The pattern of cold stagnation in the liver meridian refers to the invasion of cold pathogens into the liver meridian, leading to abnormal dispersion and stagnation of qi and blood, with the main manifestation being pain in the lower abdomen due to congealing cold and qi stagnation.

The main clinical manifestations include: lower abdominal distension and fullness pain, dragging testicular pain, even scrotal contraction, pain relieved by heat, fear of cold, cold limbs, pale complexion, clear and long urination, cold leukorrhea in women, dysmenorrhea, white and slippery tongue coating, deep and wiry or deep and tight and slow pulse, etc.

The pattern of cold stagnation in the liver meridian is commonly seen in diseases such as "hernia," "abdominal pain," and "dysmenorrhea."

This syndrome should be differentiated from the "pattern of pathogenic cold invading the stomach" and the "liver yang deficiency pattern."

bubble_chart Differentiation and Treatment

The pattern of cold stagnation in the liver meridian varies due to differences in the severity of cold exposure, individual constitution, and the location of the disease. Therefore, its clinical manifestations and treatment methods differ across various diseases and should be carefully analyzed.

1. For example, in hernia, when the pattern of cold stagnation in the liver meridian appears, mild cases may only show symptoms such as dragging pain in the lower abdomen extending to the testicles, a lingering pain sensation primarily located in the lower abdomen, accompanied by chills and cold limbs, a white and slippery tongue coating, and a deep, wiry pulse. Since the cold pathogen is mild and the qi movement obstruction is not severe, the treatment should focus on warming the liver to dissipate cold, combining warming and unblocking methods. The recommended formula is Liver-Warming Decoction (from Jingyue Quanshu). In severe cases, there may be paroxysmal pain around the navel, or even colicky pain extending to the testicles, accompanied by aversion to cold, sweating, cold hands and feet, and a tight, wiry pulse. This is due to internal cold obstruction and declining yang qi. The treatment should focus on dissipating cold to relieve pain, using Major Aconite Main Root Decoction (from Jingui Yaolue).
2. In cases of abdominal pain with the pattern of cold stagnation in the liver meridian, the pain is mainly in the lower abdomen but can spread to the entire abdomen and both flanks, with a feeling of tightness, which is different from the testicular pain in hernia. The treatment should focus on soothing the liver and regulating qi, combining warming and dispersing methods. The recommended formula is Heavenly Platform Lindera Powder (from "Medical Inventions").
3. In women with dysmenorrhea showing the pattern of cold stagnation in the liver meridian, the clinical manifestations include lower abdominal pain, mostly before menstruation, with dark and thin menstrual blood, cold limbs, pain relief with warmth, profuse leukorrhea, a pale tongue with a white, greasy coating, and a thin, deep pulse. The treatment should focus on warming the meridians and regulating qi, dissipating cold to relieve pain, using Meridian-Warming Decoction (from Jingui Yaolue) with modifications.

Although the pattern of cold stagnation in the liver meridian can be seen in different diseases, the common mechanism of disease is the stagnation of cold in the liver's collaterals. Therefore, this syndrome is more common in individuals with insufficient yang qi and internal cold, as yang deficiency leads to internal cold, and cold stagnation causes pain. In the evolution of the disease mechanism, there are often two extremes: one is due to external cold invasion leading to obstruction of liver meridian qi movement, manifesting primarily as excess evil; the other is due to inherent yang deficiency and internal cold, leading to cold stagnation in the liver meridian, manifesting primarily as deficiency cold. However, it should be noted that during the development and evolution of the disease, cold stagnation can also transform into heat, and cold stagnation can lead to vessel impediment and blood stasis. These concurrent syndromes must be carefully differentiated.

bubble_chart Differentiation of Similar Patterns

1. Pattern of pathogenic cold invading the stomach and pattern of cold stagnation in the liver meridian: Cold is a yin pathogen, which primarily causes congealing and contraction, thus congealing cold and qi stagnation will inevitably lead to pain, which is a common symptom of both syndromes. However, the pattern of pathogenic cold invading the stomach is caused by the stomach being affected by cold pathogens, leading to dysfunction in descending and the upward reversal of turbid yin qi mixed with phlegm and saliva, clinically manifesting as epigastric pain, retching, and salivation. On the other hand, cold stagnation in the liver meridian is due to the Jueyin meridian "circulating through the lower abdomen, passing the genital area," and "spreading to both flanks," with pain often occurring in the lower abdomen, and in severe cases, pain may radiate to the testicles or pull at both flanks. It is evident that the locations of pain differ between the two syndromes.
2. Liver yang deficiency pattern and pattern of cold stagnation in the liver meridian: "Liver deficiency leads to cold" (Sheng Hui Li), the liver yang deficiency pattern is caused by deficiency leading to cold, belonging to deficiency cold, while the pattern of cold stagnation in the liver meridian is caused by cold as a pathogen, leaning towards excess cold, one is deficiency, the other is excess, their natures are different. Although both can present with pain in the lower abdomen or abdominal pain and varying degrees of "cold signs," the pain in liver yang deficiency pattern is dull, prefers warmth and pressure, and is accompanied by mental depression, headache, dizziness, blurred vision, fullness and pain in the chest and flanks, reluctance to speak, frequent sighing, mental fatigue, shortness of breath, cold limbs, loose stools, pale tongue, and a weak and wiry pulse, signs of yang deficiency; whereas the pain in the pattern of cold stagnation in the liver meridian is often localized to the lower abdomen, paroxysmal, with the pain intensity increasing from mild to severe, and characterized by a sensation of distension and urgency. The former focuses on warming and nourishing liver yang, while the latter focuses on warming and dispersing liver cold.

bubble_chart Documentation

1. Suwen.Jutong Lun: "When cold qi invades the Jueyin meridian, the Jueyin meridian connects to the genitalia and is associated with the liver. When cold qi invades the meridian, it causes blood stagnation and meridian tension, hence the hypochondriac region and lower abdomen experience referred pain."
2. 《Bihua Yijing》: "Symptoms of liver cold include a deep and slow pulse in the left guan position. The symptoms include minor abdominal pain, hernia-like masses, scrotal retraction, and alternating chills and fever."