壶仙翁治乡进士许崇志病呃逆。医以雄黄烟熏其鼻。倏然目暗。热剧甚。翁诊之曰。此
由恼怒伤肝。肝气上逆而呃。经云。木郁达之。投以涌剂。更为之疏肝平气。数服而愈。所
以知崇志病者。其脉左关沉而弦。右寸微而数。沉弦为郁。微数为热。郁不行。故指为怒气
朱丹溪治一女子。年逾笄。性躁味浓。暑月因大怒而呃逆。每作一声。则举身跳动。神
昏。凡三五息一作。脉不可诊。视其形气实。以人参芦二两煎饮。大吐顽痰数碗。大汗。昏
又一老人。素浓味。有久喘病。作止不常。新秋患痢。食大减。数日呃作。脉豁大。朱
以其形瘦可治。用参术汤下大补丸。至七日而安。
虞天民治一人伤寒。前医以补药治之而发呃逆。十日后。邀虞诊之。其脉长而实大。此
阳明内实。误补所致。与大承气下之。热退而呃止。
震按此条呃已十日。脉长实大。犹易辨也。前条之脉豁大。而用参、术。何又以黄柏佐
之。岂因其形瘦素浓味为有郁热耶。至如女子因怒至呃。脉不可诊。止凭形气之实以施治。
何不用他涌剂。而用参芦至二两。又岂因其脉未得。而用涌剂中之补剂。为稳着耶。
又一人得伤寒证。七日热退而呃大作。举家彷徨。虞诊其脉。皆沉细无力。人倦甚。
以补中益气汤大剂加姜、附。一日三帖。兼灸气海乳根。当日呃止。脉亦充而平安。
吕元膺治余姚州守郭文煜呃十余日。医以丁、附等疗之。益甚。吕切其脉。阳明大而长
右口之阳数而躁。乃曰。此由胃热致呃。又以热药助其热。误矣。用竹茹汤。旋愈。
震按上条之宜用温补及灸法。人所共能。次条之服热药而益甚。合以脉之长大数躁。宜
用大剂白虎。有下证者。宜佐以承气。若竹茹汤。恐不济事。
戴同父治一人。元气素虚。胃口有蓄血。每食椒姜热汤。则呃一二声。以人参、生白术
各一两。切片。用 虫醉死绞浆制为末。入干漆灰七分。以米饮丸弹子大。早暮陈酒细嚼一
震按此证较前诸证为难辨。此方较前诸方为更佳。
壶仙翁治疗乡进士许崇志患呃逆（打嗝）。医生用雄黄烟熏他的鼻子。突然眼睛失明，热势非常剧烈。壶仙翁诊察后说：“这是由于恼怒损伤肝脏，肝气上逆导致呃逆。《内经》说：‘木郁达之’。”于是投用涌吐剂，并为他疏肝平气，服用几剂后痊愈。之所以知道许崇志的病，是因为他的脉象左关部沉而弦，右寸部微而数。沉弦表示气机郁结，微数表示有热。气机郁结不通，所以推断是怒气所致。
朱丹溪治疗一名女子，年龄超过十五岁（及笄之年），性格急躁，口味浓厚。在暑天因大怒而引发呃逆。每次发作发出一声，全身就会跳动，神志昏迷。大约每三五次呼吸就发作一次，脉象无法诊察。观察她的形体和气息都充实有力，于是用两两人参芦煎汤饮用，吐出大量顽痰数碗，大汗淋漓，昏厥片刻后又苏醒。
又有一位老人，平时饮食浓厚，患有久喘病，发作没有定时。初秋时患上痢疾，食欲大减。几天后出现呃逆，脉象豁大。朱丹溪认为他形体消瘦可以治疗，用人参白术汤送服大补丸，到第七天病情安定。
虞天民治疗一名伤寒患者，前一位医生用补药治疗却引发了呃逆。十天后，邀请虞天民诊察。患者的脉象长而实大，这是阳明腑实证，因误用补药所致。给予大承气汤攻下，热退而呃逆停止。
俞震按语：这一条呃逆已经十天，脉象长实大，还容易辨别。上一条脉象豁大，却用人参、白术，为什么还要用黄柏辅助呢？难道是因为他形体消瘦且平时口味浓厚而有郁热吗？至于那名女子因愤怒导致呃逆，脉象无法诊察，仅凭形气实来施治，为什么不使用其他涌吐剂，而使用两两人参芦？这难道是因为未能取得脉象，所以选用涌吐剂中的补益药剂作为稳妥的办法吗？
又有一个人得了伤寒证，七天后退热但呃逆大作，全家彷徨无措。虞天民诊察他的脉象，都是沉细无力，人非常疲倦。于是用补中益气汤大剂量加入干姜、附子，一天服用三帖，同时艾灸气海穴和乳根穴。当天呃逆停止，脉象也变得充盈，平安无事。
吕元膺治疗余姚州守郭文煜呃逆十余日，医生用丁香、附子等药物治疗，病情反而加重。吕元膺切按其脉象，阳明脉大而长，右口部的阳脉数而躁动，于是说：“这是由于胃热导致呃逆，又用热药助热，是错误的。”于是使用竹茹汤，随即痊愈。
俞震按语：上一条适宜使用温补及灸法，这是大家都能知道的。下一条服用热药后病情加重，结合脉象长大数躁，应该使用大剂量的白虎汤；如果有下焦实证，应该佐以承气汤。至于竹茹汤，恐怕不起作用。
戴同父治疗一人，元气素来虚弱，胃口有瘀血蓄积。每次吃花椒、生姜等热汤，就会呃逆一两次。用人参、生白术各一两，切片，用土鳖虫醉死后绞汁制成粉末，加入干漆灰七分，用米饮做成弹子大小的丸药，早晚用陈酒细细嚼服。
俞震按语：这个证候比前面诸证更难辨别。这个方剂比前面诸方更为精妙。
Huxian Weng treated the country jinshi (scholar-official) Xu Chongzhi, who suffered from hiccups. A physician used realgar smoke to fumigate his nose. Suddenly, he became blind, and the heat intensified severely. Huxian Weng examined him and said, "This is caused by anger injuring the Liver, leading to rebellious Liver Qi ascending and causing hiccups. The Classics state: 'When Wood is stagnant, unblock it.'" Therefore, he administered an emetic agent and also prescribed herbs to soothe the Liver and regulate Qi. After taking a few doses, he recovered. The reason for diagnosing Xu Chongzhi's condition was that his pulse at the left Guan position was deep and wiry, while the right Cun position was faint and rapid. Deep and wiry indicates stagnation; faint and rapid indicates heat. Due to the stagnation of Qi not flowing freely, it was inferred to be caused by anger.
Zhu Danxi treated a young woman over fifteen years old (of age to wear her hairpin), who had an irritable temperament and preferred rich flavors. In midsummer, she developed hiccups due to a fit of rage. Each time a hiccup occurred, her whole body would tremble, and she lost consciousness. This happened once every three or five breaths, making the pulse impossible to palpate. Observing that her physical constitution and Qi were robust, Zhu administered two liang of Ren Shen Lu (Ginseng Stalk) decoction orally, which induced vomiting of several bowls of stubborn phlegm, profuse sweating, and a brief period of unconsciousness before she regained consciousness.
Another case involved an elderly man who usually consumed rich foods and suffered from chronic asthma with irregular episodes. In early autumn, he contracted dysentery, leading to a significant loss of appetite. Several days later, hiccups appeared, and his pulse was vast and empty. Zhu Danxi considered him treatable despite his thin physique and used Shen Zhu Tang (Ginseng and Atractylodes Decoction) to administer Da Bu Wan (Great Tonifying Pill). By the seventh day, he stabilized.
Yu Tianmin treated a patient with Shanghan (Cold Damage) whose previous physician had used tonifying medicines, thereby inducing hiccups. Ten days later, Yu was invited to examine the patient. The pulse was long and full-large, indicating Yangming Fu Excess (internal accumulation in the stomach/intestines) caused by erroneous tonification. Yu administered Da Cheng Qi Tang (Major Order the Qi Decoction) to purge the bowels. The heat subsided, and the hiccups stopped.
Commentary by Zhen: In this case, the hiccups had persisted for ten days, and the pulse was long, full, and large, making it relatively easy to distinguish. In the previous case, the pulse was vast and empty, yet Ginseng and Atractylodes were used. Why was Huang Bai (Phellodendron Bark) added? Was it because of his thin physique and rich dietary habits suggesting latent heat? Regarding the young woman whose hiccups were triggered by anger, with an unpalpable pulse, treatment was based solely on the robustness of her form and Qi. Why were other emetics not used, but instead two liang of Ren Shen Lu? Was it because the pulse could not be obtained, so a tonifying agent within the category of emetics was chosen as a safer approach?
In another case, a patient with Shanghan syndrome experienced a cessation of fever after seven days, followed by severe hiccups. The family was in distress. Yu examined the pulse, finding it deep, fine, and weak. The patient was extremely fatigued. Yu prescribed a large dose of Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) supplemented with Gan Jiang (Dried Ginger) and Fu Zi (Aconite Root). The patient took three doses per day, combined with moxibustion on Qihai (CV6) and Rugen (ST18). On the same day, the hiccups ceased, the pulse became full, and the patient recovered safely.
Lu Yuanying treated Guo Wenyu, the prefect of Yuyao, who had suffered from hiccups for over ten days. Physicians had treated him with Ding Xiang (Clove) and Fu Zi, which worsened the condition. Lu palpated the pulse, noting it was large and long at the Yangming position, and the Yang pulse on the right side was rapid and restless. He stated, "This hiccups are caused by Stomach Heat. Using hot medicines to assist the heat was a mistake." He prescribed Zhu Ru Tang (Bamboo Shavings Decoction), and the patient recovered quickly.
Commentary by Zhen: The previous case suitable for warm tonification and moxibustion is well-known. In the next case, where hot medicines worsened the condition, combined with the large, long, rapid, and restless pulse, a large dose of Bai Hu Tang (White Tiger Decoction) should have been used; if there were signs of excess requiring purgation, Cheng Qi Tang should have been added. It seems Zhu Ru Tang might have been insufficient.
Dai Tongfu treated a man whose primordial Qi was inherently deficient and who had blood stasis accumulating in the stomach area. Whenever he consumed hot soups containing Sichuan pepper and ginger, he would hiccup one or two times. Dai prescribed one liang each of Ren Shen (Ginseng) and Sheng Bai Zhu (Raw Atractylodes Macrocephala Rhizome), sliced them, and mixed them with powder made from crushed earthworms (Di Long) drowned in wine. Seven fen of dry lac ash was added. The mixture was formed into pills the size of bullet seeds using rice water. The patient chewed one pill slowly with aged wine in the morning and evening.
Commentary by Zhen: This syndrome is more difficult to differentiate than the previous ones. This prescription is superior to the previous formulas.