The pattern of liver qi depression refers to a general term for symptoms caused by the liver's failure to properly regulate and disperse qi due to emotional distress, anger, and stagnation of qi movement, leading to a lack of smooth flow and the manifestation of various signs.

The main clinical manifestations include: mental depression, fullness or pain in the chest and hypochondrium, frequent sighing, or breast and lower abdominal distension and pain, irregular bowel movements, menstrual irregularities, thin tongue coating, and a wiry pulse.

The pattern of liver qi depression is commonly seen in conditions closely related to mental and emotional states, such as "depressive disorder," "hypochondriac pain," "epigastric pain," "abdominal pain," "globus hystericus," "abdominal mass," and "menstrual disease."

This syndrome should be differentiated from the "liver qi transverse unfavorable pattern" and the "spleen dampness pattern of liver depression."

bubble_chart Differentiation and Treatment

The pattern of liver qi depression can be seen in various diseases, each with its own clinical characteristics, and the treatment also varies.

1. This symptom and sign are commonly seen in depressive disorders, characterized by mental depression, or talking to oneself incoherently, or abnormal crying and laughing, alternating between sadness and joy, or appearing dazed and indifferent, with no desire to eat, thin and greasy tongue coating, and wiry or wiry-slippery pulse. It is mostly caused by excessive contemplation, unfulfilled desires, unresolved anger, liver qi depression, failure of wood to disperse earth, failure of spleen qi to ascend, and internal accumulation of phlegm-dampness, leading to phlegm-qi depression. The treatment should focus on resolving depression and transforming phlegm, using Peripatetic Powder(Hejiju Fang) combined with Gallbladder-Warming Decoction(Qianjin Fang).
2. In hypochondriac pain, epigastric pain, and abdominal pain, it manifests mainly as distending pain, or distension more than pain, or wandering qi, with the pain often closely related to emotional distress, increasing or decreasing with emotional changes, accompanied by chest tightness, epigastric stuffiness and fullness, and reduced appetite. It is caused by damage from the seven emotions, leading to stagnation of qi movement. The treatment should focus on soothing the liver and regulating qi to relieve pain, using Bupleurum Liver-Soothing Powder(Jingyue Quanshu) combined with Toosendan Fruit Powder(Suwen Bingji Qiyi Baomingji).
3. In globus hystericus, it manifests as a sensation of obstruction in the throat, as if there is a grilled meatball that cannot be coughed up or swallowed, sometimes gathering and sometimes dispersing. It is caused by qi depression with phlegm. The treatment should focus on dispersing qi and transforming phlegm, using Pinellia and Magnolia Bark Decoction(Jingui Yaolue).
4. In abdominal mass, it manifests as an accumulation in the abdomen, sometimes gathering and sometimes dispersing, or distending pain. It is caused by prolonged unresolved worry, anger, disharmony of the zang-fu organs, stagnation of qi movement, and poor blood circulation. The treatment should focus on regulating qi to break accumulation and invigorating the blood to unblock collaterals, using Seven Qi Decoction(Yixue Rumen).
5. In menstrual diseases, it manifests as irregular menstrual cycles, difficult menstruation, chest tightness, distension and fullness in the breasts, flanks, and lower abdomen, irritability or depression during menstruation, dark red tongue texture, and wiry pulse. It is caused by depression and stagnation of qi movement and disharmony of the Chong and Ren meridians. The treatment should focus on soothing the liver and relieving depression, regulating blood, and regulating menstruation, using Menstruation-Stabilizing Decoction(Fuqingzhu Gynecology).

The pattern of liver qi depression mostly occurs in adults, especially in female patients. Particularly in women around the age of 49, due to deficiency of the Ren meridian, decline of the Tai Chong meridian, exhaustion of reproduction-stimulating essence, and blockage of the "earth path," it often manifests as emotional instability, tendency to sadness and crying, dysphoria, palpitations, insomnia, forgetfulness, tinnitus, and vertigo. The pattern of liver qi depression is closely related to emotional changes. It can recur during unstable emotional states in seasonal diseases and improve when emotions stabilize. Therefore, those who are good at shifting emotions and changing their nature are less likely to suffer from this syndrome.

In the development and evolution of the mechanism of disease in the pattern of liver qi depression, because qi is the commander of blood and blood is the mother of qi, qi depression leads to blood stagnation, manifesting as stabbing pain in the chest and flanks, with fixed pain locations. Stagnation of liver qi leads to excessive wood overacting on earth, damaging the spleen and stomach, causing impaired transportation and transformation, leading to food stagnation, manifesting as indigestion, epigastric distension and fullness, vomiting, belching, or abdominal pain and diarrhea. Qi depression leads to the congealing of body fluids and the production of phlegm, manifesting as chest tightness, gastric stuffiness, anorexia, and greasy tongue coating. Prolonged qi depression without dispersion can transform into heat, manifesting as irritability, bitter taste in the mouth, red tongue with yellow coating.

bubble_chart Differentiation of Similar Patterns

1. Liver qi transverse unfavorable pattern and pattern of liver qi depression: Both are caused by mental stimulation and the disharmony of liver qi movement, but the tendency of disease and clinical manifestations are different. The pattern of liver qi depression is when the qi movement of the liver is depressed and cannot stretch or vent, thus accumulating and stagnating within the body. The tendency of disease is suppression, as its dispersing function is deficient, leading to clinical manifestations such as mental depression, low spirits, reticence, frequent sighing, and fullness or pain in the chest and hypochondrium. Liver qi transverse rebellion is when the qi movement of the liver is disharmonious and chaotic, starting from the wood channel and further transversely invading other organs, attacking the spleen, offending the stomach, rushing to the heart, insulting the lungs, and disturbing the kidneys. The tendency of disease is hyperactivity. Attacking the spleen causes abdominal pain, abdominal distension and fullness, and diarrhea; offending the stomach causes epigastric pain, vomiting, and hiccups; rushing to the heart causes chest tightness and heart pain as if dying; insulting the lungs causes chest fullness, wheezing, cough, and phlegm; disturbing the kidneys causes unconsolidation of the essence gate and leakage. Both the pattern of liver qi depression and liver qi transverse unfavorable pattern have manifestations of spleen dysfunction, but their mechanisms are different. According to the Five Phases' generation and restriction principle, wood restricts earth, and "restriction" is a normal controlling relationship, meaning the transportation and transformation of spleen earth must rely on the dispersing and regulating function of liver wood to complete, as Xiezheng Lun says: "The nature of wood is to disperse, and the food qi entering the stomach relies entirely on the qi of liver wood to disperse it, and thus the water and grain are transformed." Therefore, the middle energizer dysfunction symptoms in the pattern of liver qi depression are due to the stagnation of liver qi movement, which fails to assist the spleen earth's transportation and transformation, i.e., wood failing to regulate earth. The middle energizer dysfunction symptoms in liver qi transverse rebellion are due to excessive liver dispersion, transverse rebellion of qi movement, attacking the spleen earth, resulting in strong liver and weak spleen, which are clearly different. The pattern of liver qi depression can develop and transform into liver qi transverse unfavorable pattern, but liver qi transverse unfavorable pattern generally does not transform into the pattern of liver qi depression.
2. Spleen dampness pattern of liver depression and pattern of liver qi depression: The pattern of liver qi depression is the depression and stagnation of liver qi movement, with the primary location of disease in the liver, as Wang Xugao said; it is "liver qi self-depressed in Benjing" (Wangxugao Yishu Liuzhong．Xixi Shuwu Ye Hua Lu). The spleen dampness pattern of liver depression is due to internal dampness turbidity, trapped in the spleen earth, causing dysfunction of the spleen in transportation, qi stagnation in the middle energizer, and disruption of ascending and descending, affecting the liver qi movement's regulation and dispersion, with the primary location of disease in the spleen, and liver depression as its secondary manifestation. The spleen dampness pattern of liver depression clinically presents first with symptoms of dampness trapping the spleen earth such as anorexia, abdominal distension and fullness, reduced food intake, loose stool, and greasy tongue coating, followed by symptoms of liver depression such as distending pain in the hypochondrium and mental depression, i.e., earth stagnation and wood depression syndrome, which is distinctly different from liver qi depression.

bubble_chart Documentation

1. Waitai Miyao: "Men belong to yang, their qi disperses easily; women belong to yin, their qi tends to stagnate."
2. Danxi Xinfa-Six Stagnations: "Qi depression manifests as chest and hypochondriac pain, with a deep and choppy pulse; damp stagnation causes wandering pain throughout the body or arthralgia, triggered by coldness in the pudendal area, with a deep and thin pulse; phlegm stagnation results in panting upon exertion, with a deep and slippery pulse at the wrist; heat stagnation leads to a stifling sensation, dark urine, and a deep and rapid pulse; blood stagnation causes weakness in the limbs, ability to eat, red stool, and a deep pulse; food stagnation results in belching with a sour taste, abdominal fullness, inability to eat, a normal pulse at the carotid site, and a flourishing pulse at the wrist."
3. Chishui Xuanzhu: "The five zang-organs have their own stagnation syndromes. Heart stagnation manifests as mental confusion, slight chest tightness, and forgetfulness, treated with Cassia Bark, Coptis Rhizome, and Acorus; liver depression causes slight distension in the flanks, belching with sound, treated with green tangerine peel, Sichuan Lovage Rhizome, and Evodia Fruit; spleen stagnation leads to slight fullness in the middle burner, excessive saliva, reduced appetite, and weakness in the limbs, treated with Dried Tangerine Peel, Pinellia, and Atractylodes Rhizome; lung stagnation results in dry skin and hair, desire to cough without phlegm, treated with Platycodon Root, Ephedra, and Fermented Soybean; kidney stagnation causes slight hardness in the lower abdomen, lack of essence, turbid or dribbling urination, and inability to stand for long, treated with Cassia Bark, Poria, and Fennel; gallbladder stagnation manifests as a bitter taste in the mouth, slight tidal fever, and a fearful sensation as if being pursued, treated with Bupleurum, Bamboo Shavings, and Dried Ginger."
4. Leizheng Zhicai．Liver Qi: "The liver wood nature is to rise and disperse, it does not tolerate stagnation. When stagnated, the channel qi counterflows, causing belching, distension, vomiting, sudden anger, hypochondriac pain, chest fullness, loss of appetite, lienteric diarrhea, and hernia, all due to the transverse rebellion of liver qi."