bubble_chart Concept

Stomach qi ascending counterflow, with frequent hiccuping sounds in the throat. Yilin Gaicuo states: "Hiccup, commonly known as 'da ge te'."

Hiccup is referred to as such in Neijing, "Treatise on Cold Damage Diseases", Jingui Yaolue, Zhubing Yuanhou Lun, Qianjin Yifang, and other texts. By the Jin and Yuan periods, Lanshi Micang conflated "vomiting hiccup". Danxi Xinfa states: "When there is sound and substance, it is called vomiting; when there is sound without substance, it is called hiccup," thus hiccup is equivalent to retching, a type of vomiting. Therefore, in medical texts before the Jin and Yuan periods, hiccup and hiccup were synonymous, Leijing states "What was anciently called hiccup is undoubtedly hiccup," but after the Jin and Yuan periods, hiccup came to mean retching. Thus, the three symptoms of hiccup, hiccup (retching), and vomiting, while all symptoms of stomach qi ascending counterflow, manifest differently.

bubble_chart Pattern Analysis

1. Stomach Cold︰The hiccup sound is deep, slow, and forceful, accompanied by gastric discomfort that alleviates with warmth and worsens with cold, a normal sense of taste, a white and moist tongue coating, and a slow pulse. This condition arises from dietary irregularities, excessive consumption of raw or cold foods, or external contraction of cold pathogens that penetrate deeply into the stomach and intestines, stagnating in the stomach. The stomach yang is constrained, leading to impaired descending function, resulting in stomach cold hiccup, which belongs to the pattern of pathogenic cold coagulation. The deep, slow, and forceful hiccup sound occurs because stomach yang is constrained, and yang qi is obstructed. It is also accompanied by gastric stuffiness and fullness, which lessen with warmth and intensify with cold, along with a bland taste in the mouth and greasiness, which are accompanying symptoms of stomach cold. Treatment involves warming the middle and dissipating cold, with the prescription selection being Clove Powder. If the cold is severe, Cassia Bark and Evodia Fruit can be added to warm the interior, dissipate cold, downbear counterflow, and stop hiccups. If there is concurrent phlegm stagnation with symptoms such as chest tightness and belching of foul matter, Magnolia Bark, Betel Nut, and Dried Tangerine Peel can be added to regulate qi, resolve phlegm, and disperse stagnation.
2. Stomach Heat︰The belching sound is loud and forcefully expelled, accompanied by fetid mouth odor, excessive thirst, scanty dark urine, severe constipation, a yellow tongue coating, and a slippery and rapid pulse. This is due to excessive consumption of spicy foods, leading to stomach heat accumulation, or external contraction of pathogenic heat lodging in the stomach, or emotional stagnation transforming into fire, with liver fire invading the stomach, resulting in stomach fire surging upward and causing hiccups, which belongs to an excess heat pattern. The upward surge of stomach fire causes the loud and forceful belching. Concurrent symptoms include fetid mouth odor, irritability, scanty dark urine, difficulty in defecation, a yellow tongue coating, and a slippery and rapid pulse. Treatment involves clearing and descending to drain heat, and the recommended formula is Bamboo Leaf and Gypsum Decoction with the addition of Persimmon Calyx to resolve phlegm and direct qi downward. If severe constipation is present, Rhubarb Rhizoma can be added to unblock the large intestine and facilitate the downward discharge of heat.
3. Spleen-kidney Yang Deficiency︰Frequent hiccups, shortness of breath, cold hands and feet, pale complexion, poor appetite, fatigue, weakness in the waist and knees. Clear and copious urine, loose stools, pale tongue texture with white and moist coating, deep and weak pulse. Spleen-kidney yang deficiency, low and continuous hiccups, shortness of breath; accompanied by fear of cold, cold limbs, cold hands and feet, clear and copious urine, etc. Treatment involves tonifying and replenishing the spleen and kidney, harmonizing the stomach and descending adverse qi. Prescription: Inula and Hematite Decoction. If spleen-kidney yang deficiency, fear of cold, cold limbs, and loose stools are present, add Aconite Lateral Root, White Atractylodes Rhizome, and Dried Ginger to warm yang, strengthen the spleen, and pacify rebellious qi.
4. Stomach Yin Deficiency︰Hiccups are rapid and intermittent, with a dry mouth and tongue, restlessness and thirst, the tongue texture is crimson red, and the pulse manifestation is thin and rapid. Insufficient stomach yin leads to rapid and intermittent hiccups, accompanied by a dry mouth and tongue, restlessness and thirst, and a crimson red tongue. The treatment involves promoting fluid production and nourishing the stomach, and the prescription selected is Stomach-Tonifying Decoction with loquat leaf, Dendrobium, and Persimmon Calyx to downbear counterflow and stop hiccups. If stomach qi is severely deficient, with no desire to eat, then Tangerine Peel and Bamboo Shavings Decoction is used to tonify qi and harmonize the middle.

Hiccup has the distinction of deficiency and excess, cold and heat. The excess type is mostly caused by qi, phlegm, and fire stagnation. The deficiency pattern includes spleen-kidney yang deficiency and stomach yin deficiency. The principle of treatment is "treating deficiency with tonification, treating excess with purgation."

bubble_chart Documentation

1. Jingyue Quanshu．Miscellaneous Diseases: "Although hiccups in miscellaneous diseases are caused by qi counterflow, some are accompanied by cold, some by heat, some by food stagnation, some by qi stagnation, some by deficiency of middle qi, and some by exhaustion of yin qi. By identifying the cause and treating the qi, recovery is inevitable. For mild or occasional hiccups, they will cease once the qi flows smoothly and do not necessarily require treatment. However, frequent or severe hiccups indicate a significant counterflow of qi or a severe depletion of the spleen and kidney's original qi. While substantial hiccups are not difficult to treat, the most critical condition is the failure and exhaustion of original qi."