久病闻呃为胃绝。须审脉证断之。不得但据呃逆。遂断其死也。失血家气不顺利。多有呃逆。新病形实者。
为伏热攻发。火性炎上。气逆而呃。清热导气。宜三物汤。或柴胡梅连散。加枳壳槟榔。若膈间有痰闭滞者。
宜滚痰丸。指迷茯苓丸。又有瘀血阻滞。而发呃者。必见刺痛逆满之证。大柴胡汤。加桃仁丹皮苏木治之。
血府逐瘀汤亦治之。若久病发呃。形虚气弱者。为胃中空虚。客气动膈。所谓客即痰火气也。治痰气宜旋
复代赭石汤。或二陈汤。加丁香枳壳。治火气。宜玉女煎。加旋复花赭石柿蒂。或用梅连散。加柿蒂枳壳五
味子。俗治呃逆但用丁香柿蒂。丁香性温降痰。柿蒂性寒清火。二物骑墙之见。故多不效。须分寒热用之。
哕者。吐气也。血家气盛。此证最多。其治法与呃逆同。惟有伤食。胃中壅塞。而发哕者。宜越鞠丸。加旋复花
枳壳莱菔子。
以上皆治胃之法。而心气不舒。亦有发呃哕者。常见人有抑郁。心气不畅。则胸中喉间。常如有物哽塞。时
发哕呃。不得快利。治法当清其心。调其气。宜二陈汤。加黄连连翘牛蒡子桔梗栝蒌霜当归川贝母治之。
余详痰饮门。
痰饮之证。已详于咳血咯血咳嗽诸条。兹因失血诸人。无不兼痰饮者。故更言之。不惮烦复。
痰饮者。水之所聚也。人身饮食之水。由口入。由膀胱出。肺气布散之。脾气渗利之。肾气蒸化之。是以泻而
不留也。此水不留。则无饮邪矣。人身津液之水。生于肾中。寄居胞室。随气而上。布于肺经。是为津液。津液
散布。则不凝结而为痰矣。
上焦血虚火盛。则炼结津液。凝聚成痰。肺为之枯。咳逆发热。稠粘滞塞。此由血虚不能养心。则心火亢甚。
克制肺金。津液不得散布。因凝结而为痰也。豁痰丸治之。二陈汤加黄连黄芩柴胡栝蒌霜亦治之。玉女
煎加茯苓白前旋复花。或保和丸。以滋肺。胃为燥土。燥气甚。则津结为痰。指迷茯苓丸主之。顽痰壅塞者。
滚痰丸治之。
痰粘喉中哽塞不下者。名梅核气证。仲景用七气汤。理气除痰。血家病此。多兼郁火。宜指迷茯苓丸。加甘
草桔梗紫苏香附旋复花薄荷射干栝蒌霜牛蒡。余按咽中乃少阴脉所绕。心经火甚。往往结聚成痰。发
为梅核。宜甘桔汤。加射干山栀子茯神连翘薄荷。再用半夏一大枚切片。醋煮三沸。去半夏。入麝香少许。
冲前药服。又冲脉亦挟咽中。若是冲气上逆。壅于咽中。而为梅核。必见颊赤气喘等证。审其挟水饮而上
者。桂苓甘草五味汤治之。审其挟痰火而上者。猪苓汤。加梅粉栝蒌霜旋复花治之。
夫痰为津液所凝。而津液之生原于肾。下焦血虚气热。津液不升。火沸为痰猪苓汤。地黄汤。加川贝母五
味子麦冬旋复花款冬花海蛤粉牛膝白前龙骨牡蛎黄柏知母等药。
饮由水气停蓄。其责在于膀胱。若膀胱之水。因寒上泛。胸腹漉漉有声。喉中潮响。咳嗽哮吼等。此为土不
治水。肺受其惫。通用二陈汤治之。六君子汤。真武汤。小青龙汤。治之。
按失血之人。由于阴虚火旺。少病寒饮者。即或咳吐涎水。审其脉滑数心烦热者。仍是火盛水溢。火逆之
至。是以水逆之甚也。其治法清火泻水。兼而行之。宜葶苈大枣泻肺汤。消化丸。及二陈汤。加芩连柴胡白
前根。参看咳嗽诸条乃详。
Prolonged illness accompanied by hiccup indicates the exhaustion of Stomach Qi. One must evaluate the pulse and symptoms to make a diagnosis; one should not conclude that death is inevitable based solely on the presence of hiccups. Patients with blood loss often experience hiccups due to the unsmooth flow of Qi. In cases of recent onset where the physical constitution is robust, it is caused by latent heat attacking and erupting; since the nature of Fire flares upward, causing Qi rebellion, hiccups occur. Treatment should clear heat and guide Qi downward, suitable for using Sanwu Tang (Three-Ingredient Decoction) or Chaihu Meilian San (Bupleurum, Plum, and Coptis Powder), added with Zhiqiao (Aurantii Fructus) and Binglang (Arecae Semen). If there is phlegm obstruction in the diaphragm, Guntan Wan (Rolling Phlegm Pill) or Zhimi Fuling Wan (Enigma Poria Pill) is appropriate. Hiccups may also be triggered by blood stasis obstruction, which must present with stabbing pain and rebellious fullness. Daxiehu Tang (Major Bupleurum Decoction) added with Taoren (Persicae Semen), Danpi (Moutan Cortex), and Sumu (Sappan Lignum) can treat this condition; Xuefu Zhuyu Tang (Blood Mansion Stasis-Expelling Decoction) is also effective. If hiccups occur in prolonged illness with a deficient physique and weak Qi, it is due to emptiness in the Stomach allowing "guest" pathogens (phlegm, fire, or Qi) to disturb the diaphragm. For phlegm-Qi obstruction, Xuanshen Daizhe Shi Tang (Inula and Hematite Decoction) or Erchen Tang (Two-Aged Decoction) added with Dingxiang (Caryophylli Flos) and Zhiqiao is suitable. For Fire-Qi rebellion, Yupian Jian (Jade Woman Decoction) added with Xuanshenhua (Inulae Flos), Daizhishi (Hematitum), and Shidi (Kaki Calyx) is appropriate; alternatively, Meilian San added with Shidi, Zhiqiao, and Wuweizi (Schisandrae Fructus) can be used. Folk treatments for hiccups often rely only on Dingxiang and Shidi; Dingxiang is warm and descends phlegm, while Shidi is cold and clears fire. These two herbs represent a compromising view, hence they are often ineffective. One must differentiate between cold and heat patterns when prescribing.
Yue (a sound associated with vomiting or belching) refers to the expulsion of Qi. This syndrome is most common in patients with blood loss due to their excess Qi. The treatment method is the same as for hiccups. Only in cases of Yue caused by food stagnation leading to congestion in the Stomach is Yueju Wan (Regulate All-Pill) added with Xuanshenhua, Zhiqiao, and Laifuzi (Raphani Semen) indicated.
The above methods all target the Stomach. However, if Heart Qi is not smooth, hiccups and Yue may also occur. It is common to see individuals who are depressed, with unsmooth Heart Qi, causing a sensation of something stuck in the chest and throat, frequently emitting Yue or hiccup sounds without relief. The treatment should clear the Heart and regulate Qi, suitable for Erchen Tang added with Huanglian (Coptidis Rhizoma), Lianqiao (Forsythiae Fructus), Niubangzi (Arctii Fructus), Jiegeng (Platycodonis Radix), Gualou Shuang (Benincasae Semen Exocarpium), Danggui (Angelicae Sinensis Radix), and Chuanbeimu (Fritillariae Cirrhosae Bulbus). See the Phlegm-Fluids section for details.
The syndromes of Phlegm-Fluids have been detailed in sections on hemoptysis, expectoration, and cough. Here, because patients with blood loss invariably have concurrent Phlegm-Fluids, I discuss them again, not fearing redundancy.
Phlegm-Fluids are the accumulation of water. Water from dietary intake enters through the mouth and exits via the Bladder. Lung Qi disperses it, Spleen Qi percolates and drains it, and Kidney Qi steams and transforms it, thus ensuring excretion without retention. If water does not retain, no Fluid pathogen arises. The body's Jin-Ye (Body Fluids) originate in the Kidneys, reside in the Bao Palace (Uterus/Bladder area), ascend with Qi, and disperse into the Lung channels, becoming Jin-Ye. When Jin-Ye disperses normally, it does not coagulate into Phlegm.
When Upper Jiao Blood deficiency leads to excess Fire, it refines and coagulates Jin-Ye into Phlegm, causing Lung dryness, coughing, air rebellion, fever, and thick, sticky, obstructive sputum. This results from Blood deficiency failing to nourish the Heart, leading to hyperactive Heart Fire that overacts on Lung Metal, preventing Jin-Ye dispersion and causing coagulation into Phlegm. Huotan Wan (Expel Phlegm Pill) treats this; Erchen Tang added with Huanglian, Huangqin (Scutellariae Radix), Chaihu (Bupleuri Radix), and Gualou Shuang also works. Yupian Jian added with Fuling (Poria), Baiqian (Cynanchi Stauntonii Radix), and Xuanshenhua, or Baohe Wan (Preserve Harmony Pill), can moisten the Lung. The Stomach is dry Earth; excessive dryness causes Jin-Ye to congeal into Phlegm, treated primarily with Zhimi Fuling Wan. Severe stubborn Phlegm obstruction is treated with Guntan Wan.
Phlegm sticking in the throat, causing a sensation of obstruction that cannot be swallowed, is called Plum-Pit Qi Syndrome. Zhang Zhongjing used Qiqi Tang (Seven-Qi Decoction) to regulate Qi and eliminate Phlegm. Patients with blood loss suffering from this often have concurrent constrained Fire, so Zhimi Fuling Wan added with Gancao (Glycyrrhizae Radix et Rhizoma), Jiegeng, Zisu (Perillae Folium), Xiangfu (Cyperi Rhizoma), Xuanshenhua, Bohe (Menthae Haplocalycis Herba), Shegan (Belamcandae Rhizoma), Gualou Shuang, and Niubangzi is suitable. My commentary notes that the throat is encircled by the Shaoyin channel; severe Heart Fire often condenses into Phlegm, forming Plum-Pit Qi. Ganjie Tang (Licorice and Platycodon Decoction) added with Shegan, Shanzhizi (Gardeniae Fructus), Fushen (Poria with Hostwood), Lianqiao, and Bohe is appropriate. Additionally, take one large Pinellia tuber, slice it, boil three times in vinegar, discard the Pinellia, add a small amount of Shexiang (Moschus), and mix with the previous decoction for administration. Furthermore, the Chong Mai (Penetrating Vessel) also runs alongside the throat. If Chong Qi rebels upward and obstructs the throat, causing Plum-Pit Qi, symptoms like red cheeks and panting will appear. If diagnosed as Chong Qi carrying Water-Fluids upward, Guiling Gancao Wuwei Zi Tang (Poria, Licorice, and Schisandra Decoction) is used. If diagnosed as Chong Qi carrying Phlegm-Fire upward, Zhuling Tang (Polyporus Decoction) added with Meifen (Prunus Mume Ash), Gualou Shuang, and Xuanshenhua is used.
Phlegm is coagulated Jin-Ye, and Jin-Ye originates from the Kidneys. Lower Jiao Blood deficiency and Qi heat prevent Jin-Ye from ascending; boiling Fire transforms into Phlegm. Treatments include Zhuling Tang and Dihuang Tang (Rehmanniae Decoction), added with Chuanbeimu, Wuweizi, Maidong (Ophiopogonis Radix), Xuanshenhua, Kuandonghua (Farfarae Flos), Haigefen (Concha Meretricis et Cyclinae), Niuxi (Achyranthis Bidentatae Radix), Baiqian, Longgu (Fossilia Ossis Mastodi et Ossis Femoris), Muli (Concha Ostreae), Huangbai (Phellodendri Cortex), and Zhimu (Anemarrhenae Rhizoma).
Fluids result from the stagnation of Water-Qi, with responsibility lying in the Bladder. If Bladder water rises due to Cold, causing gurgling sounds in the chest and abdomen, tidal sounds in the throat, coughing, and asthma, this is Earth failing to control Water, exhausting the Lung. Erchen Tang is generally used; Liujunzi Tang (Six-Gentlemen Decoction), Zhenwu Tang (True Warrior Decoction), and Xiao Qinglong Tang (Minor Green Dragon Decoction) are also applicable.
My commentary states that patients with blood loss suffer from Yin deficiency and Fire hyperactivity, rarely contracting Cold-Fluids. Even if they occasionally cough up saliva, careful examination of slippery, rapid pulses with irritability and heat reveals that this is still Fire excess overflowing Water, extreme Fire rebellion, and consequently extreme Water rebellion. The treatment should clear Fire and drain Water simultaneously. Tingli Dazao Xiefei Tang (Descurainiae Seed and Jujube Decoction to Drain the Lung), Xiaohua Wan (Digestion Pill), and Erchen Tang added with Huangqin, Huanglian, Chaihu, and Baiqian Gen (Cynanchi Atrati Radix) are suitable. Refer to the Cough sections for further details.