The pattern of ascendant hyperactivity of liver yang refers to a condition where liver yin fails to match yang, leading to the failure of liver yang to remain latent or excessive rising of liver qi, causing yang qi to float upward, resulting in a series of clinical manifestations. This syndrome is often caused by a combination of factors such as overstrain from sexual activity, internal damage from seven emotions, and dietary irregularities.

The main clinical manifestations include: dizziness, slight distension and pain in the head, dizzy vision, photophobia, or blurred vision, nausea, a preference for quietness, and may also include symptoms such as facial redness, tinnitus, and dry mouth and tongue. The tongue edges are red, with thin yellow or thin white coating, and the pulse is wiry and thin or wiry, thin, and rapid.

The pattern of ascendant hyperactivity of liver yang is commonly seen in diseases such as "headache," "vertigo," and "deafness tinnitus."

This syndrome should be differentiated from the "pattern of internal stirring of liver wind," "pattern of up-flaming liver fire," "liver blood deficiency pattern," "liver yin deficiency pattern," and "liver-kidney yin deficiency pattern."

bubble_chart Differentiation and Treatment

This syndrome has different characteristics and corresponding treatments in various diseases.

1. In headache conditions, yang hyperactivity is often due to liver heat, manifesting as throbbing pain that worsens with anger, accompanied by restless sleep, dysphoria, irritability, hypochondriac pain, red eyes, bitter taste in the mouth, and a wiry or wiry and rapid pulse. The treatment should focus on pacifying the liver and subduing yang, commonly using Gastrodia and Uncaria Drink (Zabing New Meanings in Syndrome Treatment) by removing Gastrodia Tuber, Gardenia, motherwort herb, and adding Chrysanthemum Flower, Prunella, bitter tea, Nacre, etc.
2. In vertigo conditions, this syndrome is often caused by blood deficiency and internal heat stirring liver yang, resulting in dizziness with slight pain, blurred vision, photophobia, preference for quiet, nausea, and a fine pulse. The treatment should focus on nourishing yin and subduing yang, using Wolfberry and Chrysanthemum Rehmannia Pill ("Medical Levels") combined with Gastrodia and Uncaria Drink (Zabing New Meanings in Syndrome Treatment) with added yang-subduing herbs.
3. In deafness and tinnitus conditions, there are two scenarios: one is due to water deficiency failing to nourish wood, presenting with yang hyperactivity signs along with kidney yin deficiency symptoms such as sore back, insomnia, forgetfulness, irritability, fatigue, and spontaneous sweating due to emotional excitement, often with a history of sexual overindulgence or masturbation. The treatment should focus on nourishing water to moisten wood, using Left-Restoring Decoction (Jingyue Quanshu) or Anemarrhena, Phelloendron and Rehmannia Pill (Yifangkao) combined with Gastrodia and Uncaria Drink (Zabing New Meanings in Syndrome Treatment) with added Magnetite and Cinnabar Pill (Beiji Qianjin Yaofang) and other formulas as needed; the other is due to ascendant hyperactivity of liver yang combined with liver-gallbladder dampness-heat, presenting with red eyes, bitter taste in the mouth, constipation, dark urine, scrotal dampness and itching, and a wiry and rapid pulse. The treatment should focus on pacifying the liver and subduing yang, assisted by clearing fire and draining dampness, such as Gentian Liver-Draining Decoction ("Golden Mirror of the Medical Tradition").

The clinical manifestations and associated symptoms of this syndrome often vary from person to person.

1. In young adults with kidney essence deficiency, this syndrome often presents with tinnitus, sore back, weak legs, heel pain, and even spontaneous ejaculation upon seeing sexual stimuli, easily aroused and easily ejaculating. The treatment should combine pacifying the liver and subduing yang with nourishing the kidney and consolidating yin. For example, when using Gastrodia and Uncaria Drink, remove Skullcap Root and Gardenia, which directly repel with bitter cold, and add Tortoise Carapace, Prepared Rehmannia Root, Anemarrhena, Phelloendron Bark, etc.
2. In individuals who indulge in smoking, drinking, and consuming rich foods, this syndrome is often complicated by liver-gallbladder dampness-heat due to heat transformation, presenting with right hypochondriac distending pain, bitter taste in the mouth, epigastric fullness, nausea, dark urine, scrotal dampness and itching, yellow greasy tongue coating, and a wiry, slippery, and rapid pulse. The treatment should still focus on pacifying the liver and subduing yang, assisted by clearing and purging liver-gallbladder dampness-heat, adding Curcuma Root, Chinaberry Fruit, Gentian, Talc, gardenia, Immature Orange Fruit, red Poria, Akebia Stem, etc., selecting two or three herbs according to the symptoms.
3. Moreover, before and after the cessation of menstruation in women, kidney qi gradually declines, the Chong and Ren meridians become deficient, the Blood Sea gradually dries up, and liver yang tends to become hyperactive. If this syndrome is present, in addition to common symptoms of ascendant hyperactivity of liver yang such as dizziness, tinnitus, dysphoria, flushed face, rising heat, dry mouth, and throat dryness, there are also Chong and Ren symptoms such as menstrual irregularities or scanty menstruation leading to amenorrhea, and the onset age is usually after middle age. Occasionally, young adults may suffer from this condition, and upon inquiry, many have a history of gynecological surgeries that injured the Chong and Ren meridians, such as uterus or ovary removal. Although this condition and the pattern of ascendant hyperactivity of liver yang caused by water failing to nourish wood both involve the kidney and liver, it has unique characteristics. It is necessary to address the mechanism of disease where kidney qi has declined, and the Chong and Ren meridians are deficient, failing to nourish the liver, leading to an imbalance of liver and kidney yin and yang. The corresponding treatment should not only nourish yin and subdue yang but also supplement the Chong and Ren meridians. On one hand, use Phelloendron Bark, Anemarrhena, Tortoise Carapace, Chinese Angelica to consolidate yin, and on the other hand, use Deer Horn, Dodder Seed, Common Curculigo Rhizome, Epimedium Herb, Morinda Root, Cistanche to supplement yang. This method of simply nourishing yin is significantly effective. Similarly, for men around the age of 64 who exhibit the pattern of ascendant hyperactivity of liver yang, if it is related to the decline of kidney qi and the exhaustion of reproduction-stimulating essence, and there are mixed symptoms and signs of liver and kidney yin and yang deficiency, in addition to the main treatment, a combined approach of yin-yang dual supplementation is more appropriate to the actual condition than simply pacifying the liver and subduing yang or nourishing yin and subduing yang.

bubble_chart Differentiation of Similar Patterns

1. pattern of internal stirring of liver wind and pattern of ascendant hyperactivity of liver yang: The pattern of internal stirring of liver wind includes three types: liver yang transforming into wind, liver fire generating wind, and blood deficiency stirring wind. Among these, the one most easily confused with the pattern of ascendant hyperactivity of liver yang is liver yang transforming into wind. Both have the disease mechanism of yin deficiency with yang hyperactivity and can present symptoms and signs of yang qi floating upwards, such as headache, dizziness, facial redness, dizzy vision, tinnitus, and dry mouth and tongue, leading to potential misdiagnosis. In terms of their relationship, the misuse of warming and tonifying, lifting, fire-assisting, or fluid-depleting agents in the pattern of ascendant hyperactivity of liver yang, or other reasons, can promote the transformation of hyperactive liver yang into liver wind. Conversely, with appropriate treatment, the pattern of liver yang transforming into wind can reverse and become the pattern of ascendant hyperactivity of liver yang when the liver wind has subsided but the liver yang has not yet been subdued. Due to their close relationship, ancient practitioners often did not differentiate them in detail and collectively referred to them as wind-yang. The key points for differentiation are:
   1. In the pattern of liver yang transforming into wind, due to excessive yang hyperactivity, a qualitative change occurs, and yang transforms into wind, leading to a concentrated appearance of symptoms and signs symbolizing liver wind, such as unstable eye tremors, blurred vision, limb numbness, palpitations, insomnia, vomiting, loss of appetite, and sweating upon slight exertion. These symptoms and signs do not appear together in ascendant hyperactivity of liver yang before it transforms into wind.
   2. If the pattern of liver yang transforming into wind presents with symptoms such as facial distortion, fainting, and loss of speech, it indicates a critical condition of liver wind ascending to the vertex. If it presents with hemiplegia and limb spasms, it indicates liver wind spreading to the limbs, aiding in differentiation.
   3. Once ascendant hyperactivity of liver yang transforms into wind, the pulse manifestation often changes from wiry and rapid to wiry, long, and forceful or wiry and strong.
2. pattern of up-flaming liver fire and pattern of ascendant hyperactivity of liver yang: Differentiating these two syndromes based on their disease mechanisms of deficiency and excess is not easily confused, as the pattern of up-flaming liver fire is an excess heat syndrome caused by qi depression transforming into fire, anger stirring fire, accumulated heat transforming into fire, or wind qi affecting the liver. It is characterized by wind and fire flaring upwards. In contrast, the pattern of ascendant hyperactivity of liver yang is a root deficiency and branch excess syndrome caused by liver yin deficiency or liver-kidney yin deficiency failing to control yang, leading to yang hyperactivity disturbing upwards. However, these two syndromes share similarities, both having an upward disease tendency and clinically presenting symptoms such as headache at the two taiyang points, head distension, facial redness, tinnitus, dysphoria, irritability, dry mouth and tongue, red tongue edges, yellow coating, and wiry pulse, which can lead to misdiagnosis. Careful differentiation is necessary:
   1. Headache and head distension at the two taiyang points: In the pattern of up-flaming liver fire, it is caused by real fire rushing upwards along the meridians, with intense pain and distension, often accompanied by red eyes. In the pattern of ascendant hyperactivity of liver yang, it is due to lower deficiency and upper excess, with deficient yang rising to the head, resulting in milder headache and head distension, often accompanied by a heavy head and light feet, dizzy vision, photophobia, or blurred vision.
   2. Facial redness: In the pattern of up-flaming liver fire, it is due to fire and heat rushing upwards, appearing early in the disease with a hot sensation upon touch. In the pattern of ascendant hyperactivity of liver yang, it is due to yin deficiency with internal heat, appearing later in the disease, faint and intermittent, with almost no heat sensation upon touch.
   3. Tinnitus: In the pattern of up-flaming liver fire, it is due to liver fire rushing upwards to the ears, resulting in loud, roaring sounds, even deafness. In the pattern of ascendant hyperactivity of liver yang, it is due to liver and kidney yin failing to nourish the ears, with deficient yang rising, resulting in cicada-like tinnitus, more noticeable at night.
   4. Dysphoria and irritability: In the pattern of up-flaming liver fire, it is due to real fire rushing upwards, causing intense anger, easily triggered, and difficult to calm even in quiet environments. In the pattern of ascendant hyperactivity of liver yang, it is a deficiency heat phenomenon with root deficiency and branch excess, thus preferring quiet and not easily angered.
   5. Dry mouth and tongue: In the pattern of up-flaming liver fire, it is often due to fire forcing gall bladder bile to overflow, causing a bitter taste, and fire damaging yin, causing dry throat and thirst, with a desire to drink. In the pattern of ascendant hyperactivity of liver yang, it is due to fluid deficiency and internal heat, causing dryness but no desire to drink.
   6. Manifestations of the tongue and pulse: In the pattern of up-flaming liver fire, the edges and tip of the tongue are red, with thorns on the edges, and the yellow coating is often thick and dry. The pulse is wiry or wiry-slippery, often accompanied by rapid and large pulses. In the pattern of ascendant hyperactivity of liver yang, the tongue is red but without thorns, the pulse is wiry and rapid, often accompanied by thin but not large pulses.
   In addition, the two syndromes can be distinguished by other important symptoms, one being excess fire and the other being root deficiency with superficial excess. For example, the pattern of up-flaming liver fire often presents with symptoms of excess fire, such as hypochondriac pain, hematemesis, nosebleeds, acid regurgitation, hiccups, mania, constipation, and scanty dark urine. The pattern of ascendant hyperactivity of liver yang often presents with signs of liver yin deficiency, such as a dull complexion, vertigo, dreamfulness, dry eyes, muscle stiffness, numbness, muscular twitching, scanty or absent menstruation in women, night sweats, and episodes of hot flashes; it may also present with signs of kidney yin deficiency, such as tinnitus, forgetfulness, soreness and weakness in the lower back and knees, and vexing heat in the chest, palms, and soles.
3. Liver blood deficiency pattern and pattern of ascendant hyperactivity of liver yang: Liver blood deficiency pattern is caused by insufficient blood production or excessive loss of blood, often presenting clinical symptoms similar to those of pattern of ascendant hyperactivity of liver yang, such as vertigo, tinnitus, dry eyes, blurred vision, dull nails, dreamful sleep at night, and in women, scanty menstruation or amenorrhea. This is because part of the pattern of ascendant hyperactivity of liver yang develops from the basis of liver blood deficiency, hence the clinical manifestations of liver blood deficiency. However, the pattern of ascendant hyperactivity of liver yang is ultimately characterized by yang hyperactivity, and the common manifestations of the two syndromes will each have their own characteristics. The key points for differentiation are as follows:
   1. In liver blood deficiency pattern, due to the lack of blood nourishment, a dull complexion and dull nails are observed; in pattern of ascendant hyperactivity of liver yang, the complexion, which is dull due to wood, becomes tender red due to yang hyperactivity.
   2. In liver blood deficiency pattern, vertigo and tinnitus are present; in ascendant hyperactivity of liver yang, the sound of tinnitus may intensify, and vertigo is often accompanied by dry eyes, slight headache, and slight distension.
   3. In liver blood deficiency pattern, the tongue is pale with little luster, and the pulse is thin or deep and thin; in ascendant hyperactivity of liver yang, the edges of the tongue turn from pale to red, possibly accompanied by a yellow coating, dry mouth and tongue, and the pulse becomes thin and wiry, often with a rapid quality.
4. Liver yin deficiency pattern and pattern of ascendant hyperactivity of liver yang: Liver yin deficiency pattern is more likely to develop into pattern of ascendant hyperactivity of liver yang than liver blood deficiency pattern, and their clinical manifestations are also more similar. This is because liver yin deficiency pattern, in addition to the general symptoms of liver blood deficiency that are easily confused with pattern of ascendant hyperactivity of liver yang, also includes symptoms of yin deficiency leading to internal heat, such as flushed cheeks, night sweats, restless insomnia, red tongue, and rapid pulse, making it more easily confused with pattern of ascendant hyperactivity of liver yang. The key point for differentiation lies in the fact that the internal heat of liver yin deficiency is mostly a static manifestation; ascendant hyperactivity of liver yang, on the other hand, has a dynamic manifestation of rising and floating. Static is yin, so the heat is mostly at night, sweating occurs after falling asleep, and there is a preference for stillness, without the upward and excessive tendency of hyperactive yang; dynamic is yang, so the vexing heat of ascendant hyperactivity of liver yang is mostly during yang times, with possible paroxysmal hot flashes and spontaneous sweating, commonly seen with the upward floating and reversing of hyperactive yang, such as dizzy vision with slight redness, dizziness with distension and pain, nausea, irritability, and other symptoms. In terms of pulse manifestation, liver yin deficiency is often wiry, thin, and rapid; ascendant hyperactivity of liver yang often has a wiry and forceful pulse that extends beyond the guan position, rising to the cun position, and due to yang hyperactivity, the thready pulse may temporarily disappear. Based on this, differentiation is not difficult.
5. Liver-kidney yin deficiency pattern and pattern of ascendant hyperactivity of liver yang: The relationship between liver-kidney yin deficiency pattern and pattern of ascendant hyperactivity of liver yang is closer than that of liver yin deficiency pattern, because the pattern of ascendant hyperactivity of liver yang most commonly transforms from liver-kidney yin deficiency pattern. The key point for differentiation still lies in the distinction that liver yin deficiency heat is static, while ascendant hyperactivity of liver yang is dynamic. Additionally, it should be noted that liver-kidney yin deficiency pattern, besides liver yin deficiency, also includes the mechanism of disease and clinical manifestations of kidney yin deficiency, such as soreness and weakness of the waist and knees, vexing heat in the chest, palms, and soles, cerebral tinnitus, forgetfulness, internal blazing of dragon fire, easy arousal and emission, seminal emission, leukorrhea, etc., all of which are the basis for clinical differentiation.

bubble_chart Documentation

1. Linzheng Zhinan Yi'an．Apoplexy Section: "Wood-fire constitution, compounded by depression, liver yin increasingly depleted, rising reversal, dizziness, dizzy vision, palpitation. Nourishing liver and extinguishing wind is a definite principle. Recently, knowing hunger but eating little, feeling nauseous, due to stomach rebellion not descending. First, focus on draining wood and calming the stomach: Mulberry Leaf, Uncaria, Milkwort Root, Acorus, Fermented Pinellia, Guang Chenpi, Dendrobium, Poria."
2. Linzheng Zhinan Yi'an．Apoplexy Section: "In advanced age, water deficiency, liver rising reversal without control, both flanks feel hot, then fire rises and face reddens, worsened by fatigue. The method should be nourishing yin and harmonizing yang."
3. 《Liu Bao-yi Medical Records．Liver Fire Section》: "During sleep, yang qi is stored internally. Heat reversal externally, then limbs feel like wood; yang gathers internally, then fright and vigilance with nocturnal emissions. The disease belongs to the disharmony of yin and yang, with liver disease predominating. The method should be nourishing yin and subduing yang, calming the liver and stomach. ... Second consultation: Liver yin deficiency, then liver yang floats and disturbs, leading to restless sleep. In fact, yang loses yin nourishment and cannot be calm, not due to excess yang qi. Liver-draining medicine is also not suitable. Pulse manifestation is wiry, thin, and rapid, unable to drum the fingers, indicating liver yang also shows signs of fatigue, night sweats, spasms, dreamfulness with nocturnal emissions, yin weakness and yang not storing internally. The method should be nourishing yin and regulating, slowly adjusting. ..."