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Deficiency and Excess: The disease of Yige (dysphagia and regurgitation) presents with both deficiency and excess patterns. In the excess pattern, phlegm or blood stasis adheres to the epigastrium, struggling with Qi, wrapped externally like a membrane; occasionally, vomiting expels these pathogenic factors, providing temporary relief to the chest Qi, but the condition soon returns to its original state. In the deficiency pattern, body fluids are depleted and fail to moisten, while Qi is insufficient to fill and support, leading to a dry and shriveled epigastrium where food enters with difficulty and feels rough. For deficiency patterns, moistening and nourishing methods should be used; for excess patterns, dredging and unblocking methods should be employed. This distinction must not be overlooked. (From *Jinkui Yi*)

Various Syndromes: For Qi-type Yige, Shenshi Qiqi Tang (Deep Master's Seven-Qi Decoction) is indicated (prescription from *Qianjin Fang*, comprising twelve ingredients). For Blood-type Yige, Jiuzhi Yin (Leek Juice Drink) is indicated. For Phlegm-type Yige, Gualou Shi Wan (Trichosanthes Fruit Pill) is indicated (composed of Trichosanthis Semen, Aurantii Fructus, Pinelliae Rhizoma, Platycodonis Radix). For Fire-type Yige, Huiling Wan is indicated. For Food-type Yige, Shiyu Yueju Wan is indicated. (From *Yifang Kao*) (Refer also to the text in *Weiyi* within the Treatment Examples.)

Yie (choking sensation) is divided into five types: those caused by Qi stagnation, blood stasis, flaming fire, phlegm coagulation, and food accumulation. Although categorized into five types, they all stem from alterations due to the Seven Emotions (Joy, Anger, Worry, Pensiveness, Sorrow, Fear, Fright). Qi stagnation transforms into fire; excessive fire dries up the blood; body fluids condense into phlegm; phlegm obstruction prevents food digestion. (From *Huibu*)

Ge (obstruction) is distinguished into Wine-Ge, Qi-Ge, Worm-Ge, and Labor-Ge. Wine-Ge results from damage to the Spleen and Stomach by alcohol, leading to exhaustion of essence and fluids. Qi-Ge results from excessive anger, causing Liver Wood to overact upon Spleen Earth. Worm-Ge arises from a preference for fried and aromatic foods, which scorch and dissipate body fluids, leading to the generation of parasites. Labor-Ge is caused by undisciplined diet damaging the Middle Jiao Earth, or excessive sexual activity failing to generate Spleen Earth Qi. (From *Yixue Zhiyao*)

Alcohol Toxicity: Those addicted to alcohol who suffer from this disease invariably have stubborn phlegm. Alcohol generates fire; fire generates phlegm; phlegm is scorched by fire into a sticky mass that obstructs pathways, causing pain and roughness even when water is swallowed. If treated as blood dryness using herbs like Danggui (Angelicae Sinensis Radix) and Dihuang (Rehmanniae Radix), the blood may not be moistened, but the phlegm will instead be aggravated, and the disease cannot heal. However, if the patient is thin and dark-complexioned, with inherent True Yin deficiency, frequent internal heat, no fondness for alcohol, or a history of overusing aromatic-dry-hot medicines, then it should be treated as blood dryness. (From *Dingbu Zhizhang*)

Frequent drinkers often develop Yige, especially those who drink hot wine. Heat damages body fluids, causing dryness and roughness in the pharyngeal tube (evident from dry mouth and tongue), preventing food intake. (From *Yique*)

Dead Blood with Phlegm (Refer to subsequent blood-invigorating formulas). Whenever there is an obstruction during swallowing, a sensation of twisting descent, and slight pain, this indicates the presence of dead blood (blood stasis) and phlegm. It is appropriate to add Zhuli (Bambusa Textilis Caulis Infusum) and Jiangzhi (Zingiberis Rhizoma Expressum) to the decoction. (From *Yitong*) (Note: *Liuyao* states: Use previous paste medicines for moistening and tonifying, followed by Daididang Wan for purgation. The paste refers to mixed leek juice, cow milk, and ginger juice. Additionally, *Yuanbing Ji* prescribes Runxue Tang, found in the Yin-Nourishing section.)

A young man vomited several mouthfuls after every meal, though not completely emptying. There was occasional noise above the diaphragm, yet his complexion appeared normal. I determined the pathology lay not in the Spleen and Stomach, but in the diaphragm region. Inquiry revealed the onset followed intense anger followed immediately by eating. Anger causes blood to pool upward and accumulate in the diaphragm, obstructing the ascending and descending of Qi. Body fluids thus gather into phlegm and fluid retention, struggling with Qi to produce noise. I prescribed Erchen Tang plus Xiangfu (Cyperi Rhizoma), Jiuzhi (Leek Juice), and Laifuzi (Raphani Semen). After two days, I induced vomiting using Gouti San (Melon Sepal Powder) with sour plum juice. On the second day of vomiting, one cup of bloody sputum was expelled; on the next day, another cup. The disease then resolved. Blood stasis in the diaphragm obstructs the Qi pathway. Daididang Wan (see *Yuxue* chapter) is typically used, formed into mustard-seed-sized pills. Take 3 qian, lie supine without a pillow, and swallow slowly to search out and eliminate accumulated stasis. By morning, foul matter is evacuated via bowels. With proper recuperation, self-healing occurs. (From *Zhunsheng*) However, if only drinking hot soup or encountering pepper/ginger triggers hiccups, this also indicates blood stasis. (From *Yitong*)

Spitting Saliva Foam: Every time food enters the stomach, saliva foam is spat out, resembling egg whites. The Spleen governs saliva; Spleen deficiency fails to constrain body fluids, causing spontaneous leakage of saliva foam. Only Renshen (Ginseng Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Hezi (Chebulae Fructus), and Yizhiren (Alpiniae Oxyphyllae Semen) can secure it. (From *Yitong*)

Incurable Signs: In elderly patients, it is incurable. (From *Danxi*) (Note: *Zhengchuan* states: Over fifty years old, it is untreatable. *Yitong* states: Because both Qi and Blood are deficient. I have seen patients under sixty cured by following treatment rules and observing taboos; however, those who ignore dietary restrictions and engage in sexual exertion or worry/pensiveness face grave danger.)

Stool resembling sheep dung is absolutely incurable, due to lack of blood in the Large Intestine. (Same source)

When both Qi and Blood are deficient, excessive foam appears in the mouth. If large amounts of foam are observed, death is imminent. (From *Gouxuan*) (Note: *Tongzhi* mentions spitting red phlegm. *Yitong* states spitting phlegm like crab foam is incurable. *Jingyue Quanshu* attributes this to failure of Spleen Qi.)

Abdominal嘈杂 (burning/discomfort) and pain like knife-cutting is incurable. (From *Yitong*) (*Jingyue Quanshu* states: Extreme deficiency of Ying Blood, depletion of blood in the middle.)

Patients with this syndrome who can eat a little grain will not survive beyond one year; those who cannot eat at all will not survive beyond six months. (From *Yuanliu Lun*)

Treatment Principles: The therapeutic method involves regulating Yin and Yang, resolving phlegm, and directing Qi downward. When Yin and Yang are balanced and Qi flows smoothly with phlegm resolved, Yige cannot arise. (From *Jisheng Fang*)

Treating this disease: Throat closure and chest fullness seem to indicate Qi stagnation; however, if caused by excessive use of Qi-consuming medicines leading to non-movement of Middle Qi, tonification of Qi is required to restore movement. Dry stool resembling sheep dung seems to indicate Blood Heat; however, if caused by excessive purgatives depleting blood and worsening constipation, nourishing and moistening Blood is required to restore flow. If food cannot enter due to rebellious Fire rushing upward, with a surging, forceful, and rapid pulse, or if blocked by phlegm-fluids with a knotted and choppy pulse, clearing phlegm and draining heat is necessary to subdue the Fire. If Spleen and Stomach Yang Fire is also declining, with a deep, fine, and faint pulse, aromatic-warm medicines should warm the Qi, primarily focusing on nourishing Yin and the Stomach, rather than relying solely on drying-hot formulas as in the Bureau Formulas. Those who disregard taboos regarding rich foods and sexual activity, and the elderly lacking Blood, are beyond cure. (From *Weiyi*)

At the initial stage of Ge disease, with excessive constraint but unexhausted Blood, lifting agents like Chenxiang (Aquilariae Lignum), Muxiang (Vladimiriae Radix), and Doukou (Amomi Fructus Rotundus) should be used; do not rely solely on tonification. In chronic stages with Stomach injury and exhausted fluids, Bai Mi (Honey), Lugeng (Phragmitis Rhizoma), Danggui (Angelicae Sinensis Radix), and Baishao (Paeoniae Radix Alba) should be used to nourish; do not rely solely on aromatic-drying agents. This is the sequence of early and late treatment. (From *Huibu*)

The difficulty of this syndrome lies in the dilemma: wishing to strengthen the Spleen and resolve phlegm, one fears drying agents will harm fluids; wishing to nourish Blood and generate fluids, one fears moistening agents will obstruct the Middle Jiao. If Yin injury and Fire flourishing are identified, nourishing Blood is urgent. If Spleen injury with Yin abundance is identified, warming and tonifying come first. In cases of pent-up sorrow and anger with constrained Fire, where Spirit is not significantly depleted and the pulse remains forceful, purgative methods akin to those of Cang Gong and He Jian should be employed. (From *Bidu*)

Yige belongs to dual deficiency of Qi and Blood, resulting from diminished Blood rather than phlegm-Qi rebellion. Avoid breaking Qi, ascending, purging, digesting, drying, bitter-cold, and pungent-hot agents. Favor descending, clearing heat, moistening dryness, sweet-warm, and sweet-neutral agents to benefit Blood, slightly assisting with aromatic agents to smooth Qi. (From *Bencao Jing Shuluo*)

For regurgitation of ingested food, indicating Cold in the Middle Jiao Earth and deficiency of Fire in the Lower Jiao, Fuzi Lizhong Tang, Xiangsha Liujunzi Tang plus Ganjiang, or Bawei Dihuang Wan, taken alternately, are often effective. For inability to ingest food, Huanglian Huangqin Renshen Ganjiang Tang is primary; Xiexin Tang is also excellent. Wuzhuyu Tang is applicable to both Yige and Fanwei, specifically indicated for vomiting with chest fullness, dry retching with saliva foaming, and headache. (From *Shifang Miaoyong*) (Note: Mr. Chen has a continuation discussing the rationale for Qinlian Shenjiang Tang and Wuzhuyu Tang in Yige; refer to it.)

Differentiating Upper/Middle vs. Middle/Lower Treatment: Patients with this disease rarely survive, but distinctions exist between Upper-Middle and Middle-Lower involvement, and fast versus slow mortality. Upper-Middle involves disharmony of Upper and Middle Jiaos; Middle-Lower involves disharmony of Middle and Lower Jiaos. Middle-Lower disharmony leads to slower death; Upper-Middle to faster death. Proper treatment can slow fast mortality; improper treatment can accelerate slow mortality. Initially, physicians often use aromatic Qi-moving drugs to open the chest and stimulate appetite. However, inability to eat stems from deficiency of True Qi. Once True Qi is deficient, how can pungent-dispersing drugs be used to further consume Qi? Consuming Qi allows those with mild root deficiency to linger, but those with severe root deficiency lose their lives within months. Alternatively, some physicians initially use Blood-nourishing and Yin-moistening drugs to open the "Lanmen" gate and promote downward movement to prevent vomiting. If the Middle and Lower Jiaos are disconnected, food entering the Middle Jiao fails to connect with the Lower Jiao for proper transformation, reversing upward and causing vomiting. Such moistening-downward drugs may work initially; upon recurrence, they cease to work. Initially, Lower Jiao disconnection responds to moistening-downward drugs. Over time, Yin becomes abundant and Yang deficient; the generating Yang Qi of the Lower Jiao cannot circulate upward. Downward-only movement fails, leading to death. In Middle-Lower disharmony with weak Fire, using Renshen, Huangqi, Baizhu, Ganjiang, Guizhi, Fuzi early on may show effect. But if the disease persists despite efficacy, suspicion of warming-tonification errors arises, leading to switching treatments and ultimate failure. As the Classic says, "Those who obtain Grain prosper; those who lose Grain perish." (From *Yixue Zhenzhuan*) (Note: *Lantai Guidfan* also calls Ge disease a withering of the stomach gate, incurable.)

Treatment Requires Moistening, Prohibiting Aromatic-Heat: Some ask: Can ancient formulas treat gastric withering? Are there quicker methods to supplement predecessors? I reply: Ancient formulas use Renshen to tonify Lung, Yumi (Oryza Sativa Var. Glutinosa) to detoxify, Zhuli to resolve phlegm, Ganjiang to nourish Blood, Sumi (Panicum miliaceum) to solidify Stomach, honey-water to moisten dryness, and Ginger to remove filth. This aligns with the principle. Zhang Jifeng also stated: Yie is a disorder of the Spirit/Mind; only introspection and self-nurturing can cure it. This deeply hits the pathology, and the treatment approach is reasonable. Yie arises from Blood dryness. Blood is Yin; Yin is quiet. Inner and outer quietude prevents organ Fire from rising, nourishing Metal and Water, generating Yin-Blood, moistening intestines/stomach, and ensuring proper transmission. Thus, no Yie. Applying this logic, I formulated a prescription for a middle-aged woman: Siwu Tang plus Chenpi (Citri Reticulatae Pericarpium), Taoren (Persicae Semen), Sheng Gancao (Raw Glycyrrhizae Radix et Rhizoma), and Honghua (Carthami Flos) decocted strongly, drunk with Donkey Urine to prevent worm generation. Dozens of doses brought peace. Also, a craftsman in Taizhou, nearly thirty, diligent, widowed, fond of wine, pale, with a choppy pulse (large and powerless when heavy). Advised him to quit work, stay with cattle, drink fresh warm cow milk, one cup per sitting, 5-7 times daily, stopping other foods, gradually increasing to 8-9 times. Bowels softened in half a month; recovered in a month. If thirsty, due to unresolved alcohol toxicity, drink small amounts of Sugarcane Juice. (From *Jufang Fahui*)

Treating Ge syndrome, some use warming-tonification for Stomach deficiency, others use aromatic-drying for opening constraint, leading inevitably to death. They do not realize this is withering of the "Gate," where Kidney Water cannot ascend. The Classic states the Kidney is the Gate of the Stomach; if the gate is blocked, ascent and descent cease. The gate is the pivot of Qi interaction, the hub of Heaven. When Kidney is robust, Stomach Yin is sufficient; sufficient Stomach Yin induces appetite. Use Liuwei Yin plus Danggui and Baishao to nourish. (From *Siming*)

Most cases involve Phlegm-Fire, Blood dryness, and Qi constraint. *Jufang* typically uses Wuge Kuanzhong San or Chenxiang Kaige San, which are pungent-hot, consuming Blood and aiding Fire. Effective only for true Yang deficiency with Cold or internal constraint with excess. For Blood dryness, Fire, Phlegm, or Fluids, such treatments are paths to quick death. Be cautious. (From *Tongzhi*) (Note: The prohibition of aromatic-dry-hot drugs for Yige originates from Zhang Zihe, further analyzed by Danxi; consult both.)

Some argue: Yie is due to Qi constraint, so pungent-hot dispersants are necessary. I say: Qi constraint is due to Qi deficiency, not excess. Here, Qi deficiency leads to constrained Heat. Using pungent-hot drugs consumes Qi, making deficiency worse and Heat hotter. How can this save the patient? Early in the disease, physicians often use pungent-aromatic-dry-hot drugs to劫 (rob/crush) the pathogen. The disease recurs, gets deeper with each robbery, until critical. (From *Yitong*)

Ancient formulas generally used anti-emetics for Yige. They failed to consider that vomiting is a Damp syndrome requiring drying; Yige is a Dry syndrome requiring moistening. The Classic says: Conjunction of the Three Yang is called Ge. Conjunction implies Heat; extreme Heat causes dryness. All Yige syndromes boil down to "dryness and withering of the epigastrium." If the Stomach is already withered, adding drying drugs only increases dryness. (From *Xinwu*)

Use of Purgatives Example: If the disease has persisted long, do not attack suddenly. Even if opened, worry about aftermath. First, moisten and nourish. Start with small doses of decoctions or pills, gradually increasing until the gate opens naturally. If choking with upper obstruction of saliva/phlegm, mildly use bitter-sour agents to induce slight vomiting, facilitating downward treatment. If ineffective, use honey-salt to guide downward. Connect upper and lower agents to scatter knots and dissipate Yang, allowing food to descend. Do not use Badou (Crotonis Fructus) to consume Tianzhen (innate vitality); liquid dryness and fluid depletion leave toxins behind. People say this disease worsened by purgation became deficient and obstructed; this is Badou's fault, not Dahuang (Rhei Radix et Rhizoma) or Qianniu (Pharbitidis Semen). An official in Jicheng suffered vomiting for over a year, treated as Stomach Cold with Dingxiang (Caryophylli Flos), Banxia (Pinelliae Rhizoma), Qingpi (Citri Reticulatae Pericarpium Viride), Chenpi, Shengjiang, Fuzi, and moxibustion. Symptoms fluctuated for ten years, with dry stool and yellow urine. I diagnosed: All Wei, Chuan, and Ou belong to the Upper Jiao. Wang Taiabu said: Upper refers to Upper Jiao. Fire Qi flaring upward causes vomiting due to extreme Heat. Used Sisheng Wan (Hei Qianniu, Dahuang, Poxiao, Zaorao) to purge thirty times, evacuating liters of dry feces. Patient was confused for one-two days, drank ice water frequently, then cool yogurt and sesame drink. Days later, ate heartily, spirit and Qi restored, fathered three sons, died at fifty. (From *Shiqin*) (Note: This case is not typical Yige, intended for analogy.)

Zihehe, influenced by Hejian's San-Yi Chengqi treatment, claimed Yige requires purgation to scatter knots and dissipate Yang. However, epigastric/diaphragmatic diseases cannot be cured merely by purging. Although Zhongjing had Dahuang Gancao Tang and Dongyuan had Tongyou and Runchang methods for constipation/vomiting, these address immediate regurgitation, not Yige with inability to pass food. His advice "do not attack suddenly, first moisten/nourish" and "connect upper/lower agents" is excellent. Phlegm/blood in the epigastrium must move to heal; medicine exceeding the disease site harms True Qi. Thus, small pills gradually increased to reach the site precisely, balancing excess and deficit, is the way to treat Yige, provided one distinguishes Phlegm from Blood. (From *Jinkui Yi*)

Warming Middle and Benefiting Qi Formulas (Warm/Cool Balanced Formulas): Diseases of the Diaphragm are named Gaohuang (vital areas beyond reach of decoctions/pills/acupuncture). Therefore, pills are held in the mouth to allow vaporized qi to permeate. Five Ge Pills follow.

Maimendong (Ophiopogonis Radix) 10 parts, descored; Gancao (Glycyrrhizae Radix et Rhizoma) 10 parts, roasted; Jiao (Zanthoxyli Fructus), Yuanzhi (Polygalae Radix), Fuzi (Aconiti Lateralis Radix Praeparata), Paoganjiang (Zingiberis Rhizoma Praeparatum), Renshen (Ginseng Radix), Guizhi (Cinnamomi Ramulus), Xixin (Asari Radix et Rhizoma) each 6 parts. Pound and sieve. Make pills with premium honey the size of a bullet. Hold one pill in the mouth, slowly swallowing the juice. Take three pills daily. Indicated for shortness of breath, chest fullness, hardness below the heart, and cold Qi. Among many similar formulas, this is superior. (From *Zhouhou*)

Five Yie Pills: Indicated for chronic cold in the chest, retching/rebellious Qi, inability to eat/drink, and unconsumed constrained Qi.

Ganjiang (Zingiberis Rhizoma), Shujiao (Zanthoxyli Fructus), Shizhuyu (Torreyaefolia Fructus), Guixin (Cinnamomi Cortex), Renshen (each 5 parts); Xixin (Asari Radix et Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), Fuling (Poria), Fuzi (Aconiti Lateralis Radix Praeparata) (each 4 parts); Ju pi (Citri Reticulatae Pericarpium) (6 parts).

Ten ingredients powdered, mixed with honey into pills the size of梧子 (Chinese parasol tree seeds). Take three pills with wine, three times daily. If ineffective, increase to ten pills. (From *Qianjin*)

Guangji Formula for Yie: Chest/hypochondriac fullness, choking Qi with each meal. Tongqi Tang.

Banxia (Pinelliae Rhizoma, washed), Shengjiang (Zingiberis Rhizoma Recens) (each 6 liang); Ju pi (Citri Reticulatae Pericarpium), Guixin (Cinnamomi Cortex) (each 3 liang, sliced).

Four ingredients sliced. Boil in 8 sheng water to 2.5 sheng. Strain. Divide into three warm doses. Take intervals equivalent to walking 6-7 li. (From *Waitai*) Also, *Jiyan* Tongqi Yie Tang removes Ju pi and adds Lingyangjiao (Saigae Tataricae Cornu).

Lu: Yin-Yang reversal,已形成 Guan Ge (Obstruction-Rebellion - likely Ge syndrome). Propose Fuzi Xiexin Tang for Upper Heat and Lower Cold. (From *Linzheng Zhinan*)

Mao: Elderly, emaciated, anorexic, constipated, Qi rushing with saliva foam. Guan Ge syndrome. Propose Jintui Huanglian Tang.

Chuanlian (Coptidis Rhizoma), Dan Ganjiang (Zingiberis Rhizoma Praeparatum), Banxia (Pinelliae Rhizoma), Jiangzhi (Zingiberis Rhizoma Expressum), Renshen (Ginseng Radix), Fuling (Poria), Fuzi (Aconiti Lateralis Radix Praeparata), Sheng Baishao (Paeoniae Radix Alba) (Same source).

Bi (54 years old): Diagnosed in summer, deemed incurable. This disease results from accumulated fatigue damaging Yang. Though young in age, Spirit is exhausted. Ancient texts attribute Yige/Fanwei to Yin dryness and Yang knotting. Autumn equinox follow-up: Vital Qi in pulses exhausted, early throat dryness, scant daytime urination, exhaustion of Five Fluids. Cannot tolerate harsh-dry Yang drugs. Disease likely incurable by medicine.

Dabansha Tang (Half-Ginger Half-Semen Persicae Decoction), plus Huanglian (Coptidis Rhizoma), Jiangzhi. (Same source) (Note: Refer to *Shifang Miaoyong* for rationale of Dabansha Tang.)

Prescription for Dysphagia with Preference for Eating: Banxia San.

Banxia (Pinelliae Rhizoma) (1 liang), Ganjiang (Zingiberis Rhizoma Praeparatum) (1 liang, roasted/crushed), Shigao (Gypsum Fibrosum) (2 liang), Renshen (Ginseng Radix) (1 liang, descored), Gualougen (Trichosanthis Radix) (1 liang), Guixin (Cinnamomi Cortex) (1 liang), Gancao (Glycyrrhizae Radix et Rhizoma) (0.5 liang, roasted/red/crushed), Wuzhuyu (Evodiae Fructus) (0.5 liang, soaked/washed seven times/dried/lightly roasted).

Pound ingredients, sift coarsely. Take 3 qian per dose. Add 1 zhong lamp of water, 0.5 fen Shengjiang (Zingiberis Rhizoma Recens), 2 dates, 50 grains Xiaomai (Tritici Semen), 50 grains Xiaodou (Phaseoli Semen). Decoct to 0.6 portion. Strain. Take warm, anytime. (From *Shenghui*)

Prescription for Ge Qi Obstruction, Inability to Eat, Vomiting/Irritability/Panting: Helile San.

Helile Pi (Terminalia Chebulae Pericarpium) (1 liang), Muxiang (Vladimiriae Radix) (3 fen), Chen Ju pi (Citri Reticulatae Pericarpium) (1 liang), Wuweizi (Schisandrae Chinensis Fructus) (3 fen), Banxia (Pinelliae Rhizoma) (3 fen), Renshen (Ginseng Radix) (3 fen), Guixin (Cinnamomi Cortex) (3 fen), Chi Fuling (Poria with Red Heart) (3 fen), Lugeng (Phragmitis Rhizoma) (1 liang, crushed), Zhike (Aurantii Fructus) (3 fen).