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Hiccups (E Ni), also known as "Yue" (Hiccups/Inverted Stomach Qi) in the *Nei Jing* (Inner Canon). Some say that Cheng Wuji and Xu Xueshi indeed interpreted "Yue" as hiccups, yet Li Dongyuan and Wang Haizang interpreted "Yue" as dry heaving (Gan Ou), and Chen Wuzhe called "Yue" coughing against the reverse flow (Ke Ni). Since various theories differ, why do you alone adopt the views of Cheng and Xu? The answer is: The meaning of "Yue" is contained in the *Nei Jing*, it is just that other schools failed to examine it carefully. According to the end of the *Ling Shu* (Spiritual Pivot) chapter on Miscellaneous Diseases: "To treat Yue, prick the nose with grass until sneezing occurs; once sneezed, it stops; if one holds breath and quickly guides the qi, it stops immediately; sudden fright can also cure it." Detailed analysis of these three methods in the scripture reveals they are precisely the treatments for hiccups. Applying this, using a paper twist to stimulate the nose to induce sneezing stops hiccups immediately; or closing mouth and nose to hold breath stops it immediately; or feigning enemies/thieves to cause sudden fright also stops it. This is why I adopt Cheng and Xu's theory that "Yue" is hiccups, as it aligns with the scriptural intent. If "Yue" were dry heaving, would making a person who is dry heaving sneeze, hold breath, or be frightened stop the dry heaving immediately? Obviously not. Thus, "Yue" is clearly not dry heaving. If "Yue" were named Ke Ni (Coughing against the reverse flow), according to the *Sheng Qi Tong Tian Lun* chapter of the *Nei Jing*: "Autumn injury by dampness leads to upward reversal and cough." The *Yin Yang Ying Xiang Lun* chapter states: "Autumn injury by dampness generates cough in winter." Based on this discussion, Ke Ni is undoubtedly coughing, which becomes clear when compared with spring, summer, and winter seasons. Sun Simiao's *Qian Jin Fang* says: "Ke Ni is coughing," which is originally clear. Later generations did not know why they mistakenly equated Ke Ni with hiccups, deviating far from the truth. Zhao Yi-de said: "Cheng Wuji stated that Yue is commonly called Ke Ni, making 'e e' sounds, but citing Ke Ni refers to Yue, not cough, which is incorrect. The *Nei Jing* treats Yue and Ke Ni as two distinct conditions; Yue is a stomach disease, while Ke Ni is a lung disease, defining stomach qi reversal as Yue." The commentary notes: "The stomach is the sea of water and grain, linked with the kidney as the gate. If the gate closure is unfavorable, qi reverses upward. The stomach contains water and grain, its nature prefers warmth; cold and grain clash, thus causing Yue." It also states that when Yangming qi rebounds, there is cough and Yue; when Taiyang qi rebounds, vomiting clear fluid and Yue/belching occur; when Shaoyin qi rebounds, Yue/belching occur. The *Ling Shu* also says: Grain enters the stomach, stomach qi flows upward to the lung. Now, if old cold qi and new grain qi return together to the stomach, old and new confuse each other, true and evil attack each other, qi gathers and reverses, re-emerging from the stomach, thus causing Yue. Treatment involves tonifying Hand Taiyin and draining Foot Shaoyin. Zhang Zhongjing's mentions of Yue all appear in Yangming syndrome contexts, stating that purging wet patients too early causes Yue, and in Yangming disease where the patient cannot eat, attacking heat inevitably causes Yue, both due to stomach qi deficiency after purging. For cases with internal wind-heat obstruction, qi blockage, tidal fever, and frequent Yue, Xiaochaihu Tang (Minor Bupleurum Decoction) is used for harmonization. For Yue with abdominal fullness, observe anterior and posterior bowels to identify blockage and unblock it; these are treatable conditions. However, in extreme illness with delirium, severe Yue, inability to urinate, abdominal fullness plus Yue, these are untreatable. Danxi Mr. also stated that hiccups are qi reversal, where qi rushes straight up from below the navel, exits the mouth, and makes sound. The *Nei Jing* states that all upward rushing reversal belongs to Fire. Li Dongyuan attributed it to Yin fire rushing up, preventing inhalation, causing stomach meridian reversal, arising from hidden yang within yin, treated according to seasonal medication principles. Ancient formulas all attributed it to weak stomach, ignoring fire, and treated it with herbs like Dingxiang (Clove), Shidi (Persimmon Calyx), Zhuru (Bamboo Shavings), and Chenpi (Tangerine Peel), without clarifying who reduces fire and who tonifies deficiency. Human yin qi relies on the stomach for nourishment; when stomach earth is damaged, wood qi insults it, representing earth failure and wood aggression. Yin is overwhelmed by fire, unable to guard internally, so wood carries ministerial fire to invade, rushing directly up the clear pathways. Saying 'stomach weak' actually means yin weakness, extreme deficiency. Patients seeing this seem to have critical signs. Yet there are excess patterns, which must not be ignored. Alas! The Sages said stomach qi reversal causes Yue, not caused by a single factor. Because Wang Taipu (Wang Bing) used the meaning of the *Ling Shu*, he annotated it as a disease of cold qi reversing from the kidney. Consequently, later formula discussions either used hot agents for cold or acrid-warm agents to disperse qi. How could one know that spleen and stomach, being one yin and one yang, disharmony also causes reversal? Kidney and liver are lower; mutual encroachment causes reversal. Moreover, kidney reversal is not necessarily cold. Left kidney governs water, nature moist and descending, how can it reverse itself? It must be right kidney ministerial fire flaming upward, carrying the rushing reversal. One must observe the degree of carriage and apply direct or counter-treatment accordingly. Liver wood wind, clashing from Shaoyang ministerial fire, must also treat fire, following the Master's words. If Yue arises from other causes, one must follow Zhongjing's method, treating according to what is favorable. Liu Zongnong said: Hiccups involve deficiency and excess, fire and phlegm, water qi; one cannot solely attribute it to cold. Generally, after sweating, vomiting, or purging for Shanghan (Cold Damage), prolonged diarrhea/dysentery, post-major illness, or postpartum, these are due to great deficiency of spleen-stomach qi and blood. If a healthy person eats too fast causing qi stagnation, or drinks/laughs causing airway aspiration, or phlegm-water stagnates in the chest, or violent anger causes qi reversal and phlegm syncope, or Shanghan-febrile disease fails to purge leading to this, these are all excess patterns. Water nature is moist and descending, fire nature is flaming upward. Now qi rushes from below to above; if not fire, then what? Generally, treatment for deficiency is tonification, distinguishing cold and heat within deficiency. E.g., after sweating/vomiting/purging, if too many cold-cooling drugs were taken erroneously, use warm tonification. If spleen-stomach yin deficiency with fire reversal, use balanced tonification. With heat, use cool tonification. For excess, e.g., Shanghan failing to purge, bowel obstruction causing hiccups, use cold purgation. For phlegm-fluid retention or violent anger qi reversal/phlegm syncope, where form and qi are both excess without malignant symptoms, treat according to pathogen location using emesis, purgation, clearing, or draining. Stomach injury with yin deficiency, wood carrying ministerial fire rushing up clear pathways: use Shen Zhu Tang (Ginseng and Atractylodes Macrocephala Decoction) with Dabu Yin Wan (Great Tonify Yin Pill). Post-vomit/purge stomach deficiency-cold: Lizhong Tang (Regulate the Middle Decoction) plus Fuzi (Aconite Root), Dingxiang, Shidi. Post-vomit/purge stomach deficiency-heat: Jupi Zhuru Tang (Tangerine Peel and Bamboo Shavings Decoction). *San Yin Fang* states: Vomiting/purging often leads to Yue due to stomach deficiency and diaphragm heat. Or continuous 8-9 sounds with no returning qi, alarming. In chronic Shanghan, this is very bad, termed 'Huai Bing' (Ruined Disease) in *Nei Jing*. Danxi treated Zhao Lidao, nearly 50, weak constitution, prone to anger. In summer, after hunger and violent anger, he developed dysentery (Zhi Xia), thirst, drank raw honey mixed with cold water himself. Dysentery eased slightly. After 5-7 days, pulse was slightly large but not rapid. He ordered stopping honey water, giving Shen Zhu Tang mixed with Yiyuan San (Benefit Origin Powder) when thirsty. Dysentery converged. After 7-8 days, extreme fatigue and hiccups appeared; knowing it was yin deficiency from prolonged purging, he maintained previous meds. Dysentery hadn't stopped, so he gave refined honey. Others blamed the medicine, wanting Ginger/Aconite. He said tonics have no quick effect; Aconite does not tonify yin, taking it ensures death. Others asked if cold water caused cold. He said in such heat, cool water isn't cold; don't doubt, wait for drug power. Four days later, hiccups stopped, dysentery settled. He treated Chen Zeren, nearly 70, rich diet, chronic cough, autumn dysentery, poor appetite. After 5-7 days, hiccups started, pulse large and empty. Others thought it difficult. Danxi said thin body can still be treated; use Shen Zhu Tang with Dabu Yin Wan. Recovered in 7 days. Lou Quanshan treated his brother with September dysentery, 50+ stools nightly, vomiting/reversal, inability to eat. After 5-6 days, hiccups added. One Clove held in mouth stopped it temporarily, but it returned. Used Huanglian Xiexin Tang (Coptis Decoction to Drain the Epigastrium) plus Zhuru. Hiccups slightly stopped, dysentery unsettled. For over 10 days, used small amount of Poppy Shell (Yumi Qiao) on empty stomach to astringe sliding, daytime used Ginseng, Atractylodes, Tangerine Peel to tonify deficiency. After Poppy Shell, hiccups lightened, dysentery settled. (Examples of tonifying deficiency after vomiting/purging.) Zhongjing said: Yue with abdominal fullness, check anterior/posterior, unblock whichever is blocked, and it heals. Large intestine dryness, deep-rapid pulse: Tiaowei Chengqi Tang (Regulate the Stomach and Order the Qi Decoction). Constipation, frequent Yue with delirium: Xiao Chengqi Tang (Minor Order the Qi Decoction). Danxi treated Chao Yue Chen Shi, 20s, hiccups after running miles full. Eating triggered >100 hiccups, lasting half day. Alcohol/soup didn't trigger. Evening fever, pulse choppy-rapid. Treated blood entering qi using Tao Ren Chengqi Tang (Peach Kernel and Magnolia Bark Decoction) plus Honghua (Safflower). Passed dirty blood several times, reduced. Then Muxiang Hezhong Wan (Costus Harmonize Middle Pill) plus Dingxiang. Cured in 10 days. (Right lower example, suitable for excess accumulation.) Treated a girl, past puberty, irritable, rich diet. Summer, violent anger triggered hiccups, whole body trembled, pulse unpalpable, unconscious. Inquiry revealed acute onset. Form/qi excess. Used 2 liang of Ginseng Radix Rhizoma (Renshen Lu) decoction, drank one bowl. Vomitied large amounts of tough phlegm, profuse sweat, slept one day, recovered. Ginseng enters Hand Taiyin, tonifies yin containing yang. Lu (Rhizome tip) is opposite, greatly drains Taiyin yang. Girl's violent anger rose; Liver governs anger, Lung governs qi. Scripture says anger causes qi reversal. Anger reversed Liver wood, attacked Fire insulting Lung, causing severe hiccups and unconsciousness. Renshen Lu induces vomiting; phlegm gone, qi descends, fire declines, Metal qi restores, Stomach qi harmonizes. (Upper example, suitable for phlegm stagnation.) *San Yin Fang* says: Yue with epigastric hardness/stuffiness, dizziness/palpitations indicates phlegm-water in diaphragm. Deficiency intolerant of emesis: Erchen Tang (Two Aged Decoction) or Daotan Tang (Abundant Phlegm Decoction) plus Jiangzhi (Ginger Juice), Zhuli (Bamboo Sap). Also blood stasis causing Yue, e.g., Danxi using Tao Ren Chengqi Tang for Chao Yue Chen Shi. Deficiency intolerant of purgation: seek mild agents in Blood Stasis section. Zhongjing said: Yue reversal, Jupi Zhuru Tang governs. Also: Dry heaving/Yue with cold limbs, Chenpi Tang governs. *Ben Shi Fang* uses Zhiqiao (Immature Bitter Orange) 5 qian, Muxiang (Costus Root) 2.5 qian, fine powder, 1 qian per dose, white water. Sun Zhao's formula uses Chenpi (Tangerine Peel) 2 liang peeled, decocted orally, or add Zhiqiao 1 liang. These are qi-breaking agents, suitable for qi reversal. Only Jupi Zhuru Tang is suitable for qi reversal with deficiency. Water-cold clash: Xiao Qinglong Tang (Minor Blue Dragon Decoction). Severe cold adds fried Fuzi tips. Jiegu's Shiqian San, *Baojian*'s Dingxiang Shidi San, Qianghuo Fuzi Tang, all hot agents, only suitable for cold hiccups. Dai Fu'an believed hot hiccups only occur in Shanghan. Other diseases with hiccups belong to cold: Banxia (Pinellia) 1 liang, Shengjiang (Fresh Ginger) 1.5 liang, 1 bowl water, decoct to half bowl, take hot. Or Dingxiang 10 grains, Shidi 10 pieces chopped, 1.5 bowls white water decocted. Or Lizhong Tang add Zhiqiao/Fuling 0.5 qian each, Banxia 1 qian. If ineffective, add Dingxiang 10 grains. Also, incidental hiccups without disease arise from qi reversal. Severe cases last 1-2 days: Xiaobanxia Fuling Tang (Minor Pinellia and Poria Decoction) plus Zhishi Banxia Tang (Immature Bitter Orange and Pinellia Decoction), or radish seed juice mixed with Muxiang Tiaoqi San (Costus Regulate Qi Powder), take hot. Best for reversal qi. If stomach cold severe, hiccups persist, or vomiting adds, mild agents fail: Dingxiang Zhusan (Clove Boiled Powder) or Fuzi Jingmi Tang (Aconite and Rice Decoction) plus fried Chuanjiao (Sichuan Pepper), Dingxiang, 20-30 grains each. Treat hiccups by moxibustion at Guanyuan (CV4) below navel, 7 moxa cones, immediate cure, repeatedly verified. Another method: Men left, women right, under nipple black edge, size of leek leaf, 3 moxa cones. Severe cases 14 cones.

[Diagnosis] Heart pulse extremely small indicates Yue. Lung pulse scattered indicates untreatable. Frequent connected hiccups indicate excess, treatable. Hiccups once every half hour indicate deficiency, difficult to treat, often dying soon.

[Postpartum Hiccups] This is an ominous sign. Urgently moxa Qimen (LR14) 3 cones, miraculous. Bend nipple down to the end point is the acupoint. Small breasts: one finger width below nipple. Men left, women right, one finger width below nipple in depression arterial point. Moxa cone size of small bean, accurate point stops disease immediately. Dingxiang San, Qianghuo San, Guixin (Cinnamon Bark) 5 qian, Jiangzhi 3 he, decoct water. Shenfu Tang (Ginseng and Aconite Decoction). (All hot agents.) Dried persimmon 1 piece chopped, 1 bowl water, decoct to 6 fen, sip warm. (For internal heat, intolerant of hot agents.)