胃爱散（热七一） 祛痰丸（和百三） 香砂六君子汤（补七）
《至真要大论》曰∶诸呕吐酸，暴注下迫，皆属于热。少阳之胜，呕酸善饥。
吐酸一证，在河间言其为热，在东垣言其为寒，夫理有一定，奚容谬异若此，岂理因二
子可以易乎，必二子于理有一悖耳。此余之不能无言者，乃以东垣为是，而以河间为非也。
何以见之？盖河间之说，实本《内经》，经曰∶诸呕吐酸，暴注下迫，皆属于热。故河间《
病机》悉训为火，而甚以主寒者为非。不知《内经》此论，乃以运气所属概言病应，非以呕
吐注泻皆为内热病也。如果言热，则何以又曰∶寒气客于肠胃，厥逆上出，故痛而呕也。又
曰∶太阳之复，心胃生寒，胸中不和，唾出清水，及为哕噫。此言呕吐之有寒也，岂皆热耶
？又曰∶太阳之胜，寒入下焦，传为濡泄，此言泄泻之有寒也，岂亦热耶？由此观之，则其此
处言热，而彼复言寒，岂非自相矛盾，能无谬乎？不知《内经》之理，圆通详悉，无不周备
，故有此言其常而彼言其变者，有此言其顺而彼言其逆者，有此篇未尽而足之他论者，有总
言所属而详言所病者，此《内经》之玄，所以不易穷也。故凡善观此者，务宜悟其源流，察
其分合，其博也，必烛其为千为万；其约也，必贯其总归一理，夫如是，斯足称明眼人矣。
倘不能会其巅末，而但知管测一斑，又乌足以尽其妙哉。矧复有不明宗旨，悖理妄谈，谬借
《经》文证己偏见者，尚难枚举，无暇辨也，兹因二子之论，故并及之，而再悉于下，观者
其加政焉。
一、辨河间吐酸之论为非。据河间曰∶酸者，肝木之味也，由火盛制金，不能平木，则
肝木自甚，故为酸也，如饮食热则易于酸矣。或言吐酸为寒者，误也。所以妄言为寒者，但
谓多伤生硬粘滑，或伤冷物而为噫酸吞酸，故俗医主于温和脾胃，岂知经言∶人之伤于寒也
，则为病热。故凡内伤冷物者，或即阴胜阳而为病寒者，或寒热相击而致肠胃阳气怫郁而为
热者，亦有内伤生冷而反病热，得大汗，热泄身凉而愈也。若久喜酸而不已，则不宜温之，
宜以寒药下之，后以凉药调之，结散热去则气和也。
凡此皆河间之说，余每见之，未尝不反复切叹。观其所言病机，则由火及金，由金及木
，由木及脾，所以为酸，若发微谈理，果可转折如此，则指鹿为马，何患无辞？惟其执以为
热，故不得不委曲若此。若余言其为寒，则不然也。夫酸本肝木之味，何不曰火衰不能生土
，则脾气虚而肝邪侮之，故为酸也，岂不于理更为明切，而何以曲折强解有若是乎。又若《
内经》所言人之伤于寒也，则为病热，此言伤寒证寒邪在表，则为三阳之发热，及其传里，
则为阳明之内热，岂以内伤冷物而亦云病热者耶？又岂有内伤冷物而可以汗解者耶？即以气血
强盛之人，偶伤生冷，久留不去而郁为热者，此以郁久化热，或亦有之，岂果因生冷而反热
耶？矧《内经》本以外感言，而河间引以证内伤，谬亦甚矣。此不惟大害轩岐之旨，而致后
人执以借口，其害又将何如也。
一、辨东垣吐酸之论为是。据《发明》曰∶《内经》言诸呕吐酸，皆属于热，此上焦受
外来客邪也，胃气不受外邪故呕，仲景以生姜、半夏治之。以杂病论之，呕吐酸水者，甚则
酸水浸其心，其次则吐出酸水，令上下牙酸涩不能相对，以大辛热药疗之必减也。酸味者，
收气也，西方肺金旺也。寒水乃金之子，子能令母实，故用大咸热之剂泻其子，以辛热为之
佐，而泻肺之实，《病机》作热攻之，误矣。盖杂病醋心，浊气不降，欲为中满，寒药岂能
治之乎？
此东垣之说也，余谓其最为得理。但其立言太讳，如所云收气及西方金旺，水为金子等
义，人有未达，每多忽之。即在丹溪，亦曰东垣不言外得风寒，而作收气立说，欲泻肺金之
实，又谓寒药不可治酸，而用安胃汤、加减二陈汤，俱犯丁香，且无治热湿郁积之法，为未
合经意也。因考丹溪治法，则用茱莲丸、二陈汤，且曰∶宜用炒吴茱萸，顺其性而折之，乃
反佐之法也，必用黄连为君以治之。此丹溪之意亦主于热，正与东垣相反，而欲以芩连治吐
酸，则不可不辨也，故余以东垣之说请为之疏焉。
夫所谓收气者，金气也，即秋气也。《内经》曰∶秋气始于上。盖阴盛之渐，必始于秋
，以阳气之将退也。寒肃之渐，必始于上，以阳气之日降也。其云金旺者，非云肺气之充实
，正言寒气之有余也。其云子令母实者，以寒在上焦，则收气愈甚，故治用咸热等剂以泻其
子，亦无非扶阳抑阴之道，最切当也。丹溪未达其意，而反以非之，抑又何也。即如丁香气
味辛爽无毒，凡中焦寒滞，气有不顺者，最其所宜，又何至以犯字相戒，而使后人畏之如虎
耶？盖丹溪但知丁香不可犯，而不知黄连、黄芩又岂吞酸证所宜轻犯者哉。然说虽如此，而
说有未尽，则云寒云热，犹不无疑，谨再竟其说如下。
一、吐酸证，诸言为热者，岂不各有其说。在刘河间则曰∶如饮食热则易酸矣。在戴原
礼则曰∶如谷肉在器，湿热则易为酸也。又有相传者曰∶观之造酒者，凉作则甘，过热则酸
，岂非酸由热乎？诸说如此，宛然可信，而欲人不从不可得也，凡诸似是而非者，正以此类
。譬之射者，但能不离于前后左右，便云高手，不知犯此四字，尚足以言射乎？而诸家之说
，亦犹是耳。
何以见之？盖察病者，当察以理，察理者，当察以真。即如饮食之酸由乎热，似近理矣
，然食在釜中，使能化而不能酸者，此以火力强而速化无留也，若起置器中，必久而后酸，
此停积而酸，非因热而酸也。尝见水浆冷积既久，未有不酸者，此岂热耶，因不行也。又云
造酒者热作则酸，亦似近理，然必于二三日之后，郁热不开，然后成酸，未有热作及时而遂
致酸者。且人之胃气，原自天热，所以三餐入胃，俱能顷刻消化，此方是真阳火候之应；若
如造酒者，必待竟日而后成，则日不再餐，胃气能无惫乎？若必如冷作之不酸，方云无火，
则饮食之化，亦须旬日，此其胃中阳气不已竭乎？是可见胃气本宜暖，稍凉不可也，酒瓮本
宜疏，郁闷不可也。故酒瓮之化，亦安能如胃气之速，而胃气之健，又安可同酒瓮之迟乎？
此其性理相悬，奚啻十倍，有不待辨也明矣。且人之饮食在胃，惟速化为贵，若胃中阳气不
衰，而健运如常，何酸之有？使火力不到，则其化必迟，食化既迟，则停积不行而为酸为腐
，此酸即败之渐也。故凡病吞酸者，多见饮食不快，自食有不快，必渐至中满、痞隔、泄泻
等证，岂非脾气不强，胃脘阳虚之病，而犹认为火，能无误乎？余向在燕都，尝治一缙绅患
此而求治者，余告以寒，彼执为热，坚持造酒之说，以相问难，莫能与辩，竟为芩连之属所
毙，而终不能悟，岂非前说之误之也耶，亦可哀矣。余故曰∶人之察理，贵察其真，若见理
不真，而疑似固执，以致酿成大害者，无非此类，此似是而非之谈，所以不可不辨也。
一、吞酸之与吐酸，证有三种∶凡喉间嗳噫，即有酸水如醋浸心，嘈杂不堪者，是名吞
酸，即俗所谓作酸也，此病在上脘最高之处，不时见酸，而泛泛不宁者是也。其次则非如吞
酸之近，不在上脘，而在中焦胃脘之间，时多呕恶，所吐皆酸，即名吐酸，而渥渥不行者是
也。又其次者，则本无吞酸吐酸等证，惟或偶因呕吐所出，或酸或苦，及诸不堪之味，此皆
肠胃中痰饮积聚所化，气味每有浊恶如此，此又在中脘之下者也；但其顺而下行，则人所不
觉，逆而上出，则喉口难堪耳。凡此三者，其在上中二脘者，则无非脾胃虚寒，不能运化之
病，治此者非温不可。其在下脘偶出者，则寒热俱有，但当因证以治其呕吐，呕吐止则酸苦
无从见矣。虽然，此亦余之论证，故不得不曲尽其说，若以实理言之，则凡胃强者，何暇及
于酸苦，其有酸苦者，必其停积不行而然。此宜随证审察，若无热证热脉可据，而执言湿中
生热，无分强弱，惟用寒凉，则未有不误者矣。
【背景信息】
书名：景岳全书 作者：张介宾 朝代：明 章节：论外备用方 / 经义 / 辨证（共五条） 类别：综合
胃爱散（热七一） 祛痰丸（和百三） 香砂六君子汤（补七）
《至真要大论》中说：各种呕吐泛酸，突然腹泻且伴有里急后重，都属于热证。少阳胆经邪气偏胜时，会出现呕吐酸水、容易饥饿的症状。
关于吐酸这一病证，刘河间认为它是热证，李东垣认为它是寒证。道理应当是确定的，为何会谬误差异到这种地步？难道道理会因为这两位医家而改变吗？必定是其中一位在道理上有悖逆之处。这是我不能不说话的原因，我认为李东垣的观点是正确的，而刘河间的观点是错误的。凭什么这样判断呢？因为刘河间的说法，实际上依据的是《内经》，经文说：“各种呕吐泛酸，突然腹泻且伴有里急后重，都属于热。”所以刘河间在《原病式》中将所有病机都解释为火（火热之邪），并且非常反对以寒证来解释。但他不知道，《内经》这里的论述，是根据五运六气所属来概括疾病应验的规律，并不是说所有的呕吐、注泻都是内热病。如果说是热证，那么为什么又说：“寒气客居于肠胃，导致厥逆之气向上冲出，所以疼痛并呕吐”？又说：“太阳膀胱经复气发作，心胃产生寒邪，胸中不和顺，吐出清水，以及发生呃逆嗳气。”这是在说明呕吐有寒证的情况，难道都是热证吗？又说：“太阳经邪气偏胜，寒气进入下焦，传变为濡泄（稀便），”这是在说明泄泻有寒证的情况，难道也是热证吗？由此看来，这里说热，那里又说寒，岂不是自相矛盾，怎么能没有谬误呢？其实《内经》的道理圆通详尽，无不周全完备，所以有说常态而这里有变异的，有说顺境而这里有逆境的，有这篇没说完而在其他论述中补充的，有总括归属而详细论述病症的，这就是《内经》深奥玄妙之处，所以不容易穷尽。因此，凡是善于观察的人，务必领悟其源流，考察其分合，广博地看，必须看清千变万化；简约地看，必须贯穿其总归于一理，像这样，才足以称为明眼人。如果不能领会其始末，而只知道管中窥豹，又怎么能够穷尽其奥妙呢？况且还有不明宗旨，违背道理妄加谈论，错误地借用《内经》文句来证明自己的偏见者，多得难以列举，无暇一一辨析了。现在因为这两位医家的论述，所以一并提及，并在下面详细阐述，读者请加以审察。
一、辨析刘河间关于吐酸的论述是错误的。根据刘河间所说：酸味，是肝木的味道，由于火盛克制金（肺），不能平抑木（肝），则肝木自身亢盛，所以表现为酸，就像饮食受热就易于变酸一样。有人说吐酸是寒证，这是错误的。之所以妄言是寒证，只是认为多因损伤生硬粘滑之物，或损伤冷物而导致嗳气吞酸，所以世俗医生主张用温和脾胃的方法治疗。哪里知道经文说：“人受寒邪侵袭，就会得热病。”所以凡是内伤冷物的人，有的是阴胜阳衰而表现为寒病，有的是寒热相互搏击而导致肠胃阳气郁结而产生热病，也有内伤生冷反而得热病，通过大汗出，热随汗泄身体凉爽而痊愈的。如果长久喜欢酸味而不止，就不宜温补，应该用寒药攻下，之后用凉药调理，待结散热去则气和顺了。
这些都是刘河间的说法，我每次见到，未尝不反复深切感叹。看他所说的病机，是由火及金，由金及木，由木及脾，从而产生酸味，如果发微谈理，确实可以转折成这样，那真是指鹿为马，何愁没有借口？只因为他执着于认为是热证，所以不得不如此委曲解释。如果我说是寒证，就不是这样了。酸本是肝木的味道，为什么不说是火衰不能生土（脾），导致脾气虚弱而肝邪欺侮它，所以产生酸味呢？这难道不是道理更为明确切当，何必曲折强解到这种地步呢？另外，《内经》所说“人受寒邪侵袭，就会得热病”，这是说伤寒证中寒邪在表，就会导致三阳经发热，等到传入里，就成为阳明经的内热，难道是说内伤冷物也叫做得热病吗？难道有内伤冷物可以通过发汗解除的吗？即使是气血强盛的人，偶尔损伤生冷，久久停留不去而郁积化为热，这是以郁久化热，或许也有这种情况，难道真的是因为生冷反而变成热吗？况且《内经》原本是针对外感而言，而刘河间引用它来证明内伤，谬误也太大了。这不仅大大损害了黄帝岐伯的宗旨，而且导致后人以此为借口，其危害又将如何呢？
二、辨析李东垣关于吐酸的论述是正确的。根据《医学发明》所说：《内经》说各种呕吐泛酸，都属于热，这是上焦受到外来客邪，胃气不受外邪所以呕吐，张仲景用生姜、半夏治疗。从杂病角度讨论，呕吐酸水的，严重的酸水浸渍心脏，其次则是吐出酸水，让上下牙齿酸涩不能相对，用大辛大热的药物治疗必然减轻。酸味，是收敛之气，对应西方肺金旺盛。寒水是金之子，子能令母实，所以用大咸热的药剂泻其子（肾水），以辛热作为佐使，从而泻肺之实，《原病式》将其作热证攻治，是错误的。大概杂病中的醋心（反酸），是浊气不降，想要形成中满（胀满），寒药怎么能治疗呢？
这是李东垣的说法，我认为他最为合乎道理。但他立言太过隐晦，如所说的收气及西方金旺，水为金子等含义，人们未能通达，往往多有忽略。即使在朱丹溪，也说李东垣不说外感风寒，而是以收气立论，想要泻肺金之实，又说寒药不可治酸，而使用安胃汤、加减二陈汤，都犯了丁香，且没有治疗湿热郁积的方法，不符合经意。于是考察朱丹溪的治疗方法，则使用茱连丸、二陈汤，并且说：“宜用炒吴茱萸，顺应其性而折服它，这是反佐的方法，必须用黄连为主药来治疗。”这也是朱丹溪的意思也主于热，正与李东垣相反，而想用黄芩黄连治疗吐酸，则不可不辨析清楚，所以我替李东垣的说法进行疏解。
所谓收气，就是金气，即秋气。《内经》说：“秋气始于上。”大概阴盛的逐渐增长，必始于秋季，因为阳气将要退去。寒肃的逐渐增长，必始于上，因为阳气日益下降。他说金旺，不是说肺气充实，正是说寒气有余。他说子令母实，是因为寒在上焦，则收敛之气更甚，所以治疗用咸热等药剂以泻其子，无非是扶阳抑阴之道，最为恰当。朱丹溪未能理解其意，反而非议他，又是为什么呢？就拿丁香来说，气味辛爽无毒，凡是中焦寒滞，气机不顺的，最适合使用，又何至于用“犯”字来告诫，而使后人畏之如虎呢？大概朱丹溪只知道丁香不可犯，却不知道黄连、黄芩又难道是吞酸证所适宜轻易使用的吗？然而话说虽然如此，但说法还有未尽之处，所以对于寒与热，仍然有疑问，谨慎地继续阐述如下。
三、吐酸证，诸家言为热证的，难道没有各自的理由吗？在刘河间则说：如饮食受热就易于变酸。在戴元礼则说：如谷物肉类在容器中，湿热就易于变酸。又有相传的说法：看酿酒的人，凉快制作则甘甜，过热则变酸，难道不是酸由热产生的吗？诸家说法如此，似乎可信，而想让人不听从都不可能，凡诸似是而非的，正是这类情况。譬如射箭的人，只要不离前后左右，便说是高手，不知道犯此四字，还足以谈论射箭吗？而诸家的说法，也如同这样。
凭什么这样判断呢？大概考察病人，应当以理考察，考察理，应当考察其真。就像饮食之酸由乎热，似乎接近道理了，然而食物在釜中，如果能化而不能酸，这是因为火力强而迅速消化无残留，若取出放置在容器中，必须久而后酸，这是停积而酸，并非因热而酸。曾见水浆冷积既久，没有不变酸的，这难道是热吗？是因为不行（停滞）的缘故。又说酿酒的人热作则酸，也似乎接近道理，但必须在两三天之后，郁热不开，然后成酸，未有热作及时而遂致酸者。况且人的胃气，原本自然温暖，所以三餐入胃，都能顷刻消化，这才是真阳火候的应验；如果像酿酒的人，必须等待整天而后成，则一天不再进食，胃气能不疲惫吗？如果一定要像冷作之不酸，才说无火，则饮食的消化，也必须经过十天，这胃中阳气不是枯竭了吗？由此可见胃气本宜暖，稍凉都不行，酒瓮本宜疏，郁闷不行。所以酒瓮的转化，怎能像胃气那样迅速，而胃气的强健，又怎能同酒瓮那样迟缓呢？它们的性理相差悬殊，何止十倍，不用辨析也就很明白了。况且人的饮食在胃，只有速化为贵，如果胃中阳气不衰，而健运如常，哪里有酸？如果火力不到，则消化必迟，食物消化既迟，则停积不行而为酸为腐，这酸就是腐败的开始。所以凡是病吞酸的，多见饮食不快，自己吃觉得不舒服，必然渐渐发展到中满、痞隔、泄泻等证，这难道不是脾气不强，胃脘阳虚的病，却还认为是火，能无误吗？我以前在燕京，曾治疗一位缙绅患此病求治，我告诉他属寒，他执意为热，坚持造酒的说法，用来质问我，无法辩驳，最终被黄芩黄连之类的药物害死，始终不能醒悟，难道不是前面那种说法的错误导致的吗？也可悲哀啊。所以我常说：人考察道理，贵在考察其真，如果见理不真，而疑似固执，以致酿成大害的，无非此类，这种似是而非的谈论，所以不可不辨析。
四、吞酸与吐酸，病证有三种：凡是喉间嗳气，就有酸水如醋浸心，嘈杂不堪的，名叫吞酸，即俗所谓作酸，此病在上脘最高之处，不时见酸，而泛泛不宁的是。其次则不像吞酸那样近，不在上脘，而在中焦胃脘之间，时常多呕恶，所吐皆酸，名叫吐酸，而渥渥不行（停滞不畅）的是。又其次者，则本来没有吞酸吐酸等证，只是偶尔因呕吐而出，或酸或苦，及诸不堪之味，这都是肠胃中痰饮积聚所化，气味每有浊恶如此，这又在中脘之下；但其顺而下行，则人不觉得，逆而上出，则喉口难堪耳。凡这三种，其在上中二脘的，则无非脾胃虚寒，不能运化的病，治疗此病非温不可。其在下脘偶出的，则寒热俱有，但当因证以治其呕吐，呕吐止则酸苦无从见了。虽然，这也是我的论证，所以不得不详尽其说，若以实理言之，则凡胃强的，何暇顾及酸苦，其有酸苦的，必然是停积不行所致。这应当随证审察，如果没有热证热脉可据，而执言湿中生热，不分强弱，只用寒凉，则没有不误人的了。
[Background Information]
Book: *Jingyue Quanshu* (Complete Works of Jingyue)
Author: Zhang Jiebin (Zhang Jingyue)
Dynasty: Ming
Chapter: Discussion on External Prepared Formulas / Scriptural Principles / Syndrome Differentiation (Total five items)
Category: Comprehensive
Weiai San (Heat 71), Qutan Wan (Harmony 103), Xiangsha Liujunzi Tang (Tonify 7).
The *Suwen: Zhi Zhen Yao Da Lun* (Treatise on the Most Essential and Important Aspects of True Necessity) states: "Various vomiting and regurgitation of sour fluid, sudden diarrhea with tenesmus, all belong to Heat." When Shaoyang (Lesser Yang) pathogenic factors prevail, symptoms include vomiting sour fluid and excessive hunger.
Regarding the syndrome of vomiting sour fluid, Liu Wansu considered it a Heat syndrome, while Li Dongyuan considered it a Cold syndrome. The principle should be fixed; how can there be such a gross discrepancy? Can the principle change because of these two physicians? It must be that one of them deviates from the truth. This is why I cannot remain silent; I consider Li Dongyuan correct and Liu Wansu incorrect. How do I know this? Liu Wansu's theory is actually based on the *Neijing*. The Classic says: "Various vomiting and regurgitation of sour fluid, sudden diarrhea with tenesmus, all belong to Heat." Therefore, in his *Yuan Bing Yuan Shi* (Source Book of Pathogenesis), Liu interpreted all pathomechanisms as Fire (Fire-Heat pathogen) and strongly opposed interpreting them as Cold. However, he did not realize that this discussion in the *Neijing* summarizes disease manifestations according to the Five Movements and Six Qi, and does not mean that all vomiting and diarrhea are internal Heat diseases. If it were purely Heat, then why does it also say: "When Cold pathogen lodges in the Stomach and Intestines, causing rebellious Qi to rush upward, pain and vomiting occur"? And again: "When Taiyang (Greater Yang) reversion qi acts up, Cold generates in the Heart and Stomach, causing disharmony in the chest, spitting clear water, and producing hiccups and belching." This describes vomiting due to Cold; how can they all be Heat? It also says: "When Taiyang pathogenic factors prevail, Cold enters the Lower Jiao and transforms into Ru Xie (loose stools)," describing diarrhea due to Cold; how can this also be Heat? From this perspective, saying Heat here and Cold there seems self-contradictory and erroneous. In fact, the principles of the *Neijing* are comprehensive and detailed, covering both constant patterns and variable changes, normal conditions and reverse conditions, incomplete discussions supplemented elsewhere, and general categories elaborated in detail. This profundity makes it inexhaustible. Therefore, those who are good at observing must understand its origins and flow, examine its divisions and unions. Broadly speaking, one must see the myriad variations; concisely speaking, one must grasp the unity of the underlying principle. Only then can one be called a perceptive person. If one cannot comprehend the beginning and end, but only sees a fragment through a tube, how can one exhaust its subtleties? Moreover, there are many who ignore the main purport, speak recklessly against reason, and erroneously borrow scriptural texts to prove their biased views, which are too numerous to list and discuss here. Since we are discussing the theories of these two physicians, I mention them together and elaborate below for readers to examine carefully.
1. Refuting Liu Wansu's Theory on Vomiting Sour Fluid. According to Liu Wansu: "Sourness is the flavor of Liver Wood. It arises because excessive Fire controls Metal (Lung), failing to subdue Wood (Liver), causing Liver Wood to become hyperactive, thus manifesting as sourness, just as food becomes sour when heated by heat." Some say vomiting sour fluid is due to Cold, which is wrong. Those who wrongly claim it is Cold argue that it results from damaging hard, sticky, or cold foods, leading to belching and acid regurgitation, so folk doctors advocate warming the Spleen and Stomach. They fail to know the scripture says: "When humans are injured by Cold, they develop Heat diseases." Thus, for those who internally damage themselves with cold substances, some may suffer Yin excess and Yang deficiency manifesting as Cold disease, while others may experience Cold and Heat clashing, causing stagnation of Yang Qi in the Stomach and Intestines resulting in Heat. There are also cases where internal damage from cold/raw food leads to Heat disease, cured by profuse sweating, allowing Heat to dissipate with the sweat and body temperature to normalize. If one constantly craves sourness without cessation, warming is inappropriate; instead, Cold herbs should be used to purge, followed by cooling herbs to regulate. Once stagnation clears and Heat dissipates, Qi harmony is restored.
These are all Liu Wansu's views. Whenever I encounter them, I sigh deeply. Looking at his pathomechanism, it proceeds from Fire to Metal, from Metal to Wood, from Wood to Spleen, generating sourness. If analyzed minutely, could the reasoning really turn out like this? It would be like calling a deer a horse, finding excuses wherever possible. Because he insists on Heat, he has to twist the logic thus. If I say it is Cold, it is different. Sourness is the flavor of Liver Wood. Why not say that insufficient Fire fails to generate Earth (Spleen), leading to Spleen Qi deficiency and Liver Evil overacting, thus generating sourness? Would this not be a clearer and more direct explanation, rather than twisting the logic so much? Furthermore, the *Neijing* statement "humans injured by Cold develop Heat diseases" refers to exterior Cold pathogens causing Fever in the Three Yang channels, and later transmitting inward to cause Interior Heat in Yangming. Does it mean internal damage from cold food also causes Heat disease? Are there cases where internal damage from cold food is resolved by sweating? Even in robust individuals, occasional injury from cold/raw food lingering and stagnating into Heat might occur due to long-term stagnation transforming into Heat, but is it truly caused by cold becoming hot? Moreover, the *Neijing* originally referred to external contraction, yet Liu Wansu cites it to prove internal injury, which is a great error. This not only severely harms the teachings of Huangdi and Qibo but also gives future generations an excuse, leading to what consequences?
2. Affirming Li Dongyuan's Theory on Vomiting Sour Fluid. According to *Yi Xue Fa Ming*: "The *Neijing* states various vomiting and regurgitation of sour fluid belong to Heat; this is due to external pathogenic factors affecting the Upper Jiao. The Stomach Qi rejects the external pathogen, causing vomiting; Zhang Zhongjing treated this with Sheng Jiang (Fresh Ginger Rhizome) and Ban Xia (Pinellia Tuber)." Discussing miscellaneous diseases, vomiting sour water, if severe, the sour water immerses the Heart; if less severe, sour water is vomited, making upper and lower teeth feel sour and astringent, unable to meet. Treating with major Acrid-Hot herbs will surely reduce symptoms. Sourness is the gathering energy, corresponding to the prosperity of Western Lung Metal. Cold Water is the child of Metal; the child can make the mother full/excess. Therefore, use major Salty-Hot agents to drain the child (Kidney Water), assisted by Acrid-Hot herbs, to drain Lung Excess. Interpreting this as Heat to be attacked in the *Pathogenesis* book is erroneous. Generally, in miscellaneous diseases, acid reflux (vinegar heart) involves turbid Qi failing to descend, threatening central fullness; how can Cold herbs treat this?
This is Li Dongyuan's view, which I consider most reasonable. However, his expression is too obscure. Concepts like 'gathering energy,' 'Western Metal prospering,' and 'Water being the child of Metal' are often misunderstood and ignored. Even Zhu Danxi said Li Dongyuan did not mention external Wind-Cold but established his theory on 'gathering energy' to drain Lung Metal excess, and claimed Cold herbs cannot treat sourness, using Anwei Tang and Modified Erchen Tang, both containing Ding Xiang (Clove Bud), lacking methods to treat Damp-Heat stagnation, thus not fully aligning with scriptural intent. Examining Zhu Danxi's treatment methods, he used Zhulian Wan and Erchen Tang, stating: "Use fried Wu Zhu Yu (Evodia Fruit) to follow its nature and counteract it, which is a counter-assistance method; Huang Lian (Scutellaria Root) must be used as the sovereign herb." Zhu Danxi's intention also emphasizes Heat, opposite to Li Dongyuan. Using Huang Qin (Scutellaria Root) and Huang Lian to treat vomiting sour fluid requires careful differentiation. Therefore, I elucidate Li Dongyuan's theory.
What is meant by 'gathering energy' is Metal Qi, i.e., Autumn Qi. The *Neijing* says: "Autumn Qi begins from above." Gradual increase of Yin starts in Autumn because Yang Qi is retreating. Gradual increase of Cold/Sternness starts from above because Yang Qi descends daily. Saying 'Metal prospers' does not mean Lung Qi is solid/abundant, but rather that Cold Qi is excessive. Saying 'child makes mother full' means because Cold is in the Upper Jiao, gathering energy is intense, so treatment uses Salty-Hot agents to drain the child, which is essentially supporting Yang and suppressing Yin, very appropriate. Zhu Danxi failed to understand this and criticized him, why? Take Ding Xiang (Clove Bud): its flavor is Acrid and refreshing, non-toxic, most suitable for Middle Jiao Cold stagnation and Qi maladjustment. Why warn against 'using' it so strictly, making people fear it like tigers? Zhu Danxi only knew Ding Xiang should not be used, but did he realize Huang Lian and Huang Qin are also not suitable for lightly treating acid regurgitation? Although stated thus, the argument is incomplete regarding Cold vs. Heat, leaving doubts. I will continue the discussion below.
3. Vomiting Sour Fluid Syndromes. Those claiming it is Heat each have their arguments. Liu Wensu said: "Food becomes sour when heated." Dai Yuanli said: "Grains and meats in containers become sour under Damp-Heat." Another traditional view: "Brewing wine: cool production yields sweetness, overheating yields sourness; isn't sourness caused by Heat?" These arguments seem credible, making it hard not to agree. All seemingly plausible but false statements are of this type. Like archery: if one stays within front/back/left/right bounds, claiming mastery, ignoring these four directions, can one really talk about archery? Theories of various schools are similar.
How do I know? Observing patients requires observing by principle; observing principle requires observing truth. Food sourness due to heat seems logical, but food in a pot, if transformed quickly, doesn't sour; this is because strong fire digests it rapidly without retention. If removed to a container, it sours after time; this is sourness due to stagnation, not heat. I have seen cold liquids stored for a long time always turning sour; is this Heat? No, it is due to stagnation. Brewing wine: heating makes it sour, seems logical, but it takes 2-3 days of stagnant heat to sour; immediate heating doesn't cause sourness. Human Stomach Qi is naturally warm, digesting three meals instantly; this reflects true Yang fire function. If like brewing, taking all day, one wouldn't eat again, exhausting Stomach Qi. If cold production doesn't sour implies no fire, then digestion would take ten days, exhausting Stomach Yang Qi. Thus, Stomach Qi prefers warmth, slight coolness is bad; wine jars prefer ventilation, stagnation is bad. Wine jar transformation cannot match Stomach Qi speed; Stomach Qi vigor cannot match wine jar slowness. Their natures differ vastly, obvious without debate. Food in Stomach values rapid transformation. If Stomach Yang Qi is unimpaired and functions normally, where is sourness? If fire power is insufficient, transformation is slow; slow transformation leads to stagnation, becoming sour and putrid; sourness is the beginning of decay. Patients with acid regurgitation often show poor appetite, discomfort eating, progressing to central fullness, epigastric obstruction, diarrhea. Isn't this Spleen Qi weakness and Epigastric Yang Deficiency, mistakenly identified as Fire? In Yanjing, I treated a scholar insisting on Heat based on the wine analogy. Unable to refute him, he died from Huang Qin/Huang Lian treatments, never realizing his error. Tragic! Thus, observing truth is crucial. False beliefs lead to disaster. Such plausible fallacies must be辨析 (analyzed/differentiated).
4. Swallowing Sour Fluid vs. Vomiting Sour Fluid. There are three types: First, belching in the throat with sour fluid soaking the Heart, unbearable嘈杂 (burning/discomfort), named Swallowing Sour Fluid (commonly 'making acid'). This occurs at the highest point of the Upper Wan (Upper Stomach), appearing intermittently with uneasiness. Second, not as close as swallowing, located between Middle Jiao and Epigastrium, frequent nausea/vomiting of sour fluid, named Vomiting Sour Fluid, characterized by stagnation/sluggishness. Third, originally no swallowing/vomiting sour fluid, but occasionally vomited due to other causes, tasting sour, bitter, or unpleasant. These transform from Phlegm-Fluid accumulation in Stomach and Intestines, having foul odors, located below the Middle Wan. If flowing down smoothly, unnoticed; if rebelling upward, intolerable to throat/mouth. For the first two types in Upper/Middle Wan, it is invariably Spleen-Stomach Deficiency-Cold failing to transport/transform; treatment must use Warming methods. For the third type occurring occasionally in Lower Wan, both Cold and Heat exist; treat the vomiting according to syndrome. Once vomiting stops, sour/bitter taste disappears. Although this is my argument requiring detailed explanation, practically, strong Stomachs don't worry about sour/bitter tastes. Having sour/bitter tastes implies stagnation. One must examine syndromes. Without Heat signs/pulses, insisting on Damp generating Heat and using Cold/Cooling herbs regardless of strength will inevitably cause errors.