Hiccups That Won’t Stop, Hiccuping on Every Breath?
Opening scene: 13,500 breaths, 13,500 hiccups
In the late Ming dynasty, an old gentleman fell ill to a terrifying degree: he could breathe out smoothly — but every time he inhaled, he hiccuped. Day and night, some 13,500 breaths in a single day and night, and nearly every inhalation was cut short by a hiccup.
He had already lost consciousness. His pulse ran wildly, like water boiling and tumbling, or like the film of grease floating on the surface of a bowl of soup — trembling, unsteady, now fast, now slow, and skipping beats without any rhythm. His body was stiff; he could not move. And on the bridge of his nose, right between the eyes, hung a shadow of black qi.
💬 Note from Doctor Luo: Folks, when you see an elderly person in this state, that is essentially a critical, near-death condition. But I’ll tell you something: he was not this sick to begin with — he was driven to this brink by two doses of medicine. And the two doses that pulled him back from the gates of death were also just two doses. This is a famous case from Doctor Yu Jiayan’s Yu Yi Cao (Records of Ideas and Intentions). Physicians call the disease “stomach wind” — a name very few people know today. Let’s start from the beginning.
Who was the patient: Grand Secretary Wang Huweng, a high Ming official
The patient was a Grand Secretary — a post at the level of Minister of War — surnamed Wang, styled Huweng. In the medical record he is respectfully called “Grand Secretary Wang Huweng” (“Gongzu” was the honorific used for officials in the late Ming and early Qing).
He first met Doctor Yu Jiayan over tinnitus. That spring, the old gentleman’s ears were ringing. Doctor Yu explained in detail where the illness came from and how to regulate it, and even wrote him a letter setting it all out clearly. The old gentleman read it and thought: this physician holds to principle and refuses to flatter — a man worth relying on. From that day on, he trusted Doctor Yu deeply.
💬 Note from Doctor Luo: Let me first say who Yu Jiayan was. He was a celebrated physician of the late Ming and early Qing. His given name was Chang, his courtesy name Jiayan, and his self-styled title was “Old Man of Xichang.” Born in Xinjian, Jiangxi, he wrote Yu Yi Cao, Shang Lun Pian (Further Discourses on the Shanghan Lun), and Yi Men Fa Lü (The Laws of Medicine), pioneered classroom-style medical education in China, and proposed the concept of “da qi” (the great qi of the chest) — Doctor Zhang Xichun’s whole “sinking of the great qi” theory traces its roots right back to him. He had a signature way of practicing: first argue the disease, then prescribe the medicine — he would lay the mechanism of illness out in the clearest possible terms. It was exactly this “let me explain the reasoning” spirit that won Grand Secretary Wang over.
First consultation: winter constipation, four doses to moisten the bowels
Some time later, in winter, the old gentleman fell ill again — “spleen constraint with hard stools”, in other words, dry, stubborn constipation. In the old days this was called “spleen constraint” (pi yue).
Doctor Yu took his pulse and understood at once: advanced age, insufficient fluids in the body. When fluids can no longer nourish the intestinal tract, the stool dries out — this is the single most important cause of constipation in the elderly.
What did he prescribe? Rou cong rong (desert cistanche), hu ma (sesame seeds), he shou wu (fleeceflower root), and shan yao (Chinese yam) — all moistening, nourishing agents, with Chinese yam to fortify the spleen. Four doses, and the bowels moved.
💬 Note from Doctor Luo: We still use this approach today. Cistanche is rich in oils and also tonifies the kidneys — when kidney qi is sufficient, bowel movements come easier. Sesame seeds carry oil. Fleeceflower root moistens and nourishes liver yin. Chinese yam nourishes spleen yin. Doctor Yu called it “the long-stored wind of the intestines, well matched to the medicine.” Notice that phrase — “the long-stored wind of the intestines.” That is a huge foreshadowing for what comes later. Remember it.
The accident: late winter, a full meal in the wind, and violent vomiting
Time moved to the end of winter, just before spring. One day, the old gentleman ate a full meal and then was caught in the wind.
That single event turned into a catastrophe — he suddenly vomited violently, pouring out everything, emptying his stomach completely. His stomach qi was badly wounded. The family hastily summoned Doctor Yu again.
Doctor Yu felt his pulse: the left guan position was strikingly large — the liver pulse was enormous. There was also a hint of fever, and the old gentleman himself said he felt a current of qi attacking his left side, surging up toward his left ear.
On his own, he had first drunk a little pear juice, with no effect; then he tried sugarcane juice, which brought slight relief.
💬 Note from Doctor Luo: The left guan position corresponds to the liver. It was the end of winter, spring about to arrive — the wood qi is stirring. The liver belongs to wood and corresponds to wind, so the liver pulse stood out alone. The liver rises on the left, so the qi attacked the left side and the left ear. Both pear juice and sugarcane juice are sweet and cold — so why did pear fail and sugarcane help a little? Pear is somewhat downward-driving, and a stomach this depleted does not welcome it. Sugarcane is sweet and cold yet able to harmonize the middle and nourish the blood — you can already see the thread forming: “wind is tied up with blood deficiency.” We’ll come back to it.
The diagnostic highlight: a condition of deficient wind — the stomach emptied, wind born from within
Doctor Yu pronounced his diagnosis in two words: “a condition of deficient wind.”
His reasoning was exquisite: everything the stomach had been holding — food and drink — had just been violently expelled, leaving the stomach hollow as an empty valley. And in that emptiness, wind arose from within — the interior was thrown out of balance, so internal wind was born. On top of that, the old gentleman had “long-stored wind” in his intestines (remember that foreshadowing?), which now seized the opportunity to surge upward into the stomach — and so the stomach was thrown into turmoil.
That is why the qi attacked the left: “wind entering the stomach” seeks out its corresponding location. The liver belongs to wood, easily generates wind, and rises on the left — hence the enlarged, forceful left pulse. The Neijing says: “When wind runs riot within, treat with sweet and cold.”
💬 Note from Doctor Luo: This is the pivotal stroke of the whole case — Doctor Yu imported the concept of “wind” into spleen-stomach illness. Most people think spleen-stomach disease has nothing to do with wind. But Doctor Yu says: when your spleen and stomach are weak and your zheng qi insufficient, external wind easily harms you. Then a bout of vomiting empties the stomach, and internal wind is generated. The two winds — internal and external — churn together and rush upward, and illness arrives. So you cannot simply stop the vomiting; you must use the sweet-cold method to calm internal wind and support zheng qi.
The formula Doctor Yu wrote: ren shen (ginseng), zhu li (bamboo sap), mai dong (ophiopogon root), and sheng di huang (raw rehmannia).
Ginseng supports zheng qi; bamboo sap transforms phlegm-heat; ophiopogon and raw rehmannia nourish yin and cool the blood — together, a sweet-cold, wind-calming strategy.
Storm one: the ginseng debate — the late-Ming medical world feared ginseng “like a tiger”
But here was the problem. A grand official like Wang Huweng was never treated by a single doctor — several physicians consulted together. They conferred and decided: ginseng cannot be used.
Why? In the late Ming, the profession had come to fear ginseng like a tiger: first, it was expensive; second, they were afraid it would make the illness worse.
💬 Note from Doctor Luo: This scene appears many times in Doctor Yu’s records — he prescribes ginseng, and the patient refuses to touch it. In fact, under the vigorous advocacy of physicians like Yu Jiayan and Miao Xiyong, ginseng had once become widely used. But by the Qing dynasty, physicians like Xu Lingtai criticized it, and everyone grew afraid of it again. This is the chronic disease of Chinese medicine students — we always learn it lopsided, and miss the true root. When you study Chinese medicine, you must grasp the “zhong” — the Middle — not leaning left, not leaning right; centered, balanced, and even. That is the true heart of the art. Unfortunately, no one listened to Doctor Yu that day.
Once ginseng was removed, the medicine went down: the belly gurgled, he vomited a little yellow phlegm, his chest felt freer; the next day his bowels moved once — the illness seemed to be turning toward peace.
The oddity: the stomach pulse was fine, but the heart, liver, kidney, and lung pulses were unsettled
Then a strange thing happened: although the old gentleman’s stomach channel was clearly the one afflicted, the stomach pulse showed no disease at all; instead, the heart, kidney, liver, and lung pulses, above and to either side, had left their normal state. How to explain that?
💬 Note from Doctor Luo: Doctor Yu said: this is weakness of the center — the problem is not that all four quarters are diseased, but that the central spleen and stomach are too weak, and once they weaken, the rest of the body loses its balance. He used an analogy: when the mother is sick, the four children get no milk and naturally cry with hunger. The spleen and stomach are that “center”; when they collapse, the whole body falls into disorder. This analogy lays bare the idea that “the spleen and stomach are the root of acquired constitution.”
Then the old gentleman said himself: his mouth had almost no taste at all; and when he drank water, it often refused to go down the throat — he simply could not swallow.
💬 Note from Doctor Luo: A bland, tasteless mouth is a classic sign of spleen disorder; water stuck at the throat is also a signal of spleen-stomach weakness. Doctor Yu said: at this point, act quickly with Si Jun Zi Tang (Four Gentlemen Decoction) — ginseng, bai zhu (atractylodes), fu ling (poria), and gan cao (licorice) — to gently build up the spleen and stomach. Once the spleen and stomach are restored, the wind can gradually settle. Sadly, this correct plan was immediately wrecked.
Storm two: the Four Gentlemen dispute — Doctor Yu driven off in a huff
Doctor Yu urged that the spleen and stomach be rebuilt at once, but the other doctors would not agree and argued with him. Yu Jiayan was a man of blunt temper; exasperated, he said something harsh:
“If you will not believe me, then invite someone wiser — hurry and call in a truly competent physician to deliberate, and stop wasting time here!”
That did it. The words were too sharp, and he was accused of deliberately frightening everyone — as if he were exaggerating the illness to scare them. Fine, they would listen to someone else. Other physicians were summoned.
💬 Note from Doctor Luo: The doctors who came had differing opinions — one said the old gentleman had wind-stroke, another said it was cold damage of the stomach — but on one point they were unanimous: ginseng must not be used. “The previous doctor used ginseng, so that was certainly wrong; we absolutely will not.” Then they made a grand boast: “This illness is not serious. We will jointly guarantee a cure.” With what? Exterior-releasing herbs — to induce sweating! Once the sweat came out, they all said: “There, he’s better, he’s better.”
The mistreatment: sweating plus coptis — two doses that drove a man to the brink
But was sweating right? The old gentleman’s stomach qi was already exhausted and his zheng qi insufficient. Sweating at that moment was like pulling the firewood out from under the cauldron — the moment sweat poured out, his zheng qi scattered like water.
The result: qi flew upward and his spirit reeled, and the hiccups would not stop — qi rushed upward, and the hiccups never ceased. Seeing that, the incompetent doctors made another reckless gamble: one dose of huang lian (coptis) to “clear the heat inside” — but with the stomach already this depleted, how could it bear the bitter-cold assault of coptis?
Two wrong moves stacked on top of each other. Disaster followed.
💬 Note from Doctor Luo: This is the great terror of treating the elderly — one slightly wrong dose and the body plummets. First the exterior-releasing herbs wounded the zheng qi, then coptis came in to clear from within — a pincer attack from both ends. By the time Doctor Yu was summoned again, the old gentleman had changed completely: the pulse was in total chaos, like boiling water, like grease on soup, now fast, now slow, skipping beats; he was unconscious, his body stiff; a black shadow of qi sat on the bridge of his nose; exhaling was still smooth, but every inhalation brought a hiccup — that was the opening scene of this case.
At death’s door: the quacks pass the blame, and Doctor Yu slams his hand on the table
At this point the two physicians began shifting responsibility, even pretending to be gracious: “Ah, that Four Gentlemen Decoction Doctor Yu mentioned earlier was actually quite good — we can use it now.”
Doctor Yu was furious: “Nonsense!”
💬 Note from Doctor Luo: Doctor Yu said: the timing of a formula matters. A moment ago, using Four Gentlemen Decoction to build qi quickly would have been right. But now his qi is already rushing upward and leaking outward — if you send ginseng and atractylodes up to prop it, the qi will jam and could snap right there! What do you do instead? Only Zhang Zhongjing’s Xuanfu Daizhe Tang (Inula and Hematite Decoction), which sinks rebellious qi with heavy minerals — can work a miracle among a hundred chances! When the qi rebels upward, we make it go downward. Even in his anger, Doctor Yu’s thinking was as clean as a knife-cut.
Xuanfu Daizhe Tang, the famous formula of Zhang Zhongjing’s Shanghan Lun: xuan fu hua (inula flower) descends qi — “of all flowers, the inula alone descends”; dai zhe shi (hematite) is heavy in substance, sinking rebellious qi; ban xia (pinellia) and sheng jiang (fresh ginger) transform phlegm and open the bind; ginseng, da zao (jujube), and zhi gan cao (honey-fried licorice) support the upright and fortify the center. Descending qi, transforming phlegm, and supplementing deficiency — three prongs at once, purpose-built for vomiting and hiccups from spleen-stomach weakness with qi rebelling upward.
The turn: one dose eased the hiccups; the second, with hematite raised to five qian — life saved in two doses
The medicine went down. The first dose slightly reduced the hiccups. For the second, Doctor Yu raised the hematite to five qian to keep pressing downward — the hiccups dramatically decreased.
The old gentleman could slowly take congee again. His spirit cleared, his pulse recovered, and his body felt light and easy. Then ginseng, fu ling, mai dong, mu gua (papaya), and gan cao to harmonize for two days — he was restored to health as before.
💬 Note from Doctor Luo: There you see the difference in caliber laid bare. Those two physicians drove the man to death’s door with two doses; Doctor Yu came in and brought him back from the dead with two doses. Where was the key? Accurate judgment — this old gentleman had insufficient spleen yin and stomach yin: Xuanfu Daizhe Tang used heavy minerals to drag the rebellious qi downward, ginseng supported the upright, and ophiopogon, papaya, and licorice together “sour-sweet to generate yin” — nourishing yin and moistening. On one side, build the spleen; on the other, nourish yin and calm wind — so two doses were enough. People say of Doctor Yu, “he really was not joking when he treated illness.” That kind of skill is pure cultivated kung fu.
Doctor Yu’s modesty: it wasn’t my doing — the old gentleman had a fine foundation
Remarkably, while gravely ill, the old gentleman had asked: “Why hasn’t Doctor Yu come?” — though he was the one who had let him be driven away in the first place. When Doctor Yu returned and wrote the new prescription, the old gentleman was delighted, warm-hearted and enthusiastic, cheerfully tasting the medicine himself.
But Doctor Yu was modest, saying this was not his achievement: this old gentleman had been plain and unpolished since youth, with the bearing of a pine and cypress — the older, the sturdier — a naturally strong constitution. And as for the herbs, it was not even ginseng’s doing; it was the supreme downward-driving power of dai zhe shi (hematite), working together with ginseng, that accomplished the feat.
💬 Note from Doctor Luo: Doctor Yu said: the old gentleman knew I was a good physician, and that is the grace of being recognized and trusted. Through the medium of a bowl of medicine, I could offer this small service of a junior, and it filled my heart with joy. Folks — this trust between doctor and patient is a vital part of why treatment succeeds. Look back at that earlier “ginseng debate”: the moment suspicion arose, the illness turned for the worse.
Know your classics: what exactly is “stomach wind”?
With the story told, Doctor Luo names the disease outright: the old gentleman’s illness was called “stomach wind” — the stomach of the spleen-stomach, and the wind of wind-evil.
The Huangdi Neijing already described it, and later physicians discussed it, but never clearly enough — which is why hardly anyone knows it today. Doctor Yu Jiayan understood it thoroughly.
💬 Note from Doctor Luo: The Suwen, “Discourse on Wind,” spells out “the appearance of stomach wind” explicitly: excessive sweating on the neck, aversion to wind, inability to take food or drink, blockage in the diaphragm (bloating when eating), frequent abdominal fullness, worse bloating when dressed too lightly, and diarrhea when eating cold food. Now check yourselves: does anyone sweat heavily on the neck the moment they eat? Does anyone feel blocked the instant food goes down? When the weather turns cold and you wear one layer less, does your belly swell? Do you get diarrhea the minute you catch a chill? — The Neijing wrote it all down for you. It’s just that later generations stopped studying and researching it, and so much of this knowledge was quietly lost. What a pity.
How stomach wind arises: external wind plus internal wind — the two winds combine
How does one catch stomach wind? Doctor Yu introduced the concept of “wind” on two levels:
External wind — when your zheng qi is insufficient, especially the qi of the spleen and stomach, your body becomes highly vulnerable to external wind. Standing on a mountaintop in the wind, or by the sea as the sea wind howls — wind-cold and wind-damp are both in there. Why does wind-evil harm you? The root is still internal: the spleen and stomach have grown weak.
Internal wind — one kind arises from accumulated heat in the spleen and stomach: too much rich, fatty, sweet food, stagnation that transforms into heat and generates wind. This connects to what many diabetic patients experience: when blood sugar drops and they eat, they sweat profusely — especially the neck and upper body. That kind of sweating is often a sign of abnormal blood sugar. Another kind arises from insufficient fluids and blood deficiency, producing deficient wind stirring within: insufficient stomach yin, insufficient spleen yin — both can stir up wind.
💬 Note from Doctor Luo: I often say the body has a channel for cold, a channel for heat, and a channel for wind — it sounds mystical, but it simply means that wind-evil changes your whole defense system: when you are weak inside, the defense system stirs, the interior races along but cannot keep up, and disease results. Moreover, internal and external wind constantly combine: exactly like this old gentleman — weak spleen and stomach, internal wind already present, then external wind blows in, the two winds join forces, and he vomits violently. Once empty, external wind invades further, internal wind grows fiercer, and the spleen and stomach are thoroughly wounded.
How do you treat stomach wind? If the pattern is cold, warm the yang, build the spleen, and scatter cold-damp. If the pattern is yin deficiency, nourish yin and calm wind. In severe cases, stomach wind may also show blood in the stool or diarrhea. The ancients had specific formulas for it: Weifeng Tang (Stomach-Wind Decoction), Doukou Wan (Cardamom Pill), and others.
Bonus: Weifeng Tang is an everyday medicine in Japan — but you can’t buy it here
Speaking of Weifeng Tang, Doctor Luo gets emotional.
💬 Note from Doctor Luo: We hardly use Weifeng Tang in China anymore, but in Japan you can buy it at any pharmacy — it’s a very common Kampo ready-made medicine, especially effective for chronic diarrhea, particularly diarrhea with blood. Japanese doctors treating chronic diarrhea will press the belly, hear it gurgling with water, and worry about blood in the stool — and they’ll prescribe Weifeng Tang. But in China today, you can no longer buy it at a pharmacy — they took our treasures, inherited them, and turned them into patent medicines sold freely. Gui Zhi Tang (Cinnamon Twig Decoction) is the same: the very first formula of the Shanghan Lun — drink one bowl when you catch a chill in the wind with a weak constitution, and you’re better — but try buying it at a pharmacy; it’s nearly impossible, at best there’s a “Cinnamon Twig Granule.” To be honest, much of the time our own policies are what restrict the development of Chinese medicine. The approval process for “medicine and food homology” items is painfully slow. The people have all this accumulated experience — why do we keep limiting ourselves? It’s a real pity.
The master’s mind: where stomach wind travels — Doctor Yu saw all five roads
Finally, Doctor Luo points out where this case shows its deepest skill.
Once stomach wind appears, which way will it develop? Doctor Yu knew precisely — five directions in all: it can move toward the liver channel on the left; it can rush up to the crown of the head; it can transform downward into diarrhea; it can move to the head and face; and it can transform internally into heat.
💬 Note from Doctor Luo: That’s what a master looks like: how the disease came, how to treat it, which way it will develop if mismanaged, and what the outcome will be — all crystal clear. Others had never even heard the name “stomach wind,” while Doctor Yu set it out plainly; anyone who studies stomach wind in later generations must read his account. So although this case looks terrifying, every stroke of it is the kung fu of the “Middle”: supporting the upright without forgetting to calm wind, sinking rebellious qi without forgetting to nourish yin. Timing and direction — not a hair’s breadth off.
What to take away
The core lesson of today’s talk: spleen-stomach disharmony is very often tied to wind. People with weak spleen and stomachs are easily affected by external wind; once disharmonized, internal wind develops and then leans toward cold or heat.
Sweating on the neck when you eat, fearing wind, bloating at the slightest bite, diarrhea at the slightest chill — these seemingly trivial complaints may well be “stomach wind” telling you: it’s time to start nurturing your spleen and stomach.
Compiled from Doctor Luo Dalun’s commentary on Doctor Yu Jiayan’s case records; the case comes from Yu Yi Cao (Records of Ideas and Intentions).