Nausea, Vomiting of Pregnancy

WESTERN MEDICINE: Nausea and vomiting during pregnancy is also called "morning sickness", pernicious vomiting of pregnancy, hyperemesis gravidarum. It means the nausea and vomiting occurring in pregnancy, usually in the early months, and of varying severity. 

SYMPTOMS AND SIGNS: Nausea and vomiting appear in the 5th or 6th week of pregnancy and last for an indefinite period. Symptoms vary in severity from simple "morning sickness" to pernicious vomiting. Morning sickness begins with a feeling of nausea on arising; the patient is unable to retain her breakfast but by noon the symptoms have disappeared and she usually feels well until the following morning. Occasionally, this cyclic nausea of pregnancy may appear as "afternoon" or "evening" sickness. The condition usually clears up without treatment by the 14th to 16th week. In some cases, morning sickness evolves into pernicious nausea and vomiting, anorexia, or inability to take food at all, which may produce a weight loss. 

ETIOLOGY AND PATHOLOGY: The pathogenic changes for morning sickness are due to the deficiency of spleen and stomach which can easily cause the
ascending of stomach Qi (it should descend normally) and QI of Chong channel. The following two types are the most causative changes for morning sickness:

  1. Deficiency of spleen and stomach.
  2. Disharmony of liver and stomach.

DIFFERENTIATIONS:

1. Morning Sickness due to the Deficiency of Spleen and Stomach: 

Indications: Nausea, vomiting, inability to eat food, fatigue, somnolent, pale tongue, white coating, slippery, slow and weak pulse. 

Treatment & Formulas: Tonify the spleen and stomach, descend the rebellious stomach Qi. 

Products:

    • Xiang Sha Liu Jun Zi Tang (Saussurea Cardamon Combination, Item No. 2125): This is the first choice formula for morning sickness due to the deficiency of spleen and stomach. 
    • Xiao Ban Xia Jia Fu Ling Tang (Minor Pinellia and Hoelen Combination, Item No. 2034): This is good for morning sickness due to phlegm and fluid retention. Symptoms show vomiting with white phlegm, headache, or heavy sensation of head, or vertigo, full and suffocating sensation of chest and gastric region, greasy tongue coating and slippery pulse. 
    • Chi Pi Wan (Ginseng and Hawthorn Formula Item No. 2193): This helps digestion and tonifies the spleen and stomach. 

2. Morning Sickness due to the Disharmony of Liver and Stomach:

Indications: Vomiting sour or bitter fluids, fullness at chest or hypochondriac region, belching, sighing, depressed emotion, dizziness, restlessness, insomnia, bitter mouth, pale tongue, slightly yellowish coating wiry and slippery pulse.

Treatment & Formulas: Regulate liver and harmonize stomach.

Products:

    • Wen Dan Tang (Bamboo and Hoelen Combination, Item No. 2228): This treats morning sickness by harmonizing the liver and stomach and it also clears the damp-phlegm factors as well. 
    • Xiao Chai Hu Tang (Minor Bupleurum Combination, Item No. 2029): This is a typical formula to harmonize the liver and Sao Yang channel.
    • Xiao Yao San (Tang - kuei and Bupleurum Formula, Item No. 2195): This harmonizes liver and tonifies the spleen and stomach. 
    • An Zhong San (Cardamom and Fennel Formula, Item No. 2085): This is a very good formula for stomach problems due to the Qi stagnation plus the interior coldness. 

COMMENTS: 

If there is pernicious nausea and vomiting, anorexia, or vomiting bloody contents, fever, thirsty, scanty urine, constipation, dry and red tongue, yellow and dry coating, or no coating, thready, rapid and slippery pulse, then this shows there is deficiency of Qi and Yin. Shen Mai San and Zhan Yi Tang needs to be used immediately; or use the following combination of single herbs: Ren Shen (Ginseng Radix, Item No.1321), Mai Men Dong (Ophiopogon Radix, Item No. 1176), Wu Wei Zi (Schisandra Fructus, Item No. 1048), or Sheng Di Huang (Rehmannia Radix, Item No. 1077). 


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