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A patient suffering from Guan Ge (Obstruction and Rejection) syndrome vomits immediately after food enters the stomach, and is unable to pass urine or stool. The eyes are red and bloodshot, eyeballs protrude, the hypochondriac regions are distended and full, Qi rebels and feels suppressed, and there is no way to achieve free flow. The world considers this to be excessive Stomach Qi, but fails to realize it is actually due to excessive Liver Qi stagnation. The syndrome of Guan Ge should be distinguished into upper and lower parts: one is the upper "Ge" (Rejection), preventing downward movement; the other is the lower "Guan" (Closure), preventing exit. Now, since the upper part cannot accept intake and the lower part cannot discharge, this is true Guan Ge, a critical condition involving life and death. Originally, treatment could employ the vomiting method; if the upper part is vomited, the Qi in the lower part can become unobstructed. However, since the patient is already vomiting spontaneously without the need for emetic drugs, using emetics is of no benefit. If purgative methods are used, since there is no food entering the stomach from above, the Large Intestine is empty. Even with purgatives, only dry feces in the Large Intestine can be expelled, but the Qi of the Small Intestine and Bladder cannot be unobstructed; thus, purgation is also of no benefit. It is necessary to still use decocted herbal medicine for harmonization, but it should not be taken in large amounts suddenly. It must be sipped slowly. Initially, it may not be accepted, but later it will naturally be tolerated. The formula used is Kai Men San (Opening the Door Powder): Bai Shao (Radix Paeoniae Alba, 5 qian), Bai Zhu (Rhizoma Atractylodis Macrocephalae, 5 qian), Fu Ling (Poria, 3 qian), Chen Pi (Pericarpium Citri Reticulatae, 1 qian), Dang Gui (Radix Angelicae Sinensis, 5 qian), Chai Hu (Radix Bupleuri, 3 qian), Su Ye (Folium Perillae, 1 qian), Niu Xi (Radix Achyranthis Bidentatae, 3 qian), Che Qian Zi (Semen Plantaginis, 3 qian), Chao Zhi Zi (Fructus Gardeniae Praeparated, 3 qian), Tian Hua Fen (Radix Trichosanthis, 3 qian). Decoct with water to yield one bowl, sip slowly. After one dose, tolerance is achieved. Once tolerance is established, the upper obstruction opens; after another dose, the lower rejection also clears.

This formula acts directly on the Liver Meridian to resolve stagnation. Once the stagnation is resolved, Guan Ge heals itself, which is what is meant by seizing the key point to achieve remarkable results. If aromatic-drying herbs are used, they will consume Stomach Qi, merely serving to solidify the closure and exacerbate the rejection.

This syndrome can also be treated effectively with Tong Guan San (Unblocking the Pass Powder): Bai Shao (5 qian), Fu Ling (3 qian), Gan Cao (Radix Glycyrrhizae, unspecified amount), Zhi Ke (Fructus Aurantii, unspecified amount), Shen Qu (Massa Medicata Fermentata, 3 fen each), Bai Dou Kou (Semen Amomi Rotundus, 1 piece), Chuan Xiong (Rhizoma Chuanxiong, 2 qian), Sheng Jiang Zhi (Jucius Zingiberis Recens, half he). Decoct and take orally. One dose opens the passage; two doses cure. After recovery, kidney-tonifying formulas must be used.

There are cases where, without apparent cause, a person suddenly cannot eat from above and cannot excrete from below, with chest distension and urgency, restlessness, and extreme distress in urination and defecation. People consider this Guan Ge syndrome, but who would know it is actually due to the obstruction of Shaoyang Qi? Shaoyang belongs to the Gallbladder, and the Gallbladder belongs to Wood. Wood Qi most desires to spread and vent. When attacked by Cold Evil, the Wood Qi cannot flourish freely, and Qi becomes closed. Thus, it attacks the Stomach upwards and the Spleen downwards. The Spleen and Stomach, fearing the punishment of Wood, dare not generate Lung Qi, and consequently cease generating Large Intestine Qi. The Metal of the Lung, lacking Qi generation from the Spleen and Stomach, loses its clear-descending function, so the Bladder and Small Intestine have no one to follow its orders, leading to simultaneous Qi closure. This syndrome originally could be treated with vomiting; once vomited, the Shaoyang Qi rises and the condition improves. Alternatively, harmonization can be used to regulate the area between the exterior and interior, allowing the stagnation of Gallbladder Wood to clear naturally. Comparing these two methods, harmonization is superior to vomiting; vomiting inevitably damages the Qi of the Five Zang Organs, whereas harmonization does not. The formula used is He Jie Tang (Harmonizing Decoction): Chai Hu (1 qian), Bai Shao (3 qian), Gan Cao (1 qian), Zhi Ke (5 fen), Bo He (Herba Menthae, 1 qian), Fu Shen (Poria with Hostwood, 3 qian), Dan Pi (Cortex Moutan, 2 qian), Dang Gui (3 qian). Decoct and take orally. Sip slowly. After three doses, the gates can open. Once the upper obstruction opens, the lower rejection heals itself.

This formula is a variation of Xiao Yao San (Free and Easy Wanderer Powder). Xiao Yao San contains Bai Zhu and Chen Pi, which can indeed open the gates. I replaced them with Bo He, Zhi Ke, and Dan Pi because these are herbs that enter the Liver Meridian directly, taking advantage of their ease in resolving stagnation. This formula does not deliberately aim to open the gates, yet the gates open naturally, precisely because it excels at resolving stagnation.

This syndrome can also be treated wonderfully with Kuan Huan Tang (Relaxing Decoction): Chai Hu, Fu Ling (2 qian each), Dang Gui (3 qian), Bai Shao (5 qian), Gan Cao, Su Ye, Huang Qin (1 qian each), Zhu Ye (Bamboo Leaves, 30 pieces). Decoct and take orally. Two doses cure.

There are patients with rebellious vomiting, inability to eat, and inability to pass urine or stool. This is due to the excessive Fire of Jue Yang from the Five Emotions, which cannot nourish Yin and is suppressed within the Pericardium. Sweat appears on the head, indicating the loss of Heart Fluid externally and self-burning internally. The moment of survival or death is imminent. This is the most critical type of Guan Ge. People think it is simply Qi obstruction and wish to use Musk (She Xiang) or borneol (Bing Pian) to forcibly open the doors, which will inevitably dissipate True Qi and lead to death. The method should be to harmonize Ying (Nutritive) and Wei (Defensive) Qi, neither leaning towards Yin nor Yang, pursuing harmony and mildness, without offending Stomach Qi, allowing the Zang-Fu organs to distribute and operate themselves. There is no need to ask where the Guan opens or the Ge starts; one should only seek the pivot in the Middle Jiao to transport and gradually penetrate between the upper and lower parts. Naturally, Ying Qi will flow forward, and Wei Qi will not be closed. By following the trend and guiding it appropriately, there will be no rejection. The formula used is He Zhong Qi Guan San (Harmonizing the Middle and Opening the Gate Powder): Mai Dong (Radix Ophiopogonis, 5 qian), Ren Shen (Radix Ginseng, 5 fen), Gan Cao (5 fen), Bai Zi Ren (Semen Platycladi, 3 qian), Hua Shi (Talcum, crushed, 1 qian), Huang Lian (Rhizoma Coptidis, 1 qian), Bai Shao (5 qian), Gui Zhi (Ramulus Cinnamomi, 3 fen), Tian Hua Fen (1 qian 5 fen). Decoct and take orally. After one dose, upper vomiting stops; after two doses, lower closure clears.

This formula disperses Fire in the Middle Jiao and soothes the Liver to calm Wood. Once Wood is calm, Fire and Heat naturally decrease. The most exquisite aspect is the use of Huang Lian and Gui Zhi. Huang Lian calms the Heart to connect with the Kidney, and Gui Zhi harmonizes the Kidney to connect with the Heart. When Heart and Kidney communicate, Ying, Wei, Yin, and Yang Qi all harmonize well. Once Yin and Yang are harmonized, how can the upper and lower Jiao remain firmly closed? This demonstrates the superiority of harmonization in opening gates.

This syndrome can also be treated effectively with Huang Lian Qi Xin Tang (Coptis Awakening Heart Decoction): Ren Shen (1 qian), Bai Zhu, Dan Pi (3 qian each), Huang Lian, Xuan Shen (Radix Scrophulariae, 2 qian each), Gan Cao (1 qian), Gui Zhi (3 fen), Ban Xia (Rhizoma Pinelliae, 5 fen), Chai Hu (3 fen). Decoct and take orally. Two doses cure.

There are patients with upper vomiting and lower binding, rebellious Qi, inability to ingest food, inability to urinate, abdominal pain relieved slightly by pressure. People believe this is extreme Cold causing the reversal of Yin and Yang, and the pulse must be choppy and deep-hidden. The method should be vomiting; without vomiting, death ensues. However, vomiting is actually unnecessary. If the upper pulse is absent and the lower pulse is present, vomiting is appropriate because food is blocking the Taiyin. Now, the pulse is choppy and deep-hidden, which is not the same as absent pulse. Moreover, the ingested food has already been vomited, so it is not food blocking the Taiyin. Would vomiting not severely damage Spleen and Stomach Qi, thereby solidifying the blockage?

The reason Stomach Qi does not open, and the Small/Large Intestines and Bladder do not close, is due to the decline of Kidney Qi. The Stomach is the gate of the Kidney. If Kidney Qi does not ascend, the Stomach's gate certainly cannot open. The Kidney governs urination and defecation, and the Qi transformation of the Bladder is also driven by Kidney Qi transformation. If Kidney Qi does not reach the three meridians, how can urine and stool be discharged? Therefore, the balance of opening and closing above and below lies entirely with the Kidney. The treatment method must greatly tonify the Water and Fire in the Kidney. When the Water and Fire in the Kidney are sufficient, Guan Ge heals itself without specific treatment. The formula used is Shui Huo Liang Bu Tang (Tonifying Both Water and Fire Decoction): Shu Di Huang (Radix Rehmanniae Preparata, 1 liang), Shan Zhu Yu (Fructus Corni, 4 qian), Fu Shen (5 qian), Che Qian Zi (3 qian), Ren Shen (2 qian), Mai Dong (1 liang), Wu Wei Zi (Fructus Schisandrae, 5 fen), Rou Gui (Cortex Cinnamomi, 1 qian), Bai Zhu (5 qian), Niu Xi (3 qian). Decoct and take orally. Take continuously for two doses; upper vomiting stops and lower binding opens. Take four more doses for complete recovery.

This formula tonifies the Water and Fire in the Kidney and unblocks Qi in the Kidney. When Qi is sufficient, it reaches the Stomach upwards and the Bladder/Intestines downwards. If aromatic-drying herbs are used to save the Stomach, Stomach Qi will be further damaged; if purgative/diuretic herbs are used to save the Bladder/Intestines, the Bladder/Intestines will be further impaired. When will the gates open and rejection resolve?

This syndrome can also be treated miraculously with Hua Shen Tang (Transforming Kidney Decoction): Shu Di Huang (2 liang), Rou Gui (2 qian). Decoct and take orally. One dose brings clearance; two doses bring complete recovery.

There are cases of sudden Guan Ge with blocked urination and defecation, thirst for cold water, vomiting shortly after drinking, repeated drinking and vomiting, red face, cracked lips, inability to swallow even a grain of rice, vomiting half a cup after drinking one cup, and a deep-hidden pulse. People think this is pulse extinction, but who would know it is due to Yang being rejected and not disseminated, caused by excessive Cold Evil in the Kidney Meridian? The Kidney belongs to Shaoyin, preferring warmth and disliking cold. When Cold Evil enters the Kidney, Yang has nothing to attach to. Yang desires to suppress Yin but cannot; Yin rejects Yang and becomes stronger. Thus, Yang dares not reside in the Lower Jiao and reverses completely to the Upper Jiao throat area, making it difficult to accommodate food and causing vomiting. Logically, Yang should be checked by Yin, and Heat by Cold. It seems that with Heat/Yang above, Yin-Cold herbs should be used. However, while Heat/Yang is above, the lower part is truly Cold. Using Yin-Cold to check Yin-Cold is exactly catering to what it dislikes, achieving no merit and causing great harm. Since it is false Heat above and true Cold below, unless the method of treating according to nature (using true heat/false cold) is employed, it is impossible to follow its nature and open the gate. The formula used is Bai Tong Tang (White Connect Decoction).

The original formula consists of very hot substances. Adding Human Urine (Ren Niao) and Pig Bile (Zhu Dan) confuses it, so it feels cold when swallowed but is hot upon entering the abdomen. Yang can return heavily, and Yin can dissipate immediately. Naturally, the pulse flows and the gate opens. Then, administer a large dose of Ba Wei Tang (Eight-Ingredient Pill Decoction) to prevent recurrence of closure and vomiting.

This syndrome can also be treated miraculously with Jia Wei Shu Gui Tang (Modified Atractylodes and Cinnamon Decoction): Bai Zhu (1 liang), Rou Gui (1 qian), Gan Cao (1 fen), Ren Shen (2 qian), Ding Xiang (Flos Caryophylli, 1 qian). Decoct, add half a bowl of Human Urine, cool down, and administer by probing the throat. One dose brings relief.