Acupuncture Continuing Education

Free the Qi and Blood

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Emotional disorders

In the five elements the Liver is wood. Its character is likened to the upward, left and right movements of a tree. The external physical tree grows and sways while internally the tree distributes water, sap, and other nutrients throughout. The smooth flow of the tree movement is akin to the smooth flow of Liver Qi.

Heart is fire and flames upwards. It is strong in character. The Heart fire and Liver wood combine to effect the emotions. The wood is the fire Yin. The fire can burn out the Yin of the wood. The Heart fire is Shen that shows outwardly and is therefore apparent.

The Liver wood is the decision making element and it said to be 'hiding'. An example from analogy, the Shen of the Heart is akin to the president of U.S.A. It is the outward face of the emotions. The Liver is akin to the C.I.A. It is hidden but determines many decisions expressed in the Shen.

The flame of Shen fire is supported by the wood of Liver Yin decisions. The Lung is the metal character that has strong will and is the stubborn assistant to the Liver regarding decision making. The Qi of metal moves downwards to balance the Liver and Heart Qi upward nature. Kidney confidence is water that has a stable character to control the wood fire downwards. The Spleen and Stomach are the center earth and act to stabilize the will. The Spleen raises the Qi upwards and the Stomach downwards which act to balance movement.

Xiao Yao San uses Chai Hu to smooth Liver Qi upwards, left and right. Bai Shao astringes the Liver and harmonizes the Liver, Spleen, Stomach and Lung Qi upward and downward motions. Bo He is light weight (functioning towards the surface) to assist to flow of the Qi. Bai Zhu and Sheng Jiang assist the Spleen Qi upwards and Stomach Qi downwards. Gan Cao harmonizes the upward and downward motion and stabilizes the Kidney.

Indications
Excessive emotionality, stress, irritability, restlessness, forgetfulness, excessive worry, complaints and fear; fatigue, loose stool, upset stomach and bloating, irregular and painful menstruation, fullness and pain in the hypochondriac region, teeth-marked and pale tongue with moist coating, wiry and weak pulse.

Diagnosis
Liver Qi stagnation with Spleen Qi and Liver Blood deficiency

Ingredients
Chai Hu, Radix Bupleuri 3-6g
Bai Shao, Radix Peoniae Lactiflorae 3-15g
Bo He, Mentha Haplocalyx 3-6g
Dang Gui, Radix Angelicae Sinensis 3-12g
Bai Zhu, Rhizoma Atractylodis Macrocephalae 3-12g
Fu Ling, Sclerotium Poriae Cocoa 3-30g
Sheng Jiang, Zingiberis Officinalis Rechens Rhizoma 3-12g
Gan Cao, Radix Glycyrrhizae Uralensis 3-6g

Chai Hu, Bai Shao and Bo He regulate Liver Qi. Chai Hu emphasizes breaking through the Liver Qi stagnation and raising the Liver Qi upwards to expel depression. Bo He is lighter weight and automatically smoothes the Liver Qi in the lighter level to eliminate irritability. Bai Shao astringes and calms the Liver Yang to calm the spirit. As paired herbs, Chai Hu and Bo He raise and release the Liver upwards. This is balanced by Bai Shao’s downward moving property and deeper action which nourishes the blood and Yin. This combination harmonizes the upward and downward movement of Qi.

Dang Gui nourishes the blood and promotes blood circulation in the Liver to raise the Qi upwards.

Bai Zhu, Fu Ling and Sheng Jiang have a warm temperature to benefit the Spleen and Stomach. Bai Zhu and Sheng Jiang dry the dampness in the Middle Jiao to assist the Spleen Qi upwards and descend the Stomach Qi downwards. Fu Ling drains the dampness to assist the Spleen Qi upwards.

Gan Cao harmonizes the up and down motion of ingredients.

 

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Excess Liver Yang Rising with Spleen Qi or Liver Blood Deficiency

Indications
Angers easily, excess worrying, the mind ‘races’ or is ‘sped up’, cannot make decisions, high blood pressure, headaches, talking loudly, talking to one’s self, red eyes, hair loss, fatigue, wakes up early in the morning and cannot get back to sleep, bloating of abdomen, late or irregular menstruation, red sides of the tongue, teethmarks and a pale tongue with moist coating, wiry and floating pulse.

Formula recommendations
Xiao Yao San and Zhen Gan Xi Feng Tang modification

Xiao Yao San regulates Liver Qi and strengthens the Qi and blood. Zhen Gan Xi Feng Tang settles the Liver Yang and Clears Liver Heat.

Shi Jue, Ming Concha Haliotidis 5-30g
Mu Li, Concha Ostrae 5-30g
Long Gu, Os Draconis 5-30g
Gui Ban, Plastrum Testudinis 5-30g
Bie Jia, Carapax Amydae Sinensis 5-30g
Dai Zhe, Shi Haematitum 5-30g
Niu Xi, Radix Achyranthis Bidentatae 3-15g
Sang Shen Zi, Fructus Mori Albae 3-12g
Gou Qi Zi, Fructus Lycii 3-12g
Qing Hao, Herba Artemisia Annuae 3-12g
Yin Chen Hao, Herba Artemisiae Yinchenhao 3-30g
Mai Ya, Fructus Hordei Vulgaris 3-12g

Shi Ji Ming, Mu Li, Long Gu, Gui Ban, Bie Jia and Dai Zhe Shi settle the Liver Yang. Shi Jue Ming and Mu Li’s emphasis is to settle Liver Yang downwards. Shi Jue Ming brightens the eyes and Mu Li dissolves the nodules. Long Gu’s emphasis is to calm the Heart spirit and astringe the Kidney. Gui Ban and Bei Jia settle Yang and reduce heat. Gui Ban settles the Yang and strengthens the bones. Bie Jia cools the heat and promotes blood circulation. Dai Zhe Shi settles the Stomach Qi downwards, cools the heat and stops bleeding.

Niu Xi descends the blood downwards, promotes blood circulation, promotes urination, expels wind-damp-bi-pain and strengthens the Liver and Kidney.

Sang Shen Zi and Gou Qi Zi nourish the blood. Sang Shen Zi cools the heat. Gou Qi Zi’s emphasize is to nourish Liver blood.

Qing Hao and Yin Chen Hao cool the Liver heat. Qing Hao’s emphasis is to encourage the heat away from the body. Yin Che Hao clears damp heat in the Liver and GB.

Mai Ya opens the appetite and smoothes Liver Qi.

 

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Liver Qi stagnation with Spleen Qi or Liver Blood deficiency or Kidney Yang deficiency

Indications
Depression, negative thinking, headaches, fullness of chest, irritability, insomnia, sighing, irregular menstruation, loss of confidence, low appetite, loose stool, cold extremities, slightly purple tongue with white coating, wiry and weak pulse.

Formula: Xiao Yao Wan modified with Bu Zhong Yi Qi Wan, Si Ni San and You Gui Yin

 

With Qi deficiency

Huang Qi, Radix Astragali Membranaceus 3-30g
Ren Shen, Radix Ginseng 3-12g
Dang Shen, Radix Codonopsitis Pilosulae 3-12g
Sheng Ma, Rhizoma Cimicifugae 3-9g
Zhi Ke, Fructus Citri Aurantii 3-12g
Chen Pi, Pericarpium Citri Reticulatae 3-6g

Huang Qi, Ren Shen and Dang Shen strengthen Qi. Huang Qi’s emphasis is to raise the Spleen Qi upwards and to lift up the spirit. Ren Shen and Dang Shen strengthen the Middle Jiao Qi to lift the Qi upwards. Ren Shen is stronger than the Dang Shen, Ren Shen is used for acute and severe syndromes, Dang Shen is used for chronic and mild syndromes.

Sheng Ma, Zhi Ke and Chen Pi regulate Qi. Sheng Ma’s emphasis is to raise the Qi and spirit upwards. Zhi Ke’s emphasis is to break up the Qi stagnation and open the chest and Middle Jiao to release emotional stagnation. Chen Pi’s emphasis is to regulate the Middle Jiao and descend Stomach Qi downwards to stabilize the Liver Qi.

 

With blood stagnation

Chuan Xiong Radix Ligustici Chuanxiong 3-9g
Yu Jin Tuber Curcumae 3-12g
Xiang Fu Rhizome Cyperi Rotunda 3-12g

Chuan Xiong is acrid and light-weight to promote Qi in the blood circulation and lift up the Qi and blood to raise and release Liver Qi.

Yu Jin and Xiang Fu promote Liver Qi and blood circulation. Yu Jin cools the Liver heat and opens the orifices to cool and open stagnation of the mind. Xiang Fu functions in a deeper blood level to regulate the Qi and blood and stop pain and to regulate the physical body to comfort Liver Qi.

 

With Yang deficiency

Yin Yang, Huo Herba Epimedii 3-12g
Xu Duan, Radix Dipsaci Asperi 3-12g
Lu Rong, Cornu Cervi Parvum 3-9g

Yin Yang Huo, Xu Duan and Lu Rong warm the Kidney Yang to back up the confidence. Yin Yang Huo has a strong moving function to encourage the Yang flow to reduce depression. Xu Duan promotes blood circulation to increase healthy excitement and vitality levels. Lu Rong is the strongest to strengthen Kidney Yang and Jing.

 

With dampness creating dullness of the mind

Shi Chang Pu, Rhizome Acori Graminei 3-12g
Bai Dou Kou, Fructus Amomi Kravanh 3-12g
Pei Lan, Herba Eupatorii Fortunei 3-12g
Gui Zhi, Ramulus Cinnamomi Cassiae 3-9g
Qing Hao, Herba Artemisia Annuae 3-9g

Shi Chang Pu and Bai Dou Kou transform phlegm and open the orifice. Shi Chang Pu is stronger to open the orifice. Bai Dou Kou is aromatic and stronger to expel dampness in the upper body.

Pei Lan has a light smell and aromatic quality to penetrate through the damp stagnation to waken the mind.

Gui Zhi is acrid and warm and harmonizes the Ying and Wei to flow through the stagnant dampness to clear decision making.

Qing Hao encourages the Qi from the interior to the exterior and from the GB & Liver to break through the dampness which is creating dull mindfulness.

  

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Liver Qi stagnation with the up and down emotion of bipolar condition

Indications
Irritability, alternating insomnia, excessive energy, alternating always outside of the home, alternating depression, fatigue, alternating no talking & staying in the room, red tip and slightly purple tongue, wiry and floating pulse.

Formula
Xiao Yao San modify with Si Ni San and Gui Pi Tang

Diagnosis
Irregular Liver and GB Qi. Spleen Qi deficiency with Heart and Liver fire.

If hypotension, use strengthen the Qi herbs. For excess hypertension use calming and cooling herbs. Between the excess and deficiency states- use regulate Qi herbs to harmonize using the base formula Xiao Yao San.

 

With hypotension use raising the Qi herbs

Huang Qi, Radix Astragali Membranaceus 3-30g
Ren Shen, Radix Ginseng 3-12g
Dang Shen, Radix Codonopsitis Pilosulae 3-12g
Sheng Ma, Rhizoma Cimicifugae 3-9g
Ge Gen, Radix Puerariae 3-12g

Huang Qi, Ren Shen and Dang Shen strengthen Qi and spirit. Huang Qi’s emphasis is to raise the Qi and spirit for treating depression. Ren Shen and Dang Shen’s emphasis is to strengthen the Middle Jiao Qi to raise the Spleen and Liver Qi upwards to wake the spirit. Ren Shen is faster and stronger and more often used for acute and severe syndromes. Dang Shen is often used for chronic and milder syndromes.

Sheng Ma and Ge Gen raise Liver and Spleen Qi upwards. Sheng Ma is stronger to raise the Qi and spirit upwards to reduce depression. Ge Gen relaxes muscles to reduce headaches, neck and shoulder pain, and diarrhea.

 

With hypertension use calming herbs

Suan Zao Ren, Semen Zizyphi Spinosae 3-12g
Yuan Zhi, Radix Polygalae Tenufoliae 3-12g
Long Yan Rou, Arillus Euphoriae Longanae 3-12g
Fu Xiao Mai, Semen Tritici Aestivi Levis 3-30g

Suan Zao Ren, Yuan Zhi, Long Yan Rou and Fu Xiao Mai calm the spirit and Heart to control excess type emotions. Suan Zao Ren moistens the Heart and Liver Yin to calm the Heart and Liver. It is often used for dry and heat type hypertension. Yuan Zhi opens the orifice and dissolves phlegm, it often used for dull mind and difficulty making decisions specifically for hyperactive persons. Long Yan Rou is mild and calms the Heart fire and lubricates Qi and Yin. It often used for chronic irritability which burns out Heart Yin fluids in patients. Fu Xiao Mai astringes the spirit and sweating. It is often used for patients who haave irritability and emotions fluctuating upwards and downwards without any reason.

 

With Liver, Spleen and Stomach Qi stagnation

Mu Xiang, Radix Aucklandia Lappae 3-6g
Zhi Shi, Fructus Immaturus Citrii Aurantii 3-12g

Mu Xiang and Zhi Shi regulate Middle Jiao Qi. Mu Xiang is acrid and warm to regulate and dry dampness in the Spleen and Stomach. In this way, it assists the Spleen Qi and Stomach Qi downwards and is used for patient’s with fullness, bloating and stagnation in the abdomen. Zhi Shi breaks Qi stagnation and descends Qi downwards. It is used for breaking masses, phlegm, and Qi and phlegm stagnation in the Middle Jiao and chest. It treats cold and feet and hot head due to cold and hot not harmonized and communicating syndrome.

 

With Liver Qi and blood stagnation

Xiang Fu, Rhizome Cyperi Rotunda 3-12g
Yu Jin, Tuber Curcumae 3-12g

Xiang Fu and Yu Jin regulate Liver Qi and promote blood circulation. Xiang Fu regulates Liver Qi & blood and stops pain. It is often used Liver Qi stagnation attacking the Middle Jiao and emotions related with the Liver. It is also for pain and spasms of the groin region, chest and head. Yu Jin cools the heat, calms the Liver and opens the orifice. It is used for angering easily, frustration, and talking loudly but not coherently.

 

With Liver Qi stagnation with heat

Zhi Zi, Fructus Gardeniae Jasminoidis 3-12g
Qing Hao, Herba Artemisia Annuae 3-12g
Zhu Ru, Caulis Bambusae in Taeniis 3-15g
Mu Dan Pi, Cortex Moutan Radicis 3-12g
Huang Qin, Radix Scutellariae Baicalensis 3-15g

Zhi Zi, Qing Hao, Zhu Ru, Huang Qin and Mu Dan Pi clear Liver and GB heat. Zhi Zi mildly clears heat and damp-heat in the San Jiao (Triple Burner). It cools blood, promotes blood circulation and reduces Heart and Liver irritability. It is often used for patients with irritability, insomnia, bitter taste in the mouth, ulcers in the mouth, and scanty or mild burning urination due to San Jiao heat or damp-heat. Qing Hao raises Liver, Spleen and Lung Qi and clears damp-heat. It is used for treating depression, foggy head, and unclear decision making with underlying damp-heat. Zhu Ru’s emphasis is to clear emotional disturbances from Liver and GB damp-heat. Huang Qin eliminates excess Liver and GB Yang and damp-heat emotional disturbances. Mu Dan Pi cools and promotes the circulation of Liver blood to assist the calming of the Liver Yang excess emotions and anger.

 

Comparison of Zhi Zi, Qing Hao, Zhu Ru and Huang Qin

Zhi Zi has a milder function but can travel throughout the San Jiao. It is a good guiding herb in the formula. Qing Hao is light-weight to raise, lift upwards and open the spirit and clear turbid damp-heat. Zhu Ru and Huang Qi clear damp-heat in the GB and Liver, treat emotions that are up and down, and treat excess worrying and unclear decision making. Zhu Ru’s emphasis is to treat sticky hot phlegm. Huang Qin’s emphasis is to treat dense hot phlegm.

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