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Module 5   Lesson 7   Gan xu, gan feng

Liver: deficiency and combined patterns

An empty cupboard, a Yang that breaks loose, Wind that starts to blow: how do you read the Liver when there is too little underneath, and what does it then do to its neighbours?

After this lesson you know the deficient Liver (Blood and Yin), the mixed pictures Liver-Yang rising and Liver-Wind with their sources, and the combinations with the Spleen, Stomach, Lungs and Kidneys; with signs, tongue, pulse, cause and principle, and for each pair the finding that decides. Patterns 3, 4 and 5 from module 1 stay the same. The features are learning anchors, not validated criteria.

Liver-Wind 3 Yang rising becomes Wind Fire, lesson 6 Extreme Heat 4 Blood deficiency Liver-Yin deficiency Liver and Kidney: Yin root Blood deficiency gives Wind COMBINED, p. 559 5 Liver invading the Spleen Liver invading the Stomach Liver-Fire insulting Lungs Liver and Heart: lesson 5
Schematic. Headings after Maciocia ch. 34: deficiency p. 548, combined excess and deficiency p. 552, combined p. 559. Blue deficiency, red excess, white with a dotted border mixed; red border Heat. Check in the book under which heading Liver-Wind and the Liver and Kidney combination appear.

Know by heart

  • Deficiency: Blood or Yin. 4 Liver-Blood deficiency: dry eyes, blurred vision, cramps, brittle nails, scanty periods; pale (sides) and thin; choppy or thin; nourish Liver-Blood. Liver-Yin deficiency: the same but drier, with Empty-Heat; red without coating; thin or thin-rapid; nourish Liver-Yin. mnemonic: Blood is pale, Yin is red and dry.
  • 3 Liver-Yang rising. Throbbing headache, dizziness, tinnitus, irritability; tongue follows the root; wiry; subdue Yang and nourish the Root. mnemonic: full above, empty below.
  • Liver-Wind, three sources. Extreme Heat: fever, convulsions, neck stiffness, deep-red tongue (emergency services: 112 in Europe, 999 in the UK, 911 in North America). Yang generating Wind: tremor, tics, dizziness; when severe a stroke (emergency services). Blood deficiency giving rise to Wind: fine tremor and tingling on a pale tongue. Extinguish Wind and treat the source. mnemonic: Wind from Fire, from Yang, from emptiness.
  • Spleen or Stomach. 5 Liver invading the Spleen: stress goes into the bowel, alternating stools, tiredness; wiry left, weak right; harmonise the Liver, tonify the Spleen. Liver invading the Stomach: stress goes into the stomach, with belching, sour regurgitation, nausea; wiry; calm the Liver, make Stomach-Qi descend. mnemonic: Spleen is the bowel, Stomach is the stomach.
  • Liver-Fire insulting the Lungs. Wood insults Metal: cough or asthma with yellow or blood-streaked phlegm, pain in the hypochondrium and chest, red face; red with redder sides, yellow coating; wiry-rapid; clear Liver-Fire, make Lung-Qi descend.
  • Liver- and Kidney-Yin deficiency. Dry eyes, dizziness, tinnitus, weak lower back and knees, night sweats; red without coating; thin-rapid; nourish Liver- and Kidney-Yin. The root most often named under 3. mnemonic: Water nourishes Wood.
  • Red flag. Sudden deviated mouth, loss of strength, speech or vision disturbance: emergency services. Fever with convulsions: emergency services. New tremor: GP or primary care doctor.

The rest of this lesson is reference.

Liver: Deficiency and combined patterns: An empty cupboard, a Yang that breaks loose, Wind that starts to blow: how do you read the Liver when there is too little underneath, and what does it then do to its neighbours?
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Three practice questions from this lesson

Case. Woman, 31: dizzy on standing up, blurred vision in the evening, dry eyes, calf cramps, brittle nails, short and light periods. No warmth, no night sweats. Tongue pale, especially the sides, and thin; pulse thin.
  1. 4 Liver-Blood deficiency
  2. 3 Liver-Yang rising
  3. Liver-Yin deficiency

Answer: 4 Liver-Blood deficiency. The tissues of the Liver get too little Blood, without Heat and without dryness. First Hb, ferritin and B12.

Case. Woman, 52: gritty, dry eyes, blurred vision, dry skin, cramps, warm in the evening and sweating at night. No complaints of the lower back or ears. Tongue red without coating, dry; pulse thin and slightly rapid.
  1. 4 Liver-Blood deficiency
  2. Liver- and Kidney-Yin deficiency
  3. Liver-Yin deficiency

Answer: Liver-Yin deficiency. The picture of 4, drier, with Empty-Heat and a red tongue without coating. Without lower back and ear signs, the Kidneys are not (yet) involved. First: menopause, Sjögren's syndrome, thyroid.

Which finding best separates Liver-Blood deficiency from Liver-Yin deficiency?
  1. Short, scanty periods
  2. Dry eyes and blurred vision in the evening
  3. Pale tongue versus red tongue

Answer: Pale tongue versus red tongue. They share dry eyes, blurred vision and scanty periods. Blood is pale; Yin is red without coating and dry, with Empty-Heat.

The rest of this lesson

In the course you get the step-by-step explanation, 14 case-based practice questions, 15 spaced-repetition flashcards, the pitfalls and the bridge to physiology with evidence grades. This lesson belongs to module 5: Patterns.

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