Many people experiencing emotional stagnation, chest and flank distension, or other "liver stagnation" symptoms often think first of relieving liver qi to resolve depression. However, some find that liver-soothing medications have little effect or that symptoms recur. From the holistic perspective of Traditional Chinese Medicine (TCM), this may be due to overlooking the role of "Heart Yang."

TCM holds that the heart is the sovereign organ, governing blood vessels and housing the spirit. Heart Yang warms and propels the circulation of qi and blood throughout the body. The liver governs the free flow of qi and regulates its movement, but for its functions to operate normally, it relies on the warming and supportive role of Heart Yang. If Heart Yang is insufficient, it’s like sunlight being too weak—trees struggle to grow and stretch, and liver qi likewise easily becomes stagnant and constrained.

People with long-term liver stagnation often experience not only low or irritable moods but may also exhibit symptoms of deficient heart yang, such as cold hands and feet, aversion to cold, preference for warmth, mental fatigue, palpitations, and chest tightness. In such cases, if only liver stagnation is addressed without warming yang, the therapeutic effects are often difficult to sustain.

To address this situation, two classic prescriptions from the medical sage Zhang Zhongjing can be referenced for regulation:

Cinnamon Twig and Licorice Decoction (Guizhi Gancao Tang): This formula contains only two ingredients—cinnamon twig and licorice. Cinnamon twig, with its pungent, sweet, and warming properties, can invigorate heart yang and warm the meridians; licorice tonifies the middle and boosts qi while harmonizing the medicinal properties. When combined, these two herbs focus on supplementing heart yang. When heart yang is sufficient, blood and qi are warmed and flow smoothly, indirectly assisting in the free movement of liver qi.

Frigid Extremities Powder (Sini San): Composed of bupleurum, peony root, immature bitter orange, and licorice, this formula excels at relieving liver stagnation, regulating the spleen, and dispersing depressed yang. It is a classic prescription for regulating stagnant qi. Used in combination with Cinnamon Twig and Licorice Decoction, it addresses both the root and the symptoms—warming heart yang to treat the root cause while also relieving liver stagnation to address the symptoms.

Reference to a real-life case

I once treated a 42-year-old female patient who had been under long-term work pressure, experiencing low mood, flank distension, chest tightness, cold hands and feet in winter, and difficulty falling asleep. She had been taking liver-soothing and qi-regulating medications on her own for several months, but her symptoms recurred intermittently. Examination showed a pale tongue with white coating and a deep, thin, wiry pulse, indicating insufficient heart yang and constrained liver qi. I advised her to discontinue the original medication and prescribed a modified combination of Guizhi Gancao Decoction (Cinnamon Twig and Licorice Decoction) and Sini Powder. At the follow-up visit two weeks later, she reported that her hands and feet had warmed up, her chest tightness had lessened, and her sleep had improved somewhat.

Applicable situations and precautions

This method is suitable for those with liver stagnation accompanied by insufficient heart yang, with typical manifestations such as emotional discomfort, chest and hypochondriac fullness, as well as aversion to cold, cold limbs, fatigue, and palpitations.

The following groups are advised not to use this on their own:

Those with a heat-prone constitution, prone to internal heat, or with a red tongue and yellow coating;

Individuals with yin deficiency and fire excess or excessive internal heat;

Pregnant women and those currently taking other medications.

Conclusion

Regulating liver stagnation should not focus solely on the liver; treating from the perspective of the heart and warming and unblocking yang qi often yields good results. The combination of Guizhi Gancao Decoction and Sini Powder embodies the holistic approach of Chinese medicine—"warming yang to soothe the liver." It is recommended to use these remedies under the guidance of a physician while maintaining emotional ease and moderate exercise to better restore the balance of qi circulation.