大意
内经有咳逆而无呃逆。大率由痰闭于上。火动于下。上注于肺。直冲清道而作声也。有阴阳之分。虚实之
别。寒热之异。不可一概混治。要知胃实则噫。胃虚则哕。（汇补）
内因
有久病胃虚者。有伤寒失下者。有痰结于上。火起于下。痰火相搏者。有胃弱阴虚。木挟火势。上凌胃土者。
有过服寒凉。胃寒而得者。有水停食郁。气逆而得者。有恚怒郁热者。有单衣着寒者。（汇补）
外候
火呃。呃声大响。乍发乍止。燥渴便难。脉数有力。寒呃。朝宽暮急。连续不已。手足清冷。脉迟无力。痰呃。呼
吸不利。呃有痰声。脉滑有力。虚呃。气不接续。呃气转大。脉虚无力。瘀呃。心胸刺痛。水下即呃。脉芤沉涩。（汇
补）
呃逆上下
中焦呃逆。其声轻而短。水谷为病也。下焦呃逆。其声恶而长。虚邪相搏也。（子昆）
呃逆虚实
不足因内伤脾胃。及大病后胃弱。多面青肢冷便软。有余因外感胃热。及大怒大饱。多面红肢热便闭。虚
者难治。实者易愈。如寻常无别症。忽然发呃者。属气逆与痰滞。（入门）
呃逆危症
伤寒及滞下后。老人。虚人。妇人产后。多有呃症者。皆病深之候也。（三因）若额上出汗。连声不绝者危。（医鉴）
脉法
浮而缓者易治。大而散者难治。结促者可治。脉代者难治。又左关弦者为木乘土。右寸数者为火刑金。俱不治。
治法
治当降气化痰和胃为主。随其所感而用药。气逆者。疏导之。食停者。消化之。痰滞者。涌吐之。热郁者。清下
之。血瘀者。破导之。若汗吐下后。服凉药过多者。当温补。阴火上冲者。当平补。虚而挟热者。当凉补。（汇补）
温补宜审
局方概用丁、附、姜、桂。温暖助火。不辨寒热。其间气实痰滞。当用开导者。若执一治之。损不足而益有余。宜
乎呃逆之必死也。（丹溪）
用药
主以二陈汤。平人气呃。加枳壳、莱菔子。食呃。加山楂、麦芽。痰火。加山栀、黄连。水气。加猪苓、泽泻。胃
虚。加人参、白术。胃寒。加丁香、炮姜。伤寒失下。主以承气汤。顽痰可吐。主以瓜蒂散。气不归原。主以八味丸。
古方用柿蒂者。取其苦温能降滞气也。
呃逆选方
陈皮汤 治痰气作呃。
陈皮（四钱） 生姜（八钱）
水煎服。
橘皮竹茹汤 治虚热痰呃。
陈皮 竹茹（各二钱） 大枣（三枚） 生姜（八分） 人参（一钱） 甘草（一钱）
柿钱散（洁古） 治虚寒作呃。
柿蒂 丁香 人参（各等分）
水煎。
丁香柿蒂散 治寒气作呃。
丁香 蒂 青皮 陈皮（各等分）
水煎。
木香调气散 治气郁气逆作呃。（方见反胃）
理中汤 治虚寒作呃（方见中寒）
参附汤 治大汗大吐大泻后。厥冷呃忒腹痛。
人参（一两） 附子（炮五钱）
姜枣煎。
大补阴丸
大补丸 治阴火上炎作呃。（二方俱见火症）
大柴胡汤（方见发热） 苏子降气汤（方见气症） 凉膈散（方见火症）
三方皆治地道不通。因而呃逆。及火郁为患者。
外治法 或以纸拈鼻嚏而止。或以诈冤盗贼而止。或鼻闻食香调气而止。皆抑之骇之。而使气下也。此
治气逆之法。若夫虚寒呃逆。用乳香、硫黄、艾叶各三钱为末。好酒一钟。煎数沸。乘热使病患鼻嗅其气。
甚者灸期门穴于乳下动处。男左女右三七壮。再不止者。灸脐下丹田二三十壮。间有活者。
[General Principle]
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) mentions "ke ni" (cough with reverse flow of qi) but does not mention "e ni" (hiccups). Generally, hiccups are caused by phlegm turbidity obstructing the upper jiao (upper burner), deficiency fire stirring in the lower jiao, heat rising to the lung, and rushing directly through the clear orifices (respiratory tract) to produce sound. Hiccups are distinguished into yin and yang syndromes, deficiency and excess patterns, and cold and heat variations; they cannot be treated uniformly without differentiation. It is important to know that when stomach qi is full, belching ("yi") occurs; when stomach qi is deficient, hiccups ("yue") occur.
[Internal Causes]
Some cases arise from chronic illness leading to stomach deficiency. Some result from shaoyang disease where purgation was missed or improperly applied. Some are due to phlegm knotting in the upper jiao and fire arising in the lower jiao, with phlegm and fire battling each other. Some stem from weak stomach and yin deficiency, where liver wood carries fire to invade stomach earth. Some are caused by excessive consumption of cold-natured medicines, resulting in stomach cold. Some arise from water retention and food stagnation causing qi rebellion. Some result from anger leading to stagnant heat. Some are contracted from exposure to cold due to insufficient clothing. (From *Zhengzhi Huibu*)
[External Manifestations]
Fire-type hiccups: Loud hiccup sounds, intermittent, accompanied by dry mouth, thirst, and difficult defecation; pulse is rapid and forceful.
Cold-type hiccups: Milder in the morning, severe in the evening, continuous, with cold hands and feet; pulse is slow and weak.
Phlegm-type hiccups: Difficulty in breathing, hiccup sounds accompanied by phlegm rattling; pulse is slippery and forceful.
Deficiency-type hiccups: Disconnected breath, feeling of large but weak qi during hiccups; pulse is empty and weak.
Blood stasis-type hiccups: Stabbing pain in the chest and heart area, hiccups occurring immediately after drinking water; pulse is floating-empty (kou), deep, or choppy. (From *Zhengzhi Huibu*)
[Hiccups: Upper vs. Lower Jiao]
Upper/Middle Jiao hiccups: The sound is light and short, usually caused by disorders of water and grain (digestion).
Lower Jiao hiccups: The sound is harsh and long, caused by the interaction of deficiency and pathogenic factors. (From Zikun)
[Hiccups: Deficiency vs. Excess]
Deficiency syndromes (Insufficiency): Often due to internal injury to the spleen and stomach, or stomach weakness after a major illness. Symptoms often include dark complexion, cold limbs, and loose stools.
Excess syndromes (Surplus): Often due to external contraction with stomach heat, or extreme anger and overeating. Symptoms often include red face, hot limbs, and constipation.
Deficiency types are difficult to treat; excess types are easy to cure. If hiccups occur suddenly without other distinct symptoms, it belongs to qi rebellion and phlegm stagnation. (From *Yixue Rumen*)
[Critical Signs of Hiccups]
After typhoid fever (shaoyang disease) and dysentery (zhixia), elderly people, those with constitutionally weak bodies, and women postpartum often present with hiccups; this indicates a deep-seated disease. (From *Sanyin Fang*) If sweat appears on the forehead and hiccups continue incessantly, the prognosis is critical. (From *Yijian*)
[Pulse Diagnosis]
Floating and moderate pulses indicate ease of treatment.
Large and scattered pulses indicate difficulty in treatment.
Knotted, intermittent, or hurried pulses are treatable.
Interchangeable (dai) pulses are difficult to treat.
Furthermore, a wiry pulse at the left guan position indicates liver wood overacting on spleen earth; a rapid pulse at the right cun position indicates fire punishing metal (lung); both are considered untreatable.
[Therapeutic Methods]
Treatment should primarily focus on descending qi, resolving phlegm, and harmonizing the stomach, prescribing medications according to the specific pathogen. For qi rebellion, guide and unblock it; for food stagnation, digest it; for phlegm obstruction, induce vomiting; for heat depression, clear and purge it; for blood stasis, break stasis and guide it out. If, after sweating, vomiting, or purging methods, too many cooling medicines were taken, warm tonification should be used. For rising ministerial fire, gentle tonification is appropriate. For deficiency with accompanying heat, cool tonification is indicated. (From *Zhengzhi Huibu*)
[Caution on Warm Tonification]
The *Jufang* (Prescriptions of the Bureau of Taiyi) generally uses Dingxiang (Clove), Fuzi (Aconite), Jiang (Ginger), and Guizhi (Cinnamon Twig) to warm and assist fire without distinguishing between cold and heat. In cases of qi excess and phlegm stagnation, opening and guiding methods should be used. If one adheres rigidly to one method, it damages the healthy qi and increases the pathogenic factor, inevitably leading to death from hiccups. (From Zhu Danxi)
[Medication Selection]
The primary formula is Erchen Tang (Two-Aged Decoction). For ordinary hiccups, add Zhike (Bitter Orange Fruit) and Laifuzi (Radish Seed). For food-related hiccups, add Shanzha (Hawthorn Fruit) and Maiya (Germinated Barley). For phlegm-fire, add Shanzhi (Gardenia Fruit) and Huanglian (Coptis Rhizome). For water qi, add Zhuling (Polyporus) and Zexie (Alisma Rhizome). For stomach deficiency, add Renshen (Ginseng Root) and Baizhu (Atractylodes Macrocephala Rhizome). For stomach cold, add Dingxiang (Clove) and Paojiang (Prepared Ginger). For shaoyang disease where purgation was missed, use Chengqi Tang (Chengqi Decoction). For stubborn phlegm that can be vomited, use Guiti San (Melon Pedicle Powder). For qi failing to return to its origin, use Bawei Wan (Eight-Ingredient Pill). Ancient formulas use Shidi (Persimmon Calyx) because its bitter-warm nature can descend stagnant qi.
[Hiccups: Selected Formulas]
Chenpi Tang (Tangerine Peel Decoction): Treats hiccups caused by phlegm and qi.
Chenpi (4 qian) Shengjiang (8 qian)
Decoct in water and take orally.
Jupi Zhuru Tang (Tangerine Peel and Bamboo Shavings Decoction): Treats deficiency-heat phlegm hiccups.
Chenpi Zhuru (2 qian each) Dazao (3 pieces) Shengjiang (0.8 fen) Renshen (1 qian) Gancao (1 qian)
Shiqian San (Jiegu): Treats hiccups caused by deficiency-cold.
Shidi Dingxiang Renshen (Equal parts)
Decoct in water.
Dingxiang Shidi San (Clove and Persimmon Calyx Powder): Treats hiccups caused by cold qi.
Dingxiang Shidi Qingpi Chenpi (Equal parts)
Decoct in water.
Muxiang Tiaoqi San (Costus Regulating Qi Powder): Treats hiccups caused by qi depression and rebellion. (Formula see Fanwei section)
Lizhong Tang (Regulate the Middle Decoction): Treats hiccups caused by deficiency-cold. (Formula see Zhonghan section)
Shenfu Tang (Ginseng and Aconite Decoction): Treats hiccups, abdominal pain, and cold extremities following massive sweating, vomiting, or diarrhea.
Renshen (1 liang) Fuzi (5 qian, prepared)
Decoct with Shengjiang and Dazao.
Dabu Yin Wan (Great Yin Tonifying Pill)
Dabu Wan (Great Tonifying Pill): Treats hiccups caused by ministerial fire flaming upward. (Both formulas see Huozheng section)
Da Chaihu Tang (Major Bupleurum Decoction) (See Refa section) Suzi Jiangqi Tang (Perilla Descending Qi Decoction) (See Qizheng section) Liangge San (Cooling Chest Powder) (See Huozheng section)
These three formulas all treat hiccups caused by blockage of the lower pathways (intestines) and fire depression.
[External Treatment Methods]
One may stop hiccups by stimulating the nasal mucosa with paper twists to induce sneezing, or by pretending to accuse someone of theft to startle the patient, or by having the patient smell food aromas to regulate qi. These are methods of suppression and startling to make the qi descend. This treats qi rebellion. For deficiency-cold hiccups, use Xurxiong (Frankincense), Liuhuang (Sulfur), and Aiye (Mugwort Leaf), each 3 qian, ground into powder. Mix with one cup of good wine, boil briefly, and let the patient inhale the vapor while hot. For severe cases, moxa the Qimen acupoint (located below the nipple at the pulsating point), 27 or 39 moxa cones for men on the left side and women on the right side. If it persists, moxa the Dantian acupoint below the navel for 20-30 cones. There are occasional recoveries.