Library

E-qi (hiccup) refers to hiccuping accompanied by rebellious Qi. What is commonly referred to as fa-e, chi-ni, or chi-te should collectively be named E-qi (hiccup). Ke-ni (cough with rebellious Qi) refers to coughing accompanied by rebellious Qi, specifically the "ke" of coughing. Gan-ou (dry retching) is empty retching; sound is produced but no substance is expelled. Ou (vomiting) involves both sound and substance being expelled. Tu (spitting up) involves substance being expelled without sound. These conditions are often conflated in medical texts without distinction; how can they be differentiated? The *Ling Shu* states: When old cold pathogen in the stomach combines with the Qi of newly ingested grain, returning together into the stomach, the new and old Qi become chaotic, Zheng Qi (Upright Qi) and Xie Qi (Pathogenic Qi) attack each other, Qi gathers and rebels, and re-emerges from the stomach, thus causing E-qi (hiccup). The *Su Wen* states: In severe disease, the sound is E-qi (hiccup). The *Shang Han Lun* mentions E-qi occurring after eating, as well as various forms of rebellion caused by incorrect treatments such as drinking water, fire therapy coercion, failure to purge when indicated, or improper purging. The mention of E-qi in severe disease likely refers to the common description of hiccups producing a "chi-chi" sound. The *Qian Jin Fang*'s assertion that Ke-ni (cough with rebellious Qi) is synonymous with E-qi (hiccup) is erroneous. The *Su Wen* states: When Metal Qi is excessive in the annual cycle, diseases manifest as Ke-ni (cough with rebellious Qi); when Shaoyang governs the year, during the first and second climatic periods, diseases also manifest as Ke-ni (cough with rebellious Qi). Furthermore, when Metal Qi is stagnant and erupts, the people suffer from Ke-ni (cough with rebellious Qi). These passages discuss diseases of Lung Metal and Fire, clearly indicating that "Ke" (cough) is named so due to rebellious Qi, and it cannot be confused with E-qi (hiccup). Zhang Zhongjing's *Shang Han Lun* mentions Ke-ni (cough with rebellious Qi) only in the Pulse Differentiation and Pulse Level chapters. However, in the *Jin Gui Yao Lue*, Ke-ni (cough with rebellious Qi) appears repeatedly, allowing for a brief illustration. It states: Regarding the pulse of Ke-ni (cough with rebellious Qi), how can one know it is Fei Yong (Lung Abscess)? The Cun Kou (Inch Position) pulse is faint and rapid; faintness indicates Wind, while rapidity indicates Heat. It further states: Wind damages the skin and hair; if it combines with the Lung, it causes cough. It also says: Ke-ni (cough with rebellious Qi) with ascending Qi, frequently spitting out turbid fluid, where the patient can only sit and cannot lie down, is treated with Zao Jiao Wan (Soap Pod Pill). It also states: For Fei Yong (Lung Abscess) with chest fullness, slight swelling of the whole body, Ke-ni (cough with rebellious Qi), wheezing, and airway obstruction, Xie Fei Tang (Lung-Purging Decoction) is used. It also states: For Ke-ni (cough with rebellious Qi) requiring leaning to breathe and inability to lie flat, Xiao Qing Long Tang (Minor Blue Dragon Decoction) is used. All these describe cough with rebellious Qi as the pathology. One must understand that discussions on cough may use either "Ke" (cough) or "Ke-ni" (cough with rebellious Qi). It is the same cough condition. The addition of "Ni" (rebellious) simply indicates Qi rebelling upward due to coughing, similar to terms like Chuan-ni (wheezing with rebellion), Tu-ni (spitting up with rebellion), E-ni (hiccup with rebellion), and Ou-ni (vomiting with rebellion). The *Ming Li Lun* places cases of Ke-ni (cough with rebellious Qi) with scattered pulses in the chapter on cough and cold, grouping them with E-qi (hiccup). It claims E-qi (hiccup) produces a "chi-chi" sound. This aligns with Zhang Zhongjing's intent regarding the sound, but errs regarding the name. Thus, it incorrectly states: E-qi (hiccup) is Ke-ni (cough with rebellious Qi), echoing the *Qian Jin Fang* by forcibly merging two distinct conditions into one name. Consequently, later generations纷纭 (disputedly) referred to chi-ni (hiccups) as Ke-ni (cough with rebellious Qi). Wang Andao, while recognizing cough as Ke-ni (cough with rebellious Qi), also acknowledged chi-te (hiccups) as a form of Ke-ni (cough with rebellious Qi), thereby falling into the trap of colloquial misnomers. This stems from ignorance of E-qi (hiccup), leading to the view that Gan-ou (dry retching) is a mild form of E-qi (hiccup), and E-qi (hiccup) is a severe form of Gan-ou (dry retching). Gan-ou (dry retching) has light, small, and short sounds; E-qi (hiccup) has heavy, large, and long sounds. Although there is a difference in severity, they are essentially one condition. Wang Andao’s theory forcibly splits one condition into two names. Can severe Gan-ou (dry retching) transform into E-qi (hiccup)? If Gan-ou (dry retching) is considered mild and E-qi (hiccup) severe, and one distinguishes them by sound characteristics (light/heavy, short/long), labeling severe dry retching as hiccup, and then citing the *Su Wen* phrase "severe disease manifests as E-qi (hiccup)" to prove E-qi (hiccup) is more severe than Gan-ou (dry retching), one fails to consider that patients in critical illness often produce hiccup sounds. Is this not E-qi (hiccup) resulting from severe disease? Conversely, naming severe dry retching as E-qi (hiccup) mistakenly categorizes chi-xin (the sound of hiccups) as Ke-ni (cough with rebellious Qi). In attempting to correct past errors, does one not create further confusion? Some argue: You criticize Wang Andao. Yet the *Jin Gui Yao Lue* states: For Gan-ou (dry retching) and E-qi (hiccup) with cold extremities, Ju Pi Tang (Tangerine Peel Decoction) is used. Does this not imply Gan-ou (dry retching) and E-qi (hiccup) are the same condition, hence mentioned together? I reply: This indicates that Gan-ou (dry retching) and E-qi (hiccup) occur simultaneously, hence mentioned together. Similarly, the case of Gan-ou (dry retching), Tu-ni (spitting up with rebellion), and spitting saliva foam treated with Ban Xia Gan Jiang San (Pinellia and Dried Ginger Powder) mentions Gan-ou (dry retching) and Tu-ni (spitting up with rebellion) together; can this also be viewed as the same condition? While I do not fully agree with Wang Andao’s differentiation between E-qi (hiccup) and Ke-ni (cough with rebellious Qi), his distinction between Gan-ou (dry retching) and Tu (spitting up) is indeed a definitive conclusion through the ages. He states: Ou (vomiting) involves both sound and substance; therefore, when there is sound but no substance, it is called Gan (empty/dry), meaning empty. Tu (spitting up) necessarily involves substance and cannot be called Gan. Zhang Zhongjing adds "Gan" to "Ou" to distinguish it, as Ou (vomiting) involves the expulsion of both sound and substance. Furthermore, Zhang Zhongjing said "yu ou" (desire to vomit) but never said "yu gan ou" (desire to dry retch) or "yu e" (desire to hiccup). The term "Yu" (desire/want) implies a premonition of something about to emerge; this applies to tangible substances, not intangible sounds. Ou (vomiting) and Tu (spitting up) refer to substances, so "Yu" (desire) is appropriate. Gan-ou (dry retching) and E-qi (hiccup) refer to sounds, so "Yu" (desire) is inappropriate. To clarify: Sound and substance together indicate Ou (vomiting); substance alone indicates Tu (spitting up); sound alone indicates Gan-ou (dry retching); sound alone with chi-te sounds indicates E-qi (hiccup); cough with rebellious Qi indicates Ke-ni (cough with rebellious Qi). Who can change these definitions?