名义 哕者，呃逆也，非咳逆也。咳逆者，咳嗽之甚者也，非呃逆也。（按∶唐末以来，谬以咳逆为
呃逆之名，故景岳有此辨也。但古人意非以咳嗽逆气为哕义，故今是书所引，其云咳逆者，皆宜为呃逆看。）
干呕者，无物之吐，即呕也，非哕也。（按∶东垣、海藏以哕为干呕，故有此辨也。又《活人书》创以 为干
呕，然 、哕同字，宜参《呕吐》名义。）噫者，饱食之息，即嗳气也，非咳逆也。（按∶《圣惠》以呃逆名
咳， 或作噫，故有此辨也。）后人但以此为鉴，则异说之疑，可尽释矣。（《景岳》）
脉候 脉浮而缓者易治，弦急而按之不鼓者难治。脉结或促或微皆可治，脉代者危。（《正传》）
寒热虚实诸说 呕哕之病者，由脾胃有邪，谷气不治所为也。胃受邪气则呕。脾受邪气，脾胀气逆，
遇冷折之，气不通则哕也。（《病源论》）
脾胃俱虚，受于风邪，故令新谷入胃，不能传化，故谷之气，与新谷相干，胃气则逆，胃逆则脾胀气逆
（按∶《圣济》作水谷之精，与新谷相干，脾胃气逆痞满），因遇冷折之，则哕也。右手关上脉沉而虚者，善哕
也。（同上）
实哕者，醉饱得之。虚哕者，吐下得之，又失血虚家得
之。（《千金翼》）
哕者咳逆也，古方则谓之哕。凡吐利后多作哕，大率胃实即噫，胃虚则哕，此由胃中虚，膈上热，故哕。
或至八九声相连，收气不回，至于惊人者。若伤寒久病得此，甚恶，《内经》所谓坏腑者是也。杨上善释云∶
津泄者，知盐器之漏。声嘶者，知琴弦之绝。叶落者，知槁木之摧。举此三物衰坏之征以比哕，故知是病深之
候也。亦有哕而心下坚痞眩悸者，以膈间有痰水所为，其他病则各有治法。（《三因》）
多因吐利之后，胃中虚寒，遂成此证。亦有胃虚膈上热，哕至八九声相连，收气不回者。却当子细看脉与
证，施以治法。大抵老人虚人久病患及妇人产后有此证者，皆是病深之候，非佳兆也。（《济生》）
若气自腹中起，上筑咽喉，逆气连属不能出，或至数十声，上下不得喘息（按∶《活法秘方》无喘字）。
此由寒伤胃脘，肾气先虚，逆气上乘于胃，与气相并（肾气以下，《活法》作气不归肾，肾气不行，与气相并）
不止者难治，谓之哕。宜茱萸丸，灸中脘（《活法》作期门）、关元百壮。未止，灸肾俞百壮。（《资生》引
《指迷方》）吐利后胃虚寒，面青手足微冷，脉紧细，羌活附子散、柿蒂汤，又丁香煎汤咽苏合香丸，《三因》
丁香散、《活人》橘皮干姜汤。吐利后，胃热，面红白，手足温，《济生》橘皮汤、《活人》半夏生姜汤（即仲
景方）、橘皮竹茹汤。大病后，脾胃气衰，中州已无土，《活人》橘皮竹茹汤、《济生》橘皮汤，又荜澄茄、
良姜各三分为末，煎二钱，入醋少许煎服，又莱菔子煎汤，调木香调气散热服。（《永类》）
咳逆为病，古谓之哕，近谓之呃，乃胃寒所生，寒气自逆而上呃，此证最危。间有热呃，已见伤寒证。其有他病发
呃者，皆属寒。宜用半夏一两，生姜一两半，水一碗，煎半碗热服。若胃中寒甚，呃逆不已，或复加以呕吐，
轻剂不能取效，宜丁香煮散，及以附子粳米汤，增炒川椒、丁香，每服各三十五粒。（《要诀》）
哕声频密相连者为实，可治；若半时哕一声者属虚，难治，多死在旦夕。（《纲目》引世）
咳逆者，气逆上冲而作声也，俗谓之吃忒是也。其发也，或三五声而止，或八九声而止，或连续不绝，
收气不回者。然所得之由不同，有因久病胃虚而得者，有因伤寒失下而得者，有因痰热内郁、火气冲上而得者，
有因过服寒剂、胃寒而得者，有因水气停痰、心下痞悸而得者。治法当以降气化痰和胃为主，若胃虚者补其胃，
伤寒失下者宜下之，火逆上冲者宜降之，过服寒剂者宜温之，水气停痰者宜逐之，斯其治法也。其或病久，脾
胃衰败而发咳逆，额上汗出，连声不绝者，又为恶候也。（《选要》）
有胃气寒而呃。元礼戴氏以杂病发呃者皆属寒，惟有伤寒发呃属热。盖由阳明内实，过经失下，清浊不得
升降，以致气不宣通而作。或又有饮食填塞胸中，而气不得升降者。或有痰闭于上，火起于下而气不得伸越者。
（按∶此分实证为三，本出《正传》。）又有吐利后，胃虚膈热而作呃者。又有气血虚作呃者。不可以不辨也。
（《赤水》）
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。（《景岳》）
呃逆证，凡声强气盛而脉见滑实者，多宜清降，若声小息微而脉见微弱者，多宜温补。（同上）
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。（同上）
大抵无病而暴呃者多实，病久而乍呃者多虚。前后不利者多实，清便自调者多虚。寒而呃者必喜热，热而呃
者。必喜寒。停痰多心下痞悸，气逆必胸中喘满。虚则补之，实则泻之，热则清之，寒则温之，痰凝者利之，气
逆者顺之。贵在临证变通，不可胶于一见。（《汇论》）
呃逆在辨寒热，寒热不辨，用药立毙。凡声之有力而连续者，虽有手足厥冷，大便必坚，定属火热，下之则
愈，万举万全。若胃中无实火，何以激搏其声逆上而冲乎。其声低怯而不能上达于咽喉，或时郑声，虽无厥冷，
定属虚寒，苟非丁、附，必无生理。若胃中稍有阳气，何以致音声馁怯不前也。又有始热终寒者，始本热邪，因过
用苦寒，寒郁其热，遂至呃逆，急宜连理汤加姜、半主之。五六日大便不通者，削陈酱姜导之。若真阳素虚人，
误用苦寒通其大便，必致热去寒起，多成不救。复有饮热饮冷而呃，背微恶寒，目晴微黄，手足微冷，大便溏黑
者，属瘀血；若饮热则安，饮冷则呃，虽有背恶寒，手足冷，大便溏等证，此属湿痰，肥人多此，须推瘀血、痰
饮例治之。（《医通》）
无病而呃者，不必治也，即治不过用《内经》刺鼻取嚏，或闭息不令出入，或惊之之法，皆可立已。若有病
而呃者，形气壮实，别无恶候，审其致闭之邪，去之亦即已。惟病重得此，多为气脱。凡见其呃自丹田而上，久
久乃一声，通身振动者，即是危候，恐难治矣（此先天命门真火欲脱，多不救），与黑锡丹，灸关元。（《医碥》）
病系阴为火所乘 吃，病气逆也，气自脐下直冲，上出于口而作声之名也。《书》曰∶火炎上。《内经》
曰∶诸逆冲上，皆属于火。东垣谓火与元气不两立，又谓火气之贼也。古方悉以胃弱言之而不及火，且以丁香、
柿蒂、竹茹、陈皮等剂治之，未审孰为降火，孰为补虚。人之阴气，根据胃为养，胃土伤损，则木气侮之矣，此土
败木贼也。阴为火所乘，不得纳守，木挟相火乘之，故直冲清道而上。言胃弱者，阴弱也，虚之甚也。（《格致
余论》）（按∶哕证自此言出，而后有明诸家，多以阴火上冲为说，处以补阴方剂。今验之病者，未见其可。仍
姑录此说，以俟识者。）
偶然致呃 亦有无病，偶然致呃，此缘气逆而生，重者或经一二日，宜小半夏茯苓汤加枳实半夏汤，或
用煎汤泡萝卜子，研取汁，调木香调气散，乘热服，逆气用之最佳。（《要诀》）
瘀血（互见上） 伤寒血证呃逆不止，舌强短者，桃仁承气汤主之。心痛饮汤水下作呃逆者，是有死血在
中，桃仁承气汤下之。（《丹溪》）
超越陈氏，二十余岁，因饱后奔走数里，遂患哕病，但食物则连哕百余声，半日不止，饮酒与汤则不作，至
晚发热，如此者二月。脉涩数，以血入气中治之，用桃仁承气汤，加红花煎服，下污血数次即减，再用木香和中
丸加丁香服之，十日而愈。（《纲目》引丹）
停食 又有因于食而致呃者，脾胃不能健运，食阻气而不行，宜以温中消导可也，如二陈汤加浓朴、山
楂、砂仁、木香。（《绳墨》）
虫 因于虫者，其声或作或止，或缓或促，兼面色不一，胃中或痛，或吐清水冷涎，或心中嘈杂，脉迟大小不
匀。（《续焰》）
滞下后（诸病后）吐利后哕，即丹溪治赵立道与陈择仁哕，皆于滞下得之之类，六脉大豁，用参、术而
愈是也。予长兄，九月得滞下，每夜五十余行，呕逆食不下，五六日后加呃逆。与丁香一粒，含之立止，但少时
又至。遂用黄连泻心汤，加竹茹饮之，呃虽少止，滞下未安，如此者十余日。遂空心用御米壳些少，涩其滑，日
间用参、术、陈皮之类补其虚。自服御米壳之后，呃声渐轻，滞下亦收而安。（《纲目》）
痢后发呃，极为险证。（《尊生书》）
至若吐利后发呃者，难治。伤寒、痢疾、产后、久病、虚损及汗下后致呃者，皆难治，不可言其易也，后必
有悔。（《绳墨》）
死证（互见上）其人气不接续，呃气转大，其脉虚而无力。若虚而短数者不治，有痰者不治，饮食不入者
不治。（《绳墨》）
温中诸方 顺气汤，治咳逆神验。
丁香（四十九粒） 柿蒂（二十七个）
上用水一碗，同煎至半碗，温服一盏，立效。如未住，更服。（《家宝》）（按∶此方本出《简要济众》，
既录《伤寒》中。）《易简》丁香十粒，柿蒂十五枚，煎汤半盏，乘热顿服。《济生》名柿蒂汤，治胸满咳逆不止，
各一两，加姜煎。
治胃冷咳 ，气厥不通，高良姜散方。
高良姜（一两） 干木瓜 莲子心 菖蒲（各半两） 丁香（一分）
上件药捣筛为散，每服三钱，以水一中盏，入生姜半分，煎至六分，去滓温服。（《圣惠》）丁香煮散，治
翻胃呕逆，丁香、石莲肉各十四枚，北枣七枚截碎，生姜七片，
黄秫米半合洗。上水碗半，煮稀粥，去药，取粥食之。（《直指》）
治气逆咳 不止方。
伏龙肝（一两） 丁香（半两）
上件药捣，细罗为散，煎桃仁醋汤，调下一钱。（《圣惠》）
丁香柿蒂散，治吐利及病后，胃中虚寒，咳逆至七八声相连，收气不回者，难治。
人参 茯苓 橘皮 半夏 良姜（炒） 丁香 柿蒂（各一两） 生姜（一两半） 甘草（五钱）
上锉散，每服三钱，水一盏煎，乘热顿服。或用此调苏合香丸亦妙。（《得效》）（按∶《直指》曰∶噫
逆即咳逆，胃寒所致也。良姜为要药，人参、白茯苓佐之。良姜温胃，能解散胃中邪气。盖危氏立此方，岂本其
意乎。）
陈，食伤脾胃，复病呕吐、发呃、下利。诊两脉微涩，是阳气欲尽，浊阴冲逆，事危至急，舍理阳驱阴无
别法。
人参 茯苓 丁香 柿蒂 炮附子 干姜 吴茱萸（《临证指南》）
黄，脉小舌白，气逆呃忒，畏寒微战，胃阳虚，肝木上犯，议用镇肝安胃理阳。
人参 代赭石 丁香皮 茯苓 炒半夏 淡干姜（同上）
哕不止，干姜六分，附子四分，炮捣，苦酒丸如梧子，服三丸，日三效。（《肘后》）
吴茱萸丸。（主治全系前诸说中《资生经》文。）
橘皮（洗一两，《活法》三两） 吴茱萸（醋炒，《活法》三两） 附子（炮裂去皮脐各一两）
上为细末，白面糊为丸，如梧桐子大，每服七十丸至八
十丸，温生姜汤下，食前。（《御药》）（按∶据《资生》是王子亨方。）
止咳逆羌活散。（出《灵苑》。馆案云∶《三因方》有丁香一两。）
羌活 附子（炮） 茴香（微炒各半两） 木香 干姜（去土炮各枣许，按∶馆本各一两）
上每服二钱，水一盏，盐一捻，同煎一、二十沸，带热服，一服止。（《苏沈》）《活人》名羌活附子散。
橘皮干姜汤，治哕。
橘皮 通草 干姜（炮） 桂心（各二两） 人参（一两） 甘草（炙二两）
上锉如麻豆大，每服四钱，水一盏，煎至六分，去滓温服，日进三服。（同上）
大吐大泻后，虚寒，四肢厥冷，咳逆者，以附子理中汤主之。（《原病集》）
病后元气不足，发咳逆者，以六君子汤加柿蒂主之。（同上）
参附汤，治大汗大吐大泻后，厥逆，呃忒，腹痛。（《汇补》）
治寒气攻胃咳 方。
胡椒（三十颗） 麝香（一钱细研）
上捣破胡椒，入麝香，用酒一中盏，煎至半盏，稍热服。（《圣惠》）
清中诸方 橘皮竹茹汤，治胃热多渴，呕哕不食。
赤茯苓（去皮） 橘皮（去白） 枇杷叶（拭去毛） 麦门冬（去心） 青竹茹 半夏（汤泡七次各一两）
人参 甘草（炙各半两）
上 咀，每服四钱，水一盏半，姜五片，煎至八分，去
滓温服，不拘时候。（《济生》）
人参三白汤，身热，脉数而虚，咳逆者主之。
人参（二钱） 白茯苓 白术（各钱五分） 白芍（一钱） 竹茹（一团）
食前服。（《原病集》）《统旨》参术竹茹汤，于本方去芍药，加陈皮、半夏、甘草、姜，水煎。
[Definitions] "Yue" (Hiccups) refers to hiccuping, not coughing with reverse flow. Coughing with reverse flow is severe coughing, not hiccuping. (Note: Since the late Tang Dynasty, it was erroneously called "coughing with reverse flow," which is why Jingyue made this distinction. However, the ancients did not intend to define "Yue" as coughing with reverse flow. Therefore, in this book, whenever "coughing with reverse flow" is cited, it should be understood as hiccuping.) Dry retching is vomiting without ejecting matter, i.e., vomiting, not "Yue." (Note: Dongyuan and Haizang equated "Yue" with dry retching, hence this distinction. Also, the *Huoren Shu* pioneered using "Yue" for dry retching; however, "Yue" and dry retching are homographs with different meanings, so one should refer to the definitions in the chapter on Vomiting and Belching.) "Yi" refers to the sigh after a full meal, i.e., belching, not coughing with reverse flow. (Note: The *Shenghui Fang* named hiccuping as coughing, or wrote it as "Yi," hence this distinction.) If later generations take this as a warning, the doubts arising from divergent theories can be completely resolved. (*Jingyue Quanshu*)
[Pulse Signs] A pulse that is floating and slow is easy to treat; a pulse that is wiry and rapid but does not throb under pressure is difficult to treat. Pulse knotted (Jie), surging (Cu), or faint are all treatable; a pulse with intermittent pauses (Dai) indicates a critical condition. (*Zhengchuan*)
[Theories on Cold, Heat, Excess, and Deficiency] Diseases of vomiting and "Yue" arise from pathogenic factors affecting the Spleen and Stomach, leading to dysfunction of Grain Qi. When the Stomach is affected by pathogens, vomiting occurs. When the Spleen is affected, Spleen distension and reverse flow of Qi occur; if hindered by cold, causing Qi blockage, "Yue" results. (*Bingyuan Lun*)
If both Spleen and Stomach are deficient and affected by Wind Pathogens, newly ingested food cannot be transformed and transported. Thus, the Qi of grain interferes with the new food, causing Stomach Qi to rebel. Stomach Qi rebellion leads to Spleen distension and reverse flow of Qi (Note: *Shengji Zonglu* states that water-grain essence interferes with new food, causing Spleen-Stomach Qi rebellion and fullness). If further hindered by cold, "Yue" occurs. A deep and deficient pulse at the Guan position on the right hand predisposes one to frequent "Yue." (Ibid.)
Excess-type "Yue" results from drunkenness and overeating. Deficient-type "Yue" results from excessive vomiting or purging, or occurs in patients with blood loss or constitutive deficiency. (*Qianjin Yi*)
"Yue" is coughing with reverse flow, known as "Yue" in ancient formulas. It frequently follows vomiting and diarrhea. Generally, Stomach excess manifests as belching, while Stomach deficiency manifests as "Yue." This is due to deficiency-cold in the Stomach and heat above the Diaphragm. Sometimes, eight or nine sounds occur continuously, with inhalation failing to return, which can be startling. If a patient with chronic Shanghan develops this, it is very ominous, referred to in the *Neijing* as "destroyed Fu organs." Yang Shangshan explained: Leakage of fluids is like knowing a salt vessel is leaking; hoarseness is like knowing a lute string has snapped; falling leaves indicate the collapse of dead wood. These three signs of decay are used to compare with "Yue," indicating a deep-seated disease. There are also cases of "Yue" accompanied by hardness and fullness below the heart, dizziness, and palpitations, caused by phlegm-fluid retention in the Diaphragm. Other diseases have their respective treatments. (*Sanyin*)
It often arises after vomiting and diarrhea due to deficiency-cold in the Stomach. There are also cases of Stomach deficiency with heat above the Diaphragm, where "Yue" sounds occur continuously eight or nine times with failed inhalation. One must carefully examine the pulse and symptoms to apply treatment. Generally, elderly people, those with deficiency, chronic patients, and postpartum women developing this sign indicate a deep disease and are not auspicious. (*Jisheng*)
If Qi rises from the abdomen, striking the throat, with continuous reverse Qi unable to exit, or occurring dozens of times without ability to breathe up or down (Note: *Huofa Mifang* omits the word "wheezing"), it is caused by Cold injuring the Stomach wall and pre-existing Kidney Qi deficiency. Reverse Qi ascends to the Stomach and combines with Qi (In *Huofa*, it is described as Qi not returning to the Kidney, Kidney Qi failing to move, combining with other Qi). If unceasing, it is difficult to treat and is called "Yue." Zhuoyu Wan is indicated; moxa points Zhongwan (or Qimen per *Huofa*) and Guanyuan, 100 cones each. If it does not stop, moxa Shenshu, 100 cones. (*Zisheng* citing *Zhimi Fang*)
After vomiting and diarrhea, if the Stomach is deficient and cold, with a blue complexion, slightly cold hands and feet, and a tight, fine pulse, use Qianghuo Fuzi San, Shidi Tang, or swallow Suhexiang Wan with Dingxiang decoction. Use *Sanyin* Dingxiang San or *Huoren* Jupi Ganjiang Tang. After vomiting and diarrhea, if there is Stomach heat, with a red-and-white complexion and warm hands and feet, use *Jisheng* Jupi Tang or *Huoren* Banxia Shengjiang Tang (i.e., Zhang Zhongjing's formula), and Jupi Zhuru Tang. After severe illness, if Spleen-Stomach Qi declines and the Middle Jiao lacks Earth Qi, use *Huoren* Jupi Zhuru Tang, *Jisheng* Jupi Tang, or powdered Bichengqie and Gaoliangjiang (3 fen each), decocted with 2 qian, adding a little vinegar. Alternatively, Radish seed decoction mixed with Muxiang Tiaoqi San. (*Yonglei*)
Coughing with reverse flow was called "Yue" in antiquity and "E" recently. It is generated by Stomach Cold; Cold Qi rebels upward causing hiccups, a most critical condition. Occasionally, there is Heat-type hiccups, seen in Shanghan. Hiccups from other diseases generally belong to Cold. Use Banxia 1 liang, Shengjiang 1.5 liang, decoct in 1 bowl of water until half remains, take hot. If Stomach Cold is severe and hiccups persist, or vomiting is added, mild agents will fail; use Dingxiang Zhusan or Fuzi Jingmi Tang, increased with fried Chuanjiao and Dingxiang, 35 grains each per dose. (*Yaojue*)
Frequent, dense "Yue" sounds indicate Excess, which is treatable; "Yue" once every half hour indicates Deficiency, which is difficult to treat and often fatal within a day or night. (*Gangmu* citing popular sayings)
"Coughing with reverse flow" is Qi rebelling upward making sound, commonly called "Chite." It may stop after 3-5 sounds, 8-9 sounds, or continue incessantly with failed inhalation. Causes vary: some due to chronic Stomach deficiency, some due to missed purgation in Shanghan, some due to internal stagnation of Phlegm-Heat and rising Fire, some due to overuse of Cold herbs causing Stomach Cold, some due to Water-Qi retention and Phlegm causing epigastric fullness and palpitations. Treatment focuses on descending Qi, resolving Phlegm, and harmonizing the Stomach. Tonify the Stomach if deficient; purge if missed purgation in Shanghan; descend if Fire rebels; warm if overused Cold herbs; drain if Water-Qi/Phlegm retained. If chronic disease leads to Spleen-Stomach failure with hiccups, sweating on the forehead, and incessant sounds, it is an ominous sign. (*Xuanya*)
Some hiccups are due to Cold Stomach Qi. Yuanli Dai believed miscellaneous disease hiccups are all Cold, except Shanghan hiccups which are Heat. This is due to Yangming internal excess, missed purgation after passing the stage, preventing ascending/descending of Clear/Turbid, causing Qi obstruction. Or food blocking the chest preventing Qi movement. Or Phlegm blocking above and Fire rising below preventing Qi extension. (Note: This divides Excess into three types, originally from *Zhengchuan*). Also, hiccups after vomiting/diarrhea due to Stomach deficiency and Diaphragm heat. Also, hiccups due to Qi-Blood deficiency. These must be distinguished. (*Chuishui*)
The essentials of hiccups are these three: Cold, Heat, and Collapse. Cold hiccups can be warmed and dispersed; when Cold goes, Qi relaxes. Heat hiccups can be descended and cleared; when Fire calms, Qi levels. Only Collapse hiccups are truly critical; survival is rare luck. (*Jingyue*)
For hiccups, if sounds are strong, Qi is robust, and pulse is slippery/excess, clear and descend. If sounds are weak, breath is faint, and pulse is weak/faint, warm and tonify. (Ibid.)
Mild or occasional hiccups resolve when Qi flows smoothly and need no treatment. Frequent or severe hiccups indicate major Qi rebellion or severe depletion of Spleen-Kidney Yuan Qi. Excess hiccups are not hard to treat; only Yuan Qi exhaustion is critically dangerous. (Ibid.)
Generally, sudden hiccups without disease are Excess; hiccups appearing late in chronic disease are Deficiency. Obstruction of bowels/bladder suggests Excess; normal excretion suggests Deficiency. Cold hiccups prefer heat; Heat hiccups prefer cold. Retained Phlegm causes epigastric fullness/palpitations; Qi rebellion causes chest wheezing/fullness. Tonify Deficiency, drain Excess, clear Heat, warm Cold, promote stagnation, smooth Qi. Flexibility in clinical practice is key; do not stick rigidly to one view. (*Huilun*)
Hiccups require distinguishing Cold vs. Heat; misidentification leads to death. Sounds that are forceful and continuous, even with cold limbs, usually indicate solid stool and Heat; purgation cures it safely. Without real Fire in the Stomach, how could it force sound upward? Low, timid sounds failing to reach the throat, or muttering, indicate Cold-Deficiency even without cold limbs; without Dingxiang and Fuzi, there is no hope. If any Yang Qi existed, why would sounds be feeble? Some start with Heat then turn Cold due to overuse of Bitter-Cold herbs trapping Heat; use Lianli Tang with Shengjiang and Banxia. If constipated for 5-6 days, guide with aged ginger sauce. If True Yang is deficient and bitter-cold laxatives were wrongly used, Heat leaves and Cold rises, often fatal. Drinking hot/cold liquids causing hiccups, slight back chills, yellow eyes, cold limbs, black loose stools indicates Blood Stasis. If relieved by hot drinks but worsened by cold, despite chills/cold limbs/loose stools, it is Damp-Phlegm, common in obese people; treat according to Blood Stasis or Phlegm-Fluid patterns. (*Yitong*)
Hiccups without disease need no treatment; if treated, use Neijing methods to induce sneezing via nasal stimulation, breath-holding, or startling. If hiccups occur with disease, and the patient is robust without other bad signs, remove the obstructing pathogen and it stops. In severe disease, hiccups often indicate Qi collapse. If Qi rises from the Dantian, pausing long before each sound, with whole-body trembling, it is critical (likely collapse of Mingmen True Fire, often fatal); give Heixi Dan and moxa Guanyuan. (*Yique*)
[Disease: Yin Overcome by Fire] "Chi" (hiccups) is rebellious Qi, rising straight from below the navel to the mouth making sound. The *Book* says: Fire flares upward. *Neijing* says: All rebellious upward movements belong to Fire. Dongyuan said Fire and Yuan Qi are incompatible; Fire is a thief. Ancient formulas attributed this to weak Stomach without mentioning Fire, treating with Dingxiang, Shidi, Zhuru, Chenpi, etc., without clarifying who descends Fire and who tonifies Deficiency. Human Yin Qi relies on the Stomach for nourishment; if Stomach Earth is damaged, Wood Qi insults it (Earth fails, Wood attacks). Yin is overcome by Fire, unable to store; Wood carries Ministerial Fire upward, rushing the clear passages. Saying "Stomach weak" means Yin is weak, extremely deficient. (*Gezhi Yulun*) (Note: This theory originated here; later Ming physicians often attributed hiccups to Ministerial Fire rising, using Yin-tonifying formulas. Clinical verification shows limited efficacy. Recorded here for scholars' consideration.)
[Occasional Hiccups] Sometimes hiccups occur occasionally without disease due to Qi rebellion. Severe cases lasting 1-2 days: use Xiaobanxia Fuling Tang plus Zhishi Banxia Tang, or radish seed juice mixed with Muxiang Tiaoqi San, taken hot. Best for rebellious Qi. (*Yaojue*)
[Blood Stasis] (See above) In Shanghan blood disorders, persistent hiccups with stiff/short tongue: Taoren Chengqi Tang. Heart pain with hiccups after drinking water indicates fixed blood in the middle; purge with Taoren Chengqi Tang. (*Danxi*)
Case of Chao Yue, age 20+, developed hiccups after running miles after a full meal. Eating triggered >100 hiccups for half a day; drinking alcohol/soup stopped it. Fever at night. Lasted 2 months. Pulse choppy and rapid. Treated as Blood entering Qi layer with Taoren Chengqi Tang plus Honghua. After evacuating dark blood several times, improved. Then used Muxiang Hezhong Wan plus Dingxiang. Cured in 10 days. (*Gangmu* citing Danxi)
[Food Retention] Hiccups due to food: Spleen-Stomach fail to transport, food blocks Qi. Treat with warming middle and promoting digestion, e.g., Erchen Tang plus Houpo, Shanzha, Sharen, Muxiang. (*Shengmo*)
[Parasites] Due to parasites: sounds vary, intermittent or rapid, varying complexion, stomach pain, vomiting clear fluid/cold saliva, or heart discomfort, pulse slow and irregular. (*Xuyan*)
[After Dysentery (Post-various diseases)] Hiccups after vomiting/diarrhea, e.g., Danxi treating Zhao Lidao and Chen Zeren after dysentery, with large/hollow pulses, cured with Renshen and Baizhu. My elder brother had dysentery in September, >50 stools/night, vomiting/inability to eat, adding hiccups after 5-6 days. Held one Dingxiang grain, stopped temporarily, then returned. Used Huanglian Xiexin Tang + Zhuru; hiccups lessened but dysentery persisted for 10+ days. Used small amount of Yumike (Poppy shell) fasting to astringe slipperiness; daytime used Renshen, Baizhu, Chenpi to tonify deficiency. After Yumeke, hiccups lightened, dysentery settled. (*Gangmu*)
Hiccups after dysentery is extremely dangerous. (*Zunsheng Shu*)
Hiccups after vomiting/diarrhea are difficult to treat. Those after Shanghan, dysentery, postpartum, chronic disease, deficiency, or after sweating/purging are difficult; do not say they are easy, regret will follow. (*Shengmo*)
[Death Signs] (See above) Qi fails to connect, hiccups become louder, pulse is empty and weak. Empty/rapid-short pulse: untreatable. With Phlegm: untreatable. Unable to eat/drink: untreatable. (*Shengmo*)
[Warming Middle Formulas] Shunqi Tang, miraculous for coughing with reverse flow.
Dingxiang (49 grains), Shidi (27 pieces).
Decoct in 1 bowl water to half, take 1 zhan warm. Immediate effect. Repeat if needed. (*Jiabao*) (Note: Originally from *Jianyao Jizhong*, recorded in Shanghan texts.) *Yijian*: Dingxiang 10, Shidi 15, decoct half zhan, take hot. *Jisheng* calls it Shidi Tang, for chest fullness/unceasing hiccups, 1 liang each, add Ginger.
Treat Stomach Cold hiccups, Qi reversal blockage, Gaoliangjiang San.
Gaoliangjiang (1 liang), Gan Mugua, Lianzixin, Changpu (each 0.5 liang), Dingxiang (1 fen).
Pulverize, take 3 qian, decoct with 1 zhong water + 0.5 fen Shengjiang to 0.6, strain, take warm. (*Shenghui*) Dingxiang Zhusan, for fanwei/vomiting/reverse flow: Dingxiang, Shilianrou (14 each), Beizao (7 cut), Shengjiang (7 slices), Huang Shumi (0.5 he washed). Decoct in half bowl water to thin porridge, remove herbs, eat porridge. (*Zhizhi*)
Treat Qi rebellion/unceasing hiccups.
Fulonggan (1 liang), Dingxiang (0.5 liang).
Pulverize, sift fine, decoct Taoren vinegar soup, mix 1 qian. (*Shenghui*)
Dingxiang Shidi San, for vomiting/diarrhea/post-illness, Stomach deficiency-cold, hiccups 7-8 times continuous with failed inhalation (difficult).
Renshen, Fuling, Jupi, Banxia, Liangjiang (fried), Dingxiang, Shidi (each 1 liang), Shengjiang (1.5 liang), Gancao (5 qian).
Cut coarse, take 3 qian, decoct in 1 zhan water, take hot. Or mix with Suhexiang Wan. (*Defxiao*) (Note: *Zhizhi* says Yi-Ni is hiccups due to Stomach Cold. Liangjiang is key, assisted by Renshen/Fuling. Liangjiang warms Stomach, disperses pathogens. Did Wei Shi base this on that intent?)
Chen, food injured Spleen-Stomach, vomiting, hiccups, diarrhea. Pulses faint/choppy, Yang Qi exhausted, Turbid Yin rebelling. Critical urgency. No method but regulating Yang and expelling Yin.
Renshen, Fuling, Dingxiang, Shidi, Pao Fuzi, Ganjiang, Wuzhuyu. (*Linzheng Zhinan*)
Huang, small pulse, white tongue, Qi rebellion/hiccups, fear of cold/trembling, Stomach Yang deficiency, Liver Wood attacking. Plan: Calm Liver, soothe Stomach, regulate Yang.
Renshen, Daizheshi, Dingxiang Pi, Fuling, Chao Banxia, Dan Ganjiang. (Ibid.)
Unceasing hiccups: Ganjiang 6 fen, Fuzi 4 fen, roasted/pounded, pill size of wutong seeds, take 3 pills, 3 times/day effective. (*Zhouhou*)
Wuzhuyu Wan. (Indications based on *Zisheng Jing* text above.)
Jupi (washed 1 liang, *Huofa* 3 liang), Wuzhuyu (vinegar-fried, *Huofa* 3 liang), Fuzi (roasted/cleaned 1 liang).
Fine powder, wheat paste pills, wutong seed size. Take 70-80 pills, warm Shengjiang soup, before meals. (*Yuyao*) (Note: Per *Zisheng*, this is Wang Ziheng's formula.)
Zhikeyi Qianghuo San. (From *Lingyuan*. Library note: *Sanyin Fang* has 1 liang Dingxiang.)
Qianghuo, Fuzi (roasted), Huixiang (lightly fried, each 0.5 liang), Muxiang, Ganjiang (cleaned/roasted, date-sized, library note: each 1 liang).
Take 2 qian, 1 zhan water, pinch of salt, boil 10-20 times, take hot. Stops after one dose. (*Su Shen*) *Huoren* calls it Qianghuo Fuzi San.
Jupi Ganjiang Tang, treats hiccups.
Jupi, Tongcao, Ganjiang (roasted), Guixin (each 2 liang), Renshen (1 liang), Gancao (roasted 2 liang).
Cut like hemp beans, take 4 qian, 1 zhan water, decoct to 0.6, strain, take warm, 3 doses/day. (Ibid.)
After severe vomiting/purging, deficiency-cold, cold limbs, hiccups: Fuzi Lizhong Tang. (*Yuanbing Ji*)
Post-illness insufficient Yuan Qi, hiccups: Liu Junzi Tang + Shidi. (Ibid.)
Shenfu Tang, after severe sweating/vomiting/purging, cold limbs, hiccups, abdominal pain. (*Huibu*)
Treat Cold Qi attacking Stomach hiccups.
Hujiao (30 grains), Shexiang (1 qian finely ground).
Crush Hujiao, add Shexiang, decoct in 1 zhong wine to half, take slightly hot. (*Shenghui*)
[Clearing Middle Formulas] Jupi Zhuru Tang, for Stomach Heat/thirst, vomiting/hiccups/anorexia.
Chi Fuling (peeled), Jupi (peeled), Pipaye (brushed hairs), Maidong (cored), Qing Zhuru, Banxia (boiled 7 times, each 1 liang), Renshen, Gancao (roasted, each 0.5 liang).
Cut, take 4 qian, 1.5 zhan water, 5 slices Shengjiang, decoct to 0.8, strain, take warm, any time. (*Jisheng*)
Renshen Sanbai Tang, for body heat, rapid/deficient pulse, hiccups.
Renshen (2 qian), Bai Fuling, Baizhu (each 0.5 qian), Baishao (1 qian), Zhuru (1 ball).
Take before meals. (*Yuanbing Ji*) *Tongzhi* Canzhu Zhuru Tang removes Baishao from this formula, adds Chenpi, Banxia, Gancao, Jiang, decoct in water.