Dysphagia-occlusion

A disease characterized by sensation of blockage on swallowing, difficulty in getting food and drink down, and, in some cases, immediate vomiting of ingested food. The Chinese term is a compound of yē meaning difficulty in swallowing (dysphagia), and gé meaning blockage preventing food from going down (occlusion). Dysphagia and occlusion may occur independently. Dysphagia most commonly but not necessarily develops into occlusion. There are four principal patterns: phlegm and qì obstructing each other, liquid depletion and heat bind, static blood binding internally, and qì vacuity and yáng debilitation.

Patterns

Phlegm and qì obstructing each other (痰气交阻 tán qì jiāo zǔ) arises when thought and anxiety cause qì to bind and engender phlegm so that the two contend with each other and obstruct the gullet. The main signs are difficulty in swallowing with glomus and fullness in the chest and diaphragm. Relief experienced when the patient is emotionally calm reflects the early stages when qì is binding. Dry mouth and throat reflect depressed heat damaging liquid or binding qì preventing the upward supply of fluids. A tongue that tends to be red, a thin slimy tongue fur, and a fine slippery stringlike pulse are signs of depressed qì and obstructing phlegm with depressed heat damaging liquid.

Medicinal therapy: Rectify qì and relieve depression; transform phlegm and moisten dryness. Use Diaphragm-Arousing Powder (启膈散 qǐ gé sǎn).

Acumoxatherapy: Base treatment mainly on back transporting points, CV, ST, LR, and GB. Select BL-20 (Spleen Transport, 脾俞 pí shù), BL-21 (Stomach Transport, 胃俞 wèi shù), CV-22 (Celestial Chimney, 天突 tiān tú), CV-17 (Chest Center, 膻中 shān zhōng), CV-12 (Center Stomach Duct, 中脘 zhōng wǎn), ST-21 (Beam Gate, 梁门 liáng mén), BL-18 (Liver Transport, 肝俞 gān shù), LR-2 (Moving Between, 行间 xíng jiān), and GB-34 (Yáng Mound Spring, 阳陵泉 yáng líng quán); needle with drainage.

Liquid depletion and heat bind (津亏热结 jīn kuī rè jié) is characterized by roughness and pain on swallowing. Solid foods are harder to swallow than liquids. There is emaciation, dry mouth, dry bound stool, vexing heat in the five hearts, a red dry tongue that may be fissured, and a rapid fine stringlike pulse. It arises when stomach liquid is depleted and the gullet is deprived of nourishment. Vexing heat in the five hearts and emaciation reflect insufficiency of stomach liquid with increasing kidney yīn depression and yīn vacuity internal heat. The tongue and pulse reflect severe liquid depletion and pronounced heat.

Medicinal therapy: Enrich the fluids. Use Five Juices Center-Quieting Beverage (五汁安中饮 wǔ zhī ān zhōng yǐn).

Acumoxatherapy: Base treatment mainly on back transporting points, CV, ST, and KI. Select BL-23 (Kidney Transport, 肾俞 shèn shù), BL-17 (Diaphragm Transport, 膈俞 gé shù), SP-6 (Three Yīn Intersection, 三阴交 sān yīn jiāo), KI-2 (Blazing Valley, 然谷 rán gǔ), KI-6 (Shining Sea, 照海 zhào hǎi), ST-44 (Inner Court, 内庭 nèi tíng), LI-4 (Union Valley, 合谷 hé gǔ), CV-17 (Chest Center, 膻中 shān zhōng), and CV-12 (Center Stomach Duct, 中脘 zhōng wǎn); needle with drainage. For dry bound stool, drain SP-14 (Abdominal Bind, 腹结 fù jié), and ST-37 (Upper Great Hollow, 上巨虚 shàng jù xū).

Static blood binding internally (瘀血内结 yū xuè nèi jié) is characterized by pain, with difficulty in swallowing both solids and liquids. Stool is like sheep’s droppings, scant and hard. In some cases, there is vomiting of matter like the juice of rice bean (Phaseoli Semen, 赤小豆 chì xiǎo dòu). There is emaciation, dry skin, red tongue with little liquid (may be green-blue or purple), and a rough fine pulse. The stool reflects enduring disease that has damaged yīn. The vomiting of matter like red bean juice indicates damage to network vessels. Prolonged inability to swallow food leads to exhaustion of the source of engendering transformation (reduced food assimilation), which causes emaciation and dry skin. The tongue and pulse reflect depletion of yīn-blood and static blood binding internally.

Medicinal therapy: Enrich yīn and nourish the blood; break the bind and move stasis. Use Dark-Gate–Freeing Decoction (通幽汤 tōng yōu tāng).

Acumoxatherapy: Base treatment mainly on back transport points, SP, and LR. Select BL-17 (Diaphragm Transport, 膈俞 gé shù), BL-18 (Liver Transport, 肝俞 gān shù), BL-46 (Diaphragm Pass, 膈关 gé guān), CV-17 (Chest Center, 膻中 shān zhōng), CV-12 (Center Stomach Duct, 中脘 zhōng wǎn), LR-3 (Supreme Surge, 太冲 tài chōng), SP-10 (Sea of Blood, 血海 xuè hǎi), and SP-6 (Three Yīn Intersection, 三阴交 sān yīn jiāo); needle with drainage.

Qì vacuity and yáng debilitation (气虚阳衰 qì xū yáng shuāi) causes inability to swallow food with bright-white facial complexion, exhaustion of essence-spirit, physical cold, shortness of breath, ejection of clear drool, puffy face, swollen feet, abdominal distension, pale tongue with white fur, and a weak fine or fine sunken pulse. This pattern arises, in severe cases, when detriment to yīn affects yáng. Ejection of clear drool and devitalized essence-spirit reflects an inability to get food down. The puffy face, swollen feet, and abdominal distension reflects spleen-kidney debilitation. The bright-white facial complexion, physical cold, and shortness of breath, as well as the tongue and pulse are signs of debilitation of original yáng.

Medicinal therapy: Warm and supplement the spleen and kidney. To warm the spleen use Qì-Supplementing Spleen-Moving Decoction (补气运脾汤 bǔ qì yùn pí tāng); to warm the kidney, use Right-Restoring [Life Gate] Pill (右归丸 yòu guī wán).

Acumoxatherapy: Base treatment mainly on back transporting points, CV, SP, and ST. Select BL-23 (Kidney Transport, 肾俞 shèn shù), BL-20 (Spleen Transport, 脾俞 pí shù), BL-21 (Stomach Transport, 胃俞 wèi shù), CV-6 (Sea of Qì, 气海 qì hǎi), BL-17 (Diaphragm Transport, 膈俞 gé shù), ST-36 (Leg Three Lǐ, 足三里 zú sān lǐ), SP-4 (Yellow Emperor, 公孙 gōng sūn), KI-3 (Great Ravine, 太溪 tài xī), and Central Eminence (中魁 zhōng kuí); needle with supplementation and add moxa. For pronounced yáng vacuity, moxa GV-4 (Life Gate, 命门 mìng mén).

Comparison: Dysphagia-occlusion is similar to stomach reflux, plum-pit qì, and block and repulsion. Both dysphagia-occlusion and stomach reflux are characterized by vomiting of ingested food. Dysphagia-occlusion is largely associated with yīn vacuity and heat and is characterized principally by difficulty in swallowing and blockage preventing downflow that causes food to be brought up in small amounts. Stomach reflux is largely ascribed to yáng vacuity with cold and is characterized by no difficulty in getting food down, and by vomiting of ingested food after a long period, usually described as vomiting in the morning of food ingested in the evening, and vomiting in the evening of food ingested in the morning. Dysphagia-occlusion is also similar to plum pit qì. However, while the former is associated with a palpable blockage of the gullet, plum pit qì is associated only with a feeling of blockage that is caused by qì counterflow and phlegm blockage (formless or intangible evil) that does not cause difficulty in swallowing food. Block and repulsion is also similar, but is associated with urinary and fecal blockage. Dysphagia-occlusion is the result of factors such as seven-affect internal damage, intemperate eating and drinking, sexual taxation, and debilitation of essence in old age.