韵书∶HT 与KT 通，气上逆作声之名也。古方皆以KT 为咳逆，诸书又多误以咳嗽为咳逆，孙真人又误以哕为
咳逆，亦有书为吃逆者，皆误也。KT ，于立切。
论
《内经》曰∶诸逆冲上，皆属于火。丹溪曰∶KT ，病气逆也，以其气自脐下直冲，上出于口之名也。东垣谓火与
元气不两立，又谓火为元气之贼。古方悉以胃弱言之而不及火，且以丁香、柿蒂、竹茹、陈皮等剂治之。未审孰为降火，
孰为补虚？人之阴气根据胃为养，胃土损伤则木来侮之矣，谓之土败木贼也。阴为火所乘不得内守，木挟相火之势，故其
气直冲清道而上。言胃弱者，阴弱也，虚之甚也，病者见此似为危证。根据正法而治之者，尚不能保其一、二，而况误医
者乎。虽然，亦有因实而为KT 者，不可不审。或因饮食太过，填塞胸中，而气不得升降者。或有痰闭于上，火起于下，
而气不得伸越者。有为伤寒热病，阳明内实，过期而失下，清气不得升，浊气不得降，以致气不宣通而发KT 者。凡若
此者，皆实证也。医者宜专心致意，察审虚实而调治之，不可妄为处治，以夭人之天年也，幸甚。
脉法
脉浮而缓者，易治；弦急而按之不鼓者，难治。脉结或促或微，皆可治。脉代者危。右关脉弦者，木乘土位，难治。
方法
丹溪曰∶大率有痰，有气虚，有虚火上冲，视有余不足治之。痰与食在上者吐之，人参芦、稀涎散之类。
不足者补之，人参、白术煎汤下大补丸。
痰用陈皮、半夏，气虚用人参、白术，阴火用黄连、黄柏、滑石，或吐或补，随证施治。
KT 逆自利，滑石、甘草、黄柏、芍药、人参、白术、陈皮，加竹沥服。
痢疾发KT ，用人参白术煎汤，调益元散频服，自止。
（以上丹溪方法凡六条）
陈皮竹茹汤（活人） 治伤寒余热未解，气虚发KT 。
甘草（炙，一钱） 人参（二钱） 陈皮（去白，三钱） 青竹茹（四钱）
上细切，作一服，加生姜三片，大枣一枚，水煎服。
橘皮半夏生姜汤 治气虚有痰发KT 。
陈皮 半夏 干生姜 人参 通草（各一钱）
上细切，作一服，水一盏半，煎至一盏，去渣温服。
六君子汤（局方） 治痰挟气虚发KT 。
陈皮（一钱） 半夏（一钱五分） 茯苓（一钱） 甘草（一钱） 人参（一钱） 白术（一钱五分）
上细切，作一服，加大枣二枚，生姜三片，新汲水煎服。
（丹溪活套）云∶凡伤寒发KT 有四证，不可不辨。有中气不足，脉虚微，气不相续而发KT 者，宜用补中益气
汤加生脉散、黄柏以降虚火，或少加附子，服之立愈。有阳明内实，失下而发KT 者，宜大承气汤下之而愈。有渴而饮
水太过，成水结胸，而又发KT 者，宜小陷胸汤，或用小青龙汤去麻黄，加附子，治水寒相搏发KT ，大妙。有传
经伤寒热证，医者误用姜、桂等热药，助起火邪，痰火相搏而为咳逆者，宜用黄连解毒、白虎汤及竹沥之类治之。
（祖传方）
灸咳逆法∶
乳根二穴，直乳下一寸六分，妇人在乳房下起肉处陷中，灸七壮即止，其效如神。
又气海一穴，直脐下一寸半，灸三七壮，立止。
（医案）
东阳李氏子，病伤寒阳明内实，医与补药治而成发KT ，十日后召予。诊其脉长而实大，与大承气汤大下之，热退
而KT 亦止。
盘松周氏子，得伤寒证，七日热退而KT 连声不绝。举家 徨，召予诊其脉，六脉皆沉细无力，人倦甚。以补中益
气汤作大剂，加炮附子一钱，一日三帖，兼与灸乳根、气海三处，当日KT 止，脉亦充而平安。
韵书指出：哕（yuě，打嗝）与咳逆相通，是指气机上逆发出声音的名称。古方都将咳逆作为哕的称呼，许多书籍又错误地将咳嗽称为咳逆，孙思邈又错误地将呃逆称为咳逆，也有书籍写作吃逆的，这些都是错误的。咳逆，读音为“于立切”。
论述
《黄帝内经》说：各种气机上冲向上的病症，都归属于火证。朱丹溪说：哕，是病气上逆，因为气从脐下直冲而上，出于口部的名称。李东垣认为火与元气不能两立，又说火是元气的贼害。古方全部将其归咎于胃弱，而没有提及火邪，并且用丁香、柿蒂、竹茹、陈皮等药剂来治疗。没有弄清楚哪一种是降火，哪一种是补虚。人的阴气依靠胃土来滋养，如果胃土受损，那么肝木就会来克制它，这叫做土败木贼。阴气被火邪所乘，不能在内守持，肝木挟带相火之势，所以气直接冲入清道而上行。说胃弱的，其实是阴气虚弱，是非常严重的虚证，患者出现这种情况看似是危重证候。按照正确的方法治疗，尚且不能保全十分之一二，何况误治的医生呢。虽然如此，也有因为实证而导致哕的，不可不仔细审察。有的因为饮食过量，填塞胸中，导致气机不得升降；有的因为痰浊闭塞于上，火邪起于下，导致气机不得舒展升越；有的因为伤寒热病，阳明腑实，过期未能攻下，清气不得上升，浊气不得下降，以致气机宣通受阻而发哕。像这些情况，都是实证。医生应该专心致志，仔细辨别虚实并进行调理治疗，不可妄加处置，以免折损人的寿命，那就万幸了。
脉法
脉象浮而缓的，容易治疗；脉象弦急且按之无力鼓动的，难治。脉象结代或促或微细的，都可以治疗。脉象代的则危险。右关脉弦的，是肝木乘克脾土，难治。
治疗方法
朱丹溪说：大率来说，有痰阻的，有气虚的，有虚火上冲的，要视其有余还是不足来治疗。痰和食积在上焦的，用吐法，如人参芦、稀涎散之类。
不足的，用补法，用人参、白术煎汤送服大补丸。
痰证用陈皮、半夏，气虚用人参、白术，阴火用黄连、黄柏、滑石，或者用吐法或者用补法，随证施治。
哕逆兼腹泻的，用滑石、甘草、黄柏、芍药、人参、白术、陈皮，加竹沥服用。
痢疾并发哕逆的，用人参、白术煎汤，调服益元散频繁服用，自然停止。
（以上丹溪的治疗方法共六条）
陈皮竹茹汤（出自《类证活人书》） 治疗伤寒余热未解，气虚引发的哕逆。
甘草（炙，一钱） 人参（二钱） 陈皮（去白，三钱） 青竹茹（四钱）
以上切碎，作一剂服用，加生姜三片，大枣一枚，水煎服。
橘皮半夏生姜汤 治疗气虚有痰引发的哕逆。
陈皮 半夏 干生姜 人参 通草（各一钱）
以上切碎，作一剂服用，水一盏半，煎至一盏，去渣温服。
六君子汤（出自《太平惠民和剂局方》） 治疗痰湿挟气虚引发的哕逆。
陈皮（一钱） 半夏（一钱五分） 茯苓（一钱） 甘草（一钱） 人参（一钱） 白术（一钱五分）
以上切碎，作一剂服用，加大枣二枚，生姜三片，新汲水煎服。
（丹溪活套）说：凡是伤寒引发的哕逆有四证，不可不辨别。有中气不足，脉象虚微，气不相接续而发哕的，宜用补中益气汤加生脉散、黄柏以降虚火，或少加附子，服用后立刻痊愈。有阳明腑实，失于攻下而发哕的，宜用大承气汤攻下而愈。有口渴饮水过多，形成水结胸，而又发哕的，宜用小陷胸汤，或者用小青龙汤去掉麻黄，加附子，治疗水寒相搏引发的哕逆，效果极大。有传经伤寒热证，医生误用姜、桂等热药，助起火邪，痰火相搏而成为咳逆的，宜用黄连解毒汤、白虎汤及竹沥之类治疗。
（祖传方）
灸治咳逆法：
乳根穴两个，位于乳头下一寸六分，妇女在乳房下隆起处的凹陷中，灸七壮即止，效果神奇。
另外取气海穴一个，位于脐下一寸半，灸二十一壮，立刻停止。
（医案）
东阳李氏的儿子，患伤寒阳明腑实证，医生给予补药治疗反而引发哕逆，十日后请我诊治。诊得脉象长而实大，给予大承气汤大力攻下，热退而哕逆也停止了。
盘松周氏的儿子，得了伤寒证，七天后热退但哕逆连声不绝。全家惊慌，请我诊脉，六脉皆沉细无力，人非常疲倦。用补中益气汤做大剂量，加炮附子一钱，一天服三帖，同时灸乳根、气海三处穴位，当天哕逆停止，脉象也变得充盈而平安。
According to rhyme books: Yuě (belching/hiccup) is interchangeable with Ke Ni, referring to the name for sounds made by rebellious Qi moving upward. Ancient prescriptions all referred to Ke Ni as Yuě. Many texts further erroneously refer to coughing as Ke Ni. Sun Simiao erroneously referred to hiccups as Ke Ni. Some texts write it as Chi Ni. All these are errors. "Ke Ni" is pronounced "Yu Li Qie".
Discussion
The *Huangdi Neijing* states: "All rebellious movements rushing upward belong to Fire." Zhu Danxi stated: "Ke Ni is a disease of rebellious Qi; it is named so because Qi rushes straight up from below the navel and exits through the mouth." Li Dongyuan stated that Fire and Yuan Qi (Original Qi) cannot coexist, and further described Fire as the thief of Yuan Qi. Ancient prescriptions attributed this entirely to Stomach Weakness without mentioning Fire, and treated it with formulas containing Ding Xiang (Clove), Shi Di (Persimmon Calyx), Zhu Ru (Bamboo Shavings), and Chen Pi (Tangerine Peel). They failed to discern which methods reduce Fire and which tonify Deficiency. Human Yin Qi relies on the Stomach Earth for nourishment; if Stomach Earth is damaged, Liver Wood will invade it, a condition called "Earth Failure and Wood Invasion." When Yin is overwhelmed by Fire and fails to remain within, Liver Wood, carrying the momentum of Ministerial Fire, causes Qi to rush directly upward through the clear orifices. When it is said that the Stomach is weak, it actually refers to Yin Deficiency, specifically severe Deficiency. Patients presenting with this appear to have a critical condition. Even when treated according to correct principles, only one or two out of ten may be saved, let alone those subjected to misdiagnosis and mistreatment. Nevertheless, there are cases where Ke Ni arises from Excess patterns, which must not be overlooked. For instance, excessive food intake may block the chest, preventing the ascending and descending of Qi. Phlegm obstruction in the upper Jiao combined with Fire arising in the lower Jiao can prevent Qi from extending freely. In cases of Cold-Heat complex or febrile diseases, Yangming Interior Excess may occur; if purgation is delayed past the appropriate time, Clear Qi cannot ascend and Turbid Qi cannot descend, leading to blocked Qi circulation and resulting in Ke Ni. All such cases constitute Excess patterns. Physicians should focus attentively, carefully distinguish between Excess and Deficiency, and regulate treatment accordingly. One must not prescribe recklessly, thereby shortening a person's natural lifespan; this would be fortunate indeed.
Pulse Diagnosis
A pulse that is Floating and Slow indicates an easy-to-treat condition. A pulse that is Wiry and Rapid but lacks force upon deep pressure indicates a difficult-to-treat condition. Knotted (Jie), Surging (Cu), or Minute pulses can generally be treated. A Replacement (Dai) pulse indicates a critical prognosis. A Wiry pulse at the Right Guan position indicates Liver Wood invading Spleen Earth, which is difficult to treat.
Treatment Methods
Zhu Danxi stated: Generally, there are cases due to Phlegm, Qi Deficiency, or Deficient Fire rushing upward; treatment should be based on whether there is Excess or Deficiency. If Phlegm and Food stagnation are located in the Upper Jiao, induce vomiting using substances like Ren Shen Lu (Ginseng Stalk) or Xi Yan San (Spittle-Inducing Powder).
For Deficiency, use tonification, such as decocting Ren Shen (Ginseng) and Bai Zhu (Atractylodes Macrocephala Rhizome) and administering Da Bu Wan (Great Tonifying Pill) with the liquid.
For Phlegm, use Chen Pi (Tangerine Peel) and Ban Xia (Pinellia Tuber); for Qi Deficiency, use Ren Shen and Bai Zhu; for Yin Fire, use Huang Lian (Coptis Rhizome), Huang Bo (Phellodendron Bark), and Hua Shi (Talcum). Treatment involves either inducing vomiting or tonifying, depending on the syndrome.
For Ke Ni accompanied by diarrhea, use Hua Shi, Gan Cao (Licorice Root), Huang Bo, Shao Yao (Peony Root), Ren Shen, Bai Zhu, and Chen Pi, taken with Zhu Li (Bamboo Sap).
For Ke Ni occurring during Dysentery, decoct Ren Shen and Bai Zhu, mix with Yi Yuan San (Benefit Prime Powder), and administer frequently until it stops naturally.
(Above are six methods from Danxi.)
Chen Pi Zhu Ru Tang (from *Lei Zheng Huo Ren Shu*) treats Ke Ni caused by unresolved residual heat from Taiyang Cold Damage and Qi Deficiency.
Gan Cao (roasted, 1 qian), Ren Shen (2 qian), Chen Pi (peeled, 3 qian), Qing Zhu Ru (green bamboo shavings, 4 qian).
Finely chop, prepare as one dose. Add three slices of Sheng Jiang (Fresh Ginger) and one date. Decoct in water and take warm.
Ju Pi Ban Xia Sheng Jiang Tang treats Ke Ni caused by Qi Deficiency with Phlegm.
Chen Pi, Ban Xia, Gan Sheng Jiang (Dried Fresh Ginger), Ren Shen, Tong Cao (Tetrapanax Pith) (each 1 qian).
Finely chop, prepare as one dose. Use 1.5 cups of water, decoct to 1 cup, remove dregs, and take warm.
Liu Jun Zi Tang (from *Tai Ping Hui Min He Ji Ju Fang*) treats Ke Ni caused by Phlegm complicated by Qi Deficiency.
Chen Pi (1 qian), Ban Xia (1.5 qian), Fu Ling (Poria), Gan Cao (1 qian), Ren Shen (1 qian), Bai Zhu (1.5 qian).
Finely chop, prepare as one dose. Add two dates and three slices of Sheng Jiang. Decoct in fresh drawn water and take.
(Danxi Flexible Application) states: There are four syndromes of Ke Ni arising from Cold Damage that must be distinguished.
1. Those with Middle Qi Deficiency, with a deficient and minute pulse, where Qi fails to connect continuously, causing Ke Ni. These should be treated with Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) added with Sheng Mai San (Generate the Pulse Powder) and Huang Bo to descend Deficient Fire, or with a small addition of Fu Zi (Aconite Lateral Root) to achieve immediate recovery.
2. Those with Yangming Interior Excess who suffered from missed purgation, causing Ke Ni. These should be treated with Da Cheng Qi Tang (Major Order the Qi Decoction) to purge and cure.
3. Those who drank too much water due to thirst, forming Water Binding in the Chest, and developed Ke Ni. These should be treated with Xiao Xian Xiong Tang (Minor Infiltrating the Chest Decoction), or Xiao Qing Long Tang (Minor Green Dragon Decoction) with Ma Huang (Ephedra Stem) removed and Fu Zi added, to treat Ke Ni caused by the struggle between Water and Cold. This is highly effective.
4. Those with transmitted Cold Damage Heat syndromes where physicians mistakenly used hot herbs like Jiang (Ginger) and Gui (Cinnamon Twig), assisting Fire pathogenic factors. The struggle between Phlegm and Fire results in Ke Ni. These should be treated with Huang Lian Jie Du Tang (Coptis Decoction to Relieve Toxicity), Bai Hu Tang (White Tiger Decoction), and Zhu Li.
(Ancestral Prescription)
Moxibustion Method for Ke Ni:
Rugen (ST 17): Two points, located 1.6 cun directly below the nipple. In women, locate the depression in the fleshy prominence below the breast. Moxa seven cones (zhuang) and stop. The effect is miraculous.
Qihai (CV 6): One point, located 1.5 cun directly below the umbilicus. Moxa twenty-one cones (three sevens), and it stops immediately.
Medical Case
The son of Mr. Li from Dongyang suffered from Yangming Interior Excess due to Cold Damage. A physician administered tonifying medicines, which resulted in the onset of Ke Ni. Ten days later, he summoned me. I palpated his pulse, finding it Long and Solid-Large. I administered Da Cheng Qi Tang to purge vigorously. The heat subsided, and the Ke Ni stopped.
The son of Mr. Zhou from Pansong contracted a Cold Damage syndrome. After seven days, the fever subsided, but Ke Ni continued incessantly. The whole family was panicked and summoned me. I palpated his pulse and found all six positions to be Deep, Fine, and Forceless; the patient was extremely fatigued. I prepared a large dose of Bu Zhong Yi Qi Tang, adding 1 qian of Pao Fu Zi (Prepared Aconite). He took three doses in one day. Simultaneously, I applied moxibustion to Rugen and Qihai. On that same day, the Ke Ni stopped, his pulse became full, and he recovered safely.