Hiccup

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Textbook Prescriptions Digestive

Essentials of Chinese Acupuncture (Beijing, Shanghai and Nanjing Colleges of Traditional Chinese Medicine, 1980) — the standard prescriptions of the Chinese colleges.

Points

ST36 Zusanli bilateral

He-Sea of the Stomach; regulates the stomach and moves qi
CV12 Zhongwan midline

Front-Mu of the Stomach; settles the middle and relieves fullness
- ⚠ Organ
- Pregnancy: caution
PC6 Neiguan bilateral

Luo point of the Pericardium; opens the chest and moves qi
BL17 Geshu bilateral

Back-Shu of the diaphragm; calms the diaphragm and sends rising qi down
- ⚠ Pneumothorax
CV22 Tiantu midline

Local point at the suprasternal notch; directs rebellious qi downward
- ⚠ Pneumothorax
- ⚠ Airway

Needling Safety

Cited hazards for these points. Tick what applies to the patient to see the cautions that follow from it.

CV12 Zhongwan
- ⚠ Organ injury has been reported after needling this point. Wu J, Hu Y, Zhu Y, Yin P, Litscher G, Xu S 2015, Table 4 (Organ injury associated with acupuncture)
BL17 Geshu
- ⚠ Pneumothorax risk: too deep an insertion can puncture the pleura. World Health Organization 1999, Section II §5.2 (Lung and pleura), p. 25
CV22 Tiantu
- ⚠ Pneumothorax has been reported after needling this point. Wu J, Hu Y, Zhu Y, Yin P, Litscher G, Xu S 2015, Table 1 (Pneumothorax associated with acupuncture)
- ⚠ In front of the trachea: risk of airway injury. World Health Organization 1999, Section II §5.2 (Other points), p. 25

Treatment Principle

Regulate the stomach and push its rising qi back down to stop the hiccup.

Indications

Food retention with qi stagnation: distended epigastrium and abdomen, hiccups, yellow sticky tongue coating, rolling forceful pulse; possibly distending chest and hypochondriac pain, irritability and a wiry forceful pulseCold attacking the stomach: slow, forceful hiccups that ease with hot drinks, white moist coating, slow pulse

Method

Reducing method for food retention and qi stagnation; for the cold type, combine needling with moxibustion.

⚠ Cautions

CV22 lies directly over the trachea with the aortic arch and great vessels behind the manubrium: needle shallowly and follow the posterior border of the sternum with care, never deep and straight back. BL17 is over the thorax; oblique, shallow insertion to avoid pneumothorax. Persistent hiccup lasting days can signal serious disease (central nervous system, metabolic, thoracic or abdominal) and warrants medical investigation.

About

The colleges' prescription for hiccup, drawn chiefly from the Stomach channel, with additions for the stagnation and cold patterns.

Rationale

ST36, CV12 and PC6 ease fullness of the chest and get qi moving, while BL17 at the level of the diaphragm and CV22 at the throat act directly on the rising qi. The combination therefore treats the stomach that is failing to descend and the diaphragm where the spasm is felt.

Clinical Notes

For food retention and qi stagnation add ST44 to regulate the stomach and clear stagnation, LV3 to regulate liver qi, and CV14 to ease the chest and diaphragm. For the cold type add CV13 with moxibustion to warm the spleen and stomach. The book also gives an ear-acupuncture alternative (Ear-Shenmen, Diaphragm, Subcortex, strong stimulation, long retention).

Sources

Beijing College of Traditional Chinese Medicine, et al. Essentials of Chinese Acupuncture. Beijing: Foreign Languages Press, 1980. Chapter III, Hiccup, p. 354–355.

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