经曰∶“中焦受气，取汁变化而赤，谓之血。此知血生于中焦，而主于心，故五脏各有守经之
血，而六腑则无之。其散于脉内者，随冲任督三经，遍行经络。其散在脉外者，周流于肌腠毛皮之
间。凡吐血、衄血，牙龈齿缝出血，皆散在经络之血，涌而上决者也。近人谓巨口吐红，及牙龈齿
缝出血者，谓之胃血，此说大谬。盖胃为外腑，职司出纳，为水谷蓄泄之要区，其中并无一丝一点
之血。即牙宣出血一症，不过胃火炽盛，肉不附骨，故血热而上涌。其牙不宣而出血者，乃阴虚阳
亢，龙雷之火冲激胃经所致。湖州钱左，患齿缝出血，牙并不宣，多则血流盈盏，昼夜十余次，面
红目赤，烦扰不安，为制苍玉潜龙汤，连服十余剂而愈。
苍玉潜龙汤（自制）
生地（四钱） 龟版（六钱） 石膏（三钱） 龙齿（二钱） 石斛（三钱） 花粉（二钱）
丹皮（一钱五分） 羚羊角（一钱五分） 沙参（四钱） 白芍（一钱五分） 藕（三两） 茅根
（五钱与藕同煎汤代水）
关格一证，所系最大，《灵、素》诸书及秦越人、张长沙，俱皆论列，而未有成方；后起诸贤
，又绝无论及此证者。迨云歧子谓阴阳易位，病名关格。所传九方，动辄脑、麝、硝、黄、皂角，
非开透，即劫夺，奄奄将毙之人，其能堪此乎！是有方不如无方，医学中反添一重魔劫矣。《素问
》谓∶人迎一盛，病在少阳；二盛在太阳；三盛在
阳明；四盛以上为格阳。寸口一盛，病在厥阴；二盛在少阴；三盛在太阴；四盛以上为关阴。经络
分明，言言典要，而惜乎治法不传也。秦越人发为阴乘阳乘之论，乃合寸尺之脉并言之。寸上过位
，入鱼际为溢；尺下过位，入尺泽为复；此阴阳之偏，各造其极，最为精当，而惜乎治法不传也。
张长沙谓寸口脉浮而大，浮为虚，大为实，在尺为关，在寸为格。又曰∶心脉洪大而长，则关格不
通。又谓趺阳脉伏而涩，伏则吐逆，水谷不化，涩则食不得入，名曰关格。凡三言之。其曰在寸为格
，在尺为关者，乃言阴阳不相荣也。其曰心脉洪大而长，则关格不通者，言五志不安，营卫亏损，
孤阳独发，故上下不通也。曰趺阳脉伏而涩者，乃胃气败坏之明征也。察脉论证，更为详尽，而惜
乎治法不传也。至西江喻氏，力讲调和营卫，不偏阴，不偏阳，听胃气之自为敷布，不问其关于何
而开，格于何而通，一惟求之于中，握枢而运，以渐透于上下，营气通则加意于营，卫气通则加意于
卫，因立进退黄连汤二方，又立资液救焚汤一方，以为标准，此与云歧子之九方，霄壤悬殊矣。而愚则
以为所重者尤在于上。苟在上之格者能通，则在下之关者亦无不通。尝见患此证者，多起于忧愁怒
郁，即富贵之家，亦多有隐痛难言之处，可见病实由于中上焦，而非起于下焦也。始则气机不利，
喉下作梗；继则胃气反逆，食入作吐；后乃食少吐多，痰涎上涌，日渐便溺艰难。此缘心肝两经之
火煎熬太过，营血消耗，郁蒸为痰；饮食入胃，以类相从，谷海变为痰薮，而又孤阳独发，气火升
痰，宜其格而不入也。格与关皆为逆象，惟治之以至和，导之以大顺，使在上者能顺流而下，则在
下者亦迎刃而解矣。故于调养营卫之中，平肝理气，此一法也。于调养营卫之中，和胃化痰，亦一
法也。于调养营卫之中，兼清君相之火，又一法也。关格既成，本难施治，但仁人孝子必不忍坐视危亡，欲于死中求活，
非精心研究不可。续制四方，以备参酌。
肝气犯胃，食入作吐，宜解郁和中，归桂化逆汤主之。
归桂化逆汤（自制）
当归（二钱） 白芍（一钱五分酒炒） 青皮（一钱） 茯苓（二钱） 肉桂（五分）
郁金（二钱） 合欢花（二钱） 蒺藜（四钱） 牛膝（二钱） 玫瑰花（五分） 木香
（五分） 红枣（五枚） 降香（五分）
方以归桂化逆名，归、桂为主药无疑矣。以归、芍、红枣养其血，即以合欢、郁金、玫瑰解其
郁，以青皮、蒺藜、木香、降香利其气，又以茯苓、牛膝引之下达，治格而亦顾及关矣。祖怡注。
痰气上逆，食入呕吐，人参半夏汤主之。
人参半夏汤（自制）
人参（二钱） 半夏（三钱） 广皮（一钱） 茯苓（二钱） 当归（二钱)
沉香（五分） 郁金（二钱） 砂仁（一钱） 佩兰（一钱） 苡仁（四钱） 牛膝
（二钱） 佛手（五分） 白檀香（五分）
此方亦所以治格。以人参、当归顾气血，以茯苓、苡仁、牛膝，引之下行；以半夏、陈皮利痰，以佩兰、郁金、砂
仁、佛手、沉香、檀香通气。前法轻而此方较重，彼重用肉桂，此重用人参，意同而法自异也。祖怡注。
孤阳独发，阻格饮食，甚则作呃，和中大顺汤主之。
和中大顺汤（自制）
人参（二钱） 白芍（一钱） 丹皮（二钱） 柏仁（二钱） 潼蒺藜（三钱）
麦冬（二钱） 赤芍（一钱） 白蒺藜（三钱） 丹参（三钱） 生地（四钱） 赭石
（三钱 研） 合欢花（二钱） 竹沥（两大匙冲服） 姜汁（二滴冲服）
此方有人参、麦冬养胃家之气阴，益以生地、白芍配独发之孤阳。丹参、柏仁养心血，丹皮、
赤芍清心肝。合欢开心，赭石镇逆，竹沥、姜汁豁痰，潼白蒺藜补肾疏肝。仍着重治格，而大利于
开关。前方重用香药，此方则重用润药。祖怡注。
二气双调饮，通治关格。
二气双调饮（自制）
人参（二钱） 茯苓（二钱） 山药（三钱） 归身（二钱） 枸杞（三钱） 干
苁蓉（三钱） 牛膝（二钱） 广皮（一钱） 半夏（一钱五分） 砂仁（一钱） 青皮（一
钱五分蜜水炒） 沉香（五分人乳磨冲）
所谓二气者，阴阳也。所谓双调者，不偏阳不偏阴也。人参、茯苓、山药偏于阳，人乳、归身
、枸杞、苁蓉偏于
阴，有沉香、砂仁、陈皮、青皮以和之，通治关格，此其所以为双调也。祖怡注。
As stated in the *Huangdi Neijing* (Yellow Emperor's Inner Canon): "The Middle Jiao receives Qi, extracts fluids, transforms them, and turns them red; this is called Blood." This indicates that blood is generated in the Middle Jiao and is governed by the Heart. Therefore, each of the Five Zang organs has blood retained within its meridians, whereas the Six Fu organs do not. The blood dispersed within the vessels follows the Chong Mai (Penetrating Vessel), Ren Mai (Conception Vessel), and Du Mai (Governing Vessel), circulating throughout the meridians. The blood dispersed outside the vessels flows continuously between the muscle layers and skin/hair follicles. Any instance of hematemesis (vomiting blood), epistaxis (nosebleed), or bleeding from the gums and interdental spaces is due to blood scattered in the meridians surging upward and rupturing the vessel walls. Recent practitioners refer to profuse vomiting of blood and bleeding from the gums and teeth as "Stomach Blood," which is a gross error. The Stomach, being an external Fu organ, is responsible for reception and excretion, serving as the primary area for the storage and discharge of food and fluids; it contains not even a trace of blood. Even in cases of gingival recession with bleeding (Ya Xuan), it is merely due to blazing Stomach Fire causing the gum tissue to detach from the bone, leading to heat-induced blood surging upward. In cases where the teeth are not receding but bleeding occurs, it is caused by Yin deficiency with Yang hyperactivity, where Dragon-Lei Fire (Ministerial Fire) attacks the Stomach Meridian. Mr. Qian Zuo from Huzhou suffered from interdental bleeding without gum recession, with severe episodes filling a cup with blood, occurring more than ten times day and night. He presented with a red face, red eyes, and restlessness. I prescribed Cangyu Qianlong Decoction, which he took for over ten doses, resulting in a cure.
Cangyu Qianlong Decoction (Self-made Formula)
Sheng Di Huang (Rehmanniae Radix Preparata, 4 qian) Gui Ban (Testudinis et Chelonis Carapax et Plastrum, 6 qian) Shi Gao (Gypsum Fibrosum, 3 qian) Long Chi (Dent Draconis, 2 qian) Shi Hu (Dendrobii Caulis, 3 qian) Hua Fen (Trichosanthis Radix, 2 qian)
Dan Pi (Moutan Cortex, 1.5 qian) Ling Yang Jiao (Saigae Tataricae Cornu, 1.5 qian) Sha Shen (Glehniae Radix, 4 qian) Bai Shao (Paeoniae Radix Alba, 1.5 qian) Ou (Nelumbinis Rhizoma, 3 liang) Mao Gen (Imperatae Rhizoma, 5 qian, decocted together with Lotus Root to replace water)
The syndrome of Guan Ge (Obstruction and Rejection) is of great significance. It was discussed in various texts such as the *Ling Shu* and *Su Wen*, as well as by Qin Yue Ren (Bian Que) and Zhang Chang Sha (Zhang Zhongjing), yet no fixed formula was established. Later scholars rarely mentioned this syndrome. It was Yun Qi Zi who proposed that when Yin and Yang exchange positions, the disease is named Guan Ge. His nine transmitted formulas often employed substances like Nao Bing (Camphor), She Xiang (Moschus), Xiao Ming (Mirabilite), Da Huang (Rhei Radix et Rhizoma), and Zao Jiao (Gleditsiae Fructus Spina). These methods either open orifices aggressively or劫夺 (plunder/rob) healthy Qi. How could a patient on the verge of death endure such treatment? Having such formulas is worse than having none, adding another demonic trial to medicine. The *Su Wen* states: If the Ren Ying pulse is one-fold stronger than the Cun Kou pulse, the disease is in Shaoyang; two-fold in Taiyang; three-fold in Yangming; four-fold or more is Ge Yang (Exterior Rejection due to Yang). If the Cun Kou pulse is one-fold stronger than the Ren Ying, the disease is in Jueyin; two-fold in Shaoyin; three-fold in Taiyin; four-fold or more is Guan Yin (Interior Obstruction due to Yin). The meridian pathways are clear, and every word adheres to canonical essentials, yet unfortunately, the treatment methods were lost. Qin Yue Ren developed the theory of Yin invading Yang and Yang invading Yin, discussing the Cun (inch) and Chi (cubit) pulses together. When the Cun pulse exceeds its normal position and enters the Yu Ji region, it is called Yi (Overflow); when the Chi pulse exceeds its position and enters the Chi Ze region, it is called Fu (Return). This represents the extreme deviation of Yin and Yang, which is most precise, yet again, the treatment methods were lost. Zhang Chang Sha stated: If the Cun Kou pulse is floating and large, floating indicates deficiency, and large indicates excess. At the Chi position, it is Guan (Obstruction); at the Cun position, it is Ge (Rejection). He also said: If the Heart pulse is洪大 (surging-large) and long, then Guan Ge is blocked. He further stated: If the Zu Yang pulse is deep (Fu) and choppy (Se), deep indicates vomiting and regurgitation with undigested food and drink; choppy indicates inability to ingest food, named Guan Ge. He mentioned this three times. When he said "at Cun is Ge, at Chi is Guan," he referred to the failure of Yin and Yang to nourish each other. When he said "Heart pulse surging-large and long implies Guan Ge blockage," he meant that unrest of the Five Emotions leads to depletion of Ying and Wei Qi, causing solitary Yang to flare up, thus blocking upper and lower communication. When he said "Zu Yang pulse deep and choppy," it is a clear sign of Stomach Qi deterioration. Pulse diagnosis and symptom differentiation were more detailed, yet unfortunately, the treatment methods were lost. Later, Yu Jia Yan from Xijiang vigorously advocated harmonizing Ying and Wei Qi, neither favoring Yin nor Yang, allowing Stomach Qi to distribute itself naturally, regardless of where the obstruction or rejection lies. He sought treatment in the center, grasping the pivot to operate, gradually penetrating up and down. If Ying Qi is unblocked, focus is placed on nourishing Ying; if Wei Qi is unblocked, focus is placed on nourishing Wei. Thus, he established two variations of Huanglian Tang (Coptis Decoction) and one formula, Ziye Jiufen Tang (Fluid-Nourishing Fire-Rescuing Decoction), as standards. This differs vastly from Yun Qi Zi's nine formulas. However, I believe the emphasis should be on the Upper Jiao. If the Ge (Rejection) in the upper part can be unblocked, then the Guan (Obstruction) in the lower part will also be unblocked. I have observed that patients with this syndrome often start from sorrow, anger, and depression. Even among the wealthy, there are many unspeakable hidden pains. Thus, the disease actually originates in the Middle and Upper Jiao, not the Lower Jiao. Initially, Qi mechanism is obstructed, causing a feeling of lump in the throat. Subsequently, Stomach Qi rebels, causing vomiting after eating. Finally, intake decreases while vomiting increases, phlegm-saliva surges upward, and urination and defecation become increasingly difficult. This is because excessive fire in the Heart and Liver meridians consumes Ying Blood, condensing into phlegm through stagnation and steaming. Food entering the stomach follows its kind, turning the Stomach's abundance into a swamp of phlegm. Coupled with the flare-up of solitary Yang, Qi and Fire rise with phlegm, naturally causing rejection and inability to ingest. Both Ge and Guan are adverse phenomena. Treatment must employ utmost harmony and guide with great smoothness, enabling the upper part to flow downward smoothly, so the lower part resolves easily. Therefore, within the method of nourishing Ying and Wei Qi, soothing the Liver and regulating Qi is one approach. Within this method, harmonizing the Stomach and resolving phlegm is another approach. Within this method, clearing both Ministerial and Imperial Fire is a third approach. Once Guan Ge is established, it is inherently difficult to treat. However, benevolent people and filial sons cannot bear to watch their loved ones perish; they seek life amidst death, requiring careful research. Thus, I formulated four additional prescriptions for reference.
When Liver Qi invades the Stomach, causing vomiting after eating, one should resolve depression and harmonize the middle using Guigui Huani Decoction.
Guigui Huani Decoction (Self-made Formula)
Dang Gui (Angelicae Sinensis Radix, 2 qian) Bai Shao (Paeoniae Radix Alba, 1.5 qian, wine-fried) Qing Pi (Citri Reticulatae Pericarpium Viride, 1 qian) Fu Ling (Poria, 2 qian) Rou Gui (Cinnamomi Cortex, 0.5 qian)
Yu Jin (Curcumae Radix, 2 qian) He Huan Hua (Albiziae Flos, 2 qian) Ji Li (Tribuli Fructus, 4 qian) Niu Xi (Achyranthis Bidentatae Radix, 2 qian) Mei Gui Hua (Rosae Rugosae Flos, 0.5 qian) Mu Xiang (Aucklandiae Radix, 0.5 qian) Hong Zao (Jujubae Fructus, 5 pieces) Jiang Xiang (Dalbergiae Odoriferae Lignum, 0.5 qian)
The formula is named Guigui Huani, undoubtedly making Dang Gui and Rou Gui the principal herbs. Dang Gui, Bai Shao, and Hong Zao nourish Blood; He Huan Hua, Yu Jin, and Mei Gui Hua resolve depression; Qing Pi, Ji Li, Mu Xiang, and Jiang Xiang promote Qi circulation; Fu Ling and Niu Xi guide the action downward. This treats Ge (Rejection) while also addressing Guan (Obstruction). Note by Zuyi.
When Phlegm-Qi rebels upward, causing vomiting after eating, use Renshen Banxia Decoction.
Renshen Banxia Decoction (Self-made Formula)
Ren Shen (Ginseng Radix, 2 qian) Ban Xia (Pinelliae Rhizoma Preparatum, 3 qian) Guang Pi (Citri Reticulatae Pericarpium, 1 qian) Fu Ling (Poria, 2 qian) Dang Gui (Angelicae Sinensis Radix, 2 qian)
Chen Xiang (Aquilariae Lignum Resinatum, 0.5 qian) Yu Jin (Curcumae Radix, 2 qian) Sha Ren (Amomi Fructus, 1 qian) Pei Lan (Eupatorii Herba, 1 qian) Yi Yi Ren (Coicis Semen, 4 qian) Niu Xi (Achyranthis Bidentatae Radix, 2 qian) Fo Shou (Citrus Sarcodactylis Fructus, 0.5 qian) Bai Tan Xiang (Santalum Album Lignum, 0.5 qian)
This formula also treats Ge (Rejection). Ren Shen and Dang Gui protect Qi and Blood; Fu Ling, Yi Yi Ren, and Niu Xi guide downward; Ban Xia and Chen Pi resolve phlegm; Pei Lan, Yu Jin, Sha Ren, Fo Shou, Chen Xiang, and Tan Xiang promote Qi flow. The previous method was lighter, while this one is heavier. The former heavily used Rou Gui, while this one heavily uses Ren Shen. The intent is similar, but the method differs. Note by Zuyi.
When Solitary Yang flares up alone, blocking food and drink, and even causing hiccups, use Hezhong Dashun Decoction.
Hezhong Dashun Decoction (Self-made Formula)
Ren Shen (Ginseng Radix, 2 qian) Bai Shao (Paeoniae Radix Alba, 1 qian) Dan Pi (Moutan Cortex, 2 qian) Bai Ren (Platycladi Semen, 2 qian) Tong Ji Li (Tribuli Fructus, 3 qian)
Mai Dong (Ophiopogonis Radix, 2 qian) Chi Shao (Paeoniae Radix Rubra, 1 qian) Bai Ji Li (Tribuli Fructus, 3 qian) Dan Shen (Salviae Miltiorrhizae Radix, 3 qian) Sheng Di Huang (Rehmanniae Radix, 4 qian) Zhe Shi (Haematitum, 3 qian, powdered) He Huan Hua (Albiziae Flos, 2 qian) Zhu Li (Bambusae Succus, 2 large spoons, mixed in) Jiang Zhi (Zingiberis Recens Juice, 2 drops, mixed in)
This formula uses Ren Shen and Mai Dong to nourish Stomach Qi and Yin, supplemented by Sheng Di Huang and Bai Shao to subdue the flaring solitary Yang. Dan Shen and Bai Ren nourish Heart Blood; Dan Pi and Chi Shao clear Heart and Liver heat. He Huan Hua opens the mind; Zhe Shi suppresses rebellion; Zhu Li and Jiang Zhi resolve phlegm; Tong Ji Li and Bai Ji Li tonify Kidney and soothe Liver. It still emphasizes treating Ge (Rejection) but greatly facilitates opening Guan (Obstruction). The previous formula heavily used aromatic drugs, while this one heavily uses moistening drugs. Note by Zuyi.
Erqi Shuangtiao Yin (Two-Qi Dual-Harmonizing Drink) treats Guan Ge universally.
Erqi Shuangtiao Yin (Self-made Formula)
Ren Shen (Ginseng Radix, 2 qian) Fu Ling (Poria, 2 qian) Shan Yao (Dioscoreae Rhizoma, 3 qian) Gui Shen (Angelicae Sinensis Radix, 2 qian) Gou Qi (Lycii Fructus, 3 qian) Rong Rong (Cynomorii Folium, 3 qian) Niu Xi (Achyranthis Bidentatae Radix, 2 qian) Guang Pi (Citri Reticulatae Pericarpium, 1 qian) Ban Xia (Pinelliae Rhizoma Preparatum, 1.5 qian) Sha Ren (Amomi Fructus, 1 qian) Qing Pi (Citri Reticulatae Pericarpium Viride, 1.5 qian, honey-water fried) Chen Xiang (Aquilariae Lignum Resinatum, 0.5 qian, ground with human milk and mixed)
"Two Qi" refers to Yin and Yang. "Dual Harmonizing" means neither favoring Yang nor Yin. Ren Shen, Fu Ling, and Shan Yao lean towards Yang; Human Milk, Gui Shen, Gou Qi, and Rong Rong lean towards Yin. Chen Xiang, Sha Ren, Chen Pi, and Qing Pi harmonize them. This universally treats Guan Ge, which is why it is called Dual Harmonizing. Note by Zuyi.