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Patient Wang: Phlegm turbidity obstructs the middle jiao (middle burner), causing epigastric pain after eating, profuse flow of clear saliva from the mouth, and vomiting of sticky phlegm. Stool is hard and dry, indicating depletion of intestinal fluids. Frequent empty belching indicates failure of stomach qi to descend. The proposed treatment method is to resolve phlegm, harmonize the stomach, direct rebellious qi downward, and moisten the intestines.
*Imperatae Radix Rhizoma* (prepared with salt water) *Ostreae Concha* *Armeniacae Semen Amarum* *Pinelliae Tuber* *Citri Reticulatae Pericarpium* *Trichosanthis Pericarpium* *Arcae Concha* *Perillae Fructus* *Sinapis Albi Semen* *Raphani Fructus* *Zingiberis Rhizoma Recens Juice* *Dioscoreae Hypoglaucae Tuber Juice*

Patient Hu: Qi stagnation in the middle jiao, vomiting immediately after eating, the condition has persisted for a month, concern that it may develop into dysphagia (Yi Ge).
*Coptidis Rhizoma* (stir-fried with *Evodiae Fructus*) *Atractylodis Macrocephalae Rhizoma* *Pinelliae Tuber* *Agastachis Herba* *Citri Reticulatae Pericarpium* *Fritillariae Thunbergii Bulb* (charred) *Cyperi Rhizoma* *Poria* *Curcumae Longae Rhizoma* *Amomi Fructus Rotundus*

Patient Zhang: Ying (nutritive) yin deficiency causes internal heat and insomnia. Rebellious qi and fire cause a sensation of obstruction in the throat. The proposed treatment uses Si Wu Tang (Four Substances Decoction) to nourish yin, and Si Qi Tang (Seven Emotions Decoction) to regulate qi.
*Rehmanniae Radix Preparata* (mixed with *Amomi Fructus Rotundus*) *Perillae Caulis* *Poria* *Angelicae Sinensis Radix* *Magnoliae Officinalis Cortex* *Glehniae Radix* *Paeoniae Radix Alba* *Pinelliae Tuber* *Ziziphi Jujubae Semen* *Zingiberis Rhizoma Recens cum Bamboo Juice* *Loquat Leaf*

Patient Chen: Ying blood deficiency with hyperactive fire, dryness of stomach yin causing food dysphagia. From the heart diaphragm to the throat, there is a burning sensation like fire, sometimes accompanied by gurgling sounds; this is due to the constraint of qi and fire. The illness is related to emotional states and cannot be cured solely by medication; one should maintain a joyful mood to potentially prolong life.
*Imperatae Radix Rhizoma* *Ostreae Concha* *Glehniae Radix* *Gardeniae Fructus* (blackened) *Poria* *Fritillariae Cirrhosae Bulbus* *Fritillariae Thunbergii Bulb* (charred) *Ophiopogonis Radix* *Armeniacae Semen Amarum* *Bambusae Caulis in Taenias Succus* *Loquat Leaf*

Follow-up: Rebellious qi and fire are ascending, causing throat discomfort, chest pain, and food dysphagia; dysphagia (Ge Zheng) has already formed. Moreover, at over sixty years old and having been a vegetarian for thirty years, stomach fluids are depleted. To moisten stomach yin and facilitate eating, maintaining emotional comfort is essential.
Add *Panax Quinquefolius Radix* and *Pinelliae Tuber* to the previous prescription.

Patient Ding: The pulse is wiry and stiff. Appearing in spring, this indicates a wiry pulse without stomach qi. Pain and obstruction upon swallowing, and hard, dry stool indicate hyperactivity of liver wood and fire, with depletion of stomach juice and intestinal fluids. Treatment will be difficult.
*Imperatae Radix Rhizoma* *Armeniacae Semen Amarum* *Hemp Seed* *Peach Kernel* *Perillae Fructus* *Canarium Fruit* *Dioscorea Hypoglauca* *Reed Rhizome*

Follow-up: The previous formula moistened dryness to relieve constraint. Now, a formula to direct qi downward and resolve phlegm is prescribed.
*Ophiopogonis Radix* *Pinelliae Tuber* *Armeniacae Semen Amarum* *Citri Reticulatae Pericarpium* *Fritillariae Cirrhosae Bulbus* *Poria* *Bambusae Caulis in Taenias Succus* *Reed Rhizome* *Dioscorea Hypoglauca* *Ezeis Concha* *Loquat Leaf*

Note by Yuan: These two formulas are pleasantly moistening and clearly belong to a master physician.

Patient Qin: Phlegm and qi obstruct the chest, causing excessive phlegm and chest tightness. Eating sometimes induces vomiting, and bilateral temporal regions are distended and painful. Clear qi fails to ascend, turbid qi fails to descend. If prolonged, it may develop into dysphagia.
*Pinelliae Tuber* *Citri Reticulatae Pericarpium* *Poria* (*Coptidis Rhizoma* stir-fried with *Evodiae Fructus* juice) *Codonopsis Radix* *Alismatis Rhizoma* *Agastachis Herba* *Imperatae Radix Rhizoma* *Aurantii Fructus Immaturus* *Fritillariae Cirrhosae Bulbus* *Amomi Fructus Rotundus* *Cinnamomi Cortex* *Arecae Pericarpium* *Atractylodis Rhizoma* *Zingiberis Rhizoma Recens*
*Lai Fu Dan* (1 qian), taken with decoction juice.

Patient Chen: Grief from the loss of a son caused qi rebellion leading to fainting. The left pulse is deep, rapid, and unsmooth, indicating liver qi stagnation and insufficient blood to nourish. The right Guan and Cun positions show slippery and forceful pulses, indicating phlegm and fire. Lung and stomach qi fail to descend; liver wood fire ascends, steaming fluids into phlegm, blocking airways. This causes a sensation of obstruction in the throat and chest diaphragm, with occasional vomiting and dysphagia upon eating. Extreme emotions often transform into fire. Crying without tears and dry, blurry vision indicate hyperactive yang with yin failing to ascend. Current treatment involves smoothing qi and directing fire downward, followed by clearing metal to pacify wood.
*Perillae Fructus* *Poria* *Pinelliae Tuber* *Aurantii Fructus Immaturus* *Armeniacae Semen Amarum* *Fritillariae Cirrhosae Bulbus* *Bambusae Caulis in Taenias Succus* *Glehniae Radix* *Citri Reticulatae Pericarpium* *Ophiopogonis Radix* *Ezeis Concha* *Dioscorea Hypoglauca*
This formula is a modification of Si Qi Tang, Wen Dan Tang, and Mai Dong Yin. It directs qi downward, resolves phlegm, generates fluids, and harmonizes the stomach. Since the disease originates in the liver and involves lung and stomach, treatment should focus on these three organs.

Patient Qin: Seven emotions constrained, phlegm and qi condensed. Chest diaphragm discomfort, occasional vomiting and rebellion. Symptoms have lasted half a year, spleen and stomach are severely deficient. Previous use of Si Qi Tang and Er Chen Tang directed qi downward and resolved phlegm. Now, Li Zhong Tang is added to tonify the middle earth, focusing on treating the root.
Si Qi Tang combined with Er Chen Tang. Li Zhong Tang plus *Saussureae Involucratae Capitulum*, *Costi Rhizoma*, *Amomi Fructus Rotundus*.

Patient Xu: Qi constraint in the chest leads to dysphagia; qi stagnation in the abdomen leads to abdominal distension. Food is not accepted, and flesh rapidly wastes away.
Yin qi condenses, yang qi is buried. Pulse is fine as a silk thread. Temporarily use methods to tonify earth, unblock yang, and transform qi.
*Codonopsis Radix* *Cinnamomi Cortex* *Atractylodis Macrocephalae Rhizoma* *Arecae Pericarpium* *Aconiti Lateralis Radix Preparata* *Alismatis Rhizoma* *Poria* *Lai Fu Dan*

Note by Yuan: Injury to the stomach leads to dysphagia; injury to the spleen leads to distension. Dysphagia often involves constrained fire; distension often involves yang deficiency. When the governing function of lung metal fails, liver wood attacks it.

Patient Zhou: Chest pain and vomiting of clear fluid. Since childhood, alcohol-dampness has accumulated in the stomach, yang qi is not disseminated, and turbid qi condenses.
Suddenly recalling an episode last year of sudden asthma and rising qi, with profuse sweating on the forehead, occurring several times. Now, epigastric discomfort resembling hunger is added. All these are stomach diseases. Use Xiao Ban Xia Tang.
*Pinelliae Tuber* *Poria* *Citri Reticulatae Pericarpium* *Bambusae Caulis in Taenias Succus* *Zingiberis Rhizoma Recens*

Note by Yuan: Sudden asthma and forehead sweating indicate lung and kidney involvement, not just the stomach.

Follow-up: Retained fluids generate phlegm, vomiting sour fluid, and board-like chest pain. Previously, Xiao Ban Xia Tang was used to eliminate retained fluids. Now, wind pathogen injures the lung, causing cough and internal heat. Jin Fei Cao San is proposed to disperse wind and direct qi downward, still containing elements to dispel phlegm and eliminate fluids, treating both lung and stomach.
*Sparganii Rhizoma* *Pinelliae Tuber* *Citri Reticulatae Pericarpium* *Poria* *Farfarae Flos* *Armeniacae Semen Amarum* *Schizonepetae Spica* *Peucedani Radix* *Bambusae Caulis in Taenias Succus* *Loquat Leaf*

Patient Zhao: Qi and water constrain to form phlegm, causing throat obstruction and difficulty eating. Eating immediately induces vomiting of clear fluid and rice grains. The disease is located in the upper part of the stomach. Medications to direct qi downward and resolve phlegm should be chosen for their non-drying nature.
*Trichosanthis Semen* *Pinelliae Fermentatum* *Fritillariae Cirrhosae Bulbus* *Citri Reticulatae Pericarpium* *Illicii Fructus* *Meretrix Shell* (mixed with 3 fen of *Indigo Naturalis*, wrapped for decoction) *White Honey* *Loquat Leaf* *Bambusae Caulis in Taenias Succus* *Reed Rhizome* *Zingiberis Rhizoma Recens Juice* (taken by mixing)

Follow-up: All rebellious upward movements belong to fire. Vomiting immediately after eating indicates fire.
*Coptidis Rhizoma* *Pinelliae Tuber* *Perillae Caulis* *Rhei Radix et Rhizoma* (processed) *Bambusae Caulis in Taenias Succus* *Loquat Leaf*

Note by Yuan: The Nineteen Pathogenesis Statements in *Nei Jing* are not entirely accurate. Commentators dare not contradict them, merely elaborating on the text, which misleads later learners. Truth and falsehood are clear to discerning eyes. For instance, many cases of "rebellious upward movements" do not belong to fire and cannot be generalized. Readers of classics should be aware of this.

Patient Zhu: Stomach yang deficiency leads to retention of fluids; spleen yang deficiency leads to indigestion of grain. Gurgling in the abdomen, distension and fullness in chest and hypochondrium, vomiting sour fluid and clear saliva upon eating, or belching foul odor.
The method is warming and guiding, strengthening earth and promoting urination.
*Zingiberis Rhizoma Preparata* *Citri Reticulatae Pericarpium* *Atractylodis Rhizoma* *Pinelliae Tuber* *Aconiti Lateralis Radix Preparata* *Atractylodis Macrocephalae Rhizoma* *Codonopsis Radix* *Alismatis Rhizoma* *Aurantii Fructus Immaturus* *Trichosanthis Semen* *Amomi Fructus Rotundus* *Oryzae Fructus Germinatus*

Patient Shen: Fullness and bloating after eating, acid regurgitation and vomiting, classified as regurgitation (Fan Wei). Stomach pulse is tight when lightly pressed, wiry when deeply pressed. Wiry indicates wood insulting earth; tight indicates cold in the center.
*Codonopsis Radix* *Zingiberis Rhizoma Preparata* *Pinelliae Tuber* *Citri Reticulatae Pericarpium* *Poria* *Illicii Fructus* *Fritillariae Thunbergii Bulb* (charred) *Piperis Kadsurae Fructus* *Amomi Fructus Rotundus* *Citri Exocarpium*

Patient Xu: Hiccups after hematemesis, lasting one month. Tongue coating is white and greasy; right pulse is deep and slippery, left pulse is fine and weak. The qi for hiccups rushes up from the lower abdomen, indicating blood stasis mixed with turbid phlegm obstructing the collaterals of lung and stomach. Ministerial fire from the lower jiao chong vessel rebels upward, stirring phlegm, causing hiccups. The prescribed formula will surely help; do not be anxious.
*Pinelliae Tuber* *Poria* *Citri Reticulatae Pericarpium* *Angelicae Sinensis Radix* *Curcumae Longae Rhizoma* *Illicii Fructus* *Diospyroi Fructus* *Zingiberis Rhizoma Recens Juice* *Nelumbinis Nelumbo Nuciferae Semen* *Polygoni Multiflori Caulis*
Zi Shui Wan (Nourish Kidney Pill) by Dong Yuan, 1 qian, taken with decoction of *Citri Reticulatae Pericarpium* and *Zingiberis Rhizoma Recens*. For yin-cold hiccups, use *Cinnamomi Cortex* 5 fen, *Uterus Porci* 2 strips, *Aquilariae Lignum Resinatum* 6 fen, divided into two doses.

Note by Yuan: This refers to qi hiccups and phlegm hiccups, different from deficiency-cold hiccups.

Unknown Patient: After malaria, phlegm and qi obstruct the stomach, clear yang fails to ascend. Hiccups occur, vomiting upon eating, preventing development into dysphagia. Referencing Zhang Zhongjing’s phlegm-resolving and rebellion-directing formula for discussion.
*Imperatae Radix Rhizoma* *Ostreae Concha* *Zingiberis Rhizoma Siccatum* (light) *Pinelliae Tuber* *Poria* *Cyperi Rhizoma* (processed) *Illicii Fructus* *Diospyroi Fructus*

Patient Qin: Vomiting clear fluid, saliva, and rice grains upon eating indicates stomach disease. A previous fall from height caused intermittent pain in ribs, shoulders, and arms, indicating residual blood stasis in lung and stomach collaterals, hence the foul odor in vomit. The treatment is to resolve stasis, harmonize the stomach, direct rebellion downward, and stop vomiting.
*Imperatae Radix Rhizoma* *Rosae Multiflorae Radix* *Curcumae Longae Rhizoma* *Armeniacae Semen Amarum* *Pinelliae Tuber* *Moutan Cortex* (stir-fried) *Poria* *Crataegi Fructus* (charred) *Citri Reticulatae Pericarpium* *Amomi Fructus Rotundus*

Note by Yuan: Adding juices from garlic sprouts, ginger, and lotus root would be even better.

Follow-up: To stop vomiting, one must harmonize the stomach; to raise qi, one must direct it downward.
*Pinelliae Tuber* *Poria* *Atractylodis Macrocephalae Rhizoma* *Amomi Fructus Rotundus* *Agastachis Herba* *Citri Reticulatae Pericarpium* *Cinnamomi Ramulus* *Saccharomyces* *Zingiberis Rhizoma Preparata* *Aquilariae Lignum Resinatum* *Dragon's Blood* (Fulong Gan)

Patient Li: Alternating chills and fever with cough for over a year, coughing up blood-streaked sputum. Food feels stuck, chest diaphragm blocked, developing into dysphagia. This must involve qi constraint. Currently, harmonize the stomach and direct qi downward, hoping for cessation of bleeding and reduction of dysphagia.
*Imperatae Radix Rhizoma* *Pinelliae Tuber* *Armeniacae Semen Amarum* *Moutan Cortex* *Citri Reticulatae Pericarpium* *Poria* *Curcumae Longae Rhizoma* *Trichosanthis Pulvis* *Amomi Fructus Rotundus* *Bambusae Caulis in Taenias Succus* *Loquat Leaf*

Patient Chen: Sudden heart pain, food dysphagia, but porridge and drinks are acceptable. This is heart qi constraint, preventing progression to dysphagia.
*Trichosanthis Semen* *Allii Macrostemonis Bulbus* *Imperatae Radix Rhizoma* *Fritillariae Thunbergii Bulbus* *Poria Cum Pinode* *Pinelliae Tuber* *Platycodonis Radix* *Polygalae Radix* *Bambusae Caulis in Taenias Succus*

Patient Zhu: Pulse is slippery and large, food dysphagia, tongue coating is greasy. This belongs to phlegm dysphagia, with dryness-fire congealing in the large intestine. The proposal is to clear phlegm-fire and assist in unblocking.
*Imperatae Radix Rhizoma* *Ophiopogonis Radix* *Saccharomyces* *Gardeniae Fructus* (blackened) *Poria* *Pinelliae Tuber* *Glycine Soja* (fermented) *Citri Reticulatae Pericarpium* *Armeniacae Semen Amarum* *Bambusae Caulis in Taenias Succus* *Ezeis Concha* *Dioscorea Hypoglauca* *Loquat Leaf*

Patient Wu: Emotional constraint, dryness of yangming fluids internally, rebellion of shaoyin qi. Qi rushes from lower abdomen to throat, throat feels distended, food dysphagia. The proposal is to warm and nourish fluids to direct turbid yin downward.
*Imperatae Radix Rhizoma* *Ostreae Concha* *Cibotii Rhizoma* (dried) *Lycii Fructus* *Citri Reticulatae Pericarpium* *Poria* *Fritillariae Cirrhosae Bulbus* *Pinelliae Tuber* *Aquilariae Lignum Resinatum* *Phasianus Crest* *Dioscorea Hypoglauca*

Patient Sheng: Qi constraint and phlegm condensation, chest emptiness, back cold and spine pain, reduced intake with dysphagia. Severe cases result in vomiting. This is the root of dysphagia.
*Imperatae Radix Rhizoma* *Cinnamomi Ramulus* *Trichosanthis Pericarpium* *Armeniacae Semen Amarum* *Bambusae Caulis in Taenias Succus* *Ostreae Concha* *Allii Macrostemonis Bulbus* *Pinelliae Tuber* *Poria*

Second visit: Symptoms persist, phlegm is slightly easier to expectorate.
*Cinnamomi Ramulus* *Trichosanthis Pericarpium* *Zingiberis Rhizoma Preparata* *Allii Macrostemonis Bulbus* *Citri Reticulatae Pericarpium* *Armeniacae Semen Amarum* *Imperatae Radix Rhizoma* *Cervi Cornu Degelatinatum* *Bambusae Caulis in Taenias Succus* *Loquat Leaf*

Third visit: After taking warming and unblocking yang medicines, much cold phlegm was vomited, which is not bad. However, the trend of food dysphagia remains. Continue with warming and unblocking, observe changes.
*Aconiti Lateralis Radix Preparata* *Cinnamomi Ramulus* *Allii Macrostemonis Bulbus* *Pinelliae Tuber* *Citri Reticulatae Pericarpium* *Armeniacae Semen Amarum* *Peach Kernel* *Trichosanthis Semen* *Zingiberis Rhizoma Recens Juice* *Chinese Chives Root Juice*

Fourth visit: Vomiting from the upper jiao relates to qi; vomiting from the middle jiao relates to accumulation. Here, food dysphagia followed by vomiting a few mouthfuls after a short time, mostly clear fluid and sticky phlegm, indicates phlegm accumulation in the middle jiao. Ultimately, it is still the root of dysphagia.
*Aconiti Lateralis Radix Preparata* *Pinelliae Tuber* *Arcae Concha* *Citri Reticulatae Pericarpium* *Perillae Fructus* *Raphani Fructus* *Imperatae Radix Rhizoma* *Sinapis Albi Semen* *Peach Kernel* *Piperis Kadsurae Fructus*

Patient Gao: Earth yang is weak with dampness prevailing, abdominal discomfort. Use Ping Wei San and Li Zhong Tang combined.
Ping Wei San combined with Li Zhong Tang. Added *Cyperi Rhizoma* due to blood stasis.

Unknown Patient: After continuous administration of warming middle and transforming dampness medicines, gurgling sounds in the abdomen, comfort after morning meals but stagnation after evening meals, muscle twitching while lying down, occasional vomiting of sour fluid. Middle earth yang is weak, turbid yin qi from lower jiao rebels upward, disease is regurgitation. Warming middle is ineffective; the method should be to benefit the source of fire, disregarding season for symptoms, using Mao Zhu Fu Zi Li Zhong Tang combined with Zhen Wu Tang method.
Fu Zi Li Zhong Tang plus *Poria*, *Citri Reticulatae Pericarpium*, *Zingiberis Rhizoma Recens*.

Note by Yuan: Water and grain failing to transform into essence produce sour phlegm; liver wood loses nourishment, causing muscle twitching, indicating liver dryness-fire. Purely using warming and drying is useless.

Patient Zhang: Stomach juice is dry, intestinal fat is parched, food in upper jiao transforms entirely into phlegm, failing to generate fluids and blood. Vomiting upon eating, phlegm follows vomiting. The root of dysphagia deepens; advanced age requires quiet rest.
*Fresh Cibotii Rhizoma* (1 liang) *Qing Yan Ban Xia* (3 qian) *Poria* *Angelicae Sinensis Radix* *Citri Reticulatae Pericarpium* *Aquilariae Lignum Resinatum* *Aurantii Fructus Immaturus*

Second visit: For dysphagia due to fluid depletion and qi constraint, Cong Rong Wan is the main formula.
To the previous formula, add fried fragrant *Platycladi Semen*, aged *Ezeis Concha*, and *Dioscorea Hypoglauca*. Daily, steam one date cake on rice until soft, chew and swallow as desired.

Patient Sheng: The back is the position of yang, the heart is the organ of yang. Below the heart is the stomach. When phlegm-fluids occupy the upper opening of the stomach, heart yang loses its clarity, causing back coldness and food dysphagia; this is the root of dysphagia. Phlegm-fluids are yin and obstruct yang.
*Aconiti Lateralis Radix Preparata* *Cinnamomi Ramulus* *Armeniacae Semen Amarum* *Saccharomyces* *Allii Macrostemonis Bulbus* *Trichosanthis Pericarpium* *Imperatae Radix Rhizoma* *Amomi Fructus Rotundus* *Glycine Soja* (fermented) *Illicii Fructus* *Bambusae Caulis in Taenias Succus* *Loquat Leaf*

Note by Yuan: Warming middle, resolving fluids, directing rebellion downward, and moistening intestines align with ancient methods. The purpose of *Glycine Soja* (fermented) is unclear.

Patient Kong: Previous hematemesis left the stomach empty, cold fluids retained, yang qi blocked, water and grain undigested. Eating induces vomiting of sour fluid, with food following. Pulse is fine, limbs cold, yang deficiency is severe. Condition becomes regurgitation, fear of spleen failure if prolonged.
*Aconiti Lateralis Radix Preparata* *Zingiberis Rhizoma Preparata* *Illicii Fructus* *Citrus Reticulata* (preserved) *Cibotii Rhizoma* (dried) *Stink Bug* *Er Chen Tang* (with charred licorice)

Note by Yuan: Many cases of dysphagia and regurgitation start with hematemesis. Although blood is yin, frequent vomiting damages stomach yang, preventing recovery and the transformation of water and grain into essence. Loss of descending function initially causes regurgitation; long-term depletion of intestinal fluids leads to dysphagia.

Patient Yan: Dysphagia and regurgitation are diseases of the stomach. Upper jiao governs reception, middle jiao governs transport. Reception without transport causes repeated vomiting. Morning food, evening vomiting blames lack of yang in lower jiao. Proposal: Resolve phlegm in upper jiao, move qi in middle jiao, benefit fire in lower jiao, so that three jiaos perform their duties, food digests properly, and no regurgitation occurs. This is difficult.
*Imperatae Radix Rhizoma* *Ostreae Concha* *Aconiti Lateralis Radix Preparata* *Poria* *Aurantii Fructus Immaturus* *Aquilariae Lignum Resinatum* *Pinelliae Tuber* *Xin Hui Pi* (Newhui Tangerine Peel) *Alpiniae Oxyphyllae Fructus* *Cibotii Rhizoma* (light) *Dioscorea Hypoglauca* *Chicken Comb* (aged) *Ezeis Concha*

Ren Yuan says: Dysphagia, as Zhang Jifeng claimed, is often attributed to mental distress, but this is not always true. Overthinking injures spleen yin and raises liver fire, certainly causing such symptoms. However, many cases arise from excessive hematemesis or consuming cold foods/drinks, all damaging spleen and stomach yang. Stomach yang damage leads to failure to digest and lose descending function; spleen yang damage leads to failure to transport and lose ascending function. Food entering the stomach fails to transform into qi, blood, and fluids, instead becoming sour fluid and phlegm. Middle earth loses warmth and looseness; liver and gallbladder lose smoothness, constraint builds, attacking spleen and stomach. Qi constrains causing pain, rebels causing vomiting. Sweet flavors transform into sour/bitter wood/fire flavors and are vomited, bringing slight relief to chest/diaphragm. Accumulation and vomiting continue daily; over time, middle jiao qi is injured, fluids depleted, gastric opening narrows, eating causes pain. With loss of stomach qi descent, intestines lack irrigation, residue stagnates. Plus, liver/gallbladder constraint fire intensifies, causing dry, obstructed stool, possibly only passing after ten days. Stool like sheep droppings black granules is untreatable. Dysphagia is indeed difficult to treat, and ancient masters rarely had exquisite formulas. Yun Qi Zi’s Nine Formulas are too harsh. *Ju Fang* is too aromatic and drying. Recently, Yu Jiayan’s modifications of Huang Lian Tang hit the key point. Others like Danxi’s Wu Zhi An Zhong Yin and Zuo Jin Wan are also worth learning from. If stool is obstructed, never forcibly purge with Nux and Rhei. Know that when yangming qi descends, intestinal fluids flow, and obstruction resolves naturally. Regurgitation is the root of dysphagia. Ancients said "food cannot enter" is fire; "food enters and comes out" is no fire. Gallbladder/liver ministerial fire constrained in chest turns clear space into a prairie fire, scorching stomach gate, qi cannot descend, food cannot go down. This applies not only to dysphagia but also to anorectic dysentery. If dysphagia reaches this stage, five fluids are burned, untreatable. As for "food enters and comes out," although no fire, it is loss of middle palace warming/transport function, lifting/lowering dysfunction, wood/fire causing trouble, very different from fire failing to generate earth or earth deficiency/yang decline. Cannot simply use warming/drying. Zhang Zhongjing discussed "cold in chest, heat in dantian," similar to this. Yu’s Huang Lian Tang imitates this idea.
Those treating this must understand cold/hot, deficiency/excess, grasp the subtleties, and become skilled physicians.