大意
内经有咳逆而无呃逆。大率由痰闭于上。火动于下。上注于肺。直冲清道而作声也。有阴阳之分。虚实之
别。寒热之异。不可一概混治。要知胃实则噫。胃虚则哕。（汇补）
内因
有久病胃虚者。有伤寒失下者。有痰结于上。火起于下。痰火相搏者。有胃弱阴虚。木挟火势。上凌胃土者。
有过服寒凉。胃寒而得者。有水停食郁。气逆而得者。有恚怒郁热者。有单衣着寒者。（汇补）
外候
火呃。呃声大响。乍发乍止。燥渴便难。脉数有力。寒呃。朝宽暮急。连续不已。手足清冷。脉迟无力。痰呃。呼
吸不利。呃有痰声。脉滑有力。虚呃。气不接续。呃气转大。脉虚无力。瘀呃。心胸刺痛。水下即呃。脉芤沉涩。（汇
补）
呃逆上下
中焦呃逆。其声轻而短。水谷为病也。下焦呃逆。其声恶而长。虚邪相搏也。（子昆）
呃逆虚实
不足因内伤脾胃。及大病后胃弱。多面青肢冷便软。有余因外感胃热。及大怒大饱。多面红肢热便闭。虚
者难治。实者易愈。如寻常无别症。忽然发呃者。属气逆与痰滞。（入门）
呃逆危症
伤寒及滞下后。老人。虚人。妇人产后。多有呃症者。皆病深之候也。（三因）若额上出汗。连声不绝者危。（医鉴）
脉法
浮而缓者易治。大而散者难治。结促者可治。脉代者难治。又左关弦者为木乘土。右寸数者为火刑金。俱不治。
治法
治当降气化痰和胃为主。随其所感而用药。气逆者。疏导之。食停者。消化之。痰滞者。涌吐之。热郁者。清下
之。血瘀者。破导之。若汗吐下后。服凉药过多者。当温补。阴火上冲者。当平补。虚而挟热者。当凉补。（汇补）
温补宜审
局方概用丁、附、姜、桂。温暖助火。不辨寒热。其间气实痰滞。当用开导者。若执一治之。损不足而益有余。宜
乎呃逆之必死也。（丹溪）
用药
主以二陈汤。平人气呃。加枳壳、莱菔子。食呃。加山楂、麦芽。痰火。加山栀、黄连。水气。加猪苓、泽泻。胃
虚。加人参、白术。胃寒。加丁香、炮姜。伤寒失下。主以承气汤。顽痰可吐。主以瓜蒂散。气不归原。主以八味丸。
古方用柿蒂者。取其苦温能降滞气也。
呃逆选方
陈皮汤 治痰气作呃。
陈皮（四钱） 生姜（八钱）
水煎服。
橘皮竹茹汤 治虚热痰呃。
陈皮 竹茹（各二钱） 大枣（三枚） 生姜（八分） 人参（一钱） 甘草（一钱）
柿钱散（洁古） 治虚寒作呃。
柿蒂 丁香 人参（各等分）
水煎。
丁香柿蒂散 治寒气作呃。
丁香 蒂 青皮 陈皮（各等分）
水煎。
木香调气散 治气郁气逆作呃。（方见反胃）
理中汤 治虚寒作呃（方见中寒）
参附汤 治大汗大吐大泻后。厥冷呃忒腹痛。
人参（一两） 附子（炮五钱）
姜枣煎。
大补阴丸
大补丸 治阴火上炎作呃。（二方俱见火症）
大柴胡汤（方见发热） 苏子降气汤（方见气症） 凉膈散（方见火症）
三方皆治地道不通。因而呃逆。及火郁为患者。
外治法 或以纸拈鼻嚏而止。或以诈冤盗贼而止。或鼻闻食香调气而止。皆抑之骇之。而使气下也。此
治气逆之法。若夫虚寒呃逆。用乳香、硫黄、艾叶各三钱为末。好酒一钟。煎数沸。乘热使病患鼻嗅其气。
甚者灸期门穴于乳下动处。男左女右三七壮。再不止者。灸脐下丹田二三十壮。间有活者。
【大意】
《黄帝内经》中只有“咳逆”而没有“呃逆”。呃逆大多是因为痰浊闭塞于上焦，虚火扰动于下焦，热气上注于肺，直冲清道（呼吸道）而发出声音。呃逆有阴证和阳证的区别，有虚证和实证的差异，有寒证和热证的不同，不能一概而论地混合治疗。要知道，胃气充实则表现为嗳气（噫），胃气虚弱则表现为呃逆（哕）。
【内因】
有的因为久病导致胃气虚弱；有的因为伤寒病误用攻下法或失于攻下；有的因为痰结聚于上焦，火起于下焦，痰与火相互搏结；有的因为胃弱且阴虚，肝木挟带火势，向上侵犯胃土；有的因为过服寒凉药物，导致胃寒而患病；有的因为水饮停滞、食积郁结，气机上逆而患病；有的因为愤怒导致郁热内生；有的因为衣着单薄感受寒邪。（出自《证治汇补》）
【外候】
火呃：呃声洪亮，时发时止，伴有口干烦躁、大便困难，脉象数而有力。
寒呃：早晨较轻傍晚加重，连续不断，手足冰冷，脉象迟而无力。
痰呃：呼吸不畅，呃逆时伴有痰鸣音，脉象滑而有力。
虚呃：气息不接续，呃逆时感觉气转大但无力，脉象虚而无力。
瘀呃：心胸部位刺痛，饮水后即发生呃逆，脉象芤、沉或涩。（出自《证治汇补》）
【呃逆上下】
中焦呃逆：声音轻短，多由水谷饮食致病所致。
下焦呃逆：声音恶浊且长，多由虚邪相搏所致。（出自子昆）
【呃逆虚实】
不足之证（虚证）：多因内伤脾胃，以及大病之后胃气虚弱，常见面色青暗、四肢冰冷、大便稀软。
有余之证（实证）：多因外感胃热，以及大怒或暴饮暴食，常见面色红赤、四肢发热、大便闭结。
虚证难治，实证易愈。如果是平常没有其它病症，突然发生呃逆的，属于气逆与痰滞。（出自《医学入门》）
【呃逆危症】
伤寒病及痢疾（滞下）之后，老年人、体虚之人、妇女产后，多有出现呃逆症状的，这都是病情深重的征候。（出自《三因方》）如果额头出汗，呃逆连声不绝者，预后危险。（出自《医鉴》）
【脉法】
脉浮而缓者，容易治疗。
脉大而散者，难治。
脉结代促者，可治。
脉代者，难治。
另外，左关脉弦者为肝木乘脾土，右寸脉数为火刑金，这两种情况都不易治疗。
【治法】
治疗应当以降气、化痰、和胃为主，根据所感的病因不同而用药。气逆者，疏导之；食停者，消化之；痰滞者，涌吐之；热郁者，清下之；血瘀者，破血导滞之。如果在汗、吐、下法之后，服用过多凉药，应当温补；阴火上冲者，应当平补；虚而兼有热者，应当凉补。（出自《证治汇补》）
【温补宜审】
《局方》通常使用丁香、附子、干姜、肉桂，温暖助火，不辨别寒热。其中如果有气实痰滞，应当使用开导之法，如果固执于一法治疗，就会损伤正气而增加邪气，这必然导致呃逆死亡。（出自朱丹溪）
【用药】
主要使用二陈汤。普通人呃逆，加枳壳、莱菔子；食积呃逆，加山楂、麦芽；痰火呃逆，加山栀、黄连；水气呃逆，加猪苓、泽泻；胃虚呃逆，加人参、白术；胃寒呃逆，加丁香、炮姜。伤寒失于攻下者，主以承气汤；顽痰可吐者，主以瓜蒂散；气不归原者，主以八味丸。古方中使用柿蒂的，是取其苦温能降滞气的作用。
【呃逆选方】
陈皮汤：治疗痰气引起的呃逆。
陈皮（四钱） 生姜（八钱）
水煎服。
橘皮竹茹汤：治疗虚热痰呃。
陈皮 竹茹（各二钱） 大枣（三枚） 生姜（八分） 人参（一钱） 甘草（一钱）
柿钱散（洁古）：治疗虚寒引起的呃逆。
柿蒂 丁香 人参（各等分）
水煎。
丁香柿蒂散：治疗寒气引起的呃逆。
丁香 柿蒂 青皮 陈皮（各等分）
水煎。
参附汤：治疗大汗、大吐、大泻后，出现厥冷、呃逆、腹痛。
人参（一两） 附子（炮制五钱）
加姜、枣煎服。
大补阴丸
大补丸：治疗阴火上炎引起的呃逆。（两方均见火症章节）
大柴胡汤（方见发热章节） 苏子降气汤（方见气症章节） 凉膈散（方见火症章节）
这三方都治疗地道不通（便秘），因而导致的呃逆，以及火郁为患者。
【外治法】
或者用纸捻刺激鼻腔打喷嚏而停止，或者假装冤枉盗贼惊吓患者而停止，或者让鼻子闻到食物香气调理气机而停止，这些都是抑制和惊吓的方法，使气下行。这是治疗气逆的方法。如果是虚寒呃逆，用乳香、硫黄、艾叶各三钱研为末，好酒一杯，煎煮数沸，趁热让患者嗅其气味。严重的灸期门穴，在乳房下方的跳动处，男性左侧女性右侧，灸三七壮。再不止的，灸脐下的丹田穴二三十壮，间或有活着的。
[General Principle]
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) mentions "ke ni" (cough with reverse flow of qi) but does not mention "e ni" (hiccups). Generally, hiccups are caused by phlegm turbidity obstructing the upper jiao (upper burner), deficiency fire stirring in the lower jiao, heat rising to the lung, and rushing directly through the clear orifices (respiratory tract) to produce sound. Hiccups are distinguished into yin and yang syndromes, deficiency and excess patterns, and cold and heat variations; they cannot be treated uniformly without differentiation. It is important to know that when stomach qi is full, belching ("yi") occurs; when stomach qi is deficient, hiccups ("yue") occur.
[Internal Causes]
Some cases arise from chronic illness leading to stomach deficiency. Some result from shaoyang disease where purgation was missed or improperly applied. Some are due to phlegm knotting in the upper jiao and fire arising in the lower jiao, with phlegm and fire battling each other. Some stem from weak stomach and yin deficiency, where liver wood carries fire to invade stomach earth. Some are caused by excessive consumption of cold-natured medicines, resulting in stomach cold. Some arise from water retention and food stagnation causing qi rebellion. Some result from anger leading to stagnant heat. Some are contracted from exposure to cold due to insufficient clothing. (From *Zhengzhi Huibu*)
[External Manifestations]
Fire-type hiccups: Loud hiccup sounds, intermittent, accompanied by dry mouth, thirst, and difficult defecation; pulse is rapid and forceful.
Cold-type hiccups: Milder in the morning, severe in the evening, continuous, with cold hands and feet; pulse is slow and weak.
Phlegm-type hiccups: Difficulty in breathing, hiccup sounds accompanied by phlegm rattling; pulse is slippery and forceful.
Deficiency-type hiccups: Disconnected breath, feeling of large but weak qi during hiccups; pulse is empty and weak.
Blood stasis-type hiccups: Stabbing pain in the chest and heart area, hiccups occurring immediately after drinking water; pulse is floating-empty (kou), deep, or choppy. (From *Zhengzhi Huibu*)
[Hiccups: Upper vs. Lower Jiao]
Upper/Middle Jiao hiccups: The sound is light and short, usually caused by disorders of water and grain (digestion).
Lower Jiao hiccups: The sound is harsh and long, caused by the interaction of deficiency and pathogenic factors. (From Zikun)
[Hiccups: Deficiency vs. Excess]
Deficiency syndromes (Insufficiency): Often due to internal injury to the spleen and stomach, or stomach weakness after a major illness. Symptoms often include dark complexion, cold limbs, and loose stools.
Excess syndromes (Surplus): Often due to external contraction with stomach heat, or extreme anger and overeating. Symptoms often include red face, hot limbs, and constipation.
Deficiency types are difficult to treat; excess types are easy to cure. If hiccups occur suddenly without other distinct symptoms, it belongs to qi rebellion and phlegm stagnation. (From *Yixue Rumen*)
[Critical Signs of Hiccups]
After typhoid fever (shaoyang disease) and dysentery (zhixia), elderly people, those with constitutionally weak bodies, and women postpartum often present with hiccups; this indicates a deep-seated disease. (From *Sanyin Fang*) If sweat appears on the forehead and hiccups continue incessantly, the prognosis is critical. (From *Yijian*)
[Pulse Diagnosis]
Floating and moderate pulses indicate ease of treatment.
Large and scattered pulses indicate difficulty in treatment.
Knotted, intermittent, or hurried pulses are treatable.
Interchangeable (dai) pulses are difficult to treat.
Furthermore, a wiry pulse at the left guan position indicates liver wood overacting on spleen earth; a rapid pulse at the right cun position indicates fire punishing metal (lung); both are considered untreatable.
[Therapeutic Methods]
Treatment should primarily focus on descending qi, resolving phlegm, and harmonizing the stomach, prescribing medications according to the specific pathogen. For qi rebellion, guide and unblock it; for food stagnation, digest it; for phlegm obstruction, induce vomiting; for heat depression, clear and purge it; for blood stasis, break stasis and guide it out. If, after sweating, vomiting, or purging methods, too many cooling medicines were taken, warm tonification should be used. For rising ministerial fire, gentle tonification is appropriate. For deficiency with accompanying heat, cool tonification is indicated. (From *Zhengzhi Huibu*)
[Caution on Warm Tonification]
The *Jufang* (Prescriptions of the Bureau of Taiyi) generally uses Dingxiang (Clove), Fuzi (Aconite), Jiang (Ginger), and Guizhi (Cinnamon Twig) to warm and assist fire without distinguishing between cold and heat. In cases of qi excess and phlegm stagnation, opening and guiding methods should be used. If one adheres rigidly to one method, it damages the healthy qi and increases the pathogenic factor, inevitably leading to death from hiccups. (From Zhu Danxi)
[Medication Selection]
The primary formula is Erchen Tang (Two-Aged Decoction). For ordinary hiccups, add Zhike (Bitter Orange Fruit) and Laifuzi (Radish Seed). For food-related hiccups, add Shanzha (Hawthorn Fruit) and Maiya (Germinated Barley). For phlegm-fire, add Shanzhi (Gardenia Fruit) and Huanglian (Coptis Rhizome). For water qi, add Zhuling (Polyporus) and Zexie (Alisma Rhizome). For stomach deficiency, add Renshen (Ginseng Root) and Baizhu (Atractylodes Macrocephala Rhizome). For stomach cold, add Dingxiang (Clove) and Paojiang (Prepared Ginger). For shaoyang disease where purgation was missed, use Chengqi Tang (Chengqi Decoction). For stubborn phlegm that can be vomited, use Guiti San (Melon Pedicle Powder). For qi failing to return to its origin, use Bawei Wan (Eight-Ingredient Pill). Ancient formulas use Shidi (Persimmon Calyx) because its bitter-warm nature can descend stagnant qi.
[Hiccups: Selected Formulas]
Chenpi Tang (Tangerine Peel Decoction): Treats hiccups caused by phlegm and qi.
Chenpi (4 qian) Shengjiang (8 qian)
Decoct in water and take orally.
Jupi Zhuru Tang (Tangerine Peel and Bamboo Shavings Decoction): Treats deficiency-heat phlegm hiccups.
Chenpi Zhuru (2 qian each) Dazao (3 pieces) Shengjiang (0.8 fen) Renshen (1 qian) Gancao (1 qian)
Shiqian San (Jiegu): Treats hiccups caused by deficiency-cold.
Shidi Dingxiang Renshen (Equal parts)
Decoct in water.
Dingxiang Shidi San (Clove and Persimmon Calyx Powder): Treats hiccups caused by cold qi.
Dingxiang Shidi Qingpi Chenpi (Equal parts)
Decoct in water.
Muxiang Tiaoqi San (Costus Regulating Qi Powder): Treats hiccups caused by qi depression and rebellion. (Formula see Fanwei section)
Lizhong Tang (Regulate the Middle Decoction): Treats hiccups caused by deficiency-cold. (Formula see Zhonghan section)
Shenfu Tang (Ginseng and Aconite Decoction): Treats hiccups, abdominal pain, and cold extremities following massive sweating, vomiting, or diarrhea.
Renshen (1 liang) Fuzi (5 qian, prepared)
Decoct with Shengjiang and Dazao.
Dabu Yin Wan (Great Yin Tonifying Pill)
Dabu Wan (Great Tonifying Pill): Treats hiccups caused by ministerial fire flaming upward. (Both formulas see Huozheng section)
Da Chaihu Tang (Major Bupleurum Decoction) (See Refa section) Suzi Jiangqi Tang (Perilla Descending Qi Decoction) (See Qizheng section) Liangge San (Cooling Chest Powder) (See Huozheng section)
These three formulas all treat hiccups caused by blockage of the lower pathways (intestines) and fire depression.
[External Treatment Methods]
One may stop hiccups by stimulating the nasal mucosa with paper twists to induce sneezing, or by pretending to accuse someone of theft to startle the patient, or by having the patient smell food aromas to regulate qi. These are methods of suppression and startling to make the qi descend. This treats qi rebellion. For deficiency-cold hiccups, use Xurxiong (Frankincense), Liuhuang (Sulfur), and Aiye (Mugwort Leaf), each 3 qian, ground into powder. Mix with one cup of good wine, boil briefly, and let the patient inhale the vapor while hot. For severe cases, moxa the Qimen acupoint (located below the nipple at the pulsating point), 27 or 39 moxa cones for men on the left side and women on the right side. If it persists, moxa the Dantian acupoint below the navel for 20-30 cones. There are occasional recoveries.