As a teacher of qi gong, I am always seeking to harmonize the forms and flows of the movements with the seasons. With spring in full effect, the liver organ / meridian tends to come into a clear focus as I feel the pulse of patients and observe the subtle changes occurring as the seasons shift.
There are many effective herbal formulas / patent medicines in Chinese medicine targeting specific issues with the liver organ / meridian and its complex role in the flow and regulation of qi throughout the body. Let’s focus on two specific formulas / patent medicines I use for issues in which the flow of liver qi plays a significant role; as well as some adjunctive ways to improve the efficacy of our various treatment protocols.
Xiao Yao Wan: Overused?
When we think of the liver in Chinese medicine, liver qi stagnation is perhaps the most common pattern presentation most consider, and the formula / patent medicine Xiao Yao Wan is the first choice. I often use this formula; however, I feel it is often overused in cases of more nuanced and complex pattern presentation involving the liver and the smooth flow of qi.
While I do see considerable liver qi stagnation in clinical practice, I more frequently see the combination of liver qi stagnation and liver yin deficiency; as well as many cases of liver qi stagnation in which no overt symptoms / signs of spleen qi deficiency are apparent.
Liver qi stagnation is extremely common due to chronic stressful life experiences and chronic mental obsessions, fears, and worries. Over time, chronic stress, both conscious and subconscious, can be described as the allostatic load. This chronic stress drains the body of the deeper resources of liver blood and liver yin, which further aggravates the already-present liver qi stagnation.
Because of this, liver qi stagnation and liver yin deficiency are often intimately intertwined and difficult to clearly differentiate. Two formulas / patent medicine I frequently use in combination for such dual-pattern presentations are Chai Hu Shu Gan Wan and Yi Guan Jian.
Chai Hu Shu Gan San
Chai Hu Shu Gan Wan has the actions of soothing the liver qi, invigorating the blood, harmonizing the liver and spleen, and stopping pain. This formula is a modification of Zhong Zhong-Jing’s formulation Si Ni San with the addition of the medicinals xiang fu and chuan xiong to more strongly move the qi and blood. Some herbal patents also add the medicinal chen pi to further move the stagnant qi in the stomach / spleen. The most common pulse is the wiry pulse and the tongue tends to be normal or normal with inflamed sides, unless more deeper patterns are also present.
I find this formula to also effectively clear heat signs due to its strong function of moving the liver qi and often combine this formula with chrysanthemum tea (ju hua), which has the actions of dispersing wind, releasing the exterior, gently moving liver qi, clearing heat, calming the mind, and mildly nourishing yin.
In cases of liver qi stagnation with chronic digestive issues, chronic pain issues, and palpable masses on areas in which the Liver Meridian passes, this formula is highly effective. I use this particular formula / patent medicine more often than Xiao Yao Wan unless loose stools is a significant clinical factor.
Yi Guan Jian
I find this formula / patent medicine to be vastly underutilized for cases of chronic liver qi stagnation which lead to liver blood / liver yin deficiency. Chronic insomnia / chronic sleep disturbance is a major clinical presentation. In Chinese medicine, the blood returns to the liver organ in the evening during restful sleep. If this is not occurring due to sleep disturbances, liver yin will eventually become deficient and aggravate any mechanism causing liver qi stagnation.
Yi Guan Jian has the actions of nourishing liver yin and liver blood, soothing the liver qi, moistening the tendons, and nourishing kidney yin. The pulse can typically range from wiry to thin and weak and the tongue tends to be pale, normal, but may be reddish and have cracks and swollen edges.
This formula has become highly utilized in China for lowering liver enzymes and helping the liver organ recover from damage from allopathic pharmaceuticals such as statins and acetaminophen, as well as environmental toxins. I particularly use this formula in cases of liver qi stagnation showing signs of poor sleep and chronically tight / sore muscles; as well as what is typically termed restless leg syndrome in allopathic diagnostics. In such cases, I always suggest the patient to consume goji berries (gou qi zi), which deeply nourish liver and kidney yin.
Beyond Formulas
It is also extremely important for clinicians to emphasize that all patterns of liver qi stagnation have a foundation in what I phrase as “not letting go.” We must help our patients learn to “let go” of anger, resentments, expectations, fears, and frustrations in order to deeply resolve issues of liver qi stagnation. This is not a simple or easy fix, which makes it vitally important for clinicians to discuss stress-reduction therapies such as qi gong, tai qi, any exercise in which the patient experiences joy, and the healing power of laughter.
