23No longer drink water exclusively, but use a little wine for the sake of your stomach and your frequent ailments.
Contrary to the sentiments of some Christians, this verse says nothing about the use of alcohol as a beverage. Other passages would be more suitable for addressing such an issue (see Prov. 20:1, 31:4; John 2:1–11; 1 Cor. 10:23, 31; Col. 2:20–23, and so on). Paul recommends wine for medicinal purposes. Timothy’s weak stomach may have been the result of tensions in dealing with people who saw him as youthful and resisted his ministry. But at the least, he was apparently of a weak physical disposition.
A few facts are in order to help us understand this instruction, and then to help us understand why Paul included it. Commentators generally agree that wine in the NT times was diluted, possibly to the level of two parts water, one part wine. Clean water in the ancient world was hard to come by, especially in the cities—and that could have been the source of Timothy’s stomach problems. Today, we go through great efforts to purify water in municipal water treatment facilities or buy purified bottled water. The ancient world did not have such modern capabilities. The fact that Paul recommends “a little” suggests that this instruction should not be used to allow for excess. Timothy was to provide an example of being above reproach.
This instruction does have some spiritual value, similar to Paul’s instruction to greet one another with a holy kiss (Rom. 16:16). He obviously encourages maintaining a warm, affectionate fellowship; this has spiritual value. Our bodies are the temple of the Holy Spirit, so proper use of wine in medicinal contexts would then have spiritual value. But how does this fit in with Paul’s train of thought?
Commentators supply a variety of suggestions. It is possible Paul is connecting with previous verses dealing with purity (1 Tim. 5:2) and to “keep oneself free from sin” (1 Tim. 5:22). Or he could be cautioning Timothy in light of those who press for “abstaining from foods” (1 Tim. 4:3), that he should not succumb to ascetic tendencies (denying the earthly enjoyments). Don’t take purity to an extreme!
Lastly, we note that the apostle Paul earlier in his ministry could make the lame to walk (Acts 14:8–10) and raise the dead (Acts 20:9-12), yet with Timothy’s relatively minor stomach problems, the apostle did not call for divine healing. The Holy Spirit did not (and does not) use the supernatural for every illness. God expects us to use human wisdom for some of our problems.
Lord, help me see and act wisely in dealing with my human ailments.

“Timothy’s weak stomach *may have been* the result of tensions…” is pure speculation.
There can be a simple understanding that “drinking a little wine for the sake of your stomach AND your frequent ailments” deals with an on-going problem with the drinking water. Paul directly linked it to water by saying, “No longer drink water *exclusively*…” Drinking ONLY water was bad for Timothy and probably many others.
NOTE: A simple fix using Paul’s spiritual gift of healing was not going to change the long term, indigenous nature of the problem of drinking only water. The quantity of the on-going fix, “a little wine” needs to be determined by it’s *verified efficacy* for relieving Timothy’s stomach AND ‘frequent ailments. “If Tim felt the ailment, he was to drink a LITTLE wine.” It’s that simple.
Let’s not make this NEED for “a little wine” to be about excessive alcohol consumption such as was warned against many times in scripture. It’s just medicine.
Thanks for your insights and perspective.