Three Herb Formulas for Food Stagnation
Food Stagnation (shí zhì 食滞) is the Traditional Chinese Medicine term for the accumulation or stagnation of food in the digestive system. Essentially, food stagnation corresponds to indigestion or an upset stomach. Food stagnation is not a disease but rather a variety of symptoms that are experienced; including mild abdominal pain or cramping and a feeling of fullness soon after eating. There can also be belching or hiccoughs, nausea, bloating or distention in the upper abdomen, and loss of appetite. Occasionally, there may be loose, unformed, or watery stools and a frontal headache. Most often, indigestion is related to lifestyle and dietary choices. Common causes are overeating or eating too quickly; eating contaminated food; consuming Damp or Cold foods that are fatty, greasy, or spicy; overconsumption of alcohol, caffeinated or carbonated beverages; too much fresh tropical fruit or salads; smoking cigarettes; and emotional upset, such as anxiety or frustration. During the pandemic especially, many of us who have overindulged in comfort foods (and vices), sat in front of computers all day, and gotten less exercise may have noticed a detrimental change in our digestion. Most, if not all of us, have probably also experienced heightened fear, anxiety, and sleep issues (read more here) that has exacerbated the effects of poor digestion.
Usually, food stagnation is episodic and acute, although a chronic condition can develop from long-term overindulgence in poor food and drink choices. Although food stagnation is an excess condition, Spleen and Stomach Qi deficiency are likely exacerbating factors, especially in chronic or repetitive cases. The treatment principle is to first remove the excess by reducing and then to tonify. If deficiency preponderates, more emphasis is placed on tonifying the Spleen and Stomach Qi. Reducing food stagnation includes a variety of strategies such as expelling Dampness, descending and moving Qi, resolving Phlegm, and harmonizing the Stomach and Intestines.
Bao He Wan
The classic formula for food stasis is Plum Flower® Bao He Wan (Bǎo Hé Wán 保和丸 Preserve Harmony Pills). Attributed to Dr. Zhu Zhen Heng (1281-1358), this formula is considered most appropriate in the initial stages of food stagnation or for mild conditions. Its action is to reduce food stagnation, move and descend Qi, Drain Dampness, and Harmonize the Stomach.
The chief herb is Shan zha, which treats all types of food stagnation, and especially those caused by meat and fatty foods. The deputies are Shen qu, which acts to reduce the stagnant accumulation of food and alcohol, plus Lai fu zi and Mai ya, which reduce the accumulation of Phlegm from stagnant grains. Ban xia and Chen pi act as assistants promoting the movement of Qi, transforming Phlegm, and harmonizing the Stomach. Fu ling strengthens the Spleen Qi and drains Dampness. Since the accumulation of food can result in Heat in the Middle Jiao from Phlegm constraint, Lian qiao is added since among its secondary attributes is the dispersion of hot Phlegm and the promotion of urination to lead out Fire.
In determining whether to use Bao He Wan, look for a thick, yellow, greasy tongue coating and a full, slippery pulse. This formula should be used with caution in pregnancy because of its downward action and its ability to transform Phlegm and accumulation.
Arguably, the most famous and best-selling herbal formula for food stagnation is Curing Pills (Kāng Níng Wán 康寧丸 Healthy Peaceful Pills). Originally formulated in 1896 as “Po Chai Wan” (保濟丸), they were first manufactured in the Guangdong provincial city of Foshan. After the Communist Revolution of 1949, the original creator of the formula fled to Hong Kong (where the original product is still made) and the factory in Foshan changed the product’s name to Curing Pill. Mayway’s Plum Flower® version has continued the tradition of making them as tiny pills (for faster breakdown and absorption), but has removed the colored coating of the original. Also, instead of plastic tubes, Plum Flower® Curing Pills come in vegetarian capsules and convenient stick packs. As most practitioners who have used this prescription know, its results are exceptional. It often seems as though there are no digestive complaints that Curing Pills cannot resolve. Personally, I never leave home or go out to dinner without bringing some stick packs along-- just in case.
The herbs in this formula come from the categories of: Spicy Cool, Aromatic Transform Damp, Regulate Qi, Dispel Food Stagnation, and Dispel Wind and Phlegm. The traditional functions of Curing Pills include draining Dampness and Heat from the intestines, relieving food stagnation, clearing summertime Damp Heat, regulating the Qi, and benefiting the Spleen.
Originally designed to address summer Damp Heat invading the Large Intestine, the formula relies on the aromatic transform Damp and regulate Qi herbs Hou po, Cang zhu, Huo xiang, Ju hong and Mu xiang to wake up the Spleen to eliminate Dampness in the Large Intestine. Gu ya and Shen qu, both food stagnation herbs, further assist the Spleen by directly aiding digestion. Fu ling and Yi yi ren strengthen the Spleen's regulation of fluids, while Ge gen and Tian hua fen cool and moisten fluids in the Stomach.
Curing Pill’s characteristic ability to create that light and easy feeling in the Middle Jiao is due to the inclusion of Tian ma, Bai zhi, Ju hua and Bo he. These four herbs cool, lighten, soothe, and ease constraint, which allow the Stomach Qi to descend and the clear Qi of the Spleen to ascend. When the Spleen Qi ascends, a renewed taste for the five flavors returns; and when the Stomach Qi descends, a healthy appetite is restored. Additionally, this combination of herbs can help relieve frontal headaches, which may accompany episodes of food stagnation.
Curing Pills can be used to address lack of appetite, indigestion, food stagnation, discomfort due to overindulgence, stomach upset from external pathogens, and most complaints that arise from Stomach Qi stagnation and intestinal discomfort. The tongue and pulse will be similar to that found with Bao He Wan. Although Curing Pills have few contraindications, caution should be used in cases with Yin Deficiency. Because of the Qi-regulating aspects of the formula, its downward action, and its ability to transform Phlegm and accumulation, caution should also be used during pregnancy, particularly during the late stages or in cases of threatened miscarriage. However, many practitioners have successfully used this formula to assist in treating morning sickness during the initial months of pregnancy.
Jian Pi Wan
In cases of chronic food stagnation, Spleen Qi deficiency preponderates rather than excess, and the best formula to use is Plum Flower® Healthy Digestion Teapills (Jiàn pí wán 健脾丸 Strengthen the Spleen Pills; also available as Min Shan® Jian Pi Wan). Symptoms include repetitive incidents of poor digestion and appetite, distension in the epigastric area after even small meals, borborygmus, nausea, fatigue, foul breath, belching, malodorous flatulence, and loose or poorly formed stools. Notably, the pulse will be weak, and perhaps thin or weakly slippery. The tongue will be pale and possibly swollen with a thick greasy coat.
This relatively simple formula is focused on tonifying the Spleen Qi, with Bai zhu and Dang shen being the chief herbs. Mai ya and Shan zha are the deputies which are used to reduce the food stagnation and improve digestion. Chen pi and Zhi shi regulate and guide the Qi downwards, dry Dampness, transform Phlegm, harmonize the Stomach, and relieve abdominal distention. The formula is intended for chronic conditions and should not be used in acute cases of food stagnation due to contaminated food, or from overconsumption of food and drink. Tonifying in such cases will increase the stagnation and aggravate the situation.
Given the current conditions that may contribute to more frequent food stagnation, its incidence may be underreported by your patients. While asking patients about their digestion in a consultation is standard practice, as clinicians we may need to ask more probing questions about it to ensure that acute food stagnation does not become a chronic condition. Healthy digestion enhances the absorption of nutrients, medications, the success of herbal therapy, and is a key component in maintaining one’s overall general health.
- Bensky, D. et al., Chinese Herbal Medicine Materia Medica, 3rd ed., Eastland Press: 2004.
- Fratkin, J., Chinese Herbal Patent Medicines: The Clinical Desk Reference, Shya Publications, 2001
- Maclean, Will, Clinical Manual of Chinese Herbal Patent Medicines, Pangolin Press: 2003
- Wrinkle, A. et al., A Practitioner's Formula Guide, Elemental Essentials Press: 2008.
| Bio: Skye Sturgeon, DAOM
Skye is the Quality Assurance Manager and Special Consultant for Mayway, USA. Skye was the former Chair of Acupuncture & East Asian Medicine and core faculty member at Bastyr University, core faculty member and Faculty Council Chair at the American College of Traditional Chinese Medicine, and President and Senior Professor of the Acupuncture & Integrative Medicine College, Berkeley. Before making Chinese medicine his career choice, Skye held various positions in the Natural Foods Industry for 12 years and prior to that was a clinical biochemist and toxicologist.