bubble_chart Concept

Vomiting is one of the common symptoms in pediatrics.

Ancient people discussed vomiting, often referring to it as retching when there is substance and sound, as spitting when there is substance but no sound, and as hiccup when there is sound but no substance. However, infantile vomiting is difficult to clearly separate into these three categories, hence most pediatric monographs generally refer to it as vomiting.

In young infants, milk regurgitation and milk hiccups are similar to vomiting, and clinical differentiation can refer to this section, without further discussion.

bubble_chart Pattern Analysis

1. Food Accumulation and Stagnation︰Vomiting immediately after eating, with sour and foul-smelling vomitus, and relief of gastric discomfort after vomiting, accompanied by abdominal distension and fullness, anorexia, stools that are sour, fishy, and foul-smelling, or constipation with difficulty in defecation, a thick, greasy, and grimy tongue coating, and a slippery and rapid pulse. This condition is caused by dietary irregularities, excessive consumption of rich, sweet, and greasy foods, or indulgence in raw, cold, or melon-like fruits, leading to spleen and stomach injury, stagnation of milk or food, and failure of stomach qi to descend harmoniously, resulting in vomiting symptoms. The vomitus is exceptionally sour and foul-smelling, with relief of gastric discomfort after vomiting, along with symptoms of food injury (dyspepsia) such as foul-smelling stools and anorexia.
2. Dampness-heat of Spleen and Stomach︰vomiting nausea, cannibalism abdominal distension and fullness, often accompanied by alternating chills and fever, or fever without chills, hypochondriac distending pain, white of the eye and skin yellowing, urine yellow like cypress juice, severe constipation or loose stools, white in color, tongue coating yellow and greasy, pulse manifestation wiry and rapid. Mostly caused by internal damage due to diet, external contraction of wind pathogens, internal and external factors interacting, leading to dampness accumulation and heat generation, dampness-heat stagnation and steaming, stomach qi ascending counterflow resulting in vomiting. The difference between the two lies in: the vomitus may have a sour and foul odor, abdominal and hypochondriac pain not alleviated after vomiting, accompanied by alternating chills and fever, skin yellowing, and other dampness-heat stagnation symptoms. For food stagnation, treatment should focus on resolving food accumulation, downbearing counterflow to stop vomiting, Harmony-Preserving Pill with modifications; for dampness-heat of spleen and stomach, treatment should focus on clearing heat and resolving dampness, downbearing counterflow to stop vomiting, Virgate Wormwood Decoction combined with Coptis Rhizome Gallbladder-Warming Decoction with modifications.
3. Stomach Qi Deficiency︰Vomiting clear water, neither sour nor putrid, poor appetite, fontanel often sunken, cold hands and feet, yellowish complexion, white leukorrhea, indifferent expression, fatigue and somnolence, pale tongue with thin coating, thin and weak pulse. This is due to qi deficiency, attributed to congenital insufficiency, weak stomach qi, or misuse of digestive and purgative agents, injuring stomach qi. Stomach deficiency fails to receive food, hence vomiting symptoms occur. Treatment should focus on nourishing stomach qi, downbearing counterflow to stop vomiting, with Extraordinary Efficacy Powder as the main prescription.
4. Stomach Yin Deficiency︰Retching with scant vomitus, red lips, dry tongue, feverish sensation in palms and soles, or late afternoon tidal fever, dry stool, scanty dark urine, red tongue texture with thin coating, and thready rapid pulse. This indicates yin deficiency, with the disease located in the stomach. Commonly seen in the Rebing late stage (third stage), where stomach yin is impaired, deficient heat rises to disturb, and stomach fails to harmonize and descend, resulting in vomiting symptoms. The key points for pattern identification are: those with stomach qi deficiency vomit clear water without sour or foul odor; those with stomach yin deficiency vomit scant material with a bitter and sticky taste in the mouth. Additionally, qi deficiency manifests as sunken fontanel and cold extremities, which significantly differs from yin deficiency symptoms like red lips, dry tongue, and feverish sensation in palms and soles, making clinical differentiation relatively easy. Treatment should focus on nourishing stomach yin, clearing heat, and stopping vomiting, with Bamboo Leaf and Gypsum Decoction as the primary prescription.
5. Spleen and Stomach Yang Deficiency︰Frequent evening vomiting of food eaten in the morning, with the expulsion of milk curds or retained food, a pale complexion, cold limbs, dull abdominal pain that prefers pressure, a tendency to curl up and lie still, loose stools, a pale tongue texture with thin, slippery, and moist coating, and faint bluish finger venules. This condition arises from innate constitutional weakness or exposure to severe cold that lingers and damages the spleen and stomach yang. Yang deficiency fails to warm and transform food and fluids, leading to stagnation and impaired movement of milk or food, hence vomiting long after eating. Its characteristics include: evening vomiting of food eaten in the morning, expulsion of undigested milk curds or food, accompanied by cold limbs, loose stools, faint bluish finger venules, and a slippery, moist tongue coating—all signs of yang deficiency. It is more severe than other types of vomiting in terms of symptoms and signs. Treatment should focus on warming the middle to support yang and downbearing counterflow to stop vomiting, using modified Middle-Regulating Decoction with added Evodia and Clove.
6. External Pathogen Invading the Stomach︰Vomiting food or milk curds, with large amounts ejected in a projectile manner, accompanied by aversion to cold with fever, or high fever and dysphoria, thirst or absence of thirst, profuse sweating, a red complexion, a red tongue with thin white or thin yellow coating, and a floating or surging pulse. The invasion of Xieke due to wind-cold or summerheat-dampness in the stomach, causing the stomach qi to lose its descending and harmonizing function, is also a common cause of infantile vomiting. The vomiting is projectile in nature, with a sudden onset and identifiable external factors. Vomiting due to wind-cold attacking the stomach is more common in winter and spring, while vomiting due to summerheat-dampness attacking the stomach occurs in late summer. The distinguishing symptoms between the two are: vomiting due to wind-cold attacking the stomach lacks a filthy turbid odor, there is no thirst, drinking water induces vomiting, accompanied by aversion to cold with fever, and a floating pulse; vomiting due to summerheat-dampness attacking the stomach has a filthy turbid odor, thirst with a desire to drink, accompanied by high fever and dysphoria, and a surging pulse. Due to their differing natures, the treatment approaches also differ. For vomiting due to wind-cold attacking the stomach, the treatment should focus on dispelling wind and dispersing cold, downbearing counterflow to stop vomiting, with Ginseng and Perilla Decoction as the primary formula. For vomiting due to summerheat-dampness attacking the stomach, the treatment should focus on clearing summerheat and resolving dampness, downbearing counterflow to stop vomiting, with Huolian Decoction as the primary formula.

The differentiation of infantile vomiting first requires distinguishing between deficiency and excess, as well as cold and heat. Generally, deficiency pattern manifests with a slow onset, while excess pattern presents with a sudden onset. Cold pattern is characterized by evening vomiting of food eaten in the morning, whereas heat pattern involves vomiting immediately after eating. Excess pattern and heat pattern are often caused by dietary internal damage or pathogenic factors invading the stomach. Deficiency pattern and cold pattern are commonly seen in individuals with congenital insufficiency or chronic deficiency. Previous generations emphasized dietary control in the treatment of infantile vomiting. Youyou Jicheng states in "Treatment of Vomiting": "When treating infantile vomiting, it is first appropriate to regulate the intake of milk and food. Regulation here means reducing the amount." For frequent vomiting, fasting should be implemented. Chinese medicinals should be administered in small, frequent doses. If Chinese medicinals cannot be taken, acupuncture or tuina therapy can be used, which are also highly effective.

bubble_chart Documentation

1. "Hundred Questions on Pediatrics: Vomiting and Spitting Milk Syndrome": "When nursing infants, it is not advisable to overfeed them. If they are too full, they will overflow, hence causing vomiting. The stomach holds milk like a vessel holds objects; a small cup cannot contain the contents of a large bowl. Just as a pond overflows with sudden rain and a cup tips over with a sudden pour of wine, it is a natural principle."
2. "Golden Needle of Pediatrics": "Insufficient spleen qi cannot transform water and grains, leading to persistent fluid retention that accumulates in the middle burner. When encountering heat, it rises and causes vomiting; when encountering cold, it congeals and blocks, also causing vomiting."