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According to the *Shuowen Jiezi*, "Yi" (belching) refers to the breath emitted after a full meal, pronounced as "Yu Jie Qie", and is colloquially written as "Ai". In Shanghan disease, there are two types of syndromes caused by erroneous use of sweating, vomiting, or purging methods. These lead to weak and disharmonious Stomach Qi, with deficient Qi counterflowing upward, resulting in epigastric fullness and hardness. Therefore, if accompanied by diarrhea, Shengjiang Xiexin Tang (Ginger Decoction for Draining the Epigastrium) is used; if not accompanied by diarrhea, Xuanfu Daizhe Shi Tang (Inula and Hematite Decoction) is used.

After the exterior syndrome of Shanghan has been resolved by sweating, if the Stomach interior is disharmonious, presenting with epigastric fullness and hardness, dry belching with a smell of food rot, fluid retention under the hypochondrium, abdominal distension, borborygmus, and diarrhea, Shengjiang Xiexin Tang (Ginger Decoction for Draining the Epigastrium) is the primary treatment.

If, after the resolution of exterior syndrome via sweating, vomiting, or purging in Shanghan, the patient suffers from persistent epigastric fullness and hardness and continuous belching, Xuanfu Daizhe Shi Tang (Inula and Hematite Decoction) is the primary treatment.

Appendix:
Mr. Yun asked: What causes belching (Yi Qi) in Shanghan? The answer is: It is due to the failure of Qi interaction in the chest. The Qi of the Shaoyin meridian ascends to the chest and intersects with the Jueyin meridian; the struggle between Water and Fire produces sound, hence belching occurs. Rusheng Jia Zhishi Tang (Rusheng Decoction with Added Immature Bitter Orange) is suitable.

**Rusheng Jia Zhishi Tang Formula:**
Gancao (Licorice Root), Jiegeng (Platycodon Root) (each 5 qian); Zhishi (Immature Bitter Orange) (stir-fried, 3 qian). Chop finely. Take 5 qian per dose, add Banxia (Pinellia Tuber) 0.5 qian, decoct in water and take orally.

If panting and belching occur after vomiting or purging in Shanghan, Rusheng Jia Renshen Huoxiang Xingren Tang (Rusheng Decoction with Added Ginseng, Agastache, and Apricot Seed) is suitable.

**Rusheng Jia Renshen Huoxiang Xingren Tang Formula:**
Gancao (Licorice Root), Jiegeng (Platycodon Root), Renshen (Ginseng Root), Huoxiang (Patchouli Herb), Xingren (Apricot Seed) (equal parts). Chop finely. Take 5 qian per dose, decoct in water and take orally.

(Yi Ni, commonly known as hiccups)
Yue (hiccups/belching) is what is commonly called "Chi Ni" (hiccups). It is analyzed in detail in miscellaneous diseases. According to *Shuowen Jiezi*, "Yue" means Qi rebellion, pronounced "Yu Yue Qie" or "Yi Lue Qie". "Yi Lue" is an error that evolved into "Chi Ni". This is similar to how "Tuan" is colloquially pronounced "Tu Luan" and "Jiao" as "Ge Luo"; the reason is clear. Li Dongyuan also considered "Yue" to be severe Gan Ou (dry heaving). However, he did not realize that any sound without matter is Gan Ou (dry heaving); how can it be divided into two diseases based on severity? As for so-called "Ke Ni" (cough-reversal), it actually refers to modern asthma/cough, yet it is confused with Chi Ni. Some people conflate them, which is an error of neglecting investigation. The gains and losses, benefits and harms are significant, and this must be distinguished.

[Stomach Cold]
In Shanghan, after excessive vomiting and purging leading to extreme deficiency, followed by excessive sweating, if the physician gives water to induce sweating while the patient's exterior Qi is already stagnant, Yue (hiccups/dry heaving) may result. This happens because of cold in the Stomach. (Cheng Wuji notes: Excessive vomiting and purging cause extreme Stomach Qi deficiency; further sweating depletes Yang Qi. Exterior pathogens stagnate causing fever. Giving water to sweat creates a conflict between Stomach deficiency and cold water, resulting in Yue. Treatments include Wuzhuyu Tang, Lizhong Tang, Ju Pi Gan Jiang Tang, Qianghuo Fuzi San, Banxia Shengjiang Tang, or Tui Yin San.)

*Huoren Shu* states: If medication fails, moxibustion should be applied for cure. For women, moxa three cones at the bone space where the nipple ends downward; for men or those with small breasts, measure one finger width, left for men, right for women. Moxa cone size like a mung bean, directly opposite the nipple in the depression where the artery rises.

[Stomach Heat]
Yangming Wind Strike presents with wiry, floating, large pulse, shortness of breath, abdominal fullness, pain in hypochondrium and heart region, dry nose, inability to sweat, lethargy, jaundice of body and face, difficult urination, tidal fever, and occasional Yue (hiccups). If the pulse remains floating, Xiaochaihu Tang (Minor Bupleurum Decoction) is given. If there is no urination, abdominal fullness, and Yue, it is incurable. (See Stomach Excess chapter). In Shanghan, if Yue occurs with abdominal fullness, observe the anterior and posterior orifices to determine which is obstructed; unblocking it leads to recovery. (Zhang Zhongjing provided no formula; *Huoren Shu* suggests Zhuling Tang for anterior obstruction and Tiaoweichengqi Tang for posterior obstruction.)

If Stomach middle deficiency-cold prevents eating, drinking water causes Yue. If Xiaochengqi Tang is taken and no flatus passes, do not purge; purging will cause abdominal fullness, inability to eat, and Yue upon drinking. (See Tidal Fever chapter). If thirsty but vomiting after drinking, Chaihu Tang is contraindicated. If eating causes Yue... (See Hypochondriac Pain chapter). In Yangming disease, if Stomach excess prevents eating, purging heat will cause Yue. In dampness cases, if early purging is done when headache, back stiffness, aversion to cold, and desire for warmth are present, Yue results. (See Body Pain chapter).

In Taiyang disease, fire therapy for sweating causes blood flow overflow, jaundice, epistaxis tendency, head sweat, abdominal fullness, delirium, and in severe cases, Yue, picking at clothes, and bed sheets. If urine is free, it is treatable. (See Head Sweat chapter).

**Appendix Formulas:**
**Ju Pi Gan Jiang Tang:**
Ju Pi (Tangerine Peel), Tongcao (Tetrapanax Pith), Gan Jiang (Dried Ginger, processed), Guixin (Cinnamon Twig), Gancao (Licorice Root, honey-fried) (each 2 liang); Renshen (Ginseng Root) (1 liang). Chop like hemp seeds. Take 4 qian per dose, decoct in 1 cup water to 60%, strain, warm drink, 3 times daily.

**Qianghuo Fuzi San:** Treats Chi Ni.
Qianghuo (Notopterygium Rhizome), Fuzi (Aconite Root, processed), Huixiang (Fennel Fruit, lightly stir-fried) (each 0.5 liang); Muxiang (Costus Root), Gan Jiang (Dried Ginger, processed) (each amount equal to a jujube pit). Powder. Take 2 qian per dose, decoct in 1 cup water with a pinch of salt for 10-20 boils, take warm. One dose stops it.

**Banxia Shengjiang Tang:** Treats severe Yue.
Shengjiang (Fresh Ginger, 2 liang, sliced); Banxia (Pinellia Tuber, washed, 1.25 liang). Decoct in 2 cups water to 80%, strain, divide into 2 warm doses.

[Failure to Purge]
Haizang (Zhang Yuansu) said: In Shanghan, Ke Ni (cough-reversal) with scattered pulse indicates death. Zhang Zhongjing’s words are not false. Generally, failure to purge initially leads to Ke Ni, where Yin Qi does not enter internally and stool is soft; only Xiexin Tang is suitable. If stool is hard, Dachengqi Tang is especially suitable. Who are the good physicians for these divine tasks? Li Dongyuan and Jiegu (Zhang Yuansu).

Jiegu said: Ke Ni is due to fierce Fire-Heat rushing upward while Lung Yin cannot hold inward. Thus, constipation requires Dachengqi Tang to purge; soft stool requires Xiexin Tang.

Haizang said: Shaoyin Ke Ni is due to failure to purge. Yin fluids are nearly exhausted, Yang rebels upward, preventing Yin from being held. Since Yin is exhausted, Yang is also near exhaustion. Inhaled Qi belongs to Kidney and Liver; Yang rebels up, Yin cannot enter, thus Yang extremity. Pulse micro and near exhaustion: do not purge; use Xiexin Tang to nourish Yin and retreat Yang. If Xiexin Tang is not used, Liangge San (without Mang Xiao and Huang Qin/Huanglian depending on variant) or Qingfei San may work. If left pulse floats and right pulse is deep and solid, it is not exterior. Interior extremity manifests as exterior. Why? Ke Ni, stiff tongue, solid right pulse indicate Shaoyin interior. Excessive drinking, epigastric fullness, thirst, and reverse flow require Wuling San. If no evil symptoms, this applies. If evil symptoms arise, with tongue spasm, slurred speech, dizziness, or sore throat, it is Shaoyin; purge quickly with Dachengqi Tang. Why is floating pulse exterior? If floating is strong/large and deep is weak/small, it is exterior. If floating is strong/large and deep is also strong/large, it is not exterior. Pathogen is deep inside. Internal heat should be deep but floats; Yang extremity returns to exterior.

Yin Syndrome: Internal Yin is latent, Yin Qi is excessive, Kidney Water dominates, Liver Qi does not generate, Stomach Fire is diseased, Ding Fire (Heart Fire) is diminished. So wandering Ministerial Fire and Cold Pathogen gather in the chest, nearing exhaustion. This causes fever, great thirst, desire to remove covers. Patient feels hot alone; others feel cold skin/muscle/bone/blood vessels. This is rootless Fire. Use warming herbs like Dingxiang (Clove) and Gan Jiang (Dried Ginger) to warm Stomach, and the Fire descends naturally.

**Yunqi San:**
Chuanwu (Aconite Root, large, 3 pieces, processed, peeled). Powder. Take 3 qian per dose, soak 21 black beans and rock sugar in soup, mix, drink warm slowly.

**Formula for Yin Poison Chi Ni (*Baoshi Fang*):**
Chuanwutou (Aconite Root), Gan Jiang (Dried Ginger), Fuzi (Aconite Root, processed), Rougui (Cinnamon Bark), Shaoyao (Peony Root), Banxia (Pinellia Tuber), Zhi Gancao (Honey-fried Licorice), Wuzhuyu (Evodia Fruit), Chenpi (Tangerine Peel), Dahuang (Rhubarb Root) (equal parts). Powder. Take 1 qian per dose, decoct in 1 cup water with 3-5 slices fresh ginger to 70%, strain, warm drink.

**Roudoukou Tang:** Treats Chi Ni and Yi Qi after sweating in Shanghan.
Roudoukou (Nutmeg, 1 piece), Shilianrou (Lotus Seed Endothelion, stir-fried), Huixiang (Fennel Fruit) (each 1 liang); Renshen (Ginseng Root), Dingxiang (Clove) (each 0.5 liang); Pipaye (Loquat Leaf, 5 leaves, brushed and roasted). Chop finely. Decoct in 4 cups water with 10 slices ginger to 2 cups, strain, warm drink on empty stomach, divide into 2 doses.

**Liangjiang Tang:**
Chenpi (Tangerine Peel), Liangjiang (Galangal Root), Guizhi (Cinnamon Twig), Danggui (Angelica Sinensis Root) (each 1 liang); Xingren (Apricot Seed, 20 pieces); Mahuang (Ephedra Herb), Gancao (Licorice Root) (each 0.5 liang); Binglang (Areca Seed, 3 pieces, separate powder). Chop finely. Decoct in 4 cups water with 10 slices ginger and 3 jujubes to 2 cups, strain, add Binglang powder, boil 3 more times, drink 1 cup. If not stopped, take another. Pang Lao said: Persistent Chi Ni in Shanghan is due to failure of Yin-Yang Qi ascent/descent to produce sweat; ascending fails, so Stomach Qi rebels upward. No end. Take this formula.

**Bianque *Zhongzang Jing* Dingxiang San for Shanghan Ke Ni:**
Dingxiang (Clove), Shidi (Persimmon Calyx) (each 1 fen); Gancao (Licorice Root), Liangjiang (Galangal Root) (each 0.5 qian). Brew in boiling water as one dose, drink fiercely while hot. Very effective. The above five formulas are suitable for Yin Syndromes.

**Sanyin Ju Pi Zhu Ru Tang** (See Miscellaneous Diseases Chi Ni section): Suitable for Yang Syndromes.

**Emergency Formula for Shanghan Chi Ni:**
Xiangfu (Cyperus Rhizome), Juhe (Tangerine Seed, stir-fried) (each 0.5 liang). Finely chop. Use half cup wine. Stir-fry medicine in silver/copper vessel, dripping wine gradually until yellow-brown. Powder. Take 2 qian, decoct in small cup water to 80%, sip slowly. Alternative: Single Xiangfu powder.

**Another Formula:** Roast 2 garlic cloves until soft, mash, add Baijiang (White Ginger) powder, form pills like wutong seeds. Swallow 20 pills with natural juice of Xiecai (Scallion/Garlic chive). Take 15 more pills when symptoms recede.

Wu said: Chi Ni is Qi rebelling upward causing hiccup sounds. Medical texts sometimes confuse it with Ke Ni (cough-reversal), which is incorrect. *Neijing* says: Ke Ni with ascending Qi and scattered pulse indicates death due to形体 damage (body depletion). Cheng Wuji cites *Qianjin Fang*: Ke Ni ascending Qi refers to coughing. Heart Fire attacks Lung Metal, Qi sprays upward causing cough/wheeze. If Lung exhausts, pulse scatters, skin/hair wither, death ensues. Thus "body depletion." How does this relate to Chi Ni? Chi Ni can be caused by Stomach Heat from failure to purge. Qi rebels from Stomach to chest/throat. Yilao (Zhang Yuansu) treatment: Failure to purge, Stomach Heat internal excess, hard stool -> Chengqi Tang to purge; soft stool -> Xiexin Tang. Stomach deficiency with Heat -> Ju Pi Zhu Ru Tang. Phlegm-fluid -> Banxia Shengjiang Tang or Fuling Banxia Tang. Stomach Cold -> Ju Pi Gan Jiang Tang or modified Lizhong Tang. *Yaolue* says: Qi rushes from umbilicus to chest/throat for Chi Ni; this is Yin Syndrome, pathology not in Stomach. Lower deficiency, internal latent Yin, or misuse of cold/herbals causes extreme cold below, forcing Ministerial Fire up to gather in chest, causing Chi Ni, nearing exhaustion. Patient irritable, feels hot, but skin is cold to touch. This is rootless, lost-control Fire scattering as heat, not real heat. It is Water extremity resembling Fire. Misidentifying this and using cold herbs will fail. Treatment must use *Huoren* Qianghuo Fuzi San or modified Fuzi Tang to urgently warm the lower Jiao. Once True Yang returns, Fire descends, Chi Ni stops. If extreme cold Chi Ni persists, use Sulfur and Frankincense powder inhalation, or moxa Qimen, Zhongwan, Guanyuan, Qihai. Goal: warm hands/feet, pulse returns, Yang returns, Yin retreats -> survival.