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Chaihu shugan san (Fig. 16-3), a representative of liver smoothing and depression releasing formula, consists of seven medicinals: chaihu (Radix Bupleuri) 6g, chenpi (Pericarpium Cirri Reticulatae) 6g, chuanxiong (Rhizoma Ligustici Chuanxiong) 5g, xiangfu (Rhizoma Cyperi) 5g, zhiqiao (Fructus Aurantii) 5g, shaoyao (Radix Paeoniae) 5g, and zhigancao (Radix Glycyrrhizae Praeparatae) 3g.

This formula can smooth the liver and release depression, move qi and relieve pain. Therefore the formula is applied to treating the pattern of liver depression and qi stagnation. This pattern is marked by depressed mood, frequent sighing, feeling of a foreign body in the throat, distension, oppression and scurrying pain in the chest or lesser abdomen, distended pain of the breast and menstrual irregularities in women, white tongue coating and string-like pulse.*

Fig. 16-3 The composition of chaihu shugan san

This pattern arises when failure of liver qi in free coursing leads to qi stagnation in associated regions, mostly caused by emotional upset. Sometimes this pattern can also be caused by a pathogen obstructing the liver meridian, or diseases of other viscera affecting the liver qi.

The liver has the function of free coursing and regulating emotions. When the liver qi is depressed, body qi, especially the qi in liver meridians, cannot circulate efficiently, and the emotions cannot be regulated normally. In this condition, depressed mood and frequent sighing may occur, along with distension, oppression and scurrying pain in the chest or lesser abdomen. Depressed liver qi can transform into fire which can scorch fluid into phlegm. When liver qi brings the phlegm up, the phlegm can stagnate in the throat. Then, the patient will have the sensation of a foreign body in the throat. Thoroughfare and conception vessels pertain to the liver. Therefore, depressed liver qi and qi stagnation may cause disharmony of the two vessels, resulting in distended pain of the breast and menstrual irregularities in women. String-like pulse is a sign of liver diseases.

Chaihu is bitter and pungent, and slightly cold in nature and enters the liver and gallbladder meridians. It is a main medicinal for smoothing liver qi and regulating emotions, and therefore, serves as the sovereign medicinal in this formula. Xiangfu is pungent, slightly bitter and sweet, and mild in nature and enters the liver and triple energizer meridians. It can soothe the liver and regulate qi, and move qi and relieve pain. Chuanxiong has pungent and warm properties and enters the liver, gallbladder and pericardium meridians. It promotes the circulation of the blood and qi; therefore, it can also relieve pain. Xiangfu and chuanxiong are used as minister medicinals to assist chaihu in smoothing the liver and regulating qi. Chenpi can regulate qi, resolve qi stagnation and harmonize the stomach. When processed with vinegar, it enters the liver meridian and moves liver qi. Zhiqiao smooths the liver and regulates the spleen, and it can move qi to relieve pain. Shaoyao and gancao nourish the blood to emolliate the liver. The latter four medicinals act as assistants in this formula, and gancao also acts as a courier as it mediates all the other medicinals. This formula employs the seven medicinals to achieve the function of smoothing the liver and releasing depression, and moving qi and relieving pain.