I. Physiopathological characteristics of the liver
The liver is located in the abdomen, below the diaphragm and within the right hypochondrium. The liver is a wood in the five elements, likes to be organized but hates depression, is connected to spring energy, is active, and is the master of ascension. The liver is open to the eyes and harbors the soul, its flower is in the claws, its body is in the tendons, its will is anger, and its fluid is tears. The main physiological functions of the liver are to evacuate and to collect blood.
(A) The liver is the main draining agent
The liver is the master of draining, which means that the liver has the function of regulating and unblocking the qi of the whole body, making it flow and ventilate. The role of the liver in draining is mainly reflected in the following four aspects.
1. Regulating and draining qi, blood and fluids: the lifting and lowering of qi is the basis of the body’s life activities, and is also the premise and guarantee for the normal function of the internal organs. The normal draining function of the liver can ensure the smooth flow of qi, blood and fluids and the smooth functioning of the internal organs.
The former refers to the failure of the liver qi to flow smoothly and leads to qi discomfort, which can also be called “liver qi stagnation”, mainly manifested as swelling, pain and discomfort in the liver meridian circulation areas such as the chest, breast and abdomen, “qi flow is blood flow, qi stagnation is blood stasis”. Qi flow is blood flow, Qi stagnation is blood stasis.
Too much drainage refers to the rise of Liver Qi, too much agitation, not enough submersion and descent, resulting in pathological changes such as rebellion of Liver Qi, inflammation of Liver fire and hyperactivity of Liver Yang, with common manifestations such as headache and swelling, redness of the face and eyes, impatience and irritability, chest and fullness, etc. Blood can also appear with Qi rebellion, such as vomiting and epistaxis.
The normal emotional and mental activities of the human body mainly depend on the normal operation of qi and blood. The normal function of the liver’s draining function, the smooth regulation of qi and the circulation of blood vessels are essential to maintain a cheerful and relaxed mood. If the liver is not functioning properly, it will easily lead to mood disorders, such as liver qi stagnation often manifests as sullenness and depression; qi depression will turn into fire over time, and liver fire inflammation will manifest as impatience and irritability, easily agitated.
On the contrary, external mental stimulation, such as anger or depression, can also lead to the malfunction of liver drainage, thus manifesting the pathological changes of liver qi stagnation or liver qi transverse.
3, promote bile secretion, mediation of the spleen and stomach digestive function: Chinese medicine believes that the bile contains essence (i.e. bile), which comes from the liver, “the residual energy of the liver, drainage in the bile, gathered into the essence”. The normal secretion of bile depends on the normal drainage of the liver. On the other hand, the liver regulates the digestive function of the spleen and stomach through its function of regulating the qi flow. Physiologically, “spleen qi is healthy by ascending, stomach qi is harmonious by descending”, the spleen ascending and stomach descending way of qi operation is the basis for the normal function of spleen and stomach digestion.
The coordination and balance of the spleen ascending and stomach descending depends on the smooth regulation of liver qi, in other words, the liver is the prerequisite and guarantee of the spleen ascending and stomach descending. The loss of drainage of the liver will not only affect the normal secretion of bile and directly affect the digestive function, such as symptoms of bitterness, jaundice, anorexia, abdominal distension, etc., but also cause the spleen not to ascend the clear and the stomach not to descend the turbid, resulting in liver and spleen disharmony (pain or discomfort in the ribs, abdominal pain and diarrhea, weakness and tiredness) or liver and stomach disharmony (pain or discomfort in the ribs, belching, acid reflux, stomach distension, constipation, etc.). Therefore, the clinical treatment of spleen and stomach disorders is often accompanied by drugs to regulate the liver and qi, which is precisely the intention.
4, regulating women’s menstruation and men’s sperm discharge: the liver meridians circulate around the ear of the yin organ, and are connected to the Chong and Ren veins, “Chong is the sea of blood” and “Ren is the master of twins”. The menstruation and ovulation of women and the ejaculation of sperm of men are also closely related to the drainage function of the liver. The loss of discharge of the liver often leads to menstrual disorders, seminal emission and premature ejaculation.
(2) The liver is the main reservoir of blood
The liver collects blood, meaning that it has the function of storing blood. It has three meanings: First, it means that the liver has the function of regulating the amount of blood, “The liver collects blood, the heart carries it out, and when a person moves, blood is transported through the meridians, and when a person is still, blood is returned to the liver.” That is to say, the amount of blood in the body’s tissues and organs often increases or decreases according to different physiological needs. The normal function of the liver’s blood collection is important for maintaining the body’s vital activities. The internal organs and limbs of the body need to be adequately nourished by blood in order to perform their normal physiological functions.
Secondly, the liver has the function of preventing bleeding. The liver is gentle, so that the blood is not moved and hidden inside. Thirdly, it means that the liver has a restraining effect on its draining function through blood collection. With abundant blood in the liver, the liver body is gentle, so that yin can submerge yang and restrain the hyperactivity of liver qi and liver yang, thus maintaining its normal draining function.
The clinical manifestation is twofold. Firstly, the amount of blood is not sufficient and the function is reduced due to the loss of moistening, such as the eyes are not nourished, the vision is blurred, dryness and night blindness; the tendons and veins are not nourished, the limbs are numb, flexion and extension are unfavorable, etc. Secondly, the blood collection function is reduced and bleeding occurs, such as vomiting blood, blood in stool, blood collapse, etc. In addition, deficiency of liver blood, loss of flexibility of the liver body, yin not latent yang, can also lead to hyperactivity of liver yang, liver wind internal movement and other symptoms.
(C) Use of yin and yang in the body
Under physiological conditions, liver qi rises and moves upward and outward; under pathological conditions, yang, heat, and actual evidence are common, such as liver qi stagnation, liver stagnation and heat, liver fire, liver qi rebellion, liver yang hyperactivity, liver wind internal movement, etc.; deficiency evidence only includes liver yin deficiency and liver blood deficiency, which are relatively uncommon. Liver Yin and Liver Blood are the inherent material basis to maintain the normal function of the liver, called “liver body”, and the functional activity of the liver is called “liver use”, and the lack of material basis inevitably leads to abnormal functional activity.
However, due to the unique physiological characteristics of the liver, which is active, outward and upward, and unpredictable, the functional abnormalities caused by deficiency of Yin and Blood are mostly manifested as Yang, heat and actual symptoms. If we mistakenly judge “body-use imbalance” as purely real evidence, we may be able to dredge the liver, cleanse the liver, calm the liver, suppress the liver, suppress the liver, or cut down the liver, which may be effective for a while, but in the end, it will only hurt the vital energy and aggravate the disease. Therefore, Chinese medicine treatment of liver disease especially emphasizes the “body and use of the same regulation”, nourishing the liver body and smooth the liver use, so that the liver blood is abundant, the liver body is soft, yin and yang secret, liver qi and liver yang naturally rise and fall in a proper manner.
(4) Good dryness in other organs
”The liver is the organ of the wind and wood, which is subject to change. Where the liver meridian travels, there are many internal organs in contact with each other, and the five organs belong to the five elements, which have a complex relationship with each other. In pathological state, liver disease is very easy to affect other internal organs through the meridians, the five elements relationship, resulting in the combined appearance of other visceral lesions; other internal diseases will also be transmitted through the meridians, affecting the liver, such as the spleen and stomach damp heat, fumigation of the liver and gallbladder, will occur in the liver and gallbladder damp heat evidence; liver is wood, the spleen is earth, wood grams earth, so liver disease is most likely to transmit the spleen caused by liver and spleen disease or liver and stomach disharmony; heart main blood.
The heart is fire, the liver collects blood, is wood, wood produces fire, in the five elements is a mother-child relationship, excessive thinking, heart blood dark depletion, resulting in heart blood deficiency, the son steals the mother’s gas, will also affect the function of the liver blood collection, and finally form the heart and liver blood deficiency evidence; kidney is water, liver is wood, water produces wood, liver collects blood, kidney collects essence, liver and kidney two meridians meet, essence and blood interchange, liver and kidney homologation, kidney essence deficiency, can lead to liver yin deficiency, physical wasting, vague pain in the liver area The deficiency of kidney essence can lead to deficiency of liver yin, resulting in physical wasting, vague pain in the liver area, soreness and weakness of the waist and knees, insomnia and forgetfulness, dry mouth and dry throat.
Therefore, when the liver is diseased, it has the characteristic of interfering with other organs and causing malfunction of related internal organs, resulting in concurrent symptoms, such as deficiency of blood in the heart and liver, disharmony of the liver and spleen, heat in the liver and stomach, dampness and heat in the liver and gallbladder, and deficiency of yin in the liver and kidney. In the chronic liver disease stage, even in the same patient, the complex conditions of liver-depression and spleen deficiency, liver-kidney-yin deficiency, blood stasis and liver-biliary damp-heat may co-exist, while the simple evidence of liver qi stagnation and liver-yin deficiency is less common.