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The liver is situated in the right hypochondriac region. Its meridian connects with the gallbladder with which it is internally-externally related. Its main physiological functions are storing blood, maintaining the free flow of qi, controlling the tendons, manifesting in the nails and opening into the eye.

Storing blood

The liver stores blood and regulates the volume in circulation. The volume of blood circulating in various parts of the body changes according to different physiological needs. During vigorous movement and other daytime activities, the blood is released from the liver, increasing the volume of blood in circulation. During rest and sleep, the volume of blood required decreases, and part of the blood remains in the liver. As Wang Bing said in the explanation on the tenth chapter of Plain Questions: "The liver stores blood ... the blood circulates in the vessels during exertion and remains in the liver during rest."

Because of its function of regulating the volume of circulating blood, the liver is closely related to all the activities of the zang-fu organs and tissues. When the liver is diseased, dysfunction of the liver in storing blood will affect the normal activities of the body, and lead to pathological changes of the blood itself. For example, deficiency of liver blood may give rise to blurred vision, spasm and convulsion of the tendons and muscles, numbness of the four limbs, and oligomenorrhoea or even amenorrhoea in females.

Maintaining the free flow of qi

The liver is responsible for the unrestrained, free going, and harmonious functional activity of all the zang-fu organs, including itself. The normal character of the liver is to "flourish" and to dislike depression. Stagnation of liver qi due to emotional changes may affect the function of the liver in maintaining the free flow of qi, manifesting in the following three ways:

  1. The liver and emotional activity
    In addition to the heart, emotional activity is closely related to the liver qi. Only when the function of the liver in maintaining the free flow of qi is normal can the qi and blood be harmonious and the mind at ease. Dysfunction of the liver, therefore, is often accompanied by emotional changes such as mental depression or excitement. When liver qi stagnates, for example, there may be mental depression, paranoia, or even weeping; when liver qi is hyperactive, there may be irascibility, insomnia, dream-disturbed sleep, dizziness and vertigo. Whilst dysfunction of the liver often leads to emotional changes, at the same time prolonged excessive mental irritation often leads to dysfunction of the liver in maintaining the free flow of qi.

  2. The liver function and digestion
    The liver function of maintaining the free flow of qi is related not only to the ascending and descending function of the stomach and spleen, but also to the secretion of bile. The liver therefore has an important influence on digestion. Dysfunction of the liver may affect the secretion and excretion of bile, and the digestive function of the spleen and stomach, resulting in dyspepsia. When the liver fails to maintain the free flow of qi, there may be symptoms of stagnation of liver qi such as distending pain of the chest and hypochondrium, mental depression or irascibility. If the descending function of the stomach is affected, there may also be belching, nausea and vomiting, and if the spleen's function of transportation and transformation is affected, there may be abdominal distention and diarrhoea. The former is called "attack of the stomach by liver qi" and the latter "disharmony of the liver and spleen."

  3. The liver function and qi and blood
    The blood circulation relies upon the propelling function of qi. Although the heart and lung play the main role in the circulation of qi and blood, the function of the liver in maintaining the free flow of qi is also needed to prevent stagnation of qi and blood. Stagnation of qi and blood due to the failure of the liver in maintaining the free flow of qi may lead to stuffiness and pressure in the chest, distending or pricking pain in the hypochondriac region, dysmenorrhoea, and even the formation of palpable mass.

Controlling the tendons and manifesting in the nails

The tendons are the main tissues linking the joints and muscles and dominating the movement of the limbs. Since the liver nourishes the tendons of the whole body to maintain their normal physiological activities, when liver blood is consumed, it may derive the tendons of nourishment and give rise to weakness of the tendons, numbness of the limbs, and dysfunction of the joints in contraction and relaxation. When the tendons are invaded by pathogenic heat of the liver, there may be convulsion of the four extremities, opisthotonos and clenching of the teeth.

Manifesting in the nails means that the state of the yin and blood of the liver affects not only the movement of the tendons but also the condition of the nails. When liver blood is ample, the tendons and nails are strong, and when liver blood is deficient, the tendons will be weak and the nails soft and thin, withered, or even deformed and chipped. The tenth chapter of Plain Questions therefore says: "The liver controls the tendons and manifests in the nails."

Opening into the eye

In the eightieth chapter of Miraculous Pivot, it says: "The essential qi of the five zang and six fu organs flows upward to enter into the eyes to generate vision."

Of the five zang and six fu organs, the liver is the main organ affecting the eyes and vision. The liver stores blood and its meridian ascends to connect with the eyes. Therefore, the seventeenth chapter of Miracular Pivot says: "The liver qi is in communication with the eyes."

Whether the liver function is normal or not often reflects on the eye. For example, deficiency of the yin and blood of the liver may lead to dryness of the eyes, blurred vision or even night blindness. Wind heat in the Liver Meridian may give rise to redness, swelling and pain of the eyes.

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