"My stomach has been off for a while." A sentence that comes up often is this one. But "stomach trouble" covers an enormous amount of ground: bloating, constipation, loose stools, feeling full after a few mouthfuls, sleepiness after meals, reflux at night.

The answer first. TCM theory treats the "gut" as a set of spleen-stomach functions: the spleen governs transportation and transformation; the stomach governs receiving and smooth downbearing. [WHO-2022] The theory's direction is four things: fixed meal times and portions, neither hungry nor overfull, food at a suitable temperature, chewing slowly. [CMRO-养生]

As for "does this count as constipation?" and "what do I do about reflux?", Western patient-information pages give a yardstick to hold it against. This article puts the two side by side, in 6 points.

I. How TCM theory sees the "gut"

The TCM "spleen" and "stomach" are not quite the anatomical organs; they are sets of functions. The World Health Organization's TCM terminology standard defines them this way:

• The spleen governs transportation and transformation: the spleen "digests water and food, absorbs and distributes nutrients and regulates water metabolism". [WHO-2022]
• The stomach governs receiving and holding: "The stomach receives and holds the water and food." [WHO-2022]
• The stomach governs smooth downbearing: "Stomach qi needs to be unobstructed and flows downward, so as to pass the primarily digested chyme down to the small intestine." [WHO-2022]

The theory reads everyday "stomach trouble" as one link in that chain being affected. That is why a consultation takes the sentence apart, which is section VI.

The theory has a stock phrase for the spleen-stomach's temperament: it likes warmth and dislikes cold (喜温恶寒). On the plate, the Hong Kong Department of Health's Chinese Medicine Regulatory Office lists meals "with appropriate temperature" [CMRO-饮食] and eating less cold-natured and raw-cold food [CMRO-养生] among its dietary principles.

Within that theory, "stomach trouble" is not one description but a set of different presentations:

• Appetite is fine, but you feel full after a little
• Bloating, sleepiness and heaviness after meals
• Constipation, or stools that do not hold together
• Alternating loose stools and constipation
• Reflux or burning, particularly at night

The theory keeps them apart. The table in section III is arranged by these five.

II. A yardstick first: what Western pages say about constipation and reflux

Theory gives direction; Western patient-information pages give definitions. The following is taken from the UK National Health Service's public pages, as a yardstick.

① What counts as constipation. The NHS says it is likely to be constipation if "you have not had a poo at least 3 times during the last week or you're pooing less often than usual". [NHS-便秘]

The same page lists three more: "the poo is unusually large or small and is dry, hard or lumpy", "you are straining or in pain when you have a poo", or "you feel like you haven't fully emptied your bowels". [NHS-便秘] So it is not only a count of days: how dry, how much straining, and whether it has changed from your usual all count.

The NHS also states that constipation "is also more common if you are over 65 years old" and "is common during pregnancy and after giving birth". [NHS-便秘]

② Stool shape has a chart. NHS England's Bristol Stool Chart divides stools into 7 types. [BRISTOL]

Type 1 is "Separate hard lumps, like nuts (hard to pass)", Type 4 "Like a sausage or snake, smooth and soft", Type 7 "Watery, no solid pieces. Entirely liquid". [BRISTOL] Saying "about a type 2" at a consultation is much clearer than "very hard".

The chart's note on constipation is a single sentence: "If a poo does not look like type 3 or type 4 it could be constipation." [BRISTOL] So types 3 and 4 are the chart's reference point.

A practitioner asks about shape because shape carries a direction: towards types 1 and 2, and towards types 6 and 7, are two different questions in the theory (rows 1 and 5 of the table in section III). Section V walks the constipation route.

③ What to do about reflux. The NHS advice is: "eat smaller, more frequent meals"; "do not eat within 3 or 4 hours before bed"; "do not wear clothes that are tight around your waist"; "do not smoke"; "do not drink too much alcohol"; "do not have food or drink that triggers your symptoms". [NHS-反酸]

The same page says you "may find that using wood, bricks or books to raise the head of your bed by around 10 to 20cm, so your chest and head are above your waist, helps relieve symptoms". [NHS-反酸]

But "do not try to achieve the same effect by using additional pillows, as this can increase pressure on your belly and make your symptoms worse". [NHS-反酸]

④ Who asks a pharmacist, who sees a doctor. If you keep getting heartburn, the NHS says speak to a pharmacist, who may recommend medicines called antacids. [NHS-反酸]

See a doctor if "lifestyle changes and pharmacy medicines are not helping your heartburn", "you have heartburn most days", or "you also have other symptoms, like food getting stuck in your throat, frequently being sick, or losing weight for no reason". [NHS-反酸] Food stuck in the throat or difficulty swallowing means seek care the same day. [NHS-吞咽]

If you are on medication, the NHS's own words are: "do not stop taking any prescribed medicine without speaking to a doctor first". [NHS-反酸] Never stop your medication on your own.

For Chinese herbs alongside Western medication, see Can Chinese herbs be taken with Western medicine.

III. One table: five situations, what the theory says, the usual practice, when to see a doctor first

In the table, "seek care the same day" means a same-day visit to a Klinik Kesihatan or clinic; the "call 999 now" situations do not wait for a clinic.

The "what TCM theory says" column is how the theory explains it, not a judgement about you.

IV. 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 [NHS-便血]
• Weight loss you did not intend
• Difficulty swallowing, or a sensation of food sticking — seek care the same day [NHS-吞咽]
• Persistent vomiting, or being unable to eat or drink — vomiting blood means call 999 now, or go to the nearest hospital emergency department [NHS-腹痛]
• Severe abdominal pain, or pain that stops you functioning — see the safety note below
• Persistent fever alongside abdominal pain
• A marked change in bowel habit in an older adult

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 [NHS-便血], severe abdominal pain [NHS-腹痛], if you cannot poo or fart [NHS-腹痛], or vomiting blood [NHS-腹痛], call 999 now, or go to the nearest hospital emergency department.

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.

V. How it actually happens: reflux and constipation, each side's own model

So far, the theory's account and the Western yardstick. This section goes one step in: how reflux and how constipation happen, in each of the two accounts. The two are written separately, each under its own source.

Where the World Health Organization's 2022 TCM terminology standard is quoted below it is called "the standard"; only definition sentences are quoted, never a symptom list.

① Reflux: how the NHS explains it. The NHS definition is that heartburn is "a burning feeling in the chest caused by stomach acid travelling up towards the throat (acid reflux)". [NHS-反酸]

The same page states that symptoms "are often worse after eating, when lying down and when bending over". [NHS-反酸] So "do not eat within 3 or 4 hours before bed" has a reason behind it: lying down on a full stomach stacks two of those moments on top of each other.

The NHS also gives the logic of raising the bed: with your chest and head above your waist, it "can help stop stomach acid travelling up towards your throat"; extra pillows instead "can increase pressure on your belly and make your symptoms worse". [NHS-反酸]

② Reflux: how TCM theory explains it. The standard describes "the stomach governs smooth downbearing" (胃主通降) as: "Stomach qi needs to be unobstructed and flows downward, so as to pass the primarily digested chyme down to the small intestine." [WHO-2022] The theory's stock phrase 「胃气以下行为顺」, stomach qi is in order when it moves downward, means this direction.

The last sentence of the standard's entry on stomach qi ascending (in its patterns chapter) states that it "often occurs when cold, heat, diet or emotions causes stomach qi to ascend". [WHO-2022] The theory reads reflux as stomach qi moving up against its proper direction; diet is one of the causes the standard names.

The two accounts look at the same experience: something travelling upward. One speaks of stomach acid and body position, the other of the direction of "qi". They are not translations of each other; each stands on its own.

That is why "what time did you eat, and how long after did you lie down" are questions both sides ask.

③ Constipation: how the NHS explains it. The NHS's common causes of constipation in adults include "not eating enough fibre, which is found in fruits, vegetables and cereals", "not drinking enough fluids", "not moving enough and spending long periods sitting or lying down", "often ignoring the urge to go to the toilet", "changing your diet or daily routine" and "a side effect of medicine". [NHS-便秘]

The NHS measures answer that list. Drinking plenty of water and gradually increasing fibre are, in its words, "To make your poo softer and easier to pass". [NHS-便秘]

Toilet routine: "Keep to a regular time and place and give yourself plenty of time to use the toilet", and "Do not delay if you feel the urge to poo"; activity: "A daily walk or run can help you poo more regularly". [NHS-便秘]

On the medicine item, the NHS's own words are: "Speak to the GP before you stop taking any prescribed medicine." [NHS-便秘] Never stop your medication on your own.

④ Constipation: how TCM theory explains it. Along the route from intake to exit, the standard has a separate definition for each of these segments:

• The spleen governs transportation and transformation (脾主运化): the spleen "digests water and food, absorbs and distributes nutrients and regulates water metabolism". [WHO-2022]
• The small intestine separates the clear from the turbid (小肠泌别清浊): it "absorbs nutrients and body fluids and passes the food residue and water down to the large intestine". [WHO-2022]
• The large intestine governs conveyance (大肠主传导): it "conducts wastes and discharges faeces". [WHO-2022]
• The large intestine governs the thin body fluids (大肠主津): it "absorbs the thin, clear fluids while eliminating waste". [WHO-2022]

So within the theory, how dry the stool is has to do with how fluids are handled along that route, and whether it moves has to do with whether qi is stagnant. Those two sentences are the theory's common teaching; the standard does not join them up that way.

The standard's entry on "physical inactivity" (过逸) states that it "leads to imbalances in the flow of qi and blood, weak tendons and bones, stagnant qi of the spleen and stomach". [WHO-2022] The "a daily walk" cell in section III's table has a reason on each side.

⑤ One week, two readings. Below, an ordinary week is laid under both models. It describes how each model reads these habits, not any particular reader, and it is not a diagnosis.

• Monday to Friday: breakfast in the car, nasi campur with little veg at lunch, overtime dinner from a delivery app. On the NHS's cause list this is "not eating enough fibre". [NHS-便秘] The theory sees "dietary irregularities" (饮食不节), which the standard defines as "Improper diet, including excessive hunger and binge eating". [WHO-2022]
• All day in an air-conditioned room, the water bottle barely touched. NHS: "not drinking enough fluids". [NHS-便秘] The theory's common teaching: when fluids are short the large intestine loses its moistening and the stool turns dry; "the large intestine governs the thin body fluids" is about the water in exactly that segment.
• The urge arrives in a meeting and is held until it ends. The NHS's own words are "Do not delay if you feel the urge to poo". [NHS-便秘] The theory reads this as "conveyance" interrupted: what should move down stays where it is; that too is common teaching.
• Over the week, far more time sitting than walking. NHS: "not moving enough and spending long periods sitting or lying down". [NHS-便秘] The standard: "physical inactivity", "stagnant qi of the spleen and stomach". [WHO-2022]
• Sunday, looking back: two stools that week, and towards types 1 and 2. By the NHS yardstick, fewer than 3 times during the last week is likely to be constipation. [NHS-便秘] By the Bristol chart, "If a poo does not look like type 3 or type 4 it could be constipation". [BRISTOL]
• Where the two readings land. The NHS lands on fibre, fluids, toilet routine and activity; the theory lands on transformation, conveyance and "movement". They overlap on habits; their sources differ.

This passage describes the models, not a diagnosis. The same week landing on different people can turn out differently; the NHS itself states that "Sometimes there's no obvious reason". [NHS-便秘]

If the definition of constipation fits, the next step is the one in section II: a pharmacist or a doctor; with any item from section IV, a doctor first.

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

With the theory and the yardstick covered, the last thing is how "my kind of stomach" is handled inside a consultation.

① The five directions a practitioner asks about. 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.

The practitioner also asks 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". [WHO-2022] 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" [WHO-2022]; the tongue coating is "A layer of moss-like material covering the tongue, generated by ascending of stomach qi". [WHO-2022] 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". [WHO-2022] Those three, spirit, colour and form, 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 article, 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.

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 or a decoction; the lifestyle side means the kind of habits in section III.

Which, and whether, is decided after the consultation, and the practitioner's written instructions take precedence.

⑤ 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". [NHS-反酸] 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 "It's safe to try these simple measures when you're pregnant"; for heartburn medicines in pregnancy, "a pharmacist can advise you about medicines you can take". [NHS-便秘][NHS-反酸] Whether herbs or acupuncture suit you, ask the practitioner first.
• Under 12: the NHS constipation page states "This page is about constipation in adults. There's separate information on constipation in babies and children." [NHS-便秘] 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". [NHS-便秘] A marked change in bowel habit: see section IV.
• 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.

Fitting it into life in Malaysia

• Kopi peng or teh ais with rice: the theory's direction is a warm drink with the meal; if you really want it iced, have it between meals. That is a direction for a habit, not a ban.
• Mamak suppers: the NHS says "do not eat within 3 or 4 hours before bed". [NHS-反酸] The theory says an earlier, lighter dinner. In overtime season and exam season, say what time and how often at the consultation.
• All day in an air-conditioned office: the NHS lists "not moving enough and spending long periods sitting or lying down" among common causes of constipation and suggests considering more activity, such as a daily walk. [NHS-便秘] The theory says "move": a walk after meals.
• Holding it in: meetings, deadlines, classes. The NHS's own words are "Do not delay if you feel the urge to poo", and it advises keeping to a regular time and place and giving yourself plenty of time. [NHS-便秘]
• Chilli pan mee, curry, steamboat, durian season, festive meals: no need to give them up before the consultation. The NHS practice is to avoid "food or drink that triggers your symptoms" [NHS-反酸]; the operative word is "your", so describe how you actually eat.
• Antacids from the pharmacy (Guardian, Watsons): if you keep getting heartburn, the NHS says ask a pharmacist first; antacids help symptoms in the short term and "should not be taken regularly for long periods". [NHS-反酸]
• Herbal-tea-shop teas, direct-sales enzymes and probiotics: mention them all at the consultation; the practitioner looks at them together.
• Confinement (坐月子): constipation after giving birth is common [NHS-便秘]; confinement diets have their own arrangements, so whether something suits yours is a question for the practitioner in charge, not an online recipe.

Frequently asked

How long before it counts as constipation? The NHS says it is likely to be constipation if you "have not had a poo at least 3 times during the last week" or are "pooing less often than usual"; poo that is "dry, hard or lumpy", "straining or in pain", or feeling you "haven't fully emptied your bowels" count too. [NHS-便秘] See a doctor if you are regularly constipated, it is not getting better with treatment, there is blood in your poo, or you have lost weight without trying [NHS-便秘]; blood in your poo for 3 weeks also means see a doctor. [NHS-便血] Bleeding non-stop or a lot of blood means call 999 now, or go to the nearest hospital emergency department. [NHS-便血]

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. [WHO-2022] TCM 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 [CMRO-养生], and walk a little afterwards. With weight loss without trying or blood in your poo, see a doctor first [NHS-便秘]; bloating that does not go away, with stomach ache, means seek care the same day. [NHS-腹痛]

Do cold drinks really harm the stomach? "Harm the stomach" is TCM theory's language: the spleen-stomach likes warmth and dislikes cold, so meals "with appropriate temperature" [CMRO-饮食] and eating less cold-natured and raw-cold food [CMRO-养生] are that theory's standard counsel. It describes the direction of a habit, not a prediction of what one glass will do. It is hot here and iced drinks are routine; all the theory would change is drinking ice through the meal itself — a warm drink with the meal, iced drinks between meals.

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 lists "feeling bloated, farting a lot" as a possible sign of trapped wind and says a pharmacist can help. [NHS-腹痛] 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. [NHS-腹痛]

When do I need a gastroscopy? The doctor decides. The NHS says that if medicines do not help or symptoms are severe, a GP may refer you to a specialist for tests such as a gastroscopy. [NHS-反酸] The NHS lists as reasons to see a GP: heartburn most days, food getting stuck in your throat, frequently being sick, losing weight for no reason [NHS-反酸]; of these, food stuck in the throat or difficulty swallowing means seek care the same day. [NHS-吞咽] Vomiting blood means call 999 now, or go to the nearest hospital emergency department. [NHS-腹痛]

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". [WHO-2022] 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.

In closing

✅ Worth remembering:

1. TCM theory treats the "gut" as spleen-stomach functions: the spleen governs transportation and transformation; the stomach governs receiving and smooth downbearing. [WHO-2022]
2. The theory's direction is fixed meal times and portions, neither hungry nor overfull, food at a suitable temperature, chewing slowly. [CMRO-养生]
3. The Western yardstick: fewer than 3 poos in the last week is likely constipation [NHS-便秘]; for reflux, do not eat within 3 or 4 hours before bed, and raise the head of the bed 10 to 20cm. [NHS-反酸]
4. Blood in the stool, weight loss without trying, persistent vomiting: see a doctor for tests first; black or dark red poo, difficulty swallowing: seek care the same day. Heavy bleeding, cannot poo or fart, or vomiting blood: call 999 now, or go to the nearest hospital emergency department.
5. Reflux: the NHS says it is stomach acid travelling up, worse after eating and when lying down [NHS-反酸]; the theory says stomach qi is in order when it moves downward. [WHO-2022] Constipation: the NHS lands on fibre, fluids, toilet routine and activity [NHS-便秘]; the theory lands on transformation and conveyance. [WHO-2022]
6. An online consultation asks five directions and looks at your tongue photo; pressing on the abdomen needs an in-person visit, and investigations are a doctor's.

❌ Do not:

1. Clean up your diet just before the consultation to "look better" — the practitioner needs the real version.
2. Rely on TCM care alone when there is blood in the stool or unintended weight loss.
3. Never stop prescribed medication on your own because you have started TCM care.

👉 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.

Reviewed by Ms. Koo Shuang, a TCM practitioner registered with Malaysia's Traditional and Complementary Medicine Council under the T&CM Act 2016, practising in gastroenterology, dermatology, respiratory and women's health.

Sit with a licensed TCM practitioner from wherever you are.

HansMed Modern TCM

「医师，我肠胃一直不太好。」不少读者常说这句话。但「肠胃不好」四个字，可以指的东西太多了——胀气、便秘、腹泻、吃一点就饱、餐后想睡、半夜胃酸。

先给答案。 中医理论把「肠胃」看作脾胃的一组功能：脾主运化，胃主受纳与通降。[WHO-2022] 理论给的方向是四件事：定时定量、饥饱得当、寒温适宜、细嚼慢咽。[CMRO-养生]

至于「我这样算不算便秘」「反酸要怎么做」，西医的病人资讯页给了可以对照的尺。这篇把两边放在一起，整理成 6 个重点。

一、中医理论怎么看「肠胃」

中医的「脾」和「胃」，不完全等于解剖学上的器官，而是一组功能。世界卫生组织的中医术语标准这样定义：

• 脾主运化：脾运化水谷和水液——消化饮食、吸收和输布营养，并调节水液代谢。[WHO-2022]
• 胃主受纳：胃接受并容纳水谷。[WHO-2022]
• 胃主通降：胃气须通畅下行，把初步消化的食糜送往小肠。[WHO-2022]

理论把日常的「肠胃不好」，看成这几个功能的某一环受影响。所以问诊会拆开来问——这是第六节的内容。

理论对脾胃的性情有一句常说的话：喜温恶寒。落到饮食上，香港卫生署中医药规管办公室的养生原则写的是「食物的温度要适宜」[CMRO-饮食]，以及「少吃寒凉和生冷的食物」。[CMRO-养生]

在这套理论里，「肠胃不好」不是一个描述，是一整组不同的表现：

• 吃得下、但吃一点就饱
• 餐后胀、想睡、提不起劲
• 便秘，或大便不成形
• 腹泻与便秘交替
• 反酸、烧心，尤其在夜里

理论把它们分开看。第三节的表，就是按这五种情况排的。

二、先有一把尺：便秘、反酸的西医说法

理论讲方向，西医的病人资讯页讲定义。以下取自英国国民保健署（NHS）的公开页面，是可以对照的尺。

① 便秘怎么算。 NHS 的说法是，过去一周排便不足 3 次，或比平常少，很可能就是便秘。[NHS-便秘]

同一页还列了三种情况：大便异常地大或小，而且干、硬或成块；排便时用力或疼痛；感觉没有排干净。[NHS-便秘] 所以不能只数天数——干不干、要不要用力、和平常比有没有变，一样重要。

NHS 也写明，65 岁以上更常见，孕期与产后也常见。[NHS-便秘]

② 大便的形状有一张图。 NHS 英格兰的 Bristol 大便分类表把大便分成 7 型。[BRISTOL]

其中 1 型是「分开的硬块，像坚果（难以排出）」，4 型「像香肠或蛇，光滑柔软」，7 型「水状，没有固体」。[BRISTOL] 看诊时说「大概是 2 型」，比说「很硬」清楚得多。

图上关于便秘的说明只有一句：如果大便看起来不像 3 型或 4 型，可能是便秘。[BRISTOL] 所以 3 型和 4 型是这张图的参照点。

医师问形状，是因为形状带着方向：偏 1、2 型和偏 6、7 型，在理论里是两个不同的问题（第三节表的第 1 行和第 5 行）。第五节会讲便秘那一条路。

③ 反酸怎么做。 NHS 的建议是：少量多餐；不要在睡前 3 到 4 小时内进食；不要穿腰部过紧的衣服；不吸烟；不过量饮酒；避开会引发症状的食物和饮料。[NHS-反酸]

NHS 同一页说，用木块、砖或书把床头垫高约 10 到 20 厘米，让胸和头高过腰，可能有助缓解症状。[NHS-反酸]

但不要用叠枕头的方式达到同样效果，那会增加腹部压力，反而加重。[NHS-反酸]

④ 谁先问药剂师，谁先看医生。 一直有烧心的，NHS 建议先向药剂师咨询，药剂师可能推荐抗酸剂之类的药物。[NHS-反酸]

生活调整和药剂行的药物没有帮助、多数日子都烧心，或伴随食物卡喉、经常呕吐、体重无故下降——请看医生。[NHS-反酸] 食物卡喉或吞咽困难，当天求医。[NHS-吞咽]

正在服药的，NHS 的原话是：未先咨询医生，不要停用任何处方药。[NHS-反酸] 切勿自行停药。

中药与西药同用的问题，另见：中药和西药可以一起吃吗。

三、一张表看懂：五种情况，理论怎么说、一般怎么做、什么时候先看医生

表里「当天求医」指 Klinik Kesihatan 或诊所的当天门诊；「立刻拨打 999」的情况，不等门诊。

「中医理论的说法」一栏是理论怎么解释，不是给您的判断。

四、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-便血]
• 没有刻意减重，体重却明显下降
• 吞咽困难，或觉得食物卡住——当天求医 [NHS-吞咽]
• 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-腹痛]
• 严重腹痛，或痛到无法正常活动——见下方安全提醒
• 持续发烧伴随腹痛
• 乐龄人士出现排便习惯的明显改变

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 [NHS-便血]、严重腹痛 [NHS-腹痛]、无法排便也无法排气 [NHS-腹痛]，或呕血 [NHS-腹痛]，请立刻拨打 999，或前往最近的医院急诊部。

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。

五、它是怎么发生的：反酸与便秘，两边各自的模型

前面讲了理论的说法和西医的尺。这一节往里走一步：反酸和便秘，在两套说法里各自是怎么发生的。两边分开写，各归各的出处。

下面引用世界卫生组织 2022 年中医术语标准的地方，简称「标准」；引的都是定义句，不是症状清单。

① 反酸：NHS 怎么解释。 NHS 的定义是：烧心是胸口的灼热感，由胃酸向上走到喉咙引起，也就是胃酸倒流。[NHS-反酸]

同一页写明，症状常在进食后、躺下时和弯腰时加重。[NHS-反酸] 所以「睡前 3 到 4 小时不进食」有它的道理：吃饱就躺，是把两个加重的时机叠在一起。

床头垫高的原理，NHS 也说了：让胸和头高过腰，可以帮助阻止胃酸向上走到喉咙；叠枕头则会增加腹部压力，反而加重。[NHS-反酸]

② 反酸：中医理论怎么解释。 标准对「胃主通降」的说明是：胃气须通畅下行，把初步消化的食糜送往小肠。[WHO-2022] 理论常说的「胃气以下行为顺」，指的就是这个方向。

标准在「胃气上逆」这一条（在证候一章）的末句写明：常发生在寒、热、饮食或情志使胃气上逆的时候。[WHO-2022] 理论把反酸读作胃气逆着该走的方向往上；饮食，是标准点名的原因之一。

两套说法看的是同一个经验——东西往上走。一边讲的是胃酸和体位，一边讲的是「气」的方向。它们不是互相翻译，各自成立。

所以「几点吃、吃完多久躺」这两个问题，两边都会问。

③ 便秘：NHS 怎么解释。 NHS 列出的成人便秘常见原因包括：纤维不够（纤维在水果、蔬菜和谷物里）、水分不够、久坐少动、常忍住便意、饮食或作息改变、药物的副作用。[NHS-便秘]

NHS 的做法对着这张原因表来。多喝水、逐步加纤维，目的是让大便变软、容易排出。[NHS-便秘]

如厕习惯：固定时间和地点、给自己足够时间，有便意不要拖延；活动：每天走动。[NHS-便秘]

药物那一项，NHS 的原话是：停用任何处方药之前，先和医生谈。[NHS-便秘] 切勿自行停药。

④ 便秘：中医理论怎么解释。 食物从进到出的这条路，标准对其中几段各有一条定义：

• 脾主运化：消化水谷，吸收并输布营养，调节水液代谢。[WHO-2022]
• 小肠泌别清浊：吸收营养和水液，把食物残渣和水送往大肠。[WHO-2022]
• 大肠主传导：传送糟粕，排出大便。[WHO-2022]
• 大肠主津：大肠在排出糟粕的同时，吸收其中稀薄、清的水液。[WHO-2022]

所以在理论里，大便干不干，和水液在这条路上怎么被处理有关；推得动不动，和气有没有停滞有关。这两句是理论的通说，标准没有这样连起来写。

标准的「过逸」条目写明：缺乏活动会导致气血运行失调、筋骨软弱、脾胃之气停滞。[WHO-2022] 第三节表里「每天走动」那一格，两边各有各的理由。

⑤ 一个星期，两种读法。 下面把一个普通的星期放在两套模型下。说的是模型怎么读这些习惯，不是任何一位读者，也不是诊断。

• 周一到周五：早餐在车上，午餐 nasi campur 少菜，加班晚餐叫外卖。 NHS 的原因表上，这是「纤维不够」。[NHS-便秘] 理论看到的是「饮食不节」——标准的定义是饮食失宜，包括过饥与暴食。[WHO-2022]
• 整天在冷气房，水杯没怎么动。 NHS：水分不够。[NHS-便秘] 理论的通说是：水液不足，大肠失于濡润，大便就干——「大肠主津」讲的正是这一段的水。
• 开会时有便意，忍到散会。 NHS 的原话是「有便意时不要拖延」。[NHS-便秘] 理论把这读作「传导」被打断：该往下走的，停在那里——这也是通说。
• 一周下来，坐着的时间远多于走动。 NHS：久坐少动。[NHS-便秘] 标准：「过逸」——脾胃之气停滞。[WHO-2022]
• 周日回想，这一周只排了两次，而且偏 1、2 型。 按 NHS 的尺，过去一周不足 3 次很可能就是便秘。[NHS-便秘] 按 Bristol 图，不像 3 型或 4 型，可能是便秘。[BRISTOL]
• 两种读法的落点。 NHS 落在纤维、水分、如厕习惯和活动；理论落在运化、传导和「动」。习惯上重叠，出处各不相同。

这一段说的是模型，不是诊断。同一个星期落在不同的人身上，结果可以不一样；NHS 也写明，有时候没有明显的原因。[NHS-便秘]

符合便秘的定义，下一步是第二节说的：问药剂师或看医生；带第四节任何一项的，先看医生。

六、线上问诊会做什么，什么需要亲诊或看医生

理论和尺都讲完了，最后一件事是：「我这种肠胃」在问诊里是怎么被处理的。

① 医师会问的五个方向。 吃什么、什么时候吃；餐后的感觉；大便的次数、形状、颜色；和情绪、作息的关系；其他线索——口干口苦、食欲、睡眠、体重。

另外还会问：看过西医没有、做过什么检查、吃过什么药。已经排除过的可能性，同样是重要的资讯。

② 为什么要看舌头，照片要拍到什么。 世界卫生组织的术语标准把舌诊定义为「观察病人舌体和舌苔的诊法」。[WHO-2022] 所以照片里要有两层：舌体，和舌体上面的苔。

标准的定义：舌体是舌的肌肉与血管组织 [WHO-2022]；舌苔是覆盖舌面的一层苔状物，由胃气上蒸而生。[WHO-2022] 问肠胃而看舌苔，理论上的连结在「胃气」二字。

标准把「舌象」定义为舌的外观变化，包括舌体和舌苔在神、色、形上的变化。[WHO-2022] 医师看的是这三样。

至于哪种颜色、苔厚苔薄代表什么，是看诊后的判断，不在这篇的范围，也不该照清单自己对。

线上问诊看的是您拍的舌头照片。光线、时间、角度和常见错误，见：舌头照片怎么拍。

③ 线上做不到的，医师会说。 需要用手按压腹部、需要听诊的部分，线上做不到；需要检查的——内视镜、超音波、验血——是医生的事。

医师若认为应该先做西医检查，会直接说。

④ 可能采用的方向有三个：针灸、中药，以及生活调整。 中药可能是浓缩中药粉或水煎药；生活调整指第三节那类习惯。

用哪一种、要不要用，看诊后才决定，以医师的书面指示为准。

⑤ 按情况的提醒——不是按体质：

• 正在长期服药：所有药都告诉医师；NHS 的原话是，未先咨询医生，不要停用任何处方药。[NHS-反酸] 切勿自行停药。
• 孕期、备孕或哺乳：NHS 写明，便秘在孕期和产后常见，饮食与作息的简单调整在孕期是安全的；孕期烧心的用药，请问药剂师。[NHS-便秘][NHS-反酸] 中药与针灸是否适合，先问医师。
• 12 岁以下：NHS 的便秘页面写明只适用于成人，婴幼儿与儿童另有资讯。[NHS-便秘] 孩子的肠胃，先看儿科医生。
• 乐龄人士：NHS 写明，65 岁以上便秘更常见，而且照顾长者时，便秘容易被忽略。[NHS-便秘] 排便习惯明显改变，见第四节。
• 准备手术、慢性病定期复诊中：把您在吃的中药、凉茶、保健品告诉医生，由医生判断。

问诊前的准备，见：线上问诊前该准备什么。

大马生活里怎么安排

• kopi peng、teh ais 配饭：理论的方向是配餐改温饮；真的想喝冰的，放到两餐之间。这是习惯的方向，不是禁令。
• mamak 宵夜：NHS 说不要在睡前 3 到 4 小时内进食。[NHS-反酸] 理论说的是晚餐早一点、少一点。加班季、考试季的宵夜，几点吃、多常吃，看诊时一并说明。
• 冷气房坐一整天：NHS 把久坐、少动列为便秘常见的原因之一，建议考虑增加活动，例如每天散步。[NHS-便秘] 理论说的是「动」——饭后走一走。
• 有便意却忍着：开会、赶工、上课，常见。NHS 的原话是「有便意时不要拖延」，并建议固定时间和地点、给自己足够的时间。[NHS-便秘]
• 辣椒板面、咖喱、火锅、榴莲季、年节大餐：不必为了问诊先戒掉。NHS 的做法是避开会引发您症状的食物和饮料 [NHS-反酸]——重点是「您的」，所以如实说明您平常怎么吃。
• 药剂行（Guardian、Watsons）的抗酸剂：一直有烧心，NHS 建议先问药剂师；抗酸剂短期缓解症状，不宜长期常规服用。[NHS-反酸]
• 凉茶铺的茶、直销的酵素与益生菌：看诊时都说出来，医师会一并看。
• 坐月子：产后便秘常见 [NHS-便秘]；月子里的饮食有自己的安排，是否适合，请问负责的医师，不要照网上的方子。

常见问题

便秘多久算便秘？ NHS 的说法是，过去一周排便不足 3 次，或比平常少，很可能就是便秘；干、硬、要用力或没排干净，也算。[NHS-便秘] 经常便秘、治疗后不见好、便血或体重无故下降，请看医生 [NHS-便秘]；便血持续 3 周，也要看医生。[NHS-便血] 出血不止或大量出血，请立刻拨打 999，或前往最近的医院急诊部。[NHS-便血]

餐后想睡正常吗？ 「运化」在中医理论里指脾消化饮食、吸收和输布营养。[WHO-2022] 中医理论认为，餐后正是脾胃集中运化的时候，一餐过饱、过油，困倦就明显——这是习惯层面的说法，不是给您的诊断。方向是饥饱得当、细嚼慢咽 [CMRO-养生]，饭后走一走。伴随体重无故下降或便血，先看医生 [NHS-便秘]；胀气一直不退且伴随腹痛，当天求医。[NHS-腹痛]

冷饮真的伤胃吗？ 「伤胃」是中医理论的说法：脾胃喜温恶寒，所以「食物的温度要适宜」[CMRO-饮食]、「少吃寒凉和生冷的食物」[CMRO-养生] 是这套理论的标准建议。它讲的是习惯的方向，不是「喝一杯会怎样」的预言。大马天气热，冰饮是日常；理论要改的只是「一边吃饭一边灌冰」——配餐改温饮，冰饮放到两餐之间。

胀气当下可以做什么？ 起身走一走，不马上躺；松开腰部过紧的衣物；这一餐停在七分饱；换温饮。NHS 把「胀、常放屁」列为肠道积气的可能表现，并说药剂师可以帮忙。[NHS-腹痛] 胀气一直不退或反复出现、且伴随腹痛，当天求医；无法排便也无法排气，请立刻拨打 999，或前往最近的医院急诊部。[NHS-腹痛]

什么时候要做胃镜？ 由医生决定。NHS 的说法是，若药物没有帮助或症状严重，医生可能转介做胃镜等检查。[NHS-反酸] NHS 列为应看医生的情况是：多数日子都烧心、食物卡喉、经常呕吐、体重无故下降 [NHS-反酸]；其中食物卡喉或吞咽困难，当天求医。[NHS-吞咽] 呕血，请立刻拨打 999，或前往最近的医院急诊部。[NHS-腹痛]

中医看肠胃为什么要看舌头？ 世界卫生组织的术语标准把舌苔描述为「由胃气上蒸而生」。[WHO-2022] 舌苔和胃气有关，所以问肠胃而看舌头，是理论内部的逻辑。线上问诊看的是您拍的照片：早上刷牙前、自然光、不要刚喝完 kopi——详见舌头照片怎么拍。

结语

✅ 记住这几点：

1. 中医理论把「肠胃」看作脾胃的功能：脾主运化，胃主受纳与通降。[WHO-2022]
2. 理论给的方向是定时定量、饥饱得当、寒温适宜、细嚼慢咽。[CMRO-养生]
3. 西医的尺：一周排便不足 3 次很可能是便秘 [NHS-便秘]；反酸不要在睡前 3 到 4 小时内进食，床头垫高 10 到 20 厘米。[NHS-反酸]
4. 便血、体重无故下降、持续呕吐——先就医做检查；大便发黑或深红、吞咽困难——当天求医。大量出血、无法排便也无法排气、呕血——请立刻拨打 999，或前往最近的医院急诊部。
5. 反酸，NHS 说是胃酸向上走，进食后与躺下时加重 [NHS-反酸]；理论说胃气以下行为顺。[WHO-2022] 便秘，NHS 落在纤维、水分、如厕习惯与活动 [NHS-便秘]；理论落在运化与传导。[WHO-2022]
6. 线上问诊问五个方向、看舌头照片；按压腹部要亲诊，检查是医生的事。

❌ 不要这样做：

1. 不要为了「表现好一点」而先戒掉平常的饮食再去问诊——医师需要真实版本。
2. 不要在出现便血或体重明显下降时还只靠调理。
3. 不要因为开始中医调理就自行停掉医生开的药——切勿自行停药。

👉 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。

本文由 邱双 医师 撰稿审阅。邱双 医师依 2016 年 T&CM 法令于马来西亚传统与辅助医药理事会注册执业，专长为肠胃科、皮肤科、呼吸科与妇科。

无论身在何处，与持证中医师对坐。

汉方现代中医