Eating for Recovery: Understanding Dietary Restrictions in TCM

Kit Li

One of the most common questions I am asked in clinical practice is:

"What foods should I eat, and what foods should I avoid during my TCM treatment?"

My answer is always that it depends on the individual's constitution, diagnosis, and current health condition. There is no one-size-fits-all approach in TCM.

However, whether you are receiving acupuncture or taking Chinese herbal medicine, certain foods may influence the effectiveness of your treatment. Some foods can aggravate an existing imbalance, while others may interfere with the therapeutic actions of herbal medicine or slow the body's healing process.

For this reason, appropriate dietary guidance forms an important part of TCM treatment, helping to support recovery and maximise the benefits of both acupuncture and Chinese herbal medicine.

"Among the flavours of food, some are suitable during illness, while others may be harmful. Appropriate foods nourish the body, whereas unsuitable foods may contribute to disease and even endanger health."  As stated in the Complete Works of Zhang Zhongjing (仲景全书).  This is the fundamental principle behind dietary restriction in TCM.

In TCM, we called it 'Ji Kou '忌口 (Dietary Restrictions) refer to dietary precautions or food prohibitions for patients during illness and treatment. Many people believe that only TCM emphasizes dietary restrictions, considering it an old-fashioned concept. Therefore, patients often ask TCM practitioners whether they need to avoid certain foods.

In reality, modern medicine also places great importance on dietary restrictions.  Patients taking anticoagulant medications such as warfarin are often advised to maintain a consistent intake of vitamin K-rich foods, such as spinach, kale, and broccoli, as sudden changes may affect blood clotting. Individuals with hypertension are encouraged to reduce sodium intake to help control blood pressure. Patients with diabetes are advised to monitor their consumption of sugary foods and refined carbohydrates to maintain stable blood glucose levels.

In some cases, these dietary restrictions are even stricter than those recommended in TCM. This demonstrates that dietary regulation serves two important purposes:

1. Dietary restrictions while taking medication

In certain situations, these are essential rules. For example, patients with nephritis are advised to restrict salt intake, while some medications require the avoidance of specific foods to ensure their effectiveness and safety.

2. Dietary restrictions according to the patient's condition

These may also be necessary for particular illnesses. For example, in TCM, raw and cold foods are often avoided in Taiyang wind-strike disorders and other conditions involving Cold, Dampness, or digestive weakness.

Therefore, both the properties of the medication and the patient's condition must be carefully considered when providing appropriate and balanced dietary guidance.

In TCM, food is regarded much like medicine, possessing its own unique properties and therapeutic effects. The purpose of dietary restrictions is not to limit food choices unnecessarily, but to prevent certain foods from aggravating a patient's condition while supporting the treatment process and helping the body restore balance.

According to TCM theory, foods possess different energetic properties and may affect the body's balance in different ways. While dietary recommendations should always be individualized, foods that commonly require moderation or avoidance during treatment can be broadly grouped into the following categories:

1. Raw and Cold Foods: Ice cream, chilled drinks, salads, sushi, watermelon, and other cold foods taken directly from the refrigerator. In TCM, these foods may weaken the Spleen and Stomach, particularly in individuals with digestive weakness, bloating, loose stools, or Cold patterns.

2. Pungent, Hot, and Drying Foods: Chilli peppers, curry, garlic, ginger, pepper, alcohol, and deep-fried foods. These foods may aggravate Heat conditions, especially in individuals experiencing symptoms such as mouth ulcers, constipation, acne, irritability, or insomnia.

3. Rich and Greasy Foods: Fried chicken, fast food, fatty meats, cream-based dishes, pastries, and heavily processed foods. According to TCM, excessive consumption may contribute to Dampness and Phlegm accumulation and place additional strain on the digestive system.

4. Sticky and Excessively Sweet Foods: Cakes, chocolates, sweets, glutinous rice products, sweet desserts, and sugary drinks. These foods may weaken digestive function and contribute to Dampness and Phlegm, particularly in people who frequently experience fatigue, bloating, or mucus-related conditions.

5. Traditionally Recognised "Fa Wu" (发物, Trigger Foods) and Common Food Allergens: Shellfish, prawns, crab, certain fish, chives, and other foods traditionally believed to aggravate symptoms in susceptible individuals. Patients with allergies, eczema, urticaria (hives), or inflammatory skin conditions are often advised to monitor their response to these foods.

6. Highly Stimulating Foods and Seasonings: Excessive coffee, energy drinks, alcohol, very spicy foods, and heavily seasoned dishes. These may aggravate symptoms such as palpitations, anxiety, insomnia, dizziness, headaches, or irritability in sensitive individuals.

It is important to remember that these recommendations are not universal rules. The suitability of any food depends on the individual's constitution, syndrome pattern, and stage of illness.

In TCM, illnesses are broadly divided into two categories: external disorders and internal disorders. External disorders are often caused by external pathogenic factors, such as Wind, Cold, Heat, or Dampness, while internal disorders are usually related to imbalances or dysfunctions of the internal organs, including the Liver, Spleen, Stomach, Kidney, and Heart.

For this reason, dietary recommendations in TCM are not based solely on the disease itself, but on the individual's pattern of disharmony. Factors such as Heat, Cold, Dampness, Phlegm, digestive weakness, and deficiency conditions are all taken into consideration. Therefore, dietary advice should always be tailored to the individual rather than applied as a fixed set of rules.

For example, during the early stages of a fever accompanied by chills, raw and cold foods are often avoided. However, if a high fever persists and body fluids become depleted, cooling and hydrating foods may become beneficial. Watermelon is a classic example because of its ability to clear Heat, generate fluids, and relieve thirst.

Likewise, when illness is accompanied by digestive weakness, greasy, rich, and sticky foods are often reduced to lessen the burden on the digestive system. If symptoms involve internal Heat, irritability, or insomnia, spicy and highly stimulating foods may also be restricted.

Ultimately, dietary recommendations in TCM are based on syndrome differentiation and treatment principles. Dietary restrictions are not meant to be rigid rules, but rather practical guidelines that should be adjusted according to the patient's constitution, condition, and stage of illness.

References:

1) Zhao et al. (2021) – TCM Nutrition: https://pubmed.ncbi.nlm.nih.gov/32884122/

2) Chen et al. (2023) – Medicine and Food Homology: 

https://pmc.ncbi.nlm.nih.gov/articles/PMC10394323

3) Shi et al. (2018) – Chinese Food Therapy Review: 

https://www.tmrjournals.com/public/articlePDF/20201201/82e2f9d108396427bf11dab2693ad2d0.pdf

The Wisdom of our Renowned Chinese Physician - Zhang Zhongjing

Kit Li

Not long ago, I watched a video on the social media about a young mother who brought her 2 year old son to a Chinese Practitioner.  Her son never slept well and cried throughout the night, leaving her exhausted and agitated. She had been suffering from sleepless nights, struggling to cope with the demands of motherhood. However, unexpectedly, it was the mother, not the child, who ended up receiving treatment.

This reminded me of one the most renowned Chinese Physicians in history, Zhang Zhongjing*.  Recently, I watched a four part of documentary series about his journey. It outlined his path from a diligent student of Traditional Chinese Medicine (TCM) to becoming one of the most respected physicians of his time. His encounters with experienced mentors, his tireless search of wisdom, and his remarkable achievements made his story truly inspiring.

One particularly fascinating anecdote is about Zhang Zhongjing treating a young mother who brought her baby boy to see him. Her son cried restlessly all the time, leaving the mother was exhausted and agitated.  Using the Four Diagnostic Methods of TCM (Observation, Olfaction, Inquiry, and Palpation), Dr Zhang quickly realised that the true patient was not the baby, but the mother. Since she was breastfeeding, her physical and emotional state directly impacted her child. If the mother was unwell, how could she produce healthy milk for her baby?

From a TCM perspective, the mother had developed Yin-deficiency due to prolonged exhaustion and stress, and leading to internal heat. This imbalance affected the quality of her breast milk, transferring excessive heat to her baby. As the child consumed this milk daily, his body accumulated heat, resulting in discomfort, restlessness, and persistent crying. Instead of treating the child's symptoms directly, Zhang Zhongjing focused on restoring the mother's health, ensuring she could provide nourishing, balanced milk that would naturally soothe her baby. 

This case beautifully illustrates one of the fundamental principles of TCM: treating the root cause rather than just the symptoms. It also highlights the deep connection between mother and child, spotlighting why mental health is crucial in early childhood development.

Zhang Zhongjing's insights were truly ahead of his time, and his work continues to influence medical practices around the world. His ability to understand the deeper causes of illness, look at the whole person, and treat the root problems is what makes his legacy so special.

References:

Zhang Zhongjing - Wikipedia

https://en.wikipedia.org/wiki/Shanghan_Lun

Shanghan Lun* (also known as Treatise on Cold Damage Disorders), was written by Zhang Zhongjin in the late Han Dynasty, circa 20-200 A.D.  

The original text was then divided into two texts, 'ShangHan Lun (which focused on external conditions) and the other one was 'Jin Kui Yao Lue' (which focused on internal conditions). It has been translated into at least 12 languages, including English, French, Spanish, Japanese, and Korean, etc.  

What many may not realize is that Japan's traditional medicine system, Kampo, is highly dependent on the principles and formulas elaborated on Shanghan Lun. For over 1500 years, Kampo practitioners have used these formulas to diagnose and treat various illnesses.