呃逆,气自腹中时逆上冲,才发声于咽喉则遽止,轧轧然连续数声,其声短促不长,俗谓之呃忒。古
谓之哕,非也。且其气皆从胃中起,至胸嗌之间而为呃忒也。若将呃逆紊为哕与咳逆,误人多矣。然
呃逆之病,或胃中实热失下而作,或服寒凉太过,胃中虚冷而作,或胃中痰水□逆而作,或水气停
畜而作,或食积壅塞而作。寒者温中以散寒,热者凉膈以逐热,水停者分利之,食积者消导之,痰逆
者开豁之。俱用引而伸之,达而降之,推而逐之,由而顺之,无不愈也。
肺主气,肺为邪所干,气逆而不下,故令人咳嗽。有肺寒而咳,有停饮而咳,有邪在半表半里而咳,治
各不同。其水咳三症,不可不辨。小青龙汤,太阳之表水也。十枣汤,太阳之里水也。真武汤,少阴之水
气也。
喘者,气逆而上行,冲冲而气急,喝喝而息数,张口?肩,摇身掀肚者是也。有邪在表而喘,有邪在里
而喘,有水气之喘。在表者,因太阳表邪未解所致,必必腹满而不坚,治宜发散。在里者,因阳明内实
失下而致,必心腹胀满,治宜攻下。指掌赋云,微喘缘表之未解。喘满而不恶寒者,当下而痊。若饮水
过多,水气泛溢而喘,必心下怔忡,治宜行水。若身汗如油,喘而不休,又为绝候。
呕者,声物俱有而渐出。吐者,无声有物而顿出。较其轻重呕甚于吐也。若有声无物,为干呕也。盖因
表邪传里,里气上逆,则为呕也。大抵伤寒呕吐,多属半表半里。间有胃热而呕吐者。经曰、呕吐虽有
阳明症,不可攻之,为气逆未收歛为实也。若胃热而呕吐者,脉弦数,口燥渴是也。胃寒而呕吐者,脉
弦迟,逆冷是也。水气而呕吐者,先渴后呕鬲间怔忡是也。脓血而呕吐者,喉中腥腥,血逆上冲是也。
又有所谓干呕者,因邪热在胃脘,热气与谷气相并,逆上□胸,故有此症。大率与呕吐治法不远。
若太阳汗出而干呕,桂枝汤,主自汗也。少阴下利而干呕,姜附汤,生主下利也。厥阴吐涎沫而干呕,吴
茱萸汤,主涎沫也。邪去则呕自止矣。又有水气之症,当之表里别之。
呃逆,是气从腹中不时向上冲逆,刚在咽喉发出声音就立刻停止,连续发出几声短促的“轧轧”声,声音短促而不长,民间称为“呃忒”。古代称之为“哕”,这是错误的。而且这种气都是从胃中发起,上行至胸膈和咽喉之间才形成呃逆。如果把呃逆混淆为哕和咳逆,会误导很多人。然而,呃逆这一病症,有的是因为胃中实热未能及时通下而发作,有的是因为服用寒凉药物太过,导致胃中虚冷而发作,有的是因为胃中痰饮上逆而发作,有的是因为水气停聚而发作,有的是因为食积壅塞而发作。对于寒证,用温中法以散寒;对于热证,用凉膈法以清热;对于水停者,用分利法以排水;对于食积者,用消导法以化积;对于痰逆者,用开豁法以化痰。这些方法都运用引导、伸展、通达、降逆、推逐、顺应的原则,没有不能治愈的。
肺主气,如果肺被邪气干扰,气机上逆而不能下行,就会使人咳嗽。有因肺寒而咳的,有因停饮(水饮停留)而咳的,有因邪气在半表半里而咳的,治疗方法各不相同。其中关于水饮致咳的三种症状,不可不加以辨别。小青龙汤,治疗太阳经表证的水饮;十枣汤,治疗太阳经里证的水饮;真武汤,治疗少阴经的水气病。
喘,是指气机上逆而上行,气息急促冲动,呼吸声粗重且频率快,张口抬肩,摇动身体、掀动肚皮的状况就是喘证。有因邪气在表而喘的,有因邪气在里而喘的,有因水气导致的喘。在表的喘,是因为太阳表邪未解所致,必然伴有腹部胀满但按之不坚硬,治疗宜用发散法。在里的喘,是因为阳明腑实失于攻下所致,必然伴有心腹胀满,治疗宜用攻下法。《指掌赋》说:“轻微的喘息是因为表邪尚未解除。”如果喘息兼有胀满且不恶寒,应当用攻下法即可痊愈。如果饮水过多,导致水气泛溢而喘,必然伴有心下部悸动不安,治疗宜用行水法。如果身上出汗如油,喘息不止,这属于绝症(预后极差)。
呕,是有声音且有物吐出,逐渐而出。吐,是没有声音但有物吐出,突然而出。比较其轻重,呕比吐更严重。如果有声无物,称为干呕。这通常是因为表邪传入体内,里气上逆,从而形成呕吐。大抵伤寒引起的呕吐,多属于半表半里证。间或有因胃热而呕吐的。医经说:呕吐虽然伴有阳明病的症状,但不可攻下,因为此时气机逆乱尚未收敛,并非真正的实证。如果是胃热引起的呕吐,脉象弦数,口干燥渴。如果是胃寒引起的呕吐,脉象弦迟,四肢逆冷。如果是水气引起的呕吐,先口渴后呕吐,膈间悸动不安。如果是脓血引起的呕吐,喉中有腥臭味,血液上冲。又有所谓的干呕,是因为邪热在胃脘部,热气与谷气相搏结,逆上冲击胸部,所以出现这种症状。大体上与呕吐的治疗方法相近。如果是太阳病汗出而干呕,用桂枝汤,主治自汗。如果是少阴病下利而干呕,用姜附汤,主治下利。如果是厥阴病吐涎沫而干呕,用吴茱萸汤,主治涎沫。邪气去除则呕吐自然停止。又有水气相关的症状,应当根据表里分别论治。
Erbì (hiccups) refers to the sudden upward rushing of Qi from the abdomen. The sound is emitted at the throat and stops abruptly, producing a continuous series of short, staccato "ha-ha" sounds. This is commonly known as Erbì. In ancient texts, it was incorrectly referred to as Yuě (belching or hiccups). The Qi originates in the Stomach and rises to the chest and pharynx to produce Erbì. Confusing Erbì with Yuě or Ke-ni (coughing against the wind) has misled many practitioners. However, Erbì can arise from various causes: excess heat in the Stomach due to failure to purge; deficiency-cold in the Stomach caused by excessive intake of cold-cooling herbs; rebellion of Phlegm-fluids in the Stomach; retention of Water-Qi; or food stagnation causing obstruction. For cold patterns, warm the Middle Jiao to dispel cold; for heat patterns, cool the Diaphragm to clear heat; for water retention, promote diuresis to drain water; for food stagnation, promote digestion to resolve accumulation; for Phlegm rebellion, open and scatter the Phlegm. All these methods employ principles of guiding, extending, unblocking, descending, pushing away, and smoothing, ensuring recovery.
The Lung governs Qi. When pathogenic factors interfere with the Lung, Qi rebels and fails to descend, leading to cough. Cough may result from Lung cold, retained fluids (Yin), or pathogens located at the Shaoyang level (half-exterior, half-interior), each requiring different treatments. Among these, the three types of fluid-induced cough must be distinguished. Xiao Qing Long Tang (Minor Blue Dragon Decoction) treats Water-Fluid at the exterior of the Taiyang channel. Shi Zao Tang (Ten Jujube Decoction) treats Water-Fluid at the interior of the Taiyang channel. Zhen Wu Tang (True Warrior Decoction) treats Water-Qi associated with the Shaoyin channel.
Chuan (wheezing or panting) involves the upward rebellion of Qi, characterized by urgent, surging breath, loud respiration, rapid breathing rate, opening the mouth and raising the shoulders, and shaking the body and abdomen. Chuan can be caused by pathogens at the exterior, pathogens at the interior, or Water-Qi. Exterior Chuan results from unresolved Taiyang exterior pathogens, typically presenting with abdominal fullness that is not hard to palpation; treatment should focus on dispersing the exterior. Interior Chuan results from Yangming interior excess due to failure to purge, presenting with abdominal distension and fullness; treatment should focus on purging. The *Zhangzhi Fu* states: "Mild wheezing arises because the exterior pathogen is not yet resolved." If wheezing is accompanied by fullness but no aversion to cold, purging will lead to cure. If excessive drinking leads to Water-Qi overflow causing wheezing, there will be palpitations in the epigastrium; treatment should focus on moving water. If sweat oozes like oil and wheezing does not cease, this is a sign of terminal illness (Jue Hou).
Ou (vomiting with sound) involves both sound and material being expelled gradually. Tu (spitting up) involves material being expelled suddenly without sound. Comparing their severity, Ou is more severe than Tu. If there is sound but no material, it is called Gan Ou (dry heaving). This usually occurs when exterior pathogens transmit inward, causing interior Qi to rebel upward, resulting in vomiting. Generally, vomiting in Shanghan (Cold Damage) belongs to the Shaoyang (half-exterior, half-interior) stage. Occasionally, vomiting is due to Stomach heat. The Classics state: "Although vomiting may present with Yangming symptoms, one must not use purgatives, as the rebellious Qi has not yet converged into an excess pattern." If vomiting is due to Stomach heat, the pulse is wiry and rapid, accompanied by dry mouth and thirst. If vomiting is due to Stomach cold, the pulse is wiry and slow, accompanied by cold extremities. If vomiting is due to Water-Qi, there is initial thirst followed by vomiting, with palpitations in the diaphragm. If vomiting involves pus and blood, there is a fishy odor in the throat and blood rushing upward. Another form of Gan Ou (dry heaving) occurs when pathogenic heat resides in the Stomach cavity, where heat Qi combines with grain Qi, rebelling upward toward the chest. Its treatment is generally similar to that of vomiting. If Taiyang sweating is accompanied by Gan Ou, Gui Zhi Tang (Cinnamon Twig Decoction) is used to treat spontaneous sweating. If Shaoyin diarrhea is accompanied by Gan Ou, Jiang Fu Tang (Ginger and Aconite Decoction) is used to treat diarrhea. If Jueyin spitting of saliva and foam is accompanied by Gan Ou, Wu Zhu Yu Tang (Evodia Decoction) is used to treat the saliva and foam. Once the pathogen is eliminated, vomiting ceases naturally. Cases involving Water-Qi symptoms should be differentiated according to exterior and interior locations.