【歌】畏食分明是恶心，呕而无物亦无声。胃中寒气兼痰火，随证斟量细辨明。
【论】戴云∶恶心者，无声无物，心下欲吐不吐，欲呕不呕，心中兀兀如畏舟车者是也。
胃寒
胃中有寒气而作恶心者，呕清水，不渴，脉迟，明知食寒物、受寒气，大半夏汤、小半夏茯苓汤、理中汤
加生姜、半夏。
大半夏汤
半夏（二钱五分） 陈皮（二钱五分） 茯苓（二钱五分） 生姜（二钱五分）
上锉，一剂，水二盏，煎一盏，热服。
小半夏茯苓汤（方见咳逆。）
理中汤（方见中寒。）
胃热
胃中有热而作恶心呕酸，内有热，脉必浮大而滑数，烦渴，二陈加姜炒黄连、山栀。胃气不足，内热恶心，
六君子汤加辰砂、姜炒黄连。
二陈汤（方见痰证。）
六君子汤（方见脾胃。）
【歌】要识吞酸与吐酸，总因湿热肺脾间。吐酸吐出酸如醋，若是吞酸咯吐难。
【论】夫吞酸与吐酸不同，吐酸者，吐出酸水如醋。平时津液随上升之气郁滞日久，湿中生热，故从火
化，遂作酸味，如谷肉在器，湿热则易酸。吞酸者，郁滞日久，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；肌肤得温暖则腠理开发，或得香热汤丸，则津液流通，郁热得
行，亦可暂解，盖标寒而本热也。故《素问》、河间言热者，言其本也，东垣言寒者，言其标也。学人当究其
浅深之感，本末之治而用药，庶可取十全之效也。
【脉】吞酸脉形，多弦而滑。或沉而迟，胸有寒饮；或数而洪，胸有痰热。
吞酸
吞酸是湿热郁滞于肺胃之间，必 食自养，二陈汤加吴茱萸、黄连，顺其性而折之，佐以苍术、茯苓以行
其湿热，再加姜炒黄连。吞酸有食不化者，平胃散加神曲、麦芽、山楂、姜炒黄连。
二陈汤（方见痰证。）
平胃散（方见中湿。）
吐酸
吐酸者，津液随上升之气郁之日久，湿中生热，故从火化而作酸味，二陈汤加吴茱萸、炒黄连、山栀、苍
术、浓朴、生姜。中脘有宿食留饮，酸味蜇心痛，或吐酸水如醋之味，
蜇牙痛，曲术丸、茱连丸。
曲术丸
治中脘停食留饮，酸蜇心痛，或口吐清水。
神曲（炒，三两） 陈皮（一两） 苍术（米泔浸，炒，一两五钱）
上为末，生姜汁煮神曲为丸，每服七十丸，姜汤下。
茱连丸
黄连（一两，酒炒） 黄芩（五钱，酒炒） 陈皮（五钱） 吴茱萸（五钱，煮，晒干） 苍术
（七钱，米泔浸，炒）
上为末，煮神曲为丸，下七十丸。
按∶是方以芩、连治热，热去则不吐酸。苍术燥湿，湿除则不生热。陈皮理气，气行则湿不郁。（茱萸
味辛热，能引芩、连入肝而泻火，此从治之义也。）
【歌诀】
食欲减退且界限分明，这是恶心的表现；呕吐却没有食物排出，也没有声音。这是由于胃中寒气夹杂痰火所致，需根据具体证候仔细辨别后斟酌用药。
【论述】
戴元礼说：所谓恶心，是指没有声音也没有食物吐出，感觉心下部想要呕吐却吐不出来，心中感到不安、晕眩，如同害怕乘坐车船一样。
胃寒
胃中有寒气导致恶心的，会呕吐清水，口不渴，脉象迟缓。如果明确知道是吃了寒凉食物或受寒邪侵袭，可用大半夏汤、小半夏茯苓汤，或在理中汤中加入生姜和半夏。
大半夏汤
半夏（二钱五分） 陈皮（二钱五分） 茯苓（二钱五分） 生姜（二钱五分）
以上药材切碎，取一剂药，加水两盏，煎煮至一盏，温热服用。
小半夏茯苓汤（方剂见“咳逆”章节。）
理中汤（方剂见“中寒”章节。）
胃热
胃中有热导致恶心并呕吐酸水，体内有热，脉象必然浮大且滑数，伴有烦躁口渴。可用二陈汤加入姜炒黄连和山栀。如果是胃气不足导致的内热恶心，可用六君子汤加入辰砂和姜炒黄连。
二陈汤（方剂见“痰证”章节。）
六君子汤（方剂见“脾胃”章节。）
【歌诀】
要识别吞酸与吐酸的区别，总归是因为湿热蕴结于肺脾之间。吐酸是将酸水吐出像醋一样；如果是吞酸，则咯吐困难。
【论述】
吞酸和吐酸是不同的。吐酸，是指吐出像醋一样的酸水。平时津液随着上升的气机郁滞日久，湿气中生热，因此从火化而变成酸味，就像谷物肉类放在容器中，遇湿热就容易变酸一样。吞酸，则是郁滞日久，不能自行涌出，潜伏在肺胃之间，想咯吐上不来，想咽下去又咽不下。肌表受到风寒侵袭，则内部的热更加郁闭，酸味刺痛心脏；肌肤得到温暖则腠理开泄，或者喝下香热的汤药丸剂，则津液流通，郁热得以运行，也可以暂时缓解，这属于标症为寒而本症为热。所以《素问》和刘河间（河间）说这是热证，是说它的本质；李东垣说这是寒证，是说它的表象。学习的人应当探究其浅深的影响，针对根本和表象进行治疗来用药，才可以取得十全十美的疗效。
【脉诊】
吞酸的脉象，多表现为弦而滑。或者是沉而迟，说明胸中有寒饮；或者是数而洪，说明胸中有痰热。
吞酸
吞酸是湿热郁滞于肺胃之间，必须注意饮食调养以自养身体，用二陈汤加入吴茱萸和黄连，顺应其性而折服它，佐以苍术和茯苓来行散其湿热，再加姜炒黄连。吞酸伴有食物不消化的，用平胃散加入神曲、麦芽、山楂和姜炒黄连。
二陈汤（方剂见“痰证”章节。）
平胃散（方剂见“中湿”章节。）
吐酸
吐酸，是津液随上升之气郁滞日久，湿中生热，因此从火化而变成酸味，用二陈汤加入吴茱萸、炒黄连、山栀、苍术、浓朴和生姜。如果中脘有宿食和留饮，酸味刺痛心脏，或者吐出像醋一样的酸水，刺痛牙齿，可用曲术丸、茱连丸。
曲术丸
治疗中脘停食留饮，酸味刺痛心脏，或者口吐清水。
神曲（炒，三两） 陈皮（一两） 苍术（米泔水浸泡，炒，一两五钱）
以上研为细末，用生姜汁煮神曲制成丸药，每次服用七十丸，用姜汤送下。
茱连丸
黄连（一两，酒炒） 黄芩（五钱，酒炒） 陈皮（五钱） 吴茱萸（五钱，煮后晒干） 苍术（七钱，米泔水浸泡，炒）
以上研为细末，煮神曲制成丸药，每次服用七十丸。
按语：这个方子用黄芩、黄连治疗热证，热去则不再吐酸。苍术燥湿，湿除则不生热。陈皮理气，气行则湿不郁。（吴茱萸味辛热，能引导黄芩、黄连进入肝脏以泻火，这是从治的意义。）
[Verse]
Clear aversion to food indicates **nausea** (恶心). Vomiting without substance and without sound. Cold qi in the stomach combined with phlegm-fire; carefully distinguish according to the syndrome to measure treatment.
[Discussion]
Dai [Yuanli] said: Nausea is characterized by no sound and no vomitus, a sensation of wanting to vomit from the epigastrium but being unable to do so, and a feeling of uneasiness or vertigo in the mind, as if afraid of riding in carts or boats.
Stomach Cold
When nausea arises from cold qi in the stomach, there is vomiting of clear fluid, no thirst, and a slow pulse. If it is clearly known that one has eaten cold food or been exposed to cold pathogenic factors, use Banxia Banliu Tang (Half-Scutellaria Decoction), Xiaobanxia Fuling Tang (Minor Pinellia and Poria Decoction), or Lizhong Tang (Regulate the Middle Decoction) added with Shengjiang (Fresh Ginger) and Banxia (Pinellia).
Banxia Banliu Tang (Half-Scutellaria Decoction)
Banxia (Pinelliae Rhizoma, 2.5 qian) Chenpi (Citri Reticulatae Pericarpium, 2.5 qian) Fuling (Poria, 2.5 qian) Shengjiang (Zingiberis Rhizoma Recens, 2.5 qian)
Cut the above ingredients into small pieces. Take one dose, add two cups of water, decoct to obtain one cup, and take warm.
Xiaobanxia Fuling Tang (Minor Pinellia and Poria Decoction) (Formula see "Ke Ni" / Hiccups.)
Lizhong Tang (Regulate the Middle Decoction) (Formula see "Zhong Han" / Middle Cold.)
Stomach Heat
When heat in the stomach causes nausea and vomiting of sour fluid, internal heat is present, the pulse must be floating, large, slippery, and rapid, accompanied by irritability and thirst. Use Erchen Tang (Two-Aged Decoction) added with Jiangchao Huanglian (Ginger-fried Coptidis Rhizoma) and Shanzhi (Gardeniae Fructus). If internal heat nausea arises from insufficiency of Stomach Qi, use Liujunzi Tang (Six-Gentlemen Decoction) added with Chensha (Cinnabar) and Jiangchao Huanglian (Ginger-fried Coptidis Rhizoma).
Erchen Tang (Two-Aged Decoction) (Formula see "Tan Zheng" / Phlegm Syndrome.)
Liujunzi Tang (Six-Gentlemen Decoction) (Formula see "Pi Wei" / Spleen and Stomach.)
[Verse]
To recognize the difference between Swallowing Sourness (Tun Suan) and Spitting Sourness (Tu Suan), it is generally due to damp-heat between the Lung and Spleen. Spitting Sourness involves spitting out sour fluid like vinegar; if it is Swallowing Sourness, it is difficult to expectorate or swallow.
[Discussion]
Swallowing Sourness and Spitting Sourness are different. Spitting Sourness refers to spitting out sour fluid like vinegar. Normally, body fluids stagnate for a long time along with ascending Qi; dampness generates heat within, thus transforming via Fire, resulting in a sour taste, just as grains and meats become sour easily when subjected to damp-heat in containers. Swallowing Sourness occurs when stagnation persists for a long time, preventing spontaneous emergence; it lies hidden between the Lung and Stomach, unable to be coughed up or swallowed down. When the muscle surface is affected by wind-cold, internal heat becomes more constrained, and the sour taste pierces the heart; when the skin and muscles are kept warm, the pores open, or after taking fragrant and hot herbal pills or soups, body fluids circulate, and constrained heat can move, providing temporary relief. This is because the manifestation is cold while the root is heat. Therefore, Suwen and Hejian [Liu Wansu] speaking of heat refer to the root, while Dongyuan [Li Gao] speaking of cold refers to the manifestation. Students should investigate the depth of its influence and treat both root and manifestation to achieve perfect efficacy.
[Pulse Diagnosis]
The pulse form for Swallowing Sourness is often wiry and slippery. Or it may be deep and slow, indicating cold-fluid retention in the chest; or rapid and surging, indicating phlegm-heat in the chest.
Swallowing Sourness
Swallowing Sourness is damp-heat constrained between the Lung and Stomach; one must pay attention to dietary nourishment. Use Erchen Tang (Two-Aged Decoction) added with Wuzhuyu (Evodiae Fructus) and Huanglian (Coptidis Rhizoma) to follow its nature and subdue it, assisted by Cangzhu (Atractylodis Rhizoma) and Fuling (Poria) to promote the movement of damp-heat, plus Jiangchao Huanglian (Ginger-fried Coptidis Rhizoma). For Swallowing Sourness accompanied by undigested food, use Pingwei San (Maintain the Middle Powder) added with Shenqu (Massae Medicatae Fermentatae), Maiya (Hordei Fructus Germinatus), Shanzha (Crataegi Fructus), and Jiangchao Huanglian (Ginger-fried Coptidis Rhizoma).
Erchen Tang (Two-Aged Decoction) (Formula see "Tan Zheng" / Phlegm Syndrome.)
Pingwei San (Maintain the Middle Powder) (Formula see "Zhong Shi" / Middle Dampness.)
Spitting Sourness
Spitting Sourness occurs when body fluids stagnate for a long time along with ascending Qi, dampness generates heat within, thus transforming via Fire to produce a sour taste. Use Erchen Tang (Two-Aged Decoction) added with Wuzhuyu (Evodiae Fructus), Chao Huanglian (Fried Coptidis Rhizoma), Shanzhi (Gardeniae Fructus), Cangzhu (Atractylodis Rhizoma), Houpo (Magnoliae Officinalis Cortex), and Shengjiang (Zingiberis Rhizoma Recens). If there is retained food and fluid in the Zhongwan area, with sour pain piercing the heart, or spitting sour fluid like vinegar that stings the teeth, use Quzhu Wan (Curcuma and Atractylodes Pill) or Zhulian Wan (Evodia and Coptis Pill).
Quzhu Wan (Curcuma and Atractylodes Pill)
Treats retained food and fluid in the Zhongwan area, sour pain piercing the heart, or spitting clear fluid.
Shenqu (Massae Medicatae Fermentatae, fried, 3 liang) Chenpi (Citri Reticulatae Pericarpium, 1 liang) Cangzhu (Atractylodis Rhizoma, soaked in rice wash water, fried, 1.5 liang)
Grind the above into powder. Cook Shenqu with ginger juice to make pills. Take 70 pills per dose, washed down with ginger soup.
Zhulian Wan (Evodia and Coptis Pill)
Huanglian (Coptidis Rhizoma, 1 liang, wine-fried) Huangqin (Scutellariae Radix, 5 qian, wine-fried) Chenpi (Citri Reticulatae Pericarpium, 5 qian) Wuzhuyu (Evodiae Fructus, 5 qian, boiled and sun-dried) Cangzhu (Atractylodis Rhizoma, 7 qian, soaked in rice wash water, fried)
Grind the above into powder. Cook Shenqu to make pills. Take 70 pills per dose.
Note: This formula uses Huangqin (Scutellariae Radix) and Huanglian (Coptidis Rhizoma) to treat heat; when heat is removed, spitting sourness ceases. Cangzhu (Atractylodis Rhizoma) dries dampness; when dampness is eliminated, heat does not generate. Chenpi (Citri Reticulatae Pericarpium) regulates Qi; when Qi moves, dampness does not constrain. (Wuzhuyu [Evodiae Fructus] is pungent and hot, capable of guiding Huangqin and Huanglian into the Liver to drain fire; this is the meaning of contrary treatment.)