经义
胃为气逆，为哕，为恐。○病深者，其声哕。○若有七诊之病，其脉候亦败者死矣，必发哕噫。（《素问》）
帝曰∶人之哕者，何气使然？岐伯曰∶谷入于胃，胃气上注于肺。今有故寒气，与新谷气，俱还入胃，新
故相乱，真邪相攻，气并相逆，复出于胃，故为哕。○哕，以草刺鼻，令嚏而已；无息而疾迎引之，立已；大
惊之，亦可已。（《灵枢》）
哲言
干呕即哕之微，哕即干呕之甚。呕声轻小而短，哕声重大而长。呕为轻，哕为重。（《溯洄集》）
呃在中焦，谷气不运，其声短小，得食即发。呃在下焦，真气不足，其声长大，不食亦然。（《医方集解》）
哕者，呃逆也，非咳逆也。咳逆者，咳嗽之甚者也，非呃逆也。干呕者，无物之吐，即呕也，非哕也。
噫者，饱食之息，即嗳气也，非咳逆也。○呃由气逆，气逆于下，则直冲于上，无气则无呃，无阳亦无呃，此
病呃之源，所以必由于气也。欲得其象，
不见雨中之雷，水中之 乎？夫阳为阴蔽，所以为雷而轰轰不已者，此火为雷之本，火即气也。气为水覆，
所以为 而 不已者，此气为 之本，气即阳也。然病在气分，本非一端，而呃之大要，亦惟三者而已∶一
曰寒呃，二曰热呃，三曰虚脱之呃。寒呃可温可散，寒去则气自舒；热呃可降可清，火静而气自平；惟虚脱之
呃，则诚危矣。○凡呃虽由气逆，然有兼寒者，有兼热者，有因食滞而逆者，有因气滞而逆者，有因中气虚而
逆者，有因阴气竭而逆者，但察其因而治其气，自无不愈。若轻易之呃，或偶然之呃，气顺则已，本不必治。
惟屡呃为患及呃之甚者，必其气有大逆，或脾肾元气大有亏竭而然。然实呃不难治，而惟元气败竭者，乃最危
之候也。（张景岳）
《经》云∶木敷者，其叶发；病深者，其声哕。有此二者，毒药不及，短针无取。观之呃证，诚非细故，
如气逆，及阳明腑实而呃者，疏之通之则止，为患尚轻。倘病重，肾气衰败而呃者，大非所宜。胃呃短而促；
肾呃缓而迟，以此分别甚明。景岳云∶逆气象阳如雷，为阴蔽而轰轰然。足见治呃，又非可纯用热药耳。（《见闻录》）
《经》云，哕，以草刺鼻，令嚏而已；无息而疾迎引之，立已；大惊之，亦可已。详此三者，正治呃逆
之妙法。今人用纸捻刺鼻取嚏，则呃逆立止。或闭口鼻气，使之无息，亦立已。或作冤盗贼大惊之，亦可已。
此以哕为呃逆，正得《经》旨。谓之哕者，呃声之重也。谓之呃者，哕声之轻也。皆因病声之轻重而名之也。
呃声频密相连者为实，可治。若半时呃一声者为虚，难治。呃至八九声，气不回者；呃逆小便秘涩或腹满者；
脉见沉微散者；泻痢后呃逆；及伤寒结胸发黄而呃逆者，俱难治。（娄全善）
呃证总属乎火，即胃寒诸证，亦必火为寒遏而然。若纯由乎寒，必不相激而逆上矣。（余午亭）
呃逆，须辨寒热，寒热不辨，用药立毙。凡呃声有力而连续
者，虽有手足厥逆，而大便必坚，定属火热，下之则愈。若胃中无实火，何以激搏其声而冲逆乎？其呃声低怯，
而不能达于咽喉者，虽无厥逆，定属虚寒，苟非丁、附，必无生理。若胃中稍有阳气，何致音声馁怯而不振乎？
设误以柿蒂、芦根辈治之，仓扁不能复图矣。（张石顽）
呃逆，皆是寒热二气相搏使然，故治亦多用寒热相兼之剂，如丁香、柿蒂并投之类。试观平人冷呃，令其
思想则止，思则脾火气乘，而胃气和矣。（刘宗浓）
凡伤寒热病，阳明胃实，过期失下，清气不升，浊气不降，以致气不宣通而发呃者，仲景云∶哕而腹满，
视其前后，知何部不利，利之即愈。又有因饮食太多，填塞胸中，而气不得升降者；又有因痰闭于上，火起于
下，而气不能伸越者，此皆实证也，宜详辨而治之。（方星岩）
呃逆，气病也，气自脐下直冲，上出于口而作声之谓也。《经》曰∶诸逆冲上，皆属于火。古人悉以胃弱
言之，而不及火，惟以丁香、柿蒂等药治之，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。阴为火乘，不得内守，木挟所乘之火，直冲清道而上，言胃弱者，阴弱也。（《丹溪心法》）
呃逆，古无是名，《内经》本谓之哕，因其呃呃连声，故今以呃逆名之。然所因不一∶有胃中虚冷，阴凝
阳滞而为呃者，当用仲景橘皮汤、生姜半夏汤。有胃中虚阳上逆而为呃者，当用仲景橘皮竹茹汤。有中焦脾胃
虚寒，气逆而为呃者，宜理中汤加丁香，或温胃饮加丁香。有下焦虚寒，阳气竭而为呃者，正以元阳无力，易
为抑遏，不能畅达而然，宜景岳归气饮，或理阴煎加丁香。有食滞而呃者，宜加减二陈加山楂、乌药，或大和中
饮加干姜、木香之属。先生又谓∶肺气郁痹，及阳虚浊阴上逆，亦能为呃。每以开上焦之痹，及理阳驱阴，从
中调治，可补前人之不逮。丹溪谓呃逆属于肝肾之阴虚者，其气从脐下直冲，上出于口，
断续作声，必由相火炎上，挟其冲气，乃能逆上为呃，用大补阴丸，峻补真阴，承制相火。东垣又谓阴火上冲，
而吸气不得入，胃脉反逆，阴中伏阳即为呃，用滋肾丸以泻阴中伏热。二法均为至当，审证参用可也。（《临证指南》）
凡修炼家，无非欲其气血流通。惟华佗五禽图，差为不妄，有得呃逆证，作虎形立止，非其验耶？（《聊斋志异》）
脉候
火呃脉数有力，寒呃脉迟无力，痰呃脉滑，虚呃脉虚，瘀呃脉芤沉涩。（《证治汇补》）
选案
一人伤寒将愈，忽患呃逆，百药无效。偶用皂角末吹鼻，得嚏即止；少时又呃，又吹又止；凡百余次，渐
疏而愈。此与《灵枢》草刺鼻嚏之法恰合。（《医学纲目》）
一女因怒致呃，发则神昏。视其质实，意为膈上有痰，怒气抑郁，痰热相搏，气不得降，非吐不可。用参
芦煎饮，大吐顽痰而安。盖女子多郁，肝主怒，肺主气，怒则气上，肝木侮肺，是以呃逆神昏。痰去、气降、
火平，金安其位，胃得其和，因而疾愈。（丹溪）
一人呃逆连声，脉来有力，因相争肝木受邪。思金能克木，用铁二斤，烧红水淬，饮之即愈。（周慎斋）
一人患呃逆，诸药不效，或教食青果，其呃遂止。按∶青果味酸甘涩，本草言其开胃止呃者，亦下气之故
也。（方星岩）
附方
呃证服药法 用箸一双，十字架于碗上，麻线扎紧，将药倾入，令病患自持碗，于箸架之四空处，每空吸
药一口，圆转挨次吸去，不要换手，良验。
【经文释义】
胃气上逆，表现为呃逆（古称哕），并伴有恐惧感。○病情深重时，发出的声音是呃逆。○如果出现了“七诊”所示的危重病证，且脉象也败坏，则预示死亡，必定会出现呃逆和嗳气。（《素问》）
黄帝问道：人为什么会发生呃逆？是什么气导致的呢？岐伯回答说：食物进入胃中，胃气向上注入肺脏。现在如果有陈寒留滞，与新摄入的食物之气，一同返回胃中，新旧之气相互扰乱，正气与邪气相互攻冲，气机并行且逆乱，再次从胃中冲出，所以发生呃逆。○对于呃逆，可以用草刺激鼻子，让人打喷嚏从而停止；或者屏住呼吸并迅速引导气机下行，立刻就能痊愈；或者突然惊吓患者，也可以痊愈。（《灵枢》）
【哲人言论】
干呕就是轻微的呃逆，呃逆就是严重的干呕。呕吐的声音轻小且短促，呃逆的声音沉重且长。呕吐属于轻症，呃逆属于重症。（《溯洄集》）
呃逆病位在中焦，因谷气运行不畅，声音短小，进食后就会发作。呃逆病位在下焦，因真气不足，声音长大，即使不进食也会如此。（《医方集解》）
哕，就是呃逆，不是咳嗽气逆。咳嗽气逆，是咳嗽的严重表现，并不是呃逆。干呕，是没有吐出东西的呕吐，也就是呕吐，并不是哕。噫，是饱食后的气息排出，也就是嗳气，并不是咳嗽气逆。○呃逆是由于气机上逆，气在下方逆乱，便直冲于上，没有气就不会有呃逆，没有阳气也不会有呃逆，这是呃逆病的根源，所以必然与气有关。想要理解它的意象，难道没见过雨中的雷电吗？阳气被阴气遮蔽，所以发出隆隆雷声不停，这是因为火是雷的根本，火就是气。气被水覆盖，所以发出波涛声不停，这是因为气是水波的根本，气就是阳。然而，病在气分，原因并非只有一种，而呃逆的大要，也不过这三种罢了：一是寒呃，二是热呃，三是虚脱之呃。寒呃可以用温法或散法，寒气去除则气自然舒展；热呃可以用降法或清法，火静下来则气自然平和；只有虚脱之呃，确实非常危险。○凡是呃逆虽然都由气逆引起，但有兼夹寒邪的，有兼夹热邪的，有因食积停滞导致气逆的，有因气机郁滞导致气逆的，有因中气虚弱导致气逆的，有因阴气枯竭导致气逆的，只要审察其病因并调理气机，就没有治不好的。如果是轻微的呃逆，或是偶然的呃逆，气顺了就好了，本来不必治疗。只有频繁呃逆成为病患以及呃逆严重的，必定是气机大逆，或者是脾肾元气大有亏竭所致。然而实证呃逆不难治疗，只有元气败竭的，才是最危险的征候。（张景岳）
《内经》说：树木枝叶繁茂者，其叶子容易凋落；病情深重者，其声音表现为呃逆。出现这两种情况，药物难以奏效，短针也无能为力。观察呃逆这一病证，确实非同小可，如气机逆乱，以及阳明腑实导致的呃逆，通过疏通导滞即可停止，危害尚轻。倘若病情严重，肾气衰败导致的呃逆，就绝不适合用常规方法治疗。胃经引起的呃逆声音短促；肾经引起的呃逆声音缓慢迟滞，以此区分非常明显。张景岳说：逆气的形象像阳气如雷电，被阴气遮蔽而发出轰轰声响。足见治疗呃逆，又不能单纯使用热药。（《见闻录》）
《内经》说：呃逆，用草刺鼻让人打喷嚏即可停止；屏住呼吸并迅速引导气机下行，立刻痊愈；突然惊吓患者，也可以痊愈。详细考察这三条，正是治疗呃逆的妙法。现在的人用纸捻子刺激鼻子取嚏，呃逆立刻停止。或者闭住口鼻之气，使其屏息，也能立刻痊愈。或者装作冤家盗贼突然惊吓他，也可以痊愈。这里将哕称为呃逆，正符合《内经》的宗旨。称之为哕，是指呃逆声音沉重；称之为呃，是指呃逆声音轻微。都是根据病声的轻重来命名的。呃逆声音频密相连的是实证，可以治疗。如果半分钟才呃一声的是虚证，难治。呃逆达到八九声，气不回缩的；呃逆伴小便便秘涩或腹部胀满的；脉象呈现沉微散的；泻痢之后出现呃逆的；以及伤寒结胸发黄而出现呃逆的，都难治。（娄全善）
呃逆证总归属于火，即使是胃寒的各种证候，也必然是火被寒邪遏制所致。如果纯粹由寒引起，必然不会激荡而上逆。（余午亭）
呃逆，必须辨别寒热，如果不辨寒热，用药立即致死。凡是呃逆声音有力且连续的，即使有手足厥冷，但大便一定坚硬，定属火热，用下法即可痊愈。如果胃中没有实火，凭什么激荡搏动声音而冲逆呢？那些呃逆声音低怯，不能达于咽喉的，即使没有厥冷，定属虚寒，如果不是丁香、附子，必无生机。如果胃中稍有阳气，怎么会致使声音衰弱怯懦而不振作呢？假如误用柿蒂、芦根之类治疗，即使是仓公、扁鹊也不能再挽救了。（张石顽）
呃逆，都是寒热二气相互搏击所致，所以治疗也多使用寒热并用的方剂，如丁香、柿蒂同用之类。试看普通人患冷性呃逆，让他思考事情就会停止，因为思虑会使脾火之气旺盛，从而使胃气调和。（刘宗浓）
凡是伤寒热病，阳明胃腑实证，过期未能攻下，清气不升，浊气不降，导致气机宣通受阻而发呃逆的，仲景说：呃逆且腹部胀满，查看前后二阴，知道哪一部不通利，通利它就好了。又有因饮食过多，填塞胸中，导致气机不得升降的；又有因痰浊闭塞于上，火起于下，导致气机不能伸越的，这些都是实证，应当仔细辨证并治疗。（方星岩）
呃逆，是气病，气自脐下直冲，向上出于口而发声，这就叫呃逆。《内经》说：各种逆气冲上，都归属于火。古人全都归结为胃弱，而没有提到火，只用丁香、柿蒂等药物治疗，不清楚哪一个是降火，哪一个是补虚。人的阴气依靠胃土来滋养，胃土损伤，则肝木来克制它。阴气被火邪乘袭，不能内守，肝木挟带被乘的火邪，直冲清道而上，所说的胃弱，其实是阴弱。（《丹溪心法》）
呃逆，古代没有这个名称，《内经》原本称之为哕，因为它呃呃连声，所以现在用呃逆命名。然而致病原因不一：有因胃中虚冷，阴凝阳滞而导致呃逆的，应当使用仲景的橘皮汤、生姜半夏汤。有因胃中虚阳上逆而导致呃逆的，应当使用仲景的橘皮竹茹汤。有中焦脾胃虚寒，气逆而导致呃逆的，适宜理中汤加丁香，或温胃饮加丁香。有因下焦虚寒，阳气竭乏而导致呃逆的，正是因为元阳无力，容易被抑遏，不能畅达所致，适宜景岳的归气饮，或理阴煎加丁香。有因食积停滞而导致呃逆的，适宜加减二陈汤加山楂、乌药，或大和中饮加干姜、木香之类。先生又说：肺气郁痹，以及阳虚浊阴上逆，也能导致呃逆。每每采用开宣上焦痹阻，以及温理阳气驱除阴邪，从中调治的方法，可以弥补前人的不足。丹溪认为呃逆属于肝肾阴虚的，气从脐下直冲，向上出于口，断续发声，必定是由相火上炎，挟带冲气，才能逆上为呃，使用大补阴丸，峻补真阴，以制约相火。东垣又认为阴火上冲，吸气不能入，胃脉反而上逆，阴中伏阳即为呃逆，使用滋肾丸以泻阴中伏热。这两种方法都非常恰当，审察证候参考使用即可。（《临证指南》）
凡是修炼养生的人，无非是想让气血流通。只有华佗的五禽戏，比较不错，有人得了呃逆证，模仿虎形动作立刻停止，这不是验证吗？（《聊斋志异》）
【脉象候诊】
火性呃逆脉象数而有力，寒性呃逆脉象迟而无力，痰性呃逆脉象滑，虚性呃逆脉象虚，瘀血性呃逆脉象芤、沉、涩。（《证治汇补》）
【选录医案】
一人患伤寒快要痊愈时，忽然患呃逆，百药无效。偶然用皂角末吹入鼻腔，打了喷嚏即停止；过了一会儿又呃逆，再次吹入又停止；总共一百多次，逐渐稀疏而痊愈。这与《灵枢》中草刺鼻取嚏的方法恰好吻合。（《医学纲目》）
一女子因愤怒导致呃逆，发作时神志昏迷。观察她的体质结实，认为是膈上有痰，怒气抑郁，痰热相互搏击，气机不得下降，非吐不可。用人参芦头煎汤饮用，大吐顽痰而安宁。大概女子多郁结，肝主怒，肺主气，怒则气上，肝木侮犯肺金，所以呃逆且神志昏迷。痰去、气降、火平，肺金安其位，胃得其和，因此疾病痊愈。（朱丹溪）
一人呃逆连声，脉象有力，因争斗导致肝木受邪。想金能克木，用铁二斤，烧红后投入水中淬火，喝下铁水即痊愈。（周慎斋）
一人患呃逆，诸药无效，有人教他吃青果，呃逆于是停止。按：青果味酸甘涩，本草记载它能开胃止呃，也是由于下气的原因。（方星岩）
【附方】
呃证服药法 用筷子一双，十字交叉放在碗上，用麻线扎紧，将药液倒入，让病人自己手持碗，在筷架形成的四个空隙处，每个空隙吸一口药，圆转依次吸完，不要换手，效果很好。
[Scriptural Interpretation]
Stomach Qi rebellion manifests as hiccups (anciently termed *Yue*), accompanied by a sense of fear. ○ When the disease is deep-seated, the sound produced is hiccups. ○ If the critical signs of the "Seven Diagnoses" are present and the pulse condition is also deteriorating, death is imminent, and one will inevitably develop hiccups and belching. (*Su Wen*)
The Yellow Emperor asked: Why do people develop hiccups? What Qi causes this? Qibo replied: Food enters the stomach, and Stomach Qi flows upward to the Lungs. Now, if there is lingering cold pathogen combined with the Qi of newly ingested food, both return to the stomach. The new and old Qi interfere with each other, Zheng Qi (Upright Qi) and Xie Qi (Pathogenic Qi) attack each other, Qi moves together in rebellion, and rushes out from the stomach again; thus, hiccups occur. ○ For hiccups, one can stimulate the nose with grass to induce sneezing, which stops it; or hold the breath and rapidly guide Qi downward, which cures it immediately; or suddenly startle the patient, which also cures it. (*Ling Shu*)
[Philosophical Remarks]
Dry retching is mild hiccupping, while hiccupping is severe dry retching. The sound of vomiting is light and short; the sound of hiccups is heavy and long. Vomiting is a mild condition; hiccups are a severe condition. (*Su Hui Ji*)
Hiccups located in the Middle Jiao result from impaired transport of Grain Qi; the sound is short and triggered by eating. Hiccups located in the Lower Jiao result from deficiency of True Qi; the sound is loud and occurs even without eating. (*Yi Fang Ji Jie*)
*Yue* refers to hiccups, not coughing with rebellious Qi. Coughing with rebellious Qi is severe coughing, not hiccups. Dry retching is vomiting without expulsion of matter, i.e., vomiting, not *Yue*. *Yi* refers to the exhalation after a full meal, i.e., belching, not coughing with rebellious Qi. ○ Hiccups arise from rebellious Qi. When Qi rebels below, it rushes directly upward. Without Qi, there are no hiccups; without Yang Qi, there are no hiccups. This is the root of hiccup disease, so it must be related to Qi. To understand its imagery, have you not seen lightning in the rain? When Yang Qi is obscured by Yin, it produces continuous thunderous sounds because Fire is the root of Lightning, and Fire is Qi. When Qi is covered by Water, it produces continuous wave sounds because Qi is the root of Waves, and Qi is Yang. However, diseases in the Qi aspect have various causes, but the main categories of hiccups are only three: First, Cold Hiccups; Second, Heat Hiccups; Third, Collapse-type Hiccups. Cold hiccups can be treated with warming or dispersing methods; when cold dissipates, Qi naturally relaxes. Heat hiccups can be treated with descending or clearing methods; when Fire calms, Qi naturally levels out. Only collapse-type hiccups are truly critical. ○ Although all hiccups stem from Qi rebellion, some involve concurrent Cold, some concurrent Heat, some due to Food Stagnation causing rebellion, some due to Qi Stagnation causing rebellion, some due to Middle Qi Deficiency causing rebellion, and some due to Yin Qi Exhaustion causing rebellion. By examining the cause and regulating Qi, there is no case that cannot be cured. Mild or occasional hiccups resolve when Qi becomes smooth and require no treatment. Only frequent or severe hiccups indicate major Qi rebellion or significant depletion of Spleen and Kidney Yuan Qi (Primal Qi). While Excess-type hiccups are not difficult to treat, those caused by exhaustion of Yuan Qi are the most critical prognosis. (Zhang Jingyue)
The Classics state: "When tree branches and leaves are luxuriant, the foliage falls easily; when disease is deep, the voice manifests as hiccups." In these two cases, drugs are ineffective, and short needles are useless. Observing hiccup syndrome, it is indeed no trivial matter. For hiccups due to Qi rebellion or Yangming Fu-Excess, unblocking and purging will stop them, posing less danger. However, if the disease is severe and hiccups result from Kidney Qi failure, conventional treatments are inappropriate. Stomach-origin hiccups are short and rapid; Kidney-origin hiccups are slow and delayed, making differentiation clear. Zhang Jingyue stated: Rebellious Qi resembles Yang like lightning, rumbling continuously when obscured by Yin. This shows that treating hiccups cannot rely solely on hot herbs. (*Jian Wen Lu*)
The Classics state: "For hiccups, stimulating the nose with grass to induce sneezing stops it; holding breath and guiding Qi down cures it instantly; startling the patient also cures it." These three methods are excellent techniques for treating hiccups. Today, people use paper twists to stimulate the nose for sneezing, stopping hiccups instantly. Or closing mouth and nose to hold breath also works instantly. Or pretending to be an enemy/thief to startle them also works. Calling *Yue* hiccups aligns with the Classic's intent. Calling it *Yue* implies heavy sound; calling it *E* (hiccup) implies light sound. Names are derived from the severity of the sound. Frequent, connected hiccup sounds indicate Excess, which is treatable. Hiccups occurring once every half hour indicate Deficiency, which is hard to treat. Hiccups occurring 8-9 times with non-returning Qi; hiccups with constipation/abdominal distension; pulse appearing deep, faint, or scattered; hiccups after diarrhea/dysentery; and hiccups in Shanghan with chest binding and jaundice—all are difficult to treat. (Lou Quanshan)
Hiccup syndromes generally belong to Fire. Even Stomach Cold syndromes occur because Fire is constrained by Cold. If purely Cold, it would not agitate and rebel upward. (Yu Wuting)
Hiccups must be differentiated as Cold or Heat; failing to distinguish leads to immediate death upon medication. If hiccup sounds are forceful and continuous, even with cold limbs, if stool is hard, it definitely belongs to Heat/Fire; purgatives will cure it. How else could lack of real Fire in the Stomach agitate the sound and cause rebellion? If hiccup sounds are low and timid, unable to reach the throat, even without cold limbs, it definitely belongs to Cold/Deficiency; without Dingxiang (Clove) and Fuzi (Aconite), there is no hope. If there were any Yang Qi in the Stomach, how could the voice be weak and listless? Mistakenly using Shidi (Persimmon Calyx) or Lugeng (Reed Rhizome) would make even Cang Gong and Bian Que unable to save the patient. (Zhang Shiwan)
Hiccups result from the struggle between Cold and Heat Qi; thus, treatments often combine cold and heat herbs, such as using Dingxiang and Shidi together. Observe ordinary people with cold hiccups: asking them to think stops it, because thinking strengthens Spleen Fire Qi, harmonizing Stomach Qi. (Liu Zongnong)
In all Shanghan febrile diseases, Yangming Stomach Excess, if purgatives are missed past the appropriate time, Clear Qi fails to ascend and Turbid Qi fails to descend, leading to blocked Qi transmission and hiccups. Zhongjing said: "Hiccups with abdominal fullness—examine the anterior and posterior orifices, determine which is obstructed, and unblock it to cure." Also, hiccups due to excessive food filling the chest, blocking Qi ascent/descent; or phlegm blocking above and Fire rising below, preventing Qi extension—are all Excess patterns requiring careful differentiation and treatment. (Fang Xingyan)
Hiccups are a Qi disease, where Qi rushes straight up from below the navel, exits the mouth, and makes sound. The Classics say: "All rebellious Qi rushing upward belongs to Fire." Ancients attributed it all to Stomach Weakness, ignoring Fire, treating only with Dingxiang and Shidi, without clarifying which lowers Fire and which tonifies Deficiency. Human Yin Qi relies on Stomach Earth for nourishment; if Stomach Earth is damaged, Liver Wood attacks it. Yin Qi is attacked by Fire and cannot remain internal; Liver Wood carries the attacking Fire, rushing up the clear pathways. Saying "Stomach Weakness" actually means Yin Deficiency. (*Dan Xi Xin Fa*)
Hiccups had no ancient name; the *Neijing* called it *Yue*. Because it makes continuous "eh-eh" sounds, it is now named E-Ni (Hiccups). Causes vary: Stomach Empty-Cold with Yin stagnation and Yang blockage requires Zhongjing's Chuanpi Tang or Shengjiang Banxia Tang. Stomach Empty-Yang rebelling upward requires Zhongjing's Chuanpi Zhuru Tang. Middle Jiao Spleen-Stomach Empty-Cold with Qi rebellion requires Lizhong Tang plus Dingxiang, or Wenwei Yin plus Dingxiang. Lower Jiao Empty-Cold with Yang exhaustion requires Jingyue's Guiqi Yin or Liyin Jian plus Dingxiang. Food stagnation hiccups require Jiawei Erchen Tang plus Shan Zha and Wu Yao, or Da Hezhong Yin plus Ganjiang and Muxiang. The Master also stated: Lung Qi depression/bi obstruction and Yang Deficiency with Turbid Yin rebelling can also cause hiccups. Treating by opening Upper Jiao bi obstruction and regulating Yang to drive out Yin, treating from the center, supplements previous methods. Danxi stated hiccups due to Liver-Kidney Yin Deficiency involve Qi rushing from below navel to mouth, intermittent sound, caused by Minister Fire flaring up carrying Chong Qi; treat with Dabu Yin Wan to strongly tonify True Yin and control Minister Fire. Dongyuan stated Yin Fire rushing up prevents inhalation, Stomach Meridian rebels, latent Yang within Yin causes hiccups; treat with Zishen Wan to drain latent heat in Yin. Both methods are appropriate; use based on syndrome differentiation. (*Lin Zheng Zhi Nan*)
Cultivators seek free flow of Qi and Blood. Huatuo's Five Animal Frolics is reliable; imitating the Tiger form stops hiccups instantly, proving its efficacy. (*Liao Zhai Zhi Yi*)
[Pulse Diagnosis]
Fire hiccups: rapid, forceful pulse. Cold hiccups: slow, weak pulse. Phlegm hiccups: slippery pulse. Deficiency hiccups: deficient pulse. Blood stasis hiccups: knotted, deep, choppy pulse. (*Zheng Zhi Hui Bu*)
[Selected Cases]
A patient recovering from Shanghan suddenly developed hiccups; hundreds of medicines failed. Accidentally blowing Sophora Flower powder into the nose induced sneezing, stopping hiccups; later recurrence stopped again with same method; repeated over 100 times, gradually thinning until cured. This matches the *Ling Shu* method of grass-stimulated sneezing. (*Yi Xue Gang Mu*)
A woman developed hiccups due to anger, losing consciousness during episodes. Her constitution was solid; phlegm was suspected in the Diaphragm. Anger and depression caused Phlegm-Heat struggle, blocking Qi descent; emesis was necessary. Decocted Ren Shen Lu (Ginseng Stalk) for drinking; profuse expulsion of tough phlegm brought relief. Women often have stagnation; Liver governs anger, Lungs govern Qi. Anger causes Qi to rise; Liver Wood insults Lung Metal, causing hiccups and unconsciousness. With phlegm gone, Qi descended, Fire calmed, Lung Metal settled, Stomach harmonized, disease cured. (Zhu Danxi)
A man had continuous hiccups with a forceful pulse, due to Liver Wood injury from conflict. Thinking Metal controls Wood, he used 2 jin of iron, heated red and quenched in water; drinking the solution cured him. (Zhou Shenzhai)
A man suffered hiccups unresponsive to medicines. Someone advised eating Qing Guo (Chinese Olive); hiccups stopped. Note: Qing Guo is sour, sweet, and astringent; Materia Medica states it opens appetite and stops hiccups due to its Qi-descending property. (Fang Xingyan)
[Appendix Formula]
Method for taking medicine for hiccups: Place two chopsticks crosswise on a bowl, tie tightly with hemp thread. Pour medicine in. Let the patient hold the bowl themselves. Inhale medicine through the four gaps formed by the chopsticks, one sip per gap, rotating sequentially. Do not switch hands. Highly effective.