The Functions of the Liver

1. The Functions of the Liver • ECM class 7

2. The Functions of the Liver • The Liver has many important functions among which are those of storing Blood and ensuring the smooth movement of Qi throughout the body. • It is also responsible for our capacity for recovering energy and it contributes to the body's resistance to exterior pathogenic factors.

3. The Liver is often compared to an army general because it is responsible for overall planning of the body's functions by ensuring the smooth flow and proper direction of Qi. • Because of this quality, the Liver is also said to be the origin of courage and resoluteness, if the organ is in a good state of health. • The Liver is also said to influence our capacity of planning our life.

4. The functions of the Liver are: • It stores Blood • It ensures the smooth flow of Qi • It controls the sinews • It manifests in the nails • It opens into the eyes • It houses the Ethereal Soul

5. 1 STORES BLOOD • The Liver is the most important organ for storing Blood and by so doing, it regulates the volume of Blood in the whole body at any one time. • The Liver function of storing of Blood has two aspects: • It regulates the Blood volume according to physical activity • It regulates menstruation.

6. a) The Liver regulates the volume of Blood in the body according to physical activity. • When the body is at rest Blood flows back to the Liver, when the body is active, Blood flows to the muscles. • This is a self-regulating process, co-ordinated with physical activity.

7. When Blood returns to the Liver with the body at rest, it contributes to restoring the persons's energy; when it flows to the muscles during exercise, it nourishes and moistens the muscles to enable them to perform during exercise. • The Liver's job of regulating Blood volume throughout the body has an important influence on a person's level of energy.

8. When the Blood flows to the appropriate places in the body at the appropriate times, it will nourish the necessary tissues, and therefore give us energy. • If this regulatory function is impaired, there will be lack of Blood and therefore nourishment where and when it is needed, and the person will become easily tired. • "Simple Questions" chapter 10: "When the Liver has enough Blood...the feet can walk, the hands can hold and the fingers can grasp".

9. b) The Liver’s Blood storing function has a marked influence on menstruation and is important in clinical practice. • If the Liver stores Blood normally, menstruation will be normal. • If Liver Blood is deficient, there will be amenorrhoea or oligomenorrhoea. • If Liver Blood is in excess or hot, there may be menorrhagia or metrorrhagia.

10. The Liver function of storing Blood is extremely important in women's physiology and pathology. • Many gynecological problems are due to malfunction of Liver Qi or Blood. If Liver-Qi is stagnant, this may lead to stagnation of Blood of the Liver causing painful periods with pre‐ menstrual tension and the menstrual blood will have dark clots.

11. The Liver storage of Blood also influences the Directing (Conception) (Ren Mai) and Penetrating Vessels (Chong Mai), the two extraordinary vessels which are closely related to the uterus. • Any malfunction of the Liver will induce an imbalance in these two vessels affecting menstruation.

12. The Blood of the Liver also moistens eyes and tendons. • If Liver-Blood is deficient, there will be blurred vision, muscle cramps and contraction of the tendons.

13. Finally, there is a relationship of reciprocal influence between Blood and Liver: if Blood is abnormal (deficient or hot), it may affect the Liver function. • If, on the other hand, the Liver function is abnormal, it may affect the quality of the Blood, causing certain kinds of skin diseases, such as eczema or psoriasis.

14. 2 ENSURES THE SMOOTH FLOW OF QI • This is the most important of all the Liver functions and it is central to nearly all Liver disharmonies. • The impairment of this function is one of the most common patterns seen in practice. • What does it mean that the Liver ensures the "smooth flow of Qi"?

15. The Chinese words for this function literally mean "to flow" and "to let out". • When Chinese books explain this function they use such terms as "disperse", "extend", "loosen", "relax", "circulate", "make smooth and free" and "stop extremes". • Thus the Liver ensures the smooth flow of Qi throughout the body, in all organs and in all directions.

16. every organ's Qi has a normal direction of flow: some organs' Qi flows downward (Lungs and Stomach), other's flows upwards (Spleen). • The normal direction of movement of Liver-Qi is upwards and outwards in all directions to ensure the smooth and unimpeded flow of Qi everywhere. • This explains the importance of this function, as it involves all parts of the body and can affect all organs.

17. There are three aspects to this function: • In relation to the emotional state • In relation to digestion • In relation to the secretion of bile.

18. a) The Liver function of ensuring the smooth flow of Qi has a deep influence on the emotional state. • If this function is normal, Qi flows normally and the emotional life is happy. • If this function is impaired, the circulation of Qi is obstructed, Qi becomes restrained giving rise to emotional frustration, depression or repressed anger, accompanied by such physical symptoms as hypochondriac pain, sensation of oppression in the chest, a feeling of "lump" in the throat or abdominal distension.

19. In women, it may give rise to pre-menstrual tension including depression, irritability and distension of the breasts. • This is a reciprocal relationship: a restrained Liver function will lead to emotional tension and frustration, and a tense emotional life characterized by frustration or repressed anger will impair the Liver function and lead to a breakdown of the smooth flow of Qi. • "Simple Questions" chapter 3: "Anger makes Qi rise and Blood stagnate in the chest".

20. b) In health, the Liver function of ensuring the smooth flow of Qi assists the Stomach and Spleen digestive function. • If Liver-Qi flows smoothly, the Stomach can ripen and rot food and the Spleen can extract Food-Qi.

21. In disease, if Liver‐ Qi becomes stagnant it may "invade" the Stomach preventing the downward movement of Stomach‐ Qi resulting in belching, sour regurgitation, nausea or vomiting. • If it invades the Spleen, it obstructs the transformation and transportation of food and prevents Spleen-Qi from flowing up-wards resulting in diarrhoea.

22. In 5-Element terms this corresponds to "Wood overacting on Earth". • This is a pathological aspect of what is normally a physiological function of Liver-Qi in aiding Stomach and Spleen. • The smooth flow of Liver-Qi is all important in ensuring a harmonious movement of Qi in the Middle Burner.

23. Since Stomach-Qi should go down and Spleen-Qi should go up, the Middle Burner is a crossing place of Qi moving in different directions and the Liver makes sure that the Qi of the Stomach and Spleen flow smoothly in the proper directions.

24. c) Finally, the Liver function of ensuring a smooth flow of Qi affects the flow of bile. • If Liver-Qi is stagnant, the flow of bile may be obstructed resulting in bitter taste, belching or jaundice.

25. 3 CONTROLS THE SINEWS • The state of the sinews affects our capacity for movement and physical activity. The contraction and relaxation of sinews ensures the movement of joints. • The sinews' capacity for contraction and relaxation depends on the nourishment and moistening of the Blood from the Liver. • "Simple Questions" ch 21: "The Qi of food enters the Stomach, the refined essence extracted from food goes to the Liver and the excess Qi from the Liver overflows into the sinews".

26. If Liver-Blood is abundant, the sinews will be moistened and nourished, ensuring smooth movement of joints and good muscle action. • If Liver‐ Blood is deficient, the sinews will lack moistening and nourishment which may cause contractions and spasms or impaired extension /flexion, numbness of limbs, muscle cramps, tremors, tetany or lack of strength of the limbs. • "Simple Questions" chapter 1: "When Liver-Qi declines, the sinews cannot move".

27. The Liver influence on the sinews has also another meaning, corresponding to certain neurological conditions from a Western medical perspective. • For example: infectious meningitis with a high fever causing convulsions, in TCM terms this is due to Heat stirring Liver-Wind. • The interior Wind of the Liver causes a contraction and tremor of the sinews which leads to convulsions.

28. 4 MANIFESTS IN THE NAILS • The nails are considered in Chinese Medicine as a "by-product" of the sinews, and, as such, they are under the influence of Liver-Blood. • If Liver‐ Blood is abundant the nails will be moist and healthy, if Liver-Blood is deficient, the nails will lack nourishment and become dark, indented, dry and cracked. • "Simple Questions" chapter 10: "The Liver controls the sinews and its flourishing condition manifests on the nails".

29. 5 OPENS INTO THE EYE • The eye is the sense organ connected to the Liver. • It is the nourishment and moistening of Liver-Blood that gives the eyes the capacity to see. • If Liver-Blood is abundant, the eyes will be normally moist and the vision will be good. • If Liver-Blood is deficient, there may be blurred vision, myopia, "floaters" in eyes, colour blindness or the eyes may feel dry and gritty.

30. If the Liver has Heat, the eyes may be bloodshot, and feel painful or burning. If the Liver has internal Wind, the eyeball may turn upwards and move involuntarily (nystagmus). • Aside from the Liver, many other Yin and Yang organs affect the eye, in particular the Heart, Kidney, Lungs, Gall-Bladder, Bladder and Small Intestine.

31. In particular, the Essence of the Kidneys nourishes the eyes, so that many chronic eye diseases are related to the decline of Kidney‐Essence. • The Heart is also closely related to the eye. "Spiritual Axis" chapter 80: "The eyes mirror the state of the Heart, which houses the Mind".

32. 6 HOUSES THE ETHEREAL SOUL • The Ethereal Soul, called Hun in Chinese, is the mental-spiritual aspect of the Liver. • The concept of Ethereal Soul is closely linked to the ancient Chinese belief in "spirits" and "demons". • According to these beliefs spirits and demons are spirit-like creatures who preserve a physical appearance and wander in the world of spirit. • Some are good and some are evil.

33. In the times prior to the Warring States Period (476-221 BC), such spirits were considered to be the main cause of disease. • Since the Warring State Period, naturalistic causes of disease (such as the weather) replaced this belief, which, however, has never really disappeared even to the present day.

34. The character for Hun contains the radical Gui which means "spirit" in the above sense, and the radical Yun for "cloud". • The combination of these two characters conveys the idea of the nature of the Ethereal Soul: it is like a "spirit" but it is Yang and ethereal in nature and essentially harmless, i.e. it is not one of the evil spirits (hence the presence of the "cloud" radical).

35. The character “Hun” 魂

36. The Ethereal Soul is thus Yang in nature (as opposed to the Corporeal Soul) and at death survives the body to flow back to a world of subtle, non-material energies. • A discussion of the nature of the Ethereal Soul is not complete without discussing the Corporeal Soul as the two are but two poles of the same phenomenon.

37. The Corporeal Soul represents a very physical aspect of the Soul, the part of the Soul which is indissolubly linked to the body. At death, it goes back to the Earth. • The Chinese concept of "soul" therefore includes both the Ethereal and Corporeal Souls.

38. The Ethereal Soul has not a great relevance in Chinese Medicine compared to the other four spiritual aspects (Corporeal Soul, Mind, Will Power and Thought). • The Ethereal Soul is said to influence the capacity of planning our life and find a sense of direction in life.

39. A lack of direction in life and mental confusion could be compared to the wandering of the Ethereal Soul alone in space and time. • Thus, if the Liver (in particular Liver-Blood) is flourishing, the Ethereal Soul is firmly rooted and can help us to plan our life with wisdom and vision.

40. If Liver-Blood is weak, the Ethereal Soul is not rooted and cannot give us a sense of direction in life. • If Liver-Blood or Liver-Yin is very weak, at times the Ethereal Soul may even leave the body temporarily at night during sleep or just before going to sleep.

41. Those who suffer from severe deficiency of Yin may experience a sensation as if they were floating in the few moments just before falling asleep: this is said to be due to the "floating" of the Ethereal Soul not rooted in Blood and Yin.

42. The Ethereal Soul is also related to resoluteness and a vague feeling of fear at night before falling asleep is also said to be due to a lack of rooting of the Ethereal Soul. • The "Discussion on Blood Diseases" says: "If Liver-Blood is deficient Fire agitates the Ethereal Soul resulting in nocturnal emissions with dreams". • This confirms that the Ethereal Soul can become unrooted at night when Blood or Yin are deficient.

43. DREAMS • "Simple Questions" chapter 17: "When the Liver is in excess, one dreams of being angry". • chapter 80: "When the Liver is deficient, one dreams of very fragrant mushrooms. • If the dream takes place in Spring, one dreams of lying under a tree without being able to get up". • "Spiritual Axis" chapter 43: "When the Liver is deficient one dreams of forests in the mountains".

44. "THE LIVER IS A RESOLUTE ORGAN" • Just as in disease Liver-Qi easily becomes stagnant and excessive and Liver Yang easily flares upwards causing irritability and anger, in health the same type of energy deriving from the Liver can give a person great creative drive and resoluteness. • For this reason, it is said in Chinese Medicine that a healthy Liver function can confer on a person resoluteness, an indomitable spirit and drive.

45. "THE LIVER INFLUENCES RISING AND GROWTH" • In health, Liver-Qi rises upwards and spreads in all directions to promote the smooth flow of Qi in all parts of the body. • "Growth" here should be intended in a symbolical sense as the Liver pertains to Wood and this particular quality is compared to the rising of sap promoting growth in a tree.

46. In disease, the rising movement of Liver-Qi can get out of control, resulting in a separation of Yin and Yang and the excessive rising of Liver-Yang or Liver-Fire. • This causes irritability, outbursts of anger, a red face, dizziness, tinnitus and headaches.

47. "THE LIVER CONTROLS PLANNING" • This idea is derived from chapter 8 of the "Simple Questions" already mentioned. • The Liver is said to impart to us the capacity to plan our life smoothly and wisely. In disease, a Liver disharmony can manifest with an inability to plan our life and a lack of direction.

48. "THE LIVER IS A REGULATING AND HARMONIZING ORGAN" • This is a loose translation of a difficult expression that literally means "The Liver is the Root of stopping extremes". • This expression was first used in chapter 9 of the "Simple Questions" where it says: "The Liver has a regulating function [lit. is the Root of stopping extremes], it houses the Ethereal Soul, manifests in the nails..."

49. This means that the Liver has an important regulating activity which is mostly derived from its function of storing Blood. • the Liver regulates the volume of Blood needed by the body according to physical activity. • During movement and exercise the Blood flows to the muscles and sinews and at rest, it flows back to the Liver.

50. "THE LIVER LOATHES WIND" • Windy weather often affects the Liver. • Thus the relationship between Liver and "Wind" concerns not only interior but also exterior Wind. • It is not infrequent to hear patients who suffer from a Liver disharmony complaining about headaches and stiffness of the neck appearing after a period of windy weather.