Just like the energy of nature around us during spring, the energy in the body this time of year is rising, and things are building.
According to East Asian medicine, springtime correlates with the element of Wood [木]*, which is one of the five elements but also a symbol that co-resonates with all things that exhibit the qualities of new growth, purposeful action, and creativity-in-process. In the body, specific tissues exemplify healthy Wood [木]. These include: the Liver [肝]* organ and its associated meridians, the blood, the balance of the hormones, the tendons and sinews, the eyes, the vertex of the head, and the fingernails and hair. The Liver is responsible for regulating the smooth flow of blood throughout the body. It is thought that an evenness of blood circulation throughout the body determines the evenness of the emotional state, the regulation of our emotions, and the balance between compassion and healthy anger.
(*Note that specific words are purposefully capitalized here to denote the ancient pictographic characters and entire word-fields of meaning. Capitalized Liver denotes the Chinese medicine understanding of the organ and related acupuncture channels as well as energetic and physiologic associations. The uncapitalized liver signifies the English language word and western medicine understanding of the organ.)
Often when people acknowledge liver health in wellness circles, they immediately jump to the idea of liver detoxification. (To explore more about that complex subject, check out this blog post.) And it’s true, the liver participates in over 500 different processes in the body and detoxification is very important. However, for now, I'm more interested in zooming out to better understand the macroecology of the liver in our bodies.
Considering macroecology means that before diving into a protocol or treatment strategy, we take time to assess each person’s body and its tendencies. Also sometimes called constitution. Or tissue state. (This is akin to taking into consideration the geographic location of your home, its soil consistency, temperature, and light quality before deciding which plants you want to work with in your garden.) In treatment, making health and lifestyle decisions based not only on lab tests and protocols, but also in a grounded, felt-sense understanding of the body is not only practical, but it helps guides us towards more effective, individualized approaches.
Patterns of Liver Imbalance
To be more specific, I’m sharing three common patterns that affect the Liver from the perspective and insight of East Asian medicine. As you read about (1) Liver Yin Deficiency (2) Liver Qi Stagnation, and (3) Liver Blood Stagnation, you may want to try to feel into whether any set of tendencies or sensations seem familiar for your body.
Liver Yin Deficiency
Liver Yin Deficiency describes a state of imbalance in which there is not enough of the yin qualities of hydration, cooling, and calming within the Liver organ and associated meridians. In this pattern, the body terrain associated with the Liver – the blood, hormones, the joints, the eyes, the vertex of the head – will exhibit signs and symptoms of dryness, brittleness, and/or heat..
Liver Yin Deficiency Symptoms
Physical manifestations associated with Liver Yin Deficiency may include an overall tendency towards some or all of the following symptoms:
Dryness: dry throat, dry skin, brittle hair, dry fatigued eyes, a dry or tight feeling in the muscles, tendons, joints, or sinews.
Feeling easily overwhelmed or sensitive with a tendency to respond to stress with chronic body tightness and irritability.
Headaches with a tight feeling in the scalp that feel better with pressure on the sides of the head and the vertex.
Light menstrual flow/scant menses or skipped cycles.
Light sleep, difficulty falling asleep, insomnia, or a tendency towards easy reawakening.
A hollow, empty feeling on the inside of the lower legs.
Difficulty maintaining attention and concentration.
Causes of Liver Yin Deficiency
The pattern of Liver Yin Deficiency can be caused by a variety of circumstances, but classically since the Liver is responsible for nurturing and sustaining growth, Liver Yin Deficiency develops as a result of chronic overwork. Being chronically stressed beyond the physical capacity of the body depletes yin. It may develop after prolonged food restriction or excess energy demands beyond replenishment. It can also arise during periods of hormonal transition states such as postpartum or peri-menopause. It’s important to note that each person’s physical capacity is slightly different, so one set of circumstances may be too much for some people and manageable for others.
Treatments for Liver Yin Deficiency
Treatments for Liver Yin Deficiency symptoms include incorporating more hydrating, nourishing, and softening foods and herbs. It’s also important to avoid over-exercise, excessive stress, and get plenty of sleep, rest, and restorative movement. Learning to say no and not take on too much is very important for people who have this constitutional tendency.
Liver Qi Stagnation
This pattern is like the internal equivalent of a living inside a traffic jam: full of frustration and stop-and-go movement. Liver Qi Stagnation represents an accumulation of qi or stuck energy in the body. Symptoms manifest as tension, agitation, and pain that is dull and nagging specifically in the body areas associated with the Liver and its organ and channels.
Liver Qi Stagnation Symptoms
Physical manifestations associated with Liver Qi Stagnation may include:
Chronic pain and tension along the sides of the body especially neck and shoulders, the hips, knees.
Nagging, dull pain in the right shoulder and right shoulder blade.
Fluctuating moodiness: a chronically oscillating sense of irritability, anger, rage, or frustration. There may be cyclical depression and anxiety.
Digestive symptoms reflect a herky-jerky relationship with time: bloating, indigestion, burping, come-and-go nausea, and if more severe, alternating constipation and diarrhea.
Pain worse prior to menses.
Menses may be delayed and/or pain worse the days leading up to cycle.
Breast distention, bra feels annoying or too tight. Often people are unaware of their ribs and thoracic spine, but there’s discomfort there.
Speech may be choppy, abrupt, or harsh.
Liver Qi Stagnation Causes
This pattern can emerge due to (1) an inability to circulate qi throughout the body due to physical exhaustion, or (2) it can arise due to sedentarism or irregular physical movement (which might include sitting for prolonged periods followed by short bursts of intense movement). Rushing. Living through prolonged excessively high pressure.
Treatments for Liver Qi Stagnation
It’s important not to add additional judgment or blame to an already difficult set of sensations. Caring for symptoms of this pattern involves treating the body with tenderness and care: allowing soft, slow movements and gentle sighs, and trying to release the tendency to rush, force movements, or ‘power through’. Acupuncture and custom herbal formulations can be very helpful for releasing symptoms associated with this pattern. Alcohol probably feels like an initial relief for people who have this set of symptoms, because a small amount of alcohol helps to move and circulate qi, but overall alcohol is not helpful and contributes to further Liver Qi Stagnation.
Liver Blood Stagnation
Anatomically, the liver acts as a filter and a hydraulic pump: it pulls venous blood from the periphery, pelvis, and abdomen up through the portal veins, cleans it, and circulates it to the heart. It’s a massive hydraulic dynamic. The pattern of Liver Blood Stagnation pattern describes the mental, emotional, and physical symptoms that occur when there are impedances to this important circulatory movement.
East Asian medicine describes the role of Liver and the blood in the process of sleep. From this energetic perspective, the Liver is responsible for regulating the smooth flow of blood throughout the body. It is thought that an evenness of blood circulation throughout the body determines the evenness of the emotional state and at night, this allows for restoration as well as the spiritual quality of sleep and dreams. Therefore many symptoms associated with Liver Blood Stagnation are worse during evening and nighttime.
Liver Blood Stagnation Symptoms
Physical manifestations associated with Liver Blood Stagnation often include sharp stabbing pain (impeded circulation) and depending on the severity, severe emotional distress. Symptoms may include some or all of the following:
Insomnia, particularly in the middle of the night. Sudden abrupt reawakening in the night between 1 and 3 AM. For people who cycle, they may notice this is especially pronounced in the days leading up towards the menses.
Lack of sensation of thirst. (Not how much water is consumed, but the feeling of whether the person wants it or not.) May involve f feeling thirsty but feeling nauseated upon drinking quenching volumes of water; a tendency to only sip small amounts of water in the afternoons/evenings.
Sharp or nagging pains worse at night or when sitting still for prolonged periods.
Sharp pains in the lower abdomen during the menstrual cycle. Heavier, darker menses and a tendency towards cramping and clotting.
Unexplained dark-colored skin rashes. Darkness under the eyes or along the cheeks.
Left-sided neck pain, worse at night.
Causes of Liver Blood Stagnation
There are many potential causes of Liver Blood Stagnation. Any medical condition related to an accumulation of blood in the abdomen or pelvis (e.g. endometriosis, adenomysosis, fibroids, a bruise or contusion following a trauma or surgical procedure, stagnant blood following childbirth, or past trauma such as a motor vehicle accident) may lead to this pattern, although severity may vary. Liver Blood Stagnation can also develop if the liver itself is unable to complete its role of blood recirculation due to congestion, nutrient deficiencies, or toxin exposure.
Treatments for Liver Blood Stagnation
Acupuncture and herbal formulations may to help recirculate stagnant blood and qi in the pelvis and address seemingly disconnected symptoms. If liver detoxification or congestion is an issue, further investigative lab testing and/or imaging may help determine specific areas for support. Consider targeted detoxification support such as N-Acetyl Cysteine, methylation support, and magnesium glycinate.
Tending to the Liver
Since the liver is involved in so many different physiologic and energetic processes (immune issues, allergies, mood, hormone balance, digestion, pain patterns), tending to its health in individualized, constitutionally-appropriate way can make a big impact on symptoms. It takes years of training and practice — including assessments of the body, overall symptom expression, meridians, pulse, and abdomen — to help determine the nuances of patterns like this and distinguish their priority among many (many) others. Reach out to a trained provider to help sort out what where to focus energy for your overall health.