Part 7 of 7 in the "digestive discomfort" series. Part 1 is what the TCM "spleen-stomach" is; part 2 is the five-situation table; part 3 is what counts as constipation and what the NHS gives as its causes; part 4 is how the theory explains it; part 5 is reflux and heartburn; part 6 is when to see a doctor first.
With the theory and the yardstick covered, the last thing is how "my kind of stomach" is handled inside a consultation — and which things cannot be done online at all.
The short version
- A practitioner asks about five directions: what you eat and when; how you feel after eating; the frequency, form and colour of your stools; the link to mood and routine; and other signals.
- They also ask whether you have seen a doctor, what tests you had and what medication you took. What has already been ruled out is information too.
- A tongue photo has to show two layers: the tongue body, and the coating on top of it. The World Health Organization's terminology standard defines tongue diagnosis as inspecting the tongue body and the tongue coating.
- Pressing on the abdomen and listening with a stethoscope cannot be done online; endoscopy, ultrasound and blood tests are a doctor's. If the practitioner thinks a Western medical check should come first, they say so.
- Reminders are given by situation, not by constitution: long-term medication, pregnancy or trying or breastfeeding, under 12, older adults, before surgery or a chronic condition under review.
First, the things that cannot wait
⚠️ A safety note: TCM and Western medicine complement each other; it is not a choice between them. For heavy bleeding, severe abdominal pain, if you cannot poo or fart, or vomiting blood, call 999 now, or go to the nearest hospital emergency department. All four sit on the "call 999" lists of the NHS's rectal-bleeding and stomach-ache pages.
The full list, the reason for each, and which situations mean a same-day visit are in part 6.
A note: this section is general information only. For conditions like these, follow your doctor's diagnosis and treatment, and seek medical attention when you need it.
I. What the practitioner asks
① The five directions. What you eat and when; how you feel after eating; the frequency, form and colour of your stools; the link to mood and routine; and other signals: dry or bitter mouth, appetite, sleep, weight.
For stool form, report the Bristol type number — NHS England's Bristol Stool Chart sorts stools into seven types; part 3 covers how.
They also ask whether you have seen a doctor, what tests you had and what medication you took. What has already been ruled out is information too.
② Why the tongue, and what the photo has to show. The World Health Organization's terminology standard defines tongue diagnosis as "A diagnostic method to inspect the patient's tongue body and tongue coating". So the photo has to show two layers: the tongue body, and the coating on top of it.
The standard's definitions: the tongue body "includes the musculature and vascular tissue of the tongue"; the tongue coating is "A layer of moss-like material covering the tongue, generated by ascending of stomach qi". Looking at the coating when asking about the gut: the theory's link is the phrase "stomach qi".
The standard defines tongue manifestations (舌象) as "changes in the appearance of the tongue, including changes in the spirit, colour and form of the tongue body and its coating". Those three are what the practitioner looks at.
What a given colour, or a thick or thin coating, means is a judgement made after the consultation; it is outside this series, and not something to match against a list yourself.
An online consultation works from the tongue photo you take. Lighting, timing, angle and the common mistakes are in how to take a useful tongue photo.
💡 Remember: the photo needs both layers — body and coating. A shot of the tip alone is half the information.
II. What cannot be done online, and the directions after a consultation
③ What cannot be done online, the practitioner will say. Pressing on the abdomen and listening with a stethoscope cannot be done online; investigations such as endoscopy, ultrasound and blood tests are a doctor's.
If the practitioner thinks a Western medical check should come first, they say so.
④ Three possible directions: acupuncture, Chinese herbs, and lifestyle adjustments. The herbs may be concentrated granule powder; the lifestyle side means the kind of habits in part 2.
Which, and whether, is decided after the consultation, and the practitioner's written instructions take precedence.
III. Reminders by situation — not by constitution
- On long-term medication: tell the practitioner everything you take; the NHS's own words are "do not stop taking any prescribed medicine without speaking to a doctor first". Never stop your medication on your own.
- Pregnant, trying, or breastfeeding: the NHS states that constipation is common during pregnancy and after giving birth and that the simple measures are safe to try in pregnancy — the detail is in part 3. Whether herbs or acupuncture suit you, ask the practitioner first; for medicines in pregnancy, ask a pharmacist.
- Under 12: the NHS constipation page states "This page is about constipation in adults. There's separate information on constipation in babies and children." For a child's digestion, see a paediatrician first.
- Older adults: the NHS states constipation is more common over 65, and that when caring for an older person "constipation may be easily missed". A marked change in bowel habit: see part 6.
- Before surgery, or a chronic condition under regular review: tell your doctor the herbs, herbal teas and supplements you take, and let the doctor judge.
What to prepare beforehand is in what to prepare before an online consultation.
One thing about life in Malaysia: herbal teas and supplements
Herbal-tea-shop teas, direct-sales enzymes and probiotics. Mention them all at the consultation; the practitioner looks at them together. If you are preparing for surgery or under regular review for a chronic condition, give your doctor the same list — both sides need to see it to look at it together.
The words in this part
Three from the World Health Organization's TCM terminology standard, one from the NHS's heartburn page.
- Tongue diagnosis (舌诊) — the standard's definition: "A diagnostic method to inspect the patient's tongue body and tongue coating". It is where the "two layers" requirement comes from.
- Tongue coating (舌苔) — the standard's definition: "A layer of moss-like material covering the tongue, generated by ascending of stomach qi". This is the theory's link between the gut and the tongue.
- Tongue manifestations (舌象) — the standard's definition: "changes in the appearance of the tongue, including changes in the spirit, colour and form of the tongue body and its coating". When a practitioner says they are reading the tongue manifestations, those three are what they mean.
- Gastroscopy (胃镜) — the NHS's description: a test "where a thin tube with a camera inside it is passed down your throat and into your stomach". Whether and when is the doctor's decision.
Frequently asked
When do I need a gastroscopy? The doctor decides. The NHS's heartburn page states that if medicines do not help or symptoms are severe, a GP may refer you to a specialist for tests such as a gastroscopy. The same page lists as reasons to see a GP: heartburn most days, food getting stuck in your throat, frequently being sick, losing weight for no reason; of these, food stuck in the throat or difficulty swallowing is in the same-day band on the NHS's dysphagia page. Vomiting blood means call 999 now, or go to the nearest hospital emergency department.
Why does TCM look at the tongue for the gut? The World Health Organization's terminology standard describes the tongue coating as "generated by ascending of stomach qi". The coating relates to stomach qi, so looking at the tongue when asking about the gut is the theory's internal logic. An online consultation works from your photo: morning before brushing, natural light, not straight after a kopi. Details in how to take a useful tongue photo.
Do not: clean up your diet just before the consultation to "look better" — the practitioner needs the real version.
The other six parts
- Part 1: Digestive discomfort, how TCM sees it: first, which part of "stomach trouble" you mean
- Part 2: Five situations in one table: what the theory says, the usual practice, when to see a doctor first
- Part 3: How long before it counts as constipation? What stool shape says, and the NHS's causes
- Part 4: How TCM theory explains constipation: the route from intake to exit, and an ordinary week
- Part 5: Reflux and heartburn, especially at night: what to do, and how it happens
- Part 6: When to see a doctor first — each sign, and what it can indicate
👉 If you are unsure where to even start describing your digestive situation, you are welcome to book an online consultation with HansMed, where a practitioner registered under the T&CM Act 2016 can assess it with you; if anything in part 6 applies, see a doctor first.
Sit with a licensed TCM practitioner from wherever you are.
HansMed Modern TCM
For general wellness education only — not medical advice. Consult a registered TCM practitioner for personal guidance.
Sources
- World Health Organization, WHO international standard terminologies on traditional Chinese medicine, 2022 — https://www.who.int/publications/i/item/9789240042322
- NHS England, Bristol Stool Chart (carer web version, PDF created 15 August 2023) — https://www.england.nhs.uk/wp-content/uploads/2023/07/Bristol-stool-chart-for-carer-web-version.pdf
- NHS, Heartburn and acid reflux, page last reviewed 20 November 2023 — https://www.nhs.uk/conditions/heartburn-and-acid-reflux/
- NHS, Constipation, page last reviewed 26 October 2023 — https://www.nhs.uk/conditions/constipation/
- NHS, Dysphagia (swallowing problems), page last reviewed 02 May 2023 — https://www.nhs.uk/conditions/swallowing-problems-dysphagia/
- NHS, Stomach ache, page last reviewed 26 May 2023 — https://www.nhs.uk/conditions/stomach-ache/
- NHS, Bleeding from the bottom (rectal bleeding), page last reviewed 12 April 2023 — https://www.nhs.uk/conditions/bleeding-from-the-bottom-rectal-bleeding/
