bubble_chart Concept

The stomach qi should descend to be in harmony. When the stomach fails to descend and instead ascends, it is called the pattern of ascending counterflow of stomach qi. Ye Tianshi said, "The spleen should ascend to be healthy, and the stomach should descend to be harmonious." Zhu Gong said, "The qi of the foot yangming should descend, but now it is ascending, hence the qi counterflow." This syndrome is often caused by external contraction of the six excesses, internal damage from the seven emotions, improper diet, and weakness of the spleen-stomach, leading to abnormal descent of stomach qi.

The main clinical manifestations of this syndrome are: loss of appetite, distending pain in the epigastric region, nausea, vomiting, belching, hiccup, wiry and slippery pulse, thin white or white greasy tongue coating.

The pattern of ascending counterflow of stomach qi is commonly seen in diseases such as "hiccup," "belching," "vomiting," and "regurgitation."

The pattern of ascending counterflow of stomach qi should usually be differentiated from "pattern of stomach failing to descend and harmonize," "pattern of liver qi transversing unfavorably," and "pattern of qi rising unfavorably."

bubble_chart Differentiation and Treatment

The pattern of ascending counterflow of stomach qi can be seen in various diseases, each with its own clinical characteristics.

1. For example, the pattern of ascending counterflow of stomach qi manifested in vomiting is clinically divided into deficiency and excess types. The excess type is caused by pathogenic qi disturbing the stomach, while the deficiency type is due to stomach deficiency and disharmony. Jingyue Quanshu states: "The excess pattern is caused by pathogenic qi invading the stomach, leading to turbid qi rising and counterflow...; the deficiency pattern is due to insufficient stomach yang or stomach yin, resulting in the loss of harmony and descent...". For excess pattern vomiting, such as when external pathogens invade the stomach, it is often accompanied by exterior pattern, and treatment involves dispersing pathogenic factors and releasing the exterior, using aromatic herbs to resolve dampness, Patchouli Qi-Righting Powder(Hejiju Fang) with modifications;
2. if caused by food stagnation, there will be epigastric distension and fullness, belching of sour fluid, and treatment involves promoting digestion and resolving food stagnation, harmonizing the stomach and descending adverse qi, Harmony-Preserving Pill(Danxi Xinfa) with modifications; if liver qi invades the stomach, there will be vomiting of sour fluid, distending pain extending to the hypochondrium, and treatment involves soothing the liver and harmonizing the stomach to descend counterflow, Pinellia and Magnolia Bark Decoction(Jingui Yaolue) combined with Left Metal Pill(Danxi Xinfa) with modifications;
3. if caused by phlegm-fluid retention internally obstructing, there will be vomiting of thin, watery phlegm, and treatment involves warming and resolving phlegm and fluid retention, harmonizing the stomach and descending adverse qi, Minor Pinellia Decoction(Jingui Yaolue) combined with Poria, Cinnamon Twig, Bighead Atractylodes and Licorice Decoction(Jingui Yaolue).
4. Deficiency pattern vomiting is characterized by intermittent vomiting, often triggered by dietary irregularities or mild overstrain, and usually occurs after an illness. If due to deficiency-cold of the spleen and stomach, there will be vomiting after eating, undigested food in the stool, and epigastric and abdominal pain, and treatment involves warming the middle and strengthening the spleen, harmonizing the stomach and descending adverse qi, using Middle-Regulating Decoction(《Cold-Damage Disease Treatise》) or Cyperus, Amomum and Six Gentlemen Decoction(Zhangshi Yitong);
5. if due to stomach yin deficiency, there will be frequent retching, thirst, a burning sensation in the stomach, and a peeled tongue coating, and treatment involves nourishing stomach yin, downbearing counterflow to stop vomiting, using Ophiopogon Decoction(Jingui Yaolue) with modifications.

Generally, acute vomiting is mostly due to pathogenic excess, and treatment focuses on expelling pathogens, as the vomiting will stop once the pathogens are removed; chronic vomiting is mostly due to deficiency of healthy qi, and treatment focuses on supporting the healthy qi.

Clinically, there is also a type of retching with sound but no substance, whose disease mechanism and treatment are similar to vomiting.

1. Another example is the pattern of ascending counterflow of stomach qi seen in regurgitation, characterized by food remaining in the stomach after eating, evening vomiting of food eaten in the morning, morning vomiting of food eaten in the evening, and undigested food in the stool. This is often caused by consuming raw or cold food, or by excessive thinking damaging the spleen, leading to injury of spleen yang and resulting in deficiency-cold of the middle energizer, which cannot digest food. Shengji Zonglu states: "Food that is regurgitated after a long time is due to lack of fire." Jingyue Quanshu states: "Evening vomiting of food eaten in the morning, morning vomiting of food eaten in the evening, and food remaining undigested in the middle energizer are due to stomach deficiency." Treatment involves warming the middle and strengthening the spleen, descending counterflow and harmonizing the stomach, using Clove Diaphragm-Penetrating Powder(Hejiju Fang) or Aconite Middle-Regulating Decoction(Hejiju Fang) with modifications.
2. Another example is the pattern of ascending counterflow of stomach qi seen in hiccups, characterized by qi counterflow rushing upward, frequent short bursts of sound in the throat, and an inability to control it, anciently called "hiccup". This is mostly caused by stomach qi ascending counterflow disturbing the diaphragm, and lung qi failing to descend. Since the lung meridian of hand Taiyin originates in the middle energizer, connects downward to the large intestine, and ascends to the diaphragm to connect with the lung, the qi of the lung and stomach both govern descent, and the two organs functionally promote each other, so in disease they mutually affect each other. Therefore, treatment should focus on downbearing counterflow to stop hiccups, using Clove and Persimmon Decoction(Zhengyin Maizhi) with additions such as Inula Flower, loquat leaf, and sword jackbean seed.
3. Belching is also a manifestation of stomach qi ascending counterflow. The sound of this hiccup is deep and prolonged, often accompanied by epigastric fullness, and the symptoms are temporarily relieved after belching. It is mostly caused by the transverse rebellion of liver qi invading the stomach, and the treatment should focus on soothing the liver and harmonizing the stomach. Bupleurum Liver-Soothing Powder(Jingyue Quanshu) with modifications.

In the course of disease progression, this syndrome may be complicated by phlegm due to stomach qi ascending counterflow, manifesting as phlegm rising with qi rebellion, with symptoms such as copious yellow sputum, even panting, and gurgling sounds of phlegm in the throat. It can also be accompanied by qi depression due to emotional fluctuations, presenting with chest tightness, epigastric distension, and hypochondriac pain. In elderly patients with chronic illness, hiccup due to stomach qi ascending counterflow caused by deficiency of middle qi is a critical sign and should be taken seriously in clinical practice.

bubble_chart Differentiation of Similar Patterns

1. The syndrome of stomach qi failing to descend and the pattern of ascending counterflow of stomach qi: The stomach is the sea of water and grain, responsible for receiving and digesting food. Stomach qi should descend smoothly. If one's diet is irregular, with inconsistent hunger and fullness, or inappropriate temperatures of food, it can affect the stomach's descending function, leading to disorders such as stomach qi failing to descend and ascending counterflow of stomach qi. However, the pattern of ascending counterflow of stomach qi is more severe. Initially, it may present as the syndrome of stomach qi failing to descend, with symptoms such as epigastric stuffiness and fullness, loss of appetite, or stomach pain, and difficulty in bowel movements. If not treated or mistreated, the condition can worsen, leading to the pattern of ascending counterflow of stomach qi, causing nausea, vomiting, hiccups, and regurgitation.
2. Liver qi transverse unfavorable pattern and the pattern of ascending counterflow of stomach qi: The liver governs the free flow of qi, which should be smooth. Liver qi depression leads to dysfunction in dispersion. Physiologically, the ascent of spleen qi and the descent of stomach qi both rely on the liver's dispersing function. If liver depression causes qi stagnation, it can transversely invade the stomach. Ye Tianshi said, "Liver disease must invade the earth, which is to bully the element it restricts." Liver qi invading the stomach can cause the stomach to fail to descend, leading to symptoms such as gastric stuffiness, hypochondriac pain, bitter taste in the mouth, belching, and loss of appetite. The pattern of ascending counterflow of stomach qi can also present with belching and stomachache with distension, but it lacks the hypochondriac pain and bitter taste in the mouth seen in liver qi transverse unfavorable pattern. The former is related to emotional fluctuations, while the latter is not obvious.
3. Chong rising of qi unfavorable pattern and the pattern of ascending counterflow of stomach qi: Chong rising of qi unfavorable pattern belongs to liver and kidney disorders. The liver and stomach are both located in the lower energizer. Severe qi stagnation due to internal damage from the seven emotions can ascend along the Chong vessel; yang deficiency in the lower energizer and cold water qi can also ascend along the Chong vessel, forming the running-piglet qi of Chong rising. If it affects the lung qi failing to descend, it can be accompanied by wheezing and coughing; if it affects the stomach qi failing to descend, it can be accompanied by nausea; if qi counterflow affects the spirit, it can lead to palpitations and restlessness. Although Chong rising of qi can also affect the stomach qi's descending function and cause nausea and vomiting, the main symptom is the running-piglet qi of Chong rising, with vomiting being a secondary symptom. In contrast, the pattern of ascending counterflow of stomach qi primarily presents with vomiting, making the two easily distinguishable.

bubble_chart Documentation

1. Linzheng Zhinan Yi'an‧Spleen and Stomach: "Injury to stomach yang, the treatment of fu organ diseases focuses on promoting flow as a means of tonification, and adhering to the middle will inevitably lead to obstruction and counterflow."
2. Jingui Yaolue‧Treatment of Vomiting, Hiccup, Diarrhea, and Abnormal Pulse Syndromes: "A floating and hesitant anterior tibial pulse indicates deficiency, while a hesitant pulse indicates spleen injury. Injury to the spleen leads to impaired digestion, resulting in evening vomiting of food eaten in the morning, morning vomiting of food eaten in the evening, and undigested food, known as regurgitation."
3. 《Yibian》: "In the case of stomach wheezing, disharmony in the stomach collaterals leads to qi counterflow causing wheezing. However, the factors leading to counterflow are either fire, food, or phlegm."