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Yi (Choking/Dysphagia) refers to the obstruction and blockage when food and drink are swallowed, with a sensation of stiffness and difficulty in descending. Some cases allow descent but with difficulty, some do not descend at all, some involve vomiting, and some do not. Therefore, it is established as a separate category. For cases of blood dryness and fluid depletion, prepare a paste by decocting Dihuang (Rehmanniae Radix), Maidong (Ophiopogonis Radix), and Danggui (Angelicae Sinensis Radix). Add juice from Jiucai (Allium tuberosum), milk, Tongbian (Uterine urine/Child's urine), Lugen juice (Phragmitis Rhizoma), and Taoren mud (Persicariae Semen), mix evenly, and sip slowly. If accompanied by constipation and rough stools, add Taoren mud and Xuanningfen (Mirabilite), or use Renshen San (Ginseng Powder). For cases with excess accumulation, Nonghou Wan (Magnolia Bark Pill) can be temporarily used, or Kunbu Wan (Laminaria Pill) may also be employed. When food passes down through the esophagus with a twisting motion below the diaphragm, causing stiffness and slight pain, it is mostly due to blood stasis. After moistening and tonifying with the aforementioned paste medicines, Dai Dandang Wan (Substitute for the Blood-Expelling Pill) should be used to move the stasis. There is a formula decocted with Shengjiang juice (Zingiberis Recensis Juice): take 5 liang each of Shengjiang juice, Baimit (White Honey), and Niusu (Bovine Butter); 2 liang each of Ren Shen Lu mo (Ginseng Radix et Rhizoma, de-stemmed and powdered) and Baihe mo (Lilii Bulbus, powdered). Place in a copper pot and slow-cook into a paste. Take one spoonful at any time, about the size of half a jujube, let it melt in saliva, and swallow; or decoct Renshen Tang (Ginseng Decoction) and mix with one tea spoonful to take. This is suitable for deficiency with dryness. Wrap the head of a rice pestle with coarse bran in a towel or cloth, and wipe teeth frequently to treat sudden Yi. Scrape fine bran from the head of a rice pestle, swallow it directly, decoct it for sipping, or make pills with refined honey to suck and swallow. Equal parts of Chutoukuang (Rice Bran from Pestle Head), Renshen mo (Ginseng Radix et Rhizoma, powdered), Shilian jiaorou (Nelumbinis Semen, mashed), Shishuang (Dried Persimmon Frost), and Xuanningfen (Mirabilite) can be licked and eaten. Pipaye (Loquat Leaf), brushed clean of hairs and roasted, and Chenpi (Citri Reticulatae Pericarpium), peeled, each 1 liang, plus Shengjiang (Zingiberis Rhizoma Recens) 0.5 liang, decocted in water and taken in three warm doses. For Yi disease where a lump feels like meat in the throat and food cannot go down, use 2 liang of Kunbu (Laminaria Thallus), washed to remove saltiness, and 2 he of Xiaomai (Tritici Fructus). Decoct in 3 large cups of water until the wheat is soft and cooked, then strain. Take one small cup at any time without restriction. Still, pick up pieces of Kunbu, keep 2-3 slices in the mouth constantly to dissolve and swallow saliva; this is extremely effective. For Yi disease where voice is lost, use Zhupi Yin (Bamboo Skin Drink). Li Dongyuan said: Obstruction of the throat where Yang Qi cannot emerge is called Sai (Blockage). Where Yin Qi cannot descend is called Yi (Choking). Yi-Sai involves rebellious Qi blocking between the throat and chest/diaphragm, preventing the flow of Qi and Blood in the meridians, leading to open mouth, staring eyes, and near-asphyxiation. One should first use acrid-sweet and purely Yang-flavored herbs to guide Stomach Qi to treat the root, adding unblocking herbs to drain the branch. In cold months, when Yin Qi greatly assists Yin pathogens externally, add Wuzhuyu (Evodiae Fructus), a herb that is hot, acrid, and bitter, to the main prescription to drain Yin-Cold. In summer months when Yang is abundant, add Qingpi (Aurantii Fructus Immaturus), Chenpi (Citri Reticulatae Pericarpium), Yizhi (Alpiniae Oxyphyllae Fructus), and Huangbai (Phellodendri Cortex) to the main prescription to disperse Cold Qi and drain rebellious Yin-Fire, or use Xiaopi Wan (Eliminate Epigastric Distention Pill) combined with Zishen Wan (Tonify Kidney Pill). Zishen Wan consists of Huangbai (Phellodendri Cortex), Zhimu (Anemarrhenae Rhizoma), and a small amount of Rougui (Cinnamomi Ramulus), these three ingredients. Or add Huanglian (Coptidis Rhizoma) separately made into pills. Take 70-80 pills on an empty stomach after residual food has digested, wait a while, then eat good food to suppress the medicine so it does not stay in the Stomach. All the above methods are modifications of Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction).

For obstruction of the Diaphragm and Pharynx, and medication methods according to seasonal changes: The Huangdi Zhenjing (Yellow Emperor's Classic of Acupuncture) states: Diseases of the Stomach manifest as abdominal distension, pain in the epigastrium centered behind the heart, radiating upward to both hypochondria, obstruction of the diaphragm and pharynx, and inability to eat or drink. Treat by selecting Zusanli (ST 36). The pharynx is the gateway for swallowing food. The diaphragm is the domain of the Upper Jiao, Heart, and Lung. Obstruction means the ascending and descending Qi cannot communicate between upper and lower. It also states: Clear Qi sinking below produces Sundxie (Sporadic Diarrhea), characterized by yellow, porridge-like stool with undigested grain. Turbid Qi rising above produces Zhang (Distension), characterized by abdominal fullness, inability to pass stool, difficult stool, or hard stool followed by loose stool. Turbid Qi remaining above fails to descend because the Yin Qi inhaled by the Kidneys and Liver cannot go down and instead stays above. Rebellious Stomach Qi may cause vomiting, regurgitation, or hiccups; this is due to Yin-Fire pathogens rushing upward, preventing inhaled Qi from entering, thus causing inability to eat. These are all caused by Qi-rushing Fire rebelling against the Stomach meridian and moving upward. Clear Qi sinking below producing Sundxie occurs because, before Stomach Qi was diseased, it should have ascended to the Heart and Lung for operation. Due to irregular diet and physical overexertion, Heart Fire attacks the Earth position, weakening Stomach Qi which sinks into the Yin. Thus, ingested grain cannot ascend and instead descends as Sundxie. The communicating Qi between the diaphragm and pharynx failing to connect interior and exterior is caused by rebellious Qi ascending from the Chong Mai (Penetrating Vessel). As stated, for Stomach diseases with hypochondriac radiation, diaphragmatic/pharyngeal obstruction, and inability to eat, selecting Zusanli is correct. The Zhenjing states: When Clear and Turbid interfere with each other and chaos arises in the chest, it is called Da Huo (Great Confusion), causing dizziness and confusion. Lack of Qi communication is an acute emergency; if not treated urgently, various complications will arise. The Sages have essential methods for treating this: when Yang Qi is insufficient and Yin Qi is excessive, first tonify Yang, then drain Yin. This first allows Yang Qi to rise in the Yang aspect, then drains Yin. In spring and summer, when Yang Qi is in the meridians, benefit the meridians and remove blood from collateral vessels. In autumn and winter, when Yang Qi submerges, first treat the Zang-Fu organs. If there is Yi or Sai, Sai originates from the Five Zang organs, belongs to Yin, and relates to Blood. Yi originates from the Six Fu organs, belongs to Yang, and relates to Qi. Both are caused by Yang hidden within Yin. The following details medication and treatment methods for the four seasons. During the three winter months, Yin Qi is external and Yang Qi is internal. One should assist Yang Qi externally without sweating, and dissipate Yin-Fire internally without causing diarrhea. This is the key to keeping the Zang organs closed and secure. In deep winter, Water is prosperous, making Metal prosperous. Since the child makes the mother solid, and Lung is the mother of Kidney, the Yang of skin and hair is originally weak. Assisted by the Winter command, patients often sneeze, run clear nasal discharge, and in severe cold, thick nasal discharge. Persistent sneezing makes them more sensitive to wind and cold than normal. Urination is frequent and scanty, or drinking leads to urination with clear, abundant urine. Bowel movements are irregular. At night, they fear cold and cannot sleep. Severe cases develop phlegm-cough, vomiting, hiccups, regurgitation, spitting white foam, and even open mouth, staring eyes, lack of Qi communication, and near-asphyxiation. Wu Zhu Yu Wan (Evodia Pill) is the primary treatment. During the three summer months of great heat, Yang Qi is external and Yin Qi is internal. If this disease occurs at this time, Heaven assists Righteous Qi to defeat Evil Qi, and it may heal spontaneously without treatment. However, some cases do not heal because Yin Qi is extremely abundant and Righteous Qi cannot expand. For example, in diaphragmatic/pharyngeal obstruction with a lump sensation in the throat, and severe manifestation of previous symptoms, treatment should follow the season. Use Lige Wan (Unblock Diaphragm Pill) to drain Lung Fire, delivered with Huangqi Buzhong Tang (Astragalus Tonify Middle Decoction). If accompanied by flaccidity and cold in both legs, hesitant walking, leaning and falling, arms feeling broken and painful with weakness, shortness of breath, rapid breathing, or suffocation, decoct Huangqi (Astragali Radix), Renshen (Ginseng Radix et Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), Cangzhu (Atractylodis Rhizoma), Zexie (Alismatis Rhizoma), Zhuling (Polyporus), Fuling (Poria), and Ju Pi (Citri Reticulatae Pericarpium) as a decoction, and deliver 150 Zishen Wan (Tonify Kidney Pills). Between the sixth and seventh months, when Damp-Heat commands prevail, and the patient has shortness of breath and inability to speak, add Wuweizi (Schisandrae Fructus) and Maidong (Ophiopogonis Radix). If there is epigastric stuffiness, bloating, and inability to eat, use the aforementioned Baizhu and Cangzhu decoction to deliver 50-70 Xiaopi Wan (Eliminate Epigastric Distention Pills), using this method with caution.

[Diagnosis] If the Cun Kou (Radial Pulse) is floating and large, and the physician incorrectly uses purgation, this is a major contraindication. Floating indicates lack of Blood; Large indicates Cold. When Cold Qi combats, it causes borborygmus (bowel sounds). If the physician, unaware, gives water causing profuse sweating, the water combines with Cold Qi, causing cold combat, resulting in Yi (Choking). If the Cun Kou pulse is tight and hollow (Kou), Tight indicates Cold, Hollow indicates Deficiency. The combination of Deficiency and Cold results in a Yin-knotted and slow pulse, leading to Yi (Choking).