Part 6 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 7 is what an online consultation does.

This is the part of the series to read first. It is not meant to frighten anyone — quite the opposite: knowing what a sign can be is what gets it dealt with while it is still mild, instead of being sat out until the middle of the night.

The reason for each item comes from that condition's own NHS page; the signs themselves and their tiers are word for word as they were in this series' original list.

The short version

• The seven items below mean see a doctor for investigation first; vomiting blood, heavy bleeding, severe abdominal pain and being unable to poo or fart are all in the call 999 now band.
• Black or dark red poo, and difficulty swallowing, mean seek care the same day — a Klinik Kesihatan or clinic.
• The point of adding reasons is to tell you what a sign can point to: each one comes from that condition's own NHS page.
• A reason tells you what a sign can point to, not what you have. That takes Western medical investigation, which a TCM consultation does not substitute for.

I. See a doctor first in these situations

Some digestive symptoms need investigation to establish the cause. See a doctor first — do not rely on TCM care alone — if there is:

• Blood in the stool, or stools that look black — black or dark red means seek care the same day. The NHS's rectal-bleeding page states that bleeding from the bottom is sometimes a sign of bowel cancer; for black poo, the page gives "bleeding in the stomach or gut" among the possible causes, and with tummy pain or cramps it lists stomach ulcer.
• Weight loss you did not intend — the NHS's unintentional-weight-loss page lists problems with digestion, such as coeliac disease or inflammatory bowel disease, among the causes, and states that sometimes weight loss and loss of appetite can be caused by cancer, so it is important to get it checked if you are losing weight without trying.
• Difficulty swallowing, or a sensation of food sticking — seek care the same day. The NHS's dysphagia page states that it is usually caused by another health condition, and that over time dysphagia can itself cause weight loss, dehydration and repeated chest infections.
• Persistent vomiting, or being unable to eat or drink — vomiting blood means call 999 now, or go to the nearest hospital emergency department. The NHS's vomiting-blood page states that it is often a sign of bleeding in your stomach or food pipe (the oesophagus, which runs from your mouth to your stomach), and that its common causes include gastritis, stomach ulcers, and heartburn and acid reflux. For persistent vomiting without blood, the NHS's heartburn page lists "frequently being sick" among its reasons to see a GP — which is why it stays in the "see a doctor first" line above.
• Severe abdominal pain, or pain that stops you functioning — see the safety note below. One condition severe abdominal pain can point to is appendicitis: the NHS states that it is swelling and infection in your appendix (part of your bowel), that it needs urgent treatment in hospital, and that if it is not treated quickly the appendix can burst. That page's own "call 999" item reads "severe pain in your abdomen" — the same tier as the safety note below.
• Persistent fever alongside abdominal pain — the same page lists "a high temperature" among appendicitis's other symptoms, alongside feeling or being sick or loss of appetite and constipation or diarrhoea; it also states that the pain usually starts around the belly button and, after a few hours, moves to the lower right side and gets worse.
• A marked change in bowel habit in an older adult — the NHS's constipation page lists noticing sudden changes in how you poo among its reasons to see a GP, and states that when caring for an older person constipation may be easily missed, so look out for behaviour changes such as confusion, as it might mean they are in pain or discomfort. The appendicitis page separately states that older people can be more likely not to have the usual pain.

These need medical investigation — including endoscopy or imaging where indicated — and a TCM consultation does not substitute for them. "Seek care the same day" means a same-day visit to a Klinik Kesihatan or clinic.

⚠️ 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.

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.

II. Where the reasons come from, and where they stop

The reason on each item above comes from that condition's own page, not from the pages about digestive symptoms. The NHS's stomach-ache and constipation pages list the situations that go to a GP but mostly name no conditions; the names and the mechanisms are on the individual condition pages. Several of those pages carry the same line: do not self-diagnose, see a GP if you're worried.

No tier moved. What was added is a reason, not a band. Two places where this part stops:

• Item 7's reason is about why it is easy to miss, rather than a matching condition. None of the pages quoted here gives one for this sign on its own.
• The tier for vomiting blood still comes from the stomach-ache page's "call 999" list. The newly quoted vomiting-blood page is used for the reason only, not to change a band.

The words in this part

All four come from the NHS pages quoted above, and all four are words you may actually meet at a clinic or on a referral letter.

• Unintentional weight loss (非刻意体重下降) — the NHS's wording: losing weight without changing your diet or exercise routine. It is a reason to see a doctor in its own right, not "I've lost a bit lately".
• Dysphagia (吞咽困难) — the NHS's description: where you have problems swallowing; its signs include coughing or choking when eating or drinking, a feeling that food is stuck in your throat or chest, and a gurgly, wet-sounding voice.
• Haematemesis (呕血) — the NHS's medical name for vomiting blood. The page states that vomit can vary from bright red to brown or black, and may look like coffee granules.
• Appendicitis (阑尾炎) — the NHS's definition: swelling and infection in your appendix (part of your bowel), usually causing pain in the lower right side of the abdomen, and needing urgent treatment in hospital.

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.

Frequently asked

Which of these means calling 999 now? Vomiting blood means call 999 now, or go to the nearest hospital emergency department. Heavy bleeding, severe abdominal pain and being unable to poo or fart are in the same band — all four are in the safety note above, taken from the "call 999" lists of the NHS's rectal-bleeding and stomach-ache pages. The rest mean arranging investigation soon, not waiting for the next screening. If any of them suddenly gets worse or frightens you, do not wait at home.

I already see a TCM practitioner — do I still need tests? Yes. The situations above need Western medical investigation to establish the cause, and a TCM consultation does not substitute for it. Running both is fine — bring the report to the consultation, and take what you hear at the consultation back to your doctor. Do not drop medication your doctor prescribed because you have started TCM care — never stop your medication on your own. When a gastroscopy or any other test is arranged, and by whom, is in part 7.

Do not: rely on TCM care alone when there is blood in the stool or unintended weight loss.

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 7: What an online consultation does, and what needs an in-person visit or a doctor

👉 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 any of the situations listed in this part applies, see a doctor first.

Sit with a licensed TCM practitioner from wherever you are.

HansMed Modern TCM

Sources

• NHS, Bleeding from the bottom (rectal bleeding), page last reviewed 12 April 2023 — https://www.nhs.uk/conditions/bleeding-from-the-bottom-rectal-bleeding/
• NHS, Unintentional weight loss, page last reviewed 28 July 2025 — https://www.nhs.uk/symptoms/unintentional-weight-loss/
• NHS, Dysphagia (swallowing problems), page last reviewed 02 May 2023 — https://www.nhs.uk/conditions/swallowing-problems-dysphagia/
• NHS, Vomiting blood, page last reviewed 18 August 2025 — https://www.nhs.uk/conditions/vomiting-blood/
• NHS, Heartburn and acid reflux, page last reviewed 20 November 2023 — https://www.nhs.uk/conditions/heartburn-and-acid-reflux/
• NHS, Stomach ache, page last reviewed 26 May 2023 — https://www.nhs.uk/conditions/stomach-ache/
• NHS, Appendicitis, page last reviewed 09 August 2024 — https://www.nhs.uk/conditions/appendicitis/
• NHS, Constipation, page last reviewed 26 October 2023 — https://www.nhs.uk/conditions/constipation/

本文是「肠胃不舒服」系列的第 6 篇，共 7 篇。第 1 篇讲理论里的「脾胃」是什么，第 2 篇是五种情况的对照表，第 3 篇讲便秘怎么算、西医说成因是什么，第 4 篇讲理论怎么解释便秘，第 5 篇讲反酸烧心，第 7 篇讲线上问诊会做什么。

这一篇是整个系列里最该先读的一篇。它不是要吓人——恰恰相反：知道一个信号可能是什么，才会在它还轻的时候去处理，而不是撑到半夜。

每一项的理由，都取自那个状况自己的 NHS 页面；信号本身与它的分级，和本系列原来的清单一字不差。

一分钟看完

• 下面七项请先就医做检查；呕血、大量出血、严重腹痛、无法排便也无法排气，都在立刻拨打 999 那一档。
• 发黑或深红的大便、吞咽困难，要当天求医——指 Klinik Kesihatan 或诊所的当天门诊。
• 加上理由的目的是让您知道它可能指向什么：每一条都取自那个状况自己的 NHS 页面。
• 理由告诉您一个信号可能指向什么，不告诉您您有什么。后者要靠西医的检查，中医问诊不能取代。

一、这些情况请先看西医

肠胃的不适，有些需要检查才能确认原因。以下情况请先就医，不要只靠调理：

• 大便带血，或颜色发黑——发黑或深红的，当天求医。NHS 的便血页写明，从下面出血有时是大肠癌的征兆；至于发黑的大便，该页把「胃或肠道内出血」列为可能的成因，伴随腹痛或绞痛时列的是胃溃疡。
• 没有刻意减重，体重却明显下降——NHS 的非刻意体重下降页把消化方面的状况（例如乳糜泻或炎症性肠病）列在成因里，并写明有时体重下降与食欲下降可能是癌症造成的，所以没在减重却一直掉体重，重要的是去检查清楚。
• 吞咽困难，或觉得食物卡住——当天求医。NHS 的吞咽困难页写明，它通常由另一个健康问题引起，而时间久了，吞咽困难本身也会造成体重下降、脱水与反复的胸腔感染。
• 持续呕吐，或无法进食喝水——呕血则请立刻拨打 999，或前往最近的医院急诊部。NHS 的呕血页写明，呕血往往是胃或食道（从口腔通到胃的那条管子）内出血的征兆，常见成因包括胃炎、胃溃疡，以及烧心与胃酸倒流。不带血的持续呕吐，NHS 的反酸页把「经常呕吐」列在应看医生的清单上——所以它留在上面那句「先就医」里。
• 严重腹痛，或痛到无法正常活动——见下方安全提醒。严重腹痛可能指向的其中一个状况是阑尾炎：NHS 写明它是阑尾（肠的一部分）发炎与感染，需要在医院紧急处理，不及时处理，阑尾可能破裂。该页自己的「立刻拨打 999」那一项写的是「腹部严重疼痛」——和下方安全提醒同一档。
• 持续发烧伴随腹痛——同一页把「发烧」列在阑尾炎腹痛以外的其他症状里，一起列的还有恶心或没胃口、便秘或腹泻；它也写明那个痛通常从肚脐周围开始，几小时后移到右下腹并加重。
• 乐龄人士出现排便习惯的明显改变——NHS 的便秘页把「如厕习惯突然改变」列为应看医生的情况之一，并写明照顾长者时便秘容易被忽略，要留意意识混乱这类行为变化，那可能表示人正在疼痛或不舒服。阑尾炎页另外写明，长者更可能没有典型的痛。

以上情况需要西医的检查（包括必要时的内视镜与影像），中医问诊不能取代这些检查。「当天求医」指 Klinik Kesihatan 或诊所的当天门诊。

⚠️ 安全提醒：中医与西医是互相补位的关系，不是二选一。若出现大量出血、严重腹痛、无法排便也无法排气，或呕血，请立刻拨打 999，或前往最近的医院急诊部。这四项都列在 NHS 便血页与腹痛页的「立刻拨打 999」清单上。

小提醒：本段仅为一般知识说明。相关情况请以西医的诊断与治疗为主，并在需要时及时就医。

二、理由是怎么来的，以及它停在哪里

上面每一项的理由，来自那个状况自己的页面，不是来自讲肠胃症状的那几页。原因很实际：NHS 的腹痛页与便秘页列出要看医生的情况，但多半不点名病名；病名与机制写在各自的条目页上。NHS 在其中几页上都写了同一句话：不要自我诊断，担心就看医生。

分级没有动。 加的是理由，不是档位。两处本篇停住了：

• 第 7 项的理由讲的是「为什么它容易被漏掉」，而不是一个对应的病名。 引用的这几页，没有为这个信号单独给出对应的状况。
• 呕血的分级仍按腹痛页的「立刻拨打 999」清单。新引的呕血页只用来写理由，不用来改档位。

这篇出现的几个词

四个词都来自上面引用的 NHS 页面，而且您很可能在诊所或转介单上真的遇到。

• 非刻意体重下降（unintentional weight loss）——NHS 的用词：没有改变饮食或运动习惯而变轻。它是一个独立的就医理由，不是「最近瘦了一点」。
• 吞咽困难（dysphagia）——NHS 的说明：吞咽有困难；征象包括咳嗽或呛到、觉得东西卡在喉咙或胸口、吃喝时声音变得湿浊。
• 呕血（haematemesis）——NHS 给呕血的医学名称。该页写明，呕出来的颜色可以从鲜红到褐色或黑色，也可能像咖啡渣。
• 阑尾炎（appendicitis）——NHS 的定义：阑尾（肠的一部分）发炎与感染，通常痛在腹部的右下侧，需要在医院紧急处理。

小提醒：本段仅为一般知识说明。相关情况请以西医的诊断与治疗为主，并在需要时及时就医。

常见问题

这些情况里，哪一项要立刻打 999？ 呕血，请立刻拨打 999，或前往最近的医院急诊部。 大量出血、严重腹痛、无法排便也无法排气也在同一档——四项都在上面的安全提醒里，取自 NHS 便血页与腹痛页的「立刻拨打 999」清单。其余各项是「先就医做检查」，意思是尽快安排，不是等下一次体检。若任何一项突然加重或让您害怕，不要在家里等。

我已经在看中医，还需要去做检查吗？ 需要。上面这些情况要靠西医的检查才能确认原因，中医问诊不能取代。两边并行是可以的——把报告带去问诊，也把问诊听到的话带回去给医生。不要因为开始中医调理就停掉医生开的药——切勿自行停药。 胃镜等检查何时做、由谁安排，见第 7 篇。

不要这样做： 不要在出现便血或体重明显下降时还只靠调理。

这个系列的另外六篇

• 第 1 篇：肠胃不舒服，中医怎么看？先分清「肠胃不好」指的是哪一件事
• 第 2 篇：五种情况一张表：理论怎么说、一般怎么做、什么时候先看医生
• 第 3 篇：便秘多久算便秘？大便形状怎么说，西医说成因是什么
• 第 4 篇：中医理论怎么解释便秘：从进到出的那条路，和一个普通的星期
• 第 5 篇：反酸、烧心，尤其在夜里：怎么做，以及它是怎么发生的
• 第 7 篇：线上问诊会做什么，什么需要亲诊或看医生

👉 如果您不确定「我这种肠胃情况，该从哪里说起」，欢迎透过汉方中医的线上问诊，由依 2016 年 T&CM 法令注册的医师为您评估；若您有本篇列出的任何一项情况，请先看医生。

无论身在何处，与持证中医师对坐。

汉方现代中医

资料来源

• NHS，Bleeding from the bottom (rectal bleeding)，页面最后审阅 2023 年 4 月 12 日 — https://www.nhs.uk/conditions/bleeding-from-the-bottom-rectal-bleeding/
• NHS，Unintentional weight loss，页面最后审阅 2025 年 7 月 28 日 — https://www.nhs.uk/symptoms/unintentional-weight-loss/
• NHS，Dysphagia (swallowing problems)，页面最后审阅 2023 年 5 月 2 日 — https://www.nhs.uk/conditions/swallowing-problems-dysphagia/
• NHS，Vomiting blood，页面最后审阅 2025 年 8 月 18 日 — https://www.nhs.uk/conditions/vomiting-blood/
• NHS，Heartburn and acid reflux，页面最后审阅 2023 年 11 月 20 日 — https://www.nhs.uk/conditions/heartburn-and-acid-reflux/
• NHS，Stomach ache，页面最后审阅 2023 年 5 月 26 日 — https://www.nhs.uk/conditions/stomach-ache/
• NHS，Appendicitis，页面最后审阅 2024 年 8 月 9 日 — https://www.nhs.uk/conditions/appendicitis/
• NHS，Constipation，页面最后审阅 2023 年 10 月 26 日 — https://www.nhs.uk/conditions/constipation/