Chemo-Induced Nausea & Vomiting
Overview
Chemo-induced nausea and vomiting falls under the TCM categories of "vomiting" (outu) and "regurgitation" (fanwei), and is a common gastrointestinal adverse reaction in cancer patients receiving chemotherapy. The core pathogenesis is drug-toxin damaging the spleen and stomach, causing stomach qi to fail in its descending function and rebel upward. Chemotherapeutic agents are regarded as a "drug-toxin" pathogen that directly strikes the middle jiao, depletes spleen and stomach qi, impairs transformation and transportation, and leads to internal retention of damp-turbidity and upflow of phlegm-fluid. Alternatively, the drug-toxin may transform into heat, scorching stomach yin, depriving the stomach of moistening, and causing qi to rebel upward. In patients with constitutional deficiency, spleen-kidney yang deficiency may be exacerbated by the drug-toxin, allowing cold-fluid to stagnate internally and stomach qi to rebel, producing vomiting. Common clinical patterns include spleen-stomach weakness, phlegm-damp obstruction, stomach yin insufficiency, and spleen-kidney yang deficiency. Treatment follows the general principle of harmonizing the stomach and descending rebellion, with concurrent measures to fortify the spleen and boost qi, transform phlegm and drain damp, nourish yin and clear heat, or warm and supplement the spleen and kidney.
Pattern differentiation (clinical patterns)
Spleen-Stomach Weakness Pattern
Nausea and vomiting, poor appetite with reduced food intake, distension and fullness in the epigastrium and abdomen, fatigue and lack of strength, sallow complexion, loose stools, pale tongue with white coating, and a slow weak pulse.
Fortify the spleen and boost qi; harmonize the stomach and descend rebellion.
Phlegm-Damp Obstruction Pattern
Vomiting of phlegm and saliva, stuffiness and oppression in the chest and epigastrium, no desire for food, dizziness and vertigo, heaviness of the body and lethargy, white greasy tongue coating, and a slippery pulse.
Transform phlegm and drain damp; harmonize the stomach and descend rebellion.
Stomach Yin Insufficiency Pattern
Dry retching or vomiting of a small amount of sticky saliva, dryness of the mouth and throat, hunger without desire to eat, epigastric upset and discomfort, dry bound stools, red tongue with scanty fluid, and a thin rapid pulse.
Nourish yin and generate fluid; harmonize the stomach and descend rebellion.
Connections
Daily care & prevention
Eat a light, easily digestible diet in small, frequent meals; avoid greasy, spicy, raw, cold, and strongly odored foods. Before meals or medication, hold a slice of fresh ginger (sheng jiang) in the mouth or take a small amount of ginger juice to harmonize the stomach and stop vomiting. Maintain oral hygiene and rinse the mouth after eating; avoid noxious odors. Keep the emotions smooth and avoid anxiety and tension; listening to soothing music and practicing deep breathing can regulate qi movement. Press Neiguan (PC6) and Zusanli (ST36) for 3–5 minutes each time, 2–3 times daily. Ensure adequate rest and avoid fatigue; after vomiting, replenish fluids promptly with light salt water or rice broth to prevent damage to fluids.
When to seek medical care
Seek immediate medical attention if vomiting is frequent and severe, preventing intake of food and fluids, with obvious dehydration, scanty urine, dry skin, and sunken eyes; if vomitus is coffee-colored or bright red, suggesting gastrointestinal bleeding; or if accompanied by high fever, severe abdominal pain, confusion, or falling blood pressure, indicating a critical condition requiring integrated emergency care.