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[General Principle]
The stagnation of the San Yang (Triple Burner/Yang channels) is termed "Ge" (Diaphragm obstruction). (From *Nei Jing* / *Inner Canon*) The so-called San Yang refers to the Small Intestine, Large Intestine, and Bladder. Heat stagnation in the Small Intestine leads to dryness of the blood vessels; heat stagnation in the Large Intestine leads to constipation; heat stagnation in the Bladder leads to depletion of body fluids.
Once the San Yang channels are stagnant, causing constipation and blockage, fire pathogens ascend counterflow, resulting in difficulty swallowing and inability to ingest food. (From Liu Wansu/Zihe)

[Etiology: Internal Factors]
"Ge" implies a sense of rejection or blockage. It arises from emotional depression and frustration, as well as excessive consumption of rich and greasy foods, strong alcohol, and sexual indulgence, which stir up fire in the Spleen, Stomach, Liver, and Kidney. This causes depletion and consumption of blood, leading to withering and dryness of the Stomach cavity. Qi stagnation transforms into fire, and body fluids condense into phlegm. Phlegm and fire become firmly knotted, obstructing the pathway, making it difficult to ingest food. This is how Ye Ge (Dysphagia and Food Regurgitation) forms. (From *Zhengzhi Huibu* / *Compendium of Syndrome Differentiation and Treatment*)

[External Manifestations]
"Ye" (Dysphagia) is located above, with congestion and blockage in the throat; although drinking water may enter, solid food cannot go down. "Ge" (Food Regurgitation) is located below, with stifling distension in the chest and diaphragm; although food can enter, it is vomited back up once it reaches the Stomach. Or, after swallowing food, the patient's whites of the eyes appear and the mouth opens, with qi failing to flow smoothly; or upon entering food, there is stabbing pain in the heart region, followed by vomiting after a short while, with pain ceasing after the food is expelled. (From *Shengmo* / *Standard Rules*, likely referring to *Yizong Jinjian*)

[Five Types of Ye]
There are types due to Qi stagnation, Blood stasis, Fire flaming upward, Phlegm coagulation, and Food retention. Although divided into five types, they all ultimately return to changes caused by the Seven Emotions. Qi stagnation transforms into fire; flourishing fire dries up blood; body fluids become phlegm; phlegm becomes abundant and food fails to digest. If one feels blocked and uncomfortable upon swallowing, with restricted movement and stretching of the neck and back, resembling symptoms of Ge Ye, where food cannot go down and the heart and stomach hurt, this is due to phlegm coagulation and Blood stasis. Furthermore, if there is a phlegm-Qi nodule in the throat and chest that cannot be coughed up or swallowed, and food cannot go down, this is also caused by the Seven Emotions. In such cases, moistening agents should not be used. Instead, use Er Chen Tang (Two-Aged Decoction) added with Xiangfu (Cyperus Rhizome), Sharen (Amomum Fruit), Gualou (Trichosanthes Fruit), Suzi (Perilla Seed), Zhike (Aurantium Fruit), Houpo (Magnolia Bark), Huanglian (Coptis Rhizome), and Shengjiang (Fresh Ginger) to open the stagnation. If it is caused by excessive sexual activity, with Yin fire flaming upward, forming Ge Qi, it should be treated as fixed Blood stasis. Use Er Chen Tang added with Danggui (Angelica Sinensis), Taoren (Peach Kernel), Xiangfu, Sharen, Baizhu (Atractylodes Macrocephala Rhizome), Chenxiang (Aquilaria Wood), Jiu Zhi (Chinese Chive Juice), and Jiang Zhi (Ginger Juice). (From *Zhengzhi Huibu*)

[Ye Related to Seven Emotions]
Caused by anger, food intake leads to counterflow of Qi downwards; caused by labor/Qi exhaustion, it manifests as throat dysphagia and panting; caused by overthinking, it results in middle jiao fullness, blockage of the San Jiao (Triple Burner), and throat dysphagia with discomfort. (From *Zhen Jing* / *Needle Classic*, i.e., *Ling Shu*) Generally, this condition is a disorder of the spirit/mind. Only through introspection and quiet nourishment can recovery be expected. (From *Jifeng Pujifang* / *Jifeng General Relief Formulas*)

[Differentiation between Ye and Ge]
"Ye" is when Yin Qi fails to descend, generated from the Six Fu organs, belonging to Yang and Qi. "Ge" is when Yang Qi fails to ascend, generated from the Five Zang organs, belonging to Yin and Blood. However, both arise from hidden Yang within Yin. (From Li Dongyuan)

[Pulse Diagnosis]
Rapid and forceless pulse indicates Blood deficiency; slow and forceless pulse indicates Qi deficiency; wiry, slippery, and forceful pulse indicates Phlegm; rapid, excess, and forceful pulse indicates Heat. Additionally, for Blood deficiency, the left pulse is forceless; for Qi deficiency, the right pulse is forceless; for Phlegm coagulation, the Cun and Guan positions are deep, slippery, and large; for Qi stagnation, the Cun and Guan positions are deep, hidden, and choppy; for flaming Qi counterflow, the pulse comes rapid and large; for Blood stasis accumulation, the pulse comes hollow and choppy; small, weak, and choppy pulse indicates Fan Wei (Regurgitation); tight, slippery, and革 (Leather-like) pulse indicates Ye Ge.

[Treatment Principles]
Treatment should focus on nourishing Blood and generating fluids, clearing Phlegm and descending Fire, smoothing Qi and regulating the Spleen, suppressing the Liver and opening depression.

[Nourishing and Treating Deficiency vs. Excess]
If strengthening the Spleen and resolving Phlegm, one must fear that drying agents will hinder body fluids. If using Blood-nourishing and fluid-generating agents, one must fear that moistening agents will obstruct the Middle Jiao (Spleen/Stomach). Assess whether Yin injury and Fire flourishing exist; if so, prioritizing Blood nourishment is urgent. If Spleen injury and Yin abundance exist, prioritizing warm tonification is first. Furthermore, if there is pent-up grief and indignation, with Fire stagnation and closure, but the Spirit is not greatly depleted and the pulse still has strength, one should employ the purgative methods of Cang Gong (Chunyu Yi) and He Jian (Liu Wansu) to purge downward, allowing the blockages to open naturally. If there is abundant Phlegm in the Diaphragm, first induce slight vomiting to expel the Phlegm, then treat the lower aspect, making the medicinal action easier to proceed. Alternatively, using honey and salt to guide downward is also acceptable. (From *Bixu* / *Must Read*, i.e., *Jingyue Quanshu*)

[Treatment Focusing on Lung and Kidney]
Yin Blood roots in the Kidney, and Yang Qi operates via the Lung. The Qi and Blood in the Stomach rely on these two organs for generation. Thus, there are cases where Qi deficiency fails to transform and generate Phlegm, and cases where Blood deficiency fails to nourish the Kidney and generate Fire. One should nourish the Metal (Lung) and Water (Kidney) organs, ensuring Yin Blood is moistened and fluids are generated, so that Ye Ge gradually opens. (From *Zhengzhi Huibu*)

[Treatment Suitable for Regulation and Tonification]
Throat dysphagia and blockage, with chest and diaphragm fullness, seem like Qi stagnation, but may be caused by excessive use of Qi-consuming drugs leading to failure of Middle Qi transport; in such cases, tonify Qi. Dry and hot stool, hard like sheep dung, seems like Blood Heat, but may be caused by excessive use of purgative drugs leading to Blood depletion; in such cases, tonify Blood. (From *Yuji* / *Jade Machine*, i.e., *Yimen Falv*)

[Contraindication: Aromatic and Drying Agents]
Treatment should primarily benefit Yin and nourish the Stomach; aromatic opening and guiding is only temporary. If generally using acrid, dispersing, and drying-hot drugs, adding fire to fire severely consumes body fluids. Over time, this leads to constipation, blockage of the幽门 (Pylorus), counterflow of Qi to the吸门 (Glottis), and worsening of Ye Ge. (From *Zhengzhi Huibu*)

[Contraindication: Clinging and Stagnant Treatments]
I have seen many depressed individuals where Qi knots in the chest, gathering into Phlegm, becoming sticky in the Upper Jiao, narrowing the pathways and preventing expansion. Others who love wine develop Fire from Dampness, and Fire generates Phlegm; Phlegm and Fire scorch each other, becoming stuck and unable to separate, blocking the clear pathways, gradually causing涩痛 (astringent pain). If treating this as dried Blood and administering moistening products, the Blood may not be moistened, but rather the Phlegm is assisted, and how can the disease heal? Only in black, thin individuals whose True Yin is inherently deficient, who often feel internal heat, do not love wine, or have taken excessive aromatic-drying-hot drugs, should one treat them as dried Blood. (From *Zhengzhi Huibu*)

[Prognosis: Fatal Signs]
Difficult to treat if aged sixty or above; untreatable if stool is like sheep dung; untreatable if vomiting large amounts of white foam; fatal if chest and abdomen ache painfully like knife cuts; critical if one does not abstain from wine, sex, and grief/indignation.

[Medication Usage]
Main formula: Er Chen Tang (Two-Aged Decoction), add Baizhu and Zhike to clear Phlegm; add Zhuli (Bamboo Sap) and Jiang Zhi to descend Fire; add Zhuru (Bamboo Shavings) and Shanzhi (Gardenia Fruit) to open depression; add Xiangfu and Fuxiong (Chuanxiong Rhizome) to suppress the Liver; add Qingpi (Green Tangerina Peel) and Baishao (White Peony Root). If there is blockage in the throat, this is due to Blood deficiency; add Danggui and Jiu Zhi. If there is chest fullness, this is due to counterflow of Qi; add Hezi (Chebula Fruit) and Kunbu (Kelp). Pain in the heart after eating, stopping only after vomiting, indicates Blood stasis in the Stomach; add Jiu Zhi and Jiang Zhi to moisten. Hard abdomen with constipation and food rushing upward indicates Excess Heat in the Lower Jiao; add Dahuang (Rhubarb Root) and Taoren to purge downward. If there are parasites, add Donkey Urine. If there is Fire, add Child Urine. If Blood is deficient and the person is thin and weak, combine this formula with Siwu Tang (Four Substance Decoction). If Qi is deficient and fatigue is present, combine with Sijunzi Tang (Four Gentlemen Decoction), adding Zhuli, Jiang Zhi, and Child Urine. For dairy products: For early-stage Ge disease with excessive depression but undried Blood, use Chenxiang, Muxiang, and Doukou to lift and open; do not merely use tonics. For long-term illness damaging the Stomach and depleting fluids, use White Honey, Lugen (Reed Rhizome), Danggui, and Baishao to nourish; do not merely use aromatic-drying agents. This is the sequence of treatment.

[Appendix: Plum Pit Qi]
Plum Pit Qi (Meiheqi) is Phlegm-Qi obstructing the throat, impossible to cough out or swallow, feeling like a plum pit. This is caused by internal stagnation of Damp-Heat and condensation of Phlegm-Qi. Treatment should focus on opening depression, smoothing Qi, and resolving Phlegm. Use Modified Er Chen Tang as the main prescription. Another formula: Mix 1 cup of Jiu Zhi, half a cup of Jiang Zhi, and half a cup of Cow Milk evenly. Take slowly and warm. Once swallowed, gradually increase the dose.

[Selected Formulas for Ye Ge]
Wuzhi Yin (Five Juices Drink)
Lugen Zhi (Reed Rhizome Juice), Jiang Zhi, Jiu Zhi, Chenxiang Zhi (Aquilaria Juice), Zhuli. Mix evenly, cook in a double boiler, and take.

Qisheng Tang (Seven Sages Decoction)
Banxia (Pinellia Tuber), Huanglian, Baikou (White Cardamom), Renshen (Ginseng Root), Fuling (Poria), Zhuru (Equal parts). Decoct with Fresh Ginger water.

Yongtan Tang (Phlegm-Vomiting Decoction)
Gancao (Licorice Root), Jiegeng (Platycodon Root), Goudi (Melon Tip) (1 qian each), Zhike, Chenpi (Tangerina Peel) (0.5 qian each). Decoct in water, drink completely, then stimulate gagging to vomit.

Ziyin Qingge San (Nourish Yin Clear Diaphragm Powder) and Zixue Runchang Tang (Nourish Blood Moisten Intestines Decoction) (See "Fan Wei" section for these two formulas)

Ye Ge Xianfang (Immortal Formula for Ye Ge)
Baipengsha (Borax) 1.5 qian, Zhen Qingdai (Indigo Naturalis) 1 qian, Wu Jiao Chenxiang (Dark-horn Aquilaria) 2 qian. Grind into fine powder for later use. Then, take 1 jin (500g) of White Horse Urine (use Black Donkey Urine if Fan Wei), juice from 1 jin of White Radish, and juice from half a jin of Fresh Ginger. Boil together in a copper pot until a paste forms. Take three tea spoons of the paste per dose, mixed with seven li of the aforementioned powder, dissolved in warm water. Take three times a day. Patency and ability to eat can be achieved on the same day. Truly a miraculous immortal formula.