【歌】痰因火动令人嘈，湿痰气郁总同条。肥人自是湿痰故，伐火芩连栀子调。
【论】丹溪云∶嘈杂者，俗谓之心嘈是也。有痰因火动者，必痰多，脉滑而数，宜治痰为先，治火次之。
有食郁作热者，脉数而大，当治其火，而开导次之。有因湿痰者，脉沉而滑，宜豁痰。有因气郁者，脉沉而涩，
宜开郁理气，盖沉则为郁，滑主痰而涩主气也。医能审脉验证，真知是火、是气、是郁，斯为活法矣。
痰
痰因火动者，治痰为先，二陈汤加姜炒黄芩、黄连、山栀子为君，南星、半夏为佐，桔梗、青黛为使。
二陈汤（方见痰证。）
气郁
气郁者，越鞠丸，或二陈汤加枳壳、桔梗、香附、乌药、姜炒黄连、苍术，有痰加贝母。
越鞠丸（方见郁证。）
火
火嘈者，二陈汤加黄芩、黄连、山栀子，或三补丸。有火郁，二陈汤加山栀子、香附、抚芎、苍术。
三补丸
黄芩（四两） 黄连（四两） 黄柏（四两）
上为细末，水丸，每服七十丸，白汤送下。
食郁热
食郁有热先治火，芩连枳术丸加神曲、麦芽、山楂、陈皮、半夏。或食郁不消，胸满嘈杂，大安丸。
芩连枳术丸
即枳术丸加芩、连。（方见脾胃。）
大安丸
即保和丸加白术。（方见伤食。）
【歌】阴火攻冲成咳逆，或因痰气滞胸膈。胃中积热与停寒，病后胃虚多吃忒。
【论】咳逆者，古名哕，今名呃，又名吃忒。胃寒者，脉迟涩，手足寒，呕吐，无热证。胃热者，脉洪大，
燥渴，便难。有胃中有痰，阴虚，火炎上冲而呃者，其气从脐下逆上。丹溪云∶上升之气，至肝而出，中挟相
火。经云∶诸逆冲上，皆属于火。有痰气逆滞者，其气从胸中起，中州元气郁也。有病后发呃者，久病胃虚也，
宜细辨之。
【脉】呃逆甚危，浮缓乃宜。弦急必死，结代促微。
胃火
胃火上逆而呃，小半夏茯苓汤加山栀、黄芩吐之。利后胃热而呃，橘皮竹茹汤。
小半夏茯苓汤
半夏（五钱，汤泡） 茯苓（三钱，去皮）
上，生姜五钱，捣汁同煎，不拘时热服。
橘皮竹茹汤
治吐利后胃虚膈热而咳逆者。
橘皮（二钱） 竹茹（一钱） 人参（五分） 甘草（炙，五分）
上，生姜五片，大枣二枚，煎服。
阴火
阴火上逆，从脐下逆上，夜分转甚看，四物汤加知母、黄柏、竹茹、陈皮、茯苓。
四物汤（方见血证。）
病后呃
病后元气不足，胃虚寒而呃，人参理中汤。痢后发呃，多不救，用六君子汤犹或可生。
人参理中汤（方见中寒。）
六君子汤（方见脾胃。）
胃寒
胃寒气逆呃者，丁香柿蒂汤。吐利后胃虚寒，手足厥冷呃逆者，理中汤加丁香、木香、枳壳。
丁香柿蒂汤
丁香（一钱） 柿蒂（一钱） 陈皮（一钱） 青皮（一钱） 人参（五分）
上锉，一剂，水二钟，煎八分，温服。
理中汤（方见中寒。）
痰气
无别证，忽然发呃，痰气逆滞，气从胸中起，小半夏茯苓汤加木香、枳壳，或萝卜汤调木香调气散。痰碍
气逆而呃，用蜜汤探吐。
小半夏茯苓汤（方见前。）
木香调气散
木香（三两） 檀香（三两） 白豆蔻（三两） 丁香（三两） 砂仁（四两） 甘草（炙，一两半）
藿香（一两五钱）
上为末，每服一钱，盐汤下。
【歌诀】痰因火动引发嘈杂，湿痰与气郁在病机上总归同类。体胖之人多属湿痰，宜用黄芩、黄连、栀子来清泻火热。
【论述】朱丹溪说：所谓的“嘈杂”，就是民间所说的“心嘈”。其中有一种是痰因火热扰动所致，必然痰多，脉象滑而数，治疗应以治痰为先，清火为次。有一种是因食积郁结化热所致，脉象数而大，应当先治其火，再行消导。有一种是因湿痰所致，脉象沉而滑，宜用豁痰之法。有一种是因气机郁滞所致，脉象沉而涩，宜用开郁理气之法，因为脉沉主气郁，脉滑主痰，脉涩主气滞。医生若能审察脉象、验证症状，真正知晓是火、是气、还是郁，这才是灵活变通的治疗方法。
针对痰证：
若是痰因火动，治疗以治痰为先，使用二陈汤加姜汁炒黄芩、黄连、山栀子作为君药，南星、半夏作为佐药，桔梗、青黛作为使药。
二陈汤（方剂见痰证章节）。
针对气郁证：
气郁者，可用越鞠丸，或二陈汤加枳壳、桔梗、香附、乌药、姜汁炒黄连、苍术，若有痰则加贝母。
越鞠丸（方剂见郁证章节）。
针对火证：
火扰之嘈杂，用二陈汤加黄芩、黄连、山栀子，或用三补丸。若兼有火郁，用二陈汤加山栀子、香附、抚芎（川芎）、苍术。
三补丸
组成：黄芩（四两）、黄连（四两）、黄柏（四两）。
制法：研为细末，用水泛为丸，每次服用七十丸，白开水送下。
针对食积郁热证：
食积有热，先治火，用芩连枳术丸加神曲、麦芽、山楂、陈皮、半夏。若食积不消，出现胸满嘈杂，用大安丸。
芩连枳术丸
即枳术丸加黄芩、黄连。（方剂见脾胃章节）。
大安丸
即保和丸加白术。（方剂见伤食章节）。
【歌诀】阴火攻冲导致咳逆（呃逆），或因痰气阻滞于胸膈。胃中积热或停寒，病后胃虚则易打嗝。
【论述】咳逆，古称“哕”，今称“呃”，又称“吃忒”。胃寒者，脉象迟涩，手足寒冷，呕吐，无热证表现。胃热者，脉象洪大，口干燥渴，大便困难。若胃中有痰，阴虚，火炎上冲而致呃逆，其气从脐下逆上。朱丹溪说：上升之气，出于肝脏，中间夹带相火。《内经》说：各种逆气冲上的病症，都属于火。若有痰气逆滞者，其气从胸中起，这是中焦元气郁结所致。有病后发呃的，是因为久病导致胃虚，应当仔细辨别。
【脉诊】呃逆重症很危险，脉象浮缓尚可；若见弦急脉必死，结代促微亦危。
针对胃火证：
胃火上逆而呃，用小半夏茯苓汤加山栀、黄芩，通过催吐法治疗。若利后胃热而呃，用橘皮竹茹汤。
小半夏茯苓汤
组成：半夏（五钱，热水泡过）、茯苓（三钱，去皮）。
用法：生姜五钱，捣取汁液同煎，不拘时间，热服。
橘皮竹茹汤
主治：呕吐腹泻后，胃虚膈热而致的咳逆。
组成：橘皮（二钱）、竹茹（一钱）、人参（五分）、甘草（炙，五分）。
用法：生姜五片，大枣二枚，煎服。
针对阴火证：
阴火上逆，从脐下逆上，夜间加重，用四物汤加知母、黄柏、竹茹、陈皮、茯苓。
四物汤（方剂见血证章节）。
针对病后呃逆证：
病后元气不足，胃虚寒而呃，用人参理中汤。痢疾后发呃，大多难治，用六君子汤或许还有生机。
人参理中汤（方剂见中寒章节）。
六君子汤（方剂见脾胃章节）。
针对胃寒证：
胃寒气逆而呃，用丁香柿蒂汤。若吐利后胃虚寒，手足厥冷而呃逆，用理中汤加丁香、木香、枳壳。
丁香柿蒂汤
组成：丁香（一钱）、柿蒂（一钱）、陈皮（一钱）、青皮（一钱）、人参（五分）。
用法：切碎，一剂药，水两碗，煎至八分，温服。
理中汤（方剂见中寒章节）。
针对痰气证：
无其他症状，忽然发呃，属痰气逆滞，气从胸中起，用小半夏茯苓汤加木香、枳壳，或用萝卜汤调服木香调气散。若痰碍气逆而呃，用蜜水探吐。
小半夏茯苓汤（见前文）。
木香调气散
组成：木香（三两）、檀香（三两）、白豆蔻（三两）、丁香（三两）、砂仁（四两）、甘草（炙，一两半）、藿香（一两五钱）。
用法：研为细末，每次服用一钱，盐汤送下。
[Verse] Phlegm stirred by fire causes "zaocao" (a sensation of hunger mixed with discomfort in the epigastrium); wet phlegm and qi stagnation share similar pathological mechanisms. Obese individuals naturally tend toward wet phlegm; clear heat using Huangqin, Huanglian, and Zhizi.
[Dissertation] Zhu Danxi stated: "Zaocao" is commonly referred to as "xincao" (heart palpitations/discomfort). One type is caused by phlegm stirred by fire, characterized by abundant phlegm and a slippery, rapid pulse. Treatment should prioritize resolving phlegm, followed by clearing fire. Another type results from food stagnation transforming into heat, presenting with a rapid and large pulse; one should first treat the fire, then employ digestive methods. A third type is due to wet phlegm, with a deep and slippery pulse, requiring phlegm-resolving methods. The fourth type arises from qi stagnation, showing a deep and choppy pulse, necessitating methods to open stagnation and regulate qi, for a deep pulse indicates stagnation, a slippery pulse indicates phlegm, and a choppy pulse indicates qi constraint. If physicians can accurately examine pulses and verify symptoms, truly distinguishing between fire, qi, and stagnation, they will master flexible treatment strategies.
Regarding Phlegm:
When phlegm is stirred by fire, treatment prioritizes resolving phlegm. Use Erchen Tang (Two-Aged Decoction) with ginger-fried Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), and Zhizi (Gardeniae Fructus) as sovereign drugs, Xingren (Arisarum Rhizoma) and Banxia (Pinelliae Rhizoma) as ministerial drugs, and Jiegeng (Platycodonis Radix) and Qingdai (Indigo Naturalis) as guiding drugs.
Erchen Tang (See formula in Phlegm Syndrome chapter).
Regarding Qi Stagnation:
For qi stagnation, use Yueju Wan (Yueju Pill) or Erchen Tang (Two-Aged Decoction) added with Zhiqiao (Aurantii Fructus), Jiegeng (Platycodonis Radix), Xiangfu (Cyperi Rhizoma), Wuyao (Linderae Radix), ginger-fried Huanglian (Coptidis Rhizoma), and Cangzhu (Atractylodis Rhizoma); if phlegm is present, add Beimu (Fritillariae Bulbus).
Yueju Wan (Yueju Pill) (See formula in Stagnation Syndrome chapter).
Regarding Fire:
For fire-induced zaocao, use Erchen Tang (Two-Aged Decoction) added with Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), and Zhizi (Gardeniae Fructus), or Sanbu Wan (Three-Ingredient Pill). If accompanied by constrained fire, use Erchen Tang (Two-Aged Decoction) added with Zhizi (Gardeniae Fructus), Xiangfu (Cyperi Rhizoma), Fuxiong (Chuanxiong Rhizoma), and Cangzhu (Atractylodis Rhizoma).
Sanbu Wan (Three-Ingredient Pill)
Ingredients: Huangqin (Scutellariae Radix, 4 liang), Huanglian (Coptidis Rhizoma, 4 liang), Huangbai (Phellodendri Cortex, 4 liang).
Preparation: Grind into fine powder, form pills with water. Take 70 pills per dose, swallowed with warm water.
Regarding Food Stagnation with Heat:
For food stagnation with heat, treat the fire first. Use Qinlian Zhi Zhu Wan (Huanglian and Atractylodes Pill) added with Shenqu (Massa Medicata Fermentata), Maiya (Hordei Fructus Germinatus), Shanzha (Crataegi Fructus), Chenpi (Citri Reticulatae Pericarpium), and Banxia (Pinelliae Rhizoma). If food stagnation persists with chest fullness and zaocao, use Da'an Wan (Great Peace Pill).
Qinlian Zhi Zhu Wan (Huanglian and Atractylodes Pill)
Consists of Zhi Zhu Wan (Atractylodes Pill) added with Huangqin (Scutellariae Radix) and Huanglian (Coptidis Rhizoma). (See formula in Spleen and Stomach chapter).
Da'an Wan (Great Peace Pill)
Consists of Baohe Wan (Preserve Harmony Pill) added with Baizhu (Atractylodis Macrocephalae Rhizoma). (See formula in Food Injury chapter).
[Verse] Yin fire attacking upward causes ke ni (hiccups/cough-reversal), often due to phlegm and qi stagnating in the chest and diaphragm. Accumulated heat or retained cold in the stomach, or post-illness stomach deficiency, leads to frequent hiccupping.
[Dissertation] Ke ni (hiccups) was anciently named "yue", currently named "e", also called "cite". For stomach cold, the pulse is slow and choppy, hands and feet are cold, vomiting occurs, and there are no heat signs. For stomach heat, the pulse is surging and large, dryness and thirst occur, and defecation is difficult. If there is phlegm in the stomach, yin deficiency, and fire flaming upward causing hiccups, the qi rebels upward from below the umbilicus. Zhu Danxi said: Ascending qi originates from the Liver and carries Ministerial Fire. The Classic states: All rebellious qi rushing upward belongs to Fire. If phlegm and qi are rebellious and stagnant, the qi rises from the chest, indicating depression of primordial qi in the Middle Jiao. Hiccups occurring after illness result from stomach deficiency due to prolonged disease; careful differentiation is required.
[Pulse Diagnosis] Severe hiccups are critical; a floating and moderate pulse is favorable. A wiry and urgent pulse indicates death; knotted, intermittent, hurried, or faint pulses are ominous.
Regarding Stomach Fire:
For hiccups due to stomach fire rebelling upward, use Xiaobanxia Fuling Tang (Minor Pinellia and Poria Decoction) added with Zhizi (Gardeniae Fructus) and Huangqin (Scutellariae Radix), inducing vomiting. For hiccups due to stomach heat following purgation/diarrhea, use Ju Pi Zhu Ru Tang (Tangerine Peel and Bamboo Shaving Decoction).
Xiaobanxia Fuling Tang (Minor Pinellia and Poria Decoction)
Ingredients: Banxia (Pinelliae Rhizoma, 5 qian, soaked in hot water), Fuling (Poria, 3 qian, peeled).
Usage: Ginger (5 qian), crushed to extract juice, decocted together. Take warm at any time.
Ju Pi Zhu Ru Tang (Tangerine Peel and Bamboo Shaving Decoction)
Indication: Treats hiccups due to stomach deficiency and diaphragmatic heat following vomiting and diarrhea.
Ingredients: Ju Pi (Citri Reticulatae Pericarpium, 2 qian), Zhu Ru (Bambusae Caulis in Taenia, 1 qian), Renshen (Ginseng Radix et Rhizoma, 5 fen), Gancao (Licorice Radix et Rhizoma, roasted, 5 fen).
Usage: Ginger (5 slices), Dazao (Jujubae Fructus, 2 pieces), decoct and take.
Regarding Yin Fire:
For Yin fire rebelling upward, rising from below the umbilicus and worsening at night, use Siwu Tang (Four Substance Decoction) added with Zhimu (Anemarrhenae Rhizoma), Huangbai (Phellodendri Cortex), Zhu Ru (Bambusae Caulis in Taenia), Chenpi (Citri Reticulatae Pericarpium), and Fuling (Poria).
Siwu Tang (Four Substance Decoction) (See formula in Blood Syndrome chapter).
Regarding Post-Illness Hiccups:
For hiccups due to insufficient primordial qi and stomach deficiency-cold after illness, use Renshen Lizhong Tang (Ginseng and Atractylodes Decoction). Hiccups following dysentery are mostly incurable, but Liujunzi Tang (Six-Gentleman Decoction) may offer a chance of survival.
Renshen Lizhong Tang (Ginseng and Atractylodes Decoction) (See formula in Middle Cold chapter).
Liujunzi Tang (Six-Gentleman Decoction) (See formula in Spleen and Stomach chapter).
Regarding Stomach Cold:
For hiccups due to stomach cold and qi rebelling upward, use Dingxiang Shidi Tang (Clove and Persimmon Calyx Decoction). For hiccups with cold extremities following vomiting/diarrhea due to stomach deficiency-cold, use Lizhong Tang (Atractylodes Decoction) added with Dingxiang (Caryophylli Flos), Muxiang (Aucklandiae Radix), and Zhiqiao (Aurantii Fructus).
Dingxiang Shidi Tang (Clove and Persimmon Calyx Decoction)
Ingredients: Dingxiang (Caryophylli Flos, 1 qian), Shidi (Ebeni Calyx, 1 qian), Chenpi (Citri Reticulatae Pericarpium, 1 qian), Qingpi (Citri Reticulatae Pericarpium Viride, 1 qian), Renshen (Ginseng Radix et Rhizoma, 5 fen).
Usage: Coarsely crush. One dose with two bowls of water, decoct to eight-tenths volume, take warm.
Lizhong Tang (Atractylodes Decoction) (See formula in Middle Cold chapter).
Regarding Phlegm-Qi:
Without other symptoms, sudden onset of hiccups due to phlegm and qi rebellion and stagnation, with qi rising from the chest, use Xiaobanxia Fuling Tang (Minor Pinellia and Poria Decoction) added with Muxiang (Aucklandiae Radix) and Zhiqiao (Aurantii Fructus), or administer Muxiang Tiaoqi San (Aucklandia Regulating Qi Powder) mixed with radish soup. If phlegm obstructs and qi rebels causing hiccups, induce vomiting with honey water.
Xiaobanxia Fuling Tang (Minor Pinellia and Poria Decoction) (See previous section).
Muxiang Tiaoqi San (Aucklandia Regulating Qi Powder)
Ingredients: Muxiang (Aucklandiae Radix, 3 liang), Tanxiang (Santalum Album Lignum, 3 liang), Baidoukou (Amomi Fructus Rotundus, 3 liang), Dingxiang (Caryophylli Flos, 3 liang), Sharen (Amomi Fructus, 4 liang), Gancao (Licorice Radix et Rhizoma, roasted, 1.5 liang), Huoxiang (Agastaches Herba, 1.5 liang).
Usage: Grind into powder. Take 1 qian per dose, swallowed with salt water.