脉∶呃逆甚危，浮缓乃宜；弦急必死，结代促微。
发呃者，气逆上冲而作声也，呃，一名咳逆。若胃火上冲而逆，随口应起于上膈，病者知之易治也；自脐
下上冲，直出于口者，阴火上冲，难治。俗名谓之打呃是也。
胃口虚寒、手足冷、脉沉细，是寒呃也。
丁香柿蒂汤
丁香 柿蒂 良姜 官桂 半夏（姜汁炒） 陈皮 木香（另磨） 沉香（另磨） 茴香 藿香 浓朴
（姜汁炒） 砂仁（各等分） 甘草（减半） 乳香（为末）
上锉一剂，姜三片，水煎，磨沉、木香，调乳香末同服。寒极手足冷、脉沉细加附子、干姜，去良姜、官桂。
发热烦渴脉数者，是热呃也。
小柴胡汤 治身热、烦渴、发呃。
柴胡 黄芩 山栀 柿蒂 陈皮 砂仁 半夏（姜汁炒） 竹茹（各一钱） 藿香（八分） 沉香 木香
（各三分） 茴香（五分） 甘草（三分）
上锉一剂，姜一片、乌梅一个，水煎，磨沉、木香温服。
一切发呃，用柿蒂、沉香、木香、乳香、砂仁为细末。每服一钱，淡姜汤调服最效。如口燥渴、身热不可服。
胃中痰火发呃者。
黄连竹茹汤 治胃中痰火发呃。
黄连 竹茹 麦门冬（去心） 山栀 陈皮 半夏（各一钱） 砂仁 沉香 木香 茴香（各五分） 苏子
（八分） 甘草（二分）
上锉一剂，姜一片，乌梅一个，水煎，磨沉香、木香调服。
水寒停胃发呃者。
茯苓半夏汤 治水寒停胃发呃。
茯苓 半夏（姜汁炒） 浓朴（姜汁炒。各一钱） 干姜（炒） 丁香 官桂 砂仁（各五分） 陈皮（一钱）
藿香（八分） 柿蒂（一钱） 茴香（七分） 沉香 木香 甘草（各三分）
上锉一剂，姜三片，水煎，磨沉香、木香同服。
脐下气上升发呃者，阴火也。滋阴降火汤，治阴火上升发呃。（方见虚症。）根据本方加砂仁、茴香、沉香、木
香、山栀、柿蒂、辰砂。
中气不足，脉虚微，气不相续而发呃者，补中益气汤加生脉散、黄柏，以降阴火，或少加附子。（方见内伤。）
阳明内实失下而发呃者，六一顺气汤下之。（方见伤寒。）
伤寒传经热症，医者误用姜桂等热药助其火邪，痰火相搏而为咳逆者，黄连解毒、白虎汤及竹沥之类治之。
（方见伤寒。）
凡泻痢发呃与伤寒结胸发黄又发呃者，俱难治也。
大抵发呃不止，将乳香纸卷烧烟熏鼻中及灸中脘、膻中、期门三处即效。
咳逆丸 花椒微炒出汗，去目为末，醋糊丸，如梧桐子
大。每服十五丸，醋汤下。
伤寒发热而呃逆者，用黄荆子不拘多少，炒，水煎服，立止。
嗅法 治咳逆服药无效者。
硫黄 乳香
上各等分，为细末，以酒煎，急令患人嗅之即止。
又方
用雄黄二钱、酒一盏煎七分，急令患人嗅之愈。
灸咳逆法
乳根二穴，直乳一寸六分，妇人在乳房下起肉处陷中灸七壮，效如神。
又方 灸气海三五壮亦效。气海在脐下一寸半。
Pulse: Epigastric reflux (hiccups) is a critical condition; a floating and moderate pulse indicates a favorable prognosis, whereas a wiry and rapid pulse suggests death. A knotted, intermittent, hurried, or minute pulse also carries a poor prognosis.
Epigastric reflux (hiccups) occurs due to rebellious Qi rushing upward, producing sound. It is also known as coughing against the reverse flow (Ke Ni). If the rebellious Qi is caused by Stomach Fire surging upward, the sound arises from above the diaphragm, and since the patient is aware of the cause, it is easy to treat. However, if the Qi surges upward from below the umbilicus directly out through the mouth, this is caused by Ministerial Fire (Yin Fire) surging upward, which is difficult to treat. This is commonly referred to as "hiccupping."
Deficiency-cold in the Stomach opening, cold hands and feet, and a deep, fine pulse indicate Cold Epigastric Reflux (Han E).
Dingxiang Shidi Decoction (Clove and Persimmon Calyx Decoction)
Ingredients: Dingxiang (Caryophylli Flos), Shidi (Diospyri Fructus Pericarpium), Liangjiang (Galangae Rhizoma), Guanzi Gui (Cinnamomi Cortex), Banxia (Pinelliae Rhizoma, stir-fried with ginger juice), Chenpi (Citri Reticulatae Pericarpium), Muxiang (Aucklandiae Radix, ground separately), Chenxiang (Aquilariae Lignum Resinatum, ground separately), Huixiang (Foeniculi Fructus), Huoxiang (Agastaches Herba), Houpo (Magnoliae Officinalis Cortex, stir-fried with ginger juice), Sharen (Amomi Fructus Rotundus, all equal parts), Gancao (Glycyrrhizae Radix et Rhizoma, half dose), Xurong (Boswelliae Resina, powdered).
Preparation and Administration: Coarsely crush one dose of the herbs. Add three slices of fresh ginger and decoct in water. Grind Chenxiang and Muxiang into powder, mix with Xurong powder, and take together. If there is extreme cold causing cold hands and feet and a deep, fine pulse, add Fuzi (Aconiti Lateralis Radix Praeparata) and Ganjiang (Zingiberis Rhizoma), and remove Liangjiang and Guanzi Gui.
Fever, irritability, thirst, and a rapid pulse indicate Heat Epigastric Reflux (Re E).
Xiaochaihu Tang (Minor Bupleurum Decoction) treats body heat, irritability, thirst, and epigastric reflux.
Ingredients: Chaihu (Bupleuri Radix), Huangqin (Scutellariae Radix), Shanzhi (Gardeniae Fructus), Shidi (Diospyri Fructus Pericarpium), Chenpi (Citri Reticulatae Pericarpium), Sharen (Amomi Fructus Rotundus), Banxia (Pinelliae Rhizoma, stir-fried with ginger juice), Zhuru (Bambusae Caulis in Taenia, all 1 qian), Huoxiang (Agastaches Herba, 8 fen), Chenxiang (Aquilariae Lignum Resinatum), Muxiang (Aucklandiae Radix, both 3 fen), Huixiang (Foeniculi Fructus, 5 fen), Gancao (Glycyrrhizae Radix et Rhizoma, 3 fen).
Preparation and Administration: Coarsely crush one dose. Add one slice of fresh ginger and one dark plum (Wumei). Decoct in water, grind Chenxiang and Muxiang into powder, and take warm.
For all types of epigastric reflux, use Shidi (Diospyri Fructus Pericarpium), Chenxiang (Aquilariae Lignum Resinatum), Muxiang (Aucklandiae Radix), Xurong (Boswelliae Resina), and Sharen (Amomi Fructus Rotundus) ground into fine powder. Take 1 qian each time, mixed with light ginger soup for best effect. Do not use if there is dry mouth/thirst or body heat.
For epigastric reflux caused by Phlegm-Fire in the Stomach:
Huanglian Zhuru Tang (Coptis and Bamboo Sheath Decoction) treats epigastric reflux caused by Phlegm-Fire in the Stomach.
Ingredients: Huanglian (Coptidis Rhizoma), Zhuru (Bambusae Caulis in Taenia), Maidong (Ophiopogonis Radix, heart removed), Shanzhi (Gardeniae Fructus), Chenpi (Citri Reticulatae Pericarpium), Banxia (Pinelliae Rhizoma, all 1 qian), Sharen (Amomi Fructus Rotundus), Chenxiang (Aquilariae Lignum Resinatum), Muxiang (Aucklandiae Radix), Huixiang (Foeniculi Fructus, all 5 fen), Suzi (Perillae Fructus, 8 fen), Gancao (Glycyrrhizae Radix et Rhizoma, 2 fen).
Preparation and Administration: Coarsely crush one dose. Add one slice of fresh ginger and one dark plum (Wumei). Decoct in water, grind Chenxiang and Muxiang into powder, and take mixed in.
For epigastric reflux caused by Water-Cold stagnating in the Stomach:
Fuling Banxia Tang (Poria and Pinellia Decoction) treats epigastric reflux caused by Water-Cold stagnating in the Stomach.
Ingredients: Fuling (Poria), Banxia (Pinelliae Rhizoma, stir-fried with ginger juice), Houpo (Magnoliae Officinalis Cortex, stir-fried with ginger juice, all 1 qian), Ganjiang (Zingiberis Rhizoma, stir-fried), Dingxiang (Caryophylli Flos), Guanzi Gui (Cinnamomi Cortex), Sharen (Amomi Fructus Rotundus, all 5 fen), Chenpi (Citri Reticulatae Pericarpium, 1 qian), Huoxiang (Agastaches Herba, 8 fen), Shidi (Diospyri Fructus Pericarpium, 1 qian), Huixiang (Foeniculi Fructus, 7 fen), Chenxiang (Aquilariae Lignum Resinatum), Muxiang (Aucklandiae Radix), Gancao (Glycyrrhizae Radix et Rhizoma, all 3 fen).
Preparation and Administration: Coarsely crush one dose. Add three slices of fresh ginger. Decoct in water, grind Chenxiang and Muxiang into powder, and take together.
For epigastric reflux caused by Qi rising from below the umbilicus, this is Yin Fire. Use Ziyin Jianghuo Tang (Nourish Yin and Descend Fire Decoction) to treat epigastric reflux caused by Yin Fire surging upward. (See Formula in Deficiency Syndromes chapter.) Modify this formula by adding Sharen (Amomi Fructus Rotundus), Huixiang (Foeniculi Fructus), Chenxiang (Aquilariae Lignum Resinatum), Muxiang (Aucklandiae Radix), Shanzhi (Gardeniae Fructus), Shidi (Diospyri Fructus Pericarpium), and Chensha (Cinnabaris).
For epigastric reflux caused by deficiency of Middle Qi, with a weak and minute pulse, and discontinuous Qi, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) combined with Shengmai San (Generate the Pulse Powder) and Huangbai (Phellodendri Cortex) to descend Yin Fire, or add a small amount of Fuzi (Aconiti Lateralis Radix Praeparata). (See Formula in Internal Injury chapter.)
For epigastric reflux caused by Yangming interior excess failing to be purged, use Liuyi Shunqi Tang (Six-One Smooth Qi Decoction) to purge. (See Formula in Cold Damage chapter.)
In cold damage transmission heat syndromes, if physicians mistakenly use hot herbs like Jiang (Zingiberis Rhizoma) and Gui (Cinnamomi Ramulus/Cortex) to assist the fire pathogen, leading to phlegm-fire clashing and causing Ke Ni (coughing against the reverse flow), treat with Huanglian Jiedu Tang (Coptis Decoction for Detoxification), Baihu Tang (White Tiger Decoction), and Zhu Li (Bambusae Succus). (See Formula in Cold Damage chapter.)
Epigastric reflux occurring during dysentery/diarrhea, or accompanying chest binding and jaundice in cold damage, are both difficult to treat.
Generally, for persistent epigastric reflux, roll Xurong (Boswelliae Resina) in paper, burn it, and inhale the smoke into the nose. Also, moxa-heat the Zhongwan (CV12), Danzhong (CV17), and Qimen (LR14) acupoints for immediate effect.
Ke Ni Wan (Cough-Reverse Pill): Stir-fry Huajiao (Zanthoxyli Pericarpium) lightly until sweat appears, remove the seeds, grind into powder, make pills with vinegar paste, size of Sophora japonica seeds. Take 15 pills each time, washed down with vinegar soup.
For cold damage with fever and epigastric reflux, use Huangjingzi (Vitex negundo fruit) in any quantity, stir-fry, decoct in water, and drink; the reflux will stop immediately.
Sniffing Method: For treating Ke Ni when oral medication fails.
Ingredients: Liu Huang (Sulfur), Xurong (Boswelliae Resina).
Preparation and Administration: Equal parts, grind into fine powder. Decoct in wine, and urgently have the patient sniff the fumes to stop the reflux.
Another Prescription:
Use Xionghuang (Realgar, 2 qian) and one cup of wine. Decoct until reduced to 0.7 cups. Urgently have the patient sniff the fumes to cure.
Moxa Treatment for Ke Ni:
Rugen (ST17) acupoint: Two points, located 1.6 cun directly below the nipple. In women, moxa-heat the depression in the fleshy part under the breast mound for seven moxa cones; the effect is miraculous.
Another Method: Moxa-heat Qihai (CV6) for three to five cones; this is also effective. Qihai is located 1.5 cun below the umbilicus.