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Ascendant hyperactivity of liver yáng

肝阳上亢 〔肝陽上亢〕gān yáng shàng yàng

Also:

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:

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 SignsNoneTidal heat effusion, tidal reddening of the cheeks
Other DifferencesThirst, dry stool, yellow urineRed face, vexation and insomnia, heavy head and light feet, limp aching lumbus and knees
PulseRapidStringlike and forceful or stringlike, fine, and rapid

Analysis of signs

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:

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.

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