bubble_chart Concept

Vomiting and diarrhea refer to the simultaneous occurrence or alternating appearance of vomiting and diarrhea symptoms, which is different from simple vomiting or diarrhea.

This condition is referred to as cholera in historical texts, meaning that the disease arises suddenly, causing turmoil and unease. The term cholera first appeared in Neijing. Suwen．Liuyuan Zhengji Da Lun states: "When the Taiyin arrives, it causes abdominal fullness, cholera, vomiting, and diarrhea." It also says: "When earth stagnation occurs... the people suffer from heart abdominal distension and fullness, borborygmus leading to frequent bowel movements, and in severe cases, heart pain, hypochondriac distension, and vomiting cholera." In the "Treatise on Cold Damage Diseases" and Jingui Yaolue, there are passages respectively stating: "Vomiting with diarrhea is called cholera." "Eating donkey or horse meat together with pork can cause cholera." Zhubing Yuanhou Lun．cholera候 specifically describes the symptoms of cholera: "When the disorder is in the intestines and stomach, it is triggered by food and drink, causing colicky pain in the heart and abdomen. Those who first experience heart pain will vomit first, those who first experience abdominal pain will have diarrhea first, and those with pain in both the heart and abdomen will experience both vomiting and diarrhea. If accompanied by wind and excess, there will be fever, headache, body pain, and repeated vomiting and diarrhea. If deficient, there will only be vomiting and diarrhea, with stabbing pain in the heart and abdomen." Since then, medical practitioners throughout the ages, when mentioning cholera, besides describing the symptoms of vomiting and diarrhea, often refer to colicky pain in the heart and abdomen. Therefore, it is also commonly known as "twisting intestinal cholera" among the people. However, it must be understood that the cholera referred to in traditional Chinese medicine mainly refers to gastrointestinal disorders characterized by the symptoms of vomiting and diarrhea. As for the symptoms and pestilential nature of seasonal epidemic cholera, Yilin Gaicuo and Huoluan Lun provide more detailed descriptions.

bubble_chart Pattern Analysis

1. Summer-dampness︰The onset is acute, with sudden vomiting and diarrhea, colicky abdominal pain, sour and putrid vomitus, yellow watery stools or with mucus, foul-smelling, feverish thirst, chest and gastric stuffiness, or accompanied by fever, headache, limb pain, dark urine, yellow and greasy tongue coating, and a slippery and rapid pulse. It occurs during the transition between summer and autumn, when summerheat and dampness intermingle, and filthy turbid qi invades the body. Summerheat-dampness and filthy turbidity stagnate in the middle energizer, disrupting the normal ascent and descent of the spleen and stomach. Pathogenic qi attacks the stomach, causing vomiting; dampness descends urgently, leading to diarrhea; and qi movement is obstructed, resulting in abdominal pain. Due to the obstruction of summerheat-dampness in the middle burner, symptoms such as feverish thirst, chest and gastric stuffiness, and a yellow, greasy tongue coating appear. The treatment principle is to clear summerheat, eliminate dampness, repel foulness, and resolve turbidity. Modified Burning Bright Decoction combined with Pueraria, Skullcap, and Coptis Decoction is used.
2. Cold-dampness︰Vomiting clear water, diarrhea with thin and clear stools that are not very foul-smelling, abdominal pain that prefers warmth and pressure, epigastric distension and fullness, bland taste in the mouth, absence of thirst, clear and scanty urine, white and greasy tongue coating, and a mostly soggy and slow pulse. Primarily caused by external contraction, often due to overindulging in raw or cold fruits, sleeping outdoors exposed to wind, or invasion of cold-dampness pathogens attacking the stomach and intestines, leading to dysfunction of the gastrointestinal tract. The clear qi fails to ascend, turbid qi fails to descend, and the mixing of clear and turbid results in vomiting and diarrhea, accompanied by borborygmus and abdominal pain that prefers warmth and pressure.
3. Deficiency-Cold︰Vomiting and diarrhea, abdominal pain with desire for warmth, pale complexion, cold sweating and limbs, aversion to cold with curling up, clear and watery stool with undigested food, abdominal distension and anorexia, bland taste in the mouth without thirst, pale tongue texture, white tongue coating, thin or deep and slow pulse. This is caused by yang deficiency, resulting from cold deficiency of the middle energizer, exuberant yin and declined yang, congealing of cold-dampness, dysfunction of the spleen in transportation, and failure of the stomach to harmonize and descend, leading to vomiting and diarrhea—hence the saying, "the stomach yang is not impaired without vomiting, the spleen yang is not impaired without diarrhea." Due to exuberant yin and declined yang, symptoms such as pale face, cold limbs, aversion to cold with curling up, and other cold-deficiency manifestations appear. Treatment: For cases with cold-dampness obstructing the middle, the method is to warm the middle and dry dampness to resolve turbidity, using Patchouli Qi-Righting Powder with modifications. For cases with constitutional deficiency of middle yang, the approach is to warm the middle to rescue counterflow, invigorate the spleen, and drain dampness, selecting Cold-Extremities Decoction or Middle-Regulating Decoction with additions.
4. Food Stagnation︰Vomiting with sour and putrid odor, abdominal pain and distension, belching and anorexia, often manifesting as vomiting followed by diarrhea, with foul-smelling stools, relief of pain after diarrhea, but recurrence of pain shortly thereafter, thick and greasy tongue coating, slippery or wiry-slippery pulse. This condition can occur in all seasons, mostly caused by dietary irregularities, overeating, or gastrointestinal injury. Qianjin Yaofang, Volume 20: "Indulging in rich meats, followed by dairy products, consuming all kinds of delicacies from land and sea without restraint." Retention of food obstructing the middle energizer, impairing spleen and stomach functions, disrupting the ascending and descending movements, and weakening the transformative capacity, leading to vomiting and diarrhea, abdominal pain and distension, belching and anorexia. Treatment: Promote digestion and remove food stagnation, invigorate the spleen and drain dampness, using Stomach-Calming Powder combined with Harmony-Preserving Pill with modifications.
5. Seasonal Epidemic Cholera︰The onset is sudden, with severe vomiting and diarrhea. The vomiting is projectile, gushing out from the mouth. Initially, the stool is muddy, then turns into rice-watery stool without fecal odor, and there is usually no significant abdominal pain. The mouth is dry and thirsty, the eyes are sunken, the skin is pale, there is cold sweating like rain, the lips and nails are cyanotic, the calves cramp, and the pulse is floating or thin and rough. Cholera vomiting and diarrhea, based on clinical symptoms, are mostly of the cold pattern, as this Bingchuan is highly infectious and extremely harmful. The body is exposed to the qi of summer-heat epidemic toxin or consumes spoiled and contaminated food, leading to gastrointestinal dysfunction, the inability to separate the clear from the turbid, and the disruption of ascending and descending. As stated in Neijing: "When the clear and turbid interfere with each other and disorder the intestines and stomach, it results in cholera." Its characteristics are sudden onset, severe vomiting and diarrhea, and the near-exhaustion of body fluids throughout the body, hence the sunken eyes and emaciated, withered appearance. The stomach and large intestine belong to the Yangming, which nourishes all tendons. Due to the sudden loss of body fluids from vomiting and diarrhea, spasms occur in both calves. Yin deficiency affects yang, and yang qi gradually collapses, leading to dysphoria and restlessness, sweating like rain, and a body cold as ice. The tendency of this disease is critical; without emergency treatment, the situation is as precarious as stacked eggs. It is urgent to restore yang to save from collapse. Cold-Extremities Decoction is combined with fossil bone, oyster shell, and Cornus officinalis to restore yang and rescue from collapse. Once yang returns, large doses of Pulse-Reinforcing Powder or similar formulas should be urgently administered to replenish qi and nourish yin.

The symptom of vomiting and diarrhea can be caused by various factors, with different clinical manifestations and symptoms that can be constant or variable. There is also a condition known as "dry cholera," where one feels the urge to vomit but cannot, and the urge to have diarrhea but cannot. Although it does not present the typical symptoms of vomiting and diarrhea, it is characterized by restlessness and extreme discomfort, with colicky abdominal pain similar to that of vomiting and diarrhea. Moreover, abdominal pain and confusion are precursors to acute vomiting and diarrhea. Treatment should focus on promoting qi flow, relieving congestion, and removing toxins. Marching Powder or Yushu Dan can be used. Acupuncture (at points such as Neiguan, Zusanli, Zhongwan, and Tianshu) is also quite effective.

bubble_chart Documentation

1. Qianjin Yaofang．Volume 20: "The disease of cholera is all caused by diet, not by ghosts or gods. Overeating of greasy and raw foods, followed by dairy products, consuming all kinds of seafood and land delicacies, sleeping on cold mats, and drinking too much cold beverages cause the food in the stomach to clump and not digest. The yin and yang energies become congested and rebellious, with yang energy wanting to rise and yin energy wanting to fall. The disharmony between yin and yang leads to vomiting and diarrhea, headache as if splitting, joints of the body as if dislocated, and all the tendons throughout the body twisting and turning."
2. Yixue Zhongzhong Canxilu．Cholera Section: "An old woman of the Kou family, over sixty years old, contracted cholera in the late Mengqiu (early autumn). After being treated by several doctors for two days, the tendency of the disease was critical. Her symptoms initially included alternating vomiting and diarrhea, but by this point, there was no vomiting or diarrhea. She was barely breathing, in a deep sleep-like state, with very cold limbs and no detectable six pulse conditions. When questioned, she could still speak, but she felt a severe fever in her heart. Although her body was cold and her pulse was absent, she still felt a fever in her heart, which should still be treated according to the Re Lun (Theory of Heat)."