bubble_chart Concept

Regurgitation, also known as "regurgitation," refers to the symptom of food entering the stomach but not being digested, eventually being regurgitated. Its manifestations may include evening vomiting of food eaten in the morning, morning vomiting of food eaten in the evening, vomiting one or two hours after eating, or vomiting after a full day and night.

Neijing does not yet have the name for regurgitation, but it includes this condition in discussions related to vomiting, hiccups, and diaphragm disorders. For example, "food enters and then comes back out," "food is expelled after a cycle of a day and night" (Lingshu．Shangge). "Excessive fullness leads to upward reversal" (Suwen．Maijie Pian), etc. Jingui Yaolue first recorded the term "regurgitation." Subsequently, medical texts from various dynasties either referred to it as regurgitation or used different names, but the essence remains the same.

bubble_chart Pattern Analysis

1. Spleen and Stomach Yang Deficiency︰Vomiting undigested food in the evening that was eaten in the morning, or vomiting in the morning what was eaten in the evening, with abdominal distension and fullness, reduced appetite, loose stools, lack of strength, cold limbs, shortness of breath, reluctance to speak, pale complexion, a pale tongue with moist white coating, and a floating-rough or weak-slow pulse. This is attributed to the middle energizer (spleen and stomach), resulting from improper lifestyle, excessive worry, or misuse of diaphoresis or purgation, which injures spleen-stomach yang qi, leading to cold deficiency in the stomach, sluggish transformation and transportation, retention of undigested food, and upward rebellion of accumulated contents. The key diagnostic points include vomiting undigested food in the evening or morning, relief after expelling stagnant food, accompanied by abdominal distension and fullness, reduced appetite, loose stools, pale complexion, lack of strength, and cold hands and feet. A pale tongue with moist white coating and a floating-rough or weak-slow pulse also indicate deficiency-cold of middle qi. Treatment should focus on warming the middle, strengthening the spleen, harmonizing the stomach, and descending adverse qi, using Qi-Tonifying and Transport-Fortifying Decoction. Mild cases are due to weakened middle yang.
2. Decline of the Life-gate Fire︰evening vomiting of food eaten in the morning, or even vomiting food consumed the previous day, with undigested grains, inability to ingest food, and clear, cold, watery saliva. Symptoms include aversion to cold, cold pain in the waist and knees, facial and pedal edema, abdominal distension and fullness, lienteric diarrhea, impotence, frequent urination, or even inability to pass urine and stool, mental fatigue and drowsiness, pale complexion, faint, thin, deep, and slow pulse, pale tongue with slippery coating. The cause lies in the lower energizer and life gate. It is often due to declining yang in old age or prolonged illness unrelieved, resulting from spleen-kidney yang deficiency. The true fire of the life gate is the source of triple energizer qi transformation; thus, the decline of life gate fire inevitably leads to deficient warming, generation, and transformation as the primary mechanism of disease. Without fire beneath the cauldron, grains remain undigested and are eventually vomited, sometimes even a full day after ingestion, with the vomitus being clear and cold. Yang deficiency leads to yin exuberance, hence accompanying symptoms such as aversion to cold, cold pain in the waist and knees, facial and pedal edema, or lienteric diarrhea and frequent urination, or inability to pass urine and stool. Mental fatigue, drowsiness, faint, thin, deep, and slow pulse, and pale tongue with slippery coating are also signs of deficiency of yang with exuberance of yin. The disease is attributed to kidney yang deficiency and decline, and treatment should focus on replenishing fire to generate earth, warming yang to aid transportation. Prescriptions such as the Six-Ingredient Yang-Restoring Decoction or the Kidney Qi Pill from the Golden Cabinet may be used.
3. Internal Retention of Water and Fluid︰Regurgitation involves vomiting undigested food and clear watery phlegm-saliva, or spitting out frothy saliva. Gastric stuffiness leads to reduced appetite, palpitation, dizziness, or wheezing cough due to qi counterflow. The tongue coating is white, slippery, and greasy, with a pulse manifestation that is wiry and slippery. The condition arises from yang failing to transform fluids, leading to retained fluids forming retention. Cold-retention stagnates internally, obstructing middle yang, impairing the movement of food and water, resulting in gastric stuffiness and reduced appetite, as well as regurgitation with the expulsion of undigested food and phlegm-saliva. When retention pathogens obstruct the middle and surge upward, symptoms such as dizziness, palpitation, and wheezing counterflow may occur. Since retention is a yin-turbid pathogen, the tongue coating appears white and greasy, and the pulse is wiry and slippery. Treatment follows the principle from Jingui Yaolue: "For phlegm-fluid retention, warm medicinals should be used to harmonize." Poria and Alisma Decoction is selected with modifications.
4. Phlegm and Qi Stagnation︰Nausea and vomiting of food and phlegm, chest and diaphragm stuffiness and fullness, restlessness and discomfort, abdominal distension and fullness, unsmooth bowel movements, hiccups and belching, dysphoria with alternating joy and anger, white and greasy tongue coating, deep and wiry pulse. The disease mechanism lies in the stagnation of qi leading to the congealment of fluids into phlegm. The illness arises from unresolved anger and depression, stagnation of qi movement, congealment of fluids into phlegm, and the binding of phlegm and qi, obstructing the middle pathway. The symptoms include vomiting of undigested food and phlegm, chest and diaphragm stuffiness and fullness, hiccups and belching, unsmooth bowel movements, deep and wiry pulse, and white and greasy or slippery tongue coating as the key diagnostic points. The obstruction of phlegm-yin and qi-yang meeting together, with qi depression as the root cause, often manifests clinically as symptoms alleviating when emotions are relaxed and worsening with worry, anger, or depression. The treatment should focus on releasing depression and resolving phlegm, with Xiangsha Kuanzhong Wan as the selected prescription.
5. Alcohol Accumulation Dampness-heat︰Restlessness and stifling heat, a feeling of nausea with the urge to vomit, regurgitation of sour and foul-smelling undigested food, heaviness of the head, bodily fatigue, gastric stuffiness and chest oppression, dry mouth with thirst, dark urine, a yellow, thick, and greasy tongue coating, and a slippery-rapid or soggy-rapid pulse. This condition arises from excessive alcohol consumption, leading to internal generation of dampness turbidity, which stagnates and transforms into heat, encumbering the middle energizer and causing turbid heat to steam upward and reverse flow. The main characteristic symptom is the regurgitation of sour and foul-smelling undigested food. Dampness-heat steaming internally disrupts stomach harmony and descent, hence accompanying symptoms include restlessness and stifling heat, dry mouth with thirst, dark urine, gastric stuffiness and chest oppression, bodily fatigue, heaviness of the head, a red tongue with a yellow, greasy coating, and a wiry-rapid pulse—key signs of dampness-heat pathology. Treatment involves clearing heat and draining dampness, as well as resolving alcohol toxicity and harmonizing the stomach. The recommended formula is Pueraria Flower Sobering-Up Decoction with modifications.
6. Static Blood Stagnation︰Food enters but is obstructed and fails to transform, instead being regurgitated, with stabbing pain in the chest and epigastrium that resists pressure, fixed pain, and in severe cases hematemesis and black stools, constipation with difficulty, dry mouth and throat with thirst, purple-dark tongue texture or with ecchymosis, and wiry-choppy pulse manifestation. The root of regurgitation due to static blood lies in blood stasis obstructing the chest and epigastrium, stagnating and blocking the mechanism of harmonious downbearing, causing food to enter but fail to transform and be regurgitated, and in severe cases leading to hematemesis and bloody stool. Static blood lingers and stagnates, hence the stabbing pain in the chest and epigastrium that resists pressure, with the characteristic of being slightly relieved by warmth and aggravated by cold. Yin-blood fails to nourish, and fluids fail to ascend, hence the dry mouth and throat with thirst, or taking water in mouth but with no desire to swallow. Blood stasis causes intestinal dryness and impaired conduction, hence dry stool with stagnation and choppiness. Purple-dark tongue texture or with ecchymosis, and wiry-choppy pulse manifestation are all important signs of a stasis pattern. The treatment method focuses on invigorating blood and resolving stasis, moving qi and downbearing counterflow. Commonly used is the Peach Kernel Purgative Decoction, taken as pills with leek juice.
7. Yin Deficiency with Blood Dryness︰Difficulty in swallowing with regurgitation after a long time, dry mouth, restlessness, palpitation and insomnia, dizziness and blurred vision, soreness in the waist and tinnitus, emaciated physique, dry and withered skin, steaming bone fever and night sweats, dull complexion, dry and accumulated stool, red tongue with scant coating, and thin and rapid pulse. The disease is located in the lower energizer, involving the liver and kidneys, mostly caused by exhaustion from excessive sexual activity, indulgence in strong flavors, or prolonged anxiety and anger leading to depletion of essence and blood, dryness of the intestinal tract, and failure to digest food, resulting in regurgitation. The main symptoms are characterized by difficulty in swallowing with regurgitation after a long time, accompanied by dizziness and blurred vision, dry mouth, restlessness, palpitation and insomnia, emaciated physique, dry and withered skin, dry and accumulated stool, and other symptoms of yin-blood deficiency and withering malnutrition. Deficiency of yin-blood generates internal heat, hence the crimson tongue with scant coating and thin, rapid pulse. In clinical diagnosis and treatment, it is essential to identify the disease cause and mechanism leading to the depletion of yin-blood, as well as the characteristics of dryness and withering, and apply treatments to moisten and nourish. The commonly used prescription is Decoction for Opening Pylorus.
8. Deficiency of Both Qi and Yin︰Food intake is regurgitated, poor appetite, dry stools, palpitation spontaneous sweating, burning sensation in hands and feet, shortness of breath fatigue, dry shoulders and mouth, red tongue without coating, or tongue coating peeling, pulse manifestation thin and rapid. Deficiency of both qi and yin, regurgitation, mostly caused by Rebing aftermath, or prolonged vomiting without recovery, or misuse of warm and drying medications, damaging the lungs and stomach and depleting qi and yin. Insufficient stomach fluid is like a pot without water, making it difficult to digest food, hence causing regurgitation and poor appetite. Deficiency of both qi and yin leads to failure of qi to transform fluids, thus accompanied by dry lips and mouth, dry stools, shortness of breath spontaneous sweating, palpitation insomnia, red tongue with little coating or tongue coating peeling, pulse manifestation thin and rapid, and other symptoms. Treatment involves tonifying qi and nourishing yin, downbearing counterflow to stop vomiting, using Major Pinellia Decoction.
9. Parasitic Accumulation︰Nausea with restlessness, occurring intermittently, vomiting roundworms after eating, and in severe cases, experiencing parasitic pain with reversal cold of limbs, worm spots on the face, large red dots on the tongue, and a pulse that is alternately large and small. Parasites in the human body become restless due to cold invasion or fire agitation, wriggling and disturbing upward, leading to the stomach's failure to descend, resulting in food being regurgitated and even vomiting roundworms. Restlessness and vexation occur intermittently, and in severe cases, parasitic pain and reversal cold may develop. Zhangshi Yitong states: "Nausea with epigastric upset and restlessness, occurring intermittently, accompanied by vexation and white spots on the face, should be treated as parasitic accumulation." Commonly used prescriptions include Coptis and Plum Ascarid-Quietening Decoction or Mume Pill.

The three conditions of regurgitation, vomiting, and dysphagia all involve the symptom of expelling food and should be differentiated. Regurgitation is often associated with yang deficiency and cold, leading to indigestion. Its main characteristic is that food can still be ingested but is eventually regurgitated after a long time, such as evening vomiting of food eaten in the morning or morning vomiting of food eaten in the evening. Dysphagia is usually caused by stagnant qi and yin deficiency with blood dryness. Its main characteristic is difficulty in swallowing, with food being vomited immediately or slowly after ingestion. The treatment for regurgitation can involve tonification and warming, making it relatively easier to manage. Dysphagia, however, is much more challenging to treat. Vomiting is related to the upper stomach and is attributed to the stomach's failure to receive food, while regurgitation is related to the lower stomach and is attributed to the spleen's failure to transform food. Vomiting is often associated with excess syndromes, with sudden onset and immediate expulsion of ingested food. Regurgitation, on the other hand, is primarily associated with deficiency and cold, with a lingering and chronic nature.

bubble_chart Documentation

1. Beiji Qianjin Yaofang. Regurgitation: "The cun pulse is tight and the chi pulse is rough, the person has chest fullness, cannot eat, and vomits. What is vomited is purgation, hence cannot eat. If the vomiting does not stop, this is regurgitation, hence the chi pulse is slightly rough."
2. 《Bian Que's Heart Book. Vomiting and Regurgitation》: "When dietary habits are irregular, cold substances damage the spleen. Although the stomach can receive food, the spleen cannot transport it, hence vomiting occurs... If the damage is severe and compounded by harm from the seven emotions, then fluids accumulate in the middle energizer, causing evening vomiting of food eaten in the morning, known as regurgitation, which is due to extreme deficiency of spleen qi, unable to transport effectively."
3. 《Qixiao Liangli. Regurgitation Chapter》: "Regurgitation originates from the stomach... mostly due to initial rebellion of stomach qi, excessive injury from alcohol, or accumulation of wind-cold, or due to melancholy and depression, or due to pent-up anger and depression, chronic stagnation and fixed phlegm, abdominal mass cold phlegm, disturbing the spleen and stomach, the stomach is too weak to digest grain food, thus forming this syndrome."
4. Jingyue Quanshu. Regurgitation: "Deficiency in the lower energizer causing evening vomiting of food eaten in the morning or food being regurgitated long after eating, the responsibility lies in yin. Without supplementing the life gate to support the mother of spleen earth, then fire cannot transform, and ultimately there is no relief."