MEDICAL ACUPUNCTURE

Volume 21, Number 3, 2009

Original Article
# Mary Ann Liebert, Inc.
DOI: 10.1089=acu.2009.0672

The Liver in Chinese Medicine

Leon I. Hammer, MD

ABSTRACT

The literature regarding the Liver has largely centered on Liver Qi Stagnation and Liver Yang Rising, both of
which I believe are clinically exaggerated in importance in our time and poorly understood. Liver Blood
deficiency, Liver toxicity, and the relationship between the Liver and other solid organs also requires re-
examination and reevaluation. Ignored is the pandemic of our time, Liver Qi-Yang deficiency and Liver
Separation of Yin and Yang.
What follows is an attempt to enlarge our comprehension of these issues and in part, to present a point of
view that experiences it less in terms of pathology and more in terms of positive and natural function, an
important conceptual shift.

Key Words: Liver Qi Stagnation, Liver Blood Deficiency, Liver Qi-Yang Deficiency, Liver Yang Rising

INTRODUCTION late middle to old age (Dr Shen, personal communication).

The principal consequence was easy fatigue and less sta-

T he purpose of this article is to reframe the traditional

concepts of the Liver such as Liver Qi Stagnation1 in
terms of the Liver’s natural functions; Liver Yang Rising as a
mina in performing daily tasks. The concept of ‘‘beyond
one’s energy’’ means simply that we are not all created
equal, and that work that might deplete one person might
deficient condition; and to introduce the new and now more have little effect on another. Constitution and body condi-
relevant Liver Qi-Yang deficient conditions not previously tion (the ‘‘terrain’’), along with the ‘‘stress’’ (overwork and
noted in the literature, with one noteworthy exception re- over-exercise), are the determining factors.
cently brought to my attention.2 What I describe differs from Dr Shen’s observations in
that it presents with a greater degree of Deficiency on the
pulse. In addition, besides fatigue, there is lassitude, leth-
LIVER QI-YANG DEFICIENCY argy, and procrastination—always associated with varying
AND SEPARATION OF YIN AND YANG degrees of a clear inability to follow through and move
forward on plans and decisions about which there is endless
In the recent literature from both the West and the East, discussion and little or no action. The consequence is that
nor in either the Nei Jing or Nan Jing, have I found any ideas rarely become reality. The most serious long-term
reference to conditions that I find constantly increasing outcome described by Dr Shen is the development of a
since first learning about it (from John J.F. Shen, OMD) lymphoma of the Liver.
more than 30 years ago. The conditions are Liver Qi defi- Clearly, we are not all created equal. Some people with
ciency, Liver Yang deficiency, and the Separation of Liver very strong Livers will tolerate much more abuse than others
Yin and Yang. with less substantial Liver function. There will be many who
Liver Qi and Yang deficiency was associated with over- can say that they have used and abused the Cold substances
work (beyond one’s energy over a lifetime), and found from with no obvious consequence. In my practice, the effect of

DRCOM - Chair Governing Board, Gainesville, FL.

173
174 HAMMER

‘‘substances of abuse’’ as an etiology of Liver Qi-Yang A slower and safer approach is to use Lidan at indi-
deficiency and Separation of Liver Yin and Yang became the vidually-recommended doses (it is draining) at night and in
major cause of the pulse findings described above. the morning, and sip bentonite (clay) all day to prevent the
In the following discussion of Liver Qi-Yang deficiency toxins leached by the Lidan from being reabsorbed by
and toxicity, the Liver is the detoxifying organ whose de- the Intestine.
ficiency will greatly exacerbate the effect of any toxic During the past 10-15 years, we have noted a consistent
condition. This includes substances produced and used by increase in the appearance of the choppy quality on the
the body such as hormones whose by-products need to be entire pulse. Whereas in the first edition of Chinese Pulse
excreted. Diagnosis; A Contemporary Approach (2001),3 the quality
The 2 most important individual herbs to recovery of was listed as uncommon; in the last edition (2005), it is listed
Liver Qi-Yang deficiency and Separation of Liver Yin and as common. Traditionally, the Choppy quality is a sign of
Yang are Astragalus (Huang Qi) and Salvia (Dan Shen). Blood stagnation.4 While at first a puzzling association—the
Other herbs in the formula would depend upon the indi- choppy quality and toxicity—further investigation revealed
viduals’ other conditions. The most commonly used for- that the cause of death in poisoning is often fatal pervasive
mulas are an altered Ginseng and Longan (Gui Pi Tang), irreversible Blood stagnation with a cessation of sufficient
and Ginseng and Astragalus (Bu Zhong Yi Qi Tang). (The Blood circulation. Our first patients were veterans of the Gulf
latter tends to be too stimulating but is somewhat ame- War presenting with Gulf War Syndrome, complaining of
liorated adding the Linking Decoction, Yi Guan Jian). extreme debilitating fatigue similar to the complaint of other
people found to be toxic (as described above).
Toxins exist increasingly in every phase of our existence
LIVER TOXICITY i.e., air, food, water, clothing, and electromagnetically; it is
estimated that between 50 and 170 substances are in our
It can be argued cogently that the Cold substances blood that were not there 60 years ago. To a large measure,
described above are toxins as much as what follows. I these are fragments of a long chain of hydrocarbons derived
make the distinction by the pulse picture and the fact that from petro-chemical (oil) compounds manufactured by
though they have fatigue in common, the toxins that chemical companies.
follow do not include lassitude, procrastination, and the
inability to execute ideas that characterize the Cold sub-
stances. LIVER QI STAGNATION
Many artists who worked with solvents for years often in
poorly ventilated spaces were clearly toxic. Dr Shen de- Liver Qi stagnation is associated in the ‘‘system of cor-
scribed their pulse picture as a deep pulse with ‘‘Blood respondences’’ with repressed anger. Contrary to this
Unclear’’1 and a very slow rate. Blood Unclear is a pulse ‘‘system,’’ repressed emotions will instead affect the most
that increases in volume very slightly as one releases one’s vulnerable organ. In fact, anger is generally the result of
finger pressure from the Organ Depth to the Blood Depth frustrations, of which there is an abundance. The attempt to
rather than decreasing, which is the normal progression. contain the angry responses to this frustration exercises one
While the toxicity from inhalant solvents was occurring at of the Liver’s principal functions, to contain emotions and
the same time as the intake of Cold substances (primarily live in relative safety and harmony in society. All of the Ten
marijuana), the pattern of toxicity seemed to dominate the Commandments and almost every law and rule that regu-
pulse. lates society requires the Liver to contain negative and
The chief complaint of fatigue was greater with those dangerous responses to frustration. In Excess, we call this
afflicted with the inhalant solvents and the ambivalence less Liver Qi stagnation. Chapter 9 of the Su Wen reads, ‘‘The
than those whose Liver dysfunction was from Cold sub- Liver is the root of stopping extremes.’’5
stances. (These artists were the first people in my practice It is therefore incumbent upon us to regard the Liver’s
who would later be classified as having ‘‘chronic fatigue ability to stagnate Qi and contain emotion and response
syndrome.’’) as a normal necessary function rather than automatically
During the late 1970s and early 1980s, I encountered associated with pathology. In fact, in our time, the problem
industrial welders whose complaint, extreme fatigue, was is not too much containment (stagnation), but too little.
similar to the artists dealing with inhalant solvents with Partially, this is the result of the ubiquitous use of the Cold
similar pulse findings described above. Obviously, cessa- substances, especially marijuana, that has weakened the
tion of exposure to the toxin is primary. Reduction of the ability of the Liver to contain emotions and actions.
toxin can occur either very quickly with a combination of Even more important with regard to the Liver’s ability to
Golden Seal and Licorice (Gan Cao) (4 parts of Golden contain and stagnate is the loss of the ability to tolerate the
Seal to 1 part Licorice). This approach is valuable when frustration. The use of the Cold substances has reached into
there is an urgency or emergency aspect to the situation. every level of the educational system and into small towns
THE LIVER IN CHINESE MEDICINE 175

as well as into the cities (with children as young as 9 years strongly stimulating simultaneously: SP 6, LV 8, PC 6
old reportedly using drugs). (requiring 3 people), while the patient attempts to take
It should be noted here that excess Heat almost always 3 deep breaths, 3 times with 3 breaths between stimulation.
accompanies Liver Qi stagnation. This is at first metabolic An alternate method requiring only 1 person is strongly
heat that the body brings to the Liver to overcome the stag- stimulating PC 6 and TB 4.
nation. The fate of this Excess Heat is expounded below Asthma is a chronic condition that is less easily relieved
under the rubric Liver Yin Deficiency and Rising Liver Yang. and is characterized with relatively little of the usual
There is a condition described as ‘‘nervous system tense’’ symptoms of asthma, tending like Yin-deficient asthma to
described by Dr Shen,6 and that I call ‘‘vigilant pulse.’’ This be dry rather than wet. It is an asthma that characteristically
is a pulse that is uniformly tense at all times despite other begins in adolescence rather than childhood, and is very
qualities and conditions that may exist concomitantly. It is stress reactive. Spasms of the bronchi and bronchioles is a
associated with constitutionally endowed persecuted people parasympathetic function obviously activated when Liver
as a survival mechanism that kept them in a constant state Qi escapes the Liver and ‘‘attacks’’ the vulnerable Lungs.
of alert for danger. There are distinctions described in Palpitations at rest are associated with Liver Qi dysfunction,
the above references between the centuries-long ethnically especially Liver Qi stagnation that leads to Excess Heat
oppressed-genetically determined, which is a response to brought by the body to overcome the stagnation. When Liver
transiently dangerous situations such as moving into a dan- Qi leaves the Liver to attack the most vulnerable organ or area,
gerous neighborhood or going to war. In the former consti- it brings Excess Heat with it. Both the erratic Qi and the Excess
tutionally determined condition, the tenseness is constant and Heat stimulates the vulnerable Heart, unable to maintain ho-
the pulse rate normal or low. With the situational type, the meostasis with palpitations and sometimes tachycardia or at-
tension is there only when there is stress and the pulse rate rial fibrillation. Palpitations on exertion are only Heart-related
higher. The Nervous System Tense condition is relevant here and are the result of effort beyond the Heart’s ability to meet
because it affects the Liver more than any other organ. It will the circulatory demands of the action.
affect other vulnerable organs due to deficient terrain, but Interstitial Urethritis or Non-specific Sterile Urethritis is an
always works through the Liver to affect those organs. The inflammation of the bladder and urethra with no signs of in-
result is similar to Liver Qi stagnation with similar conse- fection. Treating it as ‘‘wandering’’ Liver Qi as a result of
quences for the Liver and for other organs described below. Liver Qi stagnation has successfully relieved the condition
The principal characteristic of Liver Qi is that it needs to (along with herbs) to reduce inflammation in the Lower Bur-
move, not only itself but Qi, in many functions, especially the ner, diminish acidity, and dilute the urine to reduce irritation.
digestive tract.When Liver Qi moves from the contained to Perhaps the most vulnerable to attack of all organs are
the repressed and the pressure to move overcomes the forces those associated with digestion, especially the Stomach.
of resistance (the irrepressible force meets the immovable This is due to many factors including poor nutrition and the
object), the Qi can break loose and will move to the most pressures of the information age in which people eat too
vulnerable organ, Liver ‘‘attacking.’’ Almost always, it car- quickly and irregularly; people ‘‘eat to live rather than live
ries with it the Excess Heat that has accumulated from failed to eat,’’ consuming fast foods, and replacing an event that
attempts by the body to have metabolic heat move the Qi. was once primarily social and an art with stress.
The term ‘‘Liver attacking’’ is unfortunate since the es- One important issue is the role of Liver Qi in the digestive
caping Liver Qi is simply moving to the area of least re- process. It is said that Stomach Qi moves downward. The
sistance, the most vulnerable area or organ. There are driving force for this downward movement is Liver Qi. If
internal pathological consequences as well as external, some Liver Qi is deficient, either because the Qi is stagnated in the
of which are discussed below; Liver Blood stagnation, for Liver or because Liver Qi is deficient, food and Stomach Qi
example (the Qi moves the Blood) that can be the result of will become stagnant in both the Stomach and Intestine.
either Qi stagnation or Qi deficiency. The digestive conditions associated with the Liver’s
The Liver can ‘‘attack’’ the Lungs in at least 2 ways. In dysfunction are several. If Liver Qi cannot move food
either instance, the Lungs are vulnerable because of previ- downward, the hydrochloric acid in the Stomach accumu-
ous disharmony. The first is the acute attack most often lates leading to an environment favorable to organisms such
associated with a sudden severe emotional stress, such as a as Helicobacter pylori and the associated gastric and duo-
piece of unexpected bad news with which the person is denal ulcer. If Qi and food does not move downward and
unable to cope. Acutely, the person is unable to take a deep Liver Qi is erratic, they may move upward (regurgitate) into
breath and stress becomes panic. Feeling that they are going the esophagus along with Stomach acid causing Barrett’s
to die exacerbates the inability to take a deep breath. syndrome, a pre-cancerous condition of the esophagus.
The mechanism of action is related to the Liver’s control Regurgitation can also occur with Spleen Qi deficiency. The
of the autonomic nervous system in which the bronchial differentiating factor is that with the Liver attacking, there is
tubes and bronchioles are temporarily in spasm and in which often nausea, while with regurgitation due to Spleen Qi
Liver Qi can activate. This is relatively easily relieved by deficiency, there is rarely nausea. Liver Qi attacking the
176 HAMMER

Intestine is characterized by only occasional explosive di- with undesirable effects. Rising Liver Yang is a deficient
arrhea, usually associated with acute stress. For the Liver to condition, a result of the Separation of Liver Yin and Yang
attack the intestines, they must be vulnerable. due to Yin deficiency, rather than from Yang deficiency as
The causes for Blood stagnation in the Lower Burner are described above.
manifold, the Heart and Circulation trying to overcome One type of Liver-Wind is associated with Rising Liver
gravity being the most important. However, the pervasive Yang. The current concept of Wind in Chinese medicine is
function of the moving aspect of Liver Qi in the human body confusing and misleading, consisting of a series of symp-
is a factor when Liver Qi is stagnant or deficient. This is toms that seem related to the Western concept of the
especially important during the menstrual cycle when the ‘‘nervous system’’ and sometimes, the skin (an avenue
Liver is responsible for releasing the blood it stores to the available to the body for the discharge of excess Heat).
uterus. Blood Stagnation during the menstrual cycle and Excess or deficient Heat (as in this case) always seems in-
Liver Qi are intimately related. volved. Apart from the fact that heat in the body seems to act
Regarding the relationship of the Liver and the Gall- erratically and out of control when either truly or relatively
bladder, we consider the larger relationship between the excess (Yin deficiency), the relationship to Wind seems
solid and hollow organs. The hollow (Fu) organs function ready to be updated. Dr Shen (personal communication)
primarily to remove pathogens from the Solid organs and in called it ‘‘the fastest moving energy in the body’’ (nervous
some instances, to supply the solid (Zang) organs. The system electrical) gone askew.
primary pathogen seems to be Heat, and this is clearest in The 2 principal etiologies of Liver Yin deficiency, the
the removal of the excess heat that builds up in the Liver that Separation of Yin and Yang and rising Liver Yang, are
attempts to move stagnant Liver Qi (though it is also ob- described as follows. Metabolic Heat is required to relieve
served less often when the Small Intestine removes Heart chronic Liver Qi stagnation. If it fails to overcome the
heat to the Bladder, another etiology of interstitial urethri- stagnation, Excess Heat accumulates. The Liver mobilizes
tis). The heat is removed with the bile, a partially Yin its Yin to balance the Excess Heat and over time, possibly
substance, to the Gallbladder that then discharges it into the years, the Yin is depleted. Eventually, the depleted Yin
Small Intestine through the Sphincter of Odi. cannot hold onto Yang, Yin and Yang separate, and Yang,
With regard to the Liver, the well-being of the Gall- without the centrifugal force of the Yin, becomes out of
bladder depends on how much Heat it must remove and how control and dysfunctional. Yang is a lighter energy and
fast it can discharge it. When it cannot maintain a steady rises, becoming the condition, Liver Yang Rising, whose
flow, the Heat then builds up in the Gallbladder, the bile consequences are well known. This is a severe Yin defi-
becomes stagnant, and we have a Damp Heat Gallbladder cient condition. It is not an excess condition simply be-
condition with the settling out of bile salts to become gall- cause the symptoms—intermittent high-pitched tinnitus,
stones and breakdown of the wall of the Gallbladder with throbbing headache, etc—may have excess characteristics.
micro-bleeding and necrosis. It is incumbent upon us to When fluids (Yin) decrease, there is only an apparent, not
keep Liver Qi moving in a functional (rather than in an real, excess. The remedy is to nourish Yin; do not drain
attacking) fashion to spare the Gallbladder and move the Qi Heat.
and Blood for all their many functions. Associated conditions are hot flashes and sweats. While
Liver Blood stagnation is a less recognized condition that these are often considered Yin-deficient conditions, the
develops as a result of Liver Qi not moving because of commonly used formula for this condition is Two Immortal
excess (classic Liver Qi stagnation from repression) and the Decoction (Er Xian Tang), a formula that has 3 Yang
related drying from excess heat or from deficiency from the nourishing herbs and 1 blood nourishing herb. Hot flashes
causes described above. It is detectable on the pulse in the and sweats are not due to Yin deficiency. (Though outside of
Engorged Positions. The Liver ‘‘stores’’ the Blood and if this discussion and my experience, they are also due to
either of the conditions mentioned above develop, the Liver blood stagnation in the Lower Burner according to Zhang
cannot perform its normal function of moving the Blood Zhong Jing). Hot flashes occur when either Yin or Yang is
both within and outside of the Liver. Within our discussion, sufficiently deficient to cause a Separation of Yin and Yang.
Blood stagnation can lead to tumors. More often, the deficiency is in Yang and while the heavier
Yin tends to remain in the body, the lighter Yang rises and
leaves the body as a hot flash. When the separation becomes
LIVER YIN DEFICIENCY severe, the Yin follows the Yang and we have hot (Yang)
AND RISING LIVER YANG sweats (Yin).
Why do these hot flashes and sweats occur most during
Liver Yang Rising is a deficient condition. This is one of the evening and night? During the day when the sun is rising
the most misunderstood conditions in Chinese medicine. It and has its maximum effect on the earth, it inhibits the
is regarded by the majority of Chinese medical students and body’s Yang from separating from the Yin and rising. Later
practitioners as an excess condition, and treated as such, in the day, in the evening and at night, the Yang of sun is no
THE LIVER IN CHINESE MEDICINE 177

longer able to inhibit the Yang of the body which ‘‘wanders autonomic nervous system and nerves to the skin as well as
aimlessly’’ (according to the Japanese). When the Separa- to the uterus at the onset of menses. The texts state that
tion of Yin and Yang is profound, even the sun cannot Spleen Qi is responsible for muscles. Dr. Shen disagreed.
control the escaping Yang and Yin. (Cold day sweats are My experience has been that the Spleen is responsible for
associated with Heart Yang deficiency). The role of the sun connective tissue and that the accumulation of fluid due to a
in Chinese medicine regarding health and disease is poorly Damp Spleen and dysfunctional Triple Burner (non-pitting
understood. edema) accounts for some obesity and the difficulty in
According to Dr Shen, while overworking the body drains losing weight, especially in women.
Yang, especially of the Liver, overworking the mind drains Where Blood is concerned, there is not only the amount
Kidney Yin, and over a lifetime, leads to a Kidney Yin of Blood, the amount produced by the bone marrow (Kidney
deficiency. Since the Yin-Jing, the fluids of the body, is Jing) and by digestion (Spleen Qi and the Triple Burner
supplied by the Kidney to all organs, the entire body and [Internal Duct]), and the capacity of the Liver to store it
mind are affected. As the urban industrial and information (which depends upon the integrity of Liver Qi). It is also the
ages have succeeded, the mind has become increasingly ability to move it where it must go dependent upon the
overtaxed. movement of Liver Qi and especially upon the Heart Qi’s
The principal symptom of this general Yin deficiency is ability to circulate it. Clinically, what often appears like a
extreme dryness of the entire body, irritability, and agitation true Blood deficient condition is actually the Heart’s in-
(agitated depression). Water satisfies thirst for only a short ability to deliver it where it needs to go.
time. Tinnitus with a cricket sound is common. (The texts There is a constant competition for Liver Blood by the
list extreme symptoms such as ‘‘Five Hearts Hot’’ [chest, above-mentioned functions throughout life. Premenstrually,
palms, and soles] that a practitioner might encounter once in this competition is exacerbated since the stored Liver
his=her career, and malar flush with extreme Yin deficiency Blood’s principal function is the preservation of the species,
in the aged.) Night sweats as described above are due to a the ability to get pregnant. Especially when the Liver Qi’s
Separation of Yin and Yang often due to Yang deficiency. priority is to move Blood down, and if it is not storing
All of the organs are secondarily affected by the Yin- sufficient Blood to supply its other obligations or cannot
draining aspects of mental activity, depending upon vulner- move it due to insufficient or stagnant Qi, musculo-skeletal
ability and upon the nature of the activity and the degree of symptoms will develop. This is especially so for areas that
the ‘‘overworking.’’ Shock, worry, and obsessive-compulsive require Liver Qi to overcome gravity such as to the head.
disorder (OCD) deplete Heart Yin. The classic formula for Symptoms can include a dull headache, visual problems
treating Heart Shock that accompanies all trauma, physical such as blurry vision, diminished night vision, and ortho-
and emotional, is a modification of Sheng Mai San consisting static hypotension (dizziness), all blood deficient symptoms.
of 3 herbs that provide or protect Yin, American Ginseng (Xi Similarly, there can be muscular spasms, numbness, and
Yang Shen), Schizandra (Wu Wei Zi), and Ophiopoganis tingling due to the deficiency of Blood to the muscles, lig-
(Mai Men). The principal symptom is agitation with constant aments, and tendons. Palpitations and labile emotions and
thinking and obsessiveness. problems with concentration ensue from deficient Blood to
Rumination about ideas while eating depletes Stomach the Heart, as well as not being comfortable in the moment,
Yin. The principal symptom is becoming easily full and receptive, and responsive, and reduced softness and self-
constant snacking, dry stools and constipation, and a dry awareness.7 Insomnia, marked by awakening after about
mouth and throat. Another etiology is overwork of the 5 hours sleep and returning to sleep within an hour, is an-
stomach from eating too many processed foods—especially other symptom of Heart Blood deficiency. This is a para-
in the form of protein powder supplements. Grief, especially doxical condition since the Heart rests best when there is
with tears, drains Lungs Yin. A dry cough and dryness of the less Blood. However, there must be enough to maintain life
nose and throat might develop. Repressed resentment, im- throughout the night, and when what is used for that purpose
potent rage, and the attempt by the body to overcome the depletes the Blood to maintain Heart muscle, the Liver ur-
concomitant Liver Qi stagnation (as explained above) gently releases Blood to the Heart and causes temporary
gradually exhaust Liver Yin. Liver Yin deficiency is noted wakening until homeostasis is restored.
for ongoing agitation and irritability with great difficulty in Over the past 25 years, fibromyalgia has become a
relaxing and resting (made worse by naps). common presenting symptom often associated with Chronic
Fatigue Syndrome. From the beginning, I found that the
condition involves the nourishment of nerve endings ordi-
LIVER BLOOD DEFICIENCY narily supplied by Liver Blood that also nourishes all
peripheral nerves including the autonomic nervous system,
Liver Blood Deficiency is associated with the Liver’s as well as ligaments, tendons, and muscles. (My belief is
inability to store the blood and deliver it to the tendons, that the Spleen controls the connective tissue [hence, non-
ligaments, muscles, and peripheral nerves, including the pitting edema] and not muscles, as the literature indicates.)
178 HAMMER

This deficit in the supply of Blood to the peripheral nerves endemic in the entire world, accepted today as necessary to
makes them more sensitive and irritable and experienced as our economic well-being, but hardly sustainable or neces-
pain when these nerves are stimulated by pressure. The sary to our physical survival. Our findings indicate that this
decreased circulation can lead to accumulation of fluid and stress on the Liver, our primary detoxifying organ, is un-
pressure on nerve endings. tenable and incompatible with health, and perhaps even with
Also significant is that the supply of Blood to the surface the survival of the individual and the entire human race,
is more often due to a Heart-circulation deficiency. There perhaps all of life.
may be enough Blood stored by the Liver but not a sufficient
delivery system to adequately supply this Blood to the su-
perficial nerves. The solution I find consistently effective is CONCLUSIONS
enhancing either Heart Qi and=or Liver Blood.
Another consideration is a Retained Pathogen that is di- This article presents a new view of the function of Liver
verted from vital organs by the divergent channels (mostly to Stagnation as a necessary natural function involving the
joints) and the Muscle-Sinew channels to muscles, ligaments, ability to contain, and attempts to correct misapprehensions
tendons, and the connective tissue. Again, the nerve endings concerning the nature of Liver Yang Rising. It presents
in these tissues become inflamed and hypersensitive. Here the pathological Liver conditions heretofore not recognized in
extra Channel, the Yang Wei, is especially useful provided the literature, Liver Qi and Yang Deficiency, the conse-
one has first eliminated the retained pathogen. quences of widespread changes in social behavior in the last
half of the 20th century that drains Liver Qi-Yang (perhaps
due to the extensive use of substances of abuse and a mas-
DISCUSSION sive drug culture).
The modern literature of the Liver in Chinese medicine is
primarily preoccupied with Liver Qi stagnation as a path-
ological condition to be overcome. The fact is that Liver Qi DISCLOSURE STATEMENT
stagnation and its consequences are a poorly understood
phenomena. The capacity for the Liver to stagnate is re- No competing financial interests exist.
framed as the capacity for the Liver to ‘‘contain’’ as its
natural function necessary to a socially stable culture, and is
a measure of our ability to maintain focus to complete a task REFERENCES
without being distracted, to move deliberately forward, or
make an orderly retreat as expounded in Dragon Rises, Red 1. Maciocia G. The Foundations of Chinese Medicine. New York,
Bird Flies.6 The condition of Liver Qi stagnation is only an NY: Churchill Livingstone; 2005:216–218, 228.
excess of a positive function of the Liver—the ability to 2. Long R. Qi and Yang deficiency of the liver. J Chin Med. 2003;
contain emotion that makes harmony in life possible. That 71:14–20.
this necessary capacity may be carried to excess by life 3. Hammer LI. Chinese Pulse Diagnosis; A Contemporary Ap-
conditions that create excessive stagnation and its undesir- proach. Vista, CA: Eastland Press; 2001.
4. Hammer LI. Tradition and revision. Clin Acupuncture Oriental
able consequences, does not obviate that this a good and
Med. 2002;3(1).
necessary function in itself. One can reflect on all pathology
5. Wen S. Simple questions. In: The Yellow Emperor’s Classic of
as an exaggeration of natural functions Internal Medicine-Simple Questions. Beijing, China: People’s
There is much more serious Liver pathology from the Health Publishing House.
various etiologies mentioned above. The fact is that the 6. Hammer LI. Dragon Rises Red Bird Flies. Vista, CA: Eastland
etiologies of the principal Liver pathologies, the ‘‘cold Press; 1990.
substances’’ and toxins, are identified as unremarkable and 7. Kaptchuk T. Lecture, mid 1980s.
acceptable, even indispensable and desirable, by a large
segment of the population.
Address correspondence to:
Toxins exist in every phase of our existence, air, food,
Leon I. Hammer, MD
water, clothing, and electromagnetically so that it is esti-
Dragon Rises College of Oriental Medicine
mated that between 50 and 170 substances are in our blood
Contemporary Oriental Medicine
that were not there 60 years ago. To a large measure, these
1000 NE 16th Street, Building F
are fragments of a long chain of hydrocarbons derived from
Gainesville, FL 32653
petro-chemical (oil) compounds manufactured by huge
chemical companies. Toxicity of unsustainable levels is E-mail: [email protected]