世有呃证，而经论有哕无呃，宁后世言呃，而古时言哕耶？《诗》云∶鸾声哕哕。谓声有节奏也。人之发
呃，匀匀而来，亦有节奏，故经论之哕，有作呃解。呃之微者，名曰KT 。呃有逆呃，有虚呃，有败呃。
逆呃者，膈中有寒，胃气从胸上膈，膈寒，其气停止，止而复出，则呃也，此膈寒气逆而呃。呃之至轻者，辛
散温行，数剂可愈。若病伤寒，而三焦不和，胃中留滞，上焦不能如雾之灌溉，中焦不能如沤之腐化，下焦不
能如渎之济
泌，则上脘、中脘、下脘之胃气，亦因以不和。三焦者，胃外之然也。今三焦火热之气，内不和于胃，外不
达于肌，蕴热上冲，发为逆呃。斯时热者清之，寒者温之，正虚邪实者，补而导之，不虚但实者，泄而通之，
平胃、泻心，皆可用也。张洁古治逆呃，有丁香辛香暖胃，柿蒂苦涩清凉，是三焦郁滞之呃相宜，而虚呃、败呃
不相宜也。虚呃者，人病伤寒，绝其谷气，中胃空虚，复加寒凉消导；中胃既虚，而三焦火热之气亦失其职，
阳明胃土不能合三焦出气以温肌肉，寒气凝滞，正气内虚，则呃矣。参、术、桂、附可以治之，然必能食则可
治，不能食则不可治矣。又有泄泻下痢，下焦虚寒，谷入少，而中、上二焦亦虚而寒，以致呃者，亦为虚呃。
败呃者，病起于阴，肾脏先虚，不救其虚，反以实治，致胃腑亦虚，于是戊癸不合，火无生原，发而为呃，
是为败呃，百无一生，虽有参、附，亦徒然耳！然虚呃不愈，则转为败呃，医者又不可不知也。
世间有呃逆这种病证，但经典医论中只提到“哕”而没有提到“呃”，难道是后世说“呃”，而古代说“哕”吗？《诗经》中说：“鸾声哕哕。”意思是声音有节奏。人发出呃逆的声音，也是一阵阵均匀地来，也有节奏，所以经典医论中的“哕”，可以解释为“呃”。呃逆轻微的，名叫“嗳气”（此处原文作KT，据语境及中医常识推测可能指代轻微呃逆或嗳气类症状，依原文保留KT或理解为轻微呃逆之别名）。呃逆分为逆呃、虚呃、败呃三种。
所谓逆呃，是膈间有寒邪，胃气从胸上行至膈，因膈部受寒，气机停止，停住后又复出，这就形成了呃逆，这是膈间寒气上逆导致的呃逆。呃逆中最轻的，用辛散温通的方法，服几剂药就可以痊愈。如果患伤寒病，导致三焦不和，胃中有留滞，上焦不能像雾露一样灌溉全身，中焦不能像沤渍一样腐熟水谷，下焦不能像沟渠一样分别清浊，那么上脘、中脘、下脘的胃气，也因此而不和。三焦，是包裹在胃外面的腑。如今三焦火热之气，在内不与胃调和，在外不达于肌表，蕴积的热气上冲，引发逆呃。此时，热者清热，寒者温阳，正气虚弱而邪气实者，补益兼疏导；正气不虚而仅邪气实者，泻下兼通利，平胃散、泻心汤等方剂都可以使用。张洁古治疗逆呃，用丁香的辛香暖胃，柿蒂的苦涩清凉，这适合三焦郁滞引起的呃逆，但不适合虚呃和败呃。
所谓虚呃，是人患伤寒病，断绝了谷气，导致中焦胃腑空虚，又加上误用寒凉消导的药物；中焦胃气既已虚弱，三焦火热之气也失去了正常职能，阳明胃土不能配合三焦出气以温养肌肉，寒气凝滞，正气内虚，从而产生呃逆。人参、白术、桂枝、附子可以治疗此证，但必须病人还能进食才可以治疗，如果不能进食则不可治。又有泄泻下痢，导致下焦虚寒，饮食摄入少，进而中焦、上焦二焦也虚而寒，以致发生呃逆的，这也属于虚呃。
所谓败呃，是疾病起于阴分，肾脏先虚，不救治其虚损，反而用攻实的方法治疗，导致胃腑也虚，于是戊（胃）癸（肾）不合，火没有生源，引发呃逆，这就是败呃，百无一活，即使有人参、附子，也是徒劳！然而虚呃如果不愈，就会转为败呃，医者对此不可不知道。
There is a condition known as hiccup (E'ze, hiccup) in the world, yet classical treatises mention "yue" (Yue, ancient term for hiccup or belching) but not "e". Is it that later generations spoke of "e", while ancients spoke of "yue"? The *Book of Songs* states: "The sound of the bells rings with rhythm." This means the sound has a rhythm. When a person hiccups, the sounds come in regular intervals, also possessing a rhythm; therefore, the "yue" mentioned in classical treatises can be interpreted as "e" (hiccup). Mild cases of hiccup are called KT [Note: Textual anomaly, likely refers to mild hiccup or belching]. Hiccup is categorized into Reversal Hiccup (Ni'e), Deficiency Hiccup (Xu'e), and Debilitated Hiccup (Bai'e).
Reversal Hiccup (Ni'e) arises from cold in the diaphragm. Stomach Qi ascends from the chest to the diaphragm; due to cold in the diaphragm, the Qi stagnates, stops, and then bursts forth, causing hiccup. This is hiccup caused by the reversal of cold Qi in the diaphragm. For the mildest forms of hiccup, pungent dispersing and warming methods can cure it after a few doses. If one suffers from Cold Damage (Shanghan, damage by cold pathogens) leading to disharmony of the Triple Burner (Sanjiao, the three cavities regulating fluid metabolism and Qi movement), with retention in the stomach, the Upper Burner cannot irrigate like mist, the Middle Burner cannot ferment and transform like a soak, and the Lower Burner cannot separate clear from turbid like a ditch. Consequently, the Stomach Qi in the Upper, Middle, and Lower Confluences (Wei Guan) becomes disharmonious. The Triple Burner is the organ surrounding the Stomach. Currently, the fiery Qi of the Triple Burner fails to harmonize internally with the Stomach and fails to reach the exterior muscles externally. Accumulated heat rushes upward, triggering Reversal Hiccup. At this time, heat should be cleared, cold should be warmed, cases with both deficiency and excess should be tonified and guided, and cases with pure excess should be purged and unblocked. Formulas such as Pingwei San (Calm the Stomach Powder) and Xiexin Tang (Drain the Epigastrium Decoction) may be used. Zhang Jiegu treated Reversal Hiccup using Dingxiang (Caryophylli Flos, Clove) for its pungent aroma to warm the Stomach, and Shidi (Diospyri Fructus Calyx, Persimmon Sepal) for its bitter-astringent and cooling properties. This combination is suitable for hiccup caused by stagnation in the Triple Burner, but not for Deficiency Hiccup or Debilitated Hiccup.
Deficiency Hiccup (Xu'e) occurs when a patient with Cold Damage loses their grain Qi, leaving the Middle Stomach empty, compounded by the misuse of cold-natured digestive aids. With the Middle Stomach already deficient, the fiery Qi of the Triple Burner also loses its function. The Yangming Stomach Earth cannot combine with the exiting Qi of the Triple Burner to warm the muscles. Cold Qi condenses and stagnates, and internal Righteous Qi (Zhengqi, vital energy) becomes deficient, resulting in hiccup. Ren Shen (Ginseng Radix et Rhizoma, Ginseng), Bai Zhu (Atractylodis Macrocephalae Rhizoma, Atractylodes), Gui Zhi (Cinnamomi Ramulus, Cinnamon Twig), and Fu Zi (Aconiti Lateralis Radix Praeparata, Prepared Aconite Root) can treat this, but treatment is only viable if the patient can eat; if they cannot eat, it is untreatable. Additionally, diarrhea and dysentery causing deficiency-cold in the Lower Burner, reduced food intake, and subsequent deficiency-cold in the Middle and Upper Burners, leading to hiccup, also fall under Deficiency Hiccup.
Debilitated Hiccup (Bai'e) originates in the Yin aspect, where the Kidney (Shen, kidney) is initially deficient. Instead of treating the deficiency, practitioners mistakenly use methods for excess conditions, rendering the Stomach organ also deficient. Thus, Wu (Stomach/Earth) and Gui (Kidney/Water) fail to interact, Fire lacks its source, and hiccup erupts. This is Debilitated Hiccup, which is almost invariably fatal; even with Ren Shen and Fu Zi, treatment is futile. However, if Deficiency Hiccup remains uncured, it transforms into Debilitated Hiccup, a progression physicians must recognize.