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In the *Ling Shu: Shang Ge Pian* chapter, the Yellow Emperor asked: "Qi stagnation causing Upper Ge (obstruction above) manifests as food and drink being vomited immediately after ingestion; I already understand this. Regarding Lower Ge (obstruction below) caused by parasites, where food is vomited only after a period of time has passed since eating, I do not grasp the rationale behind it and wish to hear your complete explanation." Qibo replied: "If emotions such as joy and anger are imbalanced, dietary intake lacks moderation, and exposure to cold or heat is irregular, then cold fluids will flow into the intestines. When these cold fluids flow into the intestines, the parasites become cold. When parasites become cold, they accumulate and gather, residing at the Xia Wan (lower opening of the stomach). This causes the intestines and stomach to become distended and expanded, preventing the Wei Qi (Defensive Qi) from circulating normally, allowing pathogenic factors to occupy the space. When a person eats, the parasites move upward to feed. As they move upward, the Xia Wan becomes deficient. When the Xia Wan is deficient, pathogenic factors prevail. The accumulated material remains stagnant; if it stays for too long, an abscess forms. Once the abscess forms, the Xia Wan becomes constricted and obstructed. If the abscess is within the lumen, pressing on it causes deep pain; if the abscess is outside the lumen, the pain on the surface is superficial, and the skin over the abscess feels hot."

Ma Shi commented: "The 'Ge' refers to the diaphragm membrane, which aligns anteriorly with the Jiutui point (CV15) and posteriorly with the eleventh thoracic vertebra. Its function is to block turbid Qi, preventing it from ascending to harass the Heart and Lungs. However, diseases located above the diaphragm are caused by Qi stagnation, where food and drink enter and are immediately regurgitated. Diseases located below the diaphragm are caused by parasite accumulation, where food and drink remain for about one shichen (two hours) before being expelled. This results from emotional imbalance, irregular diet, and improper temperature regulation, leading to cold fluids flowing into the intestines. Consequently, parasites gather in the Xia Wan due to cold (located two cun above the umbilicus). Because parasites gather at the Xia Wan, the intestines and stomach become distended, and Wei Yang Qi cannot ascend to nourish, allowing pathogenic factors to reside. The parasites move upward due to food intake; upon moving up, the Xia Wan becomes deficient, allowing pathogenic factors to prevail. Accumulation leads to obstruction, and obstruction leads to constriction ('Yue' means closure). If the obstruction is inside the stomach tube, pressing causes deep pain; if outside, pressing causes superficial pain; the skin over the obstruction is hot because the blockage is lower down, so food and drink take time to pass through.

Nan's analysis states: The *Su Wen: Yin Yang Bie Lun* says: 'When Yi Yang (the first Yang channel) is affected, its transmission leads to Ge.' It also says: 'San Yang (the three Yang channels) becoming knotted is called Ge.' 'Yi Yang' refers to the Shaoyang channel. Shaoyang governs the pivot mechanism; when the pivot is diseased, Qi stagnates and fails to rotate, eventually transmitting into a Ge disease. 'San Yang' refers to the Taiyang channel. Taiyang governs opening and releasing; its Qi moves from interior to exterior. If the channel is knotted and cannot open, internal obstruction occurs without circulation. These all refer to Yang Qi depression and rebellion causing Ge disease, which corresponds to the 'Qi causing Upper Ge' mentioned in this text. Regarding 'Lower Ge,' it arises because cold fluids flow into the intestines, accumulating and knotting to form an abscess. Treatment should primarily focus on unblocking Yang and breaking blood stasis. Its etiology differs from that of 'Yi Yang onset' and 'San Yang knotting.' Furthermore, regarding 'Wei Qi failing to circulate,' Wei Qi originates in the Lower Jiao, while Ying Qi (Nutritive Qi) originates in the Middle Jiao. Wei Qi ascends from below and communicates with Ying Qi, distributing Ying and Wei via the chest. Now, due to accumulation in the Xia Wan, Wei Qi cannot interact with Ying Qi, causing the upright Qi of Yin and Yang to lose their proper position, allowing abnormal pathogenic Qi to occupy and distend the intestines and stomach. Thus, food and drink remain undigested and are regurgitated after a delay, resembling what later generations termed Fan Wei disease (regurgitation)."