bubble_chart Overview

Hiccup is a clonic involuntary spasm of the diaphragm and intercostal muscles, accompanied by the sudden closure of the glottis during inhalation, causing air to rapidly flow into the trachea and produce a characteristic sound. Frequent or persistent hiccups lasting more than 24 hours are referred to as intractable hiccups, which often occur in certain diseases.

bubble_chart Etiology

Healthy individuals may experience transient hiccups, often related to dietary habits, especially eating too quickly or overeating, consuming very hot or cold food and beverages, drinking alcohol, or carbonated drinks. Changes in external temperature and excessive smoking can also cause hiccups.

According to the site of the lesion, the disease causes are classified as:

1. Central: Loss of inhibitory function in the hiccup reflex arc, with the medulla oblongata being the most important site of organic sexually transmitted disease changes, including brain tumors, cerebrovascular accidents, encephalitis, brain membrane inflammation, metabolic sexually transmitted disease changes such as uremia, alcohol intoxication, and others like multiple sclerosis.

2. Peripheral: Stimulation of the afferent pathway of the hiccup reflex arc. Stimulation of the phrenic nerve includes mediastinal tumors, esophagitis, esophagus cancer, thoracic stirred pulse tumors, etc. Lesions around the diaphragm such as pneumonia, chest membrane inflammation, pericarditis, myocardial infarction, subphrenic abscess, hiatal hernia, etc., and vagus nerve stimulation include gastric distension, gastritis, stomach cancer, pancreatitis, etc.

3. Others: Drugs, general anesthesia, postoperative conditions, psychological factors, etc., as well as lesions of the inner ear and prostate can also cause hiccups.

bubble_chart Auxiliary Examination

1. X-ray fluoroscopy, radiography, and contrast imaging of relevant parts and organs, CT or B-ultrasound examination. 2. Routine laboratory tests for hematuria. 3. Clinical generation and transformation: including blood urea nitrogen, creatinine, blood sugar, liver function, amylase, electrolytes, etc. 4. Electrophysiological engineering: including electrocardiogram, electroencephalogram, phrenic nerve conduction velocity, etc.

bubble_chart Diagnosis

First, it is necessary to determine whether the condition is caused by physiological or organic disease. If an organic disease is suspected, follow the sequence of examinations below.

I. Clinical Manifestations

1. Systemic and Neurological Manifestations: Pay attention to the presence or absence of vital signs, local signs, and meningeal irritation signs.

2. Local Manifestations: Signs in the head and neck, chest, and abdomen, and the presence or absence of inflammation and tumors in various parts.

II. Auxiliary Examinations

Chest fluoroscopy during an episode can determine whether diaphragmatic spasm is unilateral or bilateral. Chest CT may be performed if necessary to rule out diseases that stimulate the phrenic nerve. An ECG can be used to determine the presence of pericarditis and myocardial infarction. If central nervous system lesions are suspected, head CT, MRI, and EEG may be performed.

If digestive system lesions are suspected, abdominal X-ray fluoroscopy, B-ultrasound, and gastrointestinal contrast studies may be conducted. Abdominal CT and liver-pancreas function tests may be performed if necessary. To exclude poisoning and metabolic diseases, clinical generation and transformation tests may be conducted.

If digestive system lesions are suspected, abdominal X-ray fluoroscopy, B-ultrasound, and gastrointestinal contrast studies may be conducted. Abdominal CT and liver-pancreas function tests may be performed if necessary. To exclude poisoning and metabolic diseases, clinical generation and transformation tests may be conducted.

bubble_chart Treatment Measures

The principle of treatment is primarily to remove the disease cause and block the hiccup reflex arc.

I. Non-pharmacological treatments

1. Simple methods such as distracting conversations, painful or other uncomfortable stimuli, drinking ice water, covering the mouth and nose with a paper or plastic bag for repeated breathing, drinking a large mouthful of water and swallowing it in portions, performing the Valsalva maneuver (i.e., taking a deep breath, holding it, and then forcefully exhaling) to block the hiccup reflex arc.

2. Mechanical stimulation methods can use tongue traction (have the patient extend their tongue, wrap it with gauze, and pull outward for 3-5 minutes while taking deep breaths and holding them) or insert a soft catheter through the nasal cavity, generally inserting 8-12 cm, moving the catheter back and forth to stimulate the pharynx, often stopping hiccups by blocking the hiccup reflex loop.

3. Acupressure method: The therapist presses the patient's bilateral supraorbital areas with both thumbs, equivalent to the supraorbital nerve area, to the patient's tolerance, rotating the thumbs alternately for 2-4 minutes, and instructs the patient to rhythmically hold their breath. Zhang Wenyi treated hundreds of cases with this method with significant efficacy.

4. Eyeball kneading method: The patient closes their eyes, and the doctor places both thumbs on the patient's bilateral supraorbital areas, kneading the upper part of the eyeballs clockwise until hiccups stop. If the heart rate suddenly drops below 60 beats per minute, stop the operation. It is contraindicated for glaucoma and high myopia patients and should be used with caution in heart disease patients.

5. Smoke swallowing method: Take a long, round, hard paper box with one end open, place burning paper scraps inside to extinguish and produce smoke, immediately press the open end tightly around the mouth, leaving the nostrils exposed, instruct the patient to open their mouth and perform eating motions to swallow the smoke, avoiding suction, swallowing for 1-2 minutes can stop hiccups. Zhang Wenliang treated over 20 cases of intractable hiccups with this method, all with good results.

6. Audio frequency electrotherapy: Use an audio frequency electrotherapy machine, the patient lies supine, place the electrodes wrapped in several layers of wet gauze on the upper abdomen under the costal arches. Adjust the current to the point where the patient feels unbearable abdominal twitching, then slightly reduce to the tolerable milliampere level as the maximum tolerable current (mostly 40-80mA). Each treatment lasts 25 minutes, twice daily, for a 4-day course. Zhao Huizhen treated 37 cases of severe hiccups with an efficacy rate of 94.6%.

7. Cervical sympathetic ganglion block: Insert the needle at the junction of the inner edge of the sternocleidomastoid muscle and 3-3.5 cm above the sternoclavicular joint, vertically and slightly inward for 3-4 cm, the needle tip may touch the anterolateral side of the sixth cervical vertebra, then withdraw the needle 2-3 cm, inject 20-25 ml of 0.25% procaine, being careful not to injure surrounding tissues. If successful, ipsilateral Horner's syndrome may appear, possibly related to blocking nerve conduction. This method is suitable for hiccups caused by various reasons.

II. Acupuncture or acupoint injection therapy

1. Acupuncture at Neiguan, Hegu, Zhongwan, Geshu, Zusanli, Sanyinjiao, etc.

2. Vitamin B1, Vitamin B6 injection at Neiguan acupoint: Use a 5ml syringe with a 7-gauge needle, draw 2ml of each drug (doses of 100mg and 50mg respectively), insert vertically into the Neiguan acupoint, after feeling the needle sensation, withdraw without blood and quickly inject, 2ml per acupoint, repeat once after 2 hours if ineffective.

3. Atropine and Emol injection at Neiguan acupoint: Use a mixture of 0.2mg Atropine and 0.5ml Emol for injection at Neiguan acupoint, method as above, if the effect is poor, repeat the injection on the opposite side after 6 hours, use with caution in glaucoma and prostate hypertrophy patients.

4. Atropine injection at Zusanli acupoint: Routine skin disinfection, inject 0.5mg Atropine into both Zusanli acupoints, method is to insert the needle 1.5-2 cm vertically using strong stimulation, inject slowly after the patient feels soreness and distension.

III. Pharmacological treatments

1. Metoclopramide 10mg intravenous injection, followed by 10mg orally or intramuscularly every 6 hours.

2. Chlorpromazine 25mg orally or intramuscularly, three times daily.

3. Phenytoin sodium 200mg slow intravenous injection (over 5 minutes), followed by 100mg orally, four times daily.

4. Imipramine hydrochloride start with 25mg each time, three times daily, then gradually increase the dose, usually until hiccups stop at 225mg/day.

5. Calcium channel blockers Nitrendipine 60mg, Nifedipine 10mg, three times daily.

6. Scopolamine 0.3～0.6mg intramuscularly, every 6～12 hours, until hiccups stop.

7. Ritalin The mechanism of treating hiccups is still unclear, possibly through central-visceral nerve regulation or by overexciting the phrenic nerve to achieve inhibition. Intramuscular injection of 20mg each time, repeat after 2 hours, can be repeated for recurrent hiccups.

8. Huachansu Has cell protection and immune regulation effects, the mechanism of action on hiccups is still unclear. 2～4ml intramuscularly, two to three times daily. Has significant efficacy for stomach cancer, liver cancer, coronary heart disease, lung heart disease, and cerebrovascular disease accompanied by hiccups.

9. Lidocaine First give 100mg intravenously, then 2～3mg per minute intravenous drip, if the effect is poor, give another 100mg added to the Murphy drip tube after half an hour, can be repeated up to three times if necessary, maintain intravenous drip for 1～2 days after hiccups are controlled. The mechanism of action may be related to its blockade of peripheral and central nerve conduction.

IV. External Diaphragm Pacing Activity

Use an external diaphragm pacemaker, with medium stimulation at 9 times per minute, 30～45 minutes daily, until hiccups stop. Recurrent cases can be treated once daily. This method may inhibit the hiccup reflex center through feedback, causing the diaphragm to contract regularly.

V. Chinese Medicine Chinese Medicinals

Traditional Chinese medicine believes that hiccups are caused by stomach qi ascending counterflow. It can be divided into: ① pattern of stomach cold: that is, cold evil internal obstruction, stomach qi failing to descend. The treatment method is warming the middle and dissipating cold. The prescription uses Clove and Persimmon Decoction with modifications, commonly using Clove, Persimmon Calyx, Lesser Galangal Rhizome, Cyperus, Piper Longum, Dried Ginger, Dried Tangerine Peel, etc.; ② pattern of stomach heat: that is, excessive Yangming heat, stomach fire rushing upward. The treatment method is clearing the stomach and purging heat, the prescription uses Bamboo Leaf and Gypsum Decoction with modifications, commonly using Bamboo Leaf, Gypsum, Ophiopogon Tuber, Pinellia, Bamboo Shavings, Reed Rhizome, Loquat Leaf, Coastal Glehnia Root, etc.; ③ Qi stagnation pattern: that is, liver qi invading stomach, stomach failing to descend. The treatment method is moving qi and downbearing counterflow. The prescription uses Five Milled Ingredients Drink with modifications, commonly using Aucklandia Root, Submature Bitter Orange, Areca Seed, Lindera, Aquilaria, Finger Citron, Green Tangerine Peel, Dried Tangerine Peel, Hematite, Clove, etc.; ④ Yang deficiency pattern: that is, spleen-kidney yang deficiency, stomach qi failing to descend. The treatment method is warming and tonifying spleen and kidney, harmonizing stomach and descending adverse qi. The prescription uses Aconite Middle-Regulating Decoction, Inula and Hematite Decoction with modifications, commonly using Aconite Lateral Root, Dried Ginger, White Atractylodes Rhizome, Codonopsis, Pinellia, Inula Flower, Hematite, Clove, etc.; ⑤ Yin deficiency pattern: that is, stomach yin depletion, qi failing to harmonize and descend. The treatment method is nourishing the stomach to produce fluid, harmonizing the middle and descending counterflow, the prescription uses Stomach-Tonifying Decoction, Tangerine Peel and Bamboo Shavings Decoction with modifications, commonly using Coastal Glehnia Root, Ophiopogon Tuber, Dendrobium, Polygonatum, Persimmon Calyx, Tangerine Peel, Bamboo Shavings, Sword Jackbean Seed, Loquat Leaf, Ginger Juice, Liquorice Root, etc.