凡年高患此者多不可治，以血气虚败故也。粪如羊矢者不可治，大肠无血也。吐痰如蟹
沫者不可治，脾气败也。腹中疼痛， 杂如刀割者不可治，营虚之极，血竭于中也。
《巢氏病源》曰∶阴阳不和则三焦隔绝。三焦隔绝则津液不利，故令气塞不调，是以成
噎。此由忧恚所致。忧恚则气结，气结则不宣流，而使噎塞不通也。
张鸡峰云∶噎膈是神思间病，惟内观自养者可治。此言深中病情。
严氏云∶五膈五噎，由喜怒太过，七情伤于脾胃，郁而生痰，痰与气搏，升而不降，饮
食不下。盖留于咽嗌者，则成五噎，结于胃膈者，则为五膈。其病令人胸膈痞闷，呕逆噎塞
，妨碍饮食。治法宜调阴阳，化痰下气，阴阳平匀，气顺痰下，则病无由作矣。
刘宗浓曰∶夫治此疾也，咽嗌闭塞，胸膈痞闷，似属气滞，然有服耗气药过多，中气不
运而致者，当补气而自运。大便燥结如羊屎，似属血热，然服通利药过多，致血液耗竭而愈
结者，当补血润血而自行。有因火逆冲上，食不得入，其脉洪大有力而数者，或痰饮阻滞，
而脉结涩者，当清痰泄热，其火自降。有因脾胃阳火亦衰，其脉沉细而微者，当以辛香之药
温其气，仍以益阴养胃为之主，非如《局方》之惟务燥烈也。若夫不守戒忌浓味、房劳之人
，及年高无血者，皆不能疗也。
陈无择《三因方》曰∶五膈者，思忧喜怒悲也。五噎者，忧思气劳食也。思膈则中脘多
满，噫则醋心，饮食不消，大便不利。忧膈则胸中气结，津液不通，饮食不下，羸瘦短气。
喜膈则五心烦热，口苦生疮，倦甚体痹，胸痛引背，食少入。怒膈则胸膈逆满，噎塞不通，
呕则筋急，恶闻食气。悲膈则心腹胀满，咳嗽，气逆，腹中雷鸣，绕脐痛，不能食。忧噎，
胸中痞满，气逆时呕，食不下。思噎，心悸喜忘，目视KT KT 。气噎，心下痞，噫哕不食，胸
背痛，天阴手足冷，不能自温。劳噎，气上膈，胸中塞噎，肢满背痛。食噎，食急多胸中苦
痛，不得喘息。
凡是年事高而患此病的人，大多难以治愈，这是因为气血虚损败坏的缘故。大便像羊粪球一样干结的，属于不可治之症，这是大肠无血滋养的表现。呕吐出的痰液像螃蟹泡沫一样的，属于不可治之症，这是脾气败坏的表现。腹部疼痛，混杂着如刀割般的剧痛，属于不可治之症，这是营气极度虚弱，血液在中焦枯竭的表现。
《巢氏病源》说：阴阳不和则导致三焦隔绝。三焦隔绝则津液运行不利，因此导致气机壅塞不调，从而形成噎膈。这多由忧愁和愤懑所致。忧愁愤懑会导致气机郁结，气机郁结则不能宣通流动，从而导致噎塞不通。
张鸡峰说：噎膈是神志思维方面的疾病，只有能够内观自省、自我调养的人才能治愈。这句话深深切中了病情的要害。
严氏说：五膈五噎，是由于喜怒过度，七情损伤了脾胃，气郁而生痰，痰与气相互搏结，气机上升而不下降，导致饮食无法下行。凡停留在咽喉部位的，就形成五噎；结聚在胃膈部位的，就形成五膈。这种病使人胸膈痞闷，呕逆噎塞，妨碍饮食。治疗方法应当调理阴阳，化痰下气，如果阴阳平和均匀，气顺痰消，那么疾病就没有发作的依据了。
刘宗浓说：治疗这种疾病，咽喉闭塞，胸膈痞闷，似乎属于气滞，然而有因服用耗气药物过多，导致中气不运转而造成的，应当补气使其自然运转。大便燥结像羊屎一样，似乎属于血热，然而有因服用通利药物过多，导致血液耗竭而更加结滞的，应当补血润燥使其自然通畅。有因火邪上逆冲撞，食物无法入口，其脉象洪大有力且数的，或者因痰饮阻滞，而脉象结涩的，应当清化痰热，火热之气自然下降。有因脾胃阳气衰微，其脉象沉细而微弱的，应当用辛香类药物温煦其气，仍以益阴养胃作为主要治法，不像《局方》那样只追求燥烈之性。至于那些不遵守禁忌、食用浓味厚腻食物、纵欲房劳的人，以及年老无血的人，都是无法治疗的。
陈无择在《三因方》中说：五膈，是指思、忧、喜、怒、悲五种情志致病。五噎，是指忧、思、气、劳、食五种病因致病。思膈则中脘部多胀满，嗳气反酸，饮食不消化，大便不通畅。忧膈则胸中气机郁结，津液不通，饮食难以下咽，身体消瘦，气息短促。喜膈则五心烦热，口苦生疮，极度疲倦，肢体痹痛，胸痛牵引背部，进食量少。怒膈则胸膈逆气胀满，噎塞不通，呕吐时筋脉拘急，厌恶闻到食物的气味。悲膈则心腹胀满，咳嗽，气逆，腹中雷鸣，脐周疼痛，无法进食。忧噎，胸中痞闷胀满，气逆时常呕吐，食物难以下咽。思噎，心悸健忘，视物模糊不清。气噎，心下部痞塞，嗳气呃逆不食，胸背痛，阴天时手足寒冷，无法自行温暖。劳噎，气上冲至膈部，胸中堵塞噎塞，四肢胀满背痛。食噎，进食急促时胸中痛苦疼痛，无法喘息。
For those of advanced age suffering from this condition, it is mostly incurable due to the deficiency and deterioration of Qi and Blood. Stools resembling sheep dung are incurable, indicating a lack of Blood in the Large Intestine. Vomiting phlegm resembling crab foam is incurable, indicating the deterioration of Spleen Qi. Abdominal pain mixed with knife-like cutting sensations is incurable, indicating extreme deficiency of Ying (Nutritive) Qi and exhaustion of Blood in the Middle Jiao.
The *Nashibingyuan* (Source of Diseases by Master Chao) states: When Yin and Yang are not harmonious, the San Jiao (Triple Burner) becomes obstructed. Obstruction of the San Jiao leads to impaired flow of Body Fluids, causing Qi stagnation and disharmony, thus resulting in Ye Ge (Dysphagia and Food Impaction). This arises from sorrow and indignation. Sorrow and indignation cause Qi to knot; when Qi knots, it cannot circulate freely, leading to obstruction and blockage.
Zhang Jifeng stated: Ye Ge is a disease of the spirit and mind; only those who practice introspection and self-nourishment can be cured. This statement deeply hits the essence of the pathology.
Yan Shi stated: The Five Ge and Five Ye arise from excessive joy or anger, where the Seven Emotions damage the Spleen and Stomach. Qi stagnation generates Phlegm; Phlegm and Qi contend with each other, rising but not descending, preventing food intake. What remains in the throat and epiglottis forms the Five Ye; what knots in the stomach and diaphragm forms the Five Ge. This disease causes chest and diaphragm fullness and oppression, vomiting, regurgitation, and dysphagia, hindering food intake. The treatment method should regulate Yin and Yang, resolve Phlegm, and direct Qi downward. If Yin and Yang are balanced and even, Qi flows smoothly, and Phlegm descends, the disease will have no basis for occurrence.
Liu Zongnong stated: In treating this disease, throat closure and chest/diaphragm fullness seem to belong to Qi stagnation. However, some cases result from taking too many Qi-consuming medicines, leading to failure of Middle Qi to move; these require tonifying Qi to restore movement. Dry stools like sheep dung seem to belong to Blood Heat, but some result from taking too many purgative medicines, exhausting Blood and causing further constipation; these require nourishing and moistening Blood to restore flow. Some cases involve Fire rebelling upward, preventing food entry, with a pulse that is surging, forceful, and rapid; or Phlegm-Fluid obstruction with a knotted and choppy pulse; these require clearing Phlegm and draining Heat, so that Fire naturally descends. Some cases involve decline of Spleen and Stomach Yang Fire, with a pulse that is deep, fine, and faint; these require acrid-aromatic medicines to warm Qi, primarily focusing on nourishing Yin and benefiting the Stomach, unlike the *Ju Fang* which focuses solely on drying and heating properties. As for those who do not observe dietary and lifestyle taboos, consume rich flavors, engage in sexual excess, or are elderly without sufficient Blood, they cannot be treated.
Chen Wuyue in the *Sanyin Fang* (Formulae of Three Causes) stated: The Five Ge refer to diseases caused by Si (Overthinking), You (Worry), Xi (Joy), Nu (Anger), and Bei (Grief). The Five Ye refer to diseases caused by You (Worry), Si (Overthinking), Qi (Qi disturbance), Lao (Fatigue), and Shi (Food retention). Si Ge causes fullness in the Zhongwan region, belching with acid reflux, indigestion, and difficulty defecating. You Ge causes Qi knotting in the chest, blocked Body Fluids, inability to swallow food, emaciation, and shortness of breath. Xi Ge causes heat in the five centers (palms, soles, and chest), bitter taste, mouth ulcers, extreme fatigue, limb bi-syndrome, chest pain radiating to the back, and reduced food intake. Nu Ge causes rebellious Qi and fullness in the chest and diaphragm, dysphagia and blockage, tendon spasms during vomiting, and aversion to the smell of food. Bei Ge causes heart and abdominal distension, cough, rebellious Qi, borborygmus, periumbilical pain, and inability to eat. You Ye causes chest fullness and oppression, rebellious Qi with occasional vomiting, and difficulty swallowing. Si Ye causes palpitations, forgetfulness, and blurred vision. Qi Ye causes epigastric fullness, belching and hiccups with anorexia, chest and back pain, cold hands and feet on cloudy days, and inability to warm oneself. Lao Ye causes Qi rushing to the diaphragm, chest blockage and dysphagia, limb fullness, and back pain. Shi Ye causes severe chest pain upon hurried eating, and inability to breathe easily.