能营运其水耳。水壅胃中。中气遏绝。气逆而作呃逆也。治法当拟用五苓散。理中汤。甚者四逆汤可耳。
宗印云。此章。与辨脉篇之医不知。而反饮冷水。令大汗出。水得寒气。冷必相搏。其人即KT 。大意
相同。程云。点出胃中寒冷字。是亦吴茱萸汤之治也。汪云。理中汤亦可借用之。
活人书云。橘皮干姜汤。羌活附子散。半夏生姜汤。退阴散。
伤寒哕而腹满。视其前后。知何部不利。利之即愈。（玉函。视。作问。成本。即。作则。）
〔锡〕伤寒至哕。非中土败绝。即胃中寒冷。然亦有里实不通。气不得下泄。反上逆而为哕者。玉机真
藏论曰。脉盛。皮热。腹胀。前后不通。闷瞀。此谓五实。身汗得后利。则实者活。今哕而腹满。前后不利。
五实中之二实也。实者泻之。前后。大小便也。视其前后二部之中。何部不利。利之则气得通。下泄而不上逆。
哕即愈矣。夫以至虚至寒之哕证。而亦有实者存焉。则凡系实热之证。而亦有虚者在矣。医者能审其寒热虚实。
而为之温凉补泻于其间。则人无夭札之患矣。〔汪〕常器之云。前部不利。猪苓汤。后部不利。调胃承气汤。
愚以须小承气汤利之。
案常氏原于活人。盖前部不利。五苓散。猪苓汤。后部不利。宜三承气。撰而用之。仲景不载主方。意
在于此耶。
水液能够正常营运流动。若水湿壅滞于胃中，导致中焦之气被遏制阻断，气机上逆就会引发呃逆。治疗方法应当考虑使用五苓散、理中汤；病情严重的，可以使用四逆汤。
宗印评论说：这一章的内容，与《辨脉篇》中所述医生不知病机，反而让患者饮用冷水，导致大汗出，水液遇到寒气，寒冷相互搏结，患者随即出现噎塞（KT，此处疑为“噎”或类似症状的异体字/通假字）的情况，大意是相同的。程云波指出，点出了“胃中寒冷”这几个字，这也是吴茱萸汤的治疗范畴。汪昂认为，理中汤也可以借用。
《活人书》提到：橘皮干姜汤、羌活附子散、半夏生姜汤、退阴散。
伤寒病中出现呃逆且腹部胀满，应观察其前阴和后阴，知道哪一部分不通利，通利它即可痊愈。（《玉函经》中，“视”作“问”；成本本作，“即”作“则”。）
〔赵嗣真评〕伤寒发展到呃逆阶段，如果不是中土之气败绝，就是胃中寒冷。然而也有因为里实不通，气机不得向下宣泄，反而上逆而导致呃逆的情况。《素问·玉机真藏论》说：脉象盛大，皮肤发热，腹部胀满，前后二便不通，胸闷昏瞀，这叫做“五实”。如果身体出汗且大小便通畅，那么实证就有生机。现在呃逆且腹部胀满，前后二便不利，这是“五实”中的两种实证表现。实证应当用泻法。前后二部，指大小便。观察前后二部中，哪一部不通利，通利它则气机得以通畅，向下宣泄而不向上逆冲，呃逆就会痊愈。即使是极度虚寒的呃逆证，其中也夹杂有实证存在；那么凡是属于实热的证候，其中也可能夹杂有虚证存在。医生如果能审察清楚寒热虚实，并在其间运用温凉补泻之法，那么病人就不会有夭折的祸患了。〔汪昂注〕常器之说：前部（小便）不利，用猪苓汤；后部（大便）不利，用调胃承气汤。我认为应该用小承气汤来通利。
按语：常氏原本依据《活人书》，大概前部不利用五苓散、猪苓汤，后部不利宜用三承气汤。编纂并采用这些方法，张仲景没有记载主方，意图是否在于此呢？
Water fluids are able to circulate and operate normally. If water-dampness stagnates in the stomach, obstructing and cutting off the Qi of the Middle Jiao (Middle Burner), the rebellious upward movement of Qi will cause hiccups (E'ni). The treatment method should consider using Wuling San (Five-Ingredient Poria Decoction) or Lizhong Tang (Regulate the Middle Decoction); in severe cases, Sini Tang (Frigid Extremities Decoction) may be used.
Zong Yin commented: The content of this chapter is similar in general meaning to that described in the "Chapter on Differentiating Pulse Patterns," where a physician, unaware of the pathology, causes the patient to drink cold water, resulting in profuse sweating. When water encounters cold pathogenic factors, the coldness mutually contends, and the patient immediately develops dysphagia/choking (KT, likely a variant for 'ye' or similar symptom). Cheng Yunbo pointed out the phrase "coldness in the stomach," indicating that this is also within the therapeutic scope of Wuzhuyu Tang (Evodia Fruit Decoction). Wang Ang believed that Lizhong Tang could also be borrowed for use.
The *Ren Shu* (Book of Vitality) mentions: Jupi Ganjiang Tang (Tangerine Peel and Dried Ginger Decoction), Qianghuo Fuzi San (Notopterygium Root and Aconite Root Powder), Banxia Shengjiang Tang (Pinellia and Fresh Ginger Decoction), and Tuiyin San (Expel-Yin Powder).
In Shaoyang disease, if hiccups occur accompanied by abdominal fullness, one should examine the anterior (urinary) and posterior (anal) orifices to determine which part is obstructed; unblocking it will lead to recovery. (*Yuhan Jing* reads "ask" instead of "examine"; Cost Edition reads "ze" instead of "ji".)
[Zhao Sizhen's Commentary] When Shanghan (Cold Damage) progresses to hiccups, it is either due to the collapse of the Earth element (Spleen/Stomach Qi) or coldness in the stomach. However, there are also cases where internal excess obstruction prevents Qi from descending, causing it to rebel upward and induce hiccups. The *Suwen: Yuji Zhenzang Lun* states: Excessive pulse, hot skin, abdominal distension, obstruction of both urination and defecation, and chest stuffiness with dizziness constitute the "Five Excesses." If sweat appears and bowel/bladder functions resume, the excess condition can be saved. Currently, hiccups with abdominal fullness and obstruction of both excretions represent two of the five excess conditions. Excess conditions should be treated with purgation. The "anterior and posterior" refer to urine and stool. By examining which of the two pathways is obstructed and unblocking it, Qi circulation is restored, allowing downward discharge without upward rebellion, thus resolving hiccups. Even in cases of extreme deficiency-cold hiccups, excess patterns may exist; conversely, in heat-excess patterns, deficiency elements may be present. If physicians can accurately distinguish between cold/heat and deficiency/excess, applying warming/cooling and tonifying/reducing methods accordingly, patients will avoid premature death. [Wang Ang's Note] Chang Qizhi stated: For anterior obstruction (urinary), use Zhuling Tang (Polyporus Decoction); for posterior obstruction (intestinal), use Xiaochengqi Tang (Minor Order the Yang Decoction). I believe Xiao Chengqi Tang should be used for purgation.
Note: Chang's original reference was based on the *Ren Shu*. Presumably, for anterior obstruction, Wuling San or Zhuling Tang were used; for posterior obstruction, the three Chengqi Decoctions were appropriate. Compiling and utilizing these methods, while Zhang Zhongjing did not record a primary formula here, perhaps his intent lay precisely in this differentiation.