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The *Huoren Shu* (Book of Vitality) states that ke ni (hiccups/belching with upward rushing qi) is referred to as yue (belching/hiccuping), and suggests that if purgation is indicated, Tiaowei Chengqi Tang (Regulate the Stomach Decoction) should be used. This is because the pathogenic factor is in the Stomach, so it is diagnosed as yue. While this view has some merit, it fails to consider that ke ni arises from the transmission of disease from the Foot Yangming channel to the Hand Taiyin channel. The *Huoren Shu* only mentions the root (ben) of fire but not its branch (biao). Fire flares upward to the highest regions, causing ke ni. Observing them together, both yue and ke ni are related to heat. Differentiating them: yue belongs to the root, involving the Gallbladder and Stomach, located in the Middle Jiao; ke ni belongs to the branch, involving the Heart and Lungs, located in the Upper Jiao. If the branch disease manifests, one should treat the branch alone and need not call it yue. Referring to it as yue leads later generations to see only the root of the Gallbladder and Stomach while ignoring the branch of the Heart and Lungs. This perspective also aligns with the transmission of Qi from the Foot channels (Jia/Wu) to the Hand channels (Ding/Xin).

According to Haizang’s discussion, ke ni and yue are distinct. He argues that their sounds differ in terms of emergence and exit, and their organs differ in terms of Lung/Stomach root and branch relationships. His explanation is particularly sound. However, regarding ke ni and yue, the Qi rises from below in both cases. In yue, it exits directly from the mouth, whereas in ke ni, it rises to the throat and diaphragm, producing a "chi te" sound before pausing and then exiting. In reality, there is no fundamental difference in emergence or exit.

The *Sanyin Fang* (Formulas of Three Causes) states that ancient people considered ke ni to be yue. It often occurs after vomiting or diarrhea due to deficiency-cold in the Stomach. There are also cases of deficiency in the Stomach combined with heat above the diaphragm, where yue sounds occur continuously for eight or nine times, with the intake of breath failing to return. Generally, this condition appears after prolonged febrile diseases, in the elderly, the debilitated, and postpartum women, indicating a deep-seated illness. There are also cases of yue accompanied by epigastric fullness and palpitations, caused by phlegm-fluid retention, without other severe symptoms.

Danxi states that chi ni (hiccuping) is a condition of rebellious Qi. Qi rushes straight up from below the umbilicus, exits the mouth, and produces sound, hence the name. The *Shangshu* says: "Fire flares upward." The *Neijing* states: "All rebellious Qi rushing upward belongs to Fire." Ancient formulas attributed this solely to weak Stomach function, neglecting Fire, and treated it with herbs such as Dingxiang (Caryophylli Flos), Shidi (Date Seed), Zhuru (Bambusae Caulis in Taeniam), and Chenpi (Citri Reticulatae Pericarpium). It is unclear which agents reduce Fire and which tonify Deficiency. Human Yin Qi relies on Stomach Earth; nourishing Stomach Earth can injure Wood Qi, leading to Wood insulting Earth. This is described as Earth failing and Wood attacking. When Yin is overwhelmed by Fire and cannot remain within, Wood carries Ministerial Fire upward, rushing directly through the clear pathways. Saying "Stomach is weak" actually refers to Yin deficiency, i.e., extreme deficiency. Patients presenting with this appear to have a critical condition, but there are also excess patterns, which must be known.

Zhao Lidao was nearly fifty years old, had a weak constitution, and was prone to anger. In the height of summer, he was extremely hungry and demanded food. His family could not prepare it quickly, causing him great anger. Two days later, he developed zhixia (dysentery/diarrhea with tenesmus). Thirsty, he drank raw honey mixed with cold water, feeling considerable relief, and his dysentery gradually improved. This continued for five to seven days. His son examined him and found the pulse slightly large but not rapid. He advised stopping the honey water and, when thirsty, taking Yi Yuan San (Benefit Primordial Powder) mixed with decoctions of Renshen (Ginseng Radix) and Baizhu (Atractylodis Macrocephalae Rhizoma). The dysentery gradually resolved. Seven or eight days later, he felt extremely fatigued and developed hiccuping. I determined this was due to Yin deficiency resulting from prolonged diarrhea. I instructed him to continue the previous medication. However, since the dysentery had not fully stopped, he consumed refined honey again. After three such instances, the hiccuping persisted. Others blamed the prescription and proposed Jiangfu Yin (Ginger and Aconite Drink). I said: Tonics do not work instantly; Fuzi (Aconiti Lateralis Radix Praeparata) does not tonify Yin. Taking it would certainly lead to death. They asked: Did drinking so much cold water cause Cold? I replied: The weather is so hot; coolness is not necessarily Cold. Do not doubt; wait for the medicinal effect to take place over time, and it will stop naturally. Four days later, the hiccuping ceased, and the dysentery stabilized.

Chen Zeren was nearly seventy years old and favored rich flavors. He suffered from chronic asthma with irregular remissions. In early autumn, he contracted dysentery, and his appetite decreased significantly. Five to seven days later, hiccuping began. Upon examination, the pulse was large and hollow. Others deemed it difficult to treat. I said: Emaciated patients can still be cured. I administered Dabu Wan (Great Tonifying Pill) with Renshen-Baizhu decoction to tonify Blood. He recovered on the seventh day. These two cases were due to deficiency.

Another woman, past her coming-of-age ceremony (over fifteen), had an irritable temperament and favored rich flavors. In summer, she developed hiccuping after a fit of rage. Each episode involved whole-body tremors, unconsciousness, and inability to respond. Inquiry revealed it was an acute onset. Her physical presence and Qi were both excess. I gave her Ren Shen Lu Tang (Ginseng Root Tip Decoction) in one bowl. She vomited several bowls of stubborn phlegm, sweated profusely, slept for a day, and recovered. Renshen enters the Hand Taiyin Lung channel and tonifies Yang within Yin. Lu (root tip) acts oppositely, greatly draining Yang in the Hand Taiyin channel. Due to violent anger, Qi rebelled. The Liver governs anger, and the Lung governs Qi. The classics state: "Anger causes Qi to rebel." Qi rebelled due to anger; the Liver channel carried Fire to insult the Lung. Thus, hiccuping became severe and consciousness was lost. Ren Shen Lu promotes vomiting; once phlegm is expelled, Qi descends, Fire declines, Metal Qi returns to normal, and Stomach Qi harmonizes, leading to resolution.

In review: Ancient formulas attributed ke ni entirely to Stomach Cold, using Dingxiang, Shidi, Ginger, and Fuzi. However, this condition involves both deficiency and excess, and Heat/Fire, and cannot be exclusively treated as Cold. Cases following sweating, vomiting, or purgation in febrile diseases, prolonged dysentery, or postpartum states are due to severe Yin deficiency. Conversely, cases in healthy individuals due to eating too fast causing Qi obstruction, choking on water/laughter, phlegm-fluid retention in the diaphragm/epigastrium, violent anger causing Qi rebellion/phlegm syncope, or failure to purge in febrile diseases belong to excess patterns. Water nature is moistening and downward; Fire nature is flaming and upward. Now, Qi rushes upward from below making sound; if not Fire, what else? Generally, treatment for deficiency involves tonification, distinguishing between Cold and Heat. If caused by excessive use of cold/purgative herbs after sweating/vomiting/purging, warm tonification is needed. If due to Stomach/Spleen Yin deficiency with Fire rebellion, neutral tonification is needed. If accompanied by Heat, cool tonification is needed. For excess patterns, such as ke ni due to intestinal blockage from untreated febrile disease, cold purgation is required. For phlegm-fluid retention in the epigastrium or Qi rebellion/phlegm syncope due to anger, where physical signs and Qi are both excess without other severe symptoms, methods such as emesis, purgation, clearing Heat, and promoting urination should be applied according to the location of the pathogen. Physicians today immediately suggest Dingxiang and Shidi for this ailment, unaware that these herbs cannot tonify deficiency, reduce Fire, clear turbidity, or drain phlegm; they only warm and assist Fire. How can they be universally applied to this disease?