Ran Xuefeng's Case of Ye Ge (Dysphagia)

Ran Xuefeng (1879-1963) was a famous TCM physician of modern China. In his work Ran Xuefeng Yian (Medical Cases of Ran Xuefeng) he records a case of treating ye ge, transcribed below:

The wife of a man surnamed Li suffered from ye ge for 30 years, worsening in recent years. Her pulse was deficient and rapid, with a hesitant, rough quality. The symptoms included glomus and binding below the heart, epigastric oppression and pain, inability to swallow food; she felt food reached the area near the stomach and could only pass through if she remained still, otherwise it had to be vomited. When hungry she felt flustered and gnawing and wanted to eat; when she ate, pain intensified and she wanted to vomit. After vomiting she ate again, and after eating vomited again; when she did not vomit, she would put her finger down her throat to induce vomiting. The suffering was indescribable.

I designed a formula to free the diaphragm and loosen the epigastrium, move qi and invigorate blood, using pungent dispersion and bitter downward-bearing. The formula used: Gua Lou (Trichosanthis Fructus) 5 qian, Ban Xia (Pinelliae Rhizoma) 3 qian, Huang Lian (Coptidis Rhizoma) 1 qian, Gan Jiang (Zingiberis Rhizoma) 1.5 qian, Zhi Shi (Aurantii Fructus immaturus) 1.5 qian, Yu Jin (Curcumae Radix) 3 qian, Gan Cao (Glycyrrhizae Radix) 8 fen. After 3 doses she felt somewhat easier. The patient asked whether the disease could be cured. I replied that ye ge is a serious illness not curable in a short time, but if she took the medicine peacefully and rested quietly, over time there was a chance of recovery.

I reflected that although this case had lasted years, the body was deficient while the pattern was excess. The ancients had Ziyu Jiufen Tang for deficiency-type ye ge and Jin-Tui Huanglian Tang for excess-type ye ge. I therefore drew on both, combining the two approaches into one method, modifying with the disease, half moistening-nourishing and half out-thrusting, half freeing and moving. I did not rigidly copy their herbs, but everywhere followed their intention. For example, I added Ren Shen Xu (Ginseng rootlets), Dang Gui Xu (Angelica rootlets), Shi Shuang (Persimmon frost) and Dong Gua Zi (Benincasae Semen) to the previous formula; or removed Ban Xia and added Gua Lou Gen (Trichosanthes root, Tian Hua Fen) and Wei Rui (Polygonati odorati Rhizoma); or removed Zhi Shi and added Ju Hong and Qian Cao; or removed Yu Jin and added Hu Po (Succinum) and Xue Jie (Draconis Sanguis). Adjusting in many ways according to what dominated, after 3 months the disease decreased, after half a year it greatly decreased, and after one year she was cured.

This lady is now over seventy and in good spirits; she says the disease has not recurred. Ye ge is generally difficult to treat, but there are cures; I record this for reference.

The elderly lady in Ran Xuefeng's case had a disease that in TCM is ye ge and in modern medicine is an esophageal disorder. Judging from the history and symptoms Ran described, this patient likely had esophageal cancer, possibly already at an intermediate to advanced stage. She presented with "eaten in the morning, vomited in the evening," which generally indicates obstruction at the cardia.

Ran initially treated with a modified Jin-Tui Huanglian Tang, a derivative of Ban Xia Xie Xin Tang from the Shanghan Lun (Treatise on Cold Damage). Ban Xia Xie Xin Tang is indicated for gastric glomus and discomfort, nausea and vomiting, bowel sounds and diarrhea—patterns seen in digestive tract disease. Jin-Tui Huanglian Tang is built by adding and subtracting herbs on the basis of Ban Xia Xie Xin Tang; it harmonizes cold and heat, and upbears and downbears qi, suitable for complex patterns of intermingled cold-heat and deficiency-excess. Its core is to regulate spleen-stomach function through the pairing of pungent dispersion and bitter downward-bearing, and simultaneous supplementation and drainage, improving glomus, vomiting and diarrhea.

The patient in this case showed the typical "Ban Xia Xie Xin Tang" pattern, so Ran treated with this formula at the first visit and achieved some effect, with reduction of symptoms. But the patient had been ill for 30 years; quantitative change had produced qualitative change, and symptomatic formulas alone could not effect a radical cure.

Ran Xuefeng was a great TCM physician with broad learning. He took the classical historical formulas for deficiency-type and excess-type ye ge, combined them into one composite approach, and continuously adjusted according to the patient's current symptoms.

Composing formulas this way has two advantages: first, combining different proven formulas for the same disease yields better efficacy; second, the patient had been ill for over 30 years, with long-term consumption—chronic illness inevitably leads to deficiency—so deficiency and excess necessarily coexisted, and supporting healthy qi and dispelling pathogens should be used together.

The other ye-ge formula Ran mentioned, Ziyu Jiufen Tang, along with the Jin-Tui Huanglian Tang noted above, both come from Yü Jiayan's Yimen Falü (Medical Doors and Laws) of the Qing dynasty.

Ziyu Jiufen Tang treats a condition where the fire of the five mentalities rebels as jie-ge (here meaning obstruction). Its composition is: Sheng Di Huang (raw Rehmanniae Radix) 2 qian (pressed for juice), Mai Men Dong (Ophiopogonis Radix) 2 qian (pressed for juice), Ren Shen (Ginseng Radix) 1.5 qian (steamed with human milk), Zhi Gan Cao (honey-fried Glycyrrhizae Radix) 1 qian, Zhen E Jiao (real Asini Corii Colla) 1 qian, Hu Ma Ren (fried, ground) 1 qian, Bai Zi Ren (fried) 7 fen, Wu Wei Zi (Schisandrae Fructus) 4 fen, Zi Shi Ying (Fluoritum) 1 qian, Han Shui Shi (Gypsum rubrum) 1 qian, Hua Shi (Talcum) 1 qian (all crushed and ground to powder), Sheng Xi Zhi (raw rhinoceros juice, ground) 3 fen, Sheng Jiang Zhi (fresh ginger juice) 2 tea spoons. Jin-Tui Huanglian Tang consists of Huang Lian, Gan Jiang, Ban Xia, Ren Shen, Gan Cao and Da Zao (Ziziphi Fructus); it is also a derivative of Ban Xia Xie Xin Tang.

Ran synthesized the composition logic of these two formulas, adjusted them to the patient's specific condition, and after a year finally cured her—no small feat. Ye ge is a difficult severe disease; patients seeking treatment should also be psychologically prepared for long-term therapy.