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Home > Newsletters > February 2004 >

A Qin Bowei Anthology and Analysis of Liver Qi: A Book Review

By Monica Otto

Qin Bowei was one of the most respected physicians in China in the twentieth century. He was not only a clinician, but a writer and teacher as well. He wrote extensively about Chinese medicine and founded a number of TCM schools throughout China. He was a political activist when it came to the perpetuation of TCM during the Guomintang regime, a time when TCM was under scrutiny and repression. His teaching style was to conduct large-scale classes in which he would present case studies and then moderate discussions about them. His only apparent vice was that of smoking and even then, he used cigarette wrappers to write down his ideas. One of his masterpieces, Qian Zhai Yi Xue Jian Gao, was actually composed on hundreds of small pieces of cigarette wrappers!

Qin Bowei was fluent in articulating how to merge old world TCM into the framework of modern TCM. A Qin Bowei Anthology is a prime example of this style of writing. He takes the traditional view of liver disease and translates it into a way in which it can be directly applied to modern standards. This particular essay focuses on the differentiation between liver qi and liver depression, two of the most common disorders of not only TCM, but current times as well.

In the Anthology, Qin Bowei is especially concerned with making a precise distinction between the terminologies of these two disorders. Although these liver qi and liver depression were mentioned in English treatment manuals, the line that divides them is indistinguishable. He moves through a discussion of liver patterns with the expertise of someone who has devoted his life to understanding and teaching each pattern and disease. He defines it in such a way that you are left with a much broader range of treatment options and strategies, thereby increasing your opportunity for success. For example, intrinsic to liver qi is the presence of horizontal counter flow and hyperactivity of the liverís capacity for coursing and draining. Liver depression, on the other hand, is the failure of the liverís capacity to course and drain. Presenting symptoms may be similar; however, the pathodynamics are exactly opposite. If one fails to define the specific treatment method for each pattern and one lacks the terminology refinement required to make those distinctions, then the clinical outcome will most likely be less than favorable. Qin Bowei gives us the opportunity to make these distinctions and greatly improve our chances of success with our patients. And since "liver qi stagnation" is the most commonly diagnosed disease in today's world, it becomes a very important distinction for us as practitioners to make.

The concept of liver depression is characterized by a general inhibition of liver qi with symptoms of hypochondriac fullness and impaired digestion. There is too much liver qi  congested in the liver and it produces a malfunctioning of the liver qi. Depression describes flow stoppage associated with congestion or impairment of flow. There are six types of depressions: 1) Qi; 2) Damp; 3) Fire; 4) Phlegm; 5) Blood and 6) Food. Of these six, qi depression is the most relevant, as it underlies all others. When it is eliminated, all other forms will naturally disappear.

The concept of liver qi is characterized by horizontal counterflow with symptoms of hypochondriac pain and distention, including breast tenderness and swelling. Liver qi has counter flowed out of normal bounds and exudes undue influence on other organ symptoms.

Liver depression can produce liver qi but not vice versa. This is because a lack of circulation is inherent in liver depression. Liver depression may also produce heat while liver qi cannot. Liver qi and liver depression are related patterns yet definitely distinct. While both patterns may negatively effect digestion, liver qi is defined as the restraining of earth by an effulgence of wood; that is, excessive coursing and draining. Liver depression, on the other hand, is characterized by a failure of wood to restrain earth; that is an inability to course and drain. This has essential bearing on the diagnosis and therapy treatment. Both patterns require methods of coursing, draining and rectifying. Qin Bowei says liver depression typically requires more coursing and draining, while liver qi requires more emphasis on rectification.

Liver depression or wood not restraining earth is characterized by a depression of liver qi that is then incapable of coursing the spleen and stomach. Therapeutically, earth is often harmonized with damp transforming, stomach and spleen regulating herbs. When this is accomplished, the liver becomes regulated without further intervention. Chai Hu is the main herb used to course the liver, according to Qin Bowei.

Liver qi or wood over restraining earth is characterized by a depression of qi that has counter flowed horizontally, impairing the spleen and stomach. Treatment will focus on rectifying the liver but also coursing and draining while regulating the spleen and stomach. Bai Shao, Qing Pi and Xiang Fu are all indicated as important herbs to include in this type of disorder.

Today's society is overflowing with a number of different stressors, from to school to family to trauma. Stress plays an enormous role in liver functioning. The liver's normal function is impaired when this stress is made upon the body. More than ever, people allow stress to affect them in negative ways. That is precisely why Qin Bowei's ideas are imperative to treatment today. No other author prior to him has made the distinction between different liver disorders, yet each one deserves due respect. Treatment is not going to be as successful if we just treat everyone with typical liver qi stagnation. A differentiation must be made to treat our patients successfully.

Monica Otto is an intern at the Yo San University Clinic. (310) 577-3006.

 

This Month's Articles

February 2004
Volume 2, Number 2

Happy Chinese New Year of the Monkey

A Qin Bowei Anthology and Analysis of Liver Qi: A Book Review

Help for Women with Fibroids

Recent Research

Ask The Doctor

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