Two Faces of Liver Imbalance
In Traditional Chinese Medicine, the liver plays a central role in the free flow of energy and blood throughout the body. When this flow is disrupted, two important patterns arise that are often confused: Liver Qi Stagnation and Liver Blood Stasis. Although both involve the liver and cause tension, their mechanisms and manifestations are fundamentally different.
Liver Qi Stagnation: Energy that Gets Stuck
Liver Qi stagnation occurs when energy can no longer flow freely through the body. This is often caused by emotional tension, frustration, or prolonged stress. The energy becomes stuck in certain areas, leading to feelings of pressure, tension, and bloating.
Typical symptoms include: a feeling of tension in the chest and flanks, bloating that comes and goes, sighing, irritability, mood swings, a lump in the throat, and, in women, often premenstrual tension with breast tenderness. Symptoms fluctuate significantly depending on emotional state—they worsen with stress and improve with relaxation.
The tongue in Qi stagnation often shows purple discoloration on the sides (the liver area of the tongue), but is not fundamentally dark or purple. The tongue coating is usually normal. The pulse is the most illuminating: it feels tense, tight, and wiry, as if you were touching a guitar string. This pulse is also called “xian” and is characteristic of liver stagnation.
Liver Blood Stasis: Blood that No Longer Flows
Liver Blood Stasis takes things a step further: here, not only is the energy blocked, but the blood itself also stagnates. This pattern often develops from prolonged unresolved Qi stagnation, or from trauma, surgery, or extreme cold that has frozen blood circulation.
The symptoms are more consistent and sharp: steady, tingling pain in a fixed spot, purple discoloration of the skin or lips, small red dots (petechiae) on the skin, dark, clotted menstrual blood with clumps, severe menstrual pain that is not relieved by pressure, and possibly masses or swellings that can be felt.
The tongue reveals blood stasis: it is clearly purple or has purple spots across its entire surface, not just on the sides. Sometimes there are visible swollen veins under the tongue. The pulse feels not only tense but also “choppy” or “hesitant”—an irregular, stiff pulse indicating that the blood is struggling to flow.
The Crucial Differences
The main difference lies in the fixation of the symptoms. Qi stagnation is mobile: the pain moves, comes and goes, and reacts to emotions. Blood stasis is fixed: the pain stays in one place, is sharp and stabbing, and hardly changes.
Qi stagnation responds well to relaxation, movement, and emotional processing. Blood stasis requires more active intervention to get the clotted blood moving again.
Another distinguishing feature is chronology: Qi stagnation can develop acutely after a period of stress. Blood stasis usually develops gradually over months or years, or acutely after physical trauma.
Practical Implications
This distinction is crucial therapeutically. Qi stagnation requires the movement of energy, the release of tension, and the harmonization of emotions. Formulas such as Xiao Yao San or Chai Hu Shu Gan San are suitable in this case.
Blood stasis, on the other hand, requires more potent blood-moving and stasis-resolving herbs. Formulas such as Xue Fu Zhu Yu Tang or Tao Hong Si Wu Tang are more effective. Simple relaxation is insufficient for blood stasis—the blood must be actively moved.