Internal Medicine – Stomach Disorders

TOC

Abdominal Pain
Acid Reflux
Constipation
Diarrhea
Dysphagia
Hiccup
Stomach Ache
Upset Stomach
Vomiting

Overview Of Stomach Function

The stomach’s main functions are to aid in digestion and the production of food Qi (Gu Qi).  The stomach controls the “rotting and ripening” of food and drinks ingested.  The stomach and spleen together are regarded as the ‘root of post-haven Qi’.  The spleen and stomach are both responsible for transporting Gu Qi throughout the body but especially to the upper and lower limbs to nourish muscles and bones.  If this function the spleen and stomach is deficient the limbs will become flaccid and desensitized.  The stomach is responsible for sending transformed food downwards to the duodenum (small intestine) to prevent stagnation of food in the stomach causing belching and possibly vomiting.  The stomach is also the origin of fluids due to it’s digestion function witch depends on having fluids to digest.

Abdominal Pain – Wei Wan Tang

Pain in the area between the tip of the xyphoid process and the pubis symphysis (level of Ren 12) including appendicitis, gall stones, bladder disorders, hernia, pancreitus and indigestion. 

Pathogenesis:

External Pathogen Invasion - Esp. Cold – invades digestive system blocking middle jiao yang Qi causing stagnation = pain
Chronic Yang Deficiency - Spleen yang def. – deficient cold in middle jiao causes qi and blood stagnation = pain
Diet: over consumption of pungent/hot foods creates internal damp heat in digestive system blocking Qi and blood = pain

Food Retention (induces pain in the abdomen)

Differentiation:
• Appendicitis: pain on right side of abdomen
• Parasites: pain around and on naval
• Bladder Disorders: lower centre of abdomen
Treatment:
• Excess = Purge – Deficiency = tonify.  
• Cold = warming – Heat = cooling
• Blood Stagnation = remove
• Qi & Food Stagnation = promoting

1. Excess Cold
   1. acute  severe abdominal pain with constipation, pain below hypochondriac region, cold hands/feet
   2. T– white coating                                               P - wiry / tense
   3. Treatment:        Warm up internal region, expel cold, induce bowel movements to relieve pain.
   4. Formula:           Da Huang Fu Zi Tang
   5. Deficient Cold
   6. dull chronic abdominal pain, ameliorated by warmth and pressure, middle jiao yang def. symptoms (cold abdomen limbs, poor appetite, soft stool)
   7. T - Pale                                                            P – weak, thin
   8. Treatment:        warm middle jiao, nourish spleen, harmonize middle jiao qi to relieve pain.
   9. Formula:           Huang Qi Jian Zhong Tang
   10. Excess Heat
   11. acute distended severe pain, hot feverish feeling, constipation, thirsty (bloated after drinking) gas with possible fluid leakage while passing of, gas with odour, aggravated with pressure.
   12. T  – red with dots, brown-yellow coating          P - forceful, excessive
   13. Treatment:        induce bowel movement to purge fire and relive pain.
   14. Formula:           Cheng Qi Tang (base formula for excess heat)
   15. Qi Stagnation
   16. emotional stress (anger), fullness and moving pain which radiates to side of abdomen, pain relieved by passing of gas and belching, aggravated by emotional stress
   17. T – red                                                 P - wiry
   18. Treatment:        regulate Qi and sooth liver to relieve pain
   19. Formula:           Chai Hu Shi Gan Tang
   20. Blood Stasis        (masses in abdomen)
   21. Fixed pain in the abdomen accompanied with stabbing pain and masses which do not move
   22. T - purple                                                        P – wiry, un-even
   23. Treatment:        promote blood circulation and remove blood stasis
   24. Formula:           Xiao Fu Zhu Yu Tang
   25. Food Retention
   26. pain in abdomen due to diet, pain ameliorated with bowel movement, aggravated by constipation, acid regurgitation, poor appetite
   27. T - thick greasy coating             P – slippery
   28. Treatment:        promote digestion, remove food retention to relieve pain
   29. Formula            Bao He Wan     (base formula for food retention)
        

    

Acidic fluid up surging from Stomach, patient usually swallows back down

Western Medicine

Gastric ulcer, gastritis (chronic), indigestion, hyper-hydro-cholorea

Oriental Medicine

Pathogenesis:

Diet: sweet/greasy/hot & spicy or bad quality food
Exterior pathogen invasion:  cold invade mid. Jiao – def. yang Qi turns to turbid dampness causing acid.
Emotion:
• liver attacks stomach – sour flavour.  
• spleen creates damp/phlegm which creates acid
Deficiency Middle Jiao:  congenital dysfunction, retention of food, can’t transform or transport which creates acid

Differentiate:

Cold = warm middle jiao to harmonize Stomach
Hot = relates with liver to soothe liver to harmonize Stomach

1. COLD
   • Acid regurgitation, frothy fluids, fullness in abdomen, belching, cold limbs, soft stools, fatigue, ameliorated by warm drinks
   • T – pale, white coat                              P – deep, delayed
   • Treatment:        warm middle jiao, disperse cold to harmonize St. and reduce acid
   • Formula            Xiang Sha Liu Jun Zi Tang   +   Wu Zhu Yu
      
2. HOT
   • Frequent acid regurgitation with belching of old food, fullness in abdomen, dry mouth, thirsty, smelly stools, liver Qi stagnation symptoms
   • T - red, yellow coat                              P – Wiry, slippery, rapid
   • Treatment:        Clear heat, sooth liver, descend St. Qi, (bitter/pungent)
   • Formula            Zuo Jin Wan
      

Dry, Difficult to pass stools

Heat: external heat invasion, wrong treatments, prolong treatments, hidden heat, over consumption of alcohol …, …, …
PI YUE: weak spleen and strong stomach (usually strong spleen and weak stomach), big appetite, spleen cannot transform / transport food, frequent urination but dry stools
Liver Qi Stagnation:    patient always sitting, parasites, post surgery 
Wind: related to lung but moves to L.I. blocking bowels, wind has drying function.
Diet:over consumption of pungent / hot / spicy foods 
Accumulation of Phlegm:causes phlegm stagnation 
Qi Deficiency:needs Qi to push stool out (mainly spleen Qi) 
Blood Deficiency: blood is a fluid = dryness when deficient 
Yin Deficiency: lack of fluids = dryness in intestines 
Yang Deficiency: yang cannot move yin = yang cannot move / warm fluids 
Accumulation of Cold: injures yang Qi, cannot warm intestines to lubricate bowels, yin cold in intestine

Heat
1. Coconstipation with abdominal pain and fullness with heat signs (fever, yang ming heat symptoms, sweating …)
2. T -  red , yellow coat                            P - forceful, slippery
3. Treatment:        purge bowels to purge fire
4. Formula            Chen Qi Tang (base formula for Heat)
    
Pi Yue
1. Frequent urination with constipation, stomach heat symptoms, dry mouth, bad breath, hot sensation, sticky feeling in mouth, good appetite
2. T -  red, dry coat                                              P - slippery, rapid
3. Treatment:        clear stomach heat, lubricate intestines, relieve constipation
4. Formula            Ma Zi Ren Wan
    
Qi Stagnation
1. Dry stools, want to pass stool but cannot, do not have the energy to push, frequent belching, fullness in abdomen and hypochondriac region.
2. T - thin, greasy coat                                          P -  wiry
3. Treatment:        promote Qi circulation, remove Qi stagnation to promote bowel movements.
4. Formula            Liu Mo Tang
    
Accumulation of Wind
1. Numbness and tingling of limbs, wind symptoms
2. T – normal, red                                     P - floating, wiry, thin
3. Treatment:        eliminate wind to relive constipation
4. Formula            Xiao Xu Ming Tang
    
Food Retention
1. Poor diet history, food retention symptoms with constipation, fullness in stomach, belching, acid regurgitation, nautious, hard/distended abdomen
2. T - thick coat                                                    P - slippery, wiry
3. Treatment:        promote digestion, regulate stomach Qi to relieve constipation.
4. Formula            Bao He Wan & Da Huang
    
Phlegm Causing Constipation
1. Hot type of dyspnea and asthma, cough with phlegm, fullness in chest, steaming head syndrome (sweating on head)
2. T - red, yellow coat                                          P - slippery, rapid
3. Treatment:        eliminate phlegm and promote lung function, disperse lung Qi.
4. Formula            Yue Bi (Bei) Jia Ban Xia Tang
Qi Deficiency
1. Feels they have no force to push stool out, while passing stool sweating and shortness of breath present, general Qi deficiency present
2. T – pale, puffy                                      P -  weak
3. Treatment:        nourish Qi to lubricate intestines and relieve constipation
4. Formula            Huang Qi Tang (spleen tonic)
    
Blood Deficiency
1. Sheep poop stools (rabbit like droppings – dark/hard), blood deficiency symptoms, dull yellow complexion, palpitations, dizzy, blurred vision.
2. T - pale                                                            P - thin
3. Treatment:        nourish blood to lubricate intestines and relieve constipation
4. Formula            Run Chang Wan
    
Yin Deficiency
1. Yin deficiency symptoms with dry stools
2. T -  red, scanty coat                                         P -  thin, rapid
3. Treatment:        nourish yin, lubricate bowels to relieve constipation
4. Formula            Liu Wei Di Huang Wan
    
Kidney Yang Deficiency
1. Difficulty pushing stool out (Qi Def.) with yang deficiency signs (cold signs)
2. T – pale, puffy                                      P – deep, weak
3. Treatment:        warm up kidney yang to strengthen bowels.
4. Formula            Shen Qi Wan
                          Wu Ren Wan (elderly)
    
Stagnation of Cold
1. Dry or not dry stool with difficulty passing, cold pain, fullness in abdomen ameliorated by warmth, lower back cold sensation
2. T - white coat                                                   P - deep, delayed
3. Treatment:        expel cold to induce bowel movement
4. Formula            Ji Sheng Jian

Increased frequency of bowel movements with a consistency of soft stools, soft stools with undigested food, watery stools. Patient may also have abdominal pain with borbyrigmus.

Diarrhea is usually due to disorder of the spleen’s transformation and transportation of fluid function in chronic cases but due to dampness in exterior or interior cases.  If there is no dampness then there will be no diarrhea.  

Diarrhea is most common in summer and fall.

Exterior Pathogen Invasion:   
• Cold Dampness = attacks L.I. – acute – abdominal pain
• Summer Heat =complicated with damp – attacks SP&ST
Poor Diet: mpairs spleen function = spleen Qi cannot ascend so transform and transporting function is impaired = Qi and fluids descend.
Stress:
• Depress or Anger = attacks liver
• Worry = weaken spleen Qi
Long Term Deficiency:
• Overworked for long period of time with a poor diet
• Elderly = general spleen yang deficiency

Differentiate:

Dysentry           diarrhea with PUS and BLOOD and severe abdominal pain
Cholera            diarrhea accompanied with VOMITTING and severe abdominal pain.
Severe  -no appetite                 Mild  - appetite

Cold Dampness – Acute (cold/damp invades sp & st)
• Diarrhea:          watery, thin
• Abdominal pain with borborygmus, fullness in abdomen, poor appetite
• T - white coat (exterior invasion)                            P - floating (exterior invasion)
  T -  white greasy (int. cold damp)                                    P - soft (int. cold damp)
• Treatment:        aromatic herbs to transform dampness, expel cold and relieve diarrhea
• Formula            Ext. wind cold – Huo Xiang Zheng Qi San
                          Int. cold damp – Ping Wei San
   
Damp Heat – Acute
• Diarrhea:          yellow, stinky
• Unfinished feeling after passing stool with burning in anus, fever, thirst, dysphoria, scanty-dark urine
• T - red  body, yellow greasy coat                      P - slippery/soft, rapid
• Treatment:        clear heat from Large Intestine, eliminate dampness to stop diarrhea
• Formula            Ge Gen Qin Lian Tang
   
Poor/Irregular Diet – Acute
• Diarrhea:          rotten egg smell
• Food stagnates in stomach and intestines, starts with borbrigimus and abdominal pain, no appetite, pain ameliorated by passing of stool, belching
• T - thick greasy coating                         P - slippery
• Treatment:        remove food retention to treat diarrhea
• Formula            Bao He Wan
   
Spleen Qi Deficiency - Chronic
• Diarrhea:          undigested food in soft stools
• Patient always has soft stools, poor appetite, bloating after meals, patient has sensitive stomach to certain foods (ie. Greasy / spicy) dull yellow complexion, fatigue
• T - pale, white coat                                           P - weak
• Treatment:        nourish spleen to invigorate spleen function to stop diarrhea
• Formula            Shen Ling Bai Zhu San
                          Bu Zhong Yi Qi Tang – with prolapse of anus
                          Tong Xie Yao Fang – with abdominal pain and explosive diarrhea
   
Kidney Deficiency – Chronic
• Diarrhea:          early morning diarrhea
• Abdominal pain with borbrygima, ameliorated by passing of stool, general kidney yang deficiency symptoms
• T - pale, white coat                                           P -  deep, thin
• Treatment:        warm up spleen and kidney yang to consolidate bowels
• Formula            Si Shen Wan
                         Zhen Ren Yang Zang Tang
   
Water Retention in Intestines – Chronic
1. Diarrhea:          watery, frothy diarrhea
2. Dysfunction of in testiness, water retained, always has borborygmi, emaciation, bloated abdomen, scanty urine, thirsty
3. T – pale, swollen, teeth marks               P - soft, slippery
4. Treatment:        invigorate spleen function to eliminate dampness
5. Formula            Ling Gui Zhu Gan Tang
    
Blood Stasis – Chronic (chronic illness = blood stasis)
• Fixed stabbing pain in abdomen, unfinished feeling after bowel movement, dry mouth, no desire to drink
• T - purple spots                                                P -  wiry, uneven
• Treatment:        promote blood circulation, remove blood stasis to harmonize nutrient level and remove diarrhea
• Formula            Xiao Fu Zhu Yu Tang

Difficult swallowing, vomiting after eating (severe case). Starts with stagnated feeling in throat, may have pain behind sternum when eating. Usually occurs in middle aged men.  

Western Medicine

Possible tumor, cardiac spasms … …

Excessive or complicated deficiency,  actual stagnation of QI, FIRE, PHLEGM or BLOOD STASIS

Treatment: Remove stagnation, promote Qi/Blood circulation or purge fire.

Emotion: unbalanced lifestyle causes dysfunction of liver & spleen creating Qi stagnation and phlegm accumulation.  Long term = blood stasis
Diet: over consumption of hot and spicy , greasy and sweet foods causing Qi & Phlegm stagnation
Ext. Pathogens: cold or hot invades digestive system blocking digestive tract.
Deficiency: chronic illness = deficiency of kidneys
• Kidney yin deficiency = whole body dryness, digestive tract not lubed
• Kidney yang deficiency = ming men fire deficiency
  Can’t warm middle jiao to transform and transport phlegm – phlegm stagnates in digestive tract = Ye Ge

Differentiate:

Plum Pit in throat (Mei He Qi) – no trouble swallowing & no vomiting.
Upset stomach (Fan Wei) – delayed vomiting (vomit hours after eating)
Vomiting – no swallowing difficulty
Guan Ge – retention of urine with vomiting, no bowel movement.
Hiccup – Qi up surging only causes noise, no pain

Stagnated Qi & Phlegm
• Swallowing difficult with fullness or pain behind sternum, belching, hiccup, nautious, vomit of phlegm fluids, EMACIATION, dry throat, dry mouth.
• T – red with fissures, greasy coat                      P – wiry, slippery
• Treatment:        Eliminate phlegm, promote Qi circulation, lubricate dryness
• Formula            Qi Gu San
   
Fluid Deficiency with Stagnated Dry Heat
• Heat injures body fluid, can’t lubricate intestines, severe swallowing difficulty-painful, can swallow fluid but not dry food, vomit after eating, vomit sticky phlegm, burning pain behind sternum, emaciation, St. yin def. Symptoms-burning pain in St. like cold drink, night sweat, dry stools
• T – deep fissures                                              P –thin/wiry, rapid
• Treatment:        Nourish fluid, clear dry heat to dissolve stagnation
• Formula            Sha Shen Mai men Dong Tang
   
Phlegm & Blood Stasis
• Severe – vomit after water, swallowing difficulty, pain in chest, vomit dark brown fluid, dry dark stools, emaciation, dark grey complexion
• T – dark purple, dry                                         P – thin, uneven
• Treatment:        Remove blood stasis, dissolve hardness, nourish yin & blood
• Formula            Tong You Tang

LATER STAGE

Deficient Qi & Yang
• Pale/dull complexion, fatigued, short of breath, painful swallowing, edema (ankles), bloated abdomen, vomiting
• T – pale, purple, swollen                                   P – deep, thin
• Treatment:        Nourish Qi & Yang – rescue yang
• Formula            Shen Fu tang

Sudden Qi up surging to the throat, caused by Stomach Qi attacking the diaphragm.

Western Medicine:

Kidney Disorders with hiccup is Bad News

OM:

Irregular Diet
• ating too fast–too cold–too much =impairs ST,Qi cannot descend
• eating too pungent = dry heat in ST.
Emotion:
• Liver Qi Stagnation: anger turns to fire – creates phlegm – damages Spleen – effects Stomach
• Usually Hiccups accompanied with Cough.
SP./KD. Yang Def.: Qi also deficient – spleen looses clearing and descending turbid Qi function – Chronic diarrhea
ST. Yin Def.: Lack of fluids – deficient fire in Stomach, fire goes upward causing hiccups

Differentiate:

Hiccup: comes from throat, comes suddenly
Nausea: comes from stomach, doesn’t come suddenly
Belching: gas released from stomach, ameliorated by belch, may be accompanied with acid regurgitation and abdominal distention.
loud = excess       weak = deficient        cold =deep sound            heat = loud & short

Cold in Stomach – Excess
• Hiccup – deep sound, aggravated by cold
• Diet of cold food, exterior cold invasion, cold pathogens block stomach Qi, stomach looses it’s harmony and it’s descending function, cold sensation in abdomen.
• T – white coat                                      P – delayed , slow
• Treatment:        Warm up middle Jiao, expel cold, descend stomach Qi
• Formula            Ding Xiang San
   
Stomach Fire – Excess
• Hiccup – loud, strong, short (explosive)
• Diet of hot/spicy, excess alcohol, excess yang tonics, heat signs of thirst, desires cold drink, dry stools, constipation
• T – red, yellow dry coat                        P – slippery, rapid
• Treatment:        purge stomach fire, descend stomach Qi to relieve hiccup
• Formula            Qing Wei San + Shi Di & Zhu Ru
   
Phlegm & Qi Stagnation – Excess
• Hiccup – accompanied with cough
• Patient feels as though they can not breathe properly, tightness in chest, general phlegm stagnation symptoms, dizzy, poor appetite, flatulence
  Possible liver Qi stagnation = hypochondriac distention
• T – greasy coat                                     P - slippery
• Treatment:        regulate Qi, transform phlegm, descend Qi to regulate hiccup.
• Formula            Xuan Fu Dai Zhe Shi Tang
   
Spleen & Kidney Yang Deficiency
• Hiccup – weak, long sound with intermittent attacks
• Chronic hiccups, middle jiao Qi deficiency, nautious, vomit of clear water, general fullness in abdomen, ameliorated by warmth & pressure, spleen yang deficient symptoms & kidney yang deficiency symptoms, lower back and knee weakness, pale complexion, fatigue
• T – pale, white coat                                          P – thin, weak
• Treatment:        warm and strengthen spleen & kidney to harmonize stomach Qi
• Formula            Fu Zi Li Zhong Tang + Shi Di / Ding Xian
   
Stomach Yin Deficiency
• Hiccup – short, urgent, intermittent attacks
• Stomach yin deficient symptoms, thirst, dry tongue, dry lips, poor  appetite, bloating after meals, dry stool, night sweat.
• T – red, scanty/dry coat                                    P – thin, rapid
• Treatment:        nourish stomach yin to harmonize stomach Qi
• Formula            Yi Wei Tang

Wei Wan Tong is pain in the stomach which includes gastritis, gastric neurosis and ulcers.   Pain can be distended, burning, stabbing, dull, and bouts of acute severe pains.  The pain can be accompanied by fullness in the abdomen, acid regurgitation, food retention, belching, flatulence, nausea, vomiting, poor appetite, irregular stools and general spleen deficient symptoms.

Liver Qi attacks Stomach
• anger/depression makes liver loose its soothing function which transversely attacks stomach blocking stomach Qi causing pain.
• long term stomach Qi stagnation =     a. blood stasis or b. creates fire
Spleen
• Diet:  over consumption of food, over consumption of one type of food (spicy, raw, greasy, sweet), irregular diet, poor quality  =  all will injure spleen Qi = cold or hot = blocks     stomach functions
Congenital/Chronic illness
• takes prescriptions for too long
• -weak stomach -cold blocks stomach Qi (causes pain)
• yin def., deficient heat (causes pain)
• spleen def., does not produce enough blood. (cause pain)

Differentiate:

Heat attack: pain in left side of chest and radiates to left shoulder and arm.
Stomach pain: pain in upper abdomen and stays in abdomen

Cold Blocks Stomach Qi
•  (sudden external invasion or sudden over consumption of cold)
• acute, severe stomach pain, relieved by warmth, aversion to cold.
• T – white coating                                              P – wiry tense/retarded
• Treatment:        warm stomach, expel cold,  promote Qi circulation to relieve pain.
• Formula            Liang Fu Wan
   
Food Retention
• Distended stomach with aching, irregular diet history, fullness pain in stomach, dislike pressure, belching up of food, acid regurgitation, poor appetite, irregular stool, discomfort ameliorated by vomiting/diarrhoea
• T – thick greasy coating                                    P – slippery
• Treatment:        invigorate spleen/stomach Qi, promote digestion to relieve pain.
• Formula:           Bao He Wan    (base formula for food retention)
   
Liver Qi Stagnation
• distended fullness pain in stomach radiating to hypochondriac region, aggravated by anger, frequent belching, sighs a lot.
  o       May Turn To FIRE – bitter taste, dryness in mouth, heart burn, severe pain
• T- normal (no fire)                               P - wiry  (no fire)
  T - red with yellow coat (fire)                P - wiry rapid(fire)
• Treatment:        sooth liver, move liver Qi to relieve pain
• Formula            no fire- Chai Hu Shi Gan San
                          Fire     - Dan Zhi Xiao Yao San
   
Blood Stasis
• Chronic Stomach ache, stabbing pain or cutting pain (more severe), fixed pain, aggravated by pressure, severe cases = blood in vomit and stools (ulcer)
• T - purple                                                         P - un-even
• Treatment:        promote blood circulation, remove blood stasis to relieve pain
• Formula:           Gu Xia Zhu Yu Tong
                          Shi Xiao San – alleviates pain
   
Spleen and Stomach Deficient Cold
• chronic dull pain in Stomach ameliorated by warmth and pressure, pain better after eating, poor appetite, nausea, clear-thin-watery vomit, soft stools, general whole body deficient cold symptoms.
• T - pale                                                            P - thin
• Treatment:        warm and nourish spleen to harmonize stomach
• Formula:           Huang Qin Jian Zhong Tang   (gui zhi tang + honey + huang qi)
   
Spleen and Stomach Yin Deficiency
• burning pain, dry symptoms, dry stools, dry throat, poor appetite
• T - red, scanty coating                          P -thin wiry/rapid
• Treatment:        nourish stomach yin to relieve pain
• Formula:           Zhu Ye Shi Gao Tang
                          Liver Yin Def. – Yi Guan Jian

Vomiting after food has been retained for 10 – 12 hours.  Vomit at night after eating in morning OR vomit in morning after eating night before.

W.M

stomach/duodenum ulcer, diverticulosis, prolapse of St. membrane, spasm of St. sphincter.

OM

Irregular diet   -over eating/drinking
 Emotion          - liver/spleen – retention of food & water
 Internal Injuries   - over work will injure spleen & kidney
 Traumatic injuries   -i.e. Surgery causes Qi/blood to stagnate and food can’t be developed

Differentiate

Vomiting – no specific time for vomiting
Dysphagia – swallowing difficulty with vomiting

Syndromes

Spleen & Stomach Deficient cold
• vomit 10-12 hours after eating, bloating after meals, soft stools, cold limbs & abdomen, fatigue, vomit fluids & old food
• T – pale, white slippery coat – P – deep, thin
• Treatment: Warm middle Jiao, strengthen Sp., harmonize & descend St. Qi
• Formula            Ding Kou Li Zhong Tang
   
Heat In Stomach
• vomit 10- 12 hours after eating, bloating, vomit with sour/smelly old food, sticky fluids in vomit, dry stools, constipation, scanty dark urine, hot symptoms, thirst, red complexion
• T – red, yellow coat – P – slippery rapid
• Treatment:        Clear stomach heat, purge heat (constipation) descend turbid Qi to harmonize Stomach
• Formula            Zhu Ru Tang
   
Turbid Phlegm Retention
• vomit 10-12 hours after eating, fullness in abdomen with lumpy feeling in upper abdomen region, vomit mixed with phlegm or frothy phlegm, general phlegm symptoms, dizziness, palpitations
• T – swollen, white slippery coat – P – slippery
• Treatment: Eliminate turbid phlegm to harmonize and descend Stomach Qi
• Formula            Dao Tan Tang
   
Blood Stasis
• vomit 10-12 hours after eating, severe bloating after meals, lump on upper abdomen, possible surgery history, vomit old brown blood or fresh blood (severe)
• T - Dark red, purple dots – P – wiry, uneven
• Treatment:        promote blood circulation to remove blood stasis
• Formula            Gu Xia Zhu Yu Tang

Vomiting of food, fluids, (bitter/sour/acidic) or phlegm (sputum) due to stomach Qi up surging.

W.M.

gastritis, Stomach sphincters spasm, hepatitis, pancreatitus, febrile disease, meningitis

OM

Exterior Pathogen Invasion: acute vomiting due to (wind, fire, cold, heat, summer heat) which impairs St. Qi function causing it to up surge and cause vomiting.  Most common in summer
Diet: irregular diet – cold/hot foods , no scheduled meal times - causes spleen dysfunction – phlegm goes upward with stomach Qi
Emotion: liver Qi stagnation attacks stomach causing disharmony, which causes St. Qi to upsurge - Spleen Qi stagnates due to over thinking, causes food stagnation in middle jiao and St. Qi to up surge
Middle Jiao Def.: Sp/St def. – can’t transform/transport food and water
• cold- stomach yang Qi deficient
• hot- stomach yin deficient

POISONING                 ULCER                INTESTINAL PARASITES

Differentiate between:

Dysphagia (ye gu): vomiting with swallowing difficulty, slow progression
Upset Stomach (fan wei): eat in morning and vomit at night or eat in evening and vomit in morning.
Cholera: diarrhea and vomit together, acute with severe abdominal pain.

Distinguish between:

Excess (acute onset) & Deficient (slow onset)

**do not purge unless there is constipation complicating the vomiting.**

Exterior Pathogens Invade Stomach

Syndromes

Wind cold / Wind heat / Summer heat /  Dampness

• acute sudden vomiting
• T – (hot – red) (cold – pale)                             P - superficial
• Treatment: Expel exterior pathogens, harmonize Stomach Qi to relieve vomit.
• Formula    Wind-cold - Hou Xiang Zheng Qi San
                          Wind-heat -Yin Qiao San
                          Summer heat damp - Xin Jia Xiang Ru Yin
   

Diet – Retention of Food

• retention of food causes vomit of old food, patient has history of irregular diet, belching, poor appetite, abdominal pain, irregular bowel movements.
• T – thick, greasy coat                                       P – slippery
• Treatment: promote digestion, remove food retention to harmonize St. Qi
• Formula            Bao Hu Wan
   

Accumulation of Phlegm

• slow onset, vomiting of phlegm or fluids, general phlegm symptoms, dizziness, fullness / distension of chest, rumbling in stomach/intestines
• T – white, greasy coat                           P – slippery
• Treatment:        eliminate phlegm and fluids, harmonize stomach Qi
• Formula            Er Chen Tang (phlegm)   +  Ling Gui Zhu Gan Tang (fluids)
   

Liver Qi Stagnation

• vomiting with acid regurgitation, frequent belching, chest/hypochondriac distension & pain, aggravated by emotion
• T – thin greasy coat   - red on sides = heat – P - wiry
• Treatment:        sooth liver to harmonize stomach Qi
• Formula            Ban Xia Hou Po Tang (no heat)
                         Si Ni San   +  Zou Jin Wan (heat)
   

Spleen & Stomach Deficient Cold

• chronic illness, vomit after eating bad(different) foods, spleen & stomach deficient cold symptoms, poor appetite, cold St, dry mouth, no desire to drink, soft stools, cold limbs.
• T – pale, white coat                                          P – weak
• Treatment:        Warm middle Jiao, strengthen spleen/stomach, stop vomit
• Formula            Li Zhong Tang
   

Stomach Yin Deficiency

• chronic vomit, small amounts with dry heaves, nausea, dry mouth, thirsty, no appetite, heart burn.
• T – red, dry (scanty) coat                                 P – thin, rapid
• Treatment: Nourish St. yin, moisten St. to descend St. Qi to relieve vomit

Links - Stomach: Earth Energy Yang Organ (Bioenergetics)