bubble_chart Concept

The pattern of gallbladder heat refers to a series of symptoms and signs primarily characterized by a bitter taste in the mouth and dry throat, caused by gallbladder qi stagnation transforming into heat or stagnant heat accumulating in the gallbladder. It is often due to internal damage from the seven emotions or external contraction of the six excesses.

The main clinical manifestations include: dizziness, tinnitus, bitter taste in the mouth, dry throat, irritability, insomnia, flushed face, fullness and discomfort in the chest and hypochondrium, red tongue with yellow coating, and wiry pulse.

This syndrome is commonly seen in diseases such as "vertigo," "hypochondriac pain," "jaundice," and "insomnia."

This syndrome should be differentiated from the "pattern of up-flaming liver fire," "pattern of dampness-heat in liver and gallbladder," "pattern of liver qi depression," and "pattern of heart-gallbladder disharmony."

bubble_chart Differentiation and Treatment

The pattern of gallbladder heat

1. is seen in vertigo, often caused by long-term anxiety leading to gallbladder stagnation transforming into heat, which disturbs the seven orifices. Symptoms commonly include dizziness, blurred vision, fullness and discomfort in the chest and hypochondrium, bitter taste in the mouth, vomiting of bitter fluid, restless sleep, dreamfulness, red tongue with yellow coating, and a wiry and rapid pulse. Treatment should focus on draining the gallbladder and clearing heat, with the formula choice being Gentian Liver-Draining Decoction(Yizong Jinjian).
2. It appears in hypochondriac pain, often due to external pathogens transforming into heat internally or imbalance of the seven emotions, leading to gallbladder heat stagnating and affecting the liver collaterals, thus causing hypochondriac pain. It may be accompanied by a bitter taste in the mouth, dry throat, nausea with bitter fluid, irritability, insomnia, constipation, red tongue with yellow coating, and a wiry and rapid pulse. Treatment should aim to clear the liver and gallbladder and regulate qi movement, using Chinaberry Fruit Powder(Suwen Bingji Qiyi Baomingji) combined with Left Metal Pill(Danxi Xinfa) with modifications.
3. It is seen in jaundice, often caused by seasonal pathogens invading and stagnating, preventing the normal dispersion of gallbladder bile, which then overflows to the skin and descends to the bladder, leading to yellowing of the skin, eyes, and urine. Treatment should focus on clearing heat and resolving jaundice, using Virgate Wormwood Decoction(《Treatise on Cold Damage Diseases》) with additions such as Phelloendron Bark, Immature Orange Fruit, and Plantain Seed.
4. It appears in insomnia, due to emotional distress or fear and anxiety, leading to disorder of qi movement and gallbladder heat disturbing the heart spirit, manifesting as restless sleep, palpitations, easy fright, red tongue with yellow coating, and rapid pulse. Treatment should aim to soothe the gallbladder and drain heat, supplemented with calming the spirit, using Gallbladder-Warming Decoction(Qianjin Fang) with additions such as Tuber Fleeceflower Stem.

The gallbladder is attached to the liver, inheriting the qi of spring wood, and its nature is free-flowing. Gallbladder bile relies on the liver's dispersion to aid digestion. In the evolution of the pattern of gallbladder heat in the mechanism of disease, due to impaired dispersion, it can easily affect the spleen and stomach functions. For example, if gallbladder heat becomes rampant, it can lead to gallbladder-stomach disharmony, manifesting as distension and pain in the stomach, belching, acid regurgitation, epigastric discomfort, chest and hypochondriac discomfort, irritability, and a thin yellow tongue coating with a wiry pulse. Therefore, in treating the pattern of gallbladder heat, it is crucial to always pay attention to protecting stomach qi and avoid excessive use of bitter and cold herbs to prevent harming the stomach.

bubble_chart Differentiation of Similar Patterns

1. Pattern of up-flaming liver fire and pattern of gallbladder heat: Although both syndromes are caused by the transformation of depression and anger into heat and fire, and the liver and gallbladder are internally and externally related, often influencing each other after causing disease, the pathways of the liver and gallbladder meridians are different, and their functions are slightly distinct, so the clinical manifestations also differ. The pattern of up-flaming liver fire is a manifestation of excess-fire in the liver meridian. Fire tends to flare upwards and is most likely to disturb the seven orifices, such as headache, red eyes, tinnitus, and bitter taste in the mouth. When liver fire disturbs the heart spirit, it can cause irritability and restlessness; when liver fire invades the lung, it can cause hemoptysis. Although the pattern of gallbladder heat also disturbs the seven orifices, it mainly presents with bitter taste in the mouth, dry throat, dizzy vision, and tinnitus. Other symptoms such as headache and red eyes are not as severe as in the pattern of up-flaming liver fire. In summary, in terms of the nature of heat and fire, fire is the extreme of heat, and heat is the gradual form of fire; in terms of the functions of the liver and gallbladder, the liver governs anger, and the gallbladder dominates decision-making, so the pattern of up-flaming liver fire is often characterized by impatience and irritability, while the pattern of gallbladder heat is often characterized by sighing.
2. Pattern of dampness-heat in the liver and gallbladder and pattern of gallbladder heat: The pattern of dampness-heat in the liver and gallbladder is mostly caused by the accumulation of dampness-heat and the dysfunction of the liver and gallbladder in free coursing and discharge, with hypochondriac pain and bitter taste in the mouth similar to the pattern of gallbladder heat. However, the pattern of dampness-heat in the liver and gallbladder is often caused by external contraction of dampness-heat, or overeating rich and sweet foods, leading to dampness transforming into heat, stagnation of liver and gallbladder qi, wood failing to free earth, and dysfunction of the spleen and stomach in ascending and descending, manifesting as anorexia, nausea, epigastric distension and fullness, irregular bowel movements, or dampness-heat steaming, leading to bile overflow and jaundice. Symptoms of the spleen and stomach or jaundice are the main symptoms of the pattern of dampness-heat in the liver and gallbladder. If liver-gallbladder dampness-heat pours downward, it can cause scrotal eczema, vulvar itching, and yellow, foul-smelling leukorrhea in women. The tongue coating is yellow and greasy, and the pulse is wiry, slippery, and rapid. Compared with the pattern of gallbladder heat: one is a disease of the gallbladder organ; the other is a combination of liver and gallbladder diseases; one is caused by pathogenic heat, and the other is caused by dampness-heat. They can be differentiated.
3. Pattern of liver qi depression and pattern of gallbladder heat: The liver governs the free flow of qi and prefers smoothness. Therefore, emotional depression is the main cause of the pattern of liver qi depression. This is different from the pattern of gallbladder heat, which can be caused by internal damage from the seven emotions, depression and stagnation of qi movement, or transformation of the six excesses into heat. The pattern of liver qi depression commonly presents with hypochondriac pain, nausea, breast distending pain, abdominal pain with diarrhea, dysmenorrhea, menstrual irregularities, and can also lead to abdominal masses due to blood stasis. The pattern of gallbladder heat, in addition to discomfort in the chest and hypochondrium and nausea, also presents with dizzy vision, bitter taste in the mouth, dysphoria, insomnia, and constipation, which are manifestations of heat pattern, while the pattern of liver qi depression does not have heat signs.
4. Syndrome of heart-gallbladder不安 and pattern of gallbladder heat: The heart governs mental activity and is the master of the five zang and six fu organs. The gallbladder is the official of justice and governs decision-making. Both the heart and gallbladder are closely related to emotions. People with heart deficiency and timidity are prone to the syndrome of heart-gallbladder不安 when suddenly frightened, which is a deficiency pattern, while the pattern of gallbladder heat is an excess pattern, with essential differences between the two. The syndrome of heart-gallbladder不安 is caused by emotional injury, leading to gallbladder qi disharmony and the heart spirit losing control, manifesting as palpitations due to fright, timidity, dizziness with nausea, insomnia with dreamfulness, a pale red tongue with thin white coating, and a weak rapid pulse. The pattern of gallbladder heat is characterized by tinnitus, bitter taste in the mouth, dry throat, and fullness and discomfort in the chest and hypochondrium.

bubble_chart Documentation

1. Yixue Xinwu.shaoyang meridian pattern: "The gallbladder meridian of foot shaoyang connects to the ear. When pathogenic factors are in the shaoyang, deafness occurs. ... Deafness in the shaoyang is always accompanied by alternating chills and fever; deafness in the jueyin is accompanied by a curled tongue and retracted scrotum, which are distinguishing features."
2. Zhengyin Maizhi‧Gallbladder fire causing sleeplessness: "The symptoms of gallbladder fire causing sleeplessness include diaphragm cold and discomfort, hypochondriac region distension and fullness, as the gallbladder fire invades the spleen; heart dysphoria and confusion, restlessness, as gallbladder fluids overwhelm the heart; in severe cases, yellowing of the eyes..."