（一名呃逆）
《内经》曰∶诸逆冲上，皆属于火。又云∶岁金太过咳逆，金郁之发咳逆，少阴二气
咳逆。《金匮》治咳逆，皆指肺金及火为病也。
《千金方》云∶咳逆上气者为病肺，脉数，数者是心火刑于肺金也。
《格致余论》云∶咳逆者，俗谓之呃逆是也。呃逆病即气逆，自脐下直上出于口，而作
声之名也。书曰∶火炎上。东垣谓火与元气不两立，又谓为元气之贼是也。古方悉以胃
弱言之，而不及火，以丁香、柿蒂，竹茹、陈皮等剂治之，未审孰为降火，孰为补虚。况人
之阴气根据胃为养，胃土伤损，则木气乘之，此则土败木贼也。阴为火所乘，不得内守，木挟
火直冲清道而上。言胃弱者，阴弱之也，虚之甚也。
咳逆乃干咳之渐进，无痰有声，连连不绝，其气自丹田而逆，上出于咽喉，如有所
击逆而然也。亦有咳声出咽，复有还声吸入咽内，此所以为咳逆证也。呃逆者，即下文云
入声是也。有咳、呃兼声击发，连续千万之声而不已者，服药不效即用吐法，吐出痰涎立已。
《难知》云∶夫咳逆证，《活人书》断为哕逆，其说似是而实非也。盖哕者，干呕也。
若有物直出，则为吐；呕物旋出，则为呕；无物出，则为哕。咳逆者，则水渍于肺而心痞，
或连续不已而气逆，或喜笑过多而气噎，或咽饮错喉而气抢，或急食干物而气塞，皆能作咳
逆之声，连续不绝，俗谓之呃忒是也。大抵咳逆者，不顺之义；呃忒者，差错之义。二者
皆气不得下，为火热托之而上，至咽喉噎而止也。人或以纸捻鼻，嚏之而止，或诈冤盗贼，
因恐而止，或鼻热闻食香调气而止，皆抑之骇之而使气下也。
若哕者，出声也。哕出其气，哕声尽，然后吸，吐哕门中详言矣。呃逆者，入声也。气
逆入喉，逆声尽，然后呼也。出入呼吸，其大不同。呕秽者，本于胃；呃逆者，本于肺，
何难辨哉！
《黄帝内经》说：各种气逆冲上的病证，都属于火邪。又说：岁运金气太过导致咳逆，金气郁结发作时导致咳逆，少阴君火与少阳相火二气失调导致咳逆。《金匮要略》治疗咳逆，都是指肺金及火邪为患。
《千金方》说：咳逆上气的病证属于肺，脉象数，数脉表示心火克制肺金。
《格致余论》说：咳逆，就是俗称的呃逆。呃逆的病机即是气逆，气从脐下直冲向上出于口，从而发出声音。书上说：火性炎上。李东垣认为火与元气不能两立，又称火为元气的贼邪。古方全部将咳逆归因于胃弱，而没有提及火邪，使用丁香、柿蒂、竹茹、陈皮等方剂治疗，未能审察哪一味是降火的，哪一味是补虚的。况且人的阴气依靠胃来滋养，如果胃土受损，则肝木之气就会乘虚侵袭，这就是土败木贼。阴气被火邪所乘，不能在内守持，肝木挟带火邪直冲清道而上行。所谓胃弱，实际上是指阴气虚弱，也就是极度虚弱。
咳逆是干咳逐渐发展的结果，无痰而有声，连续不断，其气自丹田逆行，向上出于咽喉，好像受到撞击而气逆的样子。也有咳嗽的声音从咽部发出，随即又有回声吸入咽内，这就是咳逆证候的原因。呃逆，就是下文所说的“入声”。有的咳和呃兼有声音击发，连续千万声不停止，服药无效时就采用吐法，吐出痰涎后立刻痊愈。
《难知》说：关于咳逆证候，《活人书》将其断定为哕逆，这种说法看似有理实则错误。大概哕，就是干呕。如果有实物直接吐出，就是吐；呕吐物旋出，就是呕；没有东西吐出，就是哕。咳逆，则是水湿浸渍于肺而导致心下痞满，或者连续不断导致气逆，或者喜笑过多导致气噎，或者吞咽饮水误入喉间导致气抢，或者急食干硬食物导致气塞，都能产生咳逆之声，连续不绝，俗称呃忒。大体来说，咳逆是不顺的意思；呃忒是差错的意思。这两种情况都是气不能下行，被火热托举而上行，到达咽喉处噎住而停止。有人用纸捻刺激鼻腔，打喷嚏而停止，或者假装遭受冤屈或盗贼惊吓，因恐惧而停止，或者鼻热闻到食物香气调理气息而停止，这些都是通过抑制和惊吓使气下行。
如果是哕，是出声的过程。哕排出气体，哕声结束后，然后吸气，这在《吐哕门》中有详细说明。呃逆，是入声的过程。气逆入喉，逆声结束后，然后呼气。出入呼吸，二者大不相同。呕吐秽物，病本在胃；呃逆，病本在肺，这有什么难以辨别的呢！
(Coughing with upward rushing Qi, also known as hiccups)
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: All conditions involving upward rushing of Qi belong to Fire. It further states: When the metal phase of the annual运气 (Yunqi) is excessive, coughing with upward rushing Qi occurs; when the metal phase is constrained and erupts, coughing with upward rushing Qi occurs; when the Shaoyin (Lesser Yin) and Shaoyang (Lesser Yang) phases are disharmonious, coughing with upward rushing Qi occurs. The *Jingui Yaolue* (Essential Prescriptions from the Golden Cabinet) treats coughing with upward rushing Qi by addressing pathologies of Lung Metal and Fire.
The *Qianjin Fang* (Prescriptions Worth a Thousand Gold) states: Coughing with upward rushing Qi is a pathology of the Lung; the pulse is rapid (Shu), indicating that Heart Fire is punishing Lung Metal.
The *Gezhi Yulun* (Further Explorations into the Investigation of Things) states: Coughing with upward rushing Qi is what is commonly referred to as hiccups (E Ni). The pathology of hiccups is essentially rebellious Qi; it rises directly from below the navel, emerges from the mouth, and produces sound. Texts state: "Fire blazes upward." Li Dongyuan asserted that Fire and Yuan Qi (Original Qi) cannot coexist, and he referred to Fire as the thief of Yuan Qi. Ancient prescriptions attributed hiccups entirely to Stomach weakness, omitting mention of Fire, and treated it with formulas containing Dingxiang (Clove), Shidi (Persimmon Calyx), Zhuru (Bamboo Shavings), and Chenpi (Aged Tangerine Peel). This approach fails to discern which agents clear Heat/Fire and which tonify deficiency. Moreover, human Yin Qi relies on the Stomach for nourishment; if Stomach Earth is damaged, Liver Wood will invade it. This is described as Earth failing and Wood attacking. Yin Qi, being overwhelmed by Fire, cannot remain within and guard itself; Liver Wood carries Fire straight up the Clear Orifices. What is termed "Stomach weakness" is actually Yin deficiency, representing extreme deficiency.
Coughing with upward rushing Qi is a progressive stage of dry coughing; it presents with sound but no phlegm, continuous and unceasing. The Qi rebels from the Dantian, emerging upward through the throat, resembling the sensation of being struck and having Qi rush upward. In some cases, the sound of coughing exits the throat, followed immediately by an inhalation of sound back into the throat; this constitutes the syndrome of coughing with upward rushing Qi. Hiccups refer to the "entering sound" mentioned later in the text. Sometimes coughing and hiccups occur together with striking sounds, continuing for thousands of repetitions without cessation. If medication is ineffective, emesis (vomiting) should be induced; once phlegm and saliva are expelled, the condition resolves immediately.
The *Nanzhi* states: Regarding the syndrome of coughing with upward rushing Qi, the *Renhuang Shu* (Book of the Human Lord) diagnoses it as Yue Ni (dry heaving/hiccupping). This explanation seems plausible but is fundamentally incorrect. Yue refers to gan ou (dry heaving). If solid matter is expelled directly, it is vomiting (Tu); if fluid/vomit is ejected forcefully, it is retching (Ou); if nothing is expelled, it is Yue. Coughing with upward rushing Qi arises when water-dampness infiltrates the Lung causing chest fullness (Pi), or when continuous rebellion of Qi occurs, or when excessive laughter causes Qi obstruction (Ye), or when swallowing fluids leads to aspiration causing Qi snatching (Qiang), or when eating dry food hastily causes Qi blockage (Se). All these can produce the sound of coughing with upward rushing Qi, continuous and unceasing, commonly known as E Te. Generally, "coughing with upward rushing Qi" implies disorder/lack of smoothness; "E Te" implies error/disruption. Both involve Qi failing to descend, being pushed upward by Fire-Heat, reaching the throat where it stops due to obstruction. Some people stop it by stimulating the nasal cavity with paper twists to induce sneezing, or by feigning injustice or fear of thieves to induce fright, or by smelling food aromas to regulate Qi when there is nasal heat. These methods all work by suppressing and startling the Qi to force it downward.
If it is Yue, it involves an expelling sound. Yue expels Qi; after the sound of Yue ceases, inhalation follows. This is detailed in the chapter on Vomiting and Yue. Hiccups involve an entering sound. Qi rebels into the throat; after the sound of rebellion ceases, exhalation follows. The processes of exiting and entering respiration are vastly different. Vomiting foul matter originates in the Stomach; hiccups originate in the Lung. How difficult is it to distinguish them?