1 Golden Chamber 3

2 Chapter 17 On Pulse Syndrome Complex and Treatment of Nausea and Vomiting, Retching and Diarrhea

3 Concepts –Vomiting: vomitting with sound and things out of mouth is named as Ou, while without sound is named as Tu –Retching: Belching –Diarrhea Combined in one chapter because: –Location: ST –Etiology: Middle Jiao dysfunction

4 Causes and pathogenesis –Water retention 【 2 】 Differential diagnosis for vomiting caused by water retention Vomiting  thirst  relief Thirst  vomiting  water retention (in Stomach) Vomiting  no thirst  water retention 支饮

5 Causes and pathogenesis –Deficient cold 【 3 】 Pathogenesis for deficiency cold in stomach –Rapid pulse  –Should be heat in stomach  »Vomiting ? »Promoting sweat  Yang deficiency »Rapid pulse  deficiency heat »deficiency cold in stomach –Wiry pulse  stomach deficiency –Vomiting »Purging  weaken the stomach  wood overacting on earth 【 5 】 Pathogenesis and prognosis for both spleen and stomach deficiency vomiting –Fu Yang pulse  Jiexi (St 41 解溪 ) –Floating  deficiency –Hesitant  spleen deficiency  fail to digestive food –Vomiting with undigested food  spleen Qi deficiency with adverse rising of stomach Qi –If see tense pulse  difficult to treat  excess cold in stomach

6 Cautions and Forbidden Stuff – 【 1 】 Treatment principle for vomiting with stomach ulcer Vomiting w/ pus – let px vomit. This is a way to eliminate the pus/pathogen accumulation. Do not treat vomiting only. – 【 6 】 Evils in upper position contraindicate to purging  not middle Jiao stagnation Vomiting No purging

7 Ou Tu Vomiting Differentiation and Treatment –Deficient cold type of vomiting Liver stomach deficient cold –Vomiting w/fullness in the chest/epigastrium area –Wu zhu yu tang 【 8 】 Evodia Decoction 吴茱萸汤 – 吴茱萸 wu zhu yu (Fructus Evodiae Rutaecarpae) – 人参 ren shen (Radix Ginseng) – 生姜 sheng jiang (Rhizoma Zingiberis Officinalis Recens) – 大枣 da zao (Fructus Zizyphi Jujubae

8 Ou Tu Vomiting Differentiation and Treatment –Deficient cold type of vomiting Extreme Yin rejects yang – severe case –Sx: Vomiting, weak pulse, no urinary difficulties, fever, cold limbs – Difficult to treat (due to severe Ki yang qi collapse) si ni tang 【 14 】 Frigid Extremities Decoction 四 逆汤 – 附子 fu zi (Radix Lateralis Aconiti Carmichaeli Praeparata) – 干姜 gan jiang (Rhizoma Zingiberis Officinalis) – 甘草 gan cao (Radix Glycyrrhizae Uralensis)

9 Ou Tu Vomiting Differentiation and Treatment –Deficient cold type of vomiting Deficient cold in Middle Jiao w/vomiting da ban xia tang 【 16 】大半夏汤 – 半夏 ban xia (Rhizoma Pinelliae Ternatae) – 人参 ren shen (Radix Ginseng) – 蜂蜜 feng mi (Honey)

10 Ou Tu Vomiting Differentiation and Treatment –Excessive heat type of vomiting Excessive heat in stomach and intestines –Vomiting right after eat d/t excess heat rejecting food da huang gan cao tang 【 17 】大黄甘草汤 – 大黄 da huang (Radix et Rhizoma Rhei) – 甘草 gan cao (Radix Glycyrrhizae Uralensis)

11 Ou Tu Vomiting Differentiation and Treatment –Excessive heat type of vomiting Heat obstructed in Shaoyang –Sx: Vomiting, fever –Rx: xiao chai hu tang 【 15 】 Minor Bupleurum Decoction 小柴 胡汤 » 柴胡 chai hu (Radix Bupleuri) » 黄芩 huang qin (Radix Scutellariae Baicalensis) » 半夏 ban xia (Rhizoma Pinelliae Ternatae) » 人参 ren shen (Radix Ginseng) » 甘草 gan cao (Radix Glycyrrhizae Uralensis) » 生姜 sheng jiang (Rhizoma Zingiberis Officinalis Recens) » 大枣 da zao (Fructus Zizyphi Jujubae

12 Ou Tu Vomiting Differentiation and Treatment –Excessive heat type of vomiting Heat type of vomiting with diarrhea, retching –Heat in ST (vomiting) and LI (diarrhea) –Damp heat diarrhea with blood and pus huang qin jia ban xia sheng jiang 【 11 】黄芩加半夏生姜汤 – 黄芩 huang qin (Radix Scutellariae Baicalensis) – 半夏 ban xia (Rhizoma Pinelliae Ternatae) – 白芍 bai shao (Radix Paeoniae Lactiflorae) – 甘草 gan cao (Radix Glycyrrhizae Uralensis) – 生姜 sheng jiang (Rhizoma Zingiberis Officinalis Recens) – 大枣 da zao (Fructus Zizyphi Jujubae

13 –Water retention type of vomiting Cold water retention –With Vomiting xiao ban xia tang 【 12 】小半夏汤 – 半夏 ban xia (Rhizoma Pinelliae Ternatae) – 生姜 sheng jiang (Rhizoma Zingiberis Officinalis Recens)

14 –Water retention type of vomiting Severe cold water retention –Vomiting with watery saliva Ban Xia Gan Jiang San 【 20 】 半夏干姜散 – 半夏 ban xia (Rhizoma Pinelliae Ternatae) – 干姜 gan jiang (Rhizoma Zingiberis Officinalis)

15 –Water retention type of vomiting water retention above diaphragm –Thirsty, drink, vomit zhu ling san fang 【 13 】猪苓散方 – 猪苓 zhu ling (Sclerotium Polypori Umbellati) – 茯苓 fu ling (Sclerotium Poriae Cocos) – 白术 bai zhu (Rhizoma Atractylodis Macrocephalae)

16 –Water retention type of vomiting Qi disorder due to water retention, vomiting with thirst –Vomiting then thirst afterwards. Fu ling ze xie tang 【 18 】茯苓泽泻汤 – 茯苓 fu ling (Sclerotium Poriae Cocos) – 泽泻 ze xie (Rhizoma Alismatis Orientalis) – 甘草 gan cao (Radix Glycyrrhizae Uralensis) – 桂枝 gui zhi (Ramulus Cinnamomi Cassiae) – 白术 bai zhu (Rhizoma Atractylodis Macrocephalae) – 生姜 sheng jiang (Rhizoma Zingiberis Officinalis Recens)

17 Yue Retching –Treatment principle 【 7 】 Based on soothing Qi stagnation. Qi stagnation causes ST qi to go upward. Retching and hiccups are related. Hiccups are usually due to Liver and diaphragm spasms.

18 Yue –Differentiation and Treatment Stomach cold with qi disorder –Retching and cold extremities Ju Pi Tang 【 22 】橘皮汤 – 橘皮 ju pi (pericarpium Citri Reticulatae ) – 生姜 sheng jiang (Rhizoma Zingiberis Officinalis Recens)

19 –Differentiation and Treatment with stomach heat –Retching –Restlessness –Thirst –Rapid pulse Ju Pi Zhu Ru Tang 【 23 】 橘皮竹茹汤 – 橘皮 ju pi (pericarpium Citri Reticulatae ) – 竹茹 zhu ru (caulis bambusae in taeniis ) – 大枣 da zao (Fructus Zizyphi Jujubae ） – 人参 ren shen (Radix Ginseng) – 生姜 sheng jiang (Rhizoma Zingiberis Officinalis Recens) – 甘草 gan cao (Radix Glycyrrhizae Uralensis) Yue

20 Xia Li Diarrhea Treatment principles and contraindication –Damp type—promote urination 【 31 】 –Contraindication to deficient cold type—do not promote sweating 【 33 】

21 Differentiation and Treatment –Deficient cold type Deficient cold type of diarrhea with exterior syndrome –Rescue interior first si ni tang 【 36 】 Frigid Extremities Decoction 四逆汤 – 附子 fu zi (Radix Lateralis Aconiti Carmichaeli Praeparata) – 干姜 gan jiang (Rhizoma Zingiberis Officinalis) – 甘草 gan cao (Radix Glycyrrhizae Uralensis) Gui Zhi Tang 【 36 】 –Cinnamon Twig Decoction 桂枝汤 (Gui Zhi Tang).  regulate Ying and Wei » 桂枝 gui zhi (Ramulus Cinnamomi Cassiae) » 白芍 bai shao (Radix Paeoniae Lactiflorae) » 甘草 gan cao (Radix Glycyrrhizae Uralensis) » 生姜 sheng jiang (Rhizoma Zingiberis Officinalis Recens) » 大枣 da zao (Fructus Zizyphi Jujubae)

22 Differentiation and Treatment –Deficient cold type Extreme yin rejects yang –Diarrhea, sweating, cold extremities Tong Mai Si Ni Tang 【 45 】通脉四逆汤 – 附子 fu zi (Radix Lateralis Aconiti Carmichaeli Praeparata) – 干姜 gan jiang (Rhizoma Zingiberis Officinalis)  double dosage – 甘草 gan cao (Radix Glycyrrhizae Uralensis)

23 Differentiation and Treatment –Excessive heat type – 大承气汤 Da Cheng Qi Tang 【 37 】【 38 】【 39 】 【 40 】 – 大黄 da huang (Radix et Rhizoma Rhei) – 厚朴 hou po (Cortex Magnoliae Officinalis) – 枳实 zhi shi (Fructus Immaturus Aurantii) – 芒硝 mang xiao (Mirabilitum) – 小承气汤 Xiao Cheng Qi Tang 【 41 】 – 大黄 da huang (Radix et Rhizoma Rhei) – 厚朴 hou po (Cortex Magnoliae Officinalis) – 枳实 zhi shi (Fructus Immaturus Aurantii)

24 Differentiation and Treatment –Diarrhea with pus and blood Deficient cold –Diarrhea with pus and blood 桃花汤 Tao Hua Tang 【 42 】 – 赤石脂 chi shi zhi (hallyositum rubrum ) – 干姜 gan jiang (Rhizoma Zingiberis Officinalis) – 粳米 geng mi (rice)

25 Differentiation and Treatment –Diarrhea with pus and blood Heat toxin type of diarrhea with tenesmus –Fever, thirst, tenesmus, blood in stool with more blood than pus –Red tongue, yellow coating – rapid pulse Bai Tou Wen Tang 【 43 】白头翁汤 – 白头翁 bai tou weng (Radix Pulsatillae Chinensis ) – 黄连 huang lian (rhizoma coptidis chinesis ) – 黄柏 huang bai (cortex phellodendri ) – 秦皮 qin pi (Cortex Fraxini )

26 Differentiation and Treatment –Diarrhea with pus and blood diarrhea with restlessness Zhi Zi Chi Tang 【 44 】栀子豉汤 – 栀子 zhi zi （ gardeniae jasminoidis ） – 淡豆豉 dan dou chi （ Semen Sojae Praeparatum ）