FOOD AND TASTE
INTRODUCTION
The questions regarding reactions to foods, appetite, hunger and taste are aimed primarily at establishing the state of the Stomach and Spleen.
WHY WE ASK
We always need to ask about digestive symptoms because the Stomach and Spleen are the source of Postnatal Qi and therefore a pathology in these two organs eventually affects other organs.
WHEN WE ASK
I always ask about the state of the digestive system before concluding the interrogation of the patient, unless, of course, the presenting problem is a digestive one.
HOW WE ASK
It is important to ask about digestive symptoms in detail. It would not suffice to ask simply “Do you have any digestive complaints?” We need to ask whether the patient ever experiences any distension, bloating, fullness, pain, heaviness, hiccup, nausea, vomiting, belching, loose stools, diarrhoea, etc.
The Stomach and Spleen are the Root of Post-Heaven Qi and their state affects all the other internal organs; for this reason, it is always necessary to ask questions to assess their state. This is all the more important given the frequency of digestive complaints in Western patients. The Stomach controls the rotting and ripening of food and for this reason it is compared to a bubbling cauldron in the Middle Burner. The Spleen controls the transformation and transportation (Yun Hua) of Qi and it therefore affects the transportation and transformation of food essences in the Middle Burner. Thus, the Stomach and Spleen together are responsible for the proper digestion of food. However, in Chinese medicine, the function of the Stomach and Spleen goes beyond that of digesting food as, in the process of doing so, they are the source of Food Qi (Gu Qi), which, in turn, forms the Gathering Qi (Zong Qi) and True Qi (Zhen Qi). Thus, the Stomach and Spleen are the source of Post-Heaven Qi and an enquiry into the state of these two organs is crucial in every case.
The Stomach and Spleen are particularly important also because they are in the Middle Burner with opposing directions of Qi: Stomach-Qi descends while Spleen-Qi ascends. A normal coordination of these two directions of flow is vital for a proper transformation and transportation of Qi, food essences and fluids; these two organs are at a crucial crossroads in the Middle Burner and an impairment of their movement of Qi has immediate repercussions on Qi, Dampness and Phlegm pathology. In every pathology of the Stomach and Spleen there is some derangement of the proper flow of Qi. For example, when Stomach-Qi rebels upwards rather than descending, it causes symptoms such as hiccup, nausea, vomiting and belching; even when Stomach-Qi is deficient it may fail to descend properly and may cause some of the above symptoms but to a much milder degree. When Spleen-Qi descends rather than ascends, it may cause loose stools or diarrhoea.
MAIN PATTERNS OF DIGESTIVE SYMPTOMS
The main patterns causing digestive symptoms are:
Qi deficiency
Qi deficiency of the Spleen causes poor appetite, loose stools and slight abdominal distension. Qi deficiency of the Stomach causes poor appetite and slight epigastric discomfort. If there is a pain, it would be slight, dull and better after eating.
Qi stagnation
Qi stagnation causes distension, which affects the epigastrium if the Stomach is primarily involved or the abdomen if the Spleen is primarily involved. If there is a pain, it would be strongly associated with distension. “Distension” is usually described as “bloating” by patients in English-speaking countries.
Qi rebellious
Qi rebellious of the Stomach causes belching, hiccup, nausea and vomiting. Qi sinking of the Spleen (i.e. descending rather than ascending) causes loose stools or diarrhoea.
Blood stasis
Blood stasis causes intense, fixed, stabbing pain, which is epigastric in the case of the Stomach, with possible vomiting of blood, and abdominal in the case of the Spleen, with possibly blood in the stools.
Dampness
Dampness causes a feeling of fullness and heaviness in the epigastrium if the Stomach is affected, with a sticky taste and poor appetite, and in the abdomen if the Spleen is affected.
Phlegm
Phlegm causes a feeling of oppression; this usually affects the epigastrium rather than the abdomen and the Stomach more than the Spleen. There is also a sticky taste, nausea and poor appetite.
Retention of food
Retention of food causes a feeling of fullness in the epigastrium if the Stomach is affected and in the abdomen if the Spleen is affected; the latter affects children more than adults. In the case of the Stomach, there may sour regurgitation, nausea and poor appetite.
Table 30.1 illustrates the differentiation of symptoms between Stomach and Spleen in the various patterns.
Table 30.1
Differentiation of Stomach and Spleen digestive symptoms according to pattern
| Pattern | Stomach | Spleen |
| Qi deficiency | Slight epigastric discomfort, dull, slight pain improved by eating, poor appetite | Poor appetite, slight abdominal distension, loose stools |
| Qi stagnation | Epigastric distension | Abdominal distension |
| Qi rebellious | Hiccup, belching, nausea, vomiting | Loose stools, diarrhoea |
| Blood stasis | Stabbing, fixed epigastric pain, vomiting of blood | Stabbing, fixed abdominal pain, blood in stools |
| Dampness | A feeling of fullness and heaviness of the epigastrium, sticky taste, poor appetite | A feeling of fullness and heaviness of the abdomen |
| Phlegm | A feeling of oppression of the epigastrium, sticky taste, nausea, poor appetite | |
| Retention of food | A feeling of fullness and pain of the epigastrium, sour regurgitation, nausea, poor appetite | A feeling of fullness and pain of the abdomen |
Thus, the five main sensations experienced in the digestive system are a feeling of distension, fullness, oppression, stuffiness and heaviness. Table 30.2 illustrates the pathology and diagnostic manifestation of these five sensations.1
Table 30.2
Differentiation of sensations of oppression, distension, fullness, stuffiness and heaviness
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