The syndrome/pattern of up-flaming liver fire refers to the transformation of liver qi depression into fire, with the fire rising and qi rebelling, characterized mainly by symptoms and signs such as headache, red eyes, tinnitus, and a bitter taste in the mouth. It is often caused by the stagnation of wood (liver) and excessive liver function.

The main clinical manifestations include: vertigo and headache, tinnitus like the tide, even sudden deafness and loss of hearing, red face and eyes, bitter taste in the mouth and dry throat, pain in the hypochondriac region, dysphoria and irritability, insomnia and dreamfulness, or hematemesis and nosebleeds, acid regurgitation, constipation and yellow urine, red edges and tip of the tongue, yellow coating, and a wiry and rapid pulse.

The syndrome/pattern of up-flaming liver fire is commonly seen in diseases such as "headache," "tinnitus and deafness," "bleeding," "insomnia," "acid regurgitation," and "mania."

This syndrome should be differentiated from the "syndrome/pattern of gallbladder heat" and the "syndrome/pattern of ascendant hyperactivity of liver yang."

bubble_chart Differentiation and Treatment

The syndrome/pattern of up-flaming liver fire can be seen in various diseases, each with its own clinical characteristics, and the treatment should also differ accordingly.

1. For example, when seen in headache, it manifests as vertex headache, pain as if being split by a knife or a feeling of distension and discomfort, or a pulling pain with a sensation of pulsating vessels in the head, often accompanied by vertigo and inability to maintain balance, red and blurred eyes, a red tongue with yellow coating, and a wiry, slippery, and rapid pulse. This is caused by emotional depression, qi depression transforming into fire, the fiery nature rising upwards to disturb the clear orifices, and the counterflow of qi and blood. The treatment should focus on direct repulsion with bitter cold, clearing the liver and draining fire, using Gentian Liver-Draining Decoction(from "Yizong Jinjian").
2. When seen in tinnitus and deafness, it manifests as sudden onset of tinnitus like a tide, or deafness with loss of hearing, irritability and frequent anger, worsening with anger, restless sleep, dizziness and headache, a red face, bitter taste in the mouth, dry throat, a red tongue with yellow coating, and a wiry and rapid pulse. This is caused by emotional depression transforming into fire, or sudden anger damaging the liver, with liver fire ascending along the meridians to block the ears, leading to obstruction of the seven orifices. The treatment should focus on clearing the liver and draining fire, and descending fire to relieve stuffy orifices, also using Gentian Liver-Draining Decoctioncombined with Qi-Unblocking Powder(Yilin Gaicuo).
3. When seen in bleeding, it manifests as hematemesis, epistaxis with bright red blood, hypochondriac pain, bitter taste in the mouth, dry throat, irritability and frequent anger, restlessness, red eyes with eye discharge, a red tongue with yellow coating, and a wiry and rapid pulse. This is caused by emotional damage to the liver, qi depression transforming into fire, the meeting of fire, yin qi, and yang qi forcing the yang collaterals, impairing the liver's function of storing blood, and blood rising with the fiery nature to overflow from the mouth and nose. The treatment should focus on clearing the liver and draining fire, cooling blood and stopping bleeding, still using Gentian Liver-Draining Decoctioncombined with Rhinoceros Horn and Rehmannia Decoction(from Qianjin Fang).
4. When seen in insomnia, it manifests as nighttime insomnia, inability to sleep peacefully, easy fright, aversion to noise, frequent anger, irritability, red eyes, bitter taste in the mouth, dry throat, or accompanied by dizziness, tinnitus, constipation, a red tongue with yellow coating, and a full and strong pulse. This is caused by liver fire disturbing the heart, leading to the failure of the mind to keep to its abode. The treatment should focus on clearing the liver and draining fire, calming the spirit and stabilizing the mind, using Green-Blue-Draining Pill(from Xiao'er Yaozheng Zhijue).
5. When seen in acid regurgitation, it manifests as burning pain in the hypochondrium or epigastrium, acid regurgitation, gastric stuffiness, chest tightness, epigastric upset with belching, dry mouth with a bitter taste, a red tongue, and a wiry and rapid pulse. This is caused by the liver failing to act freely, qi depression transforming into fire, and heat therapy malpractice affecting the stomach, leading to the stomach's failure to descend. The treatment should focus on pungent dispersing and bitter descending, clearing the liver and draining fire, using Left Metal Pill(from Danxi Xinfa).
6. When seen in mania, it manifests as headache and insomnia, glaring eyes, a red face and red eyes, or even manic behavior, climbing walls and roofs, incessant cursing, disregard for close relationships, or attacking people and destroying objects, with strength exceeding normal, constipation, dark and scanty urine, a red tongue with yellow and rough coating, and a wiry, slippery, and rapid pulse. This is caused by anger damaging the liver, qi fire burning fluids to produce phlegm, phlegm fire rising to disturb the mind, leading to mental activity disorder. The treatment should focus on clearing the liver and draining fire, resolving phlegm and calming the spirit, using Angelica, Gentian and Aloe Pill(from "Xuanming Fanglun") combined with Biotite Schist Rolling Phlegm Pill(from "Yangsheng Zhulun").

Treatment of influenza, enterovirus, and various viral colds, Chinese medicine is more refined, non-toxic, and effective than Western medicine

In the mechanism of disease evolution, the syndrome/pattern of up-flaming liver fire, due to the characteristics of fire pathogen being flaming upwards and damaging fluids, often presents with accompanying symptoms and signs: such as up-flaming liver fire invading the lung metal, leading to symptoms of qi counterflow with choking cough, a red face and dry throat, pain in the hypochondrium during coughing, a yellow tongue with little moisture, and a wiry and rapid pulse, indicating liver fire invading the lung; since the liver is yin in substance but yang in function, relying on kidney water for nourishment, if liver fire is internally blazing for a long time, it not only burns the yin of the liver itself but also draws on kidney water, leading to symptoms of dizziness, dry eyes, soreness and weakness in the lower back and knees, vexing heat in the chest, palms, and soles, dry and painful throat, a red tongue with little coating, and a thin pulse, indicating liver-kidney yin deficiency.

bubble_chart Differentiation of Similar Syndromes

1. syndrome/pattern of gallbladder heat and syndrome/pattern of up-flaming liver fire: The gallbladder is attached to the liver, and qi depression transforms into heat. Heat is the gradual form of fire, and fire is the severe form of heat. Therefore, gallbladder heat travels along the meridians to disturb the upper body, primarily manifesting as dizzy vision, tinnitus, dry throat, and bitter taste in the mouth. Although headache and red eyes may also be present, they are generally not as severe as in the syndrome/pattern of up-flaming liver fire. Additionally, the gallbladder governs decision-making, and the liver governs anger. Hence, the former often involves frequent sighing, while the latter is characterized by irritability and impatience.
2. syndrome/pattern of ascendant hyperactivity of liver yang and syndrome/pattern of up-flaming liver fire: The syndrome/pattern of ascendant hyperactivity of liver yang is often due to insufficient yin of the liver and kidneys, where water fails to nourish wood, and yin deficiency fails to control yang, leading to the rising and hyperactivity of liver yang. On the other hand, the syndrome/pattern of up-flaming liver fire is mostly caused by extreme seven emotions, with qi depression transforming into fire. The syndrome/pattern of ascendant hyperactivity of liver yang is a condition of root deficiency and branch excess, with deficiency below and excess above; the syndrome/pattern of up-flaming liver fire is purely an excess syndrome/pattern. The disease mechanisms of the two are different, and their clinical manifestations also differ: the headache in the syndrome/pattern of ascendant hyperactivity of liver yang is often a distending pain, vertigo is characterized by dizziness and blurred vision, with a sensation of unsteadiness, tinnitus is often like the sound of cicadas, gradually starting and stopping intermittently, and in severe cases, apoplexy syncope may occur, leaving behind symptoms such as facial paralysis, slurred speech, and hemiplegia, all due to yin deficiency below and yang rising above, with qi counterflow and wind movement. Due to the deficiency of liver and kidney yin below, the external regions of the kidneys are malnourished, leading to symptoms such as soreness and weakness in the lower back and knees, lack of strength, flushed cheeks, or a flushed and hot face, a red or crimson tongue with little coating, and a thin and rapid pulse, all of which are manifestations of yin deficiency. These symptoms are not present in the up-flaming of liver fire.

bubble_chart Documentation

1. Leizheng Zhicai．Liver Qi: "Ministerial fire attaches to wood, when wood is depressed it transforms into fire, leading to acid swallow, hypochondriac pain, mania, atrophy, syncope, stuffiness, hiccups, and loss of blood, all due to the impact of liver fire." "Zhao, left hypochondriac pain, a strong pulse, tinnitus, occasional vomiting, abdominal distension, and pain, all due to the flaring up of liver fire, turbid stasis refusing to descend, should avoid anger and moderate drinking to heal. Imitating Gardenia and Evodia Decoction: Gardenia fried with ginger juice, Coptis Rhizome, Evodia Fruit fried with juice, Peony Root, raw oyster shell, Moutan Bark, and Tangerine Peel, effective after taking."
2. Wangxugao Yishu Liuzhong．Xixi Study Night Talks: "Liver fire scorches, travels through the triple energizer, causing diseases throughout the body, inside and out, too numerous to list. Including red eyes, flushed cheeks, convulsive syncope, mania, dysuria, stranguria, sores and ulcers, excessive hunger, thirst, vomiting, insomnia, and bleeding from the upper and lower body."