大意
嘈杂者。痰因火动。乃噎膈反胃之渐也。（丹溪）
病因恣食无节。蓄积痰饮。滞于中宫。故为嘈杂。此嘈杂之属于痰也。若夫大病后。每于夜分。心嘈如饥。殊
难容忍。此阴虚血少。或阳气下陷。阴火沸腾。此嘈杂之属于气血虚而有火也。（汇补）
外候
嘈杂者。似饥非饥。似痛非痛。有若热辣不宁之状。（医鉴）若五更嘈者。思虑伤血。（丹溪）
脉法
右寸关紧而滑。痰火内郁。两寸弦滑。胸有留饮。右关弦急。木乘土位。欲作反胃噎隔。若终岁嘈者。其寿必
夭。以叹万物者火也。（汇补）
治法
治宜开郁行气。兼以清痰降火。（绳墨）血分稍亏者。宜补接真阴。不可纯用辛香燥热之剂。
治各有别
有痰因火动者。脉滑而数。治痰为先。治火次之。有食郁作热者。脉数而大。治火为先。开导次之。有因湿痰
者。脉沉而滑。宜豁痰。有因气郁者。脉沉而涩。宜开郁。（汇补）
用药
主以二陈汤。加黄连、山栀、苍术、枳壳。久而不愈。属血虚脾弱。用当归、山药、茯苓、陈皮、甘草、黄连、
生地、贝母、桔梗。平调自愈。
【附嗳气】
病因积滞蕴蓄。冲逆于上。故嗳发大声。（绳墨）食罢嗳出腐气者实也。不因饮食而常嗳者虚也。（入门）
嘈杂选方
二陈汤 加姜炒黄连、山栀、半夏。治痰症嘈杂。（方见痰症）
三补丸 合二陈汤。加香附、抚芎。（方见火症）
越鞠丸 加枳壳、桔梗、黄连。（方见郁症）
枳术丸 加二陈汤、神曲、山楂、麦芽。（方见伤食）
逍遥散 治肝肾火郁嘈杂。（方见火症）
归脾汤 治思虑血亏嘈杂。（方见中风）
【大意】
嘈杂，是由于痰因火邪扰动所致，这是噎膈（吞咽困难）和反胃（食入即吐）的初期表现。（朱丹溪）
病因多为饮食不节制，导致痰饮蓄积停滞在中焦脾胃，从而引发嘈杂。这是属于痰湿引起的嘈杂。如果是大病之后，常在半夜时分感到心中烦乱饥饿，难以忍受，这是由于阴虚血少，或者阳气下陷，导致阴火沸腾。这是属于气血虚弱且伴有虚火的嘈杂。（《证治汇补》）
【外候】
嘈杂的症状，感觉像饥饿又不是饥饿，感觉像疼痛又不是疼痛，有一种热辣不安的感觉。（《医鉴》）如果在五更天（凌晨3-5点）出现嘈杂，多因思虑过度损伤心血所致。（朱丹溪）
【脉法】
右寸、关脉紧而滑，提示痰火内郁；两寸脉弦滑，提示胸中有停饮；右关脉弦急，提示肝木乘克脾土，即将发展为反胃或噎膈。如果整年都感到嘈杂，寿命必然短促，因为叹息是火邪耗伤万物的表现。（《证治汇补》）
【治法】
治疗应当疏解郁结、行气导滞，兼以清热化痰降火。（《绳墨》）对于血分稍亏的患者，适宜滋补真阴，不可单纯使用辛香燥热的药物。
【治各有别】
有因痰随火动者，脉象滑数，治疗应以治痰为主，治火为辅。有因食积郁而化热者，脉象数大，治疗应以清火为主，消食导滞为辅。有因湿痰引起者，脉象沉滑，宜豁痰利湿。有因气郁引起者，脉象沉涩，宜疏解郁结。（《证治汇补》）
【用药】
主方用二陈汤（由半夏、陈皮、茯苓、甘草组成），加黄连、山栀、苍术、枳壳。若久治不愈，属血虚脾弱，可用当归、山药、茯苓、陈皮、甘草、黄连、生地、贝母、桔梗，平调即可自愈。
【附嗳气】
病因多为积滞蕴蓄，冲逆于上，所以发出大声的嗳气。（《绳墨》）饭后嗳出腐臭气味的是实证；不因饮食而经常嗳气的是虚证。（《入门》）
【嘈杂选方】
二陈汤：加姜炒黄连、山栀、半夏。治疗痰症引起的嘈杂。（方剂见痰症章节）
三补丸：合二陈汤，加香附、抚芎。（方剂见火症章节）
越鞠丸：加枳壳、桔梗、黄连。（方剂见郁症章节）
枳术丸：加二陈汤、神曲、山楂、麦芽。（方剂见伤食章节）
逍遥散：治疗肝肾火郁引起的嘈杂。（方剂见火症章节）
归脾汤：治疗思虑导致血亏引起的嘈杂。（方剂见中风章节）
[General Principles]
Chaoza (Hectic sensation of hunger and pain) is caused by phlegm stirred up by fire, representing the initial stage of Yige (Dysphagia/Obstruction in the esophagus) and Fanwei (Regurgitation). (Zhu Danxi)
The etiology often involves unregulated diet, leading to the accumulation and stagnation of Phlegm-fluids (Tan-yin) in the Middle Jiao (Spleen and Stomach), thus causing Chaoza. This type belongs to Phlegm. If it occurs after a severe illness, typically during the night watch (midnight to 2 AM), with a heart sensation resembling hunger that is intolerable, this is due to Yin deficiency and Blood insufficiency, or sinking of Yang Qi causing boiling of Deficient Fire. This type belongs to Qi and Blood deficiency with accompanying Fire. (Zhengzhi Huibu)
[External Manifestations]
The manifestation of Chaoza resembles hunger but is not hunger, resembles pain but is not pain, presenting as a hot, spicy, and restless sensation. (Yijian) If Chaoza occurs at Wugeng (5:00-7:00 AM), it is due to excessive thinking damaging the Blood. (Zhu Danxi)
[Pulse Diagnosis]
A tight and slippery pulse at the Right Cun and Guan positions indicates internal depression of Phlegm-Fire; a wiry and slippery pulse at both Cun positions indicates retained fluids in the chest; a wiry and urgent pulse at the Right Guan position indicates Liver Wood overacting on Spleen Earth, likely developing into Fanwei or Yige. If Chaoza persists throughout the year, life expectancy will be short, as sighing reflects Fire consuming the vital essence. (Zhengzhi Huibu)
[Therapeutic Methods]
Treatment should focus on resolving depression and promoting Qi movement, combined with clearing heat, transforming phlegm, and descending fire. (Shengmo) For patients with slight Blood deficiency, it is appropriate to tonify True Yin; purely using acrid, aromatic, dry, and hot agents should be avoided.
[Differentiated Treatment]
For cases where Phlegm is stirred by Fire, with a slippery and rapid pulse, treatment prioritizes resolving Phlegm, followed by clearing Fire. For cases where Food stagnation causes Heat, with a rapid and large pulse, treatment prioritizes clearing Fire, followed by guiding out stagnation. For cases due to Damp-Phlegm, with a deep and slippery pulse, expelling Phlegm is indicated. For cases due to Qi depression, with a deep and choppy pulse, resolving depression is indicated. (Zhengzhi Huibu)
[Medication]
The primary formula is Erchen Tang (Two-Aged Decoction), added with Huanglian (Coptis Rhizome), Shanzhi (Gardenia Fruit), Cangzhu (Atractylodis Rhizoma), and Zhike (Aurantii Fructus). If it persists for a long time, indicating Blood deficiency and Spleen weakness, use Danggui (Angelicae Sinensis Radix), Shanyao (Dioscoreae Rhizoma), Fuling (Poria), Chenpi (Citri Reticulatae Pericarpium), Gancao (Glycyrrhizae Radix et Rhizoma), Huanglian, Shengdi (Rehmanniae Radix), Beimu (Fritillariae Bulbus), and Jiegeng (Platycodonis Radix). Balanced regulation will lead to spontaneous recovery.
[Appendix: Belching]
The etiology involves accumulated stagnation rushing upward, causing loud belching. (Shengmo) Belching with a putrid odor after eating indicates Excess; frequent belching unrelated to food intake indicates Deficiency. (Rumen)
[Selected Formulas for Chaoza]
Erchen Tang: Added with ginger-fried Huanglian, Shanzhi, and Banxia. Treats Chaoza due to Phlegm symptoms. (Formula see Phlegm section)
Sanbu Wan (Three-Tonic Pill): Combined with Erchen Tang, added with Xiangfu (Cyperi Rhizoma) and Fuxiong (Ligustici Chuanxiong Rhizoma). (Formula see Fire section)
Yueju Wan: Added with Zhike, Jiegeng, and Huanglian. (Formula see Depression section)
Zhizhu Wan: Added with Erchen Tang, Shenqu (Massa Medicata Fermentata), Shanzha (Crataegi Fructus), and Maiya (Hordei Fructus Germinatus). (Formula see Food Injury section)
Xiaoyao San: Treats Chaoza due to Liver and Kidney Fire depression. (Formula see Fire section)
Guipi Tang: Treats Chaoza due to Blood deficiency from excessive thinking. (Formula see Stroke section)