〔丹〕嘈杂只是痰因火而动，栀子、姜炒黄连不可无。此食郁有热，山栀、黄芩为君，南星、半夏、陈皮
为佐，热多加青黛。肥人嘈杂，二陈汤少加芜芎、苍术、白术、炒栀子。心下嘈杂者，导饮丸最妙。（方见内伤饮食。）
哕者，成无己、许学士谓之呃逆是也。或曰∶成无己、许学士固以哕为呃逆，然东垣、海藏又以哕为干呕，
陈无择又以哕名咳逆，诸论不同，今子独取成、许二家之说何也？答曰∶哕义具在《内经》，诸家察之不详，
故论纷纷耳。谨按《灵枢·杂病篇》云∶哕，以草刺鼻嚏，嚏而已；无息而疾迎引之，立已；大惊之，亦可已。
详此经文三法，正乃治呃逆之法。按呃逆用纸捻刺鼻便嚏，嚏则呃逆立止。或闭口鼻气使之无息，亦立已。或
作冤盗贼大惊骇之，亦已。此予所以取成、许二家之论，哕为呃逆为得经旨也。盖哕、呃之名虽二，而病则一。
《经》名为之哕者，哕即呃声之重也。俗名为之呃者，呃即哕声之轻也。皆因病声之轻重，得此二名，初非哕、
呃有二病。若以哕为干呕，设使干呕之人，或使之嚏，或使之无息，或使之大惊，其干呕能立已乎？哕非干呕
也明矣。若以哕名咳逆，夫哕者，哕之病声，其声发会厌下；咳者，咳之病声，其声发会厌上，故《内经》哕
有哕之口问、咳有咳之篇论，病各不同，哕不可名咳逆也明矣。
〔丹〕呃逆论 呃病气逆也，气自脐下直冲上出于口而作声之名也。《书》曰∶火炎上。《内经》曰∶诸逆
冲上，皆属于火。东垣谓火与元气不两立，又谓火元气之贼也。古方悉以胃弱言之，而不及火，且以丁香、柿
蒂、竹茹、陈皮等剂治之，未审孰为降火，孰为补虚？人之阴气根据胃为养，胃土伤损，则木气侮之矣，此土败
木贼也。阴为火所乘，不得内守，木挟相火乘之，故直冲清道而上。言胃弱者阴弱也，虚之甚也。病患见此，
似为危症，然有实者，不可不知，敢陈其说。赵立道，年近五十，质弱而多怒。七月炎暑，大饥索饭，其家不
能急具，因大怒。两日后得滞下病，口渴，自以冷水调生蜜饮之甚快，滞下亦渐缓。如此五七日，召予视，脉
稍大不数，遂令止蜜水，渴时且令以人参、白术煎汤，调益元散与之，滞下亦渐收。七八日后觉倦甚，发呃。
予知其因下久而阴虚也，令其守前药。然滞下尚未止，又以炼蜜饮之。如此者三日，呃尤未止。众皆尤药之未
当，将以姜、附饮之。予曰∶补药无速效，附子非补阴者，服之必死。众曰∶冷水饮多，得无寒乎？予曰∶炎
暑如此，饮凉非寒，勿多疑。待以日数，药力到，当自止。又四日而呃止，滞下亦安。陈择仁，年近七十，浓
味之人也，有久嗽病而作止不常。新秋患滞下，食大减。至五七日后呃作，召予视之，脉皆大豁。众以为难，
予曰∶形瘦者尚可为。以人参白术汤下大补丸以补血，至七日而安。此二人虚之谓也。又一女子年逾笄，性躁
味浓，炎月因大怒而呃作，作则举身跳动，脉不可诊，神昏不知人，问之乃知暴病。视其形气俱实，遂以人参
芦二两煎汤饮一碗，大吐顽痰数碗，大汗昏睡一日而安。人参入手太阴，补阴中之阳者也。芦则反是，大泻太
阴之阳。女子暴怒气上。肝主怒，肺主气，经曰∶怒则气逆。因怒逆肝木，乘火侮肺，故呃大作而神昏。参芦
善吐，痰尽则气降而火衰，金气复位，胃气得和而解。麻黄发汗，节能止汗；谷属金，糠之性热；麦属阳，麸
之性凉。先儒谓物物具太极，学人不可不触类而长，引而伸之也。
〔无〕凡吐利后多作哕，此由胃中虚、膈上热故哕。或至八九声相连，于气不回，至于惊人者。若伤寒久
病，得此甚恶，《内经》所谓坏府者是也。
上吐利后哕，即丹溪治赵立道与陈择仁二人哕，皆于滞下得之之类，六脉大豁，用参、术而愈是也。予
长兄九月得滞下，每夜五十余行，呕逆，食不下。五六日后加呃逆，与丁香一粒噙之立止。但少时又至，
遂用黄连泻心汤加竹茹饮之，呃虽少止，滞下未安。如此者十余日，遂空心用御米壳些少涩其滑；日间用
参、术、陈皮之类补其虚。自服御米壳之后，呃声渐轻，滞下亦收而安。
〔仲〕哕而腹满，视其前后，知何部不利，利之即愈。
小承气汤治大便不通，哕数，谵语。（方见下利中。）
〔丹〕超越陈氏，二十余岁，因饱后奔走数里，遂患哕病，但食物则连哕百余声，半日不止，饮酒与汤
则不作，至晚发热。如此者二月，脉涩数。以血入气中治之，用桃仁承气汤加红花煎服，下污血数次即减。再
用木香和中丸加丁香服之，十日而愈。
〔无〕哕而心下坚痞眩悸者，以膈间有痰水所为。
〔丹〕洪孺人，年二十六岁，夏月因事为长上所阻，怒气折郁不得舒，须臾就浴，汤热不可近，怒气复增，
就闷绝昏倒。乃以衣遮掩就房，须臾咳逆大作，每一声必浑身为跳跃，仍复昏闷，凡三五息一作，脉不可诊。
予曰∶此膈上有痰逆，为怒气所郁，痰热相搏，气不得降而逆，非吐则不可。是时夜半，又事出仓卒，适有人
参芦二两在彼，浓煎饮之，大吐稠痰二升许，通体得汗，困睡半夜而安。（此即前呃逆论所言者，自此详细，
故重出之。）燥痰不出者，用蜜水吐之。
〔世〕哕声频密相连者为实，可治。若半时哕一声者为虚，难治，多死在旦夕。
〔仲〕哕逆者，陈皮竹茹汤主之。
陈皮（二升） 竹茹（二升） 大枣（三十枚） 生姜（半斤） 甘草（五两） 人参（一两）
上六味，以水一斗，煮取三升。温服一升，日五服。
干呕哕，若手足厥者，陈皮汤主之。（方见呕吐门。）
〔《本》〕又方
枳壳（五钱） 木香（一分）
上细末。每服一钱，白汤调下。未可，再与。
〔孙〕治诸呃噫。陈皮二两，汤浸去穣锉，以水一升，煎之五合，通口服。顷刻，更加枳壳一两，去穣炒，
同煎之。
〔《外》〕治久患咳噫，连咳一二十声者。取生姜汁半合，蜜一匙，头煎令热温服。如此三服，立效。
超越陈氏哕，用桃仁承气汤下污血数升而愈，是污血为哕也。
丹溪用益元散、大补丸，治赵立道、陈择仁滞下而哕者，或用蜜水治哕者，是热哕也。
〔洁〕柿钱散 治呃逆。
柿钱 丁香 人参（各等分）
上为细末，水煎，食后服。
〔罗〕丁香柿蒂散 治诸种呃噫，呕逆痰涎。
丁香 柿蒂 青皮 陈皮（各一两）
上为粗未。每服三钱，水一盏半，煎七分，去渣温服，不拘时候。
羌活附子汤
羌活 附子（炮） 木香 茴香（各五钱，炒） 干姜（一两）
上为细末。每服二钱，盐一撮，煎二十沸，热服，一服止。
胃为哕。（全文见五脏虚实。腹满利而不哕者，胃实也。）
运气 哕有三∶
一曰热。经云∶少阴之复哕噫，治以苦寒是也。
二曰寒。经云∶太阳之复，呕出清水，及为哕噫，治以苦寒是也。
三曰燥。经云∶阳明之复，咳哕，治以辛温是也。（《灵》以草刺鼻嚏治呃。有病伤寒将愈，忽患呃逆，
予与古人治呃逆之药，殆遍皆不愈，计出无药。遂用皂角末吹入鼻中，得嚏而呃逆止，少时又呃，又与
皂角末嚏而止者，凡数百次。其嚏时出痰涕渐多，自是呃逆渐疏，至三二日而止。此是合经草刺鼻嚏之法，
故书之。）
黄帝曰∶人之哕者，何气使然？岐伯曰∶谷入于胃，胃气上注于肺。今有故寒气与新谷气，俱还入于胃，
新故相乱，真邪相攻，气并相逆，复出于胃，故为哕。补手太阴，泻足少阴。（口问篇）
〔世〕治呃逆，于脐下关元穴灸七壮，立愈，累验。
〔罗〕又方，男左女右，乳下黑尽处一韭叶许灸三壮，甚者二七壮。
〔《集》〕治气逆发呃∶ 中、中脘（先补后泻，不已，再取下穴∶）三里、肺俞、行间。
心脉小甚为哕。（全文见治虚实法。）
【朱丹溪】嘈杂仅仅是因为痰因火邪扰动所致，栀子、姜汁炒黄连这两味药不可不用。这是食积郁结化热，以山栀、黄芩为君药，南星、半夏、陈皮为佐药，若热象加重则加入青黛。体型肥胖者出现嘈杂，用二陈汤少量加入川芎、苍术、白术、炒栀子。心下部位嘈杂的，导饮丸最为巧妙。（方剂见内伤饮食章节。）
呃逆（哕），成无己、许学士称之为呃逆。有人说：成无己、许学士固然将哕视为呃逆，然而李东垣、王海藏又将哕视为干呕，陈无择又将哕称为咳逆，各家论述不同，如今您唯独采纳成氏、许氏两家的说法，为什么呢？回答说：哕的含义在《内经》中已有详述，各家考察不详细，所以议论纷纷罢了。谨按《灵枢·杂病篇》记载：治疗哕，用草刺激鼻子引起喷嚏，喷嚏打出来就好了；屏住呼吸并迅速引导气息，立刻就好；突然惊吓它，也可以好。仔细研究这三条经文中的治法，正是治疗呃逆的方法。按照呃逆用纸捻刺鼻引起喷嚏，喷嚏打出则呃逆立即停止。或者闭口鼻气使其屏息，也立即好转。或者装作冤家盗贼突然大惊吓他，也能痊愈。这就是我采纳成氏、许氏两家论述的原因，认为哕就是呃逆，符合经旨。大概哕、呃名称虽然有两个，但病症是一样的。《内经》称之为哕的，哕即是指呃声重的情况。俗称为呃的，呃即是指哕声轻的情况。都是根据发病声音的轻重，得到这两个名称，起初并不是哕、呃有两种病。如果把哕当作干呕，假设干呕的人，有的让他打喷嚏，有的让他屏息，有的让他受大惊，他的干呕能立即好吗？哕不是干呕是显而易见的。如果把哕称为咳逆，哕是哕的病声，声音发于会厌下方；咳是咳的病声，声音发于会厌上方，所以《内经》中有专门论述哕的口问篇、论述咳的咳论篇，病症各不相同，哕不能称为咳逆也是显而易见的。
【朱丹溪】呃逆论：呃病是气逆，气从脐下直冲向上出于口而发出声音的名称。《尚书》说：火性炎上。《内经》说：各种逆气冲上的症状，都属于火。李东垣说火与元气不两立，又说火是元气的贼寇。古方全部用胃弱来解释，而不提及火，并且用丁香、柿蒂、竹茹、陈皮等药剂治疗，不知道哪一个是降火，哪一个是补虚？人的阴气依靠胃来滋养，胃土受损，那么肝木之气就会克制它，这就是土败木贼。阴气被火邪所乘，不能在内守持，肝木挟带相火侵犯它，所以直冲清道而上。说胃弱就是阴弱，是非常虚弱的表现。病人出现这种情况，似乎是很危重的病症，然而也有实证，不可不知道，冒昧陈述我的观点。赵立道，年龄近五十岁，体质弱且易怒。七月酷暑，极度饥饿索要饭食，家人不能立即准备好，因此大怒。两天后得了痢疾，口渴，自己用冷水调生蜜喝下去感觉很痛快，痢疾也逐渐缓解。像这样过了五七天，请我去诊视，脉象稍大但不数，于是命令停止喝蜜水，口渴时让人用人参、白术煎汤，调益元散给他服用，痢疾也逐渐收敛。七八天后觉得非常疲倦，发生呃逆。我知道这是因为下痢日久导致阴虚，让他坚守前面的药物。然而痢疾尚未停止，又让他喝炼蜜水。像这样过了三天，呃逆仍未停止。众人都责怪药不对症，准备用姜、附子汤饮用。我说：补药没有速效，附子不是补阴的药，服用了必死无疑。众人说：喝了那么多冷水，难道不是寒证吗？我说：天气如此炎热，喝凉的并非寒证，不要多疑。等待时日，药力到达，自然会停止。又过了四天呃逆停止，痢疾也安宁了。陈择仁，年龄近七十岁，喜好肥甘厚味的人，有久咳病发作停止不规律。初秋患痢疾，食欲大减。到了五七天后呃逆发作，请我去诊视，脉象都大而空豁。众人都认为难治，我说：形体消瘦的还可以救治。用人参白术汤送服大补丸以补血，到第七天就安宁了。这两个人属于虚证。又有一个女子超过十五岁，性情急躁口味浓重，盛夏时节因为大怒而呃逆发作，发作时全身跳动，脉象无法诊察，神志昏迷不知人事，询问后才知是突发疾病。观察她的形气都属实，于是用人参芦二两煎汤让她喝下一碗，吐出顽痰几碗，大汗淋漓昏睡一天后安宁。人参入太阴肺经，是补阴中之阳的药物。人参芦则相反，是大泻太阴之阳。女子因暴怒气机上逆。肝主怒，肺主气，经书说：怒则气逆。因为愤怒导致肝木之气逆乱，乘火侮肺，所以呃逆大作而神志昏迷。人参芦善于催吐，痰尽则气降而火衰，金气复位，胃气得和而解。麻黄发汗，葱节止汗；谷属金，米糠性热；麦属阳，麦麸性凉。先儒说万物都具备太极，学医之人不可不触类旁通，引申发挥。
【王无咎】凡是呕吐腹泻后多出现哕，这是由于胃中虚、膈上有热所以哕。有时达到八九声相连，气息不回，至于令人惊骇的程度。如果是伤寒久病，出现这个症状很恶劣，《内经》所说的坏府就是指这种情况。
上面提到的呕吐腹泻后出现的哕，就是丹溪治疗的赵立道和陈择仁两人患哕，都是在痢疾之后得的这类，六脉大空豁，用人参、白术治愈的情况。我的长兄九月得痢疾，每晚五十多次，呕吐逆气，吃不下东西。五六天后加上呃逆，给一粒丁香含在嘴里立即停止。但过了一会儿又发作，于是用黄连泻心汤加竹茹饮用，呃逆虽然稍微停止，痢疾未安宁。像这样过了十多天，于是空腹用御米壳少许涩其滑脱；白天用人参、白术、陈皮之类补其虚弱。自从服用御米壳之后，呃声逐渐减轻，痢疾也收敛安宁。
【张仲景】呃逆且腹部胀满，观察前后二便，知道哪一部不通利，通利它就痊愈。
【朱丹溪】超越陈氏，二十多岁，因为饱食后奔走数里，于是患呃逆病，只要吃东西就连呃逆百余声，半天不停，喝酒和喝汤则不发作，到了晚上发热。像这样持续两个月，脉象涩数。用血入气中的方法治疗，用桃仁承气汤加红花煎服，排出污血数次即减轻。再用木香和中丸加丁香服用，十天痊愈。
【王无咎】呃逆且心下坚硬痞闷眩晕心悸的，是因为膈间有痰水造成的。
【朱丹溪】洪孺人，二十六岁，夏季因为事情被长官阻挠，怒气郁结不得舒展，一会儿就去洗澡，水温热得不堪忍受，怒气再次增加，感到闷热昏倒。于是用衣服遮掩回到房间，一会儿咳逆大作，每一声必定浑身跳跃，仍然昏闷，大约三五息发作一次，脉象无法诊察。我说：这是膈上有痰逆，被怒气郁结，痰热相互搏结，气不能下降而逆上，不吐出来是不行的。当时是半夜，又是仓促之间，恰好有人参芦二两在那里，浓煎饮用，吐出稠痰约二升，全身出汗，困倦睡眠半夜后安宁。（这就是前面呃逆论中所说的，从此处详细描述，所以重复列出。）燥痰吐不出来的，用蜜水催吐。
【世医】呃逆声频密相连的是实证，可治。如果半个时辰呃一声的是虚证，难治，多在旦夕之间死亡。
陈皮（二升） 竹茹（二升） 大枣（三十枚） 生姜（半斤） 甘草（五两） 人参（一两）
以上六味药，用水一斗，煮取三升。温服一升，每天五次服用。
【《本草》】又一方
枳壳（五钱） 木香（一分）
以上研成细末。每次服用一钱，用白开水调下。不行，再给予。
【孙思邈】治疗各种呃噫。陈皮二两，热水浸泡去掉瓤切碎，用水一升，煎至五合，一次性口服。片刻后，再加枳壳一两，去瓤炒，一起煎煮。
【《外台秘要》】治疗长期患咳噫，连续咳嗽一二十声的。取生姜汁半合，蜂蜜一匙，第一次煎煮令热温服。像这样服用三次，立即见效。
超越陈氏的呃逆，用桃仁承气汤排出污血数升而痊愈，这是污血导致的呃逆。
丹溪用益元散、大补丸，治疗赵立道、陈择仁痢疾而呃逆的，或者用蜜水治疗呃逆的，这是热呃。
【李杲】柿钱散 治疗呃逆。
柿钱 丁香 人参（各等分）
以上研成细末，水煎，饭后服用。
【罗天益】丁香柿蒂散 治疗各种呃噫，呕逆痰涎。
丁香 柿蒂 青皮 陈皮（各一两）
以上研成粗末。每次服用三钱，水一盏半，煎至七分，去渣温服，不拘时候。
羌活附子汤
羌活 附子（炮制） 木香 茴香（各五钱，炒） 干姜（一两）
以上研成细末。每次服用二钱，盐一撮，煎二十沸，热服，一服即止。
胃为哕。（全文见五脏虚实。腹部胀满有利大便且不哕的，是胃实。）
运气学说 呃逆有三种：
一是热。经书说：少阴之复出现哕噫，用苦寒药物治疗。
二是寒。经书说：太阳之复，呕吐出清水，以及出现哕噫，用苦寒药物治疗。（注：此处原文可能有误，通常寒证用热药，但依原文翻译）
三是燥。经书说：阳明之复，出现咳哕，用辛温药物治疗。（《灵枢》用草刺鼻引起喷嚏治疗呃逆。有病伤寒将要痊愈，忽然患呃逆，我用了古人治疗呃逆的药，几乎遍试都不愈，计谋已尽无药可用。于是用皂角末吹入鼻中，引起喷嚏而呃逆停止，过了一会儿又呃，又给皂角末引起喷嚏而停止，总共几百次。打喷嚏时流出的痰涕逐渐增多，从此呃逆逐渐稀疏，到两三日后停止。这是符合经书中草刺鼻嚏的方法，所以记录下来。）
黄帝说：人患哕，是什么气使之然？岐伯说：谷物进入胃，胃气上注于肺。现在有旧的寒气与新的谷气，一起还入于胃，新故相乱，真气邪气相攻，气并相逆，又出于胃，所以为哕。补手太阴经，泻足少阴经。（口问篇）
【罗天益】又一方，男左女右，乳下黑色尽头处一韭菜叶大小灸三壮，严重的灸十四壮。
[Zhu Danxi] Zaoza (Rumbling Stomach) is merely caused by phlegm stirred up by fire; Zhizi (Gardeniae Fructus) and Jiangchao Huanglian (Rhizoma Coptidis fried with ginger juice) must not be omitted. This is food stagnation with heat, using Shanzhi (Gardeniae Fructus) and Huangqin (Scutellariae Radix) as sovereign drugs, Nanxing (Arisomatis Tuber), Banxia (Pinelliae Rhizoma), and Chenpi (Citri Reticulatae Pericarpium) as ministering drugs; if heat increases, add Qingdai (Indigo Naturalis). For obese individuals with Zaoza, Erchen Tang (Two-Cured Decoction) with small amounts of Chuanxiong (Ligustici Chuanxiong Rhizoma), Cangzhu (Atractylodis Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), and Chao Zhizi (Gardeniae Fructus fried) is used. For Zaoza in the epigastrium, Dao Yin Wan (Guiding Drink Pill) is most excellent. (Formula seen in Internal Injury due to Diet chapter.)
E (Hiccups/Convulsive Hiccups), Cheng Wuji and Xu Xueshi call it E Ni (Hiccups). Some say: Cheng Wuji and Xu Xueshi indeed regard E as E Ni, however Li Dongyuan and Wang Haizang again regard E as Gan Ou (Dry Vomiting), and Chen Wuzhe again names E as Ke Ni (Coughing against the flow), various theories differ. Why do you alone adopt the theories of Cheng and Xu? I reply: The meaning of E is contained in the *Neijing* (Inner Canon); various schools examined it in detail, hence the numerous debates. Carefully according to the *Lingshu · Zabing Pian* (Spiritual Pivot · Miscellaneous Diseases Chapter): "For E, use grass to prick the nose to induce sneezing; once sneezed, it stops; hold breath and quickly guide inspiration, it stops immediately; sudden fright can also stop it." Studying these three methods in the scripture, they are precisely methods for treating E Ni. Following E Ni, using paper twists to prick the nose induces sneezing; once sneezed, E Ni stops immediately. Or closing mouth and nose to hold breath, it also stops immediately. Or pretending to be an enemy or thief to suddenly frighten him, it also stops. This is why I adopt the theories of Cheng and Xu, regarding E as E Ni, which conforms to the essence of the scriptures. Although the names E and E are two, the disease is one. Named E in the *Jing* (Canon), E refers to the heavy sound of hiccups. Commonly named E, E refers to the light sound of hiccups. Both names were derived from the severity of the sound, initially there were not two diseases of E and E. If E were regarded as Gan Ou (Dry Vomiting), suppose a person with dry vomiting, making them sneeze, holding their breath, or startling them, could their dry vomiting stop immediately? It is clear that E is not Gan Ou. If E were named Ke Ni (Coughing against the flow), E is the pathological sound of E, originating below the epiglottis; Ke (Cough) is the pathological sound of coughing, originating above the epiglottis. Thus, the *Neijing* has chapters on E in Kouwen Pian and on Ke in Ke Lun Pian, the diseases are different, it is clear that E cannot be named Ke Ni.
[Zhu Danxi] Discourse on E Ni (Hiccups): E Bing (Disease of Hiccups) is Qi Ni (Qi Reversal), the name for qi rushing straight up from below the umbilicus to the mouth producing sound. The *Shu* (Book of Documents) says: Fire flares upward. The *Neijing* says: All rebellious qi rushing upward belongs to Fire. Li Dongyuan said Fire and Yuan Qi (Primal Qi) cannot coexist, and again said Fire is the thief of Yuan Qi. Ancient formulas all explained it as Wei Ruo (Stomach Weakness), without mentioning Fire, and treated it with agents like Dingxiang (Caryophylli Flos), Shidi (Kaki Calyx), Zhuru (Bambusae Caulis in Taeniam), and Chenpi (Citri Reticulatae Pericarpium), without knowing which lowers Fire and which tonifies Deficiency. Human Yin Qi relies on the Stomach for nourishment; when Wei Tu (Earth of the Stomach) is damaged, Mu Qi (Wood Qi) insults it. This is Earth failing and Wood attacking. Yin is ridden by Fire, unable to guard internally, Mu carries Xiang Huo (Ministerial Fire) to attack it, thus rushing straight up the Clear Path. Saying Wei Ruo means Yin is weak, extremely deficient. Patients seeing this seem to have critical symptoms, yet there are Excess cases, one must know this, daring to state my theory. Zhao Lidao, nearly fifty years old, constitutionally weak and prone to anger. In July's intense heat, extremely hungry and demanding rice, his family could not prepare it quickly, causing great anger. Two days later he developed Zhixia (Dysentery/Lienteric Disease), thirst, and drank raw honey mixed with cold water himself, feeling very comfortable, and Zhixia gradually eased. After five or seven days like this, he summoned me to examine him; pulse was slightly large but not rapid, so I ordered stopping the honey water, and when thirsty, ordered Ren Shen (Ginseng Radix) and Baizhu (Atractylodis Macrocephalae Rhizoma) decocted, mixed with Yiyuan San (Yiyuan Powder) given to him, Zhixia gradually converged. Seven or eight days later he felt very tired, developing E Ni. I knew it was due to prolonged downward discharge leading to Yin Deficiency, ordered him to stick to the previous medicine. However, Zhixia had not stopped, and he drank refined honey water again. After three days like this, E Ni still did not stop. Everyone blamed the medicine as inappropriate, intending to drink Jiang (Ginger) and Fuzi (Aconiti Lateralis Radix Praeparata). I said: Tonifying medicines have no quick effect; Fuzi does not tonify Yin, taking it will surely cause death. They said: Drank so much cold water, could it not be Cold? I said: Such hot weather, drinking cool things is not Cold, do not doubt too much. Wait for days, when the medicine power arrives, it will stop naturally. Four more days later E Ni stopped, Zhixia also settled. Chen Zerén, nearly seventy years old, a person fond of rich flavors, had a chronic cough that came and went irregularly. Early autumn suffered from Zhixia, appetite greatly reduced. By five or seven days later E Ni arose, summoned me to examine, pulse was all large and hollow. Everyone thought it difficult, I said: Those who are thin can still be treated. Used Ren Shen Baizhu Tang (Ginseng and Atractylodes Macrocephala Decoction) to administer Dabu Wan (Great Tonification Pill) to tonify Blood, by the seventh day he was safe. These two people represent Deficiency. Another girl over fifteen years old, irritable nature, rich diet, in summer month due to great anger E Ni arose, upon arising whole body trembled, pulse unobtainable, spirit confused unaware of people, asked then knew it was sudden illness. Examined her form and Qi both Excess, so used Renshen Lu (Ginseng Radix Stem) two liang decocted in water, drank one bowl, vomited several bowls of stubborn phlegm, profuse sweating, slept confused for one day then safe. Ren Shen enters Taiyin Lung Meridian, tonifies Yang within Yin. Lu is opposite, greatly drains Yang of Taiyin. Girl's sudden anger Qi rises. Liver governs Anger, Lung governs Qi, Scripture says: Anger causes Qi reversal. Due to anger reversing Liver Wood, riding Fire insulting Lung, thus E Ni greatly arises and spirit confuses. Renshen Lu is good at inducing vomiting, when phlegm is exhausted Qi descends and Fire declines, Metal Qi returns to position, Stomach Qi harmonizes and resolves. Mahuang (Ephedrae Herba) induces sweating, Jie (Node of Scirpi Triquetri) stops sweating; Gu (Grain) belongs to Metal, Bran's nature is Hot; Mai (Wheat) belongs to Yang, Bran's nature is Cool. Former Confucians said every thing possesses Taiji, learners must not fail to touch categories and grow, draw and extend them.
[Wang Wuji] Generally after vomiting and purging, E often occurs, this is due to Stomach Deficiency and Heat above the Diaphragm causing E. Sometimes up to eight or nine sounds connected, Qi does not return, reaching a shocking degree. If it occurs in long-term Shaoyin disease, this is very bad, what the *Neijing* calls Huai Fu (Ruined Viscera).
The E occurring after vomiting and purging mentioned above, is similar to Danxi treating Zhao Lidao and Chen Zerén's E, both obtained from Zhixia, six pulses large and hollow, cured with Ren Shen and Baizhu. My eldest brother got Zhixia in September, more than fifty times per night, vomiting and rebellion, food not going down. Five or six days later added E Ni, gave one Dingxiang (Caryophylli Flos) to hold in mouth, stopped immediately. But shortly after returned, so used Huanglian Xiexin Tang (Coptis Decoction to Drain the Epigastrium) plus Zhuru (Bambusae Caulis in Taeniam) to drink, E Ni slightly stopped, Zhixia not safe. Like this for ten-plus days, then on empty stomach used Yu Mi Qiao (Poppy Shell) a little to astringe the sliding; during day used Ren Shen, Baizhu, Chenpi etc. to tonify deficiency. After taking Yu Mi Qiao, E sound gradually lightened, Zhixia also converged and settled.
[Zhang Zhongjing] E with abdominal fullness, observe anterior and posterior [orifices], know which part is not free, free it and it heals.
Xiao Chengqi Tang (Minor Order the Qi Decoction) treats Da Bian Bu Tong (Constipation), E Shuo (Frequent Hiccups), Chan Yu (Delirious Speech). (Formula seen in Xia Li [Diarrhea/Dysentery] section.)
[Zhu Danxi] Chaoyue Chen Shi (Mr. Chen Chaoyue), over twenty years old, because after full meal ran several miles, then suffered E Bing (Disease of Hiccups), only when eating food then continuous E over hundred sounds, half day not stopping, drinking wine and soup then does not make, until evening fever. Like this for two months, pulse Se (Choppy) and Shuo (Rapid). Treat with Blood entering Qi method, use Tao Ren Chengqi Tang (Peach Kernel Order the Qi Decoction) plus Hong Hua (Carthami Flos) decocted and taken, discharged dirty blood several times then reduced. Again use Muxiang Hezhong Wan (Costus Harmonizing the Middle Pill) plus Dingxiang (Caryophylli Flos) taken, ten days then healed.
[Wang Wuji] E with Xin Xia Jian Pi (Epigastric Hardness and Fullness) and Xuan Ji (Vertigo and Palpitations), is caused by Tan Shui (Phlegm Water) between the Diaphragm.
[Zhu Danxi] Hong Ruren (Lady Hong), twenty-six years old, summer month because matters obstructed by superior, anger depressed and郁 (stagnant) not able to舒 (relax), momentary took bath, soup heat unbearable near, anger increased again, felt stifled fainted and fell. Then used clothes to cover and go to room, momentary Ke Ni (Coughing against the flow/Hiccups) greatly arose, each sound necessarily whole body jumping, still fuddled, every three or five breaths once arose, pulse unobtainable. I said: This is Phlegm Rebellion above the Diaphragm, depressed by anger, Phlegm-Heat fighting each other, Qi cannot descend and rebels, unless vomited it cannot be resolved. At that time midnight, also matter out of haste, just happened to have Renshen Lu (Ginseng Radix Stem) two liang there, thick decocted and drunk, vomited about two sheng of thick phlegm, whole body got sweat, sleepy half night then safe. (This is what was said in the previous E Ni Discourse, detailed here, so repeated.) Dry Phlegm not coming out, use Honey Water to induce vomiting.
[World Physicians] E sound frequent and dense connected is Excess, treatable. If half hour one E is Deficiency, difficult to treat, mostly die at dawn or dusk.
[Zhang Zhongjing] E Ni, Chenpi Zhuru Tang (Tangerine Peel and Bamboo Shavings Decoction) is main treatment.
Chenpi (Two Sheng) Zhuru (Two Sheng) Dazao (Thirty Pieces) Shengjiang (Half Jin) Gancao (Five Liang) Renshen (One Liang)
These six flavors, with water one Dou, boil to obtain three Sheng. Warm take one Sheng, five doses daily.
Gan Ou (Dry Vomiting) E, if Shou Zu Jue (Hand and Foot Cold), Chenpi Tang (Tangerine Peel Decoction) is main treatment. (Formula seen in Ou Tu [Vomiting] Gate.)
*[Ben Cao]* Another Formula
Zhi Qiao (Five Qian) Muxiang (One Fen)
These finely powdered. Each dose one Qian, white soup mix down. Not okay, give again.
*[Sun Simiao]* Treat all E Yi (Hiccups and Belching). Chenpi (Two Liang), soup soak remove pith cut, with water one Sheng, decoct five He, pass mouth drink. Momentarily, additionally add Zhi Qiao (One Liang), remove pith fry, same decoct.
*[Waitai Miyao]* Treat long suffering Ke Yi (Cough and Belching), continuous Ke one or twenty sounds. Take Shengjiang Zhi (Fresh Ginger Juice) half He, Mi (Honey) one spoon, first decoct let hot warm take. Like this three doses, immediate effect.
Chaoyue Chen Shi's E, used Tao Ren Chengqi Tang (Peach Kernel Order the Qi Decoction) down dirty blood several sheng then healed, is dirty blood for E.
Danxi used Yiyuan San (Yiyuan Powder), Dabu Wan (Great Tonification Pill), treat Zhao Lidao, Chen Zerén Zhixia (Dysentery) and E, or use Mi Shui (Honey Water) treat E, is Re E (Heat Hiccups).
[Li Gao] Shi Qian San (Persimmon Coin Powder) Treat E Ni (Hiccups).
Shi Qian (Persimmon Calyx) Dingxiang (Caryophylli Flos) Renshen (Ginseng Radix) (Each equal portion)
These finely powdered, water decoct, after food take.
[Luo Tianyi] Dingxiang Shidi San (Clove and Persimmon Sepal Powder) Treat all kinds of E Yi (Hiccups and Belching), Ou Ni (Vomiting Rebellion) Tan Xian (Phlegm Saliva).
Dingxiang (Clove) Shidi (Persimmon Calyx) Qingpi (Citri Reticulatae Pericarpium Viride) Chenpi (Citri Reticulatae Pericarpium) (Each One Liang)
These coarse powder. Each dose Three Qian, water one cup half, decoct seven parts, remove dregs warm take, no fixed time.
Qianghuo Fuzi Tang (Notopterygium and Prepared Aconite Decoction)
Qianghuo (Notopterygii Rhizoma et Radix) Fuzi (Prepared Aconite Root) Muxiang (Costi Radix) Huixiang (Foeniculi Fructus) (Each Five Qian, fried) Ganjiang (Dried Ginger) (One Liang)
These finely powdered. Each dose Two Qian, Salt one pinch, decoct twenty boils, hot take, one dose stops.
Wei (Stomach) is E. (Full text seen in Zang Fu Xu Shi [Viscera and Bowels Deficiency and Excess]. Abdominal fullness with loose stools and no E is Wei Shi [Stomach Excess].)
Yun Qi (Luck and Qi) E has three:
One is Re (Heat). Scripture says: Shao Yin Zhi Fu (Rebound of Shaoyin) E Yi, treat with Ku Han (Bitter Cold).
Two is Han (Cold). Scripture says: Tai Yang Zhi Fu (Rebound of Taiyang), Ou Chu Qing Shui (Vomit clear water), and wei E Yi (and for E Yi), treat with Ku Han (Bitter Cold).
Three is Zao (Dryness). Scripture says: Yang Ming Zhi Fu (Rebound of Yangming), Ke E (Cough E), treat with Xin Wen (Acrid Warm). (*Lingshu* uses grass pricking nose to sneeze treat E Ni. Had patient Shaoyang disease about to heal, suddenly suffered E Ni, I gave ancient people's treat E Ni medicine, almost all not healed, plan out no medicine. Then used Zao Jiao Mo (Gleditsiae Sinensis Fructus Powder) blow into nose, get sneeze and E Ni stop, short time again E, again with Zao Jiao Mo sneeze and stop, total hundreds of times. When sneezing out Tan Ti (Phlegm Nasal Discharge) gradually more, since then E Ni gradually sparse, to three or two days and stop. This is combine Jing Grass Prick Nose Sneeze method, so write it.)
Huangdi (Yellow Emperor) said: Ren Zhi E (Humans' E), He Qi Shi Ran (What Qi makes it so)? Qibo said: Gu Ru Yu Wei (Grain enters into Stomach), Wei Qi Shang Zhu Yu Fei (Stomach Qi upwards pours into Lung). Jin You Gu Han Qi Yu Xin Gu Qi (Now have old Cold Qi and new Grain Qi), Ju Huan Ru Wei (All return enter Stomach), Xin Gu Xiang Luan (New Old mutually chaotic), Zhen Xie Gong Gong (True Evil mutually attack), Qi Bing Xiang Ni (Qi together mutually reverse), Fu Chu Yu Wei (Again exit from Stomach), Gu Wei E (Thus become E). Bu Shou Taiyin (Tonify Hand Taiyin), Xie Zu Shaoyin (Drain Foot Shaoyin). (Kouwen Pian [Chapter Asking the Mouth]).
[World Physicians] Treat E Ni, at Qi Xia Guan Yuan Acupoint (CV4) moxa seven Zhu, immediate heal, repeatedly verified.
[Luo Tianyi] Another Formula, Male Left Female Right, Ru Xia Hei Jin Chu (Under breast black end place) one Jiu Ye Xu (Leek leaf size) moxa three Zhu, severe ones Er Qi Zhu (Fourteen Zhu).
*[Ji Cheng]* Treat Qi Ni Fa E (Qi Rebellion Arising E): Zhong Wan (CV12), Zhong Ting (CV13) (First tonify then drain, not well, again take lower acupoints:): Zu San Li (ST36), Fei Shu (BL13), Xing Jian (LR2).
Xin Mai Xiao Shen Wei E (Heart Pulse Small Extremely is E). (Full text seen in Zhi Xu Shi Fa [Treating Deficiency and Excess Methods].)