吞酸之症有二，热与寒也。经曰∶诸呕吐酸，皆属于热。东垣曰∶病机作热，攻之误矣，浊
气不降，寒药岂能治之。二说似乎矛盾，而实一也。《素问》言热者，所以指其末也；东垣
言寒者，所以指其本也。丹溪用吴茱萸之法，亦尝谓之寒矣，然亦当分其虚实而治之。若烦
热作渴，好食啖物，饮食易化，是为实火内炽，而胃经热也，宜用清凉饮之类。若不渴喜食
热物，饮食难化，是为虚火所致，而胃经寒也，宜用香砂六君子汤之类。故东垣云∶邪热不
杀谷，苟误认为实热，概用寒凉之剂，而变为中满呕吐反胃之症者，皆末传寒中之败症也。
可不慎欤！
治验
一小儿吞酸，用六君子汤而愈。后伤食复作，兼泻，先用五味异功散加升麻、干姜，泻顿止
，又以六君子煎送四味茱萸丸而愈。
一小儿吞酸嗳腐，发热口渴，先用保和丸二服，以消宿滞，又用六君、木香、干姜，以温养
中气而愈。后伤冷粉，腹胀痛，余用异功散加干姜，诸症渐愈，用补中益气汤加木香，将愈
；又伤食吞酸腹痛，用六君、木香二剂痛止，又四剂而愈。
一小儿吞酸，喘嗽腹胀，面白兼青，余谓脾肺之气虚，先用补中益气汤加茯苓、半夏二剂，
喘胀悉愈，又用六君子汤及五味异功散而愈。
一小儿十三岁吞酸，每食碗许，稍多则泻或腹胀，面色黄或青白，此脾肺虚，肝木所胜，用
六君、干姜、柴胡、升麻，间佐以补中益气汤而痊。毕姻后，兼勤于功课，仍吞酸唾痰，服
清热药，大便不实，嗜卧少食，而似肉痿，用前药各百余剂而痊。
一女子吞酸唾痰，恪用清气化痰之药，余谓属中气虚，不信，后觉肚腹肿胀，大小便淋沥而
殁。
六君子汤（加木香、砂仁，名香砂六君子汤）
异功散（二方见内钓）
补中益气汤
保和丸（二方见虚羸）
四味茱连丸（方见噫气）
吞酸这一病症有两种情况，分别是热证和寒证。《内经》说：“各种呕吐泛酸，都属于热证。”李东垣认为：病机表现为热，如果误用攻下法就错了，因为浊气不下降，寒性药物怎么能治愈它呢？这两种说法看似矛盾，但实际上是一致的。《素问》所说的“热”，是指疾病的表象（末）；李东垣所说的“寒”，是指疾病的根本（本）。朱丹溪使用吴茱萸的方法，也曾经被归为治寒之法，但也应当区分虚实来治疗。如果出现烦热、口渴、食欲旺盛、食物容易消化等症状，这是实火内盛，属于胃经有热，适宜使用清凉饮之类的方剂。如果不口渴、喜欢热食、食物难以消化，这是由虚火引起的，属于胃经有寒，适宜使用香砂六君子汤之类的方剂。所以李东垣说：“邪热不能腐熟水谷”，如果错误地认为是实热，一概使用寒凉药物，从而转变为中满、呕吐、反胃等病症的，都是疾病由表传里转化为中焦虚寒的败坏症候。这能不谨慎吗！
医案记录
有一个小孩患吞酸症，服用六君子汤后痊愈。后来因伤食再次发作，并伴有腹泻，先用五味异功散加入升麻、干姜，腹泻立刻停止，然后又用六君子汤煎剂送服四味茱连丸而痊愈。
有一个小孩患吞酸、嗳气且有腐臭味，伴有发热、口渴，先服用两服保和丸，以消除积滞，又用六君子汤加木香、干姜，以温养中气而痊愈。后来因吃冷米粉导致腹胀痛，我用异功散加干姜，诸症逐渐好转，再用补中益气汤加木香，即将痊愈时；又因伤食出现吞酸腹痛，用六君子汤加木香两剂后疼痛停止，再服四剂而痊愈。
有一个小孩患吞酸，伴有气喘咳嗽、腹胀，面色白中带青，我认为这是脾肺之气虚弱，先用补中益气汤加茯苓、半夏两剂，喘促和胀满全部痊愈，又用六君子汤及五味异功散而痊愈。
有一个十三岁的小孩患吞酸，每餐吃一碗左右，稍多一点就会腹泻或腹胀，面色黄或青白，这是脾肺虚弱，肝木克制太过所致，使用六君子汤、干姜、柴胡、升麻，间或配合补中益气汤而康复。结婚后，兼之勤于功课，仍然吞酸、吐痰，服用清热药后，大便不成形，嗜睡少食，且类似肉痿的症状，使用前药各一百多剂而痊愈。
有一个女子患吞酸、吐痰，严格使用清气化痰的药物，我认为属于中气虚弱，她不信，后来感到肚腹肿胀，大小便淋漓不尽而死。
六君子汤（加入木香、砂仁，名为香砂六君子汤）
异功散（这两个方剂见“内钓”章节）
补中益气汤
保和丸（这两个方剂见“虚羸”章节）
四味茱连丸（方剂见“噫气”章节）
The syndrome of acid regurgitation (Tun Suan) has two types: heat and cold. The Classics state: "All vomiting and acid regurgitation belong to heat." Li Dongyuan stated: If the pathogenesis is considered heat, attacking it with purgatives is a mistake; turbid qi fails to descend, how can cold-natured herbs treat it? These two theories seem contradictory but are actually one. When *Suwen* mentions heat, it refers to the manifestation (the branch); when Li Dongyuan mentions cold, he refers to the root cause. Zhu Danxi's use of *Evodiae Fructus* (Wuzhuyu) was also categorized as treating cold, yet one must still differentiate between deficiency and excess for treatment. If there is irritability, heat sensation, thirst, good appetite, and easy digestion of food, this indicates excessive fire blazing internally, belonging to heat in the Stomach meridian; formulas such as Qingliang Yin (Cooling Decoction) should be used. If there is no thirst, preference for hot foods, and difficulty digesting food, this is caused by deficient fire, belonging to cold in the Stomach meridian; formulas such as Xiangsha Liujunzi Tang (Aucklandia and Amomum Six Gentlemen Decoction) should be used. Therefore, Li Dongyuan said: "Pathogenic heat cannot ripen grains." If mistakenly identified as excess heat and generally treated with cold-cooling agents, leading to syndromes of abdominal fullness, vomiting, and regurgitation, these are all deteriorating conditions where the disease has transmitted from the exterior to the interior, transforming into middle-jiao cold deficiency. Can one not be cautious?
Clinical Cases
One child suffered from acid regurgitation and was cured using Liujunzi Tang (Six Gentlemen Decoction). Later, due to food stagnation, the condition recurred accompanied by diarrhea. First, Wuyi Yigong San (Five Agents Extraordinary Powder) was administered with added *Rhizoma Bupleuri* (Shengma) and *Zingiberis Rhizoma Recens* (Ganjiang), which stopped the diarrhea immediately. Subsequently, the child was cured by taking decoctions of Liujunzi Tang to deliver Siwei Zhuyu Wan (Four-Ingredient Evodia Pill).
One child presented with acid regurgitation, belching with a putrid odor, fever, and thirst. Two doses of Baohe Wan (Preserve Harmony Pill) were first used to eliminate old stagnation. Then, Liujunzi Tang was combined with *Aucklandiae Radix* (Muxiang) and *Zingiberis Rhizoma Recens* (Ganjiang) to warm and nourish the middle qi, resulting in recovery. Later, after consuming cold rice noodles, the child developed abdominal distension and pain. I used Yigong San (Extraordinary Powder) with added *Zingiberis Rhizoma Recens* (Ganjiang), and the symptoms gradually improved. Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) with added *Aucklandiae Radix* (Muxiang) was then used until near recovery. Subsequently, due to food stagnation causing acid regurgitation and abdominal pain, two doses of Liujunzi Tang with *Aucklandiae Radix* (Muxiang) stopped the pain, and four more doses led to complete recovery.
One child suffered from acid regurgitation accompanied by wheezing, coughing, and abdominal distension, with a pale complexion showing bluish tints. I diagnosed this as deficiency of Spleen and Lung qi. Two doses of Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) with added *Poria* (Fuling) and *Pinelliae Rhizoma Preparatum* (Banxia) completely resolved the wheezing and distension. The child was subsequently cured using Liujunzi Tang (Six Gentlemen Decoction) and Wuyi Yigong San (Five Agents Extraordinary Powder).
One thirteen-year-old child suffered from acid regurgitation. After eating about one bowl of food, even slightly more would cause diarrhea or abdominal distension. The complexion was yellow or pale blue. This indicated Spleen and Lung deficiency with excessive Wood overacting on Earth. Treatment involved Liujunzi Tang (Six Gentlemen Decoction), *Zingiberis Rhizoma Recens* (Ganjiang), *Bupleuri Radix* (Chaihu), and *Rhizoma Bupleuri* (Shengma), intermittently supplemented with Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction), leading to recovery. After marriage, while continuing diligent study, the child still experienced acid regurgitation and expectoration of phlegm. Taking heat-clearing herbs resulted in loose stools, lethargy, poor appetite, and symptoms resembling Rou Wei (flesh atrophy). Over a hundred doses of the previously mentioned medicines cured the condition.
One female patient suffered from acid regurgitation and expectoration of phlegm. She strictly used heat-clearing and phlegm-resolving medications. I advised that this belonged to middle qi deficiency, but she did not believe me. Later, she developed abdominal swelling, dribbling urination and defecation, and eventually died.
Liujunzi Tang (Six Gentlemen Decoction) (When added with *Aucklandiae Radix* (Muxiang) and *Amomi Fructus* (Sharen), it is named Xiangsha Liujunzi Tang)
Yigong San (These two formulas are described under the section "Nei Diao")
Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction)
Baohe Wan (Preserve Harmony Pill) (These two formulas are described under the section "Xu Lei")
Siwei Zhulian Wan (Four-Ingredient Evodia and Coptis Pill) (Formula described under the section "Yi Qi")