- Email: [email protected]
Acupuncture combined with cupping therapy for 30 cases of intractable hiccup
Accepted Manuscript
Acupuncture combined with cupping therapy for 30 cases of intractable hiccup Gou Juan-ping PII: DOI: Reference:
S1003-5257(18)30049-7 10.1016/j.wjam.2018.03.017 WJAM 17
To appear in:
The End-to-end Journal
Please cite this article as: Gou Juan-ping , Acupuncture combined with cupping therapy for 30 cases of intractable hiccup, The End-to-end Journal (2018), doi: 10.1016/j.wjam.2018.03.017
This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
Clinical Report Acupuncture combined with cupping therapy for 30 cases of intractable hiccup
针罐结合治疗顽固性呃逆 30 例
ARTICLE INFO
CR IP T
GOU Juan-ping (苟娟平) Shaanxi University of Chinese Medicine, School of Basic Medical Sciences, Xianyang 712046, China (陕西中医药大学基础医学院, 咸阳 712046，中国)
Author: GOU Juan-ping. Research field: mechanism and clinical study on acupuncture treatment for encephalopathy. E-mail: [email protected]
AN US
Accepted on November 7, 2017.
ABSTRACT Objective To observe the clinical efficacy of acupuncture combined with cupping therapy for intractable hiccup. Methods Thirty patients with intractable hiccup were treated by adopting acupuncture combined with cupping therapy.
M
Acupuncture was performed at Cuánzhú ( 攒竹 BL 2), Nèiguān (内关 PC 6), Zhōngwăn (中脘 CV 12) and Zúsānlĭ (足三里 ST 36), with the time of needle
ED
retention for 30 min. Flash cupping was carried out on Fèishū (肺俞 BL 13), Géshū ( 膈俞 BL 17) and Wèishū (胃俞 BL 21), with the time of cup retention for 8-10 min. The treatment was conducted once a day, and 10 treatments were considered as one
PT
course of treatment. Clinical efficacy was observed after one course treatment. Results Among the 30 patients, 22 cases were cured, accounting for 73.33% (22/30),
CE
effective relief was found in 5 cases, accounting for 16.67% (5/30), and 3 cases had no improvement, accounting for 10.00% (3/30). The total effective rate was 90.00%
AC
(27/30). Conclusion The clinical efficacy of acupuncture combined with cupping therapy for intractable hiccup is satisfactory, which is worthy of clinical promotion and application. KEY WORDS: intractable hiccup；acupuncture combined with cupping therapy Hiccup refers to a kind of disease with belch which is continuous, short and frequent due to upward rushing of qi counter flow. Hiccup attacks continuously or intermittently which cannot be controlled by patients. In western medicine, hiccup is
ACCEPTED MANUSCRIPT
called diaphragmatic spasm. It belongs to diaphragm dysfunction, and is an abnormal voice caused by the sudden close of the glottis when inhaling. The abnormal contraction of diaphragm is because that various factors stimulate vagus nerve and phrenic nerve. Hiccup can attack by chance alone, and also can attack concomitantly with other diseases. The temporary hiccup caused by fast eating or full diet or invasion of cold can be self-cured. Temporary hiccup is generally not regarded as a pathological condition, and no special treatment is needed. If hiccup persists for more
CR IP T
than 48 h and there is no response to conventional treatment, the hiccup can be called persistent or intractable hiccup[1]. Long-term hiccup will not only seriously affect the patient's normal life, sleep and diet, and significantly decrease the patient's quality of life, but also affect the treatment and recovery of primary disease. More seriously, it can affect the patient's normal respiratory function, aggravating the patient's
AN US
condition, even leading to death[2]. In recent years, there have been many clinical reports about the treatment of hiccup through acupuncture-moxibustion therapy. Different acupuncture-moxibustion therapies adopted by different doctors have alleviated patients' pain to a certain extent. The author adopted acupuncture combined with cupping therapy to treat intractable hiccups, and the details are reported as
M
follows. CLINICAL DATA
ED
The 30 cases with intractable hiccup were from the inpatients and outpatients in acupuncture-moxibustion department, encephalopathy department and spleen and stomach diseases department of the Affiliated Hospital of Shaanxi University of
PT
Chinese Medicine from January 2015 to January 2016, were treated. They all conformed to the diagnostic criteria of intractable hiccup in western medicine
CE
formulated in Practical Technical Manual for Clinical Diagnosis and Treatment of Digestive Diseases[3]: hiccup lasts for more than 48 h with high or low hiccup sound, which can relapse after interrupt for 30-60 min; for severe hiccup, hiccup sound is
AC
frequent around the clock. Among these included patients, there were 23 females and 7 males. The youngest patient was 18 years old, and the oldest was 68 years old, with the mean age of (44.55±16.43) years old; the shortest course of the disease was 3 days, and the longest was 30 days, with the average course of (10.39±9.98) days. Predisposing factors: emotional factors (5 cases), hiccup caused by cancer operation (7 cases), cerebrovascular diseases combined with hiccup (4 cases), diet factors (6 cases), drug factors (3 cases) and no obvious inducement (5 cases). TREATMENT METHODS
ACCEPTED MANUSCRIPT Acupoint selection: Cuánzhú (攒竹 BL 2, bilaterally), Nèiguān (内关 PC 6, bilaterally), Zhōngwăn (中脘 CV 12), Zúsānlĭ (足三里 ST 36, bilaterally), Fèishū (肺 俞 BL 13, bilaterally), Géshū (膈俞 BL 17, bilaterally) and Wèishū (胃俞 BL 21, bilaterally). Manipulations: the patients were asked in supine position. After conventional disinfection on the acupoints, 0.30 mm×50 mm disposable acupuncture needles were selected for acupuncture. Oblique insertion was carried out at BL 2 with a depth of 13 mm, at the time of feeling sore and numb at the needling site, the
CR IP T
patients were asked to deeply inhale and suffocate for 10-20 s. In the process of inspiration, twirling needle was conducted in order for strong stimulation, the manipulations were interrupted when the patients were expiring. The needles were retained after the manipulations were repeated for 3 times. Perpendicular insertion was carried out at PC 6 with a depth of 25-40 mm to the extent of sensation of
AN US
electrical numb. Perpendicular insertion was also carried out at CV 12 and ST 36 with a depth of 25 mm, and even reinforcing and reducing manipulation was performed. The needles were retained for 30 min. After the acupuncture, the patients were advised in prone position, and medium-sized fire pots were used to perform flash cupping on BL 13, BL 17 and BL 21 to the extent of local skin flush, then the pots
M
retained on the acupoints. The pots were removed after 8-10 min. The treatment was conducted once a day, and treatment for 10 times was considered as one course of
ED
treatment. Clinical efficacy was observed after one course treatment. TREATMENT RESULTS
The therapeutic effect criterion was formulated by the reference of Diagnostic
PT
Basis for Clinical Disease and Standard for Cure and Improvement[4]. Cured: 22 patients' hiccup was controlled after treatment, and concomitant symptoms were
CE
disappeared, accounting for 73.33% Effective: 5 patients' hiccup was relieved or the time of duration of hiccup shortened or the interval time prolonged, accounting for 16.67%. Ineffective: 3 patients' time of duration of hiccup and episodes were not
AC
improved, accounting for 10.00%. The total effective rate was 90.00%. DISCUSSION In traditional Chinese medicine, it is believed that various factors can cause
inhibited qi movement and ascending counterflow of stomach qi, which will result in hiccup. The diaphragm is located between the lung and the stomach, and the qi of lung and stomach should be descending. When pathogenic factors invade the lung and stomach, the original harmonious qi of the lung and stomach will reverse and ascend, thus causing inhibited diaphragmatic qi movement that is hiccup. BL 2 is a specific
ACCEPTED MANUSCRIPT
acupoint for hiccup, acupuncture at which can inhibit the excitement of vagus nerve and phrenic nerve in the abdominal cavity, and smooth the diaphragm spasm, so as to eliminate the hiccups, harmonize the stomach and direct counterflow downward. PC 6 governs the stomach, heart and chest, which can loosen the chest and promote the function of diaphragm, and unblock three jiao. PC 6 is a key acupoint for directing counterflow downward. CV 12 is the front-mu point of foot-yangming stomach meridian, and the intersection of fu organs. The study [5] has shown that acupuncture at
CR IP T
CV 12 can enhance the gastrointestinal motility, release pylorospasm, and direct the qi counterflow downward, which is conducive to the treatment of intractable hiccup. According to the distribution of nerve segment, the afferent nerve of hiccup reflex arc includes
the
sympathetic
nerve
bundle
arising
from
the sixth
to
the
twelfth thoracic vertebrae. The afferent neurons of CV 12 locate in the seventh
AN US
thoracic vertebrae to the second lumber vertebrae. It can be concluded that the afferent nerve of hiccup reflex arc overlaps the afferent neurons of CV 12, therefore, acupuncture at CV 12 can regulate the hiccup reflex
[6]
. Another study [7] has shown
that the conduction path for hiccup is the gastrointestinal mucosa, so acupuncture at CV 12 may also release the hiccup symptom through adjusting the gastrointestinal
M
function. ST 36 is an important acupoint for treatment of gastrointestinal and abdominal diseases. BL 13, BL 17 and BL 21 are back-shu points. The diaphragm is
ED
located between the lung and the stomach. The failure of lung qi to purify and descend may cause inhibited diaphragmatic qi movement, therefore, direct stimulation on the back-shu points of lung and stomach can regulate the disorganized qi
PT
movement, achieving the purpose of directing counterflow downward and relieving hiccup. BL 17 is the blood intersection of eight influential points. Because septum
CE
transversum is in this acupoint, the name of BL 17 is given. The focus of hiccup is in the diaphragm, so the stimulation on BL 17 can directly act on the septum transversum, thus achieving the effect of directing counterflow downward and
AC
relieving hiccup.
Intractable hiccup, different from the transient hiccup, has a longer disease duration
and cannot recover by itself. If intractable hiccup is not treated in time, it can lead to inhibited movement of qi. Persistent illness affects collaterals, thus forming the syndrome of qi stagnation and blood stasis [8]. Therefore, the key points for treatment of hiccup should include regulating qi movement and promoting blood circulation in addition to directing counterflow downward and relieving hiccup, in order to achieve the effect that blood flow promotes qi flow. Both acupuncture and cupping therapy can
ACCEPTED MANUSCRIPT
dredge the meridians and collaterals, adjust qi movement, so as to achieve the balance of yin and yang. The combination use of the two methods can not only enhance the positive stimulation effect of acupuncture on acupoints and meridians, but also eliminate the blood stasis by virtue of the functions of fire cupping in terms of promoting blood flow and dissolving stasis, dispelling dampness and removing cold, so as to regulate qi movement and treat hiccup. To sum up, the combination use of several acupoints can dredge the meridians and
CR IP T
collaterals, regulate the qi movement in zang-fu organs, harmonize and descend the qi of lung and stomach, and relieve the etiology of hiccup fundamentally, thus curing hiccup. REFERENCES
[1] Li ZZ, Lang SY. Hiccup and cerebrovascular disease. Foreign Med Sci:
AN US
Cerebrovasc Dis (Chin) 2004; 12 (3): 198-200.
[2] Amirjamshidi A ； Hiccup and neurosurgeons ： a report of 4 rare dorsal medullarycompressive pathologies and review of the literature. Surg Neuro1 2007； 67(4)：395-402.
[3] Chen HB. Practical technical manual for clinical diagnosis and treatment of
M
digestive diseases. Beijing: Beijing USTB Electronic Publishing House; 2004: 37-41. [4] Sun CX. Diagnostic basis for clinical disease and standard for cure and improvement. Beijing: People's Military Medical Press; 2002: 220-224.
ED
[5] Wang H, Shen GM, Wang KM. Effect of electro-acupuncture at Zhōngwăn (中脘 CV 12) and Wèishū (胃俞 BL 21) on the gastric motility of rats and the levels of
PT
serum motilin and gastrin. J Anhui Tradit Chin Med Coll (Chin) 2011; 30 (4): 37-39. [6] Zhan WX, Liu CB, Li H. Ancient and modern application and research of
CE
Zhōngwăn (中脘 CV 12). Acup Res 2006; 31 (5): 311-313. [7]Becker DE. Nausea, vomiting and hiccups: a review of mechanismsand treatment.Anesth Prog 2010；57 (4)：150-157.
AC
[8] Zhao XJ. Clinical observation of acupuncture combined with cupping therapy for treatment of 35 cases of intractable hiccup. J Sichuan Tradit Chin Med (Chin) 2012; 11 (30): 130-131.
Acupuncture combined with cupping therapy for 30 cases of intractable hiccup Gou Juan-ping PII: DOI: Reference:
S1003-5257(18)30049-7 10.1016/j.wjam.2018.03.017 WJAM 17
To appear in:
The End-to-end Journal
Please cite this article as: Gou Juan-ping , Acupuncture combined with cupping therapy for 30 cases of intractable hiccup, The End-to-end Journal (2018), doi: 10.1016/j.wjam.2018.03.017
This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
Clinical Report Acupuncture combined with cupping therapy for 30 cases of intractable hiccup
针罐结合治疗顽固性呃逆 30 例
ARTICLE INFO
CR IP T
GOU Juan-ping (苟娟平) Shaanxi University of Chinese Medicine, School of Basic Medical Sciences, Xianyang 712046, China (陕西中医药大学基础医学院, 咸阳 712046，中国)
Author: GOU Juan-ping. Research field: mechanism and clinical study on acupuncture treatment for encephalopathy. E-mail: [email protected]
AN US
Accepted on November 7, 2017.
ABSTRACT Objective To observe the clinical efficacy of acupuncture combined with cupping therapy for intractable hiccup. Methods Thirty patients with intractable hiccup were treated by adopting acupuncture combined with cupping therapy.
M
Acupuncture was performed at Cuánzhú ( 攒竹 BL 2), Nèiguān (内关 PC 6), Zhōngwăn (中脘 CV 12) and Zúsānlĭ (足三里 ST 36), with the time of needle
ED
retention for 30 min. Flash cupping was carried out on Fèishū (肺俞 BL 13), Géshū ( 膈俞 BL 17) and Wèishū (胃俞 BL 21), with the time of cup retention for 8-10 min. The treatment was conducted once a day, and 10 treatments were considered as one
PT
course of treatment. Clinical efficacy was observed after one course treatment. Results Among the 30 patients, 22 cases were cured, accounting for 73.33% (22/30),
CE
effective relief was found in 5 cases, accounting for 16.67% (5/30), and 3 cases had no improvement, accounting for 10.00% (3/30). The total effective rate was 90.00%
AC
(27/30). Conclusion The clinical efficacy of acupuncture combined with cupping therapy for intractable hiccup is satisfactory, which is worthy of clinical promotion and application. KEY WORDS: intractable hiccup；acupuncture combined with cupping therapy Hiccup refers to a kind of disease with belch which is continuous, short and frequent due to upward rushing of qi counter flow. Hiccup attacks continuously or intermittently which cannot be controlled by patients. In western medicine, hiccup is
ACCEPTED MANUSCRIPT
called diaphragmatic spasm. It belongs to diaphragm dysfunction, and is an abnormal voice caused by the sudden close of the glottis when inhaling. The abnormal contraction of diaphragm is because that various factors stimulate vagus nerve and phrenic nerve. Hiccup can attack by chance alone, and also can attack concomitantly with other diseases. The temporary hiccup caused by fast eating or full diet or invasion of cold can be self-cured. Temporary hiccup is generally not regarded as a pathological condition, and no special treatment is needed. If hiccup persists for more
CR IP T
than 48 h and there is no response to conventional treatment, the hiccup can be called persistent or intractable hiccup[1]. Long-term hiccup will not only seriously affect the patient's normal life, sleep and diet, and significantly decrease the patient's quality of life, but also affect the treatment and recovery of primary disease. More seriously, it can affect the patient's normal respiratory function, aggravating the patient's
AN US
condition, even leading to death[2]. In recent years, there have been many clinical reports about the treatment of hiccup through acupuncture-moxibustion therapy. Different acupuncture-moxibustion therapies adopted by different doctors have alleviated patients' pain to a certain extent. The author adopted acupuncture combined with cupping therapy to treat intractable hiccups, and the details are reported as
M
follows. CLINICAL DATA
ED
The 30 cases with intractable hiccup were from the inpatients and outpatients in acupuncture-moxibustion department, encephalopathy department and spleen and stomach diseases department of the Affiliated Hospital of Shaanxi University of
PT
Chinese Medicine from January 2015 to January 2016, were treated. They all conformed to the diagnostic criteria of intractable hiccup in western medicine
CE
formulated in Practical Technical Manual for Clinical Diagnosis and Treatment of Digestive Diseases[3]: hiccup lasts for more than 48 h with high or low hiccup sound, which can relapse after interrupt for 30-60 min; for severe hiccup, hiccup sound is
AC
frequent around the clock. Among these included patients, there were 23 females and 7 males. The youngest patient was 18 years old, and the oldest was 68 years old, with the mean age of (44.55±16.43) years old; the shortest course of the disease was 3 days, and the longest was 30 days, with the average course of (10.39±9.98) days. Predisposing factors: emotional factors (5 cases), hiccup caused by cancer operation (7 cases), cerebrovascular diseases combined with hiccup (4 cases), diet factors (6 cases), drug factors (3 cases) and no obvious inducement (5 cases). TREATMENT METHODS
ACCEPTED MANUSCRIPT Acupoint selection: Cuánzhú (攒竹 BL 2, bilaterally), Nèiguān (内关 PC 6, bilaterally), Zhōngwăn (中脘 CV 12), Zúsānlĭ (足三里 ST 36, bilaterally), Fèishū (肺 俞 BL 13, bilaterally), Géshū (膈俞 BL 17, bilaterally) and Wèishū (胃俞 BL 21, bilaterally). Manipulations: the patients were asked in supine position. After conventional disinfection on the acupoints, 0.30 mm×50 mm disposable acupuncture needles were selected for acupuncture. Oblique insertion was carried out at BL 2 with a depth of 13 mm, at the time of feeling sore and numb at the needling site, the
CR IP T
patients were asked to deeply inhale and suffocate for 10-20 s. In the process of inspiration, twirling needle was conducted in order for strong stimulation, the manipulations were interrupted when the patients were expiring. The needles were retained after the manipulations were repeated for 3 times. Perpendicular insertion was carried out at PC 6 with a depth of 25-40 mm to the extent of sensation of
AN US
electrical numb. Perpendicular insertion was also carried out at CV 12 and ST 36 with a depth of 25 mm, and even reinforcing and reducing manipulation was performed. The needles were retained for 30 min. After the acupuncture, the patients were advised in prone position, and medium-sized fire pots were used to perform flash cupping on BL 13, BL 17 and BL 21 to the extent of local skin flush, then the pots
M
retained on the acupoints. The pots were removed after 8-10 min. The treatment was conducted once a day, and treatment for 10 times was considered as one course of
ED
treatment. Clinical efficacy was observed after one course treatment. TREATMENT RESULTS
The therapeutic effect criterion was formulated by the reference of Diagnostic
PT
Basis for Clinical Disease and Standard for Cure and Improvement[4]. Cured: 22 patients' hiccup was controlled after treatment, and concomitant symptoms were
CE
disappeared, accounting for 73.33% Effective: 5 patients' hiccup was relieved or the time of duration of hiccup shortened or the interval time prolonged, accounting for 16.67%. Ineffective: 3 patients' time of duration of hiccup and episodes were not
AC
improved, accounting for 10.00%. The total effective rate was 90.00%. DISCUSSION In traditional Chinese medicine, it is believed that various factors can cause
inhibited qi movement and ascending counterflow of stomach qi, which will result in hiccup. The diaphragm is located between the lung and the stomach, and the qi of lung and stomach should be descending. When pathogenic factors invade the lung and stomach, the original harmonious qi of the lung and stomach will reverse and ascend, thus causing inhibited diaphragmatic qi movement that is hiccup. BL 2 is a specific
ACCEPTED MANUSCRIPT
acupoint for hiccup, acupuncture at which can inhibit the excitement of vagus nerve and phrenic nerve in the abdominal cavity, and smooth the diaphragm spasm, so as to eliminate the hiccups, harmonize the stomach and direct counterflow downward. PC 6 governs the stomach, heart and chest, which can loosen the chest and promote the function of diaphragm, and unblock three jiao. PC 6 is a key acupoint for directing counterflow downward. CV 12 is the front-mu point of foot-yangming stomach meridian, and the intersection of fu organs. The study [5] has shown that acupuncture at
CR IP T
CV 12 can enhance the gastrointestinal motility, release pylorospasm, and direct the qi counterflow downward, which is conducive to the treatment of intractable hiccup. According to the distribution of nerve segment, the afferent nerve of hiccup reflex arc includes
the
sympathetic
nerve
bundle
arising
from
the sixth
to
the
twelfth thoracic vertebrae. The afferent neurons of CV 12 locate in the seventh
AN US
thoracic vertebrae to the second lumber vertebrae. It can be concluded that the afferent nerve of hiccup reflex arc overlaps the afferent neurons of CV 12, therefore, acupuncture at CV 12 can regulate the hiccup reflex
[6]
. Another study [7] has shown
that the conduction path for hiccup is the gastrointestinal mucosa, so acupuncture at CV 12 may also release the hiccup symptom through adjusting the gastrointestinal
M
function. ST 36 is an important acupoint for treatment of gastrointestinal and abdominal diseases. BL 13, BL 17 and BL 21 are back-shu points. The diaphragm is
ED
located between the lung and the stomach. The failure of lung qi to purify and descend may cause inhibited diaphragmatic qi movement, therefore, direct stimulation on the back-shu points of lung and stomach can regulate the disorganized qi
PT
movement, achieving the purpose of directing counterflow downward and relieving hiccup. BL 17 is the blood intersection of eight influential points. Because septum
CE
transversum is in this acupoint, the name of BL 17 is given. The focus of hiccup is in the diaphragm, so the stimulation on BL 17 can directly act on the septum transversum, thus achieving the effect of directing counterflow downward and
AC
relieving hiccup.
Intractable hiccup, different from the transient hiccup, has a longer disease duration
and cannot recover by itself. If intractable hiccup is not treated in time, it can lead to inhibited movement of qi. Persistent illness affects collaterals, thus forming the syndrome of qi stagnation and blood stasis [8]. Therefore, the key points for treatment of hiccup should include regulating qi movement and promoting blood circulation in addition to directing counterflow downward and relieving hiccup, in order to achieve the effect that blood flow promotes qi flow. Both acupuncture and cupping therapy can
ACCEPTED MANUSCRIPT
dredge the meridians and collaterals, adjust qi movement, so as to achieve the balance of yin and yang. The combination use of the two methods can not only enhance the positive stimulation effect of acupuncture on acupoints and meridians, but also eliminate the blood stasis by virtue of the functions of fire cupping in terms of promoting blood flow and dissolving stasis, dispelling dampness and removing cold, so as to regulate qi movement and treat hiccup. To sum up, the combination use of several acupoints can dredge the meridians and
CR IP T
collaterals, regulate the qi movement in zang-fu organs, harmonize and descend the qi of lung and stomach, and relieve the etiology of hiccup fundamentally, thus curing hiccup. REFERENCES
[1] Li ZZ, Lang SY. Hiccup and cerebrovascular disease. Foreign Med Sci:
AN US
Cerebrovasc Dis (Chin) 2004; 12 (3): 198-200.
[2] Amirjamshidi A ； Hiccup and neurosurgeons ： a report of 4 rare dorsal medullarycompressive pathologies and review of the literature. Surg Neuro1 2007； 67(4)：395-402.
[3] Chen HB. Practical technical manual for clinical diagnosis and treatment of
M
digestive diseases. Beijing: Beijing USTB Electronic Publishing House; 2004: 37-41. [4] Sun CX. Diagnostic basis for clinical disease and standard for cure and improvement. Beijing: People's Military Medical Press; 2002: 220-224.
ED
[5] Wang H, Shen GM, Wang KM. Effect of electro-acupuncture at Zhōngwăn (中脘 CV 12) and Wèishū (胃俞 BL 21) on the gastric motility of rats and the levels of
PT
serum motilin and gastrin. J Anhui Tradit Chin Med Coll (Chin) 2011; 30 (4): 37-39. [6] Zhan WX, Liu CB, Li H. Ancient and modern application and research of
CE
Zhōngwăn (中脘 CV 12). Acup Res 2006; 31 (5): 311-313. [7]Becker DE. Nausea, vomiting and hiccups: a review of mechanismsand treatment.Anesth Prog 2010；57 (4)：150-157.
AC
[8] Zhao XJ. Clinical observation of acupuncture combined with cupping therapy for treatment of 35 cases of intractable hiccup. J Sichuan Tradit Chin Med (Chin) 2012; 11 (30): 130-131.