景岳曰∶呃逆症，谓其呃之连声，无不由于气逆。而呃之大要，亦惟三者而已。一曰寒
呃，二曰热呃，三曰虚脱之呃。寒呃者，头痛，恶寒，发热，脉紧，外寒可散。宜二陈汤倍
加生姜、陈皮主之。腹痛，口中和，手足冷，脉微，内寒可温，以理中汤、四逆汤加丁香、
砂仁主之，去其蔽抑之寒，而呃止矣。火呃者，口渴烦躁，三焦之火可清，以黄芩汤加半夏
，竹叶石膏汤加姜汁主之。潮热狂乱，腹满便硬，阳明实火可下，以三承气汤主之；火势未
甚者，只以安胃饮主之，去其冲上之火，火静则气自平而呃止矣。惟虚脱之呃，或以大病之
后，或以虚羸之极，或以虚损误攻而致呃逆者，当察其中虚，速宜补脾，以六君子汤、理中
汤加丁香、柿蒂、白豆蔻主之；察其阴虚，速宜补肾，以六味汤、八味汤加紫石英主之，归
气饮最妙；虚甚者，必须大剂补元煎加丁香、白豆蔻主之。然实呃者，不难治。惟元气败竭
者，乃最危之候也。更有伤寒之呃者，仍当于伤寒门阅之。张石顽曰∶平人饮热汤，及食椒姜
即呃者，此胃中有寒痰死血也。死血用韭汁童便下越鞠丸。虚人用理中汤加蓬术、桃仁
。痰加茯苓、半夏。呃逆皆是寒热错乱，二气相搏使然。故治亦多用寒热相兼之剂，观丁香柿
蒂散，可以知其义矣。
丁香柿蒂散
治呃逆通剂。
丁香 柿蒂
等分为末，每服二钱，开水送下。
安胃散（景岳）
治胃火上冲，呃逆不止。
陈皮 山楂 麦芽（各五分） 木通 泽泻 黄芩 石斛（各一钱）
水煎，食远服。如胃火热甚，加石膏
归气饮（景岳）
治气不顺，呃逆呕吐，或寒中脾肾等症。
熟地（三五钱） 茯苓 扁豆（各二钱） 干姜（炮） 丁香 陈皮（各一钱） 藿香（一钱五分） 炙草（八分）
水煎服。中气寒甚，加制附子。肝肾寒者，加吴茱萸、肉桂，或加当归。
羌活附子汤
治胃冷呃逆。
附子 羌活 茴香（各一钱） 干姜（四分） 木香（二分）
为末，入盐一撮，水煎。微温服。
丁香煮散（与《局方》不同） 治胃反呕逆，呃哕泄泻。
丁香（三十七粒） 建莲肉（去心，二七粒，上二味另煎，去滓） 生姜（七片） 黄秫米（半盏）
水一
碗半，煮熟。去姜药啜粥。
半夏生姜汤 （方见《金匮》） 治呃逆欲死。
刀豆子散
治病后呃逆不止。
刀豆子烧存性。滚水调服二钱，即止。
元红散(各见《种福堂》）
治呃逆不止。
荔枝七个，连皮烧存性，为末。百滚汤调服，立止。
Zhang Jingyue stated: The syndrome of hiccup (E Ni) is characterized by continuous hiccups, all of which are caused by the rebellion of Qi. The general principles of hiccup can be categorized into three types: one is Cold Hiccup, two is Heat Hiccup, and three is Hiccup due to Deficiency and Collapse.
For Cold Hiccup, symptoms include headache, aversion to cold, fever, and a tight pulse; this is external cold that can be dispersed. It is appropriate to use Er Chen Tang (Two-Cured Decoction) with increased amounts of Sheng Jiang (Fresh Ginger Rhizome) and Chen Pi (Aged Tangerine Peel) as the primary treatment. If there is abdominal pain, a bland taste in the mouth, cold hands and feet, and a faint pulse, this indicates internal cold that can be warmed. Use Li Zhong Tang (Regulate the Middle Decoction) or Si Ni Tang (Reverse the Extremities Decoction) added with Ding Xiang (Clove Bud) and Sha Ren (Amomum Fruit) as the primary treatment. Once the obstructing and suppressing cold is eliminated, the hiccup will cease.
For Fire Hiccup (Heat Hiccup), symptoms include thirst and irritability; the fire of the San Jiao (Triple Burner) can be cleared. Use Huang Qin Tang (Scutellaria Decoction) added with Ban Xia (Pinellia Tuber), or Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction) added with Jiang Zhi (Ginger Juice) as the primary treatment. If there is tidal fever, mania, abdominal fullness, and hard stool, this is excess fire of the Yangming channel that can be purged downward. Use the Three Cheng Qi Tangs (Three Draining-Down Decoctions) as the primary treatment; if the fire is not severe, only An Wei Yin (Stomach-Anchoring Drink) should be used. By removing the upward-rushing fire, the fire calms, Qi levels naturally, and the hiccup stops.
Only Hiccup due to Deficiency and Collapse, which may occur after a major illness, when the body is extremely emaciated, or when deficiency damage is mistakenly treated with purgatives, requires observing whether the middle Jiao is deficient. Quickly tonify the Spleen using Liu Jun Zi Tang (Six-Gentlemen Decoction) or Li Zhong Tang added with Ding Xiang, Shi Di (Persimmon Calyx), and Bai Dou Kou (White Cardamom Seed). Observe if there is Yin deficiency; quickly tonify the Kidney using Liu Wei Tang (Six-Ingredient Pill Decoction) or Ba Wei Tang (Eight-Ingredient Pill Decoction) added with Zi Shi Ying (Fluorite), or Gui Qi Yin (Qi-Restoring Drink) which is most excellent. For severe deficiency, large doses of Yuan Bu Jian (Primordial Tonifying Decoction) added with Ding Xiang and Bai Dou Kou must be used. However, Excess Hiccup is not difficult to treat. Only when the Primordial Qi is exhausted is it the most critical condition. Furthermore, hiccups caused by Shang Han (Cold Damage) should still be consulted in the Shang Han section.
Zhang Shiwang stated: When healthy individuals drink hot soup or eat pepper and ginger and immediately experience hiccups, this indicates cold phlegm and dead blood (stasis) in the Stomach. Dead blood is treated with Yue Ju Wan (Yue-Ju Pill) administered with Jiu Zhi (Leek Juice) and Tong Bian (Child's Urine). For deficient persons, Li Zhong Tang is used with Peng Zhu (Curcuma Rhizome) and Tao Ren (Peach Seed). If there is phlegm, add Fu Ling (Poria) and Ban Xia. Hiccups are always caused by the disorder of cold and heat, where Yin and Yang Qi contend. Therefore, treatment often uses formulas combining cold and heat properties; observing Ding Xiang Shi Di San (Clove and Persimmon Calyx Powder) reveals this principle.
Ding Xiang Shi Di San
A universal formula for treating hiccups.
Ding Xiang, Shi Di
Grind equal parts into powder. Take 2 qian per dose, washed down with boiling water.
An Wei San (Created by Zhang Jingyue)
Treats stomach fire rushing upward and persistent hiccups.
Chen Pi, Shan Zha, Mai Ya (5 fen each), Mu Tong, Ze Xie, Huang Qin, Shi Hu (1 qian each)
Decoct in water and take well after meals. If stomach fire is very intense, add Shi Gao (Gypsum Fibrosum).
Gui Qi Yin (Created by Zhang Jingyue)
Treats irregular Qi flow, hiccups and vomiting, or cold invading the Spleen and Kidneys.
Shu Di Huang (3-5 qian), Fu Ling, Bian Dou (2 qian each), Gan Jiang (processed), Ding Xiang, Chen Pi (1 qian each), Huo Xiang (1.5 qian), Zhi Gan Cao (0.8 qian)
Decoct in water and take. If middle Qi cold is severe, add Zhi Fu Zi (Prepared Aconite Lateral Root). If Liver and Kidney are cold, add Wu Zhu Yu (Evodia Fruit), Rou Gui (Cinnamon Bark), or Dang Gui (Angelica Sinensis).
Qiang Huo Fu Zi Tang
Treats cold Stomach hiccups.
Fu Zi, Qiang Huo, Hui Xiang (1 qian each), Gan Jiang (0.4 qian), Mu Xiang (0.2 qian)
Grind into powder, add a pinch of salt, decoct in water. Take warm.
Ding Xiang Zhu San (Different from *Ju Fang*)
Treats gastric reflux, vomiting, hiccups, and diarrhea.
Ding Xiang (37 grains), Jian Lian Rou (Lotus Seeds without hearts, 14 grains; decoct these two separately, remove dregs), Sheng Jiang (7 slices), Huang Shu Mi (Yellow Millet, half zhan)
Use 1.5 bowls of water, cook until done. Remove ginger and herbs, consume the porridge.
Ban Xia Sheng Jiang Tang (Formula seen in *Jin Gui Yao Lue*)
Treats severe hiccups causing distress akin to death.
Dao Dou Zi San
Treats persistent hiccups after illness.
Roast Dao Dou Zi (Cardiospermum Halicacabum Seed) until the outside is charred but the inside retains its nature. Mix with boiling water and take 2 qian; it stops immediately.
Yuan Hong San (Formulas seen in *Zhong Fu Tang*)
Treats persistent hiccups.
Seven Lychees, roasted with skin until the outside is charred but the inside retains its nature, ground into powder. Mix with freshly boiled water and take; it stops immediately.