Perhaps in no organ system is the similarity and difference between Western physiological and Traditional Chinese physiology more evident than in the TCM description of the liver. The difference is essentially that of form and function but since the liver’s known Western physiological functions are so complex, it is possible for the Western scientific mind to clearly see the bridge between body and mind that is at the heart of TCM theory. Dr Michael Tierra shares some fascinating facts when looking at the liver through the eyes of Traditional Chinese Medicine.
To come to a full appreciation of the depth of observation and knowledge that over 5000 years of Chinese medical theory achieved can only serve to amplify the remarkable scientific edifice that has been created in the last 150 years or so in Western medical physiology. The two can only serve to help each other as a kind of check and balance. It would be a tragedy of profound ignorance if the West turned its back on the profound physiological wisdom of the ancient medical systems simply because of impatience in dealing with its cultural jargon and other semantic difficulties.
Finally, it is no accident that the ancient Chinese assigned the liver and gall bladder to the wood element. Probably no other organ system is so keyed to respond to botanical medicine as is the liver. Most people around the word recognize as part of their folk heritage the importance of vegetables to a health liver. Further, it is the bitter flavor of certain herbs that specifically triggers the secretion of bile that aids digestion as well as liver metabolism generally.
The first TCM description might actually serve as a summary to a description of all other liver functions. It is, however, the essential way that most TCM practitioners access and remember the various complex functions of the liver in clinical settings.
is the general governing the body-mind:
While the heart is the king or supreme commander over all body-mind functions, the Chinese describe the liver as the general or long-range planner. Let’s consider what this actually means in terms of Western Physiology:
First consider how a good general helps defend against external invasions and attacks and how the liver similarly protect the body-mind from various external poisons and pathogens. In this regard, the liver serves as an important citadel for the function of the immune system as it is primarily responsible for detoxification and elimination of various metabolic poisons. While the external immune system is involved in overcoming pathological bacteria and viruses throughout the body, the liver make the process more efficient by removing the debris in the form of vanquished and exhausted blood cells and other metabolic wastes from the blood. In this way renewed cells can arise within the blood to continue the process of phago-cytosis and other protective functions.
The liver serves as long-range planner by refining, filtering, using and storing important nutrients such proteins, glycogen, vitamins and various minerals including iron for immediate and future use. The planning capacity of the liver is also demonstrated by its ability to chemically alter or excrete different hormones including thyroxin and essentially all the steroid hormones such as oestrogen, cortisol, aldosterone and so forth. While many of these are generated as part of natural physical cycles, they can also be radically thrown out of balance in reaction to fear or stress and thus the liver plays a key role in helping to maintain a clear and balanced mental state. The liver is also actively involved in detoxifying and excreting into the bile many different drugs, including sulfonamides, penicillin, ampicillin and erythromycin to name a few.
regulates the smooth flowing of chi
Glucose is stored in the body in the form of glycogen. While all cells are capable of storing some glycogen, liver cells are uniquely able to store up to 5 to 8 per cent of their weight as glycogen. One of the important functions of the liver is to re transform glycogen into glucose and release it into the blood as needed to maintain a relatively constant energetic balance. Impaired liver function can cause fatigue, irritability and depression as a result of impaired glycogenesis which is the breakdown of glycogen to re-form glucose in the cells.
The process of gluconeogenesis described previously demonstrates the liver’s ability to play a key role in the digestion and metabolism of carbohydrates. Faulty carbohydrate metabolism by the liver will cause blood glucose to radically rise or fall causing either hypo or hyperglycemia.
The liver is also of primary importance in fat metabolism. There are four primary liver functions involved with fat metabolism:
1. The release of energy from the breakdown and burning of fatty acids and the formation of acetic acid,
2. The formation of lipoproteins
3. The formation of cholesterol and phospholipids that are found in cell membranes and intracellular structures throughout the body
4. The conversion of large quantities of carbohydrates to fat.
Besides these, the secretion of bile salts into the duodenum neutralizes the acidified food material that has passed from the stomach. Bile also stimulates natural intestinal peristalsis that helps regulate bowel movement.
Green citrus peel (Pericarpium citri Reticulatae viride) or ‘ching Pi‘. This herb has an aromatic bitter principle that helps stimulate digestion and relieve chi congestion including all the above named symptoms.
Cyperus (Rhizoma cyperi rotundi) ‘xiang fu‘ is a common grass-like herb that grows in various parts of the world including the Pacific Northwest where it is called nutgrass. The rhizomes were commonly roasted and eaten as food by the natives. It also relieves all signs of chi stagnation and is especially useful for gynecological complains with Dang Quai.
Ayurvedic medicine uses turmeric root as a liver herb that aids digestion and gently aids the flow of bile. It is used to regulate blood sugar and treat diabetes and hypoglycemia, regulate menstruation and aid digestion. In Western herbal medicine barberry root and gentian are used as bitter tonics to aid digestion. Barberry or its Western states counterpart, Oregon Grape are used as a bitter tonic for digestive problems and gynecological complaints as well treating many chronic diseases.
The fact those large amounts of liver tissue must be adversely affected in order to show up as liver dysfunction in customary liver tests. Before these are obvious given the present imprecision of these physical tests, abnormalities of liver function are readily diagnosed according to abnormal emotional reactions.
The correlation of mood swings is clearly recognized and attributed as a result of rising and falling blood sugar levels. However, the liver’s inability to maintain appropriate levels of alkalinity as food passes from the stomach to the duodenum can result in dyspeptic symptoms ranging from relatively mild abdominal pains to severe ulcers. This complex can be related to what in TCM is termed as liver invading spleen or irregular or stagnant liver chi.
Further, the liver’s function of excreting different hormones associated with stress and cyclical imbalance may be impaired as a result of its having to contend with other important functions such as the detoxification of drugs and various external pollutants. The re-circulation of various stress related hormones will result in radical mood shifts and inappropriate angry behavior.
Through this process we see that the liver is responsible for the detoxification and elimination of both endogenous as well as exogenous toxins. Endogenous toxins are produced from various stresses and attitudes while exogenous toxins are the result of external toxins and pollutants from air, food and water.
While both types of toxins are often present, endogenous, thought-produced toxins can result in extreme feelings of anger and frustration, hypertension, hyperthyroidism, premenstrual tension, aggravation of menopausal symptoms and other physiological and behavioral symptoms.
All of these obviously play upon the nervous system and it is a fundamentally important aspect of herbal strategy to treat various psychological and neurological symptoms by using herbal cholagogues that aid the secretion of bile and thereby help clear the liver.
One Chinese liver herb that is specifically used for internal heat causing irritability, restlessness, insomnia and delirium is gardeniae jasminoidis (zhi zi). This herb is sometimes called the ‘happiness herb’ because of its effect in clearing internal heat and restless irritability associated with liver chi stagnation.
A Western herb that regulates emotions associated with hormonal imbalances in women as a result of their reproductive cycle and menopause stage is vitex agnus castus or chaste berry.
Irregular liver chi causing cysts, tumors and breast lumps
Blockage of liver chi also causes swelling of the glands in various parts of the body and in women predisposes them to the formation of cysts and lumps in the reproductive organs and tumors and lumps in the breast. These are specifically caused by an accumulation of toxins, which the liver is unable to process and eliminate.
One Chinese herb that is commonly used in the West for treating liver conditions is dandelion. Chinese medicine specifically uses the entire plant of the dandelion, the upper part as well as the root for clearing heat and detoxifying fire poison as well as reducing abscesses, dissipating nodules, treating all problems of the breast. This includes breast lumps and tumors.
In Western medicine dandelion can also be used and one can also consider the use of dried pokeroot, since it is considered specifically effective for treating all glandular diseases.
Rather than pass directly to the cells of the body, all nutrients absorbed from the intestinal walls are channeled into a special vein called the “portal vein”. While all other veins go directly to the heart from where they are pumped and distributed throughout the body, the portal vein goes into the liver where it opens into a bed of fine capillaries. This food enriched blood is circulated around and through the liver cells where it is further processed then either immediately used or stored for future need. Eventually the nutrient enriched blood is collected into another large vein called the ‘vena cava’ where it finally empties into the heart for general distribution throughout the body.
An increase in veinous pressure that drains and circulates through the liver can cause the liver to markedly swell. The liver can store from 200 to 400 ml. of blood as a result of only relatively slight rise (4 to 8 mm Hg) in hepatic venous pressure. For this reason, if none other, the liver is one of the major blood reservoirs. Further, during a pathological hemorrhage condition where large amounts of blood are lost, much of the normal blood stored in the liver sinusoids is drained into the remainder of the circulation to replace the lost blood.
Another concept involving the liver’s ability to store blood is the regulation of clotting functions. The liver does this by producing many of the plasma clotting factors including prothrombin and fibrinogen as well as the production of bile salts necessary for the absorption of vitamin K which is needed for the production of the various clotting factors.
Two important Chinese herbs that tonify blood and enter the liver meridian are angelica sinensis (Dang Quai) and white peony root (Paeoniae lactiflorae). Dang Quai is one of the most popular Chinese tonic herbs for women. It tonifies the blood, cures blurred vision, anemia, and irregular menstrual problems. It also contains various plant steroids that serve as hormone precursors as well as vitamin B12 and carotene. One study in which a 5% preparation of dang quai was given to mice increased oxygen consumption of the liver without affecting the amount of nucleic acids present. This suggests a generalized increase of liver metabolism. It was also shown to have a protective effect on liver exposed to carbon tetrachloride.
White peony root is classified as a blood tonic with bitter, sour flavors and cool energy. It enters the liver and spleen organ meridians and is frequently combined with other Chinese blood tonics including dang quai, ligusticum and rehmannia root as the basis for treating gynecological imbalances. Besides its blood tonic properties, peony root is also an antispasmodic that promotes blood circulation by relieving blockage and tension of the organs and various internal and superficial areas of the body. This is described by the Chinese as ‘adjusting the Nutritive and Protective levels’.
Beta-Carotene is converted to the retinal form of vitamin A in the liver. Vitamin A then combines with a protein opsin to form rhodopsin (visual purple). Rhodopsin is found in the rod cells of the retina and is responsible for night vision. Light striking the retina splits the rhodopsin molecule that generates an electrical impulse that sends information to the brain. Each time rhodopsin is split, a small amount of retinal is destroyed. Night vision is impaired when there is a lack of re synthesis of retinal necessary for forming visual purple. In addition, other light sensitive pigments require the presence of vitamin A. These include iodopsin, cyanopsin and porphyropsin, all of which are color pigments in cone cells of the retina.
One other way that the liver governs the eyes is the maintenance of epithelial tissue. This tissue is particularly important for the proper function of the cornea as well as all other mucus secreting membranes of the body, including the gastrointestinal tract, the lungs, the vagina, the urinary tract, the bladder and the skin. Dryness of these organs is diagnosed in Chinese medicine as liver yin deficiency. This suggests that various yin tonics such as rehmannia, lycii berries, asparagus root and ophiopogon play a significant role in supply substantial amounts of beta carotene as the precursor of vitamin A and/or somehow nurturing the mucus secreting epithelial tissues of the body.
A lack of vitamin A will also cause keratitis which is an ulcerous inflammation and hardening of the cornea as well as other associated parts of the eye such as the conjunctiva. Vitamin A deficiency due to either a lack of nutritional sources of vitamin A or its precursor in the form of beta-carotene or the function of transforming beta-carotene into vitamin A in the liver manifests with symptoms such as dryness of the eye, inflammatory eye diseases, excessive lacrimation, pain, photophobia, impaired night vision and general vision loss.
Two important Chinese herbs that are specifically used to strengthen the eyes are Fructus lycii chinensis (ou gi zi) and Flos chrysanthemum morifolii. Lycii berries are classified as a blood and yin tonic and nourish the kidneys and the liver. They contain a good amount of carotene along with vitamin C, thiamin, riboflavin, linoleic acid and Beta sitosterol.
Chrysanthemum flowers has a cooling and soothing action, relieving heat and tension (wind) that causes eyestrain and blurred vision. It is also used like feverfew for headaches and fevers. It is commonly combined with lycii berries for strengthening the eyes.
opens to the nails of the hands and feet
The nail consists of a particular hard, horny tissue composed largely of keratin. Keratin is an extremely tough protein material that comprises the bulk of hair, nails and horny tissue. It is generally insoluble in water, weak acids or alkalis and unaffected by most proteolytic enzymes. The fibrous protein is produced by keratinocytes found in the body in two forms, hard and soft.
It grows from a root in the nail-bed or matrix at the tips of the fingers and toes. This consists of epithelium and cornium continuous with the epidermis and dermis of the skin of the nail fold. The white crescent shaped moons located near the root is called the lunula.
The nail grows in length and thickness through the activity of cells in the stratum germinativum of the nail root. The average nail growth rate is 1 mm per week. The complete nail replaces itself on the average every 4 to 6 months. Nail growth varies with age and certain diseases and hormonal imbalances.
Differential diagnosis of the nails is determined by various indications many of which are indirectly related to primary liver functions relating to protein metabolism, the production of hemoglobin, the liver’s synthesis of vitamin A from beta-carotene and the presence of certain toxic metabolites such as arsenic, mercury, silver and other toxic substances which the liver is unable to fully discharge and have clinically verifiable indications that can show up on the nails. In general, a thickening or weakening of the nails is directly related to the metabolism of Vitamin A.
Some of the abnormal indications that are diagnosed upon examination of the nails are as follows:
- Nail ridges may occur as a sign of defective nutrition or after a serious illness. In the absence of hydrochloric acid (achlorydia) or anemia caused by a decrease of blood cells (hypochromia), the nails may be excessively spoon shaped and depressed in the center.
- Chronic pulmonary conditions and congenital heart disease can result in spongy excess of soft tissue at the base of the nails and may be associated with clubbed fingers.
- Atrophy of the nails may occur as a result of congenital defects. In Traditional Chinese Medicine (TCM), besides indicating the condition of the liver, this also be considered a problem of the ‘yuan chi’ or congenital energy associated with kidney chi, involving the endocrine glands.
- Nail shedding or permanent atrophy of the nails can follow injuries, scars, frostbite, nerve injuries and hyperthyroidism.
- Prolonged contact with chemicals as well as too frequent manicuring can cause nails to become fragile or split easily.
- Transverse lines (Beau’s lines) can result from earlier interference with nail matrix growth. This can result from local or systemic imbalances and can be approximately dated according to the placement of the line or lines on the nail.
Various other diseases such as injury to the nerve or finger, neuritis, raynaud’s disease, pulmonary osteoarthropathy, syphilis, onychia, scleroderma, acrodermatitis and granuloma fungoides of the fingers can result in dry, malformed nails.
Black indicates gangrene perhaps caused by diabetes. Blue-black is due to stagnant blood under the nail and can be a sign of hemophilia and trauma. This can be painful and is treated by drilling a small hole in the nail at the site of the hemorrhage. Brown is a possible sign of arsenic poisoning. Brownish-black may indicate chronic mercurial poisoning caused by the formation of sulfide of mercury in the tissues. Cyanosis usually indicates anemia, poor circulation or venous stasis. White spots may be caused by trauma and are usually found in women. Transverse white bands in all nails may be a sign of acute or chronic arsenic poisoning.
Considering that many of the above indications represent some toxic reaction in the body, and that the liver is the organ that primarily deals with detoxification of the blood as well as the overall health of the blood, the TCM concept that the ‘nails are the flowering of the liver’ is quite understandable in terms of present scientific physiology.
A substance used in Chinese medicine that tonifies the blood and is of specific benefit to the nails is gelatin. Chinese medicine specifically uses asses skin gelatin (when available). It is dissolved in warm water and taken by women daily. Dang Quai Gin is a Chinese patented formula available as syrup. It combines dissolved gelatin, dang quai and various other herbs for women in syrup used for most gynecological problems as well as a general female tonic. Gelatin is especially useful for excessive menstrual bleeding.
The essential expression of the liver is appropriate tension. This is expressed in various functions especially the restrained process of bile secretion from the liver through the gall bladder to the small intestine. The bile itself then acts as a natural irritant to the lining of the intestine that stimulates appropriate peristalsis that promotes the movement of feces through the lower intestine.
As a result of this process, the liver is described as ruling the nervous system. ‘Wind’ in Chinese medicine describes a concept appropriate to any internal or external physiological movement. Spreading infectious diseases from the common cold, flu or skin rash is described as wind as is rheumatic and arthritic symptoms. Headaches, stroke or chorea are described as internal wind because they are primarily caused by an imbalance of the internal organs.
A number of liver herbs with antispasmodic properties are very effective for relieving symptoms of liver wind. Two Chinese herbs in particular are gambir (uncaria rhyncholphylla) (gou teng) and gastrodia (gastrodiae elatae) (tian ma). Both of these are powerful antispasmodic herbs that release symptoms of liver wind including tremors, seizures and symptoms such as headaches, dizziness, and chorea. They are also useful in relieving rheumatic pains.
Strong liver herbs that are used to Calm the Spirit are typically hard shells and minerals. These include dragon bone (os draconis) (long gu), oyster shell (concha ostreae (mu li), pearl margarita (Pteria margaritifera) (zhen zhu). These heavy mineral substances tend to create more grounding sedative effects that help calm the mind and emotions.