呃逆者。声自下逆上。俗名呃忒是也。不拘伤寒杂症皆有。所因不一。治法各宜随症施治。
邵评∶呃逆一症。有虚实寒热之因。中焦下焦之别。是气升上逆之病。外感内伤。
均有此症。当辨因分症施治。
阳虚阴逆 有因寒凉太过。胃中虚冷。浊阴上逆。以致呃逆呕吐。或腹痛下利。两
脉微弱。治宜理阳驱阴。人参、附子、丁香、柿蒂、茯苓、干姜、吴萸主之。若兼吐黄绿
苦水。胃虚阴浊上干也。去附子。加代赭、椒梅。
邵评∶寒凉伤中。胃阳虚弱。浊阴上逆。气不下降。而呃逆呕吐也。当用温胃通阳。以泄浊阴。
肝木犯胃 气逆呃忒。脉小舌白。厥逆寒战。此肝气犯胃。用镇肝安胃法。人参、半
夏、茯苓、干姜、丁香、柿蒂、代赭石、炒川椒、炒粳米。
邵评∶中虚胃弱。肝木乘虚上逆。胃气不降而呃忒。胃阳虚而有寒。故舌白寒战。
肝气上升则厥也。宜以温胃泄肝镇逆为治。
肺郁气逆 面冷频呃。咽中不爽。此肺气 郁。病在上焦。宜开气分之痹。俾清阳
得舒。胸次方能开达。姜汁炙枇杷叶、川贝母、川郁金、香豉、桔梗、通草、竹茹之类主之。
邵评∶气郁于肺。不得下降。清阳痹阻而频呃。治以宣肺开气。肺气宣行。则诸气
流通而下降。呃自止矣。宜以轻清开提肺气。宣泄上焦为治。
阴饮上逆 攻伐太过。胃中阳虚。饮浊上逆为呃。舌苔白润。治宜温通。半夏、茯苓、
丁香、柿蒂、吴萸、姜汁之类。如生姜半夏汤、丁香柿蒂汤、茱萸理中汤。皆可选用。
邵评∶攻伐多是寒凉。以伤中阳。阳虚。则伏饮上逆。而作呃忒也。舌白润。寒饮苔
也。宜温胃阳以散寒饮为治。
胃虚有热 如呃逆而渴。舌苔微黄。此胃虚有火。虚火上逆而呃也。宜橘皮竹茹
汤。或温胆汤。去枳实。加姜汁炙枇杷叶。如胃中有痰饮。脉沉而弦。宜橘皮半夏生姜汤。
邵评∶胃虚。内有伏火。故口渴而舌苔微黄。虚火上逆。胃气不得下降而作呃也。
治以清降胃火一法。此与上条同是胃病。有寒热之不同。用药有温清之别。上条阳虚欲逆。故用温通。此
条胃虚有火。故宜清降。当合参之。如痰饮脉沉而弦。弦为饮而沉为在里也。用涤饮和胃之法。
肝火上逆 如呃逆。舌黄而渴。左脉弦数。此肝火上逆为呃也。宜川连、吴萸、黑栀、
代赭、枇杷叶、半夏、茯苓之类降之。
邵评∶肝火上升。胃逆不降而呃。舌黄而渴。肝火灼胃也。左脉弦。肝之本象。数则
肝火乘胃而逆也。治以平肝清火。和胃降逆之法。
中焦虚冷 如脾胃虚寒。寒气格逆而呃者。脉来濡缓。右关软大。舌嫩不渴。宜理中汤。加丁香温之。
邵评∶中虚寒气上逆。格拒于中。胃气不降而呃逆也。故用温中扶阳之法。
下焦阳虚 凡呃逆起自下焦。浑身振动者。乃属下焦虚寒。阳气竭而呃也。宜理
阴煎。加丁香、五味、胡桃肉以纳之。或都气饮。加熟附、胡桃、丁香以纳之。不已则死。
邵评∶呃逆自下焦而来。肝肾大虚。气不摄纳。由丹田而冲逆。故浑身振动。此元
海无根。虚脱之候。宜摄纳下焦肝肾治之。
阴火冲逆 如六脉细数。面赤颧红而呃者。阴火上逆也。都气饮。加胡桃肉、柿蒂以纳之。
邵评∶阴火升逆。当用滋肾丸或大补阴丸壮肾水而滋阴火。
格阳呃逆 若高年命门火衰。虚阳上逆而呃者。必面赤戴阳。足冷下利。六脉微
弱。宜熟附都气饮。加人参、丁香、胡桃肉、紫石英之类。纳以镇之。（以上三症五味须重用）
邵评∶命火衰微。阴寒内伏。阻格虚阳。上逆而作呃。阴盛格阳也。宜用回阳镇纳之法。
胃阴虚馁 有发汗太过。胃中津液枯涸。以致呃逆呕吐。宜金水六君煎。加北参、
麦冬、丁香、柿蒂。和中以生津液。汗出不已。加五味。
邵评∶汗多而胃阴受伤。津液亏耗。胃气上逆而呃者。宜养阴生津以和胃。若汗
多。则津液益虚。用五味以敛之。
中脘食滞 凡呃逆脘痛。胸中胀满者。食滞为呃也。宜二陈加楂肉、浓朴、枳实、麦
芽、木香汁、莱菔子之类。疏之和之。
邵评∶食滞脘中。气机阻遏。升不得降而为呃者。此胃实也。故用运中消滞开气之剂。
幽门浊逆 伤寒表解之后。大小便不通。呃逆作呕。此糟粕未化。与邪结于幽门。
幽门之气不化。则州都闭。传道失。二便不行。恶气上冲于胃。故作呃逆也。宜利幽
门。利幽汤主之。若大便秘结。少腹硬痛而作呃逆者。承气汤主之。（此条出伤寒第一书）
邵评∶表解后津液受劫。邪浊内结肠腑。二便不通。气上冲至胃。则呃逆作呕。所
谓下既不通。必反于上也。幽门在下焦。邪结于此则便闭。故必通其幽门。大便
通行。则浊热下出。而呃逆自止矣。此亦实呃也。若便闭硬痛。此肠胃有燥屎而呃逆也。用承气汤攻下之。
Erbì (hiccup) refers to the sound rushing upward from below, commonly known as "hiccup." This symptom can occur in both Shanghan (Cold Damage) diseases and miscellaneous disorders. The causes vary, and treatment methods should be applied flexibly according to specific symptoms.
Shao's Commentary: Erbì is a condition with etiologies of deficiency (Xu), excess (Shi), cold (Han), and heat (Re), involving distinctions between the Middle Jiao and Lower Jiao. It is a disease characterized by the rebellious ascent of Qi. Both external contraction and internal injury conditions may present this symptom; one must differentiate the cause and treat accordingly.
Yang Deficiency with Yin Rebelliousness: Some cases result from excessive use of cold-cooling agents, leading to deficiency-cold in the Stomach, causing turbid Yin to rebel upward, resulting in erbì and vomiting, or accompanied by abdominal pain and diarrhea, with faint pulses. Treatment should focus on tonifying Yang and dispelling Yin. The primary herbs are Renshen (Ginseng Radix et Rhizoma), Fuzi (Aconiti Lateralis Radix Praeparata), Dingxiang (Caryophylli Flos), Shidi (Kaki Calyx), Fuling (Poria), Ganjiang (Zingiberis Rhizoma), and Wuyu (Evodiae Fructus). If accompanied by vomiting of yellow-green bitter fluid, it indicates Stomach deficiency with turbid Yin attacking upward; remove Fuzi and add Zheshi (Hematitum), Chuanjiao (Sichuan Pepper), and Wu Mei (Mume Fructus).
Shao's Commentary: Cold-cooling agents damage the Middle Jiao, weakening Stomach Yang, causing turbid Yin to rebel upward and Qi to fail to descend, leading to erbì and vomiting. One should use warming and unblocking methods for Stomach Yang to vent turbid Yin.
Liver Wood Invading Stomach: Qi rebellion causes erbì, with small pulses and white tongue coating, cold limbs, and chills. This is Liver Qi invading the Stomach. Use the method to calm the Liver and harmonize the Stomach. Herbs include Renshen, Banxia (Pinelliae Rhizoma), Fuling, Ganjiang, Dingxiang, Shidi, Daizheshi (Hematitum), Chao Chuanjiao (Stir-fried Sichuan Pepper), and Chao Jingmi (Stir-fried Rice Grain).
Shao's Commentary: Middle Jiao deficiency and weak Stomach Qi allow Liver Wood to invade upward due to weakness, causing Stomach Qi to fail to descend and resulting in erbì. Stomach Yang deficiency with cold leads to white tongue coating and chills. Ascending Liver Qi causes cold limbs. Treatment should warm the Stomach, vent the Liver, and settle rebellion.
Lung Depression with Qi Rebellion: Cold face, frequent erbì, and discomfort in the throat indicate Lung Qi depression, located in the Upper Jiao. One should open the obstruction in the Qi aspect so that Clear Yang can expand, allowing the chest to become open and accessible. Primary herbs include Jiangzhi Pipaye (Loquat Leaf processed with Ginger Juice), Chuanbeimu (Fritillariae Cirrhosae Bulbus), Chuan Yujin (Curcumae Radix), Xiangchi (Fermented Soybean), Jiegeng (Platycodonis Radix), Tongcao (Tetrapanacis Medulla), and Zhuru (Bambusae Caulis in Taeniam).
Shao's Commentary: Qi depressed in the Lung fails to descend, obstructing Clear Yang and causing frequent erbì. Treatment should diffuse Lung Qi and open the Qi mechanism. Once Lung Qi diffuses, all Qi flows and descends, stopping erbì. Light and clear herbs should be used to lift Lung Qi and vent the Upper Jiao.
Yin Fluid Retention with Upward Rebellion: Excessive purgation damages Stomach Yang, causing turbid fluids to rebel upward and trigger erbì. The tongue coating is white and moist. Treatment should warm and unblock. Herbs include Banxia, Fuling, Dingxiang, Shidi, Wuyu, and Jiangzhi. Formulas such as Shengjiang Banxia Tang (Fresh Ginger and Pinellia Decoction), Dingxiang Shidi Tang (Clove and Kaki Calyx Decoction), and Zhuyu Lizhong Tang (Evodia and Middle-Jiao Regulating Decoction) may be selected.
Shao's Commentary: Purgatives are often cold-cooling, damaging Middle Yang. Yang deficiency allows latent fluid retention to rebel upward, causing erbì. White and moist tongue coating indicates cold-fluid retention. Treatment should warm Stomach Yang to disperse cold fluids.
Stomach Deficiency with Heat: If erbì is accompanied by thirst and slightly yellow tongue coating, it indicates Stomach deficiency with fire, where deficient fire rebels upward causing erbì. Ju Pi Zhu Ru Tang (Tangerine Peel and Bamboo Shaving Decoction) or Wendan Tang (Gallbladder-Warming Decoction) removing Zhishi (Aurantii Fructus Immaturus) and adding Jiangzhi Pipaye is suitable. If there is phlegm-fluid retention in the Stomach with deep and wiry pulses, Ju Pi Banxia Shengjiang Tang (Tangerine Peel, Pinellia, and Fresh Ginger Decoction) is indicated.
Shao's Commentary: Stomach deficiency with latent fire causes thirst and slightly yellow coating. Deficient fire rebels upward, preventing Stomach Qi from descending, causing erbì. Treatment should clear and descend Stomach fire. Like the previous case, this is a Stomach disorder but differs in cold vs. heat, requiring warming vs. clearing methods. The previous case involved Yang deficiency and rebellion, treated with warming and unblocking; this case involves Stomach deficiency with fire, treated with clearing and descending. Consider them together. For phlegm-fluid retention with deep and wiry pulses (wiry indicates fluid, deep indicates interior), use methods to eliminate fluid and harmonize the Stomach.
Liver Fire Rebelling Upward: If erbì occurs with yellow tongue coating, thirst, and a wiry-rapid left pulse, it is Liver Fire rebelling upward causing erbì. Use Huanglian (Coptidis Rhizoma), Wuyu, Hei Zhizi (Gardeniae Fructus carbonized), Daizheshi, Pipaye, Banxia, and Fuling to descend the Qi.
Shao's Commentary: Ascending Liver Fire causes Stomach Qi to rebel and not descend, leading to erbì. Yellow coating and thirst indicate Liver Fire scorching the Stomach. Left wiry pulse reflects the Liver's nature; rapidity indicates Liver Fire attacking the Stomach. Treatment should soothe the Liver, clear fire, harmonize the Stomach, and descend rebellion.
Middle Jiao Deficiency-Cold: If Spleen-Stomach deficiency-cold causes cold Qi to block and rebel upward leading to erbì, with soggy-slow pulses, a soft-large right Guan pulse, tender tongue without thirst, Lizhong Tang (Middle-Jiao Regulating Decoction) added with Dingxiang is suitable.
Shao's Commentary: Middle Jiao deficiency with ascending cold Qi blocks in the middle, preventing Stomach Qi from descending, causing erbì. Therefore, warming the Middle and supporting Yang is used.
Lower Jiao Yang Deficiency: When erbì originates from the Lower Jiao accompanied by whole-body tremors, it belongs to Lower Jiao deficiency-cold and Yang exhaustion causing erbì. Liyin Jian (Yin-Regulating Decoction) added with Dingxiang, Wuwei Zi (Schisandrae Fructus), and Hutaorou (Walnut Kernel) to grasp Qi is suitable. Or Duqi Yin (Duqi Decoction) added with Shu Fuzi (Prepared Aconite), Walnut, and Dingxiang to grasp Qi. If ineffective, death ensues.
Shao's Commentary: Erbì originating from the Lower Jiao indicates severe deficiency of Liver and Kidney, failure of Qi to grasp, and rebellion from the Dantian, causing whole-body tremors. This is a sign of rootless Yuan Sea and collapse. Treatment should grasp and anchor the Lower Jiao Liver and Kidney.
Yin Fire Rushing Upward: If six pulses are fine and rapid, with red face and malar flush accompanied by erbì, it is Yin Fire rebelling upward. Duqi Yin added with Hutaorou and Shidi to grasp Qi is suitable.
Shao's Commentary: Rising Yin Fire requires Zishui Wan (Kidney-Nourishing Pill) or Dabu Yin Wan (Great Tonification of Yin Pill) to strengthen Kidney Water and nourish/subdue Yin Fire.
Ge Yang Erbì (Repelling Yang Hiccup): In elderly patients with Mingmen Fire decline, if deficient Yang rebels upward causing erbì, there will be facial redness (Dai Yang), cold feet, diarrhea, and faint six pulses. Shu Fu Duqi Yin (Prepared Aconite and Duqi Decoction) added with Renshen, Dingxiang, Hutaorou, and Zhi Shiyin (Pyrosericitis) to grasp and anchor is suitable. (Wuwei Zi should be heavily dosed in these three conditions above.)
Shao's Commentary: Declining Mingming Fire allows Yin Cold to lie hidden internally, blocking and repelling deficient Yang upward, causing erbì. This is Yin excess repelling Yang. Treatment should restore Yang and anchor/grasp.
Stomach Yin Deficiency and Emaciation: Excessive sweating dries up Stomach fluids, causing erbì and vomiting. Jinshui Liu Jun Jian (Metal-Water Six-Gentlemen Decoction) added with Beishen (Northern Ginseng/American Ginseng), Maidong (Ophiopogonis Radix), Dingxiang, and Shidi to harmonize the Middle and generate fluids is suitable. If sweating persists, add Wuwei Zi.
Shao's Commentary: Excessive sweating damages Stomach Yin and depletes fluids, causing Stomach Qi to rebel upward and erbì. Nourishing Yin and generating fluids to harmonize the Stomach is appropriate. If sweating is heavy, further depleting fluids, Wuwei Zi should be used to astringe.
Zhongwan Food Stagnation: Erbì accompanied by epigastric pain and chest fullness is caused by food stagnation. Erchen Tang (Two-Aged Decoction) added with Zharon (Crataegi Fructus), Houpo (Magnoliae Officinalis Cortex), Zhishi, Maiya (Hordei Fructus Germinatus), Muxiang juice, and Laifuzi (Radish Seed) to diffuse and harmonize is suitable.
Shao's Commentary: Food stagnating in the Zhongwan obstructs Qi mechanism, preventing descent and causing erbì. This is an excess pattern of the Stomach. Therefore, formulas that move the Middle, resolve stagnation, and open Qi are used.
Youmen Turbid Rebellion: After the exterior syndrome of Shanghan resolves, if urination and defecation are blocked, accompanied by erbì and vomiting, it is because undigested waste and pathogenic factors are knotted at Youmen (pylorus). Failure of Youmen Qi to transform closes the Zhou Du (lower jiao hub), disrupts transmission, stops urination and defecation, and foul Qi rushes upward to the Stomach, causing erbì. Unblocking Youmen with Liyou Tang (Unblocking Youmen Decoction) is indicated. If constipation with hard lower abdominal pain and erbì occurs, Chengqi Tang (Chengqi Decoction) is indicated. (This clause originates from the first book of Shanghan.)
Shao's Commentary: After resolving the exterior, fluids are depleted, and turbid pathogens knot in the Intestines, blocking urination and defecation. Qi rushes upward to the Stomach, causing erbì and vomiting. This is "when the lower does not unblock, it must rebound upward." Youmen is in the Lower Jiao; pathogen knotting here causes constipation, so unblocking Youmen is essential. Once stool passes, turbid heat exits downward, and erbì stops. This is also an excess erbì. If stool is closed, hard, and painful, it is erbì due to dry feces in the intestines; Chengqi Tang should be used to purge.