This formula is from the ‘Formulary of the Tai Ping Welfare Dispensary Bureau’ (tai ping hui min he ji ju fang), 1151, a compilation of popular and effective formulas that were used in the public dispensaries of the Song dynastic period. It is a well designed formula that addresses Liver Qi constraint ‐ together with the associated emotional disturbances ‐ when it occurs in the context of a deficiency syndrome-pattern, specifically Spleen Qi deficiency and Liver Blood deficiency.

This condition is marked by failure of the Liver to maintain the smooth and even flow of the Qi throughout the body. This is commonly caused by emotional strain or stress, but may also come about through invasion by pathogens, which obstruct the Qi and Blood, placing a critical strain on the Liver’s ability to adequately regulate the Qi. Thus, Liver function (i.e. the Liver Qi) becomes inhibited leading to what is essentially a deficiency type of syndrome.

There are three aspects to the Liver’s function of governing the Qi.

• Emotional state
• Digestion and absorption of nutrients
• Normal smooth flow of the Qi and Blood throughout the body

Failure of the Liver’s Qi governing function manifests principally in diminished emotional responses (i.e. inability to give vent to feelings, depressed mood, crying easily), impairment of digestive functions, muscular tension, and specific disturbances along the course of the Liver channel (distending pain or sense of tightness in the chest, breasts and hypochondrium).

Because Liver Qi constraint is essentially a disharmony between the Liver Qi and the Liver Blood, the latter may readily become deficient. Liver Blood deficiency may impact on the Heart (as the Liver nourishes and supports the Heart) as well as the uterus. Thus, the former may cause or worsen any disturbances in mood, cognitive function and possibly also sleep; while the latter may adversely affect menstruation and the menstrual cycle, e.g. irregular periods, lower abdominal pain and bloating premenstrually.

TCM ACTIONS
Soothes the Liver, tonifies the Spleen Qi and nourishes the Liver Blood.

TCM SYNDROMES

• Liver Qi constraint
• Spleen Qi deficiency

INDICATIONS
Stress, irritability, depressed mood, stress-related disorders, bruxism, premenstrual tension, hepatitis, hepatic cirrhosis, gastritis, duodenitis, cholecystitis, peptic ulcer disease, mastitis, mammary dysplasia (fibrocystic breast disease), irregular menstruation, chronic hepatitis.

SIGNS & SYMPTOMS
(Key clinical features in bold)

• Sense of frustration, stress, emotional strain, depressed mood
• Sense of tightness or oppressive sensation in the chest, the need to make an effort to take a deep breath, sighing.
• Tightness of the shoulders and lower thoracic paraspinal muscles
• Fatigue
• Poor appetite
• Epigastric or abdominal bloating
• Loose stools
• Hypochondrial distending pain
• Premenstrual tension with mastalgia
• Dry mouth and throat
• Headache
• Tongue may be normal or pale
• Wiry and weak-thready pulse