Nausea and vomiting are symptoms of rising stomach qi. Normally, stomach qi descends, taking the waste products of digestion to the intestines. However, stomach qi can be blocked by a pathogen, or it can simply be too weak to descend. In either case, raising stomach qi is a form of ‘rebellious’ qi.
In adults, nausea and vomiting can be caused by dysfunction of almost any organ system, reflecting a large range of different disorders, ranging from simple acute viral infections to emotional stress to cancer.
In children, vomiting may be the first sign of an infection. All children with vomiting accompanied by fever, should, in addition to the obvious gastrointestinal infection, be checked for middle ear, urinary tract, upper respiratory tract or central nervous system infection.
Aetiology
External Pathogens
Invasion by external pathogens into the Stomach is a common cause of both nausea and vomiting, and is typically associated with a seasonal pathogens, or with eating spoiled food. The most frequent cause is Dampness, either alone or in combination with another pathogen. Nausea and vomiting of this type is most commonly to occur during the humid months of Summer and Autumn, but may occur at any time of the year. External invasion usually cause acute, self limiting illness. However, in some cases, the illness can drag on and become entrenched. Chemotherapy for cancer, a frequent cause of nausea and vomiting, often resembles an external pathogen, and may be treated as such.
Diet
The type of food consumed, and the way it is consumed, are important aetiological factors in the generation of nausea and vomiting. Eating spoiled or contaminated food can produce acute vomiting, which, in traditional Chinese medicine terms, may resemble the invasion of an external pathogen, such as Summerheat or Summerdamp.
Too much cold natured or raw food can introduce Cold into the Stomach and weaken Spleen qi and yang. Over consumption in general, and excessive consumption of rich heating or supplementing foods in particular, can lead to the accumulation of food, and Heat or Damp Heat in the Stomach and Intestines. An excess of heating foods can create Stomach Heat or damage Stomach yin. Sugar, dairy products and some medications, such as antibiotics, create Dampness and Phlegm. All these pathogens can obstruct the qi mechanism and cause Stomach qi to rise.
The way food is eaten is as important as the type of food that is cinsumed. Irregular eating times, eating late at night, or while stressed, or in excessive quantities can all tax the capacity of the Stomach and Spleen to digest and distribute food. These habits can contribute to excess, deficiency and mixed pathologies.
In addition, the manipulations of modern agriculture business have added a raft of new and potentially disruptive substances to many of our foods. Pesticides, fertilisers, hormones and antibiotics find their way into our daily foods as residues of the production process. Artificial colouring and flavouring agents, preservatives and stabilisers are added to enhance shelf life and taste. It seems that some people are unable to metabolise these compounds adequately; they become sensitised and ingestion of the offending agents produced symptoms of nausea, vomiting, abdominal distension, flatulence and pain.
Emotion
Frustration, anger, resentment, prolonged emotional turmoil, repressed emotions and stress disrupt the circulation of Liver qi. These emotions cause a low grade spasm and tension in the smooth muscle of the digestive tract. Nausea or vomiting associated with Liver qi stagnation is generally intermitted and related to the patient’s emotional state.
When the smooth movement of Liver qi is impeded, it finds alternative pathways. In this case, the stagnant qi is discharged sideways, overcontrolling the Stomach through the controlling cycle, disrupting the descent of Stomach qi and causing nausea and vomiting.
There are several consequences of Liver qi invading the Stomach. When qi stagnates for any length of time, the resulting pressure can generate Heat. Chronic Heat in the Stomach will eventually consume Stomach yin. Stagnant qi can disrupt the Spleen, weakening it and contributing to the development of Dampness and Phlegm, which block the descent of Stomach qi.
Liver qi invading the Stomach can be a long term, or even lifetime disorders, and may have a constitutional component. Liver qi stagnation can run in families, with several members prone to emotional gastrointestinal upset.
Phlegm Damp
Phlegm Damp is generated by overindulgence in Phlegm or Damp producing foods and by eating habits that weaken Spleen qi. Repeated courses of antibiotics can damage Spleen qi, allowing the generation and accumulation of Dampness. Foods that can weaken the Spleen if consumed to excess including dairy products, fatty, rich, sweet or raw foods, and alcohol. Once the Spleen is weak, inefficient digestion allows accumulation of Dampness, which over time congeals into Phlegm. In the presence of Heat, Damp may be condensed to form Phlegm in a shorter time.
Poor fluid metabolism, due to Spleen, Lung or Kidney dysfunction, may cause accumulation and thickening of physiological fluids into Phlegm. In addition, prolonged Liver qi stagnation can contribute to the condition by weakening the Spleen and by retarding the movement of fluids, which gradually condense into Phlegm.
Phlegm may also arise following a serious acute febrile illness. the pathogenic Heat cooks and congeals fluid into Phlegm Heat. Once present, Phlegm or Phlegm Heat blocks the qi mechanism and the descent of Stomach qi, provoking nausea and vomiting.
Spleen and Stomach Deficiency
This refers to qi, yang or yin deficiency. The most common cause of Spleen yang qi deficiency nausea or vomiting is prolonged or excessive consumption of cold raw foods and irregular eating habits, or inappropriate use of cold natured herbs or antibiotics in the treatment of a febrile disease. Prolonged insult to the Stomach or severely limited food intake, such as occurs in patients with bulimia and anorexia nervosa, can seriously damage Spleen and Stomach yang qi. Excessive mental strain or prolonged concentration may deplete Spleen qi. The damage is aggravated when an irregular diet is combined with sustained mental activity and too much sitting. The Spleen and Stomach can also be weakened following an acute invasion of Cold and/or Dampness. Gastric surgery can deplete Spleen yang and cause Blood stagnation. When stomach qi is weakened, it can become too feeble to descend properly. The qi mechanism is disordered, qi accumulates and eventually rises causing nausea and vomiting.
Stomach yin deficiency may follow a febrile disease, long term consumption of spicy heating foods, or excessive consumption of drugs such as steroids, illicit stimulants and yang supplementing substances. It also may result from prolonged or excessive vomiting from an excess pathogen, or another chronic Stomach pathology, especially one characterised by Heat or dryness.
Spleen and Stomach deficiency may also be constitutional, and in patients with a component of inherited weakness, there will often be a history of recurrent nausea or vomiting since childhood.
Treatment
After a diagnosis with a qualified practitioner, acupuncture is the treatment of choice and herbal medicines are recommended to support correcting any systemic imbalances that may be present. In some cases, massage can also be effective.