When the Mother Cannot Warm the Child
On Liver Yáng Vacuity
In our last discussion, we approached the subject of liver qì vacuity. This week, we will continue our liver pathodynamics series with a look at liver yáng vacuity.
In their chapter on liver yáng vacuity, Yán & Lĭ (2007) point out that, while the underlying idea of liver yáng vacuity has been around in some form or other since the Hàn period, it was generally referred to as liver vacuity cold. The first published mention of liver yáng deficiency was during the Qīng period.
Liver vacuity cold largely comes to us through studying patterns like cold invading the liver channel, for which the formula Nuӑn Gān Jiān (Liver Warming Brew) by Zhāng Jièbīn (1563–1640) is given as a guiding prescription. It is often taught as a qì-regulating formula, but Scheid et al (2009) characterize its pattern as “stagnation of Liver qi with deficiency of Liver yang and blood”. Thus, mention of liver yáng vacuity is primarily associated with hernial disorders, and other manifestations of cold in the lower abdomen.
There is, however, another aspect of liver yáng vacuity which may be relevant. It is found under the heading “Impaired Warming” in the final chapter of Yán & Lĭ (2007). A summary of it follows:
Liver Yáng Vacuity with Impaired Warming
Etiology
· Chronic liver qì depression, which wears out the yáng qì
· Weak health in old age or otherwise
· Cold pathogen striking from the exterior
· Development from other organ pathologies
· Wrong treatment / iatrogenic
Pathology and clinical manifestations
· If the liver cannot bring warmth to its child, the heart, one can suffer depression (鬱) and gloominess (抑郁) with weakened and exhausted essence-spirit (精神萎靡), and the intention and will dissipated and sunken (意志消沉).
· Liver's ethereal (hún) soul cannot be aroused (肝魂不振), so the person is prone to fright (善惊), quick to fear (易恐) and cannot peacefully lie down at night (夜卧不安)
Additionally:
· The depression of qì results in dull rib-side and flank pain, heaviness in the chest, and tendency to sigh.
· The liver yáng fails to ascend, so as a result there is dizziness and headache. The sensory orifices are not warmed, so there is dimness and black spots in the visual field.
· The sinews lack warmth, and are unable to bear one's normal labors, and are prone to trembling.
· Yang cannot reach the extremities, so the hands and feet become chilled.
· The tongue is pale, the coating white and the pulse weak yet wiry.
The recommended formula is from Wáng Xùgāo’s Zhì Gān Sà Fǎ (30 Methods to Treat the Liver), referred to as Bǔ Gān Yáng Fāng (Formula to Supplement Liver Yáng):
Ròu Guì (Cx Cinnamomi), Chuān Jiāo (Pc Zanthoxyli), Cōng Róng (Hb Cistanches).
Yán & Lĭ (2007) add:
Huáng Qí (Rx Astragali), Dǎng Shēn (Rx Codonopsitis), Bái Zhú (Rz Atractylodis Macrocephalae), Yín Yáng Huò (Hb Epimedii), Lù Jiǎo (Cornu Cervi), Dāng Guī (Rx Angelicae sinensis), Fù Zǐ (Rx Aconiti Lateralis Praeparata)
Here, as in our last discussion, we see Huáng Qí with its upbearing, effusive quality included with Dǎng Shēn and Bái Zhú to supplement the qì and Dāng Guī to nourish blood. Lù Jiǎo and Yín Yáng Huò are included to supplement liver and kidney yáng and Fù Zǐ warms the interior, so the hún soul can be roused, and the eyes, sinews and limbs can be warmed.
Ikeda Masakazu and Liver Yáng Deficiency
In his The Practice of Japanese Acupuncture and Moxibustion: Classic Principles in Action (2005), Ikeda Masakazu includes among his pattern differentiations one categorized as “Liver Deficiency / Yang Deficiency / Cold Pattern”. To summarize the key points of his discourse, as I understand them:
Etiology, Pathology and Clinical Manifestations
In this pattern, both the yīn fluids and the life gate fire are deficient, along with the liver blood.
Ikeda says a lack of yíng qì (the yáng aspect of blood) results in the appearance of cold signs. In addition, the reduction of ying qì means the blood does not flow adequately, resulting in blood stasis. Thus there is a sort of dual vacuity of yíng and blood. The symptom set is similar to the yáng vacuity with impaired warming pattern above, including dizziness, weak vision, fatigue, and cold extremities as well as lower burner symptoms like infertility, irregular menstruation, and low back pain. The cold will generally sink downward to the middle and lower burners, leaving the upper burner to heat up, as in reverting yin (jué yīn) disease. The mental-spiritual manifestations are not mentioned.
The pulse is given as sinking and rough. The abdominal conformation is upper abdominal tightness, with guarding and pressure pain in the lower right quadrant; there may also be pressure pain in the inguinal area, not unlike the pattern of cold in the liver channel.
Treatment
The treatment points are given as KD3 (tài xī), LR3 (taì chōng), SP1 (yǐn bái), and GB40 (qiū xū). The idea is to supplement yíng qì but Ikeda advises against anything but extremely superficial insertion with no retention on the root treatment points. Needles may be retained on the upper abdomen with moxibustion applied to the lower abdomen. Very light needling on the back may also be used.
Formula
The formula Ikeda recommends may vary with the presentation, but a general formula for the pattern is Dāng Guī Sì Nì Jia Wú Zhū Yú Shēng Jiāng Tāng (Tangkuei Counterflow Cold Decoction with Evodia and Fresh Ginger):
Dāng Guī (Rx Angelicae Sinensis), Bái Sháo (Rx Paeoniae Alba), Gān Cӑo (Rx Glycyrrhizae), Tōng Cӑo (Medulla Tetrapanacis), Guì Zhī (Rm Cinnamomi), Xì Xīn (Hb Asari), Shēng Jiāng (Rz Zingiberis Recens), Wú Zhū Yú (Fr Evodiae), Dà Zǎo (Fr Jujubae)
Conclusion
We’re looking at the change of seasons here and so wrapping up our discussion on liver patterns. Liver yáng vacuity often gets compartmentalized as pertaining to hernial disorders, but a look at the literature shows that isn’t the whole story. Patients who are having mental-emotional difficulties or musculoskeletal problems may well have liver yáng impaired warming pattern. Thanks again for reading, and a warm welcome to everyone who has subscribed recently.
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
Ikeda, M. (2005). The practice of Japanese acupuncture and moxibustion: Classical principles in action (E. Obaidey, Trans.). Eastland Press. (Original work published 1996).
Scheid, V., Bensky, D., Ellis, A., & Barolet, R. (2009). Chinese herbal medicine: Formulas & strategies (2nd ed.). Eastland Press.
Yán, S.L. & Lĭ , Z.H. (2007). Pathomechanisms of the liver (Sabine Wilms, Trans.). Paradigm Publications.