Clinical Presentation

Hypochondrial or epigastric distension, a slight feeling of oppression of the chest, irritability, melancholy, depression, moodiness, a feeling of a lump in the throat, a feeling of heat, red face, thirst, propensity to outbursts of anger, premenstrual tension, irregular periods, premenstrual breast distension, heavy periods.

Treatment

Principle: smooth the Liver, move Qi, lightly clear Heat

Combination Points (and notes)

• Clinically, when Heat derives from Qi stagnation, the main principle stays smoothing the Liver and moving Qi rather than jumping straight to clearing Heat — LIV-2 is added only if Heat signs are pronounced, not used routinely.
• Red sides of the tongue (rather than a fully Red tongue) is the key differentiator from Liver-Fire blazing, a considerably more advanced Heat pattern.

Clinical Presentation

Hypochondrial or epigastric distension, hiccup, sighing, nausea, vomiting, belching, a churning feeling in the stomach, irritability; in women, breast distension.

Treatment

Principle: smooth the Liver, subdue Liver-Qi

Combination Points (and notes)

• LIV-3 doing double duty here — smoothing the Liver and settling the Ethereal Soul — reflects the Liver's role housing the Hun; worth remembering whenever emotional symptoms accompany the digestive ones.
• This pattern typically develops directly from Liver-Qi stagnation: ask whether distension that used to sit quietly has recently started including belching, nausea or hiccup, which marks the shift from stagnation to rebellion.

Clinical Presentation

Hypochondrial pain, abdominal pain, vomiting of blood, epistaxis, painful periods, irregular periods, dark and clotted menstrual blood, infertility, masses in the abdomen, purple nails, purple lips, purple or dark complexion, dry skin (in severe cases), purple petechiae.

Treatment

Principle: smooth the Liver, move Qi, move Blood, eliminate stasis

Combination Points (and notes)

• SP-4 + P-6 (opening the Chong Mai, the Sea of Blood) is the go-to combination specifically for Blood stasis anywhere in the body, not only gynaecological — worth remembering beyond this pattern alone.
• Case histories show Liver-Blood stasis rarely stands alone: it's frequently layered on top of pre-existing Liver-Blood deficiency (a Bluish-Purple tongue develops from a previously Pale one) or Spleen-Yang deficiency with Dampness — always check what underlies the stasis.

Clinical Presentation

Irritability, propensity to outbursts of anger, tinnitus, deafness, temporal headache, dizziness, red face and eyes, thirst, bitter taste, dream-disturbed sleep, constipation with dry stools, dark-yellow urine, epistaxis, haematemesis, haemoptysis.

Treatment

Principle: clear the Liver, drain Fire

Combination Points (and notes)

• SP-6 is the single reinforced point in an otherwise reducing protocol — nourishing Yin to help drain Fire is the same principle used in Heart-Fire blazing.
• The four local Gall Bladder head points (G.B.-1, G.B.-9, G.B.-8, G.B.-6) are add-ons only when headache is actually present, not part of the routine base treatment.

Clinical Presentation

Fullness of the hypochondrium, abdomen or hypogastrium, bitter taste, sticky taste, poor appetite, nausea, feeling of heaviness of the body, yellow vaginal discharge, vaginal itching, vulvar eczema or sores, mid-cycle bleeding and/or pain, pain, redness and swelling of the scrotum, genital papular or vesicular skin rashes and itching, urinary difficulty, burning on urination, dark urine.

Treatment

Principle: resolve Dampness, clear the Liver, clear Heat

Combination Points (and notes)

• Ren-12 is the single reinforced point — the familiar pattern of tonifying the Spleen to cut off Dampness at its source while everything else clears the Excess pathogen already present.
• The genital/urinary symptom cluster (vaginal itching, scrotal swelling, burning urination) marks this as Damp-Heat pouring downward via the Liver channel, distinct from Damp-Heat elsewhere in the body.

Clinical Presentation

Fullness and distension of the hypogastrium with pain which refers downwards to the scrotum and testis and upwards to the hypochondrium; the pain is alleviated by warmth; straining of the testis or contraction of the scrotum; vertical headache; feeling of cold; cold hands and feet; vomiting of clear watery fluid or dry vomiting. In women there can be shrinking of the vagina.

Treatment

Principle: clear the Liver, expel Cold

Combination Points (and notes)

• Pain relieved by warmth is the clinching feature separating this from Damp-Heat in the Liver, whose genital symptoms look superficially similar but worsen (not improve) with heat.
• Moxa is applied despite the overall reducing method — Cold specifically calls for warming even while the channel obstruction itself is cleared by reducing technique.

Clinical Presentation

Dizziness, numbness or tingling of limbs, insomnia, blurred vision, 'floaters' in eyes, diminished night vision, scanty menstruation or amenorrhoea, dull-pale complexion without lustre, pale lips, muscular weakness, cramps, withered and brittle nails, dry hair and skin, depression, a feeling of aimlessness.

Treatment

Principle: tonify the Liver, nourish Blood

Combination Points (and notes)

• LIV-8 + ST-36 + SP-6 is a well-known 'excellent' combination for nourishing Blood — worth leading with if time is short.
• Yuyao (an extra point at the eyebrow) is included specifically for the visual symptoms of this pattern (blurred vision, dull headaches) — a good example of adding a local point onto a systemic tonification protocol.

Clinical Presentation

Dizziness, numbness or tingling of limbs, insomnia, blurred vision, 'floaters' in eyes, dry eyes, diminished night vision, scanty menstruation or amenorrhoea, dull-pale complexion without lustre but with red cheekbones, muscular weakness, cramps, withered and brittle nails, very dry hair and skin, depression, a feeling of aimlessness. With pronounced Empty-Heat: malar flush, anxiety, feeling of heat in the evening, night sweating, five-palm heat, thirst with desire to drink in small sips, heavy menstrual bleeding.

Treatment

Principle: tonify the Liver, nourish Yin, clear Empty-Heat if necessary

Combination Points (and notes)

• The same four-point Blood-nourishing base recurs here for Yin — Blood and Yin nourishment overlap substantially in Liver treatment, differing mainly by adding KI-3/KI-6 for Yin specifically.
• LIV-2 is the single reduced point, held in reserve for when Empty-Heat signs (malar flush, night sweating, Red tongue) are actually present.

Clinical Presentation

Headache (which may be on the temples, eyes or lateral side of the head), dizziness, tinnitus, deafness, blurred vision, dry mouth and throat, insomnia, irritability, feeling worked-up, propensity to outbursts of anger, stiff neck.

Treatment

Principle: subdue Liver-Yang, nourish Yin or Blood

Combination Points (and notes)

• This is the template pattern for all four types of internal Wind discussed later on this deck — worth teaching Liver-Yang rising thoroughly before moving to its Wind-generating complications.
• The tongue and pulse genuinely vary with the underlying cause (Blood vs. Yin vs. rebellious Qi) — always ask what's driving the Yang rising rather than treating the headache symptomatically alone.

Clinical Presentation

High temperature, convulsions, rigidity of the neck, tremor of limbs, opisthotonos, in severe cases coma.

Treatment

Principle: cool Blood, nourish Yin, extinguish Wind

Combination Points (and notes)

• This is the only Liver-Wind pattern arising from extreme febrile Heat rather than chronic Yin/Blood deficiency — hence bleeding technique (Shixuan, Du-14) rather than the tonify/sedate combinations used in the other Wind patterns.
• Rigidity of the neck and opisthotonos alongside high fever mark this as an acute emergency presentation, distinct from the chronic Liver-Yang-rising-generating-Wind patterns.

Clinical Presentation

Tremor, facial tic, severe dizziness, tinnitus, headache, hypertension, dry throat, dry eyes, blurred vision, numbness or tingling of limbs, poor memory.

Treatment

Principle: subdue Liver-Yang, extinguish Wind, nourish Liver-Yin

Combination Points (and notes)

• This is the mildest of the three Liver-Yang-rising-generating-Wind subpatterns — no backache or night sweating, since only Liver-Yin (not yet Kidney-Yin) is deficient.
• The point set (five Wind/Yang points reduced, three Yin-nourishing points reinforced) recurs with minor additions across all three subpatterns — learn this base combination once.

Clinical Presentation

Tremor, facial tic, severe dizziness, tinnitus, headache, dry throat, dry eyes, blurred vision, numbness or tingling of limbs, poor memory, backache, scanty urination, night sweating, possibly hypertension.

Treatment

Principle: subdue Liver-Yang, extinguish Wind, nourish Liver- and Kidney-Yin

Combination Points (and notes)

• Backache, scanty urination and night sweating are exactly the added Kidney-Yin-deficiency signs that distinguish this from the pure Liver-Yin variant — KI-6 and Ren-4 are added to the point set precisely to address them.
• This subpattern typically represents a later stage than the pure Liver-Yin variant, since Yin deficiency has spread from Liver to Kidney over time.

Clinical Presentation

Tremor, dizziness, tinnitus, headache, hypertension, dry throat, blurred vision, numbness or tingling of limbs, poor memory, insomnia.

Treatment

Principle: subdue Liver-Yang, extinguish Wind, nourish Liver-Blood

Combination Points (and notes)

• The Pale (rather than normal-coloured) tongue is the clean differentiator here — Blood deficiency pales the tongue body in a way pure Yin deficiency does not.
• Insomnia appears specifically in this subpattern (absent from the other two) because Blood deficiency, not just Yin deficiency, directly deprives the Mind of its residence.

Clinical Presentation

Tremor, irritability, propensity to outbursts of anger, tinnitus and/or deafness (with sudden onset), temporal headache, dizziness, red face and eyes, thirst, bitter taste, dream-disturbed sleep, constipation with dry stools, dark-yellow urine, epistaxis, haematemesis, haemoptysis.

Treatment

Principle: clear the Liver, drain Fire, extinguish Wind

Combination Points (and notes)

• More common in the elderly — worth keeping in mind as a demographic clue alongside the Full-Heat presentation (sudden tinnitus/deafness, red face and eyes).
• SP-6 remains the single reinforced point even in a Wind-generating Fire pattern — nourishing Yin to drain Fire is a recurring principle across every Liver-Fire pattern here.

Clinical Presentation

Fine tremor, facial tic, dizziness, blurred vision, numbness or tingling of limbs, poor memory, insomnia, scanty periods.

Treatment

Principle: nourish Liver-Blood, extinguish Wind

Combination Points (and notes)

• Nearly identical point set to Liver-Yang rising deriving from Liver-Blood deficiency — the clinical difference is that Wind signs (tremor, tic, numbness) dominate here rather than Yang-rising signs (dizziness, headache, hypertension).
• Moxa on BL-17 is explicitly applicable here despite the overall reducing-for-Wind method — Blood deficiency this pronounced benefits from direct warming to nourish Blood.

Clinical Presentation

Irritability, abdominal distension and pain, alternation of constipation and diarrhoea, stools sometimes dry and bitty (small pieces) and sometimes loose, flatulence, tiredness.

Treatment

Principle: subdue rebellious Qi, tonify the Spleen

Combination Points (and notes)

• An important clinical distinction: sometimes the Liver is genuinely overactive and invades the Spleen; other times the Spleen is simply weak and 'allows' itself to be invaded even when the Liver is not overactive — the tongue (Red sides vs. normal-coloured) tells you which.
• Frequently seen in irritable bowel syndrome, especially once rebellious Liver-Qi and Spleen deficiency combine to impair fluid transformation and generate Dampness on top of the original Qi-mechanism disturbance.

Clinical Presentation

Irritability, epigastric and hypochondrial distension and pain, a feeling of oppression in the epigastrium, sour regurgitation, hiccups, belching, nausea, vomiting, sighing, weak limbs.

Treatment

Principle: subdue rebellious Liver-Qi and tonify the Stomach

Combination Points (and notes)

• The same tongue logic applies as with Spleen invasion: Red sides if the Liver is primarily overactive, normal-coloured if the Stomach is primarily weak and being invaded.
• Left untreated, this pattern can progress to injure Stomach-Yin over time — worth monitoring for emerging signs of Stomach-Yin deficiency (dry mouth, hunger without desire to eat) in long-standing cases.

Clinical Presentation

Breathlessness, asthma, a feeling of fullness and distension of the chest and hypochondrium, cough with a yellow or blood-tinged sputum, headache, dizziness, red face, thirst, bitter taste, bloodshot eyes, scanty dark urine, constipation.

Treatment

Principle: clear the Liver, drain Fire, subdue Liver-Qi, stimulate the descending of Lung-Qi

Combination Points (and notes)

• Described in Five-Element terms as 'Wood insulting Metal' — the Liver's Fire rebels upward and blocks the Lung's descending function directly, producing breathlessness and asthma alongside the more familiar Liver-Fire signs.
• Two specific downstream complications to watch for: Fire drying Body Fluids into Yin deficiency, and Fire condensing fluids into Phlegm — either can follow if the underlying Liver-Fire isn't cleared.

Clinical Presentation

Palpitations, dizziness, insomnia, dream-disturbed sleep, poor memory, anxiety, propensity to be startled, dull-pale complexion, pale lips, blurred vision, floaters in eyes, diminished night vision, tingling or numbness of limbs, scanty periods or amenorrhoea, cramps, muscular weakness, dry hair and skin, depression, a feeling of aimlessness, withered and brittle nails.

Treatment

Principle: nourish Blood, tonify Heart and Liver, calm the Mind and settle the Ethereal Soul

Combination Points (and notes)

• This exact combination — Liver-, Heart- and Spleen-Blood-nourishing points together — is much more common for the Liver than for most organs: Liver patterns combine with each other and with other organs' patterns far more frequently than, say, Heart patterns do.
• BL-18 and BL-23 are added specifically 'particularly in gynaecological conditions' — lean on these two when the presenting complaint centers on menstrual/reproductive symptoms rather than palpitations and insomnia alone.