Vomiting is a common symptom involving a forcible expulsion of the contents of the stomach through the mouth due to adverse rising of stomach-qi. However, vomiting may serve as a protective mechanism to expel harmful materials from the stomach.

Vomiting is different from regurgitation and hiccup, although they are all disorders of the stomach characterized by adverse rising of stomach-qi.

Syndrome Differentiation and Therapeutic Principles

Vomiting of sthenia-syndrome is usually caused by exogenous evil or improper food intake and manifests itself with an acute onset and short course, while that of asthenia-syndrome is due to weakness and hypofunction of the spleen and stomach and manifests itself with an insidious onset and a prolonged course. The former should be treated with the principle of expelling evils, eliminating dampness, regulating the stomach and keeping the adverse qi downwards, and the latter by supporting the healthy qi through such means as warming middle jiao and regulating the stomach, benefiting the stomach and regulating middle jiao, etc.

Classification and Treatment

A. Attack of exogenous evil on the stomach

Manifestations: Vomiting of sudden onset, fever, general aching, fullness and oppression of the chest and epigastium, white and greasy tongue coating and slow-floating pulse.

Therapeutic principles: Eliminate dampness with drugs of fragrant flavor disperse the superficies, and regulate middle jiao.

Prescription: Herba Agastachis Powder for Restoring Healthy Qi

Herba Agastachis 10 g
Folium Perillae 6 g
Pericarpium Citri Reticulatae 10 g
Poria 15 g
Massa Fermentata Medicinalis 10 g
Radix Glycyrrhizae 5 g
Cortex Magnoliae Officinalis 6 g
Rhizoma Pinelliae 10 g
Pericarpium Arecae 10 g
Rhizoma Atractylodis 10 g
Fructus Aurantii 10 g

Remarks: Add Radix Ledebouriellae and Herba Schizonepetae for cases with severe superficies-syndrome such as general aching and anhidrosis. Add Rhizoma Coptidis, Talcum and Folium Nelumbinis, and omit Glycyrrhizae, Atractylodis and Pinelliae for cases with vomiting and thirst due to retention of summer-heat and dampness. Add the pill of Jade Pivot for those cases with severe dizziness and vomiting due to an affection caused by dirty and turbid qi.

B. Retention of food

Manifestations: Vomiting of sour and putrid food, eructation, distension over the epigastrium and abdomen, anorexia, dyschesia with odorous tool, thick and greasy tongue coating and smooth and solid pulse.

Therapeutic principles: Relieve dyspepsia, regulate middle jiao, and keep the adverse qi downwards.

Prescription: Pill for Promoting Digestion, which is composed of Fructus Crataegi, Massa Fermentata Medicinalis, Rhizoma Pinelliae, Poria, Pericarpium Citri Reticulatae, Fructus Forsythiae and Semen Raphani. Sixiao Bolus may also be given.

C. Retention of phlegm

Manifestations: Vomiting of watery fluid, epigastric oppression, loss of appetite, dizziness, palpitations, white and greasy tongue coating and smooth pulse.

Therapeutic principles: Warm and disperse phlegm, regulate the stomach, and stop vomiting.

Prescription: Decoction of Smaller Amount of Pinelliae with Decoction of Poria, Cinnamomi, Atractylodis Macrocephalae and Glycyrrhizae

Rhizoma Pinelliae 10 g
Rhizoma Zingiberis Recens 10 g
Poria 20 g
Rhizoma Atractylodis Macrocephalae 10 g
Radix Glycyrrhizae 5 g

Remarks: Add the mixture of Semen Pharbitidis powder and Semen Sinapis Albae powder as capsules taken in three divided doses daily for cases with vomiting of a large amount of watery fluid. Change the prescription to Rhizoma Coptidis Decoction for Clearing Away Gallbladder-Heat for those cases with nausea, vomiting, bitter taste in the mouth, dizziness due to stagnated phlegm changing to heat and attacking the stomach and gallbladder.

D. Liver-qi attacking the stomach

Manifestations: Vomiting, acid eructation, hiccups, distension over the chest and hypochondrium, red tongue with thin and greasy coating and wiry and smooth pulse.
 

Therapeutic principles: Regulate stomach-qi, and stop vomiting.

Prescription: Zuojin Bolus with Siqi Decoction

Rhizoma Coptidis 5 g
Fructus Evodiae 3 g
Caulis Perillae 10 g
Fructus Jujubae 5 g
Rhizoma Pinelliae 10 g
Cortex Magnoliae Officinalis 6 g
Poria 12 g
Rhizoma Zingiberis Recens 6 g

Remarks: Add Radix et Rhizoma Rhei and Fructus Aurantii Immaturus for cases with bitter taste in the mouth, epigastric upset and constipation. Add Radix Bupleuri and Radix Curcumae for those with marked oppression and distention over the chest and hypochondrium. Add Fructus Gardeniae and Caulis Bambusae in Taeniam for those with severe stagnated heat.

E. Asthenia-cold of spleen and stomach

Manifestations: Intermittent vomiting, anorexia, pale complexion, fatigue, coldness of extremities, loose stool, pale and corpulent tongue and thready and weak pulse.

Therapeutic principles: Warm middle jiao, regulate the stomach, and keep the adverse qi downwards.

Prescription: Pill for Regulating Middle Jiao

Radix Codonopsis Pilosulae 15 g
(or Radix Ginseng, 5 g)
Rhizoma Zingiberis 6 g
Radix Glycyrrhizae 5 g
Rhizoma Pinelliae 10 g
Pericarpium Citri Reticulatae 10 g
Fructus Amomi 5 g

Remarks: For cases with vomiting of watery fluid, add fructus Evodiae and Rhizoma Zingiberis Recens. For cases with epigastric dull aching, add Radix Paeoniae Alba and Radix Angelicae Sinensis. For cases with diarrhea, add Rhizoma Zingiberis Praeparata, Halloysitum Rubrum and Semen Myristicae.

F. Insufficiency of stomach-yin

Manifestations: Frequent vomiting, retching, dryness of mouth and throat, hunger but without desire for eating, red and dry tongue and thready and rapid pulse.

Therapeutic principles: Nourish stomach-yin, regulate middle jiao, and keep the adverse qi downwards.

Prescription: The Decoction of Phiopogonis

Radix Ginseng 6 g
Radix Ophiopogonis 10 g
Radix Glycyrrhizae 5 g
Rhizoma Pinelliae 10 g
Herba Dendrobii 10 g
Radix Trichosanthis 10 g

Remarks: Add Rhizoma Phragmitis, Caulis Bambusae in Taeniam and Folium Eriobotryae, decrease the dosage of Pinelliae, and increase the dosage of Dendrobii and Trichosanthis for cases with dryness of mouth due to severe impairment of yin.        

Copyright 1995 Hopkins Technology