The pattern of gallbladder depression and harassing phlegm is a general term for a series of clinical manifestations caused by the gallbladder's failure to disperse and discharge, qi depression leading to phlegm production, and internal disturbance of phlegm-heat. It is often formed due to the stagnation of seven emotions and the obstruction of qi movement.

Main clinical manifestations: vertigo, bitter taste in the mouth, nausea and vomiting, dysphoria, insomnia, chest tightness, yellow and greasy tongue coating, wiry and slippery pulse, etc.

This syndrome is commonly seen in diseases such as "vertigo," "insomnia," and "qi depression." The pattern of gallbladder depression and harassing phlegm should be differentiated from the "pattern of phlegm-fire harassing the spirit," "pattern of up-flaming liver fire," "pattern of dampness-heat in the liver and gallbladder," and "pattern of gallbladder heat."

bubble_chart Differentiation and Treatment

In clinical practice, many diseases can present with the pattern of gallbladder depression and harassing phlegm, each with its own characteristics, and the treatments are not entirely the same, so they should be differentiated.

1. For those who present with this syndrome and experience vertigo, it is due to the gallbladder's failure to disperse and discharge, leading to qi depression and phlegm production, which in turn stirs up liver yang. Although the main symptoms are dizziness and blurred vision, because of gallbladder channel heat stagnation and internal obstruction by phlegm turbidity, it is often accompanied by a bitter taste in the mouth, nausea, chest tightness, discomfort in the right hypochondrium, anorexia, and dream-disturbed sleep. The treatment should focus on clearing heat and resolving phlegm, pacifying the liver and subduing yang, using the Gallbladder-Warming Decoction(Qianjin Fang) with additions such as Gastrodia Tuber and Uncaria.
2. For those with insomnia presenting this syndrome, it is due to emotional internal damage, the gallbladder's failure to disperse and discharge, leading to depression transforming into heat, qi depression producing phlegm, and phlegm-heat disturbing internally, resulting in mental restlessness. The characteristic symptoms include dysphoria, insomnia, dream-disturbed sleep, and being easily startled, accompanied by a bitter taste in the mouth, dry throat, dark yellow urine, red tongue with yellow greasy coating, and a wiry rapid pulse. The treatment should focus on clearing heat and resolving phlegm, nourishing the heart and tranquilizing the mind, using Coptis Rhizome Gallbladder-Warming Decoction(Liuyin Tiaobian) with additions such as Milkwort Root and jujube seed.
3. For those with qi depression presenting this syndrome, the main mechanism of disease is depression and stagnation of qi movement leading to phlegm and saliva accumulation. Therefore, it often manifests as discomfort in the throat, as if something is stuck that cannot be coughed up or swallowed, chest tightness, hypochondriac pain, thin and greasy tongue coating, and a wiry slippery pulse. The treatment should focus on clearing heat and resolving phlegm, regulating qi and relieving depression, using Gallbladder-Warming Decoction with additions such as lychee seed and Persimmon Calyx.

Gallbladder depression and qi stagnation, with phlegm turbidity obstructing the middle, easily hinder qi movement, leading to stomach qi ascending counterflow, so the pattern of gallbladder depression and harassing phlegm often includes symptoms such as nausea and vomiting.

bubble_chart Differentiation of Similar Patterns

1. pattern of phlegm-fire harassing spirit and pattern of gallbladder depression and harassing phlegm: Both syndromes involve mental symptoms caused by phlegm-heat and are often confused. However, the disease cause mechanism of pattern of phlegm-fire harassing spirit is more complex than that of pattern of gallbladder depression and harassing phlegm. It may be caused by damage from the seven emotions, where qi depression transforms into fire, scorching body fluids to form phlegm, leading to phlegm-fire disturbing the heart, or it may result from external contraction of pathogenic heat combined with phlegm disturbing the spirit. Clinically, pattern of gallbladder depression and harassing phlegm manifests as inhibited qi movement, such as chest tightness and nausea. Pattern of phlegm-fire harassing spirit shows signs of intense fire-heat, such as a flushed face, coarse breathing, constipation, and dark urine. If phlegm-fire disturbs the spirit, symptoms like mania and inappropriate laughter or crying may appear.
2. pattern of up-flaming liver fire and pattern of gallbladder depression and harassing phlegm: Both syndromes can result from internal damage by the seven emotions. The former is caused by liver depression transforming into fire, which attacks the head and eyes, often presenting with dizziness, blurred vision, dry throat, and bitter taste in the mouth, which can be confused with pattern of gallbladder heat and phlegm harassment. However, pattern of gallbladder depression and harassing phlegm primarily manifests as a combination of "depression" and "phlegm," such as chest tightness, frequent sighing, nausea, dysphoria, insomnia, yellow greasy tongue coating, and wiry-slippery pulse. In contrast, pattern of up-flaming liver fire mainly shows signs of "fire" and "heat" flaring upward, such as a flushed face, irritability, burning pain in the hypochondriac region, constipation, dark urine, or even hematemesis and nosebleeds, with a red tongue, yellow rough coating, and wiry-rapid pulse.
3. pattern of dampness-heat in liver and gallbladder and pattern of gallbladder depression and harassing phlegm: The liver and gallbladder are internally and externally related, and gallbladder depression often leads to liver depression. Therefore, both syndromes can exhibit signs of liver-gallbladder depression-heat, such as bitter taste in the mouth and discomfort in the hypochondriac region. Phlegm and dampness are closely related in the disease mechanism and can both obstruct qi movement, leading to symptoms like anorexia and nausea. These syndromes are quite similar and need to be distinguished. The disease cause mechanism of pattern of dampness-heat in liver and gallbladder is more complex, often caused by external contraction of dampness-heat pathogens, or by excessive alcohol consumption or indulgence in rich, sweet foods, leading to the production of dampness-heat. It can also arise from spleen-stomach dysfunction, internal generation of dampness turbidity, which then transforms into heat. This is unlike pattern of gallbladder depression and harassing phlegm, which is primarily caused by internal damage from the seven emotions and qi depression. Pattern of gallbladder depression and harassing phlegm has a milder heat nature, mainly presenting with vertigo, bitter taste in the mouth, dysphoria, insomnia, and chest tightness, with a wiry-slippery pulse. Pattern of dampness-heat in liver and gallbladder has more intense pathogenic heat, with various clinical manifestations. For example, if dampness-heat steams and gallbladder bile overflows, jaundice may appear. If dampness-heat obstructs middle energizer qi movement, leading to spleen-stomach dysfunction, symptoms like nausea, anorexia, abdominal distension, irregular bowel movements, and a wiry-rapid pulse may occur. If dampness-heat pours downward, symptoms like scrotal eczema, testicular swelling and pain, vulvar pruritus, and yellow foul leukorrhea may appear.
4. pattern of gallbladder heat and pattern of gallbladder depression and harassing phlegm: Both syndromes are related to emotional disturbances and clinically share symptoms like insomnia and bitter taste in the mouth, making them quite similar and requiring differentiation. Pattern of gallbladder heat arises from internal damage by the seven emotions, where gallbladder depression transforms into heat, clinically presenting as heat congesting the gallbladder, with symptoms like dizziness, blurred vision, bitter taste in the mouth, dry throat, fullness and discomfort in the chest and hypochondrium, yellow tongue coating, and wiry pulse. In contrast, pattern of gallbladder depression and harassing phlegm is primarily caused by emotional disturbances, often due to gallbladder failing to disperse, leading to qi depression and phlegm production, which then obscures the spirit. If combined with heat, it may also present with bitter taste in the mouth and dry throat, but the main symptoms are vertigo, nausea, mental depression, dysphoria, insomnia, and chest tightness.

bubble_chart Documentation

1. Zhangshi Yitong‧Depression: "The upper energizer, which is yang, is governed by defensive qi. It values smooth flow and dislikes blockage and pathogenic factors. When depressed, body fluids do not circulate and accumulate as phlegm and saliva. The gallbladder uses the throat as its envoy, and the gallbladder dominates decision-making. Its qi belongs to ministerial fire. When confronted with the seven emotions and unable to make decisions, the fire stagnates and does not disperse. Stagnant fire means the flame does not reach, and if the flame does not reach, the qi is like a flame, gathering with phlegm and saliva in the thoracic accumulation, hence it feels like a roasted mass."