30 Ways to Love Your Liver
Wáng Xùgāo's treatment principles
Spring continues, and the woody ailments that I wrote of last week have continued apace, if not increased somewhat. So, to continue with the topic of Chinese medicine liver pathology, I will share my homework of the past several days. It is from the Xī Xī Shū Wū Yè Huà Lù (Records of Nightly Chats at the Western Brook Studio) written by Wáng Xùgāo (王旭高, 1798-1862).
Wáng was a famous doctor of the Qīng era, noted for his keen intelligence, clinical adaptability, and high ethical standards. He was reputed to be unpretentious and give preferential treatment to the poor ("王旭高," 2023). He became noted especially as a liver specialist, in large part due to his differentiation of 30 patterns and treatment strategies for liver disharmonies.
I kept seeing passing reference here and there to this essay, so I looked it up and decided to bang out a working translation, which follows. To keep things consistent, I keyed most of it to the Wiseman (2022) terminology, and the identification of medicinals to the Comprehensive Chinese materia medica by Wiseman & Brand (2020) . For the sake of the post length, I decided against providing the Chinese text, but if you want to access it, you can find it here.
Thirty Methods to Treat the Liver
(by Wáng Xùgāo)
Liver qì, liver wind, and liver fire, these three are similar with different names. Among them, insulting the spleen and overwhelming the stomach, agitating the heart and attacking the lungs, harboring cold and phlegm, root vacuity and branch repletion, there are all sorts of different manifestations; thus liver disease is the most complicated and the treatment methods are the most numerous. For now, we will list the general outline below.
Liver Qi Patterns and Treatments
(1) Course the liver and rectify qì (疏肝理氣 Shū gān lǐ qì). For example if one’s liver qì is stagnated in its original channel, both flanks will be distended or painful, so it is appropriate to course the liver. Combine Xiāng Fù (Rz Cyperi), Yù Jīn (Rx Curcumae), Sū Gěng (Caulis Perillae), Qīng Pí (Pc Citri Reticulatae Viride), Jú Yè (Fm Citri Reticulatae). With concurrent cold, add Wú Yú (Fr Evodiae); for concurrent heat, add Dān Pí (Cx Moutan), and Shān Zhī (Fr Gardeniae); for concurrent phlegm, add Bàn Xià (Rz Pinelliae) and Fú Líng (Poria).
(2) Course the liver and unblock the network vessels (疏肝通絡 Shū gān tōng luò). For example if coursing the liver gives no response, yíng qì is impeded and obstructed, and the network vessels are blocked by stasis, then simultaneously unblock the network vessels, for instance with Xuán Fù (Fl Inulae), Xīn Xiàng (Galeri Comitis Fascea)*, Guī Xū (Rx Tenuis Angelicae Sinensis), Táo Rén (Sm Persicae), Zé Lán Yè (Hb Lycopi), etc.
*n.b.: Xīn Xiàng is the red tassel from a Qīng official’s hat, dyed red with Hóng Huā (Fl Carthami). Presumably the spaghetti-like tassel resembles the luò vessels and thus can treat them. Guī Xū are the whiskers from the Dāng Guī Wěi, the tail of the Chinese Angelica root.
(3) Emolliate the liver (柔肝 Róu gān). For example with severe liver qì distension, coursing will make it even more so, thus one must emolliate the liver with Dāng Guī (Rx Angelicae Sinensis), Qǐ Zĭ (Fr Lycii), Bǎi Zǐ Rén (Sm Biotae), and Niú Xī (Rx achyranthis bidentata). If it is hot, add Tiān Dōng (Rx Asparagi) and Shēng Dì (Rx Rehmanniae); if it is cold, add Cōng Róng (Hb Cistanches) and Ròu Guì (Cx Cinnamomi).
(4) Relax the liver (緩肝 Huǎn gān). For example, in liver qì and even central qì vacuity one should relax the liver, using Zhì Cǎo (Rx Glycyrrhizae Praeparata), Bái Sháo (Rx Paeoniae Alba), Dà Zǎo (Fr Jujubae), Jú Bǐng (Dulcia Citri Reticulatae)*, and Huái Xiǎo Mài (Fr Tritici Levis).
*n.b.: Jú Bǐng is identified as candied tangerine.
(5) Bank up earth and discharge wood (培土泄木 Péi tǔ xiè mù). If liver qì overwhelms the spleen, causing abdominal distension and pain, use Liù Jūn Zǐ Tāng (Six Gentlemen Decoction) plus Wú Zhū Yú (Fr Evodiae), Bái Sháo (Rx Paeoniae Alba), and Mù Xiāng (Rx Aucklandiae Seu Vladimiriae). This is the method of banking up earth and discharging wood. (Warming the interior and coursing wood, Huáng Yù Qiū* used this method.)*
*n.b.: a.k.a. Huáng Yuán Yù 黄元御; for more information, see for example Heiner Fruehauf’s site or Eran Even’s essays .
(6) Discharge the liver and harmonize the stomach (泄肝和胃 Xiè gān hé wèi). If liver qì overwhelms the stomach, (i.e. liver wood overwhelms earth) with epigastric pain and vomiting acid, use Èr Chén (Two Aged Ingredients Decoction) plus Zuǒ Jīn Wán (Left Metal Pill), or Bái Kòu (Fr Amomi Kravanh) and Jīn Líng Zǐ (Fr Meliae Toosendan). This is the method of discharging the liver and harmonizing the stomach.
(7) Discharge the liver (泄肝 Xiè gān). If the liver qì surges up to the heart, and the heart suffers pain from the heat, it is advisable to discharge the liver with Jīn Líng (Fr Melia Toosendan), Yán Hú (Rz Corydalis), Wú Yú (Fr Evodiae), and Chuān Lián (Rz Coptidis Sichuanensis). If it is cold, go with Chuān Lián, add Jiāo (Fr Piperis Nigri) and Guì (Cx Cinnamomi); if you have both cold and heat, go with Chuān Lián, or add Bái Sháo (Rx Paeoniae Alba). Constructing a prescription with bitter, acrid and sour tastes is the main method for discharging the liver.
(8) Repress the liver (抑肝 Yì gān). If liver qì surges upwards to the lungs, causing sudden ribside pain, and counterflow ascent of qì with panting, one should repress the liver, for example by combining Chǎo Sāng Pí (Cx Mori Praeparata), stir-fried with Wú Yú Zhī (Succus Evodiae), Sū Gěng (Caulis Perillae), Xìng Rén (Sm Armeniacae), and Jú Hóng (Pc Citri Reticulatae Rubrum).
(9) Disperse the liver (散肝 Sàn gān). "Depressed Wood is treated by outthrusting", Xiāo Yáo Sàn (Free Wanderer Powder) is an apt choice. "The liver wants to disperse, so quickly eat acrid food to disperse it", that is to say, to disperse the liver.
Liver Wind Patterns and Treatments
Liver wind is a pattern that, although many times it ascends to cloud the top of the head, it is also able to move laterally to the four limbs. Most of those with upper clouding have yang hyperactivity, while those in whom wind moves laterally have more blood deficiency. However, most of the internal wind arises from fire, and if there is surplus qì it is just like fire. For the rest, it is called liver qì , liver wind, and liver fire. The three have different names, their diseases are different, and the treatment methods, too, are different.
(10) Extinguish wind and harmonize yang (熄風和陽 Xí fēng hé yáng). For example, when liver wind begins to arise with clouding and dizziness of the head and eyes, use the method of extinguishing wind and harmonizing yang, employing Líng Yáng (Cornu Saigae Tataricae), Dān Pí (Cx Moutan), Gān Jú (Fl Chrysanthemi), Gōu Gōu (Uncis Uncariae), Jué Míng (Sm Cassiae), Bái Jí Lí (Fr Tribuli Terrestris), promptly to cool the liver.
(11) Extinguish wind and subdue yang (熄風潛陽 Xí fēng qián yáng). If extinguishing wind and harmonizing yang is not effective, one should extinguish wind and subdue yang, using Mǔ Lì (Concha Ostreae), Shēng Dì (Rx Rehmanniae), Nǚ Zhēn Zĭ (Fr Ligustri), Xuán Shēn (Rx Scrophulariae), Bái Sháo (Rx Paeoniae Alba), Jú Huā (Fl Chrysanthemi), and Ē Jiāo (Colla Corii Asini), to enrich the liver.
(12) Bank up earth and quiet wind (培土寧風 Péi tǔ níng fēng). If the liver wind ascends counterflow, the center is vacuous with low appetite, it is appropriate to enrich yángmíng and discharge juéyīn, for instance with Rén Shēn (Rx Ginseng), Gān Cǎo (Rx Glycyrrhizae), Mài Dōng (Rx Ophiopogonis), Bái Sháo (Rx Paeoniae Alba), Gān Jú (Fl Chrysanthemi), and Yù Zhú (Rz Polygonati Odorati). This is the method of banking up earth and quieting wind, that is, the method of relaxing the liver.
(13) Nourish the liver (養肝 Yǎng gān). If the liver wind moves to the four limbs, with pulling or numbness in the channels and network vessels, it is fitting to nourish blood and extinguish wind. That is to use Shēng Dì (Rx Rehmanniae), Guī Shēn (Rx Angelicae Sinensis), Qǐ Zĭ (Fr Lycii), Niú Xī (Rx Achyranthis), Tiān Má (Rz Gastrodiae), Zhì Shǒu Wū (Rx Polygoni Multiflori Praeparatae), Sān Jiǎo Hú Má (Sm Sesami Nigri)* to nourish the liver.
n.b.: I was unable to specifically identify this herb. From the context I labeled it as black sesame seeds but I also found some sources which suggest it may be Chōng Wèi Zǐ (Fr Leonuri).
(14) Warm earth to ward off cold and wind (暖土以禦寒風 Nuǎn tǔ yǐ yù hán fēng), as in “Jīn Guì” ("Golden Chamber"), which is close to the effect of Bái Zhú Fù Zǐ Tāng (Atractylodes Macrocephalae and Aconite Decoction), which treats wind vacuity with heaviness of the head, dizziness, extreme bitterness, and inability to recognize the taste of food. This is the method of warming earth to ward off cold and wind. This is not treating the liver, rather it is supplementing the center.
(15) Calm the liver (平肝 Píng gān). Jīn Líng (Fr Meliae Toosendan), Jí Lí (Fr Tribuli Terrestris), Gōu Gōu (Uncis Uncariae), Jú Yè (Fm Citri Reticulatae).
(16) Track the liver (搜肝 Sōu gān). Besides this, there is the method of tracking wind. Ordinary people must first have pre-existing internal wind and then contract external wind, and one could also have external wind stirring internal wind. When liver wind gets in, the two often become tangled up together, so medicinals to track wind should also be used, such as Tiān Má (Rz Gastrodiae), Qiāng Huó (Rx Notopterygii), Dú Huó (Rx Angelicae Pubescentis), Bò Hé (Hb Menthae), Màn Jīng Zĭ (Fr Viticis), Fáng Fēng (Rx Ledebouriellae), Jīng Jiè (Hb Schizonepetae), Jiāng Cán (Bombyx Batryticatus), Chán Tuì (Periostracum Cicadae), and Bái Fù Zǐ (Rz Typhonii).
Liver Fire Patterns and Treatments
Liver fire burns and scorches as it proceeds through the triple burner, and the diseases it is capable of causing through the whole body, upper and lower, inside and outside, are difficult to count. For example red eyes and reddening of the cheeks, tetanic reversal and manic agitation, strangury, constipation, sores, rapid hungering and vexation-thirst, vomiting and insomnia, and bleeding all over the body above and below.
(17) Clear the liver (清肝 Qīng gān). Such as Líng Yáng (Cornu Saigae Tataricae), Dān Pí (Cx Moutan), Hēi Zhī (Fr Gardeniae Carbonisatus), Huáng Qín (Rx Scutellariae Baicalensis), Zhú Yè (Fm Bambusae), Lián Qiáo (Fr Forsythiae), Xià Kū Cǎo (Spica Prunellae).
(18) Drain the liver (瀉肝 Xiè gān). As in Lóng Dǎn Xiè Gān Tāng (Gentiana Liver-Draining Decoction), Xiè Qīng Wán (Liver-Draining Pills), Dāng Guī Lóng Huì Wán (Chinese Angelica and Aloe Pills) and the like.
(19) Clear metal to restrain wood (清金制木 Qīng jīn zhì mù). Liver-fire flames upward, to clear it always one must restrain the liver, so clear metal to restrain the hyperactive counterflow of wood and fire, with the like of Shā Shēn (Rx Glehniae), Mài Dōng (Rx Ophiopogonis), Shí Hú (Hb Dendrobii), Pí Pá Yè (Fm Eriobotryae), Tiān Dōng (Rx Asparagi), Yù Zhú (Rz Polygonati Odorati), and Shí Jué Míng (Concha Haliotidis).
(20) Drain the child (瀉子 Xiè zi). For example, those with liver fire excess can simultaneously drain the heart, using medicinals such as Gān Cǎo (Rx Glycyrrhizae) and Huáng Lián (Rz Coptidis). This is treating repletion by draining the child.
(21) Supplement the mother (補母 Bǔ mǔ). If water is depleted and the liver fire is intense, clearing it should not be done. One must boost kidney water, which is the rule of "supplement the mother when empty", with such as Liù Wèi Wán (Six-Flavor Rehmannia Pill), or Dà Bǔ Yīn Wán (Great Yin-Supplementing Pill). It is also the meaning of “yǐ guǐ* have the same origin”.
*n.b.: yǐ and guǐ refer to stems 2 and 10, which correspond to liver and kidney respectively.
(22) Transform the liver (化肝 Huà gān). [Zhang] Jǐngyuè treats symptoms such as depressed anger damaging the liver, qì counterflow stirring fire, heat vexation and ribside pain, distension and fullness, and blood stirring types of patterns with Qīng Pí (Pc Citri Reticulatae Viride), Chén Pí (Pc Citri Reticulatae), Dān Pí (Cx Moutan), Shān Zhī (Fr Gardeniae), Sháo Yào (Rx Paeoniae), Zé Xiè (Rz Alismatis), Bèi Mǔ (Blb Fritillariae). The standard prescription is Huà Gān Jiān (Liver-Transforming Brew). This also clears and transforms depressed fire in the liver channel.
Liver Cold and Liver Vacuity and Other Patterns and Treatments
(23) Warm the liver (溫肝 Wēn gān). If the liver is cold, with vomiting of acid and panting, it is appropriate to warm the liver with Ròu Guì (Cx Cinnamomi), Wú Yú (Fr Evodiae), Shǔ Jiāo (Pc Zanthoxyli). If there is simultaneous central vacuity stomach cold, add Rén Shēn (Rx Ginseng), and Gán Jiāng (Rz Zingiberis), which is the Dà Jiàn Zhōng Tāng (Major Center-Fortifying Decoction) method.
(24) Supplement the liver (補肝 Bǔ gān). Such as making something with Shǒu Wū (Rx Polygoni Multiflori), Tú Sī Zĭ (Sm Cuscutae), Qǐ Zĭ (Fr Lycii), Zǎo Rén (Sm Zizyphi Spinosae), Yú Ròu (Fr Corni), Zhi Má (Sm Sesami), and Shā Yuàn Jí Lí (Sm Astragali).
(25) Settle the liver (鎮肝 Zhèn gān). For instance with Shí Jué Míng (Concha Haliotidis), Mǔ Lì (Concha Ostreae), Lóng Gǔ (Os Draconis), Lóng Chǐ (Dens Draconis), Jīn Bó (Auri Lamina)*, Qīng Qiān (Linaritum), Dài Zhě Shí (Haematitum), Cí Shí (Magnetitum) and the like.
n.b.: Jīn Bó is gold leaf; it is bitter, neutral, enters heart and liver channels to settle the liver and quiet the spirit. Qīng Qiān was not listed but an internet search indicated that it is linarite.
(26) Constrain the liver (斂肝 Liǎn gān). Such as with Wū Méi (FrMume), Bái Sháo (Rx Paeoniae Alba), and Mù Guā (Fr Chaenomelis).
These three methods, regardless of liver qì , liver wind, and liver fire, can be used as appropriate.
(27) Supplement liver yin (補肝陰 Bǔ gān yīn). Dì Huáng (Rx Rehmanniae), Bái Sháo (Rx Paeoniae Alba), Wū Méi (Fr Mume).
(28) Supplement liver yang (補肝陽 Bǔ gān yáng). Ròu Guì (Cx Cinnamomi), Chuān Jiāo (Pc Zanthoxyli), and Cōng Róng (Hb Cistanches).
(29) Supplement liver blood (補肝血 Bǔ gān xuè). Dāng Guī (Rx Angelicae Sinensis), Chuān Duàn (Rx Dipsaci), Niú Xī (Rx Achyranthis Bidentata), Chuān Xiōng (Rx Ligusticum Chuanxiong).
(30) Supplement liver qi (補肝氣 Bǔ gān qì). Tiān Má (Rz Gastrodiae), Bái Zhú (Rz Atractylodis Macrocephalae), Jú Huā (Fl Chrysanthemi), Shēng Jiāng (Rz Zingiberis Recens), Xì Xīn (Hb Asari), Dù Zhòng (Cx Eucommiae), Yáng Gān (Iecur Caprae seu Ovis)*.
* n.b.: Yáng Gān is the liver of a sheep or goat.
Note: this newsletter is for information purposes only and is not intended as medical advice. Please seek the opinion of a health care professional for any specific medical issues you may have.
References
Wáng, X.G. (n.d.). Xī Xī Shū Wū Yè Huà Lù. https://jicheng.tw/tcm/book/%E8%A5%BF%E6%BA%AA%E6%9B%B8%E5%B1%8B%E5%A4%9C%E8%A9%B1%E9%8C%84/index.html. Retrieved April 15, 2023.
Wáng Xùgāo 王旭高. (n.d.). https://baike.baidu.com/item/%E7%8E%8B%E6%97%AD%E9%AB%98/5317912. Retrieved April 20, 2023.
Wiseman, N. (2022). Chinese-English Dictionary of Chinese Medical Terms. Paradigm Publications.
Wiseman, N., & Brand, E. (2020). Comprehensive Chinese materia medica. Paradigm Publications.