某 面冷频呃。总在咽中不爽。此属肺气 郁。当开上焦之痹。盖心胸背部。须藉在上清阳舒
展。乃能旷达耳。（肺气郁痹）
枇杷叶 炒川贝 郁金 射干 白通草 香豉
王 脉微弱。面亮戴阳。呃逆胁痛。自利。先曾寒热下利。加以劳烦伤阳。高年岂宜反复。乃欲脱
之象。三焦俱有见症。议从中治。（阳虚浊阴上逆）
人参 附子 丁香皮 柿蒂 茯苓 生干姜
陈 食伤脾胃复病。呕吐发呃下利。诊两脉微涩。是阳气欲尽。浊阴冲逆。阅方虽有姜附之理
阳。反杂入 归呆钝牵掣。后方代赭重坠。又混表药。总属不解。今事危至急。舍理阳驱阴无别法。
人参 茯苓 丁香 柿蒂 炮附子 干姜 吴萸
某 脉歇止。汗出呃逆。大便溏。此劳倦积伤。胃中虚冷。阴浊上干。
人参 茯苓 生淡干姜 炒川椒 炒乌梅肉 钉头代赭石
黄 脉小舌白。气逆呃忒。畏寒微战。胃阳虚。肝木上犯。议用镇肝安胃理阳。
人参 代赭石 丁香皮 茯苓 炒半夏 淡干姜
又 舌白胎浓。胃阳未醒。厥逆。浊阴上干为呃。仍用通法。
人参 淡附子 丁香皮 淡干姜 茯苓
又 照方加姜汁柿蒂。
又 人参 炒川椒 附子 茯苓 淡干姜 炒粳米
呃逆一症。古无是名。其在内经本谓之哕。因其呃呃连声。故今人以呃逆名之。观内经治
哕之法。以草刺鼻嚏。嚏而已。无息而疾迎。引之立已。大惊之亦可已。然历考呃逆之症。其
因不一。有胃中虚冷。阴凝阳滞而为呃者。当用仲景橘皮汤。生姜半夏汤。有胃虚虚阳上
逆。病深声哕者。宜用仲景橘皮竹茹汤。有中焦脾胃虚寒。气逆为呃者。宜理中汤加丁香。
或温胃饮加丁香。有下焦虚寒。阳气竭而为呃者。正以元阳无力。易为抑遏。不能畅达而
然。宜用景岳归气饮。或理阴煎加丁香。有食滞而呃者。宜加减二陈加山楂乌药之属。或
大和中饮加干姜木香。凡此诸法。不过略述其端。其中有宜有不宜。各宜随症施治。不
可以此为不易之法。故先生谓肺气郁痹。及阳虚浊阴上逆。亦能为呃。每以开上焦之痹。
及理阳驱阴。从中调治为法。可谓补前人之不逮。丹溪谓呃逆属于肝肾之阴虚者。其气
必从脐下直冲上出于口。断续作声。必由相火炎上。挟其冲气。乃能逆上为呃。用大
补阴丸峻补真阴。承制相火。东垣尝谓阴火上冲。而吸气不得入。胃脉反逆。阴中伏阳
即为呃。用滋肾丸以泻阴中伏热。二法均为至当。审证参用。高明裁酌可也。（邹时乘）
徐评 仲景治呃逆。以旋复代赭石汤为主方。案中独不用此方。而纯用补热之剂。其症属虚
寒上逆者。固有此法。但不知何以俱属寒逆。不识当时曾有误用处否。
某患者面色发冷，频繁打呃。总是感觉咽喉中不畅快。这属于肺气郁结。应当宣通上焦的痹阻。因为心胸背部，必须依靠在上清阳的舒展，才能感到旷达舒畅。（病机为肺气郁痹）
王某脉象微弱，面色光亮如妆（戴阳证），打呃且胁肋疼痛，自发性腹泻。先前曾患寒热往来并伴有腹泻，加上劳累烦扰损伤阳气，年事已高，病情岂能反复无常？这是阳气欲脱的征象。三焦都有相应的症状表现。建议从中焦进行调理。（病机为阳虚浊阴上逆）
陈某因饮食损伤脾胃又患病，出现呕吐、打呃、腹泻。诊察两手脉象微涩，这是阳气即将耗尽，浊阴之气冲逆而上。查阅之前的处方，虽然有使用姜、附来温理阳气的意图，但反而混杂了当归等呆钝牵掣之药。后方的代赭石重镇下沉，又混入解表药物，总之是不懂辨证施治。如今病情危急紧急，除了温理阳气、驱散阴邪外，别无他法。
某患者脉搏有间歇，出汗，打呃，大便稀溏。这是由于劳累过度积久内伤，导致胃中虚冷，阴浊之气上犯干扰。
黄姓患者脉象细小，舌苔白，气逆打呃，怕冷且轻微颤抖。这是胃阳虚弱，肝木之气上犯。建议采用平抑肝气、安和胃气、温理阳气的方法。
复诊：舌苔白厚腻，胃阳尚未苏醒，四肢厥冷，浊阴之气上犯干扰而致打呃。仍然使用通阳之法。
再诊：在原方基础上加入姜汁和柿蒂。
打呃这一病症，古代没有这个名称。在《内经》中本称为“哕”。因为它发出呃呃连续的声音，所以现代人称之为“呃逆”。观察《内经》治疗“哕”的方法，是用草刺激鼻子引起喷嚏，喷嚏打出就好了；或者屏住呼吸迅速迎引其气，立刻就能痊愈；大惊吓它也可以治愈。然而历次考证呃逆的病症，其原因各不相同。有因胃中虚冷，阴气凝结、阳气阻滞而导致打呃的，应当使用张仲景的橘皮汤、生姜半夏汤。有因胃虚导致虚阳上逆，病深声音低微的，适宜使用张仲景的橘皮竹茹汤。有中焦脾胃虚寒，气机上逆导致打呃的，适宜用理中汤加丁香，或者温胃饮加丁香。有下焦虚寒，阳气衰竭而导致打呃的，正是因为元阳无力，容易被抑制遏制，不能畅达所致，适宜使用张景岳的归气饮，或者理阴煎加丁香。有因食滞导致打呃的，适宜用加减二陈汤加山楂、乌药之类的药物，或者大和中饮加干姜、木香。以上这些方法，不过是略微陈述其端绪。其中有的适宜，有的不适宜，各人应当根据症状随症施治，不可以将此作为一成不变的方法。所以先生认为肺气郁痹，以及阳虚浊阴上逆，也能导致打呃。常常以宣通上焦痹阻，以及温理阳气、驱散阴邪，从中调治作为法则，可以说是弥补了前人的不足。朱丹溪认为呃逆属于肝肾阴虚的，其气必然从脐下直冲向上出于口，断续发声，必定是由相火炎上，挟持冲气，才能逆上成为呃逆。使用大补阴丸峻补真阴，制约相火。李东垣曾经认为阴火上冲，吸气不能进入，胃脉反而上逆，阴中伏藏的阳气即为呃逆，使用滋肾丸以泻除阴中的伏热。这两种方法都非常恰当，审察证候参考运用，由高明之人裁量斟酌即可。（邹时乘评注）
徐氏评语：张仲景治疗呃逆，以旋覆代赭石汤为主方。医案中唯独不使用此方，而纯粹使用补益温热的药剂。那些症状属于虚寒上逆的，固然有此治疗方法。但是不知道为何都属于寒逆？不认识当时是否有误用的情况吗？
Patient with a cold facial complexion and frequent hiccups. Always feels discomfort in the throat. This belongs to Lung Qi stagnation (Lung Qi Stagnation). One should open the obstruction of the Upper Jiao (Upper Burner). For the chest, heart, and back require the spreading and unblocking of the clear Yang above to achieve a sense of openness and relaxation. (Pathogenesis: Lung Qi Stagnation and Obstruction)
Loquat Leaf (Pipalaye), Stir-fried Fritillaria Bulb (Chuanbeimu), Curcuma Aromatica Rhizome (Yujin), Belamcanda Rhizome (Shegan), Taro Stem (Baitongcao), Fermented Soybean (Xiangchi)
Wang's pulse is weak and faint. The face appears bright and flushed (Floating Yang/Dai Yang syndrome). Hiccups accompanied by hypochondriac pain, spontaneous diarrhea. Previously suffered from alternating chills and fever with diarrhea, compounded by labor and worry damaging Yang. How can an elderly person endure such recurrence? This is a sign of impending collapse. Symptoms are evident in all three Jiaos (Burners). Proposal: Treat from the Middle Jiao (Middle Burner). (Pathogenesis: Yang Deficiency with Turbid Yin Counterflow)
Ginseng Root (Renshen), Aconite Lateral Root Preparata (Fuzi), Cinnamon Bark (Dingxiangpi), Persimmon Calyx (Shidi), Poria (Fuling), Raw Dried Ginger (Sheng Ganjiang)
Chen was injured by food retention affecting the Spleen and Stomach, then fell ill. Vomiting, hiccups, and diarrhea occurred. Palpation of both pulses revealed them to be faint and choppy, indicating that Yang Qi is about to exhaust, and Turbid Yin is rushing counter-current upward. Reviewing previous prescriptions, although there was an intention to warm and regulate Yang using Ginger and Aconite, herbs like Angelica Sinensis (Gui) were mixed in, which are cloying and dragging. Later, heavy-sinking Oyster Shell (Daizheshi) was used, mixed with exterior-releasing drugs. In total, this shows a lack of understanding. Now the situation is critical and urgent. Apart from regulating Yang and driving out Yin, there is no other method.
Ginseng Root (Renshen), Poria (Fuling), Cinnamon Bark (Dingxiang), Persimmon Calyx (Shidi), Processed Aconite Lateral Root (Paofuzi), Dried Ginger (Ganjiang), Evodia Fruit (Wuyu)
Patient with intermittent pulse, sweating, hiccups, and loose stools. This results from accumulated injury due to overwork and fatigue, leading to deficiency-cold in the Stomach, with Yin turbidity invading upwards.
Ginseng Root (Renshen), Poria (Fuling), Raw Light Dried Ginger (Sheng Dan Ganjiang), Stir-fried Sichuan Pepper (Chao Chuanjiao), Stir-fried Sour Plum Flesh (Chao Wumeirou), Nucleus-like Oyster Shell (Dingtou Daizheshi)
Huang has a small pulse and white tongue coating. Qi rebels causing hiccups, aversion to cold with slight trembling. Stomach Yang is deficient; Liver Wood invades upwards. Proposal: Use methods to calm the Liver, harmonize the Stomach, and regulate Yang.
Ginseng Root (Renshen), Oyster Shell (Daizheshi), Cinnamon Bark (Dingxiangpi), Poria (Fuling), Stir-fried Pinellia Tuber (Chao Banxia), Light Dried Ginger (Dan Ganjiang)
Re-consultation: Tongue coating is white and thick/greasy. Stomach Yang has not yet awakened. Cold extremities (Jue Ni). Turbid Yin invades upwards causing hiccups. Continue using the method of unblocking/warming.
Ginseng Root (Renshen), Light Aconite (Dan Fuzi), Cinnamon Bark (Dingxiangpi), Light Dried Ginger (Dan Ganjiang), Poria (Fuling)
Again: Add Ginger Juice and Persimmon Calyx to the prescription.
Again: Ginseng Root (Renshen), Stir-fried Sichuan Pepper (Chao Chuanjiao), Aconite (Fuzi), Poria (Fuling), Light Dried Ginger (Dan Ganjiang), Stir-fried Rice Grain (Chao Jingmi)
The symptom of hiccups (E Ni) had no specific name in ancient texts. In the *Neijing* (Classic of Internal Medicine), it was originally called "Yue" (Hiccup/Cough). Because it produces continuous "eh-eh" sounds, modern people call it "E Ni". Observing the methods for treating "Yue" in the *Neijing*: stimulate the nose with grass to induce sneezing, and once sneezed, it stops; or hold breath and quickly guide the Qi, and it stops immediately; sudden great fright can also cure it. However, examining various causes of E Ni, they are not uniform. There are cases where Stomach deficiency-cold causes Yin condensation and Yang stagnation leading to hiccups; use Zhang Zhongjing's Citrus Peel Decoction (Ju Pi Tang) or Fresh Ginger and Pinellia Decoction (Sheng Jiang Ban Xia Tang). There are cases of Stomach deficiency with floating Yang counterflow, deep disease with low voice; use Zhang Zhongjing's Citrus Peel and Bamboo Shave Decoction (Ju Pi Zhu Ru Tang). There are cases of Middle Jiao Spleen-Stomach deficiency-cold with Qi rebellion; use Li Zhong Tang plus Cinnamon Bark, or Warm Stomach Decoction (Wen Wei Yin) plus Cinnamon Bark. There are cases of Lower Jiao deficiency-cold with exhaustion of Yang Qi; precisely because Yuan Yang lacks strength, it is easily suppressed and cannot flow freely; use Zhang Jingyue's Gui Qi Yin, or Li Yin Jian plus Cinnamon Bark. There are cases caused by food stagnation; use Modified Er Chen Tang plus Hawthorn and Litsea, or Da He Zhong Yin plus Dried Ginger and Costus Root. These methods merely outline the principles. Some are suitable, some are not. Each should treat according to symptoms. Do not regard this as an immutable law. Thus, the Master states that Lung Qi stagnation-obstruction, and Yang deficiency with Turbid Yin counterflow, can also cause hiccups. Often using methods to open Upper Jiao obstruction, and regulate Yang while driving out Yin, treating from the middle, can be said to supplement the deficiencies of predecessors. Zhu Danxi stated that hiccups belonging to Liver-Kidney Yin deficiency involve Qi rushing straight up from below the navel to the mouth, making intermittent sounds, necessarily driven by Minister Fire flaring up, carrying Chong Qi to rebel upwards. Use Da Bu Yin Wan to severely tonify True Yin and control Minister Fire. Li Dongyuan once stated that Yin Fire rushing up prevents inhalation, Stomach Meridian rebels, and hidden Yang within Yin becomes hiccups; use Zi Shen Wan to drain hidden heat within Yin. Both methods are highly appropriate. Examine the syndrome and apply accordingly, leaving discretion to the wise. (Commentary by Zou Shicheng)
Xu's Commentary: Zhang Zhongjing treats hiccups primarily with Perilla Seed and Oyster Shell Decoction (Xuan Fu Dai Zhe Shi Tang). In these medical records, this formula is uniquely not used, but purely warming and tonifying agents are employed. For symptoms belonging to deficiency-cold counterflow, this method is indeed applicable. But why do all cases belong to cold counterflow? Is it unknown whether there were misuses at that time?