Scholarly article on topic 'Acupuncture Treatment of Vomiting'

Acupuncture Treatment of Vomiting Academic research paper on "Clinical medicine"

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Academic research paper on topic "Acupuncture Treatment of Vomiting"

Teaching Round

Acupuncture Treatment of Vomiting

HuJinsheng ^^^

Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China

CASE HISTORY

A female patient, 46 years old, head of the foreign affairs department of a certain university in Beijing, paid her first visit on October 9, 2006, with the chief complaint of vomiting for one month. She got vomiting after meals in early September. Before that, she had discomfortable sensation in the stomach due to angry with others, but she didn't pay much attention. Later, it developed into vomiting after eating. After the vomiting, the discomfort would be relieved, but with slight hypodynamia. She was once diagnosed as having 'neurogenic vomiting'. Having taken some western and Chinese drugs, the above symptoms were a little bit improved, but she would have nausea upon eating and with regurgitation. Because of the fear for vomiting, she did not dare to have food intake, with body weight reduction of 6 kilos in one month.

Physical examination at the moment showed that the patient had a moderate body figure, with anxiety and a sickly complexion, clear mind and quick response. The blood pressure was 126/82 mmHg and the heart rate 88 beats/min. No abnormal signs were found in the heart and lungs. But a bit prominence was found at the umbilicus with mild tenderness in both the hypochondriac regions. The TCM examination showed that the patient had physical fatigue, but with mental excitement, flushed face, red eyes, frequent headache and dizziness, irritability, scanty urine, and with dry stool once every two days. The tongue proper was red especially at the tip and border with yellow and greasy coating, and the pulse was wiry and somewhat rapid.

DISCUSSION

Prof. Hu: Would you please give your TCM differentiations based on the patient's clinical manifestations?

Dr. Li: This is a case of vomiting. And I think, by location-differentiation, it should be in the stomach and liver. Before the onset of the disorder, she had emotional problem, which was not treated in time and resulted in frequent vomiting, affecting the function of the stomach in descending. Besides, the mental disturbance due to work pressure and family problems caused the stagnation of liver-qi, which gave a transverse attack to the stomach, and further made dysfunction of the stomach in descending worse, leading to adverse flow of the stomach-^ hence the appearance of vomiting. Considering the course and pathogenic factors of the disease, the vomiting at the initial stage was mainly due to mental depression injuring the liver, leading to liver-qi attacking the stomach and making dysfunction of the stomach-^/ in descending. The patient was often in a state of nervous tension and with mental depression, which injured the liver and further worsened the condition of adverse flow of the stomach-^ thus causing vomiting.

Dr. Wang: I agree to Dr. Li's analysis that this is a case of vomiting due to liver-^/ attacking the stomach. The disease location is in the liver and stomach, and the nature belongs to heat, characterized by the clinical symptoms of flushed face and red eyes, irritability, dry stool, red tongue proper, yellow and greasy tongue coating, and slightly rapid pulse, which are all the signs of heat. Based on the deficiency-excess analysis, the patient was mainly manifested by the excess signs. I

wonder whether my supplements are right.

Dr. Zhang: I agree to the above two doctors' analyses. But I have a question to ask Prof. Hu, which is about 'normal function of the six fu organs tending downwards' and the relationship between the six fu organs.

Prof. Hu: First of all, I'd like to say that Dr. Li and Dr. Wang have given very good differential analyses. They can apply the basic TCM theories they've learned in the differential analysis on the pathogenic course of the disease, and have given quite accurate location-differentiation for the disease.

Vomiting is a common disorder, mainly with the following causative factors: 1) retention of food intake, 2) liver-^7 attacking the stomach, 3) deficiency and weakness of the spleen and stomach.

1) Retention of food intake is due to overeating of raw, cold and fatty food, leading to retention of indigestive food in the stomach, and inability of the stomach-^/ to descend, which may go adversely upward and induce vomiting. The clinical manifestations are vomiting of indigested food, hypochondriac and abdominal distention, belching and anorexia, loose stool or constipation, grimy-thick tongue coating, and slippery-forceful pulse.

2) Liver-qi attacking the stomach is due to stagnation of liver-qi caused by emotional factors, which may give transverse attack to the stomach, making the stomach-^/ fail to descend but ascend, thus giving rise to vomiting. The clinical manifestations are vomiting with acid regurgitation, frequent belching, distending pain in the chest and hypochondrium, vexation, and wiry pulse.

3) Deficiency and weakness of the spleen and stomach may cause dysfunction of the spleen and stomach in transformation and transportation, leading to retention of water and food, which may result in adverse flow of the stomach-^/ with the appearance of vomiting. The clinical manifestations are vomiting upon overeating, tastelessness, sallow complexion, lassitude and asthenia, loose stool, pale tongue with thin coating, and thready-weak pulse.

From the above, we can see that the pathogenesis of vomiting is dysfunction of the stomach in descending with upward flow of stomach-^z The TCM differentiation should be based on the characteristics of vomiting and its accompanying symptoms. Besides, in clinic, analysis should be made by combining the other clinical manifestations of the patient. The patient we discussed here had the emotional factor of getting angry with others. Thus, the vomiting belonged to the type of liver -qi attacking the stomach. Now, I'd like to deliver my view-points for Dr. Wang's questions on 'normal function of the six fu organs tending downwards' and the relationship between the six fu organs.

The theory of the zang-fu organs holds that the five zang organs are morphologically solid, while the six fu organs are hollow. Being solid in morphology, the five zang organs function to store the essence. For instance, the liver stores blood, the heart dominates the circulation of blood, the lung dominates qij the spleen dominates transformation and transportation, and the kidney stores the essence. Qi, blood and the essence are important materials for maintaining the life activities, which should be amply stored, but never be lost, hence the name of zang organs, 'zang' here means storage. Whereas, the six fu organs are hollow to contain the water fluids and food. For instance, the gallbladder stores bile, the stomach receives water and food, the large and small intestines are responsible for absorption and excretion, the urinary bladder has the micturating function, and the Xx\-jiaos transport the water fluids. The fu organs are in charge of transformation of water and food, and discharging wastes, which store neither the essence nor the wastes.

What is more, each of the zang organs has an interiorly-exteriorly related fu organ. They are connected by the channels and collaterals, act and depend on each other physiologically, and influence and reflex each other pathologically. For instance, the channels and collaterals of the lung are connected with those of the large intestines. So, the lung and the large intestine are interiorly-exteriorly

related and promote each other in performing their functions. Physiologically, the lung dominates dispersing and descending, while the large intestine has the transporting and discharging function. Only when the lung's dispersing and descending function is normal, can the transporting and discharging function of the large intestine be smooth, and vice versa. Pathologically, dysfunction of the lung in dispersing and descending may lead to failure of body fluid to go downward, which will certainly affect the function of the large intestine. That's why the patients with chest distress and cough may have the accompanying symptom of dry stool; whereas the patients with constipation may have cough or asthma with chest distension. For this kind of patients, simply using the drugs for dispersing the lung and checking asthma and cough would not work. Only the drugs for dredging the intestines and promoting bowel movements are in a combined use with the drugs for dispersing the lung and checking cough can good effects be yielded.

Because the physiological functions of the six fu organs depend on smoothness and descending, their pathologic changes are mainly manifested as hyperfunction or hypofunction in 'smoothness' and 'descending'. The hyperfunction may show downward flow of qi, while the hypofunction manifest stagnation or upward flow of qi. Those with upward flow of the stomach-^/ may have belching, hiccup, nausea, and vomiting; those with dysfunction of the large intestine in downward transportation may have abdominal distention and pain and/or constipation. And those with over descending may have loose stool and diarrhea, and in severe cases, fecal incontinence or proctoptosis.

Since the six fu organs perform the function of transforming and transporting water and food, they need to be constantly receiving and emptying, or full and empty in alternation, as the saying goes that 'normal function of the six fu organs depends on unobstruction, and 'normal function of sixy^-organs tends downwards'.

Now, if you have no other questions, let's discuss the scheme for treatment.

Dr. Zhang: Based on the differentiation of liver-^/ attacking the stomach with adverse flow of the stomach-^ I think the principle of treatment should be to soothe the liver -qi, regulate the stomach, and check the adverse flow of the stomach-^z

The acupoint prescription: Zhongwan (CV 12), Tianshu (ST 25), Zusanli (ST 36), Neiguan (PC 6), Taichong (LR 3), and Hegu (LI 4). Zhongwan (CV 12) and Tianshu (ST 25) can give the effect of regulating the function of the stomach and large intestines, making the function of the six fu organs unobstructed. Zusanli (ST 36) can give the effect of strengthening the spleen and regulating the stomach. Neiguan (PC 6) can be used for regulating the function of the spleen and stomach. Taichong (LR 3) has the effect of regulating the liver-qi, and in a combined use with Hegu (LI 4), it can regulate both qi and blood, and balance yin and yang. The above prescription is indicated for vomiting due to adverse flow of the stomach-^z

Dr. Li: I suggest that Neiting (ST 44) and the auricular points be added. Since the patient has obvious signs of heat, Neiting (ST 44) can be used to reduce the stomach-heat. And the auricular points can regulate the function of the stomach and intestine, with the use of Stomach, Intestine, Liver, Ear-Shenmen, Subcortex and Sympathetic.

Dr. Zhang: Prof. Hu, can acupuncture be adopted for treating vomiting during pregnancy, and vomiting due to chemotherapy?

Prof. Hu: First, I'd like to express my ideas on your principle and method of treatment. Dr. Zhang has given very good principle of treatment with acupoint prescription, which would be better if the reinforcing and reducing manipulation methods are described. The auricular needling proposed by Dr. Li can enhance the therapeutic effects.

Now, let's come to the questions raised by Dr. Zhang.

Vomiting in pregnancy falls into the category of 'morning sickness', which is often induced by deficiency and weakness of the spleen and stomach, liver-heat, and turbid phlegm. The principle of treatment is to strengthen the spleen, regulate the stomach, and lower the adverse flow of qi so as to check the vomiting. The commonly-used points: Zusanli (ST 36), Zhongwan (CV 12) and Neiguan (PC 6). For deficiency and weakness of the spleen and stomach, Qihai (CV 6) can be added; for liver-heat, Taichong (LR 3) and Yanglingquan (GB 34) can be added; and for turbid phlegm, Fenglong (ST 40) can be added.

As for the chemotherapy-induced vomiting in cases of cancer, acupuncture can also be adopted with reference to the TCM syndrome differentiations.

TREATMENT AND RESULTS

The patient was treated by acupuncture with the combined use of body-point needling (for 30min) and auricular-point needling, followed by auricular

seed-embedding. After 5 treatments, the patient got slight improvement. Then, Shanzhong (CV 17), Geshu (BL 17) and Weishu (BL 21) were added. Shanzhong (CV 17) was used for enhancing the action of regulating qi, and when combined with Neiguan (PC6), it can treat the syndrome of adverse flow of qi. The patient had obvious tenderness at Geshu (BL 17) especially on the left side, which was used with Weishu (BL 21) for regulating the functions of the spleen and stomach to make the stomach-^/ descend in order. At the same time, the patient was asked to pay attention to rest; avoid fatty, raw and cold food; keep in a good mental state; and apply massage herself at the abdominal part. After the 5 modified treatments, the patient was much relieved with the vomiting stopped. And the patient was completely cured by five more treatments. The follow-up survey 3 months later showed no recurrence.

(Translated by Wang Xinzhong