Liver failing to store blood

Failure of the liver to perform its function of storing the blood. This concept is the subject of controversy among scholars.

Storing blood usually means ensuring sufficient supplies of blood to nourish the liver itself and its related organs. Hence, the liver failing to store blood means the liver not having enough blood to provide nourishment, that is, insufficiency of liver blood.

According to one traditional view, storing blood also includes the function of containing the blood within the vessels, that is, the prevention of bleeding (vomiting of blood, expectoration of blood, nosebleed, and in women, profuse menstruation or flooding and spotting). This is variously explained in terms of liver qì retaining the blood, liver yīn governing congealing, and/or liver blood being sufficient to counteract excessive upbearing and stirring of yáng qì that can stir the blood.

While modern scholars recognize preventing bleeding as part of the liver’s function of storing blood, they argue that the liver failing to store blood causes bleeding usually only when other factors are involved. The fact that treatments address the other factors suggests that these are the most important. Liver qì vacuity failing to retain the blood occurs with the spleen failing to control the blood and is treated by fortifying the spleen. Liver yīn vacuity failing to congeal the blood occurs with qì vacuity so that in treatment enriching liver yīn-blood is complemented by a qì-supplementing action. Liver fire involves counterflow ascent of qì, and in treatment clearing and draining of liver fire is complemented by a qì-downbearing action.

Standard textbook listings of causes of bleeding do not include the liver failing to store the blood. They generally ascribe bleeding to (1) damage to blood vessels in trauma, (2) static blood blocking the vessels and preventing the blood from pursuing its normal courses, (3) spleen failing to control the blood (qì failing to contain the blood), or (4) fire-heat or yīn vacuity with effulgent fire causing frenetic movement of hot blood or, the case of upper-body bleeding, fire-qì ascending counterflow, forcing blood upward. This seems to suggest a modern view that bleeding that may have been previously ascribed by some to the liver failing to store blood can be simply explained in terms of fire-qì ascending counterflow (as when liver fire causes vomiting of blood or nosebleed) or by the spleen failing to control the blood.

This is borne out by standard modern Chinese diagnostic texts: These generally do not recognize liver qì vacuity as a pattern and attribute qì failing to contain the blood to the spleen failing to control the blood. They do not include profuse menstruation or flooding and spotting in any liver pattern. They suggest that these signs can occur in kidney yīn vacuity as a result of vacuity fire. Of course, liver yīn vacuity often stems from kidney yīn vacuity (water failing to moisten wood) and hence the two often occur together. Furthermore, modern texts state that liver fire flaming upward can be responsible for upper body bleeding but attribute it directly to the effect of fire rather than to the liver failing to store blood.