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Ge (Obstruction) refers to blockage. When food and drink enter the throat but cannot descend immediately, they become stuck in the chest and diaphragm as if obstructed by something; hence it is named Ge Ye (Diaphragmatic Obstruction). Furthermore, since the disease is located primarily between the diaphragm, where food cannot go down, and Qi rebels upward, followed by vomiting, it is also called Ge Qi (Diaphragmatic Qi). Fan Wei (Regurgitation/Stomach Reversal) occurs when food enters the stomach without any sense of obstruction, but after one or two hours, it is vomited back up, having a meaning of "returning," thus it is called Fan Wei. In severe cases, morning meals are vomited in the evening, and evening meals in the morning, implying a flipping-over sensation, so it is also named Fan Wei (Flipping Stomach). This differs from Ge Ye, where vomiting only occurs if there is a sensation of choking; if there is no choking, there is no vomiting.

The disease of Ge Ye can be either Deficiency (Xu) or Excess (Shi). In Excess patterns, phlegm (Tan) or blood stasis (Yu Xue) may adhere to the epigastrium, struggling with Qi, wrapped externally like a membrane; sometimes it can be vomited out, leaving the diaphragm temporarily relaxed, only to return to its original state shortly after. In Deficiency patterns, body fluids are depleted and lack moisture, and Qi is insufficient, causing the stomach to shrink and dry, making food difficult to pass due to friction. Deficiency requires moistening and nourishing, while Excess requires dredging and unblocking; these must not be confused.

When food and drink enter the throat but fail to reach the stomach, it is called Ye (Choking); when food fails to descend smoothly and Qi rebels upward, it is called Sai (Blockage). Li Dongyuan stated that Yang Qi failing to exit constitutes Sai, and Yin Qi failing to descend constitutes Ye. Does this imply that ingested food belongs to Yin, while the movement of Qi belongs to Yang? Although his wording is profound, the underlying principle becomes obscure. He further suggested using Yang-tonifying herbs first to treat the root, followed by various purgative methods to treat the branch; I do not understand what he meant by this.

Zihe discussed Ge Ye at length, stating that heat accumulation in the Three Yang meridians causes blockage in both upper and lower orifices. Since the lower pathway is blocked, Qi must rebel upward, resulting in the inability to swallow food. However, Ge Ye is a disease of the Stomach. Initially, there may not be dryness and accumulation; only after a long time might symptoms such as scanty, hard stools resembling sheep feces appear. This occurs because Stomach fluids and Qi rebel upward instead of descending; thus, it is a Stomach disease affecting the Intestines, not an Intestinal disease affecting the Stomach. Influenced by Liu Hejian’s use of San Yi Cheng Qi Tang (Three Yin Major Yellow and Rhubarb Decoction), some argue that Ge Ye should only be treated with purgatives, believing that once the accumulation dissipates and Yang heat clears, the disease will heal itself. Yet, how can diseases of the epigastrium and diaphragm be cured by purgation? Although Zhang Zhongjing prescribed Da Huang Gan Cao Tang (Rhubarb and Licorice Decoction), and Li Dongyuan developed Tong You Tang (Unblock the Throat Decoction) and Run Chang Wan (Moisten the Intestines Pills), these were established for patients with constipation accompanied by vomiting. They are treatments for immediate regurgitation upon ingestion, not applicable to discussing food sticking and failing to descend. What was particularly commendable was his advice: "Do not attack abruptly; instead, prioritize moistening and nourishing. Administer small doses of decoctions or pills repeatedly until the orifices naturally open." Or, "Use bitter and sour substances to mildly induce vomiting of phlegm-fluids in the diaphragm, thereby facilitating downward treatment, allowing the medicinal force to move easily. If this fails, use honey and salt water to guide from below, connecting upper and lower forces." These words are excellent. Generally, phlegm and blood stasis in the epigastrium will not resolve without movement; however, if the medicinal force exceeds the site of the disease, it will damage True Qi, doing more harm than good. Therefore, using small pills in gradually increasing doses to reach exactly the site of the disease—neither excessive nor insufficient, aiming for balance—is the way to treat Ge Ye. One must carefully distinguish whether the pathogen is phlegm or blood stasis before applying specific treatments.

Cases of Ge Ye mostly occur in individuals over fifty years old, predominantly due to depletion of body fluids. In young adults with robust Qi and Blood, the cause is usually blood stasis or phlegm. Recently, I witnessed a physician using formulas for fluid depletion to treat a young, obese, and robust man, who died without recovering from the misdiagnosis/mistreatment. How tragic! (Recorded by Henian.)

My late aunt passed down a prescription: Soak one jin (approx. 500g) of dried jellyfish head in one jin of distilled liquor (Baijiu), place it in a porcelain jar, and bury it underground for several years until the jellyfish dissolves into water. Take half a wine glass; it is effective. (Recorded again by Henian.)