发明云病机诸呕吐酸皆属于热此上焦受外来客邪也胃气不受外邪故呕仲景以生姜半夏治
之以
杂病论之呕吐酸水者甚则酸水浸其心不任其苦其次则吐出酸水令上下牙酸涩不能相对以大辛
热药疗之必减吐酸水呕出也酸味者收气也西方
肺金旺也寒水乃金之子子能令母实故用大咸热之剂泻其子以辛热为之佐而泻肺之实以病机作
热攻之误矣盖杂病醋心浊气不降欲为中满寒药岂能治之乎
按吐酸原病式为热而此作寒论治者盖东垣以内伤不足之病末传寒中浊气不降不宜用寒药
治疗
乃指为寒却以素问病机之说作外感客邪论与诸腹胀大论分寒热胀义相同以下文丹溪之论观之
其说方备
丹溪云或曰吐酸素问明以为热东垣又言为寒何也子曰吐酸与吞酸不同吐酸是吐出酸水如
醋平
时津液随上升之气郁积而成郁积之久湿中生热故从火化遂作酸味非热而何其有郁积之久不能
自涌而出伏于肺胃之间咯不得上咽不得下肌表得风寒则内热愈郁而酸味刺心肌表温暖腠理
开发或得香热汤丸津液得行亦可暂解非寒而何素问言热者言其本也东垣言寒者言其末也但东
垣不言外得风寒而作收气立说欲泻肺金之实又谓寒药不可治酸而用安胃汤加减二陈汤俱犯丁
香且无治湿热郁结之法为未合经意予尝治吞酸用黄连茱萸各炒随时令迭其佐使苍术茯苓为辅
佐汤浸炊饼为小丸吞之仍教以 食菜蔬自养则病易安
谨按吐酸一证以病机言之则属于热以脏腑论之则脾胃受病以内邪言之则痰饮宿食之所为
故治
法热者寒之脾恶湿以苦燥之有痰饮者清之散之分利之有宿食者消之导之驱逐之局方不察斯故
以噫醋吞酸醋心吐酸水之证并入于诸气门中率用温热之药岂吐酸专主于寒而无他证也故此一
门以叙河间东垣丹溪之论其病源治法无余蕴矣
吐酸治法
刘完素在《黄帝内经》病机十九条中发明道：“诸呕吐酸，皆属于热。”这是指上焦受到外来客邪侵袭。胃气不能耐受外邪，所以发生呕吐。张仲景用生姜、半夏来治疗。
而在杂病中论述的呕吐酸水，严重时酸水浸渍心胸，患者无法忍受其痛苦；其次则是吐出酸水，导致上下牙齿感到酸涩，甚至不能相对合拢。对此应用大辛大热的药物进行治疗，必然能减轻呕吐酸水的症状。酸味是收敛之气，对应西方肺金旺盛。寒水是肺金之子，“子能令母实”，因此使用大咸热的方剂泻其子（肾水），以辛热药作为辅助，从而泻除肺金的实证。如果像刘完素那样将其归为热证而攻伐，就错了。因为杂病中的醋心（胃酸反流）是由于浊气不降，想要形成中满胀闷，寒药怎么能治疗呢？
按：李东垣在《原病式》中将吐酸归为热证，但此处却作寒证论治，这是因为李东垣认为内伤不足之病末期传变为寒中（脾胃虚寒），浊气不降，不宜使用寒药治疗，所以将其指为寒证。这却是将《素问》病机的说法当作外感客邪来论述，与《素问·至真要大论》中“诸腹胀大，皆属于热”及分寒热胀的理论意义相同。参考下文朱丹溪的论述，他的说法才完备。
朱丹溪说：有人问：“《素问》明确说明吐酸属于热，李东垣又说属于寒，为什么呢？”我说：“吐酸和吞酸不同。吐酸是吐出如醋一般的酸水。平时津液随着上升之气郁积而成，郁积久了，湿中生热，所以从火化，遂变成酸味。如果不是热，怎么会有这种变化？但是郁积久了，不能自行涌出，潜伏在肺胃之间，咳不出来，咽不下去。肌表受到风寒侵袭，则内热更加郁结，酸味刺痛心肌；肌表温暖，腠理开发，或者喝下香热的汤丸，津液得以运行，也可以暂时缓解。如果不是寒证，怎么会这样？《素问》说‘热’，是指疾病的根本；李东垣说‘寒’，是指疾病的末梢表现。只是李东垣没有提到外感风寒而发作，而是依据收敛之气立论，想要泻除肺金的实证，又谓寒药不可治酸，而使用安胃汤加减二陈汤，都犯了丁香（辛热）的错误，且没有治疗湿热郁结的方法，不符合经旨。我曾经治疗吞酸，用黄连、吴茱萸各炒制，根据时令调整佐使药，以苍术、茯苓为辅佐，制成汤剂浸泡炊饼为小丸吞服。并教导患者食用菜蔬自养，则病容易痊愈。
谨按：吐酸这一病症，从病机角度讲属于热；从脏腑角度讲，是脾胃受病；从内邪角度讲，是痰饮、宿食所致。所以治疗方法：热者寒之；脾恶湿，用苦味燥湿；有痰饮的，清化、消散、分利；有宿食的，消导、驱逐。《局方》没有考察这些，所以把噫醋、吞酸、醋心、吐酸水等证候并入诸气门中，一律使用温热药物。难道吐酸专门主于寒而无其他证型吗？因此这一门叙述河间（刘完素）、东垣（李东垣）、丹溪（朱震亨）的论述，关于病源和治法已经穷尽其蕴奥了。
吐酸的治疗方法
Liu Wansu, in his explication of the *Huangdi Neijing* (Yellow Emperor's Inner Canon) pathogenesis rules, stated: "All vomiting and acid regurgitation belong to heat." This refers to the upper jiao (Upper Burner) being invaded by exogenous pathogenic factors. The Stomach Qi cannot tolerate these external pathogens, thus vomiting occurs. Zhang Zhongjing treated this with Shengjiang (Fresh Ginger) and Banxia (Pinellia Rhizome).
In contrast, regarding miscellaneous diseases, when vomiting acid water occurs, it may severely soak the heart and chest, causing unbearable suffering; or secondarily, the patient vomits acid water, making the upper and lower teeth feel sour and astringent, to the point where they cannot close against each other. For such cases, treatment should employ major acrid-hot medicines, which will inevitably reduce the vomiting of acid water. The sour flavor corresponds to the qi of contraction/astringency, associated with the flourishing of Metal in the West (Lung). Water is cold, being the child element of Metal; according to the principle that "the child can make the mother full," one should use major salty-hot formulas to drain the child (Kidney Water), using acrid-hot herbs as assistants to drain the excess of Lung Metal. To treat it as heat and attack it directly, as Liu Wansu did, would be an error. In miscellaneous diseases, "vinegar heart" (acid reflux) is caused by turbid qi failing to descend, leading to central fullness; how can cold medicines treat this?
Note: Li Dongyuan classified acid regurgitation as heat in his *Yuan Bing Yuan Shi* (Source Book of Diseases and Etiologies), but here it is discussed and treated as cold. This is because Li Dongyuan believed that late-stage internal injury and deficiency diseases transmit to "cold center" (Spleen-Stomach deficiency-cold), where turbid qi fails to descend, making cold medicines unsuitable. Thus, he categorized it as cold. However, this interpretation applies the *Suwen* pathogenesis theory to exogenous pathogenic invasion, similar to the distinction between cold and heat in abdominal distension found in the *Suwen*. Referencing Zhu Danxi's discussion below, his explanation is more comprehensive.
Zhu Danxi said: Someone asked, "The *Suwen* clearly states that acid regurgitation belongs to heat, yet Li Dongyuan says it belongs to cold. Why?" I replied, "Acid regurgitation (Tu Suan) differs from swallowing acid (Tun Suan). Acid regurgitation involves vomiting acid water like vinegar. Normally, body fluids rise with ascending qi, accumulate, and stagnate. After long-term stagnation, dampness generates heat within, transforming via Fire, thus becoming sour. If it were not heat, how would this occur? However, after long stagnation, it cannot surge out spontaneously; it lies latent between the Lungs and Stomach, unable to be coughed up or swallowed down. When the muscle surface is exposed to wind-cold, internal heat becomes more constrained, and the sour flavor pierces the heart muscle; when the muscle surface is warm and pores open, or after consuming fragrant hot soups/pills, body fluids circulate, providing temporary relief. If it were not cold, why would this happen? The *Suwen* mentions 'heat' referring to the root cause; Li Dongyuan mentions 'cold' referring to the branch manifestation. However, Li Dongyuan did not account for onset triggered by external wind-cold. Instead, he based his theory on the qi of contraction (Metal) to drain Lung excess, and claimed cold medicines cannot treat acid, prescribing Anwei Tang modified with Erchen Tang, both containing Dingxiang (Clove). This approach lacks methods for treating damp-heat stagnation and does not align with classic principles. I once treated swallowing acid using Huanglian (Coptis Rhizome) and Zhuyu (Evodia Fruit), stir-fried separately, adjusting assistants and envoys according to seasons, with Cangzhu (Atractylodes Rhizome) and Fuling (Poria) as supports. These were made into small pills soaked in decoction and cooked dough balls, taken orally. I also instructed patients to nourish themselves with vegetables, which facilitated recovery.
Respectfully noted: Regarding the syndrome of acid regurgitation, from the perspective of pathogenesis, it belongs to heat; from the perspective of Zang-Fu organs, it involves disease of the Spleen and Stomach; from the perspective of internal pathogens, it is caused by phlegm-fluid retention and retained food. Therefore, treatment methods are: for heat, use cold methods; since the Spleen dislikes dampness, use bitter-dry methods; for phlegm-fluids, clear, dissipate, and separate/drain them; for retained food, digest, guide, and expel them. The *Ju Fang* (Formulas of the Bureau) failed to investigate these aspects, grouping symptoms like belching vinegar, swallowing acid, vinegar heart, and vomiting acid water under the category of Qi disorders, indiscriminately using warm-hot medicines. Does this mean acid regurgitation is exclusively due to cold without other patterns? Therefore, this section narrates the theories of Hejian (Liu Wansu), Dongyuan (Li Dongyuan), and Danxi (Zhu Zhenheng), exhaustively covering the etiology and treatment methods of this condition.
Treatment Methods for Acid Regurgitation