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In general, hiccups (ē nì) arising from miscellaneous diseases are caused by the rebellion of Qi. However, some cases involve an accompaniment of Cold, some involve Heat, some result from food stagnation causing Qi rebellion, some from Qi stagnation, some from deficiency of Middle Qi, and some from exhaustion of Yin Qi. By carefully identifying the cause and treating the Qi accordingly, there is no case that cannot be cured. Mild or occasional hiccups will cease once the Qi flows smoothly and require no treatment. Only frequent, troublesome hiccups or severe cases indicate a major rebellion of Qi or a significant depletion of Spleen and Kidney Yuan Qi (Primordial Qi). While excess-type hiccups are not difficult to treat, cases involving the collapse and exhaustion of Yuan Qi represent the most critical prognosis.

1. Hiccups caused by Cold stagnation may result from Wind-Cold invasion, consumption of raw/cold foods, or inherent organ Cold leading to accidental Qi rebellion. Removing the obstructing Cold will naturally stop the hiccups. Suitable formulas include Jupi Tang (Tangerine Peel Decoction), Dingxiang San (Clove Powder) from *San Yin Fang*, Erchen Tang (Two-Aged Decoction) with 5-7 slices of fresh ginger, Zuoguan Jian (Assisting the Border Decoction), Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction), or Jupi Ganjiang Tang (Tangerine Peel and Dried Ginger Decoction), chosen according to circumstances. For severe Cold, Jiangshui San (Fermented Water Powder) or Sini Tang (Frigid Extremities Decoction) may be used.

2. Hiccups caused by Stomach Fire present with various symptoms. If the pulse is slippery and solid while the physique and Qi are not deficient, and there is stagnation in the chest and diaphragm, or if stool is hard or constipated, this indicates Fire in the Stomach causing upward rebellion. Clearing the Fire will stop the hiccups; Anwei Yin (Stomach-Anchoring Infusion) is considered the most effective. I have successfully treated many patients with this pattern.

3. For hiccups accompanied by distension and fullness due to Qi rebellion, Jiajian Erchen Tang (Modified Two-Aged Decoction) with Wuyao (Lindera Root) is suitable, or Dingxiang Shidi San (Clove and Persimmon Calyx Powder) from *Yixue Mingbian*, Qianghuo Fuzi Tang (Notopterygium and Aconite Decoction), or Shenxiang San (Aromatic Musk Powder).

4. For hiccups caused by food stagnation, Jiajian Erchen Tang with Shanzha (Hawthorn Fruit), Baijiezi (White Mustard Seed), and Wuyao is appropriate, or Dahezhong Yin (Great Harmonizing the Middle Infusion) with Ganjiang (Dried Ginger) and Muxiang (Aucklandia Root).

5. For hiccups due to Cold-deficiency of the Middle Jiao (Spleen and Stomach) with Qi rebellion, Lizhong Jia Dingxiang Tang (Regulate the Middle Decoction plus Clove) or Wenwei Yin (Warming the Stomach Infusion) plus Dingxiang (Clove) is indicated. If hiccups arise from fatigue and internal injury, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) plus Dingxiang is suitable. Severe Cold in the Middle Jiao usually stems from Spleen Qi deficiency; since the Spleen and Stomach do not become deficient easily, Cold does not become severe unless they are weak. Therefore, treating Cold should prioritize regulating Spleen Qi. After vomiting or diarrhea, if Stomach Qi is slightly deficient and accompanied by Diaphragm Heat causing hiccups, Jupi Zhuru Tang (Tangerine Peel and Bamboo Shavings Decoction) is appropriate. Without Heat, ingredients such as Shengjiang (Fresh Ginger), Banxia (Pinellia Tuber), Dingxiang, Shidi (Persimmon Calyx), Baizhu (Atractylodes Rhizome), and Rougui (Cinnamon Bark) may be used酌情ly.

6. In Lower Jiao Cold-deficiency, the source of Qi generation in the Liver and Kidneys cannot flow freely. Thus, weak individuals often exhibit hiccups because Yuan Yang (Primordial Yang) is insufficient and easily suppressed. The root of such hiccups lies in the Kidney. My formulated Guiqi Yin (Returning Qi Infusion) is highly effective for this, or Liyin Jian (Nourishing Yin Decoction) plus Dingxiang to soothe Qi, which is also excellent.

7. Hiccups occurring after a serious illness, extreme emaciation, or mistaken purgative treatment for deficiency syndromes constitute the most critical conditions. If Middle Deficiency is identified, tonify Spleen Qi immediately; if Yin Deficiency is identified, tonify Kidney Yin immediately, following the principles of the previous two sections. However, fearing these measures may be insufficient, only powerful tonics like Dabu Yuanjian (Great Tonification of the Origin Decoction) and Yougui Yin (Right-Restoring Infusion) will likely suffice.

8. Regarding hiccups: if the voice is strong, Qi is robust, and the pulse is slippery and solid, clearing and descending methods are generally preferred. If the voice is faint, breathing is weak, and the pulse is thready and weak, warming and tonifying methods are generally preferred.