Hiccup

　　Hiccups are a common physiological phenomenon. The causes of its occurrence are as follows:

　　1. Diaphragmatic spasm contraction: This is the main cause of hiccups. When the diaphragm spasms, it causes abnormal operation, leading to the disruption of regularity and the formation of hiccups. Hiccups are caused by the spasm and contraction of the diaphragm. In fact, the diaphragm is not a membrane that separates the chest and abdominal cavities, but a large muscle. With each stable contraction, our lungs inhale a breath of air; as it is controlled by the respiratory center in the brain, the muscles of the diaphragm have regular activities, and our breathing can operate completely autonomously, and we do not need to constantly remember how to breathe. When hiccups occur, the diaphragmatic muscle contracts involuntarily, air is rapidly inhaled into the lungs, and the gap between the two vocal cords narrows abruptly, causing a strange sound. We are not clear why the diaphragmatic muscle contracts uncontrollably. Although most hiccups are transient, some people hiccup continuously.

　　2. Indigestion: Patients with this condition often hiccup after eating, especially after eating dry food, and hiccups are more severe.

　　3. External substances, biochemical, and physical stimuli cause. For example: too much air enters the stomach and overflows from the mouth, factors such as vagus nerve excitement and pyloric spasm, poor eating habits (such as eating and drinking too quickly), excessive swallowing (such as when there is too much or too little saliva), and when the gastrointestinal neuroses or chronic gastrointestinal diseases cause the weakening of peristalsis, the incidence rate is frequent and it is not easy to improve during treatment.

　　4. Eating too fast: As the speed of eating is very fast, it causes the food and digestive juices to mix and digest insufficiently, causing damage to the gastrointestinal tract and causing transient hiccups. If this continues for a long time, it is easy to cause indigestion. Hiccups are often caused by overeating.

      Hiccups can lead to the following diseases:

　　1. Duodenal ulcer: Duodenal ulcer refers to tissue damage beyond the mucosal layer caused by the self-digestion of gastric juice in the gastrointestinal mucosa. Ulcers can occur in any part of the digestive tract, with the stomach and duodenum being the most common, that is, gastric ulcer and duodenal ulcer. Their etiology, clinical symptoms, and treatment methods are basically similar, and the main method of clear diagnosis is gastroscopy. Duodenal ulcer is similar to gastric ulcer, which is caused by the self-digestion of digestive juice in the intestinal mucosa, which causes tissue damage beyond the mucosal layer. It is more common in young and middle-aged people and is mainly diagnosed by gastroscopy. Duodenal ulcer patients often have stomach pain when hungry, even waking up at night in pain, which can be relieved by eating something, and there are often acid regurgitation phenomena. It is prone to occur in autumn and winter, with pain on the right upper abdomen, rhythmic.

　　2. Chronic gastritis: The pain of chronic gastritis is often the most irregular, its onset is not regular, it may be caused by mental stress, or it may be related to indigestion. It is manifested as fullness after meals or throughout the day, belching without acid regurgitation, poor appetite, gradual weight loss, and slight pallor or grayish complexion.

　　3. Gastric ulcer: The pain of gastric ulcer patients is related to eating, and they usually have a feeling of distension and pain in the stomach immediately after eating, with upper abdominal pain after meals, or nausea, vomiting, and a feeling of indigestion, which may have been for a long time.

　　Because hiccups are accompanied by the closure of the vocal cords, a special sound is often produced, and when this sound is heard, it can be judged that it is caused by hiccups.

　　Since there are many causes of hiccups, the diagnosis of the cause should be based on the medical history, clinical manifestations, physical examination, and combined with necessary laboratory tests and other auxiliary examinations.

　　It is very important to inquire about the patient's medical history in detail, understand the causes, frequency, duration, whether it affects eating or sleeping, and past episodes of hiccups, etc. If the patient has frequent hiccups for many years and does not require treatment or the hiccups can stop after general symptomatic treatment, it often indicates that hiccups are caused by improper diet, gastrointestinal bloating, or nervous factors; if hiccups occur after major surgery in the chest or abdomen, it often indicates that hiccups are caused by gastrointestinal paresis, bloating, or stimulation of the diaphragm.

　　If hiccups occur frequently during the day without any other symptoms, and do not affect sleep (hiccups can stop during sleep), it is often caused by nervous factors; if the patient's hiccups are accompanied by severe headache, nausea, vomiting, and other symptoms, and are accompanied by pathological nervous reflexes, it often indicates that hiccups are caused by central nervous system lesions; if hiccups are accompanied by symptoms such as cough, sputum, dyspnea, or chest pain, it should be considered that there may be lung, bronchial, or mediastinal lesions; if hiccups are accompanied by symptoms such as acid regurgitation, burning sensation behind the sternum, upper abdominal pain, nausea, vomiting, and a feeling of obstruction during eating, it should be considered that hiccups are caused by peptic ulcer, gastric cancer, reflux esophagitis, cardia cancer, esophageal cancer, esophageal hiatus hernia, or liver and biliary tract lesions. Therefore, after a detailed medical history and a thorough physical examination, the cause of most patients' hiccups can be roughly determined.

      Preventive measures for hiccups include adults and infants, as follows:

　　1. Distract the attention, eliminate tension and adverse stimulation.

　　2. Take a deep breath, then hold your breath as long as possible, and then exhale. Repeat this several times.

　　3. Drink hot water, especially slightly warm water, take a large sip, and swallow it in several doses.

　　4. Wash your hands, insert your index finger into your mouth, and gently stimulate the pharynx.

　　5. Put the mixed gas into a plastic bag and inhale it. The mixed gas contains 90% oxygen and 10% carbon dioxide.

　　6. Chew and swallow slices of ginger.

　　7. Wash the fresh leek, squeeze out the juice, and take it orally.

　　8. Take 20 tangerine calyxes (referring to the peduncle of fresh persimmons or persimmon cakes) each time, boil them into 100 milliliters of water, and take them orally in two doses of 50 milliliters each. You can also add sesame seeds and boil them together according to circumstances.

　　If a newborn suddenly starts hiccuping without other diseases and the sound is high and forceful and continuous, it is generally caused by catching a cold. At this time, you can give the baby some hot water to drink, cover the baby's chest and abdomen with a quilt or clothes, and put a hot water bag outside the clothes and quilt in winter to keep warm. Under normal circumstances, the baby can stop hiccuping soon. However, if the baby hiccups frequently for a long time, you can also soak a small amount of tangerine peel (which has the effects of smoothing the qi, dissolving stomach turbidity, and regulating the spleen qi) in boiling water, drink it when the water temperature is suitable, and the hiccups will stop if the cold is appropriate. Generally speaking, newborn hiccups are usually benign and self-limiting, and they will stop soon. However, hiccups can make the baby feel uncomfortable, so preventive measures should be taken for newborn hiccups as well.

　　The following are TIPS for preventing hiccups in infants:

　　1. Do not feed the baby when the baby is too hungry or crying fiercely.

　　2. When the weather is cold, pay attention to keeping the baby warm and avoid catching a cold.

　　3. Whether breastfeeding or formula feeding, do not let the baby eat too fast or too eagerly.

    　The following are the three points of laboratory tests that need to be done for hiccups:

　　1. During an attack, chest fluoroscopy can determine whether diaphragmatic spasm is unilateral or bilateral. Chest CT may be performed when necessary to rule out diseases刺激 the phrenic nerve, and an electrocardiogram can be used to determine if there is pericarditis or myocardial infarction. Head CT, magnetic resonance imaging, and electroencephalography may be performed when suspected of central nervous system lesions.

　　2. When suspected of having digestive system lesions, abdominal X-ray fluoroscopy, B-ultrasound, gastrointestinal contrast, and abdominal CT and liver and pancreas function tests may be performed when necessary. Clinical biochemical tests can be conducted to exclude poisoning and metabolic diseases.

　　3. When suspected of having digestive system lesions, abdominal X-ray fluoroscopy, B-ultrasound, gastrointestinal contrast, and abdominal CT and liver and pancreas function tests may be performed when necessary. Clinical biochemical tests can be conducted to exclude poisoning and metabolic diseases.

　　1. Foods should be warm. Such as cold drinks, cold water, cold dishes, cold congee, etc. Otherwise, it is easy to cause cold stagnation in the stomach, leading to upward movement of Qi.

　　2. It is not advisable to eat cold drinks and hot foods at the same time. For example, after drinking hot tea or coffee, eating cold drinks and watermelons, apples, and pears; after excessive drinking, using cold water to quench thirst, etc. Similar situations can lead to the interaction and stimulation of cold and hot Qi, causing hiccups.

　　3. Patients with excessive sweating and prolonged thirst, or those with chronic illness and physical weakness should not drink excessive amounts of water. Otherwise, it may damage the spleen and stomach, leading to the descent of lung and stomach Qi, causing frequent hiccups.

　　4. Use appropriate soup-like foods in the diet. Otherwise, dry, hard, sticky foods may stimulate the esophagus or gastrointestinal tract, or promote food wrapping the gas in the body upward and causing hiccups.

　　5. Regular intake of foods that can keep the bowels regular, such as vegetables rich in fiber, mung beans, sesame, black fungus, bananas, etc.

　　6. Patients with chronic illness and physical weakness should take appropriate tonics, such as walnuts, dog meat, lamb, chicken, sesame, black fungus, bananas, etc.

　　7. Moderate diet, reduce stomach Qi, and adjust the mind to relieve liver Qi.

　　8. Foods that can relieve hiccups include lean pork, carrot seeds, sparrows, chives, litchi kernel, pork stomach, Astragalus, clove, and Suizi, etc.

　　The principle of treatment is first to remove the cause of the disease and block the hiccups reflex arc.

　　One, non-drug treatment

　　1. Simple method: Such as distracting attention through conversation, pain or other discomfort, drinking ice water, using a paper bag or plastic bag to cover the mouth and nose for repeated breathing, drinking large mouthfuls of water and swallowing in stages, performing the Valsalva maneuver (that is, after deep inhalation, hold your breath and force an exhalation), to block the hiccups reflex arc.

　　2. Mechanical stimulation method: Use the tongue pulling method (make the patient stick out their tongue, wrap it with gauze, and pull it outwards for 3 to 5 minutes, while performing deep inhalation and holding breath actions) or insert a soft catheter through the nasal cavity, generally inserting 8 to 12 cm, moving the catheter back and forth to stimulate the pharynx. Due to blocking the hiccups reflex arc, it often stops hiccups.

　　3. Acupressure method: The therapist presses the thumbs on both sides of the patient's orbital sockets, at the location of the supraorbital nerve, within the patient's tolerance, alternating rotation for 2 to 4 minutes, and instructing the patient to breathe rhythmically and hold their breath. Zhang Wenyi has treated hundreds of cases with this method, with significant effects.

　　4. Rubbing and pressing the eyes method: The patient closes their eyes, and the doctor places their thumbs on both sides of the patient's orbital sockets, moderately rubbing and pressing the upper part of the eyes in a clockwise direction until the hiccups stop. If the heart rate suddenly drops below 60 beats per minute, stop the operation. People with glaucoma and high myopia should avoid this method, and those with heart disease should use it with caution.

　　5. Smoking smoke method: Take a longer circular hard paper box with one end open, place the paper shavings that have been ignited into the box, let them extinguish to produce smoke, immediately press the open end of the paper box tightly around the mouth, leave the nostrils, and instruct the patient to open their mouth to make eating movements, swallowing the smoke. Avoid suction, and swallow for 1 to 2 minutes, hiccups can stop. Zhang Wenliang has treated more than 20 cases of intractable hiccups with this method, all with good effects.

　　Six, audio-frequency therapy: the patient lies on their back, and the two electrodes are wrapped in several layers of wet gauze over the upper abdomen below the costal arches. Adjust the operation current to the point where the patient can no longer tolerate the abdominal contraction. Then slightly adjust back to the maximum tolerable current that can be endured (usually between 40 to 80mA). Each treatment lasts 25 minutes, twice a day, and a course is 4 days. Zhao Huizhen treated 37 cases of severe hiccups with an efficacy rate of 94.6%.

　　Seven, cervical sympathetic ganglion block: needle insertion is at the junction of the inner margin of the sternocleidomastoid muscle and 3 to 3.5cm above the sternoclavicular joint. The needle is inserted vertically and slightly medially for 3 to 4cm, with the tip of the needle touching the anterior and lateral aspect of the sixth cervical vertebral body. Then withdraw the needle 2 to 3cm and inject 20 to 25ml of 0.25% procaine. Care should be taken not to damage the surrounding tissues. This method may cause ipsilateral Horner syndrome, which may be related to the blockage of nerve conduction. This method is applicable to hiccups caused by various reasons.

　　Two, acupuncture or acupoint injection therapy

　　One, acupuncture at the Neiguan (PC6), Hegu (LI4), Zhongwan (CV12), Geshu (BL17), Stomach 36 (ST36), and Sanyinjiao (SP6) acupoints.

　　Two, vitamin B1 and vitamin B6 acupoint injection: using a 5ml syringe and a 7-number needle, 2ml of each drug (100mg and 50mg) are aspirated. The needle is inserted vertically into the Neiguan (PC6) acupoint. After the needle sensation is felt, the medicine is injected quickly after retracting the needle to ensure no blood is aspirated. 2ml is injected per acupoint, and if ineffective, repeat once after 2 hours.

　　Three, atropine and emmer acupoint injection: 0.2mg of atropine and 0.5ml of emmer mixed solution are used for the Neiguan (PC6) acupoint injection. The method is the same as above. If the effect is poor, re-inject on the opposite side after 6 hours. Caution should be exercised in patients with glaucoma and benign prostatic hyperplasia.

　　Four, atropine acupoint injection at the Stomach 36 (ST36) point: the skin is conventionally disinfected, and 0.5mg of atropine is injected into both sides of the Stomach 36. The method is to directly puncture the acupoint 1.5 to 2cm deep using a strong stimulation method, and then slowly inject after the patient feels sore and distended.

　　Three, drug treatment

　　Gastrotropin 10mg is injected intravenously, followed by 10mg orally or injected intramuscularly every 6 hours.

　　Chlorpromazine 25mg is taken orally or injected intramuscularly, three times a day.

　　Phenytoin sodium 200mg is slowly injected intravenously (more than 5 minutes), followed by 100mg orally, four times a day.

　　Hydrochloride prochlorperazine is started at 25mg each time, three times a day, and the dose is gradually increased, usually to 225mg/d when hiccups stop.

　　Calcium channel blocker nitrendipine 60mg and nifedipine 10mg, three times a day.

　　Scopolamine is administered intramuscularly at a dose of 0.3 to 0.6mg each time, once every 6 to 12 hours, until hiccups stop.

　　The mechanism of action of Lysanxia for hiccups is not yet clear, and it may be achieved through the regulation of the central-nervous system-viscera nervous system, or by overexciting the diaphragmatic nerve to reach a state of inhibition. Intramuscular injection is 20mg each time, repeated every 2 hours, and can be repeated for recurrent hiccups.

　　8, Huachansu has the effects of cell protection and immune regulation. The mechanism of action of hiccups is not yet clear. 2 to 4ml intramuscular injection, twice or three times a day. It has a significant therapeutic effect on patients with hiccups accompanied by gastric cancer, liver cancer, coronary heart disease, pulmonary heart disease, and cerebrovascular disease.

　　9, Lidocaine is first given by intravenous injection of 100mg, followed by intravenous infusion of 2 to 3mg per minute. If the effect is not good, 100mg is added to the Murphy tube after half an hour, and it can be repeated up to 3 times if necessary. After hiccups are controlled, maintain intravenous infusion for 1 to 2 days. The mechanism of action may be related to its peripheral and central nervous conduction blockage.

　　Four, External Diaphragmatic Pacemaker Activity

　　Apply the external diaphragmatic pacemaker with moderate stimulation of 9 times per minute, for 30 to 45 minutes each day, until hiccups stop. For those who relapse, treatment can be given once a day. This method may inhibit the hiccups reflex center through feedback action, making the diaphragm contract regularly.

　　Five, Traditional Chinese Medicine and Chinese Herbs

　　Traditional Chinese medicine believes that hiccups are caused by the upward movement of stomach Qi. It can be divided into:

　　1, Stomach Cold Syndrome: It refers to the internal obstruction of cold pathogen, and the stomach Qi not descending. The treatment method is to warm the middle-jiao and dispel cold. Using Dingxiang Shidi Decoction, commonly using Gong Dingxiang, Shidi, Gao Liangjiang, Xiangfu, Biba, Ganjiang, Chenpi, etc.

　　2, Stomach Heat Syndrome: It refers to the excessive heat in Yangming meridian, and the upward冲 of stomach fire. The treatment method is to clear stomach heat and release heat. Using Zhuyeqi Shigao Decoction, commonly using Zhuyeqi, Shigao, Maidong, Fashenxia, Zhuru, Lugen, Pipa Ye, Shashen, etc.

　　3, Qi Stagnation Syndrome: It refers to liver Qi attacking the stomach, and the stomach losing the function of descending. The treatment method is to smooth Qi and descend Qi. Using Wumoyin Decoction, commonly using Muxiang, Zhike, Binglang, Wu Yao, Chenxiang, Foshou, Qingpi, Chenpi, Dazhi Shi, Dingxiang, etc.

　　4, Yang Deficiency Syndrome: It refers to the deficiency of spleen and kidney Yang, and the loss of descending Qi of stomach. The treatment method is to warm and replenish spleen and kidney, harmonize and descend Qi. Using Fuzi Lizi Decoction, Xuanfu Dazhi Decoction, commonly using Fuzi, Ganjiang, Baizhu, Dangshen, Jiangbanxia, Xuanfu Hua, Dazhi Shi, Gong Dingxiang, etc.

　　5, Yin Deficiency Syndrome: It refers to the consumption of stomach Yin and the loss of harmony in Qi. The treatment method is to nourish the stomach and generate fluid, harmonize and descend Qi, using modified Yiguan Decoction, Juipi Zhuru Decoction, commonly using Shashen, Maidong, Shihu, Yuzhu, Shidi, Chupi, Zhuru, Daodouzi, Pipa Ye, Shengjiang juice, Gancao, etc.