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Cold pathogenic factors and deficiency-cold contend with each other, resulting in borborygmus (intestinal rumbling). If the physician observes a large pulse and assumes there is heat, administering cold water to overcome the heat with coldness and induce sweating will be detrimental. Since the interior is already deficient and cold, the introduction of cold water contends with this internal state, causing cold to knot in the Upper Jiao (Upper Burner), inevitably leading to a sensation of choking or obstruction in the throat and rebellious Qi ascending.

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In Shaoyang disease (or Cold Damage) presenting with hiccups (Yue) and abdominal fullness, one should examine the anterior and posterior orifices to determine which part is obstructed; unblocking that obstruction will lead to recovery.

[Annotation]

If hiccups occur without abdominal fullness, it indicates a deficiency of healthy Qi and corresponds to the Wuzhuyu Tang (Evodia Decoction) pattern. If hiccups occur with abdominal fullness, it indicates an excess of pathogenic factors; by examining whether urination or defecation is obstructed and unblocking the respective pathway, the patient will recover.

[Collected Annotations]

Cheng Wuji stated: Hiccups accompanied by abdominal fullness indicate Qi rebelling upward without descending. One should observe the anterior and posterior orifices for any obstruction and unblock it to direct the Qi downward. The "anterior" refers to urination, and the "posterior" refers to defecation.

Cheng Zhi stated: If the anterior orifice (urination) is obstructed, later practitioners treat it with Wuling San (Five-Ingredient Powder with Poria); if the posterior orifice (defecation) is obstructed, they treat it with Chengqi Decoctions. This is the correct approach.

Shen Mingzong stated: When pathogens transmit to the Stomach, Stomach Qi becomes stagnant and constrained. The contention between healthy Qi and pathogenic factors causes Qi to rebel and rush upward, resulting in hiccups.

Zhang Xiju stated: In Cold Damage, the appearance of hiccups indicates either the exhaustion of Stomach Qi or cold within the Stomach. However, there are also cases where interior excess prevents the downward discharge of Qi, causing it to rebel upward and manifest as hiccups; these must be carefully differentiated.

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Excess conditions manifest as delirious speech (Zhanyu), while deficiency conditions manifest as monotonous/repetitive speech (Zhengsheng). Zhengsheng is characterized by repetitive utterances.

[Annotation]

The syndrome of delirious speech can be either excess or deficiency. Excess delirious speech arises from extreme Heat in the Yangming channel, which ascends to disturb the Heart, causing disordered speech without sequence and a loud, resonant voice, due to pathogenic factors...