哕逆者，哕而气逆也。俗所谓发呃、吃逆、吃忒，总当名哕是也。咳逆者，咳而气逆也
，咳
嗽之咳也。干呕者，空呕也，声出而物不出也。呕者，声物兼出也。吐者，物出而声不出也
。此数者，方书每混论无别，何以辨之？《灵枢》曰∶胃有故寒气，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。《素问》曰∶病深者其声哕，《伤寒论
》有食谷者哕，有饮水、火劫、失下、妄下诸逆治。至病深者哕，盖指俗论发呃而吃吃然
有声者为哕也，《千金方》谓咳逆为哕逆之名非矣。《素问》云∶岁金太过，有病咳逆，少
阳司天，初之气，二之气，俱有病咳逆。又金郁之发，民病咳逆，盖皆论肺金及火为病，分
明指咳嗽之咳，因气逆者而名为咳耳，乌得与哕逆紊乎？仲景《伤寒论》咳逆者，仅见于辨
脉、平脉二篇，至《金匮要略》称咳逆者叠出，可略举而证也。曰∶病咳逆脉之，何以知为
肺痈？寸口脉微而数，微则多风，数则为热。且云∶风伤皮毛，合于肺则咳。又曰∶咳逆上
气，时时吐浊。但坐不得眠，皂荚丸主之。又肺痈胸满，一身微肿，咳逆上气，喘鸣迫塞，
泻肺汤主之。又曰∶咳逆倚息不得卧，小青龙汤主之。此皆咳而气逆为病也，须知论咳而或
曰咳，或曰咳逆。同一咳证而已。兼以逆字言者，不过因咳而气上逆耳，是即喘吐哕呕，有
曰喘逆、吐逆、哕逆、呕逆类耳。《明理论》以辨脉篇咳逆脉散者，入于咳冷之条，而与哕
目为一类。谓哕则吃吃然有声者。斯皆合仲景之旨矣，奈何论声则是，论名则非。故又曰∶
哕者，咳逆是也，附和《千金》之说，强合二证为一名矣，由是后世以吃逆忒逆为咳逆者纷
纷。王安道既知咳嗽为咳逆，又认有吃忒之咳逆，故亦蹈俗呼之弊。良由昧于哕耳，谓干呕
乃哕之微，哕乃干呕之甚。干呕者，其声轻小而短。哕者，其声重大而长。夫二者虽有微甚
之分，盖一证也，安道此说，强分一证为二名矣。干呕虽甚，可变为哕哉。若视干呕为病轻
，断为病重，遂断声有轻重大小长短，以干呕甚为哕，因引《素问》病深者其声哕之句，以
证哕病重于干呕，不思人病重时，每有作哕忒声者，非病深而哕者乎。反以干呕之甚者名哕
，未免以吃芯之当名哕者为咳逆矣，欲辨昔人之非，得毋转相紊乱乎？或曰∶子以安道为非
。然《要略》有云∶干呕哕，若手足厥者，橘皮汤主之。岂非干呕哕乃同类之一证，故合言
之耶。余曰∶此正干呕且哕二证互见，故并言之也。然则所谓干呕吐逆吐涎沫，用半夏干姜
散者，亦干呕与吐逆并言也，亦可视为同类之一证哉。安道之论哕与咳逆，余虽未能从，若
夫干呕与吐之辨，则信乎千古定论也。其曰∶呕兼声物，故无物而声空鸣者，谓之干，干犹
空也。至于吐则必有物矣，其可谓之干。仲景于呕字加一干字，所以别，夫呕为声物俱去也
。又仲景尝言欲呕矣，未尝言欲干呕欲哕也。夫欲之为义，将出未出而预觉之者，惟有形之
物则然，无形之声则不然也。呕与吐，主物言，故可谓之欲，干呕与哕主声，故不可谓之欲
。发明声物兼出为呕，物之独出为吐，声之独出为干呕，声独出而吃忒作声为哕逆，咳嗽上
逆为咳逆，孰能易其言哉？
呃逆，是指打嗝且气机上逆。民间所说的发呃、吃逆、吃忒，总应当命名为“哕”（呃逆）。咳逆，是指咳嗽且气机上逆，即咳嗽的咳。干呕，是空呕，只有声音而没有实物吐出。呕，是声音和实物同时吐出。吐，是只有实物吐出而没有声音。这些症状，医书常常混淆论述而无区别，如何辨别它们呢？《灵枢》说：胃中有旧的寒气，与新进入谷物的气一起返还入胃，新旧之气相混乱，正气与邪气相冲突，气机并聚而逆乱，再次从胃中冲出，所以发生哕（呃逆）。《素问》说：病情深重的人会出现哕（呃逆）的声音，《伤寒论》中提到进食后出现哕，以及因饮水、火疗劫迫、失于攻下、误用攻下等各种错误治疗导致的逆证。至于病情深重出现的哕，大概是指民间所说打嗝时发出吃吃有声的症状为哕，《千金方》称咳逆为哕逆的名称是错误的。《素问》说：岁运金气太过，会有病证表现为咳逆；少阳司天，初之气、二之气期间，都有病证表现为咳逆。又是金气郁结发作时，百姓患病表现为咳逆，这都是在论述肺金及火邪致病，明确指因气机上逆引起的咳嗽而名为咳耳，怎么能与哕逆混淆呢？张仲景《伤寒论》中的咳逆，仅见于辨脉篇和平脉篇，到了《金匮要略》中称咳逆的情况多次出现，可以简要列举来证明。说：患咳逆病的脉象，如何知道是肺痈？寸口脉微而数，微则多风邪，数则为热邪。并且说：风邪伤及皮毛，合并于肺则引起咳嗽。又说：咳逆上气，时常吐出浊液。只能坐着不能躺下，用皂荚丸主治。又说：肺痈胸满，全身轻微浮肿，咳逆上气，喘鸣气促阻塞，用泻肺汤主治。又说：咳逆倚靠呼吸不能平卧，用小青龙汤主治。这些都是咳而气逆为病，需要知道论述咳时而或称为咳，或称为咳逆。同一咳证罢了。加上“逆”字来说，不过是因咳嗽导致气机上逆而已，这就是像喘逆、吐逆、哕逆、呕逆这类说法一样。《明理论》以辨脉篇中咳逆脉散者，归入咳冷之条，而与哕目列为一类。认为哕则是吃吃有声的症状。这些都符合张仲景的本意，奈何论述声音是对的，论述名称却是错的。所以又说：哕，就是咳逆，附和《千金方》的说法，强行将两种证候合并为一个名称了，从此后世将吃逆忒逆称为咳逆的现象纷纷出现。王安道既然知道咳嗽即为咳逆，又认为存在吃忒这种咳逆，因此也陷入了俗呼的弊端。实在是因为不明白哕的含义，认为干呕是哕的轻微表现，哕是干呕的严重表现。干呕，声音轻小短促。哕，声音重大长缓。这两者虽然有轻重之分，但本质上是一个证候，王安道此说，强行将一个证候分为两个名称了。干呕即使严重，能变成哕吗？如果视干呕为病轻，断定为病重，于是断定声音有轻重大小长短，将严重的干呕称为哕，进而引用《素问》“病深者其声哕”这句话，来证明哕病重于干呕，却不思考人在重病时，经常会有发出哕忒声音的情况，这不就是病深而哕吗？反而将严重的干呕命名为哕，未免将应当命名为哕的吃芯（打嗝声）视为咳逆了，想要辩驳前人的错误，岂不是反而造成了混乱吗？有人说：你认为王安道不对。然而《金匮要略》中说：干呕哕，如果手足厥冷的，用橘皮汤主治。难道不是干呕和哕属于同类的一个证候，所以才合在一起说吗？我说：这正是干呕和哕两种证候同时出现，所以并而言之。那么所谓干呕吐逆吐涎沫，用半夏干姜散治疗的，也是干呕与吐逆并言，也可以视为同类的一个证候吗？对于王安道关于哕与咳逆的论述，我虽然不能完全赞同，但对于干呕与吐的辨别，确实是千古定论。他说：呕兼有声音和实物，所以没有实物只有声音空鸣的，称为干，干就是空的意思。至于吐则必须有实物了，怎么能称为干。张仲景在呕字上加一个干字，就是为了区分，夫呕是声音和实物都排出。另外张仲景曾说想呕，从未说过想干呕、想哕。夫的欲字含义，是将出未出而预先感觉到的，只有有形的实物才会这样，无形的声音则不会这样。呕与吐，主要指实物，所以可以说“欲”，干呕与哕主要指声音，所以不能说“欲”。阐明声物兼出为呕，仅有实物排出为吐，仅有声音排出为干呕，声音单独排出且发出吃忒声为哕逆，咳嗽上逆为咳逆，谁能改变这些说法呢？
E-qi (hiccup) refers to hiccuping accompanied by rebellious Qi. What is commonly referred to as fa-e, chi-ni, or chi-te should collectively be named E-qi (hiccup). Ke-ni (cough with rebellious Qi) refers to coughing accompanied by rebellious Qi, specifically the "ke" of coughing. Gan-ou (dry retching) is empty retching; sound is produced but no substance is expelled. Ou (vomiting) involves both sound and substance being expelled. Tu (spitting up) involves substance being expelled without sound. These conditions are often conflated in medical texts without distinction; how can they be differentiated? The *Ling Shu* states: When old cold pathogen in the stomach combines with the Qi of newly ingested grain, returning together into the stomach, the new and old Qi become chaotic, Zheng Qi (Upright Qi) and Xie Qi (Pathogenic Qi) attack each other, Qi gathers and rebels, and re-emerges from the stomach, thus causing E-qi (hiccup). The *Su Wen* states: In severe disease, the sound is E-qi (hiccup). The *Shang Han Lun* mentions E-qi occurring after eating, as well as various forms of rebellion caused by incorrect treatments such as drinking water, fire therapy coercion, failure to purge when indicated, or improper purging. The mention of E-qi in severe disease likely refers to the common description of hiccups producing a "chi-chi" sound. The *Qian Jin Fang*'s assertion that Ke-ni (cough with rebellious Qi) is synonymous with E-qi (hiccup) is erroneous. The *Su Wen* states: When Metal Qi is excessive in the annual cycle, diseases manifest as Ke-ni (cough with rebellious Qi); when Shaoyang governs the year, during the first and second climatic periods, diseases also manifest as Ke-ni (cough with rebellious Qi). Furthermore, when Metal Qi is stagnant and erupts, the people suffer from Ke-ni (cough with rebellious Qi). These passages discuss diseases of Lung Metal and Fire, clearly indicating that "Ke" (cough) is named so due to rebellious Qi, and it cannot be confused with E-qi (hiccup). Zhang Zhongjing's *Shang Han Lun* mentions Ke-ni (cough with rebellious Qi) only in the Pulse Differentiation and Pulse Level chapters. However, in the *Jin Gui Yao Lue*, Ke-ni (cough with rebellious Qi) appears repeatedly, allowing for a brief illustration. It states: Regarding the pulse of Ke-ni (cough with rebellious Qi), how can one know it is Fei Yong (Lung Abscess)? The Cun Kou (Inch Position) pulse is faint and rapid; faintness indicates Wind, while rapidity indicates Heat. It further states: Wind damages the skin and hair; if it combines with the Lung, it causes cough. It also says: Ke-ni (cough with rebellious Qi) with ascending Qi, frequently spitting out turbid fluid, where the patient can only sit and cannot lie down, is treated with Zao Jiao Wan (Soap Pod Pill). It also states: For Fei Yong (Lung Abscess) with chest fullness, slight swelling of the whole body, Ke-ni (cough with rebellious Qi), wheezing, and airway obstruction, Xie Fei Tang (Lung-Purging Decoction) is used. It also states: For Ke-ni (cough with rebellious Qi) requiring leaning to breathe and inability to lie flat, Xiao Qing Long Tang (Minor Blue Dragon Decoction) is used. All these describe cough with rebellious Qi as the pathology. One must understand that discussions on cough may use either "Ke" (cough) or "Ke-ni" (cough with rebellious Qi). It is the same cough condition. The addition of "Ni" (rebellious) simply indicates Qi rebelling upward due to coughing, similar to terms like Chuan-ni (wheezing with rebellion), Tu-ni (spitting up with rebellion), E-ni (hiccup with rebellion), and Ou-ni (vomiting with rebellion). The *Ming Li Lun* places cases of Ke-ni (cough with rebellious Qi) with scattered pulses in the chapter on cough and cold, grouping them with E-qi (hiccup). It claims E-qi (hiccup) produces a "chi-chi" sound. This aligns with Zhang Zhongjing's intent regarding the sound, but errs regarding the name. Thus, it incorrectly states: E-qi (hiccup) is Ke-ni (cough with rebellious Qi), echoing the *Qian Jin Fang* by forcibly merging two distinct conditions into one name. Consequently, later generations纷纭 (disputedly) referred to chi-ni (hiccups) as Ke-ni (cough with rebellious Qi). Wang Andao, while recognizing cough as Ke-ni (cough with rebellious Qi), also acknowledged chi-te (hiccups) as a form of Ke-ni (cough with rebellious Qi), thereby falling into the trap of colloquial misnomers. This stems from ignorance of E-qi (hiccup), leading to the view that Gan-ou (dry retching) is a mild form of E-qi (hiccup), and E-qi (hiccup) is a severe form of Gan-ou (dry retching). Gan-ou (dry retching) has light, small, and short sounds; E-qi (hiccup) has heavy, large, and long sounds. Although there is a difference in severity, they are essentially one condition. Wang Andao’s theory forcibly splits one condition into two names. Can severe Gan-ou (dry retching) transform into E-qi (hiccup)? If Gan-ou (dry retching) is considered mild and E-qi (hiccup) severe, and one distinguishes them by sound characteristics (light/heavy, short/long), labeling severe dry retching as hiccup, and then citing the *Su Wen* phrase "severe disease manifests as E-qi (hiccup)" to prove E-qi (hiccup) is more severe than Gan-ou (dry retching), one fails to consider that patients in critical illness often produce hiccup sounds. Is this not E-qi (hiccup) resulting from severe disease? Conversely, naming severe dry retching as E-qi (hiccup) mistakenly categorizes chi-xin (the sound of hiccups) as Ke-ni (cough with rebellious Qi). In attempting to correct past errors, does one not create further confusion? Some argue: You criticize Wang Andao. Yet the *Jin Gui Yao Lue* states: For Gan-ou (dry retching) and E-qi (hiccup) with cold extremities, Ju Pi Tang (Tangerine Peel Decoction) is used. Does this not imply Gan-ou (dry retching) and E-qi (hiccup) are the same condition, hence mentioned together? I reply: This indicates that Gan-ou (dry retching) and E-qi (hiccup) occur simultaneously, hence mentioned together. Similarly, the case of Gan-ou (dry retching), Tu-ni (spitting up with rebellion), and spitting saliva foam treated with Ban Xia Gan Jiang San (Pinellia and Dried Ginger Powder) mentions Gan-ou (dry retching) and Tu-ni (spitting up with rebellion) together; can this also be viewed as the same condition? While I do not fully agree with Wang Andao’s differentiation between E-qi (hiccup) and Ke-ni (cough with rebellious Qi), his distinction between Gan-ou (dry retching) and Tu (spitting up) is indeed a definitive conclusion through the ages. He states: Ou (vomiting) involves both sound and substance; therefore, when there is sound but no substance, it is called Gan (empty/dry), meaning empty. Tu (spitting up) necessarily involves substance and cannot be called Gan. Zhang Zhongjing adds "Gan" to "Ou" to distinguish it, as Ou (vomiting) involves the expulsion of both sound and substance. Furthermore, Zhang Zhongjing said "yu ou" (desire to vomit) but never said "yu gan ou" (desire to dry retch) or "yu e" (desire to hiccup). The term "Yu" (desire/want) implies a premonition of something about to emerge; this applies to tangible substances, not intangible sounds. Ou (vomiting) and Tu (spitting up) refer to substances, so "Yu" (desire) is appropriate. Gan-ou (dry retching) and E-qi (hiccup) refer to sounds, so "Yu" (desire) is inappropriate. To clarify: Sound and substance together indicate Ou (vomiting); substance alone indicates Tu (spitting up); sound alone indicates Gan-ou (dry retching); sound alone with chi-te sounds indicates E-qi (hiccup); cough with rebellious Qi indicates Ke-ni (cough with rebellious Qi). Who can change these definitions?