嘈杂一证，或作或止，其为病也，则腹中空空，若无一物，似饥非饥，似辣非辣，似痛
非痛，而胸膈懊 ，莫可名状，或得食而暂止，或食已而复嘈，或兼恶心，而渐见胃脘
作痛。此证有火嘈，有痰嘈，有酸水浸心而嘈。大抵食已即饥，或虽食不饱者，火嘈也，宜
兼清火。痰多气滞，似饥非饥，不喜食者，痰嘈也，宜兼化痰。酸水浸心而嘈者，戚戚膨膨
，食少无味，此以脾气虚寒，水谷不化也，宜温胃健脾。又有误用消伐等药，以致脾胃亏损
，血少嘈杂，中虚则烦杂不饥，脾弱则食不运化，此宜专养脾胃。总之，嘈杂一证，多由脾
气不和，或受伤脾虚而然，所以治此者，不可不先顾脾气。然古人于此，悉以痰火论治，予
恐专用寒凉，则胃气虚寒不健者，反以日甚，而渐至恶心、嗳气、反胃、噎膈之类，将由此
而起矣。
一、痰火嘈杂等证，如脾虚微火多痰而嘈杂者，宜和中汤，或三圣丸，或术连丸。若中
焦火盛兼痰而嘈杂者，宜软石膏丸。若宿食留饮，痰滞不清而嘈杂者，宜曲术丸。若三焦火
盛，湿痰气滞而嘈杂者，宜三补丸加半夏、苍术、香附之类。
一、脾胃虚寒嘈杂者，必多吞酸，或兼恶心，此皆脾虚不能运化滞浊而然，勿得认为火
证，妄用寒凉等药。若多痰饮，或兼呕恶而嘈杂者，宜二陈汤，或二术二陈汤。若寒痰停蓄
胸膈，或为胀满少食而为嘈杂者，宜和胃二陈煎，或和胃饮。若脾胃虚寒，停饮作酸嘈杂者
，宜温胃饮，或六君子汤。若脾肾阴分虚寒，水泛为饮，作酸嘈杂者，宜理阴煎，或金水六
君煎。
嘈杂这一病证，有时发作有时停止。其发病时的表现是：腹中空虚，好像什么都没有，感觉像饿又不是饿，像辣又不是辣，像痛又不是痛，胸膈间烦闷不适，无法用言语形容。有的进食后暂时缓解，有的吃完后又出现嘈杂，有的伴有恶心，并逐渐出现胃脘部疼痛。此证有火嘈（因火热引起的嘈杂），有痰嘈（因痰湿引起的嘈杂），有酸水浸心而致的嘈杂。大致而言，饭后立即感到饥饿，或者虽然吃了饭却觉得不饱的，属于火嘈，治疗时应兼清火热。痰多气机阻滞，似饥非饥，不喜欢吃东西的，属于痰嘈，治疗时应兼化痰。酸水上泛浸心导致嘈杂的，心情忧郁、腹部胀满，饮食减少且无味，这是由于脾气虚寒，水谷不能消化所致，治疗应温补胃阳、健脾益气。又有因误用消导攻伐等药物，导致脾胃受损，血虚引起嘈杂，中焦虚弱则心烦嘈杂不思饮食，脾弱则食物不能运化，这种情况适宜专门调养脾胃。总之，嘈杂一证，多由脾气不和，或因损伤导致脾虚而引起，所以治疗此病的人，不可不首先顾护脾气。然而古人对此证，全部以痰火来论治，我担心如果专用寒凉药物，那么胃气虚寒不健壮的病人，病情反而会日益加重，进而逐渐引发恶心、嗳气、反胃、噎膈（吞咽困难）等病症，这些都将由此产生。
一、对于痰火引起的嘈杂等证，如果是脾虚伴有轻微火热和多痰而导致嘈杂的，适宜使用和中汤，或三圣丸，或术连丸。如果中焦火热旺盛兼有痰湿而导致嘈杂的，适宜使用软石膏丸。如果有宿食停滞、留饮内停，痰浊阻滞不清而导致嘈杂的，适宜使用曲术丸。如果三焦火热旺盛，湿痰气机阻滞而导致嘈杂的，适宜在三补丸基础上加半夏、苍术、香附之类的药物。
一、对于脾胃虚寒导致的嘈杂，必定多有吞酸现象，或伴有恶心，这都是因为脾虚不能运化停滞的浊气所致，不要误认为是火证，妄用寒凉等药物。如果痰饮较多，或伴有呕吐恶臭而嘈杂的，适宜使用二陈汤，或二术二陈汤。如果寒痰停滞蓄积在胸膈，或因胀满、食欲减退而导致嘈杂的，适宜使用和胃二陈煎，或和胃饮。如果脾胃虚寒，水饮停留化酸导致嘈杂的，适宜使用温胃饮，或六君子汤。如果脾肾阴分虚寒，水液泛滥成为饮邪，化酸导致嘈杂的，适宜使用理阴煎，或金水六君煎。
The syndrome of Zaocao (a sensation of hunger mixed with discomfort in the epigastrium) may come and go. Its pathological manifestation is characterized by an empty feeling in the abdomen, as if nothing were there; it resembles hunger but is not true hunger, resembles spiciness but is not true spiciness, resembles pain but is not true pain, accompanied by a sense of stifling distress in the chest and diaphragm that is indescribable. In some cases, eating provides temporary relief; in others, the sensation returns after eating; some are accompanied by nausea, gradually leading to pain in the epigastric region. This syndrome includes Huo Cao (Zaocao caused by fire), Tan Cao (Zaocao caused by phlegm), and Zaocao caused by acid water flooding the heart. Generally speaking, if one feels hungry immediately after eating, or feels unsatisfied despite having eaten, it is Huo Cao, and treatment should include clearing fire. If there is excessive phlegm and qi stagnation, resembling hunger but without appetite, it is Tan Cao, and treatment should include resolving phlegm. When acid water floods the heart causing Zaocao, accompanied by melancholy, abdominal distension, reduced food intake, and loss of taste, this is due to deficiency-cold of Spleen Qi and failure to transform food and fluids; treatment should warm the Stomach and strengthen the Spleen. Furthermore, misuse of digestive and purgative medicines may damage the Spleen and Stomach, leading to blood deficiency and Zaocao; middle-jiao deficiency causes vexation and lack of hunger, while Spleen weakness leads to poor transformation and transportation of food; such cases require nourishing the Spleen and Stomach exclusively. In summary, the syndrome of Zaocao mostly arises from disharmony of Spleen Qi or injury leading to Spleen deficiency; therefore, treating this condition requires prioritizing the protection of Spleen Qi. However, ancient physicians treated all such cases based on phlegm-fire theory. I fear that exclusive use of cold and cooling herbs will worsen the deficiency-cold of Stomach Qi in those with weak Stomach function, potentially leading to symptoms such as nausea, belching, Fanwei (regurgitation/vomiting), and Yige (dysphagia/obstruction of the esophagus).
1. For syndromes of Zaocao caused by phlegm-fire: If the cause is Spleen deficiency with slight fire and excessive phlegm, Zhonghe Tang (Harmonize the Middle Decoction), San Sheng Wan (Three Sages Pill), or Shu Lian Wan (Atractylodes and Coptis Pill) are appropriate. If there is excessive fire in the Middle Jiao combined with phlegm, Ruan Shigao Wan (Soft Gypsum Pill) is indicated. If retained food and fluid accumulation lead to unclear phlegm obstruction causing Zaocao, Qu Zhi Wan (Malt and Atractylodes Pill) is suitable. If excessive fire in the Three Jiao combined with damp-phlegm and qi stagnation causes Zaocao, San Bu Wan (Three Tonification Pill) added with Banxia (Pinellia Rhizome), Cangzhu (Atractylodis Rhizoma), and Xiangfu (Cyperus Rhizome) is recommended.
2. For Zaocao caused by Spleen-Stomach deficiency-cold: There is often acid regurgitation, possibly accompanied by nausea. This results from Spleen deficiency failing to transform turbid stagnation; do not mistake it for a fire syndrome and recklessly use cold-cooling herbs. If there is excessive phlegm-fluid retention or vomiting and disgust accompanying Zaocao, Er Chen Tang (Two-Cured Decoction) or Er Zhu Er Chen Tang (Two-Atractylodes and Two-Cured Decoction) are appropriate. If cold-phlegm accumulates in the chest and diaphragm, causing distension, poor appetite, and Zaocao, Hewei Erchen Jian (Stomach-Harmonizing Two-Cured Decoction) or Hewei Yin (Stomach-Harmonizing Infusion) are indicated. If Spleen-Stomach deficiency-cold with retained fluid transforming into acid causes Zaocao, Wenwei Yin (Warm the Stomach Infusion) or Liu Junzi Tang (Six Gentlemen Decoction) are suitable. If deficiency-cold of the Yin aspect of Spleen and Kidney leads to water overflowing as fluid retention, transforming into acid and causing Zaocao, Liyin Jian (Regulate Yin Decoction) or Jinshui Liu Jun Jian (Metal-Water Six Gentlemen Decoction) are recommended.