The Liver and Gallbladder according to Traditional Chinese Medicine (TCM)

According to Traditional Chinese Medicine (TCM), the Liver and Gallbladder are related to the Season of Spring.

TCM, the Five Elements and the Liver

The Five Elements (Water, Fire, Wood, Metal, Earth) are qualities of nature that are foundational to the theory of TCM. The theory of the Five Elements is systematically applied to symptomatology, diagnosis, and treatment.  Some may argue that, together with the theory of Yin-Yang, it constitutes the foundation of TCM theory.

Each season is associated with an element, organ system, taste, etc. Each of these correspondences are then utilized in identifying patterns (TCM diagnosis), and treatment options. For example: Herbs that are recommended for phlegm in the sinuses are generally pungent (acrid).

A partial list of the Five-Elements correspondences for Spring includes:

  • Season — Spring
  • Element — Wood
  • Yin Organ system — Liver
  • Yang Organ system —Gallbladder
  • Developments — Birth
  • Color — Green
  • Sounds — Shouting
  • Emotions — Anger
  • Taste — Sour
  • Tissue — Sinews
  • Sense organ — Eyes
  • Climate — Wind

The Liver has eight principal functions

  • Stores blood
  • Ensures smooth flow of Qi
  • Controls the sinews (and tendons)
  • Manifests in the eyes / Opens into the eyes
  • Controls tears
  • Houses the Ethereal Soul
  • Affected by anger

There is a saying in TCM, “the Spleen makes the blood the Liver stores it”.

The Liver’s functions of storing the blood and nourishing the sinews and tendons are what makes physical exercise possible. Just like a sponge, if the sponge is dry, it is not pliable and impossible to move. However, if the sponge is wet it is pliable and moveable. Fresh blood flow is necessary for unimpeded physical movement.

For women, blood is also stored in the uterus, thus ensuring a regular menstruation.

Think of the Liver as an army general. It is responsible for ensuring the smooth flow and proper direction of Qi. It is also responsible for our capacity for making plans and having a sense of direction in life.

Liver Stores the Blood

The Liver is the most important organ for storing blood. It is responsible for regulating the volume of blood in the whole body in relation to rest and activity. When the body is active the Liver sends blood to the muscles and sinews (tendons, ligaments, and cartilages) nourishing and moistening them to make them more pliable. When the body is at rest the blood is returned to the Liver to be stored. During rest the stored blood in the Liver contributes to restoring a person’s energy (rest & recovery). If these functions are impaired there will be lack of Blood and therefore nourishment, leading to becoming easily fatigued.

Common patterns and symptoms of Liver blood affecting the sinews:

  • Liver blood deficiency (failure to moisten): muscle cramps and contraction of tendons
  • Liver wind (internal wind): tremor or convulsions
  • Liver blood deficiency: Dry brittle, cracked, ridged nails (nails are considered a byproduct of sinews)

The Liver and Blood have a reciprocal relationship. If Blood is deficient or hot it can affect Liver function, and if the liver function is abnormal it can affect the quality of the blood.

The Liver’s function of regulating and storing the blood volume also plays an indirect role on our immune system (our resistance to external pathogenic factors). If the skin and muscles are well nourished by blood, external pathogens can not take root. The strength of Lung qi and Defensive (wei) Qi play a leading role in preventing external pathogens from entering.

Liver Blood Regulates Menstruation

Liver blood is stored in the uterus. Many gynecological problems can be attributed to the malfunction of the Liver blood or Liver qi. Common patterns and symptoms:

  • Liver blood deficiency: amenorrhea (lack of period) or scanty periods 
  • Liver blood is in excess or “hot”:  heavy bleeding 
  • Liver blood is stagnant: painful menstruation
  • Liver Qi stagnation: may lead to blood stasis causing painful periods with premenstrual tension (PMS) and dark blood clots

The Ren Mai (Directing Vessel) and Chong Mai (Penetrating Vessel) are influenced by the Liver’s storage of blood. These two “extraordinary vessels” are closely related to the uterus.

Liver Ensures Smooth Flow of Qi

The most important function of the Liver is its ability to ensure the smooth flow of Qi. As such, it is also the function that experiences the most disharmonies.

The dysfunction of Liver Qi is one of the most common patterns seen in clinical practice.

The Liver ensures the smooth flow of Qi throughout the body in all directions and in all organs.

Texts refer to this aspect of the Liver’s function using terms like disperse, extend, loosen, relax, circulate, make smooth and free, and balance. All of these words are congruent with the Chinese term, for Smooth flow of Qi, Shu Xie or “to flow” and “let out”.  

The smooth flow of Liver Qi affects emotional state, digestion, and secretion of bile.

Every organ has a Qi flow direction.

  • Liver facilitates descending of Lung Qi
  • Liver facilitates ascending Spleen Qi
  • Liver facilitates descending Stomach Qi
  • Liver facilitates descending Intestine Qi

Common disorders and symptoms related to flow of Liver Qi:

  • Liver Qi Stagnation or Rebellious: belching, sour regurgitation, nausea or vomiting
  • Liver invading Spleen: obstructs the transformation and transportation process of Spleen, leading to diarrhea
  • Liver Qi stagnation: leading to bile obstruction – bitter taste in the mouth, belching or jaundice, inability to digest fats

Liver opens into the eyes and controls tears

Liver blood gives us the capacity to see. The Liver also controls the tears – both the basal tears (which lubricate the eye) and the reflex tears (which occur when there is a foreign body).

Although a number of other organ systems influence the eyes, the Liver has a very close relationship with them. 

Have you ever been so angry that you’ve seen red? This saying is a good way of remembering that when the Liver Qi becomes stagnant through unresolved anger, it can cause heat to rise.

Liver blood moistens and “brightens” the eyes. Liver blood deficiency can present as dry eyes, blurred vision, or both. If the Liver blood has heat it can present as red painful eyes. Prolonged stagnation can cause heat.

Common Patterns Associated with the Eyes

  • Liver blood deficiency: blurred vision, myopia, floaters, color blindness, eyes feel dry and gritty
  • Liver yang rising: may cause watery eyes
  • Liver blood stagnation: painful eyes
  • Liver fire: dry, bloodshot eyes (may also be red, swollen painful)
  • Liver wind: eyeball moving
  • Kidney essence deficiency: chronic eye disorders
  • Heart-fire: pain and redness of eye
  • Kidney yin deficiency: failing eyesight and dryness of eyes

From: The Foundations of Chinese Medicine, p. 123 [5]

Other organ systems that affect the eyes are the Heart, Kidney, Lung, Gallbladder, Bladder, and Small Intestines.

Spiritual aspects of internal organs

  • Ethereal Soul (Hun) – Liver, responsible for sleep, plans, projects, life aims, ‘coming and going of Shen’
  • Corporeal Soul (Po) – Lung, responsible for physiological activities, sensations, sight, hearing,smell, taste, ‘entering and exiting of Jing’
  • Intellect (Yi) – Spleen, responsible for thinking, memory, concentration
  • Will-power (Zhi) – Kidney, responsible for will-power, drive, determination
  • Mind (Shen) – Heart, responsible for consciousness, thinking, affections, memory, sleep

The Liver and Anger

Anger can be viewed in a broad sense and includes frustration, resentment, repressed/ unresolved anger and rage.

As with other organ systems the emotion can cause dysfunction and also can be the symptom of pathology. For example, anger causes Liver Qi stagnation which in turn causes a disruption of the smooth flow of Qi, which then causes more frustration. A common symptom of this is frequent sighing. 

The Liver and Gallbladder meridians

The Liver is considered to be the internal, yin organ system. It forms a pair with the Gallbladder, which is considered to be the external yang organ system.

The physiological liver is located on the right side beneath the diaphragm, and the gallbladder is located on the undersurface of the right hepatic lobe. 

The only function of the Gallbladder that is the same in both TCM and Western medicine is its ability of secreting and discharging bile. In TCM, that function relies on a surplus of Liver Qi being channeled into the Gallbladder, where it accumulates to form bile.

You can see this energetic relationship between the Liver (Liv) and Gallbladder (GB) in how the energy flows through the meridians or channels. Note the internal connection between the meridians, and how the GB meridian travels to meet the first point on the Liver meridian. For a more detailed description please read pp. 418-492 of A Manual of Acupuncture. [4]

Note: “cun” is a TCM form of measurement. One cun is equivalent with the width of the interphalangeal joint (the top part of your thumb). A cun is based on your client’s body measurement.

You can see by looking at the pathway channels how the Liver Channel affects the Stomach, Lungs, and eyes. You can also see why common Liver-related symptoms such as vertex headaches and frequent sighing happen.

The Liver Channel of Foot JueYin

Image with the kind permission of www.amanualofacupuncture.com
  • Originates on the lateral aspect of the dorsum (top) of the big toe at Liv 1
  • Runs along the foot to Liv 4, 1 cun anterior to the medial malleolus
  • It ascends up the medial (inside) aspect of the lower leg, and intersects with the Spleen channel at SP 6
  • It then continues to ascend anterior to the Spleen channel to an area 8 cun above the medial malleolus, where it crosses the Spleen channel and then continues posterior to the Spleen channel up to the knee and the medial aspect of the thigh
  • Continues to the pubic region via SP 12 and Sp 13 where it encircles the genitals
  • It then ascends to enter the lower abdomen and intersects with Ren 2 (Conception Vessel), Ren 3, and Ren 4 
  • It continues upwards to curve around the Stomach before entering the Liver and connecting with the Gallbladder
  • Crosses the diaphragm and spreads in the costal and hypochondriac region (hypo= below, chondriac = cartilage)
  • Ascends along the neck and the posterior aspect of the throat to the nasopharynx to link with the tissues surrounding the eye
  • Ascends across the forehead to the vertex where it intersects with Du 20 (Governing Vessel)

Branch

  • Descends from the eye system through the cheek and encircles the inner surface of the lips

Branch

  • Separates from the Liver, crosses the diaphragm and spreads in the Lung meeting with PC 1 (Pericardium 1)

From: A Manual of Acupuncture, pp. 469-470 (4)

The Gallbladder Channel Foot ShaoYang

Image with the kind permission of www.amanualofacupuncture.com
  • Begins near the outer canthus of the eye at GB 1 
  • Crosses to the anterior [portion of the ear at GB 2 then ascends to the upper border of the zygomatic arch at GB 3
  • Ascends to the corner of the forehead at GB 4 and descends via points GB 5, GB 6, Gb 7, to the region above the ear where it meets with SJ 22
  • Curves posteriorly behind the ear to the mastoid process at Gb 12, meeting with SJ 20 on the way.
  • Curves upwards across the side of the head to the corner of the forehead at ST 8 and descends to the supraorbital region at GB 14
  • Ascends and curves across the side of the head to GB 20 at the occiput (nape of neck)
  • Crosses the top of the shoulder via GB 21 and SJ 15 to meet with the spine at Du 14
  • Passes laterally via BL 11 to SI 12 then anteriorly to enter the supraclavicular fossa at ST 12

Branch

  • Emerges from behind the ear and enters the ear at SJ 17
  • Emerges in front of the ear and passes via SI 19 and ST 7 to the outer canthus
  • Descends to the corner of the jaw near ST 5
  • Crosses the SanJiao channel and rises to the infraorbital region and meets BL 1
  • Descends to the neck, passing near ST 6 and intersecting STt 9 to rejoin the main channel in the supraclavicular fossa
  • Descends into the chest meeting with the Pericardium (PC) channel at PC 1
  • Crosses the diaphragm, connects with the Liver and unites with the Gallbladder
  • Continues along the inside of the ribs to emerge in the inguinal region
  • Encircles the genitals, runs superficially along the margin of the pubic hair then enters deeply to emerge at the sacral region where it meets the Bladder channel at Baliao (the four points of the sacral foramina) and the Governing vessel at Du 1

Branch

  • Descends from the supraclavicular fossa to the anterior aspect of the axilla, then passes through GB 22,  GB 23, and GB 24
  • Intersects the Liver channel at Liv 13
  • Descends to the hip to meet the previous branch at GB 30 and continues down the lateral aspect of the thigh and knee
  • Descends along the lateral aspect of the lower leg to the anterior aspect of the lateral malleolus
  • Follows the dorsal surface of the foot along the groove between the fourth and fifth metatarsals to end on the lateral side of the tip of the fourth toe at GB 44

Branch

  • Separates on the foot at GB 41 and runs between the first and second metatarsal bones to the medial tip of the big toe then through the toenail links with the Liver channel

From: A Manual of Acupuncture, pp. 417-418 (4)

Additional information

References

  1. Kastner, J. (2004). Chinese Nutritional Therapy. Jeorg Thieme Verlag.
  2. Pitchford, P (2002). Healing with Whole Foods 3rd edition. Berkeley, CA: North Atlantic Books
  3. Hyunbae,K. (2007). Handbook of Oriental Medicine 3rd edition. Harmony & Balance Press.
  4. Deadman, P., Al-Khafaji, M., Baker. K. (2005). A Manual of Acupuncture. East Sussex: Journal of Chinese Medicine Publications
  5. Maciocia, G. Xin Ming, S. (2005). The Foundations of Chinese Medicine: A Comprehensive Text for Acupuncturists and Herbalists. London: Churchill Livingstone.
  6. Wiseman, N. [editor, translator], and Ellis, A. [translator] (1996). Fundamentals of Chinese Medicine. [Rev. ed] Brookline, MA: Paradigm Publications
Teri Calandra, Dipl.Acu, MSTOM, L.Ac., LMT, RMT

Teri began her studies in energy medicine as part of her own personal development journey, and continues to to learn and integrate that knowledge into her practice. Teri is the founding practitioner of Calandra Center for Health & Wellness in Schaumburg, Illinois. She is licensed by the State of Illinois in acupuncture (L.Ac.), and board certified through the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM).