下载掌阅APP，畅读海量书库
立即打开
Vomiting ( Oǔ Tù ) refers to the expulsion of the milk and food in the stomach through the mouth.Ancient physicians believed that Oǔ referred to throwing up things with sound while Tù without sound. Oǔ and Tù often occur at the same time,so Oǔ Tù is named as a disease.Vomiting occurs without the season and age restrictions,but more commonly seen in summer and autumn in infants and young children.Timely treatment of vomiting generally gets good prognosis; but long-term vomiting or severe vomiting can cause a deficiency of spleen and stomach,and insufficient source of qi and blood transformation,which may affect the growth and development of children.Vomiting is a common symptom in pediatrics,such as galactorrhea after lactation.It can also happen in the occurrence and development of various acute and chronic diseases.Therefore,attention should be paid to the identification of vomiting.Vomiting due to digestive tract disorders in western medicine may refer to the treatment of this disease.
Vomiting is mainly due to the excess in feeding,the stagnation of spleen and stomach,and the invasion of exogenous pathogens.The disease is located in the stomach and is related to the liver and spleen.The pathogenesis is caused by the failure of stomach qi to descend and adverse rising of stomach qi.
Young children have the insufficient spleen,and cannot regulate milk and food intake.Improper feeding,overeating milk,and food,or eating too quickly,or addicting to greasy food with heavy tastes,may cause congestion in middle -jiao ,spleen and stomach qi disorders,and adverse rising of stomach qi,which leads to vomiting.Vomiting may also be caused by cold stagnation in middle epigastrium ( zhōng wăn ) and failure of stomach qi to descend,which is induced by insufficient spleen and stomach,devitalized middle yang,or preference to raw or cold food and fruits.Another cause may be heat accumulation in middle epigastrium( zhōng wăn ) and failure of stomach qi to descend,which is induced by lactating mother overeating fried spicy food,or contracted with dampness-heat of summer and autumn,or children overeating spicy or hot food.In addition,some children may vomit due to constraining of liver qi,counterflow of liver qi invading stomach,which results from environmental discomfort,desires failing to be satisfied,or being beaten or scolded.
History History of excess in feeding,unhygienic diet,catching a cold in the abdomen,and emotional disorder.
Clinical Manifestation Vomiting of milk,nausea,anorexia,halitosis,epigastric fullness.
a.Galactorrhea: Overflow of milk from the angle of mouth after breastfeeding,caused mostly by too hasty or too much of feeding.It is not in ill condition.
b.Vomiting due to other diseases: Various acute abdomens,brain disease,drug poisoning,digestive tract malformation and other diseases can result in vomiting,which requires identification and timely diagnosis,followed by corresponding etiological treatment.
a.Differentiating causes of diseases: infantile dyspeptic gastroenteropathy is marked by a history of improper diet,unhygienic diet,or binge overeating,accompanied by poor appetite and halitosis; deficient cold of spleen and stomach is marked by a history of catching a cold accompanied by thin clear and whitish vomit; reversed flow of qi due to stomach heat is marked by hot and foul vomit caused by overeating pungent and hot food;liver qi invading stomach is marked by a history of emotional disorder accompanied by frequent eructation.
b.Differentiating deficiency and excess:Excess syndrome often manifests with sudden onset,short course,frequent and too much vomiting,caused by external pathogens,diet and emotions; deficiency cold of spleen and stomach has the symptoms of slow onset,long course,and intermittent vomiting.
Harmonizing stomach for descending adverse qi is the basic treatment principle.For infantile dyspeptic gastroenteropathy,promote digestion and remove the stagnated-food; for stomach heat,clear heat and harmonize the stomach; for stomach cold,warm spleen and stomach for dispelling cold;for liver qi invading stomach,sooth liver and depress qi.
◆ Infantile Dyspeptic Gastroenteropathy (Milk and Food Stagnation)
Signs and Symptoms: throwing up indigested food or sour curdled milk,no desire for milk or food,fetid breath,abdominal distention,and pain,more comfortable after vomiting,constipation or foul stools; red tongue,with a thick and greasy coating,stringy and slippery pulse,and stagnant purple finger venules.
Essentials: a history of inappropriate overfeeding or overdrinking of milk,spitting up indigested food or sour curdled milk,abdominal distention and pain,and thick and greasy coating.
Treatment Principles: Promote digestion by removing stagnated-food,and harmonize the stomach for stopping vomiting.
Formula: Modified Băo Hé Wán (Harmony-Preserving Pill,保和丸) from Teachings of[Zhu] Dan-xi ( Dān Xī Xīn Fă ,丹溪心法).
Categorized Formula: Modified Xiāo Rǔ Wán (Milk Indigestion Eliminating Pill,消乳丸)from Standards for Diagnosis and Treatment ( Zhèng Zhì Zhǔn Shéng ,证治准绳).
For children with retention of food and drink as the main symptoms,apply Băo Hé Wán ; for those with retention of milk and food,apply Xiāo Rǔ Wán .
Medicinals: shén qū (Massa Medicata Fermentata), lái fú zǐ (Semen Raphani), bàn xià (Rhizoma Pinelliae), chén pí (Pericarpium Citri Reticulatae), lián qiáo (Fructus Forsythiae), fú líng (Poria), shān zhā (Fructus Crataegi), mài yá (Fructus Hordei Germinatus), gǔ yá (Fructus Setariae Germinatus),and xiāng fù (Rhizoma Cyperi).
Modifications: For frequent vomiting,add a little shēng jiāng zhī (Rhizoma Zingiberistis Succus) or huò xiāng (Agastachis Herba); for constipation,add dà huáng (Radix et Rhizoma Rhei) and zhǐ shí (Fructus Aurantii Immaturus);for loose and foul stools,add dà fù pí (Pericarpium Arecae); for fetid breath and yellow thick and greasy coating,add hú huáng lián (Rhizoma Picrorhizae) and zhú rú (Caulis Bambusae in Taenia).
◆ Spleen-Stomach Deficiency
Signs and Symptoms: throwing up clear,cold and whitish vomitus,intermittent vomiting,abdominal pain relieved with pressure,eased when warmed,poor appetite,loose stool,or pale and tired complexion,cold limbs; nasal discharge,aversion to cold with fever,nausea,vomiting,unsolved or thinning stool; pale tongue with white coating,thready and weak pulses,or reddish finger venules.
Essentials: vomitus clear,thin and odorless,abdominal pain relieved with heat,accompanied by cold limbs or external-contraction exterior syndromes.
Treatment Principles: Warm spleen and stomach for dispelling cold,and harmonize stomach for descending adverse qi.
Formula: Modified Dīng Yú Lǐ Zhōng Tāng (Clove and Evodia Middle-Regulating Decoction,丁萸理中汤) from Golden Mirror of the Medical Tradition ( Yī Zōng Jīn Jiàn ,医宗金鉴).
Categorized Formula: Modified Huò Xiāng Zhèng Qì Săn (Agastache Qi-Correcting Powder,藿香正气散) from Beneficial Formulas from the Taiping Imperial Pharmacy ( Tài Píng Huì Mín Hé Jì Jú Fāng ,太平惠民和剂局方).
For vomiting due to spleen-stomach deficiency,use Dīng Yú Lǐ Zhōng Tāng ; for vomiting due to external-contract wind cold,use Huò Xiāng Zhèng Qì Săn .
Medicinals: dăng shēn (Radix Codonopsis), bái zhú (Rhizoma Atractylodis Macrocephalae), gān jiāng (Rhizoma Zingiberis), dīng xiāng (Flos Caryophylli), wú zhū yú (Fructus Evodiae), zhú rú (Caulis Bambusae in Taenia), huò xiāng (Herba Agastachis), zǐ sū yè (Folium Perillae), bái zhǐ (Radix Angelicae Dahuricae), bàn xià (Rhizoma Pinelliae), chén pí (Pericarpium Citri Reticulatae), fú líng (Poria), hòu pò (Cortex Magnoliae Officinalis),and dà fù pí (Pericarpium Arecae).
Modifications: For continuous abdominal pain with cold limbs,add fù zǐ (Radix Aconiti Lateralis Praeparata), ròu guì (Cortex Cinnamomi),and bái sháo (Radix Paeoniae Alba);for aversion to cold with clear nasal discharge,add jīng jiè (Herba Schizonepetae)and fáng fēng (Radix Saposhnikoviae); for fever,add jīn yín huā (Flos Lonicerae Japonicae) and lián qiáo (Fructus Forsythiae).
◆ Reversed Flow of Qi due to Stomach Heat
Signs and Symptoms: throwing up immediately after intake,frequent vomiting with too much hot and foul vomitus,thirst,red lips,restlessness,little sleep,red tongue with yellow coating,slippery and rapid pulses,or purple stagnant finger venules.
Essentials: frequent vomiting with too much hot and foul vomitus,throwing up immediately after intake,thirsty and drinking a lot.
Treatment Principles: Clear heat and purge fire,and harmonizes stomach for descending adverse qi.
Formula: Modified Huáng Lián Wēn Dăn Tāng (Coptis Gallbladder-Warming Decoction,黄连温胆汤) from Systematic Differentiation of the Six Etiologies ( Liù Yīn Tiáo Biàn ,六因条辨).
Medicinals: huáng lián (Rhizoma Coptidis), chén pí (Pericarpium Citri Reticulatae), zhǐ shí (Fructus Aurantii Immaturus), bàn xià (Rhizoma Pinelliae), zhú rú (Caulis Bambusae in Taenia), fú líng (Poria), gān căo (Radix et Rhizoma Glycyrrhizae).
Modifications: For thirst and drinking a lot,add mài dōng (Radix Ophiopogonis) and tiān huā fěn (Radix Trichosanthis); for frequent vomiting,add shēng dài zhě shí (Raw Haematitum) (decocted first); for dyspepsia,add shén qū (Massa Medicata Fermentata), shān zhā (Fructus Crataegi) and mài yá (Fructus Hordei Germinatus); for dry and hard stool,and red tongue with little saliva,add shí hú (Caulis Dendrobii) and xuán shēn (Radix Scrophulariae); for restlessness and little sleep,add dì gǔ pí (Cortex Lycii) and zhú yè (Herba Lophatheri),or replaced by Zhú Yè Shí Gāo Tāng (Lophatherum and Gypsum Decoction).
◆ Liver Qi Invading Stomach
Signs and Symptoms: vomiting,acid regurgitation,frequent eructation,irritability-restlessness aggravated with unsatisfied emotions,red tongue with a thin greasy coating,wiry pulse,or purple finger venules.
Essentials: vomiting,acid regurgitation,frequent eructation,irritability-restlessness aggravated with emotion stimulations.
Treatment Principles: Sooth liver and regulate qi,and harmonizes stomach for descending adverse qi.
Formula: Modified Sì Nì Săn (Cold-Limbs Powder,四逆散) from On Cold Damage ( Shāng Hán Lùn ,伤寒论),companies with modified Bàn Xià Hòu Pò Tāng (Pinellia and Magnolia Bark Decoction,半夏厚朴汤) from Essentials from the Golden Cabinet ( Jīn Guì Yào Lüè ,金匮要略).
Medicinals: chái hú (Radix Bupleuri), bàn xià (Rhizoma Pinelliae), hòu pò (Cortex Magnoliae Officinalis), bái sháo (Radix Paeoniae Alba), zhǐ qiào (Fructus Aurantii), zǐ sū gěng (Caulis Perillae), fú líng (Poria),and gān căo (Radix et Rhizoma Glycyrrhizae).
Modifications: For dry and hard stool,add dà huáng (Radix et Rhizoma Rhei); for vomiting yellow bitter liquor,add huáng qín (Radix Scutellariae) and zhú rú (Caulis Bambusae in Taenia); for dry mouth and constipation,add běi shā shēn (Radix Glehniae) and shí hú (Caulis Dendrobii); for distending pain in chest and hypochondrium,add chuān liàn zǐ (Fructus Toosendan) and yù jīn (Radix Curcumae).
◆ Chinese Patent Medicines
1. Huò Xiāng Zhèng Qì Shuǐ (Agastache Qi-Correcting Liquor,藿香正气水) for vomiting due to external-contraction windcold.
2. Băo Hé Wán (Harmony-Preserving Pill,保和丸) for vomiting due to infantile dyspeptic gastroenteropathy.
3. Sì Mò Tāng Kǒu Fú Yè (Oral Solution of Four Milled Ingredients Decoction,四磨汤口服液) for vomiting due to infantile dyspeptic gastroenteropathy.
4. Xiāng Shā Yăng Wèi Wán (Aucklandia Root and Villous Amomum Stomach-Nourishing Pill,香砂养胃丸) for vomiting due to spleen-stomach deficiency.
◆ Plastering Therapy
1.Take 5 pieces of garlic peeled and smashed,and wú zhū yú (Evodiae Fructus) 10 g(ground to the powder).Mix them well and knead them into a medicinal cake with the diameter of 1 cm.Apply them to both soles once a day.It is applicable for deficiency cold syndrome of spleen and stomach.
2.Take wú zhū yú (Evodiae Fructus) 30 g,a little fresh ginger,and scallion.Mash and mix before steam them,then knead them into medicinal cakes with the diameter of 1 cm.Apply the cake to the navel for 2–4 hours,fixed by one-off tape,once a day.It is used for vomiting due to cold.
◆ Tuina Therapy
1.Vomiting due to Improper Diet: Press and knead LI 4 ( hé gǔ ),push dà cháng ,push héng wén to băn mén ,move nèi bā guà ,push aside abdomonial yīn-yáng,rub the abdomen clockwise,and knead ST 25( tiān shū ).
2.Vomiting due to Excess Heat: Clear wèi ,clear dà cháng ,pinch LI 4 ( hé gǔ ),push down liù fǔ ,move nèi bā guà ,push tiān hé shuǐ ,and push aside abdomonial yīn-yáng.
1.Advocate breastfeeding,add supplementary food in moderation,reasonably feeding,avoid fed-upness,avoid indigestive food,and do not gobble cold drink.
2.Strengthen the health management of infants and young children,wash hands before and after meals,and disinfect the bottles and tableware.
3.Pay attention to food hygiene,do not eat deteriorated food,and wash the fruits before eating.
4.If vomiting persists,temporary fasting for 4–8 hours is necessary,during which the patients may drink water or ginger soup in an appropriate amount; venous transfusion can be conducted if necessary.
5.During the vomiting period,the patient should eat light digestible food,and the amount should be less; drink more water;avoid eating the food of too many kinds.
6.Strengthen nursing,keep quiet,pay attention to body position,and prevent the vomitus from being inhaled into the trachea.