***
Chinese medicine says bitter taste refers to the symptoms that patients consciously have bitter taste in their mouth, mostly for patients consciously, which can occur in acute and chronic hepatobiliary diseases. "Lingshu, Evil Pathogen and Sick House" records: "People with gallbladder diseases are good at breathing more and have bitter taste." "On flaccidity" says: "Liver-qi heat can drain bile and taste bitter." Bitter mouth is caused by liver fire fumigation and bile overflow. Liver heat is different from excess and deficiency, which is mostly damp-heat in the liver and gallbladder, while deficiency is mostly internal heat due to yin deficiency, suffering from middle energizer, leading to stagnation and heat in the upper energizer. Liver heat is constant, spleen and soil are trapped, and bitter taste is often accompanied by dampness, which originates from the spleen and stomach, so it will not heal.
***
If the syndrome differentiation and treatment of bitter mouth is due to yang deficiency and internal heat, alternating cold and heat, fullness in chest and hypochondrium, dry throat, dizziness, pale mouth and nausea, red and yellow tongue coating and pulse string, properly handle it, relieve yang deficiency, soothe the liver and benefit the gallbladder. If the heart meridian is hot, the face is red and thirsty, the chest is hot and irritable, the mouth and tongue are sore, the urine is red and astringent, and the tongue is red and the pulse is counted, it is appropriate to clear the heart and facilitate urination. Qingxin Decoction and Daochi Powder can be added and subtracted; If the liver and gallbladder are damp-heat, hypochondriac pain, heartburn and pantothenic acid, yellow and greasy tongue coating, and slippery pulse, the treatment should be clearing away heat and promoting diuresis, and Longdan Xiegan Decoction should be used. If the spleen and stomach are out of balance, the appetite is abnormal, and the dryness and dampness are not good, it can also cause food stagnation or phlegm stagnation, which will turn into heat for a long time, causing yin-fire inflammation with bitter taste. Therefore, it is necessary to use Shengyang Yiwei decoction to strengthen the spleen and replenish qi, clear away heat and promote diuresis. If the qi of liver and gallbladder is unfavorable, gallbladder sweat is caused by stomach qi, hypochondriac pain, constipation, vomiting and bitter water, red tongue and rapid pulse, and the treatment should be mainly to clear the liver, promote gallbladder function, reduce adverse flow and stop vomiting. (Li Guang, Third Affiliated Hospital of Henan University of Traditional Chinese Medicine. China Chinese Medicine News)
***
Professor Sun treats bitter taste. Professor Sun believes that the disease should first distinguish between excess and deficiency, and the empirical evidence is mostly damp heat, qi stagnation and phlegm heat. Deficiency syndrome is mostly qi deficiency and cold deficiency. For damp-heat in liver and gallbladder, the method of purging liver and gallbladder fire and the combination of bitter cold medicine and urine-clearing medicine are used to achieve the purpose of eliminating dampness and clearing heat. For liver depression to turn into fire, the method of activating qi to relieve depression is adopted, and the drugs for soothing the liver and relieving depression are compatible with the drugs for relieving cold and clearing heat, so as to achieve the purpose of soothing the liver and benefiting gallbladder. For the obstruction of phlegm-heat in the middle, we should use the method of clearing away heat and drying dampness, choose the medicine of eliminating dampness and resolving phlegm, and the medicine of clearing gallbladder and regulating stomach to achieve the purpose of regulating qi and resolving phlegm. For deficiency syndrome, the methods of invigorating qi and spleen, warming kidney and eliminating dampness are mainly used to achieve the purpose of strengthening the body resistance and eliminating evil. Li Mei, Sun,. Examples of Professor Sun's experience in treating bitter mouth [J]. Asia-Pacific Traditional Medicine, 20 18,14 (11):125-126. }.
***
Professor Wang Guobin treats bitter taste all day long based on syndrome differentiation. Most greasy eaters are located in the liver and gallbladder, and non-persistent bitter taste is more serious than spleen and stomach. People who have a bitter taste or eat greasy food all day long often suffer from liver and gallbladder damp-heat, liver and gallbladder loss, steaming due to damp heat and bile overflow, which leads to bitter taste; Non-persistent bitter taste is mostly caused by liver depression and spleen deficiency. Patients are usually discouraged in the spleen and stomach, and it is difficult to stay for a long time because of indigestion in the gastrointestinal tract. However, they are eager to work hard, but they are a drop in the bucket, and the bile swims up and becomes bitter. In addition to damp-heat type of liver and gallbladder, liver depression and spleen deficiency type, there are also patients with liver yin deficiency in clinic. Yin deficiency of the liver leads to internal heat, as Su Wen Wei Lun Pian said: "Liver-qi is hot, which leads to gallbladder diarrhea, bitter taste and dry fascia ..." The clinical symptoms are bitter taste in the mouth, light or thin tongue, thin and white fur and thready pulse. In the principle of treatment, it is mainly to clear away damp-heat in the liver and gallbladder, and if necessary, it is accompanied by Xiaochaihu Decoction and Longdan Xiegan Decoction; Liver depression and spleen deficiency are mainly based on soothing the liver and strengthening the spleen, and Xiaochaihu decoction adds and subtracts six gentlemen, Bupleurum and Xiangsha. Liver yin deficiency type is mainly nourishing liver yin, and Guan Yi decoction is used. {} Zhang Pengwei, Che Zhiying, He Lei, Fan Zunfeng. Professor Wang Guobin's medical record of treating bitter mouth [J]. Traditional Chinese Medicine Research, 2018,31(11): 41-43}
***
Professor Long Zuhong's experience in treating bitter taste syndrome of damp-heat in liver and gallbladder: bitter taste, dry mouth, abdominal distension and tightness, or yellow face, yellow urine, dry stool or uncomfortable stool. The main treatment is clearing away dampness-heat in liver and gallbladder, and the prescription is Longdan Xiegan Decoction. Syndrome of liver depression transforming into fire: bitter mouth, epigastric pain, red face and red eyes, impatience and irritability, nausea and vomiting, bitter vomiting, belching, red tongue, thin white or yellow fur, and thready pulse. The main treatment is soothing liver and clearing fire, and the prescriptions are Danzhi Xiaoyao Powder and Jinlingzi Powder. Syndrome of yin deficiency of liver and kidney: bitter taste, soreness of waist and knees, night sweats, vexation and fever with insomnia, fatigue, red tongue with little coating, and rapid pulse. The main treatment is nourishing yin and soothing liver, and the prescription is Zishui Qinggan Decoction. Deficiency and cold of spleen and stomach: bitter taste, obvious at night, light taste, thirst without drinking, or spitting clear water, cold pain in upper abdomen, preference for warm pressure, fatigue, lukewarm hands and feet, and loose stool. The tongue is light, fat and tender, with teeth marks on the edge of the tongue, white, smooth or greasy tongue coating, and deep pulse. The treatment is mainly to benefit the temperature, and the prescriptions are Xiangsha Liujunzi Decoction and Fu Liang Pill. {Huaning. Professor Long Zuhong's Experience in Treating Bitter Mouth [J]. Journal of traditional chinese medicine, Yunnan, 2018,39 (1): 2-3. }
***
Chief Physician Wang Longde's clinical experience in treating oral bitterness due to damp-heat in liver and gallbladder: Chief Physician Wang Longde closely focuses on the characteristic that "the liver governs the exhaustion and sexual pleasure leads to depression", and thinks that when the body is exposed to damp-heat evil, or is addicted to greasy and spicy food, the damp evil is endogenous, and the liver is exhausted and depressed for a long time, which will turn into heat, just as Su Wenweilun said: "Liver-qi is hot, gallbladder will be discharged, and oral bitterness." The clinical manifestations are chest pain or burning, abdominal distension, poor appetite, bitter taste, unpleasant stool, red tongue with yellow greasy coating and smooth pulse. Excessive treatment, clearing the heat of liver and gallbladder, resolving shaoyang and eliminating pathogenic factors will lead to smooth operation of qi. The prescription is Xiaochaihu decoction. If the heat is severe or the mouth is sore, Gentiana macrophylla, Taraxacum, Flos Lonicerae, Gypsum Fibrosum, Fructus Gardeniae and Radix Saposhnikoviae can be added. Adding vinegar Rhizoma Cyperi, Radix Curcumae and Fructus Toosendan with obvious qi stagnation; Wet weight can be scented with Pogostemon cablin, Eupatorium odoratum and Acorus gramineus; Dai Na adds Endothelium Corneum Gigeriae Galli, Fructus Hordei Germinatus and Fructus Crataegi to invigorate the spleen and promote digestion. Professor Jian Jiang believes that the syndrome differentiation of bitterness belongs to damp-heat in liver and gallbladder. Taking Longdan Xiegan Decoction as the main prescription, nine times out of ten, a bitter taste is treated with satisfactory results. Chief physician Wang Longde seldom uses this prescription in clinic. Because of the cold and dampness in northwest China, this recipe is too bitter and cold, so it is more common to reconcile shaoyang, soothe the liver and clear heat. Syndrome of disharmony between liver and stomach: Ling Shu's four-season qi: "The evil is in the gallbladder, but it goes against the stomach, and the bile fluid is discharged, so it tastes bitter." Teacher Wang believes that if the gallbladder stagnates, the symptoms are heartburn and pain, acid reflux, irritability, redness, dry mouth and bitter taste, and constipation. The tongue is red with yellow fur, and the pulse is slippery. Treatment should be based on clearing liver and purging fire, soothing liver and regulating stomach. Zuojin Pill and Chaihu Shugan Powder (Danzhi Xiaoyao Powder is used for those with liver depression and fire) are selected as the prescriptions. Adding Radix Puerariae and Fructus Schisandrae Chinensis into dry mouth; Radix Angelicae Dahuricae is added for improper breath; Ginger, Jiang Banxia and bamboo shavings were obviously added to the vomit. Cuttlebone, concha arcae, and Fritillaria thunbergii clear liver and relieve pain, and swallow acid; Miasma, Inula, ochre and perilla stem washed down; Fructus Trichosanthis, Fructus Cannabis, Fructus Arctii, etc. Used for constipation; Syndrome of dampness blocking the spleen and stomach: Chief physician Wang Longde believes that whether it is exogenous pathogenic dampness or spleen deficiency with excessive dampness, the spleen loses its healthy movement and qi movement is abnormal. The spleen cannot be clear, and the stomach cannot be turbid. For example, Huang Yuanyu's "Four Sages Heart Source" said: "Wood is born in water, born in soil, and the soil is harmonious, then the liver rises with the spleen and the gallbladder falls with the stomach." Therefore, the hepatobiliary excretion is dereliction of duty, and the spleen and stomach turbid qi flood in the mouth and become bitter. Another example is "Lingshu Pulse Degree": "The spleen is in the mouth, and the spleen mouth can know the five grains." Bitter mouth is more common in clinical morning, and the symptoms are anorexia, abdominal distension, bitter mouth, or light mouth, uncomfortable stool, weakness of limbs, pale tongue, white greasy fur, or pale grayish yellow fur and thready pulse. Banxia Xiexin Decoction (mixed cold and heat), Sanren Decoction (wet is heavier than heat) and Wei Ping Powder are selected to restore the smoothness of qi in middle energizer. Commonly used drugs are Rhizoma Atractylodis, Jiang Banxia, Cortex Magnolia Officinalis and Pericarpium Citri Tangerinae. Pogostemon cablin, Eupatorium odoratum and Acorus gramineus are smelly, fragrant and moist; Bupleurum, Scutellaria baicalensis, Shaoyang. Chief physician Wang Longde thinks that spleen governs transport and transformation, so spleen deficiency and dampness resistance, so it is often combined with fried yam, fried atractylodes and Poria. When the qi is depressed, the water stops, so don't forget to adjust the qi when removing dampness. Pericarpium Citri Tangerinae, Radix Aucklandiae, Areca catechu, Fructus Toosendan, Pericarpium Arecae, Fructus Citri Sarcodactylis and Fructus Citri Sarcodactylis are used to dredge the qi of triple energizer and regulate it. Dampness is the evil of yin, so we can use less isothermal products such as Ramulus Cinnamomi, Evodia rutaecarpa, Herba Epimedii and Fructus Foeniculi to help yang turn into qi. Use cuttlebone, concha arcae, and Mu Ping of Zhebei to swallow acid to clear liver, so as to make acid and relieve pain; Dai Na adds fried chicken gizzard-membrane, malt and hawthorn products to strengthen spleen and promote digestion; Spleen and stomach weakness syndrome: "Su Wen Bing Qi Lun": "Deficiency leads to bitter taste." Professor Hao Zheng pointed out that the symptoms of bitter taste can be seen not only in visceral heat syndrome, but also in visceral deficiency syndrome and cold syndrome. Chief physician Wang Longde pointed out that when eating disorders, overwork, chronic illness consume temper, spleen and soil are weak, biochemical sources are lacking, and it is easy to get angry for a long time, and the food is painful when the fire is exhausted; If spleen-qi deficiency is neglected for a long time, it will lead to spleen-stomach deficiency and cold, spleen-stomach fluctuation disorder and gallbladder loss, so gallbladder deficiency and cold will lead to bitter taste. Professor Sang Xisheng pointed out that stagnation of bile, regardless of cold and heat, will inevitably lead to floating fire, and bitter taste is a symptom of chills and is caused by floating fire. Clinical manifestations are anorexia, apathy, mental fatigue, loose stool, etc. A cold is accompanied by cold pain in the upper abdomen, tepid hands and feet, vomiting while eating, loose stool, etc. The tongue is light, fat and tender, with teeth marks on the edge of the tongue, white, smooth or greasy tongue coating, and deep pulse. The treatment is mainly to tonify the middle energizer and strengthen the spleen. The prescription is Buzhong Yiqi Decoction or Xiangsha Liujunzi Decoction. Modified Huangqi Jianzhong decoction or Lizhong decoction (mainly spleen and stomach deficiency and cold). Ruo Xu is cold for a long time, and the gallbladder is depressed and phlegm is disturbed, so Wendan Decoction is used to modify it. If the moisture stays for a long time, it will lead to spleen deficiency and dampness, showing diarrhea. You can choose Wuling powder and Shen Ling Baizhu powder. This is more effective in clinic. Ren,,,, Zhang Ping, Wang, Mao Lanfang. Chief Physician Wang Longde's Clinical Experience in Treating Bitter Mouth [J]. Clinical Research of Traditional Chinese Medicine, 202 1, 13(9):3-4. }