bubble_chart Concept

Vomiting of pregnancy refers to nausea and vomiting during pregnancy, aversion to the smell of food, vomiting immediately after eating, or being unable to eat due to vomiting. It is generally seen in the early stages of pregnancy. Mild cases often disappear naturally after the second or third month of pregnancy; severe cases involve frequent vomiting or persistent vomiting due to improper food intake, which can continue until the late stage [third stage] of pregnancy. The vomit is mostly food, phlegm, or clear water, sour water, yellow-green bitter water, and in severe cases, it may be mixed with blood, resembling a sauce color. In severe cases, it can endanger both the fetus and the pregnant woman.

This condition, Zhubing Yuanhou Lun refers to it as "morning sickness," while Taiping Shenghui Fang calls it "pregnancy obstruction disease," Bencao Gangmu refers to it as "morning sickness," and "Kun Yuan Shi Bao" calls it "food illness," commonly known as "child illness."

bubble_chart Pattern Analysis

1. Stomach Qi Deficiency︰Weak constitution, early pregnancy (first trimester), vomiting and inability to eat, or vomiting immediately after eating, epigastric stuffiness, abdominal distension and fullness, mental fatigue, lack of strength, drowsiness, pale tongue with white coating, slippery and weak pulse. This is attributed to qi deficiency, often due to inherent spleen-stomach weakness. After conception, amenorrhea prevents the Blood Sea from discharging, leading to excessive Chong vessel qi. The Chong vessel is connected to the Yangming meridian, and its rising qi counterflows to attack the stomach, disrupting its descending function and causing upward rebellion, resulting in vomiting. Vomiting due to stomach deficiency occurs immediately after eating and is frequent. Associated symptoms often manifest as spleen-stomach qi deficiency with impaired transportation and transformation (epigastric and abdominal distension and fullness, mental fatigue, reluctance to speak, drowsiness, pale tongue, slippery and weak pulse). Treatment should focus on tonifying qi and strengthening the middle jiao, assisted by regulating qi and descending counterflow. Recommended formulas include Pinellia and Poria Decoction or Baosheng Decoction.
2. Stomach Cold︰In the early stages of pregnancy, vomiting and refusal to eat, or spitting clear water, epigastric pain, preference for hot drinks, physical fatigue, fear of cold, cold limbs and lethargy, {|###|}complexion{|###|} bluish-white, {|###|}tongue texture{|###|} pale, tongue coating white and slippery, pulse deep and slow. It belongs to {|###|}yang deficiency{|###|}, due to the usual lack of middle {|###|}yang{|###|} vigor, {|###|}deficiency-cold of spleen and stomach{|###|}. After pregnancy, the {|###|}cervical orifice{|###|} is blocked, the visceral qi is internally obstructed, and cold fluids reverse upward, leading to vomiting, which worsens with cold and often involves regurgitation of clear water. The accompanying symptoms mostly manifest as {|###|}yang deficiency external cold{|###|} ({|###|}complexion{|###|} bluish-white, physical fatigue, fear of cold, cold limbs and lethargy, preference for heat and aversion to cold) and {|###|}pudendal coldness{|###|} internal stagnation (epigastric pain, preference for hot drinks, pulse deep and slow). The treatment should focus on {|###|}warming the middle and dissipating cold{|###|}, {|###|}downbearing counterflow to stop vomiting{|###|}. The prescription used is Ginseng Clove Powder. For severe cold, use Dried Ginger, Ginseng and Pinellia Pill.
3. Stomach Heat︰After conception, symptoms include nausea, thirst, facial flushing, preference for cold drinks, constipation, a red tongue with yellow and dry coating, and a slippery, rapid pulse. This is caused by upward rebellion of fire-heat, often due to habitual stomach heat accumulation or a preference for spicy and rich foods, leading to stomach disharmony and failure to descend. It is accompanied by symptoms such as internal scorching of stomach fire (thirst with preference for cold drinks, restlessness, severe constipation, red tongue) and up-flaming of stomach fire (facial flushing). The treatment should focus on clearing and draining stomach fire, downbearing counterflow to stop vomiting. The recommended formula is Huanglian Tang (Coptis Decoction) with added Bamboo Shavings, Pinellia, and Ophiopogon Tuber.
4. Phlegm Stagnation︰Pregnancy in the second or third month, vomiting phlegm-drool or sticky foam, dizziness, dizzy vision, nausea, chest and diaphragm fullness, loss of appetite, palpitation, shortness of breath, bland and greasy taste in the mouth, tongue texture pale, tongue coating white and greasy, pulse slippery. The patient originally has phlegm-fluid retention stagnating in the middle burner, qi movement obstructed in ascending and descending, further aggravated by the upward rebellion of the thoroughfare vessel qi carrying phlegm-fluid retention, leading to vomiting. The vomitus mostly consists of phlegm-drool or sticky foam. It is often accompanied by symptoms of phlegm-fluid retention internally stagnating, such as pathogenic fluids invading the heart and lungs (palpitation, shortness of breath) and dampness encumbering the middle burner (chest and epigastric fullness, bland and greasy taste in the mouth, loss of appetite). Treatment should focus on resolving phlegm and dispelling dampness, downbearing counterflow to stop vomiting, commonly using Two Old Ingredients Decoction with Submature Bitter Orange. Phlegm-stagnation vomiting of pregnancy can further be divided into heat-accompanied and cold-accompanied types. The heat-accompanied type often presents with vomiting of bitter fluid, dizziness, heart vexation, dry mouth with greasy sensation, red tongue, yellow and greasy tongue coating, slippery and rapid pulse, and other signs of dampness-heat. The cold-accompanied type is often accompanied by pale complexion, vomiting of clear fluid (worse in the morning), bland taste in the mouth, pale tongue, white and greasy tongue coating, deep and weak pulse, and other signs of deficiency-cold. Thus, for the heat-accompanied type, treatment involves clearing heat and resolving phlegm, downbearing counterflow to stop vomiting, using Reed Rhizome Decoction. For the cold-accompanied type, treatment should warm and resolve phlegm and fluid retention, downbearing counterflow to stop vomiting, using Poria Pill.
5. Liver Heat︰In early pregnancy, vomiting sour or bitter fluid, immediate vomiting after eating, dizziness and blurred vision, foul breath and bitter taste in the mouth, chest tightness and hypochondriac pain, belching, red tongue texture with normal or slightly yellow coating, wiry-slippery and rapid pulse. This is caused by upward flaming of fire-heat, often due to habitual liver yang hyperactivity. After pregnancy, blood gathers to nourish the fetus, leading to further deficiency of liver yin and increased hyperactivity of liver yang, or liver depression transforming into heat, transversely invading the stomach. "The stomach itself does not vomit; it is the liver and gallbladder that cause vomiting." Accompanied by liver qi depression (fullness and pain in the chest and hypochondrium, irritability, belching) and liver channel depressive heat (dizziness and blurred vision, bitter taste in the mouth and foul breath, red tongue). Treatment should clear the liver and harmonize the stomach, downbear counterflow to stop vomiting. Huanglian Zhuru Tang (Coptis and Bamboo Shavings Decoction) can be used.

Due to frequent {|###|}vomiting{|###|}, the inability to eat leads to a lack of water intake, often resulting in the depletion of stomach fluids and the loss of nourishment to the stomach, exacerbating its adverse condition. Symptoms such as {|###|}retching thirst{|###|}, dry lips and mouth, scanty urine, dry stool accumulation, a red tongue with little moisture, a {|###|}tongue coating{|###|} that is glossy and peeled, and a fine and rapid pulse often appear, indicating the consumption of {|###|}stomach yin{|###|}. At this time, it is advisable to nourish the {|###|}stomach yin{|###|}. The prescription used is Ophiopogon Decoction.

Vomiting{|###|} is one of the main clinical manifestations of the stomach's failure to descend and harmonize. {|###|}Vomiting of pregnancy{|###|} varies in deficiency and excess, cold and heat. In cases of {|###|}stomach deficiency{|###|}, due to {|###|}qi deficiency{|###|}, one cannot ingest food and vomits immediately after eating; in cases of {|###|}stomach cold{|###|}, due to {|###|}yang deficiency{|###|}, one cannot digest food well, often vomiting undigested food and clear water, which worsens with cold; in cases of {|###|}stomach heat{|###|}, the vomiting is more severe; in cases of phlegm stagnation, one tends to vomit sticky phlegm and saliva; in cases of {|###|}liver heat{|###|}, one often vomits sour and bitter substances. From the {|###|}pulse manifestation{|###|}, {|###|}stomach deficiency{|###|} often shows a slippery and weak pulse; {|###|}stomach cold{|###|} shows a deep and slow pulse; phlegm stagnation shows a slippery pulse; {|###|}stomach heat{|###|} shows a slippery and rapid pulse; {|###|}liver heat{|###|} shows a wiry, slippery, and rapid pulse. In clinical diagnosis, it is necessary to consider both the pulse and the symptoms to make a clear distinction.

bubble_chart Documentation

1. Jingyue Quanshu-Furen Gui: "Generally, morning sickness... However, there are cases where the body is not originally deficient, but suddenly upon conception, the Chong and Ren vessels become congested above, and qi fails to descend, thus causing symptoms such as vomiting and nausea, which gradually cease after three months or so."
2. Xinkan Furen Liangfang Buyi Daquan cites Mr. Li Maoweng as saying: " If the left pulse is weak and vomiting occurs, and various medicines fail to stop it, one should take medicine that regulates blood and returns it to its origin, then recovery will follow. As the classic says: 'Without yin, there is vomiting.'" Also: " To treat severe morning sickness during pregnancy, with incessant vomiting, headache, and complete inability to eat, when various medicines prove ineffective, use this medicine to regulate blood and return it to its origin, then recovery will follow. Ginseng, Liquorice Root, Sichuan Lovage Rhizome, Chinese Angelica, Jing Peony Root, Clove, White Poria, White Atractylodes Rhizome, Dried Tangerine Peel, Bitter Orange, Submature Bitter Orange, Pinellia, Fresh Ginger Rhizome, Jujube."

bubble_chart Differentiation

This condition should be distinguished from vomiting caused by jaundice, common cold, spring warmth, summerheat warmth, and dampness warm disease during pregnancy, which are not within the scope of this discussion.