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The *Lue Li* (Brief Examples) states: In Yang syndrome cough-convulsion (Ke Ni, hiccup), it is due to stomach heat that was not purged in time. This leads to the exhaustion of Yin fluids and the reversal of Yang Qi upwards, preventing Yin from being retained internally. This is a malignant sign. If accompanied by tongue contraction, abnormal speech, sudden confusion, and pain in the stomach and throat, it belongs to Shaoyin syndrome. It should be treated with rapid purging, suitable for Da Cheng Qi Tang (Great Order the Qi Decoction). If Yang is at its extreme with faint pulse and life force fading, purging is contraindicated; instead, Xie Xin Tang (Drain the Epigastrium Decoction) should be used to nourish Yin and subdue Yang. Liang Ge San (Cool the Chest Powder) added with Mang Xiao (Mirabilite) to clear Lung heat is also acceptable.

In Yin syndrome cough-convulsion, internal cold has already latent within. Yin Qi is excessive, Kidney Water dominates (excessive Kidney water suppressing Heart Fire), Liver Qi fails to generate, Stomach Fire is diseased, and Ding Fire (Heart Fire) has diminished. The wandering Ministerial Fire is forced by Cold Evil to gather in the chest, also tending to dissipate. Thus, it causes fever, extreme thirst with excessive drinking, and the patient removes covers, feeling hot alone, while others feel cold when touching the body. This is Rootless Fire. Therefore, warming the Stomach with herbs like Ding Xiang (Clove) and Gan Jiang (Dried Ginger) causes the false fire to descend, and cough-convulsion stops. This differs from Yang syndrome, where Liang Ge San and Xie Xin Tang are used to clear Heart Fire so that Yin Qi can grow. Moreover, Yin syndrome cough-convulsion arises from vomiting and hiccups (Yue); because Stomach Cold causes persistent vomiting and hiccups, Yang Qi reverses upwards subsequently.

Commentary: Cough-convulsion originally stems from deficient Yin Qi and violent excess of Yang Fire rushing upwards, originating from the Stomach and entering the Lung, producing sound. Dong Yuan (Li Gao) used cooling medicines to purge heat and descend fire. As for the so-called Yin syndrome cough-convulsion, it is because Yin Qi has first exhausted, and Yang Fire is also depleted, floating in the chest and tending to dissipate. Therefore, cold medicines are unsuitable; instead, warm medicines are used to nourish the Stomach and retain Yang Qi. This aligns with the principle that "when Stomach Qi harmonizes, Yang generates, and when Yang generates, Yin grows." However, the *Lue Li* considers Yang syndrome as resulting from missed purgation, using Cheng Qi Tang or Xie Xin Tang depending on constipation or soft stool, which is acceptable. But regarding Yin syndrome as excessive Yin Qi with Kidney Water dominating and Cold Evil forcing Fire upward, I argue that if Kidney Yin were abundant, Fire would not move recklessly. Regarding the mentioned Cold Evil, it is unclear whether it refers to external Cold, internal Cold, or merely deficiency Cold. I leave this for wiser scholars to clarify.

Another case: Zhang Zi He stated that Fire desires to ascend but is obstructed by Cold Evil; since Cold cannot overcome Fire, sound is produced. This implies upper Cold obstructing lower Heat, similar to the meaning of external Cold郁 (stagnating) internal Heat, yet differing from previous explanations.

Nan Zhi (Zhu Gong) said: Regarding cough-convulsion, the *Huo Ren Shu* judges it as Yue (hiccup/dry heave). This view is plausible but incorrect. Generally, Yue refers to dry heaving; if material is expelled directly, it is Vomiting (Tu); if material comes out immediately after retching, it is Ou (vomiting); if there is retching without expulsion, it is Yue. Cough-convulsion may result from water dampness affecting the Lung causing epigastric fullness, continuous non-stop episodes causing Qi reversal, excessive laughter causing Qi obstruction, swallowing drinks incorrectly causing Qi snatching, or eating dry food quickly causing Qi blockage. All these can produce continuous cough-convulsion sounds, commonly called "Chi Te" (hiccups). Broadly, cough-convulsion means disorderliness, and Chi Te means error; both involve Qi failing to descend, pushed up by Heat/Fire to the throat where it stops. Some stop it by inducing sneezing with paper twists, some by feigning injustice or fear of thieves, some by smelling food fragrance to regulate Qi. These methods work by suppressing or startling the Qi to make it descend. The *Qian Jin Fang* states that cough-convulsion with ascending Qi is a Lung disease; a scattered pulse indicates death, representing Heart Fire punishing Lung Metal. Thus, Li praised Yi Lao (Zhang Yuansu) saying: "Cough-convulsion is Fire/Heat rushing upward urgently, while Lung Metal fails to contain it," which is accurate. Therefore, for constipation, Da Cheng Qi Tang is used to purge; for soft stool, Xie Xin Tang is the main prescription. Zhu judged it as Stomach Cold and used two methods for Yang syndrome to treat Yue. Although effective, the essence of Yue is merely Qi reversing upward, resembling cough-convulsion, but it is not the primary syndrome of cough-convulsion as described by Zhong Jing. Full Yue produces sound; Yue expels Qi, and inhalation follows after the sound ends. Cough-convulsion involves inhalation; Qi is suppressed and does not exit, and exhalation follows after the reverse sound ends. The difference between exiting and entering breath is significant. Cases combined with vomiting and Yue originate from the Stomach; cough-convulsion originates from the Lung. How difficult is it to distinguish them?