张养愚患伤寒八九日以上。吐逆。食不得入。小便疰闷不通。医作胃热而吐。传入膀胱。则
小便不通也。予诊其脉。见寸上二溢。而尺覆关中。伏而不见。乃断之曰。格阳关阴证也。阳溢
于上。不得下行。阴覆于下。不得上达。中有关格之病。是以屡汗而不得汗也。予投以透膈散。三啜而吐止。小便利而
解。
论曰。或问何谓格阳关阴。答曰难经云关以前动者。阳之动也。脉当见九分而浮。过者。法
曰太过。减者。法曰不及。遂入尺为覆。为内关外格。此阴乘之脉也。又曰阴气太盛。阳气不得
营。故曰关。阳气太盛。阴气不得营。故曰格。阴阳俱盛。不能相营也。故曰关格。关格者不得
尽期而死矣。素问曰人迎。四盛以上为格阳。寸口。四盛以上为关阴。人迎与寸口。俱盛四倍以
上为关格。仲景云在尺为关。在寸为格。关则小便不利。格则吐逆。又趺阳脉浮而涩。浮则吐逆。
水谷不化。涩则食不得入。名曰关格。由是言之。关脉沉伏而涩。尺寸有覆溢者。关格病也。何
以言之。天气下降。地气上升。在卦为泰。泰者通也。天气不降。地气不升。在卦为否。否者闭
也。今阳不降。上鱼际为溢。故其病吐逆。名为外格。阴不得上浮入尺为覆。故其病。小便不通。
为内关。此关格之异也。
张养愚患伤寒病已八九日以上。出现呕吐逆气，食物无法入口，小便涩滞闷痛且不通畅。医生将其诊断为胃热引起的呕吐，认为邪气传入膀胱导致小便不通。我诊察他的脉象，发现寸口脉搏向上溢出（溢脉），而尺部脉搏向下覆盖（覆脉），关部脉伏隐不见。于是判断道：这是格阳关阴证。阳气上溢于上部，不能下行；阴气下覆于下部，不能上达。中焦有关格之病，所以多次发汗却未能出汗。我给予透膈散治疗，服用三次后呕吐停止，小便通畅，病情得以解除。
论述说：有人问什么是格阳关阴？回答说：《难经》记载，关前（寸部）脉动者，是阳气的变动。脉象应当表现为九分长且浮取可得。如果超过这个限度，按法称为太过；如果不足，按法称为不及。若脉气深入尺部则为“覆”，形成内关外格的脉象，这是阴气上乘的脉象。又说：阴气太盛，阳气不能营运，所以称为“关”；阳气太盛，阴气不能营运，所以称为“格”。阴阳俱盛，不能相互营运，所以称为“关格”。患关格病的人往往活不到预定的寿数而死。《素问》说：人迎脉（颈部动脉）搏动比正常大四倍以上为格阳；寸口脉（手腕桡动脉）搏动比正常大四倍以上为关阴。人迎与寸口脉都盛大四倍以上，称为关格。张仲景说：脉在尺部为关，在寸部为格。关则小便不利，格则呕吐逆气。另外，趺阳脉（足背动脉）浮而涩，浮则呕吐逆气，水谷不化；涩则食物无法入口，名为关格。由此而言，关脉沉伏而涩，尺寸部有覆脉和溢脉表现的，就是关格病。为什么这样说呢？天气下降，地气上升，在卦象中为泰卦，泰意味着通泰。天气不降，地气不升，在卦象中为否卦，否意味着闭塞。现在阳气不降，上行至鱼际部位形成溢脉，所以其病症为呕吐逆气，名为外格；阴气不能上浮并深入尺部形成覆脉，所以其病症为小便不通，名为内关。这就是关格病的异同之处。
Zhang Yangtu suffered from Shanghan (Cold Damage) for more than eight or nine days. He experienced vomiting and regurgitation, was unable to take food, and had urinary retention with a sensation of fullness and obstruction. The physician diagnosed it as vomiting due to Stomach Heat, believing that the pathogen had transmitted to the Bladder, causing urinary obstruction. Upon examining his pulse, I observed an overflow pulse (Yi Mai) at the Cun (Inch) position extending upwards, and a covering pulse (Fu Mai) at the Chi (Cubit) position extending downwards, while the Guan (Bar) position was hidden and imperceptible. I then concluded: This is the Ge Yang Guan Yin syndrome (Exterior Grid and Interior Gate Syndrome). Yang overflows upward and cannot descend; Yin covers downward and cannot ascend. There is a pathology of Guan Ge (Grid and Gate) in the middle jiao, which is why repeated sweating failed to produce perspiration. I administered Touge San (Diaphragm-Penetrating Powder), and after three doses, the vomiting ceased, urination became smooth, and the condition resolved.
The discussion states: Someone asked, what are Ge Yang and Guan Yin? The answer is: The Nan Jing (Classic of Difficult Issues) records that movement at the Cun (Inch) position, which is anterior to the Guan (Bar), indicates the movement of Yang. The pulse should be nine fen long and floating. If it exceeds this, the method calls it "excess" (Tai Guo); if it falls short, the method calls it "deficiency" (Bu Ji). If the pulse qi enters the Chi (Cubit) position, it is called "covering" (Fu), forming the internal Guan (Gate) and external Ge (Grid) pattern, which is a pulse sign of Yin encroaching. It further states: When Yin Qi is excessively strong, Yang Qi cannot circulate, hence it is called "Guan" (Gate/Obstruction); when Yang Qi is excessively strong, Yin Qi cannot circulate, hence it is called "Ge" (Grid/Rejection). When both Yin and Yang are excessive and cannot mutually circulate, it is called "Guan Ge". Those suffering from Guan Ge often die before their natural lifespan ends. The Su Wen (Basic Questions) states: When the Ren Ying pulse (carotid artery) is four times stronger than normal, it is Ge Yang (Exterior Grid); when the Cun Kou pulse (radial artery) is four times stronger than normal, it is Guan Yin (Internal Gate). When both Ren Ying and Cun Kou pulses are four times stronger than normal, it is Guan Ge. Zhang Zhongjing stated: Pulse at the Chi position indicates Guan; pulse at the Cun position indicates Ge. Guan results in difficult urination; Ge results in vomiting and regurgitation. Furthermore, a Fu Yang pulse (dorsalis pedis artery) that is floating and choppy indicates vomiting and regurgitation with undigested food and drink due to floating; and inability to eat due to choppy quality, named Guan Ge. From this perspective, a Guan pulse that is deep, hidden, and choppy, accompanied by Fu and Yi pulses at the Cun and Chi positions, indicates Guan Ge disease. Why is this so? Heaven Qi descends, Earth Qi ascends; in the hexagrams, this is Tai (Peace), meaning openness. If Heaven Qi does not descend and Earth Qi does not ascend, in the hexagrams, this is Pi (Stagnation), meaning closure. Now, Yang does not descend, rising to the Yu Ji area to form an overflow pulse, thus the symptom is vomiting and regurgitation, named Exterior Ge; Yin cannot float upward and enter the Chi position to form a covering pulse, thus the symptom is urinary obstruction, named Internal Guan. This explains the characteristics of Guan Ge.