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Zhu Danxi, in the section on Vomiting, stated: "That which has sound and substance is called vomiting," thereby conflating vomiting and spitting. Zhang Jingyue also did not agree with this view but did not analyze it deeply. Upon reviewing Li Dongyuan's perspective, he defined "ou" (vomiting with sound) as having both sound and substance, whereas Sun Simiao defined "tu" (spitting) as having substance without sound. A detailed examination of the characters "ou" and "tu" suggests that the views of Sun and Li are correct. The *Zihui* states that "ou" is synonymous with "ou" (to sing). Indeed, "ou" must involve sound; thus it is said that "rebellious qi causes ou." Generally, when qi rebels, it inevitably produces sound, carrying the ingested food along with it to exit. In contrast, "tu" involves material that is expelled more easily than in "ou"; it flows out upon opening the mouth, so how could there be sound?

Regarding the symptom of "yue" (hiccups/dry heaving), the *Jingmai Zabi Pian* (Chapter on Miscellaneous Diseases in the Classic) directly equates it with "e ni" (hiccup), while Liu Hejian and Wang Haoxu interpreted "yue" as dry heaving. Zhang Jingyue noted that the term "e ni" did not exist in ancient times. It was referred to as "yue" in the *Neijing*; this merely reflects differences in nomenclature between ancient and modern times. However, "yue" and "e ni" must absolutely not be confused as a single syndrome. Although the interpretations of Liu Hejian and Wang Haoxu regarding "yue" have merit, the *Suhui Ji* within the *Dongyuan Shishi* (Ten Works of Dongyuan) states that the sound of "yue" is turbid, harsh, long, and forceful, continuing until the qi is exhausted, unlike the mild nature of dry heaving. This explanation is clearer and more lucid than those of Liu and Wang. As for "e ni," it corresponds to what Dongyuan called "chi te" (hiccup). The names for this syndrome vary according to dialects: some call it "ge de," others "da e," or "da ge de." In all cases, it is distinct from "yue" and clearly refers to what is currently known as hiccup. The *Lingshu* refers to it as "KT" (pronounced 'ye'), as mentioned in the phrase "KT bu de xi" (inability to breathe due to KT). The *Yizong Jinjian* describes it vividly as a continuous "ge ge" sound, where qi rises from below the umbilicus and makes noise exiting through the Chong Mai (Penetrating Vessel) at the Tuidao point. Is this not an excellent description?

Furthermore, "ke ni" (cough with rebellious qi) and "e ni" (hiccup) must not be confused. Some mistake "ke ni" for "e ni," and others for "yue"; these errors stem from a failure to carefully interpret the canonical texts. The classics originally used cough and rebellious qi to explain such phenomena. For instance, the *Qi Jiao Bian Da Lun* (Treatise on Changes in Qi Interactions) states: "When Metal Qi is excessive, severe cases manifest as panting, coughing, and rebellious qi." It also says: "Severe coughing and rebellious qi can lead to hemorrhage." This implies that blood follows the upward-rebelling qi due to persistent coughing; one has never heard of hiccups causing hemorrhage. Thus, it is evident that "ke ni" is not "e ni." Consequently, why would "ke ni" need further differentiation from "yue"?

Regarding "yi qi" (belching), the *Lingshu* states: "Cold pathogen lodges in the Stomach, causing jue-ni (rebellious qi) to scatter upwards from below and re-emerge from the Stomach, thus producing yi." Zhang Zhongjing stated: "The Upper Jiao receives Qi from the Middle Jiao but they are not harmonized, leading to indigestion, hence yi occurs." Based on this, "yi" is equivalent to belching, commonly known in vernacular as "ba qi" (pulling qi). This logic is clear and easily understood by people.

In summary: That which has sound and substance is "ou" (vomiting); that which has substance but no sound is "tu" (spitting); that which has sound but no substance is "yue" (dry heaving/hiccup-like sound). "E ni" refers to hiccupping. "Ke ni" refers to severe coughing resulting in rebellious qi rushing upward. "Yi," as explained in the *Zihui*, refers to sound produced by fullness and excess qi after a meal, which is indeed what is called "ba qi." Since each syndrome is distinct, they cannot be confused. As for the etiology and treatment methods, they differ according to deficiency/excess and cold/heat patterns, and are discussed separately in other sections; thus, they are not repeated here.