Ejection agents

Ejection medicinals cause vomiting to eject unwanted matter from the stomach, throat, and chest. Because it involves making the patient vomit, the concept of ejection in Chinese medicine is largely synonymous with the concept of emesis in Western medicine. Nevertheless, it should be noted that ejection in Chinese medicine is not always aimed at expelling the contents of the stomach. Sometimes the aim of ejection is to relieve conditions of phlegm in the throat or chest, as well as to treat epilepsy or other conditions of phlegm clouding the orifices of the heart. For this reason, some authors use the term ejection to distinguish the Chinese medical concept from the Western medical concept of emesis.

Ejection is no longer frequently used. Even in China, patients go or are taken to the emergency department of biomedical hospitals for most acute problems. Nevertheless, ejection is still included in modern textbooks not only to provide students with a comprehensive understanding of traditional Chinese medicine, but also because many of the traditional ejection medicinals have other effects, for which they are now more commonly used. A few powerful ejection medicinals have other uses.

Properties

Nature: Varied.

Flavor: All are bitter. Cháng shān (Dichroae Radix) and lí lú (Veratri Nigri Radix et Rhizoma) are also acrid.

Channel entry: All enter the stomach. Lí lú (Veratri Nigri Radix et Rhizoma) and cháng shān (Dichroae Radix) also enter the lung and liver.

Bearing: Upfloating.

Toxicity: All are toxic.

Actions and Indications

Ejection medicinals induce vomiting. They are toxic, but they produce their effect quickly before the toxin is absorbed into the body. Ejection medicinals are used to expel unwanted matter such as poisons, abiding food, and phlegm-drool from the body. Indications include:

• Accidental ingestion of poisonous substances before they have been absorbed into the body.
• Abiding food, i.e., food retained in the stomach without being digested, causing distension and pain in the stomach duct.
• Phlegm-drool in the throat that makes breathing difficult.
• Phlegm turbidity congesting in the chest and diaphragm, phlegm confounding the orifices of the heart, and epilepsy.
• Some ejection medicinals have other actions that account for their clinical use. For example, cháng shān (Dichroae Radix) is often used for its ability to interrupt malaria, while guā dì (Melonis Pedicellus) may be used to abate jaundice. Lí lú (Veratri Nigri Radix et Rhizoma) may be applied externally to treat a variety of skin diseases.

Combinations

Ejection medicinals are combined with other medicinals to enhance the ejection effect. Using other medicinals also allows a reduction in the dosage of ejection medicinals that is required, to prevent poisoning from the toxicity of the ejection medicinals themselves. Combinations can also be used to provide an excipient (to make the powder stick together for use in pills), and to reduce the harsh effects of ejection medicinals.

Warning

Side effects: Ejection medicinals are toxic. Severe vomiting damages the stomach, fluids, and qì. They are contraindicated for constitutionally weak patients, the elderly, young children, and pregnant women, as well as patients suffering from blood loss, dizziness, heart palpitation, or severe cough and panting.

Control the dosage: The dose should be just sufficient to induce effective vomiting (generally complete clearing of the stomach). When effective vomiting has been achieved, the treatment should be stopped. Excessively high doses cause excessive vomiting and damage right qì. Insufficient doses can result in nausea without vomiting, causing the patient unnecessary discomfort. More importantly, if vomiting is not achieved, the toxin of the ejection medicinals is absorbed into the body. This can cause poisoning. If, owing to constitutional differences, normal doses of ejection medicinals fail to produce vomiting, the patient can be given warm water to drink and mechanical ejection can be performed (traditionally performed by tickling the throat with a feather). Ejection medicinals should not be taken for extended periods.

Care after treatment: After ejection treatment, the patient should rest and should not eat immediately. This prevents food from stimulating further vomiting and further damage to stomach qì. Once stomach and intestinal functions are restored, the patient can take liquid or semi-liquid foods that are easy to digest. If ejection causes incessant vomiting, the patient should be given medicinals that downbear counterflow and check vomiting (qì-rectictifying agents).