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TCVM Treatment for Vomiting

TCVM Treatment for Vomiting

Acupuncture and herbal medicine treatments for common vomiting patterns

Author: Dr. Ronald Koh/Monday, April 1, 2013/Categories: TCVM Articles, TCVM Newsletter, 2013 Spring Issue

The Stomach and Spleen occupy the central position in the Middle Burner (Zhong Jiao) and are at the center of all Qi pathways of other organs. The Stomach controls the ‘Rotting and Ripening’ of food, which paves the way for the Spleen to extract the Gu Qi (food Qi) and refined essence from food. Stomach also sends the food down to Small Intestine for further separation. The Spleen is the central Organ in production of Qi. Its most important function is ‘Transporting and Transforming’ food and fluids. Food Qi and fluids are then transported upward to the Lung in the Upper Burner (Shang Jiao) for distribution to the entire body. Therefore, in the body, Stomach Qi descends or moves downwards whereas Spleen Qi ascends or moves upwards.

A failure of the smooth flow of Stomach Qi results in Stomach Qi Stagnation or Stomach Qi rebelling upwards. This disrupted function often leads to nausea and vomiting. The common causes of rebellious Stomach Qi can be categorized as Excess or Deficiency patterns. Excess patterns include Cold or Heat invading the Stomach, Food Stagnation, or Liver Qi Stagnation. Deficiency patterns include Spleen Qi/Yang Deficiency or Stomach Yin Deficiency. Acupuncture and herbal medicine treatments for common vomiting patterns are shown in Table 1 (at the end of the page).

 

PATTERN DIFFERENTIATION AND TREATMENT

1. Disruption of stomach by exogenous pathogenic factors

Exogenous pathogenic Qi, especially Wind-Cold and Summer Heat, invades the stomach from the skin, mouth, or nose leading to Stomach Qi obstruction and prevents Stomach Qi from descending, leading to vomiting. Vomiting usually happens in a sudden acute fashion, especially after changes in weather or season. Sudden changes of temperature, such as exposure to cold indoors after a long walk in hot weather outdoors, or vice versa, could also lead to disruption of Stomach Qi.

1a. Heat invading the stomach
The common clinical manifestations are vomiting of food soon after eating, and aversion to heat (under the sun). If Stomach Heat or Fire occurs, then the patient may become thirsty with a desire to drink cold water, hunger easily and eat a lot, prefer lying on a cool floor, exhibit bad breath, and have dry stool.
Tongue: normal to red color with dry coating; red in the center with dry yellow coating if Stomach Heat/Fire occurs.

Pulse: superficial/floating and rapid; may be slightly overflowing on the right middle (SP/ST) position.

Note: prolonged Heat in the stomach may lead to Stomach Heat or Fire. After a period of time, Stomach Heat or Fire may result in Stomach Yin Deficiency because Heat dries up the body fluid of the stomach.

Acupuncture Treatment: PC-6, BL-14, ST-36, BL-20,   BL-21, ST-25, CV-12, LI-4, LI-11, GV-14, ST-44.
•    PC-6 and BL-14 calm the Shen and stop vomiting.
•    ST-36 stimulates the descension of Stomach Qi.
•    BL-20 and BL-21 regulate the normal Qi flow of the Spleen and Stomach.
•    ST-25 and CV-12 subdue rebellious Stomach Qi.
•    LI-4, LI-11, and GV-14 clear Heat.
•    ST-44 clears Stomach Heat.

Herbal Medicine: Huo Xiang Zheng Qi Wan. Add Qing Wei San if Stomach Heat/Fire occurs.

1b. Accumulation of Wind-Cold in the stomach
The common clinical manifestations are sudden vomiting of clear water long after eating or upon exposure to cold, sudden stomach pain (palpation reveals cranial abdomen pain), and aversion to cold and wind.
Tongue: normal to pale color with thick white coating.
Pulse: superficial/floating, tight and slow; tight on the right middle (SP/ST) position.
Note: prolonged Cold in the stomach may lead to Stomach Qi Deficiency because Cold injures Yang energy.

Acupuncture Treatment: PC-6, BL-14, ST-36, BL-20, BL-21, ST-25, CV-12, ST-21, ST-34, GB-34, SP-4, LI-4, BL-10.
•    PC-6 and BL-14 calm the Shen and stop vomiting.
•    ST-36 stimulates the descending of Stomach Qi.
•    BL-20 and BL-21 regulate the normal Qi flow of the Spleen and Stomach.
•    ST-25 and CV-12 subdue rebellious Stomach Qi.
•    ST-21, ST-34, GB-34 and SP-4 relieve Stagnation (stomach pain).
•    LI-4 and BL-10 dispel Wind-Cold.
•    Moxa can be used at ST-21, ST-25, CV-12, and BL-21 to dispel Cold and warm the stomach.

Herbal Medicine: Huo Xiang Zheng Qi Wan. Add Ju Pi San if Stomach pain is severe.

 

2. Obstruction of stomach by food retention
Overfeeding or overeating of raw, cold, fatty, or dairy food, could lead to retention of food in the stomach and inability of the Stomach Qi to descend, which may go adversely upward and induce vomiting. Chronic Spleen Qi Deficiency could also cause food retention in the stomach due to the impairment of the digestive function.

The common clinical manifestations are vomiting after food intake, vomiting of undigested food with sour or foul smell, abdominal distention with or without pain (relieved by vomiting), foul breath, poor appetite (improved after vomiting), and loose stool or constipation.
Tongue: normal color with greasy thick white coating; tongue may be red with yellow coating if Stomach Heat/Fire also occurs.
Pulse: full and slippery; pulse is also fast if Stomach Heat/Fire occurs.
Note: prolonged food retention may generate Heat leading to Stomach Heat/Fire or the formation of Dampness or Phlegm.

Acupuncture Treatment: PC-6, BL-14, ST-36, BL-20. BL-21, ST-25, CV-12, ST-21, ST-34, GB-34, SP-4, ST-19, ST-37, ST-44.
•    PC-6 and BL-14 calm the Shen and stop vomiting.
•    ST-36 stimulates the descension of Stomach Qi.
•    BL-20 and BL-21 regulate the normal Qi flow of the Spleen and Stomach.
•    ST-25 and CV-12 subdue rebellious Stomach Qi.
•    ST-21, ST-34, GB-34 and SP-4 relieve Stagnation (stomach pain).
•    ST-19 is specific to resolving the retention of food.
•    ST-37 is a lower He-sea point for loose stool or constipation.
•    ST-44 clears Stomach Heat and Stagnation.

Herbal Medicine: Bao He Wan. Add Four Gentlemen if   there is Spleen Qi deficiency.

 

3. Disruption of stomach by Liver Qi Stagnation
Stress, depression, and emotional disturbances, such as anxiety, frustration and anger, can all constrain Liver Qi movement. When Liver Qi becomes stagnated, it moves abnormally and injures the Stomach (Cheng cycle) causing Stomach Qi to fail to descend normally, leading to rebellious Stomach Qi and vomiting. Alternately, severe or chronic stagnant Liver Qi may turn into Liver Heat or Fire and force  Stomach Qi to move upwards, thus inducing vomiting.

The common clinical manifestations are vomiting a small amount of stomach content (sour smell), yellow water or bile fluid; exhibiting a Wood personality, hyperactive behavior, or irritability; or having a flank or chest that is sensitive to palpation. Eyes may be red if there is Liver Heat/Fire. Loose stool or diarrhea occurs if stagnant Liver has also over-controlled and injured the Spleen.
Tongue: red on the sides or purple color.
Pulse: wiry; wiry on both middle positions; pulse is fast if Liver Heat/Fire occurs.
Note: If Liver Qi Stagnation persists for a long time, it may weaken the stomach leading to Stomach Qi or Yin Deficiency.

Acupuncture Treatment: PC-6, BL-14, ST-36, BL-20,    BL-21, ST-25, CV-12, LIV-3, GB-34, GB-41, BL-18, BL-19, LIV-14, HT-7.

•    PC-6 and BL-14 calm the Shen and stop vomiting.
•    ST-36 stimulates the descension of Stomach Qi.
•    BL-20 and BL-21 regulate the normal Qi flow of the Spleen and Stomach.
•    ST-25 and CV-12 subdue rebellious Stomach Qi.
•    LIV-3, GB-34 and GB-41 soothe Liver Qi and resolve Liver Qi Stagnation.
•    BL-18 and BL-19 regulate Liver Qi flow.
•    LIV-14 harmonizes Liver and Stomach.
•    HT-7 calms the Shen.

Herbal Medicine: Liver Happy or Chai Hu Shu Gan Tang. Use Xiao Yao San if loose stool or diarrhea occurs.

 

4. Stomach Qi Deficiency due to Spleen Qi/Yang Deficiency
Any Excess patterns in the stomach may, after a period of time, weaken the Spleen leading to Spleen Deficiency. Deficiency patterns such as Kidney or heart Deficiency may also lead to deficient Spleen if left untreated for some time. Spleen Qi or Yang Deficiency frequently leads to the pattern of   Stomach Qi Deficiency. Deficient Stomach Qi will then fail to descend, causing vomiting.

The common clinical manifestations of Spleen Qi/Yang Deficiency are chronic and intermittent vomiting, vomitus containing clear water or saliva, fatigue or general weakness, weak limbs, loose stool with undigested grain, poor appetite, abdominal discomfort (relieved by massage). Yang Deficiency of Spleen gives rise to interior Cold; hence there is also coldness at ears, nose and extremities, edema at ventral thoraco-abdominal area, and warm-seeking.
Tongue: pale and wet with white and moist coating; may see  swollen edges +/- tooth-marked, and/or quivering tongue.
Pulse: deep and weak, especially on the right side or the right middle (SP/ST) position.
Note: prolonged Stomach Qi Deficiency will lead to Stomach Yin Deficiency. Both Stomach and Spleen Deficiencies may also lead to Dampness or Phlegm after a period of time.

Acupuncture Treatment: PC-6, BL-14, ST-36, BL-20,     BL-21, ST-25, CV-12, Bai-hui, GV-3, GV-4, Pi-shu,           Qi-hai-shu, CV-4, CV-6.
•   PC-6 and BL-14 calm the Shen and stop vomiting.
 •  ST-36 stimulates the descending of Stomach Qi.
•    BL-20 and BL-21 regulate the normal Qi flow of the Spleen and Stomach.
•    ST-25 and CV-12 subdue rebellious Stomach Qi
•    Bai-hui, GV-3, and GV-4 warm Yang.
•    Pi-shu and Qi-hai-shu are the classical points to strengthen the  Spleen in horses.
•    CV-4 and CV-6 are general Qi tonic points for cats and dogs.
•    Moxa can be given at Bai-hui, GV-3, GV-4, CV-4, CV-6, Pi-shu, or Qi-hai-shu to warm Yang, and ST-25, CV-12, or BL-21 to stop vomiting.

Herbal Medicine: Xiang Sha Liu Jun Zi Tang (Eight Gentlemen). Add Shen Ling Bai Zhu if loose stool or diarrhea occurs.

 

5. Deficiency of Stomach Yin
As mentioned above, Stomach Heat or Liver Qi Stagnation can lead to Stomach Yin Deficiency if it persists over a period of time. Stomach Qi Deficiency from deficient Spleen may also lead to Stomach Yin Deficiency if left untreated. Irregular eating habits such as eating too fast, excessive vomiting, or chronic vomiting can damage Stomach Qi and further lead to Stomach Yin Deficiency. Hence, deficient Stomach fails to descend Qi, causing vomiting.  

The common clinical manifestations are chronic and intermittent vomiting in small amounts, vomitus containing sticky foam, lack of appetite or slight hunger with no desire to eat, dry mouth but no thirst, dry and small feces, pain upon abdominal palpation, and five-palm Heat (warm to the touch on chest area and four paws).
Tongue: red with a little dry coating or without coating,         especially on the center.
Pulse: thready and rapid.
Note: Stomach Yin Deficiency often leads to Kidney Yin Deficiency if present for some months or years.

Acupuncture Treatment: PC-6, BL-14, ST-36, BL-20,     BL-21, ST-25, CV-12, BL-17, SP-10, KID-3, SP-6, SP-9.
•    PC-6 and BL-14 calm the Shen and stop vomiting.
•    ST-36 stimulates the descension of Stomach Qi.
•    BL-20 and BL-21 regulate the normal Qi flow of the Spleen and Stomach.
•    ST-25 and CV-12 subdue rebellious Stomach Qi
•    BL-17 and SP-10 are common points to nourish Blood and Yin.
•    KID-3, SP-6, and SP-9 nourish Yin.

Herbal Medicine: Stomach Happy. Add Four Gentlemen if there is Spleen Qi deficiency.

TABLE 1. ACUPUNCTURE AND HERBAL SELECTIONS FOR COMMON VOMITING PATTERNS

PATTERN TYPE
Invasion of Xie Qi in stomach
Food Stagnation
Liver Qi Stagnation
Spleen Qi/Yang Deficiency
Stomach Yin Deficiency
Summer Heat
Winter Cold
Vomiting Patterns
Sudden onset of vomiting especially after weather/seasonal changes or travels.
Heat: vomiting of food soon after eating
Cold: vomiting of clear water long after eating or on exposure to Cold
Vomiting after eating; vomiting of undigested food with sour or foul smell

Vomiting small amount of stomach content (sour smell), yellow or bile fluid   
Chronic & intermittent vomiting,  vomitus contains clear water or saliva   
Chronic & intermittent vomiting with small amounts, vomitus often contains sticky foam
Clinical Signs
Aversion to Heat;
ST Heat/Fire: thirsty with a desire to drink cold water, hungry easily and eats a lot, prefer  lying on a cool floor, bad breath, dry stoo
Aversion to cold & wind, sudden   stomach pain
Abdominal distention (relieved by vomiting), foul breath, poor        appetite (improved after vomiting) Flank or chest is sensitive to palpation. Eye may be red if there is Liver Heat or Fire   

Fatigue, weak limbs, poor appetite, abdominal discomfort (relieved by massage);
Yang Deficiency: Cold ears, nose & extremities, edema at ventral thoraco-abdominal area, warm-seeking

Lack of appetite or slight hunger with no desire to eat, dry mouth but no thirst, pain on abdominal palpation, five-palm Heat   
Defecation Normal to dry stool
Normal to loose stool
Loose stool or   constipation   
Normal; Loose stool or diarrhea if SP Deficiency occurs
Loose stool with undigested grain
Dry and small feces   

Pulse Superficial/floating & rapid;
Slightly strong on SP/ST position
Superficial/floating, tight & slow;
Tight on SP/ST  position   

Full & slippery;
Fast if Stomach Heat occurs
Wiry; Fast if Liver Heat/Fire occurs;
Wiry on both     middle positions
Deep and weak;
Weaker on right side or SP/ST     position.   

Tongue Normal-red with dry coating;
ST Heat/Fire: red in the center with dry yellow coating   
Normal-pale with thick white coating   

Normal-red with greasy and thick coating   
Red or purple on the sides
Pale & wet with white & moist  coating
Red with little dry coating or without coating 
Energy Level
Normal Normal
Normal to            decreased
Hyperactive,        irritable
Fatigue, weakness
Normal
Common Acupoints
PC-6, BL-14, ST-36, BL-20, BL-21, ST-25, CV-12
Additional Acupoints LI-4, LI-11, GV-14, ST-44
ST-21, ST-34,   GB-34, SP-4, LI-4, BL-10   
ST-21, ST-34,   GB-34, SP-4, ST-19, ST-37, ST-44   
LIV-3, GB-34,   GB-41, BL-18, BL-19, LIV-14, HT-7    

Bai-hui, GV-3,   GV-4, CV-4, CV-6, Pi-shu, Qi-hai-shu
BL-17, SP-10, KID-3, SP-6, SP-9   
Herbal Medicine Huo Xiang Zheng Qi Wan. Add Qing Wei San if ST Heat/Fire occurs.
Huo Xiang Zheng Qi Wan. Add Ju Pi San in severe stomach pain.
Bao He Wan. Add Four Gentlemen if there is SP Qi deficiency. 
Liver Happy. Use Xiao Yao San if loose stool or diarrhea occurs
Xiang Sha Liu Jun Zi Tang. Add Shen Ling Bai Zhu if loose stool or diarrhea occurs
Stomach Happy. Add Four Gentlemen if there is SP Qi deficiency.


General Dosage: Dogs and cats - 0.5 gram per 10 pounds body weight twice daily

                           Horses: 15-30 grams twice daily

Note: It is important to keep in mind that any Excess pattern can transform into Deficiency patterns if left untreated for a period of time, and that mixed Excess-Deficiency illnesses are also common.  Treat both patterns using a combination of herbal formulas or acupoints.

References:
1.    Xie H, Priest V. Xie’s Veterinary Acupuncture. Ames, Iowa: Blackwell Publishing 2007:276-278.
2.    Hu Jinsheng. Acupuncture Treatment of Vomiting. Journal of Traditional Chinese Medicine 2008; 28(1): 75-78.
3.    Schoen AM. Veterinary Acupuncture : ancient art to modern medicine. St. Louis, Mo.: Mosby, 2001: 250-252.
4.    Maciocia G. The foundations of Chinese medicine : a comprehensive text for acupuncturists and herbalists 2nd Ed. Edinburgh; New York: Churchill Livingstone, 2005: 325-327.
5.    Liu Z. Essentials of Chinese medicine. New York; London: Springer, 2009: 95-102.
6.    Xie H, Preast V. Xie’s Chinese Veterinary Herbology. Ames. IA: Wiley-Blackwell, 2010: 565-567.


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