Epigastric upset, also known as heartburn (or heartburn), is a common symptom of discomfort in the epigastric region. Leizheng Zhicai states: "The symptom of heartburn belongs to the stomach, commonly referred to as heartburn, which is incorrect. Its manifestation is like hunger but not hunger, like pain but not pain, with a sense of unease and discomfort in the epigastric region. It may be accompanied by belching, stuffiness, gradually leading to acid regurgitation and fluid retention, with dull pain in the chest." Clinically, the symptom of epigastric upset often appears alongside symptoms such as belching, acid regurgitation, nausea, retching, epigastric stuffiness, and epigastralgia.

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1. Food Stagnation︰Epigastric upset with acid regurgitation, belching of foul odor, nausea, a restless feeling in the stomach with the urge to vomit, aversion to the smell of food, and distention in the epigastrium. Symptoms often improve after vomiting. There may also be fetid mouth odor, greasy tongue coating, or sour-smelling stools. The tongue coating and pulse may appear normal. There must be a history of dietary damage to the stomach, manifesting as epigastric distention, the urge to vomit, and aversion to food odors—symptoms of food injury (dyspepsia). If vomiting occurs, symptoms generally subside. Treatment involves using digestion-promoting and stagnation-relieving herbs, with modifications of the Harmony-Preserving Pill.
2. Stomach Heat︰Epigastric upset with a distinct spicy sensation in the stomach, or frequent sour and hot feelings, fetid mouth odor, acid swallow, or regurgitation of acidic fluid several times upon waking in the morning but normal during the day, or constipation, yellow tongue coating, and a surging or slippery pulse. For stomach heat, epigastric upset and acid swallow accompanied by a spicy sensation; it is advisable to clear stomach fire in the middle burner. Use Depression-Resolving Pill combined with Left Metal Pill with modifications.
3. Stomach Cold︰Epigastric upset with sour and watery regurgitation, or accompanied by epigastric pain, which worsens with exposure to cold or consumption of cold food but alleviates with warm drinks or food. There may be stuffiness and fullness in the epigastrium and abdomen, poor appetite, fatigue, and limb weakness. Symptoms also include qi deficiency, pale complexion, a pale tongue, and a thin pulse. In cases of stomach cold, epigastric upset with sour and watery regurgitation improves with warmth. Treatment should focus on warming the spleen and stomach. Modified Cyperus, Amomum and Six Gentlemen Decoction is recommended.

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1. Danxi Xinfa: "Coptis Rhizome, when used in phlegm medicine, is stir-fried with cape jasmine fruit and Skullcap Root as the main ingredients, with Arisaema, Pinellia, and Dried Tangerine Peel as supporting ingredients. If there is excessive heat, add Indigo. ... For obese people with epigastric upset, Two Old Ingredients Decoction should be used with a small amount of Ligusticum chuanxiong, Atractylodes Rhizome, White Atractylodes Rhizome, and stir-fried cape jasmine fruit."
2. Yixue Rumen．Epigastric Upset: "The heart feels as if it is hungry and also troubled."
3. Jingyue Quanshu．Miscellaneous Syndromes: "In summary, the symptom of epigastric upset is mostly caused by the disharmony of spleen qi or damage due to spleen deficiency. Therefore, when treating this, one must first consider the spleen qi. However, the ancients all treated this as phlegm-fire. I fear that using only cold and cool herbs will lead to stomach qi deficiency and cold, which will not strengthen the body, and instead will gradually lead to nausea, belching, regurgitation, dysphagia, and other such conditions."