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The *Shanghan Lun* (Treatise on Cold Damage) mentions "yue" (hiccups/belching with sound) but not "e" (hiccup). According to the chapter on treating "yue" in the *Ling Shu* (Spiritual Pivot), stimulating the nose with grass to induce sneezing, after which breathing pauses, or rapidly pulling/guiding the patient, can immediately cure it. Startling the patient greatly also cures it. Deduced from this, these are the principles of external treatments for hiccup today. Medical texts erroneously name dry retching and "yue" as "ke ni" (cough with reverse flow of qi). "Ke ni" is named because coughing involves reverse flow of qi. "E" refers to stomach qi being disharmonious and rushing upward to produce sound; it is named based on the sound, hence called "e ni" (hiccup).

Regarding the symptoms of hiccup: if the body presents with alternating chills and fever, vomiting accompanied by hiccup, this indicates exterior pathogenic factors transmitting to the Shaoyang (Lesser Yang) channel. If the left pulse is floating and tight, with fever and no sweating, Qianghuo Chaihu Tang (Notopterygium and Bupleurum Decoction) is the primary formula. If there is sweating and a rapid pulse, Xiaochaihu Tang (Minor Bupleurum Decoction) combined with Qingdan Tang (Clear Gallbladder Decoction) is used. If there is internal heat and thirst, hiccup that comes and goes, frequent sweating, cracked lips, and constipation, with a deep and rapid right pulse, this is due to Yangming interior heat rushing upward; Gange Zhuru Tang (Pueraria and Bamboo Shavings Decoction) or Zhuru Qingwei Tang (Bamboo Shavings Stomach-Clearing Decoction) are indicated. If there is interior heat with fecal impaction, and all six pulses are rapid and large, Xiexin Tang (Drain the Epigastrium Decoction) or Liangge San (Cool the Diaphragm Powder) are used. If there are signs indicating purgation is necessary, Chengqi Tang (Order the Qi Decoction) is used. If there is stomach heat combined with deficiency, Renshen Jupi Zhuru Tang (Ginseng, Tangerina Peel, and Bamboo Shavings Decoction) is used. If there is much phlegm in the epigastrium and the right pulse is slippery and large, Erchen Zhuru Tang (Two-Aged [Aged Tangerina Peel and Pinellia] Decoction with Bamboo Shavings) plus Zhike (Aurantii Fructus) and Jiegeng (Platycodon Root) is used. If there is both phlegm and fire, with a deep and rapid pulse, Zhilian Erchen Tang (Coptis and Two-Aged Decoction) plus Gegen (Pueraria Root) and Zhuru (Bamboo Shavings) is used, or Daotan Tang (Abundant Phlegm Decoction) is administered. If food stagnation is in the middle jiao, and the qi-kou pulse is slippery, Pingwei Baohe San (Stomach-Pacifying and Harmony-Preserving Powder) is used. If cold-cooling herbs were mistakenly taken, resulting in deep and slow pulses throughout, with stagnation in the middle jiao, Dashun Yin (Greatly Smooth Drink) should be used to warm the middle, combined with Baohe San. If yin fire rushes upward causing hiccup, Zhibo Siwu Tang (Anemarrhena, Phellodendron, and Four Substances Decoction) is used. Additionally, if there is no fever at onset, no thirst, clear urination and defecation, deep and slow pulses throughout, yet hiccup appears, this is an yin-pattern cold hiccup. For mild cases, Lizhong Tang (Regulate the Middle Decoction) is used; for severe cases, Sini Tang (Reverse the Extremities Decoction); Dingxiang Shidi Tang (Clove and Persimmon Calyx Decoction) is also indicated.

In Yangming wind-stroke, the pulse is wiry, floating, and large, with shortness of breath, generalized abdominal fullness, pain in the hypochondrium and heart region, obstruction of qi upon prolonged pressing, dry nose, inability to sweat, drowsiness, jaundice of the whole body and face, difficulty in urination, tidal fever, and frequent hiccups. Swelling around the ears and temples may occur; acupuncture brings slight relief, but the exterior syndrome remains unresolved. If the disease persists beyond ten days and the pulse continues to float, Xiaochaihu Tang is given. If the pulse is merely floating without other symptoms, Mahuang Tang (Ephedra Decoction) is given. If there is no urination, abdominal fullness increases, and hiccups worsen, it is incurable.

In Yangming disease, a wiry pulse indicates Shaoyang involvement. A floating and large pulse indicates Taiyang involvement. Abdominal fullness, hypochondriac and cardiac pain are Shaoyang symptoms. Dry nose, inability to sweat, drowsiness, full-body jaundice, tidal fever, and frequent hiccups are Yangming symptoms. Swelling around the ears and temples, slight relief after acupuncture, unresolved exterior syndrome, persistence beyond ten days, and a continuing floating pulse indicate using Xiaochaihu Tang to guide Yangming pathogenic factors out through the Shaoyang channel. If the pulse is merely floating without other symptoms, Mahuang Tang is used to guide Yangming pathogenic factors out (Note: Text implies guiding out, though Mahuang Tang typically releases the exterior). Treat according to the method. If originally there was no urination, and abdominal fullness with worsening hiccups occurs, it is incurable.

In Yangming disease, if the patient cannot eat, attacking the heat will inevitably cause hiccups. The reason is deficiency-cold in the stomach. Because the person is fundamentally deficient, attacking heat will inevitably cause hiccups.

Yangming inability to eat has two categories: cold and heat. Heat in the stomach causing inability to eat: attacking the heat leads to recovery. Cold in the stomach causing inability to eat: attacking the heat inevitably causes hiccups. The following text clarifies these two categories.

It is also stated: A floating and slow pulse indicates exterior heat and interior cold. With diarrhea of undigested food, Sini Tang is the primary treatment. If the stomach is deficient and cold, unable to eat, drinking water will cause hiccups. This means that in Yangming interior cold with inability to eat, not only does taking cold medicines cause hiccups, but even drinking water causes them.

In cold damage, if there are hiccups and abdominal fullness, observe the anterior and posterior orifices to determine which is obstructed; unblocking it will lead to recovery.

This means that in Yangming stomach excess with hiccups and abdominal fullness, one should observe which of the anterior or posterior orifices is obstructed and unblock it.

**Qianghuo Chaihu Tang (Notopterygium and Bupleurum Decoction)**
Ingredients: Qianghuo (Notopterygii Rhizoma et Radix), Chaihu (Bupleuri Radix), Fangfeng (Saposhnikoviae Radix), Huangqin (Scutellariae Radix), Guangpi (Citri Reticulatae Pericarpium), Banxia (Pinelliae Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma).
Indications: Alternating chills and fever, vomiting, bitter taste, deafness, hypochondriac pain, and hiccup require treating the Shaoyang channel. If chills and headache are present, it involves both Shaoyang and Taiyang; thus, this formula treats both channels simultaneously.

**Xiaochaihu Tang (Minor Bupleurum Decoction)** (See section on Chills and Fever).
For Shaoyang-Taiyang hiccup, use the above formula to disperse the exterior. If there is no Taiyang exterior pathogen, use this formula plus Zhuru (Bambusa Shizhusu) and Houpo (Magnoliae Officinalis Cortex), effectively combining with Qingdan Tang.

**Chengqi Tang (Order the Qi Decoction)** (See section on Constipation).

**Xiexin Tang (Drain the Epigastrium Decoction)** (See section on Fullness and Oppression).
Phlegm-fire in the middle jiao, suppressed by cold-cooling herbs, often causes hiccup. This formula uses Huanglian (Coptidis Rhizoma) and Ganjiang (Zingiberis Rhizoma) together to regulate interior qi, assisted by Banxia to disperse phlegm-saliva with its acrid nature. If vomiting is present, add Zhuru and Huoxiang (Agastaches Herba); if qi reversal and obstruction exist, add Zhike and Houpo.

**Liangge San (Cool the Diaphragm Powder)** (See section on Mania).
All rebellious upward rushing belongs to fire. Therefore, for yang-pattern hiccup with heat but no stagnation, use this formula to clear it. If signs of downward purgation appear, add Xuanmingfen (Natrii Sulfas).

**Renshen Jupi Zhuru Tang (Ginseng, Tangerina Peel, and Bamboo Shavings Decoction)**
Ingredients: Jupi (Citri Reticulatae Pericarpium), Zhuru (Bambusa Shizhusu), Shengjiang (Zingiberis Rhizoma Recens), Houpo (Magnoliae Officinalis Cortex), Banxia (Pinelliae Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma), Renshen (Ginseng Radix et Rhizoma), Huoxiang (Agastaches Herba).
If hiccup accompanies exterior signs, disperse the exterior; if hiccup involves phlegm-fire, use Zhilian Zhuru Tang or Zhilian Erchen Tang; if cold and heat are unbalanced, use Banxia Xiexin Tang. Now, since the exterior pathogen has resolved and there is no interior excess heat, but only stomach deficiency causing hiccup, this formula tonifies the stomach and harmonizes the middle.

**Erchen Zhuru Tang (Two-Aged Decoction with Bamboo Shavings)**
Ingredients: Shu Banxia (Prepared Pinelliae Rhizoma), Bai Fuling (Poria), Guangpi (Citri Reticulatae Pericarpium), Gancao (Glycyrrhizae Radix et Rhizoma), Zhuru (Bambusa Shizhusu), Zhike (Aurantii Fructus), Jiegeng (Platycodonis Radix).
For stomach-heat hiccup, use Liangge San; for cold-heat imbalance, use Xiexin Tang; for stomach-deficiency hiccup, use Renshen Jupi Tang. Now, due to phlegm coagulation and qi obstruction, Erchen Tang is used with added Zhuru, Zhike, and Jiegeng. Zhilian Erchen Tang adds Gegen and Zhuru.
For vomiting and hiccup caused by stomach phlegm-fire, Zhilian Erchen Tang is used; adding Zhuru clears gallbladder fire, and Gegen disseminates stomach heat. It treats not only hiccup but also vomiting.

**Pingwei San (Stomach-Pacifying Powder)** (See section on Delirium).
Stomach dampness stagnation and food retention can also cause hiccup. Generally, if the right pulse is solid and large but not rapid, it indicates food-fullness hiccup; do not recklessly use cold-cooling herbs. For stomach excess, add Zhishi (Aurantii Fructus Immaturus), Laifuzi (Raphani Semen), and Qingpi (Citri Reticulatae Pericarpium Viride). For vomiting, add Banxia and Huoxiang.

**Baohe San (Harmony-Preserving Powder)** (See section in Chest Fullness).
For dampness stagnation and food retention, use the preceding Pingwei San, but it must be combined with Baohe San for more specific efficacy. However, one must carefully examine what food was ingested and add corresponding herbs for better effect.

**Dashun Yin (Greatly Smooth Drink)** (See section on Abdominal Pain).
For phlegm-fire hiccup, Zhilian Erchen Tang is used, but this applies only when there is no stagnation in the stomach. If there is food stagnation suppressed by cold, Suisha (Amomi Fructus Rotundus) and Cao Kou (Cardamomi Fructus) should be used for their warming and drying properties to open cold coagulation, while Houpo and Qingpi disperse stagnation with their acrid nature, followed by combining Pingwei San and Baohe San.

**Wenzhong Pingwei San (Warm-Middle Stomach-Pacifying Powder)** is Pingwei San plus Doukou (Cardamomi Fructus) and Sharen (Amomi Fructus).
This formula is essentially Dashun Yin with Cangzhu (Atractylodis Rhizoma) added and Qingpi removed. Pingwei San plus Sharen and Doukou effectively treats stomach coagulation and stagnation, provided there is no internal dry-heat.

**Lizhong Tang (Regulate the Middle Decoction)** (See section on Abdominal Pain).
For yang-pattern hiccup, use Zhilian Erchen Tang; for yin-pattern hiccup, use Lizhong Tang. If deficient yang floats upward, add Huanglian as a guiding herb.

**Sini Tang (Reverse the Extremities Decoction)** (See section on Cold Extremities).
For yin-pattern hiccup with cold extremities, use this decoction urgently.

**Zhibo Siwu Tang (Anemarrhena, Phellodendron, and Four Substances Decoction)**
For yin-fire hiccup, use this formula to astringe and descend; this is the method of nourishing yin and descending fire.

**Dingxiang Shidi Tang (Clove and Persimmon Calyx Decoction)**
Ingredients: Dingxiang (Caryophylli Flos), Shidi (Diospyri Calyx), Renshen (Ginseng Radix et Rhizoma), Shengjiang (Zingiberis Rhizoma Recens).
This is a formula for treating cold hiccup. Using it today to treat yang-pattern hiccup is a major error.