Hiccups That Won’t Stop and Come On Every Time You Get Cold — How Doctor Wang Mengying Cured Spleen-Yang Deficiency with Lizhong Tang and Xuanfu Daizhe Tang

Patient search terms: hiccups / hiccups that won’t stop / hiccups when cold / hiccups from breathing cold air / gas rising from the stomach / what to do about hiccups Medical terms: hiccup (e ge) · belching (yi qi) · spleen-yang deficiency · stomach qi rising counterflow (turbid yin rising)

The opening: everyone hiccups — but for some, a sip of hot water fixes it, while for others the spleen and stomach need treating

Everybody has hiccuped at some point. But there is a kind of hiccup that is not the short little “hic” that passes in a moment — it is a long, powerful gush of air that rises up from the stomach, hiccup after hiccup, and simply cannot be stopped. What is worse: people with this kind often start hiccuping the moment the weather turns cold or they catch a chill — even breathing in cold air can set it off.

💬 Note from Doctor Luo: The physician in today’s story is Doctor Wang Mengying, the great Qing-dynasty master of warm (heat) diseases. As a warm-disease specialist, the vast majority of his cases called for clearing heat — yet in this case, he reached for warming yang herbs right from the start. Why? Because the patient’s condition dictates the medicine — you treat what the patient actually has, not what your school of thought prefers. Let me tell the story from the beginning.

Who was the patient: the close friend who compiled and prefaced Wang’s own case records

The patient in this case was no ordinary man. His name was Zhou Guangyuan, and he was Doctor Wang Mengying’s close friend. Zhou followed Wang’s treatments for his whole life and admired him enormously — in fact, it was Zhou Guangyuan who personally collected and edited Wang Mengying’s medical cases into a book, and when he wrote the preface he humbly signed himself as the “younger brother” in the relationship.

💬 Note from Doctor Luo: Zhou Guangyuan watched Wang Mengying rescue countless people — truly remarkable — so he compiled those cases and passed them down to later generations. The fact that we can read Wang Mengying’s case records today is thanks to this Mr. Zhou. As for Zhou himself, he was a textbook example of a qi-deficient, upright-qi-insufficient constitution leaning toward yang deficiency — plump and pale, with a face so white it looked sickly, sometimes even a little dark, because his yang qi was never quite vigorous enough.

How bad it got: hiccup after hiccup, unstoppable

Zhou Guangyuan said of himself: “Yu su huan yi qi” — I have long suffered from yi qi. What is yi qi? Belching — hiccuping — a big gulp of air rising out of the stomach, one long, loud blast after another. Other people hiccup a few times and it passes. Not him.

💬 Note from Doctor Luo: He said that “whenever the body is even slightly unwell, it flares up” — a little chill, a little fatigue, and the belching arrives. Once it started, it burst out drumbeat after drumbeat, air pushing up for no reason at all, “shi bu ke e” — unstoppable, unblockable. That winter his attacks were the worst ever, bitter beyond words. He happened to meet Wang Mengying and urgently asked the doctor to take a look.

What Doctor Wang saw: yang qi failing, turbid yin rising

One pulse-taking, and the diagnosis was out — “ci yang qi shuai wei”: the yang qi is weak. In other words, yang deficiency. And what happens when yang is deficient? Turbid yin rises (zhuo yin shang ni).

💬 Note from Doctor Luo: You can grasp Doctor Wang’s reasoning with a simple image from nature: yang qi is like the sun. When the sun stands overhead at noon, the fog burns off completely; when the sun sinks below the horizon, the fog creeps back out; and at dawn, before the sun has fully risen, the yin is still heavy. The body works the same way — when yang qi is sufficient, the clear qi rises and the turbid qi descends; once yang qi declines, the filthy turbid qi starts pushing upward, the stomach’s qi can no longer be held down, and it turns into hiccups, surging up one after another. Zhou Guangyuan was by nature deficient in upright qi and leaning toward yang deficiency, so when the weather turned cold his yang qi weakened further, the turbid yin rose harder, and winter brought his worst attacks.

The first formula: Lizhong Tang — warm the yang back up first

The treatment strategy was clear: warm the yang first. Doctor Wang began with one dose of Lizhong Tang (Center-Regulating Decoction) to lay the foundation.

💬 Note from Doctor Luo: Lizhong Tang comes from Zhang Zhongjing’s Shang Han Lun (Treatise on Cold Damage). Most people know it better as Fuzi Lizhong Wan (Aconite Center-Regulating Pill) — which is simply Lizhong Tang plus fu zi (aconite). Lizhong Tang has just four herbs: ren shen (ginseng), gan jiang (dried ginger), bai zhu (atractylodes) and zhi gan cao (honey-fried licorice). Which one matters most? In my view, gan jiang — it is the herb that warms the spleen and stomach back up. But ren shen is absolutely worthy of its place — it is almost a stroke of genius. A person in this condition is always deficient in upright qi; spleen-yang deficiency means the spleen qi is insufficient and drifting toward cold, so tonifying qi is essential — ren shen is powerful and forceful, restoring the upright qi first. Bai zhu tonifies the spleen and stomach; ren shen paired with bai zhu tonifies the spleen qi; add gan jiang to warm the spleen yang; and zhi gan cao harmonizes all the herbs and sits in command of the middle burner. Together, this is a warming-and-mobilizing spleen-yang formula — when the spleen yang is injured, it works beautifully.

A bit of history along the way: Lizhong Tang was originally for “huo luan”

What did Zhang Zhongjing originally use Lizhong Tang for? For huo luan.

💬 Note from Doctor Luo: The term “huo luan” in ancient texts means “violently disordered” — it describes a disease of sudden vomiting and diarrhea with headache and fever, not the infectious cholera of modern epidemiology. (Of course, infectious cholera with yang deficiency could also be treated with Lizhong Tang.) This “violently disordered” illness typically strikes people who are usually deficient in yang qi and upright qi, suddenly hit by cold — a sudden temperature drop, a blast of air conditioning, or cold drinks; summer is a classic season: cold drinks, sleeping with the AC on, chilling the body, and next morning you wake up drenched in sweat and weak, feverish, with a headache; you feel nauseated at the slightest movement, you sit on the toilet and diarrhea comes, and sometimes the stomach pain is unbearable. That is spleen-yang deficiency. Lizhong Tang works on it. That is why I often recommend keeping Fuzi Lizhong Wan at home — brewing Lizhong Tang yourself is a bit of trouble, but the pill is ready-made; one pill down and you will often feel markedly better.

The second formula: Xuanfu Daizhe Tang — tonify qi, lower qi and transform phlegm all at once

One dose of Lizhong Tang warmed up the yang-deficient patient and set the foundation. Then Doctor Wang wrote the second prescription — Xuanfu Daizhe Tang (Inula and Hematite Decoction).

💬 Note from Doctor Luo: This formula also comes from Zhang Zhongjing’s Shang Han Za Bing Lun (Treatise on Cold Damage and Miscellaneous Diseases). The original text says: after a cold-damage illness has been treated with sweating, vomiting or purging, one complaint remains — xin xia pi ying: the area below the heart is hard when pressed, and yi qi bu chu: the belching will not stop, one gulp of air after another. Why? After the three methods of sweating, vomiting and purging, the upright qi is depleted and the spleen and stomach are injured. Stomach qi is meant to descend, but now the stomach qi is weak with a little cold inside, so it easily rises counterflow — hence the hiccups. The strategy of Xuanfu Daizhe Tang is: tonify the qi, lower the qi, and transform phlegm at the same time — because in this kind of condition, a little phlegm usually lingers in the stomach as well.

Dissecting the formula: a flower herb that goes down, a mineral that presses the qi down

Xuanfu Daizhe Tang has seven herbs: xuan fu hua (inula flower), dai zhe shi (hematite), ren shen (ginseng), sheng jiang (fresh ginger), zhi gan cao (honey-fried licorice), ban xia (pinellia) and da zao (Chinese date). Each one is there for a reason.

💬 Note from Doctor Luo: First, xuan fu hua — most flowers have an ascending nature, but this is the one flower herb that descends; it specializes in lowering the qi. Ren shen tonifies the upright qi, because this problem always arises from deficient spleen-stomach qi. Sheng jiang — the original formula used five liang (a generous amount) — warms the cold-deficient spleen and stomach that keep pushing qi upward. Dai zhe shi is a mineral, very heavy in substance, and presses the qi downward with its weight. Zhi gan cao sits in the center and holds things together. Ban xia lowers the stomach qi and has some phlegm-transforming action. Da zao — the original used twelve pieces; four or five is enough today. And there is one special subtlety — the proportions: dai zhe shi one part, xuan fu hua three parts, sheng jiang five parts — 1:3:5. Some physicians stress this ratio strongly, saying that when you follow it clinically the results are especially good.

The mystery of the red soup: why the world feared this “sage’s wonderful formula”

Zhou Guangyuan later summed up this formula with a famous line: “Zhong sheng miao fang, yao ji ping dan, nai shi ren wei er bu gan yong” — the sage Zhang Zhongjing’s wonderful formula, made of utterly plain herbs — yet the world fears it and dares not use it. Afraid of what? Doctor Luo reveals the answer.

💬 Note from Doctor Luo: My guess: it is the dai zhe shi. What does a bowl of Xuanfu Daizhe Tang look like? The liquid comes out red, like paint, and looks terrifying. Someone unfamiliar with it takes one look and thinks: my god, what is this? A pot of paint — can you really drink that? It scares people off. But that red is simply the natural color of dai zhe shi, and it is exactly this heavy, sinking force that drives the qi down. Anyone who studies Chinese medicine will experience it after one use: this formula genuinely works.

Cured in one dose — and the same method worked every year after

What was the result? Cured in one dose. Doctor Wang gave Zhou Guangyuan Xuanfu Daizhe Tang, and after one dose the belching was gone.

💬 Note from Doctor Luo: From then on, Zhou’s condition still flared occasionally — some year the weather would turn cold, he would catch a chill, and it would come back. What to do? Follow the same method (ru fa pao zhi): first one dose of Lizhong Tang, then Xuanfu Daizhe Tang — and it was cured. Over the years the attacks grew milder and milder, until eventually they basically stopped altogether. You see, these two formulas — one warming, one descending — used in combination, are a precious piece of experience.

The commentator’s note: why did a warm-disease specialist start with warming herbs?

There is something here worth pondering carefully. Doctor Wang Mengying was a warm-disease specialist; the overwhelming majority of his cases were about clearing heat — nourishing yin and clearing heat, clearing heat and transforming phlegm-heat — and he was extremely careful with warming herbs.

💬 Note from Doctor Luo: Why? Because in Wang Mengying’s era, far too many people abused warming herbs and one-sided “warming tonification,” creating all sorts of new problems — so Wang Mengying came to correct the trend. He said: you cannot warm-and-tonify everyone by default; not every patient should be warmed and tonified. But look at him treating Zhou Guangyuan — dried ginger in one formula, Lizhong Tang in the next. What does that show? It shows that at the level of a true master like Wang Mengying, a physician uses every kind of medicine: being a warm-disease specialist does not mean using only cold, cooling herbs and never warming ones. No — you use what the patient’s condition requires. Disease does not grow according to your school of thought. Curing the patient is the first priority.

The extended story: Doctor Yu Jiayan treating critical hiccups — six doses of Lizhong Tang in a single day and night

Doctor Wang’s move was not invented out of thin air — he read widely and borrowed from his predecessor Doctor Yu Jiayan (author of the Yu Yi Cao, “Careful Notes on Medical Cases”). Doctor Yu once treated an even more severe hiccup patient.

💬 Note from Doctor Luo: Doctor Yu’s patient had suffered from belching for a long time without healing, until he could not even get rice down. He started vomiting clear water, then green water, then black water, and finally foul-smelling water — his breathing was nearly gone, and he was at death’s door. How did Doctor Yu treat him? First he gave six doses of Lizhong Tang, drunk within a single day and night — not six days: one day and one night, six bowls, without letting him stop, pouring them in continuously. Why? The patient’s “breath was about to cease” — he was too depleted to dare use dai zhe shi to press the qi down right away. When there is not a thread of qi coming up, pressing it down hard would snap the breath and the person would die. So first Lizhong Tang separates and harmonizes yin and yang and strengthens the spleen and stomach; once the middle-burner qi is sufficient and can raise the clear and lower the turbid, then lowering the qi is safe. The next morning he switched formulas to Xuanfu Daizhe Tang, and one dose settled it.

Doctor Yu’s method: decoct xuan fu hua, mix in dai zhe shi powder

Doctor Yu Jiayan had an even finer detail in how he used Xuanfu Daizhe Tang — he did not boil the formula as written; he took its principle instead.

💬 Note from Doctor Luo: Doctor Yu used only xuan fu hua as a decoction, and when it was ready, stirred in two qian (about 6 g) of dai zhe shi powder and gave it to the patient to drink. The result? “As soon as it entered the mouth, the qi felt as though it had been gathered back into the dan tian (lower abdomen)” — it returned home. The patient grew extremely sleepy and was nursed back slowly. From then on the qi no longer rushed upward; it returned to the dan tian. Then tonics were given — about twenty jin in total — and after two months of aftercare, the patient was completely fine. Doctor Yu also explained why the patient vomited black water: when the water at the very bottom of the stomach has turned black, it means the stomach’s fluids are no longer pure — at that point the spleen and stomach are deficient to the extreme, and pressing down recklessly is even more dangerous. This is the skill of the great physicians of old — Lizhong Tang warming the yang and tonifying the spleen as the foundation, Xuanfu Daizhe Tang lowering the counterflow to finish the job; the two formulas together, one treating deficiency and one treating excess, held in perfect balance. It is precisely this experience that Wang Mengying borrowed from Doctor Yu and applied to Zhou Guangyuan — with excellent results.

Everyday advice: if a breath of cold air makes you hiccup, don’t rely on a cup of hot water alone

The story is told. Now let it land on each of us — people who “hiccup whenever the weather turns cold” are really not rare in daily life.

💬 Note from Doctor Luo: Some people genuinely start hiccuping from a single breath of cold air, and a cup of hot water does the trick. But you should know: that tells you your spleen and stomach may be a little weak, and your yang qi not quite sufficient. Hot water only treats the branch; in daily life you need to regulate the spleen and stomach, which is the root. People who are truly yang-deficient, qi-deficient, spleen-stomach-insufficient can have hiccups drag on for a long time — and for such patients, the experience of Doctor Yu Jiayan and Doctor Wang Mengying is worth borrowing to regulate themselves. Once regulated well, you not only stop hiccuping — your whole body benefits: the spleen and stomach grow strong, they can raise the clear and lower the turbid, qi and blood circulate normally, and the body truly recovers. Chinese medicine looks through all the surface signs to see the problem inside and regulate the problem inside — clear away the surface signs one by one, and many problems gradually resolve. That is the principle of regulating the body in Chinese medicine.

What to take away

• Hiccups that will not stop — especially ones triggered by cold or a breath of cold air — point to spleen-yang deficiency with turbid yin rising. The yang qi is too weak to hold the turbid qi down, so it surges up as hiccups and belching.
• Doctor Wang Mengying’s two-step method: one dose of Lizhong Tang (ginseng, dried ginger, atractylodes, honey-fried licorice) to warm the spleen yang and restore upright qi, then Xuanfu Daizhe Tang (inula flower, hematite, ginseng, fresh ginger, pinellia, honey-fried licorice, Chinese date) to tonify qi, lower the qi and transform phlegm. One warming, one descending — a proven combination.
• The ratio matters: in Xuanfu Daizhe Tang, use dai zhe shi : xuan fu hua : sheng jiang in roughly 1:3:5 for the best effect.
• Doctor Yu Jiayan’s rescue method: for a critically depleted patient whose breathing is nearly gone, never press the qi down first — give Lizhong Tang continuously (six doses in a day and night) to strengthen the spleen and stomach, and only then lower the qi.
• For everyday life: if a breath of cold air sets off your hiccups, that is your body telling you the spleen and stomach are weak — treat it as a signal to regulate your spleen and stomach over the long term, not just to reach for hot water. Keeping Fuzi Lizhong Wan at home is a practical standby.

Compiled from Doctor Luo Dalun’s commentary on Doctor Wang Mengying’s case; the original case comes from the Wang Shi Yi An (The Medical Cases of Wang Mengying), compiled by Zhou Guangyuan, c. 1840s–1860s (Qing dynasty).