Disease and Condition Overview
Hiccups are characterized by involuntary contraction or spasm of the diaphragm followed by quick, noisy closings of the glottis. In Chinese medicine, hiccups are caused by the repressed and reversed flow of qi at any organs of the Sam jiao (upper. middle and lower jiao) and uprising of qi. For example, lung qi repression or deficiency in the upper jiao can cause hiccup; obstruction of stomach and qi and turbid qi rising in the middle jiao: and in the lower jiao, the repressed and obstructed liver qi can be trigged to rise upward by anger. In addition, the failure of kidney to receive qi becomes the deficiency that will later causes the ceasing and reversing of qi which results in hiccups as well.

Stomach qi uprising is the most common cause of hiccups. It is important to differentiate between other causes of hiccup such as gastrointestinal neurosis, gastritis, gastric distention, gastric caner, advanced cirrhosis, cerebrovascular disease, uremia, and post stomach or esophagus operation. It is important to differentiate between primary or secondary hiccups.

Pair-point Treatment Combinations

(1) Xuanji (RN21), Juque (RNI4) (Fig 36)
Xuanji (RN21), Juque (RN14) are both located on the Ren channel, between the ribs. This pair point combination, promotes and guides pectoral qi and calms heart harmonizes stomach. Appropriate for hiccups caused by disharmony of upper jiao qi.

Needling techniques:
1. In prone position, Xuanji (RN 21) point needle towards inferior direction, oblique insertion 1 cun.
2. Juque (RN14) perpendicular insertion 0.5 cun, manipulate 5-10 minutes.

(2) Zhongwan (RN 12), Fenglong (ST40) (Fig 76)
Zhongwan (RN 12) is the Front-mu point of the stomach channel. Fenglong (ST 40) is the luo-connecting point of foot-yangming channel. This pair point combination harmonizes stomach, resolves phlegm and reverses the rising. Appropriate for hiccups caused by blockage of dampness and phtegm, and inability to regulate the ascending and descending of stomach.

Needling techniques:
1. In prone position, Zhongwan (RN 12) perpendicular insertion 1 cun.
2. Fenglong (ST 36) perpendicular insertion 2 cun, manipulate 5-10minutes.

(3) Taibai (SP 3), Zusanli (ST 36) (Fig 95)
Taibai (SP3): on the medial aspect of the foot, in the depression proximal and inferior to the first metatarso-phalangeal joint, at the junction of the red and white skin.
Zusanli (ST 36): on the anteriolateral side of the lower leg, 3 cun inferior to Dubi (ST 35), one finger breadth (middle finger) lateral to the anterior crest of the tibia.
Taibai (SP 3) is the yuan-source point of the spleen. Zusanli (ST 36) is the lower he-sea point of the stomach. This pair point combination, one exterior, one interior, one elevates while the other lowers, regulate qi, reverses qi from rising upward and stops hiccups. Appropriate for treating hiccups caused by qi disorder of the middle jiao.

Needling techniques:
1. In supine position or upright position.
2. Taibai (SP3) perpendicular insertion 0.5 cun.
3. Zusanli (ST36) perpendicular insertion 2 cun.
4. Manipulate 5-10 minutes.

(4) Guanyuan (RN 4), Qihai (RN 6) (Fig 4)
Guanyuan (RN 4), Qihai (RN6) both points are located near the dantian in the lower jiao. This pair point combination nourishes and strengthens the congenital qi. Appropriate for treating hiccups caused by late stage of serious illness, with grave stomach qi deficiency.

Needling techniques:
Patient m prone position, apply heavy dose of moxa on Guanyuan (RN 4), Qihai (RN 6).

Commentaries
Acupuncture treatment primary hiccup has definite results.
For hiccups caused by qi irregularities, select Xuanji (RN 21), Juque (RN 14).
To treat qi obstructions in the upper jiao select Taibai (SP 3), Zusanli (ST 36)
Regulate qi in the middle jiao, such as ascending and descending of stomach qi, select Zhongwan (RN 12), Fenglong (ST 36).

As for lower jiao congenital qi and serious stomach qi deficiency, it is essential to apply heavy dose of moxibustion on the Guanyuan (RN 4), Qihai (RN 6) pair-point combination. However, acupuncture treatment of secondary hiccup result is uncertain.