三诊：病十去其八，依旧不能畅进饮食，虽少量，亦哕、噫腐气。潞党参9克，云苓、薤白头各12克，荜茇9克，粉甘草3克，佛手、生白术、半夏各9克，川椒目5克，谷芽、麦芽、麸炒枳实各9克。另：淮山药9克、厚朴3克、生鸡内金9克、莱菔子9克，共研细末，每次吞服3克。四诊：服益气健脾温通之剂，哕、噫腐气少作。今予异功散加味，缓缓图之。潞党参15克，白术15克，云苓12克，陈皮9克，谷麦芽各12克，炙甘草6克，淮山药15克，莱菔子18克，生鸡金18克。共为细末，每次3克，食后服。[按]本案心下痞，经他医予消导之剂，依然如故。先生作虚证论治，用益气健脾温通之法。至三诊而病十去其八，最后用异功散加味，经投药两月许而愈。
44．赵女。其主症一为呼吸不均匀；一为两肋有发作性之胀满，胀满而不匀益甚。此二者，胸襟拂逆，操作过度，其主因也。仙鹤草12克，旋覆花9克(包)，全当归9克，五味子5克，香甘松5克，延胡索9克，炮附块6克，补骨脂9克，金毛脊9克，清炙草3克。二诊：其主症在两肋撑胀，其胀经历数日之久，服强壮剂、镇静剂，胀向下移，原来是官能性之变化。金铃子12克，当归9克，甘草5克，生姜3片，延胡索12克，白芍9克，饴糖4只，大枣9枚，良附丸9克(分2次吞服)。
三诊：下脘按之板硬，其胀与肋间胀满相互发作，不能疑为胃之实质上变化。胀，古人多用芳香行气之属，扩张可治，功能衰减亦可治。炮附块6克，薤白头12克，橘青皮各6克，莱菔子9克，佛手9克，荜茇9克，川椒3克，神曲9克，延胡索9克。四诊：凡一切组织上变化皆难治。以体用言，组织体也，功能用也。体既败坏，用于何有?所谓皮之不存，毛将焉附者矣。今下脘板硬，有所推动，则前方可重其制。便难者，佐下之。川椒目3克，佩兰梗9克，莱菔子9克，沉香曲9克，薤白头12克，官桂皮5克，半硫丸6克(分2次吞)，谷麦芽各9克。另：服灵丑散。
五诊：主症心下痞硬，终日不思饮食，较前改善。近则骨节亦酸。此二者，皆宜辛温挥发之属。生苍术9克，香白芷9克，川桂枝5克，晚蚕沙9克(包)，炮姜炭5克，羌独活各6克，川椒目5克，荜茇9克，谷麦芽各9克，加平散9克(分2次吞)。六诊：两肋痛之有发作者，多属神经性。藜藿之人，多因劳倦。心下痞硬亦见平定，惟骨节尚酸楚。全当归9克，汉防己12克，延胡索9克，杏仁泥15克，旋覆花9克(包)，炮附块6克，羌独活各6克，大川芎6克，香甘松5克。
[按]本案主症概括有三：①肋间胀痛；②心下痞硬；③骨节酸楚。先生在初、二诊时，认为前两者为"胸襟拂逆，操作过度"所致的官能性病变；其后骨节酸楚，则认为劳苦大众，多属风寒湿所致，故在五诊方中，加用桂枝、羌独活等药。六诊时，患者两肋痛已呈发作性，心下痞硬也见平定，证明了先生初诊诊断的正确性。因骨节酸楚尚未除，故六诊处方仍用羌独活，加附块、防己以祛风、散寒、利湿；加当归、川芎以养血、活血；杏仁、旋覆、延胡、甘松，作为肋间胀痛等症治疗的扫尾。本案证情复杂，处方周到而简要，可为后学的示范。五诊所用加平散，为平胃散加砂仁、鸡内金，具有燥湿健脾、利气宽胸、消食和中之功。
45．秋女。心下痞，大便亦难，辛以开之，苦以降之。生锦纹6克，生半夏5克，蓬莪术9克，白芥子9克，莱菔子9克，生枳实9克，薤白头9克，苦楝子9克，杏仁泥12克，佛手片9克。
46．艾男。以胸中闷为主症，大便不利，辛开苦降之属。薤白头9克，苦杏仁12克，生锦纹2．4克(研末吞)，陈皮6克，川椒目3克，川楝子9克，生枳实9克，佛手片9克。另：五磨饮12克，分2次吞。
47．赵男。进芳香挥发之属，心下痞满者，自觉有攻筑之状，大便秘。此方五泻心汤之一也。炮附块6克，姜川连1．2克，乌药、生枳实、蓬莪术、熟锦纹(酒炒)各9克，炒黄芩5克，槟榔、莱菔子(包)、谷芽、麦芽各9克。
48．朱男。健胃增加肠蠕动，苦降辛开之法，最当。生锦纹5克，苦杏仁15克，薤白头12克，苦楝子9克，枳实9克，苍术片9克，川椒目3克，莱菔子9克，灵丑散9克(分3次吞)。
49．钱男。病后心下痞，默默不欲食，以辛开苦降。川雅连1．5克，生锦纹2．4克(判末)，苦杏仁12克，龙胆草3克，莱菔英9克，姜半夏9克，薤白头12克，佩兰梗6克，佛手片9克。
50．张男。病后进食不慎，中脘为之窒闷，予加味之陷胸。此方为后世辛开苦降所祖，乃健胃剂也。姜川连1．5克，姜半夏12克，全瓜蒌12克，薤白头9克，生枳实9克，荜茇9克，厚朴1．5克(研末吞)，佛手9克。[按]辛开苦降法，起源于张仲景的小陷胸汤、泻心汤。其主要作用是健胃。凡消化功能减退所引起的上腹胀满或伴有便秘者，用之均有良效。
51．张女。早食，暮亦不能消，得噫与呕，即见舒畅。古人所称之胃寒，此症最吻合。炮附块6克，荜茇9克，淡干姜3克，橘皮6克，赤石脂15克(包)，淡吴萸5克，姜半夏9克，肉桂末1．8克，云茯苓9克，姜汁几滴。
52．吴女。吐酸而兼有白沫者，多属消化不良之胃酸缺乏；如果气候转变，经期以内，其发益频，亦是神经之过敏。此二者可作古人之胃寒论治。淡吴萸5克，炮附块6克，旋覆花12克(包)干姜2．4克，荜茇9克，姜半夏18克，云苓15克，延胡索9克。
53．朱男。受寒则泛酸，但进酸物质，并不增加其酸，胃部亦不嘈杂，然则其酸是消化不良而来。炮附块6克，荜茇9克，川椒目3克，橘青皮各9克，肉桂末1．8克，吴萸5克，姜半夏9克，云苓12克，薤白头12克。
54．顾男。食已即吐，痛者，胃有火也；不痛而有痰者，胃无火也。火是炎，无火是消化不良。吴萸5克，生姜4片，旋覆花9克(包)，姜半夏12克，橘皮6克，党参9克，大枣9枚，苏子9克，云苓12克。
55．王男。主症在胃，进食无论量之多寡皆胀，自觉脘与腹汩汩有声，其外观并不胀满。此非水而是气。征之时吞酸而不吐不痛，关键在消化不良。炮附块9克，姜半夏12克，蓬莪术9克，海南片9克，生莱菔子9克(研)，淡吴萸6克，川椒目5克，沉香曲9克，台乌药9克，上肉桂末1．2克(分2次吞下)。二诊：药两服，进食胸次梗介不得下者，大见轻快，再拟芳香辛辣健胃剂复方。蓬莪术9克，佩兰梗9克，淡吴萸5克，姜半夏9克，莱菔子9克(研)，春砂仁3克(研冲)，川椒目5克，薤白头12克，橘皮6克，生姜3片。[按]以上五案均属胃寒，消化功能低下，其中三案有吞酸史。先生认为吞酸而不见嘈杂，胃脘疼痛者，为胃无火象，治用辛辣健胃方剂确有良效。这种方剂可以促进胃与十二指肠分泌消化液，也就是前人所谓"温胃"、"醒胃"的方法。但若为时已久，则应该用益气健脾和胃法。如异功散、香砂六君子汤等方剂，较为适宜。
56．俞男。上则胸闷呕酸，下则肠鸣便秘。得之肉食后受寒。花槟榔9克，山楂肉15克，黑丑6克，淡吴萸5克，平胃散9克(入煎)，莱菔子12克，薤白头9克，木香2．4克，炮姜炭5克。如不效，加服沉香化滞丸9克。二诊：便不畅，故呕酸。温下之。炮附块6克，炮姜炭5克，番泻叶9克，熟锦纹9克，黑丑6克，郁李仁12克，莱菔子12克，山楂肉15克。[按]肉食后受寒而吞酸、便秘，先生常用温下。消导的方法。因受寒而用温，伤食而消导，便秘而用下剂，施治可谓周到。这是治疗吞酸的另一种方法。
57．宋男。进甜与咸，则泛酸甚多而嘈杂，假使胃酸不足，必胀满而不嘈杂，此乃过剩也。钙虽有中和胃酸之作用，但有便秘之弊，必须复入泻剂。炮附块9克，淡吴萸5克，当归12克，半硫丸6克，熟锦纹9克，郁李仁12克，海南片9克，杏仁泥24克。[按]案中所说的钙，是指钙铋镁之类，因患者正在服用，故先生有"便秘之弊"的提示。并用半硫丸、郁李仁、熟锦纹、杏仁泥等润肠导下药。
58．王男。饱食后，其酸能止，此胃酸过剩。过剩之原因甚繁。此方用温胃而不刺激者。炮附块5克，荜茇9克，淮山药9克，陈皮6克，云苓12克，生艾叶6克，旋覆花12克(包)，沉香曲9克，潞党参9克，柿蒂5只，五磨饮9克(分3次吞)。
59．汪男。胃酸过多，其原因甚繁，病者并不呕吐作痛，尚未至溃疡程度；饥饱不时，寒暖无定而得之，恐是神经性。杏仁18克，吴萸5克，云苓12克，当归9克，姜半夏9克，淮山药12克，煅瓦楞12克，赤石脂9克(吞服)。
60．朱男。感寒则胃中泛酸。此种酸多属一时性之胃酸增加，温之。姜半夏9克，旋覆花12克(包)，云苓9克，橘皮6克，公丁香3克，薤白头12克，吴萸5克，苏子12克(包)，荜茇9克。
61．徐男。古籍中吞酸多用温药，大便难者，复入下剂。但此指不痛者而言。痛者当注意其是否有炎症，炎症则不能温。病者服刺激性食物，则酸作而不痛，以口腻为苦。荜澄茄9克，炮姜炭3克，佩兰梗9克，云苓9克，谷麦芽各9克，煨草果3克，生茅术9克，陈皮6克，沉香曲9克。
62．周男。天寒则泛吐酸水，而脘中隐痛，进食后，其酸益甚。胃寒也。炮附块6克，炮姜炭3克，川椒目3克，薤白头9克，姜半夏15克，荜澄茄9克，淡吴萸3克，北细辛3克，赤石脂6克(分2次冲)，橘皮6克。
63．郑男。胃酸过剩，有属于神经性者，多因抑郁而来，古人称为肝气犯胃。盖木曲直作酸，治酸当平肝，平肝则吐止。旋覆花12克(包)，杏仁泥12克，吴萸3克，云苓9克，代赭石15克，橘皮6克，制香附9克，姜川连1．8克，生半夏5克。
64．陈女。多酸与胃中灼热，有连锁关系。欲除灼热，先当制酸。煅瓦楞30克，米仁12克，竹茹9克，夏枯草12克，煅牡蛎30克，小蓟9克，杏仁18克，云苓12克。[按]先生对吞酸一证，属于胃寒者，都用温剂，如吴萸、附子、荜茇等药。但这些温药治吞酸证，只用于吞酸而胃不痛者。有时也可加制酸剂，如瓦楞子、鸡蛋壳、螺丝壳、牡蛎等药。由于这类药易引起便秘，所以同时应加缓下润肠剂。若吞酸伴有胃脘痛，则温性药多不宜用。上列数案读后，可知先生对吞酸证用药的梗概。
65．王女。知饥而不能食，食人则胀。以往曾经吞酸。此与胃酸过多可以鉴别。苔腻，胃不健也。淡吴萸2．4克，荜茇9克，制川椒2．4克，炮姜5克，薤白头、生鸡金、谷芽、麦芽各9克，陈广皮、佛手片各6克。[按]古人以能食不运为脾病，知饥不欲食为胃病。此证苔腻乃胃阳不足，湿浊不化之象；因胃阳不足，故不能熟腐水谷，此食入则胀之由来。方中以大队辛辣之品以温胃阳，辅以鸡内金、谷麦芽等以助消化。药偏刚燥，胃阴虚者宜慎。
66．徐男。胃酸过多之原因甚繁，因拂逆而起者属神经性，古人所谓肝气犯胃；受寒而起者属消化不良，古人称谓胃寒。胃溃疡亦有胃酸过多，其溃疡即因胃酸过多而起者。他则胃分泌不正常，则因胃之实质变化。凡胃酸过多，对症疗法多用钙剂中和之。原因疗法：消化不良者如吴茱萸汤；肝气拂逆者如逍遥散、一贯煎；胃溃疡者当保护胃粘膜，如吸着剂旋覆代赭汤、独圣散之滑石。亦有胃酸不足亦能吞酸者，以上诸法皆无效，受寒则泛泛有酸意而大便溏、腹痛，不受寒则否，所谓一时性之胃酸过多。炮附片5克，淡吴萸3克，沉香曲9克，延胡索9克，公丁香3克，肉桂末1．8克(分2次吞)，炮姜炭3克，益智仁9克，荜茇9克，生艾叶5克。[按]案中论及治胃酸过多诸法，甚为周详。方药为辛香刚燥之品，殆为受寒而引起胃酸过多者而设。
67．周男。仲景治反胃呕吐之方，有小半夏加茯苓汤，有吴茱萸汤，有甘草粉蜜汤，有橘皮竹茹汤。今食后1小时乃吐，有饮食，有酸水，并不痛，此消化不良之吐。吴茱萸6克，旋覆花12克(包)，川椒目5克，橘皮6克，苏子12克(包)，白茯苓12克，姜汁数滴，姜竹茹5克。另：生半夏9克，公丁香3克，赤石脂9克，煅瓦楞子9克，共研细末，食前吞少许。[按]食后1小时乃吐，有饮食，有酸水，为胃阳不足，不能腐熟，水谷，故以温胃降逆为主。生半夏镇逆止呕之功较制者为著，但其有毒，且食后喉舌可有发痒、发麻感，不宜多服。另方将其纳入散剂，只吞少许、即是此意。
三诊：疾病已经好了十分之八，但依然无法顺畅进食，即使是少量食物，也会出现呃逆、嗳出腐臭气味。潞党参9克，云苓（茯苓）、薤白头各12克，荜茇9克，粉甘草3克，佛手、生白术、半夏各9克，川椒目5克，谷芽、麦芽、麸炒枳实各9克。另：淮山药9克、厚朴3克、生鸡内金9克、莱菔子9克，共研成细末，每次吞服3克。四诊：服用益气健脾温通的药剂后，呃逆、嗳出腐臭气味的症状发作减少。现在给予异功散加味，缓缓调理。潞党参15克，白术15克，云苓12克，陈皮9克，谷麦芽各12克，炙甘草6克，淮山药15克，莱菔子18克，生鸡内金18克。共为细末，每次3克，饭后服用。[按语]本案心下痞满，经其他医生给予消导剂治疗，依然如故。先生将其作为虚证论治，采用益气健脾温通的方法。到了第三诊时，病情去除了十分之八，最后使用异功散加味，经过约两个月的服药而痊愈。
44．赵女。其主要症状有两个：一是呼吸不均匀；二是两肋出现发作性的胀满，胀满且气息不匀更加严重。这两者，是由于胸襟拂逆（情绪不畅）、操作过度（劳累过度）所致，这是主要原因。仙鹤草12克，旋覆花9克（包煎），全当归9克，五味子5克，香甘松5克，延胡索9克，炮附块6克，补骨脂9克，金毛脊（狗脊）9克，清炙甘草3克。二诊：主要症状在两肋撑胀，这种胀感持续了数日之久，服用强壮剂、镇静剂后，胀感向下移动，原来是功能性的变化。金铃子12克，当归9克，甘草5克，生姜3片，延胡索12克，白芍9克，饴糖4只，大枣9枚，良附丸9克（分2次吞服）。
三诊：下脘部位按压感觉板硬，其胀满与肋间胀满交替发作，不能怀疑是胃的实质性病变。对于胀满，古人多用芳香行气的药物，扩张气机可以治疗，功能衰减也可以治疗。炮附块6克，薤白头12克，橘青皮各6克，莱菔子9克，佛手9克，荜茇9克，川椒3克，神曲9克，延胡索9克。四诊：凡是组织上的病变都难治。从体用来说，组织是“体”，功能是“用”。如果体已经败坏，用又从何而来呢？这就是所谓“皮之不存，毛将焉附”。现在下脘部板硬，有所推动，则前面的方子要加重剂量。大便困难的，辅助以泻下药物。川椒目3克，佩兰梗9克，莱菔子9克，沉香曲9克，薤白头12克，官桂皮5克，半硫丸6克（分2次吞服）。另：服用灵丑散。
五诊：主要症状是心下痞硬，整天不想吃东西，比之前有所改善。最近骨节也感到酸痛。这两者，都适宜使用辛温挥发类的药物。生苍术9克，香白芷9克，川桂枝5克，晚蚕沙9克（包煎），炮姜炭5克，羌活、独活各6克，川椒目5克，荜茇9克，谷麦芽各9克，加平散9克（分2次吞服）。六诊：两肋疼痛有发作性的，多属于神经性。藜藿之人（指生活贫苦或从事体力劳动的人），多因劳倦引起。心下痞硬也已见平定，只是骨节尚且酸楚。全当归9克，汉防己12克，延胡索9克，杏仁泥15克，旋覆花9克（包煎），炮附块6克，羌活、独活各6克，大川芎6克，香甘松5克。
[按语]本案主要症状概括有三点：①肋间胀痛；②心下痞硬；③骨节酸楚。先生在初诊、二诊时，认为前两者是由“胸襟拂逆，操作过度”所致的功能性病变；其后出现的骨节酸楚，则认为劳苦大众多属风寒湿邪所致，所以在五诊的方子中，加用了桂枝、羌活、独活等药。六诊时，患者两肋痛已呈发作性，心下痞硬也见平定，证明了先生初诊诊断的正确性。因为骨节酸楚尚未去除，所以六诊处方仍用羌活、独活，加附块、防己以祛风、散寒、利湿；加当归、川芎以养血、活血；杏仁、旋覆花、延胡索、甘松，作为治疗肋间胀痛等症状的扫尾工作。本案证情复杂，处方周到而简要，可为后学的示范。五诊所用的加平散，是在平胃散基础上加砂仁、鸡内金，具有燥湿健脾、利气宽胸、消食和中的功效。
45．秋女。心下痞满，大便也困难，用辛味药以开之，苦味药以降之。生锦纹（大黄）6克，生半夏5克，蓬莪术9克，白芥子9克，莱菔子9克，生枳实9克，薤白头9克，苦楝子9克，杏仁泥12克，佛手片9克。
46．艾男。以胸中闷为主症，大便不利，用辛开苦降的药物。薤白头9克，苦杏仁12克，生锦纹2.4克（研末吞服），陈皮6克，川椒目3克，川楝子9克，生枳实9克，佛手片9克。另：五磨饮12克，分2次吞服。
47．赵男。进用芳香挥发类药物后，心下痞满者，自觉有攻筑的感觉，大便秘结。此方是五泻心汤之一。炮附块6克，姜川连1.2克，乌药、生枳实、蓬莪术、熟锦纹（酒炒）各9克，炒黄芩5克，槟榔、莱菔子（包煎）、谷芽、麦芽各9克。
48．朱男。健胃增加肠蠕动，苦降辛开的方法，最为恰当。生锦纹5克，苦杏仁15克，薤白头12克，苦楝子9克，枳实9克，苍术片9克，川椒目3克，莱菔子9克，灵丑散9克（分3次吞服）。
49．钱男。病后心下痞满，默默不欲饮食，用辛开苦降法。川雅连1.5克，生锦纹2.4克（研末），苦杏仁12克，龙胆草3克，莱菔子9克，姜半夏9克，薤白头12克，佩兰梗6克，佛手片9克。
50．张男。病后进食不慎，中脘为之窒闷，给予加味的陷胸汤。此方是后世辛开苦降法的祖方，乃是健胃剂。姜川连1.5克，姜半夏12克，全瓜蒌12克，薤白头9克，生枳实9克，荜茇9克，厚朴1.5克（研末吞服），佛手9克。[按语]辛开苦降法，起源于张仲景的小陷胸汤、泻心汤。其主要作用是健胃。凡消化功能减退所引起的上腹胀满或伴有便秘者，用之均有良效。
51．张女。早吃，晚上也不能消化，打嗝和呕吐后即见舒畅。古人所称的胃寒，此症最吻合。炮附块6克，荜茇9克，淡干姜3克，橘皮6克，赤石脂15克（包煎），淡吴萸5克，姜半夏9克，肉桂末1.8克，云茯苓9克，姜汁几滴。
52．吴女。吐酸水兼有白沫的，多属于消化不良之胃酸缺乏；如果气候转变，经期以内，其发作更加频繁，这也是神经过敏的表现。这两者可按古人的胃寒论治。淡吴萸5克，炮附块6克，旋覆花12克（包煎），干姜2.4克，荜茇9克，姜半夏18克，云苓15克，延胡索9克。
53．朱男。受寒则泛酸，但进食酸性物质，并不增加其酸度，胃部也不嘈杂，然而这酸水是消化不良而来的。炮附块6克，荜茇9克，川椒目3克，橘青皮各9克，肉桂末1.8克，吴萸5克，姜半夏9克，云苓12克，薤白头12克。
54．顾男。食后立即呕吐，痛的，是胃有火；不痛而有痰的，是胃无火。火是炎上，无火是消化不良。吴萸5克，生姜4片，旋覆花9克（包煎），姜半夏12克，橘皮6克，党参9克，大枣9枚，苏子9克，云苓12克。
55．王男。主症在胃，进食无论量之多寡皆胀，自觉脘腹汩汩有声，外观并不胀满。这不是水饮而是气滞。诊察时吞酸而不吐不痛，关键在于消化不良。炮附块9克，姜半夏12克，蓬莪术9克，海南片（木香）9克，生莱菔子9克（研碎），淡吴萸6克，川椒目5克，沉香曲9克，台乌药9克，上肉桂末1.2克（分2次吞下）。二诊：服药两剂后，进食后胸中梗塞不得下的情况，大见轻快，再拟定芳香辛辣健胃剂的复方。蓬莪术9克，佩兰梗9克，淡吴萸5克，姜半夏9克，莱菔子9克（研碎），春砂仁3克（研碎冲服），川椒目5克，薤白头12克，橘皮6克，生姜3片。[按语]以上五案均属胃寒，消化功能低下，其中三案有吞酸史。先生认为吞酸而不见嘈杂，胃脘疼痛者，为胃无火象，治疗用辛辣健胃方剂确有良效。这种方剂可以促进胃与十二指肠分泌消化液，也就是前人所谓“温胃”、“醒胃”的方法。但若病程已久，则应该用益气健脾和胃法。如异功散、香砂六君子汤等方剂，较为适宜。
56．俞男。上则胸闷呕酸，下则肠鸣便秘。得之于肉食后受寒。花槟榔9克，山楂肉15克，黑丑6克，淡吴萸5克，平胃散9克（入煎），莱菔子12克，薤白头9克，木香2.4克，炮姜炭5克。如果不效，加服沉香化滞丸9克。二诊：便不畅，故呕酸。用温下法。炮附块6克，炮姜炭5克，番泻叶9克，熟锦纹9克，黑丑6克，郁李仁12克，莱菔子12克，山楂肉15克。[按语]肉食后受寒而吞酸、便秘，先生常用温下消导的方法。因受寒而用温，伤食而消导，便秘而用下剂，施治可谓周到。这是治疗吞酸的另一种方法。
57．宋男。进甜与咸的食物，则泛酸甚多而嘈杂，假使胃酸不足，必胀满而不嘈杂，此乃过剩也。钙虽有中和胃酸之作用，但有便秘之弊，必须复入泻剂。炮附块9克，淡吴萸5克，当归12克，半硫丸6克，熟锦纹9克，郁李仁12克，海南片9克，杏仁泥24克。[按语]案中所说的钙，是指钙铋镁之类，因患者正在服用，故先生有“便秘之弊”的提示。并用半硫丸、郁李仁、熟锦纹、杏仁泥等润肠导下药。
58．王男。饱食后，其酸能止，此胃酸过剩。过剩之原因甚繁。此方用温胃而不刺激者。炮附块5克，荜茇9克，淮山药9克，陈皮6克，云苓12克，生艾叶6克，旋覆花12克（包煎），沉香曲9克，潞党参9克，柿蒂5只，五磨饮9克（分3次吞服）。
59．汪男。胃酸过多，其原因甚繁，病者并不呕吐作痛，尚未至溃疡程度；饥饱不时，寒暖无定而得之，恐是神经性。杏仁18克，吴萸5克，云苓12克，当归9克，姜半夏9克，淮山药12克，煅瓦楞12克，赤石脂9克（吞服）。
60．朱男。感寒则胃中泛酸。此种酸多属一时性之胃酸增加，温之。姜半夏9克，旋覆花12克（包煎），云苓9克，橘皮6克，公丁香3克，薤白头12克，吴萸5克，苏子12克（包煎），荜茇9克。
61．徐男。古籍中吞酸多用温药，大便难者，复入下剂。但此指不痛者而言。痛者当注意其是否有炎症，炎症则不能温。病者服刺激性食物，则酸作而不痛，以口腻为苦。荜澄茄9克，炮姜炭3克，佩兰梗9克，云苓9克，谷麦芽各9克，煨草果3克，生茅术9克，陈皮6克，沉香曲9克。
62．周男。天寒则泛吐酸水，而脘中隐痛，进食后，其酸益甚。胃寒也。炮附块6克，炮姜炭3克，川椒目3克，薤白头9克，姜半夏15克，荜澄茄9克，淡吴萸3克，北细辛3克，赤石脂6克（分2次冲服），橘皮6克。
63．郑男。胃酸过剩，有属于神经性者，多因抑郁而来，古人称为肝气犯胃。盖木曲直作酸，治酸当平肝，平肝则吐止。旋覆花12克（包煎），杏仁泥12克，吴萸3克，云苓9克，代赭石15克，橘皮6克，制香附9克，姜川连1.8克，生半夏5克。
64．陈女。多酸与胃中灼热，有连锁关系。欲除灼热，先当制酸。煅瓦楞30克，米仁12克，竹茹9克，夏枯草12克，煅牡蛎30克，小蓟9克，杏仁18克，云苓12克。[按语]先生对吞酸一证，属于胃寒者，都用温剂，如吴萸、附子、荜茇等药。但这些温药治吞酸证，只用于吞酸而胃不痛者。有时也可加制酸剂，如瓦楞子、鸡蛋壳、螺丝壳、牡蛎等药。由于这类药易引起便秘，所以同时应加缓下润肠剂。若吞酸伴有胃脘痛，则温性药多不宜用。上列数案读后，可知先生对吞酸证用药的梗概。
65．王女。知饥而不能食，食入则胀。以往曾经吞酸。此与胃酸过多可以鉴别。苔腻，胃不健也。淡吴萸2.4克，荜茇9克，制川椒2.4克，炮姜5克，薤白头、生鸡内金、谷芽、麦芽各9克，陈广皮、佛手片各6克。[按语]古人以能食不运为脾病，知饥不欲食为胃病。此证苔腻乃胃阳不足，湿浊不化之象；因胃阳不足，故不能熟腐水谷，此食入则胀之由来。方中以大队辛辣之品以温胃阳，辅以鸡内金、谷麦芽等以助消化。药偏刚燥，胃阴虚者宜慎。
66．徐男。胃酸过多之原因甚繁，因拂逆而起者属神经性，古人所谓肝气犯胃；受寒而起者属消化不良，古人称谓胃寒。胃溃疡亦有胃酸过多，其溃疡即因胃酸过多而起者。他则胃分泌不正常，则因胃之实质变化。凡胃酸过多，对症疗法多用钙剂中和之。原因疗法：消化不良者如吴茱萸汤；肝气拂逆者如逍遥散、一贯煎；胃溃疡者当保护胃粘膜，如吸着剂旋覆代赭汤、独圣散之滑石。亦有胃酸不足亦能吞酸者，以上诸法皆无效，受寒则泛泛有酸意而大便溏、腹痛，不受寒则否，所谓一时性之胃酸过多。炮附片5克，淡吴萸3克，沉香曲9克，延胡索9克，公丁香3克，肉桂末1.8克（分2次吞服），炮姜炭3克，益智仁9克，荜茇9克，生艾叶5克。[按语]案中论及治胃酸过多诸法，甚为周详。方药为辛香刚燥之品，殆为受寒而引起胃酸过多者而设。
67．周男。仲景治反胃呕吐之方，有小半夏加茯苓汤，有吴茱萸汤，有甘草粉蜜汤，有橘皮竹茹汤。今食后1小时乃吐，有饮食，有酸水，并不痛，此消化不良之吐。吴茱萸6克，旋覆花12克（包煎），川椒目5克，橘皮6克，苏子12克（包煎），白茯苓12克，姜汁数滴，姜竹茹5克。另：生半夏9克，公丁香3克，赤石脂9克，煅瓦楞子9克，共研细末，食前吞少许。[按语]食后1小时乃吐，有饮食，有酸水，为胃阳不足，不能腐熟水谷，故以温胃降逆为主。生半夏镇逆止呕之功较制者为著，但其有毒，且食后喉舌可有发痒、发麻感，不宜多服。另方将其纳入散剂，只吞少许、即是此意。
Visit 3: The illness has improved by eighty percent, yet the patient still cannot eat smoothly; even with small amounts, hiccups (involuntary spasms of the diaphragm) and belching of putrid gas occur. Radix Codonopsis (Lupardenshen) 9g, Poria (Yunling), and Allii Macrostemonis Bulbus (Xiebaitou) each 12g, Piperis Longi Fructus (Bibo) 9g, Glycyrrhizae Radix et Rhizoma preparata (Fengangcao) 3g, Fructus Aurantii (Foshou), Atractylodis Rhizoma raw (Shengbaizhu), and Pinelliae Tuber (Banxia) each 9g, Capsici Fructus Seed (Chuanjiaomu) 5g, Oryzae Fructus Germinatus (Guyaya), Hordei Fructus Germinatus (Maiya), and Ziziphi Spinosae Semen stir-baked with bran (Zhichishi) each 9g. Additionally: Dioscoreae Rhizome (Huai shanyao) 9g, Magnoliae Officinalis Cortex (Houpo) 3g, Galli Gigerii Endothelium Corneum raw (Sheng jineijin), and Raphani Semen (Laifuzi) 9g, all ground into fine powder, taken orally, 3g per dose. Visit 4: After taking decoctions for tonifying qi, strengthening the spleen, and warming unblocking, the hiccups and belching of putrid gas have decreased in frequency. Now prescribing Yigong San (Isolated Efficacy Powder) with modifications, to be managed gradually. Radix Codonopsis (Lupardenshen) 15g, Atractylodis Rhizoma (Baizhu) 15g, Poria (Yunling) 12g, Citri Reticulatae Pericarpium (Chenpi), Oryzae Fructus Germinatus and Hordei Fructus Germinatus each 12g, Glycyrrhizae Radix et Rhizoma honey-fried (Zhigancao) 6g, Dioscoreae Rhizome (Huai shanyao) 15g, Raphani Semen (Laifuzi) 18g, Galli Gigerii Endothelium Corneum raw (Sheng jin) 18g. All ground into fine powder, 3g per dose, taken after meals. [Commentary] In this case, epigastric fullness and hardness (Xin Xia Pi) persisted despite other physicians' use of digestive-promoting agents. Mr. Zhang treated it as a deficiency syndrome, employing methods to tonify qi, strengthen the spleen, and warm and unblock. By the third visit, eighty percent of the symptoms had resolved. Finally, using modified Yigong San, the patient recovered after approximately two months of medication.
44. Female Patient Zhao. Her main symptoms are: one is uneven breathing; the other is paroxysmal distension in both hypochondriac regions, where the distension worsens due to unevenness. These two stem from emotional stagnation (chest frustration) and overexertion, which are the primary causes. Agrimoniherbae Herba (Xianhecao) 12g, Inulae Flos (Xuanfuhua) 9g (wrapped), Angelicae Sinensis Radix (Quandanggui) 9g, Schisandrae Fructus (Wuweizi) 5g, Nardostachyos Radix et Rhizoma (Xianggansong) 5g, Corydalis Rhizoma (Yanhusuo) 9g, Prepared Aconiti Lateralis Radix (Pao fukuai) 6g, Psoraleae Fructus (Buguzhi) 9g, Cibotii Rhizoma (Jinmaoji) 9g, Glycyrrhizae Radix et Rhizoma honey-fried (Qingzhigancao) 3g. Visit 2: The main symptom is distension in the hypochondriac regions, lasting several days. After taking tonic and sedative agents, the distension shifted downward, indicating an originally functional change. Chrysanthemi Indici Fructus (Jinlingzi) 12g, Angelicae Sinensis Radix (Danggui) 9g, Glycyrrhizae Radix et Rhizoma (Gancao) 5g, Zingiberis Rhizoma fresh (Shengjiang) 3 slices, Corydalis Rhizoma (Yanhusuo) 12g, Paeoniae Radix Alba (Baishao) 9g, Malt (Yitang) 4 pieces, Jujubae Fructus (Dazao) 9 pieces, Liangfu Wan 9g (taken in 2 doses).
Visit 3: Palpation of the Xiawan point reveals hardness. The distension alternates with intercostal distension; this should not be suspected as an organic change in the stomach. For distension, ancients often used aromatic qi-moving herbs; expanding qi can treat it, and treating functional decline can also work. Prepared Aconiti Lateralis Radix (Pao fukuai) 6g, Allii Macrostemonis Bulbus (Xiebaitou) 12g, Tangerine Green Peel and Orange Peel (Juqingpi) each 6g, Raphani Semen (Laifuzi) 9g, Fructus Aurantii (Foshou) 9g, Piperis Longi Fructus (Bibo) 9g, Zanthoxyli Fructus (Chuanjiao) 3g, Massae Fermentatae Medicinales (Shenqu) 9g, Corydalis Rhizoma (Yanhusuo) 9g. Visit 4: Organic changes are difficult to treat. Speaking of substance and function, substance is the body, function is the application. If the body is ruined, what use remains? This is like saying if the skin does not exist, where will the hair attach? Now that the Xiawan area is hard, the previous formula needs to be intensified. For difficulty in defecation, assist with purgatives. Capsici Fructus Seed (Chuanjiaomu) 3g, Eupatorii Herba (Peilang geng) 9g, Raphani Semen (Laifuzi) 9g, Aquilariae Lignum Resinatum Cum Resina (Chenxiang qu) 9g, Allii Macrostemonis Bulbus (Xiebaitou) 12g, Cinnamomi Cortex (Guangui pi) 5g, Banshu Wan 6g (taken in 2 doses). Additionally: take Lingchou San.
Visit 5: Main symptom is epigastric fullness and hardness, with no appetite throughout the day, improved compared to before. Recently, joints also ache. Both conditions suit pungent-warm volatile herbs. Atractylodis Rhizoma raw (Sheng cangzhu) 9g, Angelicae Dahuricae Radix (Xiangbaizhi) 9g, Cinnamomi Ramulus (Chuan guizhi) 5g, Bombyx Batryticatus (Wancansha) 9g (wrapped), Zingiberis Rhizoma preparata (Pao jiangtan) 5g, Notopterygii Rhizoma et Radix (Qianghuo) and Saposhnikoviae Radix (Duhuo) each 6g, Capsici Fructus Seed (Chuanjiaomu) 5g, Piperis Longi Fructus (Bibo) 9g, Oryzae Fructus Germinatus and Hordei Fructus Germinatus each 9g, Jiaping San 9g (taken in 2 doses). Visit 6: Paroxysmal pain in the hypochondriac regions often belongs to neuralgia. People of humble origins often suffer from fatigue and overwork. Epigastric fullness and hardness have also subsided, but joint soreness persists. Angelicae Sinensis Radix (Quandanggui) 9g, Stephaniae Tetrandrae Radix (Hanfangji) 12g, Corydalis Rhizoma (Yanhusuo) 9g, Armeniacae Semen Amarum paste (Xingrenni) 15g, Inulae Flos (Xuanfuhua) 9g (wrapped), Prepared Aconiti Lateralis Radix (Pao fukuai) 6g, Notopterygii Rhizoma et Radix and Saposhnikoviae Radix each 6g, Ligustici Chuanxiong Rhizoma (Da chuanxiong) 6g, Nardostachyos Radix et Rhizoma (Xianggansong) 5g.
[Commentary] The main symptoms of this case can be summarized as three: ① Hypochondriac distending pain; ② Epigastric fullness and hardness; ③ Joint soreness. During the first and second visits, Mr. Zhang considered the first two as functional lesions caused by "emotional stagnation and overexertion." Later, regarding the joint soreness, he believed that laborers often suffer from wind-cold-dampness, hence adding Ramulus Cinnamomi (Guizhi), Notopterygii Rhizoma et Radix (Qianghuo), and Saposhnikoviae Radix (Duhuo) in the fifth-visit prescription. At the sixth visit, the patient's hypochondriac pain became paroxysmal, and epigastric fullness and hardness subsided, proving the correctness of Mr. Zhang's initial diagnosis. Since joint soreness remained, the sixth-visit prescription still included Notopterygii Rhizoma et Radix and Saposhnikoviae Radix, plus Prepared Aconiti Lateralis Radix and Stephaniae Tetrandrae Radix to dispel wind, scatter cold, and promote urination to remove dampness; plus Angelicae Sinensis Radix and Ligustici Chuanxiong Rhizoma to nourish blood and invigorate blood; Armeniacae Semen Amarum, Inulae Flos, Corydalis Rhizoma, and Nardostachyos Radix et Rhizoma served as finishing touches for treating hypochondriac distending pain. This case presents complex pathology, with a thorough yet concise prescription, serving as a model for students. The Jiaping San used in the fifth visit is Pingwei San added with Amomi Fructus and Galli Gigerii Endothelium Corneum, possessing functions to dry dampness, strengthen the spleen, regulate qi, broaden the chest, digest food, and harmonize the middle.
45. Female Patient Qiu. Epigastric fullness and hardness, accompanied by difficulty in defecation. Use pungent herbs to open and bitter herbs to descend. Rheum Palmatum Radix raw (Sheng jinwen) 6g, Pinelliae Tuber raw (Sheng banxia) 5g, Curcumae Rhizoma (Peng'e zhu) 9g, Brassicae Semenis Albi (Baijiezi) 9g, Raphani Semen (Laifuzi) 9g, Ziziphi Spinosae Semen raw (Sheng zhishi) 9g, Allii Macrostemonis Bulbus (Xiebaitou) 9g, Meliae Fructus (Kulianzi) 9g, Armeniacae Semen Amarum paste (Xingrenni) 12g, Fructus Aurantii slice (Foshoupian) 9g.
46. Male Patient Ai. Main symptom is chest stuffiness, with difficulty in defecation. Using pungent-opening and bitter-descending herbs. Allii Macrostemonis Bulbus (Xiebaitou) 9g, Pruni Semen (Ku xingren) 12g, Rheum Palmatum Radix raw (Sheng jinwen) 2.4g (ground and swallowed), Citri Reticulatae Pericarpium (Chenpi) 6g, Capsici Fructus Seed (Chuanjiaomu) 3g, Toosendan Fructus (Chuanlianzi) 9g, Ziziphi Spinosae Semen raw (Sheng zhishi) 9g, Fructus Aurantii slice (Foshoupian) 9g. Additionally: Wumo Yin 12g, taken in 2 doses.
47. Male Patient Zhao. After taking aromatic volatile herbs, the patient with epigastric fullness feels a sensation of attacking and building up, with constipation. This formula is one of the Five Bitter Heart Decoctions. Prepared Aconiti Lateralis Radix (Pao fukuai) 6g, Coptidis Rhizoma ginger-processed (Jiang chuanlian) 1.2g, Linderae Radix (Wuyao), Ziziphi Spinosae Semen raw (Sheng zhishi), Curcumae Rhizoma (Peng'e zhu), and Rheum Palmatum Radix cooked (Shu jinwen, wine-fried) each 9g, Scutellariae Radix stir-fried (Chao huangqin) 5g, Arecae Semen (Binglang), Raphani Semen (wrapped), Oryzae Fructus Germinatus, and Hordei Fructus Germinatus each 9g.
48. Male Patient Zhu. To strengthen the stomach and increase intestinal peristalsis, the method of bitter-descending and pungent-opening is most appropriate. Rheum Palmatum Radix raw (Sheng jinwen) 5g, Pruni Semen (Ku xingren) 15g, Allii Macrostemonis Bulbus (Xiebaitou) 12g, Meliae Fructus (Kulianzi) 9g, Ziziphi Spinosae Semen (Zhishi) 9g, Atractylodis Rhizoma slice (Cangzhu pian) 9g, Capsici Fructus Seed (Chuanjiaomu) 3g, Raphani Semen (Laifuzi) 9g, Lingchou San 9g (taken in 3 doses).
49. Male Patient Qian. Post-illness epigastric fullness, silent lack of appetite. Using pungent-opening and bitter-descending method. Coptidis Rhizoma (Chuan yalian) 1.5g, Rheum Palmatum Radix raw (Sheng jinwen) 2.4g (ground), Pruni Semen (Ku xingren) 12g, Gentianae Radix (Longdancao) 3g, Raphani Semen (Laifuzi) 9g, Pinelliae Tuber ginger-processed (Jiang banxia) 9g, Allii Macrostemonis Bulbus (Xiebaitou) 12g, Eupatorii Herba (Peilang geng) 6g, Fructus Aurantii slice (Foshoupian) 9g.
50. Male Patient Zhang. Improper diet after illness caused stuffiness in the Zhongwan region. Prescribing modified Xianxiong Tang. This formula is the ancestor of later pungent-opening and bitter-descending methods, serving as a stomach-strengthening agent. Coptidis Rhizoma ginger-processed (Jiang chuanlian) 1.5g, Pinelliae Tuber ginger-processed (Jiang banxia) 12g, Trichosanthis Fructus (Quangualu) 12g, Allii Macrostemonis Bulbus (Xiebaitou) 9g, Ziziphi Spinosae Semen raw (Sheng zhishi) 9g, Piperis Longi Fructus (Bibo) 9g, Magnoliae Officinalis Cortex (Houpo) 1.5g (ground and swallowed), Fructus Aurantii (Foshou) 9g. [Commentary] The pungent-opening and bitter-descending method originated from Zhang Zhongjing's Xiao Xianxiong Tang and Xiexin Tang. Its main effect is strengthening the stomach. It is effective for upper abdominal fullness or constipation caused by diminished digestive function.
51. Female Patient Zhang. Eating in the morning, digestion fails by evening; relief comes only after belching and vomiting. This closely matches the ancient concept of Stomach Cold. Prepared Aconiti Lateralis Radix (Pao fukuai) 6g, Piperis Longi Fructus (Bibo) 9g, Dried Ginger pale (Dan ganjiang) 3g, Tangerine Peel (Jupi) 6g, Halloysit Rubrum (Chishizhi) 15g (wrapped), Evodiae Fructus pale (Dan wuyu) 5g, Pinelliae Tuber ginger-processed (Jiang banxia) 9g, Cinnamomi Cortex powder (Rougui mo) 1.8g, Poria (Yunfuling) 9g, Ginger juice a few drops.
52. Female Patient Wu. Vomiting sour fluid mixed with white foam often indicates gastric acid deficiency due to indigestion; if triggered by climate changes or during menstruation, frequent attacks indicate neural hypersensitivity. Both can be treated according to the ancient theory of Stomach Cold. Evodiae Fructus pale (Dan wuyu) 5g, Prepared Aconiti Lateralis Radix (Pao fukuai) 6g, Inulae Flos (Xuanfuhua) 12g (wrapped), Dried Ginger (Ganjiang) 2.4g, Piperis Longi Fructus (Bibo) 9g, Pinelliae Tuber ginger-processed (Jiang banxia) 18g, Poria (Yunling) 15g, Corydalis Rhizoma (Yanhusuo) 9g.
53. Male Patient Zhu. Cold exposure triggers acid regurgitation, but consuming acidic substances does not increase acidity, nor does the stomach feel uncomfortable. Thus, the acid originates from indigestion. Prepared Aconiti Lateralis Radix (Pao fukuai) 6g, Piperis Longi Fructus (Bibo) 9g, Capsici Fructus Seed (Chuanjiaomu) 3g, Tangerine Green Peel and Orange Peel (Juqingpi) each 9g, Cinnamomi Cortex powder (Rougui mo) 1.8g, Evodiae Fructus (Wuyu) 5g, Pinelliae Tuber ginger-processed (Jiang banxia) 9g, Poria (Yunling) 12g, Allii Macrostemonis Bulbus (Xiebaitou) 12g.
54. Male Patient Gu. Vomiting immediately after eating; if painful, it is Stomach Fire; if painless with phlegm, it is absence of Stomach Fire. Fire implies inflammation; absence of fire implies indigestion. Evodiae Fructus (Wuyu) 5g, Zingiberis Rhizoma fresh (Shengjiang) 4 slices, Inulae Flos (Xuanfuhua) 9g (wrapped), Pinelliae Tuber ginger-processed (Jiang banxia) 12g, Tangerine Peel (Jupi) 6g, Codonopsis Radix (Dangshen) 9g, Jujubae Fructus (Dazao) 9 pieces, Perillae Fructus (Suzi) 9g, Poria (Yunling) 12g.
55. Male Patient Wang. Main symptom is in the stomach; distension occurs regardless of food quantity. The patient feels gurgling sounds in the abdomen, though externally there is no distension. This is Qi, not Water. Examination shows acid regurgitation without vomiting or pain; the key is indigestion. Prepared Aconiti Lateralis Radix (Pao fukuai) 9g, Pinelliae Tuber ginger-processed (Jiang banxia) 12g, Curcumae Rhizoma (Peng'e zhu) 9g, Aquilariae Lignum (Hainan pian) 9g, Raphani Semen raw (Sheng laifuzi) 9g (ground), Evodiae Fructus pale (Dan wuyu) 6g, Capsici Fructus Seed (Chuanjiaomu) 5g, Aquilariae Lignum Resinatum Cum Resina (Chenxiang qu) 9g, Linderae Radix (Tai wuyao) 9g, Cinnamomi Cortex powder (Shang rougui mo) 1.2g (taken in 2 doses). Visit 2: After two doses, the feeling of obstruction in the chest after eating is greatly relieved. Prescribing a compound aromatic pungent stomach-strengthening agent. Curcumae Rhizoma (Peng'e zhu) 9g, Eupatorii Herba (Peilang geng) 9g, Evodiae Fructus pale (Dan wuyu) 5g, Pinelliae Tuber ginger-processed (Jiang banxia) 9g, Raphani Semen (Laifuzi) 9g (ground), Amomi Fructus (Chun sharen) 3g (ground and taken with liquid), Capsici Fructus Seed (Chuanjiaomu) 5g, Allii Macrostemonis Bulbus (Xiebaitou) 12g, Tangerine Peel (Jupi) 6g, Zingiberis Rhizoma fresh (Shengjiang) 3 slices. [Commentary] The above five cases all belong to Stomach Cold with low digestive function, three of which have a history of acid regurgitation. Mr. Zhang believes that acid regurgitation without discomfort or epigastric pain indicates absence of Stomach Fire; treating with pungent-warm stomach-strengthening formulas is indeed effective. Such formulas promote digestive secretion in the stomach and duodenum, known as "warming" and "awakening" the stomach. However, for long-standing cases, Qi-tonifying, spleen-strengthening, and stomach-harmonizing methods are better, such as Yigong San or Xiangsha Liujunzi Tang.
56. Male Patient Yu. Upper symptoms: chest stuffiness and vomiting sour fluid; lower symptoms: borborygmus and constipation. Caused by cold exposure after eating meat. Arecae Semen (Huabinglang) 9g, Crataegi Fructus (Shanzha rou) 15g, Strychni Semen (Heiqiu) 6g, Evodiae Fructus pale (Dan wuyu) 5g, Pingwei San 9g (decocted), Raphani Semen (Laifuzi) 12g, Allii Macrostemonis Bulbus (Xiebaitou) 9g, Aucklandiae Radix (Muxiang) 2.4g, Zingiberis Rhizoma preparata (Pao jiangtan) 5g. If ineffective, add Chenxiang Huazhi Wan 9g. Visit 2: Poor bowel movement causes vomiting of sour fluid. Using warm purgation. Prepared Aconiti Lateralis Radix (Pao fukuai) 6g, Zingiberis Rhizoma preparata (Pao jiangtan) 5g, Sennae Folium (Fanxieye) 9g, Rheum Palmatum Radix cooked (Shu jinwen) 9g, Strychni Semen (Heiqiu) 6g, Pruni Semen (Yuliren) 12g, Raphani Semen (Laifuzi) 12g, Crataegi Fructus (Shanzha rou) 15g. [Commentary] For acid regurgitation and constipation after cold exposure post-meat consumption, Mr. Zhang often uses warm purgation and digestion-promoting methods. Warming for cold, promoting digestion for food injury, and purging for constipation shows thorough treatment. This is another method for treating acid regurgitation.
57. Male Patient Song. Consuming sweet and salty foods causes excessive acid regurgitation and discomfort. If gastric acid were insufficient, there would be fullness without discomfort; this is excess. Calcium neutralizes gastric acid but causes constipation, so laxatives must be added. Prepared Aconiti Lateralis Radix (Pao fukuai) 9g, Evodiae Fructus pale (Dan wuyu) 5g, Angelicae Sinensis Radix (Danggui) 12g, Banshu Wan 6g, Rheum Palmatum Radix cooked (Shu jinwen) 9g, Pruni Semen (Yuliren) 12g, Aquilariae Lignum (Hainan pian) 9g, Armeniacae Semen Amarum paste (Xingrenni) 24g. [Commentary] The "calcium" mentioned refers to calcium-bismuth-magnesium compounds, as the patient was taking them, prompting Mr. Zhang's note on "constipation side effects." Combined with Banshu Wan, Pruni Semen, cooked Rheum, and Armeniacae Semen Amarum paste as moistening laxatives.
58. Male Patient Wang. Acid regurgitation stops after full meals, indicating gastric acid excess. Causes are numerous. This formula uses warming stomach herbs without irritation. Prepared Aconiti Lateralis Radix (Pao fukuai) 5g, Piperis Longi Fructus (Bibo) 9g, Dioscoreae Rhizome (Huai shanyao) 9g, Citri Reticulatae Pericarpium (Chenpi) 6g, Poria (Yunling) 12g, Artemisiae Argyi Folium raw (Sheng aiye) 6g, Inulae Flos (Xuanfuhua) 12g (wrapped), Aquilariae Lignum Resinatum Cum Resina (Chenxiang qu) 9g, Codonopsis Radix (Lupardenshen) 9g, Diospyroi Fructus (Shidi) 5 pieces, Wumo Yin 9g (taken in 3 doses).
59. Male Patient Wang. Excessive gastric acid, causes numerous. No vomiting or pain, not yet at ulcer stage; irregular hunger/fullness and temperature exposure suggest neural origin. Armeniacae Semen 18g, Evodiae Fructus (Wuyu) 5g, Poria (Yunling) 12g, Angelicae Sinensis Radix (Danggui) 9g, Pinelliae Tuber ginger-processed (Jiang banxia) 9g, Dioscoreae Rhizome (Huai shanyao) 12g, Calcined Arcae Shell (Duan waleng) 12g, Halloysit Rubrum (Chishizhi) 9g (swallowed).
60. Male Patient Zhu. Cold exposure causes acid regurgitation. This type of acid is usually transient gastric acid increase; treat with warmth. Pinelliae Tuber ginger-processed (Jiang banxia) 9g, Inulae Flos (Xuanfuhua) 12g (wrapped), Poria (Yunling) 9g, Citri Reticulatae Pericarpium (Jupi) 6g, Eugeniophyllus (Gongdingxiang) 3g, Allii Macrostemonis Bulbus (Xiebaitou) 12g, Evodiae Fructus (Wuyu) 5g, Perillae Fructus (Suzi) 12g (wrapped), Piperis Longi Fructus (Bibo) 9g.
61. Male Patient Xu. Ancient texts often use warm herbs for acid regurgitation; if defecation is difficult, add purgatives. But this applies to painless cases. Painful cases require checking for inflammation, which precludes warming. The patient experiences acid production without pain after stimulating foods, complaining of sticky mouth. Litseae Fructus (Bidengqie) 9g, Zingiberis Rhizoma preparata (Pao jiangtan) 3g, Eupatorii Herba (Peilang geng) 9g, Poria (Yunling) 9g, Oryzae Fructus Germinatus and Hordei Fructus Germinatus each 9g, Roasted Cardamom Fruit (Wei caoguo) 3g, Atractylodis Rhizoma raw (Sheng maoshu) 9g, Citri Reticulatae Pericarpium (Chenpi) 6g, Aquilariae Lignum Resinatum Cum Resina (Chenxiang qu) 9g.
62. Male Patient Zhou. Cold weather causes vomiting of sour water with dull epigastric pain; acid worsens after eating. Stomach Cold. Prepared Aconiti Lateralis Radix (Pao fukuai) 6g, Zingiberis Rhizoma preparata (Pao jiangtan) 3g, Capsici Fructus Seed (Chuanjiaomu) 3g, Allii Macrostemonis Bulbus (Xiebaitou) 9g, Pinelliae Tuber ginger-processed (Jiang banxia) 15g, Litseae Fructus (Bidengqie) 9g, Evodiae Fructus pale (Dan wuyu) 3g, Asari Radix et Rhizoma (Beixixin) 3g, Halloysit Rubrum (Chishizhi) 6g (taken in 2 doses), Citri Reticulatae Pericarpium (Jupi) 6g.
63. Male Patient Zheng. Gastric acid excess, sometimes neural, often due to depression, called Liver Qi invading Stomach in ancient times. Wood bends and straightens to produce acid; treating acid requires soothing the Liver, which stops vomiting. Inulae Flos (Xuanfuhua) 12g (wrapped), Armeniacae Semen Amarum paste (Xingrenni) 12g, Evodiae Fructus (Wuyu) 3g, Poria (Yunling) 9g, Haematitum (Daizheshi) 15g, Citri Reticulatae Pericarpium (Jupi) 6g, Cyperi Rhizoma processed (Zhi xiangfu) 9g, Coptidis Rhizoma ginger-processed (Jiang chuanlian) 1.8g, Pinelliae Tuber raw (Sheng banxia) 5g.
64. Female Patient Chen. Excess acid and burning sensation in the stomach are linked. To remove burning, first control acid. Calcined Arcae Shell (Duan waleng) 30g, Coicis Semen (Miren) 12g, Bambusae Caulis Preparatus (Zhuru) 9g, Prunellae Spica (Xiakucao) 12g, Calcined Ostreae Concha (Duan muli) 30g, Cirsii Herba (Xiaoji) 9g, Armeniacae Semen 18g, Poria (Yunling) 12g. [Commentary] For acid regurgitation due to Stomach Cold, Mr. Zhang uses warm agents like Evodiae Fructus, Aconiti Radix, and Piperis Longi Fructus. These warm herbs are only used for acid regurgitation without stomach pain. Sometimes antacids like Arcae Shell, eggshell, snail shell, or Ostreae Concha are added. Since these cause constipation, mild laxatives should be added simultaneously. If acid regurgitation is accompanied by epigastric pain, warm herbs are generally unsuitable. Reading these cases reveals Mr. Zhang's general approach to treating acid regurgitation.
65. Female Patient Wang. Feels hungry but cannot eat; distension occurs after eating. History of acid regurgitation. This distinguishes it from excessive gastric acid. Greasy coating indicates poor stomach health. Evodiae Fructus pale (Dan wuyu) 2.4g, Piperis Longi Fructus (Bibo) 9g, Processed Zanthoxyli Fructus (Zhi chuanjiao) 2.4g, Zingiberis Rhizoma preparata (Pao jiang) 5g, Allii Macrostemonis Bulbus, Galli Gigerii Endothelium Corneum raw, Oryzae Fructus Germinatus, and Hordei Fructus Germinatus each 9g, Citri Reticulatae Pericarpium aged (Chen guangpi) and Fructus Aurantii slice each 6g. [Commentary] Ancients considered inability to transport food despite eating as a Spleen issue, while feeling hungry but not wanting to eat as a Stomach issue. The greasy coating here indicates insufficient Stomach Yang and failure to transform damp turbidity; due to insufficient Stomach Yang, food cannot be properly digested, causing distension after eating. The formula uses pungent-warm herbs to warm Stomach Yang, assisted by Galli Gigerii Endothelium Corneum and germinated grains to aid digestion. The medicine is slightly drying; those with Stomach Yin deficiency should use caution.
66. Male Patient Xu. Causes of excessive gastric acid are numerous. Those arising from emotional stagnation are neural, called Liver Qi invading Stomach; those from cold exposure are indigestion, called Stomach Cold. Gastric ulcers may also involve excessive acid, where the ulcer is caused by the acid. Other abnormal secretions result from organic changes. Symptomatic treatment for excessive acid often uses calcium agents to neutralize. Etiological treatment: indigestion uses Evodiae Decoction; Liver Qi stagnation uses Xiaoyao San or Yiguan Jian; gastric ulcers require mucosal protection using adsorbents like Xuanfudaihzhe Tang or Talcum in Dusheng San. There are also cases of acid regurgitation with insufficient acid, where above methods fail; these present with transient acid sensation upon cold exposure, loose stools, and abdominal pain, resolving without cold. Prepared Aconiti Lateralis Radix slice (Pao fupian) 5g, Evodiae Fructus pale (Dan wuyu) 3g, Aquilariae Lignum Resinatum Cum Resina (Chenxiang qu) 9g, Corydalis Rhizoma (Yanhusuo) 9g, Eugeniophyllus (Gongdingxiang) 3g, Cinnamomi Cortex powder (Rougui mo) 1.8g (taken in 2 doses), Zingiberis Rhizoma preparata (Pao jiangtan) 3g, Alpiniae Oxyphyllae Fructus (Yizhiren) 9g, Piperis Longi Fructus (Bibo) 9g, Artemisiae Argyi Folium raw (Sheng aiye) 5g. [Commentary] The case discusses various treatments for excessive gastric acid thoroughly. The formula consists of pungent-aromatic drying herbs, likely intended for excessive acid caused by cold exposure.
67. Male Patient Zhou. Zhang Zhongjing's formulas for regurgitation and vomiting include Xiao Banxia Plus Poria Decoction, Evodiae Decoction, Gancao Fenmi Decoction, and Chupi Zhuru Decoction. Now vomiting 1 hour after eating, with food and sour fluid, but no pain; this is vomiting due to indigestion. Evodiae Fructus (Wuyu) 6g, Inulae Flos (Xuanfuhua) 12g (wrapped), Capsici Fructus Seed (Chuanjiaomu) 5g, Citri Reticulatae Pericarpium (Jupi) 6g, Perillae Fructus (Suzi) 12g (wrapped), Poria (Baifuling) 12g, Ginger juice a few drops, Bamboo Shavings ginger-processed (Jiang zhuru) 5g. Additionally: Pinelliae Tuber raw (Sheng banxia) 9g, Eugeniophyllus (Gongdingxiang) 3g, Halloysit Rubrum (Chishizhi) 9g, Calcined Arcae Shell (Duan walengzi) 9g, all ground into fine powder, taken in small amounts before meals. [Commentary] Vomiting 1 hour after eating, with food and sour fluid, indicates insufficient Stomach Yang failing to rot and ripen food and water; thus, warming the stomach and descending rebellious Qi is primary. Raw Pinelliae Tuber has stronger anti-emetic effects than processed forms but is toxic and may cause throat/tongue itching or numbness, so it should not be taken in large amounts. Incorporating it into a powder for small doses addresses this concern.