Irritable Bowel Syndrome - Liver Depression with Spleen Deficiency Pattern

Dr. Li Wei, DACM

Irritable Bowel Syndrome · Liver Depression with Spleen Deficiency Pattern

Updated: June 23, 2026

Reviewed by: Dr. Li Wei, DACM

Reading Time: 7 min

Body Area: Abdomen

Pattern Overview

Liver Depression with Spleen Deficiency is the most common pattern in irritable bowel syndrome (IBS), characterized by gut-brain axis dysregulation, abdominal pain triggered by stress, alternating diarrhea and constipation, and bloating. The core pathogenesis is emotional stress causing Liver Qi depression, which overacts on the Spleen, leading to visceral hypersensitivity and abnormal gut motility.

Key Symptoms and Differentiation Points

| Differentiation Dimension | Manifestations |

| :— | :— |

| Primary Symptoms | Abdominal pain with stress, bloating, alternating diarrhea/constipation |

| Associated Symptoms | Irritability, frequent sighing, chest tightness, poor appetite |

| Tongue and Pulse | Pale red tongue with thin white coating, wiry pulse |

| Pathogenesis | Liver depression overacting on the Spleen, causing Qi dysfunction |

| Etiology | Chronic stress, emotional distress, irregular eating habits |

Acupuncture Point Prescription

| Point | Location | Function |

| :— | :— | :— |

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

| Tianshu (ST25) | 2 cun lateral to the umbilicus | Front-Mu point of Large Intestine; regulates bowel function |

| Zusanli (ST36) | 3 cun below the patella, 1 finger-width lateral to the tibial crest | Strengthens Spleen and Stomach; tonifies Qi |

| Pishu (BL20) | Lower back, 1.5 cun lateral to T11 | Back-Shu point of Spleen meridian; strengthens Spleen Qi |

| Sanyinjiao (SP6) | 3 cun above the medial malleolus | Regulates Qi and Blood; harmonizes Liver and Spleen |

Clinical Recommendation: Filiform needle, reducing method for Liver points, reinforcing method for Spleen points; combine with stress reduction techniques.

Herbal Formula

Base Formula: Chai Shao Liu Jun Zi Tang (柴芍六君子汤) + Tong Xie Yao Fang (痛泻要方)

Composition:

Bupleurum (Chai Hu), White Peony (Bai Shao), Ginseng (Ren Shen), Atractylodes (Bai Zhu), Poria (Fu Ling), Tangerine Peel (Chen Pi), Saposhnikovia (Fang Feng), Licorice (Gan Cao)

Action: Soothes Liver Qi, strengthens Spleen Qi, stops diarrhea, and relieves pain.

Modifications

| Associated Symptoms | Additions/Subtractions |

| :— | :— |

| Severe abdominal pain | Add Yan Hu Suo, Chuan Lian Zi to regulate Qi and stop pain |

| Diarrhea-predominant | Add Shan Yao, Yi Yi Ren to strengthen Spleen and stop diarrhea |

| Constipation-predominant | Add Zhi Ke, Hou Po to regulate Qi and promote bowel movement |

| Bloating | Add Mu Xiang, Sha Ren to regulate Qi and relieve distension |

Western Mechanism Reference

Gut-brain axis dysregulation causing visceral hypersensitivity, abnormal gut motility, and CRH-induced intestinal movement. Liver Depression with Spleen Deficiency corresponds to IBS associated with stress, where HPA axis activation and CRH release contribute to visceral hypersensitivity and abnormal gut motility.

References

  1. Internal Medicine of TCM - Diarrhea with Liver Overacting on Spleen.

  2. DB-XJB: Chai Shao Liu Jun Zi Tang.

  3. Lembo, A., et al. (2016). Acupuncture for IBS. American Journal of Gastroenterology, 111(8), 1145-1153.

  4. WHO. (2023). Digestive health. World Health Organization.

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