Retroflexion is an involuntary intermittent contraction of the diaphragm, which produces a special sound due to the sudden inhalation of air into the respiratory tract and the sudden closure of the vocal cords during inspiration. The pathogenesis is not well understood, but it is mainly due to some kind of stimulation that causes overexcitation of the phrenic nerve and spasm of the diaphragm. Acute hiccups are constant, short and loud, and can disappear on their own. Chronic erratic eruptions that persist for hours, weeks or longer are difficult to be cured. Frequent attacks of erratic reflux or lasting for more than 24 hours are called refractory erratic reflux, also known as intractable erratic reflux, which mostly occurs in patients with organic diseases, often affecting eating, speaking, normal breathing and sleeping, coupled with the heavy mental and physical burden, bringing great pain to patients and aggravating certain primary diseases, such as hepatic sclerosis inducing upper gastrointestinal hemorrhage, heart failure patients aggravating heart failure, myocardial infarction Patients with myocardial infarction can expand the scope of the infarction, and even lead to the death of the patient. Therefore, it is important to try to stop the eruption as soon as possible, and this article gives a brief description of the treatment methods. General therapy Inhalation followed by breath-holding method The patient can inhale deeply and then hold the breath quickly and forcefully, and then exhale slowly. This method can be used repeatedly and is mostly used for those who are triggered by mental stimulation and rapid eating. Pressing the eyeballs The patient closes the eyes, and the operator places both thumbs on the patient’s bilateral eyeballs and moderately rubs the upper part of the eyeballs in a clockwise direction until the eructation stops. This method is mostly used for patients undergoing upper abdominal surgery, but is contraindicated for patients with glaucoma and high myopia, and should be used with caution for patients with heart disease. Supraorbital nerve compression The patient is placed in a lying or sitting position, and the operator uses both thumbs to press the patient’s bilateral supraorbital, equivalent to the supraorbital nerve, as much as tolerated, rotating both thumbs alternately for 2 to 4 minutes and asking the patient to hold his breath rhythmically. Carotid sinus compression therapy The method is to ask the patient to gently rub the unilateral carotid sinus (located at the pulsation of both sides of the trachea) with the finger belly. This method strictly prohibits simultaneous compression bilaterally to prevent accidents due to cerebral ischemia. (Swallowing) smoke inhalation method Take an oblong end open cardboard tube (you can make your own, the caliber of the tube to just cover the lips of the mouth), ignite with fire and put the shredded paper into the cardboard tube, and then make it extinguish, smoke immediately after the open end of the tube pressed tightly around the patient’s mouth and lips, leaving the nostrils, and ask the patient to open his mouth to swallow the smoke (do not use suction method), swallowing time 1 to 2 minutes can be. Tongue pulling method Take the patient supine or semi-recumbent position, open the mouth, stretch the tongue, the operator with sterile gauze wrapped around the front 1/3 to 1/2 part of the tongue body, gently pull outward to the patient slightly painful for about 30 seconds and then release the tongue body to reset. This method can be repeated. Foot therapy method is to ask the patient to use the fingers to slightly pressure rub the soles of the feet (located in the Yongquan acupuncture point in the next 1 inch away), until the erratic stop. Hold water and breath method Take a glass of cool boiled water, make the patient contain a large mouthful of water, then hold the breath and stop breathing for as long as possible, until it will be unbearable, then swallow the water into the stomach, be careful not to choke into the trachea. This method can be used repeatedly, and is prohibited for those with heart and brain disease. Western medicine treatment Myorelaxant ① Baclofen is a derivative of the neurotransmission inhibitor γaminobutyric acid (GABA), which mainly acts on the GABA receptors of spinal cord motor neurons to inhibit nerve conduction, thus relieving smooth muscle and diaphragm spasm to stop erratic episodes; on the other hand, it may stop erratic episodes by inhibiting the erratic center through its sedative effect on the center. Dosage:10mg orally twice daily; the maximum dose is 15mg 3 times daily. The total efficiency is 98%. ②Eclairson hydrochloride tablet is a new type of muscle relaxant, on the one hand, it acts on the spinal cord to inhibit the spinal reflex; on the other hand, it acts on the γ motor neuron to reduce the sensitivity of the spinal cord, thus blocking its reflex arc, relieving the diaphragm spasm, reducing the further stimulation of the spastic phrenic nerve and vagus nerve; and it acts on the vascular smooth muscle to improve blood flow. Dosage:60mg orally or by gastric tube 3 times a day after meals. Antipsychotics ①Haloperidol 5mg intravenous drip or intramuscular injection 1～2 times/d, change to oral maintenance after improvement. ②Thorazine 25-50mg orally 3 times a day, but this method should be used with caution in elderly patients, especially those with cardiovascular disease. The anti-erotic effect of haloperidol and chlorpromazine may be related to their blocking of the superior reticular activating system and suppressing the excitability of the phrenic nerve. ③ Neostigmine 1mg and chlorpromazine 25mg added to 50ml of saline, each time with 30-40ml orally on an empty stomach, every 4-6h, the effect of cerebral hemorrhage, brain tumor postoperative erratic is obvious. Antidepressants ①Doxepin 25~50mg orally 3 times a day. The mechanism of its anti-ertia may be through its central and peripheral anticholinergic effect on the one hand, and through the central sedative effect on the other hand to inhibit the erratic center to stop the erratic effect. ②Amitriptyline 30mg orally 3 times daily. ③Promethazine, 25mg/d gradually increased to 225mg/d. Central excitatory drugs ①Ritalin 10-20mg intramuscular injection, repeated injection for recurrence. Its mechanism of terminating erratic reflux may be through the modulating effect of central visceral nerves, or to make the phrenic nerve overexcited and reach the inhibitory state. It may be due to the excitatory effect of the drug on the respiratory center, which accelerates the deepening of respiration and increases the activity of the diaphragm, thus relieving the spasm of the diaphragm and terminating the eruption. Calcium antagonists ①Nifedipine 10-20mg sublingual or swallowed 3 times a day, the total amount should not exceed 60mg a day. ②Flunarizine hydrochloride 10mg, 2-3 times a day, orally, after the cessation of erratic flow, change to 1 time a day to consolidate the treatment. ③Nimodipine sublingual and oral treatment of intractable erratic reflux also has good efficacy. Anesthetics ①Lidocaine 50-100mg continuous IV, 2-3 times a day, for 1-7 days, but should pay attention to heart rhythm monitoring. The mechanism of stopping eruption may be the regulation of the vegetative nerves or feedback influence on the central nervous system and inhibition of the phrenic nerve. Codeine phosphate 30mg orally, the mechanism of stopping eruption may be to inhibit the central nervous system and weaken the overreaction of the phrenic nerve, while directly inhibiting or relaxing the phrenic nerve. Anticholinergics ①Antanine, also known as benzhexol, is a central anticholinergic, which is mostly used clinically for the treatment of tremor paralysis. It is used for the treatment of this disease 4mg each time, 3 times daily orally for 2-3 days. ②Scopolamine 0.3mg intramuscularly or atropine and other drugs intramuscularly. Anti-epileptic drugs ① Sodium valproate dosage:0.2g each time, 3 to 4 times a day, gradually increase the dosage until the seizure is controlled. The effective dose of sodium valproate for the treatment of eruption varies greatly among individuals, and the dose to obtain satisfactory efficacy is 0.6-2.0g/day. ②Phenytoin sodium 0.1g each time, 3 times a day, is more effective for central eruptions. Antitumor drug Huachanin is injected intramuscularly 2~4ml each time, twice a day, or intravenously 10~20ml each time diluted with 5% glucose injection 500ml and then slowly dripped. Its antiemetic mechanism may be related to direct or indirect inhibition of the erratic center. The antiemetic mechanism is to inhibit the release of 5-HT3 from the central nerve and peripheral nerve, so that the originally excited phrenic nerve can reach the inhibitory state and the diaphragm spasm can be released. Gastrofluan is mostly used as acupuncture point injection. Carbonic anhydrase inhibitor Acetazolamide 0.25-0.5g/time, 3 times a day, its mechanism of stopping eruption may be related to the inhibition of carbonic anhydrase in the nervous system. Cough suppressant Codeine 30mg/dose, 3 times a day until the erratic disappears. Its mechanism may be to inhibit the center and reduce the overreaction of the phrenic nerve, while it may have a direct inhibitory and relaxing effect on the spastic diaphragm. H2 receptor antagonist Metformin 0.4g is added to 50% GS 40ml and pushed in a sedative once every 8h until the eruption disappears. Its mechanism may be to terminate or weaken the phrenic nerve spasm by blocking the central and gastrointestinal H2 receptors, reducing the vagal tone and making the phrenic nerve less excitable. Adrenocorticosteroids Intravenous use of desoxycorticosterone acetate and high-dose methylprednisolone or hydrofluorocortisone have been reported to be effective in the treatment of intractable eruptions due to Addsion disease and multiple sclerosis. Other drugs: dibazol, ephedrine, anti-inflammatory pain, tramadol hydrochloride, amantadine, magnesium sulfate, and vitamins B1 and B6 (acupuncture point injection) have been reported in the literature for the treatment of intractable erratic reflux with good efficacy. Patients with electrolyte disorders, especially with hyponatremia, hypocalcemia, hypomagnesemia, hypokalemia, etc., have been reported in the literature, and the erratic reflux was terminated or significantly relieved after electrolyte supplementation. Chinese medicine treatment Chinese medicine treatment Chinese medicine believes that erratic is usually caused by poor diet, excessive consumption of cold or cold drugs that cause cold knots in the stomach, as well as anger and depression, emotional and mental disorders, resulting in liver qi offending the stomach. In some cases, it is caused by the damage of Yin in the stomach or the defeat of Qi in the spleen and stomach. Treatment should be differentiated and can be classified as follows: ① Stomach cold evidence: i.e., the cold is internally blocked and stomach qi does not descend. The treatment is to warm the middle of the body and disperse the cold. The formula is based on the addition and subtraction of clove and persimmon soup, which often uses male clove, persimmon, galangal, aromatic herb, wicker, dry ginger, Chen Pi, etc.; ② Stomach heat evidence: that is, Yangming heat, stomach fire upward. The treatment is to clear the stomach to drain heat, the formula with bamboo leaves and gypsum soup plus or minus, commonly used bamboo leaves, gypsum, maitong, Fuxianxia, bamboo rhizome, rhizome, loquat leaves, sage, etc.; ③ Qi stagnation evidence: that is, liver gas offending the stomach, stomach loss of ventilation. The treatment is to smooth the Qi and lower the rebellion. The formula is based on Wu Mao Drink plus or minus, commonly used in the form of Mu Xiang, Citrus Aurantium, Betel nut, Wu Yao, Shen Xiang, Buddha’s hand, Green peel, Chen Pi, Dai Ochre, Clove, etc.; ④ Yang deficiency: i.e. deficiency of Yang in the spleen and kidney, and loss of descent of stomach qi. The treatment is to warm the spleen and kidney, harmonize the stomach and lower the rebellion. The formula is based on the addition and subtraction of Radix et Rhizoma Polygoni, Radix et Rhizoma Atractylodis Macrocephalae, Radix et Rhizoma Atractylodis Macrocephalae, Radix Codonopsis Pilosulae, Radix et Rhizoma Ginger, Radix et Rhizoma Polygoni, Radix et Rhizoma Ochraceae, Radix et Rhizoma Clove, etc. The treatment is to nourish the stomach and generate fluid, harmonize the middle and lower the rebellion. The formula is based on Yixing Stomach Soup, Orange Peel and Bamboo Roo Soup with addition and subtraction, commonly using Sha Shen, Mai Dong, Dendrobium, Yu Zhu, Persimmon, Orange Peel, Bamboo Roo, Knife Bean Seed, Loquat Leaf, Ginger Juice and Licorice. Meridian acupuncture ① Single acupuncture point: The literature reports that acupuncture points such as cataract, trapped valley, Baihui, Zhongkui, Miming, Shuigou, Tianding, and Renying are taken individually to treat this disease, and all have achieved significant efficacy. It is suitable for the clinical control of cerebrovascular disease and post-surgical combined eruption. ②Nasal acupuncture: the use of nasal acupuncture to pierce the stomach or chest points of the nasal acupuncture points for the treatment of this disease has the advantages of strong induction, less acupuncture points, convenience, and high cure rate, and is very effective for patients with a short course of disease. ③ acupuncture point pressure: the clinical use of acupuncture point pressure treatment of this disease has also achieved better results. Commonly used acupoints and effective points are: stop eruption point (equivalent to the upper edge of the orbit on the line between Zanzhu and Miming points), Neiguan, Zanzhu, Miming, Cataract, Tiantu, etc. ④Water injection (acupuncture point injection): one or more of the acupuncture points such as Neiguan, Sansili, Diayu, Zhongyu, Tanzhong, Tiantou, and Cataract are often used, and the injectable drugs include vitamin B1, B6, K3, Gastrodia, Thorazine, Promethazine, and Naloxone. ⑤ Identify the group of acupuncture points: often take Neiguan, Tiantou, Feosanli, Diaphragmatic Yu, and Zhongyu as the main points, and add additional points as needed. In addition, auricular acupuncture, pointer, and moxibustion also have obvious therapeutic effects. This method requires the operator to be familiar with local anatomy and master the correct puncture site, strictly control the concentration and dose of drugs, and be prepared to deal with changes in the condition, unilateral block is appropriate, and bilateral block is more reliable. Paracervical transverse process closure therapy Injecting drugs into the 3rd, 4th and 5th cervical transverse process by diffusion to the 3rd to 5th cervical nerve, which is a constituent branch of the phrenic nerve, disrupts the formation of the retrograde reflex arc, weakens the movement of the diaphragm, interrupts its vicious cycle, and enhances its own regulation ability, thus achieving the treatment purpose. For the treatment of erratic reflexes caused by neurogenic cervical spondylosis, press the Neiguan points on both sides, first on the left side and then on the right side, and observe whether the erratic reflexes decrease or disappear. Select the ipsilateral side where the pressure is effective to perform paracervical injection, which can achieve more satisfactory results. Extracorporeal diaphragmatic pacemaker therapy Extracorporeal diaphragmatic pacemakers have been used in the treatment of erratic reflux while being used for resuscitation of respiratory failure and diaphragmatic rehabilitation of chronic obstructive pulmonary emphysema, and have achieved good efficacy. The mechanism of diaphragmatic pacemaker in the treatment of erratic reflexes is that the electrical impulses generated by it stimulate the phrenic nerve at the outer edge of the sternocleidomastoid muscle, interfering with the reflex arc of abnormal excitatory contraction of the diaphragm, thus restoring its normal rhythm and achieving therapeutic purposes. To sum up, the pathogenesis of ergotism is not well understood, and the mechanism of action of various treatments lacks large-scale, specialized experimental studies. Although there are many therapeutic methods, the therapeutic effects vary, the individual differences in the disease are large, and some therapies have yet to be further validated. Therefore, when treating this disease, we should pay attention to the following points: ① Actively treat the primary disease and find the cause of the disease. ②Select appropriate treatment methods for different individuals; ③Emphasize the combined treatment of Chinese and Western medicine, multiple therapies combined treatment, complementary advantages, quickly and effectively stop the eruptive episodes.