Library

What are the clinical manifestations of acid regurgitation? It is said that all cases of acid regurgitation belong to Liver Wood. In the Five Elements, the nature of "bending and straightening" manifests as sourness. Liu Hejian (Liu Wansu) attributed it to Heat, while Li Dongyuan attributed it to Cold. Ultimately, Li Dongyuan discussed the etiology, whereas Liu Hejian discussed the pathogenesis transformation. Cold causes Yang Qi to fail to circulate freely; when Qi circulation is stagnant, it郁结s (becomes constrained) and transforms into Heat. Heat generates sourness. However, there are cases not caused by Cold, where Sourness arises from severe constraint of Wood Qi steaming and steaming the Damp Earth (Spleen/Stomach). This may present as swallowing acid or vomiting acid. Another type results from excessive food intake causing fullness in the stomach region, leading to Spleen Qi failure in transportation and metabolism, resulting in sourness. This is extreme frustration and constraint, with Damp-Heat steaming and transforming, similar to how a wine vat becomes sour if fermentation is too intense. Nevertheless, this is always caused by Wood Qi. Without the influence of Wood Qi, whether due to Cold, Heat, overeating, or frustration, sourness would not occur, because sourness is the characteristic of Wood Qi.

Question: What is the relationship between the Stomach and the Gallbladder/Liver, such that they can produce various types of sourness? Answer: The Shaoyang (Lesser Yang) and Yangming (Greater Yang) meridians run together. Liver Qi merges into the Stomach. Therefore, if there is Heat in the Stomach, the Ministerial Fire of Shaoyang and the Fire of Jueyin (Liver) will mutually attract each other and steam upwards. Regarding emotional constraint, in mild cases, Wood Qi is too abundant and invades the Earth position (Spleen/Stomach); in severe cases, Kidney Water is depleted, and Kidney Water rebels upward, carrying water vapor up, like thorns growing wildly, making the Damp Earth turbid. This situation is neither purely due to Cold nor purely due to Heat, yet both swallowing and vomiting yield sourness. This exceeds the scope of Liu Hejian and Li Dongyuan's theories on etiology based on Heat and Cold. There is another type where food immediately turns sour upon entering the Stomach. This must be due to incomplete recovery of Stomach Yin after prolonged cold damage or chronic malaria. When food and water enter the Stomach, they increase Damp-Heat, leading to sourness. Treatment should employ bland flavors to nourish True Yang before proceeding. (Dongzhuang stated: For the symptom of acid regurgitation, Li Dongyuan treated it as Cold, while Liu Hejian and Zhu Danxi treated it as Heat. People thus divided them into root and branch aspects. However, clinically, treatments using Huangqin (Scutellariae Radix) and Lianzi (Coptidis Rhizoma) for clearing Heat are common, while those using Jiang (Zingiberis Rhizoma) and Gui (Cinnamomi Ramulus) for warming are rare. Can Li Dongyuan's method be discarded? The reason is that initial treatment must use warm dispersal methods. Over time, Cold transforms into Heat, so treatment invariably shifts to addressing Heat. I have simply not encountered early-stage patients.)

What are the clinical manifestations of vertigo and dizziness? It is said that vertigo and dizziness all belong to Wind-Fire in the Liver and Gallbladder meridians. Wind and Fire belong to Yang, and Yang is active, causing visual blurring/rotation and dizziness. It is like a flame spinning endlessly when caught in the wind. The branch of the Hand-Shaoyang (Sanjiao) meridian emerges from behind the ear to the outer canthus and connects with the Foot-Shaoyang (Gallbladder) meridian. The branch of the Foot-Shaoyang meridian emerges from the dorsum of the foot, enters the big toe nail bed, exits at the hair tuft, and connects with the Foot-Jueyin (Liver) meridian. The Classics state: The essence of the Zang and Fu organs all ascends to the eyes to form vision. Enveloping the essence of sinews, bones, blood, and Qi along with the vessels, they merge into the Eye System (Muxi), ascending to connect with the Brain, and exiting posteriorly at the neck. Thus, when pathogenic factors strike the neck, coinciding with bodily deficiency, if the invasion is deep, it follows the Eye System into the Brain. Once in the Brain, it causes cerebral rotation. Cerebral rotation pulls the Eye System taut. Tension in the Eye System leads to visual blurring and rotation. The term "pathogenic factors" generally encompasses external and internal pathogens such as Wind, Cold, Damp, and Heat. Why then is it attributed to the Liver and Gallbladder? Because the essence of the Zang and Fu organs ascends to the eyes via the sinews and vessels. The Liver governs the sinews. If the Liver has Wind-Fire, the sinews become diseased, and the ascending essence stagnates. The Eye System, affected by Wind-Fire, becomes dry. Dryness causes contraction and tension, leading to vertigo. This is one explanation. Additionally, the Gallbladder meridian starts at Tongziliao (GB15) and ends at the Foot-Jueyin meridian; thus, Wind-Fire in the Gallbladder meridian also causes tremors and vertigo. Hence, the Classics state: All Wind syndromes, tremors, and vertigo belong to Wood. Furthermore, Taiyang (Greater Yang) Qi marks the vertex and connects to the Brain. The Bladder meridian acupoints start from Jingming (BL1) and travel externally down the leg. Excessive Cold-Water Qi can oppress the True Fire, also causing vertigo and collapse. Another case involves "branching fluid retention" (Zhi Yin) below the heart, causing mental cloudiness and vertigo; this is due to Heart Fire being blocked from descending and rushing upward to the head and eyes. Another case involves Wind-Cold battling; dizziness occurs immediately after eating. This is due to internal damp-fluid retention constraining the weak Yang Qi, which combines with constrained Heat to rush upward to the head and eyes, causing vertigo. Jingming (BL1) belongs to the Yangming meridian. (Qian notes: Jingming actually belongs to the Taiyang meridian; since the text states it belongs to Yangming, this annotation is added for verification.) Additionally, the branch of the Yangming meridian enters the inner canthus, causing vertigo. Another case involves insufficient Kidney Yin, allowing the flames of the Three Yang meridians to dazzle the vision. (Patients with Yin deficiency often feel dizzy, suddenly seeing flashes like firecrackers in their eyes; there is likely phlegm in the chest and diaphragm. During attacks, eyes cannot be opened; if opened, objects appear inverted or slanted.) Under the decline of Middle Earth (Spleen), rebellious light presses upward to the vertex. (Vertigo caused by Spleen deficiency makes patients unable to rise, accompanied by nausea, vomiting, and five-palm heat.) These seem unrelated to the Liver and Gallbladder meridians. However, although the origins differ, the final manifestation inevitably travels through specific pathways and appears at the extremity. Thus, it can still be said that they all belong to Wood. (Regarding these two symptoms, acid regurgitation and vertigo, Siming analyzed them in detail but did not provide prescriptions. One must refer to the treatment methods of Danxi, Sunan, Lizai, and Jingyue.)