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[Danxi] Madam Zheng of the Zheng residence vomited bitter fluid early in the morning. Her pulse was choppy and faint, but she moved about as usual after rising. This indicates weak Stomach Qi and dampness in the upper Jiao (upper burner).
Huangqin (Radix Scutellariae, 7 qian) Huashi (Talcum, 1.5 liang) Cangzhu (Rhizoma Atractylodis Lanceae, 1 liang, stir-fried) Feifan (Alumen Exsiccatum, 2 liang) Chenpi (Pericarpium Citri Reticulatae, 1 liang) Shanzha (Fructus Crataegi, 1 liang) Banxia (Rhizoma Pinelliae, 1 liang)
Jiegeng (Radix Platycodonis, 5 qian) Stir-fried Huangqin (Radix Scutellariae, 5 qian) Decoct with ginger water and take orally.

For acupuncture and moxibustion treatment of vomiting bitter fluid, specifically select points from the Gallbladder and Stomach meridians. The *Classic* states: "Prone to vomiting, vomiting bitter fluid, frequent sighing; the pathogen is in the Gallbladder, and rebellious Qi is in the Stomach." When Gallbladder fluid leaks, there is a bitter taste in the mouth; when Stomach Qi rebels upward, there is vomiting of bitter fluid. Therefore, it is said that for vomiting, one should select Xiazansanli (Lower Three-Li, likely referring to Zusanli ST36 or similar lower leg points on the Stomach meridian contextually linked to Gallbladder/Stomach regulation) to descend Stomach Qi; for rebellion, prick the blood collaterals of the Shaoyang (Lesser Yang) meridian to open up Gallbladder rebellion, then regulate deficiency and excess to eliminate the pathogen. It also states: "Bitter taste in the mouth and vomiting of overnight fluid, select Yanglingquan (GB34)."

In the theory of Six Qi (Yunqi), vomiting bitter fluid all belongs to Dryness. The *Classic* states: "When Yangming is in authority, excessive Dryness causes disease characterized by prone vomiting and vomiting bitter fluid." It also states: "When Yangming Qi prevails, vomiting bitter fluid occurs; treat with Bitter-Warm and Acrid-Warm methods."

[Danxi] Someone asked: "Swallowing acid (Tunsuan): *Suwen* clearly identifies it as Heat; Dongyuan (Li Dongyuan) identifies it as Cold. Why?" I say: Vomiting acid (Tuansuan) and swallowing acid are different. Vomiting acid refers to spitting out sour fluid like vinegar. Normally, body fluids accumulate due to ascending Qi stagnation, forming a mass. After long-standing accumulation, dampness generates heat within, transforming according to Wood, thus producing an acid taste. Is this not Heat? However, if the stagnation has lasted long and cannot surge out spontaneously, it lies hidden between the Lungs and Stomach, unable to be coughed up or swallowed down. When the skin surface is exposed to wind-cold, internal heat becomes more constrained, and the acid taste pierces the heart. When the skin surface is warm and pores open, or after taking fragrant hot decoctions/pills, body fluids flow, providing temporary relief. Is this not Cold? *Suwen* speaks of Heat regarding its root; Dongyuan speaks of Cold regarding its branch/symptom. However, Dongyuan did not consider the external acquisition of wind-cold leading to contraction Qi when establishing his theory. He wished to drain the excess of Lung Metal and stated that cold herbs cannot treat acid, using Angwei Tang and Jiawei Erchen Tang, both containing Dingxiang (Caryophylli Flos), lacking methods to treat damp-heat stagnation, which contradicts the classic intent. I once treated swallowing acid using Huanglian (Coptidis Rhizoma) and Zhuyu (Evodiae Fructus), each prepared and stir-fried, alternating as assistant guides according to seasons, with Cangzhu (Rhizoma Atractylodis Lanceae) and Fuling (Poria) as assistants. Made into small pills with steamed dough soaked in water and taken orally. I also instructed patients to nourish themselves with vegetables and fruits, so the disease would heal easily. For swallowing acid, Evodiae Fructus is used to follow its nature and counteract it; this is the method of reverse adjuvant therapy, and it must have stir-fried Coptidis Rhizoma as the sovereign herb.

Yancu Wan (Vinegar-Swallowing Pill)
Zhuyu (Evodiae Fructus, remove stems/branches, 0.5 liang, boiled, dried) Chenpi (Pericarpium Citri Reticulatae, remove white pith, 5 qian) Huangqin (Radix Scutellariae, stir-fried, 5 qian) Cangzhu (Rhizoma Atractylodis Lanceae, 7.5 qian)
Huanglian (Coptidis Rhizoma, 1 liang, finely cut, stir-fried with mud from old walls)
Grind all into fine powder, make pills with yeast paste, size of paulownia seeds.

Shenyu Wan Can treat swallowing acid, but cannot treat spontaneous diarrhea. (Formula seen in Diarrhea section.)

*[Bingbu Shouji]* Treats "Acid Heart," where every time vinegar-like Qi attacks upward, feeling like sour vinegar attacking. Zhuyu (Evodiae Fructus) 1 he, water 3 zhan, decoct to 0.7 portion, take in one dose. Even if strong, force it down.

[Mei] Treats Acid Heart. Binglang (Arecae Semen, 4 liang), Chenpi (Pericarpium Citri Reticulatae, 2 liang), finely ground into powder. Take one fangcun bi (measure) with honey water on an empty stomach.

[Danxi] A husband, due to external contraction of cool Qi, fought with retained fluid in the body, causing sour discomfort below the heart, vomiting clear fluid, later vomiting red fluid.
Qingpi (Exocarpium Citri Grandis, 3 qian) Huangqin (Radix Scutellariae, 1.5 qian) Renshen (Radix Ginseng, 2 qian) Zisu (Perillae Folium) Mutong (Akebiae Caulis) Gancao (Radix Glycyrrhizae) Zhike (Fructus Aurantii, 2 qian) Jiegeng (Radix Platycodonis, 1.5 qian) Mahuang (Ephedrae Herba, 0.5 fen)

[Dongyuan/Li Gao] *Jingyuan Fangfa* says: All vomiting and acid regurgitation belong to Heat. Differentiation says: This is external pathogenic factors affecting the Upper Jiao; Stomach Qi cannot accept external pathogens, hence vomiting. *Shanghan Lun* says: For vomiting patients, even if there are Yangming symptoms, do not purge. This shows the pathogen has not entered the interior, and the Three Yin meridians are not affected. It can also be seen that this syndrome is exterior. Zhang Zhongjing treats it with Shengjiang (Zingiberis Rhizoma Recens) and Banxia (Rhizoma Pinelliae). Sun Simiao says: Vomiting patients often use Shengjiang; it is the holy medicine for vomiting. Discussing miscellaneous diseases, those vomiting sour fluid, if severe, the sour fluid soaks the heart, unbearable bitterness; if less severe, they spit out sour fluid, making upper and lower teeth feel sour and astringent, unable to close against each other. Treating with major Acrid-Hot agents will surely reduce symptoms. Vomiting acid means vomiting sour fluid. The acid taste corresponds to Contraction Qi, representing the prosperity of Western Lung Metal. Cold Water is the son of Metal; the son can make the mother full/excess. Therefore, use major Salty-Hot agents to drain the son, with Acrid-Hot as assistants, to drain Lung excess. To treat according to *Jingyuan Fangfa* as Heat and attack it is erroneous. Generally, miscellaneous disease 'Acid Heart' involves turbid Qi failing to descend, desiring to form Middle Fullness; how can Cold herbs treat this?

Jiawei Erchen Tang Huoxiang Anwei San (Both formulas seen in previous Vomiting and Phlegm-Fluid sections.)

*[Bencao Yan yi / Author's Narrative]* In my life, I had two ailments: one was hematochezia (blood in stool), the other was retained fluid in the chest/diaphragm. Hematochezia stopped at times, but retained fluid never ceased. Initially, because when young I sat writing at night, leaning left on the desk, food and drink mostly settled on the left side. After midnight, feeling slightly tired, I drank 2-3 cups of wine. Then lying down, I slept on my left side. When Qi and Blood were vigorous, I felt nothing. After 3-5 years, I felt the wine draining down the left side with a gurgling sound, rib pain, decreased appetite, and every ten-plus days vomiting several sheng of sour fluid. In summer months, only the right side of the body sweated and remained moist; the left diseased side was absolutely dry. I visited famous doctors and tried sea prescriptions, rarely effective. Occasionally effective, it relapsed after a month. Tonic herbs like Tianxiong, Fuzi, Fanshi; purgative herbs like Qianniu, Gansui, Daji—I tried them all. Later, I reasoned that it had become a 'Pi Nang' (mass/cyst), like puddles having depressions; water does not flow until the depression is filled. Clear fluids could flow, but turbid fluids remained stagnant because there was no exit below. Thus, accumulating for 5-7 days, it would vomit out and relieve slightly, then relapse after a few days. Spleen Earth dislikes dampness, and water flows dampness. Better to dry the Spleen to overcome dampness, and build up Earth to fill the depressions, then the disease would go. So I discarded all medicines and took only Cangzhu (Rhizoma Atractylodis Lanceae). After three months, it was cured. Since then, for several years, no vomiting, chest/diaphragm wide, eating/drinking normal, sweating all over in summer keeping body cool, drinking flowing down from the middle. Previously, fluid soaked the Liver, eyes were often dim/dizzy; afterwards, could read small print under lamplight, all due to Cangzhu. Method: Cangzhu 1 jin, peel and grind to powder. White sesame seeds 0.5 liang, water 2 zhan, grind and extract juice. Dates 15 pieces, boil until soft, peel, remove pits, grind. Mix evenly with sesame juice into a thin paste, knead in mortar until cooked, make pills size of paulownia seeds, dry. Take 50 pills with warm water on empty stomach daily, increase to 100, then 200. Avoid peaches, plums, sparrows, pigeons. At first, chest feels slightly dry; control with Maoshu (wild Cangzhu). If very dry, take Shanzhizi San (Gardeniae Fructus Powder) once, eventually no dryness. After half a year of taking it, I only used extremely pungent, drying, strong herbs, peeled, unsoaked, very potent, naturally no dryness. Shanzhizi San uses only Gardeniae Fructus, dried and powdered, taken with boiling water. Thus, knowing that sitting for long periods leaning to one side is bad; moving occasionally is also a method of regulating breath.

Ganjiang Wan (Dried Ginger Pill) [from *Shenghui Fang*] Treats alcohol-related masses, retained fluid, vomiting sour fluid.
Ganjiang (Zingiberis Rhizoma) Gegen (Puerariae Lobatae Radix) Zhike (Fructus Aurantii) Juhong (Exocarpium Citri Reticulatae Rubrum) Qianhu (Peucedani Radix) (each 5 qian) Baizhu (Atractylodis Macrocephalae Rhizoma) Banxiaqu (Pinelliae Fermentatum, each 1 liang) Zhuyu (Evodiae Fructus) Gancao (Radix Glycyrrhizae) (each 1 fen)
Grind into fine powder, make pills with refined honey, size of paulownia seeds. Take 30 pills per dose with rice water; effective.

Treats stroke with phlegm-fluid dizziness, vomiting sour fluid, headache, nausea.
Banxia (Rhizoma Pinelliae, 2 liang) Nanxing (Arisaematis Cum Bile Rhizoma) Baifu (Typhonii Rhizoma) (each 1 liang)
All raw, grind to powder, make pills with drops of water, size of paulownia seeds, wrap in raw flour dough, dry in shade. Take 10-20 pills per dose with ginger water.

[Zihe Zhang] Zhang Fengcun of Tangxi, an old farmer surnamed Yang, suffered from vomiting sour fluid for over ten years. It was originally retained fluid. All doctors treated it with drying agents. Moxibustion and burning needles were applied to Zhongwan (CV12) and navel area, but wounds did not heal. Dai Ren (Zhang Congzheng) used bitter emetics to induce vomiting. His phlegm came out like glue, totaling 2-3 sheng. He recovered while chatting and laughing.

In the theory of Six Qi, vomiting acid all belongs to Heat. The Classic states: All vomiting and acid regurgitation belong to Heat. It also states: When Shaoyang Qi prevails, there is desire to vomit. Vomiting acid is treated with Acrid-Cold methods.

[Dongyuan/Li Gao] Vomiting overnight fluid, swallowing acid: Zhangmen (LR13) Shenguang (Extra point)