PMS - Liver Depression Transforming into Fire Pattern

Dr. Li Wei, DACM

PMS · Liver Depression Transforming into Fire Pattern

Updated: June 23, 2026

Reviewed by: Dr. Li Wei, DACM

Reading Time: 7 min

Body Area: Pelvis

Pattern Overview

Liver Depression Transforming into Fire is a common pattern in PMS, characterized by luteal phase neurotransmitter fluctuation, irritability, headache, insomnia, acne, and premenstrual migraine. The core pathogenesis is Liver-Qi stagnation transforming into Fire, leading to neurotransmitter imbalance, elevated prolactin, and emotional and physical symptoms.

Key Symptoms and Differentiation Points

| Differentiation Dimension | Manifestations |

| :— | :— |

| Primary Symptoms | Irritability, headache, insomnia, acne, premenstrual migraine |

| Associated Symptoms | Red eyes, bitter taste, constipation, hot flashes, restlessness |

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

| Pathogenesis | Liver-Qi stagnation transforming into Fire |

| Etiology | Hormonal changes, chronic stress, irritability, emotional distress |

Acupuncture Point Prescription

| Point | Location | Function |

| :— | :— | :— |

| Ganshu (BL18) | Lower back, 1.5 cun lateral to T9 | Back-Shu point of Liver meridian; soothes Liver-Qi |

| 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 |

| Dadun (LR1) | Lateral side of the big toe, 0.1 cun from the nail corner | Well point of Liver meridian; clears Liver Heat |

| Neiguan (PC6) | 2 cun above the wrist crease, between the tendons | Relieves chest tightness and calms the spirit |

Clinical Recommendation: Filament needle, reducing method; Xingjian may be pricked to bleed to enhance Liver Fire drainage.

Herbal Formula

Base Formula: Dan Zhi Xiao Yao San (丹栀逍遥散) or Hua Gan Jian (化肝煎)

Composition:

Moutan (Dan Pi), Gardenia (Zhi Zi), Bupleurum (Chai Hu), White Peony (Bai Shao), Angelica (Dang Gui), Green Tangerine Peel (Qing Pi), Alisma (Ze Xie), Fritillaria (Bei Mu), Licorice (Gan Cao)

Action: Soothes Liver-Qi, clears Fire, and regulates menstruation.

Modifications

| Associated Symptoms | Additions/Subtractions |

| :— | :— |

| Premenstrual migraine | Add Ju Hua, Xia Ku Cao to clear Liver Fire |

| Acne | Add Jin Yin Hua, Lian Qiao to clear Heat and detoxify |

| Insomnia | Add Suan Zao Ren, Yuan Zhi to calm the spirit |

| Constipation | Add Da Huang to drain heat |

Western Mechanism Reference

Luteal phase neurotransmitter fluctuation with decreased 5-HT, GABA dysfunction, and elevated PRL. Liver Depression Transforming into Fire corresponds to PMS with prominent irritability and physical symptoms, where decreased serotonin and GABA dysfunction contribute to mood changes, while elevated prolactin contributes to breast tenderness and other physical symptoms.

References

  1. Gynecology of TCM - PMS with Liver Fire.

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

  3. WHO. (2023). Women’s health. World Health Organization.

Explore More

  • Find your solution at MendGod.com – Personalized herbal protocols and acupressure tools for women’s health.

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