经云。寒气客于胃。厥逆从下上散。复出于胃。故为噫。大抵此症。伤寒汗吐下后。或
大病后多有。盖汗下后。邪气虽解。胃气弱而不和。三焦失职。清不能升。浊不能降。
是以余邪留连于胃。嗳酸作饱。胸脘不爽。仲景所谓心下痞硬。噫气不除是也。治
以旋复代赭汤。所以宣阳气而镇阴逆。阳气宣达。则阴邪不得阻格。升降顺。痞硬散。而噫气自除矣。
邵评∶中阳虚弱。寒气入胃。寒挟胃气上逆。升而不降。气从喉出有声。为噫气也。
嗳气者。因气抑遏不宣。上逆作声而嗳气。每有饱食之后而作者。可知其因于
胃气郁滞也。二症不同。噫气为虚。嗳气为实。当分别施治。惟噫气每于汗下或
大病后见者。是中虚胃弱。气机不和。余邪留伏。清浊升降。不得自如。气逆为噫
也。若胃有停滞。而挟肝火。则嗳酸饱闷。浊凝气滞。则心气痞硬而噫气。此方补
中通阳。软坚开痞。而镇浊逆。的是良法。
若湿饮内伤。阴浊聚胃。以致胃阳受伤。浊阴上犯。噫气嗳酸。中焦格拒。治宜安益
胃阳。以镇阴逆。人参、半夏、茯苓、干姜、旋复花、代赭石主之。（此条参叶案）
邵评∶湿饮阴浊内聚。胃阳虚弱失运。气逆不降。中脘格拒而噫气。乃阳虚浊逆之症也。
当以开痞镇逆。通补阳明为治。
《内经》说：寒气侵袭胃腑，厥逆之气从下向上散发，又出于胃，所以产生噫气（打嗝）。大抵这种病症，多在伤寒经过发汗、催吐或泻下治疗后出现，或者在大病之后常见。这是因为汗法、下法之后，虽然邪气已解，但胃气虚弱而不和调，三焦功能失职，清气不能上升，浊气不能下降，因此余留的邪气滞留于胃中，导致嗳出酸水、感觉饱胀，胸脘部不适。这正是张仲景所说的“心下痞硬，噫气不除”的情况。治疗使用旋复代赭汤，以此来宣通阳气而镇摄阴寒之逆气。阳气宣通达畅，则阴邪不得阻格，升降功能恢复正常，痞硬消散，噫气自然消除。
邵评注：中焦阳气虚弱，寒气侵入胃中，寒气挟带胃气上逆，只升不降，气体从喉咙发出声音，称为噫气。嗳气，是因为气机被抑制遏止而不能宣散，向上逆行发出声音而形成的嗳气，常常在饱食之后发生，可知其原因是胃气郁滞。这两种症状不同，噫气属于虚证，嗳气属于实证，应当分别施治。只有噫气多见于发汗、泻下后或大病之后，这是中气虚弱、胃气衰弱，气机不和，余邪潜伏，清浊升降失常，气机上逆形成噫气。如果胃中有停滞之物，且挟有肝火，就会出现嗳酸、饱闷；浊气凝结、气机阻滞，就会导致心下部痞硬并伴有噫气。此方能够补益中气、通达阳气、软化坚结、开泄痞塞，并镇摄浊气上逆，确实是良法。
如果是湿邪和饮邪内伤，阴浊聚集于胃，导致胃阳受损，浊阴之气上犯，出现噫气、嗳酸，中焦格拒不通，治疗应当安养补益胃阳，以镇摄阴寒之逆气。用人参、半夏、茯苓、干姜、旋复花、代赭石为主药。（此条参考叶天士医案）
邵评注：湿饮等阴浊之气内聚，胃阳虚弱失去运化功能，气机上逆不降，中脘部格拒不通而产生噫气，这是阳虚浊逆的病症。应当以开泄痞塞、镇摄逆气、通补阳明经为治疗方法。
The *Neijing* states: When cold qi invades the stomach, jue-ni (rebellious counterflow) scatters from below upwards and re-emerges from the stomach; thus, yi-qi (belching/hiccuping) occurs. Generally, this syndrome often appears after sweating, vomiting, or purging treatments for Shanghan (Cold Damage), or following severe illnesses. This is because after sweating and purging, although the pathogenic factors are resolved, the Stomach Qi becomes weak and disharmonious. The Sanjiao (Triple Burner) fails in its duties, causing clear Yang to fail to ascend and turbid Yin to fail to descend. Consequently, residual pathogens linger in the Stomach, leading to belching of sour fluid, a sensation of fullness, and discomfort in the chest and epigastrium. This corresponds to what Zhang Zhongjing described as "fullness and hardness below the heart, with persistent belching." The treatment employs Xuanfu Daizhe Tang (Inula and Hematite Decoction) to diffuse Yang Qi and suppress rebellious Yin Cold. Once Yang Qi is diffused and unobstructed, Yin pathogens cannot block the flow, the ascending and descending functions normalize, the fullness and hardness dissipate, and the belching naturally ceases.
Shao's Commentary: Deficiency of Middle Jiao Yang allows cold qi to enter the Stomach. The cold carries Stomach Qi upward in rebellion, rising without descending, producing sound from the throat, known as yi-qi. Ai-qi (belching) occurs when Qi is constrained and unable to disperse, rebelling upward to produce sound. It often happens after overeating, indicating that the cause is stagnation of Stomach Qi. These two syndromes differ: yi-qi is a deficiency pattern, while ai-qi is an excess pattern; they must be treated differently. Yi-qi typically appears after sweating/purging or severe illness, indicating Middle Qi deficiency, weak Stomach Qi, disharmony of Qi mechanism, lingering latent pathogens, and failure of clear/turbid separation, resulting in rebellious Qi forming yi-qi. If there is food stagnation in the Stomach accompanied by Liver Fire, one experiences sour belching and distension. If turbidity congeals and Qi stagnates, it leads to epigastric fullness/hardness and belching. This formula tonifies the Middle, diffuses Yang, softens hardness, opens obstruction, and suppresses rebellious turbidity, which is indeed an excellent method.
If dampness and fluid retention injure internally, causing Yin turbidity to gather in the Stomach, damaging Stomach Yang, and allowing turbid Yin to rebel upward, resulting in belching and sour eructation with rejection at the Middle Jiao, the treatment should nourish and benefit Stomach Yang to suppress Yin rebellion. The main herbs are Renshen (Ginseng Radix), Banxia (Pinelliae Rhizoma), Fuling (Poria), Ganjiang (Zingiberis Rhizoma), Xuanfuhua (Inulae Flos), and Daizheshi (Hematitum). (Refer to Ye Tianshi's medical cases for this clause.)
Shao's Commentary: Internal accumulation of Yin turbidity such as dampness and fluids, combined with deficient Stomach Yang failing to transport, causes rebellious Qi that does not descend. Rejection at the Zhongwan region leads to belching; this is a syndrome of Yang deficiency with turbid rebellion. Treatment should focus on opening obstruction, suppressing rebellion, and unblocking and tonifying the Yangming channel.