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All lessons   Module 5: Patterns   Lesson 6

Module 5   Lesson 6   Gan shi

Liver: Excess patterns

Stuck, sideways, simmering, fiery, wet, clotted or frozen: how do you see which excess the Liver has, and which finding decides?

After this lesson you know the seven Excess patterns of the Liver with signs, tongue, pulse, cause and principle; you see where patterns 1 and 2 from module 1 sit in that field and what they turn into; and for each place along the Liver channel you know which pattern to expect. The features are learning anchors, not validated criteria.

1 Liver-Qi stagnation Rebellious Liver-Qi stagnation turns to Heat Liver-Blood stasis goes sideways or up turns warm congeals Blood 2 Liver-Fire becomes Fire Damp-Heat in Liver, GB Cold in the Liver channel Dampness, fat, alcohol plus Heat external Cold invades lesson 7: Yang rising, Wind consumes Yin
Schematic; the transitions are textbook knowledge. Excess after Maciocia ch. 34, from p. 532. GB is the Gall-Bladder. Red border Heat, blue border Cold; grey and dotted comes from outside the diagram or from lesson 7.

Know by heart

  • Seven Excess patterns, three families. Qi: stagnation (1), rebellion, stagnation turning into Heat. Heat: Liver-Fire (2), Damp-Heat in Liver and Gall-Bladder. Standstill and cold: Liver-Blood stasis, Cold in the Liver channel. mnemonic: stuck, sideways, simmering; fire, wet fire; clotted, frozen.
  • Stagnation and rebellion. 1: distension that moves with the mood, sighing; tongue normal or red sides; wiry; move Liver-Qi. Rebellion: the Qi goes sideways or upwards, with belching, nausea, vomiting, hiccups; calm the Liver, make rebellious Qi descend. mnemonic: stagnation stands still, rebellion runs the wrong way.
  • From warm to Fire. Stagnation turning into Heat: 1 plus redder sides, quick temper, a slightly faster pulse; move and clear lightly. 2 Liver-Fire: red eyes, bitter taste, thirst, constipation; red with redder sides, yellow coating; wiry-rapid; clear Liver-Fire. mnemonic: red sides is warm; red all over with a yellow coating is Fire.
  • Damp-Heat in Liver and Gall-Bladder. Full hypochondrium, bitter taste, nausea, jaundice, yellow discharge, itchy genitals; red with sticky yellow coating; slippery-wiry-rapid; drain Damp-Heat. mnemonic: Liver-Fire dries, Damp-Heat sticks.
  • Liver-Blood stasis. Fixed, stabbing pain in the hypochondrium or lower abdomen, masses, painful periods with dark clots; tongue purple, especially the sides; wiry or choppy; move Liver-Blood.
  • Cold in the Liver channel. Pulling pain in the lower abdomen, radiating to the scrotum or pubic area, better with warmth; pale, wet, white coating; deep, wiry, slow; warm the channel, expel Cold. mnemonic: the channel encircles the genitals; Cold contracts.
  • Red flag. Jaundice with fever and pain in the upper right abdomen, a mass in the abdomen, sudden severe pain in a testicle, the worst headache ever: the same day or emergency services (112 in Europe, 999 in the UK, 911 in North America).

The rest of this lesson is reference.

Liver: Excess patterns: Stuck, sideways, simmering, fiery, wet, clotted or frozen: how do you see which excess the Liver has, and which finding decides?
The chart as an image, to save or share

Three practice questions from this lesson

Distension under the ribs that increases with tension and eases after a walk; tongue normal
  1. Liver-Qi stagnation
  2. Rebellious Liver-Qi
  3. Stagnation with Heat
  4. Liver-Fire
  5. Damp-Heat
  6. Liver-Blood stasis
  7. Cold in the channel

Answer: Liver-Qi stagnation. Qi that stands still and starts flowing again when you move: stagnation.

Belching, nausea and hiccups as soon as things get tense
  1. Liver-Qi stagnation
  2. Rebellious Liver-Qi
  3. Stagnation with Heat
  4. Liver-Fire
  5. Damp-Heat
  6. Liver-Blood stasis
  7. Cold in the channel

Answer: Rebellious Liver-Qi. The Qi runs the wrong way: sideways and upwards.

PMS with hot flushes, red sides, thin yellowish coating
  1. Liver-Qi stagnation
  2. Rebellious Liver-Qi
  3. Stagnation with Heat
  4. Liver-Fire
  5. Damp-Heat
  6. Liver-Blood stasis
  7. Cold in the channel

Answer: Stagnation with Heat. The picture of stagnation, turned warm, but not yet Fire.

The rest of this lesson

In the course you get the step-by-step explanation, 24 case-based practice questions, 16 spaced-repetition flashcards, the pitfalls and the bridge to physiology with evidence grades. This lesson belongs to module 5: Patterns.