Digestion you cannot predict

The Neijing’s account of digestion is a picture of traffic. The spleen and stomach, 脾胃, take in food and separate it into the clear, which is meant to rise and become the body, and the turbid, which is meant to sink and leave. When the clear sinks instead you get loose, unfinished stools; when the turbid rises you get bloating and fullness. It is a description of direction, not of chemistry, and it is still the first thing a Chinese physician listens for: is the middle moving things the right way?

The same book explains why the middle fails in a hard week. In its chapter on pain it lists what each emotion does to qi, and two lines are the whole of this page: anger sends qi upward, and worry knots it. A knotted middle does not move things in either direction properly, which is the alternation — loose, then stuck — that people describe to us more than any other single thing.

By the Ming the two ideas had been joined into one description. The liver, 肝, is the network the tradition gives to strain, frustration and the sigh; the spleen is the one it gives to the middle. When the liver is wound tight it leans on the spleen — the tradition says wood overcomes earth, 肝木乘脾土 — and a spleen that was already running low gives way. Zhang Jiebin’s Jingyue Quanshu puts the root of loose bowels in the spleen and stomach without exception, and the trigger, most of the time, in the week.

Irritable bowel — IBS — is what most people who write to us about this have been told, usually after tests that found nothing, and it is worth being clear about what that phrase is. It is a name for a way the gut behaves once the things that can be seen have been looked for and not found. That last part matters. The name is only safe to carry once someone has looked, and the boundary section at the foot of this page is about what looking means.

The tradition has no equivalent word, and would not want one. What it has is a description of a middle that works when a person is at ease and fails when they are not, and a great deal of eighteen-hundred-year-old writing about what to do with such a middle. That description is the one a reading works from. It is not a translation of the phrase you arrived with; it is a different question about the same weeks.

Three pictures, and the order matters more here than almost anywhere else on the site.

The reason the order matters is that the liver picture is the loudest and the spleen picture is the one to work on. Calming the week helps for the week. A spleen that is no longer running low is what stops the next hard week from landing in the gut.

The middle, in this tradition, wants three dull things: warmth, plainness and regularity. Almost everything that makes an unpredictable gut worse is a departure from one of them.

• Cold. Iced drinks, salads as a whole meal, food straight from the fridge. The tradition reads a cold middle as a slow middle, and the people who write to us about bloating are very often people who drink cold water all day.
• Eating while doing something else. The Neijing’s knotted qi is, in practice, lunch at the desk during an argument. Sit down, eat warm food, do nothing else for twenty minutes.
• Irregular hours. A middle that is asked to work at different times every day never settles; one fed at the same three times, with the largest meal at midday, usually does within a month.
• Raw, rich and sweet in the same meal — the three things the tradition reads as damp-forming, together. Cheese, cream, sugar and alcohol are the usual four.

The one thing that reliably eases it is warm, plain, cooked food at fixed hours, and rice congee is the form that food has taken in China for two thousand years. The essay on the middle burner is the long version of why.

The kitchen has more to offer this complaint than almost any other on the site, because the middle is where the kitchen works.

• Ginger 生姜, three thin slices simmered into the morning congee, for the cold, slow middle — and left out if the picture is hot, with thirst and a yellow coat.
• Tangerine peel 陈皮, the tradition’s plainest answer to bloating and knotted qi; one small piece in the pot, or as a tea after the evening meal.
• Poria 茯苓 and job’s tears 薏苡仁 for the damp picture, cooked into the same congee until soft.
• Lotus seed 莲子 for stools that are loose day after day; the tradition reads it as gently astringent to the intestines.
• Jujube 大枣 and licorice 甘草 for the spleen that is running low, in small amounts, for the sweet flavour the tradition assigns to the middle.

The pattern pages carry the full caution, and it is repeated here because the middle is where it bites: the warm kitchen for a cold, slow spleen and the cool kitchen for a hot, thirsty one are opposites, and bloating alone does not tell you which you are.

Of the four command points, the one given to the belly is Zusanli, Stomach 36, 足三里, four finger-widths below the kneecap on the outside of the shin. The old line is 肚腹三里留: for the belly and abdomen, stay at Zusanli. It is the most-used point in the whole of the acupuncture literature, and the one point on this site that the tradition pairs with a middle that is running low rather than with a complaint. Its entry shows how to find it on your own leg.

Pressed firmly for a minute on each side after the evening meal, with the out-breath, it is the one thing on this page that costs nothing and involves nobody else. Neiguan on the wrist is the pairing for the days when the trouble is nausea rather than the bowel.

Afterwards, the three pictures and the congee still describe the weeks accurately, and a reading is worth having then. It is written for the gut that has been looked at and found unremarkable, and then goes on being unpredictable anyway — which is most of them.