呃逆症，气逆于下，直冲于上，作呃忒声，由肺胃气不主降，
肝肾气不主吸故也。《内经》谓之哕。《内经》治哕之法，以草刺鼻嚏而已，无息而疾引之，立已。大惊之，
亦可已。今谓之呃，其症因寒火痰食，以及伤寒、吐利、病后、产后多有之。举其纲，则寒呃、热呃、虚脱呃，
三者括之而已。寒呃宜温宜散，寒去而气自舒；热呃宜降宜清，火静而气自平；古方用柿蒂，取其苦温降逆。
济生加丁香、生姜，取其开郁散痰，乃从治之法。虚脱呃则非大补真元，必难镇摄也。其寒滞为呃者，阴凝
浊逆。丁香散、二陈汤、橘皮干姜汤。其肺痹为呃者，咽阻胸闷。枇杷叶、川贝母、郁金、白通草、杏仁、
淡豆豉。其胃火为呃者，脉实便坚。安胃饮。其胃虚为呃者，虚阳上逆。橘皮竹茹汤、旋复代赭汤。其怒动
肝火者，胁痛吐酸。佐金汤加白芍、山栀、金器。金器取镇逆以平肝，其气逆作呃者，肝邪乘胃。旋复代赭汤
加降香。其痰滞为呃者，饮停气阻。丁香二陈汤。其食滞为呃者，腹痛嗳腐。养胃汤去蔻、附、肉果，或大和
中饮去干姜、泽泻。伤寒少阳症哕逆者，半表半里，气为邪抑。小柴胡汤，或柴陈煎。寒加丁香，火加黄芩。
伤寒阳明症失下内热，三焦干格，阴道不行，气冲作呃者，宜去火，白虎汤，竹叶石膏汤加减；去闭，承气汤。
逆气降，哕自止。其吐利后，胃虚膈热而呃者，橘皮竹茹汤加川贝。其病后发呃者，察其中虚，必补脾；察
其阴虚，必补肾。大补元煎，右归饮。其中焦脾胃虚寒，气滞为呃者，丁香柿蒂散，或理中汤、温胃饮，
俱加丁香。其下焦虚寒，肝肾不能畅达，或虚人元阳无力，易为遏抑而致呃者，归气饮，或理阴煎加丁香。
丹溪谓呃逆因肝肾阴虚，气从脐下直冲于口，由相火挟冲气上逆者。用大补阴丸，峻补真阴，承制相火。
东垣谓阴火上冲，吸气不得入，胃脉反逆，阴中伏阳，即为呃。用滋肾丸，壮水制火，引以归源，以泻阴中伏
热。此阳虚阴虚之辨，所当详审施治者也。产后呃逆，最危，四逆汤加人参，羌活附子汤，或桂心五钱，
姜汁三合水煎。急灸期门左穴，艾柱如豆大。《医通》曰∶平人饮热汤，及食椒姜即呃者，此胃有寒痰死血也。
死血，用韭汁、童便、下越鞠丸。虚人，用理中汤加蓬术、桃仁，痰加茯苓、半夏。盖呃逆皆是寒热错杂，
二气相搏，故治之亦多寒热相兼之剂，如丁
香柿蒂并投之类。试观平人冷呃，令其思想则止，思则脾火气乘而胃和矣。
呃逆症，是气机在下部逆行，直冲于上部，发出呃忒的声音，这是由于肺和胃的气机不能主司下降，肝和肾的气机不能主司吸入的缘故。《黄帝内经》称之为“哕”。《黄帝内经》治疗哕的方法，是用草刺入鼻腔使其打喷嚏，或者在气息停止时迅速引导它，症状立刻就会停止；或者突然惊吓患者，也可以治愈。现在称之为呃，其病症原因包括寒、火（热）、痰、食积，以及伤寒病、呕吐腹泻、大病之后、产后等情况下多有发生。概括其纲领，则分为寒呃、热呃、虚脱呃三种情况而已。寒呃适宜温散，寒气去除而气机自然舒畅；热呃适宜降逆清热，火势平息而气机自然平和；古方使用柿蒂，取其苦温之性以降逆气。《济生方》加入丁香、生姜，取其开郁结、散痰浊的作用，这是从治法（顺其势而治）。虚脱呃则非用大药补益真元，很难镇摄住气逆。如果是寒邪停滞导致的呃逆，属于阴寒凝滞、浊气上逆。可用丁香散、二陈汤、橘皮干姜汤。如果是肺痹导致的呃逆，伴有咽喉阻塞、胸闷。可用枇杷叶、川贝母、郁金、白通草、杏仁、淡豆豉。如果是胃火导致的呃逆，脉象实大、大便坚硬。可用安胃饮。如果是胃虚导致的呃逆，属于虚阳上逆。可用橘皮竹茹汤、旋复代赭汤。如果是因愤怒触动肝火导致的呃逆，伴有胁痛、吐酸水。可用佐金汤加白芍、山栀、金器（金属器物，古人认为可镇逆平肝）。金器取镇逆以平抑肝气，这是肝邪乘袭胃腑导致的气逆作呃。可用旋复代赭汤加降香。如果是痰滞导致的呃逆，属于饮水停聚、气机阻滞。可用丁香二陈汤。如果是食滞导致的呃逆，伴有腹痛、嗳腐吞酸。可用养胃汤去掉蔻仁、附子、肉果，或者用大和中饮去掉干姜、泽泻。伤寒少阳证出现哕逆的，属于半表半里证，气机被邪气抑制。可用小柴胡汤，或柴陈煎。寒重加丁香，火重加黄芩。伤寒阳明证因失于攻下导致内热，三焦干燥格拒，阴道不通，气冲引发呃逆的，适宜去火，可用白虎汤、竹叶石膏汤加减；去闭结，可用承气汤。逆气下降，哕逆自然停止。如果是呕吐腹泻后，胃虚膈热导致的呃逆，可用橘皮竹茹汤加川贝。如果是大病后发呃的，观察其中气虚弱，必须补脾；观察其阴虚，必须补肾。可用大补元煎、右归饮。如果是中焦脾胃虚寒，气滞导致的呃逆，可用丁香柿蒂散，或理中汤、温胃饮，都加入丁香。如果是下焦虚寒，肝肾气机不能畅达，或者元气虚弱无力，容易受到遏抑而导致呃逆的，可用归气饮，或理阴煎加丁香。朱丹溪认为呃逆是因为肝肾阴虚，气从脐下直冲于口，由相火挟带冲气上逆所致。应用大补阴丸，峻补真阴，以制约相火。李东垣认为阴火上冲，吸气不能进入，胃脉反而上逆，阴中伏藏阳气，即为呃逆。应用滋肾丸，壮水制火，引火归源，以泻除阴中伏热。这是阳虚与阴虚的辨别，应当详细审察施治。产后呃逆，最为危险，可用四逆汤加人参，羌活附子汤，或者桂心五钱，姜汁三合，用水煎服。急灸期门穴左侧，艾柱如豆子大小。《医宗必读》说：普通人喝热汤，以及吃花椒、生姜就发生呃逆的，这是胃中有寒痰死血。对于死血，用韭汁、童便，配合服用越鞠丸。对于体虚之人，用理中汤加蓬术、桃仁，有痰加茯苓、半夏。大概呃逆都是寒热错杂，阴阳二气相互搏结，所以治疗也多采用寒热并用的方剂，如丁香柿蒂并用之类。试看普通人冷呃，让他思考事情就能停止，因为思虑则脾气上升克制胃气，从而使胃气和顺了。
Ehicus (hiccup) is a condition where Qi rebels from the lower body and rushes directly upward, producing hiccuping sounds. This occurs because the Qi of the Lung and Stomach fails to descend, and the Qi of the Liver and Kidney fails to inhale. The *Neijing* refers to this as Yue (hiccups). The treatment method for Yue in the *Neijing* involves using grass to stimulate the nasal cavity to induce sneezing, or rapidly guiding the breath when it stops, which leads to immediate cessation; alternatively, startling the patient can also cure it. It is now called Ehicus. The etiology includes Cold, Fire (Heat), Phlegm, and Food Stagnation, and it frequently occurs in cases of Shaoyang Disease (Taiyang disease affecting the half-exterior and half-interior), vomiting and diarrhea, post-illness recovery, and postpartum conditions. Summarizing the main categories, there are only three: Cold Ehicus, Heat Ehicus, and Collapse Ehicus. For Cold Ehicus, warming and dispersing methods are suitable; once the Cold is removed, the Qi naturally relaxes. For Heat Ehicus, descending and clearing methods are suitable; once the Fire is quieted, the Qi naturally levels out. Ancient formulas use Persimmon Calyx (Shi Di), taking advantage of its bitter-warm property to direct rebellious Qi downward. The *Jisheng Fang* adds Clove (Ding Xiang) and Fresh Ginger (Sheng Jiang) to open depression and disperse Phlegm, representing a "following treatment" method (treating by following the nature of the pathogen). Collapse Ehicus cannot be controlled without major tonification of True Yuan (True Origin/Essence). If Ehicus is caused by Cold stagnation, it involves Yin coagulation and turbid rebellion. Formulas include Ding Xiang San (Clove Powder), Er Chen Tang (Two-Cured Decoction), and Ju Pi Gan Jiang Tang (Tangerine Peel and Dried Ginger Decoction). If Ehicus is caused by Lung Bi (Lung Obstruction), accompanied by throat obstruction and chest tightness, use Loquat Leaf (Pi Pa Ye), Fritillaria Bulb (Chuan Bei Mu), Curcuma Tuber (Yu Jin), White Akebia Stem (Bai Tong Cao), Apricot Seed (Xing Ren), and Fermented Soybean (Dan Dou Chi). If Ehicus is caused by Stomach Fire, with a surging pulse and hard stool, use An Wei Yin (Stomach-Calming Drink). If Ehicus is caused by Stomach Deficiency, involving floating Yang rebelling upward, use Ju Pi Zhu Ru Tang (Tangerine Peel and Bamboo Shaving Decoction) or Xuan Fu Dai Zhe Tang (Inula and Hematite Decoction). If Ehicus is triggered by anger stirring up Liver Fire, accompanied by hypochondriac pain and sour regurgitation, use Jia Jin Tang (Metal-Assisting Decoction) added with White Peony Root (Bai Shao), Gardenia Fruit (Shan Zhi), and Metal Objects (Jin Qi). Metal objects are used to suppress rebellion and calm the Liver; this addresses Qi rebellion causing Ehicus due to Liver Pathogen invading the Stomach. Use Xuan Fu Dai Zhe Tang added with Agarwood (Xiang). If Ehicus is caused by Phlegm stagnation, involving fluid retention and Qi obstruction, use Ding Xiang Er Chen Tang (Clove Two-Cured Decoction). If Ehicus is caused by Food stagnation, accompanied by abdominal pain and putrid belching, use Yang Wei Tang (Nourishing Stomach Decoction) removing Cardamom (Dou Kou), Aconite (Fu Zi), and Myrobalan (Rou Guo), or Da He Zhong Yin (Great Harmonizing Middle Drink) removing Dried Ginger (Gan Jiang) and Alisma (Ze Xie). In Shaoyang Disease of Cold Damage presenting with Yue and Ehicus, the pathogen is at the half-exterior and half-interior, suppressing Qi. Use Xiao Chai Hu Tang (Minor Bupleurum Decoction) or Chai Chen Jian (Bupleurum and Two-Cured Decoction). Add Clove for Cold, add Scutellaria Root (Huang Qin) for Fire. In Yangming Disease of Cold Damage, if failure to purge leads to internal heat, drying and blocking the Triple Burner, obstructing the Yin pathways, and causing Qi rushing upward to produce Ehicus, one should clear Fire using Bai Hu Tang (White Tiger Decoction) or Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction) with modifications; or clear blockage using Cheng Qi Tang (Order the Qi Decoction). Once rebellious Qi descends, Yue ceases spontaneously. If Ehicus occurs after vomiting and diarrhea due to Stomach Deficiency and Diaphragmatic Heat, use Ju Pi Zhu Ru Tang added with Fritillaria Bulb (Chuan Bei). If Ehicus occurs after illness, observe if Spleen Qi is deficient and must be tonified, or if Yin is deficient and must be nourished. Use Da Bu Yuan Jian (Great Tonifying Original Decoction) or You Gui Yin (Right Restoring Drink). If Middle Jiao Spleen and Stomach are deficient and cold, with Qi stagnation causing Ehicus, use Ding Xiang Shi Di San (Clove and Persimmon Calyx Powder), Li Zhong Tang (Regulate the Middle Decoction), or Wen Wei Yin (Warm the Stomach Drink), all added with Clove. If Lower Jiao is deficient and cold, with Liver and Kidney Qi unable to flow freely, or in deficient individuals with weak Yuan Yang prone to suppression causing Ehicus, use Gui Qi Yin (Returning Qi Drink) or Li Yin Jian (Regulating Yin Decoction) added with Clove. Zhu Danxi stated that Ehicus is due to Liver and Kidney Yin Deficiency, with Qi rushing straight from below the umbilicus to the mouth, driven by Ministerial Fire carrying Chong Qi upward. Use Da Bu Yin Wan (Great Tonifying Yin Pill) to vigorously tonify True Yin and control Ministerial Fire. Li Dongyuan stated that Yin Fire rushing upward prevents inhalation, causing Stomach Meridian Qi to rebel inversely; hidden Yang within Yin results in Ehicus. Use Zi Shen Wan (Kidney-Nourishing Pill) to strengthen Water to control Fire, guide Fire back to its source, and drain hidden heat within Yin. This distinction between Yang Deficiency and Yin Deficiency requires detailed examination for treatment. Postpartum Ehicus is most critical; use Si Ni Tang (Frigid Extremities Decoction) added with Ginseng, Qiang Huo Fu Zi Tang (Notopterygium and Aconite Decoction), or Cinnamon Heart (Gui Xin) 5 qian and Ginger Juice 3 he, decocted in water. Urgently moxa the Left Qimen Acupoint (LR14) with moxa cones the size of beans. The *YiTong* states: If a healthy person hiccups after drinking hot soup or eating pepper and ginger, this indicates Cold Phlegm and Dead Blood in the Stomach. For Dead Blood, use Leek Juice and Child's Urine, combined with Yue Ju Wan (Sorrow-Pill). For deficient persons, use Li Zhong Tang added with Curcuma Rhizome (Peng Zhu) and Peach Kernel (Tao Ren); for Phlegm, add Poria (Fu Ling) and Pinellia Tuber (Ban Xia). Generally, Ehicus involves mixed Cold and Heat, with Yin and Yang Qi clashing; thus, treatments often combine Cold and Heat herbs, such as using Clove and Persimmon Calyx together. Consider that for ordinary people with Cold Ehicus, making them think can stop it, because thought engages Spleen Fire to overcome Stomach Qi, thereby harmonizing the Stomach.