III. Persistent Hiccups

III. Persistent Hiccups

We were invited to consult at Lanzhou First Medical University Hospital. The patient was Jiang, an 81-year-old man who had developed a high fever, cough, and chest pain due to a cold one week ago. He was admitted to the hospital for treatment, and X-ray imaging confirmed lobar pneumonia. After four days of broad-spectrum antibiotic therapy, his fever subsided, and his cough, chest pain, and shortness of breath also improved. For two days, the patient frequently hiccupped; despite taking Midodrine and Guifuan, and receiving injections of Diphenhydramine and Phenergan, the hiccups remained unrelenting. He had also tried atropine injections at the Zusanli acupoint, but without success. The patient was elderly and frail; his hiccups were severe, occurring day and night, unable to stop. Not only did they affect his rest and diet, but there was also a tendency for pulmonary infections to recur. His family came to seek our consultation. Upon examination, we saw that the patient had a tired expression, frequent hiccups, and he described his suffering as unbearable. His pulse was wiry, smooth, and weak, with a prominent pulse in the throat, a thick, pale tongue with a yellowish, greasy coating. When we inquired about his bowel movements, we learned that he had not had a bowel movement for a week! We diagnosed damp-heat in the middle burner, with stagnation of stomach qi and failure of spleen qi to ascend, leading to upward reflux of stomach qi, constipation, and a combination of old age, frailty, and the initial recovery from high fever, resulting in damage to both qi and yin. The treatment should focus on descending rebellious qi, opening the intestines, clearing heat and drying dampness, while also tonifying qi and supporting righteous energy. The formula used was: 6 g of Coptis chinensis, 10 g of Astragalus membranaceus, 10 g of Rheum officinale, 6 g of Dried Ginger, 6 g of Pinellia ternata, 10 g of Flos Belladonnae, 20 g of Raw Hematite, 10 g of Codonopsis pilosula, 6 g of Clove, 6 persimmon seeds, 6 g of Licorice, 6 g of Fresh Ginger, 4 Jujubes, and 180 g of Kiln Clay (first decocted to extract water). The kiln clay was boiled with water for 10 minutes, and the water was used to prepare the herbal formula, one dose per day. After one dose, the effect was noticeable; after two doses, the hiccups stopped, and the patient never experienced them again. The formula combined the formulas of Xiaoxin Decoction with Pinellia, Xuanfu Daihe Decoction, Clove Persimmon Decoction, Xiao Xianxia Decoction, Sanhuang Xiaoxin Decoction, Fresh Ginger Xiaoxin Decoction, and Licorice Xiaoxin Decoction—all brought together into a single formula, embodying the principles of descending rebellious qi and harmonizing the stomach, while simultaneously clearing heat and drying dampness. The kiln clay used in this formula is also known as “Fulong Gan,” the burnt soil found in the center of a traditional wood-burning stove. Today, with rising living standards, people in both urban and rural areas rarely cook with pure firewood anymore; the kiln clay used in this formula comes from Hui Cui Tang Pharmacy in Lanzhou City. Ms. Fan Junling, the owner of the pharmacy, traveled to impoverished mountain villages in Yuzhong County after searching for pure firewood, eventually finding a particularly impoverished farmer’s household and purchasing over 200 kilograms of kiln clay. This story became a celebrated tale in the world of traditional Chinese medicine in Lanzhou City.