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There is a condition known as hiccup (E'ze, hiccup) in the world, yet classical treatises mention "yue" (Yue, ancient term for hiccup or belching) but not "e". Is it that later generations spoke of "e", while ancients spoke of "yue"? The *Book of Songs* states: "The sound of the bells rings with rhythm." This means the sound has a rhythm. When a person hiccups, the sounds come in regular intervals, also possessing a rhythm; therefore, the "yue" mentioned in classical treatises can be interpreted as "e" (hiccup). Mild cases of hiccup are called KT [Note: Textual anomaly, likely refers to mild hiccup or belching]. Hiccup is categorized into Reversal Hiccup (Ni'e), Deficiency Hiccup (Xu'e), and Debilitated Hiccup (Bai'e).

Reversal Hiccup (Ni'e) arises from cold in the diaphragm. Stomach Qi ascends from the chest to the diaphragm; due to cold in the diaphragm, the Qi stagnates, stops, and then bursts forth, causing hiccup. This is hiccup caused by the reversal of cold Qi in the diaphragm. For the mildest forms of hiccup, pungent dispersing and warming methods can cure it after a few doses. If one suffers from Cold Damage (Shanghan, damage by cold pathogens) leading to disharmony of the Triple Burner (Sanjiao, the three cavities regulating fluid metabolism and Qi movement), with retention in the stomach, the Upper Burner cannot irrigate like mist, the Middle Burner cannot ferment and transform like a soak, and the Lower Burner cannot separate clear from turbid like a ditch. Consequently, the Stomach Qi in the Upper, Middle, and Lower Confluences (Wei Guan) becomes disharmonious. The Triple Burner is the organ surrounding the Stomach. Currently, the fiery Qi of the Triple Burner fails to harmonize internally with the Stomach and fails to reach the exterior muscles externally. Accumulated heat rushes upward, triggering Reversal Hiccup. At this time, heat should be cleared, cold should be warmed, cases with both deficiency and excess should be tonified and guided, and cases with pure excess should be purged and unblocked. Formulas such as Pingwei San (Calm the Stomach Powder) and Xiexin Tang (Drain the Epigastrium Decoction) may be used. Zhang Jiegu treated Reversal Hiccup using Dingxiang (Caryophylli Flos, Clove) for its pungent aroma to warm the Stomach, and Shidi (Diospyri Fructus Calyx, Persimmon Sepal) for its bitter-astringent and cooling properties. This combination is suitable for hiccup caused by stagnation in the Triple Burner, but not for Deficiency Hiccup or Debilitated Hiccup.

Deficiency Hiccup (Xu'e) occurs when a patient with Cold Damage loses their grain Qi, leaving the Middle Stomach empty, compounded by the misuse of cold-natured digestive aids. With the Middle Stomach already deficient, the fiery Qi of the Triple Burner also loses its function. The Yangming Stomach Earth cannot combine with the exiting Qi of the Triple Burner to warm the muscles. Cold Qi condenses and stagnates, and internal Righteous Qi (Zhengqi, vital energy) becomes deficient, resulting in hiccup. Ren Shen (Ginseng Radix et Rhizoma, Ginseng), Bai Zhu (Atractylodis Macrocephalae Rhizoma, Atractylodes), Gui Zhi (Cinnamomi Ramulus, Cinnamon Twig), and Fu Zi (Aconiti Lateralis Radix Praeparata, Prepared Aconite Root) can treat this, but treatment is only viable if the patient can eat; if they cannot eat, it is untreatable. Additionally, diarrhea and dysentery causing deficiency-cold in the Lower Burner, reduced food intake, and subsequent deficiency-cold in the Middle and Upper Burners, leading to hiccup, also fall under Deficiency Hiccup.

Debilitated Hiccup (Bai'e) originates in the Yin aspect, where the Kidney (Shen, kidney) is initially deficient. Instead of treating the deficiency, practitioners mistakenly use methods for excess conditions, rendering the Stomach organ also deficient. Thus, Wu (Stomach/Earth) and Gui (Kidney/Water) fail to interact, Fire lacks its source, and hiccup erupts. This is Debilitated Hiccup, which is almost invariably fatal; even with Ren Shen and Fu Zi, treatment is futile. However, if Deficiency Hiccup remains uncured, it transforms into Debilitated Hiccup, a progression physicians must recognize.