Food Stuck in Your Throat and You Can’t Swallow?

Patient search terms: food gets stuck when I eat / can’t swallow / food sticks and won’t go down / it hurts when I eat / dry throat and esophagus Medical terms for the condition: ye ge (噎膈, dysphagia) · difficulty swallowing · regurgitation (in classical times often corresponded to esophageal or stomach cancer)

Opening: Ye Ge — one of the four great incurable diseases of antiquity

Today we continue with the medical cases of Doctor Wu Jutong (吴鞠通), the great Qing-dynasty master of warm disease. The subject is again choking on food — food gets stuck in the throat and won’t go down.

💬 Note from Doctor Luo: Ancient doctors called this disease ye ge (噎膈). A very large portion of these cases is what we now call esophageal cancer — as the cancer grows, it gradually blocks the esophagus and food can’t get through. That’s why there is an old saying listing the four great terminal diseases: “wind, wasting, drum-distension, and diaphragm” (feng lao gu ge) — ye ge is on that list, and it was considered extraordinarily hard to treat. But another portion of cases is functional: someone under emotional strain feels a blockage and discomfort every time they eat — and those cases are much more treatable. Ancient doctors did not strictly separate the two; anything that blocked the passage counted as ye ge.

We’ve told similar cases before. Today we have two more — both treated by Doctor Wu Jutong, and both involving cow’s milk.

Who was the patient? One touch of the pulse: an enlarged left chi position

The first patient was a Mr. Wang. When Doctor Wu Jutong felt his pulse, the problem announced itself immediately: the left chi position was enlarged (zuo chi du da).

💬 Note from Doctor Luo: The chi position of the left pulse corresponds to the kidney yin. A prominent left chi pulse meant, in Doctor Wu Jutong’s reading, that the kidney yin was not full — yin deficiency. Why does a lack of yin cause trouble? Yin and yang are supposed to be in balance; when yin diminishes, there is less yin to contain the yang, and the surplus yang turns into fire that flares upward. That is the classic picture of yin deficiency with yang hyperactivity (yin xu yang kang). This is why Doctor Wu Jutong said, “a large chi pulse means deficiency” — the cun position may be somewhat large, but the chi position should be deep and quietly settled; if the chi pulse is large, that is a sign of deficiency fire. In the classics this is called “yin declining below” (yin shuai yu xia).

Then he examined the right hand: all three positions were wiry, and food caused pain on the way down — eating hurt. Doctor Wu Jutong called this “yang binding above” (yang jie yu shang): fire has rushed upward and lodged in the esophagus and throat, so the passage is blocked and eating hurts.

Where was the root? Yin deficiency as the root, yang binding as the branch

Doctor Wu Jutong took one look at the patient: a tall, large-built man with every feature showing openly — the very picture of a “wood-fire bright” (mu huo tong ming) constitution.

💬 Note from Doctor Luo: “Wood-fire bright” means the liver fire and heart fire are blazing together — the liver belongs to wood, the heart to fire. An experienced physician can see the fire in this person’s face at a glance. Anyone with excess wood-fire is necessarily yin-deficient underneath: they have a yin-deficient constitution to begin with and catch fire more easily. The ancients said “thin people have much fire,” and also “in treating thin people, always fear for their yin.” When such a person shows his tongue, it is usually deep red, without coating, and pointed at the tip. At the root — yin deficiency.

So Doctor Wu Jutong concluded: in this case yin deficiency is the root, and the yang binding above is only the branch. He also said that before treating ye ge one must always sort out “yin decline versus yang binding — which comes first, which comes after, which is mild, which is severe.”

Where did the previous doctor go wrong? Rhubarb hammering down, each purge wounding the yin more

When Doctor Wu Jutong looked at the previous prescriptions, he frowned — the earlier physician had given this patient rhubarb (da huang) purgatives, several doses of them.

💬 Note from Doctor Luo: Doctor Wu Jutong asked: “How could anyone so recklessly prescribe rhubarb purgatives in such quantity?” Rhubarb purges. It might briefly open up the “yang binding” — but that is deficiency fire, not excess fire. Purging it is like purging nothing. Worse, prolonged purging wounds the yin. This patient’s yin deficiency was already severe; purging made it worse. And so Doctor Wu Jutong sighed: does a physician not know that purging drains the yin (xie xia wang yin)?

He then cited two schools of ancient opinion. In the Jin dynasty, a physician called Yun Qizi listed several treatments for ye ge, but most of them were attacking methods. By the Ming-Qing period, Yu Jiayan (喻嘉言) had argued forcefully against this — you cannot treat it that way. Doctor Wu Jutong’s point: haven’t you, as a student of medicine, read these books? The previous doctor apparently had not. To be fair, he added a qualification: if the case is a true “excess blockage” — say, after a violent rage with food stagnation stuck behind it — the descending method may be used, but even then not in excess.

How was it treated? Five-Juice Drink plus milk, to moisten the upper burner open

The patient’s yin deficiency was severe, so what was to be done? Nourish the yin. Doctor Wu Jutong used Wuzhi Yin (Five-Juice Drink, 五汁饮).

💬 Note from Doctor Luo: The Five-Juice Drink comes from Wen Bing Tiao Bian (《温病条辨》, Systematic Differentiation of Warm Diseases) — it’s often mentioned on health programs today. Originally it was for the aftermath of warm disease: body heat, injured yin fluids of the lungs and stomach, dry mouth, and scanty sticky phlegm. Which five juices? Pear juice, water chestnut juice (荸荠汁, bi qi), fresh reed rhizome juice (鲜芦根汁), ophiopogon juice (麦门冬汁), and lotus root juice (藕汁) — sometimes sugarcane juice is substituted for the lotus root. All of these nourish yin and fluids; none of them is hot in nature. When the ancients treated ye ge of the yin-deficient, heat-bound type, this is exactly the kind of fruit juice they used.

Doctor Wu Jutong added cow’s milk — milk is a “flesh-and-blood, sentient” substance (xue rou you qing zhi pin) that can “descend the stomach yin and harmonize the yang binding — treating the branch.” The upper passage is dry and blocked; these cool, moistening things open it up and scatter the heat binding. That is the branch treatment. The Five-Juice Drink is meant to be taken together with milk.

What about the root? Zhuanxi Dasheng Gao — flesh-and-blood substances

For the branch, Five-Juice Drink and milk. For the root, Doctor Wu Jutong brought out his specialty formula — Zhuanxi Dasheng Gao (专翕大生膏, the Special Great-Supplement Paste).

💬 Note from Doctor Luo: Zhuanxi Dasheng Gao is Doctor Wu Jutong’s treasured private formula, made to nourish the yin of the liver and kidneys, rescue yin decline, and treat the root. What’s in it? Prepared rehmannia (shu di huang), sea cucumber (hai shen), cornus (shan yu rou), American ginseng (xi yang shen), turtle shell (bie jia), longan (gui yuan rou), abalone (bao yu), ophiopogon (mai dong), white peony (bai shao), oyster shell (mu li), tortoise plastron (gui ban), poria (fu ling), pig spinal cord (zhu ji sui), black-boned chicken (wu ji), flatstem milkvetch seed (sha yuan ji li), goat kidney (yang yao zi), donkey-hide gelatin (e jiao), white honey (bai mi), and egg yolk (ji zi huang) — all “flesh-and-blood, sentient” substances that nourish yin and supplement the kidney essence. The effect is excellent, and it must be taken slowly, over time. Doctor Wu Jutong added one more instruction: “If you can sternly punish your own anger and protect your heavenly harmony” — stop losing your temper, regulate your emotions, and this illness still has hope of recovery.

That completes the first case. Doctor Wu Jutong said cases like this serve as a model — this is how ye ge should be analyzed. The second case makes the picture even clearer.

Second case: Mr. Li, age 55 — Jade Maiden Decoction plus a cup of milk

In the guihai year — that is, 1803 — on the 13th day of the tenth month, the patient, a Mr. Li, age 55, also had ye ge.

💬 Note from Doctor Luo: Notice how ye ge so often strikes at “half a hundred years” — the fifties — with yin declining and yang binding: the yin is depleted and fire knots up above. This Mr. Li had a deep, rapid, forceful pulse, a pale complexion, and red ear tips. He had just passed fifty, and his hair and beard were already white. He had overused his mind all his life — too much worry and brooding, and brooding wounds the blood and the yin. But note: he genuinely had fire inside him as well. So what did Doctor Wu Jutong use? The Jade Maiden Decoction method (玉女煎法).

The Jade Maiden Decoction is Doctor Zhang Jingyue’s formula. Doctor Wu Jutong used calcined gypsum (duan shi gao), achyranthes (niu xi), inula flower (xuan fu hua), large doses of prepared rehmannia (da shu di), rice (jing mi), anemarrhena (zhi mu) and honey-fried licorice (zhi gan cao) — clearing stomach heat, nourishing yin, and sending rebellious qi downward. It is like White Tiger Decoction (Bai Hu Tang) with rehmannia added — which is exactly the meaning of the Jade Maiden Decoction. And beyond the formula, he instructed: drink a teacup of cow’s milk every morning.

💬 Note from Doctor Luo: Here I must add one comment: the formula uses calcined gypsum, which is actually not right — it should be raw gypsum (sheng shi gao). We do not advocate calcined gypsum. But “a cup of milk every morning” is a lovely touch: milk moistens dryness, and it matches the mechanism of yin deficiency with yang binding perfectly.

Can you drink milk or not? The ancients argued for centuries

Both of these cases used milk, so let’s take the opportunity to talk properly about milk — many Chinese-medicine practitioners today are against drinking it. Can you drink it or not?

💬 Note from Doctor Luo: The ancients disagreed about milk: most held that it is sweet and neutral (gan ping), with neither cold nor hot nature; some said it is slightly cold; others said it is outright cold. So when using milk, you must look at the constitution. Patients like the two in these cases — people with yin deficiency and heat — suit it especially well: milk nourishes yin, moistens dryness, and supplements deficiency.

Doctor Luo then lined up four ancient authorities:

• Doctor Wang Mengying (王孟英) (Sui Xi Ju Yin Shi Pu, 《随息居饮食谱》): milk is sweet and neutral, “as effective as human breast milk, yet without the toxins of food and without the fires of the seven emotions.” A nursing mother carries the emotional fires of the seven emotions; a cow has no emotional swings. Humans eat all kinds of things and the toxins in food affect the milk; a cow eats only grass, so its milk is free of dietary toxins. Doctor Wang Mengying said milk is excellent for blood exhaustion with dry stools and for regurgitation and ye ge — “for elderly people with excess fire, it is most suitable.”
• Doctor Sun Simiao (孙思邈) (Qian Jin Fang, 《千金方》): milk treats deficiency damage, wasting and weakness, insufficiency after serious illness, and the ten-thousand ailments of vacuity and exhaustion. His method is interesting: one sheng of cow’s milk with four sheng of water, boiled down to one sheng — then, when the person is hungry, give a little at a time, never too much at once. A small cup, not the whole bowl.
• Doctor Zhu Danxi (朱丹溪) also used milk often: milk with leek juice and ginger juice mixed in, for regurgitation and ye ge — the kind where esophageal or stomach cancer makes the patient vomit upward and can’t keep food down.
• Li Shizhen (李时珍) (Ben Cao Gang Mu, 《本草纲目》): milk treats regurgitation with hot hiccup, supplements exhaustion, moistens the large intestine, treats qi dysentery, and clears pox-yellowing. He especially noted: “for the elderly, it is very suitable cooked into congee” — old people can cook it into porridge for gentle moistening.

💬 Note from Doctor Luo: You see — whether they call it sweet-neutral or slightly cold, they all use it in one direction: people with exhausted fluids and deficiency heat, elderly people, and people recovering from serious illness all do well with milk. But one group cannot drink it — people with heavy damp-phlegm: copious phlegm, thick tongue coating. Milk is on the cool side, and it will aggravate damp-phlegm. What modern medicine calls “lactose intolerance” — drinking it and getting diarrhea — Chinese medicine reads as insufficient spleen-stomach transportation and transformation, spleen-stomach yang deficiency. So the conclusion is simple: milk has a temperament, and use it according to constitution — suitable for the yin-deficient, fluid-starved, dry; not for the yang-deficient and damp-phlegmy.

Among ethnic minorities, the Tibetan “tihu” (clarified butter) of “tihu guanding” fame is a dairy product, and Mongolians drink milk daily — milk itself is not the problem. It all depends on whether it suits your constitution.

Doctor Wu Jutong’s summary: treat ye ge by type

Finally, Doctor Wu Jutong summed up the treatment of ye ge by type.

💬 Note from Doctor Luo: The ancients debated ye ge endlessly, each championing his own method, with no final agreement. Doctor Wu Jutong’s general outline: for cases leaning toward yang binding with yin decline, free the yang qi — use Xuanfu Daizhe Tang (旋覆代赭汤, Inula and Hematite Decoction), Jintui Huanglian Tang (进退黄连汤, the Advance-and-Retreat Coptis Decoction), and the like; for cases leaning toward yin deficiency, never mistakenly use fragrant-drying herbs — just as Zhu Danxi taught. Ye ge also comes in several named types: the shi ge (time diaphragm) where food is physically blocked, which calls for the descending method; the tan ge (phlegm diaphragm), where phlegm binds the passage — transform the phlegm and guide it out; the xue ge (blood diaphragm), where stagnant blood blocks the esophagus — invigorate the blood and free the collaterals; and the luo qi ge (collateral-qi diaphragm) of long illness entering the collaterals with bound qi — course the liver and regulate the qi. Many functional cases of ye ge are simply emotional; once the liver qi is soothed, the swallowing returns to normal. For vomiting so violent it damages the stomach fluids, the ancients used niu zhuan cao (牛转草) — the grass a cow chews back up from rumination, which was used as medicine. And for elderly widowers, widows and celibate monks whose excessive abstinence left essence congealed into a “bone” blocking the pylorus, they used goose blood (鹅血) to dissolve it — and indeed, old practitioners once used goose blood for the heat-bound type of esophageal cancer, reportedly with good results.

Doctor Luo’s closing notes: for yin-deficient people, milk is a good medicine

💬 Note from Doctor Luo: Both of these cases treat ye ge — a very complex disease, with everything from functional eating difficulty caused by emotion and stress to genuine organic disease. The ancients left us treatments and a great deal of insight. One last reminder: if you used to swallow food easily and now suddenly choke, and it persists for a long time — you must go to a hospital for a check-up. But if you are simply a yin-deficient constitution, dried out all over, then a little milk is fine — people often ask me what a yin-deficient person should eat, and milk is one of the things that suits them.

💬 Note from Doctor Luo: Doctor Wu Jutong was a master of warm disease; what I am presenting now are his miscellaneous-disease cases. In the coming days I will also discuss his treatment of external contraction — external contraction (epidemics) is so severe right now that we can all borrow the thinking of these warm-disease masters.

Compiled from Doctor Luo Dalun’s commentary on Doctor Wu Jutong’s case records; the cases come from Wu Jutong’s Case Records (《吴鞠通医案》, Qing dynasty).

What to take away: when food starts sticking in the throat, don’t panic — but do get it checked. Ye ge is a knot of yin-deficiency below and heat-binding above, and the classical treatment is gentle: moisten the upper passage with Five-Juice Drink and milk, nourish the root with flesh-and-blood substances like Zhuanxi Dasheng Gao, and above all stop the anger that feeds the fire. For those whose dryness is purely constitutional, a cup of milk each morning is one of the kindest things you can do for a yin-starved body.