Lesson 4: Zangfu Theory – Liver and Gallbladder

Posted on by

Liver . Gallbladder

General Information

In TCM the Liver is the most important organ for women, while the Kidney is the most important organ for men. Many women have Liver dysfunctions with endocrine/hormonal problems. When these endocrine/hormonal problems are in excess, treat the Liver; when deficient, treat the Kidney.

Location of the Liver
If you know anything at all about anatomy and physiology you know the anatomical liver is on the right side of the body, tucked up under the lower portion of the rib cage. In TCM this is still true of the physical organ, but the energy of the Liver system controls the left side of the body. This is why when you study pulse diagnosis you will find the Liver pulse on the left in the middle position.

Liver is considered to be part of the Middle Jiao anatomically, but it’s functions are said to be in the Lower Jiao. The Liver channel begins on the lateral side of the big toe.

A little confused? Location on the right, but expresses on the left; located in the Middle Jiao, but functions as part of the Lower Jiao. It gets clearer over time and with repetition. The dispersal of all of this Liver energy just emphasizes how important it is and how intertwined with the whole body function it is.

Liver Qi that doesn’t move like it is supposed to is said to be “stagnant.”

We don’t talk about the yin and yang of every organ all that often, but the Liver has strong Yin and Yang properties you will hear about frequently in Asian medicine.

Liver Yin
Yin and Blood are very closely associated. Yin is liquidy and substantial, much like blood. Liver Yin and Liver Blood are therefore the substance of Liver. This is Liver blood, the substance of Liver (remember that yin is substance while yang is function)

Liver Yang
Yang and Qi are very closely associated. Yang is light, active, and very non-physical, much like Qi. Liver Yang is the Qi of the Liver. Liver Yang is very light, very active, very warm, very moving in nature. It needs the Liver Yin to be equal to it’s active nature and to balance it or it floats upward like a hot air balloon. Liver Qi is this active function of the Liver and expresses in the Lower Jiao. Specifically, the Liver is expressed most obviously in the menstrual function, which is decidedly lower jiao.

Functions of the Liver
The Liver stores Blood
“Stores” blood? Yes. The Liver is said to store blood at night. There is a hint of this in biomedicine too. The Liver does have a strong effect on blood, converting blood sugar into glucagon. This function kicks in after midnight when there is less blood circulation to the extremeties and more to the trunk. So in effect, the Liver is kind of storing blood at night.

The Liver is one of the organs said to store blood in Chinese medicine. You will also discover that the Uterus and Chong Vessels do this too. Because Liver stores blood, it is able to regulate menstruation, regulate the bio-clock, and to house the Hun or Ethereal Soul, one of the portions of the soul in Chinese philosophy that continues on to the next life.

The Liver regulates Blood volume in relation to rest and activity
When you rest at night the blood goes to the Liver more than it does during the day. As a result, circulation is slower and your body gets cooler. In the morning as soon as your eyes open from sleep the Blood begins to circulate more actively again, warming the body and extremities because you need the added flow for full function.

The Qi of the body flows in a figure eight through the trunk and extremities. Think of this like a raceway. Race cars drive faster and have fewer accidents on the straightaways than on the curves. When the Qi of the body comes to the chest there is a curve at the top of the figure eight so the Qi naturally slows a little. When there is stuck or stagnant Qi this is exaccerbated so sometimes you will hear your patients sigh for no particular reason. This sigh helps the Qi around the curve. Something similar happens at the other end of the figure eight, but it happens in the lower jiao. There’s no sighing here to help, so the result is sometimes clots in the blood and menstrual problems.

The Liver regulates menstruation
The Liver controls the smooth graceful accumulation and circulation of Qi (also known as prana in some circles). When menstruation is not smooth, not regular, when there are strong signs of PMS, or when there is clotting, this indicates that the Liver is not moving the Qi smoothly. Depression, crying, quick anger, and irritability can indicate a that the flow Liver Qi is impeded or stuck. In TCM this is often referred to as “Liver Qi Stagnation.”

The Liver moistens and nourishes the eyes and the sinews
This is a flashback to the Five Element chart: Liver opens to the eyes and its’ associated tissues are the sinews (aka, the tendons and ligaments). A deficiency of Liver Blood often shows in the body as dryness which results from an inability to move moisture around the body. Symptoms might include dry or burning eyes, poor night vision, and tight tendons. Eye diseases in TCM are often the result of Liver dysfunction and treatment therefor focuses on the Liver.

Convulsions, tremors, and muscle cramps are all sinew conditions. These are all conditions of Wind, be that internal wind or external wind. Wind, again, is associated with the Liver and with wood in the Five Element chart. Wind moves, shakes the limbs of trees, is fast and unpredictable. Shaking and moving symptoms are always Wind related in TCM. It helps to think of our limbs as tree limbs. ☺

TCM BioClockThe Liver is in charge of the biorhythms
The Liver regulates the biorhythms of the body by controlling the circulation of Qi. Each organ gets around 2 hours during which it has more energy than the others then the energy peak shifts to the next meridian or organ system in the chain. Once the end of the full cycle is reached, the whole thing repeats for ever and ever amen — or until you die — whichever comes first. Energy switches from one channel the next every 2 hours or so.

You might notice a couple of ways in which old threads of wisdom are reflected in the bioclock to the left. If you’ve been told you should always eat breakfast, there’s are reason for that in the clock. If you eat breakfast between 7 and 9am, fabulous for you. This is your digestive peak, so your breakfast gets ground up effectively and is ready for the Spleen to absorb it during it’s high point, starting around 9am. Another example is the Lung and Large Intestine cycle. Many spiritual disciplines have a very early morning prayer or meditation practice that begins around 4am and often include breath work or prana meditations, so doing this work during the high cycle of the Lung makes sense. A number of health experts recommend getting up early as the cycle of elimination is at its’ peak between 5am and 7am. Meals should get smaller and easier to digest through the day because the energy peak of the Spleen and Stomach is receding further and further. Eating a heavy meal during the water cycles means it’s probably going to sit in your stomach longer than it would earlier in the day.

If you have a tendency to wake at night at a certain time, make note of the time period and take a peek at a chart of the various times associated with the channels. That can give you a clue as to what organ is causing you to awaken. For many people that magical wide awake time is between 2 and 3:30 in the morning, so the most likely culprit is the Liver. If the Liver energy is already excessive and 1-3am is the high point of its’ cycle, this could very well wake you up.

Bear in mind that the times shown are a guideline, not an absolute. Qi doesn’t own a watch, nor does it observe Daylight Savings Time. If you have a patient who says she wakes up at 4am and can’t go back to sleep, don’t automatically assume “Lung” because Liver is the more likely cause. Check out the other signs and symptoms your patients are displaying, as they all add up to a bigger picture. Never base a diagnosis on just one sign.

Liver ensures the smooth flow of Qi

Because Liver does this it can therefore govern emotion, digestion and the secretion of bile.

Liver governs the flow of Qi.
Every organ system in the body gets a dose of Qi which comes from that original source Qi. Spleen Qi rises upward, Stomach Qi descends, Lung Qi disperses up/out/down, Large Intestine Qi desends, and so on…..but all of these rely on the Liver Qi, which regulates their movements. Without healthy, balanced Liver Qi the Qi of the organs is not at it’s optimum.

Though Liver strongly affects emotions, not all emotional disorders are directly related to Liver. TCM is just not that cut and dried. You must take all factors into consideration before diagnosing a problem as Liver related even if it is emotional in nature. Mania, for example, is usually related to the Heart, sadness and grief to the Lungs, fear to the Kidneys. Don’t get sucked into believing that all emotions flow from the Liver! This is a common mistake many people new to TCM make.

Liver affects the emotional state
Emotional disorders, especially disorders related to temper and anger, depression, distress, irritability, PMS, and frustration are closely related to the Liver. When the Liver qi is obstructed or congested there is distress and anger, irritability and PMS.

Affects digestion
Spleen and Stomach control digestion. This is a Middle Jiao function. However, if Liver is congested because of worry, stress, anger or other factors, the digestion can be strongly impaired. Look at your Five Element chart. Wood (Liver) controls earth (Spleen/Stomach). Stuck or congested Liver Qi is an excessive condition. This excessive condition in the Wood element then overacts on the Earth element, causing abnormal digestive functions. This is often called Liver Overacting On Spleen in TCM patient charts. You might see this noted as Lv OA Sp.

Liver problems of this nature can cause the Spleen Qi to fail to ascend because it is being so strongly affected by the Liver. The result is usually loose stool or even diarrhea. Some people have this problem when they get really stressed out and this is why. Other possible manifestations of Liver overacting on the Spleen can be gas, bloating, of constipation. This usually happens when the Qi of the Spleen is so weak that it becomes insufficient to push the waste through the intestines. Biomedically this can be poor peristalsis resulting in very slow movement of the wastes through the colon. Digestive bacterial gasses will then build up causing the distention and bloating feeling and the gas.

Liver overacting on Spleen and/or StomachLiver can also overact on the Stomach. If the Stomach Qi fails to descend as a result of this interference this is called Stomach Qi rebellion. Rebellion of Stomach Qi can cause hiccups, vomiting, and food stagnation, all of which reflects a failure of the Stomach Qi to descend. Food stagnation is the uncomfortable condition of the food just sitting in the stomach organ and not moving through quickly enough. The term “focal distention” is sometimes coupled with this dysfunction. Focal distention is a full uncomfortable condition focused around the stomach. The stomach might even feel hard and distended, a little “food baby,” if you will.

If the Liver Qi Stagnation or congestion is overacting on both the Spleen and Stomach this is called Liver Overacting on Middle Jiao.

Liver affects secretion of bile
Biomedically speaking, the Liver produces bile which travels through the common bile duct to the Gallbladder, which then stores and concentrates it and releases it when needed into the small intestine to break down fatty foods. In TCM speak, when the Liver Qi is full it is transferred to the Gallbladder where the Qi is stored and transformed into bile.

Extra fun things to know about the Liver

Sinews, which are a tissue associated with the Liver and include tendons, ligaments, and other connective tissues are nourished by Liver Blood.

Fingernails and toenails are byproducts and offshoots of the sinews. When Liver blood is deficient the nails will be pale. They can also be un-nourished causing brittle nails or nails that split in layers. You can also see nail ridges which run either horizontally or vertically or both.

Liver opens to eyesLiver Qi goes to the eyes. If the eyes are dry or if there are floaters in the vision it indicates Liver dysfunction. Floaters are those little bits that people see in their field of vision when they are looking at a clear blue sky or a white wall. There’s nothing on the wall or in the sky, but rather are in the vision itself.

Ethereal soul (or Hun)
The Ethereal soul, which is one part of the soul “trinity” in Chinese ontological thought, is yang in nature and is rooted in the Liver when there is adequate Liver blood. The three parts of the Soul are rooted in the Blood because they have no substantive nature to unto themselves. These parts tend to be unsettled without adequate Blood to anchor to. The Shen, another component of the soul which is related to the Heart, is said to wander at night when there is insufficient Heart blood, causing anxious dreams, fitful sleep, difficulty going to sleep, etc. Liver Blood roots the Hun, the Ethereal soul. Inadequate Liver blood can also cause sleep problems for the same reason. Hun is also related to planning and putting plans into motion. If you have difficulty with this it could reflect a problem in this area.

The blood to soul connection is an old theme in horror tales and religious tales alike. Vampires feed on the blood and energy of humans, the Aztecs and other human sacrifice cultures spilled untold gallons of it for their deities, Christian mythology says Jesus had to shed his blood for the doomed souls of humanity, and so on. No matter your belief system or your vampire show watching habits, inadequate Blood causes the soul to be unrooted, disturbed and restless, whether it is affecting the Heart or the Liver.

Anger, distress, depression, frustration, and irritability are often related to a dysfunction of Liver.

Planning and execution
The Liver controls planning and acts as a “general.” If you have difficulty getting things done in your life or in self-motivation, there might be a Liver imbalance in your life.


Stores and secretes Bile
This is much like it’s biomedical function. The Liver creates bile then passes it to the Gallbladder through the common bile duct for storage and concentration. GallbladderThe Gallbladder releases it into the small intestine as needed to help digest dietary fats.

While the Gallbladder is one of the only two Yang organs that don’t directly deal with food (San Jiao is the other), it does have an impact on digestion. All Gallbladder problems involve digestive disorders. There is a very close relationship between the Small Intestine and the Gallbladder.

The Gallbladder controls Decisiveness
While the Liver controls planning, the Gallbladder controls your ability to be decisive. In Chinese culture, if you say someone has a “big gallbladder” you are saying that they are very brave, decisive and fast in decision making. The term for this is “Dan Da.” The opposite of this descriptive is “Dan Xiao” or “small gallbladder” meaning one is timid, fluctuates in his/her decisions and has trouble deciding.

Controls Sinews
Like Liver, Gallbladder controls sinews. Liver blood nourishes the sinews, but the Gallbladder provides Qi to the sinews to assure movement and agility. When you study the Gallbladder channel in your Energetics classes you will see that the channel has many points on it that can assist the smooth movement of sinews. You might also notice that where the Gallbladder channel flows down the leg it passes right down the fascia latte on the lateral side of the thigh as well as through may other fibrous fascia coverings of the body.

As a matter of fact, Gallbladder 34 is the control or convergent point for the sinews of the whole body. It’s on the lateral side of the lower leg not too far from Stomach 36 (some books say it is 1 cun posterior/lateral to ST 36).

Relationship between Liver and Gallbladder

Liver creates bile and sends it to the Gallbladder which stores, concentrates, and secretes bile. They are dependent upon each other, especially in their Qi-based relationship because Liver Qi drives the other types of Qi in the body. Together, the Liver and Gallbladder are responsible for the smooth flow of Qi. Tongue MapThey are also critical to one’s ability to get things done in life: Liver gives you the ability to plan while Gallbladder gives you the ability to be decisive and get busy.

All Gallbladder problems are treated through treating the Liver.

The sides of the tongue reflect the health or dysfunction of the Liver and Gallbladder….even if that tongue map looks like some kind of Rasta banner.

Works Cited

  • Source: Wu, Qianzhi. “Foundations of Chinese Medicine.” AOMA Graduate School of Integrative Medicine, Austin Texas. Fall 2007. Lecture Series.
  • Ni, Maoshing. The Yellow Emperor’s Classic of Medicine. Boston MA: Shambhala Publications, 1995. Print.
  • Beinfield, Harriet. Between Heaven and Earth. New York NY: Ballantine Books, 1991. Print.
  • Kaptchuk, Ted. The Web That Has No Weaver. New York NY: Congdon & Weed, 1983. Print.