In daily life, many people are prone to sulking, feeling irritable, and often experience a sense of tightness in the chest, with discomfort and distending pain in the hypochondriac regions. In Traditional Chinese Medicine, this is often attributed to "Liver Qi Stagnation," commonly referred to as "Liver Depression." For dealing with Liver Depression, I often advise patients that two commonly used Chinese patent medicines are sufficient—Xiaoyao Wan and Chaihu Shugan Wan. However, the key to choosing which one to use lies in distinguishing whether it is a "Deficiency Pattern" or an "Excess Pattern." Using the wrong one may lead to counterproductive effects.

How to differentiate between the "Deficiency Pattern" and the "Excess Pattern" of Liver Depression?

Liver Depression with "Deficiency Pattern": The Root Cause Often Lies in Qi and Blood Deficiency

How does it arise? Traditional Chinese Medicine (TCM) holds that "the liver belongs to wood, and the spleen belongs to earth." When liver qi is chronically depressed and stagnant, it is like the roots of a tree growing chaotically, excessively suppressing the soil (spleen earth) beneath it, thereby affecting the spleen's functions of digestion and absorption. This explains why many people experience poor appetite, feeling full after eating little, and abdominal bloating when in a low mood.

What happens over time? The spleen is the "source of qi and blood transformation." When its function is chronically impaired, the generation of qi and blood becomes insufficient. At this stage, symptoms such as a sallow, dull complexion; overall fatigue and lack of spirit; dizziness and tinnitus; and even frequent leg cramps may appear. Upon examining the tongue, while the sides (liver-gallbladder areas) might be swollen, the overall tongue color tends to be pale.

Why choose Xiaoyao Pills (Free Wanderer Pills)? The formulation of Xiaoyao Pills is ingeniously designed: it uses Bupleurum (Chaihu) to soothe and disperse the stagnant liver qi; Chinese angelica root (Danggui) and white peony root (Baishao) to nourish and supplement the blood, thereby nourishing the liver body damaged by stagnation; combined with Atractylodes macrocephala rhizome (Baizhu) and Poria (Fuling) to strengthen the spleen and boost qi, enhancing the spleen's transporting and transforming capacity. This addresses the root problem of liver depression damaging the spleen and leading to qi and blood deficiency. It soothes the liver without forgetting to supplement qi and blood, and supplements qi and blood without hindering the soothing of the liver, making it suitable for this "deficiency-type" liver depression.

Stagnant Liver "Excess Syndrome": Often Severe Qi Blockage

What are the characteristics of this type of person? These individuals are not necessarily deficient in qi and blood; they may have a fairly solid constitution, and their pulse often feels relatively strong. Their liver stagnation is typically caused by external stimuli such as sudden stress, anger, or arguments, leading to what is described as "qi blockage."

Typical manifestations: chest tightness, irritability and easily provoked anger, insomnia, noticeable distension and pain in the hypochondriac regions (both sides of the ribs), and a constant sensation that relief comes only when qi moves upward (as in belching) or downward (as in passing gas). Examination of the tongue reveals swelling along the sides, with a normal pale red or slightly red color, appearing relatively well-perfused.

Why choose Chaihu Shugan Wan? The primary focus of Chaihu Shugan Wan is "breaking qi stagnation," "moving qi," and "regulating qi." Its action is relatively strong, akin to dispatching a "powerful fleet to clear congestion," specifically targeting severe and firmly stuck qi stagnation. It can rapidly alleviate discomfort symptoms stemming from "blockage," such as chest tightness, hypochondriac pain, and abdominal distension. However, precisely because its "qi-breaking" action is potent, if used by individuals who are inherently deficient in qi and blood, it may lead to feelings of increased deficiency and fatigue. Therefore, it is more suitable for "excess-type" liver qi stagnation.

【Distinguishing Features Through Real Cases】

Case 1 (Deficiency Pattern): Patient Li, a 50-year-old woman, retired and helping to care for her grandchild. She had been under strain and experienced minor conflicts with her daughter-in-law, leading to prolonged low mood. For the past six months, she constantly felt fatigued, had a poor appetite, experienced bloating after eating, her complexion was increasingly sallow, and she frequently felt dizzy with nighttime leg cramps. Upon examination, I observed her tongue was pale with slight bulging at the sides. This is a classic case of liver depression impairing the spleen, leading to deficiency of Qi and blood. I advised her to take Xiaoyao Wan (Free and Easy Wanderer Pill), along with adjusting her mood. After over a month of treatment, her appetite improved, bloating decreased, her complexion became somewhat rosier, and the fatigue and dizziness showed significant improvement.

Case 2 (Excess Pattern): Mr. Chen, 35, a department supervisor, experienced intense discomfort in his chest, distending pain in both flanks, was easily irritable, had trouble sleeping at night, and frequent belching after a major argument with a colleague over a large project. He was generally in good health otherwise. I observed his tongue had obvious distension at the edges and was reddish in color. This is a classic excess pattern of liver depression with Qi stagnation. I recommended he take Chaihu Shugan Wan (Bupleurum Liver-Soothing Pill) for a short period while actively resolving the conflict. Upon follow-up about a week later, he reported significant improvement in chest tightness and flank distension, better flow of Qi, and improved sleep.

Dr. Wang's final reminder:

Differentiation is key: Liver qi stagnation is common, but the differences between "deficiency" and "excess" patterns are significant. Do not casually purchase and take medication simply because you feel you have "liver qi stagnation." Xiaoyao Pills tend to supplement and unblock, while Chaihu Shugan Pills focus on breaking qi and resolving stagnation. Using the wrong one may worsen discomfort.

Observing the tongue provides clues: Swollen sides of the tongue are a common sign of liver qi stagnation, but a pale color often suggests deficiency (possibly due to insufficient qi and blood), while a red color or visible blood streaks generally indicates excess (marked qi stagnation), which can serve as a preliminary reference.

Adjustment Requires Coordination: Medication is auxiliary; adjusting mindset, relieving stress, and ensuring adequate sleep are crucial for alleviating liver depression. Identify sources of stress and try to release them through exercise or talking with others.

Short-term Use (Especially for Chaihu Shugan Wan): For liver depression of excess pattern, Chaihu Shugan Wan should be discontinued or adjusted under medical guidance once symptoms are alleviated; it is not suitable for long-term use. Xiaoyao Wan is relatively mild, and it may take a slightly longer time to regulate liver depression of deficiency pattern.

Consult a Doctor for Doubts: If symptoms persist or are complex, be sure to seek face-to-face consultation with a professional traditional Chinese medicine practitioner for pattern differentiation. Adjust the medication based on specific circumstances to achieve the best results.

Distinguishing "deficiency" and "excess" is like obtaining the correct key to unlock "liver depression." Use Xiaoyao Wan and Chaihu Shugan Wan effectively to promote the smooth flow of stagnant qi, and your mood will naturally improve considerably!