Poor Appetite in Older Adults on Long-Term Medication and Supplements? A TCM Case Study on Spleen-Stomach Care Under Polypharmacy

Poor Appetite in Older Adults on Long-Term Medication and Supplements? A TCM Case Study on Spleen-Stomach Care Under Polypharmacy

Image generated by NotebookLM for quick visual reference; some Chinese characters may not render correctly.

Medical review: Dr Chan Wing-kiu (CMCHK 009463 | Middle-aged and elderly gynaecology, internal medicine).

Mr Wong (alias), 76, has hypertension, type-2 diabetes and knee arthritis. His daily regimen includes 5 medications: an antihypertensive, two diabetes drugs (including metformin), a non-steroidal anti-inflammatory pain reliever, a calcium tablet and vitamin D. His family has noticed in recent months that he puts down his chopsticks after only a few bites, complains of post-meal distension, is more tired during the day, and has lost 3 kg in half a year.

The family wonders, "Is this 'too many pills harming the stomach' — should we just stop a few?" The concern is understandable, but stopping a chronic-disease medication without medical advice can destabilise blood pressure, blood sugar or cardiovascular risk. This case study walks through three points: what may actually be driving the poor appetite, why "list the medications and book a follow-up" matters more than "stop a drug", and how Traditional Chinese Medicine (TCM) can safely sit alongside Western care.

Do not stop medication first — these 3 steps are more urgent

A family's first instinct is often "let's try stopping one or two pills". That carries real risks:

• Stopping an antihypertensive abruptly can rebound blood pressure and may trigger a stroke or cardiac event
• Stopping a glucose-lowering drug abruptly can spiral into uncontrolled blood sugar, including hyperosmolar hyperglycaemic states
• Stopping pain relief abruptly brings joint pain back in full, the person moves less, and muscle strength keeps dropping

The correct first 3 steps:

• Make a complete medication list. Write down every Western drug, Chinese proprietary medicine and supplement (name, dose, timing, start date) on a single sheet of paper.
• Build a symptom timeline. When did the poor appetite begin? Did it appear after a new prescription or a dose change?
• Book a follow-up with the prescribing doctor. Bring the list and the timeline; the doctor decides whether to adjust, reduce, switch or investigate further.

The prescribing doctor is the one who can judge "is this a side effect", "do we need to test kidney function or blood sugar", "do we need a referral". This judgement is not something the family or the patient should make on their own.

7 differential causes of poor appetite

Possible cause	Common clue	Suggested direction
Medication side effect	Nausea, distension, constipation or fatigue after a new drug	Bring the medication list to the prescribing doctor
Constipation	Bowel movement every few days, bloating, early fullness on small portions	Address bowels first, in parallel with checking medications
Acid reflux or gastric disease	Burning sensation in the chest, sour taste, stomach pain	Needs medical assessment; gastroscopy may be indicated
Dental or swallowing problem	Difficulty chewing, food getting stuck, choking on liquids	Address oral or swallowing safety first
Glucose swings	Dry mouth, frequent urination, tremor, palpitations, fatigue	Internist to adjust diabetes medication
Worsening kidney function or chronic disease	Reduced appetite, leg swelling, urine output changes, itchy skin	Blood test for renal function and electrolytes
Low mood	Loss of interest in food, poor sleep, social withdrawal	Assess for depression

Poor appetite in older adults rarely has a single cause. In Mr Wong's case it may be three at once: (a) gastric irritation from the anti-inflammatory, (b) constipation from the calcium tablet, (c) gastrointestinal side effects from metformin. Stopping one is unlikely to solve the picture.

When to see a Western doctor or call emergency

• Significant short-term weight loss (5% or more over 3 months) — rule out malignancy, hyperthyroidism, worsening diabetes
• Black stools, blood in stool or vomit — possible upper gastrointestinal bleeding, an emergency
• Persistent stomach pain that worsens with eating — rule out gastric ulcer or cancer
• Difficulty swallowing or food sticking — rule out oesophageal issues
• Vomiting lasting more than 2 days — risk of dehydration and electrolyte disturbance
• Confusion, extreme fatigue or jaundice — possible hepatic, renal or metabolic problems

How TCM views this

TCM pattern	Common signs	Direction of care
Spleen-stomach weakness	Small appetite, post-meal distension, soft stools, pale face, easy fatigue	Strengthen the spleen and tonify qi; harmonise the stomach
Liver qi stagnation	Low mood, sighing, epigastric distension, frequent belching	Soothe the liver and regulate qi; harmonise the middle
Stomach heat	Bitter-dry mouth, bad breath, constipation, irritability	Clear stomach heat; moisten the intestines
Qi-and-yin deficiency	Fatigue, dry mouth, night-time thirst, warm palms and soles, constipation	Tonify qi and nourish yin; calm the mind

Specific herbal formulae and doses must be tailored by a registered TCM practitioner based on tongue, pulse, the medication list and the recent medical reports; self-prescribing is not appropriate.

In simpler terms: "spleen-stomach weakness" describes weakened digestion; "qi-and-yin deficiency" describes a body running short on both energy and moisture. Older adults often present two or three patterns at once.

Safety conditions for combining TCM and Western medicine

• Both clinicians informed. Tell your Western doctor that you are seeing a TCM practitioner, and tell your TCM practitioner about every Western medication.
• Do not stop Western medication on your own. TCM's role is to support constitution, not to replace chronic-disease therapy.
• 60-minute spacing between Western and Chinese medicine to reduce interaction risk.
• Avoid combining blood-activating herbs with blood thinners. If the patient takes warfarin or aspirin, this must be mentioned to the TCM practitioner.
• Tonic herbs require assessment. Ginseng, deer antler, donkey-hide gelatin and similar tonics are not appropriate for everyone on polypharmacy.
• Continue regular blood tests. Maintain the Western follow-up schedule to monitor renal function, liver function and blood sugar.

6 things family carers should do

• Maintain a medication list. A single A4 sheet listing every drug (Western, Chinese proprietary, supplements), brought to every consultation.
• Keep a meal record. Note how much your elderly relative actually eats each day; seven days of records help the prescribing doctor judge the trend.
• Check swallowing safety. Watch for choking; consider whether food needs to be cut smaller or cooked softer.
• Tighten the follow-up rhythm. If poor appetite is accompanied by weight loss, book a follow-up within one month rather than waiting three.
• Do not over-supplement. Avoid giving "tonics" or "appetite soups" recommended by friends without checking.
• Post an emergency-sign list. Tape a list of red flags (black stools, vomit with blood, persistent stomach pain, extreme fatigue) on the fridge so the whole family is clear.

How Aspira TCM Clinic assesses such cases

Dr Chan reviews the complete medication list, the last 3 months of medical reports, family observation records, the meal log, and the patient's tongue and pulse. Herbal prescribing under polypharmacy follows the principle of "gentle, not cloying, not overly cold"; common formulae focus on strengthening the spleen and easing food stagnation, while avoiding constituents prone to interact with Western medicine. A typical course runs 4–8 weeks as an observation window, with Western follow-ups continuing in parallel.

Further reading

• Blood thinners and TCM: 3 prerequisites for atrial-fibrillation patients →
• Can I see a TCM practitioner while on diabetes medication? East–West collaboration →
• Is frequent night-time urination in the elderly normal? TCM on common causes →

FAQ

Will Chinese herbs clash with Western medicines?

Some will. Combinations worth flagging include:

• Blood-activating herbs (Salvia, safflower, ligusticum) plus blood thinners — may increase bleeding risk
• Liquorice plus diuretics or antihypertensives — may affect electrolytes
• Ginseng plus glucose-lowering drugs — may affect blood-sugar control

Telling your TCM practitioner exactly what Western medicines you take is the basis of safe combination.

Can older adults take tonic supplements to boost appetite?

Mild, food-grade ingredients such as Chinese yam (Huai Shan), aged tangerine peel, malted barley and ginger are generally well tolerated as small additions to soup. However, more potent tonics such as ginseng, deer antler and donkey-hide gelatin are not suitable for everyone on polypharmacy and should be checked with a TCM practitioner first.

Can Chinese herbs replace some Western drugs?

No, not for chronic-disease drugs (antihypertensives, antidiabetics, blood thinners). The role of TCM is to improve constitution and ease symptoms; the role of Western medication is to control the disease.

Is polypharmacy in older adults unavoidable?

Older adults often have several chronic conditions, so multiple medications are common. However, taking five or more concurrent medications is itself a recognised risk factor for falls and adverse drug reactions. We recommend an annual "medication review" by the family doctor or a clinical pharmacist to check whether every drug is still necessary at the current dose.

Disclaimer: Every patient's constitution and condition are different, and treatment outcomes vary accordingly. The above is for reference only. Please consult a practitioner for a treatment plan tailored to your specific situation. Prescription details are shared for TCM academic purposes only and do not constitute prescribing advice. Do not self-prescribe.

---

References

• Department of Health, Drug Office — Safe medication information https://www.drugoffice.gov.hk/eps/do/en/consumer/
• Department of Health, Elderly Health Service — Medication safety for older adults https://www.elderly.gov.hk/english/healthy_ageing/healthy_ageing.html
• Hospital Authority — Polypharmacy and elderly care https://www21.ha.org.hk/smartpatient/en/encyclopaedia-of-health.html
• Department of Health, Chinese Medicine Regulatory Office — Safety information for Chinese medicines https://www.cmro.gov.hk/