脉候 关上沉，心痛，上吞酸。（《脉经》）
寸口脉紧，寒之实也。寒在上焦，胸中必满而噫。（同上）
源由证治诸说 噫醋者，由上焦有停痰，脾胃有宿冷，故不能消谷。谷不消则胀满而气逆，所以好噫
而吞酸，气息醋臭。（《病源论》）
夫中脘有饮则嘈，有宿食则酸，食后噫醋吞酸，皆宿食证，俗谓之咽酸是也。（《三因》）
噫气吞酸，嗳宿腐气，逆咽酸水，亦有每晨吐清酸水数口，日间无事者，亦有膈间常如酸折（折当作蜇，蜇，
螫也），皆饮食伤中脘所致（文有讹脱），生料平胃散加神曲、麦 各半钱，或八味平胃散。（《要诀》）
（按∶八味平胃散，据《类方》系《三因》浓朴、升麻、射干、茯苓、大黄、枳壳、甘草、芍药水煎者，似不与证
协，恐是别方。）
人之饮食在胃，惟速化为贵。若胃中阳气不衰而健运如常，何酸之有。使火力不到，则其化必迟，食化既迟，
则停积不行而为酸为腐，此酸即败之渐也。故凡病吞酸者，多见饮食不诀，自食有不快，必渐至中满痞膈泄泻等证，
岂非脾气不强、胃脘阳虚之病，而犹认为火，能无误乎。（《景岳》）
噫气虚实 嗳气者，即《内经》之所谓噫也。此实脾胃之气滞，起自中焦而出于上焦，故经曰上走心
为噫也。凡人之饮食太饱者，多有此证；及饮食不易消化者，亦有此证。但太饱作嗳者，此系实滞，治宜行气化
食。食不消化时多虚闷作嗳者，此系胃气虚寒，治宜温补。若痰火作嗳者，亦或有之。但停痰必以胃弱，胃弱多
因无火，此当详辨脉证而酌治之也。（《景岳》）
气盛实嗳，食罢嗳转腐气，甚则物亦嗳转，多伤食湿热
所致，二陈汤加苍术、神曲、麦芽、姜炒黄连。不因饮食而嗳者虚也，盖胃有浊气，膈有湿痰，俱能发嗳，
六君子汤加沉香为君，浓朴、苏子为臣，吴萸为佐，甚者灵砂以镇坠之。（《入门》）
吞酸吐酸之别 吞酸者，胃口酸水攻激于上，以致咽嗌之间，不及吐出而咽下，酸味刺心，有若吞酸之
状也。吐酸者，吐出酸苦之水。皆由胃气不行，脾气不运，饮食痰涎津液俱化为水，郁而少久以成酸也。（《绳
墨》）
吞酸之与吐酸证有三种∶凡喉间嗳噫，即有酸水，如醋浸心，嘈杂不堪者，是名吞酸，即俗所谓作酸也，此病
在上脘最高之处，不时见酸而泛泛不宁者是也。其次则非如吞酸之近，不在上脘而在中焦胃脘之间，时多呕恶，
所吐皆酸，即名吐酸而渥渥不行者是也。又其次者，则本无吞酸吐酸等证，惟或偶因呕吐，所出或酸或苦，及
诸不堪之味，此皆肠胃中痰饮积聚所化气味，每有浊恶如此，此又在中脘之下者也。但其顺而下行，则人所不觉；
逆而上出，则喉口难堪耳。凡此三者，其在上中二脘者，则无非脾胃虚寒、不能运化之病，治此者非温不可。其
在下脘偶出者，则寒热俱有，但当因证以治其呕吐，呕吐止则酸苦无从见矣。（《景岳》）
病变翻胃膈噎 吞酸，小疾也，然可暂而不可久。或以疾小而忽之，此不知其翻胃之渐也（《汇补》
作膈噎反胃之渐也）。语曰∶毫末不斫，将寻斧柯。是故慎之。（《方考》）（按∶《百问》亦曰∶吐酸日久，
渐成翻胃。）
族妹经不行者八十日，每饮食入腹，即疼痛，必尽吐出乃止，居常亦吐酸水，上焦热，下焦寒，大便半月始
一行，食饮不进者四十日，六脉皆数，左滑右软弱。妹能事者，以其夫多病，且不谙世故，由是悒悒，病从思虑
而得，恐成膈
症。今大便燥结，吐酸，乃膈之征，急宜拂虑，庶药有功。先与丁灵丸（按∶此当是香灵丸，用丁香、辰砂、五灵
脂，用狗胆汁或猪胆汁丸）一粒而吐止。继用温胆汤加姜、连，痛吐全安。改以二陈汤加香附，条芩、山栀仁、
丹参、砂仁，调理两月，经行，大便始润而膈症斯不作矣。（《赤水》）
温中消导诸方（温利） 治噫酢咽方。（《千金》）（按∶即吴茱萸汤）《医心》∶《医门方》于本方
加橘皮。
《广济》疗常吐酸水，脾胃中冷，茯苓汤方。
茯苓（十二分） 橘皮（十二分） 白术（八分） 人参（六分） 桂心（六分） 甘草（八分炙）
紫苏（十分） 生姜（十二分） 槟榔（七枚）
上九味切，以水九升，煮取二升半，绞去滓，分温三服，每服如人行七八里。未好瘥，三两日更服一剂，老少
取微利。（《外台》）
又疗呕吐酸水，结气筑心，白术散方。
白术（八分） 茯苓（八分） 吴茱萸（四分） 橘皮（六分） 荜茇（四分） 浓朴（八分炙） 槟榔（十分）
人参（六分） 大黄（十分）
上九味捣筛为散，空腹煮姜枣汤服方寸匕，日二服，渐加至二匕半。觉热，服少饮食三两口压之。（同上）
又疗吐酸水，每食则变作醋水吐出，槟榔散，于本方去白术、吴茱萸、浓朴、大黄，平晨空腹，取生姜五大两合
皮捣，绞取汁，温，内散方寸匕，捣调，顿服之，日一服，渐加至一匕半。
《延年》增损承气丸，疗胸胁支满，背上时有一答热则痛，腹胀多噫，醋咽气逆，两胁满，并主之方。
前胡（七分） 枳实（七分炙） 桂心（五分） 干姜（五分） 吴茱萸（五分） 茯苓（四分） 芍药（六分）
浓朴（十分炙） 橘皮（十分） 大黄（七分） 杏仁（七十枚去皮尖）
上十一味捣筛为末，纳杏仁脂中研调筛，度蜜和丸，每服食后少时，酒饮任性，初服七丸如梧子，以气宣
下泄为度。（同上）
治上气冷气，噫醋吞酸，吐沫呕逆，不思饮食，半夏丸方。
半夏（汤浸去滑焙干二两） 丁香（半两） 干姜（炮裂一分）
上三味捣罗为末，生姜自然汁煮面糊为丸，如梧桐子大，每服十五丸，煎木瓜盐汤下，不拘时。（《圣济》）
曲术丸，治中脘有宿食留饮，酸蜇心痛，口吐清水，嗳宿腐气者。
神曲（炒三两） 苍术（泔浸三宿洗净干炒一两半） 陈皮（一两）
上为末，生姜汁别煮神曲末糊为丸，如梧子大，每服三、五十丸，姜汤下，无时。（《三因》）
五百九，治宿食留饮聚积中脘，噫臭吞酸，心腹疼痛，并疗中虚积聚，及脏腑飧泄，赤白痢下。（同上）
（方附《胃反》疏里诸方中。）
加减安胃汤，治脾胃虚寒，呕吐酸水。
藿香 吴茱萸（各一钱半） 人参（二钱） 陈皮（三钱） 苍术（二钱）
水二钟，姜三片，煎八分，食前服。（《统旨》）
十味保和汤，治胃气虚而滞，作嗳。（《医统》）（按∶即香砂六君子汤加藿香、木香。）
匀气丸，治气虚浊升多嗳。
草豆蔻 橘皮 沉香 人参（各五钱） 益智仁 檀香 大腹子（各一两）
为末，饭丸梧子大，每八十丸，淡姜汤下。（《入门》）
治食后吐酸水，用干姜、吴茱萸各二两为末，每服方寸匕，酒调服，日二服，胃冷服之立效。（《保元》）
汪（二十），壮年饮酒聚湿，脾阳受伤已久，积劳饥饱，亦令伤阳，遂食入反出，噫气不爽，隔拒在乎中
焦，总以温通镇逆为例。
白旋复花 钉头代赭 茯苓 半夏 淡附子 淡干姜（《临证指南》）
清火调停诸方 嗳气，胃中有火痰。
南星 半夏 软石膏 香附子 炒栀子
上为丸，或作汤服之。（《丹溪》）《回春》生姜三片，水煎，名星半汤。
破郁丹，治妇人嗳气胸紧，连十余声不尽，嗳出气，心头略宽，不嗳即紧。
香附米（醋煮四两） 栀子仁（炒） 黄连（姜汁炒二两） 枳实（麸炒三两） 槟榔（一两） 莪术
（一两） 青皮（去白一两） 栝蒌仁（一两） 苏子（一两）
上共为末，水丸如梧桐子大，每服三十丸，食后滚水送下。（《回春》）
咽酸方。
茱萸（五钱去梗煮少时浸半日晒干用） 陈皮（五钱） 苍术（七钱半泔浸） 黄连（一两陈壁土炒去土）
黄芩（五钱陈壁土炒去土）
上为末，神曲糊为丸。（《丹溪》）（按∶丹溪曰∶吞酸者，湿热郁积于肝而出，伏于肺胃之间，宜用茱萸
顺其性而折之。又曰∶反佐方，用黄连、吴茱萸各炒用。）《统旨》清胃汤，治胃热吐酸，于本方加茯苓、甘草。
（黄连用吴茱萸同炒，去茱不用。）
茱连汤，吞酸，胸中无奈，或嗳腐臭主之。
橘皮（一钱五分） 半夏 神曲 苍术（各一钱） 黄连（六分） 萝卜子（炒五分） 茯苓（一钱二分）
香附子 山楂子（各八分） 生姜（七片） 吴茱萸（四分和黄连炒）
食前服。（《原病集》）《回春》苍连汤，于本方去萝卜子、香附子、山楂子，加砂仁、甘草。
食积吞酸，或嗳腐气，以香砂二陈汤，加苍术、神曲，麦 、炒黄连主之。（《原病集》）
黄连制附丸，治气虚膈塞吞酸。
川黄连（姜汁炒一两） 川附子（火煨去皮七钱）
上为末，神曲丸如梧桐子大，每服六十丸，淡姜汤下。（《心统》）
参萸丸，治湿而带气者。湿热甚者，用之为向导，上可治吞酸，下可治自利。
六一散（一料） 吴茱萸（一两制）
上为末，饭丸。（《丹溪》）
食物作酸，萝卜生嚼数片，或生菜嚼之亦佳，绝妙。干者、熟者、盐腌者，及人胃冷者，皆不效。（《濒
湖集简方》）（《本草纲目》）
调摄法 所以中酸，不宜食粘滑油腻者，是谓能令阳气壅塞，郁结不通畅也。如饮食在器，覆盖热而自
酸也。宜餐 食菜蔬，能令气之通利也。（《原病式》）
脉象诊察：关部脉沉，伴有心痛，向上泛吐酸水。（出自《脉经》）
寸口脉紧，这是寒邪实证的脉象。寒邪停留于上焦，胸中必然感到胀满并伴有嗳气。（同上）
病因、证候与治疗的各种学说：
所谓“噫醋”（嗳气带酸味），是由于上焦有停聚的痰饮，脾胃有积存的寒气，导致不能消化谷物。谷物不消化就会引起胀满和胃气上逆，所以喜欢打嗝并吞酸，呼出的气息带有酸臭味。（出自《诸病源候论》）
中脘部位有水饮则感觉嘈杂，有宿食则感觉酸腐，饭后嗳气吞酸，都属于宿食证，俗称“咽酸”。（出自《三因极一病证方论》）
嗳气吞酸，嗳出陈腐之气，反咽酸水，也有每天早晨吐出几口清酸水，白天却无不适的情况；也有胸膈间常像被酸物蛰刺一样难受（“折”字应为“蜇”，即螫刺之意），这些都是饮食损伤中脘所致（原文可能有讹误脱漏）。可用生料平胃散加神曲、麦芽各半钱，或者八味平胃散治疗。（出自《幼幼新书·要诀》）
（按语：八味平胃散，据《类方》记载是《三因方》中的厚朴、升麻、射干、茯苓、大黄、枳壳、甘草、芍药用水煎煮而成，似乎与证候不符，恐怕是另一个方子。）
人的饮食在胃中，以迅速消化为贵。如果胃中阳气不衰，运化功能正常，怎么会有酸呢？假使火力不足，那么食物的消化必然迟缓，食物消化既慢，就会停滞积聚而不能运行，从而变成酸腐之物，这种酸就是食物败坏的开始。所以凡是患吞酸病的，大多见于饮食不节制，自己吃东西觉得不舒服，必定逐渐发展到中满、痞隔、泄泻等证候，这难道不是脾气虚弱、胃脘阳虚的病吗？如果还认为是火证，能没有错误吗？（出自《景岳全书》）
嗳气的虚实辨析：
嗳气，就是《内经》中所说的“噫”。这是由于脾胃之气滞塞，起自中焦而发于上焦，所以经文说“气上走于心则为噫”。凡是饮食过饱的人，多有此证；以及饮食不易消化的，也有此证。但如果是过饱引起的嗳气，这属于实证滞塞，治疗应当行气化食。如果是消化不良时多表现为虚闷而嗳气，这属于胃气虚寒，治疗应当温补。如果是痰火引起的嗳气，也偶有发生。但是停痰必然因为胃弱，胃弱多因无火，这应当详细辨别脉证来斟酌治疗。（出自《景岳全书》）
气盛实的嗳气，吃完饭嗳气转而有腐臭气，甚至把吃下的东西也嗳出来，多是伤食湿热所致，用二陈汤加苍术、神曲、麦芽、姜炒黄连。不是因为饮食而嗳气的属于虚证，大概是因为胃中有浊气，膈中有湿痰，都能引发嗳气，用六君子汤加沉香为君药，厚朴、苏子为臣药，吴茱萸为佐药，严重的用灵砂来镇坠降逆。（出自《医学入门》）
吞酸与吐酸的区别：
吞酸，是指胃口里的酸水攻冲向上，以致在咽喉之间，来不及吐出就咽下去了，酸味刺痛心脏，好像吞下酸水一样的状态。吐酸，是指吐出酸苦的水液。这都是由于胃气不行，脾气不运，饮食、痰涎、津液都化为水，郁结久了便成为酸。（出自《医宗必读·绳墨》）
吞酸和吐酸的证候有三种：凡是喉间嗳气，就有酸水，像醋浸心一样，嘈杂不堪忍受的，名叫吞酸，也就是俗话所说的“作酸”，这个病在上脘最高之处，不时出现酸水且泛泛不安的就是这种。其次不像吞酸那样近迫，不在上脘而在中焦胃脘之间，时常呕吐恶心，所吐的都是酸水，名叫吐酸且呕恶不止的就是这种。又其次者，本来没有吞酸吐酸等证，只是偶尔因为呕吐，吐出的或酸或苦，以及其他难闻的味道，这都是肠胃中痰饮积聚所化的气味，常常如此浊恶，这又是在中脘之下的情况。但是如果气顺而下行的，人就不会察觉；如果气逆而上出的，喉咙和嘴巴就很难受。凡这三种情况，发生在上、中二脘的，无非是脾胃虚寒、不能运化的病，治疗这种病非用温法不可。发生在下脘偶尔吐出的，寒热都有，只应当根据证候治疗其呕吐，呕吐停止了，酸苦的味道就无从出现了。（出自《景岳全书》）
病变发展为翻胃、膈噎：
吞酸是小病，但可以暂时存在而不可以长久。有人因为病小而忽视它，这是不知道它是翻胃的开端（《汇补》写作膈噎反胃的开端）。俗话说：“毫末不斫，将寻斧柯。”所以要谨慎对待。（出自《方考》）（按语：《百问》也说：吐酸日久，逐渐形成翻胃。）
族妹月经停止八十天，每次饮食入腹，就疼痛，必须全部吐出才停止，平时也吐酸水，上焦热，下焦寒，大便半个月才排一次，饮食不进四十天，六脉皆数，左脉滑，右脉软弱。妹妹能干，但因为丈夫多病，且不谙世故，因此忧郁，病从思虑而来，恐怕会发展成膈症。现在大便燥结，吐酸，这是膈症的征兆，急宜疏解忧虑，否则药物难以见效。先给丁灵丸（按：这应该是香灵丸，用丁香、辰砂、五灵脂，用狗胆汁或猪胆汁制丸）一粒，呕吐就停止了。继用温胆汤加生姜、黄连，疼痛和呕吐完全痊愈。改为二陈汤加香附、条芩、山栀仁、丹参、砂仁，调理两个月，月经来潮，大便开始润通，膈症就不再发作了。（出自《赤水玄珠》）
温中消导各类方剂（温利法）：
治疗嗳气酸水的方子。（出自《千金方》）（按：即吴茱萸汤）《医心方》引《医门方》在本方基础上加橘皮。
《广济方》治疗经常吐酸水，脾胃中冷，茯苓汤方。
茯苓（十二分） 橘皮（十二分） 白术（八分） 人参（六分） 桂心（六分） 甘草（八分，炙）
紫苏（十分） 生姜（十二分） 槟榔（七枚）
以上九味切碎，用水九升，煮取二升半，绞去药渣，分三次温服，每次服药后行走七八里的时间。未痊愈，两三天后再服一剂，老少皆以微利为度。（出自《外台秘要》）
又治疗呕吐酸水，结气筑心，白术散方。
白术（八分） 茯苓（八分） 吴茱萸（四分） 橘皮（六分） 荜茇（四分） 厚朴（八分，炙） 槟榔（十分）
人参（六分） 大黄（十分）
以上九味捣碎筛成散剂，空腹煮姜枣汤送服一方寸匕，每日两次，逐渐增加至二匕半。如果觉得热，喝两三两口饮食压住它。（同上）
又治疗吐酸水，每顿饭吃完就变成醋水吐出，槟榔散，在本方中去掉白术、吴茱萸、厚朴、大黄，平晨空腹，取生姜五大两连皮捣烂，绞取汁液，温热后，加入散剂一方寸匕，捣匀调服，一次性服下，每日一次，逐渐增加至一匕半。
《延年方》增损承气丸，治疗胸胁支满，背上有时有一处发热则痛，腹胀多嗳气，酸水咽下气逆，两胁满，并主治这些症状的方子。
前胡（七分） 枳实（七分，炙） 桂心（五分） 干姜（五分） 吴茱萸（五分） 茯苓（四分） 芍药（六分）
厚朴（十分，炙） 橘皮（十分） 大黄（七分） 杏仁（七十枚，去皮尖）
以上十一味捣碎筛成末，纳入杏仁脂中研磨调匀筛过，用蜂蜜和丸，每次饭后稍顷，随意饮酒送服，初服七丸如梧桐子大，以气宣通下行排泄为度。（同上）
治疗上气冷气，嗳气吞酸，吐沫呕逆，不思饮食，半夏丸方。
半夏（汤浸去滑焙干二两） 丁香（半两） 干姜（炮裂一分）
以上三味捣罗成末，用生姜自然汁煮面糊为丸，如梧桐子大，每次服十五丸，煎木瓜盐汤送下，不拘时候。（出自《圣济总录》）
曲术丸，治疗中脘有宿食留饮，酸蛰心痛，口吐清水，嗳出陈腐之气的。
神曲（炒三两） 苍术（泔水浸泡三宿洗净晒干炒一两半） 陈皮（一两）
以上为末，用生姜汁单独煮神曲末成糊状为丸，如梧桐子大，每次服三五十丸，姜汤送下，不拘时候。（出自《三因方》）
五百九号方，治疗宿食留饮聚积中脘，嗳臭吞酸，心腹疼痛，并治疗中虚积聚，以及脏腑飧泄，赤白痢下。（同上）
（方子附在《胃反》疏里各类方剂中。）
加减安胃汤，治疗脾胃虚寒，呕吐酸水。
藿香 吴茱萸（各一钱半） 人参（二钱） 陈皮（三钱） 苍术（二钱）
水二钟，生姜三片，煎至八分，饭前服。（出自《医宗统旨》）
十味保和汤，治疗胃气虚而滞，产生嗳气。（出自《医统正脉》）（按：即香砂六君子汤加藿香、木香。）
匀气丸，治疗气虚浊气上升多嗳气。
草豆蔻 橘皮 沉香 人参（各五钱） 益智仁 檀香 大腹子（各一两）
为末，米饭为丸如梧桐子大，每次八十丸，淡姜汤送下。（出自《医学入门》）
治疗食后吐酸水，用干姜、吴茱萸各二两为末，每次服一方寸匕，酒调服，每日两次，胃冷者服用立即见效。（出自《保元编》）
汪（二十岁），壮年饮酒聚湿，脾阳受伤已久，积劳饥饱，也令阳气受损，于是食入反出，嗳气不爽，阻隔在于中焦，总以温通镇逆为原则。
白旋复花 钉头代赭石 茯苓 半夏 淡附子 淡干姜（出自《临证指南医案》）
清火调停各类方剂：
嗳气，是胃中有火痰。
南星 半夏 软石膏 香附子 炒栀子
以上为丸，或作汤剂服用。（出自《丹溪心法》）《回春方》加生姜三片，水煎，名星半汤。
破郁丹，治疗妇人嗳气胸紧，连续十余声不尽，嗳出气后心头略宽，不嗳气就感到紧绷。
香附米（醋煮四两） 栀子仁（炒） 黄连（姜汁炒二两） 枳实（麸炒三两） 槟榔（一两） 莪术
（一两） 青皮（去白一两） 栝蒌仁（一两） 苏子（一两）
以上共为末，水丸如梧桐子大，每次三十丸，食后滚水送下。（出自《回春方》）
咽酸方。
吴茱萸（五钱，去梗煮少时浸半日晒干用） 陈皮（五钱） 苍术（七钱半，泔水浸） 黄连（一两，陈壁土炒去土）
黄芩（五钱，陈壁土炒去土）
以上为末，神曲糊为丸。（出自《丹溪心法》）（按：丹溪说：吞酸者，湿热郁积于肝而出，伏于肺胃之间，宜用吴茱萸顺其性而折之。又说：反佐方，用黄连、吴茱萸各炒用。）《统旨》清胃汤，治疗胃热吐酸，在本方基础上加茯苓、甘草。
（黄连用吴茱萸同炒，去茱不用。）
茱连汤，治疗吞酸，胸中无奈，或嗳腐臭主之。
橘皮（一钱五分） 半夏 神曲 苍术（各一钱） 黄连（六分） 萝卜子（炒五分） 茯苓（一钱二分）
香附子 山楂子（各八分） 生姜（七片） 吴茱萸（四分，和黄连炒）
食前服。（出自《原病集》）《回春方》苍连汤，在本方中去掉萝卜子、香附子、山楂子，加砂仁、甘草。
食积吞酸，或嗳腐气，以香砂二陈汤，加苍术、神曲、麦芽、炒黄连为主治。（出自《原病集》）
黄连制附丸，治疗气虚膈塞吞酸。
川黄连（姜汁炒一两） 川附子（火煨去皮七钱）
以上为末，神曲丸如梧桐子大，每次六十丸，淡姜汤送下。（出自《医方心统》）
参萸丸，治疗湿而带气者。湿热甚者，用之为向导，上可治吞酸，下可治自利。
六一散（一料） 吴茱萸（一两，制）
以上为末，米饭为丸。（出自《丹溪心法》）
食物变酸，生嚼几片萝卜，或生菜嚼之也很好，绝妙。干的、熟的、盐腌的，以及人胃冷者，都不见效。（出自《濒湖集简方》）（《本草纲目》）
调摄方法：
之所以导致中酸，不宜食用粘滑油腻的食物，这是因为能使阳气壅塞，郁结不通畅。就像饮食在容器中，覆盖加热而自己变酸一样。宜餐食菜蔬，能使气机通利。（出自《原病式》）
Pulse Diagnosis: The pulse at the Guan position is deep, accompanied by heart pain and upward regurgitation of acid fluid. (From *Mai Jing* [Pulse Classic])
The pulse at the Cun position is tight, indicating an excess pattern of Cold pathogen. When Cold resides in the Upper Jiao, the chest must feel full and distended with belching. (Ibid.)
Theories on Etiology, Symptoms, and Treatment:
"Yi Cu" (belching with sour odor) arises from retained phlegm-fluid in the Upper Jiao and lingering cold in the Spleen and Stomach, which prevents the digestion of grains. Undigested grains cause distension and rebellious Qi, leading to frequent belching and acid regurgitation, with breath smelling sour. (From *Bing Yuan Lun* [Treatise on the Origins and Manifestations of Various Diseases])
Fluid retention in the Zhongwan area causes a sensation of hunger pangs (tsao), while retained food causes acidity. Belching and acid regurgitation after meals are all signs of retained food syndrome, commonly known as "swallowing acid." (From *San Yin* [Three Causes])
Belching with acid regurgitation, belching of stale foul air, and reverse swallowing of acid water occur. Some patients spit out several mouthfuls of clear acid water every morning but have no discomfort during the day; others often feel a stinging sensation in the chest and diaphragm (the character 'zhe' should be 'zhe', meaning sting). All these are caused by dietary injury to the Zhongwan. (Original text may have errors or omissions). Treat with Shengliao Pingwei San plus Shenqu and Maiya, each half qian, or Bawei Pingwei San. (From *Yaojue*)
(Note: Bawei Pingwei San, according to *Leifang*, consists of Houpo, Shengma, Shegan, Fuling, Dahuang, Zhike, Gancao, and Shaoyao decocted in water from *San Yin Fang*. This seems inconsistent with the syndrome; it is likely a different formula.)
Food in the stomach should be digested quickly. If Stomach Yang Qi is unimpaired and transport functions normally, how can acidity arise? If fire power is insufficient, digestion will inevitably be slow. Once digestion is slow, food stagnates and fails to move, turning into acid and rot. This acid is the beginning of spoilage. Therefore, patients with acid regurgitation mostly show irregular eating habits and discomfort after eating, eventually developing into fullness, obstruction, and diarrhea. Is this not a disease of weak Spleen Qi and deficient Yang in the Stomach epigastrium? To still consider it a Fire syndrome would surely be erroneous. (From *Jingyue Quanshu*)
Differentiation of Excess and Deficiency in Belching:
Belching is what the *Neijing* calls "Yi." It results from Qi stagnation in the Spleen and Stomach, originating in the Middle Jiao and emerging in the Upper Jiao. Hence, the classic states, "Qi moving up to the Heart causes Yi." People who eat too much often have this syndrome; those whose food is hard to digest also have it. However, belching due to overeating is an excess stagnation, treated by promoting Qi movement and digesting food. Belching accompanied by deficiency-related oppression when food is indigestible indicates deficient-cold Stomach Qi, treated by warming and tonifying. Belching due to Phlegm-Fire also occurs occasionally. But retained phlegm implies weak Stomach function, and weak Stomach function often stems from lack of Fire. One must carefully differentiate pulses and symptoms to decide treatment. (From *Jingyue Quanshu*)
Excess belching with Qi abundance involves belching foul-smelling air after meals, sometimes even regurgitating undigested food, mostly caused by food damage and damp-heat. Treat with Erchen Tang plus Cangzhu, Shenqu, Maiya, and Huanglian stir-fried with ginger. Belching not caused by diet indicates deficiency, likely due to turbid Qi in the Stomach and damp-phlegm in the diaphragm. Treat with Liujunzi Tang using Chenxiang as the sovereign herb, Houpo and Suzi as minister herbs, and Wuzhuyu as assistant herb. For severe cases, use Lingsha to anchor and descend. (From *Rumen*)
Distinction between Acid Regurgitation (Tun Suan) and Vomiting Acid (Tu Suan):
"Tun Suan" (swallowing acid) refers to acid fluid from the Stomach gate rushing upward, so that before it can be vomited, it is swallowed down through the throat. The acid taste pierces the Heart, resembling the act of swallowing acid. "Tu Suan" (vomiting acid) refers to vomiting out sour and bitter fluids. Both result from Stomach Qi failing to descend and Spleen Qi failing to transport, causing food, phlegm-fluid, and body fluids to transform into water, which stagnates and becomes acidic over time. (From *Shengmo*)
There are three types of Tun Suan and Tu Suan syndromes: First, when there is belching in the throat with acid water, feeling like vinegar soaking the Heart, unbearable tsao, this is named Tun Suan, commonly called "making acid." This disease is located at the highest point of the Shangwan, characterized by intermittent appearance of acid and restlessness. Second, unlike Tun Suan, it is not proximal but located between the Middle Jiao and Stomach epigastrium, often involving nausea and vomiting of sour fluid, named Tu Suan, characterized by persistent retching. Third, originally without Tun Suan or Tu Suan symptoms, but occasionally vomiting sour, bitter, or other unpleasant tastes due to vomiting. These are odors transformed from accumulated phlegm-fluid in the intestines and stomach, often turbid and foul, located below the Zhongwan. If Qi moves downward smoothly, one does not notice it; if it rebels upward, the throat and mouth become unbearable. For the first two types located in the Upper and Middle Wan, they are invariably diseases of Spleen-Stomach deficient-cold failing to transport; treatment requires warming. For the third type occurring occasionally in the Xiawan, both Cold and Heat patterns exist; one should treat the vomiting according to the syndrome. Once vomiting stops, the sour and bitter flavors disappear. (From *Jingyue Quanshu*)
Progression to Fan Wei (Regurgitation) and Ge Ye (Obstruction):
Acid regurgitation is a minor ailment but should not persist. Ignoring it because it is minor means failing to realize it is the precursor to Fan Wei (*Huibu* writes Ge Ye Fan Wei). As the saying goes, "If you do not cut off the sprout, you will need an axe later." Therefore, caution is required. (From *Fangkao*) (Note: *Baiwen* also states: Long-term acid regurgitation gradually becomes Fan Wei.)
Case Study:
My clan sister had amenorrhea for eighty days. Every time food entered her stomach, she felt pain and had to vomit everything to find relief. She usually vomited acid water. She had Heat in the Upper Jiao and Cold in the Lower Jiao. Her bowels moved only once every fifteen days, and she had not eaten for forty days. Her six pulses were rapid; the Left was slippery, and the Right was weak and soft. She was capable, but due to her husband's frequent illnesses and her own ignorance of worldly affairs, she became depressed. The illness arose from excessive thinking, and I feared it would develop into a Ge syndrome. Currently, her stool is dry and constipated, and she vomits acid, which are signs of Ge syndrome. Urgent relief of emotional distress is needed, otherwise medication will be ineffective. First, administer one pill of Dingling Wan (Note: This should be Xiangling Wan, made of Dingxiang, Chensha, and Wulingzhi, pillified with dog or pig bile). Vomiting stopped immediately. Then use Wendan Tang plus Ginger and Huanglian; pain and vomiting completely resolved. Switch to Erchen Tang plus Xiangfu, Huangqin, Zhizi Ren, Danshen, and Sharen. After two months of regulation, menstruation resumed, stools became moist, and the Ge syndrome did not recur. (From *Chishui*)
Formulas for Warming the Middle and Promoting Digestion (Warming and Purging Methods):
Formula for treating belching and acid regurgitation. (From *Qianjin Fang*) (Note: This is Wuzhuyu Tang). *Yixin Fang* cites *Yimen Fang* adding Ju Pi to this formula.
*Guangji Fang* treats frequent vomiting of acid water and cold in the Spleen-Stomach with Fuling Tang:
Fuling (12 fen), Ju Pi (12 fen), Baizhu (8 fen), Renshen (6 fen), Guixin (6 fen), Gancao (8 fen, roasted), Zisu (10 fen), Shengjiang (12 fen), Binglang (7 pieces).
Cut the nine ingredients, decoct in 9 sheng of water to obtain 2.5 sheng. Strain and divide into three warm doses. Take one dose per journey of seven to eight li. If not cured, take another dose after two or three days. Mild purgation is desired for all ages. (From *Waitai Miyao*)
Another formula for vomiting acid water and Qi knot pressing on the Heart, Baizhu San:
Baizhu (8 fen), Fuling (8 fen), Wuzhuyu (4 fen), Ju Pi (6 fen), Bibo (4 fen), Houpo (8 fen, roasted), Binglang (10 fen), Renshen (6 fen), Dahuang (10 fen).
Grind the nine ingredients into powder. Decoct Jiang and Zao in water and take one fangcun bi on an empty stomach, twice daily. Gradually increase to two and a half bi. If heat is felt, suppress it with a few mouthfuls of food or drink. (Ibid.)
Another formula for vomiting acid water, where food turns to vinegar-like fluid upon eating, Binglang San: Remove Baizhu, Wuzhuyu, Houpo, and Dahuang from the above formula. On an empty stomach in the morning, take five large liang of fresh ginger with peel, crush and squeeze juice. Warm the juice, mix with one fangcun bi of powder, stir well, and take at once. Once daily, gradually increase to one and a half bi.
*Yannian Fang* Zengsun Chengqi Wan treats fullness in chest and hypochondrium, occasional heat-pain on the back, abdominal distension with belching, acid regurgitation with rebellious Qi, and fullness in both hypochondria:
Qianhu (7 fen), Zhishi (7 fen, roasted), Guixin (5 fen), Ganjiang (5 fen), Wuzhuyu (5 fen), Fuling (4 fen), Shaoyao (6 fen), Houpo (10 fen, roasted), Ju Pi (10 fen), Dahuang (7 fen), Xingren (70 pieces, peeled and tip removed).
Grind the eleven ingredients into powder, mix with Xingren fat, sieve, and honey-pill. Take shortly after meals with wine as desired. Initial dose: seven pills the size of wutong seeds. Adjust until Qi moves downward and excretes. (Ibid.)
Banxia Wan for upper Qi cold, belching with acid regurgitation, spitting foam, vomiting, and loss of appetite:
Banxia (soaked in water, remove slipperiness, baked dry, 2 liang), Dingxiang (0.5 liang), Ganjiang (roasted cracked, 1 fen).
Grind into powder. Use fresh ginger juice to make a flour paste for pills, size of wutong seeds. Take fifteen pills each time with decocted Chaenomelum salt water, anytime. (From *Shengji Zonglu*)
Quzhu Wan treats retained food and fluid in Zhongwan, acid-stinging heart pain, spitting clear water, and belching of stale foul air:
Shenqu (stir-fried, 3 liang), Cangzhu (soaked in rice water for three nights, washed, dried, stir-fried, 1.5 liang), Chenpi (1 liang).
Grind into powder. Stir-fry Shenqu powder separately with ginger juice to make a paste for pills, size of wutong seeds. Take thirty to fifty pills each time with ginger water, anytime. (From *San Yin Fang*)
Formula No. 509 treats retained food and fluid accumulation in Zhongwan, foul belching with acid regurgitation, heart-abdominal pain, deficiency accumulation in the middle, and loose stools or dysentery with red and white discharge. (Ibid.)
(Attached to formulas for purging in *Wei Fan*.)
Jiajian Anwei Tang treats Spleen-Stomach deficient-cold and vomiting of acid water:
Huoxiang, Wuzhuyu (each 1.5 qian), Renshen (2 qian), Chenpi (3 qian), Cangzhu (2 qian).
Decoct in two zhong of water with three slices of ginger to obtain 0.8 zhong. Take before meals. (From *Tongzhi*)
Shiwei Baohe Tang treats deficient and stagnant Stomach Qi causing belching. (From *Yitong*) (Note: This is Xiangsha Liujunzi Tang plus Huoxiang and Muxiang.)
Yunqi Wan treats Qi deficiency with rising turbidity causing frequent belching:
Caodoukou, Chenpi, Chenxiang, Renshen (each 5 qian), Yizhiren, Tanxiang, Dafuzi (each 1 liang).
Grind into powder, rice-pill size of wutong seeds. Take eighty pills each time with light ginger water. (From *Rumen*)
For vomiting acid water after meals, use Ganjiang and Wuzhuyu (each 2 liang) ground into powder. Take one fangcun bi each time with wine, twice daily. Immediate effect for cold Stomach. (From *Baoyuan*)
Wang (age 20): A young man drank alcohol, accumulating dampness. Spleen Yang was injured for a long time. Accumulated fatigue and irregular meals further damaged Yang. Food enters but is rejected, belching is unsatisfactory, obstruction is in the Middle Jiao. The principle is always warming, unblocking, and anchoring rebellion:
Baixuanfuhua, Dingtou Daizhe, Fuling, Banxia, Dan Fuzi, Dan Ganjiang. (From *Linzheng Zhinan Yitan*)
Formulas for Clearing Fire and Regulating:
Belching indicates Fire-Phlegm in the Stomach.
Nanxing, Banxia, Ruang Shigao, Xiangfu, Chao Zhizi.
Make into pills or decoct. (From *Danxi Xinfa*). *Huichun Fang* adds three slices of ginger, decoct in water, named Xingban Tang.
Poyu Dan treats women with belching and chest tightness, lasting more than ten sounds, feeling slightly relieved after belching, but tight again if not belching:
Xiangfu Mi (boiled in vinegar, 4 liang), Zhizi Ren (stir-fried), Huanglian (stir-fried with ginger juice, 2 liang), Zhishi (bran-roasted, 3 liang), Binglang (1 liang), Ezhu (1 liang), Qingpi (peeled, 1 liang), Gualou Ren (1 liang), Suzi (1 liang).
Grind together into powder, water-pill size of wutong seeds. Take thirty pills each time with boiling water after meals. (From *Huichun Fang*)
Formula for Swallowing Acid:
Wuzhuyu (5 qian, remove stem, boil briefly, soak for half a day, dry), Chenpi (5 qian), Cangzhu (7.5 qian, soaked in rice water), Huanglian (1 liang, stir-fried with old wall soil, remove soil), Huangqin (5 qian, stir-fried with old wall soil, remove soil).
Grind into powder, Shenqu paste for pills. (From *Danxi Xinfa*) (Note: Danxi said: In acid regurgitation, damp-heat stagnates in the Liver and emerges, lying hidden between the Lung and Stomach. Use Wuzhuyu to follow its nature and restrain it. Also said: Counter-assistant formula uses Huanglian and Wuzhuyu stir-fried together.) *Tongzhi* Qingwei Tang treats Stomach Heat vomiting acid, adding Fuling and Gancao to this formula. (Huanglian stir-fried with Wuzhuyu, discard Wuzhuyu.)
Zhuolian Tang treats acid regurgitation, unbearable chest sensations, or belching of foul rot:
Chenpi (1.5 qian), Banxia, Shenqu, Cangzhu (each 1 qian), Huanglian (6 fen), Luobozi (stir-fried, 5 fen), Fuling (1.2 qian), Xiangfu, Shanzhazhi (each 8 fen), Shengjiang (7 slices), Wuzhuyu (4 fen, stir-fried with Huanglian).
Take before meals. (From *Yuanbing Ji*). *Huichun Fang* Calian Tang removes Luobozi, Xiangfu, and Shanzhazhi from this formula, adding Renchen and Gancao.
For food stagnation acid regurgitation or belching of foul air, use Xiangsha Erchen Tang plus Cangzhu, Shenqu, Maiya, and stir-fried Huanglian as main treatment. (From *Yuanbing Ji*)
Huanglian Zhi Fu Wan treats Qi deficiency with obstruction and acid regurgitation:
Chuan Huanglian (stir-fried with ginger juice, 1 liang), Chuan Fuzi (fire-roasted, skin removed, 7 qian).
Grind into powder, Shenqu pill size of wutong seeds. Take sixty pills each time with light ginger water. (From *Xintong*)
Can Yu Wan treats dampness with Qi involvement. For severe damp-heat, use as a guide: treats acid regurgitation above and spontaneous diarrhea below.
Liuyisan (one batch), Wuzhuyu (1 liang, processed).
Grind into powder, rice-pill. (From *Danxi Xinfa*)
To counteract food turning sour, chew raw radish slices or raw vegetables; excellent. Dried, cooked, salted, or for people with cold Stomach, these are ineffective. (From *Binhu Jijianfang*) (*Bencao Gangmu*)
Regulation Method:
To prevent internal acid formation, avoid sticky, slippery, and greasy foods, as these obstruct Yang Qi and cause stagnation. Like food covered in a container heating up and turning sour itself. Prefer vegetable meals to promote Qi flow. (From *Yuanbingshi*)