Relationship between liver and psycho-emotional problems in TCM

In traditional Chinese medicine (TCM),  the liver is responsible for the flow of energy or qi in the body. It is also the organ that affects decision making and strategy, controls the emotions of frustration, irritability, and anger, controls the relaxation and contraction of muscles, and stores blood (which it discharges to other part of the body, when needed). Practitioners and followers of TCM believe that the Hun or ethereal soul resides in the liver. This Hun departs the body when a person dies and is also what causes the person to focus on long term objectives and goals. The statement in the Nei Jing "blame the liver in adults" means that adults are by definition people who have now come to live with "delayed gratification" compared to a child who longs for "instant gratification". This social limitation of being unable able to do what you want to do whenever and wherever you want to, is due to the restraint of the qi mechanism, that in turn brings qi to stagnation. The function of the liver is to control the flow of qi. Stagnation of qi then affects the liver first manifesting on a mental emotional level in symptoms such as irritability, frustration, and anger. And since the liver is also interconnected with the other organs, physical symptoms such as nausea, vomiting, and abdominal cramping can also manifest as well as other symptoms based on what system or organ becomes affected from the accumulation of qi in the liver.

The traditional characteristic that arises when one or more of the above symptoms are caused by stagnant Liver qi is that the symptoms become worse when there is stress in the body. Therefore, it may be helpful to ask: "Is it worse for stress?" In other words, the practitioner may need to ask the patient if he or she is living a highly stressed out life besides the need to observe the abovementioned symptoms.

For stagnant liver qi, the acupuncture points that a practitioner selects should include the Ren 12, LI 14, Liver 3, Liver 13, and UB 18. Herbal remedies to treat the underlying problem include Bu Shong Yi Chi Tang, Chai Hu Shu Gan San, and Hsao Yao San, especially when stagnant liver is accompanied by deficient Spleen qi.

The organ or organ system most often implicated in psycho-emotional conditions is the liver although some other organs or organ systems can also have the same associations. They may include:

Heart – The heart can be injured by too much joy. This can slow down the flow of qi or cause qi to "slacken." If the person has an existing heart problem, this can become fatal.

Lungs – The lungs can be weakened by sadness and grief and since these organs play a huge role in the production of qi in the body, their weakness usually results in qi deficiency that can appear in the form of asthma, shortness of breath, and chronic fatigue.

Kidneys – The kidney is where a person’s Zhi or willpower resides. This organ’s emotion is fear and therefore, when the kidney is weak, inordinate fear and lack of willpower usually appear. Too much fear or fright may also result in kidney weakness that may then lead to impotence, incontinence, and bedwetting.

Stomach/Spleen – The stomach/spleen can be injured by too much worrying resulting in symptoms such as weak appetite, profuse bleeding, metrorhaggia, loose stools, and in long term cases may lead to various autoimmune dysfunctions. People with this underlying problem are susceptible to obsessive behaviors and can have difficulty in making decisions.

Occasionally, TCM practitioners may treat patients with a pre-diagnosed psychiatric condition or a specific psycho-emotional condition. They are well-trained in resolving such disorders due to the new tools and approaches they have at their disposal

The following are the more common patterns that underlie many of these conditions and some recommendations on how to treat them:

Withdrawal: This is usually caused by either weak kidney yang which means that the issue is the lack of willpower to interact with the outside world or phlegm-cold that blocks the pathways of the heart which oftentimes presents with a white thick coating in the tongue that almost wraps the entire surface of the tongue.

Treatment: Stimulation of the acupoints: Yintang or St 40 for phlegm and K 7 and UB 23 for weak kidney yang. Herbal remedies: Ban Hsia Bai Zhu Tian Ma Wan and Fu Gui Ba Wei Wan for phlegm.

SAD or Seasonal Affective Disorder: All too often caused by weak kidney yang

Paranoia: More to do with blood stasis although deficient blood vacuity may sometimes be also the cause.

Anxiety: Usually caused by either deficient yin or deficient blood.

Mania: Can either be caused by phlegm-fire blocking the heart or liver-fire.

Treatment: St 40 for phlegm and Liv 2 for Liver-fire. Herbal remedies: Wen Den Tang for phlegm and Long Dan Hsie Gan Wan for Liver fire.

Obsessive-compulsive tendencies/disorders: This problem is usually associated with spleen weakness resulting in the buildup of dampness.

Treatment: Sp 3 and St 40. Herbal remedies Modified Si Jun Hsi Tang.

To conclude, it must be noted that while acupuncture and Chinese Herbal therapy can treat a lot of many psycho-emotional problems, the practitioner should not replace the role of the psychologist or psychotherapist.