Liver qi stagnation: signs, causes, diet, and formulas

Liver qi stagnation, gan qi yu jie, is the pattern in which the Liver fails in its charge of free-coursing (shu xie), the smooth and even movement of qi through the whole body, so that qi knots along the Liver channel and wherever emotion is felt: the flanks and ribs, the chest and breasts, the throat, the lower abdomen. Its signature is distension rather than pain, frequent sighing, a mood that swings between irritability and low spirits, symptoms that come and go with emotional state, and a wiry pulse. It is the most common excess pattern in modern practice and the starting point from which Liver fire, Liver invading the Spleen, Blood stasis, and phlegm nodules develop.

Recognising the pattern

Distension and a sense of oppression below the ribs and in the chest, moving from place to place, often more on one side; sighing, which is the body's own attempt to move qi; irritability, frustration, and a low mood that lifts with movement or an outburst; a sensation of something lodged in the throat that can be neither swallowed nor coughed up, the plum-pit qi (mei he qi) of the Jingui Yaolue; breast distension and tenderness before the period, premenstrual irritability, an irregular cycle, and painful periods with clots once stasis has followed; abdominal bloating, belching, and a bowel that alternates between constipation and loose stool; an appetite that fails with the mood rather than with the stomach.

The tongue is often unchanged, or slightly red at the sides where the Liver is read, with a thin white coat; in this pattern the pulse carries the diagnosis. The pulse is wiry (xian), like a string pulled taut, most clearly at the left middle position, which belongs to the Liver. Timing distinguishes it: worse with pressure and confinement, better after exercise, weeping, or a walk; waking between one and three in the morning, the Liver's hours on the organ clock, with irritability rather than heat.

The neighbours: Liver fire shows a red face and eyes, a bitter taste, real anger, a red tongue with a yellow coat, and a wiry rapid pulse. Liver Blood deficiency shows pallor, dizziness, floaters, a scanty period, and a thin wiry pulse. Liver invading the Spleen shows abdominal pain relieved by passing a loose stool.

Causes

The Suwen makes the Liver the general among the organs, from whom planning and strategy issue; a general who cannot act stagnates. Anger held in, frustration, resentment, and grief that cannot move bind the qi, and the tradition treats repressed emotion, not stress in the abstract, as the cause. The Liver is yin in substance and yang in function, so a Liver short of the Blood it stores becomes harsh and stagnates readily; the menstrual cycle draws on that Blood, which is why the pattern is more common in women. A sedentary life stagnates qi that is never moved. Irregular eating weakens the Spleen, and a weak earth cannot hold the wood that overacts on it.

Treatment principle and formulas

The principle is to soothe the Liver and regulate qi (shu gan li qi), nourishing the Blood and fortifying the Spleen where they are deficient and clearing heat where stagnation has produced it. The formulas form a ladder:

• Xiao Yao San, from the Taiping Huimin Heji Ju Fang, for stagnation with Blood deficiency and Spleen weakness: tense and tired, irregular periods.
• Chai Hu Shu Gan San, from Zhang Jingyue's Jingyue Quanshu, for stagnation with pain and no deficiency: Chai Hu 6 to 9 grams, Chen Pi 6 grams, Chuan Xiong 6 grams, Xiang Fu 6 to 9 grams, Zhi Ke 6 grams, Bai Shao 9 grams, Zhi Gan Cao 3 grams.
• Jia Wei Xiao Yao San, for stagnation turned to heat, with Mu Dan Pi and Zhi Zi added.
• Si Ni San, from the Shanghan Lun, for qi bound inward with cold hands and feet and a deep wiry pulse.
• Yue Ju Wan, Zhu Danxi's pill for the six stagnations, where qi stagnation has drawn food, damp, phlegm, and fire after it.

The single herbs that regulate Liver qi: Xiang Fu, Cyperi Rhizoma, 6 to 12 grams; Chen Pi, aged tangerine peel, 3 to 9 grams; Mei Gui Hua, rose bud, 3 to 6 grams steeped; Fo Shou, finger citron, 3 to 9 grams; He Huan Pi, albizia bark, 9 to 15 grams for the mood. Their points: LR3 Taichong with LI4 Hegu, the four gates that open the whole body's qi; GB34 Yanglingquan; PC6 Neiguan for the chest; LR14 Qimen and CV17 Shanzhong for the ribs and breasts.

Diet and daily life

The Liver is eased by food that is pungent, light, aromatic, and slightly cool: mint, the peel and juice of citrus, rose buds and chrysanthemum steeped as tea, fennel, dill, basil, radish, celery, and a little sour taste, vinegar or a plum, since sour enters the Liver. Heavy and greasy food, alcohol beyond a small amount, and sweets in quantity burden the Spleen and thicken the stagnation, and a meal eaten in anger stagnates before it is digested. The Liver rules the sinews, and the pattern is treated as much by walking, stretching, and qigong as by herbs; the Liver's sound in the six healing sounds, xu, is breathed out long and slow.

Not medical advice.