张子和治遂平李官人妻，咽中如物塞，食不下，中满，他医治之不效。诊其脉曰∶此痰膈也。《内经》曰
三阳结为膈。王启玄又曰格阳，云阳盛之极，故食格拒而不入。先以通经散越其一半，后以舟车丸下之，凡三
次食已下。又以瓜蒂散再越之，健啖如昔日矣。
王思中治盐院某行部，至常州，病膈症不起。诸太医 集，皆技穷。王至曰∶此是关而非膈，可治也。乃
以半夏曲一两为君，制剂与服，不半月动履如常。（《吴江县志》。）
章良玉老年得关格症，医药不效，殊无起色。偶道人过门索食，其子食之。顷曰∶汝家何事奔皇乃尔？语
之故，且延视之。道人曰∶勿虑，而翁今日可不死矣，令人从我去。其子即偕至三山门外小茅庵中，道人出囊
中药草一束，悉以付之曰∶此通肠接骨草也，四月发芽百日枯，多生于观音山，早向阳，晚受阴，状似益母，
梗方而凹，绿叶如芸，采得汁一盏，便活一人。此则去年所收干者，可将若干放砂罐内，用一大盂水煎。归如
法治以进，父服三碗，果神效。及走谢，已行矣。此草尚有半，又转以活上河一徐姓者。考本草无所谓通肠接
骨草也。（《续金陵琐事》。此条似属可删，但世间实有治噎，草药用之如神。今形状悉具，可以按形而索。倘
遇识者，诚活人至宝也，故存之。至草药多随口起名，必欲执本草以求之拘矣。）
一贫叟病噎膈，食入即吐，胸中刺痛。或令取韭汁，入盐梅卤汁少许，细呷得入渐加，（此条乃真噎症，治
法亦佳。）忽吐稠涎数升而愈。此亦仲景治胸痹用薤白，皆取其辛温，能散胃脘痰饮恶血之义也。（《本草纲目》。）
薛立斋治一妇人，患膈症，胸膈痞闷，以此属脾经血虚，遂用四君、芎、归，调补脾气寻愈。又因怒兼两
胁痞闷，头目不清，月经旬余未竭，用加味逍遥散加钩藤治之复瘥。
一妇人患膈病，胸膈作痛，面青目札，小便频数，或时寒热。此肝气滞而血凝，先用失笑散，二服痛止，
又用加味逍遥散而愈。
陈三农治一老人，患膈气，饮食不下，大便干燥，六脉浮大而硬，用乌药四分，小茴香一钱，研末，肉汤
调下二钱，饮食即进。三服后用乌药三分，陈皮、苏梗、杏仁各五分，苡仁钱半，煎服而愈。
一中年妇患梅核气，用二陈加芎、归、栀、连、枳实、乌药、栝蒌、旋复花、香附、桔梗，十数剂而愈。
山氏患咽喉噎塞如梅核，时时嗳气，足冷如冰，用散结化痰汤十数剂罔效。细思之，此阴火也。三阴至项
而还，阴虚火炎，故嗳气咽塞足冷耳。用滋阴清膈饮，数剂诸症悉愈。
一士膈噎呕吐，或与清火，或与疏通，或与化痰散郁之药，半载愈甚。陈曰∶气口无力，两尺迟缓，脾肾
交虚之候也。脾虚则升降失职而痰起中焦，肾虚则真火衰微食难运化。与白术五钱炒焦色，半夏二钱，炮姜二
钱，沉香一钱，二剂而愈。
孙文垣治张溪亭乃眷，喉中梗梗有肉如炙脔，吞之不下，吐之不出，鼻塞头晕，耳常啾啾不安，汗出如雨，
心惊胆怯，不敢出门，稍见风则遍身疼，（火盛而郁者，多畏风畏寒。）小腹时痛，小水淋涩而疼。（皆郁火为患。）
脉两尺皆短，两关滑大，右关尤抟指。孙曰∶此梅核症也。以半夏四两，浓朴一钱，苏叶一钱，茯苓一钱三分，
姜三片，水煎食后服。每用此汤调理多效。
按∶梅核症，乃郁怒忧思，七情大伤，乃成此病。案中所叙，无非木燥火炎之候，乃以燥克之剂成功，
合前陈三农案大同小异，或当时病患质浓故耳。（香燥之剂暂能开气，故即愈，但久则必复，特案中不肯叙及耳，非
缘病患质浓也。）
臧少庚年五十，每饮食胸膈不顺利，觉喉中哽哽，宛转难下，大便燥结内热，肌肉渐瘦，医与五香连翘汤、
五膈丁香散不效。孙脉之，其色苍黑，两目炯炯不 ，（可治。）惟气促骨立，其脉左弦大右滑大。曰∶据脉乃谋而
不决，气郁成火，脾志不舒，致成痰涎，因而血少便燥，内热肌消。张鸡峰有言，膈乃神思间病。即是推之，
当减思虑，断色欲，薄滋味，绝妄想，俾神思清净，然后服药有功。以桂府滑石六两，甘草一两，真北白芥子、
萝卜子、射干、连翘各一两半，辰砂五钱，以竹茹四两煎汤，打馒头糊为丸，绿豆大，每食后及夜用灯心汤送
下一钱，一日三服，终剂而愈。
易思兰治一人患膈满。其症胸膈胃脘饱闷，脐下空虚如饥不可忍，腰腿酸痛，坐立战摇，大便燥结，每日
虽进清粥一二钟，食下呕酸吐水，醋心，众作膈治，二年不效。诊得左右寸关俱沉大有力，两尺自浮至沉，三
候俱紧，按之无力，有摇摆之状。此气膈病也，须开导其上，滋补其下，兼而行之可也。遂以畅胃舒中汤投之。
制之香附、苍术、贝母各八分，苏梗、连翘各五分，抚芎六分，神曲、沙参各一钱，桔梗四分，南木香半分，
大剂煎，徐徐呷之，每日空心服八味丸百粒。服二日，嗳气连声，后亦出浊气，五日可以坐立，啖饭二碗。服
至二七，动履如常。
喻嘉言治倪庆病膈气，十四日粒米不入口，始吐清水，次吐绿水，次吐黑水，次吐臭水，呼吸将绝，医已
歇手。喻适诊之，许以可救，渠家不信。喻曰∶尽今日昼夜先服理中汤六剂，不令其绝，来早转方，一剂全安。
渠家曰∶今已滴水不食，安能服药六剂？曰∶但得此等甘温入口，必喜而再服也。渠诸子或庠或弁，颇识理析，
佥曰∶既有妙方，何不即投？必先与理中，此何意也？曰∶《金匮》云，病患噫气不除者，旋复代赭石汤主之。
吾于此病分别用之者有二道，一者以黑水为胃底之水，臭水为肠中之水，此水且去，则胃中之津液，久已不存，
不敢用半夏以燥其胃也。一者以将绝之气，止存一丝，以代赭坠之，恐其立断，先用理中，然后代赭得以建奇
奏绩，一时之深心，即同千古之已试也。及简仲景方，见方中只用炮姜，而不用干姜，又谓干姜比半夏更燥，
而不敢用。曰今所噫者，下焦之气也，所呕者，肠中之水也。阴乘阳位，加以日久不食，诸多蛔虫，必上居
膈间，非干姜之辣，则蛔不下转，而上气亦不必下转，妙处正在此，君曷可泥哉？服之果再索药，三剂后能言，
云内气稍接。但恐太急，俟天明再服，后日转方为妥。次早旁议交沮，后三剂不肯服矣。乃持前药一盏，勉
令服之。曰∶立地转方，顷刻见效何如？乃用旋复花一味煎汤，调代赭石末二匙与之。才入口，病者曰∶好药，
吾气已转入丹田矣。二剂胸腹顿爽，已有起色。因触冷气复呕，与前药立止。思粥，令食半盏，饥甚竟食二盏，
少顷已食六盏。复呕，与前药立止。又因动怒，以物击婢复呕，与前药立止。以后不复呕，但精神困倦之极，
服补药二十剂，丸药一斤，将息二月，始能出门，方悔从前少服理中二剂耳。
李士材治张邑宰妇，忧闷之余得食辄噎，胸中隐隐作痛。诊之，脉紧且滑，曰∶痰在上脘，用二陈加姜汁、
竹沥。或曰∶半夏不燥乎？曰∶湿痰中满，非此不治。遂用四剂，病尚不减。改大半夏汤，服四帖，胸痛乃止。
又四帖，而噎亦减，服二十剂而安。若泥半夏为燥，而以他药代之，岂能愈乎？惟痰不盛，形不肥者，不宜与
服也。（凡用半夏者，宜审之。）
方春和年近五旬，多欲善怒，患噎三月，日进粉饮一钟，腐浆半钟，且吐其半，六脉细软，此虚寒之候也。
用理中汤加人乳、姜汁、白蜜、半夏，一剂便减，十剂而进糜粥。更以十全大补加竹沥、姜汁，四十帖诸症皆愈。
一人膈噎不通，渣质之物不能下咽，惟以人乳醇酒数杯，吐沫不已。李曰∶口吐白沫，法在不治，脉犹未
败，姑冀万一。用人参、黄 、当归、白术、陈皮、桃仁、牛乳、白蜜、姜汁，连进十剂，白沫渐少。倍用参、
术，三月全安。
一人二十三岁，以鼓盆之戚，悲哀过度，不能食饭。又十余日，粥亦不能食，随食随吐，二便闭塞，自谓
必死。诊之，脉按有力，非死症也。以酒蒸大黄加桃仁、当归、砂仁、陈皮，蜜丸与服，凡五服下燥矢干血甚
多，病若失矣，数日之间，能食倍常。
张孟端夫人，忧愤交乘，食下辄噎，胸中隐隐痛。阳脉滑而阴脉搏，痰血互凝之象。以二陈汤加归尾、桃
仁、郁金、五灵脂，四剂未效。因思人参与五灵脂同用，善于浚血，即以前剂入人参三钱，倍用五灵脂，再剂
血从大便而出，十剂噎止，弥月而愈。（人参与五灵脂并用，非明于奇变者不可。）
金元之之内，患噎膈，胸腹奇痛，经阻，医认瘀血。察其脉细为气衰，沉为寒痼，况自下及上，处处皆痛，
明非血矣。用参、 、白术、木香、姜、桂，煎成和醇酒进之，甫入口便快，服理中汤半月而瘥。（以上二案，医通妙入。）
张路玉治朱彦真酒膈，呕逆不食，每日惟痛饮热酒一二觥，少顷即作酸呕出，膈间大痛，杂治经年不效。
良由平昔好饮热酒所致，即丹溪所谓好饮热酒，死血留胃口之候。授以人参散方，用人参一两，煎成加麝香半分，
（雄按∶麝兼能败酒。）冰片三厘，三剂便能进食，盖片麝善散胃口之痰与瘀血耳。十剂后改服柏子仁汤，半月而安。
二方出自云岐，人多未知，每以予为尚异，何可为之辨耶？
沈锡蕃平昔大便燥结，近患噎膈，不能安谷者月余。虽素禀丰腴，近来面色皎白，大非往昔，时方谷雨，
正此症危殆之际。诊得六脉沉涩，按久则衰，幸举指则应。为疏六君子汤，下一味狗宝作散调服。甫十剂，呕
止食进。再十剂，谷肉渐安。更十剂，起居如故，惟大便尚艰，以六味丸去泽泻加芎、归、首乌作汤，月余便
溺自如，秋深更服八味丸而安。大抵噎膈之人，体肥痰逆者可治，枯瘠津衰者不可治。同道王公峻患此，禀气
病气，与沈氏相类，误信方士，专力委之，致不起。顾人月亦患此，自谓胀急不当用参，日服仙人对坐草而毙。
瘦人亦间有可疗者，秦伯源患此，形神枯槁，神志抑郁，且汤药无资，予门人邹恒友，令其用啄木鸟入麝熬膏，
时嗅其气以通结，内服逍遥散加香、砂以散郁，不数剂顿瘳。后陈君亦用此法而愈。又一农人噎膈不食，时呕
清涎如赤豆沙水，此属血瘀可知，误用消克破气药，致绝粒不食。用桂苓饮加当归、桃仁、丹皮、牛膝，用熬
枯黑糖和虫浆调服，下溏黑如污泥者甚多。
俞东扶曰∶石顽治病，喜用古方而杂以新药，能生后学智能。如此数条，虽皆昔贤成法，无甚精义，亦
足以广识见。然《金匮》只有反胃汤药，不载噎膈情形，岂真正膈症？虽医中之圣，亦无法以治之耶。
张路玉曰∶王御九仲君，因惊恐受病，时方晚膳，即兀兀欲吐而不得出，遂绝粒不食，而起居自如。向后
醇酒膏粱，略无阻碍，惟谷气毫不可犯，犯之辄吐。医不知为何病，补泻杂陈，牛黄、狗宝、虎肚、猫胞，总
无一验。数月来，湿面亦得相安。延及八月，偶遇一人，谓言此病非药可除，令用生鹅血乘热饮之，一服便安。
此虽未见方书，（生鹅血能化坚癖，见江案心脾痛门。）揆之于理，谅无妨碍。一阳之夜，遂宰一鹅取血热饮，
下咽 有声，忍之再三，少顷呕出瘀血升许，中有血块数枚，是夜小试稀糜竟不吐。其后渐能用饭从少至多，
不藉汤药而安。（此即血膈症。）
马元仪治王客，六旬外患关格，上不得食，下不得便，口燥胸满已一月。诊其两脉俱虚而涩。此因脾胃
之气，郁而不宣，郁久成火，消铄津液，升降失常，上下不交而成痞塞。治法宜宣通肺郁，则清肃下行，而燥
火可除；滋养胃源，则精液四布，而升降自如矣。用紫菀五分，蒌仁五钱，枳壳、桔梗、杏仁、苏子、半夏曲、
郁金，二剂两脉起，四剂胸满释。后去郁金，加生首乌五钱，四剂大便通，脉和。惟进饮不纳谷，盖肺金郁结
之气乍舒，而胃土冲和之气未复也。令服人参仓廪汤，一月而食进。再服加味归脾膏，二月全愈。
朱丹溪治一人，饮热酒食物，梗塞胸痛，盖有死血而然。白术、贝母、麦芽、香附一两，栝蒌仁、杏仁、
丹皮、生甘草、干葛、山栀、黄芩、红花、荜澄茄，右或丸或散，任意服之。
黄濡富倾郡，年逾艾，病胸膈不宽。俗医或以降火而剂凉寒，病滋甚。又或以过伤而剂辛热，病益深，而
形神如故。（膈病皆如是。）桥曰∶脉两寸益涩，余皆弦数而躁，两尺特甚，病由阴火炎上，感怒伤肝，此血膈也，
法当不治。黄不怿，乃谢桥。逾月即呕血如桥言，医麇治无效，后吐败血如腐肝乃卒。（同上。）
蒋銮年六十，体故浓，饮食起居如常，惟胸膈稍稍不宽，直自以为痰火耳，久治无效。桥诊之曰∶寸口脉
涩，非痰火也，此为血膈，顷之必有死气出焉。勿谓无伤，法当不治。闻者大骇，然疑信半之。又曰∶公病之
来且速，亟问良医，如稍迟，将咎桥发之晚也。其后呕紫血块如指大者数十百枚，呕后竟胸膈颇宽。桥曰∶不
然，此肝伤而不藏血，血随气逆行，宿血去而新血继之，缓治则缓死，速攻则速死。后更数医，月余死。
Zi Hezi treated the wife of Official Li from Suiping County. The patient felt a sensation of an object blocking her throat, could not swallow food, and suffered from chest and abdominal fullness. Other physicians failed to achieve efficacy. Zi Hezi examined her pulse and said, "This is Phlegm Ge (Phlegm obstruction)." The *Neijing* states: "The binding of the three Yang meridians leads to Ge syndrome." Wang Qixuan further explained this as "Ge Yang," meaning extreme excess of Yang qi, causing food to be rejected and unable to enter. First, he administered Tongjing San (Meridian-Opening Powder) to induce vomiting, expelling half of the phlegm. Subsequently, he used Zhouche Wan (Boat and Cart Pill) to purge the bowels. After three courses, bowel movements occurred after eating. He then used Gadi San (Melon Tip Powder) for another round of emesis, after which the patient's appetite returned to normal as before.
Wang Sizhong treated a Salt Transport Commissioner who fell ill with Ge syndrome while on inspection tour in Changzhou. Numerous Imperial Physicians gathered but were at a loss. Upon arrival, Wang Sizhong stated, "This is Guan-Ge (obstruction and reversal) rather than simple Ge syndrome; it is treatable." He prepared a formula using Banxia Qu (Fermented Pinellia) as the chief ingredient, one tael in quantity, and administered it. Within half a month, the patient's mobility and daily activities returned to normal. (Source: *Wujiang County Annals*.)
Zhang Liangyu treated an elderly patient suffering from Guan-Ge syndrome, for whom medical treatment had been ineffective with no improvement. A Daoist priest passed by begging for food, and the patient's son fed him. Afterward, the son asked, "Why are you in such a hurry?" Upon learning the reason, the priest invited the son to see the patient. The priest said, "Do not worry, your father will not die today. Have someone accompany me." The son went to a small thatched hut outside Shanshan Gate. The priest took out a bundle of herbs from his pouch and gave them to the son, saying, "This is Tongchang Jiegu Cao (Intestine-Unblocking and Bone-Connecting Herb). It sprouts in April and withers in a hundred days, growing mostly on Guanyin Mountain. It faces the sun in the morning and receives shade in the evening. Its shape resembles Yimucao (Motherwort), with a square and concave stem and green leaves like Yuntae (Mustard greens). One cup of its juice can save a person. This is dried material collected last year. Take an appropriate amount, place it in a clay pot, and decoct it with one large bowl of water. Return home and administer it according to this method. Your father drank three bowls, and it was indeed miraculous. When the son returned to thank him, the priest had already left. Half of the herb remained, which was then used to save a Mr. Xu from Shanghe. Pharmacopoeias do not record a herb named 'Tongchang Jiegu Cao.' (Source: *Continued Jinling Trivial Matters*. This entry seems deletable, yet there truly exist herbal remedies for dysphagia that work miraculously. Since its morphology is fully described, one can search for it based on appearance. If encountered by an expert, it would indeed be a precious life-saving treasure, so it is preserved. Herbal names are often coined casually; insisting on finding them in pharmacopoeias is too rigid.)"
A poor old man suffered from Ye Ge (dysphagia/choking), vomiting immediately after eating, with stabbing pain in the chest. Someone advised extracting fresh chive juice, adding a little salt and plum brine, and sipping it slowly until it could be swallowed gradually. (This case represents true Ye syndrome, and the treatment is excellent.) Suddenly, he vomited several sheng (a unit of volume) of thick saliva and recovered. This aligns with Zhang Zhongjing’s use of Xiebai (Allium macrostemon) for Chest Bi (chest obstruction), both utilizing their pungent-warm nature to disperse phlegm-fluids and evil blood in the stomach region. (Source: *Bencao Gangmu* / Compendium of Materia Medica.)
Xue Lizhai treated a woman with Ge syndrome, presenting with chest and diaphragm stuffiness. He attributed this to Blood deficiency in the Spleen meridian and prescribed Sijun Zi Tang (Four Gentlemen Decoction) plus Chuanxiong (Szechwan Lovage Rhizome) and Danggui (Angelica Sinensis) to tonify Spleen Qi, leading to recovery. Later, due to anger, she developed stuffiness in both hypochondria, unclear head and eyes, and menstruation lasting over ten days without cessation. She was treated with Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) plus Gouteng (Uncaria Rhynchophylla), resulting in further improvement.
Another woman suffered from Ge disease, with chest pain, blueish complexion, squinting eyes, frequent urination, and alternating chills and fever. This indicated Liver Qi stagnation and Blood coagulation. She first received Shixiao San (Pain-Stopping Powder); after two doses, the pain ceased. She was then cured with Jiawei Xiaoyao San.
Chen Sansan treated an elderly man with Ge Qi (Qi obstruction in the diaphragm), inability to eat, dry stool, and floating, large, hard pulses in all six positions. He prescribed Wuyao (Lindera Root) 4 fen and Huixiang (Fennel Fruit) 1 qian, ground into powder, taken with meat broth, 2 qian per dose. Food intake resumed immediately. After three doses, he switched to Wuyao 3 fen, Chenpi (Aged Tangerine Peel), Sugeng (Perilla Stem), and Xingren (Apricot Seed) each 5 fen, and Yiren (Coix Seed) 1.5 qian, decocted and taken, leading to recovery.
A middle-aged woman suffered from Meiheqi (Plum-Pit Qi), treated with Erchen Tang (Two-Cured Decoction) plus Chuanxiong, Danggui, Zhizi (Gardenia), Lianlian (Scutellaria), Zhishi (Immature Bitter Orange), Wuyao, Gualou (Trichosanthes Root), Xuanfuhua (Inula Flower), Xiangfu (Cyperus Rhizome), and Jiegeng (Platycodon Root). After more than ten doses, she recovered.
A member of the Shan family suffered from throat blockage feeling like a plum pit, frequent belching, and cold feet like ice. Scanjie Huatan Tang (Dissipating Knots and Resolving Phlegm Decoction) was ineffective after more than ten doses. Upon reflection, Chen realized this was Yin Fire. The Three Yin meridians return at the neck; Yin deficiency causes Fire to flare up, leading to belching, throat blockage, and cold feet. Ziyin Qingge Yin (Nourishing Yin and Clearing Diaphragm Decoction) was used, and after several doses, all symptoms resolved.
A scholar suffered from Ge-Ye vomiting. Some doctors prescribed cooling-fire herbs, some prescribed unblocking agents, and others prescribed phlegm-resolving and depression-dispersing herbs. The condition worsened over half a year. Chen said, "The Qi Kou pulse is weak, and the two Chi pulses are slow and delayed, indicating simultaneous deficiency of Spleen and Kidney. Spleen deficiency leads to failure of ascending and descending functions, generating phlegm in the Middle Jiao; Kidney deficiency leads to decline of True Fire, making food difficult to transform." He prescribed Chaojiu Bai Zhu (Charred White Atractylodes) 5 qian, Banxia (Pinellia Tuber) 2 qian, Paojiang (Prepared Ginger) 2 qian, and Chenxiang (Agarwood) 1 qian. Recovery occurred after two doses.
Sun Wen Yuan treated the wife of Zhang Xiting, who felt a lump in the throat like a roasted piece of meat, unable to swallow or spit out, accompanied by nasal congestion, dizziness, constant buzzing in the ears, profuse sweating, heart palpitations, fearfulness, reluctance to go out, body pain upon exposure to wind (indicating Fire excess with constraint, often fearing wind and cold), occasional lower abdominal pain, and painful, scanty urination (all due to constrained Fire). Pulses were short in both Chi positions, slippery and large in both Guan positions, especially pounding in the Right Guan. Sun diagnosed this as Meihe Zheng (Plum-Pit Syndrome). He prescribed Banxia (Pinellia) 4 liang, Houpo (Magnolia Bark) 1 qian, Suye (Perilla Leaf) 1 qian, Fuling (Poria) 1.3 qian, and 3 slices of Ginger, decocted in water and taken after meals. This formula is often effective for regulation.
Commentary: Meihe Zheng arises from severe emotional injury due to depression, anger, worry, and thought. The symptoms described reflect Wood dryness and Fire flaring, yet success was achieved with drying agents, similar to Chen Sansan’s case, possibly due to the patient’s robust constitution. (Aromatic-drying agents temporarily open Qi, hence immediate relief, but relapse is likely with long-term use, though not mentioned in the case, nor necessarily due solely to constitution.)
Zang Shaogeng, aged fifty, experienced discomfort in the chest and diaphragm during meals, a choking sensation in the throat, difficulty swallowing, dry constipation with internal heat, and gradual emaciation. Wuxiang Lianqiao Tang and Wuge Dingxiang San were ineffective. Sun Yikui observed his dark complexion and bright eyes (indicating treatability), but noted rapid breathing and skeletal thinning. Pulses were string-large on the Left and slippery-large on the Right. Sun diagnosed this as arising from indecisiveness, Qi constraint transforming into Fire, and Spleen spirit dissatisfaction, leading to phlegm-saliva generation, Blood deficiency, dry stool, internal heat, and muscle wasting. Citing Zhang Jifeng, "Ge is a disease of the mind/spirit," Sun advised reducing thought, abstaining from sexual desire, eating bland foods, and eliminating delusions to purify the spirit before medication would work. He prescribed Guifu Huashi (Guifu Talcum) 6 liang, Gancao (Licorice Root) 1 liang, Zhenbei Baijiezi (True Northern White Mustard Seed), Luobozhi (Radish Seed), Shaye (Shé Kǎu), and Lianqiao (Forsythia) each 1.5 liang, Chensha (Cinnabar) 5 qian. These were made into pills the size of mung beans using Bamboo Ru (Bamboo Sap) decoction as a binder. Taken after meals and at night with Dengxin Cao (Juncus Effusus) tea, 1 qian three times daily, cure was achieved after one course.
Yi Silan treated a man with Ge Man (Diaphragmatic Fullness). Symptoms included chest and epigastric fullness, emptiness below the navel resembling unbearable hunger, soreness and pain in waist and legs, trembling when sitting or standing, dry constipation, and despite drinking only one or two cups of clear porridge daily, he vomited acid and water with heartburn. Treated as Ge syndrome for two years without effect. Pulses were deep, large, and forceful in the Cun and Guan positions bilaterally; the Chi positions were tight from superficial to deep, but weak upon pressure and swaying. Yi diagnosed this as Qi Ge (Qi Obstruction). Treatment required opening the upper Jiao and tonifying the lower Jiao simultaneously. He prescribed Changwei Shuzhong Tang (Unblocking Stomach and Relaxing Middle Decoction): Zhi Xiangfu, Cangzhu, and Beimu each 8 fen, Sugeng and Lianqiao each 5 fen, Fujiong (抚芎) 6 fen, Shenqu and Shashen each 1 qian, Jiegeng 4 fen, Nanmuxiang 0.5 fen. Decocted in large volume and sipped slowly. Additionally, 100 pills of Bawei Wan (Eight-Ingredient Pill) were taken on an empty stomach daily. After two days, continuous belching occurred, followed by expulsion of turbid gas. By day five, he could sit and stand and eat two bowls of rice. By day fourteen, mobility was normal.
Yu Jiayan treated Ni Qing with Ge Qi. For fourteen days, he consumed nothing, vomiting clear water, then green water, then black water, then foul-smelling water. Breathing was nearly absent, and doctors had given up. Yu Jiayan examined him and promised a cure, but the family doubted him. Yu said, "Administer Lizhong Tang (Regulate the Middle Decoction) for six doses continuously today and tonight to prevent death. Tomorrow morning, we will change the prescription for a complete cure." The family asked, "He cannot even drink water; how can he take six doses?" Yu replied, "If these sweet-warm medicines enter the mouth, he will surely accept more." The sons, educated and reasonable, questioned why start with Lizhong Tang. Yu explained, citing *Jingui Yaolue*: "For patients with persistent eructation, Xuanfu Daizhe Shi Tang is indicated." He reasoned: "Black water is gastric bottom fluid; foul water is intestinal fluid. Removing these fluids means gastric fluids have long been depleted; thus, I dare not use Banxia to dry the stomach. Furthermore, the vital Qi is barely existing; using Daizhe Shi (Hematite) to weigh it down might cause immediate collapse. I must first use Lizhong Tang to stabilize, then Daizhe Shi can perform miracles." Consulting Zhang Zhongjing’s formulas, Yu noted the use of Paojiang (Prepared Ginger) instead of Ganjiang (Dried Ginger), considering Ganjiang too drying. However, Yu reasoned, "The eructation comes from the Lower Jiao; the vomiting is intestinal fluid. Yin invading Yang positions, combined with long-term fasting, likely involves ascariasis residing in the diaphragm. Without the pungency of Ganjiang, the worms will not descend, nor will the rebellious Qi. This is the key point; why be rigid?" The patient subsequently requested medicine. After three doses, he could speak, reporting internal Qi connection. Yu advised waiting until dawn to continue. The next day, relatives opposed further Lizhong Tang. Reluctantly, they took a cup of the previous medicine. Yu suggested changing the formula immediately for instant effect. He prescribed Xuanfuhua (Inula Flower) decoction mixed with Daizhe Shi powder. Upon ingestion, the patient exclaimed, "Good medicine! My Qi has entered the Dantian!" After two doses, chest and abdomen felt refreshed. Vomiting recurred due to cold air but stopped immediately with the same medicine. Hunger led to increased food intake. Vomiting stopped completely thereafter. Due to extreme fatigue, he took twenty doses of tonic medicine and one jin of pills, recuperating for two months before going out, regretting having taken fewer doses of Lizhong Tang initially.
Li Shicai treated the wife of Magistrate Zhang, who choked after eating amidst worry, with dull chest pain. Pulse was tight and slippery. Diagnosis: Phlegm in the Upper Wan (Upper Epigastrium). Prescription: Erchen Tang plus Jiangzhi (Ginger Juice) and Zhuli (Bamboo Sap). Questioned: "Is Banxia not too drying?" Li replied: "For damp-phlegm and middle fullness, nothing else works." Four doses yielded no reduction. Changed to Banbanxia Tang (Large Banxia Decoction). After four doses, chest pain stopped. After four more, choking reduced. After twenty doses, stability was achieved. Substituting Banxia due to fear of dryness would fail. Only those with mild phlegm and non-obese constitutions should avoid it. (Caution advised when using Banxia.)
Fang Chunhe, near fifty, prone to desires and anger, suffered from dysphagia for three months, consuming only one cup of starch drink and half a cup of fermented bean curd liquid daily, vomiting half. Pulses were fine and soft, indicating Deficiency-Cold. Prescribed Lizhong Tang plus Renru (Human Milk), Jiangzhi, Baimi (White Honey), and Banxia. Reduced after one dose; tolerated congee after ten doses. Then, Shiquan Dabu Tang (Ten Complete Tonifying Decoction) plus Zhuli and Jiangzhi for forty doses resulted in full recovery.
A man with obstructive dysphagia could not swallow solid matter, only human milk and strong wine, with incessant foaming. Li said, "Foaming from the mouth indicates untreatability, but the pulse is not yet collapsed; let us hope for the best." Prescribed Renshen (Ginseng), Huangqi (Astragalus), Danggui, Baizhu, Chenpi, Taoren (Peach Kernel), Niu Nai (Cow Milk), Baimi, and Jiangzhi. Ten doses reduced foaming. Doubling Renshen and Baizhu led to full recovery in three months.
A twenty-three-year-old man, grieving his wife's death excessively, could not eat rice. After ten days, could not even eat porridge, vomiting immediately after eating, with closed bowels and bladder, believing death was inevitable. Pulse was forceful upon pressure, not a death sign. Prescribed Jiuzheng Dahuang (Wine-Steamed Rhubarb) plus Taoren, Danggui, Sharen (Amomum), and Chenpi, made into honey pills. Five doses expelled much dry stool and clotted blood. Illness vanished; within days, appetite doubled.
Madam of Zhang Mengduan, overwhelmed by grief and indignation, choked after eating with dull chest pain. Yang pulse slippery, Yin pulse wiry, indicating intermingled Phlegm and Blood stasis. Erchen Tang plus Guiwei (Angelica Tail), Taoren, Yujin (Curcuma), and Wulingzhi (Trogopterus Dung) for four doses was ineffective. Recalling that Renshen and Wulingzhi together promote blood circulation, Li added 3 qian of Renshen and doubled Wulingzhi in the previous formula. After two doses, blood passed via stool. After ten doses, choking stopped; recovery in one month. (Combining Renshen and Wulingzhi requires mastery of paradoxical variations.)
Jin Yuanzhi, confined indoors, suffered dysphagia with strange chest/abdominal pain and amenorrhea. Doctors misdiagnosed Blood stasis. Pulse fine indicated Qi deficiency; deep indicated Cold retention. Pain from bottom to top confirmed it was not Blood stasis. Prescribed Renshen, Huangqi, Baizhu, Muxiang (Aucklandia), Ginger, and Rougui (Cinnamon Bark), decocted with strong wine. Comfortable upon ingestion. Lizhong Tang for half a month led to recovery. (These two cases demonstrate profound medical skill.)
Zhang Luyu treated Zhu Yanzhen’s Wine Ge. Vomiting and refusal to eat; drank hot wine passionately, soon vomiting sour fluid with severe diaphragm pain. Years of mixed treatments failed. Caused by habitual hot wine consumption, leading to Dead Blood lodging in the stomach opening (per Danxi). Prescribed Renshen San (Ginseng Powder): Renshen 1 liang decocted, plus Shexiang (Musk) 0.5 fen, Bingpian (Borneol) 3 li. Eating resumed after three doses, as Musk and Borneol dissipate stomach phlegm and stasis. Switched to Baiziren Tang (Seed of Platycladi Decoction) after ten doses; recovered in half a month. These formulas come from Yunqi Zi, unknown to many who criticize my uniqueness.
Shen Xifan, usually constipated, recently suffered dysphagia, unable to eat grains for over a month. Once robust, now pale and weak, critical during Guyu season. Pulses deep and choppy, fading with pressure, responsive on lift. Prescribed Liujunzi Tang (Six Gentlemen Decoction) plus Goubao (Dog Gallstone) powder. Ten doses stopped vomiting and improved intake. Ten more doses stabilized grain/meat. Ten more restored routine. Constipation persisted; Liuwei Dihuang Wan minus Zexie plus Chuanxiong, Danggui, and Shouwu decocted normalized bowels in a month. Babu Wan in late autumn ensured safety. Generally, obese patients with Phlegm-Reversal are treatable; emaciated patients with Fluid depletion are not. Fellow official Wang Gongjun died due to trusting a quack. Gu Renyue died taking Xianren Duizuo Cao, refusing Ginseng. Emaciated patients can sometimes be treated; Qin Boyuan, emaciated and depressed, lacked funds. Student Zou Hengyou used Woodpecker and Musk paste for inhalation to open blockage, plus Xiaoyao San plus Xiangfu and Sharen internally. Rapid recovery. Chen Jun also succeeded with this method. Another farmer vomited clear saliva like red bean soup (Blood stasis), worsened by Qi-breaking herbs. Guiling Yin plus Danggui, Taoren, Danpi, and Niuxi (Achyranthes), taken with charred brown sugar and insect paste, expelled muddy black stool.
Yu Dongfu commented: "Shiweng prefers ancient formulas mixed with new drugs, inspiring later generations. Though these cases lack profound theory, they broaden knowledge. *Jingui* only mentions Fanwei (Reverse Regurgitation) formulas, not Ge syndrome specifics. Does this mean the Sage of Medicine had no cure for true Ge?"
Zhang Luyu recounted: "Wang Yujiu’s brother fell ill from fright. During dinner, he felt nauseous but couldn't vomit, stopping all food intake, yet daily activities remained normal. Later, alcohol and rich foods were tolerated, but grains caused vomiting. Doctors tried various remedies including Niuhuang (Calculus Bovis), Goubao, Hudu (Tiger Stomach), and Maobao (Cat Placenta) without success. Wet noodles were tolerated for months. After eight months, someone suggested drinking hot raw goose blood. One dose brought relief. Though not in texts, Goose blood resolves hardness (see Jiang’s Heart/Spleen Pain case). Logic supports it. On a winter night, he drank hot goose blood. Swallowed with sound, endured briefly, then vomited a sheng of bloody clots. That night, tested congee without vomiting. Gradually resumed eating, recovering without medicine. (This is Blood Ge syndrome.)"
Ma Yuanyi treated a guest over sixty with Guan-Ge, unable to eat or defecate, dry mouth and chest fullness for a month. Pulses deficient and choppy. Spleen/Stomach Qi constrained, turning to Fire, consuming fluids, disrupting ascent/descent. Treatment: Vent Lung Qi to allow clearing descent and remove Dry Fire; Nourish Stomach Source to distribute fluids and restore movement. Used Ziwan (Aster) 5 fen, Goulou Ren (Trichosanthes Seed) 5 qian, Zhike (Bitter Orange), Jiegeng, Xingren, Suzi (Perilla Seed), Banxia Qu, and Yujin. Two doses raised pulses; four relieved fullness. Removed Yujin, added Sheng Shouwu (Raw Polygonum) 5 qian. Four doses opened bowels, harmonized pulse. Could drink but not eat, as Lung Qi relaxed but Stomach Qi hadn't recovered. Ren Can Canglin Tang (Ginseng Granary Decoction) for one month improved intake. Jiawei Guipi Gao (Modified Restore the Spleen Paste) for two months ensured full recovery.
Zhu Danxi treated a man with chest pain and blockage after drinking hot wine and eating, due to Dead Blood. Prescribed Baizhu, Beimu, Maiya (Barley Sprout), Xiangfu 1 liang, Goulou Ren, Xingren, Danpi (Moutan), Sheng Gancao, Gange (Kudzu), Shanzhi, Huangqin (Scutellaria), Honghua (Safflower), and Bidengqie (Long Pepper). Made into pills or powder, taken as desired.
Huang Rufu, over sixty, suffered chest tightness. Folk doctors used cold-cooling herbs for Fire, worsening it; or hot-pungent herbs for Injury, deepening it, while constitution remained unchanged. Qiao diagnosed: Cun pulses increasingly choppy, others wiry-numb and restless, Chi particularly severe. Yin Fire flaring, Liver injured by anger, indicating Blood Ge, untreatable. Huang disagreed and apologized. A month later, vomited blood as predicted. Many doctors failed; he died vomiting rotten-liver-like blood.
Jiang Luan, sixty, robust, normal diet/lifestyle, slight chest tightness, assumed Phlegm-Fire, untreated effectively. Qiao diagnosed: Cun pulse choppy, not Phlegm-Fire, but Blood Ge, expecting death Qi soon. Warned against delay. Patient vomited dozens of purple blood clumps finger-sized. Chest felt wide afterward. Qiao explained: Liver injured, failing to store Blood; Blood rebels with Qi. Old Blood gone, New Blood follows. Slow treatment = slow death; fast attack = fast death. After consulting other doctors, he died in a month.