呃逆，即《内经》所谓哕也。或曰成无己、许学士固以秽为呃逆，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？曰哕义具在《内经》，顾诸家不察耳。按《灵枢》杂病篇末云∶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。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，按《内经》生气通天论曰∶秋伤于湿，上逆而咳。阴阳
应象论曰∶秋伤于湿，冬生咳嗽。以此论之，则咳逆为咳嗽无疑，以春夏冬三
时比例自见。孙真人《千金》曰∶咳逆者嗽也，本自明白，后人不知何以将咳
逆误作呃逆，失之远矣。赵以德曰∶成无己云哕者俗谓之咳逆，呃呃然有声，然引咳逆
是哕非也。《内经》以哕与咳逆为两证，哕是胃病，咳逆是肺病，谓胃气逆为哕。注
云∶胃为水谷之海，肾与为关，关闭不利，则气逆而上，胃以包容水谷，性喜受寒
寒谷相搏，故为哕也。又谓阳明之复，咳哕。太阳之复，呕出清水及为哕噫。少阴
之复，哕噫。《灵枢》亦谓谷入于胃，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。张仲
景言哕者，皆在阳明证中，谓湿家下之太早则哕，而阳明病不能食，攻其热必哕，
皆因下后胃气虚而哕者也。至有风热内壅，气不能通，有潮热，时时哕者，与小柴
胡汤和解之。哕而腹满，视前后知何部不利，利之者，此皆可治之证。至若病极谵
语，甚者至哕，又不尿腹满加哕者，皆不治。丹溪先生亦尝谓呃逆、气逆也，气自
脐下直冲，上出于口，而作声之名也。《内经》谓诸逆冲上，皆属于火。东垣谓是阴
火上冲，而吸之气不得入，胃脉反逆，由阴中伏阳而作也，从四时用药法治。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，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，似为危证。然亦有实者，不可不知。嗟乎！圣人之言胃气逆为哕者，非
由一因而逆，缘王太仆用《灵枢》之意，竟作肾寒逆上之病注之，由是后代方论，
或用热剂治寒，或用辛温散气。安知脾与胃，一阴一阳也，二者不和亦逆。肾肝在
下，相凌亦逆，且肾之逆，未可便谓之寒也。左肾主水，性本润下，乌能自逆，必
右肾相火炎上，挟其冲逆，须观所挟多寡，分正治反治以疗之。肝木之风，从少阳
相火冲克者，亦必治火，皆当如先生所言者以治。若别有其故而哕者，又必如仲景
法，随其攸利而治之。刘宗浓曰∶呃逆一证，有虚有实，有火有痰，有水气，不可
专作寒论。盖伤寒发汗吐下之后，与泻利日久，及大病后、妇人产后有此者，皆脾
胃气血大虚之故也。若平人食入太速而气噎，或饮水喜笑错喉而气抢，或因痰水停
隔心中，或因暴怒气逆痰厥，或伤寒热病失下而有此者，则皆属实也。夫水性润下，
火性炎上，今其气自下冲上，非火而何。大抵治法，虚则补之，虚中须分寒热，如
因汗吐下后，误服寒凉过多，当以温补之。如脾胃阴虚，火逆上冲，当以平补之。
挟热者，凉而补之。若夫实者，如伤寒失下，地道不通，因而呃逆，当以寒下之。
如痰饮停蓄，或暴怒气逆痰厥，此等必形气俱实，别无恶候，皆随其邪之所在，涌
之泄之，清之利之也。胃伤阴虚，木挟相火直冲清道而上者，宜参术汤下大补阴丸。
吐利后胃虚寒者，理中汤加附子、丁香、柿蒂。吐利后胃虚热者，橘皮竹茹汤。《三
因方》云∶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》所谓坏病者是也。丹溪治赵立道年近五
十，质弱多怒，暑月因饥后大怒，得滞下病，口渴，自以冷水调生蜜饮之，痢渐缓，
五七日后，诊脉稍大不数，遂令止蜜水，渴时且以参术汤调益元散与之，痢亦渐收。
七八日后觉倦甚发呃，知其因下久而阴虚也。令守前药，然利尚未止，又以炼蜜与
之，众皆尤药之未当，欲用姜附，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。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。又治陈择仁年近七十，素浓味，有久嗽病，新秋患滞下，
食大减，至五七日后呃作，脉皆大豁，众以为难。丹溪曰∶形瘦者尚可为，以参术
汤下大补丸，七日而安。娄全善治其兄九月得滞下，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。若此者十余日，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。（以上吐利后补虚例。）仲景
云∶哕而腹满，视其前后，知何部不利，利之即愈。大肠结燥，脉沉数者，调胃承
气汤。大便不通，哕数谵语，小承气汤。丹溪治超越陈氏二十余岁，因饱后奔走数
里患哕，但食物则连哕百余声，半日不止，饮酒与汤则不作，至晚发热，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。（右下例，有实积者宜之。）又治一女子，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。（上宣例，痰郁者宜乏。）《三因》云∶哕而心下坚
痞眩悸者，膈间有痰水所为，虚不禁吐者，宜二陈汤、导痰汤加姜汁、竹沥。亦有
污血而哕者，丹溪治超越陈氏用桃仁承气汤是也。虚不禁下者，于蓄血门求轻剂用
之。仲景云∶哕逆者，陈皮竹茹汤主之。又云∶干呕哕，若手足厥者，陈皮汤主之。
《本事方》用枳壳五钱，木香二钱半，细末，每服一钱，白汤调下。孙兆方用陈皮二
两去白，水煎通口服，或加枳壳一两，此皆破气之剂，气逆者宜之。唯陈皮竹茹汤，
气逆而虚者宜之。水寒相搏者，小青龙汤。寒甚加附子尖炒。洁古柿钱散《宝鉴》丁
香柿蒂散，羌活附子汤，皆热剂，唯寒呃宜之。戴复庵以热呃，唯伤寒有之。其他
病发呃者，皆属寒，用半夏一两，生姜一两半，水一碗。煎半碗热服。或用丁香十粒，
柿蒂十个切碎，白水一盏半煎。或理中汤加枳壳、茯苓各半钱，半夏一钱，不效更
加丁香十粒。亦有无病偶然致呃，此缘气逆而生，重者或经一二日，宜小半夏茯苓
汤加枳实半夏汤，或煎汤泡萝卜子研取汁，调木香调气散，乘热服，逆气用之最佳。
若胃中寒甚，呃逆不已，或复加以呕吐，轻剂不能取效，宜丁香煮散，及以附子粳
米汤，增炒川椒、丁香，每服各二三十粒。治呃逆，于脐下关元灸七壮，立愈，累
验。又方，男左女右，乳下黑尽处一韭叶许，灸三壮，甚者二七壮。
【诊】心脉小甚为哕。肺脉散者不治。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。
【产后呃逆】此恶候也。急灸期门三壮，神效。屈乳头向下尽处是穴，乳小者，
乳下一指为率。男左女右，与乳正直下一指陷中动脉处是穴，炷如小豆大，穴真病
立止。丁香散、羌活散，桂心五钱，姜汁三合，水煎服。参附汤。（上皆热剂。）干柿一
个切碎，以水一盏，煎六分热呷。（内有热，不禁热剂者可用。）
呃逆，就是《内经》中所说的“哕”。有人说成无己、许学士确实将“哕”解释为呃逆，然而李东垣、王海藏又将“哕”解释为干呕，陈无择又将“哕”称为咳逆，各家论述不同。如今您唯独采纳成无己、许学士两家的观点，这是为什么呢？回答说：“哕”的含义在《内经》中已有记载，只是各派学者没有仔细考察罢了。查阅《灵枢·杂病》篇末说：“治疗哕，可以用草刺激鼻子引起喷嚏，打个喷嚏就好了；或者屏住呼吸并迅速引导气息，立刻就好；或者突然惊吓它，也可以痊愈。”详细分析这三条经文中的方法，正是治疗呃逆的方法。按照呃逆用纸捻刺激鼻子引起喷嚏，打喷嚏后呃逆立刻停止；或者闭住口鼻气息使其屏息，也立刻停止；或者装作冤家盗贼进行大惊吓，也能停止。这就是我采纳成无己、许学士两家关于“哕”即“呃逆”的论述，认为这符合经典旨意。如果把“哕”当作干呕，假设让干呕的人打喷嚏，或让他屏息，或让他受大惊吓，干呕能立刻停止吗？显然不能，“哕”不是干呕，这是很明显的。如果把“哕”称为咳逆，按《内经·生气通天论》说：“秋季伤于湿邪，气机上逆而咳嗽。”《阴阳应象大论》说：“秋季伤于湿邪，冬季产生咳嗽。”据此讨论，那么咳逆就是咳嗽无疑，拿春、夏、冬三时来类比自然可见。孙思邈《千金方》说：“咳逆就是嗽（咳嗽），本来很清楚，后人不知道，为什么把咳逆误作呃逆，相差太远了。”赵以德说：“成无己说哕是俗称咳逆，发出呃呃的声音，然而引用咳逆是指哕而非咳，这是不对的。《内经》将哕与咳逆作为两种病症，哕是胃病，咳逆是肺病，称胃气上逆为哕。”注释说：“胃是水谷之海，肾与之相表里作为关隘，如果关闭不利，则气机上逆而上，胃包容水谷，本性喜欢温暖，寒谷相互搏结，所以发生哕。”又说阳明经之气复返，会出现咳哕；太阳经之气复返，会呕吐清水并发生哕和嗳气；少阴经之气复返，也会发生哕和嗳气。《灵枢》也说谷物进入胃中，胃气上注于肺，现在如果有旧的寒气与新的谷气一起返回胃中，新旧之气相乱，正气与邪气相攻，气机并聚且逆乱，再次从胃中出来，所以发生哕，治疗应补手太阴肺经，泻足少阴肾经。张仲景所说的哕，都在阳明病证中，说湿病患者过早使用下法会导致哕，以及阳明病不能进食，攻其热邪必然导致哕，都是因为下法之后胃气虚弱而导致哕。至于有风热内壅，气机不通，伴有潮热，时时出现哕的，给予小柴胡汤和解。哕并且腹部胀满，观察前后二便知道哪一部不通利，通利它，这些都是可以治疗的证候。至于病情极重出现谵语，严重的甚至出现哕，又不排尿、腹部胀满加上哕的，都是不治之症。丹溪先生也曾说呃逆是气逆，气自脐下直冲，向上出于口，从而发出声音的名称。《内经》说各种气逆冲向上部，都属于火。李东垣说是阴火上冲，吸气的气不能进入，胃脉反而上逆，由阴中伏阳而产生，根据四时用药法则治疗。古方都用胃弱来解释，而不涉及火，并且用丁香、柿蒂、竹茹、陈皮等药剂治疗，不知谁用来降火，谁用来补虚。人的阴气，依靠胃来滋养，胃土受损则木气来克制它，这就是土败木贼。阴气被火所乘，不能在内守持，木挟带相火侵犯它，所以直冲清道而上，说胃弱，其实是阴弱，是非常虚弱的表现。病人见到这种情况，似乎是危重证候。然而也有实证，不可不知道。唉！圣人说胃气上逆为哕，并非由一种原因导致气逆，因为王冰（王太仆）运用《灵枢》的意思，竟然将其注为肾寒逆上的病，因此后代的方论，有的用热剂治疗寒证，有的用辛温药散气。怎知脾与胃，是一阴一阳的关系，二者不和也会导致气逆。肾肝在下，相互凌犯也会导致气逆，而且肾的气逆，未必就能称之为寒。左肾主水，本性润下，怎么能自己逆上，一定是右肾相火炎上，挟带冲逆之气，必须观察所挟带的多少，区分正治反治来治疗。肝木之风，从少阳相火冲克而来的，也必须治火，都应当像先生所说的那样去治疗。如果有其他原因导致的哕，又必须像张仲景的方法，顺着其有利的方向去治疗。刘宗浓说：呃逆这一证候，有虚有实，有火有痰，有水气，不可专门当作寒证来论。大概伤寒发汗、催吐、泻下之后，以及腹泻痢疾日久，还有大病后、妇人产后出现这种情况的，都是脾胃气血大虚的缘故。如果是普通人吃饭太快导致气噎，或者喝水时喜笑呛到气管导致气抢，或者因为痰水停积在心胸之间，或者因为暴怒导致气逆痰厥，或者伤寒热病失于攻下而出现这种情况的，则都属于实证。水的性质是滋润向下，火的性质是炎上，现在气自下向上冲，不是火是什么。大致治疗方法，虚证就补益它，虚证中必须分清寒热，比如因发汗、催吐、泻下后，误服过多寒凉药，应当用温补法。如脾胃阴虚，火气上逆冲撞，应当用平补法。挟有热邪的，用凉性药补益。如果是实证，如伤寒失于攻下，肠道不通畅，因而导致呃逆，应当用寒下法。如痰饮停蓄，或暴怒气逆痰厥，这些情况必定形气都实，没有其他恶候，都随着邪气所在的位置，采用涌吐、泄下、清热、通利的方法。胃受伤导致阴虚，木气挟带相火直冲清道而上，适宜用参术汤送服大补阴丸。吐利后胃虚寒者，用理中汤加附子、丁香、柿蒂。吐利后胃虚热者，用橘皮竹茹汤。《三因方》说：凡是吐利后多出现哕，这是由于胃中虚、膈上有热所以哕，或者连续八九声相连气不回，以至于惊人的，如果是伤寒久病出现这个症状就很恶劣，就是《内经》所说的坏病。丹溪治疗赵立道年近五十，体质弱易怒，暑月因饥饿后大怒，得了滞下病（痢疾），口渴，自己用冷水调生蜜饮用，痢疾逐渐缓解，五七日后，诊脉稍大但不数，于是令停止喝蜜水，渴时就用参术汤调益元散给他服用，痢疾也逐渐收敛。七八日后觉得非常疲倦并发出呃逆，知道他是因为下利日久导致阴虚。令他坚守前药，然而痢疾尚未止住，又给他炼蜜，众人都责怪药不对症，想用姜、附子，他说补药没有速效，附子不是补阴的药，服用必死。众人说冷水喝得多，难道不寒吗？他说炎热酷暑如此，喝凉水不算寒，不要多疑，等待几天，药力到了自然会停止，又过了四天呃逆停止，滞下也安好了。又治疗陈择仁年近七十，平时口味浓厚，有久咳病，初秋患滞下，饮食大减，到五七日后呃逆发作，脉象皆大而无根，众人都认为难治。丹溪说：形体消瘦的还可以治，用参术汤送服大补阴丸，七天就好了。娄全善治疗他哥哥九月得滞下，每夜五十多次，呕吐逆气吃不下东西，五六日后加上呃逆，给一粒丁香含在嘴里立刻停止，但过了一会儿又到了，于是用黄连泻心汤加竹茹服用，呃逆虽然稍微停止，滞下未安。像这样的情况十多天，于是空腹用少量御米壳涩其滑脱，白天用人参、白术、陈皮之类补其虚。自从服用御米壳之后，呃声逐渐减轻，滞下也收敛安好了。（以上都是吐利后补虚的例子。）张仲景说：哕并且腹部胀满，观察前后二便，知道哪一部不通利，通利它就痊愈。大肠燥结，脉沉数的，用调胃承气汤。大便不通，哕频密伴谵语，用小承气汤。丹溪治疗超越陈氏二十多岁，因为饱食后奔走几里路患哕，只要吃东西就连着哕一百多声，半天不停，喝酒和喝汤就不发作，到晚上发热，脉涩数，用血入气中的方法治疗，用桃仁承气汤加红花煎服，排出污血几次，症状就减轻，再用木香和中丸加丁香服用，十天痊愈。（右下例，有实积者适宜。）又治疗一个女子，年龄超过十五岁，性格急躁口味浓厚，炎月因大怒而呃逆发作，发作时全身跳动，脉象无法诊察，神志昏迷不知人，询问后才知是突发疾病。看她的形气都实，于是用人参芦二两煎汤，喝一碗，大吐顽痰数碗，大汗昏睡一天而安。人参入手太阴肺经，是补阴中之阳的药。芦则相反，大泻太阴之阳。女子暴怒气上，肝主怒，肺主气，经上说怒则气逆，因怒导致肝木逆气，乘火侮肺，所以呃逆大作而神昏。参芦善于催吐，痰尽则气降而火衰，金气复位，胃气得和而解。（上宣例，痰郁者适宜。）《三因方》说：哕并且心下坚硬痞闷眩晕心悸的，是膈间有痰水所致，虚证不耐受催吐的，适宜用二陈汤、导痰汤加姜汁、竹沥。也有因污血导致哕的，丹溪治疗超越陈氏用桃仁承气汤就是例子。虚证不耐受攻下的，在蓄血门寻求轻剂使用。张仲景说：哕逆者，陈皮竹茹汤主治。又说：干呕哕，如果手足厥冷的，陈皮汤主治。《本事方》用枳壳五钱，木香二钱半，研成细末，每次服一钱，白开水调下。孙兆方用陈皮二两去白，水煎通口服，或者加枳壳一两，这都是破气的药剂，气逆者适宜。只有陈皮竹茹汤，气逆而虚者适宜。水寒相搏的，用小青龙汤。寒甚加炒过的附子尖。洁古的柿钱散，《宝鉴》的丁香柿蒂散，羌活附子汤，都是热剂，只有寒呃适宜。戴复庵认为热呃，只有伤寒才有。其他病发呃的，都属于寒，用半夏一两，生姜一两半，水一碗，煎半碗热服。或者用丁香十粒，柿蒂十个切碎，白水一盏半煎。或者理中汤加枳壳、茯苓各半钱，半夏一钱，无效再加丁香十粒。也有无病偶然致呃，这是因为气逆而生，重的或者经过一二日，宜用小半夏茯苓汤加枳实半夏汤，或者煎汤泡萝卜子研取汁，调木香调气散，乘热服，对逆气效果最佳。如果胃中寒甚，呃逆不止，或者再加上呕吐，轻剂不能取效，宜用丁香煮散，以及用附子粳米汤，增加炒川椒、丁香，每次各服二三十粒。治疗呃逆，在脐下关元穴灸七壮，立刻痊愈，屡次验证。又一方，男左女右，乳下黑尽处一韭叶大小，灸三壮，严重的灸十四壮。
【诊】心脉小甚为哕。肺脉散的预后不良。呃逆声频密相连的为实证，可治。如果半时哕一声的为虚证，难治，多在旦夕之间死亡。
【产后呃逆】这是恶候。急灸期门穴三壮，神效。屈乳头向下尽头处是穴位，乳房小的，以乳下一指为标准。男左女右，与乳头正直下一指的凹陷中动脉处是穴位，艾炷如小豆大，穴位准确病立刻停止。丁香散、羌活散，桂心五钱，姜汁三合，水煎服。参附汤。（以上都是热剂。）干柿一个切碎，用水一盏，煎至六分热呷服。（内有热，不耐受热剂的可用。）
Hiccups (E Ni), also known as "Yue" (Hiccups/Inverted Stomach Qi) in the *Nei Jing* (Inner Canon). Some say that Cheng Wuji and Xu Xueshi indeed interpreted "Yue" as hiccups, yet Li Dongyuan and Wang Haizang interpreted "Yue" as dry heaving (Gan Ou), and Chen Wuzhe called "Yue" coughing against the reverse flow (Ke Ni). Since various theories differ, why do you alone adopt the views of Cheng and Xu? The answer is: The meaning of "Yue" is contained in the *Nei Jing*, it is just that other schools failed to examine it carefully. According to the end of the *Ling Shu* (Spiritual Pivot) chapter on Miscellaneous Diseases: "To treat Yue, prick the nose with grass until sneezing occurs; once sneezed, it stops; if one holds breath and quickly guides the qi, it stops immediately; sudden fright can also cure it." Detailed analysis of these three methods in the scripture reveals they are precisely the treatments for hiccups. Applying this, using a paper twist to stimulate the nose to induce sneezing stops hiccups immediately; or closing mouth and nose to hold breath stops it immediately; or feigning enemies/thieves to cause sudden fright also stops it. This is why I adopt Cheng and Xu's theory that "Yue" is hiccups, as it aligns with the scriptural intent. If "Yue" were dry heaving, would making a person who is dry heaving sneeze, hold breath, or be frightened stop the dry heaving immediately? Obviously not. Thus, "Yue" is clearly not dry heaving. If "Yue" were named Ke Ni (Coughing against the reverse flow), according to the *Sheng Qi Tong Tian Lun* chapter of the *Nei Jing*: "Autumn injury by dampness leads to upward reversal and cough." The *Yin Yang Ying Xiang Lun* chapter states: "Autumn injury by dampness generates cough in winter." Based on this discussion, Ke Ni is undoubtedly coughing, which becomes clear when compared with spring, summer, and winter seasons. Sun Simiao's *Qian Jin Fang* says: "Ke Ni is coughing," which is originally clear. Later generations did not know why they mistakenly equated Ke Ni with hiccups, deviating far from the truth. Zhao Yi-de said: "Cheng Wuji stated that Yue is commonly called Ke Ni, making 'e e' sounds, but citing Ke Ni refers to Yue, not cough, which is incorrect. The *Nei Jing* treats Yue and Ke Ni as two distinct conditions; Yue is a stomach disease, while Ke Ni is a lung disease, defining stomach qi reversal as Yue." The commentary notes: "The stomach is the sea of water and grain, linked with the kidney as the gate. If the gate closure is unfavorable, qi reverses upward. The stomach contains water and grain, its nature prefers warmth; cold and grain clash, thus causing Yue." It also states that when Yangming qi rebounds, there is cough and Yue; when Taiyang qi rebounds, vomiting clear fluid and Yue/belching occur; when Shaoyin qi rebounds, Yue/belching occur. The *Ling Shu* also says: Grain enters the stomach, stomach qi flows upward to the lung. Now, if old cold qi and new grain qi return together to the stomach, old and new confuse each other, true and evil attack each other, qi gathers and reverses, re-emerging from the stomach, thus causing Yue. Treatment involves tonifying Hand Taiyin and draining Foot Shaoyin. Zhang Zhongjing's mentions of Yue all appear in Yangming syndrome contexts, stating that purging wet patients too early causes Yue, and in Yangming disease where the patient cannot eat, attacking heat inevitably causes Yue, both due to stomach qi deficiency after purging. For cases with internal wind-heat obstruction, qi blockage, tidal fever, and frequent Yue, Xiaochaihu Tang (Minor Bupleurum Decoction) is used for harmonization. For Yue with abdominal fullness, observe anterior and posterior bowels to identify blockage and unblock it; these are treatable conditions. However, in extreme illness with delirium, severe Yue, inability to urinate, abdominal fullness plus Yue, these are untreatable. Danxi Mr. also stated that hiccups are qi reversal, where qi rushes straight up from below the navel, exits the mouth, and makes sound. The *Nei Jing* states that all upward rushing reversal belongs to Fire. Li Dongyuan attributed it to Yin fire rushing up, preventing inhalation, causing stomach meridian reversal, arising from hidden yang within yin, treated according to seasonal medication principles. Ancient formulas all attributed it to weak stomach, ignoring fire, and treated it with herbs like Dingxiang (Clove), Shidi (Persimmon Calyx), Zhuru (Bamboo Shavings), and Chenpi (Tangerine Peel), without clarifying who reduces fire and who tonifies deficiency. Human yin qi relies on the stomach for nourishment; when stomach earth is damaged, wood qi insults it, representing earth failure and wood aggression. Yin is overwhelmed by fire, unable to guard internally, so wood carries ministerial fire to invade, rushing directly up the clear pathways. Saying 'stomach weak' actually means yin weakness, extreme deficiency. Patients seeing this seem to have critical signs. Yet there are excess patterns, which must not be ignored. Alas! The Sages said stomach qi reversal causes Yue, not caused by a single factor. Because Wang Taipu (Wang Bing) used the meaning of the *Ling Shu*, he annotated it as a disease of cold qi reversing from the kidney. Consequently, later formula discussions either used hot agents for cold or acrid-warm agents to disperse qi. How could one know that spleen and stomach, being one yin and one yang, disharmony also causes reversal? Kidney and liver are lower; mutual encroachment causes reversal. Moreover, kidney reversal is not necessarily cold. Left kidney governs water, nature moist and descending, how can it reverse itself? It must be right kidney ministerial fire flaming upward, carrying the rushing reversal. One must observe the degree of carriage and apply direct or counter-treatment accordingly. Liver wood wind, clashing from Shaoyang ministerial fire, must also treat fire, following the Master's words. If Yue arises from other causes, one must follow Zhongjing's method, treating according to what is favorable. Liu Zongnong said: Hiccups involve deficiency and excess, fire and phlegm, water qi; one cannot solely attribute it to cold. Generally, after sweating, vomiting, or purging for Shanghan (Cold Damage), prolonged diarrhea/dysentery, post-major illness, or postpartum, these are due to great deficiency of spleen-stomach qi and blood. If a healthy person eats too fast causing qi stagnation, or drinks/laughs causing airway aspiration, or phlegm-water stagnates in the chest, or violent anger causes qi reversal and phlegm syncope, or Shanghan-febrile disease fails to purge leading to this, these are all excess patterns. Water nature is moist and descending, fire nature is flaming upward. Now qi rushes from below to above; if not fire, then what? Generally, treatment for deficiency is tonification, distinguishing cold and heat within deficiency. E.g., after sweating/vomiting/purging, if too many cold-cooling drugs were taken erroneously, use warm tonification. If spleen-stomach yin deficiency with fire reversal, use balanced tonification. With heat, use cool tonification. For excess, e.g., Shanghan failing to purge, bowel obstruction causing hiccups, use cold purgation. For phlegm-fluid retention or violent anger qi reversal/phlegm syncope, where form and qi are both excess without malignant symptoms, treat according to pathogen location using emesis, purgation, clearing, or draining. Stomach injury with yin deficiency, wood carrying ministerial fire rushing up clear pathways: use Shen Zhu Tang (Ginseng and Atractylodes Macrocephala Decoction) with Dabu Yin Wan (Great Tonify Yin Pill). Post-vomit/purge stomach deficiency-cold: Lizhong Tang (Regulate the Middle Decoction) plus Fuzi (Aconite Root), Dingxiang, Shidi. Post-vomit/purge stomach deficiency-heat: Jupi Zhuru Tang (Tangerine Peel and Bamboo Shavings Decoction). *San Yin Fang* states: Vomiting/purging often leads to Yue due to stomach deficiency and diaphragm heat. Or continuous 8-9 sounds with no returning qi, alarming. In chronic Shanghan, this is very bad, termed 'Huai Bing' (Ruined Disease) in *Nei Jing*. Danxi treated Zhao Lidao, nearly 50, weak constitution, prone to anger. In summer, after hunger and violent anger, he developed dysentery (Zhi Xia), thirst, drank raw honey mixed with cold water himself. Dysentery eased slightly. After 5-7 days, pulse was slightly large but not rapid. He ordered stopping honey water, giving Shen Zhu Tang mixed with Yiyuan San (Benefit Origin Powder) when thirsty. Dysentery converged. After 7-8 days, extreme fatigue and hiccups appeared; knowing it was yin deficiency from prolonged purging, he maintained previous meds. Dysentery hadn't stopped, so he gave refined honey. Others blamed the medicine, wanting Ginger/Aconite. He said tonics have no quick effect; Aconite does not tonify yin, taking it ensures death. Others asked if cold water caused cold. He said in such heat, cool water isn't cold; don't doubt, wait for drug power. Four days later, hiccups stopped, dysentery settled. He treated Chen Zeren, nearly 70, rich diet, chronic cough, autumn dysentery, poor appetite. After 5-7 days, hiccups started, pulse large and empty. Others thought it difficult. Danxi said thin body can still be treated; use Shen Zhu Tang with Dabu Yin Wan. Recovered in 7 days. Lou Quanshan treated his brother with September dysentery, 50+ stools nightly, vomiting/reversal, inability to eat. After 5-6 days, hiccups added. One Clove held in mouth stopped it temporarily, but it returned. Used Huanglian Xiexin Tang (Coptis Decoction to Drain the Epigastrium) plus Zhuru. Hiccups slightly stopped, dysentery unsettled. For over 10 days, used small amount of Poppy Shell (Yumi Qiao) on empty stomach to astringe sliding, daytime used Ginseng, Atractylodes, Tangerine Peel to tonify deficiency. After Poppy Shell, hiccups lightened, dysentery settled. (Examples of tonifying deficiency after vomiting/purging.) Zhongjing said: Yue with abdominal fullness, check anterior/posterior, unblock whichever is blocked, and it heals. Large intestine dryness, deep-rapid pulse: Tiaowei Chengqi Tang (Regulate the Stomach and Order the Qi Decoction). Constipation, frequent Yue with delirium: Xiao Chengqi Tang (Minor Order the Qi Decoction). Danxi treated Chao Yue Chen Shi, 20s, hiccups after running miles full. Eating triggered >100 hiccups, lasting half day. Alcohol/soup didn't trigger. Evening fever, pulse choppy-rapid. Treated blood entering qi using Tao Ren Chengqi Tang (Peach Kernel and Magnolia Bark Decoction) plus Honghua (Safflower). Passed dirty blood several times, reduced. Then Muxiang Hezhong Wan (Costus Harmonize Middle Pill) plus Dingxiang. Cured in 10 days. (Right lower example, suitable for excess accumulation.) Treated a girl, past puberty, irritable, rich diet. Summer, violent anger triggered hiccups, whole body trembled, pulse unpalpable, unconscious. Inquiry revealed acute onset. Form/qi excess. Used 2 liang of Ginseng Radix Rhizoma (Renshen Lu) decoction, drank one bowl. Vomitied large amounts of tough phlegm, profuse sweat, slept one day, recovered. Ginseng enters Hand Taiyin, tonifies yin containing yang. Lu (Rhizome tip) is opposite, greatly drains Taiyin yang. Girl's violent anger rose; Liver governs anger, Lung governs qi. Scripture says anger causes qi reversal. Anger reversed Liver wood, attacked Fire insulting Lung, causing severe hiccups and unconsciousness. Renshen Lu induces vomiting; phlegm gone, qi descends, fire declines, Metal qi restores, Stomach qi harmonizes. (Upper example, suitable for phlegm stagnation.) *San Yin Fang* says: Yue with epigastric hardness/stuffiness, dizziness/palpitations indicates phlegm-water in diaphragm. Deficiency intolerant of emesis: Erchen Tang (Two Aged Decoction) or Daotan Tang (Abundant Phlegm Decoction) plus Jiangzhi (Ginger Juice), Zhuli (Bamboo Sap). Also blood stasis causing Yue, e.g., Danxi using Tao Ren Chengqi Tang for Chao Yue Chen Shi. Deficiency intolerant of purgation: seek mild agents in Blood Stasis section. Zhongjing said: Yue reversal, Jupi Zhuru Tang governs. Also: Dry heaving/Yue with cold limbs, Chenpi Tang governs. *Ben Shi Fang* uses Zhiqiao (Immature Bitter Orange) 5 qian, Muxiang (Costus Root) 2.5 qian, fine powder, 1 qian per dose, white water. Sun Zhao's formula uses Chenpi (Tangerine Peel) 2 liang peeled, decocted orally, or add Zhiqiao 1 liang. These are qi-breaking agents, suitable for qi reversal. Only Jupi Zhuru Tang is suitable for qi reversal with deficiency. Water-cold clash: Xiao Qinglong Tang (Minor Blue Dragon Decoction). Severe cold adds fried Fuzi tips. Jiegu's Shiqian San, *Baojian*'s Dingxiang Shidi San, Qianghuo Fuzi Tang, all hot agents, only suitable for cold hiccups. Dai Fu'an believed hot hiccups only occur in Shanghan. Other diseases with hiccups belong to cold: Banxia (Pinellia) 1 liang, Shengjiang (Fresh Ginger) 1.5 liang, 1 bowl water, decoct to half bowl, take hot. Or Dingxiang 10 grains, Shidi 10 pieces chopped, 1.5 bowls white water decocted. Or Lizhong Tang add Zhiqiao/Fuling 0.5 qian each, Banxia 1 qian. If ineffective, add Dingxiang 10 grains. Also, incidental hiccups without disease arise from qi reversal. Severe cases last 1-2 days: Xiaobanxia Fuling Tang (Minor Pinellia and Poria Decoction) plus Zhishi Banxia Tang (Immature Bitter Orange and Pinellia Decoction), or radish seed juice mixed with Muxiang Tiaoqi San (Costus Regulate Qi Powder), take hot. Best for reversal qi. If stomach cold severe, hiccups persist, or vomiting adds, mild agents fail: Dingxiang Zhusan (Clove Boiled Powder) or Fuzi Jingmi Tang (Aconite and Rice Decoction) plus fried Chuanjiao (Sichuan Pepper), Dingxiang, 20-30 grains each. Treat hiccups by moxibustion at Guanyuan (CV4) below navel, 7 moxa cones, immediate cure, repeatedly verified. Another method: Men left, women right, under nipple black edge, size of leek leaf, 3 moxa cones. Severe cases 14 cones.
[Diagnosis] Heart pulse extremely small indicates Yue. Lung pulse scattered indicates untreatable. Frequent connected hiccups indicate excess, treatable. Hiccups once every half hour indicate deficiency, difficult to treat, often dying soon.
[Postpartum Hiccups] This is an ominous sign. Urgently moxa Qimen (LR14) 3 cones, miraculous. Bend nipple down to the end point is the acupoint. Small breasts: one finger width below nipple. Men left, women right, one finger width below nipple in depression arterial point. Moxa cone size of small bean, accurate point stops disease immediately. Dingxiang San, Qianghuo San, Guixin (Cinnamon Bark) 5 qian, Jiangzhi 3 he, decoct water. Shenfu Tang (Ginseng and Aconite Decoction). (All hot agents.) Dried persimmon 1 piece chopped, 1 bowl water, decoct to 6 fen, sip warm. (For internal heat, intolerant of hot agents.)