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This syndrome is caused by the stagnation of the seven emotions (joy, anger, worry, thought, sorrow, fear, fright) qi; or by encountering anger during meals. It is most common in women. It is generally due to the knotting of phlegm and qi, resembling a plum pit or broken cotton wadding, lodged between the throat and epiglottis, unable to be coughed out or swallowed down. It may present with fullness and distension in the Zhongwan region, with uncomfortable qi flow; or with excessive phlegm and heat, leading to upper asthma and rapid breathing; or with retained fluid causing nausea and vomiting of saliva and foam. If left untreated for a long time, it will gradually develop into Yige (dysphagia) and Guange (simultaneous vomiting and constipation). The treatment should focus on resolving stagnation and smoothing qi, benefiting the diaphragm and transforming phlegm, and clearing the lungs.

Main Formula: Chenpi (Citri Reticulatae Pericarpium), Banxia (Pinelliae Rhizoma processed with ginger), Baifuling (Poria, each 1 qian), Zhishi (Aurantii Fructus Immaturus), Qingpi (Citri Reticulatae Pericarpium Viride), Nanting (Arisaematis Rhizoma processed with ginger), Luobozij (Brassicae Semen), Suzi (Perillae Fructus), Shenqu (Massa Medicata Fermentata stir-fried), Sharen (Amomi Fructus stir-fried and crushed), Baidoukou (Cardamomi Albi Fructus crushed), Yizhiren (Alpiniae Oxyphyllae Fructus), Binglang (Arecae Semen, each 5 fen). Add five slices of fresh ginger, decoct in water. After decoction, mix in the powders of Sharen and Baidoukou. Take slowly while lying in bed.

For aggravated qi stagnation, add Xiangfu (Cyperi Rhizoma), Fuxiong (Ligustici Chuanxiong Rhizoma), and Nongpo (Magnoliae Officinalis Cortex). For aggravated distension, add Qingpi and Fupi (Tangerine Peel). For aggravated fire, add Zhizi (Gardeniae Fructus) and Huangqin (Scutellariae Radix).

Qi Qi Tang (also known as Si Qi Tang): Treats phlegm formed by the stagnation of qi due to the seven emotions and nine types of qi. Symptoms include sensations like broken cotton wadding or a plum pit stuck in the throat, unable to be coughed out or swallowed down, fullness and distension in the Zhongwan region, and uncomfortable qi flow; or symptoms such as phlegm-fluid retching and counterflow. It treats these conditions with great efficacy.

Banxia (Pinelliae Rhizoma), Fuling (Poria, each 3 qian), Zisuye (Perillae Folium), Nongpo (Magnoliae Officinalis Cortex stir-fried with ginger, each 2 qian). Add two cups of water and three slices of ginger. Decoct until one cup remains. Take well after meals.

Simple Prescription: Use one jin of dry La Zao (distiller's grains from cured wine residue) that contains no water, and half a jin of purified Puxiao (Natrii Sulfas). Mix evenly. Store in a new porcelain jar, seal it, and place it in a clean area. Each time, take three spoons, decoct in one cup of water, and drink slowly while lying in bed.

The Classics state: When yin and yang do not correspond with each other, the disease is named Guange. The Nan Jing states: When the five zang organs are not in harmony, the nine orifices become blocked; when the six fu organs are not in harmony, stagnation and knotting occur, forming abscesses. Pathogenic factors in the six fu organs cause disharmony of the yang pulses; disharmony of the yang pulses causes qi stagnation; qi stagnation leads to an excess of yang pulses. Pathogenic factors in the five zang organs cause disharmony of the yin pulses; disharmony of the yin pulses causes blood stagnation; blood stagnation leads to an excess of yin pulses. When yin qi is too excessive, yang qi cannot nourish it, hence it is called "Ge" (blocking/rejection). When yang qi is too excessive, yin qi cannot nourish it, hence it is called "Guan" (closing/obstruction). When both yin and yang are excessive and cannot nourish each other, it is called "Guange". Guange results in death before the natural lifespan is exhausted. This syndrome presents as a sensation of obstruction in the chest and diaphragm, where rising is attempted but fails, descending is attempted but fails, eating is desired but impossible. This is referred to as horizontal blocking by qi. "Guan" refers to the inability to pass urine and feces. Extreme heat qi in the lower jiao fills and blocks without exit, hence it is called "Guan". "Ge" refers to vomiting and counterflow preventing food intake. Extreme cold qi in the chest blocks rejection and prevents entry, hence it is called "Ge". For cold in the chest, hot herbs should be used for treatment; for heat in the Dantian, cold herbs should be used. For the cold in the chest and heat in the Dantian, treatments for the upper and lower should prioritize treating the root (chronic condition) slowly and the branch (acute pathogen) urgently. The Classics state: When yang is excessive and yin cannot be nourished, the Renying pulse is three times larger than the Cunkou pulse, which is called "Guan"; when yin is excessive and yang cannot be nourished, the Qikou pulse is four times larger than the Renying pulse, which is called "Ge".

Main Formula: Chenpi (Citri Reticulatae Pericarpium), Baifuling (Poria), Beimu (Fritillariae Bulbus), Zhishi (Aurantii Fructus Immaturus stir-fried with bran, 1 qian), Suzi (Perillae Fructus stir-fried and crushed), Gualouren (Trichosanthis Semen), Xiangfu (Cyperi Rhizoma stir-fried with child's urine), Fuxiong (Ligustici Chuanxiong Rhizoma), Nongpo (Magnoliae Officinalis Cortex, each 7 fen), Muxiang (Aucklandiae Radix), Chenxiang (Aquilariae Lignum Resinatum, each 5 fen, both ground separately), Gancao (Glycyrrhizae Radix et Rhizoma, 3 fen). Add three slices of fresh ginger and decoct in water. Add Dengxincao (Junci Medullia) and Zhuli (Bambusae Sap), and mix in the ground powders of Chenxiang and Muxiang before taking.

Li Ge Tang: Treats Guange.

Chenpi (Citri Reticulatae Pericarpium), Huashi (Talcum), Mutong (Akebiae Caulis, each 1 qian), Banxia (Pinelliae Rhizoma), Fuling (Poria, each 8 fen), Renshenlu (Ginseng Radicula, 1.5 qian), Gancao (Glycyrrhizae Radix et Rhizoma, 4 fen). Decoct with ginger and jujube. Take the decoction and induce vomiting. If there is qi deficiency and spleen weakness, the treatment should employ emesis to lift the horizontally blocked qi, rather than focusing on phlegm. If there is phlegm, use Erchen Tang to induce vomiting. If middle qi does not circulate, remove Huashi, Mutong, and Renshenlu from Li Ge Tang, and add Renshen (Ginseng Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Shengma (Cimicifugae Rhizoma), Zhishi (Aurantii Fructus Immaturus), and Gualou (Trichosanthis Fructus). If stomach cold prevents intake, grind Chenxiang, Muxiang, Sharen, and Baikou into powder and lick/swallow occasionally. For lower jiao constipation, grind Chengqi Tang into powder, make pills with paste, dry them, and take with water. Alternatively, make a ring with Dahuang (Rhei Radix et Rhizoma) powder around the umbilicus, and drip Puxiao solution spoon by spoon into the ring until bowel movement occurs. For excessive phlegm, use Erchen Tang with added Mutong.