能营运其水耳。水壅胃中。中气遏绝。气逆而作呃逆也。治法当拟用五苓散。理中汤。甚者四逆汤可耳。
宗印云。此章。与辨脉篇之医不知。而反饮冷水。令大汗出。水得寒气。冷必相搏。其人即KT 。大意
相同。程云。点出胃中寒冷字。是亦吴茱萸汤之治也。汪云。理中汤亦可借用之。
活人书云。橘皮干姜汤。羌活附子散。半夏生姜汤。退阴散。
伤寒哕而腹满。视其前后。知何部不利。利之即愈。（玉函。视。作问。成本。即。作则。）
〔锡〕伤寒至哕。非中土败绝。即胃中寒冷。然亦有里实不通。气不得下泄。反上逆而为哕者。玉机真
藏论曰。脉盛。皮热。腹胀。前后不通。闷瞀。此谓五实。身汗得后利。则实者活。今哕而腹满。前后不利。
五实中之二实也。实者泻之。前后。大小便也。视其前后二部之中。何部不利。利之则气得通。下泄而不上逆。
哕即愈矣。夫以至虚至寒之哕证。而亦有实者存焉。则凡系实热之证。而亦有虚者在矣。医者能审其寒热虚实。
而为之温凉补泻于其间。则人无夭札之患矣。〔汪〕常器之云。前部不利。猪苓汤。后部不利。调胃承气汤。
愚以须小承气汤利之。
案常氏原于活人。盖前部不利。五苓散。猪苓汤。后部不利。宜三承气。撰而用之。仲景不载主方。意
在于此耶。
Water fluids are able to circulate and operate normally. If water-dampness stagnates in the stomach, obstructing and cutting off the Qi of the Middle Jiao (Middle Burner), the rebellious upward movement of Qi will cause hiccups (E'ni). The treatment method should consider using Wuling San (Five-Ingredient Poria Decoction) or Lizhong Tang (Regulate the Middle Decoction); in severe cases, Sini Tang (Frigid Extremities Decoction) may be used.
Zong Yin commented: The content of this chapter is similar in general meaning to that described in the "Chapter on Differentiating Pulse Patterns," where a physician, unaware of the pathology, causes the patient to drink cold water, resulting in profuse sweating. When water encounters cold pathogenic factors, the coldness mutually contends, and the patient immediately develops dysphagia/choking (KT, likely a variant for 'ye' or similar symptom). Cheng Yunbo pointed out the phrase "coldness in the stomach," indicating that this is also within the therapeutic scope of Wuzhuyu Tang (Evodia Fruit Decoction). Wang Ang believed that Lizhong Tang could also be borrowed for use.
The *Ren Shu* (Book of Vitality) mentions: Jupi Ganjiang Tang (Tangerine Peel and Dried Ginger Decoction), Qianghuo Fuzi San (Notopterygium Root and Aconite Root Powder), Banxia Shengjiang Tang (Pinellia and Fresh Ginger Decoction), and Tuiyin San (Expel-Yin Powder).
In Shaoyang disease, if hiccups occur accompanied by abdominal fullness, one should examine the anterior (urinary) and posterior (anal) orifices to determine which part is obstructed; unblocking it will lead to recovery. (*Yuhan Jing* reads "ask" instead of "examine"; Cost Edition reads "ze" instead of "ji".)
[Zhao Sizhen's Commentary] When Shanghan (Cold Damage) progresses to hiccups, it is either due to the collapse of the Earth element (Spleen/Stomach Qi) or coldness in the stomach. However, there are also cases where internal excess obstruction prevents Qi from descending, causing it to rebel upward and induce hiccups. The *Suwen: Yuji Zhenzang Lun* states: Excessive pulse, hot skin, abdominal distension, obstruction of both urination and defecation, and chest stuffiness with dizziness constitute the "Five Excesses." If sweat appears and bowel/bladder functions resume, the excess condition can be saved. Currently, hiccups with abdominal fullness and obstruction of both excretions represent two of the five excess conditions. Excess conditions should be treated with purgation. The "anterior and posterior" refer to urine and stool. By examining which of the two pathways is obstructed and unblocking it, Qi circulation is restored, allowing downward discharge without upward rebellion, thus resolving hiccups. Even in cases of extreme deficiency-cold hiccups, excess patterns may exist; conversely, in heat-excess patterns, deficiency elements may be present. If physicians can accurately distinguish between cold/heat and deficiency/excess, applying warming/cooling and tonifying/reducing methods accordingly, patients will avoid premature death. [Wang Ang's Note] Chang Qizhi stated: For anterior obstruction (urinary), use Zhuling Tang (Polyporus Decoction); for posterior obstruction (intestinal), use Xiaochengqi Tang (Minor Order the Yang Decoction). I believe Xiao Chengqi Tang should be used for purgation.
Note: Chang's original reference was based on the *Ren Shu*. Presumably, for anterior obstruction, Wuling San or Zhuling Tang were used; for posterior obstruction, the three Chengqi Decoctions were appropriate. Compiling and utilizing these methods, while Zhang Zhongjing did not record a primary formula here, perhaps his intent lay precisely in this differentiation.