Rib Pain - Liver Qi Stagnation Pattern

Dr. Li Wei, DACM

Rib Pain · Liver Qi Stagnation Pattern

Updated: June 23, 2026

Reviewed by: Dr. Li Wei, DACM

Reading Time: 6 min

Body Area: Chest

Pattern Overview

Liver Qi Stagnation is the most common pattern in rib pain, characterized by intercostal neuralgia, distending pain, worsening with stress, chest tightness, and frequent sighing. The core pathogenesis is emotional stress causing Liver Qi stagnation, which obstructs the meridians in the rib area, leading to distending pain and chest tightness.

Key Symptoms and Differentiation Points

| Differentiation Dimension | Manifestations |

| :— | :— |

| Primary Symptoms | Distending pain in the rib area, worse with stress, chest tightness, frequent sighing |

| Associated Symptoms | Irritability, depression, hypochondriac fullness, premenstrual tension |

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

| Pathogenesis | Liver Qi stagnation obstructing the rib meridians |

| Etiology | Chronic stress, emotional distress, prolonged sitting |

Acupuncture Point Prescription

| Point | Location | Function |

| :— | :— | :— |

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

| LR14 Qimen | On the chest, 4 cun lateral to the midline, below the nipple | Front-Mu point of Liver meridian; treats rib and chest pain |

| PC6 Neiguan | 2 cun above the wrist crease, between the tendons | Luo-Connecting point; relieves chest tightness and regulates Qi |

| GB34 Yanglingquan | Depression below the head of the fibula | He-Sea point of Gallbladder meridian; regulates Qi and relieves pain |

Clinical Recommendation: Filiform needle, reducing method; combine with deep breathing exercises and stress reduction techniques.

Herbal Formula

Base Formula: Chai Hu Shu Gan San (柴胡疏肝散)

Composition:

Bupleurum (Chai Hu), White Peony (Bai Shao), Immature Bitter Orange (Zhi Ke), Cyperus (Xiang Fu), Chuanxiong (Chuan Xiong), Tangerine Peel (Chen Pi), Licorice (Gan Cao)

Action: Soothes Liver Qi, regulates Qi flow, relieves depression, and stops pain.

Modifications

| Associated Symptoms | Additions/Subtractions |

| :— | :— |

| Pronounced depression | Add Yu Jin, He Huan Pi to relieve depression and calm the spirit |

| Severe chest tightness | Add Zhi Ke, Hou Po to regulate Qi and relieve distension |

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

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

Western Mechanism Reference

Intercostal neuralgia with stress-induced muscle tension, autonomic dysfunction, and nerve sensitization. Liver Qi Stagnation corresponds to rib pain related to stress and emotional factors, where autonomic dysfunction and increased muscle tension contribute to intercostal nerve sensitization and pain.

References

  1. Database + Textbook.

  2. WHO. (2023). Musculoskeletal pain. World Health Organization.

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