Monday, April 8, 2013

The Liver in Traditional Chinese

In Traditional Chinese Medicine, the Spring season is associated with the Liver and its paired organ the Gallbladder. Natural medicine systems from both east & west concur that Spring is an important time to attend to the health of the liver. To better understand what this really means, let's take a look at the roles that the Liver and Gallbladder play in the human body, according to Chinese medicine.

(Note: The names of organs are often capitalized in western-language discussions of Traditional Chinese Medicine, i.e. Liver, Gallbladder. This is because the "organ"-name in Chinese medicine does not directly equal the anatomical organ, but rather a "system" or set of essential physiological, mental and emotional functions and qualities associated with that organ.)

First, to highlight some remarkable facts about the liver  from a western biomedical perspective:

Weighing about four pounds, the liver is our second largest organ (the skin is the largest). Not only is it big -- it's also BUSY, delivering a multitude of essential functions.

Among its contributions, the liver metabolizes food, stores vitamins and minerals, makes and breaks down hormones, controls blood sugar levels, synthesizes and regulates cholesterol, contributes to the immune system, generates bile, and detoxifies our blood.

Every day the liver:
  • manufactures 13,000 different chemicals
  • manages 2000 internal enzyme systems
  • filters 100 gallons of blood, and
  • produces 1 quart of bile.
The detoxification functions of the liver protect us from the damaging effects of the many toxic compounds we are exposed to every day. Some of these compounds are the natural by-products of our metabolic processes. Others come from processed foods, disease processes in our body, alcohol, medications, chemical pollutants, etc. 

Stress, toxins and lifestyle factors take their toll on the liver, with liver cells losing structural and functional integrity over time. (Extreme examples are fatty liver disease often, associated with diabetes and obesity, and cirrhosis associated with hepatitis viruses.) At the same time, the liver is resilient. Even after 70% of its mass has been destroyed or removed, the organ can still function, albeit with decreased effectiveness. If the conditions that caused the destruction have been removed or corrected, the liver can usually bounce back. (Source.) This motivates us to care for our livers by means of diet, lifestyle choices, and holistic medicine. As mentioned above, Spring is a great time to do that.

Now, let's turn our attention to the
Traditional Chinese Medicine (TCM) 
perspective on the Liver:

The Liver's primary responsibility, in TCM theory, is to maintain a smooth flow of energy throughout the body.

Nutritionist Paul Pitchford writes,

"Traditional Chinese Physiology tells us that the healthy liver establishes a smooth and soothing flow of energy through the whole system, in both body and mind. When the liver is harmonious, there is never stress or tension. People with vital livers are calm; they also have unerring judgement and can be naturally effective as leaders and decision-makers."

Indeed, the Liver is poetically associated with qualities like courage, ambition, decision-making and strategic leadership. At the same time, the Liver is thought to be a moody organ. Of all the body's systems, the Liver system is the most easily injured by the demands and stresses of modern life, environmental toxins, excessive computer work and screen-time, etc. When affected by stress or emotional excess, the Liver is prone to become congested and the flow of energy through the body stagnant. Liver is also prone to becoming deficient of Blood, particularly due to poor nutrient intake or lack of sleep. These two patterns, Liver congestion-Qi stagnation and Liver Blood vacuity are at the root of many prevalent chronic diseases.

When your acupuncturist suspects Liver imbalance at the root of your symptoms, he/she will look for confirming signs (related to Liver and Gallbladder organ and meridian pathologies):

  • digestive troubles
  • sleep problems
  • headaches
  • dry/red eyes or blurry vision
  • allergies
  • irritability, depression, anger
  • moods swings
  • tinnitus, ear infections
  • PMS, menstrual cramps
  • neck and shoulder pain/ TMJ
  • pain or discomfort in the area of the ribs
  • tendon/ligament injuries, muscle spasms or cramps
  • certain hormonal imbalances, particularly in relation to cyclical transitions.

Here is more detail about the functions of the Liver in Chinese medicine:

1. The Liver Stores Blood:

The Liver stores Blood and regulates the volume of Blood in the body at any one time. When the body is active, Blood is said to flow to the muscles and sinews; when the body is at rest, the Blood is said to return to the Liver.

(Note: 'Blood' is a capital-B, as a Chinese medicine concept, both encompasses and is somewhat different from its meaning in western medicine. It is a dense, material form of Qi with functions of nourishing and moistening all body tissues and organs and providing the material foundations for the Mind.)

This pattern has important implications for our overall health. When we rest at night, the Blood is said to be refreshed and renewed and our energy restored. (This bares some relation to the western anatomical concept of the liver's role in filtering and cleansing our blood.) When Blood flows to the tissues of the body, it  nourishes and irrigates them. Proper quality and circulation of Blood is essential to our overall energy, immune function, mental and emotional regulation, quality of sleep, etc.

One of the most important things we can do for the health of our Liver and the quality of our Blood, from a Chinese medicine perspective, is to maintain a regular night-time sleep schedule. Specifically, the hours when the Blood returns to the Liver are 11:00 p.m. to 3:00 a.m. These are the most important hours to get deep sleep. It is a good idea to go to bed by 10:30 p.m. in order to be soundly asleep by 11:00 p.m.

The Liver's function in relation to Blood storage and Qi circulation give it a primary role in regulating a woman's menstrual cycle. Most menstrual irregularities (amenorrhea, irregular cycles, PMS, painful cycles, etc.) are rooted in Liver Qi or Blood imbalances. By extension, the Liver has a close relationship to the uterus and to a woman's reproductive health. (I hope to elaborate on these issues in future posts.)

The Liver has a special relationship with the eyes and the sinews (ligaments and tendons). Specifically the
Liver Blood nourishes and moistens these tissues. Dry, blurry or inflammed eyes result from specific Liver imbalances as do muscle cramps or lack of flexibility. Skin conditions such as hives, rashes, or excema are sometimes rooted in poor quality Blood resulting from Liver dysfunction. The quality of the finger & toenails also relates to the quality of Liver Blood. Ridged, dry, brittle and cracked nails are a result of Liver Blood deficiency.

2. The Liver Ensures the Smooth Flow of Qi

This is the most important of the Liver's functions and it is central to nearly all patterns of Liver dysfunction. The concept of "smooth flow of Qi" is subtle and difficult for the western-trained mind to understand. Yet, the impairment of this function of "smoothly flowing Qi" is one of the most common patterns seen in clinical practice.

The Chinese words for this function are "shu xie," meaning to "flow, dredge, disperse, scatter," and to "let out, discharge, release, vent," respectively. We can think of this function in relation to circulation of vital energy in the body, as well as to the body's energy to disperse tension, release excess energy, and to moderate extremes.

The Liver's influence on the flow of Qi ensures that all the other organs' physiological function flow in a proper direction: i.e. the Lung descends Qi, oxygen, fluids; the Stomach descends food nutrients; the Spleen is said to raise clear energy to the head; etc.

Remember that the Liver corresponds to the element Wood, with its expansive movement in all directions.

The smooth flow of Qi is strongly related to emotional health, ensuring emotional balance, resilience and happiness. If the Liver's function is impaired and the circulation of Qi obstructed, the result on an emotional level is frustration, depression, repressed anger, and a "pent-up" feeling, often accompanied by physical symptoms such as rib-area or abdominal distension, a sense of oppression in the chest or a feeling of a 'lump' in the throat.

The smooth flow of Liver Qi also assists digestion. Liver dysfunction and Qi stagnation can hamper the digestive functions of the Stomach and Spleen resulting in a range of symptoms including acid reflux, nausea, vomiting, diarrhea, constipation, IBS and gastrointestinal disorders like colitis and crohn's disease. 

Finally, the smooth flow of Liver Qi affects the flow of bile in the body. A healthy Liver and smooth flow of Qi  ensures proper secretion of bile and good digestion. Obstruction of bile results in bitter taste, belching, jaundice and/or the inability to digest fats.

3. Spiritual Aspects of the Liver

In TCM, there is no rigid division between body and mind or spirit. The health of each organ system has a specific relationship to a certain aspect of mental, emotional and spiritual health.

The Liver Houses the Ethereal Soul

The Ethereal Soul, called the Hun in Chinese, is the mental-spiritual aspect of the Liver. The Ethereal Soul relates to our capacity for planning our life and finding a sense of direction in life. Strong Liver-Blood, in particular, keeps us firmly rooted and helps us plan our life with wisdom and vision. If our Liver Blood is weak, we lack a sense of direction in life. The Ethereal Soul is also said to be the source of life dreams, visions, aims, projects, inspiration, creativity, and ideas. 

The Liver is in Charge of Planning & Strategy

The nature of wood (plants) is to spread upward and outward in their quest for light. Representing the wood element in our body, the Liver is responsible, on a physical level, for the movement of Qi and Blood throughout our body. On a social-emotional level, the Liver helps a person spread his/her influence through society. Individuals with strong Qi and Liver Blood tend to make excellent strategic planners and decision-makers (decision-making is officially the domain of the Liver's partner organ, the Gallbaldder). If, however, this tough and determined spreading nature of the liver is not in a state of harmonious balance with the softer side of liver wood-ease, smoothness, flexibility-the wood-endangering state of rigidity arises.

The Liver is Affected by Anger

Anger (also frustration, resentment, repressed anger and rage) is the emotion associated with the Liver. Like any emotion that is out of balance, anger can have negative mental and physical health affects. In TCM, we say that repressed anger causes Liver congestion Qi stagnation; whereas expressed anger often causes syndromes known as Liver-Yang rising or Liver-fire. 

Anger and Liver pathology are mutually-reinforcing. Anger can weaken the Liver's function over time and Liver pathology can cause symptoms of anger and irritability.

Any dysfunction in the various Liver functions listed above (storing of Blood, regulation of Qi, regulation of emotions) can also lead to syndromes of excess in the Liver. These include wind-heat (external heat) entering the liver channel causes red, swollen, or painful eyes. Upflaring liver fire may also produce red eyes. Hyperactivity of liver yang manifests in upwardly mobile symptoms, especially hypertension and dizziness. Liver-wind (internal wind) may produce seizures, tremors or tics. Cold pathogens have a coagulating affect on the liver channel causing abdominal pain or hernia-like symptoms.

So, how do practitioners of Chinese medicine treat the Liver? Western naturopathic practitioners tend to emphasize cleansing the Liver in springtime. Indeed, from a Chinese medicine perspective, Liver imbalances tend to arise or be exacerbated in springtime. Cleansing, per se, is not emphasized in Chinese medicine. Rather, a practitioner of Chinese medicine carefully assesses all of a patients symptoms in order to determine a pattern or pattern of imbalances. If sufficient signs and symptoms point to Liver imbalance, we carefully determine the nature of that imabalance, and then use acupuncture, herbs, lifestyle/dietary recommendations and other modalities to rebalance the Liver & support the body's healing. Indeed, many modern diseases are rooted in Liver imbalance.

Remember, from an eastern or western perspective, Liver health is essential to emotional ease, health and longevity. Spring is an optimal time to attend to the health of the Liver with acupuncture and herbal medicine.

See also these articles by Stephanie for practical tips for Spring/Liver health:

Ten Lifestyle Tips for Spring Wellness

Eight Easy Herbal Teas for Spring

Spring Food & Cooking Tips

Spring Recipe: Nettle Soup

Macciocia, Giovanni. The Foundations of Chinese Medicine: A Comprehensive Text for Acupuncturists and Herbalists. Elsevier/Churchill Livingstone, 2005.

Ptichford, Paul. Healing with Whole Foods: Asian Traditions & Modern Nutrition. Berkeley: North Atlantic Books, 2002.

Institute for Traditional Medicine's website: