论
《内经》曰∶诸呕吐酸，皆属于热。惟李东垣独以为寒，诚一偏之见也。河间原病式曰∶酸者肝木之味也，由火盛
制金，不能平木，则肝木自甚，故为酸也。如饮食热，则易于酸矣，是以肝热则口酸也。或言为寒者，但谓伤生冷硬物，
而喜噫醋吞酸，故俗医主于温和脾胃。岂知人之伤于寒也，则为病热，盖寒伤皮毛，则腠理闭密，阳气怫郁而为热证。
故伤寒热在表，而以麻黄汤热药发散，使腠理开通，汗泄热退而愈也。凡内伤冷物者，或但阴胜阳而为病寒，或寒热相
搏怫郁而为病热，亦有内伤冷物而反病热，得汗泄热退身凉而病愈也。或微而止为中酸，俗谓之醋心，法宜温药散之，
亦犹伤寒解表之义。若久吞酸不已，则不宜温，宜以寒药治之，后以凉药调之，结散热去则气和矣。所以中酸不宜食粘
滑油腻者，谓能令气郁不通畅，如食物在器复盖，热而自酸。宜 食菜蔬，能令气之通利也。曰寒曰热，于斯明矣，
学人详之。
脉法
脉弦而滑。两寸或浮而弦，或浮而滑，或沉而迟，或紧而洪，或洪而数，或沉而迟。胸中有寒饮洪数者，痰热在膈
间。时吐酸水，欲成胃反也。
方法
茱连丸
吴茱萸（去梗泡浸半日） 陈皮（去白） 黄芩（陈壁土炒，各五钱） 黄连（土炒，一钱） 苍术（米泔浸，七
钱半）
上为细末，神曲糊丸，如绿豆大，每服二、三十丸，津唾咽下。一方茱萸、连二味，随时令寒热，迭为佐使（寒月
倍茱萸，热月根据本方），苍术茯苓为补助，汤浸蒸饼为小丸，吞之。
治酸必用茱萸，顺其性而折之。
食郁有痰，二陈汤加南星、黄芩之类。
加味平胃散，治吞酸因食郁所致，生料平胃散加炒神曲、炒麦芽、姜、枣同煎。
酸味宜节浓味，必蔬食自养，则病易安。
吐清水，用苍术（陈壁土炒） 茯苓 滑石（炒） 白术 陈皮 煎服。
参萸丸 上可治吞酸，下可治自利。又云∶治湿而气滞者，湿热甚者用之为响导。
六一散（一料） 吴茱萸（一两，制）
上为饭丸服。
（以上丹溪方法凡七条）
藿香安胃散（东垣） 治脾胃虚弱，饮食入胃，呕吐作酸，不待腐熟。
藿香 丁香 人参（各二钱五分） 陈皮（五钱）
上为细末，每服二钱，加生姜，水煎温服。
加减二陈汤（丹溪） 治痰饮为患，呕吐头眩心悸，或因食生冷硬物，脾胃不和，时吐酸水。
丁香（五分） 半夏 陈皮（各二钱五分） 茯苓（一钱五分） 甘草（七分半）
上细切，作一服，加生姜三片，水煎服。
曲术丸（三因） 治中脘宿食留饮，酸蜇心痛，吐清水。
神曲（炒，三两） 苍术（米泔浸，一两半） 砂仁（一两） 陈皮（去白，一两）
上为细末，生姜汁别煮神曲糊为丸，如梧桐子大，每服七十丸，姜汤送下。
（祖传方）
治吞酸方
用黄连吴茱萸各一两，上以黄连细切，同茱萸以井花水浸七日，去连，将茱萸焙干，每日清晨，以米汤下四十九粒。
论
《黄帝内经》说：各种呕吐和泛酸，都属于热证。只有李东垣独自认为是寒证，这确实是一种片面的见解。刘河间在《原病式》中说：酸味是肝木的味道，由于火气过盛克制了肺金，导致不能制约肝木，于是肝木之气亢盛，所以表现为酸味。就像食物受热后容易变酸一样，因此肝热就会导致口中有酸味。有人说这是寒证，只是指因损伤生冷坚硬的食物，而出现喜欢打嗝、泛吐酸水的症状，所以民间医生主张用温和脾胃的方法治疗。哪里知道人受寒邪侵袭，反而会转化为热病，因为寒邪损伤皮毛，使腠理闭塞致密，阳气郁结而化为热证。所以伤寒表热证，使用麻黄汤这样的热性药物来发散，使腠理开通，汗出热退而痊愈。凡是内伤冷食的人，或者只是阴气胜阳气而表现为寒证，或者寒热相互搏结郁滞而表现为热证，也有内伤冷食反而得热病的，通过发汗泄热、身体凉爽而病愈。如果病情轻微而仅表现为中焦泛酸，俗称“醋心”，治法适宜用温药散之，这也如同伤寒解表的道理。如果长期泛酸不止，则不适宜用温法，应当用寒凉药物治疗，随后再用清凉药物调理，待郁结消散、热气去除，气机自然调和。所以中焦泛酸不宜食用粘滑油腻的食物，因为这些食物会导致气机郁滞不通畅，就像食物放在容器中盖上盖子，受热后自然会变酸。适宜吃蔬菜，能使气机通畅流利。说是寒证还是热证，到这里就明白了，学习中医的人要仔细研究。
脉法
脉象弦而滑。两寸脉或浮而弦，或浮而滑，或沉而迟，或紧而洪，或洪而数，或沉而迟。胸中有寒饮且脉象洪数的，是痰热停留在膈间。时常吐出酸水，快要形成胃反（朝食暮吐）的病证了。
方法
茱连丸
吴茱萸（去掉梗，浸泡半天） 陈皮（去掉白色内皮） 黄芩（用陈壁土炒，各五钱） 黄连（用土炒，一钱） 苍术（用米泔水浸泡，七钱半）
以上研成细末，用神曲糊制作药丸，如绿豆大小，每次服用二三十丸，用唾液咽下。另一方案：吴茱萸、黄连这两味药，根据季节的寒热变化，交替作为佐使药（寒冷月份加倍吴茱萸，炎热月份按本方标准），苍术、茯苓作为辅助，用水浸过的蒸饼制成小丸，吞服。
治疗泛酸必须使用吴茱萸，顺应其性质而折伏其逆气。
饮食停滞且有痰湿的，用二陈汤加天南星、黄芩等药。
加味平胃散，治疗因饮食停滞导致的泛酸，在原方生料平胃散基础上加入炒神曲、炒麦芽，与生姜、大枣同煎。
酸味宜节制浓烈口味，必须依靠素食调养，这样病容易痊愈。
吐出清水，用苍术（陈壁土炒）、茯苓、滑石（炒）、白术、陈皮，煎服。
参萸丸：上面可以治疗泛酸，下面可以治疗自利（腹泻）。又说：治疗湿气重而气机阻滞的，湿热严重的用它作为向导引导药。
六一散（一料） 吴茱萸（一两，炮制）
以上研末，用饭做成丸剂服用。
（以上是朱丹溪的方法共七条）
藿香安胃散（李东垣方） 治疗脾胃虚弱，饮食进入胃中，呕吐并泛酸，食物未经腐熟即吐出。
藿香 丁香 人参（各二钱五分） 陈皮（五钱）
以上研成细末，每次服用二钱，加生姜，用水煎煮温服。
加减二陈汤（朱丹溪方） 治疗痰饮为患，呕吐、头晕、心悸，或因进食生冷坚硬食物，导致脾胃不和，时常吐出酸水。
丁香（五分） 半夏 陈皮（各二钱五分） 茯苓（一钱五分） 甘草（七分半）
以上切碎，为一服的量，加生姜三片，用水煎服。
曲术丸（《三因极一病证方论》方） 治疗中脘部宿食停留、饮水积留，酸水刺痛心痛，吐出清水。
神曲（炒，三两） 苍术（米泔水浸泡，一两半） 砂仁（一两） 陈皮（去白，一两）
以上研成细末，用生姜汁单独煮神曲糊制作药丸，如梧桐子大小，每次服用七十丸，用姜汤送下。
（祖传方）
治疗泛酸方
使用黄连、吴茱萸各一两，将黄连切碎，与吴茱萸一起用井花水浸泡七天，取出黄连，将吴茱萸焙干，每天清晨，用米汤送服四十九粒。
Treatise
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: "All vomiting and acid regurgitation belong to heat." Only Li Dongyuan alone considered it to be cold, which is indeed a one-sided view. Liu Wansu in his *Yuanbing Shi* (Treatise on the Original Causes of Diseases) said: "The sour taste belongs to Liver Wood. It arises because excessive Fire controls Lung Metal, preventing it from subduing Liver Wood; thus, Liver Wood becomes hyperactive, resulting in the sour taste. Just as food becomes sour easily when heated, so does Liver Heat cause sourness in the mouth." Some say it is due to cold, referring only to cases where damage from raw, cold, or hard foods leads to a preference for belching and acid regurgitation; hence, folk physicians advocate warming the Spleen and Stomach. How could they know that when humans are injured by Cold pathogens, the disease transforms into heat? This is because Cold damages the skin and hair pores, causing the interstices (*Couli*) to close tightly, leading to the stagnation of Yang Qi and the manifestation of heat syndromes. Therefore, in exterior heat syndromes of Shanghan (Cold Damage), hot-natured formulas like Mahuang Tang (Ephedra Decoction) are used to disperse the pathogen, opening the interstices, inducing sweating to release heat, and thereby achieving cure. In cases of internal injury from cold food, the condition may manifest as cold due to Yin excess overcoming Yang, or as heat due to the struggle and stagnation between Cold and Heat. There are also cases where internal injury from cold food results in heat syndrome, which resolves through sweating, heat release, cooling of the body, and recovery. If the condition is mild and limited to middle-jiao acid regurgitation, commonly called "vinegar heart," the treatment should employ warm herbs to dissipate the stagnation, similar to the principle of releasing the exterior in Shanghan. However, if acid regurgitation persists for a long time, warm methods are inappropriate; instead, cold-natured herbs should be used for treatment, followed by cooling herbs for regulation. Once the stagnation dissipates and heat clears, the Qi will harmonize. Therefore, those with middle-jiao acid regurgitation should avoid sticky, slippery, and greasy foods, as these can cause Qi stagnation and obstruction, much like food covered in a container becoming sour due to trapped heat. It is advisable to consume vegetables, which promote the free flow of Qi. Thus, whether it is cold or heat is clarified here; students of medicine should study this carefully.
Pulse Diagnosis
The pulse is wiry (*Xian*) and slippery (*Hua*). The pulses at both Cun positions may be floating and wiry, or floating and slippery, or deep and slow, or tight and surging, or surging and rapid, or deep and slow. If the chest contains cold fluid retention and the pulse is surging and rapid, it indicates phlegm-heat lodged between the diaphragm. Frequent spitting of sour water suggests the impending formation of Wei Fan (Gastric Regurgitation).
Methods
Zhulian Wan (Evodia and Coptis Pill)
Wuzhuyu (Evodiae Fructus, remove stems, soak for half a day) Chenpi (Citri Reticulatae Pericarpium, remove white pith) Huangqin (Scutellariae Radix, stir-fried with aged wall soil, 5 qian each) Huanglian (Coptidis Rhizoma, stir-fried with earth, 1 qian) Cangzhu (Atractylodis Rhizoma, soaked in rice wash water, 7.5 qian)
Grind all ingredients into fine powder. Use Shenqu (Massae Fermentatae Medicatae paste) to make pills the size of mung beans. Take 20–30 pills per dose, swallowing with saliva. Another prescription: Use only Evodia and Coptis, adjusting their roles as assistant and guide according to seasonal cold or heat (double the Evodia in cold months, follow the standard formula in hot months). Add Cangzhu (Atractylodis Rhizoma) and Fuling (Poria) as supplements. Make small pills using steamed bread dough soaked in water, and swallow.
To treat acid regurgitation, Evodia must be used to follow its nature and subdue its rebellious Qi.
For food stagnation with phlegm, use Erchen Tang (Two-Aged Decoction) plus Tian Nanxing (Arisaematis Rhizoma) and Huangqin (Scutellariae Radix).
Jiawei Pingwei San (Modified Pingwei Powder) treats acid regurgitation caused by food stagnation. Add Chao Shenqu (Stir-fried Massae Fermentatae Medicatae) and Chao Maiya (Stir-fried Hordei Fructus Germinatus) to Shengliao Pingwei San (Raw Ingredient Pingwei Powder), decoct together with Shengjiang (Zingiberis Rhizoma Recens) and Zao (Jujubae Fructus).
Limit strong flavors associated with sourness; rely on a vegetable-based diet for self-care, and the illness will heal easily.
For vomiting clear fluid, use Cangzhu (Atractylodis Rhizoma, stir-fried with aged wall soil), Fuling (Poria), Huashi (Talcum, stir-fried), Baizhu (Atractylodis Macrocephalae Rhizoma), and Chenpi (Citri Reticulatae Pericarpium); decoct and take orally.
Shenyu Wan (Ginseng and Evodia Pill): Treats acid regurgitation above and spontaneous diarrhea below. It is also stated to treat dampness with Qi stagnation; for severe damp-heat, it serves as a guiding agent.
Liuyi San (Six-to-One Powder, one portion) + Wuzhuyu (Evodiae Fructus, 1 liang, processed)
Grind into powder and form pills with rice paste. Take orally.
(Above are seven methods from Zhu Danxi.)
Huoxiang Anwei San (Agastache Stomach-Anchoring Powder, by Li Dongyuan) treats Spleen and Stomach deficiency weakness, where food enters the Stomach but vomits with acid regurgitation before proper digestion.
Huoxiang (Agastaches Herba) Dingxiang (Syzygii Flos) Renshen (Ginseng Radix et Rhizoma, 2.5 qian each) Chenpi (Citri Reticulatae Pericarpium, 5 qian)
Grind into fine powder. Take 2 qian per dose, add Shengjiang (Zingiberis Rhizoma Recens), decoct with water, and take warm.
Jiajian Erchen Tang (Modified Two-Aged Decoction, by Zhu Danxi) treats disorders caused by phlegm-fluid retention, including vomiting, dizziness, palpitations, or frequent acid regurgitation due to eating raw, cold, or hard foods causing Spleen-Stomach disharmony.
Dingxiang (Syzygii Flos, 5 fen) Banxia (Pinelliae Rhizoma) Chenpi (Citri Reticulatae Pericarpium, 2.5 qian each) Fuling (Poria, 1.5 qian) Gancao (Glycyrrhizae Radix et Rhizoma, 0.75 qian)
Cut finely for one dose. Add three slices of Shengjiang (Zingiberis Rhizoma Recens), decoct with water, and take orally.
Quzhu Wan (Curcumae and Atractylodes Pill, from *Sanyin Fang*) treats retained food and fluid in the Zhongwan region, sour stinging pain in the heart, and vomiting of clear fluid.
Shenqu (Massae Fermentatae Medicatae, stir-fried, 3 liang) Cangzhu (Atractylodis Rhizoma, soaked in rice wash water, 1.5 liang) Sharen (Amomi Fructus, 1 liang) Chenpi (Citri Reticulatae Pericarpium, peeled, 1 liang)
Grind into fine powder. Cook Shenqu separately in Shengjiang juice (Zingiberis Rhizoma Recens juice) to make a paste for pill-making. Form pills the size of paulownia seeds. Take 70 pills per dose, sending down with ginger soup.
(Ancestral prescription)
Prescription for Treating Acid Regurgitation
Use Huanglian (Coptidis Rhizoma) and Wuzhuyu (Evodiae Fructus), each 1 liang. Cut Huanglian finely, soak together with Wuzhuyu in well water for seven days. Remove the Huanglian, dry the Wuzhuyu by baking. Every morning, take 49 pills with rice gruel.