Depressed liver qì

Also:

• Liver depression and qì stagnation (肝郁气滞 gān yù qì zhì)
• Liver depression (肝郁 gān yù)
• Liver qì depression (肝气郁 gān qì yù)
• Binding depression of liver qì (肝气郁结 gān qì yù jié)

A disease pattern chiefly characterized by anger, frustration, and affect-mind depression; distension and pain in the chest, rib-side and lesser abdomen; menstrual irregularities.

Description: Anger, frustration, and affect-mind depression; sighing; distension and pain in the chest and rib-side or, in some cases, in the lesser abdomen, scurrying around with no fixed location; in some cases, plum-pit qì, goiter, scrofula, or a mass beneath the rib-side; in women, distension and pain in the breasts; menstrual irregularities, or menstrual pain; signs worsening in bad moods and relieved by good moods; thin white tongue fur; a stringlike pulse.

Diseases: Stomach duct pain; belching; vomiting; diarrhea; concretions, conglomerations, accumulations, and gatherings.

Pathogenesis: Impaired (deficient) free-coursing causing stagnation of qì and forming a repletion pattern. This results from

• excesses among the seven affects;
• spleen-stomach damp-heat or cold-damp invading the liver;
• liver blood vacuity.

Analysis of signs: Depressed liver qì can: affect the rib-sides and breasts on the liver channel; move cross-counterflow and affect the spleen and stomach; affect the thoroughfare (chōng) and controlling (rèn) vessels, inhibiting the normal flow of the menses; and cause blood stasis.

• Liver-channel signs: Distension and pain in the rib-side, and lesser abdomen, areas on the liver channel.
• Affect-mind: Anger, frustration, or affect-mind depression.
• Spleen and stomach: Distension and pain in the stomach duct and abdomen, sloppy stool, belching, vomiting, and sloppy stool. See combined patterns below.
• Women: Distension and pain in the breasts; menstruation at irregular intervals, and even menstrual pain and amenorrhea. Depressed liver qì causing blood stasis may manifest in clotted menstrual discharge.
• Erratic functions: Inhibited flow, a feature of qì stagnation, manifests in menstruation at irregular intervals (sometimes advanced and sometimes delayed); stool that is sometimes sloppy and sometimes bound; emotionality (laughing and weeping).
• Phlegm complication: When stagnant qì and phlegm bind together, there may be goiter, scrofula, or plum-pit qì.
• Stasis complication: When depressed qì gives rise to blood stasis, abdominal masses called concretions and conglomerations may arise.
• Tongue: Thin white tongue fur.
• Pulse: Stringlike pulse.

Treatment

Medicinal therapy: Depressed liver qì is treated by coursing the liver and rectifying qì. Medicinals commonly used to treat depressed liver qì include bupleurum (Bupleuri Radix, 柴胡 chái hú), curcuma (Curcumae Radix, 郁金 yù jīn), unripe tangerine peel (Citri Reticulatae Pericarpium Viride, 青皮 qīng pí), bitter orange (Aurantii Fructus, 枳壳 zhǐ ké), cyperus (Cyperi Rhizoma, 香附子 xiāng fù zǐ), toosendan (Toosendan Fructus, 川楝子 chuān liàn zǐ), corydalis (Corydalis Rhizoma, 延胡索 yán hú suǒ), perilla stem (Perillae Caulis, 紫苏梗 zǐ sū gěng), akebia fruit (Akebiae Fructus, 八月札 bā yuè zhá), liquidambar fruit (Liquidambaris Fructus, 路路通 lù lù tōng), lindera (Linderae Radix, 乌药 wū yào), and tangerine pip (Citri Reticulatae Semen, 橘核 jú hé).

Bupleurum Liver-Coursing Powder (柴胡疏肝散 chái hú shū gān sǎn) or Depression-Overcoming Pill (越鞠丸 yuè jú wán) may be used as a basic formula and varied according to need. Counterflow Cold Powder (四逆散 sì nì sǎn) plus cyperus (Cyperi Rhizoma, 香附子 xiāng fù zǐ), curcuma (Curcumae Radix, 郁金 yù jīn), and unripe tangerine peel (Citri Reticulatae Pericarpium Viride, 青皮 qīng pí) is a further option.

• When depressed qì transforms into fire, Moutan and Gardenia Free Wanderer Powder (丹栀逍遥散 dān zhī xiāo yáo sǎn) combined with Left-Running Metal Pill (左金丸 zuǒ jīn wán) can be used, adding gentian (Gentianae Radix, 龙胆 lóng dǎn) and rhubarb (Rhei Radix et Rhizoma, 大黄 dà huáng) for constipation.
• Liver qì invading the stomach can be treated with Left-Running Metal Pill (左金丸 zuǒ jīn wán).
• Liver-spleen disharmony can be treated with Free Wanderer Powder (逍遥散 xiāo yáo sǎn) or Pain and Diarrhea Formula (痛泻要方 tòng xiè yào fāng).
• Plum-pit qì is treated by downbearing qì and transforming phlegm with formulas such as Four-Seven Decoction (四七汤 sì qī tāng) or Pinellia and Officinal Magnolia Bark Decoction (半夏厚朴汤 bàn xià hòu pò tāng).
• Goiter is treated by rectifying qì and dispersing goiter with Sargassum Jade Flask Decoction (海藻玉壶汤 hǎi zǎo yù hú tāng).
• Menstrual problems arising when depressed liver qì affects the thoroughfare (chōng) and controlling (rèn) vessels can be treated with variations of Free Wanderer Powder (逍遥散 xiāo yáo sǎn).
• Epilepsy can be treated with Fit-Settling Pill (定痫丸 dìng xián wán).
• Accumulations and gatherings can be treated with Bupleurum Liver-Coursing Powder (柴胡疏肝散 chái hú shū gān sǎn) combined with Toosendan Powder (金铃子散 jīn líng zǐ sǎn) or Costusroot Qì-Normalizing Decoction (木香顺气汤 mù xiāng shùn qì tāng).
• Drum distension can be treated with Bupleurum Liver-Coursing Powder (柴胡疏肝散 chái hú shū gān sǎn) combined with Stomach-Calming Powder (平胃散 píng wèi sǎn), or Free Wanderer Powder (逍遥散 xiāo yáo sǎn) combined with Harmony-Preserving Pill (保和丸 bǎo hé wán).
• Most liver-coursing qì-rectifying medicinals are dry and aromatic, and therefore readily damage yīn-blood. This effect can be reduced by the inclusion of liver-emolliating medicinals such as white peony (Paeoniae Radix Alba, 白芍药 bái sháo yào), Chinese angelica (Angelicae Sinensis Radix, 当归 dāng guī), dried/fresh rehmannia (Rehmanniae Radix, 生地黄 shēng dì huáng), and lycium berry (Lycii Fructus, 枸杞子 gǒu qǐ zǐ).

Acumoxatherapy: Base treatment mainly on LR, PC, SP and back transport points. Select BL-18 (Liver Transport, 肝俞 gān shù), PC-6 (Inner Pass, 内关 nèi guān), LR-3 (Supreme Surge, 太冲 tài chōng), SP-6 (Three Yīn Intersection, 三阴交 sān yīn jiāo), LR-13 (Camphorwood Gate, 章门 zhāng mén), ST-36 (Leg Three Lǐ, 足三里 zú sān lǐ), LR-2 (Moving Between, 行间 xíng jiān), TB-6 (Branch Ditch, 支沟 zhī gōu), and GB-34 (Yáng Mound Spring, 阳陵泉 yáng líng quán); needle with even supplementation and drainage and add moxa.

Point selection according to the signs:

• For mental depression, add HT-7 (Spirit Gate, 神门 shén mén) and GV-26 (Human Center, 人中 rén zhōng).
• For oppression in the chest, add CV-17 (Chest Center, 膻中 shān zhōng).
• For rib-side pain and distension, add LR-14 (Cycle Gate, 期门 qī mén), GB-40 (Hill Ruins, 丘墟 qiū xū), and TB-5 (Outer Pass, 外关 wài guān).
• For pain and distension of the breasts, add CV-17 (Chest Center, 膻中 shān zhōng) and LR-14 (Cycle Gate, 期门 qī mén).
• For pain and distension in the lesser abdomen, add LR-5 (Woodworm Canal, 蠡沟 lǐ gōu), and LR-6 (Central Metropolis, 中都 zhōng dū). GB-32 (Central River, 中渎 zhōng dú).
• For plum-pit qì, add CV-17 (Chest Center, 膻中 shān zhōng), PC-5 (Intermediary Courier, 间使 jiān shǐ), and CV-22 (Celestial Chimney, 天突 tiān tú).

Combined patterns

Liver-spleen disharmony, characterized by distension and fullness and scurrying pain in the chest and rib-side, frequent sighing, torpid intake, abdominal distension, sloppy stool, rumbling intestines, and passing of flatus.

Liver-stomach disharmony, marked by distending or scurrying pain in the stomach duct, rib-side, with belching and acid swallowing.

Further developments: In addition to causing blood stasis, depressed liver qì, when persistent, can transform into fire, giving rise to liver fire flaming upward. Extreme qì depression may cause a counterflow upsurge of liver qì, one form of qì reversal.

Comparison:

Liver fire flaming upward: Depressed liver qì and liver fire flaming upward are both associated with inhibition of liver channel qì causing rib-side pain and distension of the breasts. However, liver fire flaming upward is associated with heat signs not observed in simple depressed liver qì. Depressed liver qì is often associated with diarrhea from a strong liver that restrains the spleen and poor appetite. Liver fire flaming upward is associated with heat signs such as scorching pain in the rib-side, as well as headache, dizziness, tinnitus, deafness, red face and red ears. When liver fire scorches the blood network vessels, there may be blood ejection or spontaneous external bleeding.