（一名呃逆）
《内经》曰∶诸逆冲上，皆属于火。又云∶岁金太过咳逆，金郁之发咳逆，少阴二气
咳逆。《金匮》治咳逆，皆指肺金及火为病也。
《千金方》云∶咳逆上气者为病肺，脉数，数者是心火刑于肺金也。
《格致余论》云∶咳逆者，俗谓之呃逆是也。呃逆病即气逆，自脐下直上出于口，而作
声之名也。书曰∶火炎上。东垣谓火与元气不两立，又谓为元气之贼是也。古方悉以胃
弱言之，而不及火，以丁香、柿蒂，竹茹、陈皮等剂治之，未审孰为降火，孰为补虚。况人
之阴气根据胃为养，胃土伤损，则木气乘之，此则土败木贼也。阴为火所乘，不得内守，木挟
火直冲清道而上。言胃弱者，阴弱之也，虚之甚也。
咳逆乃干咳之渐进，无痰有声，连连不绝，其气自丹田而逆，上出于咽喉，如有所
击逆而然也。亦有咳声出咽，复有还声吸入咽内，此所以为咳逆证也。呃逆者，即下文云
入声是也。有咳、呃兼声击发，连续千万之声而不已者，服药不效即用吐法，吐出痰涎立已。
《难知》云∶夫咳逆证，《活人书》断为哕逆，其说似是而实非也。盖哕者，干呕也。
若有物直出，则为吐；呕物旋出，则为呕；无物出，则为哕。咳逆者，则水渍于肺而心痞，
或连续不已而气逆，或喜笑过多而气噎，或咽饮错喉而气抢，或急食干物而气塞，皆能作咳
逆之声，连续不绝，俗谓之呃忒是也。大抵咳逆者，不顺之义；呃忒者，差错之义。二者
皆气不得下，为火热托之而上，至咽喉噎而止也。人或以纸捻鼻，嚏之而止，或诈冤盗贼，
因恐而止，或鼻热闻食香调气而止，皆抑之骇之而使气下也。
若哕者，出声也。哕出其气，哕声尽，然后吸，吐哕门中详言矣。呃逆者，入声也。气
逆入喉，逆声尽，然后呼也。出入呼吸，其大不同。呕秽者，本于胃；呃逆者，本于肺，
何难辨哉！
(Coughing with upward rushing Qi, also known as hiccups)
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: All conditions involving upward rushing of Qi belong to Fire. It further states: When the metal phase of the annual运气 (Yunqi) is excessive, coughing with upward rushing Qi occurs; when the metal phase is constrained and erupts, coughing with upward rushing Qi occurs; when the Shaoyin (Lesser Yin) and Shaoyang (Lesser Yang) phases are disharmonious, coughing with upward rushing Qi occurs. The *Jingui Yaolue* (Essential Prescriptions from the Golden Cabinet) treats coughing with upward rushing Qi by addressing pathologies of Lung Metal and Fire.
The *Qianjin Fang* (Prescriptions Worth a Thousand Gold) states: Coughing with upward rushing Qi is a pathology of the Lung; the pulse is rapid (Shu), indicating that Heart Fire is punishing Lung Metal.
The *Gezhi Yulun* (Further Explorations into the Investigation of Things) states: Coughing with upward rushing Qi is what is commonly referred to as hiccups (E Ni). The pathology of hiccups is essentially rebellious Qi; it rises directly from below the navel, emerges from the mouth, and produces sound. Texts state: "Fire blazes upward." Li Dongyuan asserted that Fire and Yuan Qi (Original Qi) cannot coexist, and he referred to Fire as the thief of Yuan Qi. Ancient prescriptions attributed hiccups entirely to Stomach weakness, omitting mention of Fire, and treated it with formulas containing Dingxiang (Clove), Shidi (Persimmon Calyx), Zhuru (Bamboo Shavings), and Chenpi (Aged Tangerine Peel). This approach fails to discern which agents clear Heat/Fire and which tonify deficiency. Moreover, human Yin Qi relies on the Stomach for nourishment; if Stomach Earth is damaged, Liver Wood will invade it. This is described as Earth failing and Wood attacking. Yin Qi, being overwhelmed by Fire, cannot remain within and guard itself; Liver Wood carries Fire straight up the Clear Orifices. What is termed "Stomach weakness" is actually Yin deficiency, representing extreme deficiency.
Coughing with upward rushing Qi is a progressive stage of dry coughing; it presents with sound but no phlegm, continuous and unceasing. The Qi rebels from the Dantian, emerging upward through the throat, resembling the sensation of being struck and having Qi rush upward. In some cases, the sound of coughing exits the throat, followed immediately by an inhalation of sound back into the throat; this constitutes the syndrome of coughing with upward rushing Qi. Hiccups refer to the "entering sound" mentioned later in the text. Sometimes coughing and hiccups occur together with striking sounds, continuing for thousands of repetitions without cessation. If medication is ineffective, emesis (vomiting) should be induced; once phlegm and saliva are expelled, the condition resolves immediately.
The *Nanzhi* states: Regarding the syndrome of coughing with upward rushing Qi, the *Renhuang Shu* (Book of the Human Lord) diagnoses it as Yue Ni (dry heaving/hiccupping). This explanation seems plausible but is fundamentally incorrect. Yue refers to gan ou (dry heaving). If solid matter is expelled directly, it is vomiting (Tu); if fluid/vomit is ejected forcefully, it is retching (Ou); if nothing is expelled, it is Yue. Coughing with upward rushing Qi arises when water-dampness infiltrates the Lung causing chest fullness (Pi), or when continuous rebellion of Qi occurs, or when excessive laughter causes Qi obstruction (Ye), or when swallowing fluids leads to aspiration causing Qi snatching (Qiang), or when eating dry food hastily causes Qi blockage (Se). All these can produce the sound of coughing with upward rushing Qi, continuous and unceasing, commonly known as E Te. Generally, "coughing with upward rushing Qi" implies disorder/lack of smoothness; "E Te" implies error/disruption. Both involve Qi failing to descend, being pushed upward by Fire-Heat, reaching the throat where it stops due to obstruction. Some people stop it by stimulating the nasal cavity with paper twists to induce sneezing, or by feigning injustice or fear of thieves to induce fright, or by smelling food aromas to regulate Qi when there is nasal heat. These methods all work by suppressing and startling the Qi to force it downward.
If it is Yue, it involves an expelling sound. Yue expels Qi; after the sound of Yue ceases, inhalation follows. This is detailed in the chapter on Vomiting and Yue. Hiccups involve an entering sound. Qi rebels into the throat; after the sound of rebellion ceases, exhalation follows. The processes of exiting and entering respiration are vastly different. Vomiting foul matter originates in the Stomach; hiccups originate in the Lung. How difficult is it to distinguish them?