四诊：服一剂，大便通畅，但觉肛门灼热、口渴，是湿热又注于大肠。宜泻热和胃。用《伤寒论》调胃承气汤。处方：
前二味同煎取汁，每次调入芒硝3克，连服二次。
上方服后，症状消失而愈。
[按]：《灵枢·五邪篇》云： “邪在脾胃，阳气不足，阴气有余，则寒中肠呜腹痛。”。这是指阴寒所致之腹痛。因“背为阳，腹为阴”，腹部既然属阴，则喜温而恶寒，故腹痛以寒证为多。本例脉证合参，再结合服苦寒药及香蕉后，腹痛加剧，断为肝寒胃冷所致腹痛，殆无疑议。因寒则凝，阳气不能舒展，无力运送，故大便停滞不通，此为寒结。至于肝寒见症，孙思邈《千金方》谓：“肝虚寒，病苦胁下坚，寒热腹满，不欲饮食，腹胀，悒悒不乐。”由于肝寒而导致木郁，郁则肝之疏泄和升发机能受制，必然影响脾胃之消化吸收，此“木郁不能疏土”之谓也。经云。“木郁逸之”，达即条达舒畅之意。故初诊用“霹雳汤”，予吴萸、木瓜温肝散寒，以遂其条达之性，附片、公丁、灶心土扶阳。温中、散寒除湿而培脾土，丝瓜络通络散结而利血脉。药证相符，一剂痛止。此方凡肝胃虚寒所致腹痛、胁痛、呕吐，、用之多效。
又：本例因寒结滞于里，经温通之后，邪气外达，乃出红斑。后因邪郁酿热，终成湿热下注，故治法先后不同。胃脘痛二例
例一：
包××，男，四十五岁。因胃脘痛住某医院，诊断为“胃溃疡”。治疗二月余，疼痛未减，反而泄泻不止，日行十余次，大便色黑，已七、八日不能进食，病情危笃，乃邀余会诊。患者精神倦怠，脉细小无力，舌淡苔薄白。证属申气不足，脾虚下陷，胃气不和。治宜温脾健胃。俾脾阳健运复常，则胃痛自缓，泄泻亦可自止。方用吴萸理中汤。处方：
炙甘草6克
方中潞党参补气益脾，炒白术健脾燥湿而止泻，吴萸温胃散寒，炮姜、甘草苦甘化阴而止血。
二诊：服二剂，泄泻全止，精神好转。继用上方去吴萸，加砂仁6克，法半夏9克，茯苓15克，以开胃醒脾。
三诊：服二剂，胃痛全止，能进饮食。再以陈夏六君汤二剂，补气益脾。最后用黄坤载黄芽汤，干姜改炮姜。以巩固疗效。处方：
黄坤载云：“中气者，和济水火之机，升降金木之轴”。又云：“中气之治，崇阳补火，则宜参姜，培土泄水，则宜甘苓”。特制黄芽汤一方，专以益气温中，燥湿利水。
服二剂，便血全止，大便色转黄，精神恢复而出院。
例二：
李××，男，三十四岁。因胃脘疼痛，长期反复发作，大便色黑而住某医院。诊断为“胃溃疡”。经治疗二月余，输血2000毫升而病情未见好转。症见：胃痛腹胀，暖气、反酸，畏寒肢冷，声低息短，少气懒言，面色青黯，舌质青滑，脉沉。证属肾阳大虚，阴寒凝滞，气机不畅。治宜扶阳抑阴，回阳祛寒。方用《伤寒论》四逆汤。处方：
附片60克 干姜15克 甘草6克
此方专以驱散阴邪，峻扶元阳。郑钦安说：“凡人一身，全赖一团真火(即元阳、真阳、肾阳)，真火欲绝，故病见纯阴。”又说；“四逆汤一方，乃回阳之主方也。……既能回阳，则凡世之一切阳虚阴盛为病者，皆可服也。”故余临证以来，每遇阴寒重证，均以此方投之，往往应手取效。
二诊：服二剂，胃痛大减，精神好转，大便黑色转淡，微觉腹胀。再就原方加肉桂9克，砂仁6克。桂、砂两味，是阴症开窍药，温胃散寒，并具升降气机之力。
此方有纳气归肾之妙。方中砂仁辛温，能散脾胃寒邪，且有纳气归肾之功；龟板咸平，滋阴潜阳，补血止血，附子辛热，能补肾中真阳，配龟板能阴阳两补；肉桂辛甘大热，补肾阳，暖脾胃，除积冷，通血脉，配附子能温肾强心，配砂仁温胃散寒；复用甘草之甘以补中，则先后天并重，阴阳两补。
四诊：服二剂，大便颜色转黄，惟稍觉腹痛，原方加炒吴萸6克，以温中止痛。嘱服二付，诸症消失。
[按]：胃痛一症，原因较多，分类不一，但不出外感、内伤两大类。上述两例均属内伤。例一胃痛兼泄泻不止，辨证为中气不足，脾气下陷，故以理中汤加减，经益气温中而愈。例二亦胃痛，但兼全身虚寒，辨证为肾阳大虚，以四逆汤等方回阳祛寒而愈。病变均在胃脘，但前例以脾气虚为主，后例以肾阳虚为主，具体表现不同，故治法亦异，而疗效均佳。故临证之际，须细审病机，切忌见痛止痛，见血止血。
嘈杂二例
例一：
李××，女，四十余岁。自诉七、八年来每于经期前后均感坐卧不安，心中嘈杂，时吐清水，经多方求医概从胃治，所用处方不外理中汤、六君汤和枣仁、远志、龙骨、牡蛎等安神定志潜阳之品，服后不仅罔效，尤增烦躁不安。今余查其脉，皆弦微细数，舌质微干苔薄白。详问经信情况，诉每月经来色暗量少，且手足心烘热，乳部胀痛，细审此证，系胆气不降，肝木侮土，以致懊（忄农）嘈杂。拟四逆散与小建中汤合方为治。处方：
方中四逆散疏肝解郁理脾，柴胡、枳实配合具升清阳降浊阴之效；小建中汤滋肝达木、补虚散寒，温建中脏。四逆散佐小建中汤意在使中阳建运，肝木得升，胆气下降则懊侬螬杂之症自消。本“上热之病，甲木不降”之旨立法。
二诊：上方服二剂后，症状大减，续服原方三剂后症状全消。为巩固疗效，嘱守原方于月经前服二剂，并用自拟当归调经汤于经期服用。追踪观察数年均未再发作。
例二：
刘××，女，30余岁。患心中嘈杂，口苦，常吐清水，得食即止，伴有手足麻木，心慌，失眠。病已年余，经西医诊断为“神经官能症”。查其脉虚弱无力，舌质青滑无苔，兼见神疲乏力。此系烦劳过度心血不足所致。治宜补血安神，稍佐清心降逆为治，用归脾汤加减。处方：
归脾汤以补心血之不足，加法夏降胃逆，杭芍养肝敛阴活血以制木香之燥，少佐黄连以清心火。
二诊：上方服二剂，症状见减，仍用归脾汤去黄连再加山荧肉以补肝之不足。
三诊：服四剂后，心中嘈杂及手足麻木、心慌已基本控制。为了巩固疗效以防再发，故嘱患者仍用归脾汤减木香之燥，加天麻15克、法夏10克、杭芍10克，在补心脾的基础上佐养肝镇静为调治。服药三剂后，数年来未见复发。
[按]：嘈杂一症《类证治裁》谓“嘈症属胃”，朱丹溪云“皆痰火为患或食郁有热”。《类证》所言以脏腑立论，病往在胃，丹溪所言以病因立论，痰火为患。二书所立处方多属常法，不外健脾化痰之类。如属变局，拘于常法则难取效。余举此二例均属嘈杂症之变局，例一系肝木乘土，甲木不降、乙木不升，故用四逆散合小建中汤舒肝理脾、温聿中脏。例二既属心脾受损又兼肝气不舒，故虽经三次诊治其方不变，始终以归脾汤补心血为主治，随证加减。由此可见中压精湛之理论及辨证论治的灵活性，不拘常规、常法，力求理论与实践的统一，方能取效于临床。
李××，男，三十岁。素有胃病，胸闷纳呆，食入作账，自感消化迟滞。病已日久。诊其脉缓而濇，舌体胖。苔薄白。此系脾湿过重，以致运化失权，影响胃气不降。治宜健脾燥湿，理气散寒，兼行滞气。处方用：
方中鸡内金健脾胃，消积滞。木香醒脾和胃，合台乌、厚朴以行滞气。良姜温胃散寒，增进食欲。再加沉香降气调中，温肾助阳，配诸理气药，又能理气宽胀。如此相辅为用，则寒去阳复，湿浊下行，胃气随降即不致上逆为病。药仅六味，配伍有法。
次诊：服一剂，即觉病情缓减。原方加京三棱6克、郁金6克，以行气化瘀。服三剂，症状消失。
[按]：隔食系饮食停滞难消之症，与脾胃功能失常有关。脾主运化，胃主受纳。脾病则运化迟滞，胃病则纳食欠佳。前人云：“脾宜升则健，胃宜降则和”。本例因湿邪滞碍气机，影响脾胃升降，故方中用鸡内金健脾化滞，配以温中散寒，降逆和胃诸品，使湿去滞消，脾气得升，胃气得降，气机调畅，升降复常。为食滞中焦、消化迟滞之治又增一法。
噎
膈
李××，男，四十岁，患噎膈已半年，询其病由，因忧思郁结，劳心伤神而起。现每当进食即感咽部梗阻，吞咽困难，食入有时吐出。诊其脉沉而弦，舌淡白。证属肝气郁结，胃逆不降，脾阳不足，影响贲门的正常启闭。所幸病程不久，胃阴未损，用荜澄茄散加砂仁。处方：
香附9克 甘草3克
上方为降逆理气、和中、化瘀、逐寒、开郁之方，尤妙在三棱一味，是肝经血分药，能化瘀血，协同香附、厚朴、陈皮更能理血中之气，而降胃逆。
二诊：上方服六剂，噎膈减轻，饮食下咽已较舒畅。原方加潞党参15克、白术9克，以益气健脾。脾能健运，则运化如常。服二剂，噎膈全止，饮食能正常受纳。
嗳气不止
李××，男，四十五岁。七个多月来，每于饭后即暖气，声大而长，连续不止，有时可达二小时之久，甚为烦恼。兼见胃脘微痛，头昏、口臭，口苦、欲呕、心烦。久治无效，始来所就诊。察其舌质绛，脉弦劲。脉症合参，显系肝胃郁热，胃失和降所致。治宜清泄肝胆郁热、和胃降逆。然病久正气已虚，应兼补气扶正之品。选方用《伤寒论》旋复代赭汤合丹溪左金丸化裁：
复诊：服上方二剂后，暖气呕逆即减，胃痛亦止。但余症尚存，脉转弦数。用原方加陈皮6克，生石膏15克以疏理中焦气机，进一步清泄郁热。连服五剂，诸症消失而愈。
[按]：嗳气即噫气，又称噫。张景岳谓：“噫者，饱食之息，即嗳气也。”嗳气与呃逆有剐。《证治汇补》谓：“胃实则噫，胃虚则哕。”哕即呃逆。说明暖气以实证居多，而呃逆声低无力者则以虚证为常见。二者均系胃气冲逆所致，但嗳则声大而长，呃则声急而短。若嗳气连续不止，或反复发作者，应结合患者体质、病程，辨清虚、实、寒、热，及夹痰、夹火等情况，灵活施治。如本例系肝胃郁热，胃失和降；但病程较长，正气已伤，故用旋复代赭汤去草、姜、枣，用旋复花消痰结、降逆气；代赭石重镇降逆，配旋复花善治暖气、呃逆、反胃等症，潞党参扶正补虚，竹茹清热止呕，涤痰开郁。左金(黄连、吴萸)清泄肝火，少用昊萸反佐黄连，引热下行，左金配竹茹，能清肝胃郁热，降逆止呕，常用于暖气、呕吐、口苦等症。遣方用药，恰中病饥，故取效神速。
饮 癖
王××，男，四十二岁，云南省陆良县人。平时嗜饮浓茶，常吐清水，每吐甚多，已达十余年之久，经西医治疗无效。中医作反胃治之，用温运法以丁香、桂心、干姜、附片、益智仁、破故纸、吴萸以及四逆汤等方药化裁，服用亦多，见效不大。后改五苓散、胃苓汤健脾利水，亦无效。且每年夏季病发尤剧，乃专程来昆就余诊治。
察其脉，弦滑满指，舌苔厚腻，面色黄暗，胃脘满闷，食少。脉症合参，诊断为饮癖。处以徐灵胎香砂胃苓汤加良姜。服后其病如故。因思此症予温运或健胃利水之剂，未司厚非，但何以不效?恍悟此病历十余年之久，脾虚是其本，饮聚是其标。经云：“能知标本，万举万当。”治本应从健脾燥湿入手，脾健自可运湿，饮何由生!乃予专治饮癖之苍术丸，改为大剂汤药。处方：
嘱日进一剂。方中苍术苦温，能燥湿健脾。《别录》谓能“消痰水”；大枣甘温，补益脾胃。二药相合，补散兼施，刚柔相济。苍术之散，得大枣之补以济之，则不致过散，大枣之补，得苍术之散以调之，则无壅滞之弊。调剂得宜，大有益于脾胃，故多服而无害。
患者连服二十剂，吐水减其半。仍守原方加灶心土30克以助扶脾之力。再服二十剂，病遂痊愈。乃告患者，今后宜少饮浓茶，以免苦降过度，有损脾阳。愈后，经追踪观察半年，未见复发。
附注：此方用治反胃吐酸等症，疗效亦佳。
四诊：服用一剂后，大便通畅，但感觉肛门灼热、口渴，这是湿热之邪又注于大肠。应当泻热和胃。使用《伤寒论》中的调胃承气汤。处方：
前两种药材一同煎煮取汁，每次调入芒硝3克，连续服用两次。
服用上方后，症状消失而痊愈。
[按语]：《灵枢·五邪篇》说：“邪气在脾胃，阳气不足，阴气有余，则会出现寒中、肠鸣、腹痛。”这是指由阴寒引起的腹痛。因为“背为阳，腹为阴”，腹部既然属阴，就喜欢温暖而厌恶寒冷，所以腹痛以寒证居多。本例脉象与证候结合分析，再结合服用苦寒药物及香蕉后，腹痛加剧，断定为肝寒胃冷所致的腹痛，毫无疑问。因为寒性凝滞，阳气不能舒展，无力运送，所以大便停滞不通，这属于寒结。至于肝寒的表现，孙思邈在《千金方》中说：“肝虚寒，病苦胁下坚硬，寒热交替，腹部胀满，不想饮食，腹胀，心情抑郁不乐。”由于肝寒导致木气郁结，郁结则肝的疏泄和升发机能受到制约，必然影响脾胃的消化吸收，这就是所谓的“木郁不能疏土”。经文说：“木郁达之”，“达”即条达舒畅的意思。所以初诊使用“霹雳汤”，用吴茱萸、木瓜温肝散寒，以顺应其条达的特性；附子、公丁香、灶心土扶助阳气，温中散寒除湿以培补脾土；丝瓜络通络散结以利于血脉。药证相符，一剂后疼痛停止。此方凡因肝胃虚寒所致的腹痛、胁痛、呕吐，使用大多有效。
另外：本例因寒结滞留于体内，经过温通治疗后，邪气向外透达，于是出现红斑。后来因为邪气郁积化热，最终形成湿热下注，所以治疗方法前后不同。
胃痛两例
病例一：
包某某，男，四十五岁。因胃痛住在某医院，诊断为“胃溃疡”。治疗两个多月，疼痛未减轻，反而腹泻不止，每天十多次，大便色黑，已经七八天不能进食，病情危重，于是邀请我会诊。患者精神倦怠，脉细小无力，舌淡苔薄白。证属中气不足，脾气下陷，胃气不和。治疗宜温脾健胃。使脾阳健运恢复正常，则胃痛自然缓解，腹泻也可自行停止。方用吴萸理中汤。处方：
炒吴茱萸6克，潞党参15克，炒白术12克，炮姜12克，炙甘草6克。
方中潞党参补气益脾，炒白术健脾燥湿而止泻，吴茱萸温胃散寒，炮姜、甘草苦甘化阴而止血。
二诊：服用两剂后，腹泻完全停止，精神好转。继续用上方去掉吴茱萸，加砂仁6克，法半夏9克，茯苓15克，以开胃醒脾。
三诊：服用两剂后，胃痛完全停止，能进食。再用陈夏六君汤两剂，补气益脾。最后用黄坤载的黄芽汤，将干姜改为炮姜。以巩固疗效。处方：
黄坤载说：“中气，是调和水火的关键，升降金木的枢纽。”又说：“中气的治疗，崇尚阳气补火，则适宜用人参、干姜；培土泄水，则适宜用甘草、茯苓。”特制黄芽汤一方，专门用于益气温中，燥湿利水。
服用两剂后，便血完全停止，大便颜色转黄，精神恢复而出院。
病例二：
李某某，男，三十四岁。因胃痛，长期反复发作，大便色黑而住进某医院。诊断为“胃溃疡”。经治疗两个多月，输血2000毫升而病情未见好转。症状见：胃痛腹胀，嗳气、反酸，畏寒肢冷，声音低微气息短促，少气懒言，面色青暗，舌质青滑，脉沉。证属肾阳大虚，阴寒凝滞，气机不畅。治疗宜扶阳抑阴，回阳祛寒。方用《伤寒论》四逆汤。处方：
附片60克，干姜15克，甘草6克。
此方专门用于驱散阴邪，峻补元阳。郑钦安说：“凡人一身，全赖一团真火（即元阳、真阳、肾阳），真火欲绝，故病见纯阴。”又说：“四逆汤一方，是回阳的主方。……既能回阳，那么世间一切阳虚阴盛导致的疾病，都可以服用。”所以我临证以来，每遇到阴寒重证，都用此方投治，往往应手取效。
二诊：服用两剂后，胃痛大减，精神好转，大便黑色转淡，微觉腹胀。在原方基础上加肉桂9克，砂仁6克。桂、砂两味药，是阴症开窍药，温胃散寒，并具备升降气机的力量。
此方有纳气归肾的妙处。方中砂仁辛温，能散脾胃寒邪，且有纳气归肾之功；龟板咸平，滋阴潜阳，补血止血，附子辛热，能补肾中真阳，配龟板能阴阳两补；肉桂辛甘大热，补肾阳，暖脾胃，除积冷，通血脉，配附子能温肾强心，配砂仁温胃散寒；复用甘草之甘以补中，则先后天并重，阴阳两补。
四诊：服用两剂后，大便颜色转黄，惟稍觉腹痛，原方加炒吴茱萸6克，以温中止痛。嘱咐服用两付，诸症消失。
[按语]：胃痛一症，原因较多，分类不一，但不外乎外感、内伤两大类。上述两例均属内伤。例一胃痛兼腹泻不止，辨证为中气不足，脾气下陷，故以理中汤加减，经益气温中而愈。例二也是胃痛，但兼全身虚寒，辨证为肾阳大虚，以四逆汤等方回阳祛寒而愈。病变均在胃脘，但前例以脾气虚为主，后例以肾阳虚为主，具体表现不同，故治法亦异，而疗效均佳。所以临证之际，须仔细审察病机，切忌见痛止痛，见血止血。
嘈杂两例
病例一：
李某某，女，四十余岁。自诉七八年来每逢经期前后都感到坐卧不安，心中嘈杂，时常吐清水，经多方求医概从胃治，所用处方不外理中汤、六君汤和枣仁、远志、龙骨、牡蛎等安神定志潜阳之品，服用后不仅无效，反而增加烦躁不安。现在我查其脉，皆弦微细数，舌质微干苔薄白。详细询问月经情况，诉说每月经来色暗量少，且手足心烘热，乳部胀痛，细审此证，系胆气不降，肝木侮土，以致懊侬嘈杂。拟四逆散与小建中汤合方为治。处方：
柴胡10克，桂枝9克，杭芍15克，枳实9克，甘草6克，生姜3片，大枣2个，饴糖15克。
方中四逆散疏肝解郁理脾，柴胡、枳实配合具升清阳降浊阴之效；小建中汤滋肝达木、补虚散寒，温建中脏。四逆散佐小建中汤意在使中阳建运，肝木得升，胆气下降则懊侬嘈杂之症自消。本“上热之病，甲木不降”之旨立法。
二诊：上方服用两剂后，症状大减，续服原方三剂后症状全消。为巩固疗效，嘱咐守原方于月经前服用两剂，并用自拟当归调经汤于经期服用。追踪观察数年均未再发作。
病例二：
刘某某，女，30余岁。患心中嘈杂，口苦，常吐清水，得食即止，伴有手足麻木，心慌，失眠。病已年余，经西医诊断为“神经官能症”。查其脉虚弱无力，舌质青滑无苔，兼见神疲乏力。此系烦劳过度心血不足所致。治疗宜补血安神，稍佐清心降逆为治，用归脾汤加减。处方：
北口芪15克，潞党参15克，当归15克，炙远志6克，炒枣仁10克，白术9克，茯神15克，木香3克，元肉15克，法夏10克，云黄连3克，杭芍10克。
归脾汤以补心血之不足，加法夏降胃逆，杭芍养肝敛阴活血以制木香之燥，少佐黄连以清心火。
二诊：上方服用两剂，症状见减，仍用归脾汤去黄连再加山茱萸以补肝之不足。
三诊：服用四剂后，心中嘈杂及手足麻木、心慌已基本控制。为了巩固疗效以防再发，故嘱患者仍用归脾汤减木香之燥，加天麻15克、法夏10克、杭芍10克，在补心脾的基础上佐养肝镇静为调治。服药三剂后，数年来未见复发。
[按语]：嘈杂一症，《类证治裁》谓“嘈症属胃”，朱丹溪云“皆痰火为患或食郁有热”。《类证》所言以脏腑立论，病多在胃，丹溪所言以病因立论，痰火为患。二书所立处方多属常法，不外健脾化痰之类。如属变局，拘于常法则难取效。我举此两例均属嘈杂症之变局，例一系肝木乘土，甲木不降、乙木不升，故用四逆散合小建中汤舒肝理脾、温建中脏。例二既属心脾受损又兼肝气不舒，故虽经三次诊治其方不变，始终以归脾汤补心血为主治，随证加减。由此可见中医精湛之理论及辨证论治的灵活性，不拘常规、常法，力求理论与实践的统一，方能取效于临床。
李某某，男，三十岁。素有胃病，胸闷纳呆，食入作胀，自感消化迟滞。病已日久。诊其脉缓而涩，舌体胖，苔薄白。此系脾湿过重，以致运化失权，影响胃气不降。治疗宜健脾燥湿，理气散寒，兼行滞气。处方用：
鸡内金9克，广木香3克，台乌9克，厚朴9克，高良姜9克，沉香3克（后下）。
方中鸡内金健脾胃，消积滞。木香醒脾和胃，合台乌、厚朴以行滞气。良姜温胃散寒，增进食欲。再加沉香降气调中，温肾助阳，配诸理气药，又能理气宽胀。如此相辅为用，则寒去阳复，湿浊下行，胃气随降即不致上逆为病。药仅六味，配伍有法。
次诊：服用一剂，即觉病情缓减。原方加京三棱6克、郁金6克，以行气化瘀。服用三剂，症状消失。
[按语]：隔食系饮食停滞难消之症，与脾胃功能失常有关。脾主运化，胃主受纳。脾病则运化迟滞，胃病则纳食欠佳。前人云：“脾宜升则健，胃宜降则和”。本例因湿邪滞碍气机，影响脾胃升降，故方中用鸡内金健脾化滞，配以温中散寒，降逆和胃诸品，使湿去滞消，脾气得升，胃气得降，气机调畅，升降复常。为食滞中焦、消化迟滞之治又增一法。
李某某，男，四十岁，患噎膈已半年，询其病由，因忧思郁结，劳心伤神而起。现每当进食即感咽部梗阻，吞咽困难，食入有时吐出。诊其脉沉而弦，舌淡白。证属肝气郁结，胃逆不降，脾阳不足，影响贲门的正常启闭。所幸病程不久，胃阴未损，用荜澄茄散加砂仁。处方：
荜澄茄9克，高良姜9克，肉桂9克，公丁香3克，厚朴9克，桔梗6克，广陈皮6克，砂仁6克，三棱9克，香附9克，甘草3克。
上方为降逆理气、和中、化瘀、逐寒、开郁之方，尤妙在三棱一味，是肝经血分药，能化瘀血，协同香附、厚朴、陈皮更能理血中之气，而降胃逆。
二诊：上方服用六剂，噎膈减轻，饮食下咽已较舒畅。原方加潞党参15克、白术9克，以益气健脾。脾能健运，则运化如常。服用两剂，噎膈全止，饮食能正常受纳。
嗳气不止
李某某，男，四十五岁。七个多月来，每于饭后即嗳气，声大而长，连续不止，有时可达二小时之久，甚为烦恼。兼见胃脘微痛，头昏、口臭，口苦、欲呕、心烦。久治无效，始来我所就诊。察其舌质绛，脉弦劲。脉症合参，显系肝胃郁热，胃失和降所致。治疗宜清泄肝胆郁热、和胃降逆。然病久正气已虚，应兼补气扶正之品。选方用《伤寒论》旋复代赭汤合丹溪左金丸化裁：
旋复花6克（布包），生代赭石15克，法半夏9克，潞党参15克，炒云连5克，炒吴茱萸2克，竹茹6克。
复诊：服用上方两剂后，嗳气呕逆即减，胃痛亦止。但余症尚存，脉转弦数。用原方加陈皮6克，生石膏15克以疏理中焦气机，进一步清泄郁热。连续服用五剂，诸症消失而愈。
[按语]：嗳气即噫气，又称噫。张景岳谓：“噫者，饱食之息，即嗳气也。”嗳气与呃逆有别。《证治汇补》谓：“胃实则噫，胃虚则哕。”哕即呃逆。说明嗳气以实证居多，而呃逆声低无力者则以虚证为常见。二者均系胃气冲逆所致，但嗳则声大而长，呃则声急而短。若嗳气连续不止，或反复发作者，应结合患者体质、病程，辨清虚、实、寒、热，及夹痰、夹火等情况，灵活施治。如本例系肝胃郁热，胃失和降；但病程较长，正气已伤，故用旋复代赭汤去草、姜、枣，用旋复花消痰结、降逆气；代赭石重镇降逆，配旋复花善治嗳气、呃逆、反胃等症，潞党参扶正补虚，竹茹清热止呕，涤痰开郁。左金（黄连、吴茱萸）清泄肝火，少用吴茱萸反佐黄连，引热下行，左金配竹茹，能清肝胃郁热，降逆止呕，常用于嗳气、呕吐、口苦等症。遣方用药，恰中病机，故取效神速。
王某某，男，四十二岁，云南省陆良县人。平时嗜饮浓茶，常吐清水，每吐甚多，已达十余年之久，经西医治疗无效。中医作反胃治之，用温运法以丁香、桂心、干姜、附片、益智仁、破故纸、吴茱萸以及四逆汤等方药化裁，服用亦多，见效不大。后改五苓散、胃苓汤健脾利水，亦无效。且每年夏季病发尤剧，乃专程来昆就余诊治。
察其脉，弦滑满指，舌苔厚腻，面色黄暗，胃脘满闷，食少。脉症合参，诊断为饮癖。处以徐灵胎香砂胃苓汤加良姜。服用后其病如故。因思此症予温运或健胃利水之剂，未司厚非，但何以不效？恍悟此病历十余年之久，脾虚是其本，饮聚是其标。经文说：“能知标本，万举万当。”治本应从健脾燥湿入手，脾健自可运湿，饮何由生！乃予专治饮癖之苍术丸，改为大剂汤药。处方：
嘱咐日进一剂。方中苍术苦温，能燥湿健脾。《别录》谓能“消痰水”；大枣甘温，补益脾胃。二药相合，补散兼施，刚柔相济。苍术之散，得大枣之补以济之，则不致过散，大枣之补，得苍术之散以调之，则无壅滞之弊。调剂得宜，大有益于脾胃，故多服而无害。
患者连续服用二十剂，吐水减其半。仍守原方加灶心土30克以助扶脾之力。再服用二十剂，病遂痊愈。乃告患者，今后宜少饮浓茶，以免苦降过度，有损脾阳。愈后，经追踪观察半年，未见复发。
附注：此方用治反胃吐酸等症，疗效亦佳。
Black Prepared Aconite Root (Hei Fupian) 30g, Rhubarb (Dahuang) 9g (simmered together), Asarum (Xixin) 3g.
Fourth consultation: After taking one dose, bowel movements became unobstructed, but there was a burning sensation in the anus and thirst. This indicates that damp-heat has again poured into the Large Intestine (Da Chang). The treatment should be to purge heat and harmonize the Stomach (Wei). Use Tiao Wei Cheng Qi Tang (Regulate the Stomach and Purge Accumulation Decoction) from *Shang Han Lun*. Prescription:
Rhubarb (Dahuang) 6g, Honey-fried Licorice Root (Zhi Gancao) 4.5g, Mirabilite (Mangxiao) 6g (packaged separately).
Decoct the first two ingredients together to obtain the juice. Mix in 3g of Mirabilite each time, and take continuously for two doses.
After taking the above prescription, symptoms disappeared and the patient recovered.
[Commentary]: *Ling Shu: Wu Xie Pian* states: "When pathogenic factors are in the Spleen and Stomach, if Yang qi is insufficient and Yin qi is excessive, it results in cold affecting the interior, intestinal borborygmus, and abdominal pain." This refers to abdominal pain caused by Yin-cold. Since "the back is Yang and the abdomen is Yin," and the abdomen belongs to Yin, it prefers warmth and dislikes cold; therefore, abdominal pain is mostly due to cold syndromes. In this case, combining pulse and symptom analysis, along with the aggravation of abdominal pain after taking bitter-cold medicines and bananas, it is concluded without doubt that the abdominal pain is caused by Liver cold and Stomach cold. Because cold causes stagnation, Yang qi cannot expand, lacking the strength to transport, leading to stagnant bowels and obstruction; this is known as cold accumulation. Regarding manifestations of Liver cold, Sun Simiao in *Qian Jin Fang* says: "Liver deficiency cold causes suffering from hardness under the hypochondrium, alternating cold and fever, abdominal fullness, loss of appetite, abdominal distension, and depression." Due to Liver cold causing Wood stagnation, stagnation restricts the Liver's functions of free flow and ascending, inevitably affecting the digestion and absorption of the Spleen and Stomach; this is referred to as "Wood stagnation failing to soothe Earth." The Classics state: "For Wood stagnation, promote its free flow." "Promote" means to make smooth and unobstructed. Therefore, in the first consultation, Pi Li Tang (Thunderbolt Decoction) was used, employing Evodia Fruit (Wuyu) and Quince (Mugua) to warm the Liver and dissipate cold, thereby facilitating its free-flowing nature; Prepared Aconite Root (Fupian), Clove (Gongding), and Kitchen Hearth Soil (Zaoxintu) were used to support Yang qi, warm the middle, dissipate cold, remove dampness, and nourish Spleen Earth; Luffa Fruit Network (Sigualuo) was used to unblock collaterals, dissipate nodules, and benefit blood vessels. The medicine matched the syndrome, and pain ceased after one dose. This formula is effective for abdominal pain, hypochondriac pain, and vomiting caused by Liver and Stomach deficiency-cold.
Furthermore: In this case, cold accumulation was retained internally. After warming and unblocking treatments, pathogenic factors reached the exterior, resulting in red macules. Later, because pathogenic factors stagnated and transformed into heat, it ultimately formed damp-heat pouring downward. Thus, the treatment methods differed at different stages.
Two Cases of Epigastric Pain
Case 1:
Bao XX, male, 45 years old. Admitted to a certain hospital due to epigastric pain, diagnosed with "Gastric Ulcer." After more than two months of treatment, pain did not subside; instead, diarrhea persisted incessantly, occurring more than ten times a day, with black stools. The patient had been unable to eat for seven or eight days, and the condition was critical. I was invited for consultation. The patient appeared mentally fatigued, with a fine, small, and weak pulse, pale tongue, and thin white coating. The syndrome belongs to insufficiency of Middle Qi, sinking of Spleen Qi, and disharmony of Stomach Qi. The treatment should be to warm the Spleen and strengthen the Stomach. Once Spleen Yang qi recovers normal transportation, epigastric pain will naturally ease, and diarrhea will stop. Use Wuyu Lizhong Tang (Evodia Regulating the Middle Decoction). Prescription:
Stir-fried Evodia Fruit (Chao Wuyu) 6g, Dangshen (Lu Dangshen) 15g, Stir-fried Atractylodes Macrocephala Rhizome (Chao Baizhu) 12g, Roasted Ginger (Paojiang) 12g, Honey-fried Licorice Root (Zhi Gancao) 6g.
In the formula, Dangshen tonifies Qi and benefits the Spleen; stir-fried Atractylodes strengthens the Spleen, dries dampness, and stops diarrhea; Evodia warms the Stomach and dissipates cold; roasted ginger and Licorice root use bitter-sweet transformation to generate Yin and stop bleeding.
Second consultation: After two doses, diarrhea completely stopped, and mental state improved. Continue with the above formula, removing Evodia, adding Amomum Fruit (Sharen) 6g, Processed Pinellia Tuber (Faxia) 9g, Poria (Fuling) 15g, to open the stomach and awaken the Spleen.
Third consultation: After two doses, epigastric pain completely ceased, and the patient could eat. Administer Chenxia Liujun Tang (Chenpi and Pinellia Six Gentlemen Decoction) for two doses to tonify Qi and benefit the Spleen. Finally, use Huang Yutang (Yellow Sprout Decoction) by Huang Kunzai, changing Dry Ginger (Ganjiang) to Roasted Ginger (Paojiang), to consolidate efficacy. Prescription:
Dangshen (Lu Dangshen) 15g, Roasted Ginger (Paojiang) 9g, Poria (Fuling) 15g, Honey-fried Licorice Root (Zhi Gancao) 6g.
Huang Kunzai stated: "Middle Qi is the mechanism harmonizing Water and Fire, and the axis lifting and lowering Metal and Wood." He also said: "For treating Middle Qi, promoting Yang and tonifying Fire suits Ginseng and Ginger; cultivating Earth and draining water suits Licorice and Poria." He specially formulated Huang Yutang, dedicated to benefiting Qi, warming the middle, drying dampness, and promoting urination.
After two doses, hematochezia completely stopped, stool color turned yellow, mental state recovered, and the patient was discharged.
Case 2:
Li XX, male, 34 years old. Admitted to a certain hospital due to epigastric pain, recurring frequently over a long period, with black stools. Diagnosed with "Gastric Ulcer." After more than two months of treatment and transfusion of 2000ml of blood, the condition showed no improvement. Symptoms included: epigastric pain and abdominal distension, belching, acid regurgitation, aversion to cold and cold limbs, low voice and short breath, reluctance to speak, dark bluish complexion, cyan slippery tongue, and deep pulse. The syndrome belongs to severe deficiency of Kidney Yang, stagnation of Yin-cold, and obstructed Qi mechanism. The treatment should be to support Yang and suppress Yin, restore Yang and dispel cold. Use Si Ni Tang (Frigid Extremities Decoction) from *Shang Han Lun*. Prescription:
Prepared Aconite Root (Fupian) 60g, Dry Ginger (Ganjiang) 15g, Licorice Root (Gancao) 6g.
This formula is specifically for dispersing Yin pathogens and vigorously supporting Yuan Yang (Primordial Yang). Zheng Qin'an said: "The whole body relies on a cluster of True Fire (i.e., Yuan Yang, Zhen Yang, Kidney Yang); when True Fire is about to perish, pure Yin diseases appear." He further said: "Si Ni Tang is the main formula for restoring Yang... If it can restore Yang, then all diseases in the world caused by Yang deficiency and Yin excess can be treated with it." Therefore, since I began clinical practice, whenever encountering severe Yin-cold syndromes, I have always used this formula, often achieving immediate effects.
Second consultation: After two doses, epigastric pain significantly decreased, mental state improved, stool color lightened from black, and slight abdominal distension occurred. Add Cinnamon Bark (Rougui) 9g and Amomum Fruit (Sharen) 6g to the original formula. Cinnamon and Amomum are opening agents for Yin syndromes, warming the Stomach and dissipating cold, possessing the power to regulate the ascending and descending of Qi.
Third consultation: After two doses, all symptoms continued to decrease. Change to Qian Yang Tang (Subduing Yang Decoction) plus Cinnamon Bark. Prescription:
Prepared Aconite Root (Fupian) 60g, Amomum Fruit (Sharen) 6g, Turtle Shell (Guiban) 15g, Licorice Root (Gancao) 6g, Cinnamon Bark (Rougui) 9g.
This formula has the subtlety of guiding Qi back to the Kidney. Amomum is acrid and warm, able to disperse Cold pathogens in the Spleen and Stomach, and has the function of guiding Qi back to the Kidney; Turtle Shell is salty and neutral, nourishing Yin, subduing Yang, tonifying Blood, and stopping bleeding; Aconite is acrid and hot, tonifying True Yang in the Kidney, and when paired with Turtle Shell, tonifies both Yin and Yang; Cinnamon is acrid, sweet, and greatly hot, tonifying Kidney Yang, warming the Spleen and Stomach, removing accumulated cold, and unblocking blood vessels. Paired with Aconite, it warms the Kidney and strengthens the Heart; paired with Amomum, it warms the Stomach and dissipates cold; using Licorice's sweetness to tonify the Middle ensures equal emphasis on Pre-heaven and Post-heaven, and tonification of both Yin and Yang.
Fourth consultation: After two doses, stool color turned yellow, with only slight abdominal pain. Add stir-fried Evodia Fruit (Chao Wuyu) 6g to the original formula to warm the middle and stop pain. Instructed to take two doses, after which all symptoms disappeared.
[Commentary]: Epigastric pain has many causes and classifications, but falls into two main categories: external contraction and internal injury. Both cases above belong to internal injury. Case 1 involved epigastric pain with incessant diarrhea, differentiated as insufficiency of Middle Qi and sinking of Spleen Qi, thus treated with modifications of Lizhong Tang, recovering through benefiting Qi and warming the middle. Case 2 also involved epigastric pain, but accompanied by systemic deficiency-cold, differentiated as severe deficiency of Kidney Yang, thus treated with Si Ni Tang and other formulas to restore Yang and dispel cold. Although the lesions were both in the epigastrium, the former primarily involved Spleen Qi deficiency, while the latter primarily involved Kidney Yang deficiency. Specific manifestations differed, so treatment methods varied, yet both yielded excellent results. Therefore, in clinical practice, one must carefully examine the pathogenesis, avoiding the mistake of merely stopping pain when seeing pain, or stopping bleeding when seeing bleeding.
Two Cases of Zazao (Discomfort/Heartburn)
Case 1:
Li XX, female, over 40 years old. Reported that for seven or eight years, around menstruation, she felt restless sitting and lying down, experienced zazao (discomfort/heartburn), and occasionally vomited clear fluid. Seeking medical help from many doctors, treatment generally focused on the Stomach, using prescriptions such as Lizhong Tang, Liujun Tang, and herbs like Zicao (Suanzaoren), Yuanzhi, Longgu, and Muli for calming the spirit and subduing Yang. After taking these, not only was there no effect, but irritability increased. Upon examination, her pulses were wiry, faint, fine, and rapid; tongue was slightly dry with a thin white coating. Detailed inquiry into menstrual history revealed dark, scanty flow, hot palms and soles, and breast distension/pain. Careful analysis indicated that Gallbladder Qi failed to descend, Liver Wood insulted Earth, resulting in zazao. Prescribed a combination of Si Ni San (Frigid Extremities Powder) and Xiao Jianzhong Tang (Minor Construct the Middle Decoction). Prescription:
Bupleurum Root (Chaihu) 10g, Cinnamon Twig (Guizhi) 9g, White Peony Root (Hangshaoyao) 15g, Immature Bitter Orange (Zhishi) 9g, Licorice Root (Gancao) 6g, Fresh Ginger (Shengjiang) 3 slices, Jujube (Dazao) 2 pieces, Maltose (Yitang) 15g.
In the formula, Si Ni San soothes the Liver, resolves depression, and regulates the Spleen; the combination of Bupleurum and Immature Bitter Orange lifts Clear Yang and descends Turbid Yin; Xiao Jianzhong Tang nourishes the Liver, promotes Wood growth, tonifies deficiency, dissipates cold, and warms the Middle Jiao. Combining Si Ni San with Xiao Jianzhong Tang aims to establish Middle Yang, allow Liver Wood to ascend, and cause Gallbladder Qi to descend, thereby eliminating zazao. This follows the principle: "For upper heat disease, Jia Wood fails to descend."
Second consultation: After two doses of the above formula, symptoms significantly decreased. After continuing three doses, symptoms completely disappeared. To consolidate efficacy, instructed to take two doses of the original formula before menstruation, and use self-formulated Danggui Tiaojing Tang (Angelica Menstrual Regulation Decoction) during menstruation. Follow-up observation for several years showed no recurrence.
Case 2:
Liu XX, female, over 30 years old. Suffered from zazao, bitter taste, frequent vomiting of clear fluid (relieved by eating), accompanied by numbness in hands and feet, palpitations, and insomnia. The illness lasted over a year, diagnosed by Western medicine as "Neurosis." Pulse was weak and powerless; tongue was cyan, slippery, and devoid of coating, accompanied by mental fatigue and weakness. This was caused by excessive labor leading to insufficiency of Heart Blood. Treatment should be to tonify Blood and calm the spirit, with slight assistance of clearing Heart fire and directing rebellious Qi downward. Use Guipi Tang (Restore the Spleen Decoction) with modifications. Prescription:
Astragalus Root (Beikuiqi) 15g, Dangshen (Lu Dangshen) 15g, Angelica Sinensis Root (Danggui) 15g, Processed Polygala Root (Zhi Yuanzhi) 6g, Stir-fried Sour Jujube Seed (Chao Zaoren) 10g, Atractylodes Macrocephala Rhizome (Baizhu) 9g, Poria (Fushen) 15g, Aucklandia Root (Muxiang) 3g, Longan Aril (Yuanrou) 15g, Processed Pinellia Tuber (Faxia) 10g, Yunlian (Yunnan Coptis) 3g, White Peony Root (Hangshaoyao) 10g.
Guipi Tonics the insufficiency of Heart Blood; adds Pinellia to direct Stomach Qi downward; White Peony nourishes the Liver, astringes Yin, invigorates Blood, and counteracts the dryness of Aucklandia; adds a small amount of Coptis to clear Heart fire.
Second consultation: After two doses, symptoms decreased. Continued using Guipi Tang, removing Coptis, and adding Cornus Fruit (Shanyuzhuyu) to tonify Liver insufficiency.
Third consultation: After four doses, zazao, numbness in hands and feet, and palpitations were basically controlled. To consolidate efficacy and prevent recurrence, instructed the patient to continue using Guipi Tang, reducing the dryness of Aucklandia, adding Gastrodia Rhizome (Tianma) 15g, Processed Pinellia Tuber (Faxia) 10g, and White Peony Root (Hangshaoyao) 10g. Based on tonifying Heart and Spleen, assisted by nourishing the Liver and calming the spirit. After three doses, no recurrence was observed for several years.
[Commentary]: Regarding zazao, *Lei Zheng Zhi Cai* states "Zazao belongs to the Stomach," while Zhu Danxi said "It is all caused by Phlegm-Fire or food stagnation with heat." *Lei Zheng* discusses based on Zang-Fu organs, locating the disease mainly in the Stomach; Danxi discusses based on etiology, attributing it to Phlegm-Fire. Prescriptions in both books mostly follow standard methods, essentially involving strengthening the Spleen and resolving Phlegm. If it is a variant situation, adhering to standard methods makes efficacy difficult. These two cases I cited are variants of zazao. Case 1 involves Liver Wood attacking Earth, Jia Wood failing to descend, Yi Wood failing to ascend, thus using Si Ni San combined with Xiao Jianzhong Tang to soothe the Liver, regulate the Spleen, and warm the Middle Jiao. Case 2 involves damage to Heart and Spleen combined with constrained Liver Qi; thus, despite three consultations, the formula remained unchanged, primarily using Guipi Tang to tonify Heart Blood, with modifications according to symptoms. This demonstrates the profound theory of Traditional Chinese Medicine and the flexibility of syndrome differentiation and treatment, not bound by routine or standard methods, striving for unity of theory and practice to achieve clinical efficacy.
Ge Shi Syndrome (Food Impaction/Dysphagia)
Li XX, male, 30 years old. Had chronic stomach disease, chest tightness, poor appetite, abdominal distension after eating, feeling of slow digestion. The illness had lasted a long time. Pulse was slow and choppy; tongue was enlarged with a thin white coating. This is due to excessive Spleen dampness, leading to loss of transportation authority, affecting the failure of Stomach Qi to descend. Treatment should be to strengthen the Spleen, dry dampness, regulate Qi, dissipate cold, and move stagnant Qi. Prescription:
Chicken Gizzard Membrane (Jineijin) 9g, Aucklandia Root (Guamuxiang) 3g, Curcuma Zedoaria Rhizome (Taiwu) 9g, Magnolia Bark (Houpo) 9g, High Galangal Rhizome (Gaoliangjiang) 9g, Agarwood (Chenxiang) 3g (added later).
In the formula, Chicken Gizzard Membrane strengthens the Spleen and Stomach and eliminates stagnation. Aucklandia awakens the Spleen and harmonizes the Stomach, combined with Curcuma and Magnolia Bark to move stagnant Qi. Galangal warms the Stomach and dissipates cold, increasing appetite. Adding Agarwood directs Qi downward and regulates the Middle, warms the Kidney and assists Yang; paired with Qi-regulating herbs, it also relieves abdominal distension. Used synergistically, cold dissipates, Yang recovers, turbid dampness descends, and Stomach Qi descends accordingly, preventing rebellion. Only six herbs are used, with methodical compatibility.
Second visit: After one dose, the condition felt relieved. Add Spiny Eel Rhizome (Jingsanleng) 6g and Turmeric Tuber (Yujin) 6g to the original formula to move Qi and resolve stasis. After three doses, symptoms disappeared.
[Commentary]: Ge Shi is a syndrome where food stagnates and is difficult to digest, related to dysfunction of Spleen and Stomach. The Spleen governs transportation and transformation; the Stomach governs reception and decomposition. When the Spleen is diseased, transportation slows; when the Stomach is diseased, reception is poor. Ancients said: "The Spleen is healthy when it ascends; the Stomach is harmonious when it descends." In this case, Damp-Evil obstructed the Qi mechanism, affecting Spleen and Stomach ascent and descent. Thus, the formula uses Chicken Gizzard Membrane to strengthen the Spleen and resolve stagnation, paired with herbs that warm the middle, dissipate cold, direct rebellious Qi downward, and harmonize the Stomach. This removes dampness and stagnation, allows Spleen Qi to ascend, Stomach Qi to descend, regulates Qi mechanism, and restores normal ascent and descent. This adds another method for treating food stagnation in the Middle Jiao and slow digestion.
Ye Ge Syndrome (Dysphagia)
Li XX, male, 40 years old, suffered from Ye Ge for half a year. Inquiry into the cause revealed it arose from worry, thought, depression, and mental exhaustion. Now, upon eating, he feels obstruction in the throat, difficulty swallowing, and sometimes vomits what he eats. Pulse is deep and wiry; tongue is pale white. The syndrome belongs to constrained Liver Qi, rebellious Stomach Qi failing to descend, insufficient Spleen Yang, affecting the normal opening and closing of the cardiac orifice. Fortunately, the course is not long, and Stomach Yin is not damaged. Use Bicengqiao San (Picrasma Dispelling Cold Powder) plus Amomum. Prescription:
Picrasma Rhizome (Bicengqiao) 9g, High Galangal Rhizome (Gaoliangjiang) 9g, Cinnamon Bark (Rougui) 9g, Clove (Gongdingxiang) 3g, Magnolia Bark (Houpo) 9g, Platycodon Root (Jiegeng) 6g, Tangerine Peel (Guangchenpi) 6g, Amomum Fruit (Sharen) 6g, Spiny Eel Rhizome (Sanleng) 9g, Cyperus Rhizome (Xiangfu) 9g, Licorice Root (Gancao) 3g.
The above formula is for directing rebellious Qi downward, regulating Qi, harmonizing the Middle, resolving stasis, dispelling cold, and opening depression. Particularly ingenious is the use of Spiny Eel Rhizome alone, a herb entering the Liver blood level, capable of resolving blood stasis. Collaborating with Cyperus, Magnolia Bark, and Tangerine Peel, it better regulates Qi within the blood and directs Stomach Qi downward.
Second consultation: After six doses of the above formula, Ye Ge alleviated, and swallowing food was smoother. Add Dangshen (Lu Dangshen) 15g and Atractylodes Macrocephala Rhizome (Baizhu) 9g to the original formula to benefit Qi and strengthen the Spleen. When the Spleen functions normally, transportation proceeds as usual. After two doses, Ye Ge completely stopped, and food intake normalized.
Incessant Belching
Li XX, male, 45 years old. For over seven months, belched immediately after meals, with loud and long sounds, continuous without stopping, sometimes lasting up to two hours, causing great annoyance. Accompanied by slight epigastric pain, dizziness, bad breath, bitter taste, desire to vomit, and irritability. After ineffective long-term treatment, he came to my clinic. Tongue was crimson; pulse was wiry and forceful. Combining pulse and symptoms, it clearly resulted from Liver and Stomach constrained heat, with Stomach losing harmony and descending function. Treatment should be to clear and drain constrained heat of the Liver and Gallbladder, and harmonize the Stomach while directing Qi downward. However, due to the long duration, Righteous Qi is already deficient, requiring herbs that benefit Qi and support Righteousness. Select Xuanfu Daizhe Tang (Inula and Hematite Decoction) from *Shang Han Lun* combined with Danxi Zuojin Wan (Left Metal Pill) by Zhu Danxi, modified:
Inula Flower (Xuanfuhua) 6g (wrapped in cloth), Raw Hematite (Sheng Daizheshi) 15g, Processed Pinellia Tuber (Faxia) 9g, Dangshen (Lu Dangshen) 15g, Stir-fried Coptis (Chao Yunlian) 5g, Stir-fried Evodia Fruit (Chao Wuyu) 2g, Bamboo Shavings (Zhuru) 6g.
Follow-up: After two doses of the above formula, belching and vomiting decreased, and epigastric pain stopped. However, residual symptoms remained, and the pulse turned wiry and rapid. Use the original formula plus Tangerine Peel (Chenpi) 6g and Raw Gypsum (Sheng Shigao) 15g to regulate Qi mechanism in the Middle Jiao and further clear constrained heat. After five consecutive doses, all symptoms disappeared and the patient recovered.
[Commentary]: Belching is also called Yi Qi or simply Yi. Zhang Jingyue stated: "Yi is the sigh after a full meal, i.e., belching." Belching differs from hiccups. *Zheng Hui Bu* states: "Full Stomach leads to belching; Empty Stomach leads to hiccups." Hiccups refer to hiccupping. This indicates that belching is mostly excess syndrome, while hiccups with low and weak sounds are mostly deficiency syndrome. Both result from rebellious Stomach Qi rushing upward, but belching has loud and long sounds, while hiccups have urgent and short sounds. If belching continues incessantly or recurs frequently, one must combine the patient's constitution and disease course to differentiate deficiency/excess and cold/heat, as well as complications with Phlegm or Fire, and treat flexibly. For example, this case involved Liver and Stomach constrained heat with Stomach losing descending function; however, the course was long, damaging Righteous Qi. Thus, Xuanfu Daizhe Tang was used, removing Licorice, Ginger, and Jujube. Inula resolves Phlegm nodules and directs rebellious Qi downward; Raw Hematite heavily settles and directs Qi downward; paired with Inula, it treats belching, hiccups, and regurgitation well. Dangshen supports Righteousness and tonifies deficiency; Bamboo Shavings clears heat, stops vomiting, and resolves Phlegm to open depression. Zuojin (Coptis and Evodia) clears and drains Liver fire; a small amount of Evodia acts as an antagonist to Coptis, guiding heat downward. Zuojin paired with Bamboo Shavings clears Liver and Stomach constrained heat, directs rebellious Qi downward, and stops vomiting, commonly used for belching, vomiting, and bitter taste. The prescription and medication hit the pathology precisely, hence the rapid effect.
Yin Pi Syndrome (Fluid Retention/Lump)
Wang XX, male, 42 years old, from Luliang County, Yunnan Province. Habitually drank strong tea, often vomited clear fluid, in large amounts, for over ten years. Western medical treatment was ineffective. TCM treated it as Fanwei (regurgitation/vomiting), using warming and transporting methods with herbs like Clove, Cinnamon Heart, Dry Ginger, Prepared Aconite, Alpinia Oxyphylla Fruit, Psoralea Fruit, Evodia, and formulas like Si Ni Tang. Many doses were taken with little effect. Later changed to Wuling San (Five Ling Powder) and Weiling Tang (Stomach Five Ling Decoction) to strengthen the Spleen and promote urination, also ineffective. Moreover, the illness worsened especially in summer each year, so he came specifically to Kunming for my treatment.
Examination revealed pulse wiry, slippery, and filling the fingers; tongue coating thick and greasy; complexion yellowish-dark; epigastric fullness and stuffiness, poor appetite. Combining pulse and symptoms, diagnosed as Yin Pi. Prescribed Xu Lingtai Xiangsha Weiling Tang (Aucklandia and Amomum Stomach Five Ling Decoction) plus Galangal. After taking it, the illness remained unchanged. Thinking about this, prescribing warming/transporting or strengthening Stomach/promoting urination agents was not wrong, but why ineffective? Suddenly realized: this illness lasted over ten years; Spleen deficiency is the root, fluid accumulation is the branch. The Classics say: "Knowing root and branch, ten thousand actions will be appropriate." Treating the root should start with strengthening the Spleen and drying dampness; once the Spleen is strong, it can transport dampness, how would fluid arise! Thus, prescribed Cangzhu Wan (Atractylodes Pill) specifically for treating Yin Pi, changed to a large-dose decoction. Prescription:
Atractylodes Lancea Rhizome (Cangzhu) 60g, Jujube (Dazao) 12 pieces.
Instructed to take one dose daily. Cangzhu is bitter and warm, able to dry dampness and strengthen the Spleen. *Ben Cao Bei Lu* states it can "eliminate phlegm-water"; Jujube is sweet and warm, tonifying and benefiting the Spleen and Stomach. The two herbs combined apply both tonification and dispersion, balancing rigid and soft. The dispersing nature of Cangzhu is balanced by the tonifying nature of Jujube, preventing excessive dispersion; the tonifying nature of Jujube is regulated by the dispersing nature of Cangzhu, preventing stagnation. Properly adjusted, it greatly benefits the Spleen and Stomach, so taking many doses does no harm.
The patient took twenty doses continuously, and vomiting of water reduced by half. Still adhering to the original formula, added Kitchen Hearth Soil (Zaoxintu) 30g to assist in supporting the Spleen. Took another twenty doses, and the illness was completely cured. Informed the patient to drink less strong tea in the future to avoid excessive bitter-descending action damaging Spleen Yang. After recovery, half a year of follow-up observation showed no recurrence.
Note: This formula is also effective for treating regurgitation and acid regurgitation.
Cold Closing Lung Qi, Cough, and Hypochondriac Pain