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Any hiccups (e, hiccup) caused by Shanghan (Cold Damage) are essentially disorders of rebellious Qi. Some cases differ from miscellaneous diseases, as discussed by Zhang Zhongjing, yet there remain omissions and incomplete treatments. The following is a brief summary:

First, conditions such as deficiency-cold in the stomach caused by Shanghan are roughly similar to those in miscellaneous diseases mentioned previously. They should all be treated with warming middle-jiao formulas as described earlier. Or, for conditions like deficiency-cold in the stomach and hiccups induced by drinking water, as stated by Zhang Zhongjing, one should follow the methods of Zhang Zhongjing detailed in the subsequent paragraphs.

Second, when the pathogen of Shanghan is at the exterior level and does not involve the interior, hiccups do not occur. However, in Shaoyang syndrome, where the pathogen is between the exterior and interior, causing alternating chills and fever, hiccups may occur due to Qi being suppressed by the pathogen. In such cases, Chaichen Decoction (Chaichen Jian) is indicated; add Dingxiang (Clove) if cold is present, or Huangqin (Scutellaria Root) if heat/fire is present; alternatively, Xiaochaihu Tang (Minor Bupleurum Decoction) may also be used.

Third, if Shanghan is mishandled by purgation, allowing the pathogen to enter the Yangming stage, extreme internal heat may cause dryness and obstruction in the Sanjiao (Triple Burner), blocking Yin fluids and causing upward rushing that triggers hiccups. It is essential to clear heat and resolve obstruction so that rebellious Qi descends and hiccups cease. One must carefully assess the severity of the pathogen. If there are no signs of firmness, distension, or fullness, but only dryness and燥热 (dry-heat), Baihu Tang (White Tiger Decoction), Zhuyeshi Gao Tang (Bamboo Leaf and Gypsum Decoction), or Xiexin Tang (Drain the Epigastrium Decoction) can be used to cool and resolve. If there is indeed dry feces, constipation, and complete symptoms of distension, fullness, firmness, and excess, then the three Chengqi Decoctions (San Chengqi Tang) should be used to purge.

Fourth, if Shanghan pathogens are unresolved and excessive warming and tonifying agents are used, it leads to rebellious Qi in the Middle Jiao, most likely causing hiccups. Anwei Yin (Stomach-Anning Infusion) is the most effective formula here. If Qi rebellion occurs without heat, Jupi Tang (Tangerine Peel Decoction) is suitable. If accompanied by unresolved exterior pathogens, Chaichen Decoction is appropriate.

Fifth, if Shanghan is mistakenly attacked via emesis or purgation, or if cold-cooling herbs are misused, resulting in severe deficiency and cold of the Spleen, Kidney, and Stomach Qi leading to hiccups, this is a critical condition. Immediate treatment with warming Stomach or regulating Yin methods, as described in previous miscellaneous disease sections, is required. Delay may render treatment ineffective.

Zhang Zhongjing stated: "In Yangming disease, inability to eat, attacking the heat will inevitably cause hiccups. The reason is deficiency-cold in the stomach. Because the person is originally deficient, attacking the heat will inevitably cause hiccups." "After severe vomiting and purging in Shanghan, leading to extreme deficiency, followed by profuse sweating, because the external Qi is constrained (Fu Yu), giving water to induce sweating causes hiccups. The reason is deficiency-cold in the stomach." "In Yangming disease, no bowel movement for six or seven days, suspecting dry feces, the method to verify is to give a small amount of Xiao Chengqi Tang. If after ingestion, flatus is passed, this indicates dry feces, and purging can proceed; if no flatus is passed, the stool is merely hard at the beginning and loose later, purging is contraindicated. Purging will cause distension and inability to eat." "Those desiring water who are given water develop hiccups. Those with deficiency-cold in the stomach unable to eat who are given water develop hiccups." These four passages all discuss deficiency-cold of the stomach. Since deficiency-cold cannot be purged nor can water be freely administered, it is evident that cold-cooling medicines should also be avoided.

The treatise states: "Shanghan with hiccups and abdominal fullness: observe the anterior and posterior orifices to determine which is obstructed; unblocking it will cure the condition." This passage refers to excess pathogens causing hiccups. Generally, if defecation is obstructed, Qi cannot descend; failure to descend leads to upward rebellion. Therefore, if urination is obstructed, diuresis is indicated; if defecation is obstructed, purgation is indicated.

Jingui Yaolue states: "When patients feel like panting but do not pant, like vomiting but do not vomit, like hiccuping but do not hiccup, and feel profoundly distressed and helpless in their hearts, Shengjiang Banxia Tang (Ginger and Pinellia Decoction) is the primary treatment. For dry heaves and hiccups with cold extremities, Jupi Tang (Tangerine Peel Decoction) is indicated. For hiccups, Jupi Zhuru Tang (Tangerine Peel and Bamboo Shavings Decoction) is indicated."

Zhang Hezi's "Chapter on Emesis" states: "For diseases located in the upper body, emesis is generally appropriate. However, for severe fullness and excess above the chest, with phlegm-turbidity as sticky as glue, mild decoctions or powders are trivial. Without the emetic method, how can the disease be removed? I have seen cases where physicians exhausted their skills with drugs for upper-body diseases without effect, whereas my use of strong emetics in small doses often yielded slight effects. This shows that emesis is certainly applicable to upper-level diseases, explaining its rapid efficacy." According to this, the emetic method can also treat hiccups, as it allows Qi to extend and stagnation to dissipate. Thus, for conditions characterized by excess Qi and stagnation, Zhang Hezi's method is also suitable.