Introduction
Obstinate hiccup refers to spasm of diaphragm resulting from the stimulation of the diaphragm due to various reasons. The clinical manifestations are constant and involuntary hiccup in the throat affecting talking, chewing, respiration and sleep. According to TCM, hiccup is usually caused by failure of gastric qi to descend, adverse flow of gastric qi over the diaphragm and disorder of qi due to improper diet, or stagnation of liver qi or weakness of spleen yang.

Syndrome differentiation
1. Dyspepsia
The symptoms are loud hiccup, distending pain in the chest and abdomen, belching, anorexia, thick and greasy tongue coating, slippery and sthenic pulse.

2. Qi stagnation syndrome
The symptoms are constant hiccup, distending pain in the chest and hypochondria, dysphoria, thin tongue coating, taut and powerful pulse.

3. Stomach-cold syndrome
The symptoms are slow and strong hiccup, alleviation with warmth, aggravation with cold, discomfort in the epigastrium, normal taste in the mouth, whitish and slippery tongue coating and slow pulse.

Treatment
1. Body acupuncture
Prescription: Geshu (BL 17), Neiguan (PC 6) and Zhongwan (CV 12).

Modification: For dyspepsia, Neiting (ST 44) and Zusanli (ST 36) are added; for qi stagnation, Danzhong (CV 17) and Taichong (LR 3) are added; for stomach-cold, Weishu (BL 21), Liangmen (ST 21) and Guanyuan (CV 4) are added.

Performance: The acupoints are needled with filiform needles and reducing technique. For the treatment of stomach-cold syndrome, warmed-needle moxibustion or moxibustion with moxa-roll is used.

2. Ear acupuncture
Prescription: Internal Ear (HX1), Sympathetic Nerve (AH6a), Stomach (CO4), Liver (CO12) and Spleen (CO13).

Performance: The acupoints are needled with strong stimulation and the needles are retained for 30 minutes. Or embedment of needles is used and the ears are embedded alternatively once, 3 - 4 days.