嘈杂辨析

Discrimination of Stomach Burning Disease

嘈杂病名始见于宋代。"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,而胸膈懊憹,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"。或作或止,腹中空空,若无一物,乃脾胃虚弱;似辣非辣,胸膈懊憹,得食而暂止,系胃中热扰;似饥非饥,似痛非痛,或兼胸闷痞满,为胃中邪滞(主要是痰饮),胃腑不降;烦怫杂乱,嗳气吞酸,则肝气郁滞。历代医家对嘈杂病的病因病机论述颇多,有"痰饮火动""湿痰气郁""胃气虚冷""阴虚血少""土虚木乘""虫"等,众说纷纭。要之,从痰饮、火热、土虚、木乘立论者,是为各执一端,从脾阴与胃阳不调和立论者,是为统论其本。嘈杂实为脾阴与胃阳不调和的一种征象。只要抓住脾阴与胃阳之阴阳偏胜这一关键病机,则辨证与治疗皆可豁然而解。正如近代名医姚国美指出:"嘈杂一症,痰是其标,阴阳偏胜是其本,然总由于脾胃不和,治此病者,不可不先顾脾胃,调其阴阳",可谓一语道破,要言不繁。

Stomach burning disease is found in Song Dynasty. ＂The stomach burning disease sometimes appears and sometimes disappears. It characterized by feeling like an empty stomach and be hungry and non- hungry, spicy and non-spicy, pain and non-pain, and still feeling like chest and diaphragm remorseful and indescribable. After meal the disease gets an obvious relief or follows recurrence, or combining nausea and gradually epigastria pain＂ . The symptom that stomach burning sometimes appears and sometimes disappears, sometimes performance as an empty stomach is due to the weakness of spleen and stomach; the symptom that the feeling like be spicy and non-spicy, chest and diaphragm remorseful and indescribable which after meal the disease get an obvious relief or got recurrence, is due to heat disturbance in stomach; the symptom that feel like be hunger and non-hunger, pain and non-pain, or combining tightness and fullness in chest is due to pathogen resistance in gastric cavity （mainly phlegm and fluid） and stomach Qi not being fall; the symptom that upset and belching and acid swallowing are due to liver Qi stagnation. In Chinese medical literatures, there have been widely differing versions about the pathogenesis of stomach burning disease, such as phlegm and fluid leading fire, damp phlegm and gas stagnation, deficiency cold of stomach Qi, Yin deficiency and blood deficiency, deficient of soil being subjugated by wood, worm. To sum up, Ancient physicians who established the statement of phlegm, hot, deficiency of soil, wood by argument, all stick to their own version, who established the statement of spleen Yin and stomach Yang disharmony comment its fundamental synthetically. In fact stomach burning is actually a kind of disorder of spleen Yin and stomach Yang disharmony. If only we have nailed the argument that the key pathogenesis of stomach burning is unilateral side in spleen Yin or stomach Yang, then its discrimination and treatment can be solved easily. As modern famous doctor Yao Guo-mei pointed out that： ＂As for the pathogenesis of stomach burning, sputum is the appearance, unilateral side in Yin or Yang is the fundamental, and generalization due to the incoordination between the spleen and the stomach, so to cure the disease, it must first take into account spleen and stomach, and regulate Yin and Yang＂, his comment is quite concise and to the point.