Hiccups (Aigou)
Overview
In Miao medicine, hiccups are called Aigou (also “menpang soupang” or “dougu”). Both productive hiccups and dry heaving fall under this term. Causes include eating too fast or too much; consuming raw or greasy foods that injure qi and blood; emotional distress that stagnates qi; cold–damp retention in the GI tract; or underlying weakness of spleen–stomach. Qi stagnation transforms into heat and reverses upward, forcing the diaphragm to spasm and produce hiccups.
In TCM, hiccups are “reversal of stomach qi stirring the diaphragm,” causing the throat to emit repeated short, frequent “hic” sounds that cannot be voluntarily stopped. In Western medicine, hiccups may accompany GI neurosis, gastritis, gastric dilation, end-stage cirrhosis, cerebrovascular disease, uremia, or diaphragmatic spasm after surgery—this syndrome can guide differential (used in traditional contexts).
Syndrome Classification
Hiccups are a minor condition divided into Heat-Channel hiccups and Cold-Channel hiccups.
Etiology
Typically triggered by rapid or excessive eating; raw or greasy diet causing cold–damp retention; emotional imbalance obstructing qi; or constitutional weakness and deficient middle qi.
Pathogenesis
The lesion lies at the diaphragm, with the stomach as the primary organ and links to lung, liver, and kidney meridians. The diaphragm connects lung and stomach channels, both of which govern downward qi. If lung or stomach qi rebels, diaphragm qi stagnates and reverses into the throat, producing hiccups. Stimulating nasal mucosa can help stop hiccups.
Diagnostic Essentials
Main Sign: Short, frequent “hic” sounds from the throat, beyond voluntary control.
Accompanying symptoms: chest/epigastric distension, burning in the stomach, belching, restlessness.
Onset often abrupt, triggered by diet indiscretion, mood swings, cold exposure, or foul odors.
After control, imaging (barium X-ray, endoscopy) helps identify organ lesions.
Auxiliary Tests: Chest fluoroscopy or CT to localize diaphragm spasm; ECG to exclude pericarditis or MI; abdominal imaging and liver–pancreas function as needed; vomitus or blood tests to exclude metabolic or toxic causes.
Differential Diagnosis
Dry heaving (Ailuo’o) also stems from stomach qi rebellion and may produce sound without material. Hiccups feature short, frequent diaphragm spasms; dry heaving yields longer, low-pitched retching with nausea and is classified as vomiting.
Pattern Differentiation & Treatment
1. Heat-Channel Hiccups
Presentation: Loud hiccups, foul breath, thirst for cold drinks, epigastric fullness, frequent belching.
Pattern: Heat in the channel
Principle: Clear heat, descend qi, stop hiccups
Formula (decoction):
Sangexianzha (Dioscorea nipponica rhizome, sangexianzha) 15g
Shengjiang (Zingiber officinale, shengjiang) 10g
2. Cold-Channel Hiccups
Presentation: Slow hiccups, epigastric distension, pale complexion, poor appetite, fatigue, cold limbs.
Pattern: Cold in the channel
Principle: Warm middle, nourish qi, descend qi, stop hiccups
Formula (decoction):
Jiuxiangchong (Holotrichia diomphalia, jiuxiangchong) 10g
Zhizhuxiang (Hedysarum polybotrys, zhizhuxiang) 12g
Yangquehua (Lonicera japonica, yangquehua) 10g
Fuling (Poria cocos, fuling) 12g
Houpo (Magnolia officinalis, houpo) 10g
Prevention & Care
Maintain emotional calm; avoid extremes of joy or anger.
Guard against environmental pathogens (wind, cold, heat, damp).
Eat lightly; avoid raw, cold, spicy foods; keep regular meal patterns.
During attacks, consume easily digested semi-liquid warm foods.
Live regularly; combine activity and rest.
Commentary
Miao medicine holds hiccups arise from a mix of external invasion and internal deficiency injuring qi mechanism. The condition often involves both excess and deficiency. Treatment focuses on nourishing qi and stomach, warming the middle, and descending rebellious qi—while removing the triggering factors.
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