LIVER Flashcards
LV blood stagnation
hypochondrial or abd. pain, vomiting blood, epistaxis, painful period, irregular period, menstrual blood dark and clotted, infertility
T n/a
P choppy or irregular
key
- sharp pain or masses along LV channel,
- plus blood stagnation
LV fx
The two most important functions of the Liver include:
1. Ensure smooth flow of qi
● “Governs coursing and discharging”
-
Storing Blood
● Storing blood, retaining blood, and regulating its circulatory volume
The Liver regulates emotional activities
2. Assists digestion and absorption
3. Promotes the smooth flow of qi, blood and
water
4. Helps in water metabolism
5. Regulates reproductive function
Stores blood, nourishes Liver,
controls Liver Yang, and
prevents bleeding
2. Regulates Blood volume:
according to the body’s
activities, the Liver increases
or decrease blood volume
inside the body to nourish
organs and tissues as needed
cold stagnation in LV channel
usually caused by being out in the cold
sagging distention and pain of pudendum
lower abdomen cold pain
cold limbs
vertex headache
T moist, white tc
P deep slow and tight
Tx warm liver decoction
clear liver points
Yin Deficiency
Generating Wind
LV and KD yin xu
- trembling,
- LV sx and
- yin xu heat sx
Blood Deficiency Generating Wind
malnutrition of tendons meridians
- numbness in limbs
- stiff joints, muscle spasms,
- trembling hands and feet,
- itching
- & dizziness, tinnitus
Extreme Heat Generating Wind
extreme heat consumes body fluid, leads sinews/tendons to spasm. or extreme heat invade PC reversely during exogenous febrile disease.
sx:
- high fever
- irritability, fidgeting, coma, spasm, convulsion, stiff neck
- opistotonus, lockjaw, upward or straight staring eyes
t deep red, dry yellow tc
p wiry, rapid
Liver Yang Transforming into Wind
sx:
- dizziness, vertigo, tend to fall, shaking head, headache, neck stiffness, slurred speech, limb numbness, hand and feet trembling, staggering
- sudden loss consciousness, deviated mouth/eyes, hemiplegia, difficult speech, rattling sound in throat
t red, white or greasy tc
p wiry, thready forceful
4 causes of LV wind stirring internally
Liver Wind Stirring Internally (also referred to as Liver Wind Agitating Within)
1. Liver Yang Transforming into Wind
2. Extreme Heat Generating Wind
3. Blood Deficiency Generating Wind
4. Yin Deficiency Generating Wind
Liver Yang Rising Pattern
肝阳上亢証
gān yáng shàng yàng zhèng
Definition: hyperactivity of Liver yang with Liver and Kidney Yin deficiency
Clinical Manifestations: Dizziness, vertigo, tinnitus, distending pain in the head and eyes, flushed face, congested eyes, vexation, lassitude in the loins and legs, lumbar and knee soreness and weakness, feeling heaving in the head, ‘top heavy’, tendency to fall, insomnia and dream-disturbed sleep, poor memory.
Tongue: Red, scanty or no tc if there’s more yin xu
Pulse: Wiry and rapid
Key Points: Distending pain in the head and eyes, dizziness, vertigo, ‘top heavy’ feeling, lumbar and knee soreness and weakness
Liver Fire Blazing Pattern
肝火上炎証
gān huǒ shàng yán zhèng
Definition: flaring up of qi and fire in the Liver channel
Clinical Manifestations: Dizziness, vertigo, distending headache, flushed face, conjunctival congestion, bitter taste and dryness in the mouth, irritability, burning pain in the chest and hypochondrium, insomnia, dream-disturbed sleep, sudden tinnitus and deafness, dry stool and
yellow urine, nosebleed or hematemesis.
Tongue: Red tongue with yellow tc
Pulse: Wiry and rapid
Key Points:
- Dizziness, vertigo,
- distending headache,
- tinnitus or deafness,
- plus interior excess heat signs and symptoms.
Liver Qi Stagnation Pattern 肝气郁証
gān qì yù zhèng
Definition: Liver’s failure to course and discharge, which inhibits the smooth flow of qi
Clinical manifestations: Distending pain in the hypochondria or lateral abdomen (shao fu), sensation of chest oppression, frequent sighing, depression, short temper, irregular
menstrual cycle, premenstrual syndrome, distending breast pain, dysmenorrhea. There may possibly be plum-pit syndrome (globus hystericus) or goiter
Tongue: n.a. doesn’t rly change
Pulse: Wiry
Key Points:
- Depression,
- distending hypochondrium/ lateral abdomen pain,
- irregular menstrual cycle,
- wiry pulse,
- plus qi stagnation
causes
- emotional stress
- Improper diet: overconsumption of alcohol, or greasy food
- Exopathogens: Wind-cold, wind-dampness, etc. These exterior pathogenic factors may cause phlegm, dampness or blood stasis
which obstructs the Liver channel, leading to Qi stagnation
- Chronic illness may lead to qi and blood deficiency, which deprives the Liver of proper nourishment, and impairs its function of coursing and discharging
Liver Yin Deficiency
肝阴虚証 gān yīn xū zhèng
Definition: insufficient yin fluid in the Liver
Clinical Manifestations: Dizziness, tinnitus, dry eyes, blurry vision, hypochondriac pain with burning sensation, hot flashes, low-grade fever in the afternoon or evening,
five-center heat (palms chest soles), night sweats, trembling hands and feet
Tongue: Red, with dry coating
Pulse: Thin, wiry and rapid
Key Points:
- Malnourishment of eyes, sinews, and nails,
- plus yin deficiency
Etiology
- Long-term and excessive emotional stress
- causes qi stagnation
- which generates heat,
- which in turn impairs Yin
Treatment Principle: Tonify the Liver, nourish Yin, clear Empty-Heat if necessary
Acupuncture Method: Reinforcing, except for LIV-2 which is sedated. No moxibustion.
Formula: 一贯煎 yī guàn jiān
Linking Decoction, a.k.a. All the way through Brew
Liver Blood Deficiency
肝血虚証 gān xuè xū zhèng
TEN
* tendons
* eyes
* nails
Definition: Liver and other organs lacking nourishment due to insufficient blood.
Clinical Manifestations: Dizziness, tinnitus, blurry vision, dry eyes, night blindness, floaters, pale brittle or withered nails, numbness of the limbs, muscle twitching, joint stiffness, and trembling of hands and feet. Scanty menses with light-colored bleeding, dysmenorrhea or
amenorrhea, pale lips.
Tongue: Pale
Pulse: Thin wiry
Key Points:
- malnourishment of tendons, eyes, and nails,
- plus blood deficiency
Treatment Principle: Tonify the Liver, nourish the Liver Blood
Acupuncture: Reinforcing, moxibustion may be used
formula: 補肝湯bǔ gān tāng Tonify the Liver Decoction
LV primary functions
- Ensuring the smooth flow of qi
● “Governs coursing and discharging” - Storing Blood
● Storing blood, retaining blood, and regulating its
circulatory volume
LV major clinical manifestations
SHWIM
stress
hypochondriac pain or distention
wind (internal)
menstrual
LV patterns
Excess Patterns
* Liver Qi Stagnation
* Liver Fire Blazing
* Liver Wind Stirring Internally
* Cold Stagnation in the
* Liver Channel
* Liver Blood Stagnation
Excess/Deficiency Pattern
* Liver Yang Rising
* Liver Yin Deficiency
* Liver Blood Deficiency
* Extreme Heat Generating Wind
* Liver Yang Transformed into Wind
Deficiency Patterns
* Blood Deficiency Generating Wind
* Yin Deficiency Generating Wind
Primary signs and symptoms of Liver
Wind include:
● Spasms
● Tremors
● Tics
● Convulsions
● Paralysis
● Tingling or numbness in the limbs
● Muscle twitching
● Seizures
● Hemiplegia
two classifications of Wind Symptoms:
There are two classifications of Wind Symptoms:
1. Group 1: Dizziness, vertigo, headache with a pulling sensation and/or loss of consciousness (i.e., symptoms located in the head area)
● Caused by disturbance of sensory orifices of the head and brain, referred to as the clear orifices 清竅 qīng qiào
● The disturbance of the sensory orifices is caused by pathogenic factor or lack of nourishment
- Group 2: Tense and stiff neck, tics, tremors, convulsions, paralysis, tingling or numbness of the limbs, seizures, hemiplegia, deviated or stiff tongue, and wiry pulse
● Caused by spasms of the tendons, sinews and muscles
Liver Fire Blazing
vs.
Heart Fire Blazing
Pathogenesis
* LV FIRE: Qi stagnation transforms into fire and flares up along the Liver channel
* HT FIRE: Internal excess heat disrupts the Heart
Common
* Insomnia, irritability, dream-disturbe sleep, bitter taste in the mouth, red face, thirst and preference for cold
water, yellow urine, dry stool, red tongue with yellow coating, rapid pulse, or nosebleed, hematemesis
Different
* Dizziness, distending headache, conjunctival congestion, burning pain in hypochondrium, sudden tinnitus and deafness
* Vexation, hot sensation in the chest, palpitations, tongue ulcers, rapid and forceful pulse, manic behavior, delirium, burning painful urination
Tongue & Pulse
* Red tongue with yellow coating, rapid pulse
Treatment strategy Clear Liver fire Clear Heart Fire
Herbal Formulas Jia Wei Xiao Yao San, Chai Hu Qing Gan Wan Xie Xin Tang, Dao Chi San Symptoms
pattern that causes wind stroke?
LV fire
LV yang rising
LV fire blazing
vs
LV yang rising
LV fire blazing
- more acute
- excess heat
- Red tongue with yellow coating,
- Pulse Wiry and rapid
LYR
- gradual onset and chronic
- LYR is excess + deficiency. excess above with deficiency below
- thin yellow tc, dry coating,
- wiry thready pulse
distinguish
lv extreme heat
liver yang
lv blood xu
lv yin xu
lv extreme heat
- excess heat
- convulsion, stiff neck, lockjaw, opistotonus, upward/straight staring eye
- high fever, fidget, coma
- t red/deep red
- p rapid, wiry, forceful
liver yang
- KD LV yin xu, LV yang hyperactive
- heat, excess above, deficiency below
- severe vertigo, tremor, difficult speech, sudden coma, hemiplegia
- HA, stiff tongue, staggering
- t red
- p wiry, may be thready, forceful
lv blood xu
- xu heat
- numbness, trembling, twitching, stiff joints
- paleness, dizziness
- t pale
- p thready, weak
lv yin xu
- xu heat
- tidal fever, night sweat
- t red, cracked with little tc
- p thready, rapid, weak
Liver Relationships
Spirit Ethereal Soul 魂 hún
Internal-external connection Gallbladder
Open orifice Eyes
Controls Tendons and Sinews
External manifestation Nails
Fluid Tears
Fire Ministerial fire
Emotion Anger
Season Spring
Five Phase Wood
Six Climate Factor Wind
Physiological characteristics of the Liver
In relation to Qi, the most important pattern is Liver Qi stagnation
● The Liver only very rarely suffers from deficiency of Qi
Deficiency
- Liver Qi deficiency does occur, manifesting primarily on a psychological level, with symptoms such as depression, shyness and lack of initiative
- The Liver does encounter patterns of deficiency of Blood and Yin
- Blood may easily be depleted, giving rise to Blood deficiency and scanty
periods
○ Blood may also become stagnant, often due to stagnation of Liver Qi
○ ‘Qi is the commander of Blood’ and when Qi stagnates, Blood congeals
Liver and the Sinews
● The relationship between the Liver and the Sinews very often manifests in pathology of the muscles and fatigue
● Physical tiredness with weakness or contraction of the tendons may be seen
Liver pathology also involves pathological changes that
develop very rapidly (just like Wind) such as:
● Sudden tinnitus
● Skin rashes appearing out of the blue
● Sudden outbursts of anger
● If severe, sudden collapse and coma
LV 6 channel pairing
internal/external pair
In the Six-Channel pairing the
Liver Foot Jueyin
Pericardium Hand Jueyin
Internal/external
LV GB
Liver Disease Patterns (12)
Excess Patterns (5)
* Liver Qi Stagnation
* Liver Fire Blazing
* Liver Wind Stirring Internally
* Cold Stagnation in the Liver Channel
* Liver Blood Stagnation
Excess/Deficiency Pattern (5)
* Liver Yang Rising
* Extreme Heat Generating Wind
* Liver Yang Transformed into Wind
* Blood Deficiency Generating Wind
* Yin Deficiency Generating Wind
Deficiency Patterns (2)
* Liver Yin Deficiency
* Liver Blood Deficiency
