Liver and Gallbladder Pattern Differentiation in Chinese Medicine
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Liver and Gallbladder Pattern Differentiation in Chinese Medicine

Liver Patterns

Gallbladder Patterns

Etiology of Liver Patterns

Emotions

According to Five Element theory, anger and other related emotions such as resentment, unfulfilled desires, frustration, etc. are attributed to the Liver. The relationship between an organ and its corresponding emotion is reciprocal. The Liver for instance, is responsible for the free and smooth flow of Qi, which has a deep relationship with a person's emotional state. Conversely, anger, repressed emotions, etc. affect the Liver organ itself, and disrupt the smooth flow of Qi in the body.

If Liver is functioning well, and its Qi is flowing smoothly, the emotional state will be happy, and "relaxed" or "free and easy". Emotions will be freely expressed. When Liver Qi does not freely flow, stagnation of Qi occurs, and affects the emotional state. This causes anger and irritability. Over a long period of time, stagnation of Liver Qi impairs circulation of Qi and can cause emotional states of constant low level anger, depression, and resentment. These may be transferred to and appear in the physical body, such as the chest, breasts in women, hypochondriac region, epigastric region, or throat. Stagnation of Liver Qi, therefore, produces feelings of tightness in the chest and hypochondriac region, often with frequent sighing, pain and swelling of the breasts, tension in the stomach, the sensation of a lump in the throat.

Liver Qi may "rebel" upward and cause Liver Yang to rise. Symptoms include irritability, headaches, and the propensity to lose one's temper.

Diet

Excessive greasy and hot foods can cause Liver Fire. Examples of hot foods are lamb, beef, curry, and other spices. Examples of damp or greasy foods are deep fried food, and alcohol. Not enough warming foods, such as meat and grains, can contribute to inadequate Blood production and Blood Deficiency. Blood Deficiency, in turn, can lead to Liver Blood Deficiency. Women are particularly prone to Blood Deficiency especially at puberty, after childbirth, and somewhat after each period.

Liver Qi Stagnation

Signs:

  • Distention and pain in the chest and hypochondriac region
    Areas coursed by the Liver channels
  • Frequent sighing
    Releasing Stagnant Qi in the chest
  • Depression, moodiness, melancholy, unhappiness, and a general tense feeling
    Flow of Liver Qi affecting the emotions or vice versa
  • Sensation of a lump in the throat with trouble swallowing
    Internal branch of the Liver channel ascends along the neck and throat
  • nausea, vomiting, epigastric pain, reduced appetite, sour reflux, belching, awareness of pulsating (abdominal aorta) in the epigastric region, a sensation of the Stomach churning
    Liver invading the Stomach
  • Abdominal distention, borborygmus, diarrhea
    Liver invading the Spleen
  • Alternating Constipation and Diarrhea, irregular elimination
    Liver Qi stagnating in the Intestines
  • Irregular menstruation, dysmenorrhea, premenstrual breast tenderness, PMS
    Liver channel is closely associated with menstruation

Tongue

  • Normal tongue body

Pulse

  • Wiry pulse

Notes

This is an extremely common pattern. Wide range of symptoms, which typically fluctuate considerably in proportion to the amount of stress the person feels. the patient will have periods of depression with worsening of physical symptoms, and times when symptoms improve. Women during the premenstrual time are naturally more prone to stagnation-related problems, since at this time Blood is collecting in the uterus and Qi levels are diminishing.

Stagnation of Liver Qi over a long time induces stasis of Liver Blood

Etiology/Pathology

Emotional disharmony, especially repressed anger, resentment, frustration, over a long time, which impairs the circulation of Liver Qi.

Treatment Principle

Disperse the Liver and regulate Qi

Points

  • LIV-3 (Taichong)
    Regulates Liver Qi and especially effective when the throat is involved
  • GB-34 (Yanglingquan)
    Regulates Liver Qi and especially useful when the hypochondriac region in involved
  • LIV-13 (Zhangmen)
    Regulates Liver Qi in Middle Jiao, especially when it affects the Stomach
  • LIV-14 (Qimen)
    Regulates Liver Qi in the Middle Jiao, especially when it invades the Spleen
  • SJ-6 (Zhigou)
    Regulates Liver Qi and especially affects the sides
  • P-6 (Neiguan)
    Regulates Liver Qi and is especially good when emotional problems are major symptoms

Liver Blood Stagnation

Signs:

  • Dysmenorrhea, irregular periods, dark and clotted menstrual blood
    Liver Blood Stagnation affects menstruation
  • Fixed and stabbing abdominal pain, abdominal masses, fixed, not movable
    Blood Stagnation
  • Epistaxis or vomiting of Blood
    Blood Stagnation

Tongue

  • Purple, more purple on the sides, possible purple spots

Pulse

  • Wiry pulse

Treatment Principle

  • Disperse the Liver, regulate Blood

Points

  • LIV-3 (Taichong)
    Regulates Liver Qi and Blood
  • GB-34 (Yanglingquan)
    Regulates Liver Qi to regulate Blood
  • BL-18 (Ganshu)
    Regulates Liver Blood
  • BL-17 (Geshu)
    Influential Point of Blood, regulates Blood when needled
  • SP-6 (SanYinjiao)
    Needle to regulate Blood and the three Yin of the lower limb
  • SP-10 (Xuehai)
    Regulates Blood
  • REN-6 (Qihai)
    Regulates Qi and moves Blood in the abdomen, especially where there is abdominal pain.

Points for acute menstrual cramps

  • SP-8 (Diji)
    Xi Cleft point of Spleen, stops pain, regulates the uterus, moves Qi and Blood
  • LI-4 (Hegu)
    Regulates channels, stops pain and spasm
  • Ear Points
    Uterus, Liver, Endocrine

    Method: Sedate body points, even method on ear points

Points for masses such as fibroids, cysts, and tumors

  • SP-6 (SanYinjiao)
    Regulates uterus, stops pain, moves Blood and eliminates stasis
  • KI-8 (Jiaoxin )
    Removes obstructions from channel, removes masses, regulates menstruation
  • KI-13 (Qixue)
    Circulates Qi and Blood in abdomen & removes masses

    Method: Sedate, even method on weak patients

Blazing Liver Fire

Signs

  • Red face and eyes, Irritability, angry outbursts, tinnitus, deafness, temporal headache, or migraine, dizziness
    Liver Fire rising to the head
  • Thirst
    heat damaging fluids
  • Bitter taste in the mouth
    Liver Fire rising to the mouth
  • Constipation with dry stools
    Heat damaging fluids
  • Insomnia with dream disturbed sleep
    Liver Fire disturbing Shen
  • Dark yellow urine
    Heat burring fluids
  • Possible epistaxis, hemoptysis, hematemesis
    Liver Heat causes Blood to extravasate

Tongue

  • Red body, redder sides, with a dry yellow coating

Pulse

  • Full, wiry, and rapid pulse

Etiology

Long-standing state of anger, repressed anger or frustration which causes Qi to stagnate and form Heat.

Diet

Excessive consumption of alcohol, fried foods, meat also tend to cause Liver Heat. Especially meats such as beef and lamb, which are attributed to hotter energy.

Treatment Principle

Sedate Liver, clear Fire

Points

  • LIV-2 (Xingjian)
    Clears Liver Fire
  • LIV-3 (Taichong)
    Sedates the Liver
  • GB-20 (Fengchi)
    Clear Liver Fire, pacify rising Liver Yang. Especially useful where eye problems or headache
  • TaiYang (Extra Point)
    Clear Liver Fire and treats temporal headache
  • GB 13 (Benshen)
    Subdue ascending Liver Yang and calms the Mind

Method

Sedate all points


Liver Blood Deficiency

The Liver stores Blood, so deficiency of Blood can easily affect Liver.

The Liver also opens to eyes, so when Liver Blood is deficient, the eyes may lack nourishment and be unable to see clearly.

The Liver also affects muscular tension. When deficient Liver Blood can not nourish the tendons, symptoms such as muscular weakness, cramping, and hypertonicity of tendons appear.

Liver manifests in nails, and when the nails are not nourished by Liver Blood, they become brittle

The Ren Mai and Chong Mai also depend on the Liver for their Blood supply. When Deficient Liver Blood does not provide Blood to these channels, it leads to scanty menstruation or amenorrhea.

Signs

  • Blurred vision and floaters in the eyes
    Liver Blood not nourishing the eyes
  • Scanty menstruation and amenorrhea
    Deficient Liver Blood not nourishing the Ren Mai and Chong Mai
  • Dull pale face, dizziness, orthostatic hypertension, pale lips
    Blood Deficiency
  • Numbness of the Limbs, muscular weakness, muscle spasms, cramps
    Liver Blood not nourishing the muscles and tendons
  • Pale, withered, and brittle nails
    Liver Blood not nourishing the nails

Tongue

  • Pale, especially on the sides
  • In severe cases, the sides may be orange

Pulse

  • Choppy and/or fine pulse

Etiology

  • Not enough protein in the diet or an irregular/poor diet can weaken Spleen.
    The Spleen then, does not produce Blood, which leads to Liver not having enough Blood to store.
  • Serious hemorrhage can deplete Blood
    Blood loss
  • Kidney Qi or Kidney Jing Deficiency can cause Deficient Blood
    This is because or Kidneys play an important role in production of Blood and Qi

Treatment Principle:

Tonify the Liver and Nourish Blood

Points

  • BL-18 (Ganshu)
    Tonifies Liver and Liver Blood
  • BL-20 (Pishu)
    Tonifies Spleen to produce Blood
  • BL-23 (Shenshu)
    Tonifies Kidneys to produce Blood
  • BL-17 (Geshu)
    Direct moxa to tonify Blood
  • LIV-8 (Ququan)
    Tonifies Liver Yin and Blood
  • ST-36 (Zusanli)
    Tonify Qi of Middle Burner to produce Blood
  • SP-6 (SanYinjiao)
    Tonify Qi of Middle Burner to produce Blood
  • REN-4 (Guanyuan)
    Direct moxa to tonify Blood

Method

Tonify. Moxa is applicable

Liver yang Rising/Ascending

Signs

  • Headaches (temporal/parietal, unilateral (Gall Bladder), lateral, occipital
    Liver Yang rising to the head
  • Dizziness, tinnitus, sudden deafness
    Liver Yang rising to the head
  • Dry mouth and throat
    Heat
  • Insomnia
    Liver Fire disturbing the Shen
  • Irritability, shouting in anger, stress
    Liver Yang Rising

Tongue

  • Red with redder sides
  • If due to Liver Blood Deficiency, the tongue is pale
  • If due to severe Liver and Kidney Yin Deficiency, the tongue is red and peeled

Pulse

  • Wiry Pulse
  • If due to Liver Blood Deficiency, the pulse is choppy and more deficient.
  • If due to severe Liver and Kidney Yin Deficiency, the pulse is floating and empty

Treatment Principle:

  • Subdue Liver Yang, Tonify Yin

Points

  • LIV-3 (Taichong)
    Subdues Liver Yang
  • SJ-5 (Waiguan)
    Subdues Liver Yang
  • SP-6 (SanYinjiao)
  • KID-3 (Taixi)
    Tonify Kidney Yin
  • LIV-8 (Ququan)
    Tonify Liver Yin
  • GB 43 (Xiaxi)
    Subdue Liver Yang. Especially good for headache on Gall Bladder channel
  • GB 38 (Yangfu)
    Subdue Liver Yang and Liver Fire, good for chronic and stubborn migraine headache (sedation point)
  • BL-2 (Zanzhu)
    Subdues Liver Yang, local point for headache around eye
  • TaiYang (Extra Point)
    Subdues Liver Yang, local point for headache on temple
  • GB-20 (Fengchi)
    Subdues Liver Yang, use as local pt for headache in occiput or headache around eye
  • GB-9 (Tianchong)
    Subdues Liver Yang, important local points for headaches on the lateral aspect of head
  • GB-8 (Shuaigu)
    Subdues Liver Yang, important local points for headaches on the lateral aspect of head
  • GB-6 (Xuanli)
    Subdues Liver Yang, important local points for headaches on the lateral aspect of head

Method

  • Sedate points that subdue Liver Yang
  • Tonify points that nourish Yin

Notes

This both an excess and deficient pattern. The excess being the Rising Liver Yang and heat, the deficiency usually being that of Liver Yin and/or Kidney Yin. In Five Element theory, Water fails to nourish wood.

Difference between Liver Fire Blazing Upwards and Liver Yang Rising:

Liver Fire Blazing is a true Excess pattern where it produces Excess Fire that dries up Body Fluids and causes signs of Dryness, such as constipation, red eyes, scanty and dark urine, bitter taste, etc. Liver Yang Ascending does not have full Heat signs because the excess is due to deficiency

Cold Stagnation in the Liver Channel

Signs

  • Fullness/distention of hypogastric region, pain in the scrotum/testes
    Cold in the Liver Channel
  • Straining of testes or contraction of scrotum
    Cold in the Liver Channel
  • In women, it can cause severe dysmenorrhea which is relieved by heat

Tongue

  • Pale and wet with a white coat

Pulse

  • Wiry, deep, and slow pulse


Notes

Caused by invasion of Liver channel by Cold. Liver channel traverses external genitals; Cold contracts, causing pain and contraction.

Etiology/Pathology

Invasion of exterior Cold (aggravated by Stagnation of Liver Qi)

Treatment Principle

Sedate Liver, Disperse Cold

Points

  • REN-3 (Zhongji)
    Moxa to disperse Cold from Lower Burner
  • LIV-5 (Ligou)
    Connecting (Lo) point; opens Lo channel which flows around genitals: can disperse Cold from the channel
  • LIV-1 (Dadun)
    Clears Liver channel and removes obstruction of Cold from Lower Burner

Method

Sedate. Moxa is applicable

Damp-Heat in the Liver and Gallbladder

This pattern is a combination of Heat in Liver and Dampness in Spleen. There must be Dampness in Spleen for the pattern to manifest.
Dampness in Liver and Gallbladder channel causes Liver Qi to stagnate by obstructing the smooth flow of Liver Qi. This results in distention/pain of hypochondrium and chest. Then the Liver Qi invades Stomach, with symptoms such as (nausea, vomiting, loss of Appetite and abdominal distention.

Accumulation of Dampness can obstruct the flow of bile and cause jaundice.

Damp-Heat causes low grade continuous fever

Dampness can flow down and settles in Lower Burner and give rise to symptoms such as vaginal discharge and itching or pain/swelling and redness of scrotum

Signs

  • Fever, Bitter taste
    Presence of Heat
  • Scanty dark urine
    Damp and heat obstructing
  • Fullness/pain of the chest and hypochondrium
    Dampness causing Qi to stagnate
  • Jaundice, nausea, vomiting, loss of appetite
    Dampness obstructs bile, Liver Qi invades Stomach
  • Abdominal distention, vaginal discharge, vaginal itching, pain/redness/swelling of scrotum
    Dampness settles in the Lower Jiao

Tongue

  • Red body with a sticky yellow coat

Pulse

  • Slippery, wiry, and rapid


Etiology

  • Internal:
    Spleen Deficiency (irregular eating habits, excessive consumption of Cold and raw foods, protein deficient diet, excessive thinking or mental strain). Liver Qi stagnation over long time (excessive emotional frustration, repressed anger, etc.) causes Liver Heat, which combines with dampness to obstruct the Liver and Gallbladder
  • External:
    Invasion of exogenous Damp-Heat.
    Common in tropics, less common in temperate climates.

Treatment Principle

Resolve Dampness, Clear Heat, Disperse Liver and Gallbladder

Points

  • LIV-14 (Qimen)
    Regulates Liver Qi in hypochondrium/epigastrium
  • GB-24 (Riyue)
    Regulates Liver Qi, soothes Gallbladder, Resolves Damp
  • GB-34 (Yanglingquan)
    Move stagnant Liver Qi and resolve Dampness
  • BL-18 (Ganshu)
    Move stagnant Liver Qi and resolve Dampness
  • BL-19 ( Danshu)
    Move stagnant Liver Qi and resolve Dampness
  • DU-9 (ZhiYang)
    Resolves Dampness from Gallbladder
  • REN-12 (Zhongwan)
    Tonifies Spleen to resolve Dampness
  • SP-9 (Yinlingquan)
    Resolve Dampness in Lower Burner
  • SP-6 (SanYinjiao)
    Resolve Dampness in Lower Burner
  • SP-3 (Taibai)
    Resolve Dampness
  • LI-11 (Quchi)
    Clear Heat, resolve Dampness
  • LIV-2 (Xingjian)
    Clear Heat in Liver

Method

Sedate all points except REN-12, which is tonified to tonify Spleen

Gallbladder Patterns

Gallbladder Functions:

Stores bile. The Gallbladder's job of storing and emptying the bile is dependent on the Liver ensuring the smooth flow of Qi. The Gallbladder is easily affected by Dampness deriving from an impairment of the Spleen function of transformation and transportation.

Etiology/Pathology:

  1. Diet: excessive consumption of greasy and fatty foods leads to the formation of Dampness which can lodge in the Gallbladder.
  2. Emotions: Anger, frustration and bottled-up resentment can cause stagnation of Liver Qi which, in turn, can produce Heat which affects the Gallbladder. Pent up anger over a long period of time implodes to give rise Fire in Liver and Gallbladder with symptoms of irritability, bitter taste, thirst, headaches, etc. Gallstones can be seen as the manifestation of "Gall"- Liver Qi stagnation here.
  3. Climate: Exogenous Dampness and Heat, as found in tropical or subtropical regions, can cause Damp-Heat in the Gallbladder. (Impairs the Spleen's function of transforming and transporting, deficient Spleen Qi creates many Gallbladder problems. Dampness lodges in the Gallbladder and gets stuck.)

Notes

  • Only Yang organ that doesn't deal with waste
  • Doesn't communicate with the external environment
  • Doesn't revive or transport
  • Called the curious organ
  • Receives bile from liver, stores in GB and secrets in on demand from Liver
  • Controls sinews with Liver
  • Mobility, agility
  • Controls Decision making
  • Courage, initiative
  • GB XU=indecisiveness, easily discouraged=GB40
  • Too timid to have dreams and ideas or at first stumbling block give it up

Damp-Heat in the Gallbladder

Clinical Manifestations

  • Hypochondriac pain and distention: (Dampness in the GB interferes with the smooth flow of LV Qi which stagnates and causes hypochondriac pain and distention, usually starts in front and radiates around to B18 or 19).
  • Nausea: (stagnant Liver Qi invading the Stomach/dampness prevents dissension)
  • Vomiting
  • Inability to digest fats
  • Yellow complexion: bile backed up
  • Scanty, dark yellow urine
  • Fever
  • Thirst without desire to drink (the thirst is heat, without the desire is dampness)
  • Bitter taste: (Liver Heat)

Tongue

  • Thick-sticky yellow coating (esp. on Right side), either bilateral or only on one side.

Pulse

  • Slippery and wiry pulse

Differentiation from Damp-Heat in Liver/Gallbladder=More pain after eating and inability to digest fats-pain radiating to the back (nausea, vomiting, jaundice). This is a sub-category of Damp-heat in the Liver/Gallbladder.

Pathology

Pure excess. UnderlYing Spleen Qi Deficiency leading to the formation of Dampness which obstructs the GB-damp always obstructs the flow of Qi.

Etiology/Pathology

  1. Emotional problems: long-standing anger causing stagnation of LV Qi and implosion of stagnant Qi into fire.
  2. Excessive consumption of greasy and fatty foods leads to formation of Dampness which combines with the Heat.
  3. Exogenous Damp-Heat-in tropical or subtropical regions.

Treatment Principle

Resolve damp, clear heat in the Gallbladder, smooth the flow of Liver Qi

Method

Reducing (except Ren12 and UB20)


Points

  • GB-24 and UB-19
    Front Mu and Back shu, clear heat in the GB, good for acute stage
  • LIV-14 and BL-18
    Clear Heat in the Liver
  • REN-12 and BL-20
    Resolve dampness
  • Dannangxue (Extra point)
    Special point slightly below GB34) Stimulates the smooth flow of Liver Qi. Resolves Dampness and Clears heat. (Only used if tender on pressure-choose between this and GB34).
  • DU-9
    Clears Heat in the GB, stimulates the smooth flow of Liver Qi and Resolves Dampness
  • LI-11
    Clears Heat and resolves Damp.
  • SJ-6
    Stimulates the smooth flow of Liver Qi and Clears Heat in the Shao Yang channels. GB24 to 34 with electricity can stop a GB stone attack-Very well treated
    If in acute phase, get them on herbs, off rich food, hook them up to electro-acupuncture. Can get fever in very acute phase.

Western Conditions

Three kinds of Gallstones:

  1. Calcium, which are white and hard
  2. Cholesterol, which are soft and green
  3. Combined

Gallbladder Deficiency

Clinical Manifestations

  • Dizziness
  • Blurred vision
  • Nervousness
  • Timidity
  • Propensity to being easily startled
  • Lack of courage and initiative
    Weakness of the Hun, Liver not housing the Hun. Deficiency of wood that manifests more as fear than anger.
  • Sighing

Tongue

  • Pale or normal tongue

Pulse

  • Normal, possibly weak

Pathology

This is Deficiency
Yang aspect of liver. Should give you the energy to face the world. Makes up for lack of a liver Qi Deficiency syndrome
Often combined with Liver Blood Deficiency

Etiology

None
Severe Deficiency of Blood may result in fear (esp. on going to bed at night) and lack of courage. Blood and Yin are the root of the Ethereal Soul (Hun).
Childhood wounding, abuse, repressed anger, kid who was always ridiculed

Treatment Principle

  • Tonify and warm the Gallbladder

Method

Reinforcing and Moxibustion if there is no heat

Points:

  • GB-40
    The Source point the tonify the Gallbladder, and it has a good effect on this particular mental aspect of the Gallbladder.
  • UB-48
    Outer back Xu of the Gallbladder
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