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Various Theories on the Etiology, Syndrome, and Treatment of Zaot (Clammy Hunger):

The sensation of clammy hunger in the chest and heart region is commonly seen in women. The primary cause of this disease is mostly Phlegm (Tan, phlegmatic pathogen), which transforms from blood, tears, and sweat. Some say it is "Blood Zaot," and nowadays people often use pig residual blood, stir-fried and eaten, to cure it. Analyzing the rationale behind this, it is a matter of using blood to guide blood back to its origin, similar to the principle of using salt to suppress saliva secretion. It would be better to use Xu Xueshi's Xuanfu Hua Tang (Inula Flower Decoction) to treat Phlegm-cold Qi in the epigastrium, manifesting as a wave-like sensation of Zaot in the heart area, frequent bowel sounds with excessive salivation, spontaneous flow of clear fluid from the mouth, and distending pain in the hypochondrium with loss of appetite. This is caused by deficiency-cold of Stomach Qi, with a pulse that is deep, slow, wiry, and fine; this is the pulse manifestation of this syndrome. (From *Furen Liangfang*) [Note: Xuanfu Hua Tang is the Banxia Fuling Tang formula from *Duanju Fang*, see the chapter on Water-Fluid Retention.]

Zaot is caused by Phlegm stirred by Fire; treatment should prioritize resolving Phlegm. Use Jiang-chao Huanglian (Ginger-fried Coptis Rhizome) added to Phlegm-resolving herbs, with Chao Shanzhi (Stir-fried Gardenia Fruit) and Huangqin (Scutellaria Root) as the sovereign drugs, Nanxing (Arisaema Rhizome), Banxia (Pinellia Tuber), and Chenpi (Tangerine Peel) as ministering drugs. If heat signs are severe, add Qingdai (Indigo Naturalis). (From *Danxi Xinfa*)

Zaot results from food stagnation transforming into heat; Chao Zhizi (Stir-fried Gardenia Fruit) and Jiang-chao Huanglian (Ginger-fried Coptis Rhizome) are indispensable. (From *Danxi Xinfa*)

Zaot refers to a sensation in the heart resembling hunger, accompanied by vexation and discomfort, leading to reluctance to eat, termed "Heart Zaot." This is caused by Phlegm stirred by Fire, or dampness stagnation due to excessive alcohol consumption, or internal Phlegm-heat in obese individuals. (From *Yuanbing Ji*)

Regarding the syndrome of Zaot [Note: *Yitong* adds here: suddenly feeling heat like fire in the abdomen, the chest cavity feels empty as if containing nothing, slightly spicy but not quite], it feels like hunger but is not hunger, feels like pain but is not pain, and presents with a state of restlessness and inability to settle [ *Yitong* notes here: temporarily relieved after eating]. This is the syndrome. Symptoms may include belching, or fullness and obstruction, or nausea, gradually progressing to epigastric pain [ *Yitong* notes here: developing into Ge Ye (dysphagia/chest obstruction)]. This is actually a disorder caused by Phlegm-Fire. (From *Yixue Zhengchuan*)

The etiology of Zaot lies in unregulated diet, or consuming foods such as wine, noodles, roasted items, and sticky, slippery, hard-to-digest substances, which stagnate in the Middle Jiao (Spleen and Stomach), damaging the Spleen and Stomach [Note: *Yitong* records as indulging in wet noodles, fish, raw/cold foods, and strongly flavored cooked dishes, causing morning injury and evening damage, forming thin Phlegm and thick fluid retention in the Middle Jiao]. If left untreated for a long time, it gradually develops into Pi Man (fullness and obstruction) and Tun Suan (acid regurgitation), and in severe cases, leads to Ge Ye (dysphagia) or Fan Wei (vomiting/regurgitation). Patients suffering from this disease must not take it lightly; early treatment is required, along with dietary restrictions and moderation of desires, to ensure recovery. (From *Tongzhi*)

This syndrome includes Huo Cao (Fire Zaot), Tan Cao (Phlegm Zaot), and Zaot caused by acid water soaking the heart. Generally, feeling hungry immediately after eating, or feeling unsated despite eating, indicates Huo Cao, requiring simultaneous clearing of Fire. Phlegm abundance with Qi stagnation, feeling like hunger but not really hungry, and aversion to food, indicates Tan Cao, requiring simultaneous resolution of Phlegm. Zaot caused by acid water soaking the heart, characterized by a sorrowful feeling, abdominal distension, low appetite, and lack of taste, is due to deficiency-cold of Spleen Qi and failure to transform food and water, requiring warming of the Stomach and strengthening of the Spleen. Additionally, improper use of draining and reducing medicines can lead to Spleen-Stomach deficiency, blood deficiency causing Zaot. Deficiency in the Middle causes vexation and lack of hunger; weakness of the Spleen causes failure to transport and transform food; this requires specialized nourishment of the Spleen and Stomach. In summary, Zaot is mostly caused by disharmony of Spleen Qi or deficiency of the Spleen due to injury. Therefore, treating this condition requires prioritizing the protection of Spleen Qi. However, ancient physicians treated this primarily through the lens of Phlegm-Fire. I fear that exclusive use of cold and cooling herbs will worsen those with deficient-cold Stomach Qi, gradually leading to nausea, belching, Fan Wei, and Ge Ye. (From *Jingyue Quanshu*)

Zaot belongs to Stomach Fire; it must not be confused with Excess Syndrome of the Stomach. Treatment should focus on clearing heat and descending fire, with slight addition of digestive-promoting methods. (From *Bencao Jing Shu*)

Treatment Formulas:

Hezhong Tang (Harmonize the Middle Decoction), treats deficiency-fire Zaot. (*Yitong*) [Note: This is Liu Junzi Tang (Six Gentlemen Decoction) plus Huanglian (Coptis Rhizome) and Jingsmi (Rice Grain).]

Sansheng Wan (Three Sages Pill), highly effective for Zaot.
Baizhu (Stir-fried, 4 liang), Huanglian (Stir-fried, 5 qian), Juhong (1 liang).
Grind into fine powder, make pills with Shenqu paste, size of mung beans. Take 50 pills per dose, down with Ginger decoction. (Same source) Also, Shulian Wan removes Juhong from this formula.

Xianglian Wan (Coptis and Costus Pill), treats Zaot due to Fire depression, especially suitable for thin individuals. (Same source) [Formula see chapter on Dysentery/Zhili.]

Jiaotai Wan (Interlocking Harmony Pill), treats chest oppression and Zaot. Bowel movements being loose brings relief to the chest; hard stools cause unbearable chest oppression and loss of appetite.
Huanglian (2 liang, soaked in Ginger juice, stir-fried with Loess soil), Zhishi (1 liang, bran-stir-fried), Baizhu (de-rhizome, earth-stir-fried, 3 liang), Wuzhuyu (soaked in water, slightly stir-fried, 2 liang).
Dangguiwei (wine-washed, 1.2 liang), Dahuang (4 liang: soak in water boiled from Danggui, Honghua, Wuzhuyu, and Ganqi each 1 liang for one day and night, cut, dry, still mix with wine and sun-dry, nine steams and nine sun-dries).
Grind into fine powder, make pills with Ginger juice and Shenqu paste, size of mung beans. Take 70-80 pills per dose, at any time, down with plain boiling water. (From *Huichun*)

Jiawei Xiaoxiongtang (Modified Minor Chest-Harmonizing Decoction), (Secret Formula) treats Zaot caused by Fire stirring Phlegm.
Huanglian (Stir-fried, 3 qian), Banxia (2 qian), Gualou (half fruit), Zhishi (1 qian), Zhizi (1 qian) (From *Dahuan*).

Danggui Buxue Tang (Angelica Tonifying Blood Decoction), treats Zaot due to blood deficiency in the Heart, and also treats Jingji (palpitations) and Zhengchong (frequent palpitations/panic).
Danggui, Shaoyao, Shengdihuang, Shudihuang (each 3 qian), Renshen (5 fen), Baizhu (de-rhizome), Fuling (peeled), Maidong (de-heart), Zhiren (Stir-fried), Chenpi (each 8 fen), Gancao (2 fen), ChenSha (ground powder, add 2 fen before taking), Wumei (one, pitted), Chaomi (100 grains).
Cut into pieces for one dose, add two Jujubes, decoct in water, take warm. (From *Huichun*)