〔垣〕堵塞咽喉，阳气不得出者曰塞；阴气不得下降者曰噎。夫噎塞迎逆于咽喉、胸膈之间，令诸经不行，
则口开目瞪，气欲绝。当先用辛甘气味俱阳之药，引胃气以治其本；加堵塞之药，以泻其标也。寒月阴气大助
阴邪于外，于正药内加吴茱萸大热大辛苦之味以泻阴寒之气；暑月阳盛，则于正药中加青皮、陈皮、益智、黄
柏散寒气泄阴火之上逆，或以消痞丸合滋肾丸。滋肾丸者，黄柏、知母，微加肉桂三味是也。或更加黄连别作
丸。二药七八十丸，空心约宿食消尽服之，待少时以美食压之，不令胃中停留也。（以上诸法，皆于补中益气汤
加减之。）
膈咽不通、并四时换气用药法《黄帝针经》曰∶胃病者，腹 胀，胃脘当心而痛，上支两胁，膈咽不通，
饮食不下，取三里。夫咽者，咽物之门户也；鬲者，上焦心肺之分野。不通者，升降之气上不得下交通。又云∶
清气在下，则生飧泄。飧泄者，谓泄黄如糜，米谷不化者是也。浊气在上，则生 胀。腹中胀满，不得大便，
或大便难，先结后溏皆是也。浊气在上，当降而不降者，乃肾肝吸入之阴气不得入，故食不得下也。此皆气冲
之火，逆胃之脉反上而作者也。清气在下，则生飧泄者，胃气未病之日，当上行心肺而荣经也。因饮食失节，
劳役形体，心火乘于土位，胃气弱而下陷入阴中，故米谷入而不得升，反降而为飧泄也。咽膈之间，壅遏之甚，
不得交通者，皆冲脉上行逆气所作也。盖胃病者，上冲两胁，膈咽不通，饮食不下，取之三里者是也。《针经》
云∶清浊相干，乱于胸中，是为大 。大 者，惑也。气不交通，最为急证，不急去之，诸变生矣。
圣人治此有要法∶阳气不足阴气有余，先补其阳，后泻其阴，是先令阳气升发于阳分，而后泻阴也。春夏之月，阳气在
经，当益其经脉，去其血络。秋冬阳气降伏，当先治其脏腑。若有噎有塞，塞者五脏之所主，阴也血也；噎者
六腑之所主，阳也气也。二者皆由阴中伏阳而作也。今立四时用药法并治法于后。
冬三月，阴气在外，阳气在内，当外助阳气，不得发汗；内消阴火，勿令泄泻，此闭藏周密之大要也。盛
冬乃水旺之时，水旺则金旺，子能令母实，肺者肾之母。皮毛之阳，元本虚弱，更以冬月助其令，故病者善嚏，
鼻流清涕，寒甚则浊涕、嚏不止，比常人尤大恶风寒，小便数而欠，或上饮下便，色清而多，大便不调，常夜
无寐，甚则为痰、为嗽、为呕、为哕、为吐唾白沫，以至口开目瞪，气不交通欲绝者，吴茱萸丸主之。
吴茱萸丸 治寒在膈上，膈咽不通。
吴茱萸 草蔻（各一钱二分） 益智仁（八分） 白僵蚕（四分） 陈皮 人参 黄 升麻（各八分） 麦芽（一
钱半）
甘草 归身（各六分） 半夏（一钱） 木香（二分） 泽泻 姜黄 柴胡（各四分） 青皮（二分）
上为末，汤浸蒸饼为丸，如绿豆大。细嚼三十丸，白汤送下，不拘时候。勿多饮汤，恐速走下，则减药力。
夏三月大暑，阳气在外，阴气在内。以此病值此时，是天助正气而锉其邪气，不治而自愈矣。然亦有当愈
不愈者，盖阴气极盛，正气不能伸故耳。且如膈咽不通，咽中梗甚者，前证俱作，治法当从时用利膈丸泻肺火，
以黄 补中汤送下。如两足痿厥，行步 怯，欹侧欲倒，臂 如折，及作痛而无力，或气短气促而喘，或不足
以息，以黄 、人参、甘草、白术、苍术、泽泻、猪苓、茯苓、陈皮等作汤，送下滋肾丸五六十丸。六七月之
间，湿热之令大行，气短不能言者，加五味子、麦门冬。如心下痞闷，食不下，以上件白术、苍术等汤送下消
痞丸七十丸，更审而用之。
黄 补中汤（方见痞）。利膈丸（方见翻胃）。滋肾丸（方见淋）。消痞丸（方见痞）。
【李东垣论述】咽喉堵塞，阳气不能外达的称为“塞”；阴气不能下降的称为“噎”。所谓噎塞之气逆乱于咽喉、胸膈之间，导致各条经脉气血运行受阻，就会出现口张目瞪，气息将绝的症状。治疗时应当先用气味俱属阳性的辛甘药物，来引导胃气以治其本；同时加入疏通堵塞的药物，以泻除其标症。
在寒冷的月份，外界阴气大盛助长了体内的阴邪，应在主药中加入吴茱萸这种大热、大辛、大苦的药物，以泻除阴寒之气；在暑热的月份，阳气旺盛，则应在主药中加入青皮、陈皮、益智仁、黄柏，以散寒气并泄除上逆的阴火，或者使用消痞丸配合滋肾丸。滋肾丸由黄柏、知母三味药组成，微量加入肉桂。或者另外加黄连单独制成丸剂。每次服用七八十丸，空腹待宿食消化尽后服用，稍等片刻后用美食压住药力，不让药物在胃中停留过久。（以上各种方法，都是在补中益气汤的基础上进行加减变化而来的。）
关于膈咽不通以及四季换季时的用药法则，《黄帝针经》说：胃病表现为腹部胀满，胃脘部当心而痛，向上支撑两侧胁肋，膈咽不通，饮食难以下咽，治疗应取足三里穴。咽，是吞咽食物的门户；膈，是上焦心肺的分野。所谓不通，是指升降的气机在上不能下行交通。又说：清气在下，就会产生飧泄（完谷不化的腹泻）。飧泄，指的是排泄物像糜粥一样黄色，米谷不消化的情况。浊气在上，就会产生胀满。腹中胀满，大便不通畅，或者大便困难，先干结后稀溏都是这种情况。浊气在上，应当下降而不能下降，是因为肾肝吸入的阴气不能入内，所以食物无法下咽。这都是冲脉之火上冲，胃脉反常上行所致。
清气在下产生飧泄的情况，是在胃气尚未生病的时候，本该上行至心肺以滋养经络。因为饮食不节制，劳累形体，导致心火侵犯脾土之位，胃气虚弱而下陷于阴分，所以米谷进入后不能上升，反而下降成为飧泄。咽膈之间壅遏严重，不能交通，都是冲脉上行逆气所造成的。正如《针经》所说：胃病者，气上冲两胁，膈咽不通，饮食不下，取足三里治疗。《针经》还说：清浊之气相互干扰，扰乱于胸中，这就称为“大惑”。大惑，就是迷惑混乱的意思。气机不交通，是最为急重的证候，如果不紧急去除，各种变证就会发生。
圣人治疗此病有要领：如果是阳气不足阴气有余，应先补阳气，后泻阴气，这是先让阳气升发于阳分，然后再泻阴。春夏季节，阳气在经脉，应当增益经脉，去除血络中的瘀滞。秋冬季节阳气潜降，应当先治疗脏腑。如果有噎和塞两种症状，塞是由五脏所主，属于阴、属于血；噎是由六腑所主，属于阳、属于气。这两种情况都是由阴中伏藏阳气而引发的。现在制定四季用药法则及治疗方法如下。
冬季三个月，阴气在外，阳气在内，应当在外部辅助阳气，不可发汗；在内部消除阴火，不要导致泄泻，这是闭藏周密的大要。隆冬是水旺之时，水旺则金旺，子能令母实，肺是肾之母。皮毛的阳气原本虚弱，再加上冬季助长其令，所以病人容易打喷嚏，鼻流清涕，寒冷严重时流浊涕、喷嚏不止，比常人更怕风寒，小便频数且量少，或者上饮下便，尿液清亮量多，大便不调，常夜间失眠，严重时出现痰、咳嗽、呕吐、呃逆、吐出白色唾沫，以至于口开目瞪，气机不交通欲绝的情况，用吴茱萸丸主治。
吴茱萸丸：治疗寒邪在膈上，导致膈咽不通。
药材：吴茱萸、草蔻（各一钱二分）、益智仁（八分）、白僵蚕（四分）、陈皮、人参、黄芪、升麻（各八分）、麦芽（一钱半）、甘草、当归身（各六分）、半夏（一钱）、木香（二分）、泽泻、姜黄、柴胡（各四分）、青皮（二分）。
制法与用法：以上药物研为细末，用汤浸过的蒸饼制作成丸，如绿豆大小。细细咀嚼三十丸，用白开水送服，不拘时候。不要多喝汤水，恐怕药力迅速下行，从而减弱药效。
夏季三个月是大暑时节，阳气在外，阴气在内。如果此病正值此时，是天时帮助正气而挫败邪气，不治也能自愈。然而也有该愈却不愈的情况，这是因为阴气极盛，正气不能伸展的缘故。例如膈咽不通，咽中梗塞严重的，前述症状全部发作，治疗方法应当顺应时令使用利膈丸泻肺火，用黄芪补中汤送服。如果出现两足痿软厥冷，行走不稳摇晃欲倒，手臂如同折断般疼痛且无力，或者气短气促喘息，或者呼吸不足，可用黄芪、人参、甘草、白术、苍术、泽泻、猪苓、茯苓、陈皮等煎汤，送服滋肾丸五六十丸。六七月之间，湿热之令盛行，出现气短不能说话的情况，加五味子、麦门冬。如果心下痞闷，饮食不下，用上述白术、苍术等汤送服消痞丸七十丸，再仔细审察后使用。
[Li Dongyuan's Discussion] When the throat is blocked and Yang Qi cannot reach the exterior, it is called "Se" (Obstruction); when Yin Qi cannot descend, it is called "Ye" (Choking). The rebellious Qi of Ye-Se interferes between the throat and chest-diaphragm, obstructing the flow of Qi and Blood in all meridians, resulting in symptoms such as an open mouth and staring eyes, with Qi on the verge of exhaustion. Treatment should first employ acrid-sweet herbs with Yang properties to guide Stomach Qi to treat the root cause; simultaneously, herbs that unblock obstructions should be added to drain the branch manifestation.
In cold months, external Yin Qi greatly assists internal Yin Pathogens. In the principal formula, add Wu Zhu Yu (Evodiae Fructus), a herb that is extremely hot, acrid, and bitter, to drain Yin-Cold Qi. In hot months, when Yang Qi is abundant, add Qing Pi (Aurantii Fructus Pericarpium), Chen Pi (Citri Reticulatae Pericarpium), Yi Zhi Ren (Alpiniae Oxyphyllae Fructus), and Huang Bo (Phellodendri Cortex) to disperse Cold Qi and drain rebellious Yin-Fire, or use Xiao Pi Wan (Eliminate Lump Pill) combined with Zi Shen Wan (Nourish Kidney Pill). Zi Shen Wan consists of Huang Bo (Phellodendri Cortex), Zhi Mu (Anemarrhenae Rhizoma), and a small amount of Rou Gui (Cinnamomi Cortex). Alternatively, add Huang Lian (Coptidis Rhizoma) to make separate pills. Take 70-80 pills on an empty stomach after residual food has digested. Wait a short while and then eat rich food to suppress the medication, preventing it from lingering in the Stomach. (All the above methods are modifications of Bu Zhong Yi Qi Tang [Spleen-Qi Boosting Decoction].)
Regarding the treatment of obstruction in the diaphragm and throat, and medication principles for seasonal changes: *Huang Di Zhen Jing* (The Yellow Emperor’s Classic of Acupuncture) states: "Disease of the Stomach manifests as abdominal distension, pain in the epigastrium centered at the heart, radiating upward to support both hypochondria, obstruction of the diaphragm and throat, and difficulty swallowing food. Treat by selecting Zusanli (ST36)." The throat is the gateway for swallowing food; the diaphragm is the domain of the Upper Jiao (Upper Burner), governing the Heart and Lung. "Obstruction" refers to the failure of ascending and descending Qi to communicate. It also states: "When Clear Qi remains below, Sundry Diarrhea (unformed stool with undigested food) occurs." Sundry Diarrhea refers to yellow, porridge-like excrement containing undigested grains. "When Turbid Qi remains above, Distension occurs." Abdominal fullness, constipation, difficult defecation, or hard stools followed by loose stools are all manifestations of this. Turbid Qi remaining above, failing to descend, occurs because the Yin Qi inhaled by the Kidneys and Liver fails to enter, thus food cannot go down. This is caused by Fire from the Chong Mai (Penetrating Vessel) rushing upward, causing the Stomach Meridian to rebel and ascend.
When Clear Qi stays below causing Sundry Diarrhea, it is because on days when Stomach Qi was healthy, it should have ascended to the Heart and Lung to nourish the meridians. Due to irregular diet and physical overexertion, Heart Fire invades the Earth position (Spleen/Stomach), weakening Stomach Qi so it sinks into the Yin level. Consequently, ingested grains fail to ascend and instead descend, becoming Sundry Diarrhea. Severe congestion between the throat and diaphragm preventing communication is caused by rebellious Qi ascending from the Chong Mai. As *Zhen Jing* says: "Stomach disease involves Qi rushing to the hypochondria, diaphragmatic and throat obstruction, and inability to swallow food; treat by selecting Zusanli." *Zhen Jing* further states: "When Clear and Turbid Qi interfere with each other and chaos ensues in the chest, it is called 'Da Huo' (Great Confusion)." Da Huo means confusion and disorder. Failure of Qi to communicate is a critical emergency; if not urgently resolved, various complications will arise.
The Sages have essential methods for treating this: If Yang Qi is insufficient and Yin Qi is excessive, first tonify Yang, then drain Yin. This allows Yang Qi to rise in the Yang aspect before draining Yin. In Spring and Summer, when Yang Qi is in the meridians, benefit the meridians and remove blood stasis from collaterals. In Autumn and Winter, when Yang Qi descends, first treat the Zang-Fu organs. If there are symptoms of Ye (Choking) and Se (Obstruction): Se is governed by the Five Zang Organs, belonging to Yin and Blood; Ye is governed by the Six Fu Organs, belonging to Yang and Qi. Both conditions arise from Yang trapped within Yin. The following seasonal medication principles and treatments are established.
During the three winter months, Yin Qi is outside and Yang Qi is inside. One should assist Yang Qi externally without inducing sweating; internally, eliminate Yin-Fire without causing diarrhea. This is the key principle of secure closure and storage. In deep winter, Water Qi is prosperous; Water prosperity leads to Metal prosperity. The child strengthens the mother; the Lung is the mother of the Kidney. The Yang Qi of the skin and hair is originally weak. Assisted by the winter season, patients often sneeze frequently, run clear nasal discharge, and in severe cold, thick nasal discharge with incessant sneezing. They are more sensitive to wind and cold than normal people, urinate frequently with scant volume, or drink much and urinate much with clear urine. Bowel movements are irregular, insomnia at night is common. In severe cases, phlegm, cough, vomiting, hiccups, and spitting white foam occur, leading to an open mouth, staring eyes, lack of Qi communication, and impending collapse. Treat with Wu Zhu Yu Wan (Evodia Pill).
Wu Zhu Yu Wan: Treats Cold in the upper diaphragm causing obstruction of the diaphragm and throat.
Ingredients: Wu Zhu Yu (Evodiae Fructus), Cao Kou (Amomi Fructus Rotundus), Yi Zhi Ren (Alpiniae Oxyphyllae Fructus) [each 1 qian 2 fen]; Bai Jiang Can (Bombyx Batryticatus) [4 fen]; Chen Pi (Citri Reticulatae Pericarpium), Ren Shen (Ginseng Radix et Rhizoma), Huang Qi (Astragali Radix), Sheng Ma (Cimicifugae Rhizoma) [each 8 fen]; Mai Ya (Hordei Fructus Germinatus) [1 qian 5 fen]; Gan Cao (Glycyrrhizae Radix et Rhizoma), Dang Gui Shen (Angelicae Sinensis Radix) [each 6 fen]; Ban Xia (Pinelliae Rhizoma) [1 qian]; Mu Xiang (Aucklandiae Radix) [2 fen]; Ze Xie (Alismatis Rhizoma), Jiang Huang (Curcumae Longae Rhizoma), Chai Hu (Bupleuri Radix) [each 4 fen]; Qing Pi (Aurantii Fructus Pericarpium) [2 fen].
Preparation and Administration: Grind into powder, mix with steamed dough soaked in decoction, and form pills the size of mung beans. Chew 30 pills finely and swallow with warm water, at any time. Do not drink large amounts of water, lest the medicine move downward too quickly and lose efficacy.
During the three summer months of intense heat, Yang Qi is outside and Yin Qi is inside. If this disease occurs at this time, Heaven assists Righteous Qi to defeat Pathogenic Qi, and it may heal spontaneously without treatment. However, some cases do not heal because Yin Qi is extremely abundant, preventing Righteous Qi from expanding. For example, in cases of diaphragmatic and throat obstruction with severe choking sensation, if previous symptoms manifest, treatment should follow the seasonal timing using Li Ge Wan (Clear Diaphragm Pill) to drain Lung Fire, taken with Huang Qi Bu Zhong Tang (Astragalus Spleen-Qi Boosting Decoction). If the legs are flaccid and cold, walking is unsteady and swaying, arms feel broken and painful with weakness, or there is shortness of breath, rapid breathing, or insufficient respiration, use a decoction of Huang Qi (Astragali Radix), Ren Shen (Ginseng Radix et Rhizoma), Gan Cao (Glycyrrhizae Radix et Rhizoma), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Cang Zhu (Atractylodis Rhizoma), Ze Xie (Alismatis Rhizoma), Zhu Ling (Polyporus), Fu Ling (Poria), and Chen Pi (Citri Reticulatae Pericarpium) to take Zi Shen Wan (Nourish Kidney Pill), 50-60 pills. Between the sixth and seventh lunar months, when Damp-Heat dominates, if shortness of breath prevents speech, add Wu Wei Zi (Schisandrae Chinensis Fructus) and Mai Men Dong (Ophiopogonis Radix). If there is epigastric stuffiness and inability to eat, take Xiao Pi Wan (Eliminate Lump Pill), 70 pills, using the aforementioned Bai Zhu and Cang Zhu decoction, applying careful judgment.
Huang Qi Bu Zhong Tang (Formula see entry "Pi"). Li Ge Wan (Formula see entry "Fan Wei"). Zi Shen Wan (Formula see entry "Lin"). Xiao Pi Wan (Formula see entry "Pi").