao, 1 liang) Immature Bitter Orange (Zhishi, 1 liang) Rhubarb (Dahuang, wine-soaked, 1 liang) Magnolia Bark (Nong Po, ginger-processed, 1 liang)
Grind into fine powder. Make water pills. Take 50 pills with warm water, size of wutong seeds. Still use pig bile suppository to facilitate bowel movement; achieving soft stool is ideal.

Zhusha Anshen Wan (Cinnabar-Calming Spirit Pills) (Formula see Palpitations section.)

Deficiency
For Yige caused by dryness and weakness of Qi and Blood, use Yangxue Tang (Nourish Blood Decoction) or Runxue Yinzi (Moisten Blood Infusion). For Spleen deficiency and insufficient Middle Qi, use Bazhen Tang (Eight-Treasures Decoction) plus Chenpi (Tangerine Peel), Zhuru (Bamboo Shavings), and Pipaye (Loquat Leaf).

Yangxue Tang (Nourish Blood Decoction)
Angelica Root (Danggui, 2 qian) Rehmannia Root (Sheng Dihuang, 2 qian) Scrophularia Root (Xuanshen, 2 qian) Donkey-Hide Gelatin (Ejiao, 2 qian) Anemarrhena Rhizome (Zhimu, 2 qian) Safflower (Honghua, 5 fen, wine-rinsed) Peach Kernel (Taoren, 5 fen, ground to paste)
Cut into pieces. For one dose, add 2 zhan of water, decoct to 0.8 zhan. Add 2 spoons of raw white honey and take.

Runxue Yinzi (Moisten Blood Infusion) (Added)
Treats Yige caused by blood dryness.
Take 1 zhong of water, add 1 liang of Ejiao, dissolve, and decoct to 0.7 zhong. Add half a zhan of bamboo sap, 1 zhan of human milk, and 5 spoons of honey. Take slowly.

Blood Stasis
Blood stasis presents with a choppy pulse. Use Taochengqi Tang (Peach Kernel and Gut-Draining Decoction) to purge.

Taochengqi Tang (Peach Kernel and Gut-Draining Decoction) (Formula see below this section.)