凡杂证之呃，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。
一、寒滞为呃者，或以风寒，或以生冷，或其脏气本寒，偶有所逆，皆能致呃，但去其
蔽抑之寒，而呃自止。宜橘皮汤、《三因》丁香散，或二陈汤加生姜五七片，或佐关煎，或
甘草干姜汤、橘皮干姜汤之类，皆可酌用。若寒之甚者，浆水散，或四逆汤。
一、胃火为呃者，其证极多，但察其脉见滑实而形气不虚，胸膈有滞，或大便坚实或不
行者，皆其胃中有火，所以上冲为呃，但降其火，其呃自止，惟安胃饮为最妙。余尝治愈多
人，皆此证也。
一、气逆为哕而兼胀闷者，宜加减二陈汤加乌药，或《宝鉴》丁香柿蒂散，或羌活附子
汤，或神香散。
一、食滞而呃者，宜加减二陈加山楂、白芥子、乌药之属，或用大和中饮加干姜、木香
。
一、中焦脾胃虚寒，气逆为呃者，宜理中加丁香汤，或温胃饮加丁香。若因劳倦内伤而
致呃逆者，宜补中益气汤加丁香。凡中焦寒甚者，多由脾胃气虚而然，盖脾胃不虚则寒亦不
甚，故治寒者，当以脾气为主。若吐痢后胃气微虚，或兼膈热而呃者，宜橘皮竹茹汤；无热
者，宜生姜、半夏、丁香、柿蒂、白术、肉桂之类，皆可酌用。
一、下焦虚寒者，其肝肾生气之原不能畅达，故凡虚弱之人多见呃逆，正以元阳无力，
易为抑遏而然。此呃逆之本，多在肾中，故余制归气饮主之甚效，或用理阴煎加丁香以疏气
，妙亦如之。
一、凡以大病之后，或以虚羸之极，或以虚损误攻而致呃逆者，此最危之证，察其中虚
，速宜补脾；察其阴虚，速宜补肾，如前二条固其法矣，然犹恐不及，则惟大补元煎及右归
饮之类，斯其庶几者也。
一、呃逆证，凡声强气盛而脉见滑实者，多宜清降；若声小息微而脉见微弱者，多宜温
补。
凡是各种杂病引起的呃逆，虽然都是由气机上逆所致，但有的兼有寒邪，有的兼有热邪，有的是因为饮食停滞导致气逆，有的是因为气机阻滞导致气逆，有的是因为中气虚弱导致气逆，有的是因为阴气枯竭导致气逆。只要仔细辨别病因并针对气机进行治疗，没有不能治愈的。如果是轻微的呃逆，或者是偶尔发生的呃逆，只要气机顺畅就会停止，本来不需要治疗；只有频繁发作成为病患，以及呃逆严重的情况，一定是气机严重上逆，或者是脾肾元气严重亏损导致的。然而实证呃逆不难治疗，只有元气败坏枯竭的情况，才是最危险的征候。
一、因寒邪阻滞引起呃逆的，可能是因为风寒侵袭，或者食用生冷食物，或者脏腑本身寒气偏盛，偶然气机逆乱，都能导致呃逆。只要去除遮蔽压抑的寒邪，呃逆自然停止。适宜使用橘皮汤、《三因方》丁香散，或者二陈汤加入生姜五到七片，或者佐关煎，或者甘草干姜汤、橘皮干姜汤之类，都可以酌情选用。如果寒邪严重的，可用浆水散，或者四逆汤。
一、因胃火引起呃逆的，症状表现很多，只要诊察脉象滑实而形体气息不虚，胸膈部位有滞塞感，或者大便坚硬或者不通畅的，都是胃中有火，所以上冲引发呃逆。只要清降胃火，呃逆自然停止，其中安胃饮最为巧妙。我曾经治愈过许多人，都是这种证候。
一、因气逆引起哕（呃逆）并且兼有胀闷感的，适宜使用加减二陈汤加入乌药，或者《医学发明》丁香柿蒂散，或者羌活附子汤，或者神香散。
一、因饮食停滞引起呃逆的，适宜使用加减二陈汤加入山楂、白芥子、乌药这类药物，或者使用大和中饮加入干姜、木香。
一、中焦脾胃虚寒，气机上逆引起呃逆的，适宜使用理中加丁香汤，或者温胃饮加入丁香。如果是因劳累过度、内伤导致呃逆的，适宜使用补中益气汤加入丁香。凡是中焦寒邪严重的，多是由脾胃气虚造成的，大概是因为脾胃不虚则寒邪也不会严重，所以治疗寒证时，应当以调理脾气为主。如果在呕吐腹泻后胃气轻微虚弱，或者兼有膈部热邪而呃逆的，适宜使用橘皮竹茹汤；没有热邪的，适宜使用生姜、半夏、丁香、柿蒂、白术、肉桂这类药物，都可以酌情选用。
一、下焦虚寒的，其肝肾化生元气的根本不能畅达，所以凡是身体虚弱的人多见呃逆，正是因为元阳无力，容易被抑制遏阻而导致的。这种呃逆的根本原因，多在肾脏，所以我制定的归气饮主治此证非常有效，或者使用理阴煎加入丁香来疏理气机，效果也同样奇妙。
一、凡是大病之后，或者极度虚弱消瘦，或者因为虚损误用攻伐药物而导致呃逆的，这是最危险的证候。诊察如果是中气虚弱，应当迅速补益脾气；诊察如果是阴虚，应当迅速补肾，如前两条所述的方法已经确立了原则，然而仍然担心力度不够，那就只有大补元煎及右归饮这类方剂，才差不多能挽回局面。
一、呃逆这一证候，凡是声音强盛、气息壮实且脉象滑实的，大多适宜清热降逆；如果声音微弱、气息短促且脉象微弱的，大多适宜温补。
In general, hiccups (ē nì) arising from miscellaneous diseases are caused by the rebellion of Qi. However, some cases involve an accompaniment of Cold, some involve Heat, some result from food stagnation causing Qi rebellion, some from Qi stagnation, some from deficiency of Middle Qi, and some from exhaustion of Yin Qi. By carefully identifying the cause and treating the Qi accordingly, there is no case that cannot be cured. Mild or occasional hiccups will cease once the Qi flows smoothly and require no treatment. Only frequent, troublesome hiccups or severe cases indicate a major rebellion of Qi or a significant depletion of Spleen and Kidney Yuan Qi (Primordial Qi). While excess-type hiccups are not difficult to treat, cases involving the collapse and exhaustion of Yuan Qi represent the most critical prognosis.
1. Hiccups caused by Cold stagnation may result from Wind-Cold invasion, consumption of raw/cold foods, or inherent organ Cold leading to accidental Qi rebellion. Removing the obstructing Cold will naturally stop the hiccups. Suitable formulas include Jupi Tang (Tangerine Peel Decoction), Dingxiang San (Clove Powder) from *San Yin Fang*, Erchen Tang (Two-Aged Decoction) with 5-7 slices of fresh ginger, Zuoguan Jian (Assisting the Border Decoction), Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction), or Jupi Ganjiang Tang (Tangerine Peel and Dried Ginger Decoction), chosen according to circumstances. For severe Cold, Jiangshui San (Fermented Water Powder) or Sini Tang (Frigid Extremities Decoction) may be used.
2. Hiccups caused by Stomach Fire present with various symptoms. If the pulse is slippery and solid while the physique and Qi are not deficient, and there is stagnation in the chest and diaphragm, or if stool is hard or constipated, this indicates Fire in the Stomach causing upward rebellion. Clearing the Fire will stop the hiccups; Anwei Yin (Stomach-Anchoring Infusion) is considered the most effective. I have successfully treated many patients with this pattern.
3. For hiccups accompanied by distension and fullness due to Qi rebellion, Jiajian Erchen Tang (Modified Two-Aged Decoction) with Wuyao (Lindera Root) is suitable, or Dingxiang Shidi San (Clove and Persimmon Calyx Powder) from *Yixue Mingbian*, Qianghuo Fuzi Tang (Notopterygium and Aconite Decoction), or Shenxiang San (Aromatic Musk Powder).
4. For hiccups caused by food stagnation, Jiajian Erchen Tang with Shanzha (Hawthorn Fruit), Baijiezi (White Mustard Seed), and Wuyao is appropriate, or Dahezhong Yin (Great Harmonizing the Middle Infusion) with Ganjiang (Dried Ginger) and Muxiang (Aucklandia Root).
5. For hiccups due to Cold-deficiency of the Middle Jiao (Spleen and Stomach) with Qi rebellion, Lizhong Jia Dingxiang Tang (Regulate the Middle Decoction plus Clove) or Wenwei Yin (Warming the Stomach Infusion) plus Dingxiang (Clove) is indicated. If hiccups arise from fatigue and internal injury, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) plus Dingxiang is suitable. Severe Cold in the Middle Jiao usually stems from Spleen Qi deficiency; since the Spleen and Stomach do not become deficient easily, Cold does not become severe unless they are weak. Therefore, treating Cold should prioritize regulating Spleen Qi. After vomiting or diarrhea, if Stomach Qi is slightly deficient and accompanied by Diaphragm Heat causing hiccups, Jupi Zhuru Tang (Tangerine Peel and Bamboo Shavings Decoction) is appropriate. Without Heat, ingredients such as Shengjiang (Fresh Ginger), Banxia (Pinellia Tuber), Dingxiang, Shidi (Persimmon Calyx), Baizhu (Atractylodes Rhizome), and Rougui (Cinnamon Bark) may be used酌情ly.
6. In Lower Jiao Cold-deficiency, the source of Qi generation in the Liver and Kidneys cannot flow freely. Thus, weak individuals often exhibit hiccups because Yuan Yang (Primordial Yang) is insufficient and easily suppressed. The root of such hiccups lies in the Kidney. My formulated Guiqi Yin (Returning Qi Infusion) is highly effective for this, or Liyin Jian (Nourishing Yin Decoction) plus Dingxiang to soothe Qi, which is also excellent.
7. Hiccups occurring after a serious illness, extreme emaciation, or mistaken purgative treatment for deficiency syndromes constitute the most critical conditions. If Middle Deficiency is identified, tonify Spleen Qi immediately; if Yin Deficiency is identified, tonify Kidney Yin immediately, following the principles of the previous two sections. However, fearing these measures may be insufficient, only powerful tonics like Dabu Yuanjian (Great Tonification of the Origin Decoction) and Yougui Yin (Right-Restoring Infusion) will likely suffice.
8. Regarding hiccups: if the voice is strong, Qi is robust, and the pulse is slippery and solid, clearing and descending methods are generally preferred. If the voice is faint, breathing is weak, and the pulse is thready and weak, warming and tonifying methods are generally preferred.