bubble_chart Concept

Loss of appetite, Neijing refers to as anorexia. The "Treatise on Cold Damage Diseases" refers to it as unwillingness to eat and drink. Later generations of physicians have various terms for it, such as poor appetite, unawareness of hunger, stagnation of appetite, anorexia, poor intake, no desire to eat, inability to eat, and so on. In severe cases, there is an aversion to the smell of food, nausea at the sight of food, and even a desire to vomit, which is then called aversion to food or anorexia.

bubble_chart Pattern Analysis

1. Liver-stomach Disharmony︰Loss of appetite, hiccup and belching, mental depression, distension and oppression in the chest and hypochondrium or distending pain, and wiry pulse. This syndrome is mostly caused by emotional distress, leading to liver qi depression invading the stomach. Its characteristics include loss of appetite accompanied by belching and hiccup, and the condition is often related to emotional changes. Clinically, it is differentiated based on the disease cause, mechanism of disease, and symptom characteristics, as well as the manifestations of liver qi depression, such as mental depression, dysphoria, irritability, distending pain in the hypochondrium or chest oppression, and wiry pulse. The treatment aims to soothe the liver and harmonize the stomach, and the prescription selected is Peripatetic Powder combined with Xiang Su Powder with modifications.
2. Dampness-heat of Spleen and Stomach︰Nausea and anorexia, epigastric and abdominal stuffiness, general fatigue and lassitude, loose stool with incomplete evacuation, scanty and yellow urine, red tongue with yellow-white greasy coating, soggy and rapid or slippery pulse. Mostly caused by dietary irregularities, excessive consumption of rich and greasy foods injuring the spleen and stomach, or exposure to dampness-heat, leading to accumulation and binding in the middle energizer and dysfunction of the spleen and stomach in receiving, transforming, ascending, and descending. Its characteristics include: epigastric and abdominal stuffiness, nausea and vomiting, aversion to greasy foods, dislike of food odors, general lassitude, heaviness of the limbs, loose stool with incomplete evacuation, etc. Treatment involves clearing and resolving dampness-heat, with the formula Sanxiang Decoction as the base, modified as needed. If the tongue coating is greasy, it is advisable to use Three-Kernel Decoction with modifications.
3. Stomach Yin Deficiency︰Hunger without appetite, thirst with a desire to drink, red and dry lips, dry stool, scanty urine, red tongue texture with scant coating, and a thin and slightly rapid pulse. This condition often occurs in the late stage (third stage) of external-contraction febrile disease, caused by pathogenic heat consuming stomach yin, as mentioned in Zabing Yuanliu Xizhu. Regarding food injury (dyspepsia) and inability to eat, *Yuanliu* states: "After seasonal diseases, if stomach qi has not yet harmonized, leading to hunger without the ability to eat, it should be regulated and nourished. Suitable herbs include Poria with Pine, Zao Ren, Sichuan Dendrobium, Anemarrhena, fresh Lotus Seed, and fresh *Shengtoucao*." The described disease cause, mechanism, and medication all point to stomach yin deficiency. The characteristic symptoms include hunger without appetite, accompanied by thirst, dry lips and tongue, retching and hiccups, dry stool, and a dry tongue with little moisture—all manifestations of stomach yin deficiency. The treatment focuses on enriching yin and nourishing the stomach, with modifications of Stomach-Tonifying Decoction as the primary formula.
4. Spleen-stomach Qi Deficiency︰Loss of appetite, abdominal distension and fullness after eating, or nausea after consuming even small amounts of food, shortness of breath, reluctance to speak, fatigue, and weakness. The tongue appears pale with a white coating, and the pulse is slow and weak. This condition is often caused by dietary irregularities or overstrain leading to qi depletion. The characteristic symptoms include a gradual decline in appetite, even to the point of not feeling hunger, accompanied by epigastric and abdominal fullness after eating, nausea upon overeating, shortness of breath, and fatigue—all manifestations of spleen and stomach qi deficiency. The treatment principle is tonifying the spleen and replenishing qi, and the recommended formula is Extraordinary Efficacy Powder with modifications.
5. Spleen and Stomach Yang Deficiency︰Loss of appetite, no sense of hunger, feeling bloated and nauseous after eating slightly more, dull pain or colic in the epigastric and abdominal regions, preference for warmth and fear of cold, relief upon pressure, fatigue and shortness of breath, cold limbs, loose and thin stools, pale tongue with white coating, deep and slow pulse. Often caused by constitutional weakness, irregular diet, excessive consumption of cold foods, etc., leading to spleen-stomach yang deficiency and internal cold, hence the lack of appetite. The characteristic symptoms include persistent dull pain in the epigastric and abdominal regions or intermittent abdominal pain, relief upon pressure, worsening with cold and alleviation with warmth, loose stools, slow pulse, etc. Treatment involves warming the middle and dispelling cold, tonifying qi to strengthen the spleen. The prescription is Middle-Regulating Pill combined with Lesser Galangal and Cyperus Pill with modifications.
6. Spleen-kidney Yang Deficiency︰Bland taste in mouth, pale complexion, shortness of breath and reluctance to speak, fatigue and lassitude, fear of cold and cold limbs, abdominal distension and fullness or abdominal pain, soreness and weakness in the lower back and legs or edema of the limbs, undigested food or diarrhea before dawn, pale and swollen tongue, deep, thin, and weak pulse. This condition may result from excessive consumption of cold foods or overuse of cold-natured medications, which damage spleen yang, or from prolonged spleen deficiency that affects kidney yang, leading to the decline of spleen and kidney yang. The characteristic symptoms include a long course of illness, cold pain in the abdomen, intermittent abdominal distension and fullness that improves with warmth, regurgitation of clear fluid, timidity and aversion to cold, cold limbs, soreness and weakness in the lower back and legs, or abdominal pain radiating to the lower back, undigested food or diarrhea before dawn, and in severe cases, abdominal distension and bloating. Treatment involves warming and tonifying the spleen and kidney. The recommended formula is Ershen Wan with modifications. For cases accompanied by edema, True Warrior Decoction with modifications is preferred.
7. Food Stagnation︰Anorexia, acid regurgitation, epigastric and abdominal distension, foul-smelling stools or constipation, thick and greasy tongue coating, and slippery pulse. There is often a clear history of food injury (dyspepsia) caused by overeating or consuming hard-to-digest foods. Suwen· "On Impediment" states: "When food intake doubles, the intestines and stomach are injured." And Jingyue Quanshu· "Dietary Disorders" mentions: "Those with food injury (dyspepsia) must have an aversion to food." The condition is characterized by anorexia, accompanied by epigastric and abdominal distension, belching, foul-smelling stools or constipation, turbid and greasy tongue coating, and slippery pulse. Anorexia due to food injury (dyspepsia) should be differentiated from anorexia caused by dampness-heat of the spleen and stomach based on differences in disease cause and accompanying symptoms. The treatment focuses on promoting digestion and resolving food stagnation, with the prescription Harmony-Preserving Pill modified as needed. If accompanied by spleen-stomach deficiency, White Atractylodes Rhizome should be added. If food stagnation transforms into heat, Immature Orange Fruit Stagnation-Removing Pill is recommended.

Deficiency-cold of spleen and stomach and spleen-kidney yang deficiency both belong to deficiency pattern, and both can evolve from spleen-stomach qi deficiency. Therefore, they both exhibit manifestations of spleen-stomach qi deficiency, such as bloating after eating, shortness of breath, fatigue, and reluctance to speak.

This condition affects the spleen and stomach, and since the spleen and stomach are the foundation of postnatal life, especially in chronic diseases, poor appetite and reduced food intake will hinder the body's recovery. Moreover, the efficacy of drug treatment also depends on the transportation and transformation functions of the spleen and stomach. Therefore, this condition should be given special attention in cases of prolonged illness.

bubble_chart Documentation

1. Jingyue Quanshu．Miscellaneous Syndrome Discussion: "After illness, if the appetite does not improve and food intake is hindered, there are two syndromes. One is due to impure turbid qi or residual fire not yet cleared, which should be treated primarily with modifications of the Minor Harmonizing Middle Decoction. The other is due to injury to the spleen and stomach, where although the pathogenic factors have been eliminated, the middle qi has not yet recovered. Hence, there may be several days of inability to eat, or a period of ten days without appetite, or a sensation of something stuck in the chest or throat, like globus hystericus. In this case, there is no actual accumulation, but the yang qi is not flowing smoothly, and yin nebula causes stagnation, with stomach qi being too deficient to transform and transport. In mild cases, warming the stomach to resolve fluid retention is sufficient; in severe cases, Ginseng and Aconite Lateral Root must be added. Once the yang qi is able to circulate, the appetite will naturally improve."
2. Zabing Yuanliu Xizhu．Origin and Flow of Food Injury (Dyspepsia) Inability to Eat: "Inability to eat is a disease of both spleen and stomach deficiency... Only by determining whether there is retention of food, real fire, cold phlegm, or damp fluid in the spleen and stomach, and if the original qi is not yet depleted while the pathogenic qi is strong, can one slightly use methods to disperse and guide, but still primarily focus on supplementation and tonification."