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Patient's question:

, eating often causes nausea recently for a year, past treatment and effectiveness: took Chinese medicine but it didn't work, also unaware of the reason what kind of assistance you want: just want to know what's going on...

Doctor's answer:

Nausea accompanied by dizziness, no organic inflammation. Often triggered by unpleasant environments or psychological stress. It presents as recurrent, uncontrolled nausea, typically occurring after defecation, followed by sudden explosive episodes of vomiting. There is no significant nausea or other discomfort, and it does not interfere with appetite. Nausea may be followed by defecation, with little to no weight loss, no endocrine disorders, and often associated with a hysteric personality.
II. Differential Diagnosis and Confirmation:
Nausea is a common clinical symptom seen in various modern medical conditions, such as neurotic vomiting, gastritis, pyloric spasm, intestinal obstruction, cholecystitis, and other diverse diseases. If the history, physical examination, and various tests confirm that nausea is related to a specific physical illness, the primary diagnosis should be that physical illness, rather than considering a diagnosis of isolated neurotic vomiting.
Brief Overview of Neurotic Vomiting:
Neurotic vomiting, also known as psychogenic nausea, is characterized by recurrent episodes of nausea without an underlying organic cause and is often linked to psychological and social factors. It is essential to rule out neurologic and physical conditions that may cause nausea. No other symptoms of hysteria are present.
Treatment Measures:
I. Medication Treatment:
General antispasmodic and antiemetic medications are often ineffective. Tranquilizers may help reduce anxiety but are not highly effective. Behavioral treatment can yield more ideal results.
II. Behavioral Treatment:
Psychological treatment should involve explaining the nature of the disease, its mechanisms, and prognosis to the patient, completely eliminating anxiety to enable active cooperation with medical treatment and achieve satisfactory outcomes.
(1) Psychological Treatment:
1) General psychological therapy. Through interviews, clarify the psychological and social factors related to neurotic vomiting and provide targeted responses, support, and encouragement, which can be somewhat effective.
2) Behavioral treatment, such as aversion therapy or positive reinforcement, can reduce the sensitivity of nausea until it is completely eliminated.
(2) Medication Treatment:
1) Psychiatric medications are rarely used. Symptomatic treatment can be provided with small doses of drugs like sulpiride or fluoxetine, depending on accompanying symptoms.
2) Nutritional supportive treatment. Physical supportive treatment can be administered based on the interference caused by nausea, such as vitamins, ATP, coenzyme A, etc.