Cluster Headache - Liver-Gallbladder Fire Pattern

Dr. Li Wei, DACM

Cluster Headache · Liver-Gallbladder Fire Pattern

Updated: June 23, 2026

Reviewed by: Dr. Li Wei, DACM

Reading Time: 7 min

Body Area: Head

Pattern Overview

Liver-Gallbladder Fire is the core pattern in cluster headache, characterized by hypothalamic gray matter activation, trigeminal autonomic reflex, severe unilateral periorbital pain, red eye, tearing, and nasal congestion. The core pathogenesis is Liver-Gallbladder Fire blazing upward, causing trigeminal vascular activation, autonomic symptoms, and severe headache.

Key Symptoms and Differentiation Points

| Differentiation Dimension | Manifestations |

| :— | :— |

| Primary Symptoms | Severe unilateral periorbital pain, red eye, tearing, nasal congestion |

| Associated Symptoms | Bitter taste, irritability, red face, tinnitus, restlessness |

| Tongue and Pulse | Red tongue with yellow coating, wiry and rapid pulse |

| Pathogenesis | Liver-Gallbladder Fire blazing upward |

| Etiology | Emotional stress, anger, alcohol consumption, sleep disruption |

Acupuncture Point Prescription

| Point | Location | Function |

| :— | :— | :— |

| Fengchi (GB20) | Depression below the occipital bone, between the sternocleidomastoid and trapezius | Clears Liver-Gallbladder Fire and treats headache |

| Taiyang (EX-HN5) | In the depression at the temple | Key point for headache; relieves periorbital pain |

| Taichong (LR3) | Dorsum of the foot, between the 1st and 2nd metatarsals | Source point of Liver meridian; clears Liver Fire |

| Xingjian (LR2) | Dorsum of the foot, between the 1st and 2nd metatarsals, proximal to the web margin | Spring point of Liver meridian; drains Liver Fire |

| Waiguan (TE5) | 2 cun above the wrist crease, dorsal side | Unblocks the Triple Energizer meridian; treats headache |

Clinical Recommendation: Filament needle, reducing method; Fengchi and Taiyang may be pricked to bleed to enhance Fire clearing. Strong stimulation may be used during acute attacks.

Herbal Formula

Base Formula: Long Dan Xie Gan Tang (龙胆泻肝汤)

Composition:

Gentian Root (Long Dan Cao), Scutellaria (Huang Qin), Gardenia (Zhi Zi), Bupleurum (Chai Hu), Rehmannia (Sheng Di), Angelica (Dang Gui), Alisma (Ze Xie), Akebia (Mu Tong), Licorice (Gan Cao)

Action: Clears Liver-Gallbladder Fire, drains Damp-Heat, and relieves headache.

Modifications

| Associated Symptoms | Additions/Subtractions |

| :— | :— |

| Severe headache | Add Chuan Xiong, Bai Zhi, Quan Xie to enhance pain relief |

| Red eye and tearing | Add Ju Hua, Xia Ku Cao to clear Liver Fire |

| Irritability | Add Mu Li, Long Gu to calm the spirit |

| Constipation | Add Da Huang to drain heat |

Western Mechanism Reference

Hypothalamic gray matter activation triggering trigeminal autonomic reflex, with posterior hypothalamic activation and CGRP release. Liver-Gallbladder Fire corresponds to cluster headache, where hypothalamic activation and trigeminal vascular activation contribute to severe periorbital pain and autonomic symptoms.

References

  1. Internal Medicine of TCM - Headache with Liver Fire.

  2. Zang-Fu Pattern Differentiation: Liver Fire → Clearing Pathway.

  3. Bartsch, T., et al. (2023). Cluster headache: pathophysiology and management. The Lancet Neurology, 22(7), 672-684.

  4. WHO. (2023). Headache disorders. World Health Organization.

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