Patient: Mr. Lee (Male) Age 43
Date：19 June 2022，First Consultation
Main Issue: Vomit cum Belching for one night

Mr. Lee’s first visit is telling me his problem with a dull face and sluggish expression: “TCM Doctor, now I feel my throat is having an inflammation and heat sensation. I have also a frequent belching. I vomited since last midnight 12.00am till 7:00am this morning. “

After detail checking, we confirmed that he had a sore throat, frequent belching with no acid flow back in the esophagus. Yesterday night he felt stomachache but today stopped. Due to worries, if he will continue vomit for tonight, so he turns up for a consultation.

I ask: “May you tell me the story how it happens please?”

He answers: “Yesterday 11am I took my first meal as ‘brunch’. I ate curry noodles and drunk a glass of iced-milk tea.

In the afternoon around 5pm, I met with my friends and I have a plate of Italian spaghetti and a glass of iced-lemon tea.

About half an hour later, my stomach cramped and feel gastro reflux. I kept belching every minute. I feel heat sensation in the throat and stomachache. I went back home to take a rest. Then I started vomiting from 12am midnight until 7am this morning for the total of 5 times. The residue vomited was watery mixed with small pieces of digested food. I has also purged watery stool few times in the midnight. ”

I ask: “So your stool in normal day also watery?”

He answers: “I always have loose and dark brown stool, usually I have constipation, I will purge once in a three to four days.”

Taken the measurement of the blood pressure it shows BP=126/87_mm，p=81.

When I asked him the details, we got to know that he only take two meals per day for past 2 months. He started his first meal around 12pm and the second meal at 7pm. Besides this, he drinks a cup of green apple cider vinegar with an empty stomach.

Stomach diagnosis: When we press on the stomach, we feel stomach distension.

Tongue diagnosis: A deep crack in the middle and blood clots underneath the tongue.

【Acupuncture treatment】

Advice: Ask the patient to follow a regular meal which is three meals per day. Emphasize him must take breakfast in the morning. Advise him to stop the green apple vinegar in the morning with an empty stomach. Stop cold or icy food, fried food and spicy food.

25-06-2022 Revisit：

Vomit has stopped. The heat sensation in the throat has mitigated.

Mr. Lee’s appetite has improved much. He abides the recommendations to follow a regular meal which is three meals per day with appropriate portion. He stopped spicy and fried food. Only vomited on 19th and 20th of June, observed some vegetable residue. This few days the occurrence of belching has increased, he senses the stinky smell especially after taking spicy or oily food.

After taking the herbs for last week, the loosen stool become firm and solid, and the bowel movement increased to daily once.

Stomach Diagnosis: When we press on the stomach, we feel stomach distension especially the left side.

Tongue diagnosis: A deep crack in the middle and blood clots underneath the tongue.

Acupuncture treatment.

Diagnosis：

Main Issue: Vomit cum Belching for one night.

Base on the conversation, the main root cause is due to the mixture of cooling and heaty food. He took curry noodle (heaty) and iced-milk tea (cooling). Not long after, he took dinner as Italian Spaghetti (oily) and iced-lemon tea (sour). Lemon used to dissolve oily food, when it was taken, the stomach started to have reaction, the mixture of heaty and cooling, the acid has been released to digest the food. As a conditioned reflex, it caused the acid flow back from the cardia of stomach towards the esophagus, when it rises to the throat hence causing the heat sensation and causing a frequent expelling of air, eventually the burping start. During the occurrence of burping, the food hardly been digested via acid in the stomach, the force pushing the food to rise up through the esophagus and causing a vomit. The discomfort in the intestine will cause a weakening digestion and hence the purge of bowel movement is watery stool.

As for the past 2 months, the patient changed his meal pattern to 816. That is, taking food within 8 hours and fasting within the next 16 hours. Besides, he took a glass of green apple vinegar with an empty stomach. Due to the longer hours of fasting, the vinegar trigger the outer layer of the stomach membrane, and mix with the acid that released from the stomach, so when the he takes spicy food, the mixture of all these acidic food has caused the issue of vomit, belching. The medical term for this disease is called “Gastro esophageal reflux disease”(GERD).

Recommendation:

1. Regular meal. Three meals per day. Must take breakfast as the first meal.
2. Avoid drinking green apple vinegar with an empty stomach; you can mix with sugar like honey or brown sugar.
3. Taking heated food with warm water, avoid cold water.
4. Menu for your meal include both cold and heaty food at a balancing portion. Neither too cool nor too heaty or too spicy.
5. Ensure a daily bowel movement. If you have a constipation issue, we try to make it the next day for a regular bowel movement.
6. Our daily life has numerous of stress and we learn to release the stress via regular exercise or some outing activities or execute some hobbies we loved.