Zang Fu Patterns: LV Main Patterns Flashcards
What are the two primary functions of the Liver?
- Liver ensure smooth flow of Qi (throughout the body, in all directions)
- Liver stores Blood (Xue)
What is the importance of free flowing qi?
Any activity that depends on Qi depends on the Liver’s flowing and spreading function. Gan rules the evenness of Qi flow, smooth, unobstructed movement of Substances through the body and hence the harmony and regularity of body functions and behaviour.
Failure of this function forms the basis of Gan pathology. It results in obstruction, blockage and stagnation of not only the flow of Qi but other substances by connection to qi.
What are the four main facets of the free-flowing function of Gan?
- Harmony of Emotions
- Harmony of Digestion
- Secretion of Bile
- Harmony of Menstruation
How does obstruction of qi flow affect emotions?
When Qi flows normally, emotions are approximate and easy. When the spreading of Qi impaired or the circulation of Qi restrained, there is a disharmony between the individual and environment. This involves the intellectual faculties of planning and decisions making. There will be emotional depression, frustration, repressed anger, and physical symptoms.
What emotion is most connected to Liver disharmony?
Anger: “Anger makes Qi rise and Blood stagnate in the chest.”
What are the primary symptoms that result from Liver Qi stagnation?
Stagnation along channels related to Liver: hypochondriac and costal pain, “plum pit Qi”, chest oppression, swollen/tender breasts and genitals, lower abdominal pain.
How is the harmony of digestions affected by impairment of Qi flow?
Digestion and the Liver - Five element: Wood controls Earth.
The Gan function of free flowing of Qi is necessary for the activity of Pi and Wei (SP/ST) in digestion and is important to ensure harmonious Qi movement in the Middle Burner. Also if Gan is disharmonious, stagnant Gan Qi may overflow, “invade” or “attack” horizontally into Pi and Wei (Wood overacts on Earth)
How does the obstruction of Qi flow affect secretion of bile?
Smooth flowing of Liver Qi affects bile flow. Stagnant Liver Qi can obstruct bile flow (bitter taste, belching, or jaundice).
How does obstruction of qi flow affect harmony of menstruation?
The free flowing function of Gan is important for menstruation where there must be an even, unobstructed flow of Qi and Xue. This is related to the second function of the Liver, storage of Blood.
What is the Liver’s role in storing blood (TCM)?
Gan stores Xue, and regulates the quantity of Blood in circulation at any given time. When the body is active, Xue moves out of Gan into circulation and returns to the Liver at rest. Disharmony of this function may result in too little or too much Xue in circulation or in irregular fluctuations in the volume of circulating Xue.
How does the TCM liver function of storing blood correlate with true physiological function?
The liver produces albumin, the most abundant protein in blood serum. It is essential in the maintenance of oncotic pressure, and acts as a transport for fatty acids and steroid hormones. If there is not enough albumin, water leaves the blood vessels and causes swelling and low blood pressure.
The liver synthesizes angiotensinogen, a hormone that is responsible for raising the blood pressure when activated by renin, an enzyme that is released when the kidney senses low blood pressure.
How does the Liver storage of blood affect energy level and muscle function?
When at rest, Blood returns to Liver (Liver contributes to restoring energy). When body is active, Blood nourishes muscles to enable them to perform.
Blood regulation function influences energy level: if this function impaired, lack of Blood (= nourishment) where needed, hence easily tired.
If Liver Blood is deficient, there can be muscle cramps, tics and twitches or tremors/shaking in muscles. (Liver Wind from Blood Deficiency)
What is the liver’s role in gynecology?
Liver is very important in gynecology. If Blood storage function is abnormal, e.g. Liver Blood is deficient, menstrual problems e.g. amenorrhea, oligomenorrhea. If Liver is Hot or Excess, menorrhagia or metrorrhagia can occur.
If Liver Qi stagnant, Liver Blood can stagnate (dysmenorrhea, PMS, dark clots).
Liver malfunction influences energy of Ren Mai & Chong Mai which are closely related to uterus.
How do blood and liver function affect each other?
Blood & Liver function reciprocally affect each other. Where Blood is Deficient or Hot, Liver function can be affected. If Liver function abnormal, can affect quality of Blood. For example: If Liver is Hot, Blood can become Hot (causing skin eruptions, eczema, etc.: Blood becomes heated by being stored in a hot “container”).
What are all of the main functions of the Liver?
- Ensures smooth flow of Qi
- Stores blood
- Rules the Tendons (controls sinews)
- Opens into the eyes
- Manifests in the nails
- Houses the Hun (ethereal soul)
- Influences rising and growth
- Controls planning
How does the Liver rule the tendons (and affect muscles)?
The Liver controls the Sinews (tendons), or the contractile aspect of the muslces. The Spleen controls the muscles, or the mass or bulk. Liver imbalances are more likely to affect movement, and Spleen weakness more likely affects flaccidity, atrophy, etc.
How does liver blood affect tendons?
Sinews (tendons) depend on Liver Blood to moisten and nourish them so they can contract and relax as needed (smooth movement of joints and good muscle action). Deficient Liver Blood leads to lack of nourishment in the tendons, which leads to contractions, spasms, impaired extension/flexion, numbness of limbs, cramps, tremors, muscle weakness, etc.
All of the Zang Fu are involved in the proper function of the eyes and various Zang Fu disharmonies manifest in the eyes. Which functions/disharmonies are associated with the liver?
Gan Qi is associated with the ability to distinguish colours and with good vision.
- Deficient Gan Xue results in blurred vision, myopia, “floaters” color blindness, dry “sandy” eyes.
- Heat or Blazing Gan Fire results in red, sore and irritated eyes
- Stirring of Gan Wind results in tremor of the eyeball
Liver manifests in the nails, how do they look in health and disharmony?
If Gan stores and regulates Xue properly the nails are pink and well-formed. The finger and toe nails are the outgrowth of sinews and are influenced by Liver Blood. When Liver Blood is deficient, the nails will lack nourishment and become pale or dark, indented, dry, cracked, brittle, etc.
Liver houses the Hun, what does this mean?
The Hun is also called the ethereal Soul. Hun is related to ability to be resolute, to plan and have creative drive and assertiveness. When the Liver is out of balance in excess for instance, this becomes anger.
How does the liver influence rising and growth?
Energy moves up and out like tree (Wood element). The liver also relates to growth in the sense of personal growth, ability to change. People who feel stuck in life or a situation usually have Liver Qi Stagnation.
How is the liver connected to planning?
Liver gives capacity to plan. Said to be like General of an army (Gall Bladder gives ability to make decisions, hence very closely linked).
What are signs that are most common to all Gan Patterns of disharmony?
Digestive disorders, emotional disharmonies (irritability, anger), menstrual or testis problems (free flowing qi)
Afflictions of the tendons, eyes and head eg. numbness of limbs, trembling hands, convulsion (Tissues and Orifices ruled by Gan)
Distending, burning or dull pain in chest/hypochondrium, lower abdomen and head, dizziness and blurred vision (Gan Jing Luo passes through and connects with head, eyes, hypochondriac and genital regions)
What are the common Liver disharmony patterns?
- Liver Qi Stagnation
- Liver Blood Stagnation
- Liver Fire
- Liver Blood Deficiency
- Liver Yin Deficiency
- Liver Yang Rising
- Stirring of Liver Wind
- Cold Stagnation in the Liver Channel
- Damp-Heat in the Liver and Gallbladder
What are the most common etiologies of liver disorders?
- Emotional Disturbance According to Five Element theory, anger and other related emotions such as resentment, unfulfilled desires, frustration, etc. are attributed to the Liver. The relationship between an organ and its corresponding emotion is reciprocal. The Liver for instance, is responsible for the free and smooth flow of Qi, which has a deep relationship with a person’s emotional state. Conversely, anger, repressed emotions, etc. affect the Liver organ itself, and disrupt the smooth flow of Qi in the body.
Over a long period of time, stagnation of Liver Qi impairs circulation of Qi and can cause emotional states of constant low level anger, depression, and resentment. These may be transferred to and appear in the physical body, such as the chest, breasts in women, hypochondriac region, epigastric region, or throat. Stagnation of Liver Qi, therefore, produces feelings of tightness in the chest and hypochondriac region, often with frequent sighing, pain and swelling of the breasts, tension in the stomach, the sensation of a lump in the throat.
Liver Qi may “rebel” upward and cause Liver Yang to rise. Symptoms include irritability, headaches, and the propensity to lose one’s temper.
- Diet Excessive greasy and hot foods can cause Liver Fire. Examples of hot foods: Lamb, beef, curry, and other spices. Examples of damp or greasy foods: Deep fried food and alcohol.
Not enough warming foods, such as meat and grains, can contribute to inadequate Blood production and Blood Deficiency. Blood Deficiency, in turn, can lead to Liver Blood Deficiency. Women are particularly prone to Blood Deficiency especially at puberty, after childbirth, and somewhat after each period.
What is the etiology of Liver Qi Stagnation?
- Emotional disharmony, especially repressed anger, resentment, frustration, over a long time, which impairs the circulation of Liver Qi.
- Invasion of pathogenic factors
- 1 & 2 —> Stagnation of liver qi —> accumulation of phlegm, blood stasis
- May have preexisting LV BL Xu
- May have preexisting KI Xu
Why are women more prone to Liver Qi Stagnation during premenstrual time?
Women during the premenstrual time are naturally more prone to stagnation-related problems, since at this time Blood is collecting in the uterus and Qi levels are diminishing.
What are some Western diseases associate with Liver Qi Stagnation?
Chronic hepatitis
Chronic cholecystitis
Chronic gastritis
Gastric/duodenal ulcers
Menopausal syndrome
Mental Health problems
What key signs of Liver Qi stagnation arise from Jing Luo pathology?
Sensation of distention in hypochondrium and chest, sighing, sensation of Plum Pit Qi, lumps along Jing Luo
The pain is not severe, may move in location and come and go. Depression of Gan may invade the throat combining with Phlegm to cause the feeling of a lump in the throat. This also comes and goes with depression. Qi and blood may stagnate along the course of the channel forming lumps.
What key signs of Liver Qi Stagnation are connected to the emotions?
Depression, frustration, irritation, anger
Physical, emotional and mental vitality are stagnant and depressed, the individual has low spirits. Depression may be punctuated with outbursts of anger and irritability.
This pattern emphasizes the important of emotional disturbance in etiology. Depression may precipitate digestive and gynecological disharmonies as well as pain and discomfort along the course of Gan Jing Luo.
What are the key signs of Liver Qi Stagnation associated with digestion?
There is a very close relationship between Gan and Dan, Pi and Wei. If depression of Gan Qi invades Pi/Wei, there may be a mixture of these organ signs. If Gan invades Wei predominantly, Qi tends to ascend causing nausea, belching, sour regurgitation, vomiting and epigastric pain. If it invades Pi, Qi tends to descend causing borborygmus, loose stools and abdominal pain.
What are the key signs of Liver Qi Stagnation associated with bile?
If depression of Gan Qi impairs bile secretion, there may be jaundice, bitter taste and vomiting of yellow fluid (along with the general digestive disharmony like loss of appetite and nausea)
What is the pathology and key signs of Liver Qi stagnation associated with gynecology?
In menstruation Gan communicates with teh uterus via Ren Mai and Chong Mai. Gan, Ren Mai and Chong Mai are all concerned with the unobstructed movement of Qi and Blood during menstruation. Interrupted and uneven flow of Qi and blood may result in irregular and scanty menstruation. Sensation of depression and irritability, distention of abdomen and breasts may build up prior to menstruation and decline once it commences.
Liver Qi Stagnation Sn/Sx
Distention and pain in the chest and hypochondriac region
Areas coursed by the Liver channels
Frequent sighing
Releasing Stagnant Qi in the chest
Depression, moodiness, melancholy, unhappiness, and a general tense feeling
Flow of Liver Qi affecting the emotions or vice versa
Sensation of a lump in the throat with trouble swallowing
Internal branch of the Liver channel ascends along the neck and throat
nausea, vomiting, epigastric pain, reduced appetite, sour reflux, belching, awareness of pulsating (abdominal aorta) in the epigastric region, a sensation of the Stomach churning
Liver invading the Stomach
Abdominal distention, borborygmus, diarrhea
Liver invading the Spleen
Alternating Constipation and Diarrhea, irregular elimination
Liver Qi stagnating in the Intestines
Irregular menstruation, dysmenorrhea, premenstrual breast tenderness, PMS
Liver channel is closely associated with menstruation
Tongue: Normal tongue body (thin and white tongue coating)
Pulse: Wiry pulse
Liver Qi Stagnation POT and Herbs
POT: Disperse the liver and regulate qi
Herbs: Chai Hu Shu Gan San (Bupleurum Powder to Spread the Liver)
Liver Qi Stagnation Point Px
LIV-3 (Taichong - Great Surging) Shu Stream/Earth, Yuan Source, Heavenly Star; Regulates Liver Qi and especially effective when the throat is involved
GB-34 (Yanglingquan - Yang Mount Spring) He Sea/Earth, Meeting Point of Sinews, Heavenly Star; Regulates Liver Qi and especially useful when the hypochondriac region in involved
LIV-13 (Zhangmen - Completion Gate) Front Mu of SP, Meeting Pt of Zang, Origin of Dai Mai; Regulates Liver Qi in Middle Jiao, especially when it affects the Stomach
LIV-14 (Qimen - Cycle Gate or Gate of Hope) Front Mu of Liver, Exit Pt to Lung, Spirit Pt; Regulates Liver Qi in the Middle Jiao, especially when it invades the Spleen
SJ-6 (Zhigou - Branch Ditch) Jing River/Fire/Horary; Regulates Liver Qi and especially affects the sides
P-6 (Neiguan - Inner Pass) Luo Connecting, Confluent with Yin Wei paired with SP4 of Chong; Regulates Liver Qi and is especially good when emotional problems are major symptoms
SP4 (Gongsun Grandfather Grandson) Luo Connecting Pt; Confluent with Chong Mai; Regulates Pi and Wei, relieves indigestion and gastric pain.
ST18 (Rugen - Root of Breast) Great Luo of Stomach; Specific for breast problems
Flaring up of Liver Fire Etiology
- Emotion: Long-standing state of anger, repressed anger or frustration which causes Qi to stagnate and form Heat.
- Depression of Gan Qi, Stagnation gives rise to Heat that flares up as fire
- Diet: Excessive consumption of alcohol, fried foods, meat also tend to cause Liver Heat. Especially meats such as beef and lamb, which are attributed to hotter energy.
- Past history of Internal Heat or Deficient Gan Yin
- Pathogenic heat attacking liver channel
Blazing Gan Fire (Flaring up of Liver Fire) Pathology
General Excess Heat signs such as red tongue with yellow coat, full rapid pulse, thirst, bitter taste, constipation etc. These signs arise from the damage heat causes to Yin and Jin Ye and hence on Shen, Shen has no residence and insomnia results. Blazing Liver Fire can turn into Blazing Heart Fire and the two are closely related.
Blazing Gan Fire is distinguished by sudden severe signs of anger, headache, tinnitus and deafness. These result from sudden ascent of hot Qi and Xue to the head, ascending the Gan and Dan channels with their distributions in the vertex and temporal regions respectively.
This pattern is the extreme case of failure of the free flowing function of Gan Qi resulting in disharmony between the individual and the environment. The individual may be hypersensitive and liable to explode with rage. May have outbursts of extreme anger, perhaps involving physical violence.
Liver Fire Flaring Up Sn/Sx and Pathology
Red face and eyes, Irritability, angry outbursts, tinnitus, deafness, temporal headache, or migraine, dizziness
Liver Fire rising to the head
Thirst
heat damaging fluids
Bitter taste in the mouth
Liver Fire rising to the mouth
Constipation with dry stools
Heat damaging fluids
Insomnia with dream disturbed sleep
Liver Fire disturbing Shen
Dark yellow urine
Heat burning fluids
Possible epistaxis, hemoptysis, hematemesis
Liver Heat causes Blood to extravasate
Liver Fire Flaring Up POT and Herbs
POT: Sedate Liver, clear fire
Hersb: Long Dan Xie Gan Tang
Liver Fire Flaring Up Point Px
LIV-2 (Xingjian - Moving Between) Ying Spring/Fire; Clears Liver Fire
LIV-3 (Taichong Great Surge) Shu Stream/Earth, Heavenly Star, Yuan Source; Sedates the Liver
GB-20 (Fengchi - Wind Pool) Clear Liver Fire, pacify rising Liver Yang. Especially useful where eye problems or headache
M-HN-5 TaiYang (Extra Point) Clear Liver Fire and treats temporal headache (bleed with BL2)
BL2 (Zanzhu Gathered Bamboo) Bleed this along with TaiYang to disperse heat locally and pacify mind.
GB 13 (Benshen - Root of Spirit) Subdue ascending Liver Yang and calms the Mind
Method: Sedate all points
KD1 (Yongquan - Gushing Spring) Entry Pt, Jing Well/Wood/Child Pt; May be added to pacify fire, strengthen Yin and calm Shen. Indicated for headache at vertex, vertigo, blurred vison and mental health problems.
Liver Fire Flaring Up Western Diseases
- Hypertension
- Abnormal uterine bleeding
- Migraine
- Acute conjunctivitis
- Glaucoma
- Otitis
- Meniere’s disease
- Hemmorrhage of upper digestive tract
- Violent behaviour
How is the liver related to water metabolism?
If qi moves, blood moves. If qi is stuck, blood is stuck. Need free flow of qi to move water and blood. LU/SP/KI related to water metabolism but first we need free flow of qi.
If the Liver affects menstruation and ovulation for women what does it do in terms of reproduction for men?
Promotes ejaculation for men.
What vital substances does the Liver have?
Qi, Yang, Yin, Blood
What is the … for the Liver?
… Liquid
… Pulse
….Season
….EPI
Liquid is tears
Pulse is wiry
Season is spring
EPI is wind
What are the causes of tremors/contractions or convulsions?
- Liver fails to nourish tendons, tendons contract creating abnormal movement —> sign of wind
- Exterior heat burns the tendons causing convulsions (wind). This is purely an excess condition (example: kids with a fever can easily turn into wind convulsions)
What are the primary symptoms of a liver disorder?
Hypochondriac pain (often distending), temple headache, lower abdominal (side) and groin area pain (eg. abdominal hernia, testicle/scrotum pain)
