Internal Medicine – Liver Disorders

Dizziness
Headache
Hypochondriac Pain
Jaundice

Overview Of Liver Function:

The liver has many important functions dealing with blood and maintaining the smooth flowing of Qi within the body.  The liver stores blood and regulates blood volume within the body depending on the amount of physical activity of the individual.  It also plays a major role in menstruation and pms.  The liver ensures that Qi is moving smoothly throughout the body.  If Qi movement is disturbed then this can be reflected upon  the emotional state, digestive disorders and the secretion of bile.  The liver controls the sinews and tendons throughout the body giving rise to such symptoms as  soreness and stiffness inhibiting movement.

Xuan translates to blurred vision and Yun translates to dizziness or ‘off balance’.  This pattern of disease will have the symptoms of blurred vision, dizziness, black outs, viritgo, nausea, vomiting, un-balanced feeling, spinning, tinnitus, deafness, cold sweats, fatigue and possibly shaking.  It is most commonly due to three factors, wind, phlegm or deficiency.

May be caused by:

Liver Yang Rising: excess or deficiency
• Excess: brings internal wind causing dizziness
• Liver/Kidney Yin deficiency:  
Kidney Essence Deficiency:  can’t nourish marrow & brain
Qi/Blood Deficiency: clear Qi is unable to ascent to brain
Accumiliation Of Turbid Phlegm: phlegm blocks channels and collaterals, clear Qi is  unable to ascend.  Phlegm may turn to Phlegm Fire
Blood Stasis: due to injury or chronic illness, blocks Heart and Mind

Hyperactive Liver Yang
• Dizziness, tinnitus, severe distended H/A, dysphoria, scanty dark urine, insomnia with excess dreams, bitter taste in mouth, constipation
• T – red, yellow coat                              P – rapid, wiry
• Treatment:        Soothe hyperactive liver Yang
• Formula            Tian Ma Gou Teng Yin
   
Liver Yin Deficiency Causing Hyperactive Yang
• Dizziness, tinnitus, distended H/A, angry, scanty dark  urine, insomnia with dreams, weakness of lower back and knees with possible pain. Seminal emission
• T -  red, thin yellow coat                       P – Thin, rapid, wiry
• Treatment:        Soothe hyperactive liver Yang and Nourish Liver Yin
• Formula            Tian Ma Gou Teng Yin + Shou Di/Gui Ban
   
Liver Wind
• Dizziness, numbness, shaking limbs, nausea, severe vomiting, can’t stand up
• T - red                                                 P – wiry
• Treatment:        soothe liver to extinguish wind
• Formula            Tian Ma Gou Teng Yin + Ling Yang Jiao (heavy minerals)
   
Qi & Blood Deficiency
• Dizziness with tiredness and fatigue, pale complexion, insomnia, palpitation, poor appetite, loose stools
• T – pale, puffy                                      P – thin, weak
• Treatment:        nourish Qi and blood and strengthen spleen and stomach
• Formula            Ba Zhen Tang
                          Bu Zhong Yi Qi YTang (spleen Qi sinking)
                          Gui Pi Tang (heart)
   
Kidney Essence Deficiency
• Lower back & knee pain, lack of concentration, poor memory, loosing hair, dry hair, reproductive system disorders
• T – Pale, puffy                                      P – deep, weak
• Treatment:        nourish kidney essence
• Formula            He Che Da Zao Wan
                          Zou Gui Wan (heat signs - yin def.)
                          You Gui Wan   (cold signs – yang def.)
   
Turbid Phlegm Accumilation
• Heaviness of head, nautious, vomiting, fullness in chest, poor appetite, sleepiness, tired
• T – swollen, greasy, thick, dirty coat                 P – slippery
• Treatment:        dry dampness, elimin ate phlegm, invigorate spleen and stomach
• Formula            Ban Xia Bai Zhu Tian Ma Tang
                          Wen Dai Tang (phlegm heat)
   
Blood Stasis
• History of injury, fixed H/A, poor memory, palpitation, stabbing pain
• T – purple                                            P – uneven
• Treatment:        remove blood stasis and promote circulation to treat dizziness
• Formula            Tong Qiao Huo Xue Tang
                          Xue Fu Zhu Yu Tang (opens chest)

Pain in the head due to many causes.  Symptoms include sudden sharp pain on one side of the head, top of the head (vertex), back of the head (occipital), temporal area and possible spreading too facial area, neck area, and tearing with pain.

Western Medicine:

Epidemic febrile disease, common cold, influenza, neurological disorders, hypertension, brain tumor, brain blood vessel disorder …

May be caused by:

Exterior Pathogenic Invasion -wind attacks head blocking other meridian channels – clear yang Qi is unable to ascend – turbid Qi is unable to descend
Interior Injuries-Lung/Spleen/Kidney disorder makes essence unable to ascend to brain, Qi/Blood deficiency and produces dampness

Exterior Pathogenic Invasion

Wind Cold
• Occipital headache with stiff neck and shoulders, aversion to cold, shivering,  cough, runny nose, clear discharge, no fever, no sweating, no thirst
• T – thin white coat                                            P – tight, floating
• Treatment:        expel wind cold to relieve head ache
• Formula            Chuan Xiong Cha Tiao San (take with green tea)
   
Shao Yin Cold
• Cold limbs/upper back
• T – thin white coat                                            P – deep/thin
• Treatment:        warm cold and remove blockage to ShaoYin meridian
• Formula            Ma Huang Fu Zi Xi Xin Tang
   
Jue Yin
• Vertex headache, painful behind eyes
• T – white coat                                                  P – wiry
• Treatment: expel cold pathogen and remove obstruction from JueYin meridian
• Formula            Wu Zhu Yu Tang
   
Wind heat
• Distended headache, aversion to cold, cough, runny nose, yellow mucus, fever,    slight sweat, itchy sore throat, thirsty, slight constipation
• T – red tip/sides                                                P – rapid, floating
• Treatment:        expel wind heat to relieve headache
• Formula            Xiong Zhi Shi Gao Tang
                          severe constipation  +  Da Huang
   
Toxic Wind Damp
• Pounding headache with swollen head
• Treatment:        expel wind, dry dampness, clear heat and detoxify
• Formula            Qing Zhen Tang  +  Pu Ji Xiao Du Yin
   
Wind Damp
• Heavy head, poor appetite, heavy limbs, fullness in chest, soft stools
• T – white greasy coat, swollen body                  P – soft
• Treatment:        expel wind damp to relieve headache
• Formula            Qiang Huo Sheng shi Tang
                          Summer heat with dampness – Huang Lian Xiang Pu Yin
   

 Interior Injuries

Hyperactive Liver Yang
• Temporal headache, complicated with dizziness, pulsing/pounding temples,             dysphoria, bitter taste, hypochondriac pain
• T – red, yellow coat                                          P – rapid wiry
• Treatment:        calm liver and suppress hyperactive yang to relieve headache
• Formula            Tian Ma Go Tang Yin (mild)
                                      Zhi Zi Qing Gan San (severe)
                                      Qi Jue Di Huang Wan (due to Liver/kidney yin Deficiency)
   
Qi Deficiency
• Chronic dull/mild headache, aggravated by activity, easily fatigued, easily catch    cold, pale complexion, spontaneous sweat
• T – pale/normal                                                P – weak
• Treatment:        nourish Qi, ascend nutrients to head to relieve headache
• Formula            Shun Qi He Zhong Tang
   
Blood Deficiency
• History of loss of blood, chronic illness, generally blood deficient, dull headache, complicated with light headedness, dull yellow complexion, palpitations, insomnia
• T – pale                                                            P – thin
• Treatment:        nourish blood to relieve headache
• Formula            Jia Wei Si Wu Tang
                          Ren Shen Yang Ying Tang (Qi & Blood Deficiency)
   
Kidney Yang Deficiency
• Empty headache, dizziness, tinnitus, cold hands/feet, weak/cold lower back/knees, reproductive disorders, abundant clear urination
• T – pale, swollen, wet                                       P – deep, weak
• Treatment:        nourish kidney essence to relieve headache
• Formula            Da Bu Yuan Jian
   
Kidney Qi Deficiency
• Turbid yin up surging
• Sore/weak lower back, clear frequent urination, dribbling after urination, frequent urination, reproductive disorders
• T – pale                                                            P – deep, weak
• Treatment: nourish and stabilize kidney Qi while descending up surging yin
• Formula            yu Zhen Wan
   
Turbid Phlegm
• Heavy headache, cloudy head, poor concentration, nauseous, distended chest
• T – white, greasy                                              P – wiry, slippery
• Treatment:        resolve phlegm, descend turbid yin
• Formula            Ban Xia Bai Zhu tian Ma Tang
   
Blood Stasis
• Fixed headache in one area
• T – purple                                                        P – thin, uneven
• Treatment:        promote blood circulation and remove stasis
• Formula            Tong Qiao Huo Xue Tang

Pain in the hypochondriac region usually due to blood stasis, liver yin deficiency or  external pathogen invasions.  The pain can be on one or both sides of the abdomen and have a distended, stabbing, fixed or dull quality.

Liver Qi Stagnation
• Hypochondriac pain which moves, pain aggravated by stress and emotion
•  T – red                                                             P – wiry
• Treatment:        spread liver qi, harmonize the blood and alleviate pain
• Formula            Chai Hu Shu Gan Tang
   
Blood Stasis
• Hypochondriac pain which is fixed and is aggravated at night
• T – purple                                            P – wiry
• Treatment:        promote blood circulation and remove stasis in collaterals
• Formula            Xuan Fu Hua Tang
   
Liver Yin Deficiency
• Hypochondriac pain which is dull and chronic, blurred vision, dull/pale complexion
• T – pale                                                P – thin, rapid
• Treatment:        nourish liver Qi
• Formula            Yi Guan Jian
   
Damp Heat Invasion
• Hypochondria pain with bitter taste, aversion to cold, fever, fullness in chest, nauseous, vomit, possible jaundice
• T – red, yellow greasy  coat                 P – rapid
• Treatment:        clear liver heat, induce diresis to eliminate dampness
• Formula            Long Dan Xie Gan Tang

A yellow discolouring of the skin, yellow mucous membranes, yellow eyes and yellow urine caused by too much bile in the blood.  May be accompanied by nausea, vomiting, poor appetite and stomach pain.  The primary factor in Jaundice is damp heat due to internal or external disease.

May be caused by:

Accumulation of  Damp Heat   -impairs liver soothing function pushing bile out of its tract.
Stagnated Heat in Liver & Gall Bladder   - due t long term stress or sudden shock, bile turns to stones blocking bile tract.
Deficient Cold in Middle Jiao:   Spleen Deficiency complicated with cold – can’t transform damp blocking
bile tract
Spleen & Stomach Deficiency – can’t produce enough Qi & Blood
Toxic Heat Accumulation   - invades Ying & Xue levels injuring Liver andKidney
Abdominal Mass (Ji Ju)   - stagnation in abdomen blocks Gall Bladder channel pushing bile out

Yang Jaundice

 Damp Heat With Superficial Symptoms
• Yellow eyes, yellow skin, yellow urine, aversion to cold, fever heaviness of head and body, fatigue, no appetite
• T – thin, greasy coat                                         P – floating, wiry, rapid
• Treatment:        clear heat, transform dampness, relieve superficial area
• Formula            Ma Huang Lian Qiao Chi Xiao Dou Tang
                          + Gan Lu Xiao Du Dan
   
Accumulation of Damp HEAT
• Yellow eyes, yellow skin, yellow scanty urine, fresh, bright yellow jaundice color, fever, thirst, nauseous, fullness in abdomen, poor appetite, dry stools
• T – red, yellow greasy coat                   P – soft, rapid, slippery
• Treatment:        induce diresis to eliminate damp and clear heat
• Formula            Yin Chen Hao Tang
   
Accumulation of DAMP Heat
• Yellow eyes, yellow skin, yellow urine, recessive fever, heaviness and fullness of chest/abdomen, thirst with no desire to drink, soft sticky stool
• T – mixed yellow/greasy                                   P – soft
• Treatment:        induce diresis to eliminate damp and clear heat
• Formula            Yin Chen Si Ling Tang
   
Liver And Gall Bladder Heat Stagnation
• Yellow eyes, yellow skin, yellow scanty urine, hypochondriac pain, irritability, bitter taste in mouth, thirst, nauseous, vomiting, poor appetite, dry stools, fullness in abdomen
•  T – red, yellow/dry coat                        P – wiry, slippery, rapid
• Treatment:        Clear Liver and Gall Bladder to transform dampness
• Formula            Qing Dan Tang

Yin Jaundice

Accumulation of Damp Cold
• Yellow eyes, dark yellow skin, yellow urine,  fatigue, poor appetite, bloating, aversion to cold, soft stools
• T – swollen/pale, greasy white coat       P – deep, thin, retarded
• Treatment:        strengthen spleen and stomach to warm cold and transform damp
• Formula            Yin Chen Zhu Fu Tang
   
Liver Blood Stasis
• Yellow eyes, dark yellow skin, yellow urine, distended pain in hypogastrium, spider veins
• T – purple                                            P – wiry, thin, uneven
• Treatment: promote blood circulation, remove blood stasis to soothe liver
• Formula            Bie Jia Jian Wan
   
Blood Deficiency
• Yellow eyes, yellow skin, yellow urine, poor appetite, shortness of breath, fatigue, soft stools
• T – pale, thin coat                                             P – thin, soft
• Treatment:        strengthen spleen, nourish Qi/Blood, warm middle jiao
• Formula            Xiao Jian Zhong Tang

Severe Jaundice

Excess Toxic Heat
• Yellow eyes, yellow skin, yellow scanty urine, acute onset, turns to deep yellow with excessive fever, severe nauseous and vomiting, abdomen distension with pain, constipation, irritable
• T – dry/red, yellow coat                                    P – wiry, rapid, surging
• Treatment:        Clear heat and detoxify
• Formula            Huang Lian Jie Du Tang
                          Wu Wei Xiao Du Yin
   
Toxic Heat Invades Ying And Xue Levels
• Yellow eyes, golden skin, yellow urine, retention of urine, excessive fever, bleeding, irritability, delirium, spasm of limbs
• T – deep red, turbid coat                                  P – wiry/thin, rapid
• Treatment:        clear heat, detoxify, cool blood and rescue yin
• Formula            Xi Jiao San

 Links - Liver: Wood Energy Yin Organ (Bioenergetics)