Pagpapakahulugan ng Mga Uri ng Vomiting sa TCM
【Mga Katangian ng Reaksyon】
Ang vomiting sa klinika ay may iba't ibang katangian, maaaring maging dry heaves, walang ingay na pagboto, malakas na pagboto, o kahit pagboto tulad ng spray; maaaring magboto agad pagkatapos kumain, o ilang oras pagkatapos, o hindi kumain at nagboto; maaaring magboto ng bagong kainan, o hindi na-naboto na food, o magboto ng saliva; ang dami ng bote ay maaaring maliit o maliit. Ang vomiting ay madalas may trigger, tulad ng pagkakaroon ng special odor, hindi pantay na pagkain, emotional stress, at hindi angkop na temperature, lahat ay maaaring mag-trigger o mapalala ang vomiting. Madalas kasama ang karamdaman tulad ng tightness sa tiyan, loss of appetite, acid reflux, etc. Ang vomiting ay madalas nangyayari nang random, ngunit maaari rin itong mag-umpisa nang paulit-ulit. Ang mga katangian ay iba’t iba depende sa kahinaan, init, kahinaan, at kalakasan.
【Pagpapakahulugan at Paggamot】
1. External Pathogens Invading the Stomach
Symptoms: sudden vomiting, acute onset, usually accompanied by fever, chills, headache, body pain, chest fullness, lack of appetite, white tongue coating, soft and slow pulse.
Treatment: Release exterior pathogens, harmonize the stomach, reverse downward flow.
Formula: Huoxiang Zhengqi San. Ingredients: Huoxiang, Zi Su, Bai Zhi – fragrant to transform turbidity, dispel exterior pathogens; Da Fu Pi, Hou Po – regulate qi, relieve fullness; Bai Zhu, Fu Ling, Gan Cao – strengthen spleen, dry dampness; Chen Pi, Ban Xia – harmonize stomach, reverse downward flow. Together, they have the effect of releasing exterior pathogens and harmonizing the stomach to stop vomiting. If wind-cold is dominant, no sweat, add Jing Jie, Fang Feng to disperse wind and cold; if summer-dampness invades the stomach, fever with sweating, use Xin Jia Xiang Ru Yin to clear summer and transform dampness; if foul air invades the stomach, severe vomiting, take Yu Shu Dan orally to expel foulness and stop vomiting; if wind-heat invades the stomach, headache, fever, use Yin Qiao San without Jiegeng (to avoid upward movement), add Chen Pi, Zhu Ru to clear heat and harmonize the stomach; if there is food stagnation, bloating, belching, sour taste, remove Bai Zhu, Gan Cao, add Shen Qu, Ji Nei Jin, Lai Fu Zi to eliminate accumulation and aid digestion; if summer-heat invades the stomach, high fever, thirst, use Huang Lian Jie Du Tang.
2. Food Stagnation
Symptoms: vomits sour and rotten food, abdominal distension, belching, worse after eating, feels better after vomiting, stool either loose or hard, foul smell, thick greasy coating, slippery and forceful pulse.
Treatment: Eliminate food stagnation, harmonize the stomach, reverse downward flow.
Formula: Bao He Wan. Ingredients: Shen Qu, Shan Zha, Lai Fu Zi – eliminate food stagnation; Chen Pi, Ban Xia, Fu Ling – harmonize stomach, reverse downward flow; Lian Qiao – clear accumulated heat. If stagnation turns to heat, abdominal distension, constipation, use Xiao Cheng Qi Tang to clear the bowels and purge heat, so that turbid matter descends and vomiting stops automatically; if food is vomited immediately, mouth odor, thirst, gastric heat rising, use Zhu Ru Tang to clear stomach and reverse downward flow; if contaminated or spoiled food is eaten, abdominal pain, unable to vomit, use burning salt formula or Guati San to induce vomiting and expel pathogens. Other options include Zhi Shi Dao Zhi Wan, Ji Shu Wan.
3. Phlegm-Dampness Accumulation Inside
Symptoms: vomiting mostly clear phlegm or saliva, chest and abdomen fullness, lack of appetite, dizziness, palpitations, or vomiting with rumbling sounds in the intestines, white greasy coating, slippery pulse.
Treatment: Warm and transform phlegm-dampness, harmonize stomach, reverse downward flow.
Formula: Xiao Ban Xia Tang combined with Ling Gui Zhu Gan Tang. Ingredients: Ginger, Ban Xia – harmonize stomach, reverse downward flow; Fu Ling, Gui Zhi, Bai Zhu, Gan Cao – warm spleen, transform dampness. If qi stagnation causes abdominal pain, add Hou Po, Zhi Ke to move qi and relieve fullness; if spleen is weakened, bloating, lack of appetite, add Sha Ren, Bai Dou Kou, Cang Zhu to open stomach and awaken spleen; if phlegm blocks clear yang, dizziness, use Ban Xia Bai Zhu Tian Ma Tang; if phlegm turns to heat, irritability, bitter taste, use Huang Lian Wen Dan Tang to clear heat and resolve phlegm. Other options include Er Chen Tang, Gan Sui Ban Xia Tang.
4. Liver Qi Invading the Stomach
Symptoms: vomiting with sour regurgitation, frequent belching, chest and flank distension, irritability, worsens with emotional stress, red edges of tongue, thin greasy coating, wiry pulse.
Treatment: Soothe liver, regulate qi, harmonize stomach, stop vomiting.
Formula: Si Ni San combined with Ban Xia Hou Pu Tang. Ingredients: Chai Hu, Zhi Ke, Bai Shao – soothe liver, regulate qi; Hou Po, Zi Su – move qi, relieve depression; Ban Xia, Fu Ling, Sheng Jiang, Gan Cao – harmonize stomach, reverse downward flow, stop vomiting. If qi stagnation turns to fire, irritability, bitter taste, dry mouth, combine with Zuo Jin Wan to clear heat and stop vomiting; if there is qi stagnation and no bowel movement, constipation, use Da Chai Hu Tang to clear heat and purge bowels; if qi stagnation leads to blood stasis, stabbing pain in flanks, use Ge Xia Zhu Yu Tang to activate blood and remove stasis. Other options include Yue Ju Wan, Chai Hu Shu Gan San.
5. Spleen-Stomach Deficiency
Symptoms: easily vomits even with minor dietary indiscretion, intermittent episodes, poor appetite, food hard to digest, abdominal fullness, bland taste, pale complexion, fatigue, loose stools, pale tongue, thin white coating, weak and soft pulse.
Treatment: Tonify qi, strengthen spleen, harmonize stomach, reverse downward flow.
Formula: Xiang Sha Liu Jun Zi Tang. Ingredients: Ren Shen, Fu Ling, Bai Zhu, Gan Cao – strengthen spleen and tonify qi; Sha Ren, Mu Xiang – regulate qi, harmonize middle burner; Chen Pi, Ban Xia – harmonize stomach, reverse downward flow. If spleen yang is deficient, cold limbs, add Fu Zi, Gan Jiang, or use Fu Zi Li Zhong Wan to warm and strengthen spleen; if stomach deficiency leads to upward rebellion, hard feeling in the epigastrium, belching with food odor, use Xuan Fu Dai Zhe Tang to reverse downward flow and stop vomiting. If central qi is severely depleted, fatigue, use Bu Zhong Yi Qi Tang to tonify central qi; if long-term illness affects kidney, kidney yang deficiency, sore back and legs, cold sweats, use Fu Zi Li Zhong Tang with Rou Gui, Wu Zhu Yu to warm and tonify spleen and kidney. Other options include Shen Ling Bai Zhu San, Qi Wei Bai Zhu San.
6. Stomach Yin Deficiency
Symptoms: recurrent vomiting, but small amount, or only spitting saliva, occasional dry heaves, dry mouth and throat, hunger-like sensation but no desire to eat, red tongue with little moisture, fine and rapid pulse.
Treatment: Nourish stomach yin, reverse downward flow, stop vomiting.
Formula: Mai Men Dong Tang. Ingredients: Ren Shen, Mai Men Dong, Jing Mi, Gan Cao – nourish stomach yin; Ban Xia – reverse downward flow, stop vomiting. If yin deficiency is severe, five palms feel hot, add Shi Gao, Hua Fen, Zhi Mu to nourish yin and clear heat; if vomiting is severe, add Ju Pi, Zhu Ru, Pi Pa Ye; if constipation due to yin deficiency, add Huo Ma Ren, Gu Lou Ren, Bai Mi to moisten intestines and promote bowel movement. Other options include Yi Wei Tang, Zhu Ye Shi Gao Tang.
【Prognosis and Outcome】
In general, real syndrome vomiting has short duration, mild condition, easy to cure; while deficiency and mixed deficiency-real syndromes have longer duration, heavier condition, recurring episodes, harder to treat. If neglected or improperly treated, it may turn from real to deficiency, mixed deficiency-real, from mild to severe, prolonged vomiting leading to spleen-stomach failure, insufficient source of transformation, prone to complications. Therefore, vomiting should be promptly diagnosed and treated to prevent damage to the foundation of life. Vomiting occurring during other diseases should also be taken seriously.
【Prevention and Care】
Avoid exposure to wind-cold, summer-heat, dampness, or foul air; avoid emotional stress; avoid eating fishy or foul foods; avoid binge eating; avoid raw, cold, spicy, and stimulating foods. Patients with severe vomiting should rest in bed.