吞酸之症有二，热与寒也。经曰∶诸呕吐酸，皆属于热。东垣曰∶病机作热，攻之误矣，浊
气不降，寒药岂能治之。二说似乎矛盾，而实一也。《素问》言热者，所以指其末也；东垣
言寒者，所以指其本也。丹溪用吴茱萸之法，亦尝谓之寒矣，然亦当分其虚实而治之。若烦
热作渴，好食啖物，饮食易化，是为实火内炽，而胃经热也，宜用清凉饮之类。若不渴喜食
热物，饮食难化，是为虚火所致，而胃经寒也，宜用香砂六君子汤之类。故东垣云∶邪热不
杀谷，苟误认为实热，概用寒凉之剂，而变为中满呕吐反胃之症者，皆末传寒中之败症也。
可不慎欤！
治验
一小儿吞酸，用六君子汤而愈。后伤食复作，兼泻，先用五味异功散加升麻、干姜，泻顿止
，又以六君子煎送四味茱萸丸而愈。
一小儿吞酸嗳腐，发热口渴，先用保和丸二服，以消宿滞，又用六君、木香、干姜，以温养
中气而愈。后伤冷粉，腹胀痛，余用异功散加干姜，诸症渐愈，用补中益气汤加木香，将愈
；又伤食吞酸腹痛，用六君、木香二剂痛止，又四剂而愈。
一小儿吞酸，喘嗽腹胀，面白兼青，余谓脾肺之气虚，先用补中益气汤加茯苓、半夏二剂，
喘胀悉愈，又用六君子汤及五味异功散而愈。
一小儿十三岁吞酸，每食碗许，稍多则泻或腹胀，面色黄或青白，此脾肺虚，肝木所胜，用
六君、干姜、柴胡、升麻，间佐以补中益气汤而痊。毕姻后，兼勤于功课，仍吞酸唾痰，服
清热药，大便不实，嗜卧少食，而似肉痿，用前药各百余剂而痊。
一女子吞酸唾痰，恪用清气化痰之药，余谓属中气虚，不信，后觉肚腹肿胀，大小便淋沥而
殁。
六君子汤（加木香、砂仁，名香砂六君子汤）
异功散（二方见内钓）
补中益气汤
保和丸（二方见虚羸）
四味茱连丸（方见噫气）
The syndrome of acid regurgitation (Tun Suan) has two types: heat and cold. The Classics state: "All vomiting and acid regurgitation belong to heat." Li Dongyuan stated: If the pathogenesis is considered heat, attacking it with purgatives is a mistake; turbid qi fails to descend, how can cold-natured herbs treat it? These two theories seem contradictory but are actually one. When *Suwen* mentions heat, it refers to the manifestation (the branch); when Li Dongyuan mentions cold, he refers to the root cause. Zhu Danxi's use of *Evodiae Fructus* (Wuzhuyu) was also categorized as treating cold, yet one must still differentiate between deficiency and excess for treatment. If there is irritability, heat sensation, thirst, good appetite, and easy digestion of food, this indicates excessive fire blazing internally, belonging to heat in the Stomach meridian; formulas such as Qingliang Yin (Cooling Decoction) should be used. If there is no thirst, preference for hot foods, and difficulty digesting food, this is caused by deficient fire, belonging to cold in the Stomach meridian; formulas such as Xiangsha Liujunzi Tang (Aucklandia and Amomum Six Gentlemen Decoction) should be used. Therefore, Li Dongyuan said: "Pathogenic heat cannot ripen grains." If mistakenly identified as excess heat and generally treated with cold-cooling agents, leading to syndromes of abdominal fullness, vomiting, and regurgitation, these are all deteriorating conditions where the disease has transmitted from the exterior to the interior, transforming into middle-jiao cold deficiency. Can one not be cautious?
Clinical Cases
One child suffered from acid regurgitation and was cured using Liujunzi Tang (Six Gentlemen Decoction). Later, due to food stagnation, the condition recurred accompanied by diarrhea. First, Wuyi Yigong San (Five Agents Extraordinary Powder) was administered with added *Rhizoma Bupleuri* (Shengma) and *Zingiberis Rhizoma Recens* (Ganjiang), which stopped the diarrhea immediately. Subsequently, the child was cured by taking decoctions of Liujunzi Tang to deliver Siwei Zhuyu Wan (Four-Ingredient Evodia Pill).
One child presented with acid regurgitation, belching with a putrid odor, fever, and thirst. Two doses of Baohe Wan (Preserve Harmony Pill) were first used to eliminate old stagnation. Then, Liujunzi Tang was combined with *Aucklandiae Radix* (Muxiang) and *Zingiberis Rhizoma Recens* (Ganjiang) to warm and nourish the middle qi, resulting in recovery. Later, after consuming cold rice noodles, the child developed abdominal distension and pain. I used Yigong San (Extraordinary Powder) with added *Zingiberis Rhizoma Recens* (Ganjiang), and the symptoms gradually improved. Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) with added *Aucklandiae Radix* (Muxiang) was then used until near recovery. Subsequently, due to food stagnation causing acid regurgitation and abdominal pain, two doses of Liujunzi Tang with *Aucklandiae Radix* (Muxiang) stopped the pain, and four more doses led to complete recovery.
One child suffered from acid regurgitation accompanied by wheezing, coughing, and abdominal distension, with a pale complexion showing bluish tints. I diagnosed this as deficiency of Spleen and Lung qi. Two doses of Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) with added *Poria* (Fuling) and *Pinelliae Rhizoma Preparatum* (Banxia) completely resolved the wheezing and distension. The child was subsequently cured using Liujunzi Tang (Six Gentlemen Decoction) and Wuyi Yigong San (Five Agents Extraordinary Powder).
One thirteen-year-old child suffered from acid regurgitation. After eating about one bowl of food, even slightly more would cause diarrhea or abdominal distension. The complexion was yellow or pale blue. This indicated Spleen and Lung deficiency with excessive Wood overacting on Earth. Treatment involved Liujunzi Tang (Six Gentlemen Decoction), *Zingiberis Rhizoma Recens* (Ganjiang), *Bupleuri Radix* (Chaihu), and *Rhizoma Bupleuri* (Shengma), intermittently supplemented with Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction), leading to recovery. After marriage, while continuing diligent study, the child still experienced acid regurgitation and expectoration of phlegm. Taking heat-clearing herbs resulted in loose stools, lethargy, poor appetite, and symptoms resembling Rou Wei (flesh atrophy). Over a hundred doses of the previously mentioned medicines cured the condition.
One female patient suffered from acid regurgitation and expectoration of phlegm. She strictly used heat-clearing and phlegm-resolving medications. I advised that this belonged to middle qi deficiency, but she did not believe me. Later, she developed abdominal swelling, dribbling urination and defecation, and eventually died.
Liujunzi Tang (Six Gentlemen Decoction) (When added with *Aucklandiae Radix* (Muxiang) and *Amomi Fructus* (Sharen), it is named Xiangsha Liujunzi Tang)
Yigong San (These two formulas are described under the section "Nei Diao")
Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction)
Baohe Wan (Preserve Harmony Pill) (These two formulas are described under the section "Xu Lei")
Siwei Zhulian Wan (Four-Ingredient Evodia and Coptis Pill) (Formula described under the section "Yi Qi")