吞酸之病形何如。曰。凡为吞酸。尽属肝木。曲直作酸也。河间主热。东垣主寒。毕竟东垣
是言其因。河间言其化也。盖寒则阳气不舒。气不舒。则郁而为热。热则酸矣。然亦有不因寒而
酸者。尽是木气郁甚。熏蒸湿
土而成也。或吞或吐也。又有饮食太过。胃脘填塞。脾气不运而酸者。是拂郁之极。 湿热蒸变。
如酒缸太甚则酸也。然总是木气所致。若非木气。即寒即热即饱即拂郁亦不酸。以酸为木气也。
曰。胃与肝胆。其分野若何。而能令种种作酸也。曰。少阳与阳明经。相并而行。肝并于胃。故
胃热。则少阳相火。与厥阴之火。皆外相引而熏蒸。至于七情之郁。轻者木气太盛。干犯土位。
重者肾水枯涸。肾水奔逆。载水上浮。荆棘横施。湿土混浊。不由于寒。不由于热。而吞吐皆酸。
此又河间东垣因热因寒之说所不及也。又有一种饮食入胃。即成酸味。此必伤寒久疟。胃阴未复。
水谷入胃。增其湿热而酸者。当以淡味滋养真阳。而后可治也。（东庄云。吞酸一症。东垣作寒
论。河间丹溪作热论。世人因有标本之说分属之。但治酸常得芩连症。姜桂者甚少。岂东垣之法
可废与。缘治初见必用温散。久之寒化为热。未有不从热治也。予特未遇初病者耳。）
眩晕之病形何如。曰。眩晕之病。悉属肝胆两经风火。风火属阳阳主动。故目眩转而头晕也。
譬如火焰得风。则旋转不已。缘手少阳之支者。从耳后出至目锐 。而交于足少阳。足少阳之支
者。从跗上。入大指爪甲。出三毛。而交于足厥阴。经曰。五脏六腑之精气。皆上注于目而为之
精。裹撷筋骨血气之精与脉。并为目系。上属于脑。后出项中。故邪中于项。因逢其身之虚。其
入深。则随目系以入于脑。人于脑。则脑转。脑转
则引目系急。目系急。则目眩而转矣。所谓邪者。总风寒湿热内外之诸邪也。然则何为而属于肝
胆。盖五脏六腑之精气。上注于目。是必循筋脉而才能上注。肝主筋。肝有风火。则筋病。而上
注者。壅而不行。所谓目系者。因风火而燥。燥则收引而急。急则目眩。此一说也。又胆经之脉
。从童子 穴。终足厥阴。故胆经风火。亦致掉眩也。故经曰。诸风掉眩。悉属于木也。又有太
阳之气。标在于巅。又络于脑。又膀胱穴。自睛明出至阴于足外。故寒水之气太过。凌逼真火。
亦眩仆也。又有心下有支饮。其人冒眩。是格心火不行。而上冲头目也。又有风寒相搏。食谷即
眩。是内受湿饮之郁。而不足之微阳。与所郁之热。并而上冲于头目为眩也。睛明穴。属阳明。（
谦按。睛明穴属太阳。此言属阳明。故注以俟考。）又阳明支者。入目内 。故眩也。又有肾阴
不足。三阳之焰。震耀于当前。（阴虚之人。常若眩晕。目中忽见火如星炮。胸膈必有痰。发晕
时眼不可开。开则所见之物。非倒即斜。）中土虚衰下。逆之光。上薄于颠顶。（土虚之发。其眩
仆也不能起。必恶心呕吐。而五心烦热。）此则似乎不关于肝胆两经。不知其始也。各有所因
。其终也。不能不由其所从历之途。而见端于极也。则仍谓之悉属于木可也。（此与吞酸两症。四
明分晰详尽。而俱不立方治。须参丹溪损庵立斋景岳诸法治之。）
吞酸这种病的症状表现是怎样的？回答说：凡是出现吞酸的症状，都归属于肝木。因为五行中“曲直”之性表现为酸味。刘河间主张吞酸由热引起，李东垣主张由寒引起。究竟来说，李东垣说的是病因，刘河间说的是病机转化。因为寒邪会导致阳气不能舒展，气机不舒展，就会郁结而化热，热盛则产生酸味。然而也有不是因寒而致酸的，都是由于木气郁结严重，熏蒸湿土（脾胃）而形成的。或者表现为吞酸，或者表现为吐酸。又有因为饮食过量，导致胃脘部填塞胀满，脾气运化失常而产生酸味的，这是极度拂郁，湿热蒸腾变化所致，就像酒缸发酵过度会变酸一样。但这总是木气所致，如果不是木气作祟，无论是寒、是热、是饱食、还是拂郁，都不会产生酸味，因为酸味属于木气的特性。
问：胃与肝胆的分野关系如何，却能让人产生各种各样的酸味呢？回答说：少阳经与阳明经并行，肝气并入胃中，所以如果胃有热，那么少阳相火与厥阴肝火都会互相牵引而熏蒸。至于七情郁结，轻者则是木气太盛，干犯脾土之位；重者则是肾水枯竭，肾水奔逆，携带水气上浮，如同荆棘横生，使湿土变得混浊。这种情况既不单纯由于寒，也不单纯由于热，但吞吐皆呈酸味。这又是刘河间、李东垣关于因热因寒的说法所涵盖不到的地方。还有一种情况是饮食进入胃中，立刻变成酸味，这必定是因为伤寒或久疟之后，胃阴尚未恢复，水谷进入胃中，增加了湿热而导致变酸，应当用淡味药物滋养真阳，然后才可以治疗。（东庄说：吞酸这一症状，李东垣将其归为寒证论治，刘河间和朱丹溪将其归为热证论治。世人因此有了标本之说，分别归属。但是临床上治疗吞酸常用黄芩、黄连清热者多，用干姜、肉桂温散者很少，难道李东垣的方法可以废弃吗？这是因为治疗初期必须用温散法，时间久了寒邪转化为热邪，没有不从热证来治疗的。我只是没有遇到初病患者罢了。）
眩晕这种病的症状表现是怎样的？回答说：眩晕的病，全部归属于肝胆两经的风火。风火属于阳，阳主动，所以眼睛昏花旋转且头晕。譬如火焰遇到风，就会不停地旋转。因为手少阳经的支脉，从耳后出来到达目外角，并与足少阳经相交；足少阳经的支脉，从足背出来，进入大脚趾甲，出于丛毛处，并与足厥阴经相交。《内经》说：五脏六腑的精气，都上注于眼睛而形成视觉。包裹着筋骨血气的精华与脉络，合并成为目系，向上连属于脑，向后出于项部。所以邪气中于项部，恰逢身体虚弱，邪气深入，就随着目系进入脑中。进入脑后，就会导致头脑旋转，头脑旋转就会牵引目系紧张，目系紧张，就会导致眼睛昏花旋转。所谓的邪气，总括了风寒湿热内外诸邪。那么为什么归属于肝胆呢？因为五脏六腑的精气上注于眼睛，必须沿着筋脉才能上注。肝主筋，肝有风火，则筋脉生病，而上注的气血就会壅滞不行。所谓的目系，因为风火而变得干燥，干燥就会收缩牵引而紧张，紧张就会导致目眩。这是一种解释。另外胆经的脉气，从瞳子髎穴开始，终于足厥阴经，所以胆经的风火，也会导致动摇眩晕。所以《内经》说：所有的风证、动摇、眩晕，都归属于木。还有太阳之气，标在头顶，又络属于脑，膀胱经穴位自睛明穴出发至阴，行于足外侧，所以寒水之气太过，凌驾逼迫真火，也会导致眩晕仆倒。还有心下有支饮（水饮停聚），其人感到头目昏冒眩晕，这是格拒心火不能下行，反而上冲头目所致。还有风寒相互搏结，进食后就眩晕，这是内受湿饮郁遏，微弱的阳气与郁遏的热邪并而上冲头目导致眩晕。睛明穴，属于阳明经。（谦按：睛明穴实际属于太阳经，此处言属阳明，故加注以等待考证。）另外阳明经的支脉，进入目内眦，所以也会眩晕。还有肾阴不足，三阳之火旺盛，闪耀于眼前。（阴虚之人，常常感觉眩晕，眼中忽然看见如火星炮竹般的闪光，胸膈必有痰，发作时眼睛不能睁开，睁开则所见之物非倒即斜。）中土虚衰之下，逆乱之光，上迫于头顶。（土虚引发的眩晕，患者不能起身，必然恶心呕吐，且五心烦热。）这些似乎与肝胆两经无关，不知道其起始原因各不相同，但最终都不能不由其所经历的途径，而在极点处显现端倪，所以仍然可以说全部归属于木。（这与吞酸两个病症，四明先生分析详尽，但都没有列出方剂治疗，需要参考丹溪、损庵、立斋、景岳等人的方法来治疗。）
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.)