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Pulse: Deep, slow, and weak indicates Qi deficiency. Rapid yet weak, accompanied by a choppy quality, indicates Blood deficiency. Full, rapid, and forceful indicates Fire. Deep and slippery pulses at the Cun (inch) and Guan (middle) positions indicate Phlegm. Wiry and slippery pulses at both Guan positions indicate vomiting and regurgitation; if the pulse is slow and slippery, the condition is treatable; if it is choppy and weak, it is difficult to treat.

Symptoms: The *Neijing* states: "The binding of the Three Yang meridians is called 'Ge' (obstruction)." The commentary notes that the Three Yang refer to the Large Intestine, Small Intestine, and Bladder. "Binding" refers to heat accumulation. Heat binding in the Small Intestine causes blood vessels to become dry and parched; heat binding in the Large Intestine leads to constipation; heat binding in the Bladder causes the depletion of body fluids. Once the Three Yang are bound, the opening and closing of the bowels and bladder must reverse and ascend. This is why food cannot be swallowed down, and even if forced down, it is vomited back up. Although there are distinctions among the five types of Ye (choking) and Ge (obstruction), the root pathology is essentially the same. Even if treatment is administered according to the methods, if one does not abstain from rich and strong flavors, refrain from anger, and exercise caution in daily life, even good medicines will be ineffective. Therefore, Zhang Jifeng stated: "Ge disease is a disorder of the mind and spirit; only introspection and self-nurturing can cure it." These words deeply hit the mark of the disease's nature; how can they not be believed?

Treatment: The approach should involve generating fluids, nourishing Blood, smoothing Qi, clearing Phlegm, descending Fire, and resolving bind, so that Yin and Yang achieve harmony. When Qi flows smoothly and Phlegm descends, the disease has no basis for occurrence.

Prescribe Tongbian (Child's urine), Jiangzhi (Ginger juice), Zhuli (Bamboo sap), Lugen汁 (Reed rhizome juice), Jiujiu (Leek juice), Renru (Human milk), or cattle/sheep milk. For Qi deficiency, add Sijunzi Tang (Four Gentlemen Decoction); for Blood deficiency, add Siwu Tang (Four Substances Decoction); for Phlegm, add Erchen Tang (Two Aged Ingredients Decoction); for Heat, add Jiudu (Detoxification) formulas. Strictly avoid aromatic and drying herbs. Ancient formulas used Renshen (Ginseng Root) to tonify Lung Qi, Yumi (Poppy Shell) to detoxify, Zhuli to clear Phlegm-Heat, Danggui (Angelica Sinensis) to nourish Blood, Sumi (Millet) to strengthen the Stomach, Honey to moisten dryness, and Ginger to remove turbidity. This differs from the *Jufang* (*Tai Ping Hui Min He Ji Ju Fang*), which uses entirely acrid, aromatic, and drying-hot herbs indiscriminately. In cases complicated by Cold, occasional efficacy may be seen. However, modern cases are clearly caused by Phlegm-Fire and Seven Emotions, without Cold. If one recklessly administers the aforementioned drying herbs, who shall bear the blame?

Formula: Qingtan Yangxue Tang (Clear Phlegm and Nourish Blood Decoction) treats Ge obstruction, acid regurgitation, and vomiting sour fluid.
Composition: Banxiaqu (Prepared Pinellia Fermented) 1.5 qian, Baifuling (White Poria) 1 qian, Danggui (Angelicae Radix Sinensis) 2 qian, Chenpi (Aged Tangerine Peel) 1 qian, Gancao (Licorice Root) 0.3 qian, Baibiandou (White Hyacinth Bean) 1 qian, Renshen (Ginseng Root) 1 qian, Baizhu (Atractylodes Rhizome) 0.5 qian, Yumi (Papaveris Pericarpium, stir-fried) 0.8 qian, Luobozhong (Radish Seed, stir-fried) 0.7 qian, Huanglian (Coptidis Rhizome) 1 qian (stir-fried with Wuqiong, then discard Wuqiong).
Take as one dose. Add 1.5 zhong of water, decoct to 0.8 zhong. Take far after meals. Before taking, add Jiangzhi (Ginger Juice, 5 spoons), Zhuli (Bamboo Sap, 1 zhan), and Lugenjuice (Reed Rhizome Juice, 2 zhan), mix evenly with the medicine, and take.

If Phlegm is abundant, add Beimu (Fritillaria Bulb) 1 qian, Zhishi (Immature Bitter Orange) 0.5 qian.
If Fire is abundant, add Shanzhiren (Gardenia Seed, stir-fried with ginger juice) and Huangqin (Scutellaria Root, wine-fried), each 0.8 qian.
To smooth Qi, add Muxiang (Costus Root) 0.5 qian, Binglang (Areca Seed) 0.8 qian.
To resolve depression, add Xiangfu (Cyperus Rhizome, stir-fried in child's urine) 1.5 qian, Shenqu (Medicated Leaven) 0.7 qian.
To nourish Blood, add Maidong (Ophiopogon Tuber) 1 qian, Taoren (Peach Kernel) 20 grains, Shengdihuang (Rehmannia Root, raw) 0.8 qian, and cattle/sheep milk, each 1 zhan.
To generate fluids, add the above ingredients, plus Wumei (Chinese Plum) 1 piece.
To moisten dryness, add Mahren (Hemp Seed), Xingren (Apricot Seed), each 1 qian, Yuliren (Prunus Seed) 1 qian, and human/cattle/sheep milk, as needed.
To suppress Liver, add Baishaoyao (White Peony Root), Juye (Tangerine Leaf), each 1 qian, Qingpi (Green Tangerine Peel) 0.5 qian.
To tonify Spleen, add Lianzi (Lotus Seed) 5 pieces, double the dosage of Renshen and Baizhu.
To stop vomiting, add Huoxiang (Patchouli Herb), Sharen (Amomum Fruit), each 0.7 qian.
To reduce distension, add Zhishi (Immature Bitter Orange), Sharen (Amomum Fruit), each 0.7 qian.
To stop diarrhea, add Baishaoyao (White Peony Root), Rouguo (Nutmeg) 1 qian each, remove Danggui.
For acid regurgitation/vomiting, add Huoxiang (Patchouli Herb) 0.8 qian, Sharen (Amomum Fruit) 0.5 qian, double the dosage of Zhuyu (Evodia Fruit), Chao Huanglian (Stir-fried Coptidis Rhizome). For heart/abdominal pain, add Muxiang (Costus Root) 0.5 qian, Binglang (Areca Seed) 0.7 qian, Qingpi (Green Tangerine Peel) 0.5 qian, Baishaoyao (White Peony Root) 1 qian, Gui (Cinnamon Twig) 0.3 qian, Baidoukou Ren (Cardamom Seed) 0.5 qian, remove Renshen and Baizhu, halve Danggui.