1 Liver governs excretion and qi, blood and water.
1. 1 has an effect on the circulation of qi, and the physiological characteristics of the liver are ascending, moving and dispersing. Its sparseness can make the operation of qi pass without stagnation; It can release qi without depression, which is an important factor for the smooth rise of qi. Regulating qi is an important function of the liver in controlling the discharge, and it is also the basis of other functions of the liver in controlling the discharge. Author: 1 100029, Ph.D. student of grade 02, Beijing University of Chinese Medicine, 2 100700. Dongzhimen Hospital affiliated to Beijing University of Chinese Medicine has insufficient elevation, and its qi is not smooth, so it is stagnant, and there are pains and discomforts such as chest, hypochondrium and less abdomen, which is often called "stagnation of liver qi". This is common in clinic. The treatment should be soothing the liver and relieving depression, and Sini powder and Chaihu Shugan powder can be given.
1.2 Influence on blood circulation Qi is handsome in blood, which can promote blood circulation, replenish blood and generate blood. When the liver is drained as usual, the qi is regulated smoothly, and the liver blood is hidden, the whole body blood can be regulated. "On Blood Syndrome" said: "The liver governs the storage of blood, and blood is born in the heart. The descending cell is the sea of blood. All the blood in the whole body always regards the blood sea as a way to control chaos. If the blood sea is not disturbed, all the blood in the whole body will be safe. The liver meridian governs its parts, so the liver governs storing blood. As far as hiding is concerned, the liver belongs to wood, and the wood rushes to it. If you don't suppress depression, your blood will be smooth. " If the liver is not well drained, it will affect blood circulation. Excessive drainage, liver-qi imbalance, then "excessive blood, vomiting, menstrual disorders, blood diseases"; Obstruction of qi, stagnation of liver qi and blood stasis, leading to stabbing pain in chest and hypochondrium, or syndrome accumulation. Tang Rongchuan advocated: "The inner person has liver qi." Radix Bupleuri, Radix Paeoniae Rubra, Cortex Moutan, Semen Persicae, etc. It is also used to treat blood stasis and general pain between meridians and viscera. This is enough to show that the liver plays an important pivotal role in regulating the gas discharge of human blood. Therefore, special attention should be paid to regulating liver qi in the diagnosis and treatment of blood diseases.
Effects of 1.3 on water and body fluid metabolism. Gas can absorb body fluid through water, and the operation of water and liquid depends on the promotion of gas and moves with the rise and fall of qi machine. Where water and body fluids pass, gas will arrive. The liver governing the discharge is the pivot of the triple energizer, which can discharge the triple energizer waterway, so it plays an important role in regulating the body's water and fluid metabolism. If the liver loses the function of dispersing qi and the triple energizer channel is unfavorable, it may cause the transport and metabolism disorder of body fluid, or it may gather into phlegm, and the phlegm will be blocked in the throat, resulting in "plum nucleus gas"; Or stop storage locally, but for excessive phlegm, abdominal distension and constipation; Or overflow to the skin, but edema. "Theory of Blood Syndrome" said: "A family of qi and water, treating qi means treating water. ..... So Xiaochaihu decoction reaches the body fluid, which can reduce the amount of water. " Therefore, all diseases caused by triple energizer should pay attention to soothing the liver and regulating qi, and later generations should often add products that promote qi and control water, which is the whole meaning. The clinical syndrome of Jiang's syndrome is often based on dispersing triple energizer, transforming qi and promoting water circulation, which is also proved by taking Bupleurum root as the guide and starting with the liver controlling diarrhea.
2. The liver governs excretion and emotion.
Emotional activity is closely related to the antidiarrheal function of liver, and one of the important functions of liver antidiarrheal is to regulate emotion. Emotion is based on blood (essence) (material basis) and qi is used (functional basis). The influence of emotional abnormality on the body is mainly manifested in interfering with the normal operation of qi and blood. In fact, the reason why the function of the liver governing catharsis can affect people's emotional activities stems from the physiological functions of the liver governing catharsis, regulating qi and promoting blood circulation. If the excretory function of the liver is normal, the qi is smooth, the qi and blood are harmonious and the mood is happy. The liver loses the function of dispersing qi, the qi is not smooth, and the mood is depressed, which is called "depression due to illness"; On the other hand, abnormal emotional activity will lead to the disorder of qi-flowing, which often affects the function of dispersing and discharging the liver. In people's emotional activities, anger has the greatest influence on the flow of qi controlled by the liver. Anger hurts the liver. Anger can be divided into rage and depression. In a rage, Su Wen's Theory of Great Pain said, "Anger begets anger". Therefore, anger can make liver qi rush upward, even liver wind move inward, causing a series of clinical manifestations, which is called "anger disease". Depressed anger refers to daring to anger but not to speak, which can lead to stagnation of qi and make the liver lose its function of dispersing qi. In addition to the manifestations of stagnation of liver qi, it can further develop into liver depression attacking the stomach, which is called "depression disease". Yang Tang said to Shan Yun, "The liver ... keeps the spirit in and out, mixed with sorrow and joy." Emphasize the regulating effect of liver qi on mood and consciousness. Treatment also begins with soothing the liver and regulating qi. In Su Wenzhizhen's treatise, it is said that "the fish is a big branch". For example, in Treatise on Febrile Diseases, Chaihu plus Gulong Muli Decoction is used to treat chest tightness, upset and delirium.
3. The liver governs the catharsis and viscera.
3. The effect of1on lung governing and descending; The lung is located in the upper jiao, which controls qi, and the liver controls qi, which can be declared normally. If the liver loses the function of activating qi and relieving depression, lung qi will be unfavorable, and symptoms such as wheezing and chest tightness will inevitably appear. As "Introduction to Medicine" said: "I am afraid, worried and depressed, and I am bored. Wheezing, wheezing, shortness of breath, no phlegm sound "is. "Su Wen Meridian Differentiation Theory" says: "Fear of falling, exhaled in the liver." "On Su Wenke" says: "Liver cough, pain under the chest and hypochondrium". They all reveal the mechanism of asthma and cough caused by liver failure and lung failure. Clinically, on the basis of liver depression and internal injury, exogenous pathogens are also common. Every time you are in a bad mood, you will feel evil spirits, and the treatment should be based on soothing the liver and relieving depression, dispersing the lung and dispelling evil spirits.
3.2 Influence on the heart controlling blood and storing spirit; The heart is in focus, and the main blood hides the spirit. However, the normal operation of blood depends on the promotion of qi, and the regulation of qi and the operation of blood depend on the function of liver in regulating and expelling qi. If the liver loses the function of activating qi and relieving depression, it will lead to obstruction of qi stagnation and blood stasis, which often leads to chest obstruction and heartache. If great anger injures the liver, and the liver qi is contrary to the heart, it is a syndrome of fright, palpitation, syncope, heartache and even coma. "Difficult Classics Eighteen Difficult Classics" says: "If the heart is anxious, liver evil will dry the heart." "Lingshu Miscellaneous Diseases" says: "Heartache leads to abdominal distension ... pricking foot and Jue Yin." Clinically, emotional factors are important pathogenic and inducing factors of cardiovascular diseases. Zhao [1] used the methods of soothing the liver and regulating qi, removing blood stasis and relieving pain to treat variant angina pectoris, and achieved satisfactory results.
3.3 Influence on spleen and stomach transport: The spleen and stomach are located in the middle jiao, mainly in Shui Gu, where the transport is subtle. It is summarized by the rise of spleen and the fall of stomach turbidity, that is, the rise and fall of spleen and stomach qi. The liver governing the drainage is beneficial to the coordination of spleen ascending and stomach descending. Only when the liver-qi is unobstructed, the qi axis is constantly moving, and the spleen rises to the stomach and falls to the stomach can it be reconciled and not get sick, and * * * will become the function of "focusing on the middle energizer". Therefore, "Su Wen Bao Quan Ming Xing Lun" said: "Land gains wood." If the liver does not drain, the wood does not drain, and the lifting is surly, it will directly affect the transportation and transformation of the spleen and stomach. If the temper does not rise, it will lead to diarrhea and loose stool, while if the temper does not hurt, it will lead to abdominal distension and abdominal pain, which is called disharmony between liver and spleen. Stomach qi rises instead of falling, causing belching, hiccups, acid regurgitation, nausea and vomiting. Obstruction of stomach qi causes abdominal pain, which is called disharmony between liver and stomach. You can give Chaihu Shugan Powder, Xiaoyao Powder and Zuojin Pill. As "Theory of Blood Syndrome" said, "The nature of wood is mainly to relieve qi. When qi enters the stomach, it depends on the qi of liver wood to relieve qi, while Shui Gu is the essence." If the liver's clear yang does not rise, it can't drain the valley, and the syndrome of osmotic fullness is inevitable. "
3.4 Influence on the gasification function of kidney and bladder; The kidney is located in the lower jiao, which controls water. Although water depends on the evaporation of kidney yang, it is also related to liver qi pivot. If the liver qi is not smooth, it will inevitably affect the gasification of kidney and bladder, and the unfavorable gasification is carbuncle, arthralgia, stranguria or flooding. Su Wen's Theory of Atmosphere says: "Liver stagnation ... no peeing." "Sixteen Difficult Classics" says: "It's hard to get a liver pulse ... if you close the stranguria." It is the syndrome mechanism of kidney and bladder qi disorder caused by liver qi deficiency. Chiang's clinical syndrome also includes edema (lupus kidney) and stranguria (urinary tract infection) [2]. Treatment with Bupleurum is beneficial to resolving phlegm, and the effect is like a drum, which is a strong evidence of the influence of soothing the liver and regulating qi on kidney, bladder and water metabolism.
3.5 The influence on gallbladder is connected with liver and gallbladder. Bile is stored in the gallbladder. Bile comes from the liver and is transformed from the residual gas of the liver. Bile leakage into the small intestine depends on the unobstructed gas. Therefore, the activity, secretion and excretion of bile depend on the function of the liver to control excretion. When the liver is drained as usual, bile is excreted smoothly, which is helpful for the digestion and absorption of food and drink. If the liver is not excreted smoothly, which affects the secretion and excretion of bile, and the bile is small and thick, and the excretion is not smooth, hypochondriac pain, bitter taste, indigestion, boredom and even jaundice will occur. Therefore, the clinical treatment of gallbladder diseases should be based on soothing the liver and benefiting the gallbladder, and we must maintain a good mood. 4. The liver governs the drainage, and the yin organs of both male and female meridians pass through the liver meridian. The spermatorrhea of men and menstruation of women are also closely related to the liver governing the drainage. The normal excretion of male sperm is the result of the joint action of liver and kidney. When the liver meridian discharges semen as usual, the semen is discharged smoothly and moderately, and when the liver meridian discharges, the semen is discharged excessively or poorly. Clinical impotence, non-ejaculation and chronic prostatitis are all related to liver failure. Take impotence as an example, less than 10% of patients have organic diseases, mostly psychological factors, which are used to soothe the liver and regulate qi, and they always gain something. Harmony between qi and blood is an important condition for women to discharge menstrual blood smoothly and moderately. If the liver-qi is regulated, the blood vessels circulate, the pulse gas is vigorous, and the blood sea is full, the menstrual period will be normal and the menstrual flow will be smooth. If the liver has no right to vent, qi and blood are disordered, the impulse and ren are abnormal, and the blood stasis is abnormal, the menstruation is irregular, and the menstrual flow is more or less, or even leaking. Qi stagnation leads to blood stasis stagnation, so menstruation is dark red and menstruation is not smooth; If the blood circulation is not smooth, it will hurt, then dysmenorrhea will occur, and even the pulse will be blocked, thus causing amenorrhea. Liver qi stagnation, qi stagnation in the liver meridian, the liver meridian is distributed under the chest and hypochondrium and passes through the lower abdomen, and it is full of qi before or during menstruation. The combination of the two affects the smoothness of menstrual blood, leading to stagnation of liver meridian, which is manifested as breast pain before and during menstruation. Wang [3] thinks that women are born with a liver, and gynecological diseases are mostly related to liver failure, and the method of soothing the liver and relieving depression is often effective. 5. Liver main discharge and modern research Some scholars have found that liver main discharge is closely related to the excitement and inhibition of cerebral cortex and the functional state of autonomic nerves (especially sympathetic nerves) [4,5]. Stagnation of liver qi is closely related to the abnormality of the central nervous system in regulating mental and emotional functions [6, 7]. Zhong et al [8] found that some patients with hyperthyroidism had abnormal liver function. According to the theory of traditional Chinese medicine, this abnormality may be mainly caused by the abnormality of the liver governing the discharge, suggesting that the function of the liver governing the discharge seems to have a certain relationship with the onset of hyperthyroidism. Yan et al. [9] found that the immune function of patients with liver depression syndrome and rats with liver depression syndrome decreased, and thought that the theory of liver governing and relieving diarrhea in traditional Chinese medicine had its modern immunological basis. The main functions of TCM liver should include the immune system function of modern medicine. Ling [10] thinks that "liver" plays a bridge role between the brain and digestive function, and the liver governs the discharge, which is related to brain-gut peptide. Therefore, the stagnation of liver-qi caused by liver-qi stagnation, in addition to mental and emotional abnormalities, often appears anorexia, belching, abdominal distension, abdominal pain, diarrhea and other digestive system symptoms. Some scholars believe that the function of the liver governing the discharge plays a decisive role in the body's psychological stress, and the liver of traditional Chinese medicine is the core of the body's psychological stress response [1 1, 12].
To sum up, it can be seen that the function of the liver governing the discharge has a certain mechanism of neuroendocrine _ immunomodulation (NIM) network. There are many interactions and adjustments between neuroendocrine and immune systems mediated by neurotransmitters, neuropeptides, hormones and immune factors, forming a NIM network on the whole level. NIM network is the fundamental basis for maintaining the balance and stability of internal environment and physiological functions.
The essence of the connotation of the liver governing the discharge is to keep the whole body qi flowing smoothly and regulate the normal operation of the body's essence, qi, spirit, blood and water. The purgative function of the liver is a summary of the basic forms of the functional activities of human viscera. Zhao said to him, "covering your liver is impatient and angry ... so when you talk about it, you get dizzy and tinnitus, and your eyes are red;" In the middle, chest is full of hypochondriac pain, or swallowing acid; When it occurs in the lower abdomen, it is a small abdominal pain and hernia, but it is not good for drowning; Outside, it's hot and cold, like malaria, not malaria. These symptoms are not like liver depression. " "Reading Medical Essays" said: "Doctors are good at regulating the liver, and the liver is good at treating all diseases. Neijing said that lifting and dispersing qi can regulate. Therefore, Dongyuan talks about spleen and stomach, Hejian talks about Fu Xuan, Danxi talks about depression, and Shi Tian talks about dredging collaterals, which is nothing more than soothing the liver. " It can be seen that the liver does not drain water, which leads to all diseases, but it can cure all diseases if it is good at regulating the liver and draining it as usual. It is of great clinical significance to understand the overall regulation of liver on the body.