Liver Physiology Liver Pathology Cases Roger M Clemmons, DVM, PhD, CVA CDR, IRC, USPHS Aso Prof Neurology & Neurosurgery University of Florida rmc@neuro.vetmed.ufl.edu http://neuro.vetmed.ufl.edu/chi-files/ TCM Liver Disease Liver Physiology Liver Pathology Cases

Wood Sound Emotion Climate Season Direction Opening Body Part Zang/Fu shout Emotion anger Climate windy-warm Season spring Direction east Opening eyes Body Part ligaments Zang/Fu LIV/GB

TCM LIVER Physiology Stores the Blood Maintains the Smooth Flow of Qi & Blood Controls the Sinews Opens in the Eyes

TCM LIVER Physiology Stores the Blood Acts to regulate blood volume Similar to WIM function of the liver (plus spleen function) Closely related to tolerance to tiredness Measure of athletic performance

TCM LIVER Physiology Maintains the Smooth Flow of Qi & Blood Ensuring SP/ST digestive function Maintaining vital activities of the body Maintaining smooth flow of water-damp

TCM LIVER Physiology Controls the Sinews Moistens and nourishes the tendons and ligaments Ensures smooth joint movements Depends upon adequate LIV blood

TCM LIVER Physiology Opens in the Eyes Meridian connection LIV yin & blood deficiency leads to dry eyes LIV heat leads to red, swollen eyes

Liver Patterns

TCM 24 Hour Clock

Liver Pattern Excess Deficiency Liver Damp Heat Liver Fire Blazing Upwards Extreme Heat Generating Liver-Wind Retention of Cold in the Liver Meridian Excess Liver Blood Deficiency Liver Yin Deficiency Internal Wind due to Liver Blood Def Internal Wind due to Liver Yin Def Deficiency

Scanty dark yellow urine Liver Damp Heat Jaundice Scanty dark yellow urine Swollen, hot, itchy, painful vagina, scrotum or prostate Tongue: Red or Yellow Pulse: Wiry and rapid GB34, GB40-41, BL19, LI-11, SP-9 Yin Chen Hao plus Liver Fire Blazing Upwards Epistaxis Red, swollen, painful eyes Weak vision or Corneal opacity Ocular discharge Dry feces or constipation Thick, dark yellow urine Tongue: Red and dry LIV-3, GB-34, GB-1, Tai Yang, ST-1, GB-37 Snake & Dragon (Long Dan Xie Gan) Extreme Heat Generating Liver-Wind High fever Rigidity of Neck Tremors or Convulsions Opisthotonus or Coma Running into walls or circling Tongue: Red GB-20, LIV-3, BL-17, SP-10, GB-41, GB-34, GV-14, LI-4, hemo-12 Ting points Ling Yang Gou Teng Retention of Cold in the Liver Meridian Hind limb stiffness Cold ears and nose Cold trunk and limbs Swollen, cold scrotum and testes Swollen or painful prostate Infertility due to coldness in the uterus Tongue: Purple and wet Pulse: Deep and slow Moxa LIV-3 / 8 / 14, LIV-1, LIV-3, GB-34 Hui Xiang (Foeniculum powder)

Callie (3 yr F/S DLH) Jaundice Anorexia Dark yellow urine Fever (103.5) Tongue: Red/Yellow Pulse: Wiry and rapid Dx: Liver Damp Heat

Callie Treatment Acupuncture Herbal GB34, GB40-41, BL19, LI-4, LI-11, SP-9, LIV-3, LIV-8 Herbal Yin Chen Hao plus

Liver Blood Deficiency Dry or cracked paws or hooves Dandruff Lethargy and prefers to lie on ground Tongue: Pale and dry Pulse: Wiry and thready BL-18, SP-10, BL-17, SP-6 Si Wu Tang Liver Yin Deficiency Red eyes Tearing or watery eyes Slightly swollen eyelids Nebula Tongue: Red and dry Pulse: Thready or wiry and rapid LIV-3, BL-18, BL-23, KID-3, SP-6 Liu Wei Di Huang Wan Internal Wind due to Liver Blood Def Tremor or convulsions Pulse: Weak and thready BL-18, SP-10, BL-17, SP-6, GB-20, GB-34, GV-21 Tian Ma San Internal Wind due to Liver Yin Def Liver Yang Rising Wind Prolonged low fever Night sweating Tongue: Red and Dry (no coating) LIV-3, BL-18, BL-23, KID-3, SP-6, GB-20, GB-34, GV-21 Tian Ma plus

Bojangles (7 yr F/S Mix) Lethargic Seeks cool, hard surfaces Dry, brittle hair Mild intention tremor Tongue: Pale and dry Pulse: deep, weak and thready particularly on left Dx: Liver Blood Deficiency with Internal Wind

Bojangle Treatment Acupuncture Herbal GB-20, LIV-3, SP-6, SP-10, BL-17, BL-18 Herbal Si Wu Wan Di Tan Tang Bu Xue Zi Feng Tang

Eye Pattern Excess Deficiency Liver Heat Liver Stagnation Liver & Kidney Yin Deficiency

Liver & Kidney Yin Deficiency Qi Ju Liu Wei Di Huang Wan Liver Heat Conjunctivitis or keratitis Congestion of the conjunctival vessels Red or swollen eyes Clear to mucoid ocular discharge Tongue: Red Pulse: Wiry, rapid and surging Fang Feng San Liver Stagnation Swollen eyelids Ocular discharge Photophobia Miosis Nebula (blue or grey) or corneal opacity Tongue: Red or pale Pulse: Surging & fast or Deep & weak Jue Ming Sna Bo Yun San (topically) Liver & Kidney Yin Deficiency Atrophied pupil Scant, thick, mucoid discharge (at medial canthus) Corneal opacity Yellow or grey sclera Tongue: Red and dry Pulse: Weak and thready Qi Ju Liu Wei Di Huang Wan

One For the Money (2 yr M QH) Wood personality Swollen, red, painful eyes Congested conjunctival vessels Scant, clear discharge Tongue: Red Pulse: Wiry, superficial and fast Dx: Liver Heat (Liver Yang Rising)

One For the Money Treatment Acupuncture: BL-2/1, LIV-1-3, GB-40, GB-44, LI-4, GV-14, ST-44/45, SP-6 Herbal Fang Feng San

Pogo (3 yr M Rottweiler) Thick mucus discharge from eyes Corneal opacification KCS Tongue: Red and dry Pulse: Weak and thready (particularly on the right) Dx: Liver & Kidney Yin Deficiency

Pogo Treatment Acupuncture Herbal SP-6, SP-9, LI-4, LIV-3, KID-3, BL-23, BL-2/1, GB-1, ST-1 Herbal Qi Ju Liu Wei Di Huang Wan

TCM Liver Disease Don’t get angry Smooth and easy gets it every time