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[Symptoms of Internal Injury Yige] During eating and drinking, one gradually feels difficulty in swallowing. Or, if swallowing is slightly hurried, food gets stuck in the chest. After about a month like this, the condition worsens day by day, eventually leading to choking with every meal. The patient can only consume thin porridge and cannot eat dry food. This is the symptom pattern of internal injury Yige (dysphagia and regurgitation).

[Etiology of Internal Injury Yige] Usually, due to chronic worry and depression, the fire of the Five Emotions (heat generated from joy, anger, worry, thought, and fear) becomes active, simmering day and night, causing the drying up of body fluids. Alternatively, long-term consumption of rich, fatty, sweet foods, spicy items, and roasted or grilled dishes, without dietary restraint, leads to accumulated heat that consumes Yin essence. Both of these factors contribute to the formation of Yige and regurgitation.

[Pulse Patterns of Internal Injury Yige] The pulse is predominantly deep and choppy (Chen Se). A deep and choppy pulse at the Left Cun position indicates exhaustion of Heart Blood; a deep and choppy pulse at the Left Guan position indicates depletion of Liver Blood; a deep and choppy pulse at the Chi position indicates deficiency of Kidney Water; a deep and choppy pulse at the Right Guan position indicates severance of Spleen Yin; a deep and choppy pulse at the Stomach position indicates dryness of Stomach Juice. When Stomach Juice is dry, the Intestines also become obstructed.

[Treatment of Internal Injury Yige] The treatment should focus on generating fluids and nourishing the Stomach, using Er Mu Er Dong Tang (Two Mothers and Two Winter Decoction). For those with deficiency, Sheng Mai San (Generate the Pulse Powder) should be used, added with blood-nourishing herbs. If Qi stagnation has persisted for a long time and phlegm-saliva has accumulated in the epigastrium, cloying and stagnating herbs must not be used. Instead, clear phlegm and fire, and open up to resolve phlegm using Maidong Tang (Ophiopogon Decoction) from *Jin Gui Yao Lue*, mixed with Zhuli (Bamboo Sap), Jiangzhi (Ginger Juice), and Lugen juice. After several doses, if the Large Intestine is hard and obstructed, add a small amount of Xuanmingfen (Mirabilite). If body fluids are dried up, Chengqi Tang (Purgative Decoction) is contraindicated. If there is accumulated heat from rich foods and the Root Yuan (Original Vitality) is robust, Chengqi Tang or Er Mu Er Dong Tang may be used.
*Er Mu Er Dong Tang* ingredients: Zhi Mu (Anemarrhenae Rhizoma), Bei Mu (Fritillariae Bulbus), Maidong (Ophiopogonis Radix), Tiandong (Asparagi Radix).
Zhu Danxi's secret formula: If there is excessive phlegm, temporarily add Qingdai (Indigo Naturalis) and Haishi (Aragonitum); if the intestines are dry, temporarily add Danggui (Angelicae Sinensis Radix) and Shaoyao (Paeoniae Radix); if Qi is stagnant and phlegm is obstructive, temporarily add Banxia (Pinelliae Rhizoma) and Xiangfu (Cyperi Rhizoma) to move the stagnation of the main formula. This is a last resort; take for two or three doses only.
Sheng Mai San see previous section on Lung Cough.
Si Shun Yin see previous section on Lung Cough.
*Jin Gui* Maidong Tang (Ophiopogon Decoction): Maidong (Ophiopogonis Radix), Banxia (Pinelliae Rhizoma), Renshen (Ginseng Radix), Jingmi (Oriza Sativa Granum), Gancao (Glycyrrhizae Radix et Rhizoma), Juhong (Citri Reticulatae Pericarpium Rubrum).
Chengqi Tang (Purgative Decoction): Zhiqiao (Aurantii Fructus), Houpo (Magnoliae Officinalis Cortex), Dahuang (Rhei Radix et Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma).

Commentary by Zhen: Geqi vomiting and Yige vomiting are both types of vomiting, but their origins differ, and their treatments are worlds apart. What formularies refer to as "Geqi vomiting" corresponds to the line in *Nei Jing* stating "Qi causes Upper Ge"; what they refer to as "Yige vomiting" corresponds to the line in *Nei Jing* stating "The binding of the Three Yangs causes Ge". Geqi vomiting involves both cold and heat patterns; Yige vomiting involves only heat, with no cold.
Yige caused by external contraction is easier to treat because it is merely temporary exposure to dryness-heat, which can be cleared. Internal injury cases are difficult to treat because the Yin essence is internally exhausted and cannot be restored quickly.
However, there are degrees of severity. In early stages, when phlegm-saliva has not yet formed, Yin-nourishing methods can be used. In chronic cases, forced feeding often leads to the vomiting of dry stomach juices. If mistaken treatment with drying-heat herbs is administered, extreme dryness may paradoxically manifest as dampness, leading to surging phlegm-saliva; extreme heat may paradoxically manifest as cold, leading to the upward rush of cold Qi. In such scenarios, Yin-nourishing herbs will cause stagnation and intolerance. Detailed discussions are found in the General Discussion of Volume One; careful study will reveal the principles. The primary requirement is proper diet. Initially, avoid dry food and spicy items; consume only soft porridge, milk, and light fermented bean curd liquids. Swallow slowly in small sips to gradually moisten and open the esophagus before swallowing. If consuming meat, cook it thoroughly over low heat and consume only the rich broth; absolutely avoid solid, hard chunks. Treat with Yangyin Zixue Tang (Nourish Yin and Nourish Blood Decoction) etc. Physicians usually discuss medication alone, but who knows that treating Yige depends more on dietary regulation? For example, if the Stomach is injured by diet, one must be cautious with food intake; if injured by labor, one must swallow saliva and rest quietly to recover.