Vomiting

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Textbook Prescriptions Digestive

Essentials of Chinese Acupuncture (Beijing, Shanghai and Nanjing Colleges of Traditional Chinese Medicine, 1980) — the standard prescriptions of the Chinese colleges.

Points

ST36 Zusanli bilateral

He-Sea of the Stomach; with CV12 it settles the stomach and turns its qi back downward
CV12 Zhongwan midline

Front-Mu of the Stomach; the local partner of ST36 for harmonising the stomach
- ⚠ Organ
- Pregnancy: caution
PC6 Neiguan bilateral

Confluent point paired with SP4; eases oppression of the chest and epigastrium
SP4 Gongsun bilateral

Confluent point paired with PC6; together they relieve fullness above and below the diaphragm

Needling Safety

Cited hazards for these points. Tick what applies to the patient to see the cautions that follow from it.

CV12 Zhongwan
- ⚠ Organ injury has been reported after needling this point. Wu J, Hu Y, Zhu Y, Yin P, Litscher G, Xu S 2015, Table 4 (Organ injury associated with acupuncture)

Treatment Principle

Restore the downward movement of stomach qi so that it stops rising, draining the excess types and strengthening the deficient one.

Indications

Food retention: distended or painful epigastrium and abdomen, sour fermented vomitus, belching, poor appetite, constipation, foul flatus; thick sticky tongue coating, rolling forceful pulseLiver qi invading the stomach: vomiting with acid regurgitation, repeated belching, distending hypochondriac pain; thin sticky coating, wiry pulseSpleen and stomach weakness: sallow face, vomiting after a large meal, little appetite, slightly loose stools, tiredness; thin sticky coating, pulse lacking force

Method

Reducing method for food retention and for liver qi attacking the stomach; reinforcing method with moxibustion when the spleen and stomach are weak.

⚠ Cautions

Persistent or projectile vomiting, blood or coffee-ground material in the vomitus, severe abdominal pain, signs of bowel obstruction or dehydration need medical assessment before or alongside acupuncture. Consider pregnancy as a cause of vomiting in women of childbearing age. CV12 lies over the stomach and left lobe of the liver; avoid deep needling in thin patients.

About

The base Stomach-channel prescription the colleges give for vomiting of every type, adjusted with one secondary point for each pattern.

Rationale

ST36 and CV12, the He-Sea and Front-Mu of the Stomach, work as a distal and local pair to bring rebellious stomach qi back down. PC6 and SP4 form one of the Eight Confluent couples and clear the sense of fullness from the chest and stomach, so the four points address both the organ and the oppression that drives the vomiting.

Clinical Notes

Secondary points by pattern: for food retention add ST25 to clear the intestines; for liver qi invading the stomach add LV3, needled with reducing method; for spleen and stomach weakness add BL20 with reinforcing method. For intractable (pernicious) vomiting, the extra points Jinjin and Yuye (EX-HN12, EX-HN13) under the tongue are pricked to bleed, an empirical measure. The book equates this section mainly with acute and chronic gastritis and with nervous vomiting.

Sources

Beijing College of Traditional Chinese Medicine, et al. Essentials of Chinese Acupuncture. Beijing: Foreign Languages Press, 1980. Chapter III, Vomiting, p. 353–354.

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