Part 2 of 7 in the "digestive discomfort" series. Part 1 is what the TCM "spleen-stomach" is; 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; part 7 is what an online consultation does.
Part 1 said that within TCM theory "stomach trouble" is not one thing but five. This part arranges the five as one table, to be read in a single pass — and while reading it, hold on to this: column two is how the theory explains it, not a judgement about you.
The short version
- The five: constipation · bloating and sleepiness after meals · reflux at night · full after a little, gassy · stools that do not hold together, or alternating with constipation.
- The bold function names in column two are definitions from the World Health Organization's TCM terminology standard; what follows "the theory holds" is this article's commentary. In column three, anything with a number or a quotation is the NHS's and anything marked "the theory's direction" is the theory's habit advice.
- Column four's tiers all come from NHS pages and are the situations to have ruled out by a Western doctor first; the full list, with a reason for each, is part 6.
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. The table
A few things first. The bold function names are all entries in the World Health Organization's TCM terminology standard, quoted as definitions; what follows "the theory holds" is this article's commentary, which the standard does not write. Every page named in brackets in the last two columns is an NHS page — constipation, rectal bleeding, stomach ache, dysphagia, heartburn. "Seek care the same day" means a same-day visit to a Klinik Kesihatan or clinic; the "call 999" situations do not wait for a clinic.
| Situation | What TCM theory says | Usual practice | When to see a doctor first |
|---|---|---|---|
| Constipation (fewer than 3 times in the last week, dry and hard, straining — the NHS constipation page's definition) | The large intestine governs conveyance: it "conducts wastes and discharges faeces"; the theory holds that when the propelling force is weak, stools do not pass easily; the spleen governs transportation and transformation, which the theory holds to be the upstream handling of fluids and nutrients | A regular time for the toilet, do not delay the urge, drink plenty of water, increase fibre gradually (the NHS's stated purpose: "To make your poo softer and easier to pass"), a daily walk; the theory's direction is fixed meal times and warm food | Not improving with treatment, regularly constipated, blood in your poo, weight loss without trying, tummy pain (constipation page); poo black or dark red means seek care the same day (rectal-bleeding page); bleeding non-stop or a lot of blood means call 999 now (same page) |
| Bloating and sleepiness after meals | The spleen governs transportation and transformation; the theory holds that an overfull or oily meal loads that work; dietary irregularities: "Improper diet, including excessive hunger and binge eating" | Neither hungry nor overfull (what Malaysians call "七分饱"), chew slowly (the Hong Kong Chinese Medicine Regulatory Office's health-maintenance page); walk a little after eating, do not lie down straight away (the theory's direction) | Bloating that does not go away or keeps coming back, with stomach ache, means seek care the same day (stomach-ache page); weight loss without trying means see a doctor first (constipation page) |
| Reflux or burning, especially at night | The stomach governs smooth downbearing; the theory holds that stomach qi should flow downward, and reads reflux as stomach qi rising against that direction; the last sentence of the standard's entry on stomach qi ascending states that it "often occurs when cold, heat, diet or emotions causes stomach qi to ascend" | Smaller, more frequent meals; nothing to eat within 3 or 4 hours of bed; head of the bed raised 10 to 20cm, not extra pillows (the NHS heartburn page: symptoms "are often worse after eating, when lying down", and extra pillows "can increase pressure on your belly and make your symptoms worse"); the theory's direction is an earlier, lighter dinner | Heartburn most days, frequently being sick, losing weight for no reason (heartburn page); food stuck in the throat or difficulty swallowing means seek care the same day (dysphagia page); vomiting blood means call 999 now, or go to the nearest hospital emergency department (stomach-ache page) |
| Full after a little, gassy | The stomach governs receiving and holding; the theory holds that spleen and stomach are an interior–exterior pair: the stomach receives, the spleen transports and transforms, and when transporting falls short, receiving shrinks too; the stomach governs decomposition: it "primarily digests water and food and forms chyme" | Smaller, more frequent meals; a warm drink with the meal, iced drinks between meals (the theory's direction) | Difficulty swallowing or food stuck in the throat means seek care the same day (dysphagia page); cannot poo or fart means call 999 now (stomach-ache page) |
| Stools that do not hold together, or alternating with constipation | The spleen governs transportation and transformation, including water metabolism; the theory holds that when fluid handling falters, stools lose form; the large intestine governs the thin body fluids: it "absorbs the thin, clear fluids while eliminating waste" | Eat less cold-natured and raw-cold food (the Regulatory Office's health-maintenance page); keep three days of food and stool notes and bring them to the consultation | A sudden change in bowel habit, blood in your poo, weight loss without trying (constipation page); bloody diarrhoea means seek care the same day (rectal-bleeding page); diarrhoea that does not go away after a few days, with stomach ache, means seek care the same day (stomach-ache page) |
💡 Remember: rule out first, then adjust — column four is what a Western doctor should rule out.
Saying "I was row 1, and lately it is row 5" is far clearer at a consultation than "stomach trouble". Parts 3 and 4 walk the constipation row; part 5 walks the reflux row.
The words in this part
All three come from the World Health Organization's TCM terminology standard, and all three are used in the table.
- The large intestine governs conveyance (大肠主传导) — the standard's definition: it "conducts wastes and discharges faeces". Row 1, on constipation, works from it.
- Dietary irregularities (饮食不节) — the standard's definition: "Improper diet, including excessive hunger and binge eating". Note that it counts both ends: going too hungry, and eating too much at once.
- The stomach governs decomposition (胃主腐熟) — the standard's definition: the stomach "primarily digests water and food and forms chyme". Row 4 works from this one plus receiving.
Frequently asked
Is feeling sleepy after meals normal? In TCM theory, "transportation and transformation" is the spleen's work of digesting food and absorbing and distributing nutrients — the World Health Organization standard's definition. The theory holds that after a meal the spleen-stomach is busy with exactly that, and after an overfull or oily meal the drowsiness is more marked — a statement about habit, not a diagnosis of you. The direction is neither hungry nor overfull, chew slowly, and walk a little afterwards. With weight loss without trying or blood in your poo, the NHS constipation page lists both as reasons to see a doctor, so see a doctor first.
What can I do about bloating right now? Get up and walk a little, do not lie down straight away; loosen clothes that are tight around your waist; stop this meal at seven-tenths full; switch to a warm drink. The NHS stomach-ache page lists "feeling bloated, farting a lot" as a possible sign of trapped wind and says a pharmacist can help. Bloating that does not go away or keeps coming back, with stomach ache, means seek care the same day; if you cannot poo or fart, call 999 now, or go to the nearest hospital emergency department.
Do not: use this table to file yourself into a row — column two is the theory's explanation, not a diagnosis.
The other six parts
- Part 1: Digestive discomfort, how TCM sees it: first, which part of "stomach trouble" you mean
- 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
- 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 anything in column four above or 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
- Chinese Medicine Regulatory Office, Department of Health, Hong Kong, Health Maintenance and Common Bare-handed Exercises — https://www.cmro.gov.hk/html/gb/useful_information/public_health/exhibit_boards/Health_Maintenance_and_Common_Bare-handed_Exercises.html
- NHS, Constipation, page last reviewed 26 October 2023 — https://www.nhs.uk/conditions/constipation/
- 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, Bleeding from the bottom (rectal bleeding), page last reviewed 12 April 2023 — https://www.nhs.uk/conditions/bleeding-from-the-bottom-rectal-bleeding/
- NHS, Dysphagia (swallowing problems), page last reviewed 02 May 2023 — https://www.nhs.uk/conditions/swallowing-problems-dysphagia/
