The Treatment of Vomiting with Tiao Wei Cheng Qi Tang (Regulate the Stomach and Order the Qi Decoction)
by Dr. Wang Chang-Yong 王常勇
Patient: Wan, female, 32 years old.
Chief Complaint: vomiting
Medical History: Ms. Wan suffered for a long time from low-grade fever, chest pain and cough. The respiratory department in the hospital diagnosed her with pulmonary tuberculosis, and after receiving treatment, she was all better.
But five days ago she started to vomit, gradually worsening, with many bouts each day; she vomited after eating, and had difficulty eating and drinking. She self-administrated some Western medicine sedatives and anti-emetic drugs but without any results. Then she sought care from a Chinese medicine doctor.
First examination took place on April 28th 1984.
Her state of mind was mildly depressed. Her body was thin and weak. She had a flushed red complexion and was feverish. She did not want to eat or drink, and frequently vomited – including immediately after eating. She said that since she started to vomit 6-7 days ago, she had not had a bowel movement.
Tongue Appearance: her tongue body was red with a slightly yellow, greasy coating.
Pulse: her pulse was wiry, thin and rapid.
CM Diagnosis: because the disease is chronic, her body was thin and weak; the interior heat had damaged the yin, there was clumping heat in the middle jiao, the qi of the fu organs was not moving, the Stomach qi not descending, and turbid qi was rebelling upwards.
Treatment Principle: the suitable treatment was to unblock the bowels, and descend the rebellious qi.
Formula: tiao wei cheng qi tang with dang gui (Regulate the Stomach and Order the Qi Decoction with added Angelica Sinensis)
da huang (Radix et Rhizoma Rhei) 10g (added at end)
mang xiao (Natrii Sulfas) 10g
gan cao (Radix et Rhizoma Glycyrrhizae) 15g
dang gui (Radix Angelicae Sinensis) 15g
Instructions: Decoct one package, and drink small amounts frequently.
Results: The patient finished drinking the formula before going to bed at night, and she did not vomit between drinking doses; she slept calmly through the night, woke up early in the morning, and had a watery bowel movement. Her abdomen felt comfortable, her feverishness had subsided, her mouth was dry and she felt slightly thirsty. She ate half a bowl of porridge, drank a small amount of water, and did not vomit afterward.
Synopsis: the reasons for vomiting in this case were blockage of the qi in the fu organs and rebellious Stomach qi. The doctor chose a purging treatment principle based on the saying “use unblocking method to treat disorders of the fu organs” which also agrees with the saying “choose purging when treating diseases that are in the upper part of the body.” In considering a chronic disease with a yin-deficient type of body, and with middle jiao damage to the fluids with clumping heat, it is inappropriate to strongly purge so therefore the doctor added dang gui to the modified formula tiao wei cheng qi tang to tonify the yin, nourish blood, protect the normal qi, moisten the intestines, and gently purge the pathogen. The direction to frequently drink small amounts of the decoction benefits and restores Stomach qi. This gradual intake therefore aids to rid the heat via purging, the qi follows the unblocking motion of descending, and therefore the qi stops rebelling and the so does the vomiting.
Originally published at Hei Long Jiang Chinese Medicine Journal 1986, volume 4, pg 49.
Source: shang han ming yi yan an jing xuan – selective shang han lun case studies of famous doctors, pg 294
Xue yuan chu ban she – Xue Yuan publishing house, beijing, 1998