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According to the *Shuowen Jiezi*, "Yi" (belching) refers to the breath after a full meal, pronounced as "Yu Jie Qie", and is colloquially written as "Ai". In Shanghan disease, there are two types of syndromes, both caused by the misuse of sweating, vomiting, or purging methods, leading to weak and disharmonious Stomach Qi, with deficient Qi rebelling upward, causing stuffiness and hardness in the epigastrium. Therefore, for those accompanied by diarrhea, Shengjiang Xiexin Tang (Ginger Decoction for Draining the Epigastrium) is used; for those without diarrhea, Xuanfu Daizhe Shi Tang (Inula and Hematite Decoction) is used.

After the exterior syndrome of Shanghan disease has been resolved through sweating, if the Stomach interior is disharmonious, resulting in stuffiness and hardness in the epigastrium, dry belching with a smell of food decay, fluid retention under the hypochondrium, abdominal distension, borborygmus (rumbling in the intestines), and diarrhea, Shengjiang Xiexin Tang should be administered.

After the exterior syndrome of Shanghan disease has been resolved through sweating, vomiting, or purging, if there is stuffiness and hardness in the epigastrium and belching persists without relief, Xuanfu Daizhe Shi Tang should be administered.

Supplement:
Question: What causes belching (Qi rebellion) in Shanghan disease? Answer: It is due to the failure of Qi interaction in the chest. The Qi of the Shaoyin meridian reaches the chest and intersects with the Jueyin meridian; the struggle between Water and Fire generates sound, thus causing belching. Rusheng Jia Zhishi Tang (Rusheng Decoction with Added Immature Bitter Orange) is suitable.

Formula for Rusheng Jia Zhishi Tang:
Gancao (Licorice Root), Jiegeng (Platycodon Root) (each 5 qian); Zhishi (Immature Bitter Orange) (stir-fried, 3 qian). Chop the herbs finely. Take 5 qian per dose, add Banxia (Pinellia Tuber) half a qian, decoct in water, and take orally.

If panting and belching occur after vomiting and purging in Shanghan disease, Rusheng Jia Renshen Huoxiang Xingren Tang (Rusheng Decoction with Added Ginseng, Agastache, and Apricot Seed) is suitable.

Formula for Rusheng Jia Renshen Huoxiang Xingren Tang:
Gancao (Licorice Root), Jiegeng (Platycodon Root), Renshen (Ginseng Root), Huoxiang (Patchouli Herb), Xingren (Apricot Seed) (equal parts). Chop the herbs finely. Take 5 qian per dose, decoct in water, and take orally.

(Yi Ni, commonly known as hiccups)
Yue (hiccups/belching) is what the common people call "Chi Ni" (hiccup). It is analyzed in detail in miscellaneous diseases. According to *Shuowen Jiezi*, Yue means Qi rebellion, pronounced as "Yu Yue Qie" or "Yi Lue Qie". The error of "Yi Lue" evolved into "Chi Ni", similar to how "Tuan" is colloquially pronounced as "Tu Luan" and "Jiao" as "Ge Luo"; the reason is clear. Li Dongyuan also stated that Yue is a severe form of Gan Ou (dry retching). However, it is unknown that having sound but no substance expelled is all called Gan Ou; how can they be divided into two diseases based on severity? As for "Ke Ni" (coughing rebellion), it refers to modern asthma and cough, yet it is confused with Chi Ni. Or the belief that Yue is all due to lack of investigation involves significant gains and losses, which must not be ignored.

Stomach Cold
After excessive vomiting and purging in Shanghan disease, leading to extreme deficiency, followed by profuse sweating, because the patient's exterior Qi is stagnant, and the doctor gives water to induce sweating, Yue occurs. This is because the Stomach is cold internally. (Cheng Wuji's commentary: Excessive vomiting and purging cause extreme Stomach Qi deficiency; further profuse sweating leads to Yang depletion. Exterior pathogens stagnate at the surface causing fever. The doctor gives water to induce sweating; the deficient Stomach combined with cold water creates a conflict of deficiency and cold, resulting in Yue. Treatments include Wuzhuyu Tang, Lizhong Tang, Ju Pi Gan Jiang Tang from *Huoren Shu*, Qianghuo Fuzi San, Banxia Shengjiang Tang, and Tui Yin San.)

*Huoren Shu* states: If medication fails, moxibustion will cure it. The method is: For women, moxa three cones at the bone space at the end of the nipple pointing downward; for men and those with smaller breasts, use one finger's width as the standard, left side for men, right side for women. The moxa cone should be the size of a small bean, directly aligned with the nipple in the depressed area where the artery pulses.

Stomach Heat
Yangming Wind-Strike presents with a wiry, floating, and large pulse, shortness of breath, abdominal distension, pain in the hypochondrium and heart region, nasal dryness, inability to sweat, lethargy, jaundice of the whole body and face, difficult urination, tidal fever, occasional Yue, and a continuing floating pulse. Xiao Chaihu Tang (Minor Bupleurum Decoction) should be given. If there is no urination, abdominal distension worsens, and Yue increases, it is incurable (see Stomach Excess Syndrome). In Shanghan, if Yue is accompanied by abdominal distension, observe the anterior and posterior orifices to determine which is obstructed; unblocking it will lead to recovery. (Zhang Zhongjing did not provide a formula; *Huoren Shu* suggests Zhuling Tang for anterior obstruction and Tiaoweichengqi Tang for posterior obstruction.)

If the Stomach is deficient and cold, unable to eat, drinking water causes Yue. Xiaochengqi Tang (Minor Order the Yellow Dragon Decoction) is used. If after taking the medicine, there is no passage of gas in the abdomen, do not purge; purging will cause abdominal distension and anorexia, and giving water will cause Yue (see Tidal Fever). If originally thirsty but vomiting after drinking water, Chaihu formulas are contraindicated; eating causes Yue (see Hypochondriac Pain). In Yangming disease, if the Stomach is excess and unable to eat, attacking the heat will cause Yue. In dampness patients, if head sweating, back stiffness, aversion to cold, and desire for warmth occur, premature purging will cause Yue (see Body Pain).

In Taiyang disease, using fire coercion to induce sweating causes blood and Qi to overflow, yellowing of the body, desire for nosebleed, head sweating, abdominal distension, delirium, and in severe cases, Yue, picking at clothes, and touching the bed. If urination is free, it is treatable (see Head Sweating discussion).

Supplement:
Ju Pi Gan Jiang Tang (Tangerine Peel and Dried Ginger Decoction):
Ju Pi (Tangerine Peel), Tongcao (Tetrapanax Pith), Gan Jiang (Dried Ginger) (processed), Guixin (Cinnamon Twig), Gancao (Licorice Root) (honey-fried, each 2 liang), Renshen (Ginseng Root) (1 liang). Chop like hemp seeds. Take 4 qian per dose, decoct in one cup of water until reduced to 60%, strain, and take warm, three times daily.

Qianghuo Fuzi San (Notopterygium and Aconite Powder) treats Chi Ni (Hiccups):
Qianghuo (Notopterygium Rhizome), Fuzi (Aconite Root) (processed), Huixiang (Fennel Fruit) (lightly stir-fried, each 0.5 liang), Muxiang (Aucklandia Root), Gan Jiang (Dried Ginger) (processed, each amount equal to a jujube seed). Grind into fine powder. Take 2 qian per dose, decoct in one cup of water with a pinch of salt for ten boils, take with residue warm. One dose stops it.

Banxia Shengjiang Tang (Pinellia and Fresh Ginger Decoction) treats severe Yue (Hiccups):
Shengjiang (Fresh Ginger) (2 liang, sliced), Banxia (Pinellia Tuber) (washed, 1.25 liang). Decoct in two cups of water until reduced to 80%, strain, divide into two doses, and take warm.

Failure to Purge (Shi Xia)
Haicang (Zhang Yuansu) said: In Shanghan, Ke Ni (coughing rebellion) with a scattered pulse indicates death. Zhang Zhongjing's words are not false. Generally, this arises from failing to purge when indicated, generating Ke Ni, with Yin not entering internally and stool being soft; only Xiexin Tang (Draining the Epigastrium Decoction) is suitable. If stool is hard, Dachengqi Tang (Major Order the Yellow Dragon Decoction) is especially suitable. Are these two medicines divine tasks? Li Dongyuan and Jiegu consider them excellent remedies.

Jiegu said: Ke Ni is caused by fierce heat rushing upward while Lung Yin cannot enter internally. Thus, for constipation, Dachengqi Tang should be used to purge; for soft stool, Xiexin Tang is the main treatment.

Haicang said: Shaoyin Ke Ni is due to failure to purge. Yin fluids are nearly exhausted, Yang rebels upward, preventing Yin from being retained. However, if Yin is exhausted, Yang will also soon exhaust. Inhaled Qi returns to Kidney and Liver; Yang rebels upward, Yin enters but is not retained, thus indicating extreme Yang. If the pulse is faint and near exhaustion, do not purge; instead, take Xiexin Tang to nourish Yin and retreat Yang. If Xiexin Tang is not used, Liangge San (Cool the Chest Powder) without Xiaoshi (Mirabilite) and Huangqin (Scutellaria Root), or Qingfei San (Clear Lung Powder) can be used. If the left pulse is floating and the right is deep and solid, it is not a exterior syndrome. Extreme interior conditions may manifest as exterior. Why? Ke Ni with stiff tongue and solid right pulse indicates Shaoyin interior syndrome. Excessive drinking, epigastric stuffiness, thirst, and rebellion are treated with Wuling San (Five-Ingredient Powder with Poria). There are no other evil signs. If evil signs arise, such as tongue spasms, abnormal speech, dizziness, or sore throat, it is Shaoyin syndrome; purge quickly with Dachengqi Tang. Why is a floating pulse considered exterior? If floating is solid and large, but deep is diminished and small, it is exterior. If floating is solid and large, and deep is also solid and large, it is not exterior. The pathogen has entered deeply. Internal heat should be deep but floats; extreme Yang returns to the exterior.

Yin Syndrome: Yin is already hidden internally, Yin Qi is too strong, Kidney Water dominates, Liver Qi does not generate, Stomach Fire is diseased, Ding Fire (Heart Fire) is diminished. Thus, Mingmen Fire (Ministerial Fire) travels, cold pathogens force their way and gather in the chest, also nearing exhaustion. This causes fever, extreme thirst with desire to drink, and wanting to remove covers. The patient feels hot alone, but others feel cold when touching the body, muscles, bones, marrow, and blood vessels. This fire is rootless fire. Therefore, use hot herbs like Dingxiang (Clove) and Gan Jiang (Dried Ginger) to warm the Stomach, and the fire will descend from below.

Yunqi San (Harmonizing Qi Powder):
Use Chuanwu (Aconite Root) (three large ones, processed, cracked, skin and umbilicus removed). Grind into fine powder. Take 3 qian per dose, soak 21 black beans and rock sugar in soup, mix well, and drink slowly while hot.

Formula for Treating Yin Toxin Hiccups (from *Ben Shi Fang*):
Chuanwutou (Aconite Root), Gan Jiang (Dried Ginger), Fuzi (Aconite Root) (all processed), Rougui (Cinnamon Bark), Shaoyao (Peony Root), Banxia (Pinellia Tuber), Zhi Gancao (Honey-fried Licorice Root), Wuzhuyu (Evodia Fruit), Chenpi (Tangerine Peel), Dahuang (Rhubarb Root and Rhizome) (equal parts). Grind into fine powder. Take 1 qian per dose, decoct in one cup of water with 3-5 slices of fresh ginger until reduced to 70%, strain, and take warm.

Roudoukou Tang (Myristica Decoction) treats hiccups and belching after sweating in Shanghan:
Roudoukou (Nutmeg) (one), Shilianrou (Lotus Seed Embryo) (stir-fried), Huixiang (Fennel Fruit) (each 1 liang), Renshen (Ginseng Root), Dingxiang (Clove) (each 0.5 liang), Pipaye (Loquat Leaf) (five leaves, brushed clean, roasted). Chop finely. Decoct in four cups of water with ten slices of ginger until reduced to two cups, strain, and take warm on an empty stomach, divided into two doses.

Liangjiang Tang (Galangal Decoction):
Chenpi (Tangerine Peel), Liangjiang (Galangal Rhizome), Guizhi (Cinnamon Twig), Danggui (Angelica Sinensis Root) (each 1 liang), Xingren (Apricot Seed) (twenty), Mahuang (Ephedra Stem), Gancao (Licorice Root) (each 0.5 liang), Binglang (Areca Seed) (three, separately ground into powder). Chop finely. Decoct in four cups of water with ten slices of ginger and three jujubes until reduced to two cups, strain, add Binglang powder, boil three more times, and take one cup orally. If not stopped, take another dose. Pang Lao said: Persistent hiccups in Shanghan are due to the rise and fall of Yin and Yang Qi attempting to produce sweat; rising fails, so Stomach Qi rebels upward as hiccups without cessation. This formula is suitable.

Bianque Zhongzang Jing treats Shanghan Ke Ni with Dingxiang San (Clove Powder):
Dingxiang (Clove), Shidi (Persimmon Calyx) (each 1 fen), Gancao (Licorice Root), Liangjiang (Galangal Rhizome) (each 0.5 qian). Brew with boiling water as one dose, drink fiercely while hot. Extremely effective. The above five formulas are suitable for Yin syndromes.

Sanyin Ju Pi Zhu Ru Tang (Three Causes Tangerine Peel and Bamboo Shaving Decoction) (see Miscellaneous Diseases Hiccups Section):
The above formulas are suitable for Yang syndromes.

Emergency Formula for Treating Shanghan Hiccups:
Xiangfu (Cyperus Rhizome), Juhe (Tangerine Seed) (stir-fried, each 0.5 liang). Chop finely. Use half a cup of wine. First, stir-fry the herbs in a silver or ceramic vessel, gradually dripping wine until the herbs are scorched yellow. Grind into fine powder. Take 2 qian, decoct in a small cup of water until reduced to 80%, and sip slowly. Another formula uses only Xiangfu powder.

Another Formula: Roast two garlic bulbs until soft, mash them, add Baijiang (White Ginger) powder (until pills can be formed), mix well into pills the size of Sophora seeds. Swallow twenty pills with natural juice of Xieshi (Welsh Onion). Take fifteen more pills when symptoms recede.

Wu Kun said: Hiccups are Qi rebelling upward causing "Chi Te". Medical texts sometimes mistake this for Ke Ni (coughing rebellion), which is incorrect. The Classic says: Ke Ni with upper Qi rebellion and a scattered pulse indicates death, because the form is damaged. Cheng Wuji's annotation cites *Qianjin Fang*: Ke Ni upper Qi rebellion refers to coughing, stating that Heart Fire attacks Lung Metal, causing Qi to spray rebelliously as cough and wheezing. If Lung Qi exhausts, the pulse scatters, skin and hair wither, and death ensues; thus it is called form damage. How does this relate to hiccups? Hiccups can be caused by Stomach heat due to failure to purge, and the Qi rebels from the Stomach to the chest and throat. Yilao's (Zhang Yuansu) treatment: For failure to purge with Stomach heat and interior excess, hard stool, use Chengqi Tang to purge; for soft stool, use Xiexin Tang. For Stomach deficiency with heat, use Ju Pi Zhu Ru Tang; for phlegm-fluid retention, use Banxia Shengjiang Tang or Fuling Banxia Tang. For Stomach cold, use Ju Pi Gan Jiang Tang with added Lizhong Tang. The Essentials state: Qi rushing straight from below the navel to the chest and throat causing hiccups is a Yin syndrome, and the disease is not in the Stomach. Moreover, the lower deficiency hides Yin internally; or misuse of cold herbs leads to extreme cold below, forcing Ministerial Fire to rush upward and gather in the chest, causing hiccups, also nearing exhaustion. The patient is irritable and feels very hot, but others feel cold when touching the skin. This is rootless, lost-control fire scattering as heat, not real heat, but water extreme resembling fire. If this is not recognized and cold herbs are mistakenly used, it will fail. Treatment must use *Huoren Shu*'s Qianghuo Fuzi San or modified Fuzi Tang to urgently warm the lower part. Once True Yang returns, fire descends, and hiccups stop naturally. For extreme cold hiccups that do not stop, or combined with Sulfur and Frankincense powder inhalation, or moxibustion at Qimen, Zhongwan, Guanyuan, and Qihai acupoints. The goal is to ensure hands and feet become warm, pulse returns, Yang returns, and Yin retreats for survival.