'Poyu Dan' for Persistent Belching and Hiccups
The Ming-dynasty Wanbing Huichun (Restoring Health to Myriad Diseases) by Gong Tingxian records a formula called Poyu Dan (Stasis-Breaking Pill). Its composition is: Xiangfumi (Cyperus Rhizome, vinegar-processed) 4 liang (120 g), Zhiren (stir-fried Gardenia Seed) 4 liang (120 g), Huanglian (Coptis, processed with ginger juice) 2 liang (60 g), Zhishi (Immature Bitter Orange, bran-stir-fried) 2 liang (60 g), Binglang (Areca) 1 liang (30 g), Ezhu (Zedoaria) 1 liang (30 g), Qingpi (Tangerine Peel, pith removed) 1 liang (30 g), Gualouren (Trichosanthes Seed) 1 liang (30 g), Suzi (Perilla Seed) 1 liang (30 g).
Preparation: grind all the above into a fine powder, form pills with water into the size of wutong seeds. Take 1 liang (30 g) per dose—one may start at 10 g; if effective, do not increase; if ineffective, gradually raise the dose—twice daily, taken with warm water after meals. This formula moves qi and clears fire, resolves phlegm and dissipates stasis. It is indicated for qi constraint transforming into fire, with phlegm-stasis obstructing the interior, presenting belching, chest tightness, and continuous belching of over ten sounds without relief; after belching, the chest feels momentarily easier, but without belching it feels tight again.
Transient belching is experienced by nearly everyone and is no cause for concern, but the belching treated by this formula is not transient—it is long-standing and frequent. Such chronic, frequent belching may arise from many causes: reflux esophagitis, chronic gastritis, peptic ulcer, gastrointestinal tumors, mediastinal lesions (such as mediastinal emphysema), mental tension, functional dyspepsia, aerophagia, and nonspecific excessive belching.
Traditional Chinese medicine holds that such chronic, frequent belching is due to qi constrained in the chest and diaphragm; prolonged constraint transforms fire, and phlegm and stasis bind together. Treatment should therefore combine moving qi, resolving stasis, freeing constraint, and clearing heat—exactly the design of this formula. Xiangfu, Zhishi, Binglang, Ezhu, Qingpi, and Suzi are all qi-moving herbs; among them, Xiangfu also frees constraint, while Ezhu and Qingpi additionally activate blood and resolve stasis. Zhiren and Huanglian clear heat; Gualouren disperses phlegm and nodules and widens the chest to free constraint. Combined, these herbs match the pattern and relieve belching.
In clinical practice, belching is most often caused by or evolves from gastritis or reflux esophagitis. The Huanglian in this formula treats gastroenteritis well, and the other herbs also relieve gastric distension and belching due to digestive tract diseases; thus the combination does indeed provide some relief. In addition, the formula also helps belching due to mental causes.
This formula may also be decocted. An adult dose is: Xiangfu (Cyperus) 12 g, Zhizi 12 g, Huanglian 6 g, Zhishi 6 g, Binglang 3 g, Ezhu 3 g, Qingpi 3 g, Gualouren 3 g, Suzi 3 g. Reduce appropriately for children. If the patient has heartburn and acid regurgitation, add Wuzeigu (cuttlebone) 12 g and Baiji (Bletilla) 6 g. If belching is accompanied by loud hiccups, add Daizheshi (Hematitum) 12 g and Xuanfuhua (Inula) 6 g as appropriate. For stomach cold, add Bibo (Long Pepper) 12 g and Gaoliangjiang (Lesser Galangal) 12 g as appropriate.