Liver-stomach disharmony pattern refers to a series of symptoms caused by emotional distress, liver depression, stomach weakness, and liver qi transversely invading the stomach.

The main clinical manifestations include: epigastric distension and pain, radiating to both flanks with scurrying pain, hiccup and belching, acid regurgitation and epigastric upset, indigestion, dysphoria and irritability, thin white or thin yellow tongue coating, and wiry pulse.

Liver-stomach disharmony pattern is commonly seen in diseases such as "epigastric pain," "vomiting," and "hiccup."

This syndrome should be differentiated from "pattern of ascending counterflow of stomach qi" and "pattern of gallbladder depression and harassing phlegm."

bubble_chart Differentiation and Treatment

Liver-stomach disharmony pattern can be seen in various diseases, but the clinical manifestations are not entirely consistent and should be differentiated.

1. In epigastric pain, liver-stomach disharmony pattern manifests as epigastric distension, pain radiating to the waist, and even discomfort in both flanks, frequent belching, thin white tongue coating, and a deep, wiry pulse. It is mostly caused by emotional distress, liver qi depression failing to disperse, transversely invading the stomach, and stomach failing to descend. Treatment should focus on soothing the liver and regulating qi, harmonizing the stomach, and relieving pain. The formula used is Bupleurum Liver-Soothing Powder(Jingyue Quanshu).
2. In vomiting, it manifests as vomiting of sour fluid, frequent belching, fullness and pain in the chest and flanks, restlessness, red tongue edges, thin greasy coating, and wiry pulse. It is caused by emotional imbalance, liver qi stagnation, transversely invading the stomach, stomach qi failing to descend, and instead rising. Treatment should focus on soothing the liver and regulating qi, harmonizing the stomach, using the formula Four Seven Decoction(Hejiju Fang).
3. In hiccup, it manifests as audible hiccups, intermittent occurrence, especially noticeable during emotional fluctuations, accompanied by nausea, epigastric and flank distension, dry and bitter mouth, red tongue with thin white coating, and wiry pulse. It is caused by emotional stagnation, qi movement obstruction, rising to invade the stomach, and stomach failing to descend. Treatment should focus on soothing the liver and harmonizing the stomach, descending counterflow, using the formula Bupleurum Liver-Soothing Powder combined with Tangerine Peel and Bamboo Shavings Decoction(Jingui Yaolue) with modifications.

Liver-stomach disharmony pattern is often seen in individuals with seven emotions stagnation or worsens or recurs during emotional distress. The harmonious descent of stomach qi relies on the liver's generation, distribution, and dispersion of qi. Normal dispersion function requires a relaxed and open heart and mind, ensuring no issues. Therefore, liver-stomach disharmony pattern often has a history of emotional distress before onset and often manifests as mental depression or dysphoria, emotional irritability, etc., after onset.

In the disease mechanism evolution of liver-stomach disharmony pattern, it can often result from liver qi depression, which over time transforms into fire. The urgent nature of fire heat leads to fire qi attacking the stomach earth, manifesting as intense pain, irritability, acid reflux, epigastric upset, dry mouth, bitter taste in mouth, red tongue with yellow coating, and wiry, rapid pulse of fire stagnation syndrome. Additionally, internal fire not only burns liver yin but also easily damages stomach fluid, forming yin deficiency type liver-stomach disharmony, often manifesting as vague pain in the hypochondriac region, epigastric distension and pain, belching, hiccup, hunger without appetite, dry stool, dry mouth, red tongue with little coating or cracks, and thin, wiry, rapid pulse. Furthermore, the root and branch of liver-stomach disharmony pattern mainly lies in qi movement stagnation. Qi commands blood, and blood is the mother of qi. Qi movement leads to blood movement, and prolonged qi stagnation leads to blood stasis pattern, manifesting as fixed pain in the flanks and epigastrium, stabbing pain, tenderness, or further injury to the collaterals leading to hematemesis and black stool.

1. Pattern of ascending counterflow of stomach qi and liver-stomach disharmony pattern: Both present with symptoms of the stomach meridian, but the disease cause and mechanism of disease are different and should be differentiated. The pattern of ascending counterflow of stomach qi is caused by irregular diet, abnormal hunger and fullness, or improper temperature regulation, leading to dysfunction of the stomach's descending function and upward counterflow of qi movement, with pathological changes in the stomach. On the other hand, liver-stomach disharmony pattern is caused by emotional distress, liver depression, and transverse invasion of the stomach, leading to dysfunction of the stomach's descending function, with pathological changes primarily in the liver and secondarily in the stomach. Therefore, although both can clinically present with symptoms of the stomach meridian such as vomiting, hiccup, and belching, liver-stomach disharmony pattern also includes manifestations of the liver meridian such as hypochondriac pain, rib distension, chest tightness, and wiry pulse, and often presents with liver meridian symptoms before stomach meridian symptoms.
2. Pattern of gallbladder depression and harassing phlegm and liver-stomach disharmony pattern: Both can present with some similar symptoms clinically, such as vomiting and nausea, and should be differentiated. The pattern of gallbladder depression and harassing phlegm is caused by emotional stagnation, qi depression producing phlegm, phlegm-heat internally harassing, gallbladder losing its free flow, and stomach losing its descending function. In addition to symptoms of the stomach meridian such as vomiting and nausea, it also includes manifestations such as palpitation due to fright, dysphoria insomnia, dizziness, blurred vision, yellow greasy tongue coating, and wiry slippery pulse. On the other hand, liver-stomach disharmony pattern is mainly characterized by hypochondriac region distending pain due to meridian qi dysfunction. Although both can present with symptoms of the stomach meridian, the pattern of gallbladder depression and harassing phlegm often does not present with pain, while liver-stomach disharmony pattern is mainly characterized by pain. Careful observation can easily differentiate the two.

bubble_chart Documentation

1. Wangxugao Yishu Liuzhong‧Xixi Shuwu Ye Hua Lu: "Liver qi invades the stomach, causing epigastric pain and acid vomiting. Add Left Metal Pill to Erchen Decoction, or use White Cardamom and Chinaberry Fruit."
2. Leizheng Zhicai‧Vomiting: "The symptom of vomiting is caused by the failure of stomach qi to descend, often due to liver qi rushing up to the stomach. Lingshu states: The diseases caused by the foot Jueyin include chest fullness and vomiting. The stomach is responsible for receiving food and maintaining smooth descending. Its upward reversal causing vomiting is due to liver evil invading the stomach or stomach deficiency allowing liver qi to invade. Therefore, to treat vomiting, it is necessary to drain the liver and calm the stomach, using bitter descending and acrid moistening herbs, assisted by sour draining."