Trouble Swallowing? What to Do When You Can’t Eat or Drink for Twenty Days

What the patient searched for: food gets stuck and won’t go down / difficulty swallowing / can’t eat and always want to vomit / phlegm coming up / no bowel movement for twenty days / pulse so weak you can barely feel it

What the doctors would call it: dysphagia (ye ge) · ge qi (blockage of the diaphragm) · spleen and stomach deficiency · phlegm-dampness blocking the middle · rebellious qi ascending · severe vomiting of pregnancy

The opening scene: before the patient had even died, one doctor had already pronounced the death sentence

In the late Ming and early Qing dynasty, the famous Jiangxi physician Doctor Yu Jiayan (喻嘉言) took on a case that everyone else shook their heads at. There was a household surnamed Huang, headed by a man named Huang Zixu, and his wife had been sick for more than twenty days — not a grain of food, not a drop of water would go down. To all appearances, she was dying.

Even more frightening, there was a local doctor surnamed Shi who was famous for judging whether people would live or die: it was said his pulse-taking was so uncanny he could calculate whether a patient would survive. Doctor Shi came, looked at her, and dropped a single sentence: “The pulse has already left its root; in a moment she will be gone.” — the pulse has separated from its foundation, and within no time, the person would be finished.

The family’s hearts sank. But Doctor Yu Jiayan did not see it that way.

💬 Note from Doctor Luo: Let me introduce Doctor Yu Jiayan first. He was a celebrated physician of the late Ming and early Qing dynasty — his given name was Chang, his courtesy name Jiayan, and he came from Xinjian in Jiangxi. He wrote Yu Yi Cao (Records of Meaningful Insights), Shang Lun Pian, and Yi Men Fa Lu (Standards of the Medical Profession), and holds a pioneering place in the history of Chinese medicine — the “stories of Doctor Yu Jiayan seeing patients” series we have been telling comes from the real cases recorded in his Yu Yi Cao. This case was named by Doctor Yu himself: “A critical case of ge qi, cured by the slow method.” Notice his confidence — he calls it a “critical case,” but adds the phrase “the slow method,” as if he already knew exactly how it would go.

Who was the patient: the Huang family’s daughter-in-law, unable to eat for twenty days

The patient was Huang Zixu’s wife. Her illness is what the ancients called “ge qi” (blockage of the diaphragm), also known as ye ge (dysphagia) — “ye” means food gets stuck, a sense of obstruction when swallowing; “ge” means it is blocked and will not go down. Together: eating is difficult, food will not descend, and may even come back up — in severe cases, not a single mouthful will go in.

How sick was she? For over twenty days, not a grain or a drop entered her mouth — more than twenty days, and she could not even drink water. By the time Doctor Yu Jiayan was called in:

• Her chi pulse was raised but never landed — in the three positions (cun, guan, chi), the chi pulse (which governs the kidneys) had weakened to the point of almost disappearing;
• Her bowels and urine had not moved even once since the illness began — no bowel movement and no urine for more than twenty days. This was a serious matter; the qi mechanism had fallen into complete disorder;
• Phlegm-foam rushed upward, her breath nearly spent — foam kept coming up, she had no strength at all, as if she were on the verge of death.

💬 Note from Doctor Luo: I want to add a word here. Doctor Yu’s original record says, “her bowels and urine had not moved even once since the illness began” — for over twenty days, neither stool nor urine. No bowel movement for twenty days is possible; but no urine for twenty days is not normal — it is extremely abnormal. I have never seen a person survive twenty days without urinating, so I have some doubt about this detail — I don’t know whether Doctor Yu recorded it accurately. The rest of his account mainly concerns the bowels, so let’s understand it that way. Either way, it does not affect the core value of this case.

What is ye ge? One of the ancients’ “four great severe diseases”

Why was the whole family in such panic? Because ye ge was one of the most famous severe diseases of antiquity. There is an old saying in Chinese medicine: “wind, consumption, abdominal swelling, and diaphragm blockage — the four great severe diseases” — wind stroke, consumptive disease, abdominal distension, and dysphagia (ge). The “ge” of this saying is precisely this condition.

💬 Note from Doctor Luo: Why is ye ge counted among the severe diseases? Because part of ye ge is actually what we today call esophageal cancer or stomach cancer — malignant tumors, which are genuinely very hard to treat. But another part of ye ge is functional: for example, esophageal spasm and similar problems can also make food feel stuck, yet they are not fatal illnesses. How do you tell them apart? Look at this patient — she had been sick only about twenty days. A truly malignant disease like esophageal cancer usually progresses slowly over a long time; twenty days or so should still be the early stage. Also, don’t confuse it with plum-pit qi (mei he qi): in plum-pit qi you only feel something in the throat, as if a plum pit were stuck there, but it does not affect eating; in ye ge you genuinely cannot get food down — it will not descend, and it comes back up as vomiting. This disease is genuinely hard to treat.

A battle over life and death: one doctor who “judged fate,” one Yu Jiayan who would not believe it

Doctor Shi pronounced that she would “be gone in a moment.” Doctor Yu Jiayan said: Not so.

He quoted a line from the Mai Jing (Pulse Classic): “If the upper region has a pulse and the lower region has none, the person should vomit; if they do not vomit, they die.”

What does that mean? If a person has a pulse above and no pulse below, the Pulse Classic says such a person “should vomit” — they ought to vomit; if they ought to vomit but cannot, that is the fatal sign. And this patient? She could vomit — the phlegm-foam kept rushing upward, which meant her qi mechanism still had a thread of room to move.

💬 Note from Doctor Luo: This passage is the basis on which Doctor Yu argued with Doctor Shi, and it has real flavor. In pulse study there is a refined principle: a pulse above with no pulse below means the qi mechanism is all blocked up above and cannot descend. At that moment you must see whether this breath has an exit — if it can be vomited out, the qi can still move, and there is hope; if it cannot even be vomited, the qi is completely blocked, and that is truly the end. So Doctor Yu said: “As long as the heavenly qi can descend, the earthly passage will open.” — the heavenly qi above is the lung qi; the earthly passage below is the bowels and urine: as long as the lung qi above can descend, the stool and urine below will naturally pass. Now the qi mechanism was all blocked above and could not come down — what to do? Nourish the earth in the middle — regulate and tonify the spleen and stomach. When the spleen and stomach are too deficient, transportation and transformation fail, and the qi stagnates above. This is what he meant by “qi high above with no return, and no pivot turning in the middle”: the middle burner (the spleen and stomach) — the pivot — had stopped turning, so the qi could not descend.

The root of the disease: the spleen and stomach weakened to the extreme, all the qi blocked above

Doctor Yu Jiayan concluded that this woman’s spleen and stomach were extremely deficient. When the spleen and stomach are deficient to a certain degree, their function of ascending and descending is lost: water-dampness and turbid phlegm block the middle, the qi mechanism cannot turn, and so everything rushes upward — vomiting, hiccups, and dysphagia are all signs of qi failing to descend.

So although the disease looked dangerous, it could be treated. Doctor Yu leveled with the family: “There is a method, but it must be done slowly, and it will naturally improve day by day.” — this disease has a rule: treat it slowly. An illness in which the spleen and stomach have weakened to this degree cannot be smashed out in one dose of medicine; as long as you treat it patiently, it will get better day by day.

Then he made a request: “Let me be the only one treating her, to see whether it works” — trust me, let me treat her alone. Don’t call in other doctors; let’s see whether I can produce results.

Xuanfu Daizhe Tang: the famous qi-descending formula left by Zhang Zhongjing

The method Doctor Yu Jiayan used followed the thinking of Xuanfu Daizhe Tang — but he changed the ingredients.

What is Xuanfu Daizhe Tang? It is one of the most classic formulas in Chinese medicine, from the Shanghan Lun (Treatise on Cold Damage), the work of Zhang Zhongjing. Why is Zhang Zhongjing called the “Medical Sage”? Because he wrote the causes and treatment principles of many diseases directly into his formulas — one formula is a complete set of treatment principles.

💬 Note from Doctor Luo: What does Xuanfu Daizhe Tang treat? It treats rebellious qi ascending caused by spleen and stomach deficiency — vomiting, belching, hiccups, qi moving upward. Why does qi move upward? Because the spleen and stomach are weak, phlegm-dampness is heavy and blocks the middle, so the qi cannot descend and keeps rushing back up: some patients vomit, some hiccup, some feel nauseated and cannot eat, with fullness in the stomach cavity — but no pain when pressed, because this is not excess heat; it is deficiency, it is water-dampness and phlegm-dampness blocking the middle. The thinking of this formula is beautifully clear: send the qi down + tonify the spleen and stomach + transform phlegm, three approaches at once. When students of formulas study prescriptions, this is a must-learn.

The composition of Xuanfu Daizhe Tang, as understood by Doctor Yu (and physicians through the ages), is this:

• Xuanfuhua (inula flower) — the chief herb, descends qi, especially good at sending the lung qi downward. There is an old saying in Chinese medicine: “All flowers ascend; only inula flower descends.” Most flowers have a nature that rises and unfolds, but inula flower alone moves downward — it is very special;
• Daizheshi (hematite) — a mineral substance, heavy in nature, weighty and suppressing, calming rebellion — it presses the rebellious qi downward;
• Banxia (pinellia) + Shengjiang (fresh ginger) — the golden partnership for transforming phlegm. Pinellia also has a descending nature; ginger can open up the qi mechanism. Together the two transform phlegm and open the movement of the spleen and stomach;
• Renshen (ginseng) — tonifies qi. At this point the spleen and stomach qi is deficient; simply sending qi down is not enough. If you do not support the upright qi, the spleen and stomach still cannot turn, so ginseng tonifies the middle;
• Dazao (jujube) + Zhigancao (honey-fried licorice) — harmonize the spleen and stomach and regulate the middle burner. Jujube and ginger together are basically the meaning of harmonizing the spleen and stomach.

💬 Note from Doctor Luo: Look at Zhang Zhongjing’s thinking: he has something to send qi downward, something weighty to suppress and gather qi, something to transform phlegm, and something to tonify the spleen and stomach and regulate the middle — put all these threads together and the disease is resolved. So this formula teaches a great principle: when the spleen and stomach weaken to a certain degree, the ascending-descending function is lost, water-dampness and turbid phlegm block the middle, the qi mechanism cannot turn, and the person rebels upward — vomiting, belching, hiccups. The treatment principle is to descend the qi, tonify the qi, and transform phlegm. Doctor Yu Jiayan used the thinking of Xuanfu Daizhe Tang, but did not cling to the original formula — why? Because he had experience: he had stumbled on several similar cases before.

The crucial step: the chi pulse could not even be felt — could she be pregnant? Change the formula!

Why did Doctor Yu dare not use the original formula? Because this woman had weakened to the extreme — her chi pulse (which governs the kidneys and lower burner) was so weak it could barely be felt. A question formed in Doctor Yu’s mind: Could she actually be pregnant?

Here Doctor Luo told a real, major case that every physician should remember for life:

💬 Note from Doctor Luo: When treating women, whenever there is any doubt, you must ask: could she be pregnant? Some women themselves do not know they are pregnant. There was a case like this before that made a deep impression on me: a woman vomited every day and was told it was her stomach. She went to see Chinese medicine doctors; the pulse was read as spleen-stomach disharmony, and seven or eight practitioners all prescribed formulas to send qi downward. The result? She miscarried. The woman took several of the doctors to court together, and it became a big case at the time. Some people whispered privately, wondering whether the woman had done it deliberately — after all, she had been pregnant once before and given birth; how could she not feel it? But whether or not it was deliberate, the lesson cannot be taken lightly: if you read her pulse as spleen-stomach disharmony and prescribe herbs to press qi downward, and there really is a fetus inside her, how could it survive that pressing? So this is true clinical experience — in gynecology, always think one layer deeper and examine carefully.

Doctor Yu Jiayan was a famous physician who had seen much: it looked like ye ge, but he knew better — what if this was severe vomiting caused by pregnancy? Now that the chi pulse was this weak, there was no way to test whether she was pregnant. The original formula could not be used: Daizheshi is heavy and descends hard — if there really were a fetus, pressing it down would cause disaster; and dried ginger is drying and hot — if there were heat inside, it could also disturb the fetus.

So Doctor Yu changed the formula:

• Chishizhi (red halloysite) replaced Daizheshi (hematite) — red halloysite is a mineral (a kaolin-type clay) with an astringent nature; its action also moves downward, but it is not as fierce as hematite;
• Roasted ginger (wei jiang) replaced dried ginger — roasted ginger is made by wrapping fresh ginger in paper and slowly roasting it in the fire; it is warming but nowhere near as drying and fierce as dried ginger, with a far gentler nature;
• Liu Junzi Tang (Six Gentlemen Decoction) plus Xuanfuhua (inula flower) — the Six Gentlemen Decoction is a famous spleen-tonifying formula: ren shen (ginseng), bai zhu (atractylodes), fu ling (poria), and gan cao (licorice) form the “Four Gentlemen,” which tonify qi and strengthen the spleen; adding chen pi (aged tangerine peel) and ban xia (pinellia) regulates qi and transforms phlegm. The spleen and stomach were too weak, so first tonify them; then add inula flower to send the rebellious qi downward. Slowly decoct and take.

The father-in-law grudged the price of ginseng; Doctor Yu slapped his chest and made a bet

After taking the medicine, the vomiting gradually stopped — it was clearly working.

But then came an interruption: the woman’s father (or some elder of the Huang family) saw ginseng in the formula and felt the pinch — ginseng is expensive, and he lamented that this illness “was a money-spending disease.”

Seeing this, Doctor Yu’s stubborn temper flared: if you are afraid of spending money, this disease may never be cured. On the spot he slapped his chest and made a bet:

“Have no fear! If I fail to cure this disease, I willingly pay a fine of thirty jin of silver; if I cure it, I will not take a single coin!”

— Don’t be afraid! If I can’t cure this, I’ll happily pay you thirty jin of silver as compensation; but if I do cure it, I’ll accept not one coin!

The family thought this was a wonderful bargain and threw themselves into cooperating — the medicine must be personally prepared — Doctor Yu decocted it himself, and everyone pitched in with all their might. Free from interference, the treatment went beautifully: three days later she gradually stopped vomiting; three days after that she began to drink congee — her porridge intake slowly increased. The whole family was overjoyed.

💬 Note from Doctor Luo: In his early years, this was Doctor Yu Jiayan’s character — full of enthusiasm, red-faced and eager, even daring to bet with patients. Look at his temperament: afraid of spending money? If I fail to cure it, I’ll fine myself thirty jin of silver; if I cure it, I take nothing. He valued saving lives far above money. But this temperament also brought him plenty of trouble, as we will see later. There is also a clinical lesson hidden in this story: in treating disease, nothing is more damaging than interference from the family — today they worry the ginseng is too expensive, tomorrow they suspect the formula is wrong, changing their minds every few days; even the best prescription will be wasted. Doctor Yu dared to make this bet both to reassure the family and to clear away interference for himself.

The illness improved, but the bowels had not moved for a month, and the family exploded

The disease improved day by day, but one thing kept the family uneasy: the bowels still had not moved.

Counting from the start of the illness, she had now gone more than a month without a bowel movement. The family began to worry: was the disease really cured? If she eats but cannot transform and transport it, how can that do? One after another they pressed Doctor Yu: “Doctor, please move her bowels!”

Doctor Yu Jiayan said: don’t be anxious. The qi mechanism has been blocked for a long time; now that food and drink have just recovered, what she eats moves into the stomach and into the intestines, working its way down one or two segments of the bowel each day — it descends little by little. When the inside gradually opens up all the way, the stool will naturally pass, like savings accumulating along the way.

💬 Note from Doctor Luo: Doctor Yu was right, and there is a principle of daily life here, called “gathering the belly” (zan du). Children have this experience: diarrhea severe enough to empty them out, so they stop eating; later, as they slowly recover and can eat again, they may go many days without a stool — the parents panic, but this is “gathering the belly”: the contents inside have to accumulate enough before elimination begins. It is the same for people just recovering from a serious illness who have not eaten for a long time: the food slowly accumulates, and when there is enough, it naturally passes. So there was no need to worry. But this family could not help worrying — their attitude toward Doctor Yu even turned nasty: the relatives standing beside him breathed heavily and grumbled, almost ready to curse.

The battle over laxatives: moistening would not work and purging was too dangerous — Doctor Yu held his ground

Facing the family’s relentless urging, Doctor Yu explained his dilemma:

“If I use danggui (angelica) and shudi (prepared rehmannia) and other moistening herbs to lubricate the dryness — these nourishing, moistening drugs are bad for a patient with weak spleen and stomach: the spleen and stomach are too weak to transform and move them. And if I use mangxiao (Glauber’s salt) and dahuang (rhubarb) and similar purgatives to move the bowels — if she really is pregnant, I am afraid of harming the fetus.”

So he insisted: no purgatives; just tonify the spleen and stomach and let the food accumulate slowly. When enough has gathered, it will pass. He held out for another three to five days, and sure enough the bowels moved — stool and urine returned to normal, she could eat again, and no longer vomited — she was completely well.

But then the aunts and cousins of the family started gossiping again: Look at this doctor! We asked him to move her bowels, and he made such a fuss — it took over a month! Any other doctor would have dropped a single dose of purgative and had it out long ago! The family was still not satisfied.

The plot twist: her belly swelled up — she really was pregnant

Another month passed, and something remarkable happened: the woman’s belly swelled — she was pregnant! The signs of pregnancy gradually appeared.

What did this prove? Doctor Yu Jiayan had judged correctly! The card he had held back was right — he suspected pregnancy, so he avoided the heavy, descending hematite, the drying ginger, and the purging salts and rhubarb. Every dangerous choice had been sidestepped.

But guess what the family said? They started in again: “Look — pregnant! And he never even detected the pregnancy pulse. What kind of expert is that!”

💬 Note from Doctor Luo: To be honest, I feel this family’s attitude was the real problem — in the first round they grudged the price of ginseng, in the second round they pushed for purging, and in the third round they faulted him for missing the pregnancy pulse. But what Doctor Yu said at the end is deeply moving. He said: “I treated you with complete sincerity, hoping to keep a husband and wife together with their child!” — You are a married couple; your wife did not die, and the child is here; I wanted you to be able to be proper parents. I treated you with all my heart, and in return I receive this slander. There is truly nothing to be done. But think about it: when the chi pulse was that weak, the pulse in early pregnancy is naturally indistinct. Doctor Yu did not “fail to detect” it — he chose to be conservative rather than take risks — precisely because he could not be certain, he changed the formula and left room. That is not a mistake; that is the prudence of a master.

Doctor Luo’s commentary: Yu Jiayan’s early life, and the words “explaining the principles”

After telling this case, Doctor Luo deliberately said a few extra words about Doctor Yu Jiayan’s life — because this case happens to be a miniature of his early years.

In his youth, Doctor Yu Jiayan treated patients with full-hearted enthusiasm, but his doctor-patient relationships were always rather poor: he cured difficult and complicated illnesses, yet the families would not speak well of him at home and found every excuse to pick fault. When he wrote Yu Yi Cao, he still did not understand why he felt so wronged. Later, when the Ming dynasty fell and the Qing entered, he suffered a great blow and became a monk. After he became a monk, he watched the monks explain the dharma to people, and suddenly understood: principles are meant to be explained to people. So he left monastic life, became a great master, and began establishing schools and teaching disciples — that was the earliest classroom education in Chinese medicine. From then on his doctor-patient relationships improved dramatically, and his whole level of being rose.

💬 Note from Doctor Luo: Doctor Yu Jiayan’s whole life tells us: medical education matters enormously. When you explain principles to ordinary people and popularize medical knowledge, once they understand, treatment goes smoothly; when they understand nothing of your principles — when they reject yin-yang and the five elements entirely and dismiss them as feudal superstition — then prescribing for them becomes extremely hard. If you cure them, they think, “Of course I got better; it had nothing to do with you”; if there is the slightest reaction, they stop treatment at once. That is why I have always insisted on popularizing medicine. Some people tell me there is no need for popularization, just treat patients directly — that is not the right way of thinking. Some worry that if we popularize too much, patients will arrive at the clinic with opinions and “know everything,” making things difficult — a patient’s knowledge may be incomplete, but you can correct them and explain to them; a patient with some medical literacy is always better than one with none. All beings suffer; illness is everywhere. The best we can do is explain the principles clearly and treat the illness well — that is a good thing. This is also the reason we tell these medical cases here — so that the wisdom of two hundred years ago can be understood and used by ordinary people today.

Bonus: what do we learn from this case?

At the end, Doctor Luo summarized the lessons of this case in a few sentences:

💬 Note from Doctor Luo: First, when the spleen and stomach weaken to the extreme, the qi mechanism falls into disorder inside — phlegm-dampness blocks the middle, qi fails to descend, rebels upward: hiccups, vomiting, dysphagia. This too counts as a kind of ye ge: ye ge is not only the very severe disease of esophageal cancer — functional disorders exist as well. Second, if at such a time the woman happens to be pregnant, the reaction becomes even stronger — how strong? Some women suffer unbearably, vomiting without end. Third, the road of treatment has already been shown to us by Doctor Yu Jiayan: tonify the middle — slowly build up the qi of the spleen and stomach; then gently descend the qi — slowly press the qi downward. In this way the patient’s stool and urine gradually pass, eating and drinking return to normal, and the disease is cured. The spleen and stomach are the foundation of acquired constitution; once the middle burner turns, the qi mechanism ascends and descends as it should, and the disease naturally disperses.

This case looked dangerous, but it shows the “living art” of Chinese medicine at every turn: treat slowly, do not attack urgently; when pregnancy is suspected, avoid heavy, descending, drying, and hot substances; in the debate over laxatives, hold steady rather than attack — protecting the patient’s spark of life with complete care.

Compiled from Doctor Luo Dalun’s explanation of Doctor Yu Jiayan’s case, recorded in Yu Yi Cao (Records of Meaningful Insights).