Post-meal Fatigue and Weakness
M, 52 years old. 52-year-old male with intense post-meal fatigue, frequent loose stools and general heaviness sensation for a long time.
The patient
- Age and sex
- 52 years · M
- Chief complaint
- 52-year-old male with intense post-meal fatigue, frequent loose stools and general heaviness sensation for a long time.
- Tongue
- Pale, swollen body, with teeth marks on the edges and a white, moist coating.
- Pulse
- Slow (Chi), weak (Ruo) and sunken pulse in the right Guan (關) position (Spleen-Stomach).
Symptoms
- Fatigue and drowsiness after eating
- Loose stools or with undigested food
- Sensation of heaviness in the limbs
- Poor appetite and distended abdomen
- Yellowish and dull complexion
- Weak voice, little energy to speak
Warning signs to rule out
- Persistent change in bowel habit, blood in the stool, or unintended weight loss in a patient over fifty. → Refer to gastroenterology for colorectal screening before continuing. Age and symptom match the screening profile.
- Fatigue with marked pallor, exertional breathlessness or tachycardia. → Order blood work: anaemia mimics Qi and Blood vacuity point by point and is corrected with iron, not moxa.
- Fatigue with intense thirst, frequent night urination and weight loss despite eating the same. → Check blood glucose. This is the usual onset of diabetes and closely resembles Qi vacuity.
Case resolution
Think through the pattern first, then expand the resolution
- Pattern
- Spleen Qi Deficiency with Internal Dampness
- Meridians involved
- Spleen, Stomach
- Pathogenic factors
- Spleen Qi Deficiency, Failure of transformation and transportation
The Spleen in TCM is the central organ of digestion. Its function is to transform and transport nutrients extracted from food. When Spleen Qi is deficient, this function fails, accumulating internal Dampness. Dampness is heavy and turbid, explaining post-meal fatigue, limb heaviness, loose stools and mental dullness.
Differential diagnosis
Shares: Marked fatigue, loose stools and a sense of cold.
Sets it apart: Kidney Yang vacuity gives early-morning diarrhoea, cold and weakness in the lower back and knees, and a deep, weak pulse in the Chi (尺) position. Here fatigue is clearly postprandial and the pulse is weak and slippery at Guan (關): the problem is in the Center, not the root.
Shares: Fatigue, loose stools and a pale tongue with teeth marks.
Sets it apart: Sinking adds a dragging sensation in the lower abdomen, haemorrhoids or prolapse, and worsens on standing. It changes the formula: it calls for Bu Zhong Yi Qi Tang and raising Yang, not tonification alone.
Shares: Body heaviness, pasty stools and a thick tongue coating.
Sets it apart: Damp-Heat gives foul, sticky stools, anal burning, dark urine, a yellow coating and a slippery, rapid pulse. Here the coating is white and the pulse is not rapid: there is Dampness, but cold and from vacuity.
Treatment
Principle: Tonify Spleen Qi, transform Dampness and raise the clear Yang.
| Point | Role | Technique |
|---|---|---|
| ST36 | The reference point for replenishing acquired Qi; with moxa it is the pillar of the treatment. | Perpendicular 1-1.5 cun, tonifying, with ten minutes of moxa. |
| SP3 | Spleen Yuan-source: it tonifies transportation and transformation at their origin. | Perpendicular 0.5 cun, tonifying. |
| CV12 | Stomach Mu and influential point of the Fu organs: the Center point when digestion feels heavy. | Perpendicular 0.5-1 cun, tonifying. Never on a full stomach. |
| BL20 | Spleen Back-Shu: it sustains the tonification between sessions. | Oblique toward the spine 0.5 cun, with moxa. |
| SP9 | Spleen He-sea: it drains the Dampness behind the heaviness in the legs. | Perpendicular 1-1.5 cun, even technique. |
| CV6 | Sea of Qi: with moxa it lifts the Yang when fatigue is deep-seated and will not shift. | Perpendicular 0.8-1.2 cun, or fifteen minutes of moxa. |
Formula: Liu Jun Zi Tang. Tonifies Qi while transforming Dampness and Phlegm, which is exactly this case's mixture. If a dragging sensation or prolapse appears, switch to Bu Zhong Yi Qi Tang.
- Frequency
- One session weekly for eight weeks, with home moxa between visits. Qi is replenished by accumulation, and isolated, widely spaced sessions do not achieve it.
Home care
- A hot, cooked breakfast: a bowl of grain porridge does more for the Spleen than any supplement.
- Remove cold dairy, raw food and sugar for six weeks; they are the direct source of the Dampness.
- Moxa on ST36 for ten minutes, three times a week.
- Walk for ten minutes after meals instead of sitting down: it moves the Center exactly when it feels heaviest.
Progress
- Session 1 · day 0 Fatigue 8 out of 10 that spikes after meals, two or three loose stools a day, and a sense of heavy legs. ST36, SP3, CV12 and BL20 with moxa. Cold dairy and the cold breakfast are removed before adding any further points. Within ten days the post-meal drowsiness clearly decreases; stools remain loose.
- Session 2 · day 7 Better morning energy, but heaviness in the legs and a white greasy coating persist. SP9 and ST40 are added: tonifying without draining leaves the Dampness in place and stalls the improvement. The heaviness eases within two weeks and stools begin to form.
- Session 3 · day 21 One formed stool a day and energy at 5 out of 10, but mornings are very hard to start. Moxa on CV6 and GV20 is added to raise the clear Yang, and Liu Jun Zi Tang is started to sustain the effect between sessions. Morning drowsiness resolves within three weeks.
- Session 4 · day 42 Energy steady at 7 out of 10 through the day and normal bowel habit. The tongue remains pale with teeth marks. Clinic moxa is withdrawn and home moxa continues. He is told the tongue will take months to change and that this is not a reason to prolong treatment. The improvement holds at the three-month review.
- Discharge
- Treatment ends after four consecutive weeks of formed stools and energy that does not collapse after meals. The tongue is the last sign to normalize, and waiting for it prolongs treatment for no reason.
- Watch for relapses
- Seasons of business lunches and summers of cold drinks. The first sign to return is afternoon heaviness in the legs, before the fatigue: at that point diet correction plus one session is enough.
Health notice. Educational and study content. It describes concepts of Traditional Chinese Medicine and does not replace diagnosis or treatment by a healthcare professional. Needling, medicinal herbs and invasive techniques must be applied by trained professionals. Safety guide.
