Liver yin deficiency pattern refers to a group of clinical symptoms caused by insufficient liver yin and blood, leading to failure of nourishing and moistening, malnutrition of tendons and vessels, or failure of yin to restrain yang, resulting in internal generation of deficiency heat. It is often caused by excessive blood loss, prolonged illness, or depletion of liver yin.

The main clinical manifestations include: vertigo, headache, dry eyes, photophobia, blurred vision, or night blindness, tinnitus, hypochondriac pain, irritability, brittle nails, or muscular twitching, or even a sensation of facial heat, dry mouth and throat, flushed cheeks and lips, vexing heat in the chest, palms, and soles, tidal fever, night sweats, insomnia, dreamfulness, a bright red tongue with little coating, and a wiry, thin, and rapid pulse. Women may experience delayed menstruation, scanty menstruation, or amenorrhea.

Liver yin deficiency pattern is commonly seen in conditions such as "hypochondriac pain," "vertigo," "headache," "deficiency fatigue," "internal damage fever," "sweating syndrome," "insomnia," "dryness and pain in the white of the eye," "bluish blindness (optic atrophy)," "high-wind internal visual obstruction (pigmentary retinopathy)," as well as "delayed menstruation," "amenorrhea," and "menorrhagia and metrostaxis."

Liver yin deficiency pattern should be differentiated from "kidney-yin deficiency pattern," "pattern of yin deficiency and yang hyperactivity," "pattern of up-flaming liver fire," and "liver-kidney yin deficiency pattern."

bubble_chart Differentiation and Treatment

Liver yin deficiency pattern is one of the common clinical symptoms and signs, which can appear in various diseases.

1. For example, in hypochondriac pain, if liver yin deficiency pattern is observed, it is characterized by dull pain in the hypochondriac region, continuous pain, a red tongue with little coating, and a wiry, thin, and rapid pulse. This is caused by the insufficiency of liver yin and blood, which fails to nourish Jingmai, as stated in Jingui Yi．The General Discussion on Hypochondriac Pain says: "Liver deficiency refers to liver yin deficiency. Yin deficiency leads to tense and rapid pulses. The liver meridian passes through the diaphragm and spreads to the hypochondriac region. Yin deficiency and blood dryness cause Jingmai to lose nourishment, resulting in pain." The treatment should focus on enriching yin and emolliating the liver, using All-Along Decoction (from "Liuzhou Medical Talks").
2. If vertigo or headache presents with liver yin deficiency pattern, symptoms include dizziness with reluctance to open the eyes, lingering headache, and tinnitus resembling the sound of cicadas. This is often due to insufficient liver yin, leading to the lack of nourishment of the seven orifices. The treatment should focus on enriching yin and nourishing the liver, using Wolfberry and Chrysanthemum Rehmannia Pill (from "Medical Levels") with modifications.
3. In cases of internal damage fever with liver yin deficiency pattern, symptoms include tidal fever in the afternoon or at night, feverish sensations in the palms and soles, bitter taste in the mouth, dry throat, and dysphoria. This is caused by insufficient liver yin, where yin fails to control yang, leading to internal heat. The treatment should focus on enriching yin, nourishing the liver, and clearing heat, and All-Along Decoction can also be used with modifications.
4. If sweating syndrome presents with liver yin deficiency pattern, symptoms include night sweats, insomnia, and restlessness. This is due to insufficient liver yin, yin deficiency with fire excess, and yin failing to internally regulate. Yixue Zhengzhuan．Sweating Syndrome states: "Night sweats refer to profuse sweating during sleep, noticed upon waking, which belongs to yin deficiency and is governed by the nutritive blood." The treatment should focus on nourishing yin and reducing fire to stop sweating, using Angelica Six Yellows Decoction (from Lanshi Micang) with modifications.
5. If deficiency fatigue presents with liver yin deficiency pattern, symptoms include emaciation, flushed face, dull nails, limb numbness, or muscular twitching, often accompanied by symptoms of multiple zang-fu organ deficiencies. The condition is chronic and difficult to cure, often caused by insufficient liver yin and blood, leading to the lack of nourishment of the tendons and vessels. "The Golden Mirror of Medicine" states: "Pain in the ribs extending to the chest, with flaccid tendons and inability to walk, is liver fatigue." This highlights the characteristics of the syndrome, and the treatment should focus on enriching and tonifying liver yin, using Liver-Tonifying Decoction (from "The Golden Mirror of Medicine").
6. If liver yin deficiency pattern appears in ophthalmic diseases, it may manifest as dryness and pain in the white of the eye, high-wind internal visual obstruction (pigmentary retinopathy), or bluish blindness (optic atrophy). Symptoms include dry eyes without swelling or redness, photophobia, night blindness, blurred vision, or even blindness. This is caused by insufficient liver yin and essence-blood deficiency, leading to the lack of nourishment of the eyes. Zhubing Yuanhou Lun states: "The eyes are the external manifestation of the liver... When their fluids are exhausted, dry eyes occur." The treatment should focus on nourishing blood and improving vision, using Eyesight-Improving Rehmannia Pill (from Shenshi Yaohan).
7. If liver yin deficiency pattern appears in gynecological diseases, symptoms include delayed menstruation, scanty flow, red or pale color, or amenorrhea, with a red tongue and little coating, and a wiry, thin pulse. This is caused by insufficient liver yin, deficiency of the Chong and Ren meridians, and the Blood Sea not being full. The treatment should focus on nourishing the liver and regulating menstruation, using All-Along Decoction with modifications.
8. Additionally, liver yin deficiency may also appear in menorrhagia and metrostaxis, characterized by prolonged menstrual bleeding of varying amounts, bright red color, dull pain in the lower abdomen, soreness and weakness in the lower back and knees, and feverish sensations in the palms and soles. This is caused by insufficient liver yin, kidney essence deficiency, yin deficiency with internal heat, and qi disturbing the Chong and Ren meridians, leading to reckless bleeding. The treatment should focus on nourishing water to moisten wood, regulating menstruation, and stopping bleeding, using Liver-Regulating Decoction (from Fuqingzhu Gynecology).

The liver yin deficiency pattern is commonly seen in elderly and physically weak individuals, those with prolonged illnesses that deplete the body, or patients who have undergone improper or incorrect treatments that deplete yin fluids. Since the liver is considered the "innate foundation" for women, this syndrome is more frequently observed in females. In women, the liver yin deficiency pattern primarily manifests as late-stage menstruation [third stage], dysmenorrhea, or amenorrhea, hypomenorrhea with continuous spotting, threatened abortion, infertility, and other related characteristics.

The liver is the organ that stores blood, governs dispersion, and prefers smoothness and free flow. Therefore, the storage of blood and the regulation of qi movement are closely related to the liver. In the process of disease mechanism evolution, insufficient liver yin and blood failing to nourish the liver, along with the constraint of liver qi, lead to yin deficiency and liver depression. Conversely, prolonged liver depression can cause the five minds to transform into fire, deplete liver yin, and further exacerbate liver yin deficiency. Additionally, since the liver and kidney share the same origin, their pathological changes often influence each other, resulting in liver and kidney yin deficiency. Moreover, liver and kidney yin deficiency leads to water failing to nourish wood, causing excessive ascendant hyperactivity of liver yang. If the liver's yang rises uncontrollably, depleting essence and blood, and the meridians lose nourishment, wind arises internally, leading to internal stirring of liver wind, which worsens the condition.

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1. Kidney-yin deficiency pattern and liver yin deficiency pattern: The liver stores blood, the kidney stores essence, and essence and blood share the same source. Their clinical manifestations are quite similar, both potentially presenting with vexing heat in the chest, palms, and soles, insomnia due to deficiency vexation, tidal fever, night sweats, flushed cheeks, dry mouth and throat, dizziness, and blurred vision. In terms of disease cause, kidney-yin deficiency pattern is often caused by congenital weakness, excessive sexual activity, depletion of the lower origin, loss of blood, emotional internal damage, or depletion of essence and blood, leading to injury of true yin. On the other hand, liver yin deficiency pattern often develops from liver blood deficiency pattern, or liver depression transforming into fire, which depletes liver yin, or prolonged illness depleting liver yin. The liver opens into the eyes, and insufficient liver yin fails to nourish the orifices, resulting in dry eyes, blurred vision, or night blindness. The liver governs the tendons, and its brilliance is in the nails. The hypochondriac region is where the liver meridian distributes. Insufficient liver yin fails to nourish the tendons, nails, and meridians, leading to limb numbness, muscular twitching, dull nails, and dull pain in the hypochondriac region. In contrast, kidney-yin deficiency pattern differs in that the kidney governs the bones and generates marrow, the teeth are the surplus of the bones, and the lower back is the residence of the kidneys. Insufficient kidney yin leads to emptiness of the sea of marrow, malnutrition of the bones, resulting in vertigo, tinnitus, forgetfulness, weak legs, heel pain, hair loss, loose teeth, and soreness and weakness in the lower back and knees. Liver yin deficiency pattern is located in the liver, with a wiry, thin, and rapid pulse; kidney-yin deficiency pattern is located in the kidney, with a deep, thin, or deep, thin, and rapid pulse, which can be used for differentiation.
2. Pattern of yin deficiency and yang hyperactivity and liver yin deficiency pattern: The liver is a firm-characterized zang organ, with yin as its substance and yang as its function. Pattern of yin deficiency and yang hyperactivity is often caused by liver-kidney yin deficiency, water failing to nourish wood, or liver qi depression transforming into fire, which scorches liver yin, leading to liver yang surging upward. Sudden flaring of liver yang disturbs the clear orifices, causing distending headache, vertigo with a tendency to fall, heavy head and light feet, and is often triggered by fatigue or anger, with a sudden onset and severe condition. Due to yang floating upward, there is facial redness, red eyes, a red and crimson tongue with little coating, and a wiry, thin, and rapid or wiry and forceful pulse, possibly accompanied by liver-kidney yin deficiency. In contrast, liver yin deficiency pattern is primarily characterized by deficiency of liver yin fluid. Insufficient yin fluid fails to nourish the seven orifices, leading to lingering headache, vertigo with reluctance to open the eyes, a slower progression of the disease, dry eyes without redness or swelling, dull pain in the hypochondriac region, a red tongue with little coating, and a wiry, thin, and rapid pulse. Pattern of yin deficiency and yang hyperactivity is often a combination of root deficiency and branch excess, with liver yin deficiency as the root and yang hyperactivity as the branch; liver yin deficiency pattern is root deficiency without branch excess, which is the key to differentiation.
3. Liver-kidney yin deficiency pattern and liver yin deficiency pattern: The liver and kidney both reside in the lower energizer. Kidney yin deficiency often leads to liver yin deficiency, and liver yin deficiency can also lead to kidney yin depletion. Therefore, liver-kidney yin deficiency pattern and liver yin deficiency pattern are easily confused and should be differentiated. Liver yin deficiency pattern often develops from liver blood deficiency, or liver depression transforming into fire, which depletes liver yin, or prolonged illness depleting liver yin. Liver-kidney yin deficiency pattern is often caused by liver yin deficiency pattern further affecting the kidney, or internal damage from the seven emotions, overexertion depleting essence and blood, or prolonged illness depleting liver and kidney yin. Liver yin deficiency primarily manifests as insufficient liver yin fluid; while liver-kidney yin deficiency pattern not only includes liver yin deficiency pattern but also presents with symptoms of kidney yin deficiency such as soreness and pain in the lower back and spine, soreness in the calves and heels, loose teeth, hair loss, seminal emission, premature ejaculation, and infertility in women. The two are not difficult to differentiate.
4. Pattern of up-flaming liver fire and liver yin deficiency pattern: Both can present with heat signs, such as vertigo, headache, tinnitus, hypochondriac pain, and a rapid pulse. However, their disease causes and mechanisms differ: pattern of up-flaming liver fire is often caused by liver depression transforming into fire, with qi and fire surging upward. Due to the flaming nature of fire, it disturbs the clear orifices, leading to distending headache, or even splitting headache, tinnitus like a tide, often sudden onset, or sudden loss of hearing. The disease cause of liver yin deficiency is different, with symptoms characterized by lingering headache, tinnitus like cicadas, which diminishes with pressure. Pattern of up-flaming liver fire, due to liver meridian heat stagnation, presents with burning pain in the hypochondriac region, thirst with a desire to drink, red and swollen eyes, bitter taste in the mouth, and dry throat. Qi and fire flaming upward can lead to reckless blood movement, resulting in hematemesis, nosebleeds, and other bleeding phenomena. In contrast, liver yin deficiency pattern, due to insufficient yin fluid and malnutrition of the orifices and collaterals, presents with dull pain in the hypochondriac region, dry eyes, and dry mouth without a desire to drink. Pattern of up-flaming liver fire presents with a red tongue with yellow coating and a wiry, rapid, and forceful pulse, belonging to excess heat; liver yin deficiency pattern presents with a red tongue with little coating and a wiry, thin, or wiry, thin, and rapid pulse, belonging to deficiency heat, which can be used for differentiation.

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bubble_chart Documentation

1. Suwen．"Zangqi Fa Shi Lun": "For those with liver disease, there is pain under both flanks extending to the lower abdomen, making one prone to anger; in deficiency, there is blurred vision and inability to see, deafness and inability to hear, proneness to anger, as if one is about to be captured. ... Qi counterflow leads to headache, deafness, and swelling of the cheeks."
2. Zhubing Yuanhou Lun．Volume 15: "Insufficiency of liver qi leads to unclear vision, tightness under both flanks, muscular spasms, inability to sigh, withered nails, a greenish complexion, proneness to sadness and fear, as if one is about to be captured. This is a deficiency of liver qi and should be treated with tonification."
3. Shengji Zonglu．Volume 41: "It is said that the symptoms of liver deficiency include a greenish complexion, a tendency to cleanliness and anger, a pulsating sensation on the left side of the navel that is firm and painful when pressed, lack of appetite, melancholy, and fear as if one is about to be captured. The pulse appears on the left guan position, indicating yin deficiency, which is a sign of this condition."
4. Shengji Zonglu．Volume 102: "The kidney stores essence, and the liver stores blood. When a person's essence and blood are abundant and harmonious, the qi of the kidney and liver is balanced, nourishing the ears and eyes, thus ensuring clear hearing and vision. If essence and blood are depleted, and these two organs are deficient, the aqueous humor becomes unclear, leading to weak vision and darkening of the eyes."
5. 《Four Examinations Juwei．Volume 3》: "…… Frequent yawning with a red face and many tendons indicates liver fire; frequent yawning with a greenish face and palpitations due to fright indicates both heart and liver issues; red eyes with excessive tearing indicate accumulated heat; dizziness and inability to look down indicate liver fire; withered blood and stiff hair indicate liver deficiency; photophobia and fear of sunlight indicate issues with both the liver and kidney."