bubble_chart Concept

Dysphagia is a clinical symptom of swallowing disorder. To elaborate, "ye" refers to the difficulty and obstruction when swallowing food, while "ge" denotes the blockage and inability to pass food down. "Ye" is mild and "ge" is severe; "ye" is the beginning of "ge," and "ge" is the progression of "ye." The "Qianjin Yanyi" states: "Ye and ge are fundamentally of the same nature; the onset of ge is invariably preceded by ye." Therefore, they can be collectively referred to as dysphagia and discussed together.

This condition is referred to as "ge," "yan ye," and "ge sai bu tong" in the Neijing. Zhubing Yuanhou Lun distinguishes five types of "ye": "qi ye," "you ye," "lao ye," "shi ye," and "si ye." Zhouhou Fang further differentiates five types of "ge": "you ge," "han ge," "re ge," "qi ge," and "hui ge."

Although both dysphagia and regurgitation involve vomiting, they are conceptually different. Dysphagia occurs between the esophagus and the diaphragm, above the appetite, where food has not yet entered the stomach, with the main symptoms being the inability to swallow or vomiting immediately after eating. Regurgitation occurs in the stomach, where food has already entered the stomach, and may involve evening vomiting of food eaten in the morning, morning vomiting of food eaten in the evening, or vomiting immediately after eating. Therefore, Zhao Xian-ke in the Yiguan．Dysphagia Discussion states: "Dysphagia and regurgitation... are each different, with distinct etiologies, and should be treated differently; they must not be confused." Additionally, globus hystericus also involves a sensation of obstruction in the throat, but without the difficulty in purgation, making it easily distinguishable from this condition.

bubble_chart Pattern Analysis

1. Phlegm and Qi Stagnation︰Difficulty swallowing, chest and diaphragm stuffiness and fullness with dull pain, difficulty in bowel movements, dry mouth and throat, emaciation, red tongue with thin greasy coating, and wiry pulse. This condition is attributed to melancholy damaging the spleen. When the spleen is impaired, qi becomes stagnant, leading to damp accumulation, which in turn generates phlegm. The convergence of yin qi and yang qi obstructs the stomach qi from descending, resulting in esophageal obstruction and difficulty in swallowing, thus causing dysphagia. The treatment should focus on relieving stagnation, moistening dryness, and resolving phlegm. The recommended prescription is modified Qige Powder.
2. Static Blood︰The difficulty in swallowing recurs, and in severe cases, even water is hard to ingest, accompanied by chest and diaphragm pain, emaciated constitution, scaly skin, a bluish-purple tongue or with ecchymosis, and a thin, rough pulse. This is due to anger damaging the liver, resulting in liver qi depression, blood stagnation following qi stagnation, loss of smooth flow, accumulation of unresolved stasis, and obstruction of the esophagus, leading to dysphagia. The treatment should focus on nourishing blood, activating stasis, and resolving masses, using a modified Decoction for Opening the Pylorus.
3. Yang Deficiency︰Unable to eat, frequent vomiting of clear saliva, pale complexion, puffy appearance, cold body and shortness of breath, abdominal distension and fullness, white and moist tongue coating, thin and weak pulse. Often appears in the late stage [third stage] of the disease. If due to prolonged phlegm obstruction and blood stasis, deficiency of both the spleen and kidney, spleen qi deficiency leads to impaired transportation and transformation, while kidney yang decline results in weakened warming and transformation. Qi deficiency and yang weakness prevent the transformation of fluids, hence frequent vomiting of clear saliva and difficulty in eating, leading to dysphagia. Those with qi deficiency and yang weakness exhibit signs of yang deficiency and cold, such as a cold body, pale face, and frequent vomiting of clear saliva. Treatment should focus on warming and tonifying the spleen and kidney, descending rebellion and harmonizing the stomach, using the formula Tonifying Qi and Promoting Movement Decoction.
4. Exhaustion of Yin Fluid︰Difficulty in swallowing, obstruction when eating, emaciation, dry skin, vexation and stomach heat, dry stool like sheep droppings, short and reddish urine, red tongue with scant fluid, wiry-thin and rapid pulse, or due to qi depression transforming into fire, prolonged consumption of spicy and dryness-heat substances that deplete stomach yin, or excessive indulgence in alcohol and sex that exhausts essence and blood. The Yangming dry earth fails to receive moisture, leading to dryness in the esophagus and difficulty in swallowing above, and dryness accumulation in the large intestine with stool like sheep droppings below. In cases of yin-fluid exhaustion, signs of yin deficiency and heat can be observed, such as dry skin, red tongue with scant fluid, thin and rapid pulse, etc. Treatment should focus on nourishing yin and blood, moistening dryness, and promoting fluid production. Prescriptions such as Adenophora and Ophiopogon Decoction or Modified Five-Juice Beverage for Calming the Middle can be used.

Dysphagia has long been regarded as a critical condition. In the initial stage, it often manifests as an excess syndrome, gradually transforming from excess to deficiency, progressing from mild to severe. In cases of excess, qi depression, phlegm coagulation, and blood stasis interact as cause and effect, accumulating in the esophagus. In cases of deficiency, it is primarily due to qi deficiency and yin depletion. There are also cases where deficiency and excess are intertwined, making the condition even more complex. Therefore, clinical treatment relying on a single method often fails to achieve success. It is essential to assess the degree of deficiency and excess and apply pattern identification and treatment accordingly. Additionally, maintaining a carefree and worry-free state of mind is an indispensable factor in promoting the recovery from dysphagia. At the same time, it is necessary to abstain from sexual activity and regulate diet to further enhance the effectiveness of treatment.

bubble_chart Documentation

1. Zabing Guangyao. Ge Ye: "The method of treatment is to regulate yin-yang, resolve phlegm and lower qi. When yin-yang is balanced and qi flows smoothly with phlegm descending, the disease of ge ye will not occur" (Jisheng Fang).
2. "In treating this disease, throat obstruction and chest stuffiness and discomfort seem to be due to qi stagnation; however, if one has taken too much qi-dispersing medicine, leading to the non-movement of middle qi, then one should tonify qi to restore its movement. Dryness and accumulation in the stool, resembling sheep droppings, seem to be due to blood heat; however, if one has taken too much purgative medicine, leading to the exhaustion of blood and further constriction, then one should tonify blood and moisten it to restore its flow. If it is due to the malpractice of heat therapy rushing upwards, causing food to be unable to enter, with a pulse that is full, forceful, and rapid, or if phlegm-fluid retention obstructs and the pulse is knotted and rough, then one should clear phlegm and drain heat, and the fire will naturally descend. If it is due to the decline of spleen and stomach yang fire, with a pulse that is deep, thin, and faint, then one should use pungent and aromatic medicines to warm the qi, while still focusing on nourishing yin and stomach as the main treatment, unlike the Taiping Huimin Heji Jufang which only focuses on drying and heating. If one fails to abstain from rich flavors and sexual overindulgence, and in elderly people with insufficient blood, it cannot be treated" ("Yu Ji Wei Yi").