From This Practice: Meeting People Where They Are

Daniel was malnourished.

This was his own word, and it fit the situation well. About to turn thirty-five years old in a few months, he had not been able to eat enough since he was twenty. His will seemed strong. However, he struggled to focus at work because he was only eating one small meal per day. He was underweight but had given up even on nutritional shakes. The biggest problem was an immediate sense of fullness whenever he began eating, as if he had already eaten more than his fill. As a result, his body would not accept food, and at times, not even water. 

He had tested positive for SIBO a couple of years before and did a course of Rifaximin. This targeted antibiotic gave a small improvement. Since then, he had gastrointestinal examinations, upper and lower. He had a test to measure transit time. From the standpoint of this testing, there was no observable or measurable explanation. Multiple gastrointestinal specialists had hit a wall, as had other alternative practitioners, including a recent nutritionist. Daniel had begun using online forums to explore supplements and less common treatments. By the time I met him, he had begun falling down. His legs would give out randomly.

His case required something more complex than another antimicrobial treatment: digestion had to become stronger and at the same time movement had to be restored. These are not necessarily the same thing, and these two sides ended up figuring prominently in the herbal formulas that helped Daniel.

It is possible to make progress, even in challenging cases, by focusing on the pattern that remains after a diagnosis explains or resolves only part of a health problem. If you would like to see whether this approach could apply to your case, you can schedule a consultation here.

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The Treatment Problem

Digestive problems can have features of both excess and deficiency. Infections, stagnant food and fluids, residual stool, inflammatory processes, excessive bile, acid, unhealthy microbial populations, and subsequent gases—these can all be described as features of excess. On the other hand, fatigue, weak appetite, low muscle tone, poor heart rate variability, under populations of healthy microbes, and decreased stomach acid, digestive enzymes, and bile quality —these can be described as features of deficiency.

Daniel had symptoms that pointed to there being features of both excess and deficiency, and it seemed that each was worsening the other: poor processing led to unhealthy accumulations (food, fluids, stool, microbes, etc.) in the digestive tract. These accumulations became a burden on the system when they could not be cleared, and this further weakened digestive processing. It also led to discomfort, lethargy, and more under eating, so the situation would naturally repeat and worsen.

Strongly attacking or “moving” accumulations does not work well in cases like this. Daniel had already tried several treatments aimed at individual aspects of the stagnation, with limited results. The difficulty was that reducing accumulation was only half of the problem. Any treatment also had to account for how depleted he had become.

The First Formula

Although the main difficulty was fullness, this was not just a blockage of food, and the case called for at least a two-pronged approach: strengthen digestion and increase movement at the same time. East Asian medicine describes this as food stagnation arising from deficient digestive qi.

I began with a customized combination based on:

Zhi Zhu Wan — Immature Bitter Orange and Atractylodes Formula

There were two central herbs, one for excess and one for deficiency:

Zhi Shi — immature bitter orange fruit
Bai Zhu — largehead atractylodes rhizome

Zhi Shi helps restore movement when there is blockage in the digestive tract. Bai Zhu supports the digestive system’s ability to process food and manage fluids, and research suggests that it may positively influence the intestinal microbiome. Together, these herbs have been studied for effects on appetite, gastric contractions, and stomach emptying. This includes signaling pathways associated with vagal digestive activity. 

Bai zhu also has a stabilizing influence, which prevents unproductive and uncoordinated contractions in the digestive tract. I used it in a much larger amount, in Daniel’s case, because he was not a strong person with a simple blockage. The moving action had to occur within a strongly supportive formula.

This was the initial custom formula in grams of 5:1 powdered extract per week
— Rx: 1.1

A number of these herbs can be explained in simple terms: hawthorn fruit—Shan Zha—for retained food, costus root—Mu Xiang—for fullness, bamboo shavings—Zhu Ru—for retching, and skullcap root—Huang Qin—for mild inflammation and to add a low-level antibiotic component. 

However, what matters here is the activity of this formula as a whole. The goal was to meet the complexity of Daniel’s problem, through the coordinated influence of numerous herbs. The problem, though, does not boil down to one factor or even a root cause.

The model of excess and deficiency is only a starting point. Daniel’s case involved several processes happening all at once: weak digestive function, reduced movement, retained food and fluids, fermentation, irritation, and poor tissue nourishment. These were not separate problems that could be treated one at a time. They interacted with one another in important ways, and the formula had to address that interaction without pushing too hard in any one direction.

East Asian medicine describes these relationships through concepts such as qi deficiency, food stagnation, phlegm, stomach rebellion, and heat. Modern physiology describes some of the same circumstances differently, through motility, vagal regulation, microbial activity, inflammatory signaling, digestive secretions, and tissue function. Neither vocabulary reduces the case to one cause. The practical task is to understand how the pieces fit together well enough to treat the whole pattern.

In Daniel’s case, increasing movement without supporting digestion could weaken him further, while strengthening digestion without restoring movement could worsen stagnation and fermentation.

Early Improvement

Within the first couple of weeks, Daniel began to feel hungry more often and could eat larger amounts without remaining full for as long. Belching and retching decreased, drinking water became easier, and he began gaining weight.

After approximately one month:

• He was regularly eating breakfast and dinner.
• Appetite was consistently present but not yet strong.
• He was eating substantially more food in each meal.
• Retching had improved by approximately 80–90 percent at its best.
• Dry, peeling lips had resolved.
• His acne had also begun to improve.

The formula changed multiple times over the next three months, largely in response to changes in his condition. There was a constantly shifting balance point between the overall strength of Daniel’s digestive processes and the accumulations that resulted. These shifts were not always caused by the formulation but also by what Daniel ate, how much he worked, whether he rested, how stressful his week had been, and other factors.

For example, herbs to supplement qi had been improving vitality, but the internal balance of factors shifted and those same herbs began to encourage excessive fermentation and smelly gas. In response, aromatic herbs were added to directly stimulate processing in the upper digestive tract and correct the issue without removing the supplementing herbs that were helping. Their addition immediately reduced flatulence by more than fifty percent:

Throughout this process, the main strategy remained stable: build digestive strength without allowing food to become obstructed.

Further Details, Complications, and Outcomes

From the beginning, Daniel wanted to regain the ability to eat anything he wanted. It was his definition of wellness, developed over many years of being unable to enjoy food. When his appetite returned, Daniel began eating anything and everything, but especially heavy, fatty, carbohydrate rich foods from various restaurants. This directly contributed to increased fermentation, and it gave the digestion a greater physical and chemical burden.

A turning point came when Daniel realized that his progress slowed when he ate beyond his system’s capacity to digest. I encouraged him to start doing more home cooking, and when he did, the improvement to his health was evident. He noticed too and began adjusting how he felt about food, the pleasures of eating, and all those years of deprivation. It was an important step.

Daniel suffered a calorie and nutrient deficit for fifteen years. Improving his ability to digest allowed him to finally begin rebuilding. It would take time.

After about three months, Daniel began making significant changes outside the herbal treatment plan. Specifically, he began incorporating high doses of over-the-counter supplements. His eagerness for wellness was understandable. Some of these changes produced both improvements and new symptoms, and they complicated my ability to assess his response. Treatment therefore became less linear than the early results.

After five months, Daniel had become able to eat much more normally. He decided to stop the herbal formulas and focus on cooking, eating, and rebuilding. Although he would not get his twenties back easily, the outlook for his life had changed considerably. He had gone from struggling to tolerate even a small meal — or sometimes a drink of water — to enjoying food again. Along the way, he also began expanding his ideas about what is satisfying and nourishing.

Daniel’s case also reflects the complexity of treating actual people. As a mentor of mine once said, “People are not stones.” Treatment does not happen under controlled conditions. People eat, work, experiment, become discouraged or enthusiastic, and make decisions based on everything else happening in their lives. Those things become part of treatment too. Good treatment has to respond to the person who is actually living through it.

If your digestive problems have become difficult to separate into one diagnosis, one cause, or one treatment target, this is the kind of complexity I work with. The first step is to schedule a consultation here.