The TCM approach to gut health: Address digestion holistically

The TCM gut health approach:

This article explores the vital connection between diet, lifestyle, and digestive wellbeing—factors which not only influence gut function but also shape broader aspects of overall health. As a practitioner of Traditional Chinese Medicine (TCM) and acupuncture in Nowra and Gerringong, I’ve observed just how prevalent digestive complaints are in clinical practice. While acupuncture and Chinese herbal medicine offer powerful tools for regulating the digestive system, the importance of nutritional foundations and mindful eating habits cannot be overstated. This article offers a practical and integrative look at TCM gut health, weaving together functional dietary strategies and Chinese medicine principles that can be gradually adopted to support a stronger, more resilient digestive system.

Topics at a glance:

• A look at digestion and its connection to health
• Plant based foods and the gut microbiome
• Specific dietary tips: Chewing food, portion size and snacks
• The effects of raw and cooked foods in the body according to Chinese medicine
• The 80/20 rule to balanced eating
• Beans and legumes: Friend or foe
• How to boost digestion and stomach acid production
• The ultimate breakfast food for improved digestive health

The connection between digestion & health

I’m sure you’ve heard “you are what you eat’, but in reality this is only a fraction of the equation. Within the holistic context, we are also why we eat, how we eat and when we eat. It’s the culmination of these factors which influences our digestive health, and to a larger degree, the state of our overall health and wellbeing.

Good digestion is not merely about having healthy bowel habits (although this is certainly a vital part), it is also the ways we digest and absorb food, how we function and nourish our body, deal with age related and chronic illnesses, as well as how we can best support our mood, immune function, longevity and quality of life.

The importance of food / a focus on plants

Probably an no-brainer, humans eat food to extract nutrients which provide the energy our bodies require for growth, repair, and maintenance. Consuming plant-based foods in particular help us to absorb an abundance of highly beneficial phytonutrients and antioxidants from plants, as well as feed the trillions of beneficial bacteria present in our guts, which have been with us since day 1 of life.

Numerous epidemiological studies have demonstrated that a higher intake of plant foods is correlated with lower rates of chronic illnesses and death. Additionally, phytonutrients from plants have shown in several human studies to reduce stress, increase sleep quality, improve immune function, reduce allergic rhinitis, improve digestion, increase cognitive function, and even provide a role in the prevention of some chronic diseases such as diabetes, high blood pressure, obesity, and certain cancers [1]. Wow, what a mouthful (pun intended).

Plants and the gut microbiome

Not only does a varied diet provide an abundance of essential nutrients and phytochemicals, certain foods like dietary fibres are essential to feeding our friendly gut microbiome (bacteria), which then repay us handsomely with their numerous health benefits [2]. Here’s just a small list on what these good guys do for out digestion and overall health [3], [4], [5], [6], [7].

1. Supply essential nutrients to the body
2. Synthesising certain vitamins such as B vitamins and vitamin K
3. Promote a healthy gastrointestinal lining and prevent conditions like increased intestinal permeability (leaky gut)
4. Play a role in the prevention of gut dysbiosis and microbial imbalances
5. Regulate healthy gut motility and bowel habits
6. Assist with modulating the body’s immune system
7. Prevent the onset of obesity, inflammatory bowel diseases, atopic eczema, allergies, diabetes and even cancer
8. Potentially play a role in the treatment and prevention of anxiety and depression (more research is needed)
9. Produce short-chain fatty acids, which have anti-inflammatory, immuno-regulatory, anti-obesity, anti-diabetic, anti-cancer, heart, liver, and neuro-protective activities

Why you should masticate

No, thats not innuendo. Mastication is a fancy word to describe the process of chewing food. The act of properly chewing our food serves a few key important purposes, such as the secretion of salivary amylase (digestive enzyme) to break down carbohydrates, and signalling the stomach to produce stomach acid (HCL), which is essential for the proper digestion and absorption of proteins and minerals.

The Chinese medicine perspective

The Chinese medicine perspective is not at all dissimilar, as we often advise our patient’s to thoroughly chew food to support the Spleen Qi. You can think of the Spleen Qi as being similar to our pancreas and its function in digestive processes. The Spleen and Stomach organs are actually considered the cornerstone for good health in Chinese medicine because they are responsible for the digestion and production of our post-natal qi – our basic daily energy that we cultivate through our diet and lifestyle. Therefore, the healthier our diet, the better quality Qi we can extract, and therefore the greater is our sense of health and wellbeing.

How much per meal / a general guide

Chinese medicine also stipulates that the timing and amount of food we consume can influence the function of our digestion and later impacts on health. You might have also heard the saying, “eat breakfast like a king, lunch like a prince and dinner like a pauper”. According to Chinese medicine, our smallest meal of the day is normally eaten at dinner. This is because when we drift off to sleep, our Yang Qi begins its descent into the vital organs. But, when our stomach is too full, the descent of Yang is disrupted and cannot fully settle, leading to restlessness and insomnia.

Think back to a time when you ate a large meal and struggled to fall asleep due to bloating and fullness. Or maybe you frequently experience heartburn after a big dinner? So, the take-home message is eat your big nourishing meals in the day and your smallest during the evening. If you struggle to eat breakfast due to lack of appetite, then there are some strategies to tackle this, which will be explored further below.

Supportive eating practices for optimal digestion

Chinese medicine also recommends that we aim to eat in a relaxed environment with the focus of being mindful of our food as we’re eating. This means turning of off the tv, putting away the phone and allowing ourselves to be in the present moment, without external stresses or stimuli affecting our digestion. In essence we want to activate our parasympathetic nervous system, or rest and digest mode. This doesn’t mean we can’t talk or be social. On the contrary, sharing food with friends, family and loved ones can be a great source of emotional nourishment.

In a purely physical sense, we should also work with gravity to aid the digestive process. This means not eating too close to bedtime or lying down straight after a meal. Anyone who has suffered from reflux or heartburn would certainly agree with this advice. When studying Chinese medicine at university, we were often told to either walk for 20 minutes after eating or rub our belly 50x clockwise to support our Stomach Qi and aid digestion.

To snack or not to snack, that is the question

In Chinese medicine, fasting between main meals allows intestinal Qi to move food contents through the intestines, preventing food stagnation. This concept parallels our modern understanding of the migrating motor complex (MMC), a cyclic gut motility pattern that propels food and other particles through the small intestine. However, the body signals the MMC to pause each time we eat, which can become problematic for some individuals. A delayed or dysfunctional MMC has been associated with gastrointestinal conditions such as gastroparesis (slow gut motility), Small Intestinal Bacterial Overgrowth (SIBO), and intestinal pseudo-obstruction syndrome [8].

Okay, I take it back: Some of you should snack

It’s important to point out that certain medical conditions or stages in life may require that someone snacks between meals, such as paediatrics and adolescence, pregnancy related nausea and vomiting, hypoglycaemia (low blood sugar) or post-bariatric surgery. In the later case, a person may be required to consume more than three meals per day in order to meet their daily dietary needs. This is where nutritional recommendations and lifestyle advise becomes an individualised approach. If you have any underlying medical conditions or specific health requirements, always seek the advice of a trusted health practitioner before making any significant dietary changes.

Raw or cooked foods / Chinese medicine takes a firm stance

Salads and fresh juices are often considered healthy, right? Maybe, maybe not. A key aspect of good digestion, particularly unique to Chinese medicine, is understanding the energetic nature of food and how it affects the body. This perspective emphasizes the balance between Yin and Yang, heat and cold, and excess or deficiency. According to Chinese medicine, raw foods, salads, dairy, grains, and processed sugars are considered to have cold or damp-forming properties, especially when consumed too frequently.

As a consequence, the over-consumption of cold or damp forming foods impairs our Spleen and Stomach’s ability to transform food into our post-natal qi. Conversely, cooked foods or aromatic spices such as garlic and ginger are internally warming and preserve our digestive fire. The energetic nature of a food or beverages also extends to its thermal temperature, so reduce those icy-cold drinks and foods (sorry smoothie and acai bowl lovers), and instead opt for either room temperature to warm-hot food and drinks. The emphasis here is on the moderation of consuming cold or damp forming foods, not advocating complete abstinence. This then leads us to the 80/20 rule.

The 80/20 rule for a healthy compromise

The recommended dietary changes can at times feel overwhelming when exploring Chinese medicine’s nutritional and lifestyle advice. Many of us are attached to certain foods because we’ve been told they are good for us. The 80/20 rule can be considered a healthy compromise when it comes to choosing the types of food we eat. Simply put, allow approximately 80% of your daily food intake to be cooked and the remaining 20% fresh, raw foods and fruit. But aim to keep the 20% foods as close to room temperature as possible. This will alleviate the energy that the Spleen and Stomach must expend to energetically warm and metabolise these foods.

Warming aromatic spices can also be used to offset the cooling energetics of raw foods (more on this below). The 80/20 rule, can also be extended to 80% of our diet being whole-foods, healthy proteins, fats and carbs, whilst 20% can be used flexibly for those occasional treats or ‘naughty foods’. At the end of the day, food should be a pleasure and source of nourishment and not a burden!

“Beans, beans, the musical fruit”..

Beans and lentils have long been a staple food amongst almost every culture in history. Touted for their digestive health benefits, beans and lenils should definitely be apart of our daily meals right? Well, its not always so simple, so lets break it down (ha, ha).

Dietary beans and pulses serve as a prebiotic food source for our gut microbiome, which plays a crucial role in producing short-chain fatty acids (SCFAs) and supporting overall health. A study by Kadyan et al. investigated the resistant starches found in beans and lentils, exploring their impact on gastrointestinal and metabolic health. The authors concluded,

“the incorporation of dietary pulses and their resistant starch in diet fosters the growth of beneficial gut bacteria and significantly enhances the production of short-chain fatty acids in the colon”.

Kadyan, S., Sharma, A., Arjmandi, B. H., Singh, P., & Nagpal, R. (2022). Prebiotic Potential of Dietary Beans and Pulses and Their Resistant Starch for Aging-Associated Gut and Metabolic Health. Nutrients, 14(9), 1726 [9]

Other studies demonstrate than beans and lentils also possess broad health promoting effects, such as anti-obesity, anti-diabetic, anti-hypertensive, cholesterol lowering and inflammation reducing effects [10]. Based on these recent findings regarding the benefits of dietary fibres for our gut microbiome, and their health fostering benefits, it should be a no-brainer that we consume beans every day right? Let’s look at what Chinese medicine has to say.

Chinese medicine energetics of beans & legumes

As we continue deeper into the energetics of food, Chinese medicine considers beans and lentils to be cooling and dampening, which due to their yin nature, are used to tonify the body fluids and clear heat and toxicity from the body. In fact, beans were traditionally used in Chinese medicine to clear the toxic nature of certain herbs such as aconite, which is more commonly known as foxglove or wolfsbane.

Although the health promoting effects of beans and lentils are well documented, there are certain individuals who may find it difficult to digest them on a regular basis, or at all. This is very common in conditions like SIBO, Ulcerative Colitis (UC), Crohn’s disease, gut dysbiosis, leaky gut and individuals who typically consume a low fibre diet.

In Chinese medicine, beans are considered cooling, and excessive consumption may dampen the Spleen Qi and weaken the digestive fire. Symptoms of a weakened Spleen include bloating, gas or flatulence, loose or sticky stools, and fatigue. So, should beans be categorized alongside raw and cold foods, or do they still have a place in our diets? Ultimately, this depends on the individual—how the beans are cooked or processed, how frequently they’re consumed, whether they aggravate digestive symptoms, and whether any underlying health conditions make them difficult to digest.

Ginger / a digestive boosting spice

As previously highlighted, warming aromatics like ginger play a significant role in Chinese medicine for stoking the digestive fire and supporting Spleen Qi. When working with vegetarians or plant-based patients who regularly consume tofu, beans, and lentils, an initial recommendation is to increase the use of aromatic warming spices to counterbalance the cooling nature of these foods. Ginger, with its ‘hot’ nature, is an excellent choice as it directly tonifies Stomach Qi. Other beneficial warming spices include black pepper, cinnamon, cardamom, cassia, clove, fennel, fenugreek, garlic, and star anise. After all, variety is the spice of life!

Recent research on ginger shows that it can increase stomach acid (HCL) production, stimulate appetite, improve gut motility and gastric emptying time, and alleviate nausea [11], [12]. Could there be anymore reason to love this herb? Actually, yes—ginger’s ability to enhance HCL production plays a crucial role in the digestion and absorption of amino acids (the building blocks of the body) and essential minerals. With that in mind, let’s dive deeper into the importance of strong stomach acid and its impact on overall digestion and nutrient absorption.

The importance of strong stomach acid (HCL)

Inadequate HCL production can present with a multitude of nutritional and digestive issues. For instance, an insufficiency of HCL prevents the proper denaturing and breakdown of dietary proteins into amino acids, which can subsequently increase incidences in food sensitivities. A lower intake of HCL is also associated with reduced absorption of key vitamins and minerals, including zinc, iron, calcium, folic acid, and vitamins B6 [13].

Insufficient HCL production also impairs the activation and secretion of stomach intrinsic factor, which combines with B12, allowing it to be readily absorbed in the small intestine [14]. This is an important consideration for vegetarians or vegans, who may already be susceptible to low vitamin B12 intake. Low HCL can also increase the risk for developing gastrointestinal conditions such as SIBO, helicobacter pylori infection in the stomach, and specific microbial overgrowths, such as Clostridium difficile, which is a common cause of the gastro bug [15].

Fluids with meals / don’t drown your digestive fire

Fluid intake directly around a main meal can also affect how well we digest and breakdown food. When possible, Chinese medicine advises that we avoid fluid consumption 20mins before up until 30mins after eating a main meal, to allow our Stomach Qi to properly work on breaking down food. If fluids are needed during a meal to aid in swallowing or to take medications and supplements, focus on smaller sips of warm fluids slowly throughout the meal.

Speaking of fluids: When is too much, too much?

It may be a surprise that Chinese medicine also generally advises against the excessive intake of fluids. Similar to the overconsumption of raw, sweet or cold foods, excessive water intake can impair the efficient functioning of the Spleen and Stomach, leading to internal dampness. When observing adequate hydration levels, a general key is to check the colour of the urine. The colour should be a light hay-colour with a moderate urine output proportionate to the one’s daily fluid intake. If the urine is concentrated and dark, then this can be a sign of dehydration or internal heat consuming fluids. On the other hand, copious clear urine can be a sign of excessive fluid intake and/or weak Kidney and Bladder Qi.

There are several factors which can effect the colour or urine, including B vitamins (hello fluro-coloured pee), medications and urinary-tract infections (UTI’s). It is also very normal for the first passing of urine in the morning to be darker. As a caveat to the advise on daily fluid intake, if you have an underlying health condition or have been advised to consume a certain amount of fluids by your primary healthcare practitioner, then it is always a must to follow the specific advise given to you.

Breakfast food / congee to the rescue

Congee, also known as ‘juk’, is a nourishing rice porridge used in asian style cuisine, which is prized for its flavour, simplicity and digestive health benefits. Often considered a comfort food, congee has played a significant role in Asian culinary traditions for centuries and can be a wonderful breakfast addition or replacement. A personal favourite is pressure cooked rice congee with organic chicken drumsticks, ginger, spring onion, egg and low-sodium soy sauce.

What makes congee so incredible for breakfast is that it ticks all Chinese medicine requirements for improving digestion, which includes eating a well cooked, easy to digest, protein rich, internally warming and deeply nourishing meal. The Spleen and Stomach have to spend very little energy to breakdown congee, making it the perfect warming breakfast to start the day. Congee has also been widely used in Chinese medicine for a weak appetite, during a cold or flu, and after recovery from illness. A personal congee recipe using the pressure cooker method can be found here.

Closing thoughts:

This article delves into a range of digestive health concepts grounded in Traditional Chinese Medicine (TCM) philosophy. Over the years in clinical practice, one principle has become increasingly clear—TCM gut health is not a one-size-fits-all approach. Each person has a unique digestive constitution, and finding the right balance often requires a personalised treatment plan that considers individual patterns and needs. If you’re experiencing persistent digestive symptoms or are simply seeking natural digestion support in Nowra or Gerringong, get in touch with Ancient Waters Acupuncture & Chinese Medicine to explore how Chinese medicine may help restore your digestive harmony.

[1] Monjotin, N., Amiot, M. J., Fleurentin, J., Morel, J. M., & Raynal, S. (2022). Clinical Evidence of the Benefits of Phytonutrients in Human Healthcare. Nutrients, 14 (9), 1712.

[2] Fu, J., Zheng, Y., Gao, Y., & Xu, W. (2022). Dietary Fiber Intake and Gut Microbiota in Human Health. Microorganisms, 10(12), 2507

[3] Zhang, Y. J., Li, S., Gan, R. Y., Zhou, T., Xu, D. P., & Li, H. B. (2015). Impacts of gut bacteria on human health and diseases. International journal of molecular sciences, 16 (4), 7493–7519

[4] Clapp, M., Aurora, N., Herrera, L., Bhatia, M., Wilen, E., & Wakefield, S. (2017). Gut microbiota’s effect on mental health: The gut-brain axis. Clinics and practice, 7 (4), 987.

[5] Bull, M. J., & Plummer, N. T. (2014). Part 1: The Human Gut Microbiome in Health and Disease. Integrative medicine (Encinitas, Calif.), 13 (6), 17–22.

[6] Xiong, R. G., Zhou, D. D., Wu, S. X., Huang, S. Y., Saimaiti, A., Yang, Z. J., Shang, A., Zhao, C. N., Gan, R. Y., & Li, H. B. (2022). Health Benefits and Side Effects of Short-Chain Fatty Acids. Foods (Basel, Switzerland), 11 (18), 2863.

[7] Hills, R. D., Jr, Pontefract, B. A., Mishcon, H. R., Black, C. A., Sutton, S. C., & Theberge, C. R. (2019). Gut Microbiome: Profound Implications for Diet and Disease. Nutrients, 11 (7), 1613.

[8] Deloose, E., Janssen, P., Depoortere, I., & Tack, J. (2012). The migrating motor complex: control mechanisms and its role in health and disease. Nature reviews. Gastroenterology & hepatology, 9 (5)

[9] Kadyan, S., Sharma, A., Arjmandi, B. H., Singh, P., & Nagpal, R. (2022). Prebiotic Potential of Dietary Beans and Pulses and Their Resistant Starch for Aging-Associated Gut and Metabolic Health. Nutrients, 14 (9), 1726

[10] Mullins, A. P., & Arjmandi, B. H. (2021). Health Benefits of Plant-Based Nutrition: Focus on Beans in Cardiometabolic Diseases. Nutrients, 13(2), 519

[11] Kines, K., & Krupczak, T. (2016). Nutritional Interventions for Gastroesophageal Reflux, Irritable Bowel Syndrome, and Hypochlorhydria: A Case Report. Integrative medicine (Encinitas, Calif.), 15 (4), 49–53

[12] Nikkhah Bodagh, M., Maleki, I., & Hekmatdoost, A. (2018). Ginger in gastrointestinal disorders: A systematic review of clinical trials. Food science & nutrition, 7 (1), 96–108

[13] Untersmayr, E., & Jensen-Jarolim, E. (2008). The role of protein digestibility and antacids on food allergy outcomes. The Journal of allergy and clinical immunology, 121(6), 1301–1310

[14] Carabotti, M., Annibale, B., & Lahner, E. (2021). Common Pitfalls in the Management of Patients with Micronutrient Deficiency: Keep in Mind the Stomach. Nutrients, 13(1), 208

[15] Guilliams, T. G., & Drake, L. E. (2020). Meal-Time Supplementation with Betaine HCl for Functional Hypochlorhydria: What is the Evidence?. Integrative medicine (Encinitas, Calif.), 19(1), 32–36