Liver blood deficiency pattern refers to a condition where the liver blood is insufficient, leading to the loss of nourishment of the tendons and vessels, resulting in symptoms such as blurred vision, muscle cramps, dull nails, pale tongue texture, and wiry-thin pulse. It is often caused by excessive blood loss, insufficient blood production, or prolonged illness depleting liver blood.

The main clinical manifestations include: pale or shallow yellow complexion, emaciation, dry eyes, night blindness, or blurred vision, vertigo, tinnitus, numbness in the hands and feet, or muscle cramps, dull nails, and in women, scanty and pale menstruation, or even amenorrhea, pale lips and tongue texture, and a thin or wiry-thin pulse.

Liver blood deficiency pattern is commonly seen in diseases such as "deficiency fatigue," "vertigo," "insomnia," "numbness," "nyctalopia," "menstrual irregularities," and "dysmenorrhea."

Liver blood deficiency pattern should typically be differentiated from "heart blood deficiency pattern," "pattern of blood deficiency generating wind," "liver yin deficiency pattern," and "pattern of blood deficiency due to liver depression."

bubble_chart Differentiation and Treatment

Liver blood deficiency pattern can be seen in various diseases, and its clinical characteristics vary, necessitating careful differentiation.

1. For instance, in women with menstrual irregularities, the liver blood deficiency pattern is characterized by delayed menstruation, scanty flow, pale color, and thin consistency, or even amenorrhea. This is due to insufficient liver blood, an empty Blood Sea, and the inability to fill on time. Treatment should focus on nourishing the liver, enriching blood, and regulating menstruation, using the Minor Nutrient Decoction(Jingyue Quanshu).
2. If seen in dysmenorrhea, it is characterized by continuous lower abdominal pain during or after menstruation, preference for pressure, soreness and weakness in the lower back and knees, vertigo, tinnitus, and a deep, wiry, and thin pulse. This is often due to insufficient liver blood affecting kidney essence, leading to deficiency in the Chong and Ren meridians and malnutrition of the uterine vessels. Treatment should focus on regulating and tonifying the liver and kidneys, using the Liver-Regulating Powder(Fuqingzhu Gynecology).
3. In deficiency fatigue, the liver blood deficiency pattern is characterized by a dull complexion, emaciation, numbness or cramps in the limbs, brittle and thin nails, or even deformation. This is due to insufficient liver blood and malnutrition of the tendons and vessels. Treatment should focus on tonifying blood and nourishing the liver, using the Liver-Tonifying Decoction(《Medical Golden Mirror》).
4. If seen in the eye condition "nyctalopia," it is characterized by blurred vision, night blindness, accompanied by soreness and pain in the eyeballs, and pain radiating to the supraorbital bone. This is often due to insufficient liver blood and malnutrition of the seven orifices. 《Bihua Medical Mirror》 states: "Liver deficiency is due to kidney water failing to nourish wood, leading to blood deficiency. The left guan pulse is weak or empty and large, with symptoms such as hypochondriac pain, dizziness, dry eyes, and pain in the eyebrow ridge and eye sockets." Treatment should focus on nourishing the liver, enriching blood, and improving vision, using the Four Ingredients Decoction(Taiping Huimin Heji Jufang) with modifications.
5. If seen in "insomnia," it is characterized by insomnia, dreamfulness, easy awakening, dizziness, blurred vision, and a wiry, thin pulse. This is often due to insufficient liver blood, leading to malnutrition of the spirit and loss of soul containment. Treatment should focus on nourishing blood, tonifying the liver, and calming the spirit, using the Sour Jujube Decoction(Jingui Yaolue) with modifications.

Liver blood deficiency pattern is commonly seen in patients with excessive blood loss or insufficient production of nutrient-blood, especially in women. Clinical manifestations include scanty menstruation, pale color, late stage [third stage], amenorrhea, post-menstrual abdominal pain, threatened abortion, agalactia, and infertility.

The liver stores blood and governs dispersion, with blood as its foundation. "It is yin in substance and yang in function." If blood is abundant, the liver can store it properly, and dispersion can function normally. Conversely, if liver blood is insufficient, the liver loses its nourishment, leading to deficient dispersion and symptoms such as chest and hypochondriac distension, depression, suspicion, and even a desire to cry, indicating liver qi depression. If blood deficiency leads to yang floating, internal deficiency heat may arise, causing irritability, insomnia, dreamfulness, head distension, headache, dizziness, and blurred vision, indicating ascendant hyperactivity of liver yang.

Additionally, the liver stores blood, and the kidneys store essence. "Essence and blood share the same source." In the progression of disease mechanisms, prolonged liver blood deficiency pattern can lead to kidney essence deficiency, manifesting as vertigo, tinnitus, soreness and weakness in the lower back and knees, hair loss, loose teeth, male infertility, and female infertility, indicating liver-kidney depletion.

Furthermore, insufficient liver blood can lead to poor qi movement and stagnant blood flow, often accompanied by qi stagnation and blood stasis, manifesting as stabbing pain in the hypochondriac region, fixed pain, scaly skin, a purplish tongue edge, or petechiae and ecchymosis. If static blood obstructs, new blood cannot be generated, further exacerbating liver blood deficiency, creating a cycle that makes the condition difficult to resolve.

bubble_chart Differentiation of Similar Patterns

1. Heart blood deficiency pattern and liver blood deficiency pattern: the heart governs blood and vessels, the liver stores blood. If there is insufficiency of heart blood, it is often accompanied by liver blood deficiency; if liver blood is insufficient, heart blood is also affected. Therefore, their clinical manifestations are quite similar, both can present with symptoms of blood deficiency such as pale or shallow yellow complexion, pale lips and nails, vertigo, pale tongue, and weak pulse, so they should be differentiated. In terms of disease cause, heart blood deficiency pattern is mostly caused by excessive blood loss, insufficient source of blood generation and transformation, and excessive thinking, which depletes heart blood. Insufficiency of heart blood leads to the heart losing its nourishment, resulting in palpitations, or even severe palpitations; the heart stores the spirit and governs the mind, if blood does not nourish the heart, the mind fails to keep to its abode, leading to insomnia, dreamfulness, forgetfulness, and mental restlessness. Liver blood deficiency pattern can also be caused by excessive blood loss, insufficient source of blood transformation, and chronic illness depleting liver blood. Since the liver governs the tendons, its brilliance is in the nails, and it resuscitates in the eyes, insufficient liver blood cannot nourish its orifices, leading to dry eyes, blurred vision, nyctalopia, or even impaired vision; liver blood deficiency cannot nourish the tendons, leading to numbness of the limbs, or tendon spasms, and dull nails; the liver is the Sea of Blood, insufficient liver blood leads to an empty Sea of Blood, unable to transform into menstrual blood, resulting in delayed menstruation, scanty flow, or even amenorrhea; the wiry pulse is the liver pulse, the thready pulse is a sign of blood deficiency, liver blood deficiency pattern often presents with a wiry thready pulse. In summary, although the nature of the disease is the same, the location of the disease is different, one is in the liver, the other is in the heart, which can be used for differentiation.
2. Pattern of blood deficiency generating wind and liver blood deficiency pattern: both are caused by blood deficiency, both have clinical manifestations of liver blood deficiency, such as dry eyes, blurred vision, dull complexion, numbness of the limbs, or tendon spasms, pale tongue texture, wiry thready pulse, etc. However, the severity of the disease is different, blood deficiency producing wind is often a further development of liver blood deficiency pattern, the condition is more severe, due to liver blood deficiency, the tendons lose nourishment. Deficiency wind stirs internally, leading to symptoms such as skin itching, limb tremors, or even convulsions, numbness of the limbs, etc. It is different from liver blood deficiency pattern, which is purely blood deficiency without signs of wind stirring, the two are not difficult to differentiate.
3. Liver yin deficiency pattern and liver blood deficiency pattern: liver blood refers to the blood stored in the liver, which belongs to yin, so liver blood deficiency can develop into liver yin deficiency pattern. Both have the location of the disease in the liver, both belong to liver deficiency pattern, the disease cause, mechanism of disease, and clinical manifestations are very similar: liver blood deficiency pattern is mostly caused by excessive blood loss, insufficient source of blood transformation, chronic illness, severe illness depleting liver blood; while liver yin deficiency pattern can be a further development of liver blood deficiency pattern, or it can be caused by kidney yin depletion, water failing to nourish wood, essence not transforming into blood, or Rebing late stage [third stage], consuming yin fluids, and liver depression transforming into fire, depleting liver yin. Their clinical characteristics are different; liver blood deficiency pattern, due to blood deficiency not nourishing the head and face, presents with pale or shallow yellow complexion, pale lips; while liver yin deficiency pattern, due to yin failing to control yang, deficiency heat generating internally, presents with flushed face, red lips and dry mouth, accompanied by vexing heat in the chest, palms and soles, deficiency vexation insomnia, tidal fever night sweat, yellow urine and dry stool, etc., symptoms of yin deficiency with internal heat. Liver blood deficiency pattern often presents with pale tongue texture, wiry thready pulse; liver yin deficiency pattern presents with bright red tongue with little coating, wiry thready rapid pulse. For women, liver blood deficiency, the Sea of Blood is not full, can manifest as delayed menstruation, scanty flow, pale color, or even amenorrhea; while liver yin deficiency, due to yin deficiency with internal heat, heat lodging in the thoroughfare and conception vessels, can burn yin blood and see delayed menstruation, varying flow, amenorrhea, etc., or due to deficiency heat forcing blood to move recklessly, see early menstruation, heavy flow, bright red color, or even menorrhagia and metrostaxis, etc. Liver blood deficiency pattern is purely liver blood deficiency, without signs of yin deficiency with internal heat; liver yin deficiency pattern, in addition to symptoms of yin blood deficiency, has obvious signs of yin deficiency with internal heat, which is the key to differentiation.
4. Pattern of blood deficiency due to liver depression and liver blood deficiency pattern: Both exhibit manifestations of liver blood deficiency, but their disease cause, mechanism of disease, and clinical characteristics differ. The pattern of blood deficiency due to liver depression is often caused by accumulated depression, excessive worry, unresolved resentment, and the gradual depletion of yin, leading to deficiency of yin in the viscera. It primarily manifests as symptoms of yin and blood deficiency in the heart, liver, and kidneys, which fail to nourish the spirit, such as a tendency to cry, or abnormal laughing and crying, mental confusion, difficulty in self-control, or seeing without recognition, hearing without comprehension, frequent yawning, and erratic expressions. Jingui Yaolue states: "In women with visceral agitation, they are prone to sadness and crying, as if influenced by spirits, with frequent yawning and stretching. Licorice, Wheat, and Jujube Decoction is the primary treatment." It is not difficult to distinguish from simple liver blood deficiency.

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bubble_chart Documentation

1. Suwen．"Discussion on the Correspondence of Visceral Qi to Time": "For those with liver disease... deficiency leads to blurred vision and inability to see, inability to hear, frequent fear, as if someone is about to capture them."
2. Zhubing Yuanhou Lun．"On Deficiency Fatigue in Various Princes": "The liver is associated with the eyes and stores blood. Blood nourishes the eyes. When the viscera are overworked and injured, both blood and qi are deficient, the qi of the five zang-organs is insufficient, and cannot nourish the eyes, thus causing dim vision."
3. Bencao Jingshu．Volume 2: "Ten syndromes of liver deficiency, chest and hypochondriac pain, belong to liver blood deficiency; spasms, belong to blood deficiency; short-sightedness, belongs to liver blood deficiency and insufficient kidney water true yin; blurred vision, belongs to liver blood deficiency with heat, combined with insufficient kidney water true yin,... excessive blood loss, opisthotonos, belongs to liver blood deficiency with heat;... dark eyes and vertigo, belong to blood deficiency, combined with insufficient kidney water true yin."
4. Tongsu Shanghan Lun．"Six Classical Formulas and Medicines": "Blood deficiency producing wind is not really wind. It is because blood does not nourish the tendons, the tendons and vessels are cramped, and cannot stretch and contract freely, thus causing hand and foot spasms, similar to wind movement, hence it is called internal deficiency and hidden wind, commonly known as liver wind. This syndrome is often seen in the late stages of warm febrile disease, because heat damages the blood."
5. "Bihua Yijing．Volume 4": "Women are primarily governed by blood. When blood is sufficient, it is abundant and the wood qi is strong; when blood is deficient, it is hot and the wood qi is hyperactive. Both strong and hyperactive wood qi easily produce anger.... However, when anger is vented, liver blood is greatly injured; when anger qi is depressed, liver blood is also subtly damaged. Anger is the thief of blood."