We’re coming up on the halfway point of liver season and I promise I’ll start talking about something else with the next blog post. But understanding the elements of Classical Chinese medicine is crucial to recognizing patterns of imbalance in yourself.

That’s why this year my focus is on teaching you the foundations, so that you can bring seasonal living together with learning what your body needs, and what season your body is in. Because while we are part of the world, we are not always in synch with it.

This blog post is about imbalances in the liver system and what it looks like when our qi isn’t flowing optimally.

We're coming up on the halfway point of liver season and I promise I'll start talking about something else with the next blog post. But understanding the elements of Classical Chinese medicine is crucial to recognizing patterns of imbalance in yourself.

The information in this post is for general purposes only and does not constitute medical advice. This post does contain affiliate links. For more information please see my privacy policy.

Before we begin

I have a disclaimer on every blog post. You’ll see it at the bottom in italics and it basically says that everything I talk about on every blog post is for general purposes and does not constitute medical advice. This post has three. This one, one in the middle and the one at the end.


Because diagnosing yourself is hard. It’s easy to read yourself into every condition you learn about. There’s a common problem in medical schools where students start getting “sick” in their second year. They’re not actually sick, they’re just self-diagnosed.

So if any of these patterns resonate with you, find a licensed Chinese herbalist or acupuncturist to confirm, because chances are it’s more complicated than it seems.

Liver patterns

So, before we get into the nitty, gritty details of what liver disharmonies are, we need to differentiate patterns versus diseases.

A disease is a collection of specific signs and symptoms that are not due to a physical injury. Diseases are usually associated with a particular pathogen (like a bacteria or virus) or a pathological process, like cancer.

A pattern is a constellation of signs and symptoms that form the root for many possible diseases, which arise before the disease manifests and can predict likely outcomes. Patterns are broken down by category of function (organ system) or category of invasion (traditional pathogenic understanding).

Diseases and patterns form complete diagnoses together. Let’s say you contract the rhinovirus and come down with a cold. You have chills, clear runny mucus and you’re achy. You have a cold (disease) due to wind cold (pattern).

Because we’re dealing with an organ system here, we’ll only be talking about patterns by the liver’s category of function (which you can read more about here.) If you want to learn more about traditional pathogens I touched on it in this cold and flu recipe post. And if you want a quick refresher on Acupuncture terms, head on over to Acupuncture 101.

Liver Qi Stagnation

If you’ve been around this blog for awhile you’ve definitely heard me talk about liver qi stagnation. This is the most common pattern I see in clinic because this is the state of being of modern society. The best modern description of liver qi stagnation is “stress.”

But just like qi you can’t define a concept with a one to one conversion. Liver qi stagnation is a constellation of symptoms, remember? You don’t have to see all the stars to see the general shape.

Traditionally, liver qi stagnation looks like bloating or stretching feelings in the ribs and upper abdomen, sighing, depression, mood swings, malaise and melancholy, irritability, irregular periods, clotted menstrual blood that is dark or purple,mittleschmertz (ovulatory pain), and cramping.

This pattern is associated with tons of Western conditions, but the most notable ones are depression, generalized feelings of stress, infertility, delayed ovulation, PMS and emotional changes at ovulation, luteal phase defect, slow progesterone rise post-ovulation, IBS (C and D), morning sickness (called rebellious qi), feeling lumps in the throat (plum pit qi), muscle tension and pain, post date babies who aren’t engaging with the cerivx, a cervix that won’t dilate…. The list goes on and on.

But the biggest thing to note here is that stress impacts hormones. As you remember from the last blog post, the liver system is half the hormonal picture of Chinese medicine. The liver smooths the flow of everything in our body and when it can’t move freely, the hormones that run your body can’t do their job.

Liver Qi Stagnation with Heat

When there is enough friction from things rubbing together, the friction creates heat. When qi and blood are stagnant in the body for long enough they do the same.

Because the conditions are associated they have many of the same symptoms and often the only way to differentiate the two is for a practitioner to diagnose with the patient’s tongue and pulse. But there are some clues:

In addition to the symptoms above, the patient will have a red or warm face (especially when angry), emotional outbursts beyond irritability, and a slight difficulty in breathing that comes from holding your muscles so tightly your ribcage can’t expand.

Because this is pretty much the same pattern as liver qi stagnation but with more heat, it’s associated with the same sorts of Western medical conditions as above.

Is this all sounding familiar?

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Liver Fire

Finally, when enough heat is generate you create fire.

Liver fire is essentially uncontrolled liver qi stagnation.

This is the type of anger that erupts with a red face, ringing in the ears, tears, and headaches and dizziness. When this patient is not angry, they’re still constantly irritable, suffer from frequent headaches from all the muscle tension they carry in their neck and shoulders, suffer from constipation (the dry, hard type) and may have nosebleeds.

Blood stasis

Blood stasis isn’t, strictly speaking, a liver pattern but I tend in include it for the simple reason that qi moves the blood. When qi doesn’t move, blood doesn’t move. When blood doesn’t move, there is pain and hormones don’t circulate.

The main symptom of blood stasis is pain. But this isn’t the diffuse, generalized pain of liver qi stagnation. It is fixed, and it is excruciating. It is the pain of endometriosis, a PCOS patient’s cyst threatening to pop or on a more serious side, heart attack or cancer pain.

Most patients in my clinic have more minor forms of blood stasis, but that doesn’t mean it shouldn’t be taken seriously. Blood stasis is a sign that things need to be moved.

Pattern diagnoses are like maps. You can look at where you are and see the rough trajectory that you’re on and shift the route or, often, decide to go a different place all together. That’s the magic of preventative medicine. You get to take control of your health.

Common blood stasis patterns I see in my clinic tend to be associated with the Western conditions of acute injuries (bruises from a fall) or a chronic injury from a previous trauma (like a concussion leading to chronic headaches or joint issues.) But I also hear patients reporting fertility findings list a delay in endometrial lining growth or reporting periods with scant flow or heavy flow with pain.

I also see a lot of overlap with conditions due to the liver qi stagnation pattern: painful and/or delayed ovulation, slow BBT rise in the luteal phase, and painful menses

Pattern diagnoses are like maps. You can look at where you are and see the rough trajectory that you’re on and shift the route or, often, decide to go a different place all together. That’s the magic of preventative medicine. You get to take control of your health.

Liver Blood Deficiency

All the conditions above are what we call excess conditions. You can read more about excess versus deficiency here. But most of the time, things aren’t as simple as “this is excess” and “this is deficiency.”

Remember in the detox post a couple of weeks ago I talked about moving qi in deficient patients?

Think of it like a river in the low season – a little bit smelly, slow flowing and stagnant. Suddenly a huge storm rolls in and the torrent of rain swells the banks and it floods. Now it’s moving! But it’s also tearing away at the banks and changing the shape of the river.

Eventually, when the river recedes the water goes back to its stagnant levels but – uhoh, now the same amount of water spreads even thinner to fit the widened banks, moving even more slowly and creating more stagnancy.

This is what happens to a deficient patient when they strongly move qi

Why Your Pinterest Cleanse Won’t Work

Well, the most common cause of liver qi stagnation in women is liver blood deficiency.

The root cause

Every month, women who menstruate lose blood. If they aren’t compensating for that loss with a good diet and a health balance of rest and activity, their overall level of blood decreases. I’m not talking about anemia here (though if blood deficiency goes on long enough it can lead to anemia). We’re talking about the metaphorical, Chinese medicine blood.

If you remember from the last blog post blood is created by the digestive system (the spleen and stomach) and is transformed by the kidneys and lungs. While the heart controls where blood goes, the liver is responsible for storing it.

During the menstrual cycle and pregnancy, the liver sends blood to the uterus to build the endometrial lining. But if it doesn’t have enough blood to send, liver blood deficiency signs start to pop up.

Liver blood deficiency looks like insomnia, floaters in the eyes or blurred vision (like your eyes are tired), scanty menstruation or complete amenorrhea, muscle weakness or numbness (muscle tension without pain), muscle cramps, dry hair and skin, depression and a feeling of aimlessness.

In clinic we see this pattern associated with Western conditions like burnout, apathetic types of depression, hormonal imbalances that hint at developing into bigger problems like thyroid issues, early chronic fatigue syndrome, early adrenal fatigue syndrome, shortened menses indicated low endometrial proliferation, brown menstrual fluid instead of red, amenorrhea and infertility.

It’s important to treat liver blood deficiency when you start to see the signs because it can help prevent liver qi stagnation. But treating liver blood deficiency also helps delay the development of:

Fertility is a long and sometimes complicated journey. Acupuncture can help!
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Are you feeling resistant to the coming winter? Living seasonally helps you settle into the rhythm of the year and autumn helps you prepare for winter properly
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Liver Kidney Yin Deficiency

Age is inevitable. It’s a fact of life.

In women who menstruate, this means that menopause is inevitable. In Chinese medicine, we begin to see signs of perimenopause when our tiankui begins to diminish. If we’ve taken care of ourselves and supported our bodies throughout our lives the transition is an easy one.

Most modern women have lived lives that are immensely hard on their livers and kidneys, making the transition happen unnecessarily early or unnecessarily uncomfortable.

Liver blood deficiency is a warning sign. It’s telling you to take a break, eat better and manage your stress because you’re throwing off your hormones.’

When liver blood deficiency combines with kidney yin deficiency we begin to see more obvious hormonal imbalances. The symptoms of liver blood deficiency become even more pronounced, only now the insomnia is an inability to let go of the thoughts that are keeping us up at night and can be accompanied by night sweats or hot flashes.

Depression and aimlessness begins to accompany anxiety.

Changes to the menstrual cycle begin to directly impact fertility leading to a prolonged follicular phase, too high of a BBT in the first phase, and luteal phase defect. Eventually, menstruation may stop all together indicated a cessation of ovulation.

A liver kidney yin deficient pregnancy is prone to low back pain, anxiety, delayed cervical ripening and a prolonged and tiring labor because hormones can’t circulate appropriately.

And a liver kidney yin deficient postpartum period is rife with fatigue, lactation issues and postpartum depression and anxiety.

Age happens, but liver kidney yin deficiency doesn’t need to. If you start to see signs of blood or yin deficiency, treat it through acupuncture, herbs and diet changes. There’s no reason your transition from mother to wise woman does need to be smooth.

A special case of hormone disruption

There are two populations that I often think about with liver kidney yin deficiency but don’t often get mentioned: women who have never menstruated and men who used to. In other terms, transmen and transwomen who are choosing to undergo hormonal therapy.

Medically altering physiological hormone production is rough on your liver and kidneys. (Which is why suppressing ovulation with hormonal birth control is such an issue.)

Supporting yourself through hormonal changes is vital for longevity. Supplementation with diet therapy, exercises changes, acupuncture and very carefully chosen herbs (that don’t throw off your dosage) can make the transition easier.

The pattern that’s not a pattern

There is one pattern that I see in clinic all the time. Classically, it’s not technically a pattern. In fact, my foundations teacher would tear me a new one for talking about it. But my herb teacher is the one who taught it to me, and ever since he did he not only changed my prescriptions in clinic, but also, how I treat most liver conditions, especially in women.

He called it liver qi deficiency. Classically, the liver is the only organ that is only prone to excess qi and yang. But as you saw above, patterns are combined all the time: liver kidney yin deficiency, liver invading the spleen, etc.

Liver qi deficiency is quite simply liver blood deficiency combined with qi deficiency which is basically every stressed out, worn out, burned out patient on the planet. This patient is anxiety-ridden, easily frightened, prone to stomach upset when stressed, isn’t willing to try new things (because change is scary) and in general has deficient emotional issues (like sad depression) instead of excess ones (like irritable depression).

It’s important to know that this combination is incredibly common and can’t be treating with the normal liver moving treatments. This condition needs to be built up before it’s moved. Talk to a practitioner if this sounds like you.

It’s not as simple as it seems

Remember that this is all general information. While you may recognize some of your conditions in the following description no one is a “textbook” case of any pattern and most people have a few layered on top of each other.

The best way to take care of these patterns is to consult an acupuncturist or Chinese herbalist. If you’re in the Twin Cities area click the button below and schedule a free 15 minute phone consult. Otherwise, check out the NCCAOM Find a Practitioner directory to find a properly trained acupuncturist in your area.

Treating Liver and Wood Disharmony

The good news is that if you’ve been reading this blog for awhile, you already have a good idea about what you need to do to treat liver and wood disharmonies: you need to live your life as though it’s spring.

Most often where we are in life and health doesn’t match up with the world around us. While living seasonally can get us in tune, sometimes we have to accept where we’re at. If we can treat ourselves through lifestyle changes and bring ourselves closer to a balanced state, living seasonally with have a bigger impact on our overall well-being.

1. Change your diet

In general, follow the rules for eating seasonally in the spring. The only difference is when treating liver conditions in the fall and winter, supplement with warming vinegar based dressings, warm beverages and soups to balance out colder salads.

2. Cut back on qi moving beverages

Like I mentioned in the detox post, moving qi feels good but if you’re deficient you’ll be worse off than when you started. Cut back or eliminate qi moving beverages like caffeine and alcohol.

Don’t worry, it’s not forever.

3. No more detoxes or cleanses

Because livery people tend to be competitive and on edge, they are the most attracted to strict exercise regimens and detoxes or cleanses. This is probably the absolute worst thing for them for all the same reasons as outlined in the detox post.

4. Walk on the grass barefoot

There is no Classical Chinese association with this, it’s just that it’s a good thing for everyone to do.

5. Focus on exercises that emphasize increasing flexibility

Sometimes qi stagnation and liver problems become a feedback loops. Qi stagnates and causes tension, tension doesn’t allow qi to flow so qi continues to stagnate. This reduces blood flow, lowering the new qi coming to an area and before you know it you have a mess on your hands. This is the phenomenon of somatoemotional tension – muscle tension caused by emotions.

Focusing on flexibility soothes the liver by stretching the muscles and tendons (which it’s associated with) moves blood, which moves qi, interrupting the cycle of stagnation.

6. Forest bathing

I’m a fan of forest bathing for most conditions, but surrounding yourself with natural wood energy for wood conditions is one of the best things you can do.

7. Acupuncture and herbs

Acupuncture and herbs are the point in a health journey when I usually see someone, but it shouldn’t be the beginning of your journey. Everything else we’ve discussed is.

Changes to diet and lifestyle are the foundation of your health and can help prevent the need for a health care practitioner of any kind.

But I’m here to help, and to give you the specialized support you need. Sometimes, patterns are just too ingrained and you need a bit of oomph to your treatment. So if you read this post and thought it sounded like you schedule a free 15-minute phone consult.

Or if you’re ready to jump on board, click the button below to see me in clinic. I’d be happy to give you the chance to relax.

Want to work with me in person?

Resources and links

Acupuncture 101

Seasonal living for the spring

Why Your Pinterest Cleanse Won’t Work

Women’s Water

Disclaimer: I am an acupuncturist in the state of Minnesota, and the information falls within my scope of practice in my state. However, unless I have directed you here as your homework I am probably not your acupuncturist. The information in this post is for general purposes only and does not constitute medical advice. As always, check with your own acupuncturist or primary care provider before making any lifestyle changes. This post does not create a patient-practitioner relationship and I am not liable for any losses or damages resulting or relating to the content in this post.​​​

Jessica Gustafson is a licensed acupuncturist in St Paul, MN specializing in women's health and fertility. She loves working with patients through the Health Foundations Birth Center on Grand Avenue in St Paul as well as doing home visits in the Twin Cities area. Check out the services page for more information! ​ ​Follow Reverie Acupuncture on Facebook, Pinterest and Instagram for updates!

Jessica Gustafson is a licensed acupuncturist in St Paul, MN specializing in women’s health and fertility. She loves working with patients through the Health Foundations Birth Center on Grand Avenue in St Paul and doing home visits in the Twin Cities area. Check out the services page for more information!

​Follow Reverie Acupuncture on FacebookPinterest and Instagram for updates! Please follow and like Reverie Acupuncture!


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