Hiccups — Meaning, Causes and TCM Treatment of Hiccoughing

By Dr (TCM) Attilio D'Alberto | Traditional Chinese Medicine Practitioner, Wokingham, Berkshire

Hiccups (also spelt hiccoughs) are involuntary contractions of the diaphragm followed by sudden closure of the vocal cords, producing the characteristic “hic” sound. Most episodes settle within minutes. Hiccups lasting more than 48 hours are classed as persistent, and those lasting more than a month as intractable — both warrant medical investigation. From a Chinese medicine perspective, hiccups are rebellious Stomach Qi rising abnormally upward, and acupuncture, acupressure on PC 6 (Neiguan) and Chinese herbal formulas such as Ju Pi Zhu Ru Tang are highly effective at restoring the Stomach’s downward function.

On this page

1. What hiccoughing means
2. Causes of hiccups
3. Can hiccups be caused by stress?
4. Constant hiccups: when to worry
5. Hiccups in Chinese medicine
6. Pressure points for hiccups
7. Acupuncture for persistent hiccups
8. Chinese herbal medicine for hiccups
9. Home remedies that work
10. Frequently asked questions

1. What hiccoughing means

The medical term for hiccups is singultus, from the Latin meaning “to catch one’s breath while sobbing’. A hiccup begins with a sudden involuntary contraction of the diaphragm, which causes a quick intake of breath. This is immediately followed by the snapping shut of the glottis (the vocal cords), which produces the characteristic “hic”. The whole cycle is driven by an arc of nerves: the phrenic nerve (which controls the diaphragm), the vagus nerve, and a central pattern generator in the brainstem. Anything that irritates this reflex arc anywhere along its path can trigger hiccups.

Hiccoughs or hiccups? Both spellings are correct. “Hiccup” is the more common modern spelling; “hiccough” is the older form, dating from the seventeenth century when the sound was wrongly thought to be related to coughing. They refer to exactly the same phenomenon.

2. Causes of hiccups

The most common triggers of brief hiccups are:

• Eating too quickly — large boluses of food stretch the stomach and irritate the phrenic nerve
• Eating too much — gastric distension is the single most common cause
• Carbonated drinks — gas distension of the stomach
• Hot or spicy food — irritates the oesophagus and stomach lining
• Sudden change of temperature in food or drink — particularly hot drinks straight after cold food
• Alcohol — especially carbonated alcoholic drinks and strong spirits
• Smoking — swallowing air while smoking
• Sudden excitement, laughter or strong emotion — vagal stimulation
• Stress and anxiety — see below

Persistent and intractable hiccups have more serious causes and require medical investigation. These include gastro-oesophageal reflux disease (GORD), hiatus hernia, peptic ulcer, oesophagitis, central nervous system causes (stroke, multiple sclerosis, brain tumour), electrolyte disturbances, kidney failure, certain medications (corticosteroids, benzodiazepines, opioids), and post-surgical irritation of the phrenic nerve.

3. Can hiccups be caused by stress?

Yes. Stress is one of the most under-recognised triggers of hiccups, particularly recurrent or stress-cluster hiccups. The mechanism is partly direct (sympathetic nervous-system arousal stimulates the vagus nerve, which connects to the diaphragmatic reflex arc) and partly indirect (stress causes air-swallowing or aerophagia, which distends the stomach and triggers the reflex). In my clinic I commonly see patients whose hiccups come in clusters at high-stress periods — exams, work deadlines, bereavement. From a Chinese medicine perspective, this is the classical pattern of Liver Qi invading the Stomach, where emotional constraint disrupts the smooth descent of Stomach Qi and forces it to rebel upward as hiccups.

4. Constant hiccups: when to worry

Brief hiccup episodes settle on their own and rarely need investigation. Seek medical advice if hiccups:

• Last more than 48 hours (persistent hiccups)
• Last more than a month (intractable hiccups)
• Are accompanied by abdominal pain, swallowing difficulty, weight loss, vomiting blood or black stools
• Follow recent abdominal or chest surgery
• Occur in someone with kidney disease, advanced cancer, or new neurological symptoms
• Significantly disrupt sleep, eating or daily life

Persistent hiccups can cause serious secondary problems including weight loss, sleep deprivation, exhaustion, depression and oesophageal damage. They are not just an inconvenience and deserve thorough evaluation.

5. Hiccups in Chinese medicine

In traditional Chinese medicine, the Stomach’s function is to receive food and descend it downward toward the Small Intestine. When this descending function is disrupted, Stomach Qi rebels upward, producing belching, nausea, vomiting or hiccups (called e ni in Chinese, meaning “rebellious counterflow”). The classical patterns are:

1. Cold attacking the Stomach — hiccups triggered by cold food, drink or weather, with clear watery vomit, cold abdominal pain and preference for warmth. The dominant pattern in winter and in cold-constitution patients.
2. Stomach Heat rising — loud, forceful hiccups with foul breath, thirst, dry mouth and a red tongue with yellow coating. Common after spicy meals, heavy alcohol or in feverish illness.
3. Stomach Qi deficiency with mild Heat — weak, repeated hiccups in someone who is tired, recovering from illness, post-partum or elderly. The Stomach Qi is too weak to descend properly. The classical formula is Ju Pi Zhu Ru Tang.
4. Liver Qi invading the Stomach — the stress-driven pattern. Hiccups triggered or worsened by emotional upset, with chest tightness, sighing and irritability.
5. Phlegm-Fluid in the Middle Jiao — hiccups with vomiting of clear watery fluid, splashing sounds in the epigastrium, dizziness and palpitations. The classical formula is Xiao Ban Xia Jia Fu Ling Tang.

6. Pressure points for hiccups

Three acupressure points reliably stop most hiccup episodes when pressed firmly for 1–2 minutes:

1. PC 6 (Neiguan, “Inner Pass”) — the single most-used point for descending rebellious Stomach Qi. Located three finger-widths above the inner wrist crease, between the two central tendons. Apply firm thumb pressure for 1–2 minutes on each wrist. This is the same point used in motion-sickness wristbands.
2. CV 12 (Zhongwan, “Middle Cavity”) — on the midline of the upper abdomen, halfway between the lower end of the breastbone and the navel. Apply firm but gentle pressure with two or three fingertips for 1–2 minutes.
3. Tian Tu (CV 22, “Heavenly Chimney”) — in the hollow at the base of the throat, just above the sternum. Apply very gentle pressure directing downward (do NOT press into the throat) for 30 seconds at a time. Particularly useful for hiccups arising from emotional shock or laughter.

Combining PC 6 pressure with slow exhalation-emphasised breathing (4 seconds in, 8 seconds out) for two minutes settles most acute hiccup episodes.

7. Acupuncture for persistent hiccups

Acupuncture has a long-established place in the treatment of persistent hiccups and is recognised in Chinese hospital medicine as the first-line non-pharmacological treatment for refractory cases. Multiple clinical trials have reported response rates of 70–90% in persistent hiccups, including post-surgical hiccups, hiccups associated with stroke, and hiccups in advanced cancer patients receiving chemotherapy. The most-used points are:

• PC 6 (Neiguan) — the principal point
• CV 12 (Zhongwan) — harmonises the Middle Jiao
• ST 36 (Zusanli) — tonifies Stomach Qi and helps it descend
• CV 22 (Tian Tu) — descends rebellious Qi at the throat
• BL 17 (Geshu) — for diaphragmatic spasm
• LV 3 (Taichong) — for the Liver-Qi-invading-Stomach pattern

Most persistent-hiccups patients see complete cessation within 1–3 sessions. Patients with stroke-related or post-surgical hiccups may need 5–10 sessions.

8. Chinese herbal medicine for hiccups

Formulas are matched to the underlying pattern:

• Stomach Qi deficiency with mild Heat — Ju Pi Zhu Ru Tang (Tangerine Peel and Bamboo Shaving Decoction) is the classical formula from the Jin Gui Yao Lue for post-illness, post-partum or post-surgical hiccups
• Phlegm-Fluid with rebellious Qi — Xiao Ban Xia Jia Fu Ling Tang (Minor Pinellia and Poria Decoction)
• Stomach Cold — Ding Xiang Shi Di Tang (Clove and Persimmon Calyx Decoction), with Ding Xiang (clove) the principal herb
• Stomach Heat — modified Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction)
• Liver Qi invading the Stomach — modified Xiao Yao San or Chai Hu Shu Gan San

9. Home remedies that work

For brief acute hiccups, these have varying degrees of evidence and clinical effectiveness:

1. Hold your breath and swallow 3 times — raises CO2 levels, which suppresses the hiccup reflex
2. Slow, deep diaphragmatic breathing — emphasising slow exhalation
3. Swallow a teaspoon of granulated sugar — the granular irritation on the back of the throat stimulates the vagus nerve and resets the reflex
4. Drink a glass of cold water steadily without breathing — same vagal-reset mechanism
5. Press firmly on PC 6 (Neiguan) — see pressure points section above
6. Bear down (Valsalva manoeuvre) — close mouth and nose and try to exhale forcefully; raises intra-thoracic pressure and stimulates the vagus
7. Cold pressure on the back of the neck — brief cold stimulus to the dorsal vagal complex
8. Lemon wedge with bitters — a slice of lemon soaked in angostura bitters has a small evidence base

If hiccups continue beyond 24 hours despite these measures, seek acupuncture treatment promptly. The longer they go on, the harder they become to resolve.

10. Frequently asked questions

What does it mean when you have hiccups?

Hiccups are an involuntary contraction of the diaphragm followed by closure of the vocal cords. In TCM terms, they signal rebellious Stomach Qi rising upward when it should be descending. Most are harmless and triggered by eating too quickly, large meals, carbonated drinks or strong emotion. Hiccups lasting over 48 hours need medical assessment.

Are hiccups and hiccoughs the same?

Yes. Hiccoughs is the older spelling (since the seventeenth century); hiccups is the modern spelling. They refer to the same condition.

Can stress cause hiccups?

Yes — stress is a well-recognised trigger of recurrent hiccups, both directly (through vagal stimulation) and indirectly (through air-swallowing). In Chinese medicine this is the Liver-Qi-invading-Stomach pattern.

What is the best pressure point for hiccups?

PC 6 (Neiguan), located three finger-widths above the inner wrist crease between the two central tendons. Apply firm thumb pressure for 1–2 minutes on each wrist. It is the single most reliable point for descending rebellious Stomach Qi.

How do I get rid of persistent hiccups?

Hiccups lasting over 48 hours need investigation. Acupuncture has strong clinical evidence for persistent hiccups, with response rates of 70–90%. Chinese herbal formulas such as Ju Pi Zhu Ru Tang for post-illness hiccups, or Xiao Ban Xia Jia Fu Ling Tang for hiccups with vomiting clear fluid, address the underlying pattern.

Can acupuncture stop hiccups during chemotherapy?

Yes. Chemotherapy-induced hiccups (particularly with dexamethasone or platinum-based agents) often respond well to acupuncture at PC 6 and ST 36. Multiple oncology centres in China incorporate this into routine cancer supportive care.

To discuss persistent hiccups or any of the conditions on this page, contact me or book a consultation at my Wokingham, Berkshire clinic.

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