Liver and Gallbladder Lecture by Dr. Luo, Filling in for Dr. Wu

Course: Foundations of Traditional Chinese Medicine Date: 3/14/07 Class #: 8

Liver and Gallbladder lecture by Dr. Luo, filling in for Dr. Wu

The Liver is the most important organ for women, while the Kidney is the most important organ for men. Most women have Liver dysfunctions with endocrine/hormonal problems. When the endocrine/hormonal problems are in excess, treat the Liver; when deficient, treat the Kidney.

Location Anatomically, the Liver is located on the right in the Middle Jiao (MJ). When you study pulse diagnosis, however, you will notice that the Liver pulse can be felt in the middle position on the Left. (Why?! I have no idea. Ask Dr. Wu. There might be a reason I’m not remembering. If you find out, e-mail me! As of Dec 2010, I still don’t know – I just accept it as an exception and go with it. Seriously. E-mail me.)

However, the function of the Liver is said to be Lower Jiao. The Liver channel begins on the big toe on the lateral side of the corner of the toenail.

Constitution Constitutionally, per TCM, the Liver has both Liver yin and Liver yang properties. 1. Liver Yin This is Liver blood, the substance of Liver (remember that yin is substance while yang is function) 2. Liver Yang This is the qi of the Liver. Qi is yang in nature and is very light. Liver qi is the function of the Liver and expresses in the LJ (lower jiao). Specifically, the Liver is expressed most obviously in the menstrual function, which is decidedly lower jiao.

Functions of the Liver 1. The Liver stores Blood This is not the only organ to do so: Uterus and Chong (Penetrating) Vessel do also. But because Liver stores blood, it is able to regulate menstruation, regulate the bio-clock, and to house the Hun or Ethereal Soul (see the last page for more on that one).

a. The Liver regulates Blood volume in relation to rest and activity. When the body rests at night the blood goes to the Liver: circulation is slower and the body gets cooler as a result. In the morning as soon as your eyes open from sleep the Blood begins to circulate more fully again throughout the body. When you work during the day your body needs this blood in order to function.

Foundations 1 – Winter 2007 – Class 8 www.CatsTCMNotes.com Page 1 of 5 Disclaimer: This is not an official AOMA document, is intended for reference only and is not a replacement for your own class notes. This document is available for your use As Is and may contain errors and omissions. Cat Calhoun retains full copyright ownership, rights and protection in all material contained herein. You may use this document for your own purposes and distribute it to other people provided you 1) do not charge for it and 2) attribute it as having been generated by Cat Calhoun and disclose that it available free of charge on CatsTCMNotes.com. © 2010 Catherine (Cat) Calhoun b. The Liver regulates menstruation The Liver controls the smooth graceful accumulation and circulation of energy or qi. When menstruation is not smooth, not regular, when there are strong signs of PMS and clotting this indicates that the Liver is not moving the qi smoothly. Depression, crying, quick anger and irritability can indicate this as well. In TCM this is often referred to as “Liver Qi Stagnation.”

c. The Liver moistens and nourishes the eyes and the sinews. Remember back to the Five Element correspondence chart. When a person is Liver Blood deficient the symptoms are dryness and an inability to move the moisture around the body. Symptoms include dry eyes and tight tendons. In TCM eye diseases are often treated by focusing on the Liver.

Convulsions, tremors, and muscle cramps are all sinew conditions. These are all conditions of Wind, be that internal wind or external wind. Wind, again, is associated with the Liver and with wood in the Five Element chart. Wind moves, shakes the limbs of trees, is fast and unpredictable. Shaking and moving symptoms are always Wind related in TCM. It helps to think of our limbs as tree limbs. 

d. The Liver is in charge of the biorhythms. Liver does this by controlling the cycles via controlling the circulation of qi in the body. The 12 regular channels cycle through, one after another in this pattern:

Lung  Large Intestine  Stomach  Spleen  Heart  Small Intestine  Bladder  Kidney  Pericardium  San Jiao  Gallbladder  Liver.

Once the end of the cycle is reached, it repeats with Liver passing back to Lung and so on for ever and ever amen…or until you die….whichever comes first. Energy switches from one channel the next every 2 hours or so. The Liver hours are from 1am – 3am and from 1pm – 3pm.

If you have a tendency to wake at night at a certain time, make note of the time period and take a peek at a chart of the various times associated with the channels.

Foundations 1 – Winter 2007 – Class 8 www.CatsTCMNotes.com Page 2 of 5 Disclaimer: This is not an official AOMA document, is intended for reference only and is not a replacement for your own class notes. This document is available for your use As Is and may contain errors and omissions. Cat Calhoun retains full copyright ownership, rights and protection in all material contained herein. You may use this document for your own purposes and distribute it to other people provided you 1) do not charge for it and 2) attribute it as having been generated by Cat Calhoun and disclose that it available free of charge on CatsTCMNotes.com. © 2010 Catherine (Cat) Calhoun 2. Liver ensures the smooth flow of Qi. Because Liver does this it can therefore govern emotion, digestion and the secretion of bile.

a. Governs the flow of Qi. There is qi for each organ of the body. The action of Spleen qi is to rise upward. Stomach qi descends. Lung qi disperses upward and outward and downward. Large Intestine qi descends. All of these rely on the qi of the Liver to regulate them.

b. Affects the emotional state Emotional disorders, especially those of temper, depression, distress, irritability, PMS, and frustration are closely related to the Liver. When the Liver qi is obstructed there is distress and anger. When the Liver qi is congested there is irritability, PMS.

Cat’s note: not all emotional disorders are related to Liver. TCM is just not that cut and dried. You must take all factors into consideration before diagnosing a problem as Liver related just because it is an emotional dysfunction. Mania, for example, is usually related to the Heart, sadness and grief to the Lungs, fear to the Kidneys. Don’t get sucked into believing that all emotions flow from the Liver! This is a common mistake many people new to TCM make. You’ll get lots more on this in Energetics, Point Locations, Diagnostics, Treatment of Disease classes and so on, so don’t think you have to memorize all of this right this second. Just bear this principle in mind.

c. Affects digestion Spleen and Stomach control digestion (a Middle Jiao function). However, if Liver is congested because of worry, stress, anger or other factors, the digestion can be strongly impaired. Per the Five Element theory wood (Liver) controls earth (Spleen/Stomach). When the Liver is congested it overacts on Spleen.

This is a really common TCM diagnosis, as a matter of fact: Liver Overacting on Spleen. A person with a Liver problem can eventually have an affected Spleen causing the Spleen qi to fail to ascend. The result is usually loose stool, but can also be diarrhea, gas, bloating or even constipation when the qi of the Spleen is so weak there isn’t enough “umph” to push the waste out. If the Stomach qi fails to descend it is said to rebel resulting in hiccups, vomiting, and food stagnation. Food stagnation is the uncomfortable condition of the food just sitting in the stomach and not moving through quickly enough. The result is something you’ll hear referred to as “focal distention” which is a full

Foundations 1 – Winter 2007 – Class 8 www.CatsTCMNotes.com Page 3 of 5 Disclaimer: This is not an official AOMA document, is intended for reference only and is not a replacement for your own class notes. This document is available for your use As Is and may contain errors and omissions. Cat Calhoun retains full copyright ownership, rights and protection in all material contained herein. You may use this document for your own purposes and distribute it to other people provided you 1) do not charge for it and 2) attribute it as having been generated by Cat Calhoun and disclose that it available free of charge on CatsTCMNotes.com. © 2010 Catherine (Cat) Calhoun uncomfortable condition focused around the stomach. The stomach might even feel hard and distended….probably because it is!

d. Affects secretion of bile. When the Liver qi is full it is transferred to the Gallbladder where the qi is stored and transformed into bile.

Extra fun things to know about the Liver  Sinews: are nourished by Liver Blood  Nails: are byproducts and offshoots of the sinews. When Liver blood is deficient the nails will be pale. They can also be un-nourished causing brittle nails or nails that split in layers. You can also see nail ridges which run either horizontally or vertically or both.  Eyes: Liver Qi goes to the eyes. If the eyes are dry or if there are floaters in the vision it indicates Liver dysfunction. Floaters are those little bits that people see in their field of vision when they are looking at a clear blue sky or a white wall. There’s nothing on the wall or in the sky, but rather are in the vision itself.  Ethereal soul: The Ethereal soul is yang in nature and is rooted in the Liver when there is adequate Liver blood. Inadequate Blood causes the soul is unrooted, disturbed and restless. Can result in sleep, talking in one’s sleep and that dream disturbed sleep thing we spoke of earlier. (Again, don’t get the idea that dream disturbed sleep is always related to Liver…it’s often related to Heart dysfunction in TCM. Remember: no hard and fast rules! Every condition, every patient is a unique combination which you will come to recognize more easily than you think.)  Anger: Distress, depression, frustration, and anger are often related to Liver.  The Liver controls planning and acts as a “general.”

Foundations 1 – Winter 2007 – Class 8 www.CatsTCMNotes.com Page 4 of 5 Disclaimer: This is not an official AOMA document, is intended for reference only and is not a replacement for your own class notes. This document is available for your use As Is and may contain errors and omissions. Cat Calhoun retains full copyright ownership, rights and protection in all material contained herein. You may use this document for your own purposes and distribute it to other people provided you 1) do not charge for it and 2) attribute it as having been generated by Cat Calhoun and disclose that it available free of charge on CatsTCMNotes.com. © 2010 Catherine (Cat) Calhoun Gallbladder Functions: 1. Stores and secretes Bile This is like it’s biomedical function. The Liver creates bile, passes it to the Gallbladder through the common bile duct. The Gallbladder stores it and concentrates it then releases the bile into the Small Intestine as needed to help digest fats. Actually, the Gallbladder is the only yang organ that doesn’t deal directly with food.

All Gallbladder problems involve digestive disorders and there is close relationship between the Small Intestine and the Gallbladder and digestion.

2. The Gallbladder controls Decisiveness While the Liver controls planning, the Gallbladder controls one’s ability to be decisive. In Chinese if you say someone has a “big gallbladder” you are saying that they are very brave, decisive and fast in decision making. The term for this is “Dan Da.” The opposite of this descriptive is “Dan Xiao” or “small gallbladder” meaning one is timid, fluctuates in his/her decisions and has trouble deciding.

3. Controls Sinews Like Liver, Gallbladder controls sinews. Liver blood nourishes the sinews, but the Gallbladder provides qi to the sinews to assure movement and agility. When you study the Gallbladder channel in Energetics 3 you will see that the channel has many points on it that can assist the smooth movement of sinews. You might also notice that where the Gallbladder channel flows down the leg it passes right down the fascia latte on the lateral side of the thigh as well as through may other fibrous fascia coverings of the body.

As a matter of fact, Gallbladder 34 is the control or convergent point for the sinews of the whole body. It’s on the lateral side of the lower leg not too far from Stomach 36 (some books say it is 1 cun posterior/lateral to ST 36).

Relationship between Liver and Gallbladder Liver creates bile and sends it to the Gallbladder which stores, concentrates, and secretes bile. They are dependent upon each other, especially in their relationship via qi (Liver Qi drives the other qi’s). Together, the Liver and Gallbladder are responsible for the smooth flow of qi. They are also critical to one’s ability to get things done on the planet: Liver gives you the ability to plan while Gallbladder gives you the ability to be decisive and get busy.

All Gallbladder problems are treated through treating the Liver.

The sides of the tongue reflect the health or dysfunction of the Liver and Gallbladder.

Foundations 1 – Winter 2007 – Class 8 www.CatsTCMNotes.com Page 5 of 5 Disclaimer: This is not an official AOMA document, is intended for reference only and is not a replacement for your own class notes. This document is available for your use As Is and may contain errors and omissions. Cat Calhoun retains full copyright ownership, rights and protection in all material contained herein. You may use this document for your own purposes and distribute it to other people provided you 1) do not charge for it and 2) attribute it as having been generated by Cat Calhoun and disclose that it available free of charge on CatsTCMNotes.com. © 2010 Catherine (Cat) Calhoun