Vomiting

Vomiting is a common symptom in clinic, resulting from the failure of thestomach qi to descend, or from other disorders affecting the stomach. It mayoccur in many diseases, but the most common causes are retention of food, attackof the stomach by the liver qi and hypofunction of the spleen and stomach.

Etiology and Patbogenesis

Overeating of raw, cold and greasy food leads to upward perversion of the stomach qi, resulting in vomiting.

Emotional disturbance and depression of the liver qi harm the stomach, impairing the downward movement of the stomach qi, causing vomiting.

Weakness of the spleen and stomach or overstrain leads to hypo function of the stomach in transportation and transformation, then causing retention of food. The stomach qi ascends instead of descends.

Differentiation

Retention of food:

Main manifestations: Acid fermented vomitus, epigastric and abdominal distension, belching, anorexia, loose stool or constipation, thick, granular tongue coating, rolling and forceful pulse.

Analysis: Retention of food impedes the function of the spleen and stomach in transportation and transformation. Since qi in the middle jiao is stagnated, there appear epigastric and abdominal distension, belching and anorexia. Retention of food leads to upward flowing of the turbid qi, so acid fermented vomitus, and loose stool or constipation occur. Thick, granular tongue coating and rolling, forceful pulse are the signs of retention of food.

Attack of the stomach by the liver qi:

Main manifestations: Vomiting, acid regurgitation, frequent belching, distending pain in the chest and hypochondriac regions, irritability with an oppressed feeling, thin, sticky tongue coating, string - taut pulse

Analysis: Depressed liver qi attacks the stomach, causing upward perversion of the stomach qi, so there occur vomiting, acid regurgitation, frequent belching, distending pain in the chest and hypochondriac regions. In case of stagnation of the liver qi, irritability with an oppressed feeling occurs. Thin, sticky tongue coating and string - taut pulse are the signs of the stagnation of the liver qi.

Hypofunction of the spleen and stomach:

Main manifestations: Sallow complexion, vomiting after a big meal, loss of appetite, lassitude, weakness, slightly loose stool, pale tongue, thin, white tongue coating, thready and forceless pulse.

Analysis: Weakness of the spleen and stomach leads to hypoactivity of the yang in the middle jiao, which fails to receive food and water, so vomiting appears after a big meal. If the spleen fails in transportation and transformation, the essentials of water and food no longer supply the body for nourishment, there may appear lassitude, weakness, loss of appetite and slightly loose stool. Pale tongue, thin white tongue coating, and thready and forceless pulse are the signs of weakness of the spleen and stomach.

Treatment

Method: The points of Yangming and Taiyin Meridians of Foot are selected as the principal points to activate the descent of qi and to pacify the stomach. For retention of food, reducing is indicated, for attack of the stomach by the liver qi, even movement is usually used to soothe the liver and regulate the flow of qi, and for weakness of the spleen and stomach, reinforcing combined with moxibustion is used to strengthen the function of the spleen and warm up the middle jiao.

Prescription: Zhongwan (RN12), Zusanii (ST36), Neiguan (MH6), Gongsun (SP4).

Syndromes points:

Retention of food: Xiawan (RN10).

Ren 10 & 21 (10 meets Spleen meridian, 21 regulates stomach Qi), ST 36 & PC 6 (descend Stomach Qi), SP 14 (stagnation), ST 44 (clear Heat – purge)

Attack on the stomach / spleen by the liver qi: Taichong (LR3).

Ren 13 & ST 34 (regulate chest and diaphragm and Stomach Qi), LR 3 & GB 34 (soothe Liver), HT 7 (calm emotions)
• acid reflux – PC 6, SP 4

Weakness of the spleen and stomach: Pishu (BL20).

Spleen Stomach deficient Cold

P/T – warm and strengthen Spleen and Stomach
Acupuncture Rx – Ren foot yangming, Moxa, warm and tonify, Ren 12, PC 6, ST 36, BL 20, 21, LR 13, Ren 4

Stomach Yin deficiency

P/T – nourish Stomach Yin
Acupuncture Rx – Shu, foot yangming, BL 20, 21, SP 10, 6, ST 36, PC 6
• burning stomach – KI 3 or 6
• dry heaves – SP 4

Cold Pathogenic attack

Ren 12 & ST 36 (regulate and descend Stomach Qi), PC 6 (regulate 3 Jiao Qi), LI 4 & GB 20 (expel Wind/Cold)
• dry heaves – moxa PC 5
• vomit bile water – GB 40

Accumulation of phlegm fluids

LR 13 & SP 14 (strengthen Spleen to eliminate fluids), Ren 12 & ST 40 (Phlegm), PC 6 (nausea/vomiting)
• borborygmi – BL 20, 25
• palpitations – HT 7

Persistent vomiting: Jinjing, Yue (Extra).

Explanation: Zusanii (ST36) is the He - (Sea) point of the Stomach Meridian and Zhongwan (RN12), the Front - Mu point of the stomach. The two points used together are effective in pacifying the stomach and activating the descent of qi. Neiguan (MH6) and Gongsun (SP4), one of the pair - points of the Eight Confluent points, relieve the fullness of the chest and stomach. Xiawan (RN10), a point located in the epigastria, is able to regulate the stomach qi and remove stagnation by applying reducing method Needling at Taichong (LR3), the Yuan (Primary) point of the Liver Meridian regulates the function of the liver. Pishu (BL20), a point where the spleen qi is infused, used in combination with Zusanii (ST36) and Gongsun (SP4), may reinforce the spleen qi and invigorate the qi in the middle jiao to perform the function of transportation and transformation and to restore the normal activities of qi. Pricking Jinjing (Extra) and Yuye (Extra) to cause bleeding is an experienced method for checking vomiting.

Remarks

Vomiting as described here may be found in acute and chronic gastritis, cardiospasm, pylorospasm and neurotic vomiting.

Alternative treatment methods

auricular – ST, LR, sympathetic, subcortex, shenmen, leave for 30 minutes
injection – PC 6, ST 36, vitamin B6, B12