Common TCM Approaches to Nausea and Vomiting Caused by Chemotherapy and Targeted Therapy in Cancer Patients
Chemotherapy and targeted therapy are common cancer treatments. For some patients they are reliably effective, greatly prolonging survival and even achieving clinical cure.
But a considerable proportion of patients develop various complications during chemotherapy and targeted therapy; nausea and vomiting are the most frequent complications cancer patients experience during these treatments.
Mild nausea and vomiting may resolve on their own, or may be relieved by holding a slice of ginger in the mouth or brewing a little perilla as tea. But some patients have severe reactions, and some vomit incessantly, hard to stop. TCM has relatively mature experience and methods for handling nausea and vomiting caused by chemotherapy and targeted therapy.
In the clinic, the formulas commonly used for chemotherapy-induced nausea and vomiting include Erchen Decoction (Two-Aged Decoction), Jupi Zhuru Decoction (Tangerine-Peel and Bamboo-Shavings Decoction), Xuanfu Daizhe Decoction (Inula and Hematite Decoction), and Dingxiang Shidi Decoction (Clove and Persimmon-Calyx Decoction). Ordinary nausea and vomiting can generally be treated with these simple formulas, with good results.
Erchen Decoction is mainly used for patients with abundant phlegm and excess dampness. It is the most important TCM formula for treating phlegm-dampness, and its phlegm-transforming effect is outstanding. Erchen Decoction consists of Juhong (Red Tangerine Peel), Fabanxia (processed Pinellia), Fuling (Poria), Zhi Gancao (honey-fried Licorice), Shengjiang (Fresh Ginger), and Wumei (Mume). It has the actions of moving qi and harmonizing the middle, drying dampness, and transforming phlegm. It is especially suitable for patients with nausea and vomiting accompanied by abundant white phlegm, stuffiness in the chest and diaphragm, poor appetite, heaviness of the limbs, a white greasy or white slippery tongue coating, and a slippery pulse.
The patent medicine Erchen Wan (Two-Aged Pills) is made according to the composition of Erchen Decoction. When it is inconvenient for patients to take decoctions, they can buy Erchen Wan themselves. I have repeatedly advised patients with nausea, vomiting, and abundant phlegm to take Erchen Wan to stop vomiting, and the effect is very rapid.
If it is inconvenient to take Erchen Wan, one may instead decoct the following formula to resolve nausea and vomiting:
Juhong (Red Tangerine Peel) 15 g, Fabanxia (processed Pinellia) 15 g, Fuling (Poria) 9 g, Zhi Gancao 4.5 g, Shengjiang 7 slices, Wumei 1 piece
Other patients develop nausea and vomiting during chemotherapy or while on targeted drugs, but their overall constitution is hot. If a patient shows yin deficiency with yang hyperactivity, or yin deficiency with effulgent fire, then a warm-drying formula like Erchen Decoction is inappropriate; one should consider Jupi Zhuru Decoction instead.
Jupi (Tangerine Peel) 12 g, Zhuru (Bamboo Shavings) 12 g, Shengjiang 9 g, Renshen (Ginseng) 3 g, Gancao 6 g
Besides nausea and vomiting, patients suited to Jupi Zhuru Decoction have a series of signs of insufficient stomach yin: such patients generally have a red tongue and rapid pulse, dry mouth, scant coating or cracks in the tongue—a full picture of exuberant heat and fire. Giving them Pinellia and other warm-drying herbs would backfire, so one must use phlegm-transforming herbs with a sweet-cold nature like Zhuru. If the patient has severe dry cough, fresh Zhuli (Bamboo Sap) may be added to clear and transform hot phlegm; if the patient is not markedly deficient, Renshen should be omitted. Patients who cannot decoct may simply brew Juhong and Zhuru together as a tea substitute.
Xuanfu Daizhe Decoction is for patients with more severe gastrointestinal reactions. Such patients generally have a deficient-wiry pulse, white slippery coating, severe stuffiness and fullness below the stomach, and besides nausea and retching they have frequent belching, stifling eructation, and drooling, with a pale tongue. At such times one should promptly use Xuanfu Daizhe Decoction.
Xuanfuhua (Inula) 10 g, Daizheshi (Hematite) 10 g, Fabanxia 10 g, Shengjiang 10 g, Renshen 6 g, Zhi Gancao 6 g, Dazao 4 pieces
Here I must caution: Daizheshi (Hematite), if taken for too long, can affect liver function. Hematite is an iron ore; some patients with excessive iron deposition in the liver should not take it. Physicians should be aware of this.
Dingxiang Shidi Decoction has the actions of warming the middle and boosting qi, and descending counterflow to stop hiccups. It is suitable for vomiting and hiccups due to stomach-qi deficiency-cold and qi counterflow that fails to descend. Besides relieving nausea and vomiting caused by chemotherapy and targeted drugs, it can also be used for hiccups caused by excessive intravenous infusion.
Dingxiang Shidi Decoction formula:
Dingxiang (Clove) 6 g, Shidi (Persimmon Calyx) 6 g, Shengjiang 6 g, Renshen 3 g
In summer, when nausea and vomiting occur, Huoxiang Zhengqi Shui (Patchouli Qi-Righting Liquid) may also be used to harmonize the middle and transform dampness, relieving the symptoms.
All the above formulas are used to relieve symptoms like nausea and vomiting; they are not routine anti-cancer formulas but rather small prescriptions for handling complications arising during cancer treatment. When using them, patients should follow the principle of "stop once the disease is reached": after the symptoms resolve, they should not continue taking them. They should seek a professional TCM physician for pattern differentiation and a more comprehensive treatment plan.