Regurgitation

Regurgitation is a disorder characterized by the intermittent vomiting of partially digested food more than 12 hours after the previous meal. The most common presentation is the oral ejection of the evening meal the next morning, usually without the diaphragmatic spasm that is typical of vomiting. In general, the vomited material from the stomach has a bitter taste, while regurgitated material from the esophagus does not.

Regurgitation of ingested material occurs when there is an obstruction to the natural descent of Stomach qi or when the weakness of the Stomach organ prevents it from breaking down food and passing it on to the Intestines. The undigested food remains in the Stomach until it is regurgitated.

Causes

Spleen and Stomach Deficiency

Insufficient Spleen yang is a common cause of regurgitation. The Spleen is responsible for digesting and transforming food, but when it is weak, it can cause stomach qi to rebel and bring up undigested food. This can be caused by cold-natured herbs, antibiotics, general anesthesia, upper abdominal surgery, prolonged stress on the stomach, or eating disorders like bulimia and anorexia nervosa.

Diet

Eating a diet that weakens the function of the Spleen and Stomach, promotes the production of phlegm, or creates heat in the stomach can contribute to this disorder. Eating cold or raw foods can weaken the Spleen yang qi, while skipping meals or eating at irregular times can disrupt the balance of the Stomach and gradually deplete its qi and yang. Restrictive diets and eating disorders can severely damage the Spleen and Stomach yang.

Consuming large amounts of rich, spicy, or heating foods, alcohol, sugar, and dairy products can lead to the accumulation of food, heat, or damp-heat in the stomach, while sugar and dairy products can create dampness and phlegm.

Emotional Factors

Chronic stress or emotional factors can lead to regurgitation when they cause the Liver qi to invade and disrupt the normal functioning of the Spleen and Stomach and the qi dynamic. Prolonged qi constraint can generate heat, which can damage the Stomach yin, dry and tighten the Stomach, esophagus, and associated structures, and intensify the rising tendency of the already disordered Stomach qi. This can also slow and retard fluids, which can gradually congeal into phlegm. Any heat that has developed may combine with preexisting dampness to form phlegm or phlegm-heat. Once phlegm or phlegm-heat has been created, the obstruction is more substantial and physical changes can take place in the tissues of the Stomach and esophagus. Prolonged accumulation of qi and phlegm, and perhaps heat and yin deficiency, can gradually slow and obstruct the circulation of blood, leading to more serious regurgitation.

Liver qi constraint can also cause acute or one-off episodes of regurgitation. Anger or emotional upset around the dinner table can lead to acute Liver qi invasion of the Stomach and Spleen, causing them to fail to proceed with digestion and shutting down the qi dynamic. This can eventually cause qi to rebel and eject the unprocessed meal.

Trauma

Trauma can lead to regurgitation, such as surgery on the stomach and upper abdomen, or bruising and blood stasis that may occur following a direct trauma to the lower chest or upper abdomen, such as a car accident.

Treatment

Pathology of the pyloric or cardiac sphincter is a common cause of regurgitation. This can be functional or structural, involving edema, inflammation, spasm, scarring, or stenosis. A significant structural component, such as scarring, stricture, or tumor, has a poor prognosis and may not respond well to Chinese medical treatment. Chinese medical treatment is more effective for functional issues such as pyloric spasm, edema, and inflammation. Responsive patterns include Liver qi constraint, yang qi deficiency, and Stomach heat. Blood stasis and phlegm accumulation generally indicate physical lesions, with variable results from Chinese medical treatment. However, some people may still respond well to treatment, even with longstanding pathology, so it may be worth trying. People with nonresponsive blood stasis and phlegm patterns may be best referred to a surgeon.