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Important Chinese Herbal Medicine Formulas: Liver Detox Formula

One of the most famous Liver Detox Formulas of Traditional Chinese Medicine is called by many names:

  • Long Dan Xie Gan Tang or

  • 龙胆泻肝汤 


  • LIVER DETOX FORMULA (you can click this link)

Chinese herbal medicine Organic herbs 2
Chinese herbal medicine Organic herbs 2

The Traditional Chinese Medicine formula “Long Dan Xie Gan Tang” is listed in the “Analytic Collection Of Medicine Formulas” (Yi Fang Ji Jie) by Dr. Wang Ang in 1682AD.   It has a proven track record for safe human consumption for the last 330 years!

Traditionally used for:

  • detox of  the liver  (from abuse of pharmaceuticals, alcohol, and recreational drugs, tobacco)
  • fatty liver
  • gallstones or other bile duct problems like inflammation
  • hepatitis, chronic or acute
  • vertigo or dizziness
  • tinnitus or ear ringing
  • high blood pressure
  • drug and alcohol abuse
  • vaginal or bladder infections
  • eye/ear infections
  • stubborn migraines and other headaches
  • chronic fatigue
  • obesity
  • emotional and digestive imbalances
  • smoking detox

The Traditional Liver Detox Formula contains the following ingredients:

Common Name (Chinese Pinyin Name), Latin Name

  • Gentian Root (Long Dan Cao) Gentiana manshurica
  • Scullcap Root (Huang Qin) Scutellaria baicalensis
  • Thorowax Root (Chai Hu) Bupleurum chinense
  • Angelica Root Tips (Dang Gui Wei) Angelica sinensis
  • Foxglove Root (Sheng Di Huang) Rehmannia glutinosa
  • Gardenia Fruit (Zhi Zi) Gardenia jasminoides
  • Water Plantain Root (Ze Xie) Alisma plantago-aquatica
  • Plantago Seed (Che Qian Zi) Plantago asiatica semen
  • Akebia Stem (Mu Tong) Akebia quinata
  • Licorice Root (Gan Cao) Glycyrrhiza glabra

sometimes added:

  • Oldenlandia Herb
  • Dandelion Herb
  • Prunella Herb
  • Pennywort Herb
  • Prepared Coptis Root
  • Buddleia Flower

Many modern formulas are based on this classic Traditional Chinese Medicine formula.  Here is a high quality Organic, chemical free version:

LIVER DETOX FORMULA  is a modification of the classic Chinese Medicine formula:


龙胆泻肝汤 –


They have added five very powerful detoxifying and healing herbs, especially important for the liver:

  • Oldenlandia Herb (Bai Hua She She Cao) Hedyotis diffusa or Oldenlandia diffusa
  • Dandelion Herb (Pu Gong Ying) Taraxacum officinale
  • Prunella or “Selfheal Spike” Herb (Xia Ku Cao) Prunella vulgaris
  • Pennywort or “Gotu Kola” Herb (Ji Xue Cao) Centella asiatica
  • Buddleia or Buddleja Flower (Mi Meng Hua) Buddleja oflicinalis

Please note there are NO Aristolochia species nor aristolochic acid or AA in this formula. Their “Mu Tong” is the species Akebia, which does NOT contain AA or aristolochic acid. Aristolochic acid is found in many inexpensive brands from China, and is a known nephrotoxin and carcinogen.

This formula drains “heat” and toxins from the Liver, Gallbladder, and Kidneys especially, but includes all the internal organs. These toxins come in the form of poor diet, alcohol, smoking, pesticides, pharmaceuticals, hormones, vaccinations, parasites, bacteria, viruses, pollution, or other impurities in food, water, and air.

Toxins may also be internally generated from improper digestion of food, overgrowth of bad intestinal flora (like Candida), or other internal imbalances of the organs (like blockage of the bile in the Liver and Gallbladder, commonly causing inflammation, or stones).

This formula can be used as a starting point in a general Detox protocol for most people, and is generally used until symptoms subside, and if symptoms are mild or not obvious, it is generally only used for a short period of time (less than a few months to a few days, depending on severity and constitution).

This is not a formula for long term use, as it can be excessively draining of the normal body fluids or “Yin”. However, the formula is designed with some Yin nourishing herbs to help protect from this, even with this short term (2-3 weeks) use (Angelica Root and Rehmannia Root both nourish the body fluids and “Yin”).



All the herbs have different functions in a proper and balanced Traditional Chinese Medicine Formula. Western herbal formulations, which tend to focus on treating symptoms, are usually a collection of herbs with similar functions, and can mildly alleviate symptoms short term, but are inadequate in treating the deeper causes of disease because they fail to recognize it! For this reason Chinese Medicine is a superior system of medicine because it understands and recognizes internal imbalances of the organs as the CAUSE of disease.

The following excerpt explains in technical Chinese medicine language the elegant sophistication of different groups of herbs working in concert to create deep equilibrium in the body:

Long Dan Cao is very bitter and cold. It is the principal or sovereign medicinal in this formula for both draining fire and eliminating dampness. It drains replete liver and gallbladder fire from the upper body, while it also precipitates and clears damp heat from the lower body.

Huang Qin and Zhi Zi are the ministers within this formula. They also have the functions of draining fire with bitterness and cold and are combined with Long Dan Cao for that purpose.

Ze Xie, Mu Tong, and Che Qian Zi clear heat and disinhibit dampness.

Therefore, they assist in eliminating damp heat via the urinary tract. The liver stores the blood and heat within the liver channel can easily damage yin and blood. Thus, when using bitter cold ingredients to dry dampness, to avoid drying and dehydrating the body, we add Sheng Di Huang and Dang Gui Wei as assistants to moisten and enrich yin and nourish the blood.

Gan Cao regulates and harmonizes all the other medicinals. Therefore, within this formula there is supplementation within drainage and enrichment within disinhibition. This assists the downbearing of fire and the clearing of heat and the separation of clear from damp turbidity. In other words, this formula can detoxify the body without damaging or draining it.

This cannot be said of most modern detox formulas, which merely combine purging and draining herbs which can damage digestion and deplete body fluids, even though they are intended to improve it.

That being said, this formula is also quite draining and detoxifying, but the harsh edge has been removed, and it has a more balanced, milder effect as far as drying or draining the body, but an even stronger effect in detoxifying it.

Basically, we have modified an existing well balanced formula and added stronger detoxifying herbs and greater quantities of moistening herbs to create a completely new detoxification formula which is strong in its detoxifying abilities, yet gentle and slightly nourishing at the same time. Of course, this formula is intended for short term use, meaning less than 2 months to 2 weeks at a time.

Then one should move on to a truly balanced long term formula for the liver, yin, and blood like the XIAO YAO SAN SERIES FORMULAS: including INSOMNIA FORMULA, DEPRESSION FORMULA, DIGESTION HARMONY FORMULA: or even deeper nourishment like HORMONAL HEALTH FORMULA. This formula can treat patterns in both the upper and lower body. This is one of its phenomenal and unique properties which shows the high degree of sophistication of understanding of the combining of natural medicinal substances.

The most common conditions which are treated by this formula and have been well documented in clinical use and modern research all over Asia, especially China: Hepatitis, including all viral forms Migraines, High Blood Pressure, Tinnitus (Ear Ringing), Vertigo or Dizziness are all treated successfully with “Long Dan Xie Gan Tang” when used as an acute formula to relieve the symptoms.

To properly treat the root of these diseases, one should use a Yin nourishing formula long term like “Tian Ma Gou Teng Yin Wan” HEADACHE AND DIZZINESS FORMULA or “Liu Wei Di Huang Wan” HORMONAL HEALTH FORMULA.


Do not use long-term, in large doses, or in cases of severe digestive weakness, severe fatigue, or after recovering from a serious illness like cancer, etc. without the supervision of a qualified Chinese medicine herbalist.

External Uses:

This formula can also be used EXTERNALLY for eczema, rashes, herpes, infections, cuts, bites, especially when there is redness and swelling.

Test to make sure there is no adverse reaction like more redness and swelling by using a small amount of this diluted “wash” on a small area of your skin which is not irritated. You can keep diluting until it is mild enough, or increase the concentration gradually so it is more effective.

If you can keep the area soaked for 15 minutes every 2 hours you will get the best therapeutic effect. For most external lesion type conditions you should also be taking the formula internally.


Headaches Part 11: Internal Dampness or Phlegm

VI. Internal Dampness or Phlegm

This is a common cause of headaches and is associated with a digestive deficiency which results in the accumulation of undigested food in the form of “dampness”, phlegm, or excess mucus in the body. It is often caused by the pattern of Qi Deficiency (page 22), and many symptoms overlap. It can be caused by overeating in general, and is usually associated with poor diet. The modern western diet of fast food, junk food, and generally processed food is a planetary plague contributing to many health problems and disease processes. Hydrogenated oil, refined sugars including high fructose corn syrup, and refined, bleached, and enriched white flour are found in most processed foods. These are often the source of dampness in modern westernized society. Some people are able to digest these food poisons, as I like to call them, and the dampness is not evident, until after years of eating these poisons, the digestion and immunity are weakened and eventually the accumulation of these poisons or toxins becomes apparent as obesity, fibromyalgia, digestive disorders such as Chron’s disease, diverticulitis, irritable bowel syndrome, and other modern digestive disorders. It can also result from eating too much raw or cold food, or just by consuming very rich, damp natured food like dairy, pork, duck and other fatty meats, eggs, nuts, shellfish, and others in excess proportions, or without other foods which promote digestion like warming aromatic herbs (ginger, cinnamon, onion, garlic, and others). While diet and digestion play key roles in the formation of this pattern, it can be aggravated by living in a damp climate (external dampness) as well.
In Chinese Medicine the emotional state of worrying, or over thinking, as it is often translated into English, can be the source or the symptom of this pattern of imbalance. Basically, the energetic resources of the body are allocated to mental processes instead of to digestion (transformation and transportation) of food. In other words, the act of worrying or excessive mental pressure consumes the Qi which should be used for digestion. In our modern culture of long working hours, followed by recreational activities of over-stimulation of the mind (think of watching television, computer activities, being bombarded by loud stimulating music, etc.), the mind never really gets a proper rest. The physical body is often pushed to exhaustion as well. The energy needed to sustain these human processes is becoming more and more difficult to extract from modern degraded food sources. All these factors combined lead to another hallmark pattern of our modern world, the accumulation of undigested or untransformed food in the form of “Internal Dampness”. Here are the symptoms related to this pattern:
1) The headache can be in the whole head, but is often located in the forehead. It is usually a dull ache (as opposed to a sharp headache from “Blood Stagnation” or throbbing headache from “Liver Yang Rising”). It is often described as a heavy sensation of the head, and the sense organs and thinking is often cloudy. It can manifest as a feeling of the head being “wrapped in a cloth” or “full of cotton”. Often the pain is worse in the mornings. The headache may be alleviated by inhaling strongly dispersing aromatic oils (like camphor, menthol, borneol) or by consuming herbs which disperse phlegm in the body (like cardamom, coriander, fennel, anise, and others).
2) This pattern is often associated with digestive problems, especially modern conditions like lactose or food intolerances, “food allergies” or the inability to digest dairy, wheat, nuts, and other damp forming foods. Symptoms include abdominal pain, especially above the umbilicus (belly button), loose or watery stools, fatigue or low energy in general, poor appetite (but could manifest as overeating or sweet cravings as well), a feeling of fullness or distention after eating, tiredness after eating.
3) There may be edema, swelling, or water retention in the body, or a generally overweight condition.
4) Nausea and/or vomiting of saliva or sputum
5) A feeling of fullness or pressure in the chest and upper abdomen (epigastric distention)
6) Sinusitis (inflammation of the sinuses of the nose), ear infections or blockage of the ear, and cloudy or fuzzy vision or thinking in general.
7) The classic tongue has a thick sticky tongue coating, and often the body of the tongue is large or swollen, with teeth marks visible ( small scallops on the side of the tongue caused from indentations of the teeth, due to edema of the tongue from improper circulation of water in the body)
8) The classic pulse is weak and floating, or soft, so it is easy to push down and feel no pulse at all, especially in the middle right position. If the dampness is strong, the pulse will feel rolling or slippery, as if a pearl or little ball was moving through the blood vessel, pushing up on the finger.

Headaches Part 10: Cold Stagnation (in the Liver)

V. Cold Stagnation (in the Liver)

This is an uncommon cause of headache, but if you fit the pattern, it is easy to identify. It is caused by a pathogenic internal cold in the Liver channel or meridian. It is often caused by being exposed to external cold, as in cold weather, and especially being submerged in cold water. It can affect people who swim in cold water, or those that have to work in conditions which repeatedly expose them to cold temperatures.
1) The headache is at the top of the head, or a vertex headache. This is the hallmark symptom of this pattern. This shouldn’t be confused with a headache that starts at the base of the head and goes up to the top. This pattern is isolated on top of the head. It is usually a dull pain and differs from a Liver Yang Rising headache which is sharper in quality and may also be on top of the head. It is often an intense headache, and sometimes alleviated by warming up the body or lying down, and generally aggravated by cold, internal or external.
2) There is generally a feeling of cold in the body.
3) There is a desire for constant sleep
4) There is a cold feeling, pain, or fullness in the abdomen. This pain is often radiating to the external genital organs, especially the scrotum or testes in men. The testicular pain is described as a “bearing down”, expanding, or bursting sensation, and often with swelling, coldness, or contraction of the scrotum. It should be alleviated by warmth and aggravated by cold.
5) Hernia, especially abdominal, including hiatal and inguinal hernias.
6) Vomiting is common in this pattern, and it is often after eating. It may only be retching or spitting up of saliva or mucus, especially after eating cold or raw food.
7) Contraction of the tendons, cramping, or spasm which is usually alleviated by warmth and aggravated by cold.
8) For women, this can manifest as painful menstruation (dysmenorrheal) or infertility, with a lowered basal body temperature, or a small change in basal body temperature in the two different phases of menstruation; similar to the symptom discussed earlier under the pattern of “Kidney Yang Deficiency”. To differentiate between this pattern and Kidney Yang Deficiency, you must decide whether there is an external source of cold which has gotten inside the body, like in this pattern, or just a metabolic weakness of creating heat internally, as in the Kidney Yang Deficiency pattern.
9) Infertility is often caused by this pattern.
10) Constant nasal drip can be caused from this pattern
11) The classic tongue is a pale or bluish-pale body, with a slippery, white coating
12) The classic pulse is deep and wiry, or slow.

Headaches Part 9: Blood Stagnation or Blood Stasis

IV. Blood Stagnation or Blood Stasis

This pattern often develops from the above “Qi Stagnation” pattern, but usually the key symptom is that the headache pain is fixed in one location, and usually, but not always, sharp like a knife, or at least very intense in nature (8 or more on a scale of 1 to 10). It can also be described as boring, like a hot poker or needle. These types of headaches are almost always chronic in nature, meaning they have been going on for a long time (months to more likely years), and often begin with symptoms in the category of Qi Stagnation, or overlap with it. Cluster headaches (extreme intensity, coming in “clusters” of time, and usually one sided) are often in this pattern, but can also evolve from Liver Yang Rising or Liver Fire. It can also develop from an old trauma or head injury, fall, or other accident, often that the person is no longer aware of.
1) Headache pain can be anywhere in the head, and is often described as a knife or a nail being driven into the head, intense and severe in nature, almost always occurring in the same spot. The headache is chronic, or lasting months or years. The hallmark symptom is that the pain is fixed in location.
2) Pain tends to be worse at night or with little activity, like sitting all day, and better with movement, mild exercise like walking, or any activity that makes the blood circulate.
3) For women, their periods are often very painful and the menses has clots, or is dark, dark red, or purplish in color. The pain tends to subside after the clots have passed or the period is nearing the end.
4) If the blood stagnation is in the whole body, there may be fixed sharp pain in other locations, especially the abdomen and chest.
5) Varicose veins, or the appearance of small purple vessels on the surface of the skin anywhere on the body.
6) Purpura, petechia or other purple or dark red blotches on the skin.
7) Purple or darker than normal lips.
8) An abnormally dark or dull complexion
9) Purple nails or nail bed
10) Abdominal or other masses in the body that do not move, they tend to be in a fixed location.
11) A general aversion to pressure or massage of a painful area, including the head, neck, or abdomen.
12) Disorders of the blood, especially coagulation disorders including Vitamin K deficiency, idiopathic thrombocytopenic purpura, claudication of the legs, especially the vascular type, atherosclerosis, peripheral vascular disease, disseminated intravascular coagulation, hemostasis, and others.
13) A purple or purple hued tongue. The blood vessels under the tongue are often enlarged and dark blue or purple in color. There may be only a small dark, red, or purple spot on the tongue, especially the tip of the tongue.
14) The classic pulse is tense or tight, choppy, and generally feels constrained.

Headaches Part 8: Qi Stagnation, also known as “Liver Qi Stagnation”, “Qi Stasis”, or “Blockage of Qi”.

III. Qi Stagnation, also known as “Liver Qi Stagnation”, “Qi Stasis”, or “Blockage of Qi”.

This is the basic pattern of blockage of energy flow in the body, and if untreated, can lead to more severe patterns, commonly Blood Stagnation. The main difference between Qi Stagnation and Blood Stagnation is that in Qi Stagnation the pain is often moving around in the body, or the headache is moving locations in the head, and the pain can be strong, but it is not fixed in one location or sharp like a knife, as in Blood Stagnation.
1) The primary symptom of this pattern is emotional imbalance. It can manifest similarly to symptoms 12 and 13 under the first pattern described as “Liver Yang Rising” or “Liver Fire” (anger, rage, violence, etc.) but is usually milder in nature. It more commonly manifests as mental irritation, impatience, maybe mild temper tantrums, depression swinging to pent up anger, anxiety, self-doubts, crying, stress and nervous tension in general.
2) The headache often occurs in the forehead or temples, and can change sides or location in general. It is usually fairly intense, but not necessarily throbbing like a “Liver Yang Rising” pattern headache. Pain which changes locations in the head or body in general is the hallmark symptom of this pattern.
3) Digestive problems which includes poor digestion, belching (eructation), gas or flatulence, small clumpy stools, obstruction of bowel movements or feeling of incomplete bowel movements, abdominal pain or distention, a feeling of a foreign body or a lump stuck in the throat or esophagus (globus hystericus), or vomiting.
4) General fatigue or tiredness
5) Pain, discomfort, tightness, distention, pressure, pulling or moving pain in the side of the chest, ribcage, lower flanks (hypochondrial) or lower abdominal area. A sensation of “stuffiness” in the chest/abdomen.
6) Frequent sighing
7) Cold hands and feet, or poor circulation in general.
8) Goiter or a swelling of the thyroid gland in the neck
9) Blurred vision or dry and distended eyes.
10) Constipation with stools shaped like pebbles but not dry, commonly with a desire to go to the bathroom, but difficulty in doing so.
11) This headache is usually aggravated by emotional states, especially anger, resentment, frustration, or feeling “stuck” mentally; inactivity or sitting at a desk all day; any repressed states, physical or emotional; cold climate or cold natured food. It is usually alleviated by relaxation or resolution of repressed states, movement and activity, and warming and circulating foods (like aromatic herbs) and/or climates (like mild warmth and wind). It is often better after sex or smoking a cigarette (no joke, this is often reported by patients) as both circulate the Qi, although I do not advocate the latter.
12) For women this often shows up as PMS moodiness, over-sensitivity, and irritability in general; often includes distention, pain, lumps, or sensitivity of the breasts; menstrual pain (dysmenorrhea) which gets better at the onset of menstrual flow; blood clots or dark purple blood in the menses; and irregular or short menstrual cycles. This pattern untreated often leads to PCOD (polycystic ovarian disease), ovarian cysts, endometriosis, uterine fibroids, and infertility
13) The classic tongue is more red than normal, especially on the sides of the tongue, and has a thin, often slightly yellow, coating.
14) The classic pulse is called wiry, which is rather forceful or excess, feeling like a wire or thick guitar string pushing up on the finger (not smooth, but constrained)

This pattern often leads to other patterns including “Blood Stagnation” and “Turbid Phlegm” and less often to “Cold Stagnation in the Liver” and “Turbid Phlegm with Wind”. These pattern symptoms are described below. You may have multiple symptoms of “Liver Qi Stagnation” and also a few of the symptoms of another pattern below. A few symptoms in a group may show a mild tendency or affliction of another pattern. Remember it is the predominant pattern which you are trying to identify (i.e. you have many symptoms in one category).

Headaches Part 7, Yang Deficiency, also known as “Kidney Yang Deficiency”

C. Yang Deficiency, also known as “Kidney Yang Deficiency”

This pattern usually includes the above symptoms of Yin Deficiency with some added symptoms unique to “Kidney Yang Deficiency”. For simplification we will call this pattern Yang Deficiency. If Kidney Yang is deficient for a long period of time, it can lead to Kidney Yin Deficiency, in which case one may see many of the symptoms under Yang Deficiency, and only several of the above Yin Deficiency symptoms, commonly night sweats or lower back pain. Likewise, if Yin deficiency is lasting a long time it can lead to Yang Deficiency, in which case most of the symptoms would be under the pattern of Yin Deficiency, with only a few under Yang Deficiency. Yin and Yang Deficiency can show as having symptoms of both patterns. It can be predominantly one pattern or the other, but includes both. For instance you could have night sweats, lower back pain, urination at night (Yin Deficiency) and cold limbs with severe fatigue (Yang Deficiency). This is very common. Most likely one pattern will predominate, and the tongue and pulse usually show the dominant pattern.
Kidney Yang Deficiency is mainly a constitutional problem these days, meaning it is mostly part of your genetic makeup inherited from your parents. It is often present in the elderly, or again, from chronic disease or sexual overindulgence. The decline of Yin and Yang is a normal part of aging, but symptoms can be treated at any stage, thus preventing further decline leading to illness. Many of these symptoms overlap with the pattern of Qi Deficiency, since the pattern of Yang Deficiency usually evolves from the pattern of Qi Deficiency.
A pure Yang Deficiency pattern is rare these days. It was more prevalent when people had real deficiencies, like lack of food or firewood/fuel to warm them. Also the problems of cold climate are not as common today as we live in heated houses with unlimited sources of heat. If you didn’t have food or fuel, or exposed yourself to extreme conditions like mountaineering in cold conditions, you could present with pure Yang Deficiency. Most commonly today we see a combination of Yin and Yang Deficiency.

1) The headache can present as any of the patterns already listed, and also have some of the symptoms below.
2) Frequent or pale urination, low output of urine (oliguria)
3) An aversion to cold, feeling cold, cold limbs (not just the hand or foot, but the forearm and/or calve as well), difficulty warming up the body
4) Lassitude or lack of energy or vitality, severe fatigue, exhaustion, especially in the morning.
5) Loose stools, or diarrhea, especially early in the morning.
6) Constipation can also manifest in this pattern, although more rare, and especially if there is difficulty in going to the toilet, and exhaustion and sweating after going. The stools are usually NOT dry.
7) Lower back/ knee weakness and/or feeling of cold or coolness of the skin
8) Edema, swelling, or water retention in the body, usually more pronounced in the lower limbs.
9) Upper body distress or a feeling of heat and restlessness, especially in the head
10) A lack of will power, or spirit of initiative.
11) The headache is aggravated or caused by eating lots of cold (both energetically, like cucumber or oyster, and physically like ice cream) and/or raw foods or drinking cold drinks over a prolonged period of time, being exposed to cold weather or living in a cold climate, or by exhausting the mental or physical energy. It may be alleviated by warm or hot foods (both energetically, like spicy, or physically hot, like soup), being in a warm environment, or application of heat to the body, and by rest or recovery from exhaustion.
12) For males: impotence, or spermatorrhea (excessive or involuntary ejaculation), for both male and female, a generally low or no sex drive.
13) For females: infertility and cold in the uterus, clear vaginal discharge, no ovulation, little or scanty menses, or amenorrhea (no menses), usually manifesting as severe hormonal imbalances, many women are already on HRT (hormone replacement therapy); often a luteal phase defect; ovulation occurs but there is little rise in basal body temperature (less than 2/10 of a degree).
14) Low basal body temperature would be a hallmark symptom of Yang Deficiency for male or female.
15) Diseases or weakness of the bone or marrow, like cancer of the marrow, including leukemia, myeloma, and pancytopenia; especially conditions where the western treatment involves a bone marrow transplant.
16) Very weak teeth, especially from birth or a young age.
17) Developmental or growth problems, especially in childhood, and those involving growth hormones or the immune system, like cretinism or congenital hypothyroidism, PIDD (primary immune deficiency disease), or SCID (severe combined immunodeficiency) or the bubble boy syndrome. Also neuro-developmental conditions like autism, cerebral palsy, and Down’s syndrome are worth mentioning here. These conditions usually have a Yin Deficiency component as well, but are often a combination of Yin and Yang Deficiency acquired from the parents.
18) The classic tongue is pale and swollen, with a white coating, so a generally pale color of the body is the key symptom.
19) The classic pulse is deep and threadlike, so one has to press deeply to feel it, and it feels weak, like a thread pushing up on the finger. In severe conditions the pulse can be downright feeble or hard to find.

Most of you will have found the patterns causing your headaches from above. The diagnosis will be either one of the excess patterns of Liver Yang Rising or Liver Fire, and caused from one of the three deficiency patterns of Blood, Yin, or Yin and Yang (for example, the patterns of Liver Yang Rising from Blood Deficiency is the most common). Or you could fall under only the deficiency patterns, without symptoms from the excess patterns above, but this is less common (an example would be headache from Blood Deficiency).
You may also have symptoms falling under multiple pattern categories. For instance it is common to see “Liver Yang Rising” from “Yin Deficiency”, AND “Liver Qi Stagnation”. You must remember that is important to figure out which patterns are predominant and which patterns are minor. Maybe 1 or 2 or even 3 symptoms in a category shows a mild involvement of a pattern, while 4 or more symptoms shows a stronger or predominant pattern. Maybe a key or hallmark symptom of a pattern shows a strong involvement of that pattern, its not just about the numbers. Be sure to read through all the patterns presented in this series.

Headaches Part 6: Yin Deficiency

B. Yin Deficiency, or more specifically “Liver Yin Deficiency” and “Liver and Kidney Yin Deficiency”

Other patterns which can lead to “Liver Yang Rising” or “Liver Fire” are called “Liver Yin Deficiency” or “Liver and Kidney Yin Deficiency”. For practical purposes, we will consider these patterns as the same, since the symptoms overlap tremendously. This is basically the major Yin Deficiency pattern, as the Liver and Kidneys are the deeper source of other Yin Deficiency patterns. One could also have a Yin Deficiency of the Lung, Heart, Spleen and Stomach as well, but these are not as applicable to the diagnosis of headaches and therefore not elaborated upon in this document. For the sake of simplification, we will call this pattern “Yin Deficiency” with the understanding that it is of the Liver and/or Kidneys. The possible causes of “Yin Deficiency” include chronic emotional frustration or depression, especially when combined with longstanding anti-depressant medications, which are considered a “Fire which consumes the Water” or Yin in the body; chronic heat or fire diseases, especially of the liver, like hepatitis, cirrhosis, or liver cancer; alcoholism; drug addictions; longstanding fevers or infections; excessive sexual activity (this is a relative idea, and warrants its own discussion, but use your common sense). The cause of Yin Deficiency can also be inherited from the genetics of your parents. If they were Yin Deficient, chances are you will express it as well at some point in your life. If your mother was weak or Yin Deficient at the time of conceiving or carrying you, you may be Yin Deficient. It is also a normal part of aging, but in Chinese Medicine you can do many things to preserve or improve the Yin. Severe, usually inherited Yin Deficiency is called Kidney Essence Deficiency, which can manifest as severe developmental diseases like mental retardation or Down’s syndrome, or the inability to conceive a baby (infertility). Severe drug addiction or any long term disease can also consume the Kidney Essence, or create severe Yin Deficiency.
Any serious chronic disease like cancer, AIDS/HIV heart disease, or autoimmune diseases in general will consume the Yin over a period of time, and actually these diseases considered merely symptoms which come from a longstanding Yin Deficiency in the body. The Yin can translate into Western medicine or scientific understanding as the blood, body fluids, hormones, neurotransmitters, immune factors, enzymes, reproductive fluids, and others. That’s why deficiencies of these factors point to the pattern of Yin Deficiency. This is also why Chinese medicine is superior at preventing serious disease. It is able to recognize and treat the symptoms of Yin Deficiency in the early stages when the symptoms are evident but mild. If you can boost the blood quality, balance the hormone levels, neurotransmitters, and immune factors (basically preserve or improve the Yin), you can prevent disease. This is a huge step in Modern Medicine, and it is thanks to the meeting of East and West.
The symptoms of the pattern of Yin Deficiency can include some that fall under the pattern of “Blood Deficiency” as stated above, but also include symptoms unique to the pattern of Yin Deficiency as follows:
1) Night sweats or hot flashes, especially for women.
2) Malar flush or “rosy cheeks”
3) Lower back pain, especially the type that is dull and achy, and not necessarily caused from trauma or injury. The diagnosis in western medicine might be “low back pain of an idiopathic nature or unknown cause”, as evidenced in general debility and weakness of the lower back. It could be caused from changes in the spine or bone, namely osteoporosis, arthritis, degenerative joint disease, stenosis ( a narrowing of the bone on the nerve canal) and others.
4) Night urination or nocturia, basically waking up to urinate at night, the more often, the more severe the yin deficiency (more than 3 times per night shows strong yin deficiency), can be hot or deep yellow urine, but is commonly normal or slightly more yellow.
5) Burning sensations of the face or the palms of the hands and soles of the feet and chest (five center heat) or recurrent low fever
6) Dryness of the mouth, the throat, and especially the eyes (dry eyes is a hallmark symptom of Liver Yin Deficiency as opposed to Liver Blood Deficiency)
7) Thirst, especially with a desire to sip slowly.
8) Constipation with dry stools.
9) Better energy in the morning, but tending toward fatigue in afternoon and evening.
10) Lack of saliva or body fluids in general (including ejaculate for men and vaginal secretions for women), or low sperm count/volume or vaginal dryness.
11) Lack of or low sex drive or libido, although it can also manifest as excess sexual desire.
12) Frequent dreams of sex. Although this seems unlikely to be included with a symptom of low sex drive, there is often a desire for sex, with the inability to perform.
13) Premature ejaculation for men, and a general inability to maintain erections. Easily excited but short lived sex.
14) Chronic vaginal infections or cystitis.
15) Diseases of the eyes, especially those stemming from a deficient or degenerative nature including glaucoma, poor vision, macular degeneration, non-inflammatory retinopathies, corneal dystrophies, blindness, lazy eye.
16) The classic tongue presents as a more red than normal, with little or no coating, sometimes with cracks or fissures, and a longer, thinner body as opposed to a pale, fat, swollen tongue.
17) The classic pulse is wiry and rapid, so feels like a wire or thick guitar string under the finger and rapid would be 90 beats or more per minute.

Headaches Part 5: Blood Deficiency

A. Blood Deficiency, also commonly called “Liver Blood Deficiency” or “Heart Blood Deficiency”

The pattern of Blood Deficiency usually stems from a Qi Deficiency (which is discussed in detail on page 22), especially the Qi of the Spleen and Stomach, in transforming and transporting food. This manifests as digestive dysfunction or weakness. This could present itself as simple indigestion, fatigue, loose bowels, low appetite or fullness/tiredness after eating in the early stages; or as a more advanced pattern which can manifest as IBS (irritable bowel syndrome), Crohn’s Disease (an inflammation of the bowels), Chronic Fatigue Syndrome, Fibromyalgia (multiple sites of muscle and connective tissue pain), Candidiasis (an overgrowth of yeast like bacteria in the intestines), and many other digestive dysfunctions leading to fatigue and muscle pain (yes, they are closely related). In the advanced cases, there will likely be some of the symptoms below. Blood Deficiency can also result from an excessive loss of blood (including menstrual bleeding, uterine bleeding, childbirth, trauma, blood transfusions or donations, chronic internal bleeding from an ulcer). It can also originate from exhaustion due to a prolonged or chronic illness, especially hepatitis, alcoholism, or drug addiction, for instance. You can also check the symptoms of Qi Deficiency on page 22 to see if you fit this pattern as well, as this will often be the case. The key is to determine which pattern is predominant. The Blood Deficiency type of headache tends to be more severe than Qi Deficiency. The key symptoms showing that the headache is caused by a more advanced pattern of Blood Deficiency and not Qi Deficiency, would be that the headache is worse in the afternoon or evening, is accompanied by forgetfulness or memory problems, and it is worse after one looses blood.

1) This headache is often and classically on the top or vertex of the head. It can also manifest as the whole head, or back of the head, but if it is only on top of the head this is a significant symptom of a Blood Deficiency headache. Make sure it is not from Cold Stagnation in the Liver pattern (page 16) as it also manifests as a vertex headache. It can, however manifest in other places as well.
2) Dizziness or vertigo can also be a main complaint and is a key symptom
3) This headache can be worse in the afternoon or evening, and is often after a menstrual cycle for women, since the loss of blood makes the headache worse.
4) The headache is often alleviated or reduced by lying down.
5) Poor memory, forgetfulness, or poor concentration, also called cognitive dysfunction.
6) A scattered personality with disorganization, inattentiveness, or easily distracted.
7) Dull, pallid, lusterless complexion, or dryness of the skin.
8) Paleness of the tongue, lips, inner eyelids, or complexion in general.
9) Weak, dull, dry, cracking nails possibly with other imperfections like ridging or white specs in the nail matrix.
10) Emaciation or excessively low body weight, thinness (including anorexia, bulimia, etc.)
11) Dry eyes, can be with blurred vision or night blindness
12) Spasm of the tendons, weak tendons, tending toward tendon type injuries, tendonitis, tennis or golf elbow, etc.
13) Numbness or lack of sensation in the extremities (hands and feet) or limbs, may include tingling sensations. This is the blood failing to nourish the channels.
14) Tremors of the hands and feet, or spasms in general, like “restless leg syndrome”, and in severe cases epilepsy, Parkinson’s disease, and other conditions with tremors or convulsions. These symptoms actually fall under the pattern of Wind, as in Turbid Phlegm Wind discussed below (page 19), but mild tremors can often start with this pattern of Blood Deficiency.
15) Constipation with dry stools; difficulty in going to the toilet. Usually the stools are not small or clumpy like pebbles (this would indicate Liver Qi Stagnation on page 14).
16) For women the symptoms can manifest as infrequent or very light volume/color of menses, often with a 35 day cycle or more (oligomennorhea), or no menses (amenorrhea), vaginal dryness, pain during sex; could also but less commonly manifest as irregular menses or (metrorraghia), or excessive menses (menorrhea).
17) Anemia or low red blood cell count.
18) Bruising easily, or bruises not going away after a normal amount of time (a few days).
19) Eczema, psoriasis, and many other skin conditions, especially if they show as dryness of the skin.
20) Other blood disorders including thrombocytopenia (low platelet count), hemophilia (blood not coagulating properly), lack of clotting factors, Wiskott-Aldrich syndrome (which is a combination of eczema, thrombocytopenia, and immune deficiency, often with bloody diarrhea) which by the way are all symptoms within this pattern of Blood Deficiency; vitamin K deficiency. If the disease of the blood has a lack or deficiency of any normal components, we would call this Blood Deficiency in Chinese Medicine.
21) Immune deficiencies of all kinds, ranging from catching colds easily or often to HIV and cancers.
22) Diabetes both type I and II, although this is usually evolves from a longstanding Qi Deficiency (page 22).
23) The classic tongue is pale with a thin white coating, especially pale on the sides of the tongue.
24) The classic pulse is taut and threadlike, so basically feels like a thread or thin guitar string pushing up, instead of a smoother, softer pulse.

Headaches, part 4: Liver Fire

I. Liver Fire

The pattern of “Liver Fire” is basically a more severe version of and stems from the pattern “Liver Yang Rising”. We are in the medical age of fire diseases and “Liver Fire” is by far the most common. Cancer, HIV, Alzheimer’s, and many major diseases present with symptoms in this category, and could be prevented with recognizing these patterns of disharmony from Chinese Medicine. The main distinguishing symptoms of Liver Fire are:
1) A severe and sudden onset of the headache, especially accompanied by more Fire signs in this category. The headache is usually even more intense than the pattern above, and may last longer as well. It tends to be fixed in one location, occur often (daily or more), and evolved from a long history of headaches (months to years).
2) Dizziness or vertigo is more severe, and can affect balance and spatial orientation, or manifest as more severe conditions like Meniere’s disease.
3) Strong thirst
4) A bitter taste in the mouth
5) Dark yellow or little urine
6) Constipation with dry stools, infrequent bowel movements (not every day, like normal); can be severely dry or very infrequent (more than 2-3 days).
7) Burning or hot sensations anywhere in the body, but more commonly the upper body and head.
8) Strongly red eyes or diseases of the eyes, especially those of an excess nature, showing with redness, inflammation, and burning, and usually affecting the external parts of the eye. Examples would be “red eye”, “pink eye”, or conjunctivitis; pterygium, which is an abnormal growth on the conjunctiva (the covering of the eye or inner eyelids); subconjunctival hemorrhage (bleeding of the conjunctiva); basically any infection of the eye with redness, tearing, swelling, or bleeding. There could be eye diseases of a deficient nature as well (see page 12, number 12 under Yin Deficiency) like poor vision, macular degeneration, etc.
9) Insomnia of a more severe nature, including nightmares, especially with themes of violence or fire; vivid dreaming, or “remembering lots of dreams”; sleep walking, talking in one’s sleep.
10) Bursts of anger or loss of emotional control, violence, aggression or other extreme or deviant behaviors, including psychological conditions like schizophrenia or manic states.
11) Severe tinnitus or strong, high pitched ringing in the ears.
12) Deafness or hearing loss, especially with a sudden onset, but can be chronic hearing problems as well.
13) Meniere’s disease is a hallmark symptom of this pattern, with symptoms including dizziness or vertigo, ear ringing (tinnitus), hearing loss, and often nausea and vomiting. This is a good example of western medicine not knowing the cause, or saying it is caused from a physical problem within the ear (especially, the vestibular system or that affecting balance) or fluid in the ear.
14) Trigeminal neuralgia (severe facial nerve pain on one side, usually only lasting a short time) is another hallmark symptom which can fall under this pattern. This is a great example of western medicine being the radical and failing approach since the apparent cause is pressure on the nerve, modern research showing it may often be a blood vessel pressing on the nerve. This would seem the ideal candidate for surgery, since it would relieve the “cause” by relieving the pressure. But often times the western treatment of drugs and surgery only creates more complications, and the symptoms come back. Wouldn’t you rather avoid the surgery if you could reduce the Liver Fire and nourish the Yin Deficiency and it worked to eliminate the symptoms long term? I have also seen this pattern treated many times successfully with Chinese Medicine, meaning all the symptoms resolve with no recurrence.
15) It is often associated with excessive consumption of alcohol, smoking, or long term drug use (both recreational and pharmaceutical), all of which create excess Fire in the body.
16) This headache pattern could also arise from being exposed to relatively high amounts of environmental toxins like cosmic or other high frequency radiation, as in airline hostess, jet pilot, or MRI technician; petro-chemicals as in gas station attendant, migrant farmer, and truck mechanic; or electromagnetic radiation as in high voltage electrician or computer server technician. I know these things from my own clinical experience as I have treated people such as these.
17) Exposure to pesticides, heavy metals, hormones, and long term or particularly strong pharmaceutical use also often leads to this pattern. Some drugs in particular which tend to create a lot of Fire in the body are ones used to treat cancer, rheumatoid arthritis, endometriosis, especially the hormonally related drugs, and immunosuppressive therapies to name a few.
18) Bleeding disorders of the excess type including nose bleeds, coughing up of blood, bleeding gums, bloody stools, and excessive blood loss from gynecological issues for women (including hormone imbalances, endometriosis, uterine fibroids, or cancers of the uterus).
19) The headache can be worse right before, but will most likely get even worse during the menstrual period. This may vary.
20) There will more than likely be a strong intolerance of heat, light, and stimulation in general, and these factors can often cause the onset of the headache or make it worse.
21) The tongue body will often be more red than normal, or has a red tip or sides, and may have a dry or peeled coating.
22) The pulse will often be rapid, and classically is described as a wiry, thready, or tight pulse, which will usually feel excessive or constrained, like a guitar string pushing up on the finger, as opposed to a smoothly flowing pulse.

If you have determined that there are sufficient symptoms, say 3 or more, pointing to the pattern of “Liver Yang Rising” or “Liver Fire”, you next need to figure out the cause of your pattern by grouping together further signs and symptoms. The pattern of “Liver Yang Rising” or “Liver Fire” is an Excess condition usually arising from one of the three major underlying patterns of Deficiency: Blood Deficiency, Liver and Kidney Yin Deficiency, or Liver and Kidney Yin Deficiency with Kidney Yang Deficiency. For simplicity we will call these patterns Blood Deficiency, Yin Deficiency, and Yin and Yang Deficiency. Even if you don’t have many symptoms of the above patterns, keep reading to see if you fall under one of the below patterns. It is possible to have a few symptoms from the above patterns, but have the majority fall under one of the following deficiency patterns. In this case the cause of your headache is not advanced enough to show symptoms of Liver Yang Rising or Liver Fire yet. You could also have a headache from a purely deficient pattern as well (see page 22), in which case you may have no symptoms from the above categories, but only symptoms from the next three deficiency patterns below:


Internal vs. External Causes of Headaches
External causes include exposure to the elements, like wind, water, heat, or cold, and also exposure to pathogens like bacteria or viruses which we call “heat/toxins” in Chinese Medicine. This includes common cold, sinusitis, head cold, and in more severe cases hypothermia or sun stroke. Chinese medicine can also treat externally contracted headaches (for example from cold and flu) very well without pharmaceuticals, but that is beyond the scope of this document. I wish to present only the Internal causes of chronic or long term headaches.
In cases where one has a headache from an external cause, and it’s not a commonly recurrent event, the occasional use of western drugs can be a quick and easy way to alleviate the short term suffering. Unfortunately the more common scenario is that these conditions persist or come back often because the immunity is weak and/or there is an underlying imbalance of the internal organ systems. In this case there is an external and an internal cause of the headaches. According to the principles of Chinese Medicine, one would treat or eliminate the external causes first, thus eliminating the acute symptoms, and then treat the internal causes to prevent the recurrence of symptoms. A good example would be chronic sinus infections causing headaches. An external exposure to wind and cold could aggravate or trigger a sinus headache, but after treating it with decongestants and antibiotics, the symptoms recur even without exposure to wind and cold. This pattern would indicate an underlying internal condition, quite possibly a weak immune system stemming from a number of different internal patterns of disharmony. For the purpose of this discussion, we will omit the discussion of Chinese Medicine treatment of externally caused headaches, and focus on the chronic internal patterns. If an external condition exists, as evidenced by symptoms of a cold or infection with heat and swelling, sinusitis, ear infection or otitis media, sore throat, aversion to cold, cough or lung problems, etc. one would first treat the external condition before looking into the diagnosis and treatment of the underlying internal causes.

Internal Patterns of Disharmony Leading to Headaches:
I. Liver Yang Rising

The most common pattern in Chinese Medicine leading to chronic migraines and headaches of a severe nature is one of Liver Yang Rising or Liver Fire. The pattern of Liver Yang Rising usually leads to its more severe sister pattern of Liver Fire, which is basically more severe and listed as a separate category after Liver Yang Rising. Both patterns are a classic example of an imbalance of Water and Fire or Yin and Yang within the body. A Deficiency of Water or Yin leads to a flaring up of Fire or Yang. An example would be “Liver Fire caused from a Deficiency of Liver and Kidney Yin”. This, I would venture to say, is probably THE most common pattern of imbalance in humans today. It is largely a result of over-stimulation, over-medication, over-chemicalization and electro-magnetization that is the hallmark of our modern western civilization. This pattern is actually a secondary Excess pattern which has a deeper root in a Deficiency pattern of the Liver and Kidneys, as we will discuss shortly. Let’s look at the symptoms of “Liver Yang Rising” first:
1) Headache of a strong, intense, distending nature (having the feeling of swelling out and expanding as if from internal pressure), and includes throbbing, bursting, or pulsating pain. It could also be described as sharp. A very sharp pain, like a knife or hot poker, or a “splitting” headache can fall in this category, but usually means there is also “Blood Stagnation” as well. You can check the symptoms of Blood Stagnation on page 15. The headache is often diagnosed as a migraine, or headache of a severe nature.
2) The location is often times in the occipital area (the back of the head) with pain radiating to the neck muscles or upper back; in the temples or eyebrow region or on one or both sides of the head; or behind the eyes. Basically it can affect the whole head. It can move around or be fixed in one spot.
3) This is usually is a chronic condition already lasting months or years, and the bouts tend to be more often (daily to weekly) and often coming on in the afternoon or evening.
4) The headache only occurs on the “weekend”. This pattern is usually due to excessive work, long hours, and high stress related jobs which tend to mask the headache when one is working, but surfaces during periods of rest or inactivity. Very common in med students, emergency room nurses, and other high stress, high workload occupations.
5) This headache is often connected with an emotional imbalance like anger, frustration, or resentment, either expressed or repressed. This is actually the hallmark symptom for this pattern. Manifestations include irritability; marked impatience, throwing fits of anger, and patterns including disorganization, disinterest, procrastination, distractibility, or a hypersensitive character. For children and adults this often results in diagnoses like ADD (attention deficit disorder) or ADHD (with hyperactivity). Chronic excessive emotions of this nature can actually be the cause of this pattern of headaches.
6) Dizziness or vertigo
7) Dry throat or mouth in general.
8) Nausea or vomiting, with possible acid reflux disorders like GERD (gastro-esophageal reflux disorder) or acid regurgitation.
9) Visual disturbances including seeing an aura or other types of visual distortions like flashing lights; blurred vision.
10) Pain, redness, or dryness of the eyes.
11) Tinnitus (ear ringing).
12) Bitter and dry taste in the mouth and/or a red face (classic symptoms, rare, but very diagnostic, this would be another hallmark group of symptoms).
13) Throbbing or burning pain along the sides of the chest (another rare classic symptom)
14) Constipation or dry stools, tending toward the mild side.
15) Insomnia or restless sleep.
16) The headache is aggravated by heat, anger, after excessive sexual activity or vigorous exercise, or after eating sour foods like citrus or vinegar; light, sound, smell, vibration, or other stimuli can onset or aggravate the headache; it can also be made worse with pressure or massage.
17) The headache is alleviated by cold applications (temporarily), light exercise, reduction of external stimuli (being in a dark, quiet room), or in rare cases sexual activity. Sometimes patients report relief in a sitting position or propping the head up with pillows when lying down.
18) The headache usually happens before the beginning of a woman’s menstrual period (as a PMS symptom), but this may vary.
19) Gallbladder related disorders including gallstones or bile duct obstruction.
20) Liver related disorders including hepatitis, cirrhosis, elevated liver enzymes, liver cancer.
21) The classic tongue is a red body with yellow coating, and this would be the case in an acute or aggravated condition, but more often the tongue will present as some deficiency pattern which is the root of this pattern, as described below.
22) The classic pulse is wiry, so feels rather forceful like a thick guitar string and rapid, so 90 plus beats per minute, but this is the acute flare-up stage. The actual pulse may show as a deficiency pattern as described below.