1. Vomiting TCM Diagnoses and Treatments dysfunction of the descending of the stomach, reverse flow of Qi including the food in the stomach adversely going up, through the mouth going out. Vomiting with sound & without food -- retching Vomiting without sound & food – nausea Neuropathic vomiting Etiology & Pathology: 1. Inversion of Exopathogen factors 2. Improper diet 3. Emotional disorder 4. Sp. & St. def.

2. Main Points for differentiationMain Points for differentiation Location: St. & Intestine: Liver & GB Spleen & Kidney Heart & Brain Excess or Def. Cold or Heat

3. TreatmentExcess 1). Exopathogens invading the Stomach. Signs & Symptoms: –Main Sym. : sudden vomiting obviously related with external factors –Concurrent sym.: affected by wind or cold, or summer- dampness –Tongue: –Pulse: floating, slippery and rapid or weak Treatment Protocol: –Removing pathogens –Relieving exterior sym –Regulating the function of St.

4. Formula: Modifications: wind-cold: -- Dan Dou Chi, Shen Jiang, Fang Feng Wind-heat -- Jing Jie, Bo He, Lu Geng Summer-Heat -- Huo Xiang, Pei Lan, He ye, Liu Yi San Xiang Su San Xiang FuZi Su GengZi Su YeChen piGan Cao

5. TreatmentExcess 2). Food retention or indigestion Signs & Symptoms: –Main Sym. : vomiting indigestion food, more sever after meal, and comfort after vomiting –Concurrent sym.: distension and fullness in the stomach, eructation and anorexia, tenderness, loose stool or constipation –Tongue: white and thick or greasy coating –Pulse: slippery Treatment Protocol: –Promoting digestion –Regulating the stomach –Stop vomiting

6. Formula: Modifications: Food retention due to eating meat: -- Shan Zha Food retention due to eating rice -- Mai Ya, Lai Fu Zi Retention of indigestive alcohol & food -- Shen Qu Retention food lead to heat -- Huang Qin, Huang Lian, Shan Zhi Zi Constipation or loose stool -- Da Huang or Bing Lang Vomiting due to unclean or putrefactive food Bao He Wan Ban xiaChen piShen QuShan ZhaFu LingMai Ya Lai Fu ZiLian Qiao

7. TreatmentExcess 3). Retention of phlegm & fluid Signs & Symptoms: –Main Sym. : Nausea, vomiting phlegm & clear saliva, or cough with white or yellowish phlegm & saliva –Concurrent sym.: Fat or thin body type, preference for eating fat & sweat food, or discomfort in the stomach after meal, dizziness & palpitation –Tongue: white & greasy coating –Pulse: fine and slippery Treatment Protocol: –Removing retention of phlegm & fluid –Regulating the function of St. & stop vomiting

8. Formula: Modifications: Fullness in the chest due to phlegm: -- Chen pi, Zhi Ke Severe Coughing lead to vomiting -- Su Zi, Lai Fu Zi, Xuan fu Hua, Pi Pa Ye Xiao ban xia Tang + Ling Gui Zhu Gang Tang Ban XiaShen JiangFu LingBai ZhuGui ZhiGan Cao

9. TreatmentExcess 4). Liver Qi attacking St. Signs & Symptoms: –Main Sym. : Vomiting acid and bitter substances in taste, frequent belching, comfort after belching –Concurrent sym.: fullness & pain in the chest & hypochondrium, restless, discomfort, indigestion, deterioration at dysthmia –Tongue: red on sides of tongue body within thin & greasy fue –Pulse: wiry and slippery Treatment Protocol: –Smoothing liver Qi –Regulating the St. Qi & stop vomiting

10. Formula: Modifications: Heat ( red tongue with yellow coating): -- Huang Qin, Zu Ru, Shan Zhi zi Bitter taste in mouth with nausea & constipation -- Da Huang, Zhi Shi dark tongue body with purple spots -- Chi Shao, Pu Huang Si Qi tang Su YeBan XiaHou PuFu LingShen JiangDa Zhao Zuo Jing Wan Huang LianHu Zhu Yu

11. TreatmentDeficiency 1). Spleen Yang Def. Signs & Symptoms: –Main Sym. : Protracted vomiting, or repeated vomiting, or nausea & vomiting after over tired or improper diet, or vomiting clear –Concurrent sym.: sallow complexion, tiredness, weakness, loose stools, or pale complexion, cool extremities, preference for warmness and aversion to cold. –Tongue: pale body –Pulse: fine and weak Treatment Protocol: –Warming the middle-jiao –Regulating the function of St. & stop vomiting

12. Formula: Modifications: Regular rebellion of St. Qi: -- Ban Xia, Sha Ren Vomiting clear fluid -- Wu Zhu Yu, Shen Jiang Vomiting with repeated belching -- Xuan Fu Hua, Dai Zhe Shi Spleen Yang Def. -- Fu Zhi, Rou Gui, Chen Xiang, Li Zhong Wan Ren ShenBai ZhuGan JiangGan Cao

13. TreatmentDeficiency 2). Stomach Yin Def. Signs & Symptoms: –Main Sym. : repeated vomiting or occasional retching –Concurrent sym.: gastric discomfort with acid regurgitation, hunger-like and anorexia, dry mouth and throat, dislike drink –Tongue: reddish body with less fluid or no fur –Pulse: fine & slightly rapid Treatment Protocol: –Nourish St. Yin –Lowering the adverse flow of Qi –Stop vomiting

14. Formula: Modifications: stop vomiting: -- Ban Xia, Zu Ru Clear empty heat -- Lu Geng, Liao Qiao, Bo He Severe St. Yin def. -- Shi Hu, Shen Di, Sha Sheng Rebellion of St.& Lu. Qi -- Pi pa ye, Xuan Fu Hua, Constipation -- Huo Ma Ren, Gua Lou Mai Meng Dong Wan Mai DongSha ShenRen ShenJing MiGan Cao

15. Treatment Difficulty Disease Psychogenic vomiting: Signs & Symptoms: –Continuous –habitual postprandial –irregular vomiting –nausea –self induced Formula: Ling Gui Zhu Gan Tang + Xiao Ban Xia Tang Ding Xiang Shi Di San Zhu Ling Tang

16. Review Common cold Cough Brachial wheezing syndrome Panting syndrome Lung distension Sputum retention Spontaneous perspiration and night sweat Blood syndrome Palpitation Pectoral pain and stuffiness Insomnia Melancholia Manic and depressive psychosis Epilepsy Stomachache Vomiting

17. Case History 1. male 14 years First visiting: Main complain: sweating under left oxter for 1 year occasionally feel thirst, pain of tongue Pulse: Tongue: ulcer on the body TCM diagnose: Heart-heat Treatment protocol: -- Clear away heart heat Formula: Shen Di ; Gan Cao ; Mu Tong ; Zhu Ye