Ju Pi Zhu Ru Tang for Nausea and Vomiting in TCM

Ju Pi Zhu Ru Tang first appears in Zhang Zhongjing's Jin Gui Yao Lue of the Han dynasty. It is composed of five Chinese herbs: Ju Pi (Citri Reticulatae Pericarpium, tangerine peel), Zhu Ru (Bambusae Caulis in Taeniam, bamboo shavings), Sheng Jiang (Zingiberis Rhizoma recens), Ren Shen (Ginseng), Gan Cao (Glycyrrhizae Radix) and Da Zao (Jujubae Fructus). The Jin Gui Yao Lue describes its indication very briefly, in a single sentence: "Hiccup-counterflow (yue ni) is addressed by Ju Pi Zhu Ru Tang."

Yue ni is what today we call reflux, regurgitation, nausea and vomiting. These symptoms occur in many conditions, such as morning sickness of pregnancy, nausea and vomiting due to incomplete pyloric obstruction, postoperative vomiting and hiccup, reflux esophagitis, intractable hiccup, and the nausea, regurgitation and vomiting caused as a side effect of radiotherapy and chemotherapy in cancer patients. All of the above are indications for Ju Pi Zhu Ru Tang.

Later generations generally regard Zhang Zhongjing's Ju Pi Zhu Ru Tang as the representative formula for vomiting due to stomach deficiency with heat, and many have modified it. The Ju Pi Zhu Ru Tang in the Zheng Zhi Zhun Sheng and the Yi Xin Wu adds Ban Xia to the original; the one in the Ji Sheng Fang adds Pi Pa Ye (Eriobotryae Folium), Ban Xia, Fu Ling and Mai Dong; the one in the Shou Shi Bao Yuan combines the original Jin Gui formula with Ding Xiang Shi Di San, adding Ding Xiang (Clavi Caryophylli), Shi Di (Kaki Calyx) and Da Zao; the one in the Yi Zong Jin Jian adds Shi Di and Huang Bai to the original.

For severe vomiting due to chemotherapy, I often combine five formulas—Ju Pi Zhu Ru Tang, Er Chen Tang, Ding Xiang Shi Di San, Zuo Jin Wan and Xuan Fu Dai Zhe Tang—into one. The result is a large compound prescription of fourteen herbs: Ren Shen, Zhu Ru, Fa Ban Xia, Dan Nan Xing (Arisaema cum Bile), Fu Ling, Ju Hong (Citri Exocarpium Rubrum, or Chen Pi), Xuan Fu Hua (Inulae Flos), Dai Zhe Shi (Hematitum), Ding Xiang, Shi Di, Wu Zhu Yu (Evodiae Fructus), Huang Lian (Coptidis Rhizoma), Gan Cao, Sheng Jiang and Da Zao.

This compound formula works best for patients with severe vomiting who do not respond to a single formula. In most cases, chemotherapy-induced nausea and vomiting can be managed with the patent medicine Er Chen Wan; such a complex large formula is unnecessary. But some patients have complicated conditions with especially severe gastrointestinal reactions, and Er Chen Wan alone is not enough—such a large compound is required. Some patients develop not only nausea and vomiting after chemotherapy but also severe diarrhea; in that case, this large compound must be combined with the diarrhea-stopping Si Shen Wan.

Brain tumors and cerebrovascular accidents can also cause nausea and vomiting. Such patients may also be treated with a Ju Pi Zhu Ru Tang–based formula, but Ju Pi Zhu Ru Tang alone is not ideal. If the patient has cerebral edema, the formula should be combined with Fu Ling Gui Zhi Bai Zhu Gan Cao Tang or Huang Qi Fang Ji Tang; in both formulas, Bai Zhu should be replaced by Cang Zhu, and Niu Xi and Che Qian Zi added. For brain tumor and cerebrovascular accident patients, Ban Xia, Dan Nan Xing and Bai Fu Zi (Typhonii Rhizoma) are also needed. But all three of these Araceae-family herbs are somewhat toxic; use them safely, starting at a low dose and increasing gradually.