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The syndrome of Zaocao (a sensation of hunger mixed with discomfort in the epigastrium) may come and go. Its pathological manifestation is characterized by an empty feeling in the abdomen, as if nothing were there; it resembles hunger but is not true hunger, resembles spiciness but is not true spiciness, resembles pain but is not true pain, accompanied by a sense of stifling distress in the chest and diaphragm that is indescribable. In some cases, eating provides temporary relief; in others, the sensation returns after eating; some are accompanied by nausea, gradually leading to pain in the epigastric region. This syndrome includes Huo Cao (Zaocao caused by fire), Tan Cao (Zaocao caused by phlegm), and Zaocao caused by acid water flooding the heart. Generally speaking, if one feels hungry immediately after eating, or feels unsatisfied despite having eaten, it is Huo Cao, and treatment should include clearing fire. If there is excessive phlegm and qi stagnation, resembling hunger but without appetite, it is Tan Cao, and treatment should include resolving phlegm. When acid water floods the heart causing Zaocao, accompanied by melancholy, abdominal distension, reduced food intake, and loss of taste, this is due to deficiency-cold of Spleen Qi and failure to transform food and fluids; treatment should warm the Stomach and strengthen the Spleen. Furthermore, misuse of digestive and purgative medicines may damage the Spleen and Stomach, leading to blood deficiency and Zaocao; middle-jiao deficiency causes vexation and lack of hunger, while Spleen weakness leads to poor transformation and transportation of food; such cases require nourishing the Spleen and Stomach exclusively. In summary, the syndrome of Zaocao mostly arises from disharmony of Spleen Qi or injury leading to Spleen deficiency; therefore, treating this condition requires prioritizing the protection of Spleen Qi. However, ancient physicians treated all such cases based on phlegm-fire theory. I fear that exclusive use of cold and cooling herbs will worsen the deficiency-cold of Stomach Qi in those with weak Stomach function, potentially leading to symptoms such as nausea, belching, Fanwei (regurgitation/vomiting), and Yige (dysphagia/obstruction of the esophagus).

1. For syndromes of Zaocao caused by phlegm-fire: If the cause is Spleen deficiency with slight fire and excessive phlegm, Zhonghe Tang (Harmonize the Middle Decoction), San Sheng Wan (Three Sages Pill), or Shu Lian Wan (Atractylodes and Coptis Pill) are appropriate. If there is excessive fire in the Middle Jiao combined with phlegm, Ruan Shigao Wan (Soft Gypsum Pill) is indicated. If retained food and fluid accumulation lead to unclear phlegm obstruction causing Zaocao, Qu Zhi Wan (Malt and Atractylodes Pill) is suitable. If excessive fire in the Three Jiao combined with damp-phlegm and qi stagnation causes Zaocao, San Bu Wan (Three Tonification Pill) added with Banxia (Pinellia Rhizome), Cangzhu (Atractylodis Rhizoma), and Xiangfu (Cyperus Rhizome) is recommended.
2. For Zaocao caused by Spleen-Stomach deficiency-cold: There is often acid regurgitation, possibly accompanied by nausea. This results from Spleen deficiency failing to transform turbid stagnation; do not mistake it for a fire syndrome and recklessly use cold-cooling herbs. If there is excessive phlegm-fluid retention or vomiting and disgust accompanying Zaocao, Er Chen Tang (Two-Cured Decoction) or Er Zhu Er Chen Tang (Two-Atractylodes and Two-Cured Decoction) are appropriate. If cold-phlegm accumulates in the chest and diaphragm, causing distension, poor appetite, and Zaocao, Hewei Erchen Jian (Stomach-Harmonizing Two-Cured Decoction) or Hewei Yin (Stomach-Harmonizing Infusion) are indicated. If Spleen-Stomach deficiency-cold with retained fluid transforming into acid causes Zaocao, Wenwei Yin (Warm the Stomach Infusion) or Liu Junzi Tang (Six Gentlemen Decoction) are suitable. If deficiency-cold of the Yin aspect of Spleen and Kidney leads to water overflowing as fluid retention, transforming into acid and causing Zaocao, Liyin Jian (Regulate Yin Decoction) or Jinshui Liu Jun Jian (Metal-Water Six Gentlemen Decoction) are recommended.