胃脉浮数者，消谷；肺脉滑数者，消渴。大率数大者生，细微者死；沉小者生，牢实者死。（《证治汇补》）
选案
山左周公，年逾四旬，因案牍积劳致疾，神困食减，时多恐惧，通宵不寐，半年有余，上焦无渴，不嗜汤
水，或有少饮，则沃然不行，然每夜必去溺二、三升，莫知其所从来，且半皆如膏浊， 羸至极。诊脉犹缓，
肌肉未脱。知其胃气尚存，乃定归脾汤去木香，及大补丸煎之属，一以养阳，一以养阴，出入间服，至三
百余剂，计用人参二十斤，乃得全愈。此神消于上、精消于下之
证也。可见消有阴阳，不得尽言为火，姑记此案为鉴。（张景岳）
朱麟生，病消渴，后渴少止，反加躁急，足膝痿弱。予用白茯苓丸加犀角。医曰∶肾病而以犀角、黄连治
心，毋乃倒乎？予曰∶肾者胃之关，胃热下传于肾，则关门大开，心之阳火，得以直降于肾。《经》云∶阳精
所降，其人夭。今病者心火烁肾，燥不能濡，用犀角、黄连入肾，对治其下降之阳光，岂为倒乎？服之果效，
再更地黄汤加犀角，肌泽而起。（喻嘉言）
证治总论
嘈杂一证，或作或止，其为病也，腹中空空，若无一物，似饥非饥，似辣非辣，似痛非痛，胸膈懊 ，莫
可名状。或得食暂止，或食已复嘈，或兼恶心，而渐见胃脘作痛。此证有火嘈，有痰嘈，有酸水浸心而嘈。大
抵食已即饥，或虽食不饱者，火嘈也，治宜清火。痰多气滞，似饥非饥，不喜食者，痰嘈也，宜兼化痰。酸水
浸心而嘈者，戚戚膨膨，食少无味，此脾气虚寒，水谷不化也，治宜温胃健脾。又有误用消伐等药，脾胃亏
损，血少嘈杂者，中虚则烦杂不饥，脾弱则食不运化，此宜专养脾胃。（张景岳）
有因恣食无节，蓄积痰饮，滞于中宫，而为嘈杂者，属于痰也。有因病后，每于夜分，心嘈如饥，殊难
容忍者，此阴虚血少，或阳气下陷，阴火沸腾，属于气血虚而有火也。（《证治汇补》）
五更嘈者，乃思虑伤血所致。（朱丹溪）
嘈有虚实真伪，其病总在于胃。《经》云∶饮入于胃，游溢精气，上输于脾。又云∶脾与胃，以膜相连
耳，而能为之行其津液。盖脾属阴，主乎血；胃属阳，主乎气。胃易燥，全赖脾阴以
和之；脾易湿，必赖胃阳以运之。若脾阴一虚，则胃家饮食游溢之精气，全输于脾，不能稍留津液以自润，
则胃过于燥而有火矣。故欲得食以自资，稍迟则嘈愈甚，得食则嘈暂止。失治则延成便闭、三消、噎隔等证。治
当补脾阴，养营血，兼补胃阴，甘凉濡润，或稍佐微酸，此乃脾阴之虚，而致胃家之燥也。更有热病之后，胃
气虽渐复，津液尚未充，亦有是证，但以饮食调之，可以自愈。此二种，乃为虚嘈证也。所谓实嘈者，年岁壮
盛，脾胃生发之气，与肾阳充旺，食易消磨，多食易饥而嘈，得食即止，此非病也，不必服药。以上皆是真嘈
证也。所云伪者，因胃有痰火，以致饮食输化不清，证见恶心、吞酸、微烦、眩晕、少寐、似饥非饥，虽饱食
亦不能止，此乃痰火为患；治宜清胃，稍佐降痰，苦寒腻滞之药，不宜多用。又有胃阳衰微，积饮内聚，凄凄
戚戚，似酸非酸，似辣非辣，饮食减少，此属脾胃阳虚；治宜温通，仿痰饮门治之。此二种，乃似嘈之伪证也。
俗云心嘈者，误也；心但有烦而无嘈，胃但有嘈而无烦，不可不辨明也。（《临证指南》）
脉候
嘈杂∶有痰因火动者，脉滑而数；有食郁作热者，脉数而大；有因湿痰者，脉沉而滑；有因气郁者，脉沉
而涩。（《证治汇补》）
[Pulse and Pathogenesis]
When the stomach pulse is floating and rapid (Shu), it indicates excessive hunger and digestion (Xiaogu); when the lung pulse is slippery and rapid (Shu), it indicates Xiao Ke (Wasting-Thirst). Generally, a rapid and large pulse indicates a favorable prognosis (life), while a fine and minute pulse indicates an unfavorable prognosis (death); a deep and small pulse indicates a favorable prognosis (life), while a firm and solid pulse indicates an unfavorable prognosis (death). (From *Zhengzhi Huibu*)
[Selected Medical Cases]
Official Zhou from Shandong, over forty years old, fell ill due to long-term fatigue from desk work. He suffered from mental exhaustion, reduced appetite, frequent fear, and insomnia throughout the night for more than half a year. There was no thirst in the upper jiao, and he had no desire for soups or water; even if he drank a little, he felt stagnation. However, he urinated two to three sheng every night, the source of which was unknown, and half of it was turbid like paste. His body became extremely emaciated and weak. Upon examination, his pulse was still moderate, and his muscles had not wasted away. Knowing that his Stomach Qi was still present, he was prescribed Guipi Tang (Spleen-Restoring Decoction) with Xiangmu removed, along with Dabu Wan (Great Tonifying Pill) decoctions. One formula nourishes Yang, the other nourishes Yin. They were taken alternately. After more than three hundred doses, using a total of twenty jin of Renshen (Ginseng), he made a full recovery. This is a case of Shen (Spirit) wasting upwards and Jing (Essence) wasting downwards. It can be seen that Xiao disorders have Yin and Yang distinctions and cannot all be attributed to Fire. This case is recorded as a reference. (Zhang Jingyue)
Zhu Linsheng suffered from Xiao Ke (Wasting-Thirst). Later, his thirst subsided slightly, but irritability and urgency increased, accompanied by flaccidity and weakness of the feet and knees. I used Baifuling Wan (White Poria Pill) added with Xijiao (Rhinoceros Horn). A physician asked, "Treating the Kidney disease with Xijiao and Huanglian (Coptis Rhizome) to treat the Heart—is this not inverted?" I replied, "The Kidney is the gate of the Stomach. When Stomach Heat transmits downward to the Kidney, the gate opens wide, allowing the Heart's Yang Fire to descend directly into the Kidney. The *Jing* (Classic) states: 'Where Yang essence descends, people may die prematurely.' Now, the patient's Heart Fire scorches the Kidney, causing dryness and inability to moisten. Using Xijiao and Huanglian entering the Kidney to counteract the descending solar fire (excessive heat)—how could this be considered inverted?" The medication proved effective. Subsequently, Dihuang Tang (Rehmannia Decoction) with Xijiao was used, resulting in lustrous skin and recovery. (Yu Jiayan)
[General Discussion on Zaotao Syndrome]
The syndrome of Zaotao (Hunger-like discomfort/irritability) comes and goes. Its pathological sensation is characterized by an empty feeling in the abdomen, as if nothing is there; it feels like hunger but is not hunger, like burning but is not burning, like pain but is not pain. There is a sense of restlessness and discomfort in the chest and diaphragm that is indescribable. In some cases, eating temporarily relieves it; in others, it returns after eating; some are accompanied by nausea, gradually leading to epigastric pain. This syndrome includes Huo Cao (Fire-type Zaotao), Tan Cao (Phlegm-type Zaotao), and Zaotao caused by acid water soaking the heart. Generally, feeling hungry immediately after eating, or feeling unsatisfied despite eating, belongs to Huo Cao (Fire-type), and treatment should focus on clearing Fire. Phlegm accumulation with Qi stagnation, feeling like hunger but not hunger, and lack of appetite belong to Tan Cao (Phlegm-type), and treatment should include resolving Phlegm. Zaotao caused by acid water soaking the heart, accompanied by a sense of unease and abdominal distension, low food intake, and lack of taste, is due to Spleen Qi deficiency and Cold, with failure to transform food and fluids; treatment should warm the Stomach and strengthen the Spleen. Additionally, misuse of purgative or draining medicines can damage the Spleen and Stomach, leading to blood deficiency and Zaotao. Middle Jiao deficiency causes irritability and lack of hunger; Spleen weakness leads to poor food transformation. In such cases, one should specifically nourish the Spleen and Stomach. (Zhang Jingyue)
Some cases arise from unregulated diet, leading to accumulated Phlegm-Fluids obstructing the Middle Jiao (Spleen and Stomach), causing Zaotao; this belongs to Phlegm. Some cases occur post-illness, where at midnight, the heart feels irritable like hunger, which is particularly intolerable; this is due to Yin deficiency and Blood deficiency, or sinking of Yang Qi with boiling Yin Fire, belonging to Qi and Blood deficiency with Fire. (*Zhengzhi Huibu*)
Zaotao occurring at the fifth watch (3-5 AM) is caused by excessive worry damaging Blood. (Zhu Danxi)
Zaotao has true/false and excess/deficiency distinctions, but its pathology always resides in the Stomach. The *Jing* (Classic) states: "Food enters the Stomach, its refined essence floats and overflows, and is transported upward to the Spleen." It also says: "The Spleen and Stomach are connected by membranes and assist each other in transporting fluids." Generally, the Spleen belongs to Yin and governs Blood; the Stomach belongs to Yang and governs Qi. The Stomach tends toward dryness and relies entirely on Spleen Yin to harmonize it; the Spleen tends toward dampness and relies on Stomach Yang to transport it. If Spleen Yin becomes deficient, the refined essence from food in the Stomach is fully transported to the Spleen, unable to retain any fluids for self-moistening. This leads to excessive dryness and Fire in the Stomach. Therefore, the patient desires food to sustain themselves; if delayed, Zaotao worsens; after eating, Zaotao temporarily stops. If untreated, it may progress to constipation, San Xiao (Three Wastes), or Ye Ge (Swallowing Obstruction). Treatment should tonify Spleen Yin, nourish Ying (Nutrient) Blood, and simultaneously tonify Stomach Yin, using sweet-cool and moistening methods, perhaps slightly supplemented with sour flavors. This is Spleen Yin deficiency leading to Stomach dryness. Furthermore, after febrile diseases, although Stomach Qi gradually recovers, fluids may not yet be sufficient, presenting similar symptoms; these can resolve with dietary regulation. These two types are Deficient Zaotao syndromes. True Excess Zaotao occurs in vigorous individuals whose Spleen-Stomach generating Qi and Kidney Yang are robust. Food digests easily, leading to frequent hunger and Zaotao, which stops upon eating. This is not a disease and requires no medication. All the above are True Zaotao syndromes. False Zaotao is caused by Phlegm-Fire in the Stomach, leading to unclear transformation of food and fluids. Symptoms include nausea, acid regurgitation, slight irritability, dizziness, insomnia, and a feeling of hunger without actual hunger, which does not stop even after full meals. This is caused by Phlegm-Fire; treatment should clear the Stomach and slightly assist in descending Phlegm. Bitter-cold and cloying drugs should not be used excessively. Another type involves declining Stomach Yang with internal accumulation of fluids, causing a chilly and uneasy feeling, neither sour nor spicy, with reduced food intake. This belongs to Spleen-Stomach Yang deficiency; treatment should warm and unblock, following the methods for Phlegm-Fluids. These two types are False Zaotao syndromes resembling Zaotao. The common saying of "Heart Zaotao" is incorrect; the Heart only experiences Fan (Irritability) but not Zaotao, while the Stomach experiences Zaotao but not Fan. This distinction must be clarified. (*Linzheng Zhinan*)
[Pulse Diagnosis]
Zaotao: When caused by Phlegm moving with Fire, the pulse is slippery and rapid; when caused by Food stagnation generating Heat, the pulse is rapid and large; when caused by Damp-Phlegm, the pulse is deep and slippery; when caused by Qi stagnation, the pulse is deep and choppy. (*Zhengzhi Huibu*)