Poor appetite

Also reduced eating; reduced food intake. A reduced desire to eat. The stomach governs intake and the rotting and ripening of grain and water (i.e., food); the spleen governs movement and transformation of grain and water and the distribution of their essence (i.e., nutrients). Appetite is principally related to the spleen and stomach. The stomach and spleen together form the root of the later heaven, i.e., the basis of the acquired constitution. The presence of stomach means life; the absence of stomach is death. A good appetite is a sign of health. In disease, a good appetite is a sign of a mild condition, and its return is a sign of recovery. Sudden return of an appetite in critical illness is a last flicker of the candle, and bodes death. Poor appetite is observed in externally contracted disease and internal damage. In most instances of externally contracted disease, it is of relatively short duration and hence of little significance. In internal damage miscellaneous disease, in which the duration of poor appetite can undermine the health of the patient, it commands greater attention. Distinction can be made between three categories of poor appetite: poor appetite without hunger; aversion to food; and no desire to eat despite hunger.

Types

No thought of food and drink (不思饮食 bù sī yǐn shí): Simple poor appetite characterized by lack of thought of food and drink and reduced hunger sensation is what is normally meant by poor appetite. Traditionally, this is often referred to as no desire for food and drink, no thought of food and drink, obliviousness of hunger and satiety, or no pleasure in eating. It occurs in several situations.

• With distension after eating, diarrhea, emaciation, and lack of strength, poor appetite is ascribed to spleen-stomach qì vacuity arising when the stomach’s function of decomposing food and the spleen’s function is impaired.
• Accompanied by oppression in the stomach duct, heavy cumbersome head and body, rumbling intestines, diarrhea, and slimy tongue fur, it is a sign of dampness encumbering the spleen that prevents the normal upbearing of clear yáng and causes disharmony of stomach qì.
• With aversion to oily food and accompanied by yellowing of the body, abdominal distension and glomus in the stomach duct, nausea, fatigue, and scant yellow urine is a sign of spleen-stomach damp-heat causing disharmony of stomach qì.
• With belching, abdominal distension, rib-side pain, frequent passing of flatus, and sloppy stool, it is a sign of liver-spleen disharmony.
• With alternating heat and cold, [suffering of] chest and rib-side fullness, bitter taste in the mouth, dry throat, and dizzy vision, it is a sign of cold damage lesser yáng (shào yáng) disease.

Torpid intake (纳呆 nà dāi): Torpid intake is absence of hunger or desire for food accompanied by bloating of the stomach duct and abdomen. Patients with torpid intake may or may not eat. Torpid intake with reduced eating, accompanied by generalized heaviness, heavy-headedness, oppression and distension in the stomach duct and abdomen, and a thick tongue fur, is due to exuberant dampness encumbering the spleen or to food stagnation.

Aversion to food (厌食 yàn shí): Aversion to food is sickness at the sight or thought of food and occurs in two situations:

• Aversion to food is most commonly observed when voracious eating and drinking impairs stomach function, causing food to stagnate in the stomach. Hence, it is said, Food damage is invariably characterized by aversion to food.
• Occurring with vomiting, with absence of menstruation, and with a rapid slippery harmonious pulse in sexually active women, aversion to food is a sign of pregnancy vomiting, which is caused by upsurge of thoroughfare (chōng) vessel qì causing disharmony of stomach qì. No thought of food and drink differs from aversion to food in that it is associated with a reduced feeling of hunger.

No desire to eat despite hunger (饑不欲食 jī bù yù shí): This is observed in three situation:

• With clamoring stomach and scorching heat sensation, a red tongue with scant fur, it indicates insufficiency of stomach yīn and vacuity fire. In such cases, the lack of desire to eat is explained by the insufficiency, whereas the presence of hunger is explained as result of the vacuity fire.
• With dizziness, tinnitus, insomnia, forgetfulness, dry throat and tongue, it is attributed to insufficiency of kidney yīn and frenetic movement of the ministerial fire.
• In advanced stages of febrile disease with lassitude of spirit, lack of strength, and dry tongue with little liquid, a poor appetite is a sign of insufficiency of stomach yīn resulting from qì, blood, and liquid depletion when the evil has abated.

Also the term reduced food intake is effectively a synonym of poor appetite, denoting its objective consequence. Poor appetite associated with indigestion is also called torpid intake, in reference to stomach function (see stomach governs intake).