3. Liver Disease Differentiation

3. Liver Disease Differentiation

(1) Liver Qi Stagnation

Bitter taste in the mouth, dry throat, irritability, fullness and distension in the chest and hypochondrium, and a wiry pulse are the basic symptom complex of this condition. If accompanied by abdominal distension, loss of appetite, and nausea, it is Liver-Stomach Disharmony; if accompanied by a sensation of something stuck in the throat that cannot be swallowed or expelled, it is Liver Qi Reversal (Meiheqi). For Liver Qi Stagnation, disperse the liver qi and relieve stagnation using the Chaihu Shugan San (Zhang Jingyue); for Liver-Stomach Disharmony, disperse the liver qi and harmonize the stomach using the Xiaoyao San (Jufang); for Liver Qi Reversal, disperse the liver qi and descend the qi using the Banxia Houpu Tang (Zhang Zhongjing). The liver’s nature is to flow freely; when it stagnates, it may rebel against the stomach (Liver-Stomach Disharmony) as the first manifestation, or it may ascend and strike the throat (Meiheqi) as the second manifestation. Both are outcomes of Liver Qi Stagnation.

(2) Liver-Gallbladder Real Fire

Bitter taste in the mouth, dry throat, irritability, fullness and distension in the chest and hypochondrium, dizziness, headache, tinnitus, red face and eyes, palpitations, shortness of breath, and reddish, scanty urine—all indicate Clearing the Liver and Draining the Fire using the Longdan Xiegan Tang (Yizong Jinjian). This condition often arises from prolonged stagnation turning into fire, so the basic symptom complex consists of two parts: ① bitter taste, dry throat, irritability, and fullness in the chest and hypochondrium (Liver Qi Stagnation). ② dizziness, headache, red face and eyes, reddish, scanty urine, and a rapid pulse (fire ascending). Palpitations, shortness of breath, and tinnitus are manifestations of the governing and assisting fire.

(3) Liver Yin Deficiency

Dizziness, tinnitus, lower back pain, ear ringing, bone-steaming heat, vexation in the five hearts, night sweats, numbness and tremors in the limbs, a red tongue with little coating, and a wiry, fine pulse—all indicate Nourishing Water and Containing Wood using the Qiju Dihuang Wan. The liver and kidneys share a common origin; liver Yin relies on kidney Yin for nourishment, so the manifestations of liver Yin deficiency consist of three parts: ① dizziness, tinnitus, and lower back pain (kidney deficiency symptoms). ② bone-steaming heat, vexation in the five hearts, and night sweats (yin deficiency symptoms). ③ numbness and tremors in the limbs (yin failing to nourish the sinews).

(4) Internal Liver Wind (All wind-related dizziness belongs to the liver)

① Extreme heat generating wind (wind-fire interaction): high fever, palpitations, convulsions, syncope, and a wiry, rapid pulse—all indicate Draining Fire and Calming the Spirit using the Lingyang Gouteng Tang (Yu Genchu).

② Yang excess generating wind (all sudden rigidity belongs to wind): severe headache, hemiplegia, facial asymmetry, convulsions, and coma—all indicate Calming the Liver and Extinguishing Wind using the Zhen Gan Xi Feng Tang (Zhang Xichun).

③ Blood deficiency generating wind: tremors, numbness, and convulsions—all indicate Nourishing Blood and Extinguishing Wind using the Da Ding Feng Zhu (Wenbing Tiaobian).

(5) Cold Stagnation in the Liver Meridian

Cold pain in the lower abdomen, retraction of the scrotum, and heaviness in the testicles—all indicate Warming the Liver and Dispelling Cold using the Nuangan Jian (Zhang Jingyue). The lower abdomen, scrotum, and testicles are all areas traversed by the Foot-Jueyin Liver Meridian.