The pattern of liver depression and blood stasis refers to the symptoms and signs caused by the stagnation of blood due to prolonged qi depression resulting from the failure of liver qi to disperse and regulate.

The main clinical manifestations include a dull and dark complexion, stuffiness and hardness with pain in the hypochondriac region, accompanied by abdominal distension and fullness, fatigue, anorexia, a dark red tongue with ecchymosis on the edges, a white coating, and a wiry pulse.

The pattern of liver depression and blood stasis is commonly seen in diseases such as "hypochondriac pain," "jaundice," "abdominal mass," "liver stagnancy," and "tympanites."

This syndrome should typically be differentiated from the "stomach stasis pattern" and the "yangming stasis pattern."

bubble_chart Differentiation and Treatment

The pattern of liver depression and blood stasis can be seen in various diseases, each with different clinical manifestations that must be carefully differentiated.

1. For example, in hypochondriac pain, the pattern of liver depression and blood stasis often presents with stabbing pain in the chest and hypochondrium, fixed and unrelenting, worse at night, possible stuffiness or lumps under the hypochondrium, a purplish-dark tongue texture, and a wiry and choppy pulse. This condition arises from prolonged liver depression leading to qi stagnation and blood stasis, with static blood accumulation. Treatment should focus on regulating qi and resolving stasis to transform blood stasis, using the modified Blood House Stasis-Expelling Decoction(Yilin Gaicuo).
2. If the pattern of liver depression and blood stasis appears in jaundice disease, it often manifests as dark, dull jaundice, blue eyes and black face, mild abdominal distension and fullness, black forehead, black and sometimes loose stools, a red tongue tip with yellow greasy coating, and a deep, wiry, and choppy pulse. This is due to jaundice caused by sexual intemperance, resulting from liver depression and blood stasis, spleen deficiency failing to transport, and internal dampness-heat. Yu Jiayan stated, "Jaundice caused by sexual intemperance is due to blood stasis." (Yimen Falu) Treatment should aim to resolve stasis, eliminate dampness, and clear heat, using Niter and Alumite Powder (Jingui Yaolue) with additions such as Giant Knotweed, Salvia, and India Madder Root.
3. In liver stagnancy, the pattern of liver depression and blood stasis often presents with distension and stabbing pain in the chest and hypochondrium, fixed pain, acid regurgitation, vomiting, thirst for hot drinks, slight relief with heat, a purplish-dark tongue texture, and a thin, choppy pulse. You Zai-jing said, "Although the liver is affected, it reflects on the lung, which is the nature of transverse disease." ("Jinmin Yaolue Xindian") This is due to liver depression and stasis affecting the lung. Treatment should focus on moving qi, dispersing stagnation, and activating blood, using Inula Flower Decoction (Jingui Yaolue) with additions such as Albizia Flower, Platycladi Seed, and Luffa Vegetable Sponge.
4. In abdominal mass, the pattern of liver depression and blood stasis often presents with lumps under the hypochondrium, soft but firm, fixed and immovable, accompanied by distending pain, a thin tongue coating, and a wiry pulse. This condition arises from liver depression and qi stagnation leading to blood stasis, which accumulates over time to form lumps. Treatment should focus on regulating qi and resolving stasis to disperse accumulation, using Chinaberry Fruit Powder(Suwen Mechanism of Disease Baoming Ji) combined with Sudden Smile Powder(Taiping Huimin Heji Jufang) with additions such as Green Tangerine Peel, Dried Tangerine Peel, Sparganium, and Zedoary Rhizome.
5. In tympanites, the pattern of liver depression and blood stasis often presents with a dark complexion, a large and firm abdomen, prominent abdominal veins, emaciated limbs, difficulty breathing when lying down, poor urination and defecation, a purplish-dark tongue texture, and a deep, wiry pulse. This condition arises from qi stagnation and blood stasis leading to water retention and mutual binding of water and stasis. Treatment should focus on reducing fullness, eliminating dampness, activating blood, and expelling water. For yang deficiency, warming yang should be added, using Cinnamon Twig Decoction without Peony Root plus Aconite Decoction (Jingui Yaolue) combined with Infradiaphragmatic Stasis-Expelling Decoction(Yilin Gaicuo) with modifications. For yin deficiency, nourishing yin should be added, using Peach Kernel, Carthamus and Four-Ingredient Decoction(Taiping Huimin Heji Jufang) combined with Dredging and Channelling Decoction(Jisheng Fang) with modifications.

bubble_chart Differentiation of Similar Patterns

1. Stomach stasis pattern and pattern of liver depression and blood stasis: The liver is the Jueyin, the organ that stores blood, and the stomach belongs to the Yangming, an organ with abundant qi and blood. Both conditions are prone to progress from the qi aspect to the blood aspect, often manifesting as static blood symptoms. Stomach stasis pattern is clinically characterized by fixed epigastric pain, pain like needles or knives, or the appearance of dark purple hematemesis, black bloody stool, a purplish tongue texture, and a thin, choppy pulse. The pattern of liver depression and blood stasis, on the other hand, is clinically characterized by hypochondriac pain and stuffiness, with different disease locations leading to different symptoms. If liver disease affects the stomach, static blood symptoms may also appear in both the liver and stomach.
2. Yangming stasis pattern and pattern of liver depression and blood stasis: Both Yangming stasis pattern and pattern of liver depression and blood stasis present with jaundice and static blood symptoms. In terms of disease cause and mechanism, the jaundice seen in Yangming stasis pattern is primarily caused by damp-heat, leading to stasis due to heat, and is often seen in external-contraction febrile diseases. The pattern of liver depression and blood stasis, although it can also present with jaundice, is primarily characterized by stasis, with heat and dampness arising from stasis, leading to jaundice, often seen in jaundice due to sexual intemperance or advanced liver disease. Clinically, the jaundice seen in Yangming static blood is due to damp-heat stagnation and stasis internally, progressing from the qi aspect to the blood aspect, leaning towards an excess pattern, characterized by bright yellow skin like the color of an orange, difficulty urinating, slight abdominal fullness, and fever. The jaundice seen in the pattern of liver depression and blood stasis is due to stasis leading to damp-heat stagnation, accompanied by liver and kidney deficiency, characterized by dark forehead, jaundice with a dark black color, and black, loose stools. Although both present with jaundice, they can be differentiated based on the brightness or dullness of the yellow color, the presence or absence of urinary and bowel difficulties, and the duration of the disease.

bubble_chart Documentation

1. 《Chinese Medicine Clinical Essentials．Hypochondriac Pain》: "Hypochondriac pain like a prick, the pain location does not move, pressing it worsens the pain, pulse manifestation is wiry and choppy or deep and choppy, mostly caused by... blood stasis accumulating below the ribs, the skin at the pain location has blue-purple bruises, the main treatment should be to expel stasis, using the Origin-Restoring Blood-Invigorating Decoction, within the formula Bupleurum is a guiding herb, not for the purpose of soothing the liver. Or use the modified Sanqi Powder."
2. Linzheng Zhinan Yi'an．Hypochondriac Pain》: "Liver collaterals congealed stasis hypochondriac pain, must guard against anger causing loss of blood"