寒，虚寒相搏，则为肠鸣。医见脉大，以为有热，饮以冷水，欲以水寒胜热而作汗，
里先虚寒，又得冷水与之相搏，则冷结上焦，必至咽噎塞而气逆矣。
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伤寒哕而腹满，视其前后，知何部不利，利之则愈。
【注】
伤寒哕而不腹满者，为正气虚，吴茱萸汤证也。哕而腹满者，为邪气实，视其二便何
部不利，利之则愈也。
【集注】
成无己曰：哕而腹满，气上而不下也。视其前后有不利者，即利之以降其气，前部小
便也，后部大便也。
程知曰：前部不利，后人治以五芩；后部不利，后人治以承气是也。
沈明宗曰：邪传于胃，胃气壅遏，两气相搏，气逆上冲，则为哕矣。
张锡驹曰：伤寒至哕，非胃气败，即胃中寒。然亦有里实不通，气不得下泄，反上逆
而为哕者，当详辨之。
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夫实则谵语，虚则郑声，郑声者重语也。
【注】
谵语一证，有虚有实。实则谵语，阳明热甚，上乘于心，乱言无次，其声高朗，邪气
寒邪与虚寒相互搏结，就会导致肠鸣。医生看到脉象大，认为体内有热，便给病人喝冷水，企图用冷水的寒气来克制体内的热并促使出汗。然而患者里气原本就虚寒，再得到冷水与之相搏，导致冷气结聚在上焦，必然会出现咽喉噎塞感且气机上逆的情况。
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伤寒病中出现呃逆（哕）并且腹部胀满，应当观察病人的前阴和后阴，知道是哪一部分不通利，通利那一部分就可以痊愈。
【注】
伤寒病中出现呃逆但腹部不胀满的，是正气虚弱，属于吴茱萸汤证。出现呃逆且腹部胀满的，是邪气实盛，应当观察其二便（小便和大便）哪一部分不通利，通利它就可以痊愈。
【集注】
成无己说：呃逆且腹部胀满，是气向上冲而不向下行。观察前后二阴中有不通利的地方，就通利它以降下上逆之气，前部指小便，后部指大便。
程知说：前部（小便）不通利，后人治疗用五苓散；后部（大便）不通利，后人治疗用承气汤，就是这样的道理。
沈明宗说：邪气传入胃中，胃气壅滞遏阻，正邪两气相互搏结，气逆向上冲撞，就会发生呃逆。
张锡驹说：伤寒病发展到出现呃逆，如果不是胃气败绝，就是胃中寒冷。然而也有因为里实不通，气不能向下排泄，反而上逆而成为呃逆的，应当详细辨别。
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实证会出现谵语（神志不清，胡言乱语），虚证会出现郑声（语言重复，声音低微）。郑声是指语言重复不断。
【注】
谵语这一证候，有虚证也有实证。实证谵语，是因为阳明热势极盛，热气上乘于心，导致言语错乱没有次序，声音高亢洪亮，这是邪气……
Cold pathogenic factors and deficiency-cold contend with each other, resulting in borborygmus (intestinal rumbling). If the physician observes a large pulse and assumes there is heat, administering cold water to overcome the heat with coldness and induce sweating will be detrimental. Since the interior is already deficient and cold, the introduction of cold water contends with this internal state, causing cold to knot in the Upper Jiao (Upper Burner), inevitably leading to a sensation of choking or obstruction in the throat and rebellious Qi ascending.
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In Shaoyang disease (or Cold Damage) presenting with hiccups (Yue) and abdominal fullness, one should examine the anterior and posterior orifices to determine which part is obstructed; unblocking that obstruction will lead to recovery.
[Annotation]
If hiccups occur without abdominal fullness, it indicates a deficiency of healthy Qi and corresponds to the Wuzhuyu Tang (Evodia Decoction) pattern. If hiccups occur with abdominal fullness, it indicates an excess of pathogenic factors; by examining whether urination or defecation is obstructed and unblocking the respective pathway, the patient will recover.
[Collected Annotations]
Cheng Wuji stated: Hiccups accompanied by abdominal fullness indicate Qi rebelling upward without descending. One should observe the anterior and posterior orifices for any obstruction and unblock it to direct the Qi downward. The "anterior" refers to urination, and the "posterior" refers to defecation.
Cheng Zhi stated: If the anterior orifice (urination) is obstructed, later practitioners treat it with Wuling San (Five-Ingredient Powder with Poria); if the posterior orifice (defecation) is obstructed, they treat it with Chengqi Decoctions. This is the correct approach.
Shen Mingzong stated: When pathogens transmit to the Stomach, Stomach Qi becomes stagnant and constrained. The contention between healthy Qi and pathogenic factors causes Qi to rebel and rush upward, resulting in hiccups.
Zhang Xiju stated: In Cold Damage, the appearance of hiccups indicates either the exhaustion of Stomach Qi or cold within the Stomach. However, there are also cases where interior excess prevents the downward discharge of Qi, causing it to rebel upward and manifest as hiccups; these must be carefully differentiated.
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Excess conditions manifest as delirious speech (Zhanyu), while deficiency conditions manifest as monotonous/repetitive speech (Zhengsheng). Zhengsheng is characterized by repetitive utterances.
[Annotation]
The syndrome of delirious speech can be either excess or deficiency. Excess delirious speech arises from extreme Heat in the Yangming channel, which ascends to disturb the Heart, causing disordered speech without sequence and a loud, resonant voice, due to pathogenic factors...