Chapter 3. Liver and gallbladder

The liver plays a major role in the regulation, production and circulation of the resources that all our energy is created from. Consequently, when the liver ceases to function normally, this tends to produce powerful physical symptoms.

The Nei Jing authors noticed that when the liver function stagnates, this causes the patient to experience signs and symptoms from the following list. Not all these would be present at once, but most patients would experience a good selection of them.

• discomfort at the front or back of the torso at the level of the liver (the hypochondrium), frequent sighing or hiccups;

• feeling of irritability, with outbursts of angry shouting;

• muscular spasms, cramps, twitching, stiff neck;

• a feeling as though something were stuck in your throat;

• fluctuations of mood, melancholy or depression, paranoia;

• migraines or headaches with pain on the top or sides of the head or associated with the eyes, visual disturbances;

• dizziness, vertigo, hearing high pitch ringing sounds (tinnitus), insomnia;
• strong pain, stiffness or discomfort anywhere along the liver or gallbladder meridian, particularly on the head, neck, hips, outside of the legs;
• (in women) irregular periods with cramps, tender breasts, either scanty or absent menses or, alternatively, heavy flow with clots, and emotional fluctuations and irritability in the pre-menstrual phase (PMS); and (in all patients)
• effects on other organs, producing constipation, or the alternation of constipation with loose stools and other digestive signs.

Causes of stagnated liver function

Stagnated liver function (called "Liver chi stagnation" in Chinese medicine) is extremely common in developed countries, since the condition is primarily caused by mental and emotional stresses of the kind that are rife in such societies.

Chinese medicine has always recognised the connection between our thoughts and organ functions. In the body, the liver's main role is a regulatory one; and when this function is used to process our thoughts, this produces our tendency to organize the world around us. But problems result when the world declines to obey our "rules". That is, when people do not do things the way we would like, or break etiquette rules, or things are not organized as we would like. This blocks the flow of our liver-related thoughts, which the liver feels as though the physical substances in the body had stopped flowing as they should. The liver produces a powerful reaction to try to correct this blocked flow, and this is the feeling of irritation or anger that we feel when our "rules" are broken. However, our usual tendency is to suppress our anger. We may perhaps sigh, but do little else. But since the situation in our life is not resolved, the liver continues to behave as though the flow of substances and energy in our own body were also still blocked. And it is this that produces the many powerful symptoms in us.

Patient example

Female, aged 32. This patient sought treatment for issues related to her menstrual cycle, primarily acne but also PMS and painful periods. All these issues were addressed by the treatment, which focused on alleviating her stagnated liver function. See the full case history on page ref.

Traits of a liver-dominated person

When our liver function is habitually stagnated, our mental activity would tend to be dominated by the "concerns" of our liver, causing the following traits to become excessive.

We would tend to over regulate our environment. At the simplest level, we may find ourselves frequently (almost unconsciously) adjusting the position of objects: straightening a picture on the wall or an object on our desk. And we would also tend to minutely organize every other aspect of our life. We may spend much time planning-writing lists, organizing our own and other's schedules and itineraries, organizing things such as filing systems or inventing other such systems to minutely organize the activities of everyday life, both our own and other people's.

For a person who is dominated by their liver's concerns, a major health problem is caused in them when the people (or objects) around them decline to obey their "rules". This routinely blocks their liver function, producing the following condition.

Diagnosis and treatment

When a patient has stagnated liver function they would usually have a selection of the symptoms listed on page ref above, which the practitioner would determine by questioning. And the diagnosis would be confirmed by examining the patient's tongue and pulses.

To the practitioner, the liver pulse would resemble the feel of a taut wire under the fingers-and is called "wiry" in Chinese medicine. Some of the other organ pulses may also have this same "wiry" quality, since the stagnation often extends to the other organs as well. And the body of the patient's tongue would often have "stagnation dots" and also red sides, to one degree or another-the more pronounced the stagnation, the more this redness would be obvious. In tongue diagnosis, the left side of the tongue relates to the liver and the right to the gallbladder.

Facial colour and tone of voice

When the stagnated function is pronounced or chronic, the patient would tend to have a green facial hue which other people can often see.

The patient example on page ref provides a striking example of this, where a boy's problems were caused by stagnated liver function, and his family reported that his complexion was notably green when his condition was at its worst.

This is also doubtless the origin of the expression "green with envy". When a person is prone to stagnated liver function, this would tend to create within them states such as envy and paranoia. The enviable situation would be seen as the breaking of "rules" (it is unfair that the other person has this desirable advantage, rather than me; it is an injustice), and the more this "injustice" were focused on, the more the person's liver function would stagnate, heightening their green hue.

The Nei Jing associates the liver with a "shouting" voice. When a person is prone to stagnated liver function, they would usually have a loud voice and when in normal conversation would sound as though shouting. This is a reliable diagnostic sign, and easy to recognise.

Treatment

When stagnated liver function is present, one or more of the key acupoints related to the liver tend to feel tender when pressed. The key acupoints are

• Liver-3 (on the top of the foot),
• Gallbladder-41 (on the top of the food),
• Gallbladder-34 (on the side of the leg, below the knee),
• Pericardium-6 (on the wrist; this is the familiar acupoint used for treating travel sickness),
• Liver-14 (on the chest, below the breast),
• Bladder-18 (on the back), and
• Bladder-14 (on the back).

These acupoints become tender due to their association with this particular liver malfunction. When one of these acupoints is stimulated, this encourages the organ to cancel out the malfunction in itself that caused the tenderness at the acupoint, and the organ returns to normal function.

The effect is often instant, or could sometimes takes a few minutes, when the "wiry" quality in the patient's pulses would clear, indicating the organ function was now modified. I have also noticed that any red areas on the patient's tongue also tend to clear within seconds of the liver acupoints being needled. And, of course, patient's often feel considerably less stressed at the end of the treatment, since their liver function is now more normal.

The progress of treatment

As when treating all conditions, after the first treatment the positive effects of the treatment may wear off after a day or two. But with each successive treatment, the positive effects tend to last longer. This phenomenon is partly due to resistive factors in the patient's lifestyle.

Acupuncture can "get under the radar" to address mental and emotional issues

Each person may have adopted patterns in their thinking and emotional behaviour that tend to encourage their main organs to malfunction. This is particularly so with the liver (as summarized on page ref above), but it is also true with the other four main organs.

Their habits might include being too controlling of other people (and themselves), resulting in constant obstructed thoughts, irritability and (almost inevitably) stagnated liver function. And any difficulties might be compounded by a tendency to not express their frustrations or anger.

With all these patterns, there may be particular key incidents in a person's life which marked the start of the pattern, such as traumatic events; and the memory of these experiences can make it harder for the person to break the pattern. Ordinarily, mental and emotional patterns of these types would need to be changed in order for the patient's organs to return to functioning normally, and for their symptoms to thus clear-since, if these mental and emotional patterns remain the same, after every acupuncture treatment, the organs would soon re-adopt the same malfunction.

The process of us gradually changing such habits is normally a long and slow one, and with some people it may be beyond them. But acupuncture seems to "get under the radar" of our...