源候证治诸说 夫心胸嘈杂，妇人多有此证。原疾之由，多是痰也，皆血液泪汗变成。或云是血嘈，今
人多用猪余血，炒而食之则愈。详其此理，是以血导血归原尔，恰如以盐极下涎之义。不若用许学士旋复花汤，
治心腹中脘痰水冷气，心下汪洋嘈杂，肠鸣多唾，口中清水自出，胁肋急胀满痛不欲食，此胃气虚冷所致，其脉沉
迟弦细，是其证也。
《妇人良方》）（按∶旋复花汤，即《短剧》半夏茯苓汤方，见《水饮》中。）
嘈杂是痰因火动，治痰为先，姜炒黄连入痰药，用炒山栀、黄芩为君，南星、半夏、陈皮为佐，热多加青黛。
嘈杂，此乃食郁有热，炒栀子、姜炒黄连不可无。（《丹溪》）
嘈杂，乃心中似饥，烦杂不安，懒于饮食，谓之心嘈。此乃痰因火动，或酒过湿滞，或肥人痰热，皆使然也。
（《原病集》）
夫嘈杂之为证也（按∶《医统》此下曰∶倏尔腹中如火发，腔内空空，若无一物，似辣非辣。），似饥不饥，
似痛不痛，而有懊 不自宁之况（《医统》此曰∶得食暂止）者是也。其证或兼嗳气，或兼痞满，或兼恶心，渐至
胃脘作痛（《医统》此曰∶而作膈噎），实痰火之为患也。（《正传》）
嘈杂之由，为其恣食无节，或酒面炙 粘滑难化之物，滞于中宫，伤损脾胃（按∶《医统》作恣食湿面鱼腥生
冷，以及烹饪浓味等物，朝伤暮损而成，清痰稠饮，滞于中宫），日久不治，渐成痞满吞酸，甚则为膈噎反胃。
得斯疾者，不可轻视，必须早治，及忌口节欲，无有不安者也。（《统旨》）
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。（《景岳》）
嘈杂属胃火，忌同胃实，宜清热降火，略兼消导。（《本草经疏》）
治方 和中汤，治虚火嘈杂。（《医统》）（按∶即六君子汤加黄连、粳米。）
三圣丸，治嘈杂神效。
白术（炒四两） 黄连（炒五钱） 橘红（一两）
上为细末，神曲糊丸，绿豆大，每服五十丸，姜汤下。（同上）又术连丸，于本方去橘红。
香连丸，治嘈杂火郁，瘦人尤宜服。（同上）（方见《滞下》门。）
交泰丸，治胸中痞闷嘈杂，大便稀则胸中颇快，大便坚则胸中痞闷难当，不思饮食。
黄连（二两姜汁浸黄土炒） 枳实（一两麸炒） 白术（去芦土炒三两） 吴茱萸（汤泡微炒二两）
归尾（酒洗一两二钱） 大黄（用当归、红花、吴茱萸、干漆各一两煎水，浸大黄一昼夜，切碎晒干，仍以酒
拌晒之，九蒸九晒用，四两。）
上为细末，姜汁打神曲糊为丸，如绿豆大，每服七、八十丸，不拘时，白滚水送下。（《回春》）
加味小陷胸汤，（秘方）治火动其痰，嘈杂。
黄连（炒三钱） 半夏（二钱） 栝蒌（半个） 枳实（一钱） 栀子（一钱）（《大还》）
当归补血汤，治心中血少而嘈，兼治惊悸怔忡。
当归 芍药 生地黄 熟地黄（各三钱） 人参（五分） 白术（去芦） 茯苓（去皮） 麦门冬（去心）
山栀仁（炒） 陈皮（各八分） 甘草（二分） 辰砂（研末临服入二分） 乌梅（一个去核） 炒米（百粒）
上锉一剂，枣二枚，水煎温服。（《回春》）
关于嘈杂的病因、证候及治疗的各种学说：
心胸部位出现嘈杂感，妇女中多见此证。其原发病因，多由痰邪引起，这些痰邪皆是由血液、泪液、汗液转化而成。有人说这是“血嘈”，现在人们常用猪余血，炒熟后食用即可痊愈。详细分析其中的道理，是以血引血归源的意思，恰如用盐来抑制唾液分泌的道理一样。不如使用许学士的旋复花汤，治疗心腹中脘部的痰水冷气，表现为心下汪洋般的嘈杂感，肠鸣音多且口水多，口中清水自出，胁肋部拘急胀满疼痛不欲饮食，这是胃气虚冷所致，其脉象沉迟弦细，这就是该证的脉象表现。（出自《妇人良方》）（按语：旋复花汤，即《短剧方》中的半夏茯苓汤方，见《水饮》篇中。）
嘈杂是由于痰因火动引起的，治疗应以治痰为先。用姜炒黄连加入治痰药物中，以炒山栀、黄芩为君药，南星、半夏、陈皮为佐药，若热象加重则加青黛。（出自《丹溪心法》）
嘈杂，这是由于食积郁而化热所致，炒栀子、姜炒黄连不可不用。（出自《丹溪心法》）
嘈杂，是指心中感觉像饥饿一样，烦乱不安，懒得进食，称为“心嘈”。这是由于痰因火动，或者饮酒过多导致湿滞，或者是肥胖之人痰热内蕴，都是造成这种情况的原因。（出自《原病集》）
所谓嘈杂这一证候（按语：《医统》在此处补充说：忽然腹中如火烧发，胸腔内空空荡荡，好像没有东西，似辣非辣），感觉像饥饿又不是饥饿，感觉像疼痛又不是疼痛，而有懊恼不自安的情况（《医统》此处说：进食后暂时缓解），就是这种证候。其症状有时兼有嗳气，有时兼有痞满，有时兼有恶心，逐渐发展到胃脘作痛（《医统》此处说：进而发展为膈噎），这实际上是痰火为患。（出自《医学正传》）
嘈杂的成因，是因为恣意饮食无节制，或者食用酒面、炙烤、粘滑难消化的食物，停滞在中焦脾胃，损伤了脾胃（按语：《医统》记载为恣食湿面、鱼腥、生冷，以及烹饪浓味等物，早晨受伤晚上损害，形成清稀之痰和稠厚之饮，停滞于中焦），日久不治疗，逐渐形成痞满、吞酸，严重时甚至发展为膈噎、反胃。得了这种病的人，不可轻视，必须早期治疗，并且忌口、节制欲望，就没有不安稳的道理。（出自《景岳全书·杂病谱》或相关辑录，此处标为《统旨》）
此证有火嘈，有痰嘈，有酸水浸心导致的嘈杂。大致来说，吃完饭就感到饥饿，或者虽然吃了但不饱的，是火嘈，应当兼清火热。痰多气滞，感觉像饥饿又不是饥饿，不喜欢吃东西的，是痰嘈，应当兼化痰。酸水浸心而嘈杂的，心情戚戚然，腹部膨隆，吃得少且无味，这是因为脾气虚寒，水谷不能消化，应当温胃健脾。又有误用消伐类药物，导致脾胃亏损，血少而嘈杂，中气虚弱则烦杂不饥，脾弱则食物不能运化，这应当专门调养脾胃。总之，嘈杂一证，多由脾气不和，或者受损脾虚所致，所以治疗此病的人，不可不先顾护脾气。然而古人对此，都以痰火论治。我担心专用寒凉药物，会使胃气虚寒不健者反而日益严重，从而逐渐引发恶心、嗳气、反胃、噎膈之类疾病，将由此而起。（出自《景岳全书》）
嘈杂属于胃火，忌讳与胃实证混淆，宜清热降火，略微兼用消导之法。（出自《本草经疏》）
治疗方剂：
和中汤，治疗虚火嘈杂。（《医统》）（按语：即六君子汤加黄连、粳米。）
三圣丸，治疗嘈杂神效。
白术（炒四两） 黄连（炒五钱） 橘红（一两）
以上研为细末，用神曲糊制成丸药，如绿豆大小，每次服用五十丸，姜汤送服。（同上）另外有术连丸，在本方中去掉橘红。
香连丸，治疗嘈杂火郁，瘦人尤其适宜服用。（同上）（方剂见《滞下》门。）
交泰丸，治疗胸中痞闷嘈杂，大便稀时胸中颇觉爽快，大便干结时胸中痞闷难受，不思饮食。
黄连（二两，姜汁浸，黄土炒） 枳实（一两，麸炒） 白术（去芦，土炒三两） 吴茱萸（汤泡，微炒二两）
当归尾（酒洗一两二钱） 大黄（用当归、红花、吴茱萸、干漆各一两煎水，浸泡大黄一昼夜，切碎晒干，仍用酒拌晒，九蒸九晒后用，四两。）
以上研为细末，用姜汁打神曲糊为丸，如绿豆大小，每次服用七、八十丸，不拘时间，白开水送服。（出自《外科正宗》或《回春》，此处标为《回春》）
加味小陷胸汤，（秘方）治疗火动其痰引起的嘈杂。
黄连（炒三钱） 半夏（二钱） 栝蒌（半个） 枳实（一钱） 栀子（一钱）（出自《大还》）
当归补血汤，治疗心中血少而嘈杂，兼治惊悸怔忡。
当归 芍药 生地黄 熟地黄（各三钱） 人参（五分） 白术（去芦） 茯苓（去皮） 麦门冬（去心）
山栀仁（炒） 陈皮（各八分） 甘草（二分） 辰砂（研末，临服时加入二分） 乌梅（一个，去核） 炒米（百粒）
以上锉成一剂，加枣二枚，水煎温服。（出自《回春》）
Various Theories on the Etiology, Syndrome, and Treatment of Zaot (Clammy Hunger):
The sensation of clammy hunger in the chest and heart region is commonly seen in women. The primary cause of this disease is mostly Phlegm (Tan, phlegmatic pathogen), which transforms from blood, tears, and sweat. Some say it is "Blood Zaot," and nowadays people often use pig residual blood, stir-fried and eaten, to cure it. Analyzing the rationale behind this, it is a matter of using blood to guide blood back to its origin, similar to the principle of using salt to suppress saliva secretion. It would be better to use Xu Xueshi's Xuanfu Hua Tang (Inula Flower Decoction) to treat Phlegm-cold Qi in the epigastrium, manifesting as a wave-like sensation of Zaot in the heart area, frequent bowel sounds with excessive salivation, spontaneous flow of clear fluid from the mouth, and distending pain in the hypochondrium with loss of appetite. This is caused by deficiency-cold of Stomach Qi, with a pulse that is deep, slow, wiry, and fine; this is the pulse manifestation of this syndrome. (From *Furen Liangfang*) [Note: Xuanfu Hua Tang is the Banxia Fuling Tang formula from *Duanju Fang*, see the chapter on Water-Fluid Retention.]
Zaot is caused by Phlegm stirred by Fire; treatment should prioritize resolving Phlegm. Use Jiang-chao Huanglian (Ginger-fried Coptis Rhizome) added to Phlegm-resolving herbs, with Chao Shanzhi (Stir-fried Gardenia Fruit) and Huangqin (Scutellaria Root) as the sovereign drugs, Nanxing (Arisaema Rhizome), Banxia (Pinellia Tuber), and Chenpi (Tangerine Peel) as ministering drugs. If heat signs are severe, add Qingdai (Indigo Naturalis). (From *Danxi Xinfa*)
Zaot results from food stagnation transforming into heat; Chao Zhizi (Stir-fried Gardenia Fruit) and Jiang-chao Huanglian (Ginger-fried Coptis Rhizome) are indispensable. (From *Danxi Xinfa*)
Zaot refers to a sensation in the heart resembling hunger, accompanied by vexation and discomfort, leading to reluctance to eat, termed "Heart Zaot." This is caused by Phlegm stirred by Fire, or dampness stagnation due to excessive alcohol consumption, or internal Phlegm-heat in obese individuals. (From *Yuanbing Ji*)
Regarding the syndrome of Zaot [Note: *Yitong* adds here: suddenly feeling heat like fire in the abdomen, the chest cavity feels empty as if containing nothing, slightly spicy but not quite], it feels like hunger but is not hunger, feels like pain but is not pain, and presents with a state of restlessness and inability to settle [ *Yitong* notes here: temporarily relieved after eating]. This is the syndrome. Symptoms may include belching, or fullness and obstruction, or nausea, gradually progressing to epigastric pain [ *Yitong* notes here: developing into Ge Ye (dysphagia/chest obstruction)]. This is actually a disorder caused by Phlegm-Fire. (From *Yixue Zhengchuan*)
The etiology of Zaot lies in unregulated diet, or consuming foods such as wine, noodles, roasted items, and sticky, slippery, hard-to-digest substances, which stagnate in the Middle Jiao (Spleen and Stomach), damaging the Spleen and Stomach [Note: *Yitong* records as indulging in wet noodles, fish, raw/cold foods, and strongly flavored cooked dishes, causing morning injury and evening damage, forming thin Phlegm and thick fluid retention in the Middle Jiao]. If left untreated for a long time, it gradually develops into Pi Man (fullness and obstruction) and Tun Suan (acid regurgitation), and in severe cases, leads to Ge Ye (dysphagia) or Fan Wei (vomiting/regurgitation). Patients suffering from this disease must not take it lightly; early treatment is required, along with dietary restrictions and moderation of desires, to ensure recovery. (From *Tongzhi*)
This syndrome includes Huo Cao (Fire Zaot), Tan Cao (Phlegm Zaot), and Zaot caused by acid water soaking the heart. Generally, feeling hungry immediately after eating, or feeling unsated despite eating, indicates Huo Cao, requiring simultaneous clearing of Fire. Phlegm abundance with Qi stagnation, feeling like hunger but not really hungry, and aversion to food, indicates Tan Cao, requiring simultaneous resolution of Phlegm. Zaot caused by acid water soaking the heart, characterized by a sorrowful feeling, abdominal distension, low appetite, and lack of taste, is due to deficiency-cold of Spleen Qi and failure to transform food and water, requiring warming of the Stomach and strengthening of the Spleen. Additionally, improper use of draining and reducing medicines can lead to Spleen-Stomach deficiency, blood deficiency causing Zaot. Deficiency in the Middle causes vexation and lack of hunger; weakness of the Spleen causes failure to transport and transform food; this requires specialized nourishment of the Spleen and Stomach. In summary, Zaot is mostly caused by disharmony of Spleen Qi or deficiency of the Spleen due to injury. Therefore, treating this condition requires prioritizing the protection of Spleen Qi. However, ancient physicians treated this primarily through the lens of Phlegm-Fire. I fear that exclusive use of cold and cooling herbs will worsen those with deficient-cold Stomach Qi, gradually leading to nausea, belching, Fan Wei, and Ge Ye. (From *Jingyue Quanshu*)
Zaot belongs to Stomach Fire; it must not be confused with Excess Syndrome of the Stomach. Treatment should focus on clearing heat and descending fire, with slight addition of digestive-promoting methods. (From *Bencao Jing Shu*)
Treatment Formulas:
Hezhong Tang (Harmonize the Middle Decoction), treats deficiency-fire Zaot. (*Yitong*) [Note: This is Liu Junzi Tang (Six Gentlemen Decoction) plus Huanglian (Coptis Rhizome) and Jingsmi (Rice Grain).]
Sansheng Wan (Three Sages Pill), highly effective for Zaot.
Baizhu (Stir-fried, 4 liang), Huanglian (Stir-fried, 5 qian), Juhong (1 liang).
Grind into fine powder, make pills with Shenqu paste, size of mung beans. Take 50 pills per dose, down with Ginger decoction. (Same source) Also, Shulian Wan removes Juhong from this formula.
Xianglian Wan (Coptis and Costus Pill), treats Zaot due to Fire depression, especially suitable for thin individuals. (Same source) [Formula see chapter on Dysentery/Zhili.]
Jiaotai Wan (Interlocking Harmony Pill), treats chest oppression and Zaot. Bowel movements being loose brings relief to the chest; hard stools cause unbearable chest oppression and loss of appetite.
Huanglian (2 liang, soaked in Ginger juice, stir-fried with Loess soil), Zhishi (1 liang, bran-stir-fried), Baizhu (de-rhizome, earth-stir-fried, 3 liang), Wuzhuyu (soaked in water, slightly stir-fried, 2 liang).
Dangguiwei (wine-washed, 1.2 liang), Dahuang (4 liang: soak in water boiled from Danggui, Honghua, Wuzhuyu, and Ganqi each 1 liang for one day and night, cut, dry, still mix with wine and sun-dry, nine steams and nine sun-dries).
Grind into fine powder, make pills with Ginger juice and Shenqu paste, size of mung beans. Take 70-80 pills per dose, at any time, down with plain boiling water. (From *Huichun*)
Jiawei Xiaoxiongtang (Modified Minor Chest-Harmonizing Decoction), (Secret Formula) treats Zaot caused by Fire stirring Phlegm.
Huanglian (Stir-fried, 3 qian), Banxia (2 qian), Gualou (half fruit), Zhishi (1 qian), Zhizi (1 qian) (From *Dahuan*).
Danggui Buxue Tang (Angelica Tonifying Blood Decoction), treats Zaot due to blood deficiency in the Heart, and also treats Jingji (palpitations) and Zhengchong (frequent palpitations/panic).
Danggui, Shaoyao, Shengdihuang, Shudihuang (each 3 qian), Renshen (5 fen), Baizhu (de-rhizome), Fuling (peeled), Maidong (de-heart), Zhiren (Stir-fried), Chenpi (each 8 fen), Gancao (2 fen), ChenSha (ground powder, add 2 fen before taking), Wumei (one, pitted), Chaomi (100 grains).
Cut into pieces for one dose, add two Jujubes, decoct in water, take warm. (From *Huichun*)