Lost in the woods: Chinese medicine, depression, and the liver

chinese medicine depression portland

I’ve briefly discussed depression in past articles, specifically that depression that can arise from a closed heart wherein a person loses the ability to feel joy. Today I want to turn to a more common kind of depression: stagnation of liver qi.

In Chinese medicine, as in western medicine, the liver has an extraordinary number of functions.

Paramount among these is the smooth circulation qi and blood in the entire body, in a cyclical and rhythmic way. The liver also “stores” the blood, which is a function closely linked with hormonal cycles in both women and men, and with the circulation of blood in the lower abdomen.

Emotionally, when we are in balance our liver helps us to strategize and plan our way around obstacles.

The liver is deeply connected to the sympathetic or “fight or flight” nervous system, and it takes charge when we need a dose of healthy fear or anger to get ourselves out of dangerous situations. Our ability to manifest healthy anger, to set boundaries or reestablish them when they are violated, is a liver function.

As with anything tasked with so many jobs, the liver tends to be the bottleneck in our bodies where things get stuck.

Liver issues are the most common presentation in any Chinese medicine clinic. Because the liver is managing the flow of qi and blood in the entire body, any problem with either substances anywhere will cause extra stress on it. This is true for physical illness and injury, but more often applies to any kind of emotional stress.

If your life is putting you in positions where you feel frustrated, anxious or unsafe in a chronic way, this will eventually wear down the liver organ and channel’s ability to smooth things out. When the liver gets overwhelmed, quite a wide variety of symptoms can manifest.

The liver channel begins on the foot and runs up the inner leg, over the belly and then winds around the ribs before diving into the chest. When qi and blood stop moving smoothly, or stagnate, people will often experience a painful stuck sensation in the ribs. This is often diagnosed as costochondritis, or inflammation of the rib junctions. The rib junctions are indeed inflamed, because they are no longer receiving what they need from the channel that runs through them.

In general the liver supplies all of the tendons and sinews in the body with blood, so stiffness and pain around the joints often occurs with liver pathology. Cold hands and feet, even to the point of turning white or black, can be a symptoms of liver channel problems if the organ is unable to send the blood all the way out to the ends of the limbs. Cramping in the intestines is also common, because the rhythmic flow of the healthy liver keeps GI tract in time.

In terms of a person’s inner world, the liver’s function of healthy anger can turn inward to create frustration and even rage that is self-directed.

This kind of reversed anger congeals, over time, into a toxic and volatile kind of depression. People stuck in the wilderness of liver pathology often lose the ability to see their way out of the situation that are causing them pain, because the liver’s ability to persevere and plan an escape has been impaired. They are often morose and argumentative; the kind of depressed person who will argue with anyone who tries to cheer them up, almost as if they don’t want to stop feeling sad.

It must be said here that Chinese medical pathology in the liver does not always correlate with frank biomedical liver disease.

Chaihu 柴胡 Bupleurum chinensis plant – the main ingredient in Xiao chaihu tang

Liver qi stagnation is the beginning of a long process of possible decline, during which the biomedical liver might become subtly less efficient in its function. If left unchecked for years, this can manifest in the physical body as frank liver disease, but our aim is to treat it before things progress that far.

In Chinese medicine, most treatments are fairly straightforward in their logic. If something is blocked, unblock it. If it’s empty, fill it with something. For the liver, if it has become stagnant, we get it moving again and smooth it out. One easy way to accomplish this goal is to needle the liver channel, and channels connected to it. As the flow of qi is corrected, mostly people feel significant relief from their symptoms.

Another strategy for smoothing the liver qi is to prescribe herbal remedies that balance the liver with other organs, a technique we call “harmonizing” the liver. One common Chinese herbal formula that accomplishes this goal is Xiao chaihu tang 小柴胡湯, which unblocks the flow of qi in the Liver while simultaneously building the qi of the Earth organs, Spleen and Stomach.

Liver issues can range from mild and transient to chronic and longterm.

A traffic jam will cause mild to moderate liver qi stagnation in everyone. An emotionally abusive boss can cause severe liver qi stagnation that can lead to pelvic pain, menstrual irregularity and chronic depression. Whatever the presentation, the good news is that healing is always possible.

This article is not intended to help you diagnose yourself or your friends, but simply to shed light on how Chinese medicine understands and treats emotional distress. Your particular depression or rib pain may or may not fit this Chinese medical pattern, which is why finding a qualified practitioner who can diagnose and treat your condition is important. If you’ve enjoyed my articles, why not get on my schedule to get yourself on a path to healthier Liver qi!

Written by Rowan Everard


I discovered Chinese medicine shortly after moving to Portland to complete my undergraduate studies. I began my journey as a patient, but after several years of being an increasingly curious patient I found myself drawn into the formal study of this medicine. In Chinese medicine, I found tools that helped me to transform myself, and which I have seen lead to dramatic positive shifts in patients.