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》）
【脉象与病机】
胃的脉象浮而数，主消谷善饥；肺的脉象滑而数，主消渴。一般来说，脉象数而大者预后良好（生），脉象细微者预后不良（死）；脉象沉小者预后良好（生），脉象牢实者预后不良（死）。（引自《证治汇补》）
【医案选录】
山东周姓官员，年龄超过四十岁，因长期伏案劳累致病，精神困倦，食欲减退，时常感到恐惧，整夜无法入睡，持续半年多。上焦没有口渴感，不喜欢喝汤水，即使少量饮用，也感觉停滞不行。然而每晚小便量达二、三升，不知从何而来，且有一半尿液浑浊如膏脂，身体极度消瘦虚弱。诊察其脉象仍然缓和，肌肉尚未脱失。判断其胃气尚存，于是制定归脾汤（Guipi Tang, Spleen-Restoring Decoction）去掉木香，以及大补丸（Dabu Wan, Great Tonifying Pill）煎服等方药，一方以养阳，一方以养阴，交替服用，共计三百余剂，累计使用人参二十斤，才得以完全痊愈。这是神气耗散于上、精气耗损于下的证候。可见“消”症有阴阳之分，不能一概而论为火邪，暂记此案例作为借鉴。（张景岳）
朱麟生，患消渴病，后来口渴症状稍止，反而加重了烦躁急迫感，足膝痿弱无力。我用白茯苓丸（Baifuling Wan, White Poria Pill）加入犀角（Rhinoceros Horn）。医生问：“肾病却用犀角、黄连来治心，岂不是颠倒了吗？”我说：“肾是胃的关口，胃热下传于肾，则关门大开，心的阳火得以直接下降至肾。《内经》说：‘阳气精微所降之处，人易夭折。’如今病人之心火灼烧肾脏，导致燥热而不能濡润，使用犀角、黄连入肾，以对治其下降的阳光（指亢盛之火），难道算是颠倒吗？”服药果然见效，再改用地黄汤（Dihuang Tang, Rehmannia Decoction）加入犀角，肌肤润泽而康复。（喻嘉言）
【嘈杂证治总论】
“嘈杂”这一病症，时作时止。其发病时的感觉，腹中空空荡荡，好像没有什么东西，似饥非饥，似辣非辣，似痛非痛，胸膈间懊恼不适，难以名状。有的进食后暂时停止，有的吃完后又出现嘈杂，有的兼有恶心，逐渐出现胃脘疼痛。此证有火嘈、痰嘈、酸水浸心而致的嘈杂。大致而言，吃完食物立刻感到饥饿，或者虽然吃了但不觉得饱的，属于火嘈，治疗宜清火。痰多气滞，似饥非饥，不喜欢吃东西的，属于痰嘈，治疗宜兼化痰。酸水浸心而致嘈杂的，感到心中戚戚不安、腹部膨隆，食少无味，这是脾气虚寒，水谷不消化的表现，治疗宜温胃健脾。又有误用消伐类药物，导致脾胃亏损，血少而嘈杂的，中气虚弱则烦杂不饥，脾弱则食物不能运化，这种情况宜专门调养脾胃。（张景岳）
有的因为饮食无节制，蓄积痰饮，阻滞于中焦（脾胃），从而引起嘈杂，这属于痰证。有的因病后，每到半夜，心中嘈杂如饥，特别难以忍受，这是阴虚血少，或阳气下陷，阴火沸腾所致，属于气血虚而有火的证候。（《证治汇补》）
嘈杂有虚实真伪之分，其病位总在于胃。《内经》说：“饮食进入胃，游溢精气，向上输送给脾。”又说：“脾与胃通过膜相连，能够协助胃运行津液。”大概脾属阴，主血；胃属阳，主气。胃容易干燥，全赖脾阴来调和它；脾容易湿滞，必赖胃阳来运化它。如果脾阴一旦虚弱，那么胃中饮食游溢的精气，全部输送到脾，不能稍微留下津液来自我滋润，就会导致胃过于干燥而生火。因此想要进食来资助自己，稍晚一点则嘈杂更加严重，进食后嘈杂暂时停止。若失治则会延变为便闭、三消、噎隔等证。治疗应当补脾阴，养营血，兼补胃阴，用甘凉濡润之法，或稍佐微酸，这是脾阴虚导致胃家燥热的情况。更有热病之后，胃气虽逐渐恢复，但津液尚未充盈，也有这种证候，只需通过饮食调理，可以自愈。这两种情况，属于虚嘈证。所谓的实嘈，是指年岁壮盛，脾胃生发之气，与肾阳充旺，食物容易消化，多吃容易饥饿而嘈杂，进食后即止，这不是病，不必服药。以上这些都是真嘈证。所谓伪嘈，是因为胃中有痰火，导致饮食输化不清，证见恶心、吞酸、微烦、眩晕、少寐、似饥非饥，即使吃饱了也不能停止，这是痰火为患；治疗宜清胃，稍佐降痰之药，苦寒腻滞的药物不宜多用。又有胃阳衰微，积水内聚，感到凄凄戚戚，似酸非酸，似辣非辣，饮食减少，这属于脾胃阳虚；治疗宜温通，仿照痰饮门的治法。这两种情况，是似嘈的伪证。俗话说的“心嘈”，是错误的；心只有烦而没有嘈，胃只有嘈而没有烦，不可不辨明。（《临证指南》）
【脉候】
嘈杂：有因痰随火动的，脉象滑而数；有因食郁化热的，脉象数而大；有因湿痰引起的，脉象沉而滑；有因气郁引起的，脉象沉而涩。（《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*)