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Internal Medicine – Stomach Disorders

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Abdominal Pain

Acid Reflux

Constipation

Diarrhea

Dysphagia

Hiccup

Stomach Ache

Upset Stomach

Vomiting

Important: as with all items posted on TCM Health-info, it is very strongly recommended that you seek proper advise from your healthcare professional before administering any form of treatment to yourself.  This website is for informational purposes and does not replace the proper diagnosis of your physician. 

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

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

Differentiate:

            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

Excess Cold

acute  severe abdominal pain with constipation, pain below hypochondriac region, cold hands/feet

T– white coating                                               P - wiry / tense

Treatment:        Warm up internal region, expel cold, induce bowel movements to relieve pain.

Formula:           Da Huang Fu Zi Tang

Deficient Cold

dull chronic abdominal pain, ameliorated by warmth and pressure, middle jiao yang def. symptoms (cold abdomen limbs, poor appetite, soft stool)

T - Pale                                                            P – weak, thin

Treatment:        warm middle jiao, nourish spleen, harmonize middle jiao qi to relieve pain.

Formula:           Huang Qi Jian Zhong Tang

Excess Heat

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.

T  – red with dots, brown-yellow coating          P - forceful, excessive

Treatment:        induce bowel movement to purge fire and relive pain.

Formula:           Cheng Qi Tang (base formula for excess heat)

Qi Stagnation

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

            T – red                                                 P - wiry

Treatment:        regulate Qi and sooth liver to relieve pain

Formula:           Chai Hu Shi Gan Tang

Blood Stasis        (masses in abdomen)

Fixed pain in the abdomen accompanied with stabbing pain and masses which do not move

T - purple                                                        P – wiry, un-even

Treatment:        promote blood circulation and remove blood stasis

Formula:           Xiao Fu Zhu Yu Tang   

Food Retention

pain in abdomen due to diet, pain ameliorated with bowel movement, aggravated by constipation, acid regurgitation, poor appetite

T - thick greasy coating             P – slippery

Treatment:        promote digestion, remove food retention to relieve pain

Formula            Bao He Wan     (base formula for food retention)

Acid Reflux – Tu Suan

Top of the Document

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

Western Medicine:

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

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

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

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

Constipation – Bian Bi

Top of the Document

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

Heat

Coconstipation with abdominal pain and fullness with heat signs (fever, yang ming

 heat symptoms, sweating …)

                                                T -  red , yellow coat                            P - forceful, slippery

                        Treatment:        purge bowels to purge fire

                        Formula            Chen Qi Tang (base formula for Heat)

Pi Yue

            Frequent urination with constipation, stomach heat symptoms, dry mouth, bad breath, hot sensation, sticky feeling in mouth, good appetite

                        T -  red, dry coat                                              P - slippery, rapid

            Treatment:        clear stomach heat, lubricate intestines, relieve constipation

            Formula            Ma Zi Ren Wan

Qi Stagnation

            Dry stools, want to pass stool but cannot, do not have the energy to push, frequent belching, fullness in abdomen and hypochondriac region.

                        T - thin, greasy coat                                          P -  wiry

Treatment:        promote Qi circulation, remove Qi stagnation to promote bowel movements.

Formula            Liu Mo Tang

Accumulation of Wind

            Numbness and tingling of limbs, wind symptoms

                        T – normal, red                                     P - floating, wiry, thin

            Treatment:        eliminate wind to relive constipation

            Formula            Xiao Xu Ming Tang

Food Retention

Poor diet history, food retention symptoms with constipation, fullness in stomach, belching, acid regurgitation, nautious, hard/distended abdomen

            T - thick coat                                                    P - slippery, wiry

Treatment:        promote digestion, regulate stomach Qi to relieve constipation.

Formula            Bao He Wan & Da Huang

Phlegm Causing Constipation

Hot type of dyspnea and asthma, cough with phlegm, fullness in chest, steaming head syndrome (sweating on head)

                T - red, yellow coat                                          P - slippery, rapid

Treatment:        eliminate phlegm and promote lung function, disperse lung Qi.

Formula            Yue Bi (Bei) Jia Ban Xia Tang

Qi Deficiency

Feels they have no force to push stool out, while passing stool sweating and shortness of breath present, general Qi deficiency present

                        T – pale, puffy                                      P -  weak

            Treatment:        nourish Qi to lubricate intestines and relieve constipation

            Formula            Huang Qi Tang (spleen tonic)

Blood Deficiency

Sheep poop stools (rabbit like droppings – dark/hard), blood deficiency symptoms, dull yellow complexion, palpitations, dizzy, blurred vision.

                        T - pale                                                            P - thin

Treatment:        nourish blood to lubricate intestines and relieve constipation

Formula            Run Chang Wan

Yin Deficiency

            Yin deficiency symptoms with dry stools

                        T -  red, scanty coat                                         P -  thin, rapid

            Treatment:        nourish yin, lubricate bowels to relieve constipation

            Formula            Liu Wei Di Huang Wan

Kidney Yang Deficiency

            Difficulty pushing stool out (Qi Def.) with yang deficiency signs (cold signs)

                        T – pale, puffy                                      P – deep, weak

            Treatment:        warm up kidney yang to strengthen bowels.

            Formula            Shen Qi Wan

                                    Wu Ren Wan (elderly)

Stagnation of Cold

Dry or not dry stool with difficulty passing, cold pain, fullness in abdomen ameliorated by warmth, lower back cold sensation

                        T - white coat                                                   P - deep, delayed

            Treatment:        expel cold to induce bowel movement

            Formula            Ji Sheng Jian

Diarrhea – Xie Xie

Top of the Document

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:                               Impairs 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

                        Diarrhea:          watery, frothy diarrhea

Dysfunction of in testiness, water retained, always has borborygmi, emaciation, bloated abdomen, scanty urine, thirsty

            T – pale, swollen, teeth marks               P - soft, slippery

Treatment:        invigorate spleen function to eliminate dampness

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

Dysphagia – Ye Ge

Top of the Document

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

Hiccup – E Ni

Top of the Document

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

Western Medicine:

            Kidney Disorders with hiccup is Bad News

Irregular Diet              -eating 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

Stomach Ache - Wei Wan Tong

Top of the Document

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

                                                                                                            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

Upset Stomach – Fan Wei

Top of the Document

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.

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

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 – Ou Tu

Top of the Document

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

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)

Exterior Pathogens Invade Stomach

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                                          P - wiry

            - red on sides = heat

            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

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