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Ascendant hyperactivity of liver yáng
肝阳上亢 〔肝陽上亢〕gān yáng shàng yàng
Also:
- Liver yáng (肝阳 gān yáng)
- Liver yáng ascending counterflow (肝阳上逆 gān yáng shàng nì), also counterflow ascent of liver yáng.
- Effulgent liver yáng (肝阳偏旺 gān yáng piān wàng)
A disease pattern chiefly characterized by dizziness; tinnitus; headache; distension in the head; heavy head and light feet; red face and red eyes; limp aching lumbus and knees.
Description: Dizziness; tinnitus; headache; distension in the head; red face; red eyes; impatience, agitation, and irascibility; insomnia and profuse dreaming; heavy head and light feet (top-heaviness); limp aching lumbus and knees; red tongue with scant liquid; a pulse that is stringlike and forceful or stringlike, fine, and rapid.
Biomedical correspondence: hypertension.
Pathogenesis: Liver yáng hyperactive in the upper body as a result of depletion of liver yīn in the lower body. Hence it is a vacuity-repletion complex. This stems from any of the following factors:
- liver-kidney yīn vacuity failing to keep liver yáng in check, often referred to as
water failing to moisten wood
(水不涵木 shuǐ bù hán mù); - general yáng exuberance and rash, impatient nature; liver qì depression stemming from anger, worry, and anxiety, transforming into fire and damaging to yīn humor.
| Comparison Between Liver Fire Flaming Upward and Ascendant Hyperactivity of Liver Yáng | ||
|---|---|---|
| Liver Fire | Ascendant Liver Yáng | |
| Common Signs | Dizziness, impatience, agitation, and irascibility | |
| Heat Signs | None | Tidal heat effusion, tidal reddening of the cheeks |
| Other Differences | Thirst, dry stool, yellow urine | Red face, vexation and insomnia, heavy head and light feet, limp aching lumbus and knees |
| Pulse | Rapid | Stringlike and forceful or stringlike, fine, and rapid |
Analysis of signs
- Upper body heat signs: When liver yáng ascends counterflow, the upward movement of qì and blood manifests in red face, eyes, and tongue, and in dizziness, distension, and pain in the head and eyes.
- Spirit: When ascendant hyperactivity of liver yáng harasses the spirit, we see impatience, agitation, and irascibility, as well as insomnia and profuse dreaming.
- Upper body exuberance and lower body vacuity: Heavy head and light feet and limp aching lumbus and knees.
- Tongue: Red tongue with scant liquid, reflecting yáng exuberance.
- Pulse: Stringlike, fine, and rapid. The stringlike quality reflects the disturbance of free coursing. The fineness reflects yīn vacuity, while the rapidity reflects the hyperactive yáng.
Comparison: Liver fire flaming upward is similar in that it manifests in upper body repletion signs associated with excessive free coursing. It differs in that it is rooted in liver yīn vacuity with an underlying kidney yīn vacuity (water failing to moisten wood
), making it a vacuity-repletion complex. See table.
Treatment
Medicinal therapy: Enrich yīn, calm the liver, and subdue yáng using tiān má gōu téng yǐn (天麻钩藤饮 Gastrodia and Uncaria Beverage) or qǐ jú dì huáng wán (杞菊地黄丸 Lycium Berry, Chrysanthemum, and Rehmannia Pill).
Acumoxatherapy: Base treatment mainly on LR, GB, and KI. Needle with drainage at LR-3 (Supreme Surge, 太冲 tài chōng), LR-2 (Moving Between, 行间 xíng jiān), and GB-43 (Pinched Ravine, 侠溪 xiá xī); and with supplementation at BL-18 (Liver Transport, 肝俞 gān shù), BL-23 (Kidney Transport, 肾俞 shèn shù), KI-3 (Great Ravine, 太溪 tài xī), and SP-6 (Three Yīn Intersection, 三阴交 sān yīn jiāo).
Point selection according to signs:
- For irascibility, add PC-6 (Inner Pass, 内关 nèi guān). For dizziness, add GB-20 (Wind Pool, 风池 fēng chí).
- For distension and pain in the head, add Greater yáng (tài yáng) (
太阳 tài yáng) and LI-4 (Union Valley, 合谷 hé gǔ). For tinnitus, add TB-17 (Wind Screen, 翳风 yì fēng) and GB-39 (Severed Bone, 绝骨 jué gǔ). - For insomnia, add HT-7 (Spirit Gate, 神门 shén mén), PC-6 (Inner Pass, 内关 nèi guān), and Alert Spirit Quartet (
四神聪 sì shén cōng). - For heart palpitation, add HT-7 (Spirit Gate, 神门 shén mén), PC-6 (Inner Pass, 内关 nèi guān), and BL-15 (Heart Transport, 心俞 xīn shù).
- For lumbar pain, add GV-3 (Lumbar Yáng Pass, 腰阳关 yāo yáng guān), BL-40 (Bend Center, 委中 wěi zhōng), and ouch points (
阿是穴 ā shì xué). - For weakness in the legs, add GB-34 (Yáng Mound Spring, 阳陵泉 yáng líng quán), ST-36 (Leg Three Lǐ, 足三里 zú sān lǐ), and GB-39 (Severed Bone, 绝骨 jué gǔ).
Further developments: Liver yáng transforming into wind, one form of liver wind stirring internally.
Clinical sketch: A 46-year-old Chinese male complains of tinnitus, flowery vision, and dizziness that he described as resembling the sensation of sitting in a boat. He sometimes suffered from clamoring stomach, upwelling, and nausea. He had palpitation and insomnia. He was diagnosed in Western medicine as having Ménière’s disease. The pulse was weak at the cubit position on both wrists, and stringlike and large on the cubit of the left hand. The diagnosis was insufficiency of liver yīn and ascendant hyperactivity of liver yáng, with concomitant phlegm-damp causing internal obstruction.