Author | Ban Jin Fu Zi Feeds You Images | Zi Fei Yu Edited | Chun Feng Reviewed | Xiao YeRecently, I encountered a patient who said that last month she had a big argument with her son. After the argument, she felt a persistent distension and pain in her hypochondrium. Rubbing it could relieve the pain, but it would return after a while.Now her son has apologized, and they have reconciled, but her symptoms have not improved much; instead, they seem to have worsened. She not only experiences chest tightness but also has little appetite at mealtimes, feeling bloated after eating a little, accompanied by belching. Her son feels very guilty and is worried about his mother’s health, so he brought her in for treatment.Upon hearing this, I understood her condition well. I examined her tongue and pulse: her tongue was pale with a white coating, and her pulse was wiry, indicating a typical case of Liver Qi Stagnation. I treated her with a modified Chai Hu Shu Gan San (Bupleurum Powder to Spread the Liver), and within three days, her symptoms significantly reduced, and she was basically cured after a week.
Liver Qi Stagnation
Liver Qi Stagnation is actually quite easy to understand; almost everyone experiences it at some point. In layman’s terms, it means “being upset harms the body”—you can hurt yourself by getting too angry.Traditional Chinese Medicine (TCM) believes that the liver is responsible for the smooth flow of Qi and emotional regulation. If a person is emotionally distressed and cannot resolve their feelings, the flow of Liver Qi will be obstructed, much like traffic at a congested intersection where all vehicles are stuck, and the congestion only worsens.Over time, this will manifest as symptoms of distension and pain in the hypochondrium. Therefore, when people are angry, they often unconsciously sigh or place their hands on their hips; this is actually a way to relieve the congestion at that “intersection,” allowing some vehicles to pass. Once the action stops, the “traffic” becomes congested again, which explains why that mother felt relief from rubbing but experienced pain again when she stopped.Liver Qi Stagnation can also lead to symptoms related to the spleen and stomach. We often hear people say things like “I can’t eat because I’m upset” or “I’m too upset to eat”. This is because, according to the Five Elements theory, the liver belongs to wood, and the spleen belongs to earth; wood overcomes earth. Liver Qi Stagnation affects the spleen, which TCM refers to as “Liver Qi invading the Spleen,” a progression of Liver Qi Stagnation, primarily characterized by symptoms of hypochondrial distension and pain, along with stomach bloating, loss of appetite, and frequent sighing.
Chai Hu Shu Gan San
Chai Hu Shu Gan San is derived from the “Medical Essentials” and consists of Chai Hu (Bupleurum), Chen Pi (Dried Tangerine Peel), Chuan Xiong (Szechuan Lovage), Bai Shao (White Peony), Zhi Ke (Bitter Orange), Xiang Fu (Cyperus), and Zhi Gan Cao (Honey-Fried Licorice). It has the effects of spreading the liver, relieving depression, promoting Qi flow, and alleviating pain. It primarily treats Liver Qi Stagnation, clinically manifested as hypochondrial distension and pain, chest tightness, and frequent sighing. Emotional depression and a wiry pulse are also common.
Dosage and Administration
Chai Hu 12g, Chen Pi 12g, Chuan Xiong 10g, Bai Shao 10g, Zhi Ke 10g, Xiang Fu 10g, Zhi Gan Cao 6g, decoct in water for oral administration.
Chai Hu
Chai Hu is slightly cold in nature, bitter in taste, and enters the liver and gallbladder meridians. It has the effects of dispersing heat, soothing the liver, relieving depression, and uplifting Yang Qi. As you might guess, its primary role in this formula is to soothe the liver and relieve depression.When discussing Chai Hu, we must mention its dosage, as different dosages yield different effects. We have a saying: “Small doses uplift Yang, medium doses soothe the liver, and large doses dispel heat.” This means that when we need Chai Hu to uplift Yang Qi, a small dose is sufficient, such as 3-6g in the Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi); when we need it to soothe the liver and relieve depression, a medium dose is used, like in this formula, around 6-15g; and when we need Chai Hu to dispel heat, a large dose is required, as in the Da Chai Hu Tang (Major Bupleurum Decoction), where Chai Hu can be used in amounts over 30g.
Xiang Fu and Chuan Xiong
Xiang Fu is neutral in nature, with a spicy, slightly bitter, and slightly sweet taste, entering the liver, spleen, and San Jiao meridians. It has the effects of soothing the liver, relieving depression, regulating Qi, and alleviating pain. In this formula, it primarily assists Chai Hu in soothing the liver and relieving depression.Xiang Fu is praised by Li Shizhen as the “master of Qi disorders and the commander of gynecology,” so it appears in many Qi-regulating and menstrual-regulating formulas, such as the Yue Ju Wan (Escape Restraint Pill) and Ai Fu Nuan Gong Wan (Mugwort and Cyperus Warming the Palace Pill).Chuan Xiong is warm in nature, spicy in taste, and enters the liver, gallbladder, and pericardium meridians. It has the effects of invigorating blood, promoting Qi flow, dispelling wind, and alleviating pain. Together with Xiang Fu, it assists Chai Hu in regulating the stagnant Liver Qi. These three herbs act like diligent traffic police at a congested intersection, directing traffic. With their efforts, the traffic quickly returns to normal, and as the Qi flows smoothly, the symptoms of hypochondrial distension and chest tightness naturally disappear.
Chen Pi, Zhi Ke, and Bai Shao
Chen Pi is a familiar friend to many; nowadays, health enthusiasts often buy “Xin Hui Chen Pi” to brew tea for dampness removal and weight loss. However, dampness removal is just one of its functions; it also has the effect of regulating Qi.Chen Pi and Zhi Ke work together to assist the chief herb in regulating Qi and promoting flow. Interestingly, Chen Pi is warm in nature, spicy and bitter in taste, and primarily promotes upward movement, while Zhi Ke is slightly cold, sour, and bitter, primarily promoting downward movement. The combination of one herb promoting upward movement and the other promoting downward movement effectively regulates the ascending and descending of Qi in the body, ensuring that the “intersection” operates smoothly without congestion.
If we exclude Zhi Gan Cao, Bai Shao is the only tonic in this formula. It nourishes blood, regulates the liver, and softens the liver to alleviate pain, particularly effective for hypochondrial pain. Moreover, many Qi-regulating herbs are spicy, warm, and drying, which can easily damage Yin. Adding Bai Shao helps prevent excessive aggression.
Zhi Gan Cao
Zhi Gan Cao serves as a harmonizing herb, balancing the effects of the other herbs. Additionally, it pairs well with Bai Shao, harmonizing the sour and sweet, nourishing blood, softening the liver, and alleviating pain.
Application
Chai Hu Shu Gan San is a commonly used formula for soothing the liver and relieving depression, primarily treating Liver Qi Stagnation. Any clinical presentation characterized by hypochondrial distension and pain, wiry pulse, and symptoms related to emotional distress can be adjusted with this formula.If the patient also experiences dry mouth and irritability, we should be cautious of Liver Qi transforming into fire. This can be diagnosed through tongue and pulse examination; patients with Liver Qi transforming into fire often have a red tongue and a wiry pulse. In this case, we can add 10g of Shan Zhi Zi (Gardenia), 10g of Chuan Lian Zi (Toosendan), and 10g of Huang Qin (Scutellaria) to clear heat and drain fire.For instance, in the case of the patient mentioned at the beginning, who exhibited symptoms of Liver Qi invading the Spleen, we can add 10g of Jiao Mai Ya (Toasted Barley Sprout) and 10g of Tan Xiang (Sandalwood) to strengthen the spleen and stomach, treating both the liver and spleen.
Precautions
1. During medication, avoid spicy, stimulating, cold, and greasy foods.2. This formula contains aromatic and warm-drying herbs, which can easily deplete the body’s Qi and Yin; it should not be taken for extended periods.3. If hypochondrial pain is accompanied by dry mouth and a thin, rapid pulse indicating Liver Yin deficiency, it is advisable to combine it with blood-nourishing and Yin-replenishing herbs.
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The content of this article is for reference only. Non-professionals in TCM should not self-medicate.
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