The pattern of liver and spleen disharmony, also known as the pattern of liver and spleen disharmony, is caused by liver depression qi stagnation, liver qi attacking the spleen, and dysfunction of the spleen in transportation; or due to spleen deficiency with dampness accumulation, earth stagnation and wood depression, leading to dysfunction of both the liver and spleen. It is often caused by depression, anger damaging the liver, dietary overstrain, and excessive thinking harming the spleen.

The main clinical manifestations include: distension and pain in the chest and hypochondrium, frequent sighing, mental depression or irritability, bitter taste in the mouth, dry throat, reduced appetite, abdominal distension and fullness, loose stools, borborygmus and flatus, or abdominal pain and diarrhea, white or greasy tongue coating, and wiry pulse.

The pattern of liver and spleen disharmony is commonly seen in diseases such as "diarrhea," "hypochondriac pain," "tympanites," "abdominal pain," "menstrual irregularities," and "leukorrhea."

This syndrome should be differentiated from the "liver-stomach disharmony pattern," "pattern of deficiency of both heart and spleen," "pattern of spleen deficiency with dampness encumbrance," and "pattern of up-flaming liver fire."

bubble_chart Differentiation and Treatment

The pattern of liver and spleen disharmony can be seen in various diseases.

1. In diarrhea disease, the pattern of liver and spleen disharmony manifests with the following characteristics: frequent chest and hypochondriac stuffiness, belching, reduced appetite, and the occurrence of abdominal pain and diarrhea due to emotional influences such as anger, depression, or stress. This is caused by a constitutional deficiency of spleen qi, or pre-existing food stagnation and dampness, which, when combined with emotional damage to the liver, leads to liver dysfunction in dispersion, transverse invasion of the spleen, and dysfunction of the spleen in transportation, resulting in the failure to digest food and water. As stated in Jingyue Quanshu‧Diarrhea: "Those who experience diarrhea due to excessive anger must first have food stagnation during anger, which damages the spleen and stomach. Thus, any trigger immediately causes a reaction, indicating a disease of the liver and spleen. This is due to liver wood overacting on earth, injuring spleen qi." Treatment should focus on suppressing the liver and reinforcing the spleen. The formula used is Pain and Diarrhea Vital Formula (Danxi Xinfa).
2. In hypochondriac pain, the pattern of liver and spleen disharmony is also seen, characterized mainly by distending pain that moves around, often worsening with depression or anger. This pain arises from the liver failing to act freely, leading to disturbance of qi movement and dysfunction in dispersion. Over time, liver qi invades the spleen, causing not only hypochondriac distending pain but also reduced appetite, anorexia, facial puffiness, and limb fatigue. Treatment should focus on soothing the liver and regulating qi, while strengthening the spleen. The formula used is Bupleurum Liver-Soothing Powder (Jingyue Quanshu), with the addition of spleen-strengthening herbs such as Poria and White Atractylodes Rhizome.
3. In tympanites, the pattern of liver and spleen disharmony manifests with a focus on qi stagnation and dampness obstruction, characterized by abdominal distension that is not firm upon palpation, tight abdominal skin, hypochondriac fullness or pain, scanty urine, reduced appetite, postprandial distension, belching discomfort, white greasy tongue coating, and wiry pulse. As stated in "Shen's Treatise on Life Preservation‧Source and Course of Swelling": "Tympanites... may arise from anger damaging the liver, gradually impairing the spleen. When spleen deficiency reaches an extreme, yin and yang fail to interact, clear and turbid mix, and the pathways become obstructed. Stagnation generates heat, heat retains dampness, and dampness-heat mutually engender, leading to abdominal distension and fullness." This condition can also result from external dampness invasion, improper diet, or excessive alcohol consumption, causing dysfunction of the spleen in transportation, internal retention of water-dampness, dampness-heat accumulation in the middle energizer, spleen deficiency with dampness overwhelming the liver, and liver qi failing to flow freely, leading to qi and blood stagnation, meridian obstruction, and the gradual formation of tympanites. Jingyue Quanshu‧Abdominal Mass states: "If eating habits are irregular, with alternating hunger and overeating, leading to rebellion of stomach qi in the yangming, cold qi from the pudendum can take advantage, causing spleen deficiency and incomplete digestion. Thus, residual stagnation combines with intestinal fluids, accumulating and failing to disperse, gradually forming abdominal mass disease." Treatment should focus on soothing the liver and regulating qi, removing dampness, and relieving abdominal fullness. The formula used is Bupleurum Liver-Soothing Powder (Jingyue Quanshu) combined with Stomach Poria Decoction (Danxi Xinfa).
4. In abdominal pain, the pattern of liver and spleen disharmony manifests with reduced appetite, epigastric distension and fullness, pain radiating to the lower abdomen, shifting pain that worsens with emotional changes, and relief upon belching or passing gas. This is caused by liver qi depression and dysfunction of the spleen in transportation. Jingyue Quanshu‧Heart Abdominal Pain states: "Pain syndromes should differentiate between tangible and intangible forms. Intangible pain lies in the qi aspect, where qi disorders cause distending pain that comes and goes, with no fixed location. When qi gathers, pain manifests; when qi disperses, it subsides without trace. This is intangible pain, which should be treated by regulating qi, as qi regulation will naturally resolve the pain." Treatment should focus on soothing the liver and regulating qi. The formula used is Bupleurum Liver-Soothing Powder.
5. In women's menstrual irregularities, the pattern of liver and spleen disharmony is characterized by irregular menstrual cycles, varying menstrual flow, unsmooth menstruation with dark clots, chest and hypochondriac distension, lower abdominal distension and pain, often accompanied by irritability, reduced appetite, and anorexia. This is also caused by emotional depression or anger damaging the liver, leading to liver qi rebellion, dysfunction in dispersion, and disharmony of the thoroughfare and conception vessels. Liver depression invades the spleen, and spleen deficiency fails to control blood, causing irregularity in the Blood Sea. Treatment should focus on soothing the liver and fortifying the spleen, nourishing blood, and regulating menstruation. The formula used is Peripatetic Powder (Hejiju Fang).
6. In leukorrheal disease, the pattern of liver and spleen disharmony is characterized by continuous yellowish leukorrhea that is thick, sticky, and foul-smelling, or accompanied by yellow discharge or blood, with a burning sensation or itching in the genital area. It is also accompanied by a bitter taste in the mouth, dry throat, irritability, chest and hypochondriac distension, abdominal distension and fullness, and loose stools. This is due to excessive dysphoria and anger damaging the liver, causing liver qi to transversely invade the spleen, leading to impaired spleen transportation and transformation, internal generation of dampness turbidity, prolonged stagnation of dampness-heat transforming into heat, and dampness-heat pouring down to injure the Chong and Dai vessels. It can also result from spleen deficiency with excessive dampness counter-restraining the liver wood, leading to liver qi depression transforming into heat and dampness-heat pouring down. As stated in Bencao Jingshu·Women's Section: "Leukorrhea is mostly due to spleen deficiency. When liver qi is depressed, the spleen is injured, causing the damp-earth qi to sink, resulting in the spleen essence failing to be retained and unable to transform into nourishing blood, leading to the discharge of white, slippery substances. This is all caused by liver wood depression in the earth. The treatment should focus on uplifting liver qi and supporting the spleen's origin." The treatment principle is to soothe the liver, clear heat, and drain dampness. The formula used is Gentian Liver-Draining Decoction (Yizong Jinjian).

The pattern of liver and spleen disharmony often occurs in women. It is mostly caused by emotional distress leading to liver qi depression, zang-fu organ dysfunction, as the saying goes, "All diseases arise from qi." Patients usually experience emotional depression or dysphoria and irritability, and the onset and progression of the disease are often related to emotional changes.

The liver stores blood and governs free flow, while the spleen controls blood and dominates the circuit by element qi transformation. Liver depression and qi stagnation can lead to poor blood circulation, causing blood stasis. Alternatively, if the liver fails to store blood and the spleen fails to control blood, blood may overflow from the vessels and remain, also forming blood stasis. This can result in symptoms such as stabbing pain, lumps, bleeding, a dark complexion, scaly skin, a purplish or spotted tongue texture, and a fine, choppy, or irregular pulse.

bubble_chart Differentiation of Similar Patterns

1. Liver-stomach disharmony pattern and pattern of liver and spleen disharmony: Both liver-stomach disharmony pattern and pattern of liver and spleen disharmony are caused by emotional stress or anger leading to liver qi depression, with liver qi transversely invading the middle energizer. Both syndromes present with symptoms such as distension and pain in the chest and hypochondrium, mental depression or irritability, slight abdominal distension and fullness, pain, and frequent sighing, which are manifestations of liver qi depression. However, the spleen should ascend to be healthy, and the stomach should descend to be harmonious. Liver-stomach disharmony pattern is caused by the liver's failure to disperse, transversely invading the stomach, leading to the stomach's failure to descend. Clinically, besides the symptoms of liver qi depression, it is also accompanied by symptoms such as epigastric distension and pain, hiccup and belching, acid regurgitation, epigastric upset, and vomiting, which are manifestations of stomach qi ascending counterflow. On the other hand, pattern of liver and spleen disharmony is caused by liver qi depression, with liver wood overacting on the spleen, leading to dysfunction of the spleen in transportation. Therefore, clinically, it not only presents with symptoms of liver qi depression but also includes symptoms such as poor appetite, anorexia, abdominal distension and fullness, diarrhea, borborygmus, flatulence, fatigue, and lack of strength, which are manifestations of spleen deficiency. One is due to the stomach's failure to descend, with stomach qi ascending counterflow; the other is due to spleen qi deficiency and dysfunction in transportation. These two are distinctly different and can be differentiated.
2. Pattern of deficiency of both heart and spleen and pattern of liver and spleen disharmony: Both pattern of deficiency of both heart and spleen and pattern of liver and spleen disharmony clinically present with symptoms of spleen deficiency. However, pattern of deficiency of both heart and spleen is mostly caused by excessive thinking, overwork injuring the heart and spleen; improper diet, injuring the source of qi and blood generation and transformation, leading to the heart losing its nourishment; or post-illness maladjustment, long-term blood loss leading to heart blood depletion and spleen qi damage. On the other hand, pattern of liver and spleen disharmony is mostly caused by depression and anger damaging the liver, leading to liver qi depression and transversely invading the spleen; or dietary overstrain injuring the spleen, with spleen deficiency and dampness accumulation counteracting liver wood. Besides the common symptoms of poor appetite, anorexia, abdominal distension and fullness, loose stool, borborygmus, and flatulence, pattern of deficiency of both heart and spleen also presents with palpitations, shortness of breath worsening with activity, insomnia, dreamfulness, forgetfulness, pale complexion, mental fatigue, spontaneous sweating, and a thin, choppy or knotted pulse, which are manifestations of heart qi and blood deficiency. In contrast, pattern of liver and spleen disharmony is accompanied by symptoms such as distension and pain in the chest and hypochondrium, irritability, frequent sighing, and menstrual irregularities, which are manifestations of liver depression qi stagnation. The disease cause, mechanism, and clinical manifestations of these two syndromes have both similarities and differences, making them easy to distinguish.
3. Pattern of spleen deficiency with dampness encumbrance and pattern of liver and spleen disharmony: Both syndromes clinically present with symptoms such as abdominal distension and fullness, loose stool, or irregular bowel movements, borborygmus, and flatulence, which are manifestations of spleen qi deficiency. However, pattern of spleen deficiency with dampness encumbrance is caused by dampness damaging the spleen, leading to spleen yang deficiency and dysfunction in transportation; or by spleen deficiency leading to internal dampness accumulation. Clinically, it presents with symptoms such as heaviness in the head and body, chest tightness, diarrhea, edema, a white and greasy tongue coating, a soggy pulse, and worsening in damp climates, which are manifestations of dampness accumulation. On the other hand, pattern of liver and spleen disharmony involves dysfunction of the liver and spleen, and must present with symptoms such as mental depression or dysphoria, irritability, distension and pain in the chest and hypochondrium, and frequent sighing, which are manifestations of liver depression qi stagnation, making it distinguishable.
4. Pattern of up-flaming liver fire and pattern of liver and spleen disharmony: Both syndromes present with symptoms such as mental depression or dysphoria, irritability, and distension and pain in the chest and hypochondrium, which are manifestations of liver depression qi stagnation, thus requiring differentiation. Pattern of up-flaming liver fire is mostly caused by liver depression qi stagnation, with prolonged depression transforming into fire, and the fire nature rising, leading to qi counterflow. It primarily presents with symptoms such as a red face, red eyes, bitter taste in the mouth, dry throat, dysphoria, irritability, burning pain in the hypochondriac region, headache, vertigo, tinnitus like a tide, constipation, dark urine, or hematemesis and nosebleeds, which are manifestations of liver fire. On the other hand, pattern of liver and spleen disharmony is characterized by symptoms such as poor appetite, anorexia, abdominal distension and fullness, loose stool, or abdominal pain and diarrhea, which are manifestations of spleen deficiency.

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bubble_chart Documentation

1. 《Shen's Nyuke Jiyao Annotation and Correction: Symptoms such as hoarseness during menstruation, dim vision, diarrhea, leukorrhea, etc.》: "...The so-called liver wood insulting earth means that the left pulse should be wiry, while the right pulse should be weak. It is advisable to support the earth and emolliate the liver. There are also cases where the left guan pulse is unexpectedly soft, while the right guan pulse is unexpectedly strong. This is the so-called wood occupying the earth position, where the liver is particularly aggressive and the earth virtue is increasingly declining. It is advisable to use ginseng and astragalus to lift the sinking and also employ methods to gently tame the liver wood."
2. Suwen-Jutong Lun: "Anger leads to qi counterflow, and in severe cases, hematemesis and lienteric diarrhea, hence the rising of qi."
3. Jingyue Quanshu‧Stagnation Syndrome》: "Excess pathogen in the liver often manifests as qi fullness, abdominal distension and fullness, which should be pacified. After the anger has subsided and the rebellious qi has gone, only the middle qi is injured. If there are no symptoms of distension, fullness, or pain, but instead fatigue or reduced appetite, this indicates that wood depression is overcoming earth, damaging the spleen."
4. Leizheng Zhicai‧Liver Qi》: "The nature of liver wood is to ascend and disperse, it does not tolerate depression. Depression leads to qi counterflow, causing belching, distension, vomiting, sudden anger, hypochondriac pain, chest fullness, loss of appetite, lienteric diarrhea, hernia, all of which are due to the rampant decision of liver qi."
5. Zhangshi Yitong‧Various Sweat Pores》: "Anger can cause hematemesis, lienteric diarrhea, scorching syncope, emotional syncope, heat reversal, chest fullness, hypochondriac pain; anger leads to qi counterflow and not descending, causing panting, thirst, vexation, emaciation, lump at the left hypochondrium, sudden blindness, sudden deafness, flaccid tendons, externally manifesting as Yongju."