TCM Pattern Diagnosis: Liver "Overacting" on the Spleen (aka IBS)

Liver Overacting on the Spleen in Traditional Chinese Medicine (TCM)

In Traditional Chinese Medicine (TCM), health is seen as a dynamic balance among the organ systems, each with specific functions and interrelationships. One important interaction is the controlling (ke) cycle in the Five Element Theory, where each element keeps another in check to maintain harmony. Within this framework, the Liver (Wood element) naturally controls the Spleen (Earth element). However, when the Liver becomes excessive or imbalanced, it can "overact" on the Spleen, disrupting digestion and leading to a range of symptoms. This is known as Liver Overacting on the Spleen (肝乘脾).

Pathophysiology and Causes

The Liver’s primary role in TCM is to ensure the smooth flow of Qi (vital energy) throughout the body and support emotional balance. The Spleen governs digestion and the transformation and transportation of food into Qi and Blood.

When the Liver becomes stagnant—due to emotional stress, anger, frustration, or lack of physical movement—it can generate excessive Qi that disrupts the Spleen's function. The overactive Liver "attacks" the Spleen, impairing its ability to digest food and produce energy, leading to digestive and emotional symptoms.

Common causes include:

• Emotional stress (especially frustration, resentment, and anger)

• Irregular eating habits or overeating

• Overwork and lack of rest

• Sedentary lifestyle

• Chronic Liver Qi Stagnation

Signs and Symptoms

Symptoms reflect the interaction of Liver Qi Stagnation with Spleen Qi Deficiency or dysfunction. Common clinical manifestations include:

• Digestive issues: Bloating, loose stools or diarrhea, abdominal pain relieved by bowel movement, flatulence, poor appetite.

• Emotional signs: Irritability, mood swings, depression, stress-induced digestive upset.

• Energy disturbances: Fatigue, especially after eating; heaviness in limbs.

• Menstrual irregularities (in women): PMS, breast tenderness, irregular cycles.

• Tongue: Pale or normal color with teeth marks, and possibly a thin white or greasy coating.

• Pulse: Wiry on the left (Liver side) and weak or soft on the right (Spleen side).

Treatment Principles

The treatment strategy for Liver Overacting on the Spleen involves:

1. Soothing the Liver and regulating Qi

2. Strengthening the Spleen and improving digestion

3. Harmonizing the Liver-Spleen relationship

Diet and Lifestyle Recommendations

Dietary Guidance:

• Avoid: Spicy, greasy, fried, or raw foods; alcohol and caffeine; overeating; eating while stressed.

• Favor: Warm, cooked foods; small, frequent meals; foods that strengthen the Spleen such as:

  • Cooked grains (rice, oats, millet)

  • Root vegetables (carrots, yams, squash)

  • Warming spices (ginger, cinnamon)

  • Leafy greens in moderation (to support Liver)

  • Sour flavors (to mildly course Liver Qi)

Lifestyle Suggestions:

• Engage in regular moderate exercise (e.g., walking, tai chi, yoga) to move Liver Qi.

• Practice stress-reduction techniques like breathing exercises, journaling, or meditation.

• Maintain regular meal times and avoid multitasking while eating.

• Allow time for rest and emotional processing.

Acupuncture Points

• Liver 3 (Taichong): Moves Liver Qi, calms the mind.

• Spleen 6 (Sanyinjiao): Strengthens the Spleen, harmonizes the Liver.

• Stomach 36 (Zusanli): Tonifies Spleen and Stomach, boosts Qi.

• Ren 12 (Zhongwan): Regulates the middle jiao, strengthens digestion.

• Liver 14 (Qimen): Front-Mu point of the Liver, spreads Liver Qi.

Herbal Medicine

Formulas are customized based on presentation but often include combinations that both soothe the Liver and support the Spleen.

Common formulas:

• Xiao Yao San (Free and Easy Wanderer Powder): Harmonizes Liver and Spleen, ideal for stress-induced digestive issues.

• Tong Xie Yao Fang (Important Formula for Painful Diarrhea): Specifically for Liver attacking the Spleen with diarrhea.

• Jia Wei Xiao Yao San (Augmented Free and Easy Wanderer): Addresses heat signs with stress and digestive upset.

Always consult a qualified herbalist or TCM practitioner before starting herbal treatments.