A Potent Antiemetic Formula for Adjunctive Chemotherapy Support
I have previously written about the Chinese medicine treatment of chemotherapy-induced vomiting. In most cases I recommend starting with a Chinese patent medicine to control chemotherapy-induced vomiting; if a patent medicine does not work, then consider a decoction.
Most patients with chemotherapy-induced vomiting obtain significant relief after taking the patent medicine Erchen Wan. In some patients for whom Erchen Wan alone is not strong enough, adding Pingwei Wan (or Xiangsha Pingwei Wan) markedly reduces vomiting. When vomiting is accompanied by acid regurgitation after chemotherapy, Erchen Wan plus Zuojin Wan works well. For vomiting, diarrhea and fever together, use Huoxiang Zhengqi Wan plus Erchen Wan. All of these patent medicines are available in pharmacies across the country.
In a very small minority of patients, however, the above regimens still fail; in that case an herbal decoction should be considered. I have an empirical formula that has some effect in relieving severe vomiting after chemotherapy.
The formula is as follows: Chenpi (Citri Reticulatae Pericarpium) 10 g, Fabanxia (processed Pinelliae Rhizoma) 10 g, Huoxiang (Agastachis Herba) 6 g, Peilan (Eupatorii Herba) 10 g, Zisugeng (Perillae Caulis) 6 g, Sharen (Amomi Fructus) 3 g, Xuanfuhua (Inulae Flos, wrapped) 10 g, Daizheshi (Haematitum, wrapped) 10 g, Zhuru (Bambusae Caulis in Taeniam) 10 g, Fuling (Poria) 10 g, Renshen (Ginseng) 6 g, Shidi (Kaki Calyx) 10 g, Dingxiang (Caryophylli Flos) 6 g, Cangzhu (Atractylodis Rhizoma) 6 g, Houpo (Magnoliae Cortex) 10 g, Zhi Pipaye (processed Eriobotryae Folium) 10 g, Caoguo (Tsaoko Fructus) 3 g, Roudoukou (Myristicae Semen) 6 g. For acid regurgitation and heartburn, add Wuzhuyu (Evodiae Fructus) 3 g, Huanglian (Coptidis Rhizoma) 6 g, Baiji (Bletillae Rhizoma) 10 g and Wuzeigu (Sepiae Endoconcha) 10 g as appropriate. The above is the adult dose; children may have it reduced according to their condition. Children weighing over 50 kg may take the adult dose; others should be dosed in proportion to body weight relative to 50 kg. Of course, in patients whose vomiting is not especially severe, not all of these herbs are necessary, and the physician may judiciously reduce the formula.
The above formula combines several Chinese medicine phlegm-resolving and antiemetic formulas, to which I have added some additional potent antiemetic herbs. It blends Xuanfuhua Daizheshi Tang, Erchen Tang, Jupi Zhuru Tang, Dingxiang Shidi San, Pingwei Wan and Huoxiang Zhengqi San, and adds Pipaye, Caoguo and Roudoukou; hence its antiemetic power is very strong. I have used this formula repeatedly to relieve severe vomiting that other Chinese and Western drugs could not control, and in every case it produced immediate results.
Acid regurgitation and heartburn generally occur because chemotherapy has strongly irritated the stomach and produced a gastric ulcer; antiemetics alone will not suffice. For patients with acid regurgitation and heartburn, add Zuojin Wan (composed of Wuzhuyu and Huanglian) and Wuji San (composed of Wuzeigu and Baiji) to the base formula; this not only reduces vomiting but also heals the gastric ulcer.
If the patient has other severe chemotherapy side effects as well, a doctor should tailor a separate formula. This formula is symptomatic treatment directed at vomiting; once the vomiting is gone, it may be stopped. If symptoms have markedly improved and appetite has basically returned, the patient may stop taking this formula and either take no medicine or switch to Pingwei Wan (or Xiangsha Pingwei Wan) to consolidate the recovery.