Can’t Swallow Food, Food Getting Stuck in Your Chest?

A warning before we begin: if you are eating right now, mute this

Today’s story comes from the great Qing-dynasty master of warm disease, Doctor Wu Jutong (吴鞠通). Everyone knows Doctor Wu as one of the founders of warm-disease theory — his Wen Bing Tiao Bian (Systematic Differentiation of Warm Diseases) is justly famous. But he was also superb at ordinary internal medicine — truly at the level of a great physician. Today’s case involves an illness that is uncomfortable just to hear about: Ye Ge (噎膈), dysphagia.

💬 Note from Doctor Luo: A heads-up first — if you are eating right now, turn off the sound and finish your meal before you listen on. Some illnesses are fine to hear about; others leave you feeling quite uneasy. I am not trying to scare anyone — let us simply continue in a moment.

Who was the patient? Thirty-five and in his prime — and yet he “choked”

The case is dated the 18th day of the fifth lunar month, Daoguang year ten (1830). The patient, Mr. Chen, was 35 years old. Notice how young that is — thirty-five, not even middle-aged.

But his problem was no small thing. The record says it in eight characters: “jiu ke bu jie yu nu” — a fond drinker who could not give up anger.

💬 Note from Doctor Luo: What does “jiu ke” mean? A person who genuinely enjoys wine. Note — not an alcoholic, but a wine lover. “Bu jie yu nu”? His emotions were unwell; he flared into rage constantly. Fond of wine and quick to anger — and what did that lead to? Ye shi — choking on food, food that would not go down. And that, my friends, is a nasty illness.

What was the disease? Feng, Lao, Gu, Ge — one of the four incurable diseases of antiquity

The ancients spoke of “feng, lao, gu, ge” — wind, consumption, tympanites, and diaphragm blockage — the four incurable diseases. The “ge” is Ye Ge, dysphagia: food cannot pass down; it lodges in the chest. It is also called Guang Ge (关格) — the blockage of the upper and lower: nothing can enter from above, nothing passes below, and in the end the person is choked off entirely.

💬 Note from Doctor Luo: What is Ye Ge in modern terms? Something like esophageal cancer or stomach cancer. There is an old phrase, “zhao shi mu tu” — morning food vomited in the evening: what you eat in the morning slowly comes back up and is vomited at night, because nothing moves downward. Ye Ge leans toward esophageal cancer. Why could the ancients not cure it? Because the esophagus was truly blocked — something had grown inside it. That is precisely why they listed it among the incurable diseases. There was real reason behind it.

The ancients had no endoscope, however, so hidden inside this diagnosis were really two kinds of illness: the organic kind (esophageal cancer), and the functional kind — an esophageal function disorder driven by emotion, which also makes food catch on the way down. Nobody could say exactly what proportion was cancer. But whatever the kind, the ancients understood one thing very well: this disease is not easy to treat.

Where did the illness come from? Doctor Luo’s “esophageal cancer prevention class”

Doctor Wu Jutong’s case is about Ye Ge, so Doctor Luo took the opportunity to explain the causes of esophageal cancer thoroughly:

💬 Note from Doctor Luo: What is this disease connected to? First, eating scalding-hot food. In some regions people drink porridge or tea straight off the boil — one mouthful and the esophageal lining is burned. It heals, gets burned again, heals again — and in that endless cycle of repair, mutation can occur. Second, barbecue. I once heard the late Doctor Li Peiwen of China-Japan Friendship Hospital talk about his youth, when he went to Xinjiang to do field research and visited places where people eat grilled skewers every single day. Daily barbecue means carcinogens — bad for both the esophagus and the stomach. These days skewers have become a culture and nobody mentions it, but it truly is carcinogenic. Third, pickled and preserved foods — salted fish, pickled goods, processed meats loaded with nitrites. All are causative factors.

And there is aflatoxin — moldy peanuts and corn infected with aflatoxin make people prone to these diseases. Long-term heavy drinking of hard liquor directly irritates the esophageal lining — and look, this very patient was a wine lover. Then there is heredity: when many people in a family have had cancer, the risk rises. Smoking counts too, though Doctor Luo believes drinking is the more direct factor.

💬 Note from Doctor Luo: The fastest-rising factor right now is HPV (human papillomavirus) infection — in the reproductive system it causes that sexually transmitted disease called genital warts. Women infected with HPV are prone to cervical cancer — Anita Mui (梅艳芳) died of it. Infected men may show no symptoms, but HPV is spreading widely and out of control in the United States right now, closing in on the scale of AIDS. Some people contact infected areas with the mouth; HPV enters the oral cavity, and in some people it develops into throat cancer, in others esophageal cancer — the Hollywood actor Michael Douglas had throat cancer and admitted himself that it came from HPV infection. So I say: living a disciplined, puritanical life will help you dodge a great many dangers. Now that lifestyles have gone Western, this disease is spreading worldwide — the more medical knowledge you have, the better.

But this esophageal illness has one special feature: it is closely tied to emotion.

💬 Note from Doctor Luo: The whole digestive tract runs on a peristaltic rhythm — you swallow, the esophagus smoothly carries the food down to the stomach and on to the intestines, all in rhythm. But when a person is depressed, stifled, or angry all day, liver fire and heart fire surge upward and concentrate in the esophagus, and the peristaltic rhythm of the digestive tract falls into disorder: some parts are suppressed, others move too fast, fast and slow out of balance, producing pressure and blockage. Kept up long enough, this change becomes physiological and even pathological. Many people who bottle up their anger end up with stagnation — some in the stomach, some in the esophagus, sometimes even ulcers or a deep pocket in the esophageal wall. In mild cases it is Mei He Qi (plum-pit qi) — the constant feeling that something is stuck at the very top of the throat. When it creeps a little lower, you feel blockage in the esophagus itself, and belching does not bring it out. That is the sign of early functional disorder. But when it truly goes on for years, combined with scalding food and other factors, real esophageal cancer can form. Esophageal cancer is a terribly painful disease — treatment means cutting out a section of the esophagus and pulling the stomach up, a major operation. Chinese medicine can help, but to be honest, we cannot overstate the cure rate — one of the four incurable diseases of antiquity has been difficult to treat since ancient times.

Doctor Wu Jutong’s first prescription: not medicine, four words

The patient’s condition had already taken hold — “qi shi yi cheng” — food really was beginning to refuse to go down. Doctor Wu Jutong wrote him a few characters, which Doctor Luo says are especially important:

“Unless you promptly leave home, travel the mountains and waters, and open your heart wide, no treatment will ever succeed.”

💬 Note from Doctor Luo: What does this mean? If you do not get away from home right now — do not keep worrying, raging, and drinking at home — go traveling, see the mountains and rivers, and open up your chest. However stifled you feel, look at the sea, look at the great mountains and rivers standing there for hundreds of millions of years — what do you have to be aggrieved about? Seeing mountains and water is treatment. Why do we call Doctor Wu Jutong a great master? Because his case records are not “for this disease, prescribe that formula” — he said things like this. And that final line, “duan bu wei gong” — if you do not do this, the treatment may well have no effect at all. Why? Because “wu qing cao mu, bu neng zhi you qing zhi bing” — emotionless plants and herbs cannot cure a disease born of feeling. Medicine can adjust your body, but your illness was caused by emotion: here you are taking herbs while you keep generating new illness by raging — when will it ever end? The herbs are without feeling; they cannot match your heart. You must first turn your own heart around.

Doctor Luo says Doctor Wu Jutong’s words were exactly right — and not only for Ye Ge; ordinary illnesses work the same way. Look at how the hotels in Sanya are booked solid after the pandemic — in the blazing heat everyone has figured it out: happiness first, health first. A weekend outing, a farmhouse meal, climbing a hill to watch clouds drift past and a river wind through the valley — people feel happy. When the emotions are put right, half the illness is cured.

What medicine did he use? The Jintui Huanglian Tang method — a formula that can advance or retreat

As for medicine, Doctor Wu Jutong used the Jintui Huanglian Tang fa (进退黄连汤法) — the Advancing-and-Retreating Coptis Decoction method.

Its foundation is Zhang Zhongjing’s Huanglian Tang (Coptis Decoction). Some people suspect the formula was added to the canon later, but its construction is impeccable. What does it do? Harmonize cold and heat, harmonize the stomach, and descend rebellious qi. When there is heat in the chest, pathogenic qi in the stomach, abdominal pain, vomiting — cold and heat tangled together in the chest — this is the formula. Huang lian (coptis) clears heat, gan jiang (dried ginger) warms the yang, gui zhi (cassia twig) moves the qi and soothes the liver, ren shen (ginseng) supplements upright qi, ban xia (pinellia) descends rebellion and stops vomiting, and gan jiang with da zao regulate the stomach and spleen. This is called “qing shang wen xia” — clear the heat above while warming the cold below — the same idea as Wu Mei Wan (Mume Pill).

💬 Note from Doctor Luo: In the Qing dynasty, Yu Jiayan (喻嘉言) — whom I discussed in earlier episodes — modified this into the Jintui Huanglian Tang, specifically for Guang Ge: the upper and lower body blocked, the stomach and spleen jammed. He said it should by rights be a death sentence. How does the “advance and retreat” work? The advancing method (jin fa): none of the herbs are processed, three cups of water are decocted down to half — the potency is strong. The retreating method (tui fa): remove gui zhi, add a little rou gui (cinnamon bark), halve the huang lian, and process every other herb — huang lian prepared with ginger juice, gan jiang soaked and dried, ren shen steamed with human milk, ban xia prepared with ginger, and just two da zao dates — the potency becomes gentle and moderate. That is the meaning of “advance and retreat”: when the illness is fierce, advance; when it is easing, retreat.

Doctor Wu Jutong used this method but did not copy it wholesale. His first consultation (the 18th of the fifth month) prescribed: Yun ling kuai (poria — raising the clear and lowering the turbid, dispelling dampness and strengthening the spleen, letting the spleen qi and yang rise), ren shen (ginseng — supporting upright qi), zhi gan cao (honey-fried licorice), xuan fu hua (inula flower) — note that the inula flower was wrapped in new-vermilion silk (xin jiang sha), cooked like a little medicine bundle. This is one of Doctor Wu Jutong’s signature touches; he used it constantly — then stir-fried huang lian, one qian five fen (about 4.5 g), ban xia (descending stomach qi, working with the inula flower to press downward), sheng jiang zhi (fresh ginger juice), gan jiang (dried ginger), and xie bai (Chinese chive — resolving phlegm, unblocking the yang, warming and opening). Boiled into three cups, taken in three doses.

Consultation by consultation: same formula, then chen pi, then hematite

This case is a true outpatient record, day by day:

• 18th of the fifth month — first consultation, using the Jintui Huanglian Tang method.
• 22nd of the fifth month — the patient returns: very effective! The illness did not change, so neither did the formula — four more doses.
• 28th of the fifth month — the previous formula plus guang chen pi (aged tangerine peel), three qian (about 9 g), four more doses. What does chen pi do? It moves qi and resolves phlegm, and opens the lung qi — scattering the bound-up qi so it descends.
• 4th of the sixth month — the patient flared into anger again, on top of wine toxicity — a relapse! The Jintui Huanglian Tang method was used again and it worked: ren shen to support upright qi, yun ling kuai to raise the clear and lower the turbid, sheng jiang zhi to resolve phlegm, open the binding, and stop vomiting, shen qu (medicated leaven) to open the stomach, xuan fu hua in new-vermilion silk to move and descend qi, ban xia to resolve phlegm and descend qi, zhi gan cao to harmonize the middle, huang lian to take down heat from the upper burner, and xie bai to unblock yang and transform phlegm — cold and heat regulated together, separated apart. Three cups, three doses.
• 12th of the sixth month — all the symptoms had eased — no longer choking so much — but the pulse in all six positions was tight and wiry. The previous formula reduced the huang lian and added warming herbs to harmonize the nutritive and defensive qi: ren shen and fu ling to strengthen the spleen and supplement qi, sheng bai shao (white peony) to restrain and soften the liver and harmonize qi and blood, ban xia to descend qi, guang chen pi to move qi, gui zhi to warm the yang, unblock the channels, and soothe the liver, xuan fu hua wrapped and decocted to descend qi, stir-fried huang lian, five fen (about 1.5 g) — just a trace of heat-clearing left — gan cao and da zao rou to harmonize the nutritive and defensive, xie bai to unblock yang, shen qu to aid digestion, and sheng jiang — still the spirit of Huanglian Tang.
• 22nd of the sixth month — symptoms eased further but the pulse was still tight and wiry; from the previous formula he removed huang lian and xie bai, and added dai zhe shi (hematite), one qian five fen (about 4.5 g).

💬 Note from Doctor Luo: Why add dai zhe shi? It is heavy and settles downward — later, Doctor Zhang Xichun (张锡纯) loved using hematite to press the stomach qi down. This patient really was choking; to push things down, use hematite to drive the stomach qi downward. See how Doctor Wu Jutong prescribed: moving qi, descending stomach qi, regulating cold and heat together — the logic is crystal clear. If you remember which formulas he used for which conditions, you will have a solid mental map — he leaned on a finite set of herbs and formulas, and he especially loved wrapping xuan fu hua in new-vermilion silk for decoction. Study him and you will gradually pick it up.

The record ends here — why no “fully cured”?

Notice: the case record stops on the 22nd of the sixth month. Most of Doctor Wu Jutong’s records are like this — they go on to a certain point; not every one ends with the words “the disease was cured.”

💬 Note from Doctor Luo: An illness like Ye Ge — like esophageal cancer — does not resolve after a few visits. We do not even know whether this man was ultimately cured: his symptoms eased, but whether he fully recovered is a question mark. If it was functional — an esophageal function disorder driven by emotion — he might well have recovered. But if true esophageal cancer had formed, growing worse by the day, he might not have. I will not exaggerate the efficacy; let us be objective. But this case teaches us two things. First, learn about esophageal cancer and take precautions. Second, whether it is cancer or not, Doctor Wu Jutong’s words were excellent — emotionless plants and herbs cannot cure a disease born of feeling. The patient’s cooperation, the patient’s emotions — they matter enormously.

Doctor Luo’s parting advice: who are you living for? For yourself

💬 Note from Doctor Luo: Have you ever seen someone take a long trip and slowly, mysteriously get better? It is because their emotions changed. So here is a wake-up call: if you are still frowning all day, stifling your feelings, and nursing your anger — wake up now. Who are you living for? For yourself. What other people say about you is not that important. How others judge you is not that important. When you fall ill, nobody else suffers it for you — even your closest family cannot share the burden. The illness is on your own body. More and more people have figured this out: happiness first, health first. Make time to go out, travel, open up your heart — this matters.

Doctor Luo hopes that after this case, everyone takes away something real, and thinks some things through. Doctor Wu Jutong’s way of treating disease — how to use the Jintui Huanglian Tang — is something to remember as well. Tomorrow, Doctor Luo will continue with more stories of Doctor Wu Jutong’s practice.

What to take away

• Ye Ge (dysphagia) was one of the four incurable diseases of antiquity (“feng, lao, gu, ge”); today it corresponds roughly to esophageal cancer and related organic or functional swallowing disorders — “zhao shi mu tu” (morning food returned in the evening) describes the blockage.
• Prevention of esophageal cancer: avoid scalding-hot food and drink, heavy barbecue, pickled and nitrite-heavy foods, aflatoxin (moldy peanuts and corn), and long-term hard liquor; watch for HPV infection and heredity.
• Emotion is a core driver: when depression and rage disrupt the digestive rhythm, dysfunction appears — from Mei He Qi (the feeling of a lump in the throat) to ulcers and worse. “Emotionless plants and herbs cannot cure a disease born of feeling” — the patient’s state of mind is half the treatment.
• The formula: Jintui Huanglian Tang (based on Zhang Zhongjing’s Huanglian Tang: huang lian, gan jiang, gui zhi, ren shen, ban xia, zhi gan cao, da zao; modified by Yu Jiayan into an “advancing” strong version and a “retreating” gentle version with rou gui and processed herbs) — harmonizing cold and heat, clearing above and warming below, opening the blockage of Guang Ge.
• Doctor Wu Jutong’s style: inula flower wrapped in new-vermilion silk, then chen pi to move qi, then dai zhe shi (hematite) to press the stomach qi downward — and above all, a “prescription” of leaving home to travel the mountains and waters.

Based on Doctor Luo Dalun’s commentary on Doctor Wu Jutong’s case records; the case is from Wu Jutong’s Case Records (Qing dynasty, c. 1830).