Pulse
The pulse is wiry and slippery. The pulses at the cun position of both hands may be floating and wiry, or floating and slippery, or deep and slow, or tight and surging, or surging and rapid, or deep and slow, indicating cold-fluid retention in the chest. If the pulse is surging and rapid, it indicates hot-phlegm lodged between the diaphragm, with occasional regurgitation of sour fluid, which may develop into Fanwei disease (disease of vomiting and reflux).

Diseases
Zhu Danxi said: Tun-suan (acid regurgitation without vomiting) differs from Tu-suan (vomiting of acid fluid). Tu-suan is explicitly described as a heat syndrome in *Suwen* (Basic Questions), while Li Dongyuan describes it as a cold syndrome. Why? Tu-suan refers to vomiting sour fluid resembling vinegar. This occurs when normal body fluids accumulate due to stagnant ascending qi. After long-term stagnation, warmth generates heat within, transforming via fire, thus producing sour fluid that is vomited out. Is this not a heat syndrome? In cases where accumulation persists for a long time and cannot erupt spontaneously, lying latent between the lungs and stomach, unable to be coughed up or swallowed down: if the body surface is exposed to wind-cold, internal heat becomes more constrained, causing the sour taste to pierce the heart; if the body surface is kept warm, the couli (pores) open. Or, after consuming fragrant and hot decoctions or pills, body fluids circulate, providing temporary relief. Is this not a cold syndrome? When *Suwen* states "heat," it refers to the root cause; when Li Dongyuan states "cold," he refers to the branch manifestation.

Dai Shi said: Damp-heat resides above the gastric opening. When food enters the stomach, it is constrained by damp-heat, preventing proper transmission and transformation, thus generating acidity. It is like grain and meat in a vessel becoming sour easily under conditions of damp-heat.

*Yuan Bing Shi* (Treatise on the Origin of Diseases) states: Tu-suan belongs to Liver Wood pathology. It arises because excessive Fire controls Metal (Lung), failing to subdue Wood (Liver), leading to hyperactivity of Liver Wood, hence manifesting as sourness. Just as food becomes sour easily when heated. One must nourish oneself with rice and vegetables, and should moderate the intake of rich and strong flavors.

Formulas
Qingyu Erchen Tang (Clear Stagnation and Resolve Phlegm Decoction): Treats Tun-suan piercing the heart and Tun-suan accompanied by a sensation of hunger discomfort (zaoci).
Chenpi (Citri Reticulatae Pericarpium, 1 qian), Banxia (Pinelliae Rhizoma, 1 qian), Fuling (Poria, 1 qian), Cangzhu (Atractylodis Rhizoma, 8 fen), Chuanxiong (Chuanxiong Rhizoma, 8 fen), Xiangfu (Cyperi Rhizoma, 1 qian), Shenqu (Massae Fermentatae Medicinalis, stir-fried, 5 fen), Zhishi (Aurantii Fructus Immaturus, stir-fried, 8 fen), Huanglian (Coptidis Rhizoma, stir-fried, 1 qian), Zhizi (Gardeniae Fructus, stir-fried, 1 qian), Baishao (Paeoniae Radix Alba, 7 fen), Gancao (Glycyrrhizae Radix et Rhizoma, 3 fen).
Crush these ingredients for one dose, add three slices of Shengjiang (Fresh Ginger), and decoct in water. Alternatively, prepare as pills for better efficacy.

Zhuolian Wan (Evodia and Coptis Pill): Treats Tun-suan caused by stagnant accumulation.
Zhuyu (Evodiae Fructus, remove stems, soak in boiling water for half a day, stir-fry), Chenpi (Citri Reticulatae Pericarpium, remove white pith), Huangqin (Scutellariae Radix, stir-fry with aged wall soil, each 5 qian), Huanglian (Coptidis Rhizoma, stir-fry with aged wall soil, 1 liang), Cangzhu (Atractylodis Rhizoma, soak in rice wash water, stir-fry, 7.5 qian).
Grind into powder, bind with Shenqu paste to form pills. Take 60–70 pills per dose, swallowing with saliva.

Canglian Wan (Atractylodes and Coptis Pill): Treats Tu-suan caused by stagnant accumulation.
Cangzhu (Atractylodis Rhizoma, soak in rice wash water, stir-fry, 1 liang), Chenpi (Citri Reticulatae Pericarpium, 1 liang), Banxia (Pinelliae Rhizoma, 1 liang, stir-fry with ginger juice), Huanglian (Coptidis Rhizoma, 1.5 liang, double dose in summer), Baifuling (Poria, 1 liang), Zhuyu (Evodiae Fructus, stir-fried, 1 liang, double dose in winter).
Grind into powder, bind with steamed bread dough to form pills, size of mung beans. Take 30 pills per dose, after meals.

Qushu Wan (Massa Fermentata and Atractylodes Pill): Treats retained food and lingering fluid in the Zhongwan region, sour-piercing heart pain, and spitting clear fluid.
Shenqu (Massae Fermentatae Medicinalis, stir-fried, 3 liang), Cangzhu (Atractylodis Rhizoma, soak in rice wash water, 1.5 liang), Chenpi (Citri Reticulatae Pericarpium, 1 liang), Sharen (Amomi Fructus, 1 liang).
Grind into fine powder, bind with ginger juice-boiled Massa Fermentata paste to form pills, size of sophora seeds. Take 70 pills per dose, delivered with ginger soup.

Pinggan Shunqi Baozhong Wan (Soothe Liver, Smooth Qi, and Protect Middle Pill) (Prepared by Yunlin) [Commentary]: This formula treats multiple conditions including Tun-suan, Tu-suan, zaoci, and belching.
Treats damage to the Spleen by stagnant fire, failure of Middle Qi to circulate, latent fire in the Stomach, and phlegm generation from stagnant accumulation, leading to vomiting, Tun-suan with zaoci, and abdominal distension and fullness. Regular use smooths Qi and harmonizes the Middle, strengthens the Spleen and opens the appetite, promotes digestion, resolves phlegm and stagnation, clears fire, and suppresses Liver hyperactivity.
Xiangfumiao (Cyperi Rhizoma, 3 liang, soak in urine of young boys for three days, stir-fry), Chuanxiong (Chuanxiong Rhizoma, 2 liang), Chenpi (Citri Reticulatae Pericarpium, remove white pith, 3 liang), Baizhu (Atractylodis Macrocephalae Rhizoma, 4 liang, stir-fry with soil), Houpo (Magnoliae Officinalis Cortex, 1 liang), Zhishi (Aurantii Fructus Immaturus, 2 liang, stir-fried), Huanglian (Coptidis Rhizoma, 1 liang, stir-fry with ginger juice), Shenqu (Massae Fermentatae Medicinalis, 2 liang, stir-fried), Maiya (Hordei Fructus Germinatus, 7 qian, stir-fried), Muxiang (Aucklandiae Radix, 3 qian), Zhizi (Gardeniae Fructus, 2 liang, stir-fry with ginger juice), Laifuzi (Raphani Semen, 1 liang, stir-fried), Banxia (Pinelliae Rhizoma, 1.5 liang, stir-fry with ginger juice), Baifuling (Poria, 1 liang), Sharen (Amomi Fructus, 4 qian, stir-fried), Ganshengjiang (Dried Fresh Ginger, 1 liang), Shanzha (Crataegi Fructus, flesh only, 2 liang), Qingpi (Citri Reticulatae Pericarpium Viride, 6 qian, stir-fry with sesame oil), Gancao (Glycyrrhizae Radix et Rhizoma, 4 qian, honey-fried).
Grind into powder, bind with bamboo sap and Massa Fermentata paste to form pills, size of mung beans. Take 100 pills per dose, delivered with plain boiled water after meals, twice daily.