Many people assume that "not wanting to eat anything and feeling annoyed at the sight of food" is merely a temporary phenomenon caused by poor appetite, hot weather, or a bad mood, and that it can be resolved by enduring it or eating some appetite-stimulating snacks. This is not the case. In traditional Chinese medicine (TCM) clinical practice, this presentation is often not a simple appetite issue, but rather a signal that some internal system in the body has become imbalanced. It may arise from dysfunction of the spleen and stomach in transportation and transformation, stagnation of liver qi, internal obstruction by dampness and turbidity, or even be related to deficiency of qi and blood. Ignoring it may allow a minor problem to gradually evolve into chronic indigestion or a decline in constitutional health.
Causes: From External Contraction and Internal Damage to Emotions and Diet
The causes of anorexia are not singular. Among the six external pathogenic factors, summerheat-dampness or cold-dampness encumbering the spleen and stomach is most common—during hot, humid summers, the body is easily invaded by dampness, leading to sluggish transportation and transformation in the middle jiao. Regarding internal damage, improper diet is a major driver: excessive consumption of cold and raw foods, greasy foods, or overeating all damage the yang qi of the spleen and stomach. Emotional factors are equally important; prolonged excessive worry or emotional suppression easily leads to liver qi stagnation, which then attacks the stomach. As the Huangdi Neijing states: "When food and drink are doubled, the intestines and stomach are harmed." Excessive or improper eating directly weakens digestive function.
Location of Disease: Spleen and Stomach as the Center, Liver Qi Often at Play
Traditional Chinese medicine holds that the core disease location of anorexia is the spleen and stomach. The spleen and stomach both reside in the middle jiao, govern the transportation and transformation of water and grain essence, and are the foundation of acquired constitution. When spleen-stomach function is weak or obstructed, it cannot properly receive and decompose food, resulting in the sensation of "not wanting to eat." Zusanli, also known as Xialing or Sanli, is located on the anterior-lateral aspect of the lower leg, 3 cun below Dubi, one finger-breadth from the anterior crest of the tibia. It belongs to the Foot Yangming Stomach Meridian and is the He-sea point of the Stomach Meridian and the lower He-sea point of the stomach. The Lingshu states: "When pathogenic factors are in the spleen and stomach, the disease manifests as muscle pain... all are regulated at Zusanli." Precisely because Zusanli is closely connected to the transportation and transformation function of the spleen and stomach, physicians throughout the ages have often used it as a key acupoint for observing and regulating the qi dynamics of the middle jiao. However, the disease location is not limited to this. The liver governs free coursing and regulates the movement of qi. If liver qi becomes stagnant, it restrains the spleen and stomach, leading to qi movement congestion. In clinical practice, many individuals with anorexia also experience distension and fullness in the chest and hypochondrium, emotional irritability, or depression—precisely the manifestation of simultaneous liver and spleen disease. Taichong is located on the dorsum of the foot, in the depression anterior to the junction of the first and second metatarsal bones. It belongs to the Foot Jueyin Liver Meridian and is the Yuan-source point of the Liver Meridian. The liver governs free coursing, and Taichong is closely related to the pattern of liver qi stagnation; it is an important acupoint in TCM theory that reflects the state of liver qi free coursing. The Ming dynasty physician Zhang Jingyue pointed out in the Jingyue Quanshu: "Damage to the spleen and stomach is mostly caused by the invasion of liver qi."
Nature of Disease: Intermingling of Deficiency and Excess, Distinction Between Cold and Heat
The nature of anorexia must be carefully differentiated. Deficiency patterns are mostly due to qi deficiency or yang deficiency of the spleen and stomach: those with qi deficiency often experience fatigue and postprandial abdominal distension; those with yang deficiency fear cold and have loose stools. Excess patterns are primarily characterized by dampness-turbidity, food accumulation, or qi stagnation: those with heavy dampness-turbidity have a thick, greasy tongue coating and a sticky sensation in the mouth; those with food accumulation experience acid-regurgitating belching; those with qi stagnation have distending pain in the hypochondrium. More commonly, there is an intermingling of deficiency and excess—for example, spleen-stomach qi deficiency combined with internal retention of dampness-turbidity, or liver depression transforming into heat that damages stomach yin. Yinlingquan is located on the medial aspect of the lower leg, in the depression below the medial condyle of the tibia. It belongs to the Foot Taiyin Spleen Meridian and is the He-sea point of the Spleen Meridian. Traditional Chinese medicine holds that the spleen governs the transportation and transformation of water-dampness, and Yinlingquan is closely related to water-dampness metabolism in the body; therefore, it is often mentioned in discussions of disease mechanisms related to internal obstruction by dampness-turbidity. The Qing dynasty physician Ye Tianshi emphasized in the Linzheng Zhinan Yi'an: "Diseases of the spleen and stomach, whether deficiency or excess, cold or heat, should be carefully differentiated." They cannot be lumped together under one generalization.
Disease Trend: The Trajectory from Occasional to Protracted
If anorexia is left without intervention, the disease trend may gradually worsen. In the early stage, it is mostly occasional loss of appetite that can be relieved by adjusting diet or rest. However, if the causative factors persist—such as long-term high stress or irregular eating habits—it will progress from functional imbalance to organic damage. The transportation and transformation capacity of the spleen and stomach further declines, water and grain essence cannot be properly distributed, leading to insufficient generation and transformation of qi and blood, manifesting as emaciation, fatigue, and sallow complexion. In more severe cases, dampness-turbidity or food accumulation can transform into phlegm-heat, disturbing the mind and causing insomnia or anxiety. The Jingui Yaolue states: "Those who treat disease before it arises, upon seeing liver disease, know that the liver will transmit to the spleen, and should first fortify the spleen." This reminds us that anorexia is often a precursor to pathological changes in other organs.
Prognosis: The Critical Point Between Reversibility and Irreversibility
The prognosis of anorexia depends on the timing of intervention and constitutional foundation. For those with simple spleen-stomach qi deficiency or food accumulation, most can recover through dietary adjustment, regular daily routines, and appropriate exercise. However, if accompanied by obvious emotional problems or chronic diseases, such as liver depression transforming into fire or stomach yin depletion, the recovery process will be more prolonged. Clinically, if some individuals simultaneously present with dry mouth, red tongue with scant coating, and dry bound stools, they may have stomach yin insufficiency and should not simply use warm, drying medicinals. Conversely, if the tongue coating is thick and greasy with heaviness and sluggishness of the body, the primary approach should be to resolve dampness. The Wenbing Tiaobian points out: "Treating the middle jiao is like balancing a scale; without balance, there is no calm." Regulating the spleen and stomach requires balancing yin and yang and harmonizing ascent and descent.
Care Approaches: An Integrated Plan from Diet to Emotions
Caring for individuals with anorexia requires a multi-dimensional approach. Regarding diet, avoid cold and raw, greasy, and overly sweet foods, and choose easily digestible porridges and soups, such as millet porridge and Chinese yam paste. The eating environment should be relaxed and quiet, avoiding looking at mobile phones while eating. Regarding emotions, stress can be relieved through walking, listening to music, or communicating with family and friends. TCM theory holds that "the spleen's emotion is pensiveness," and excessive pensiveness damages the spleen; therefore, appropriate relaxation is crucial for improving appetite. Attention should also be paid to seasonal changes: spring is windy, so nourish the liver; summer is damp, so resolve dampness; autumn is dry, so moisten the lungs; winter is cold, so warm the yang. These care approaches should be combined with individual constitution, and specific plans should be formulated by a licensed TCM practitioner after pattern differentiation.
Reflection: Anorexia Is the Body's "Language"
Anorexia is not an isolated symptom; it is the body "speaking." It may tell you: the spleen and stomach are tired and need rest; liver qi is blocked and needs to be coursed; or there is excessive dampness-turbidity that needs to be cleared. Rather than forcing yourself to eat, it is better to listen to the body's signals and seek the root cause. The TCM classic Suwen admonishes us: "Food and drink should be moderate, daily life should be regular, and one should not overexert oneself." Lifestyle adjustment is far more fundamental than temporary medication. When "feeling annoyed at the sight of food" repeatedly occurs, one might pause and ask: Have I been under too much stress lately? Is my diet too chaotic? Are my daily routines irregular? The answer may lie in the details of daily life.
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Frequently Asked Questions
1. Are anorexia and spleen deficiency the same concept?
Not exactly the same. Anorexia is a symptom, while spleen deficiency is one of the disease mechanisms. Spleen deficiency can cause anorexia, but anorexia may also be caused by liver depression, food accumulation, dampness-turbidity, and other reasons. TCM emphasizes "treating the same disease with different methods," requiring treatment based on pattern differentiation.
2. Why do some people with anorexia actually become obese?
This may be related to spleen deficiency with exuberant dampness. When the spleen is deficient, its transportation and transformation power is weak, water-dampness accumulates internally, and although appetite is poor, metabolism is slow, leading to fat accumulation. These individuals often experience heaviness of the limbs and sticky stools, and the focus of regulation should be on fortifying the spleen and resolving dampness.
3. How do emotional factors specifically affect appetite?
The liver governs free coursing and regulates the movement of qi. Long-term anxiety or depression causes liver qi stagnation, which attacks the stomach, leading to failure of stomach qi to descend and decreased appetite. In clinical practice, these individuals with anorexia often have hypochondriac distending pain, belching, and emotional fluctuations, and treatment should focus on coursing the liver and relieving depression.
4. How do the care approaches for childhood anorexia and adult anorexia differ?
Children "often have insufficiency of the spleen," and anorexia is mostly related to improper feeding, food accumulation, or infantile malnutrition, with emphasis on promoting digestion and guiding out stagnation. Adults mostly involve emotions, overwork, or chronic diseases, requiring simultaneous attention to coursing the liver, resolving dampness, or supplementing deficiency. Both require pattern differentiation by a licensed TCM practitioner based on age and constitution.