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(Shuhuai He)（Bin He）
Patient: Italian, male, 60 years old
Occupation: Farmer
Initial consultation date: 4/3/2012
Chief complaint: Frequent episodes of hiccups for over 30 years
Current Medical History: About 30 years ago, following the death of a family member, the patient experienced excessive grief, and shortly thereafter he started experiencing bouts of hiccuping. Despite undergoing various medical examinations, no pathological changes were found. The patient tried multiple treatment methods, but the symptoms were not improved. At present, the symptoms are still ongoing, with continuous hiccups and no ability to control it. The hiccup sounds are deep and weak.
Belching attacks are related to psychological factors, and they worsen during periods of mental distress or depression. The hiccup episodes are related to mental factors, and worsen during periods of mental distress or depression. Additionally, the patient frequently experiences sadness, crying, loss of appetite, abdominal bloating, and frequent gas.
Clinical Examination: The patient has a thin body, with a pale complexion. His speech is subdued, and the sound of the hiccup is low and deep. He has a pale tongue 〖JP2〗with a thin white coating, and a pulse that is thin and wiry.
Diagnosis: Hiccups.
Pattern diagnosis: Liver qi stagnation with liver attacking the stomach, thus the stomach qi does not descend, the qi counterflows and moves the diaphragm, resulting in episodes of hiccups.
Treatment Principles: Dispers stagnant liver qi to relieving qi stagnation, and regulate the stomach to descend counterflow qi
Treatment Plan: Acupuncture points, Sishencong (EX-HN-1), Neiguan (P6), Zhongwan (Ren 12), Qihai (CV 6), Zusanli (ST 36), Gongsun (SP 4), Zhongkui (EX-UE-4).
Treatment Procedure: First, needle Neiguan with even reinforcing and reducing technique, and Gongsun with the reinforcing method. Then needle Sishencong using reinforcing and reducing techniques, with other points being treated with reinforcing methods. Apply moxibustion on Zhongkui point for 5 cones, leaving all the needles in for 30 minutes.
Follow-up Record: The patient was treated twice a week, and improvement was observed after four treatments. The patients mood gradually stabilized, and the hiccuping episodes decreased. After eight treatments, the hiccuping stopped. There were two additional consolidating treatments.
Analysis: Neiguan and Gongsun are confluence points for the eight extraordinary vessels. Neiguan is also the Luo point of the Pericardium channel, connected with the Yinwei Channel, and regulates the Zang-Fu organs, soothes the Liver, and promotes the generation of Earth by nurturing Fire. Gongsun is the Luo point of the Spleen channel, linking to the Chong Mai, which is the sea of the twelve channels, and it regulates deficiency and excess of the Zang-Fu organs, in this case helping to descend the counterflow central qi. These two points combined can address liver stagnation with counterflow stomach qi. The patient has suffered from hiccups for many years, with a quiet hiccup sound, which indicates insufficient central qi. By needling Zhongwan (CV12), Qihai (CV6), Zusanli (ST36), and Sanyinjiao (SP6) points in combination, it is possible to strengthen the spleen, boost qi, and regulate the ascending and descending movement of middle qi. “Zhongkui is an extraordinary point located on the dorsal side of the proximal interphalangeal joint of the middle finger, corresponding to the area of the diaphragm. It can harmonize stomach qi and reduce the ascending of the diaphragm. Yulong Fu (The Ode of the Jade Dragon, a compilation of treatments in verse form from the Zhen Jiu Da Cheng) contains the description:‘Zhongkui governs the overturning of the stomach, bringing immediate relief.’ Therefore, by combining various points, one can alleviate liver stagnation, invigorate the spleen, harmonize the stomach, and effectively alleviate hiccuping.”
Suffering from hiccups for 30 years, he used various treatments to no effect, and was then cured after eight treatments with acupuncture, which is an unusually good result. This success highlights the importance of accurate pattern identification, appropriate acupoint selection, and precise needling techniques in achieving positive outcomes even for challenging and chronic conditions, Just as stated in the chapter “Ling Shu · Nine Needles and Twelve Sources”: “For those who are skilled in using needles, treating illness is like removing thorns, cleaning dirt, unraveling knots, opening blockages. Even if the illness has been present for a long time, it can still be completely resolved. When it is said that a condition cannot be treated, it is because the technique has not yet been mastered.”
About the Author:
Shuhuai He，graduated from the Beijing Traditional Chinese Medicine College in 1963, he founded the Italian Qihuang Tradition Chinese medicine college in 2018, and serves as academic Dean.
呃逆的臨床治驗
何樹槐 何斌
患者：意大利人，男，60歲，農民，初診時間2012/04/03
主訴：呃逆30餘年, 發作頻繁。
現病史：自30餘年前因親人過世，悲傷過度,隨後即出現呃逆症。曾進行多種檢查未發現病理性改變，經多種方法治療，至今不愈。目前仍持續發作，呃聲連續，不能自製，呃聲低沉無力。呃逆發作與精神因素有關，精神憂鬱時加重。另外，時常憂鬱悲傷，時哭泣，食慾不振，腹脹多氣。
檢查：身體消瘦，面色無華，言語低沉，呃逆聲低沉。舌質淡，苔薄白，脈弦細。
診斷：呃逆。
辯證：肝氣鬱結，橫犯於胃，胃氣不降，氣逆動膈，發為呃逆。
首診記錄
治則：疏肝理氣，和中降逆。
治療：四神聰、內關、中脘、氣海、足三里、公孫、中魁。
操作：先針內關、公孫，內關平補平瀉，公孫補法。再針四神聰，平補平瀉，餘穴用補法。中魁穴艾炷灸 5壯，留針30分鐘。
複診記錄：一周兩次，四診後開始好轉。心情逐漸平靜，呃逆減少。治療8次後，呃逆停止。又鞏固治療兩次，恢復健康。
解析：內關、公孫為八脈交會穴，內關是手厥陰心包經的絡穴，通陰維脈，有調節內臟，疏肝解鬱，益火生土的作用。公孫是足太陰脾經絡穴，上通衝脈，衝脈為十二經之海，可調節內臟之虛實，降中氣上逆，所以二穴相配，疏肝之鬱結，降胃氣之上逆。患者呃逆多年，呃聲低微，為中氣不足，針中脘、氣海、足三里、三陰交四穴相配，可健脾益氣，斡旋中氣之升降。中魁為經外奇穴，位於中指背側第二節骨尖上，相當於橫膈的部位，可調和胃氣，降橫膈之上逆，《玉龍賦》有“中魁理翻胃而即愈”的記載。故諸穴相配，疏肝解鬱，健脾和胃呃逆可止。
患呃逆30年不愈，曾採用多種方法治療乏效，採用針灸治療8次而愈，獲得如此難得的好效果。可見只要辨證準確，用穴得當，手法正確，即便是頑疾、難症也可獲得良好效果，正如《靈樞·九針十二原篇》說：“夫善用針者，取其疾也，猶拔刺也，猶雪污也，猶解結也，猶決閉也，疾雖久，猶可畢也。言不可治者，未得其術也。”
作者簡介：
何樹槐,1963畢業於北京中醫學院，2018年創立了意大利岐黄中醫學院，並擔任學術院長。
