呃逆俗名冷呃。有寒有热、有虚、有实；有因痰火而发；有因血郁而成；有因食阻而得；有因气阻而生；有因病重
发喘为呃，谓之喘呃。若一概认呃为冷，以丁香柿蒂主之，谬矣。故老弱气虚犯呃，非参不补；若虚极阴寒犯呃，非姜
桂附子不温；即此冷呃治之亦异，而况痧胀为呃，有痰火血郁之分，有食阻气阻之异，有病重喘呃之凶。苟非细辨受病
之原，用药稍或不妥，非惟不效，势必呃死，是用明痧呃之害焉。
治验∶
一徐望舒，伤寒变疟，呃逆三日夜，两寸脉微，余脉紧滑。余曰∶“呃逆，脉异，病后兼痧也。”阅腿弯上下痧筋，
放四针，紫黑血流，不愈。用细辛大黄丸，清茶稍冷服之，付清凉至宝饮，微冷下而痊。
一王彦甫内室，产后月余，发热呃逆，腹胀沉重，其长子谓余曰∶“老母产后，伤寒六日，沉重异常，忽发冷呃，将
若何？”余诊之，六脉弦细而疾，口渴畏热饮，痧症显然。放臂痧三针，血流如注，又放指上痧三十余针。用苏木散并
付桃仁红花汤加山楂、卜子二剂，俱微温饮之乃愈。
一孙靖公，六月，心烦呃逆，两寸关俱细涩而数，且喜冷冻饮料。余曰∶“痧脉已现，痧症昭然。”刮痧放痧，不愈。用
清凉至宝饮减细辛加香薷，黄连、童便∶食盐微冷服，遂愈。
Erbì (hiccup) is commonly known in folk medicine as "cold erbì". Its etiology includes cold patterns, heat patterns, deficiency patterns, and excess patterns; some arise due to phlegm-fire, some due to blood stasis, some due to food obstruction, and some due to qi stagnation. Additionally, severe illness may lead to panting followed by hiccup, termed "panting hiccup" (chuan e). If one universally assumes hiccup to be caused by cold and treats it solely with Dingxiang Shidi Tang (Clove and Persimmon Calyx Decoction), this is erroneous. Therefore, for elderly or weak individuals with qi deficiency causing hiccup, Ginseng Radix et Rhizoma (Renshen) is indispensable for tonification; if the hiccup is caused by extreme deficiency and yin-cold, Dried Ginger Rhizome (Ganjiang), Cinnamon Twig (Guizhi), and Aconite Lateral Root Preparata (Fuzi) are required for warming. Even in treating simple cold hiccup, methods vary; how much more so for hiccup caused by Sha-zhang (sand swelling/toxin), which differentiates into phlegm-fire versus blood stasis, food obstruction versus qi stagnation, and the perilous condition of severe panting hiccup. Without carefully distinguishing the root cause of the disease, even slight impropriety in medication will not only fail to cure but inevitably lead to death from hiccup. Thus, the dangers of hiccup caused by Sha must be clarified.
Clinical Cases:
1. Mr. Xu Wangshu suffered from hiccups for three days and nights after his typhoid fever transformed into malaria. His radial arteries at both cun positions were faint, while other pulses were tight and slippery. I stated, "Hiccup accompanied by abnormal pulse indicates a post-illness complication of Sha." Observing Sha veins above and below the popliteal fossa, I performed needle-lancing at four points, releasing dark purple-black blood, yet the condition persisted. Subsequently, Xixin Dahuang Wan (Asarum and Rhubarb Pill) was administered with slightly cool clear tea, along with Qingliang Zhibao Yin (Cooling Precious Treasure Drink). The patient recovered after the medicinal effect moved downward with a slightly cool sensation.
2. The wife of Mr. Wang Yanfu, over a month postpartum, presented with fever, hiccup, abdominal distension, and heaviness. Her eldest son said to me, "My mother contracted typhoid six days after childbirth, her body is extremely heavy, and she suddenly developed cold hiccup. What should we do?" Upon diagnosis, her six pulses were wiry, thin, and rapid; she had thirst and feared drinking hot liquids, clearly indicating Sha syndrome. I lanced three Sha points on the arm, resulting in profuse bleeding, and then lanced over thirty Sha points on the fingers. Su Mu San (Sappan Wood Powder) was used, combined with Taoren Honghua Tang (Peach Kernel and Safflower Decoction) added with Hawthorn Fruit (Shanzha) and Radish Seed (Buzi/Lai Fuzi). Two doses were taken while slightly warm, leading to recovery.
3. Mr. Sun Jinggong experienced mental restlessness and hiccup in June. Both cun and guan positions of his radial arteries were fine, choppy, and rapid, and he preferred frozen beverages. I remarked, "The Sha pulse has appeared, and the Sha syndrome is evident." After scraping and lancing Sha, the condition did not improve. Therefore, Qingliang Zhibao Yin was modified by removing Asarum (Xixin) and adding Elsholtzia Herb (Xiangru), Coptis Rhizome (Huanglian), children's urine (Tongbian), and salt. It was taken slightly cool, resulting in immediate recovery.