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Zi He (He Xiaozhi) quoted from the *Neijing* (Inner Canon): "When the three yang meridians are knotted, it is called Ge (obstruction)." The so-called "three yang" refers to the Small Intestine Meridian of Hand-Taiyang, the Large Intestine Meridian of Hand-Yangming, and the Bladder Meridian of Foot-Taiyang. The term "knot" (Jie) refers to heat accumulation. If heat accumulates in the Small Intestine, the blood vessels become dry; if heat accumulates in the Large Intestine, defecation is obstructed (Qing, referring to visiting the toilet); if heat accumulates in the Bladder, body fluids are depleted. Once the three yang meridians are knotted, both urination and defecation become blocked. Since the lower orifices are obstructed, the Qi mechanism must reverse and ascend, resulting in dysphagia where food cannot be swallowed, or even if forced down, it is vomited back up. This is akin to fire being at the bottom but forced to rise upwards. Therefore, the *Neijing* states: "Where Shaoyang (Lesser Yang) Qi prevails, it manifests as vomiting, regurgitation, and inability to eat." This principle is clear.

Later generations arbitrarily divided Ge disease into "Ten Ges" and "Five Yes" (dysphagias). With so many categories, confusion has only increased. When a person begins to vomit food, it does not happen suddenly. It may be due to injury from alcohol or food stagnation, stomach heat causing an urge to vomit, or wind invading the stomach causing an urge to vomit. Physicians, failing to investigate the root cause, administer aromatic and warm herbs such as Chenxiang (Aquilaria Wood), Rougui (Cinnamon Bark), Hujiao (Black Pepper), and Dingxiang (Clove). If the condition is indeed caused by alcohol or food stagnation, purgative methods should be used; how can one claim it is deficiency and use warm tonics? For individuals who are constitutionally hot, the three yang meridians will inevitably knot, and food will tend to reflux. Yet physicians still claim it is "stomach cold failing to receive," employing burning needle therapy (Fanzhen) and moxibustion (Zhuo'ai). This causes the three yang knots to deepen over years, eventually forming a Yes disease.

The popular "Kuanzhong San" for treating five Yes contains Jiang (Ginger) and Gui (Cinnamon); the "Shige San" for ten Ge contains Fuzi (Aconite) and Wutou (Aconite Root). Are these truly applicable? In contemporary times, Liu Hejian treated Ge Qi and dysphagia using Chengqi Tang (Gut-Draining Decoction) variants, surpassing modern practitioners by carefully assessing severity. For instance, if constipation persists for a long time, moistening and nourishing methods should be used first, administering small doses of decoctions or pills repeatedly until the obstruction clears. If there is upper esophageal blockage with phlegm-saliva, mild sour-bitter emetics may be used to induce vomiting; once phlegm is expelled, purgatives can then be administered more effectively. If these fail, honey-salt enemas can be used to guide out the blockage, dissipating the knot and clearing yang, allowing food to descend naturally. One must not use Radix Euphorbiae Pekingensis (Badou, Croton Seed) which consumes the True Qi (Tianzhen).

Commentary: This discussion on "three yang knots causing Ge disease" powerfully corrects the secular error of assuming stomach cold and using hot medicines, demonstrating great clarity. However, relying solely on Chengqi Tang is too harsh. Such formulas are suitable only for excess-heat patterns; they are contraindicated for those with spleen-stomach deficiency-cold or blood exhaustion.

The *Zhenjing* (Needle Classic) states: "When anger prevails, eating causes Qi to rebel and fail to descend; when labor-fatigue Qi prevails, it causes Yes disease and panting; when excessive thought prevails, it causes middle jiao fullness and triple burner obstruction, leading to difficulty in swallowing."

Elucidation: Yes (dysphagia) arises from the six fu organs, belongs to Yang, and is governed by Qi. Se (obstruction) arises from the five zang organs, belongs to Yin, and is governed by Blood. Both conditions are caused by "Yang hidden within Yin." Specifically, Yes is often triggered by seven emotions or dysfunction in the transmission and transformation of the Triple Burner, primarily involving Qi disorders. Alternatively, it may result from blood deficiency causing dryness of the stomach lining, or blood stasis, primarily involving Blood disorders. "Se" implies blockage by filling. Thus, the *Elucidation* cites the Tongyou Tang (Unblock the幽 Decoction) for treating pyloric obstruction and severe dysphagia. Generally, Yang cannot function without Yin; when Yin loses its proper position, Yang becomes trapped within, causing transmission to reverse and ascend. Furthermore, trauma such as blows or falls can cause internal blood stasis, leading to immediate vomiting and inability to retain food, a case of combined Qi and Blood injury. Broadly speaking, if the origin is Qi-related, treatment should initially focus on regulating Qi; if Blood-related, on nourishing/moving Blood. How can one indiscriminately use aromatic-hot agents that further deplete Qi and Blood? It is merely that世俗 (secular/ordinary) physicians are rigid and fail to probe the nature of the disease, leading to critical conditions. Alas!