参附汤(补三七) 五味子汤(补五七 喘渴) 十全大补汤(补二十 虚喘) 蜜酥煎(补
六五) 百合汤(和一三五 浮肿作喘) 人参胡桃汤(补五九 喘不得卧) 苏子煎(和一四一
润肺喘) 定喘汤(和一三三 风寒喘) 人参定喘汤(和一三四 寒邪咳喘) 黄栝蒌丸(和
百十八 痰喘) 神秘汤(和一三八 水气喘) 苏陈九宝汤(散八五 哮喘) 泻白散(寒四二
肺火) 双玉散(寒七一 火喘) 安眠散(固七 喘不止) 葶苈大枣泻肺汤(和百四十 浮
肿喘)
《口问篇帝》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
气与新谷气俱还入于胃,新故相乱,真邪相攻,气并相逆,复出于胃,故为哕。肺主为哕,
取手太阴,足少阴。
《宣明五气篇》曰∶胃为气逆,为哕为恐。
《杂病篇》曰∶哕,以草刺鼻,嚏,嚏而已;无息而疾迎引之,立已;大惊之,亦可已。
《至真要大论》曰∶阳明之复,呕吐咳哕。太阳之复,唾出清水,及为哕噫。诸逆冲上,皆属于火。
《宝命全角论》曰∶病深者,其声哕。
《邪气脏腑病形篇》曰∶心脉小甚为善哕。
《三部九候论》曰∶若有七诊之病,其脉候亦败者死矣,必发哕噫。
呃逆一证,古无是名,其在《内经》本谓之哕,因其呃呃连声,故今以呃逆名之,于义
亦妥。观《内经》治哕之法,以草刺鼻,嚏,及气息迎引、大惊之类,是皆治呃之法,此
哕本呃逆,无待辨也。自孙真人云∶遍寻方论无此名,遂以咳逆为哕,因致后世讹传,乃以
咳逆、干呕、噫气之类互相肴乱,自唐迄今矣,此名之不可不察,亦不可不正也。
一、咳逆之名,原出《内经》,本以咳嗽气逆者为言。如《气交变大论》曰∶岁金太过
,甚则喘咳逆气。此因喘咳以致气逆,故云咳逆气也。又曰∶咳逆甚而血溢。正以咳逆不止
,而血随气溢,则病之常也,未闻以呃逆而见血者也。即如《六元正纪大论》云∶金郁之发
,民病咳逆者,亦是此意,此咳逆之非呃逆亦甚明矣。而今后世诸公,乃悉以哕为咳逆,岂
皆未之详察耶?及观丹溪之言,在《纂要》则曰∶孙真人误以哕为咳逆。是谓哕非咳逆也。
在《心法·附录》则曰∶咳逆为病,古谓之哕,近谓之呃。此又谓哕即咳逆也。在呕吐门则
又曰∶有声有物谓之呕吐,有声无物谓之哕。此又以干呕为哕也。前后不一,何其自谬若此
。再如海藏、河间诸公,有以哕为干呕者,有以咳逆为噫者,总皆谬矣。盖呕即吐之类,但
吐而无物者曰呕,呕而有物者曰吐,腹胀嗳气者曰噫,逆气自下而上者亦曰噫,此四者之辨
自有正名,顾可纷纷若是乎?兹余析而判之曰∶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。后人但以此为鉴,则异说之疑,可尽释矣。
一、呃逆证,有伤寒之呃逆,有杂证之呃逆。其在古人则悉以虚寒为言,惟丹溪引《内
经》之言曰∶诸逆冲上,皆属于火,病患见此,似为死证,然亦有实者,不可不知。余向见
此说,疑其与古人相左,不以为然,盖亦谓此证必属虚寒,何有实热,兹及晚年历验,始有
定见,乃知丹溪此言为不诬也。虽其中寒热虚实亦有不同,然致呃之由,总由气逆,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,而火即
气也。气为水覆,所以为 而 不已者,此气为 之本,而气即阳也。然病在
气分,非本一端,而呃之大要,亦惟三者而已,则一曰寒呃,二曰热呃,三曰虚脱之呃,寒
呃可温可散,寒去则气自舒也。热呃可降可清,火静而气自平也。惟虚脱之呃,则诚危殆之
证,其或免者,亦万幸矣。凡诸治法,当辨如下。
Shenfu Tang (Cinnamon Twig and Aconite Decoction) [indicated for tonification at age 37] Wuzi Wan (Five-Seed Decoction) [indicated for tonification at age 49, treating panting and thirst] Shiquan Dabu Tang (Complete Great Tonifying Decoction) [indicated for tonification at age 20, treating deficiency-type panting] Misu Jian (Honey and Butter Decoction) [indicated for tonification at age 65] Baihe Tang (Lily Decoction) [indicated for harmonization at ages 13, 35, and others, treating edema with panting] Renshen Hetao Tang (Ginseng and Walnut Decoction) [indicated for tonification at age 59, treating panting preventing supine position] Suzi Jian (Perilla Seed Decoction) [indicated for harmonization at age 41, moistening the Lung to treat panting] Dingchuan Tang (Panting-Stopping Decoction) [indicated for harmonization at age 33, treating wind-cold panting] Renshen Dingchuan Tang (Ginseng Panting-Stopping Decoction) [indicated for harmonization at age 34, treating cough and panting due to cold pathogen] Huangguawa Wan (Yellow Trichosanthes Pill) [indicated for harmonization at age 80, treating phlegm-panting] Shenmi Tang (Mysterious Decoction) [indicated for harmonization at age 38, treating water-qig panting] Suchen Jiubao Tang (Perilla and Chenpi Nine-Treasures Decoction) [indicated for dispersal at age 5, treating asthma] Xiebai San (Draining White Powder) [indicated for clearing heat at stage 42, treating Lung fire] Shuangyu San (Double Jade Powder) [indicated for clearing heat at stage 71, treating fire-type panting] Anmian San (Sleep-Calming Powder) [indicated for consolidating at stage 7, treating intractable panting] Tingli Dazao Xiefei Tang (Descurainia Seed and Jujube Decoction to Drain the Lung) [indicated for harmonization at age 40, treating edema with panting]
The *Kouwen* Chapter of the *Lingshu* states: The Yellow Emperor asked Qibo, "What qi causes hiccups (anciently termed 'yue')?" Qibo replied, "When food enters the stomach, Stomach qi flows upward into the Lungs. If old cold qi and new food qi both return to the stomach, the new and old interfere with each other, true qi and evil qi clash, qi merges and reverses, and re-emerges from the stomach; thus, hiccups occur." The Lungs govern hiccups; treatment should select points from the Hand-Taiyin Lung Meridian and Foot-Shaoyin Kidney Meridian.
The *Xuanming Wuqi* Chapter of the *Suwen* states: "Stomach qi rebellion leads to qi reversal, hiccups, and fear."
The *Zabing* Chapter of the *Suwen* states: "For hiccups, prick the nose with grass to induce sneezing; once sneezed, it stops. Alternatively, hold the breath and quickly guide the qi downward, and it will stop immediately. Sudden fright can also cure it."
The *Zhiyao Dalun* Chapter of the *Suwen* states: "When Yangming qi rebounds, vomiting, coughing, and hiccups occur. When Taiyang qi rebounds, spitting clear fluid and hiccups/belching occur. All rebellious qi rushing upward belongs to Fire."
The *Baoming Quanxing* Chapter of the *Suwen* states: "In severe disease, the voice manifests as hiccups."
The *Xieqi Zangfu Binxing* Chapter of the *Lingshu* states: "A very small Heart pulse indicates a predisposition to hiccups."
The *Sanbu Jiuhou* Chapter of the *Suwen* states: "If one suffers from diseases indicated by the 'Seven Diagnoses' and the pulse is also depleted, death is imminent, accompanied by hiccups and belching."
The syndrome of hiccupping was not named as such in ancient times; in the *Neijing*, it was originally called 'yue'. Because it produces continuous 'e-e' sounds, it is now called 'ehni' (hiccup), which is semantically appropriate. Observing the methods for treating 'yue' in the *Neijing*, such as pricking the nose to induce sneezing, regulating breath to guide qi downward, and using sudden fright, these are all methods for treating hiccups. This confirms that 'yue' is indeed hiccupping, requiring no distinction. Since Sun Simiao stated, "I have searched all formulas and theories but found no such name," he equated 'yue' with 'ke ni' (cough-reversal), leading to later errors where 'ke ni', dry retching, and belching were confused. From the Tang Dynasty to the present, this confusion has persisted. This nomenclature must be investigated and corrected.
First, the term 'ke ni' originates from the *Neijing*, originally referring to coughing with qi rebellion. For example, the *Jiaobi Daolun* states: "When Metal Qi is excessive, severe cases involve panting, coughing, and qi rebellion." This refers to qi rebellion caused by panting and coughing, hence 'ke ni qi'. It further states: "Severe ke ni leads to blood溢 (overflow)." This means when ke ni does not cease, blood overflows with qi, which is the normal progression of the disease; there is no record of bleeding caused by hiccups. Similarly, the *Liuyuan Zhengji Dalun* states: "When Metal Depression occurs, people suffer from ke ni," indicating that ke ni is clearly not hiccups. Yet modern physicians all equate 'yue' with 'ke ni'. Have they not examined this carefully? Zhu Danxi, in his *Zuanyao*, stated: "Sun Simiao mistakenly equated yue with ke ni," implying yue is not ke ni. However, in the *Xinfa Fulu*, he wrote: "Ke ni, in ancient times called yue, in recent times called e," implying yue is ke ni. In the Vomiting section, he said: "Sound with matter is vomiting; sound without matter is yue," equating yue with dry retching. These statements are inconsistent and self-contradictory. Zhang Yuansu (Haizang) and Liu Wansu (Hejian) also erred, some equating yue with dry retching, others with belching. Vomiting and spitting differ only by the presence of matter; belching ('yi') is gas from fullness or rising qi. These four have distinct names and should not be confused. I analyze and judge thus: 'Yue' is hiccupping, not ke ni. 'Ke ni' is severe coughing, not hiccupping. 'Dry retching' is vomiting without matter, not 'yue'. 'Yi' is belching after eating, not ke ni. Let future generations take this as a warning, so that doubts regarding these differing theories may be resolved.
Second, hiccupping syndromes include those from Cold-Damage and those from miscellaneous diseases. Ancients generally attributed them to deficiency-cold. Only Zhu Danxi cited the *Neijing*: "All rebellious qi rushing upward belongs to Fire." Patients presenting this might seem to face a fatal prognosis, but excess patterns exist and must be known. I previously doubted this view, thinking it contradicted ancients and that hiccups must be deficiency-cold, lacking excess-heat. However, through extensive verification in my later years, I formed a definitive opinion and realized Zhu Danxi was correct. Although cold, heat, deficiency, and excess vary, the cause of hiccups is always qi rebellion. Qi rebelling below rushes directly upward; without qi, there are no hiccups; without Yang, there are no hiccups. Thus, the source of hiccups lies in qi. To understand its nature, observe thunder in rain or bubbles in water. Yang obscured by Yin creates thunder; the roaring sound stems from Fire, which is Qi. Qi covered by Water creates bubbles; the bubbling stems from Qi, which is Yang. Disease in the Qi aspect is not limited to one end. The main types of hiccups are three: Cold Hiccup, Heat Hiccup, and Collapse Hiccup. Cold Hiccups can be treated with warming and dispersing methods; removing cold allows qi to relax. Heat Hiccups can be treated with descending and clearing methods; calming fire allows qi to level out. Collapse Hiccups are truly critical conditions; survival is rare. Treatment methods should be differentiated as follows.