Chest and Stomach Pain That Flares Up When You Get Angry?

People search for: chest pain / stomach pain too / stomach ache whenever I get angry / feel like vomiting after anger / face turning yellow and green / stomach pain under stress

The medical terms behind it: liver wood overacting on spleen earth · liver fire invading the stomach · pain in the chest and abdomen · weakness of the spleen and stomach

The opening: a good doctor reads the face first — liver and spleen problems show up right there

Today we continue with the case stories of Doctor Xue Lizhai (薛立斋), the Ming-dynasty imperial physician who served as head of the Imperial Medical Institute and left behind more than three thousand case records. These two cases today share one striking feature: before the patient says a word, the doctor reads the face. A quick look at the complexion, and he already knows where the liver and spleen stand.

💬 Note from Doctor Luo: Doctor Xue Lizhai put inspection (wang zhen) — the first of the four diagnostic methods — to brilliant use. The classics say, “One who knows by looking is called a sage.” These two cases are textbook demonstrations of “reading the face to diagnose the liver and spleen” — which is why today’s lecture is titled: Liver-spleen problems — visible at a glance.

Patient one: Tang Yibu — a month of chest pain, then the stomach joined in

The first patient was an official in the Ming-dynasty Ministry of Rites. (“Yibu” was the department in charge of ceremonial protocol — roughly a senior civil servant in today’s ministries.) This official suffered pain inside the chest — a dull, hidden ache in the chest cavity. After more than a month of this, the trouble spread: his stomach began to hurt too.

💬 Note from Doctor Luo: Watch this progression: first the chest hurt, then the belly joined in. In Chinese medicine, these two areas point to two organs — the chest relates to the liver, the abdomen to the spleen. One patient with pain in both places means the illness sits between the liver and the spleen. Doctor Xue Lizhai already had a strong hunch.

One pulse reading, and the answer is even clearer: liver wood overacting on spleen earth

Doctor Xue took the pulse: the left guan position was wiry and long; the right guan position was wiry and tight.

The left guan position reflects the liver — a wiry quality is the liver pulse’s natural color, and wiry and long means liver qi is bound up and stagnant, jammed tight. The right guan position reflects the spleen — the spleen pulse should not be wiry at all; now the right guan was wiry and tight too, which tells you the stagnated liver qi has marched over and started bullying the spleen and stomach.

💬 Note from Doctor Luo: This is the model we keep coming back to — liver wood overacting on spleen earth. The liver belongs to wood, the spleen to earth, and wood overcomes earth. When the emotions turn sour and liver qi stagnates, the first organ to take the beating is the spleen and stomach. Doctor Xue Lizhai put it in one sentence: “This is spleen deficiency caused by liver pathogen” (此脾虚，肝邪所成) — the spleen and stomach were already weak, and the liver came along to bully them, so both organs failed together.

The prescription: Buzhong Yiqi Tang with ban xia and mu xiang — lifting and descending at once

With the mechanism clear, the formula wrote itself: Buzhong Yiqi Tang (Tonify the Middle and Augment Qi Decoction), plus ban xia (pinellia) and mu xiang (costus root).

💬 Note from Doctor Luo: The beauty of this formula lies in four characters: “there is lifting, there is descending.” Buzhong Yiqi Tang lifts the qi mechanism — it tonifies the spleen and sends the clear qi upward. But this patient’s liver qi was stagnant, and lifting alone won’t do — you have to open up the qi in the chest. So he added ban xia, which sends qi downward, and mu xiang, which moves qi, dispersing the stagnant knot. Lift and descend together, and the qi in the chest flows smoothly again.

The result? Two doses cured it. Then for follow-up he gave Liu Jun Zi Tang (Six Gentlemen Decoction) — two more doses to tonify the spleen and lock in the recovery. Four doses in all, and the illness was gone.

💬 Note from Doctor Luo: See Doctor Xue’s pattern: first use Buzhong Yiqi Tang plus qi-moving, qi-descending herbs to straighten out the immediate mess, then use Liu Jun Zi Tang to tonify the spleen as aftercare — his eyes never leave the spleen and stomach. That is his governing strategy: when the liver is sick, it will transmit to the spleen, so first strengthen the spleen.

The key stroke of the whole case: a yellow face tinged with green

The original case record ends with one line: his complexion was yellow tinged with green (面色黄中见青). Don’t underestimate that sentence — it is the decisive diagnostic clue.

💬 Note from Doctor Luo: Chinese medicine gathers information from many angles — the location of the pain, the pulse, the complexion — and none can be left out, because a person is a three-dimensional being. This man’s face was yellow — yellow is the color of the spleen, and when yellow dominates the face, that means spleen deficiency. Within that yellow there was a greenish cast — green is the color of the liver — just like a tree: when a person’s emotions are off, a greenish tint tends to surface on the face. Yellow tinged with green — spleen deficiency and liver stagnation, both present at once. So the moment he walked through the door, Doctor Xue already knew.

What does a normal Asian complexion look like? “Red and yellow, faintly” (红黄隐隐) — a subtle flush of red and yellow underneath, the color of health. When yellow dominates, the spleen is deficient; when green surfaces, the liver qi is not flowing. That is the art of inspection.

The craft of inspection: the Huangdi Neijing laid it all out long ago

Speaking of inspection, Doctor Luo shares a deeply moving memory.

💬 Note from Doctor Luo: The Huangdi Neijing (Yellow Emperor’s Classic of Internal Medicine) actually places enormous weight on inspection — it describes complexions for all kinds of illnesses in precise detail. It’s all written there, but later generations paid little attention, and few people studied it. I once consulted the great master of inspection, Professor Wang Hongmo — we had a wonderful relationship. He told me: everything about inspection is already written clearly in the Neijing; it’s just that nobody took it out and practiced it separately. And the trouble is, this art doesn’t transmit easily — reading it in a book is not enough; it must be refined generation after generation, with a master guiding the apprentice. Professor Wang comes from a long line of physicians. As a child, his father would stand with him at the family gate and have him study the faces of passersby, one by one, while his father coached: “Look at this person’s complexion — what’s its character? Now look at that one…” That’s how he learned. Today, when he looks at people, he says: “To me, everyone’s face is a map of colors.” We see an ordinary face; he sees layers of color, all clear. There’s no secret to it — it’s just that the skill must be ground, little by little, to the point of mastery.

Patient two: Li Beichuan — after one fit of anger: belly pain, chest-flank distension, and a rising urge to vomit

The second patient, Li Beichuan, was also a Ministry of Rites official, like Tang Yibu. He had always been prone to stomach pain — under stress, under anxiety, it would flare up, and he had his own standard remedy: Buzhong Yiqi Tang with zhi zi (gardenia fruit) — tonifying the spleen while clearing fire. One dose and he was fine.

But one day, he got angry — at home, at work, wherever — he flew into a rage.

💬 Note from Doctor Luo: Officials in the Ming dynasty had plenty of stress too — anyone who has read Those Stories of the Ming Dynasty knows that. That day, the moment anger hit, he developed pain in the belly and distension across the chest and flanks — stomach pain, both sides of the chest bloated — plus nausea and vomiting: stomach qi pushing upward. Why vomit? Stomach qi should descend; when it rebels upward, it means liver qi is shoving it too hard. This time it was no simple liver qi stagnation — it was liver fire flaring up.

Doctor Xue took the pulse: the liver pulse was wiry and tight. Then he looked at the face: yellow tinged with green — and mixed with red. Yellow, green, and red, all three colors at once.

💬 Note from Doctor Luo: Yellow means spleen deficiency, green means liver stagnation — so what is the red? It is liver fire! Liver qi stagnation is the qi “bottled up inside”; liver fire is the qi “erupting upward.” Fire by nature flares upward, and it shoves the stomach qi up along with it — hence the vomiting. Doctor Xue’s verdict: “This is spleen qi weakness brought on by liver fire” (此脾气虚弱，肝火所成). Compared with the previous case, the only difference is the fire.

The prescription: Buzhong Yiqi Tang swallowed with Zuo Jin Wan — cured in one dose

Different mechanism, upgraded treatment: last time Buzhong Yiqi Tang with ban xia and mu xiang was enough. This time Doctor Xue still used Buzhong Yiqi Tang to tonify the spleen, but now swallowed together with Zuo Jin Wan (Left Metal Pill) — the classic formula that specifically drains liver fire.

Zuo Jin Wan is a famous classical formula created by Doctor Zhu Danxi: huang lian (coptis) as the main herb, with a small amount of wu zhu yu (evodia) — roughly a six-to-one ratio.

💬 Note from Doctor Luo: The pairing in Zuo Jin Wan is full of learning. Huang lian drains heart fire — why drain the heart? This is the principle of “when the child is excess, drain the child”: the liver belongs to wood, the heart to fire, and wood generates fire — the heart fire is the liver wood’s “child.” When liver fire rages, you drain its child: put out the heart fire, and the liver fire comes down with it. Wu zhu yu is added in only a tiny amount (about one-sixth), and it is warm in nature and enters the liver channel — a counterbalancing touch: huang lian is so cold that without it you might “freeze” the liver, so you warm things gently and move the qi — cold and heat regulated together, with clearing heat as the leading strategy. This formula is made precisely for the problems of excess liver fire: acid regurgitation, sour vomit, nausea and vomiting.

The result: one dose cured him.

💬 Note from Doctor Luo: Some people say Doctor Xue Lizhai treats slowly — but when he’s fast, he’s very fast. As long as the differentiation is right and the medicine matches the pattern, results come immediately. Look at the two cases side by side and it’s crystal clear: the first was liver qi stagnation — tonify the spleen and move the qi, done; the second was liver fire — tonify the spleen and drain the liver fire, add Zuo Jin Wan. One tonifies the spleen, one drains liver fire, and the two fit together like lock and key.

The core idea: when the liver is sick, it transmits to the spleen — so first strengthen the spleen

After both cases, Doctor Xue’s strategy stands out clearly: in people whose emotions are off, liver wood overacts on spleen earth — but the solution is not to attack the liver with all your might. It is to — tonify the spleen earth.

💬 Note from Doctor Luo: When the spleen earth is fully built up, it in turn releases the knot of stagnant liver qi — this is exactly what the Synopsis of the Golden Chamber (《金匮要略》) teaches: “When you see disease of the liver, know that it will transmit to the spleen, and first strengthen the spleen” (见肝之病，知肝传脾，当先实脾). Doctor Xue Lizhai used Buzhong Yiqi Tang to strengthen the spleen and stomach, with just a little qi-moving, liver-soothing medicine on the side — and the liver qi settled down on its own. One caution, though: once you’re well, you must regulate your emotions. If the emotions stay tangled, the illness will easily come back — so strengthening the spleen is crucial, but managing the emotions is even more crucial.

Extension: why do so many of today’s children have greenish faces?

Finally, Doctor Luo brings the discussion back to the present — children with greenish complexions are everywhere today.

💬 Note from Doctor Luo: Today’s children carry enormous pressure: homework that can’t be finished even by midnight; no moving in class — and classrooms have cameras, teachers film the students and send the clips to parents; then after school there are tutoring classes. When pressure mounts, liver qi stagnates and the face turns greenish; and liver qi stagnation always drags the spleen and stomach down with it, so spleen deficiency is extremely common too — streets are full of children with sallow, yellowish faces. What to do? Learn from the ancients: regulate the spleen and stomach first — make the spleen strong, and it in turn restrains the stagnant liver qi; add a little liver-soothing, qi-moving medicine on the side, and the person smooths out. This approach, I think, is especially useful today.

What to take away

• Read the face first. Yellow is the color of the spleen (too much yellow = spleen deficiency); green is the color of the liver (green tints = stagnant liver qi); red added on top = liver fire. Doctor Xue Lizhai could size up a patient at the door — you can learn to read your own family’s complexions too.
• Emotional problems hit the spleen first. Liver wood overacting on spleen earth is the classic chain: chest pain + stomach pain together almost always means the illness sits between the liver and the spleen.
• Don’t attack the liver — fortify the spleen. The ancient rule “when you see disease of the liver, know it will transmit to the spleen, so first strengthen the spleen” is Doctor Xue’s whole strategy: Buzhong Yiqi Tang to strengthen the spleen, a touch of qi-moving herbs (ban xia, mu xiang) to open the chest, and Zuo Jin Wan when liver fire is added to the mix.
• The pattern upgrades when fire joins in. Stagnation alone: tonify the spleen and move the qi. Stagnation plus fire (vomiting, red in the face): tonify the spleen and drain liver fire. Same foundation, one extra step — and one dose can be enough.

Organized from Doctor Luo Dalun’s commentary on Doctor Xue Lizhai’s case records; the original cases come from Xue’s Case Records (《薛氏医案》).