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According to rhyme books: Yuě (belching/hiccup) is interchangeable with Ke Ni, referring to the name for sounds made by rebellious Qi moving upward. Ancient prescriptions all referred to Ke Ni as Yuě. Many texts further erroneously refer to coughing as Ke Ni. Sun Simiao erroneously referred to hiccups as Ke Ni. Some texts write it as Chi Ni. All these are errors. "Ke Ni" is pronounced "Yu Li Qie".

Discussion
The *Huangdi Neijing* states: "All rebellious movements rushing upward belong to Fire." Zhu Danxi stated: "Ke Ni is a disease of rebellious Qi; it is named so because Qi rushes straight up from below the navel and exits through the mouth." Li Dongyuan stated that Fire and Yuan Qi (Original Qi) cannot coexist, and further described Fire as the thief of Yuan Qi. Ancient prescriptions attributed this entirely to Stomach Weakness without mentioning Fire, and treated it with formulas containing Ding Xiang (Clove), Shi Di (Persimmon Calyx), Zhu Ru (Bamboo Shavings), and Chen Pi (Tangerine Peel). They failed to discern which methods reduce Fire and which tonify Deficiency. Human Yin Qi relies on the Stomach Earth for nourishment; if Stomach Earth is damaged, Liver Wood will invade it, a condition called "Earth Failure and Wood Invasion." When Yin is overwhelmed by Fire and fails to remain within, Liver Wood, carrying the momentum of Ministerial Fire, causes Qi to rush directly upward through the clear orifices. When it is said that the Stomach is weak, it actually refers to Yin Deficiency, specifically severe Deficiency. Patients presenting with this appear to have a critical condition. Even when treated according to correct principles, only one or two out of ten may be saved, let alone those subjected to misdiagnosis and mistreatment. Nevertheless, there are cases where Ke Ni arises from Excess patterns, which must not be overlooked. For instance, excessive food intake may block the chest, preventing the ascending and descending of Qi. Phlegm obstruction in the upper Jiao combined with Fire arising in the lower Jiao can prevent Qi from extending freely. In cases of Cold-Heat complex or febrile diseases, Yangming Interior Excess may occur; if purgation is delayed past the appropriate time, Clear Qi cannot ascend and Turbid Qi cannot descend, leading to blocked Qi circulation and resulting in Ke Ni. All such cases constitute Excess patterns. Physicians should focus attentively, carefully distinguish between Excess and Deficiency, and regulate treatment accordingly. One must not prescribe recklessly, thereby shortening a person's natural lifespan; this would be fortunate indeed.

Pulse Diagnosis
A pulse that is Floating and Slow indicates an easy-to-treat condition. A pulse that is Wiry and Rapid but lacks force upon deep pressure indicates a difficult-to-treat condition. Knotted (Jie), Surging (Cu), or Minute pulses can generally be treated. A Replacement (Dai) pulse indicates a critical prognosis. A Wiry pulse at the Right Guan position indicates Liver Wood invading Spleen Earth, which is difficult to treat.

Treatment Methods
Zhu Danxi stated: Generally, there are cases due to Phlegm, Qi Deficiency, or Deficient Fire rushing upward; treatment should be based on whether there is Excess or Deficiency. If Phlegm and Food stagnation are located in the Upper Jiao, induce vomiting using substances like Ren Shen Lu (Ginseng Stalk) or Xi Yan San (Spittle-Inducing Powder).
For Deficiency, use tonification, such as decocting Ren Shen (Ginseng) and Bai Zhu (Atractylodes Macrocephala Rhizome) and administering Da Bu Wan (Great Tonifying Pill) with the liquid.
For Phlegm, use Chen Pi (Tangerine Peel) and Ban Xia (Pinellia Tuber); for Qi Deficiency, use Ren Shen and Bai Zhu; for Yin Fire, use Huang Lian (Coptis Rhizome), Huang Bo (Phellodendron Bark), and Hua Shi (Talcum). Treatment involves either inducing vomiting or tonifying, depending on the syndrome.
For Ke Ni accompanied by diarrhea, use Hua Shi, Gan Cao (Licorice Root), Huang Bo, Shao Yao (Peony Root), Ren Shen, Bai Zhu, and Chen Pi, taken with Zhu Li (Bamboo Sap).
For Ke Ni occurring during Dysentery, decoct Ren Shen and Bai Zhu, mix with Yi Yuan San (Benefit Prime Powder), and administer frequently until it stops naturally.
(Above are six methods from Danxi.)

Chen Pi Zhu Ru Tang (from *Lei Zheng Huo Ren Shu*) treats Ke Ni caused by unresolved residual heat from Taiyang Cold Damage and Qi Deficiency.
Gan Cao (roasted, 1 qian), Ren Shen (2 qian), Chen Pi (peeled, 3 qian), Qing Zhu Ru (green bamboo shavings, 4 qian).
Finely chop, prepare as one dose. Add three slices of Sheng Jiang (Fresh Ginger) and one date. Decoct in water and take warm.

Ju Pi Ban Xia Sheng Jiang Tang treats Ke Ni caused by Qi Deficiency with Phlegm.
Chen Pi, Ban Xia, Gan Sheng Jiang (Dried Fresh Ginger), Ren Shen, Tong Cao (Tetrapanax Pith) (each 1 qian).
Finely chop, prepare as one dose. Use 1.5 cups of water, decoct to 1 cup, remove dregs, and take warm.

Liu Jun Zi Tang (from *Tai Ping Hui Min He Ji Ju Fang*) treats Ke Ni caused by Phlegm complicated by Qi Deficiency.
Chen Pi (1 qian), Ban Xia (1.5 qian), Fu Ling (Poria), Gan Cao (1 qian), Ren Shen (1 qian), Bai Zhu (1.5 qian).
Finely chop, prepare as one dose. Add two dates and three slices of Sheng Jiang. Decoct in fresh drawn water and take.

(Danxi Flexible Application) states: There are four syndromes of Ke Ni arising from Cold Damage that must be distinguished.
1. Those with Middle Qi Deficiency, with a deficient and minute pulse, where Qi fails to connect continuously, causing Ke Ni. These should be treated with Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) added with Sheng Mai San (Generate the Pulse Powder) and Huang Bo to descend Deficient Fire, or with a small addition of Fu Zi (Aconite Lateral Root) to achieve immediate recovery.
2. Those with Yangming Interior Excess who suffered from missed purgation, causing Ke Ni. These should be treated with Da Cheng Qi Tang (Major Order the Qi Decoction) to purge and cure.
3. Those who drank too much water due to thirst, forming Water Binding in the Chest, and developed Ke Ni. These should be treated with Xiao Xian Xiong Tang (Minor Infiltrating the Chest Decoction), or Xiao Qing Long Tang (Minor Green Dragon Decoction) with Ma Huang (Ephedra Stem) removed and Fu Zi added, to treat Ke Ni caused by the struggle between Water and Cold. This is highly effective.
4. Those with transmitted Cold Damage Heat syndromes where physicians mistakenly used hot herbs like Jiang (Ginger) and Gui (Cinnamon Twig), assisting Fire pathogenic factors. The struggle between Phlegm and Fire results in Ke Ni. These should be treated with Huang Lian Jie Du Tang (Coptis Decoction to Relieve Toxicity), Bai Hu Tang (White Tiger Decoction), and Zhu Li.

(Ancestral Prescription)
Moxibustion Method for Ke Ni:
Rugen (ST 17): Two points, located 1.6 cun directly below the nipple. In women, locate the depression in the fleshy prominence below the breast. Moxa seven cones (zhuang) and stop. The effect is miraculous.
Qihai (CV 6): One point, located 1.5 cun directly below the umbilicus. Moxa twenty-one cones (three sevens), and it stops immediately.

Medical Case
The son of Mr. Li from Dongyang suffered from Yangming Interior Excess due to Cold Damage. A physician administered tonifying medicines, which resulted in the onset of Ke Ni. Ten days later, he summoned me. I palpated his pulse, finding it Long and Solid-Large. I administered Da Cheng Qi Tang to purge vigorously. The heat subsided, and the Ke Ni stopped.

The son of Mr. Zhou from Pansong contracted a Cold Damage syndrome. After seven days, the fever subsided, but Ke Ni continued incessantly. The whole family was panicked and summoned me. I palpated his pulse and found all six positions to be Deep, Fine, and Forceless; the patient was extremely fatigued. I prepared a large dose of Bu Zhong Yi Qi Tang, adding 1 qian of Pao Fu Zi (Prepared Aconite). He took three doses in one day. Simultaneously, I applied moxibustion to Rugen and Qihai. On that same day, the Ke Ni stopped, his pulse became full, and he recovered safely.