TCM Liver DiseaseTCM Liver Disease Liver PhysiologyLiver Physiology Liver PathologyLiver Pathology CasesCases

Roger M Clemmons, DVM, PhD, CVARoger M Clemmons, DVM, PhD, CVA

CDR, IRC, USPHSCDR, IRC, USPHS

Aso Prof Neurology & NeurosurgeryAso Prof Neurology & Neurosurgery

University of FloridaUniversity of Florida

rmc@neuro.vetmed.ufl.edu

http://neuro.vetmed.ufl.edu/chi-files/http://neuro.vetmed.ufl.edu/chi-files/

WoodWood

SoundSound shoutshout

EmotionEmotion angeranger

ClimateClimate windy-warmwindy-warm

SeasonSeason springspring

DirectionDirection easteast

OpeningOpening eyeseyes

Body PartBody Part ligamentsligaments

Zang/FuZang/Fu LIV/GBLIV/GB

TCM TCM LIVER LIVER PhysiologyPhysiology

Stores the BloodStores the Blood

Maintains the Smooth Maintains the Smooth Flow of Qi & BloodFlow of Qi & Blood

Controls the SinewsControls the Sinews

Opens in the EyesOpens in the Eyes

TCM TCM LIVER LIVER PhysiologyPhysiology

Stores the BloodStores the Blood Acts to regulate blood Acts to regulate blood

volumevolume Similar to WIM function of Similar to WIM function of

the liver (plus spleen the liver (plus spleen function)function)

Closely related to Closely related to tolerance to tirednesstolerance to tiredness

Measure of athletic Measure of athletic performanceperformance

TCM TCM LIVER LIVER PhysiologyPhysiology

Maintains the Smooth Maintains the Smooth Flow of Qi & BloodFlow of Qi & Blood Ensuring SP/ST digestive Ensuring SP/ST digestive

functionfunction Maintaining vital activities Maintaining vital activities

of the bodyof the body Maintaining smooth flow Maintaining smooth flow

of water-dampof water-damp

TCM TCM LIVER LIVER PhysiologyPhysiology

Controls the SinewsControls the Sinews Moistens and nourishes Moistens and nourishes

the tendons and the tendons and ligamentsligaments

Ensures smooth joint Ensures smooth joint movementsmovements

Depends upon Depends upon adequate LIV bloodadequate LIV blood

TCM TCM LIVER LIVER PhysiologyPhysiology

Opens in the EyesOpens in the Eyes

Meridian connectionMeridian connection LIV yin & blood LIV yin & blood

deficiency leads to deficiency leads to dry eyesdry eyes

LIV heat leads to red, LIV heat leads to red, swollen eyesswollen eyes

Liver PatternsLiver Patterns

TCM 24 Hour ClockTCM 24 Hour Clock

GB 11- 1AM

TH 9- 11 PM

PC 7- 9 PM

KID 5- 7 PM

BL 3- 5 PM SI 1- 3 PM

HT 11- 1 PM

SP 9- 11 AM

ST 7- 9 AM

LI 5- 7 AM

LU 3- 5 AMLIV 1- 3 AM

Liver PatternLiver Pattern

Liver Damp Heat

Liver Fire Blazing Upwards

Extreme Heat Generating Liver-Wind

Retention of Cold in the Liver Meridian

Liver Blood Deficiency

Liver Yin Deficiency

Internal Wind due to Liver Blood Def

Internal Wind due to Liver Yin Def

Excess

Deficiency

Liver Damp HeatLiver Damp Heat

JaundiceJaundice Scanty dark yellow urineScanty dark yellow urine Swollen, hot, itchy, painful vagina, scrotum or Swollen, hot, itchy, painful vagina, scrotum or

prostateprostate Tongue: Red or YellowTongue: Red or Yellow Pulse: Wiry and rapidPulse: Wiry and rapid

GB34, GB40-41, GB34, GB40-41, BL19, LI-11, SP-9BL19, LI-11, SP-9

Yin Chen Hao plusYin Chen Hao plus

Liver Fire Blazing Liver Fire Blazing UpwardsUpwards

EpistaxisEpistaxis Red, swollen, painful eyesRed, swollen, painful eyes Weak vision or Corneal opacityWeak vision or Corneal opacity Ocular dischargeOcular discharge Dry feces or constipationDry feces or constipation Thick, dark yellow urineThick, dark yellow urine Tongue: Red and dryTongue: Red and dry Pulse: Wiry and rapidPulse: Wiry and rapid

LIV-3, GB-34, GB-1, LIV-3, GB-34, GB-1, Tai Yang, ST-1, GB-Tai Yang, ST-1, GB-

3737Snake & Dragon Snake & Dragon

(Long Dan Xie Gan) (Long Dan Xie Gan)

Extreme Heat Extreme Heat Generating Liver-WindGenerating Liver-Wind

High feverHigh fever Rigidity of NeckRigidity of Neck Tremors or ConvulsionsTremors or Convulsions Opisthotonus or ComaOpisthotonus or Coma Running into walls or circlingRunning into walls or circling Tongue: RedTongue: Red Pulse: Wiry and rapidPulse: Wiry and rapid

GB-20, LIV-3, BL-17, GB-20, LIV-3, BL-17, SP-10, GB-41, GB-34, SP-10, GB-41, GB-34, GV-14, LI-4, hemo-12 GV-14, LI-4, hemo-12

Ting pointsTing pointsLing Yang Gou Teng Ling Yang Gou Teng

Retention of Cold in Retention of Cold in the Liver Meridianthe Liver Meridian

Hind limb stiffnessHind limb stiffness Cold ears and noseCold ears and nose Cold trunk and limbsCold trunk and limbs Swollen, cold scrotum and testesSwollen, cold scrotum and testes Swollen or painful prostateSwollen or painful prostate Infertility due to coldness in the uterusInfertility due to coldness in the uterus Tongue: Purple and wetTongue: Purple and wet Pulse: Deep and slowPulse: Deep and slow

Moxa LIV-3 / 8 / 14, Moxa LIV-3 / 8 / 14, LIV-1, LIV-3, GB-34LIV-1, LIV-3, GB-34

Hui XiangHui Xiang(Foeniculum powder)(Foeniculum powder)

Callie (3 yr F/S DLH)Callie (3 yr F/S DLH)

JaundiceJaundice AnorexiaAnorexia Dark yellow urineDark yellow urine Fever (103.5)Fever (103.5) Tongue: Red/YellowTongue: Red/Yellow Pulse: Wiry and rapidPulse: Wiry and rapid Dx: Liver Damp HeatDx: Liver Damp Heat

Callie TreatmentCallie Treatment

AcupunctureAcupuncture GB34, GB40-41, BL19, LI-4, LI-11, GB34, GB40-41, BL19, LI-4, LI-11,

SP-9, LIV-3, LIV-8SP-9, LIV-3, LIV-8

HerbalHerbal Yin Chen Hao plusYin Chen Hao plus

Liver Blood DeficiencyLiver Blood Deficiency

Dry or cracked paws or hoovesDry or cracked paws or hooves DandruffDandruff Lethargy and prefers to lie on groundLethargy and prefers to lie on ground Tongue: Pale and dryTongue: Pale and dry Pulse: Wiry and threadyPulse: Wiry and thready

BL-18, SP-10, BL-17, BL-18, SP-10, BL-17, SP-6SP-6

Si Wu TangSi Wu Tang

Liver Yin DeficiencyLiver Yin Deficiency

Red eyesRed eyes Tearing or watery eyesTearing or watery eyes Slightly swollen eyelidsSlightly swollen eyelids NebulaNebula Tongue: Red and dryTongue: Red and dry Pulse: Thready or wiry and rapidPulse: Thready or wiry and rapid

LIV-3, BL-18, BL-23, LIV-3, BL-18, BL-23, KID-3, SP-6KID-3, SP-6

Liu Wei Di Huang Liu Wei Di Huang Wan Wan

Internal Wind due to Internal Wind due to Liver Blood DefLiver Blood Def

Tremor or convulsionsTremor or convulsions DandruffDandruff Tongue: Pale and dryTongue: Pale and dry Pulse: Weak and threadyPulse: Weak and thready

BL-18, SP-10, BL-17, BL-18, SP-10, BL-17, SP-6, GB-20, GB-34, SP-6, GB-20, GB-34,

GV-21GV-21Tian Ma San Tian Ma San

Internal Wind due to Internal Wind due to Liver Yin DefLiver Yin Def

Liver Yang Rising WindLiver Yang Rising Wind Tremor or convulsionsTremor or convulsions Prolonged low feverProlonged low fever Night sweatingNight sweating Tongue: Red and Dry (no coating)Tongue: Red and Dry (no coating) Pulse: Weak and threadyPulse: Weak and thready

LIV-3, BL-18, BL-23, LIV-3, BL-18, BL-23, KID-3, SP-6, GB-20, KID-3, SP-6, GB-20,

GB-34, GV-21GB-34, GV-21Tian Ma plus Tian Ma plus

Bojangles (7 yr F/S Mix)Bojangles (7 yr F/S Mix)

LethargicLethargic Seeks cool, hard surfacesSeeks cool, hard surfaces Dry, brittle hairDry, brittle hair Mild intention tremorMild intention tremor Tongue: Pale and dryTongue: Pale and dry Pulse: deep, weak and Pulse: deep, weak and

thready particularly on leftthready particularly on left Dx: Liver Blood Deficiency Dx: Liver Blood Deficiency

with Internal Windwith Internal Wind

AcupunctureAcupuncture GB-20, LIV-3, SP-6, SP-10, BL-17, GB-20, LIV-3, SP-6, SP-10, BL-17,

BL-18BL-18

HerbalHerbal Si Wu WanSi Wu Wan Di Tan TangDi Tan Tang

Bojangle TreatmentBojangle Treatment

Bu Xue Zi Feng TangBu Xue Zi Feng Tang

Eye PatternEye Pattern

Liver Heat

Liver Stagnation

Liver & Kidney Yin Deficiency

Excess

Deficiency

Liver HeatLiver Heat

Conjunctivitis or keratitisConjunctivitis or keratitis Congestion of the conjunctival vesselsCongestion of the conjunctival vessels Red or swollen eyesRed or swollen eyes Clear to mucoid ocular dischargeClear to mucoid ocular discharge Tongue: RedTongue: Red Pulse: Wiry, rapid and surgingPulse: Wiry, rapid and surging

Fang Feng SanFang Feng San

Liver StagnationLiver Stagnation

Swollen eyelidsSwollen eyelids Ocular dischargeOcular discharge PhotophobiaPhotophobia MiosisMiosis Nebula (blue or grey) or corneal opacityNebula (blue or grey) or corneal opacity Tongue: Red or paleTongue: Red or pale Pulse: Surging & fast or Deep & weakPulse: Surging & fast or Deep & weak

Jue Ming SnaJue Ming SnaBo Yun San Bo Yun San (topically)(topically)

Liver & Kidney Yin Liver & Kidney Yin DeficiencyDeficiency

Atrophied pupilAtrophied pupil Scant, thick, mucoid discharge (at medial canthus)Scant, thick, mucoid discharge (at medial canthus) Corneal opacityCorneal opacity Yellow or grey scleraYellow or grey sclera Tongue: Red and dryTongue: Red and dry Pulse: Weak and threadyPulse: Weak and thready

Qi Ju Liu Wei Di Qi Ju Liu Wei Di Huang Wan Huang Wan

One For the Money (2 yr M QH)One For the Money (2 yr M QH)

Wood personalityWood personality Swollen, red, painful eyesSwollen, red, painful eyes Congested conjunctival Congested conjunctival

vesselsvessels Scant, clear dischargeScant, clear discharge Tongue: RedTongue: Red Pulse: Wiry, superficial and Pulse: Wiry, superficial and

fastfast Dx: Liver Heat (Liver Yang Dx: Liver Heat (Liver Yang

Rising)Rising)

One For the Money TreatmentOne For the Money Treatment

Acupuncture:Acupuncture: BL-2/1, LIV-1-3, GB-40, GB-44, LI-4, BL-2/1, LIV-1-3, GB-40, GB-44, LI-4,

GV-14, ST-44/45, SP-6GV-14, ST-44/45, SP-6

HerbalHerbal Fang Feng SanFang Feng San

Pogo (3 yr M Rottweiler)Pogo (3 yr M Rottweiler)

Thick mucus Thick mucus discharge from eyesdischarge from eyes

Corneal opacificationCorneal opacification KCSKCS Tongue: Red and dryTongue: Red and dry Pulse: Weak and Pulse: Weak and

thready (particularly thready (particularly on the right)on the right)

Dx: Liver & Kidney Dx: Liver & Kidney Yin DeficiencyYin Deficiency

Pogo TreatmentPogo Treatment

AcupunctureAcupuncture SP-6, SP-9, LI-4, LIV-3, KID-3, SP-6, SP-9, LI-4, LIV-3, KID-3,

BL-23, BL-2/1, GB-1, ST-1BL-23, BL-2/1, GB-1, ST-1

HerbalHerbal Qi Ju Liu Wei Di Huang Wan Qi Ju Liu Wei Di Huang Wan

TCM Liver DiseaseTCM Liver Disease

Don’t get angryDon’t get angry

Smooth and easy Smooth and easy gets it every timegets it every time