Belching

　　First, what causes belching?

　　1. Unregulated diet, indulging in cold and raw fruits or sticky and difficult-to-digest foods, can cause damage to the Spleen and Stomach, and these substances remain in the center, leading to belching due to retained food. As stated in Treatise on the Etiology of Disease: 'If the grains are not digested, there will be distension and Qi reversal, which is why belching and acid regurgitation occur.'

　　2. External attack of wind and cold, cold Qi staying in the Stomach, can lead to belching. As stated in Treatise on Cold Damage: 'After taking sweat, if there is vomiting or diarrhea, there will be epigastric tightness and belching that does not subside.'

　　3. Overthinking and worry can injure the Spleen and Stomach; or if there is an attack of the Liver by anger, both can lead to belching.

　　4. After the disease or in old age, if the Spleen and Stomach are weak, and there is upward reversal of Qi, it can lead to belching.

　　Second, the pathogenesis of the disease

　　The pathogenesis of belching is mainly due to disharmony of the Spleen and Stomach, and the upward reversal of Stomach Qi. The Stomach is the sea of grains and fluids, accepting everything. If it is due to unbalanced diet, irregular living habits, leading to disharmony of Yin and Yang of the Spleen and Stomach, the clear Yang of the Spleen does not rise, and the turbid Yin of the Stomach does not descend, or phlegm and fire are produced in the Stomach, or the Spleen and Stomach are weakened, causing the upward reversal of Stomach Qi and resulting in belching.

　　This disease belongs to a functional disease, mainly manifested as hiccups in clinical practice, which is called hiccups in Western medicine, caused by crural muscle spasm. Generally, it can improve spontaneously after rest. There are no direct complications, and some hiccups can stimulate the posterior wall of the pharynx to cause vomiting. If aspirated into the lungs, it can cause aspiration pneumonia, which is more serious and should be paid attention to clinically.

　　Belching, abdominal distension, ulcer, and poor digestion:

　　1. Different from the short and sharp retching with sound. After a full meal, occasional belching without other symptoms does not belong to a pathological condition and can usually be self-healed. Clinically, according to the different sounds and smells of belching, differentiate between deficiency and excess.

　　2. The belching is frequent and loud, and the epigastric distension decreases after belching. If the onset and cessation of belching are related to changes in mood, it is mostly due to Liver Qi attacking the Stomach, belonging to a实证.

　　3. The belching is low and intermittent, without sour smell, and accompanied by poor appetite and decreased food intake, which is mostly due to stomach deficiency and Qi reversal, commonly seen in the elderly or those with chronic illness and weakened physique, belonging to a deficiency syndrome.

　　4. Frequent belching without sour smell, accompanied by epigastric pain, is mostly due to invasion of cold in the stomach, belonging to cold syndrome.

　　5. Especially in gastroesophageal reflux disease, chronic gastritis, peptic ulcer, and functional dyspepsia, there are often belching symptoms.

　　This disease belongs to a functional disease, and its etiology is due to diaphragmatic spasm, so the focus of clinical prevention is mainly to prevent gastrointestinal diseases, such as avoiding overeating, avoiding alcohol, avoiding eating too much spicy and刺激性 food, to reduce gastrointestinal dysfunction, which can reduce the occurrence of hiccups. For those with existing hiccups, oral Huoxiang Zhengqi Liquid can be given to reduce the occurrence of complications.

　　1. Upper gastrointestinal barium meal examination:Can observe for inflammation, dilation, stricture, ulcer, or tumor lesions of the esophagus, cardia, stomach, and duodenum, whether there are hiatal hernia or achalasia, which is often helpful for the etiological diagnosis of hiccups.

　　2. Chest and abdominal flat films:X-ray chest film can observe for bronchial, lung, and mediastinal lesions; abdominal flat film can observe for high intestinal cavity distension (including the liver flexure and spleen flexure of the colon), whether there are signs of intestinal obstruction, and whether there are abnormalities above and below the diaphragm.

　　3. Endoscopy:For unclear etiology of hiccups, endoscopy is indispensable. Compared with barium meal examination, endoscopic examination has higher diagnostic value for the disease.

　　4. Abdominal B-ultrasound examination:For those suspected to have hiccups caused by gallstones, cholecystitis, liver abscess, liver cancer, and other liver and gallbladder lesions, B-ultrasound examination should be the first choice. B-ultrasound can provide important information or diagnostic evidence for these lesions.

　　5. CT or MRI examination:If it is considered that hiccups are caused by central nervous system lesions, then it is necessary to perform intracranial CT or MRI examination in a timely manner to determine the location or nature of the lesion. If chest or abdominal lesions cannot be diagnosed clearly by other examinations, CT or MRI examination can also be performed to further assist in diagnosis.

　　Diet should include easily digestible foods such as congee. Vegetables can include fresh vegetables like radish. Fruits can include oranges, hawthorn, etc. Avoid cold, sticky, and hard foods. Try to eat foods made with leavening (alkaline foods) and do not overeat. After each meal, it is recommended to chew 2 tablets of stomachic and digestive tablets. Avoid alcohol and very spicy chili. Otherwise, pay attention to the amount of (high-fat, high-salt, high-sugar, pure wheat, fish) that is not forbidden to eat! Eating less helps the self-repair of organs such as the stomach, intestines, and esophagus.

　　Precautions before the treatment of hiccups:

　　One, Cold nature

　　1. {Etiology} Unregulated diet, overeating of cold and raw foods.

　　2. {Pathogenesis} The spleen and stomach belong to the Earth element, located in the central region, responsible for receiving and transforming food and essence. If the Yang of the spleen and stomach is deficient, cold qi invades the stomach, leading to dysfunction of receiving and transforming, with the Qi reversing from below to above, escaping through the mouth as belching.

　　3. {Symptoms} Vomiting and diarrhea, epigastric and abdominal pain, aversion to cold but not thirst, retained food not digesting, frequent belching, liking to saliva, pale tongue with white coating, deep and slow pulse.

　　4. {Key Diagnosis} Vomiting and epigastric pain, aversion to cold but not thirst, belching of retained food, deep and slow pulse.

　　5. {Treatment Principle} Warm the stomach and dispel cold.

　　6. {Prescription} Liren Decoction, Jiangzao Pill.

　　Two, heat nature

　　1. {Etiology} Unregulated diet, excessive intake of spicy and hot foods.

　　2. {Pathogenesis} Excessive drinking leads to dampness in the spleen, excessive intake of spicy, hot, greasy foods produces phlegm, phlegm fire stays in the stomach, phlegm rises and falls with fire, fire leads phlegm to spread horizontally, causing the Yin and Yang of the spleen and stomach to lose balance in ascending and descending, leading to belching.

　　3. {Symptoms} Red face and heat, chest and diaphragm fullness, dry mouth and chapped lips, thirst without desire for drink, coughing up hot phlegm, frequent belching hot and smelly, yellow greasy tongue coating, slippery and rapid pulse.

　　4. {Diagnosis Key Points} Red face and heat, thirst without desire for drink, belching hot and smelly, slippery and rapid pulse.

　　5. {Treatment Principle} Clear the Qi and resolve phlegm.

　　6. {Prescription} Qingqi Huatan Pill, belching formula.

　　{Etiology} Unregulated diet

　　Three, deficiency

　　1. {Pathogenesis} Weakness of the spleen and stomach, loss of function, leading to phlegm turbidity obstruction inside, stomach Qi rising, so the belching does not stop.

　　2. {Symptoms} Pale and thin, hard and stuffy in the heart, undigested food, frequent belching, constipation. Thick and greasy tongue coating, wiry and hollow pulse.

　　3. {Diagnosis Key Points} Pale and thin, irregular diet, frequent belching, wiry and hollow pulse.

　　4. {Treatment Principle} Tonify the middle and reduce the reverse.

　　5. {Prescription} Xuanfu Dazao Decoction. {Xuanfu flower three qian, Dazhaishi three qian, Ren Shen two qian, Banxia three qian, Gancao one qian, Shengjiang one qian, Dazao four pieces.}

　　Four, real nature

　　1. {Etiology} Unregulated diet.

　　2. {Pathogenesis} Injury to diet, damage to the spleen and stomach, retained food not digested, food accumulation and obstruction, blocking the flow of Qi, stomach Qi rising, leading to belching.

　　3. {Symptoms} Chest and epigastric fullness, abdominal distension and pain, retained food, belching, acid regurgitation, vomiting and diarrhea, aversion to food, yellow greasy tongue coating, wiry and slippery pulse.

　　4. {Diagnosis Key Points} Abdominal distension and pain, belching, acid regurgitation, vomiting and diarrhea, aversion to food, pulse wiry and slippery.

　　5. {Treatment Principle} Harmonize the stomach and digest food.

　　6. {Prescription} Baohe Pill.

　　5.备用良方

　　3. Experience method: Treats hiccups that do not stop. Sichuan pepper four liang fried and ground, made into pills with flour paste, as big as Wuzi, take ten pills each time, take with vinegar decoction for better effect.

　　4. This method: Treats febrile dysentery and hiccups.枳壳 half a liang, Muxiang one qian, made into powder, take one qian with white decoction, if not effective, take it again.