Emotions are a healthy and normal part of life – they are what make us human. But when they become extreme, repressed or unresolved, they have the potential to become pathological and open the door to illness. Emotions that do not have an avenue for expression or release can create disease and disharmony in the body that eventually manifest as physical symptoms and illness. It is when grief, fear, worry or anger overwhelm us and take over the mind that they also threaten our body, not unlike a viral infection or injury. That’s because our physical health cannot be divorced from our thoughts and emotions: every cell in the body is aware of – and reacts to – what we’re thinking and feeling. For centuries, Chinese medicine has understood that our emotional and mental health is inextricably linked with our physical well-being. This is the essence of mind-body medicine and explains why a migraine, stomach ulcer or shingles can develop after a particularly stressful event, such as the loss of a job, the end of a relationship, or the death of a loved one.
This wisdom is clearly stated in the Huang Di Nei Jing (The Inner Canon of the Yellow Emperor), a classic Chinese medical text written over 2,500 years ago: “Overindulgence in the five emotions — happiness, anger, sadness, worry and fear creates imbalance.” Disease can occur when we experience any of these feelings intensely, suddenly, or when we chronically hold onto an emotion for an extended period of time. In this way, emotions behave like internally-generated pathogens that have the ability to undermine our health and disrupt our internal organs. Joy, which refers to mania or agitation (rather than elation or happiness), can injure the heart, causing insomnia, poor memory and palpitations. Worry, over-thinking and obsessiveness can all weaken the spleen, resulting in fatigue, poor digestion, easy bruising or diarrhea. Long-term or unresolved grief and sadness deplete lung energy, leading to respiratory issues and compromised immune function. Chronic fear can impair the kidney, leading to urinary issues, as well as low back pain, weak knees and a diminished libido. Finally, anger and resentment – arguably, the most powerful and pervasive emotions – impact the liver and can cause headaches and migraines, dizziness, blurred vision, PMS and other symptoms.
Of course, we all experience anger at times – it’s a natural and unavoidable response to personal threats and attacks, injustice and disappointment. And the free-flowing, honest expression of frustration is crucial to maintain one's health. It is when anger is repressed, extreme or chronic, that it can become pathological. Indeed, research has found that the inability to express “healthy anger” (as well as other conventionally labeled "negative" emotions) creates fertile conditions for the development of illness.
Specifically, scientists have found that emotions such as frustration, stress and anger cause a spike in the hormone cortisol – which in turn, suppresses the immune system – making it hard to stay healthy. This strongly suggests that poor emotional health can weaken our immunity, making it more likely that a person will get sick with a cold, flu or other infection during emotionally difficult times. Moreover, research reveals that it can take as long as a year for individuals to recover a healthy immune system following the death of a spouse, while long-term caregivers (who bare a chronic burden of stress) suffer suppressed immunity compared with the general population. Likewise, studies among survivors of sexual abuse and PTSD show elevated levels of stress hormones and diminished immune function. For these individuals, as well as those experiencing profound loneliness, anger and other trauma, infections last longer and wounds take longer to heal.
Research published in the journal Genome Biology also suggests that feelings of bitterness related to disappointment and failure can disrupt endocrine function and damage our physical health over time. When we hold onto these feelings and the changes become chronic (due to a prolonged negative emotional state) it suppresses the immune system and increases our vulnerability to disease. Researchers have also found an elevated risk of inflammatory disease in individuals who experience chronically high levels of subjective social isolation and frustration.
In addition to highlighting the link between our emotions and the immune system, there is also a growing body of research that shows how anger is linked to long term heart damage. Research from Duke University Medical Center reveals that profound anger causes our bodies to release adrenaline and cortisol into the bloodstream – hormones that increase heart rate, blood pressure and sugar metabolism – raising the risk of a stroke or heart attack. Moreover, increased blood pressure caused by these anger-emitted hormones damages the lining of arteries, causing them to clog.
According to Chinese medicine, the liver is responsible for the smooth flow of our emotions, as well as our Qi (our vital energy) and blood. It is also the organ that is most affected anger, frustration and irritation. If you are often irritable, get angry easily, have trouble unwinding after a difficult day, or find it difficult to “go with the flow” and let things go, your liver energy is most likely blocked. Liver Qi stagnation is a common clinical diagnosis when a person’s Qi – and their emotions – are blocked and unable to flow freely. Over time, experiencing anger-associated emotions chronically, intensely or excessively can seriously impair the function of the liver.
Stagnant liver energy is responsible for a wide and varied array of physical symptoms, often along the path of the liver channel (or its partner, the gallbladder). This includes a feeling of distension in the chest, discomfort just below the ribcage, neck and shoulder tension. Tendon issues and muscle cramps can also arise when imbalances keep the liver from properly nourishing these areas of the body. People suffering with carpal tunnel or plantar fasciitis often have some degree of liver imbalance connected to these conditions. Because a branch of the liver channel ascends to the top of the head, vertex headaches are common among those with liver blockage. Finally, migraines almost always have a stagnant liver component that needs to be addressed.
Menstrual irregularities almost always have an element of liver imbalance due to the liver’s function of storing blood – irregular or painful periods, breast tenderness, fibroids and PMS are all common symptoms. Among men, liver imbalance can manifest as prostate inflammation.
Because of the liver’s regulatory effect on the Qi of the stomach and spleen, digestive complaints are also quite common among people suffering with liver Qi stagnation. Acid reflux, irritable bowel syndrome, nausea, abdominal distention, diarrhea and/or constipation can all arise from an out-of-balance liver that’s over-acting (or “insulting”) the stomach or spleen.
A weak or imbalanced liver can also lead to ocular malnutrition, causing dry eyes, blurry vision, myopathy, floaters and poor night vision. Because energy in the liver channel is predominant between the hours of 1:00am and 3:00 a.m. according to the Chinese medical theory, people with a liver imbalance will often habitually wake up during this time and not be able to fall back asleep.
Emotionally, the liver’s role in maintaining the smooth, unrestrained flow of Qi helps us adapt to life’s vicissitudes and roll with the punches. The more constrained liver Qi becomes, the more inflexible (literally and figuratively) we become in our bodies and spirit. Often, people with liver Qi imbalances also feel their lives have become stagnant: lacking a sense of direction, an inability to plan ahead, a weak vision of the future, and the sense that they’re not growing or moving forward in life.
We are also likely to feel frustrated, impatient and depressed – or suffer pronounced mood swings – when liver energy is stuck. Because the liver channel also flows to the throat, it can also feel as though we have a lump here, as if something – such as the words to express our anger or frustration – are stuck or trapped and can’t be said out loud. This phenomenon is referred to as “Plum-Pit Qi” in Chinese medicine and is attributed to liver Qi stagnation. The liver is the great “strategist” and is related to initiative, ambition, and desire. It provides the capacity to organize, helps us stay focused, and gives us a clear sense of direction. When its energy is weak, we can experience a lack of imagination, poor initiative, or an overall feeling of being stuck in our life.
People suffering with liver Qi stagnation will often sigh – reflecting an unconscious attempt to release the liver’s energetic blockage. You may notice, if you practice vinyasa yoga, that students will often audibly sigh after a particularly vigorous sequence of postures – an indication that the flow of their liver Qi is responding well to the flow of their body in class.
The liver is the largest gland in the body (and our second largest organ after the skin) and can be thought of the “general” that commands over 500 functions, including detoxification. Everything we eat and drink is filtered by the liver, including medications, toxins and drugs. The liver keeps us healthy by getting rid of what we don’t need. Our hormonal balance, cholesterol levels and weight are all dependent on a healthy liver.
The liver stores, preserves and regulates blood supply throughout the body – filtering over a liter of blood every minute. It is responsible for cleansing, nourishing, replenishing, and storing blood. It energizes the blood by releasing stored sugar, and recombines amino acids to create the protein our body needs to grow and repair tissue. The liver gives life and even has the remarkable ability to regenerate its own tissue.
Importantly, the liver is not just a place where chemical toxins are deposited – it is also the storehouse for toxic emotions, particularly suppressed anger, along with its good friends resentment, irritability, frustration, rage, indignation, animosity and bitterness. All of these emotions tend to gather in the liver and get stuck here. The health of our liver not only depends on how much we embrace life, but also how self-destructive we are. A healthy liver encourages enthusiasm, inner strength and resilience.
According to Chinese medical theory, the liver is the harmonizing organ in the body. When the “wood” energy that governs the liver is balanced – allowing us to grow, expand and spread out – it also helps us work harmoniously with other people. More than that, it helps us flow through life with equanimity and meet its challenges with grace and strength. The willow tree is a common metaphor used in Chinese medicine when talking about the liver. Willows have watery bark sap, which means that the tree has soft, pliant wood that remains flexible against the forces of nature. The roots of a willow are also remarkable for their size and strength that anchor the tree firmly to the earth. Bruce Lee captured the essence of healthy liver/wood energy when he said: “Notice that the stiffest tree is most easily cracked, while the bamboo or willow survives by bending with the wind.”
Chinese medicine seeks to regulate and re-balance the liver by “smoothing” or “coursing” Qi that has become stuck or blocked. Certain acupuncture points and herbal formulae are specifically designed to free up liver energy so it can flow like a river once again.
A classic acupuncture treatment for the stress, anger and frustration associated with liver Qi stagnation is known as the "Four Gates." These two acupuncture points – Taichong (Liver 3) on the dorsum of the foot and Hegu (Large Intestine 4) on the dorsum of the hand – are needled bilaterally on the right and left side of the body. Together, this point combination helps “open the gates” to allow Qi to flow freely, enhancing the circulation of energy throughout the body. Because of their ability to disperse stagnant energy, these points also have an analgesic effect as renewed Qi flow alleviates pain and promotes relaxation. Depending on the patient’s individual needs, this classic liver point prescription is supplemented with additional needles to address and rebalance the mind and body.
While there are dozens of herbal prescriptions in Chinese medicine designed to harmonize the liver and rebalance the flow of energy, two of the most prominent formulae are Xiao Yao San and Chai Hu Shu Gan San.
Xiao Yao San is perhaps the most popular, representative herbal formula that harmonizes wood and earth as it simultaneously moves liver Qi (wood energy) while also supplementing the spleen (earth energy). The name of the formula alludes to its action: “xiao” alludes to melting the signs of stasis, without harming the blood, (much like the sun melts ice without diminishing the essence of water), while “yao” relates to moving the Qi without dispersing it (like an oar stirs up ripples in the water without harming its basic nature).
Also called “Free and Easy Wanderer,” Xiao Yao San is named after the ancient, roaming Daoist priests who lived in peace and serenity. Specifically, its name is derived from a chapter title in a book of writings attributed to Zhuang Zi called “Rambling Without a Destination” whose stories focus on overcoming limited worldviews. More than perhaps any other formula in the entire Chinese herbal materia medcia, Xiao Yao San is credited being able to re-establish the happy going and free flowing nature of liver Qi, which in turn encourages an open minded, free and flexible approach to life (No wonder some jokingly refer to it as Chinese Prozac).
Alternately, Chai Hu Shu Gan San is considered the representative formula to treat conditions characterized by the binding depression of liver Qi. It contains multiple key pairings of herbs that form its core structure. For example, the pairing of Chai Hu and Bai Shao helps to provide a balance between supplementing and coursing: Bai Shao’s constraining, nourishing nature controls Chai Hu’s tendency to be too out-thrusting and drying. Likewise, pairing Chai Hu with Zhi Ke (or Zhi Shi) gives the formula a greater ability to systemically move Qi as Chai Hu moves Qi upward while Zhi Ke moves Qi downward. Pairing Bai Shao and Gan Cao is also important since together they relax tension and relieve pain. Chai Hu Shu Gan San is also famous because it illustrates the combination of Chai Hu with Xiang Fu, which have a mutually supportive action in terms of coursing liver Qi. Finally, Chuan Xiong is added to the formula because of it’s acrid nature and Qi-moving action. While many people overlook Chuan Xiong’s ability to move Qi because it is classified as a blood-moving medicinal, its Qi-moving ability is essential in this application.
Both Chai Hu Shu Gan San and Xiao Yao San are derivatives of the formula Si Ni San, one of Chinese medicine’s first formulae for regulating wood and earth, as well as a fundamental, base formula for treating binding depression of liver Qi. When supplementing medicinals are added to Si Ni San to bank up earth, the formula moves in the direction of Xiao Yao San allowing it to nourish the spleen (digestive function) and tonify blood. If one instead adds Xiang Fu and Chuan Xiong to strengthen the liver-coursing effect, the formula moves in the direction of Chai Hu Shu Gan San to provide a stronger Qi moving and pain relieving effect. Consequently, we can see that Xiao Yao San is more appropriate for a mixed pattern characterized by liver Qi constraint with blood deficiency, while Chai Hu Shu Gan San is more effective treating a purely excess condition of liver Qi stagnation.
According to Chinese medical theory, the liver is responsible for the smooth flow of Qi (energy) and blood throughout the body, and for smoothing our emotions. It is the organ most affected by stress – anger, irritability and depression are all signs that our Qi may be “stuck” and not flowing freely. If you’re under a great deal of stress and get angered or frustrated easily, then your liver needs support. Consult with your Doctor of Chinese Medicine to rebalance your energy, re-establish well-being, and love your liver.