经义
胃为气逆，为哕，为恐。○病深者，其声哕。○若有七诊之病，其脉候亦败者死矣，必发哕噫。（《素问》）
帝曰∶人之哕者，何气使然？岐伯曰∶谷入于胃，胃气上注于肺。今有故寒气，与新谷气，俱还入胃，新
故相乱，真邪相攻，气并相逆，复出于胃，故为哕。○哕，以草刺鼻，令嚏而已；无息而疾迎引之，立已；大
惊之，亦可已。（《灵枢》）
哲言
干呕即哕之微，哕即干呕之甚。呕声轻小而短，哕声重大而长。呕为轻，哕为重。（《溯洄集》）
呃在中焦，谷气不运，其声短小，得食即发。呃在下焦，真气不足，其声长大，不食亦然。（《医方集解》）
哕者，呃逆也，非咳逆也。咳逆者，咳嗽之甚者也，非呃逆也。干呕者，无物之吐，即呕也，非哕也。
噫者，饱食之息，即嗳气也，非咳逆也。○呃由气逆，气逆于下，则直冲于上，无气则无呃，无阳亦无呃，此
病呃之源，所以必由于气也。欲得其象，
不见雨中之雷，水中之 乎？夫阳为阴蔽，所以为雷而轰轰不已者，此火为雷之本，火即气也。气为水覆，
所以为 而 不已者，此气为 之本，气即阳也。然病在气分，本非一端，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。寒呃可温可散，寒去则气自舒；热呃可降可清，火静而气自平；惟虚脱之
呃，则诚危矣。○凡呃虽由气逆，然有兼寒者，有兼热者，有因食滞而逆者，有因气滞而逆者，有因中气虚而
逆者，有因阴气竭而逆者，但察其因而治其气，自无不愈。若轻易之呃，或偶然之呃，气顺则已，本不必治。
惟屡呃为患及呃之甚者，必其气有大逆，或脾肾元气大有亏竭而然。然实呃不难治，而惟元气败竭者，乃最危
之候也。（张景岳）
《经》云∶木敷者，其叶发；病深者，其声哕。有此二者，毒药不及，短针无取。观之呃证，诚非细故，
如气逆，及阳明腑实而呃者，疏之通之则止，为患尚轻。倘病重，肾气衰败而呃者，大非所宜。胃呃短而促；
肾呃缓而迟，以此分别甚明。景岳云∶逆气象阳如雷，为阴蔽而轰轰然。足见治呃，又非可纯用热药耳。（《见闻录》）
《经》云，哕，以草刺鼻，令嚏而已；无息而疾迎引之，立已；大惊之，亦可已。详此三者，正治呃逆
之妙法。今人用纸捻刺鼻取嚏，则呃逆立止。或闭口鼻气，使之无息，亦立已。或作冤盗贼大惊之，亦可已。
此以哕为呃逆，正得《经》旨。谓之哕者，呃声之重也。谓之呃者，哕声之轻也。皆因病声之轻重而名之也。
呃声频密相连者为实，可治。若半时呃一声者为虚，难治。呃至八九声，气不回者；呃逆小便秘涩或腹满者；
脉见沉微散者；泻痢后呃逆；及伤寒结胸发黄而呃逆者，俱难治。（娄全善）
呃证总属乎火，即胃寒诸证，亦必火为寒遏而然。若纯由乎寒，必不相激而逆上矣。（余午亭）
呃逆，须辨寒热，寒热不辨，用药立毙。凡呃声有力而连续
者，虽有手足厥逆，而大便必坚，定属火热，下之则愈。若胃中无实火，何以激搏其声而冲逆乎？其呃声低怯，
而不能达于咽喉者，虽无厥逆，定属虚寒，苟非丁、附，必无生理。若胃中稍有阳气，何致音声馁怯而不振乎？
设误以柿蒂、芦根辈治之，仓扁不能复图矣。（张石顽）
呃逆，皆是寒热二气相搏使然，故治亦多用寒热相兼之剂，如丁香、柿蒂并投之类。试观平人冷呃，令其
思想则止，思则脾火气乘，而胃气和矣。（刘宗浓）
凡伤寒热病，阳明胃实，过期失下，清气不升，浊气不降，以致气不宣通而发呃者，仲景云∶哕而腹满，
视其前后，知何部不利，利之即愈。又有因饮食太多，填塞胸中，而气不得升降者；又有因痰闭于上，火起于
下，而气不能伸越者，此皆实证也，宜详辨而治之。（方星岩）
呃逆，气病也，气自脐下直冲，上出于口而作声之谓也。《经》曰∶诸逆冲上，皆属于火。古人悉以胃弱
言之，而不及火，惟以丁香、柿蒂等药治之，未审孰为降火，孰为补虚。人之阴气根据胃为养，胃土损伤，则木
来侮之。阴为火乘，不得内守，木挟所乘之火，直冲清道而上，言胃弱者，阴弱也。（《丹溪心法》）
呃逆，古无是名，《内经》本谓之哕，因其呃呃连声，故今以呃逆名之。然所因不一∶有胃中虚冷，阴凝
阳滞而为呃者，当用仲景橘皮汤、生姜半夏汤。有胃中虚阳上逆而为呃者，当用仲景橘皮竹茹汤。有中焦脾胃
虚寒，气逆而为呃者，宜理中汤加丁香，或温胃饮加丁香。有下焦虚寒，阳气竭而为呃者，正以元阳无力，易
为抑遏，不能畅达而然，宜景岳归气饮，或理阴煎加丁香。有食滞而呃者，宜加减二陈加山楂、乌药，或大和中
饮加干姜、木香之属。先生又谓∶肺气郁痹，及阳虚浊阴上逆，亦能为呃。每以开上焦之痹，及理阳驱阴，从
中调治，可补前人之不逮。丹溪谓呃逆属于肝肾之阴虚者，其气从脐下直冲，上出于口，
断续作声，必由相火炎上，挟其冲气，乃能逆上为呃，用大补阴丸，峻补真阴，承制相火。东垣又谓阴火上冲，
而吸气不得入，胃脉反逆，阴中伏阳即为呃，用滋肾丸以泻阴中伏热。二法均为至当，审证参用可也。（《临证指南》）
凡修炼家，无非欲其气血流通。惟华佗五禽图，差为不妄，有得呃逆证，作虎形立止，非其验耶？（《聊斋志异》）
脉候
火呃脉数有力，寒呃脉迟无力，痰呃脉滑，虚呃脉虚，瘀呃脉芤沉涩。（《证治汇补》）
选案
一人伤寒将愈，忽患呃逆，百药无效。偶用皂角末吹鼻，得嚏即止；少时又呃，又吹又止；凡百余次，渐
疏而愈。此与《灵枢》草刺鼻嚏之法恰合。（《医学纲目》）
一女因怒致呃，发则神昏。视其质实，意为膈上有痰，怒气抑郁，痰热相搏，气不得降，非吐不可。用参
芦煎饮，大吐顽痰而安。盖女子多郁，肝主怒，肺主气，怒则气上，肝木侮肺，是以呃逆神昏。痰去、气降、
火平，金安其位，胃得其和，因而疾愈。（丹溪）
一人呃逆连声，脉来有力，因相争肝木受邪。思金能克木，用铁二斤，烧红水淬，饮之即愈。（周慎斋）
一人患呃逆，诸药不效，或教食青果，其呃遂止。按∶青果味酸甘涩，本草言其开胃止呃者，亦下气之故
也。（方星岩）
附方
呃证服药法 用箸一双，十字架于碗上，麻线扎紧，将药倾入，令病患自持碗，于箸架之四空处，每空吸
药一口，圆转挨次吸去，不要换手，良验。
[Scriptural Interpretation]
Stomach Qi rebellion manifests as hiccups (anciently termed *Yue*), accompanied by a sense of fear. ○ When the disease is deep-seated, the sound produced is hiccups. ○ If the critical signs of the "Seven Diagnoses" are present and the pulse condition is also deteriorating, death is imminent, and one will inevitably develop hiccups and belching. (*Su Wen*)
The Yellow Emperor asked: Why do people develop hiccups? What Qi causes this? Qibo replied: Food enters the stomach, and Stomach Qi flows upward to the Lungs. Now, if there is lingering cold pathogen combined with the Qi of newly ingested food, both return to the stomach. The new and old Qi interfere with each other, Zheng Qi (Upright Qi) and Xie Qi (Pathogenic Qi) attack each other, Qi moves together in rebellion, and rushes out from the stomach again; thus, hiccups occur. ○ For hiccups, one can stimulate the nose with grass to induce sneezing, which stops it; or hold the breath and rapidly guide Qi downward, which cures it immediately; or suddenly startle the patient, which also cures it. (*Ling Shu*)
[Philosophical Remarks]
Dry retching is mild hiccupping, while hiccupping is severe dry retching. The sound of vomiting is light and short; the sound of hiccups is heavy and long. Vomiting is a mild condition; hiccups are a severe condition. (*Su Hui Ji*)
Hiccups located in the Middle Jiao result from impaired transport of Grain Qi; the sound is short and triggered by eating. Hiccups located in the Lower Jiao result from deficiency of True Qi; the sound is loud and occurs even without eating. (*Yi Fang Ji Jie*)
*Yue* refers to hiccups, not coughing with rebellious Qi. Coughing with rebellious Qi is severe coughing, not hiccups. Dry retching is vomiting without expulsion of matter, i.e., vomiting, not *Yue*. *Yi* refers to the exhalation after a full meal, i.e., belching, not coughing with rebellious Qi. ○ Hiccups arise from rebellious Qi. When Qi rebels below, it rushes directly upward. Without Qi, there are no hiccups; without Yang Qi, there are no hiccups. This is the root of hiccup disease, so it must be related to Qi. To understand its imagery, have you not seen lightning in the rain? When Yang Qi is obscured by Yin, it produces continuous thunderous sounds because Fire is the root of Lightning, and Fire is Qi. When Qi is covered by Water, it produces continuous wave sounds because Qi is the root of Waves, and Qi is Yang. However, diseases in the Qi aspect have various causes, but the main categories of hiccups are only three: First, Cold Hiccups; Second, Heat Hiccups; Third, Collapse-type Hiccups. Cold hiccups can be treated with warming or dispersing methods; when cold dissipates, Qi naturally relaxes. Heat hiccups can be treated with descending or clearing methods; when Fire calms, Qi naturally levels out. Only collapse-type hiccups are truly critical. ○ Although all hiccups stem from Qi rebellion, some involve concurrent Cold, some concurrent Heat, some due to Food Stagnation causing rebellion, some due to Qi Stagnation causing rebellion, some due to Middle Qi Deficiency causing rebellion, and some due to Yin Qi Exhaustion causing rebellion. By examining the cause and regulating Qi, there is no case that cannot be cured. Mild or occasional hiccups resolve when Qi becomes smooth and require no treatment. Only frequent or severe hiccups indicate major Qi rebellion or significant depletion of Spleen and Kidney Yuan Qi (Primal Qi). While Excess-type hiccups are not difficult to treat, those caused by exhaustion of Yuan Qi are the most critical prognosis. (Zhang Jingyue)
The Classics state: "When tree branches and leaves are luxuriant, the foliage falls easily; when disease is deep, the voice manifests as hiccups." In these two cases, drugs are ineffective, and short needles are useless. Observing hiccup syndrome, it is indeed no trivial matter. For hiccups due to Qi rebellion or Yangming Fu-Excess, unblocking and purging will stop them, posing less danger. However, if the disease is severe and hiccups result from Kidney Qi failure, conventional treatments are inappropriate. Stomach-origin hiccups are short and rapid; Kidney-origin hiccups are slow and delayed, making differentiation clear. Zhang Jingyue stated: Rebellious Qi resembles Yang like lightning, rumbling continuously when obscured by Yin. This shows that treating hiccups cannot rely solely on hot herbs. (*Jian Wen Lu*)
The Classics state: "For hiccups, stimulating the nose with grass to induce sneezing stops it; holding breath and guiding Qi down cures it instantly; startling the patient also cures it." These three methods are excellent techniques for treating hiccups. Today, people use paper twists to stimulate the nose for sneezing, stopping hiccups instantly. Or closing mouth and nose to hold breath also works instantly. Or pretending to be an enemy/thief to startle them also works. Calling *Yue* hiccups aligns with the Classic's intent. Calling it *Yue* implies heavy sound; calling it *E* (hiccup) implies light sound. Names are derived from the severity of the sound. Frequent, connected hiccup sounds indicate Excess, which is treatable. Hiccups occurring once every half hour indicate Deficiency, which is hard to treat. Hiccups occurring 8-9 times with non-returning Qi; hiccups with constipation/abdominal distension; pulse appearing deep, faint, or scattered; hiccups after diarrhea/dysentery; and hiccups in Shanghan with chest binding and jaundice—all are difficult to treat. (Lou Quanshan)
Hiccup syndromes generally belong to Fire. Even Stomach Cold syndromes occur because Fire is constrained by Cold. If purely Cold, it would not agitate and rebel upward. (Yu Wuting)
Hiccups must be differentiated as Cold or Heat; failing to distinguish leads to immediate death upon medication. If hiccup sounds are forceful and continuous, even with cold limbs, if stool is hard, it definitely belongs to Heat/Fire; purgatives will cure it. How else could lack of real Fire in the Stomach agitate the sound and cause rebellion? If hiccup sounds are low and timid, unable to reach the throat, even without cold limbs, it definitely belongs to Cold/Deficiency; without Dingxiang (Clove) and Fuzi (Aconite), there is no hope. If there were any Yang Qi in the Stomach, how could the voice be weak and listless? Mistakenly using Shidi (Persimmon Calyx) or Lugeng (Reed Rhizome) would make even Cang Gong and Bian Que unable to save the patient. (Zhang Shiwan)
Hiccups result from the struggle between Cold and Heat Qi; thus, treatments often combine cold and heat herbs, such as using Dingxiang and Shidi together. Observe ordinary people with cold hiccups: asking them to think stops it, because thinking strengthens Spleen Fire Qi, harmonizing Stomach Qi. (Liu Zongnong)
In all Shanghan febrile diseases, Yangming Stomach Excess, if purgatives are missed past the appropriate time, Clear Qi fails to ascend and Turbid Qi fails to descend, leading to blocked Qi transmission and hiccups. Zhongjing said: "Hiccups with abdominal fullness—examine the anterior and posterior orifices, determine which is obstructed, and unblock it to cure." Also, hiccups due to excessive food filling the chest, blocking Qi ascent/descent; or phlegm blocking above and Fire rising below, preventing Qi extension—are all Excess patterns requiring careful differentiation and treatment. (Fang Xingyan)
Hiccups are a Qi disease, where Qi rushes straight up from below the navel, exits the mouth, and makes sound. The Classics say: "All rebellious Qi rushing upward belongs to Fire." Ancients attributed it all to Stomach Weakness, ignoring Fire, treating only with Dingxiang and Shidi, without clarifying which lowers Fire and which tonifies Deficiency. Human Yin Qi relies on Stomach Earth for nourishment; if Stomach Earth is damaged, Liver Wood attacks it. Yin Qi is attacked by Fire and cannot remain internal; Liver Wood carries the attacking Fire, rushing up the clear pathways. Saying "Stomach Weakness" actually means Yin Deficiency. (*Dan Xi Xin Fa*)
Hiccups had no ancient name; the *Neijing* called it *Yue*. Because it makes continuous "eh-eh" sounds, it is now named E-Ni (Hiccups). Causes vary: Stomach Empty-Cold with Yin stagnation and Yang blockage requires Zhongjing's Chuanpi Tang or Shengjiang Banxia Tang. Stomach Empty-Yang rebelling upward requires Zhongjing's Chuanpi Zhuru Tang. Middle Jiao Spleen-Stomach Empty-Cold with Qi rebellion requires Lizhong Tang plus Dingxiang, or Wenwei Yin plus Dingxiang. Lower Jiao Empty-Cold with Yang exhaustion requires Jingyue's Guiqi Yin or Liyin Jian plus Dingxiang. Food stagnation hiccups require Jiawei Erchen Tang plus Shan Zha and Wu Yao, or Da Hezhong Yin plus Ganjiang and Muxiang. The Master also stated: Lung Qi depression/bi obstruction and Yang Deficiency with Turbid Yin rebelling can also cause hiccups. Treating by opening Upper Jiao bi obstruction and regulating Yang to drive out Yin, treating from the center, supplements previous methods. Danxi stated hiccups due to Liver-Kidney Yin Deficiency involve Qi rushing from below navel to mouth, intermittent sound, caused by Minister Fire flaring up carrying Chong Qi; treat with Dabu Yin Wan to strongly tonify True Yin and control Minister Fire. Dongyuan stated Yin Fire rushing up prevents inhalation, Stomach Meridian rebels, latent Yang within Yin causes hiccups; treat with Zishen Wan to drain latent heat in Yin. Both methods are appropriate; use based on syndrome differentiation. (*Lin Zheng Zhi Nan*)
Cultivators seek free flow of Qi and Blood. Huatuo's Five Animal Frolics is reliable; imitating the Tiger form stops hiccups instantly, proving its efficacy. (*Liao Zhai Zhi Yi*)
[Pulse Diagnosis]
Fire hiccups: rapid, forceful pulse. Cold hiccups: slow, weak pulse. Phlegm hiccups: slippery pulse. Deficiency hiccups: deficient pulse. Blood stasis hiccups: knotted, deep, choppy pulse. (*Zheng Zhi Hui Bu*)
[Selected Cases]
A patient recovering from Shanghan suddenly developed hiccups; hundreds of medicines failed. Accidentally blowing Sophora Flower powder into the nose induced sneezing, stopping hiccups; later recurrence stopped again with same method; repeated over 100 times, gradually thinning until cured. This matches the *Ling Shu* method of grass-stimulated sneezing. (*Yi Xue Gang Mu*)
A woman developed hiccups due to anger, losing consciousness during episodes. Her constitution was solid; phlegm was suspected in the Diaphragm. Anger and depression caused Phlegm-Heat struggle, blocking Qi descent; emesis was necessary. Decocted Ren Shen Lu (Ginseng Stalk) for drinking; profuse expulsion of tough phlegm brought relief. Women often have stagnation; Liver governs anger, Lungs govern Qi. Anger causes Qi to rise; Liver Wood insults Lung Metal, causing hiccups and unconsciousness. With phlegm gone, Qi descended, Fire calmed, Lung Metal settled, Stomach harmonized, disease cured. (Zhu Danxi)
A man had continuous hiccups with a forceful pulse, due to Liver Wood injury from conflict. Thinking Metal controls Wood, he used 2 jin of iron, heated red and quenched in water; drinking the solution cured him. (Zhou Shenzhai)
A man suffered hiccups unresponsive to medicines. Someone advised eating Qing Guo (Chinese Olive); hiccups stopped. Note: Qing Guo is sour, sweet, and astringent; Materia Medica states it opens appetite and stops hiccups due to its Qi-descending property. (Fang Xingyan)
[Appendix Formula]
Method for taking medicine for hiccups: Place two chopsticks crosswise on a bowl, tie tightly with hemp thread. Pour medicine in. Let the patient hold the bowl themselves. Inhale medicine through the four gaps formed by the chopsticks, one sip per gap, rotating sequentially. Do not switch hands. Highly effective.