The 3 Tiers of Doctors Forum: Examining the Scientific Basis of ‘Anger Harms the Liver’

From the perspective of traditional Chinese medicine, the liver is considered a high-ranking commander-in-chief, leading troops into battle.
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By Jingduan Yang, M.D.
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Modern life can be exhilarating—but living at a fast pace also brings worries, stress, tension, anxiety, and even mental exhaustion. In today’s chaotic world, many people are looking for a sense of peace and good health. Dr. Yang Jingduan, a well-known Chinese psychiatrist in Philadelphia, launched a series of lectures titled “The Three Tiers of Doctors Forum” to share his insights into spiritual and physical health. The following is a general transcription of his talk:

The liver is one of the largest organs in the human body, undertaking a substantial role as the largest digestive gland and metabolic organ. According to modern medicine, the liver serves as a site for protein synthesis, storing various essential nutrients derived from food, such as vitamin B12, folic acid, and other essential substances. Blood, fatty acids like triglycerides, cholesterol, and other carriers all originate from the liver. Additionally, the liver plays a crucial role in detoxification, processing, and detoxifying various substances we ingest into the body.

From the perspective of traditional Chinese medicine (TCM), if we liken our body to a country, the liver is considered a high-ranking commander-in-chief, leading troops into battle. In other words, as long as you are awake and active, the liver, along with its corresponding organ, the gallbladder, operates continuously.

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Therefore, according to TCM, the liver not only encompasses all the functions recognized by modern medicine, such as digestion and metabolism but more crucially, it plays a key role in transporting energy throughout the body, ensuring unhindered energy flow. Additionally, the liver is believed to regulate various brain functions, including decision-making, judgment, and the execution of actions. Simultaneously, it is involved in regulating emotions, sleep, blood pressure, and other essential functions.

The Liver as the Central Hub of Energy

Traditional Chinese medicine not only perceives the human body as a biochemical entity but also recognizes it as an energetic entity. TCM’s understanding of the liver differs from Western medicine. In TCM, the concept of the liver goes beyond the physical organ—it is considered an energy center. The liver is believed to have extensive and intricate connections with other organs throughout the body via complex energy pathways known as meridians. These meridians facilitate the flow not only of blood and bodily fluids, as recognized by modern medicine, but more importantly, they facilitate the flow of energy, also known as “qi.”

Air, upon entering the body through respiration, becomes a part of qi. Similarly, food that enters the body and transforms into energy, such as adenosine triphosphate (ATP), also becomes a part of qi. Therefore, qi is not something peculiar or mysterious. Despite being invisible to the naked eye, qi, air, and ATP play crucial roles within our bodies.

In TCM, the liver is perceived as an energy system highly responsive to various forms of energy, including natural forces like wind. Wind, with its dynamic nature, rapid movement, and significant changes, shares similarities with the energy of the liver. From the TCM perspective, the liver’s energy is dynamic, serving as a crucial driving force for the circulation of both blood and energy throughout the body. It can be likened to a traffic police officer, ensuring unobstructed routes and regulating the flow of various energies according to predetermined directions—all of which are vital functions of the liver.

Emotions as Pathogenic Energies

Human emotions are, indeed, a form of energy. Joy, anger, sorrow, and happiness all represent various manifestations of energy. In the Chinese language, when discussing emotions, it is common to add the word “qi,” which means “energy.” For instance, phrases like “angry” or “joyful” include the word “qi.” From the perspective of traditional Chinese medicine, both external energies and internal emotions have a profound impact on the body’s energy system.

In TCM, there is a common saying—“anger harms the liver.” When a person experiences intense anger, the impact on the liver is significant. This anger may stem from others directing their frustration towards you, and receiving such anger can affect your liver. Likewise, if you harbor anger or resentment towards others, it will also impact the function of your liver.

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Emotions have always been regarded as highly significant in TCM. The causes of illness are categorized into internal, external, and neither internal nor external factors. One of the internal factors is emotional imbalance, and having a poor emotional state is considered a primary cause. TCM asserts that only when these internal factors are present do external factors have a more significant impact on the body. Therefore, from the perspective of TCM, emotions and mental stress play a substantial role in influencing the functions of the liver.

How do emotions and stress affect the liver and contribute to the development of liver diseases? Why do emotional and mental factors impact overall health, particularly affecting the liver?

TCM has long acknowledged emotions as a form of energy, understanding that a person’s emotional state significantly impacts overall health. Modern medicine is increasingly recognizing the impact of psychological factors on the nervous system, endocrine system, and immune system. However, in clinical medicine, these findings from modern medical science have not been fully integrated. Clinical medicine still predominantly leans towards surgery and medication, with less emphasis on the impact of psychological factors.

A team from the University of Edinburgh in the United Kingdom published a survey report in the Gastroenterology journal in 2015. The report revealed that patients experiencing psychological distress and depression had a significantly higher mortality rate from liver disease compared to other groups. The study, involving around 160,000 people, spanned approximately 10 years. The research directly emphasized the impact of depression and psychological distress on the progression and worsening of liver diseases.
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What is depression? It encompasses feelings of being down, oppressed, disheartened, disappointed, and angry, among other emotions. Depression is essentially a manifestation of anger, sometimes directed towards others, characterized by irritability, temper flare-ups, and frequent outbursts. More often, this suppressed anger turns inward, resulting in a state of depression. Therefore, extreme depression is essentially a state of extreme anger and can even lead to acts of violence or suicide. Many individuals with depression eventually progress to the point of contemplating or committing suicide. In other words, the nature of depression aligns with the TCM concept that “anger harms the liver.”

A 2020 study found that rats subjected to stress stimuli exhibited a significantly higher number of liver tumors and tumor load compared to rats not exposed to stress. Additionally, the expression levels of the biomarkers Ki67 and Survivin, associated with tumorigenesis, were higher in rats with both liver cancer and depression than in rats with only liver cancer. This suggests that rats in the liver cancer plus depression group experienced more cell proliferation and less cell apoptosis, indicating that prolonged psychological stress can lead to tumor development and cancer progression.
A study published in Nature Medicine in 2019 revealed that social defeat leads to anxiety-like behaviors in mice and diminishes therapeutic responses to carcinogen-induced neoplasias and transplantable tumors.

When people are mentally and emotionally down, they may resort to various coping methods. For example, some individuals may turn to alcohol when angry. However, alcohol consumption can harm the liver, as the saying goes, “Drinking alcohol to drown your sorrows only deepens the sorrow.” Others, when upset, may turn to eating, sometimes engaging in binge-eating unhealthy foods, leading to elevated blood sugar and blood pressure. Additionally, individuals experiencing depression may withdraw from social interactions and avoid engaging in healthy activities. All of these coping methods significantly increase the risk of cancer.

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In this context, TCM employs a vivid analogy, likening the liver to a tree. Similar to a tree that resists suppression and seeks freedom for unrestricted growth, the liver reacts adversely to attempts at suppression. Just as trees flourish freely in spring and the wind embodies a unique energy during this season, a person’s mood and emotions, characterized by a sense of ease and freedom, play crucial roles in maintaining liver health.

Therefore, whether viewed from the perspective of TCM, Western medicine, modern science, or laboratory research, it is widely recognized that mental stress and depressive emotions are crucial factors affecting overall bodily health. This is particularly evident in the significant harm they can inflict on the liver, causing substantial adverse effects on the prognosis of liver diseases, including liver cancer.

Risk Factors for Liver Cancer

The high mortality rate and limited efficacy of late-stage treatment make liver cancer prevention crucial. Apart from the influence of emotions, there are other aspects to consider.

Who is more prone to liver cancer? We have previously discussed the complexity of genetic factors. Even if someone carries these genetic factors, it does not guarantee the expression of problematic genes leading to liver cancer.

Currently, viral hepatitis infections, specifically hepatitis B and hepatitis C, are the most common causes of liver cancer, particularly in the context of chronic conditions. Following the infection of these two types of chronic hepatitis, some individuals may gradually develop liver cirrhosis, further progressing to liver cancer. Hepatitis, cirrhosis, and liver cancer form a common sequence of events. Therefore, preventing and treating hepatitis is a crucial measure in preventing the occurrence of liver cancer.

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The prevention of hepatitis B can be achieved through vaccination, but currently, there is no vaccine for hepatitis C. Therefore, understanding the transmission routes of hepatitis is crucial for prevention. The primary modes of transmission for hepatitis B and C are through blood, and many infections occur as a result of blood transfusions.

Alcohol consumption is a known risk factor for liver cancer. Consuming more than two drinks per day increases the risk of various cancers, and it can cause significant harm to the liver. There is a saying that getting drunk once is equivalent to contracting hepatitis once, which, while exaggerated, may not be too far from the truth. Long-term alcohol consumption can lead to fatty liver disease, further elevating the risk of liver cancer.

Additionally, molds, particularly aflatoxins, are a major cause of liver cancer.  Common ingredients such as peanuts, corn, rice, wheat, and various nuts can become moldy when stored in damp environments, leading to the production of aflatoxins. Therefore, it is crucial to ensure the freshness of these ingredients and check for any signs of mold before consumption.

Recently, researchers have found that conditions such as diabetes, high blood pressure, and obesity can impact the liver. This is because factors contributing to these conditions can increase the burden on the liver, potentially leading to the development of liver cancer.

Views expressed in this article are the opinions of the author and do not necessarily reflect the views of The Epoch Times. Epoch Health welcomes professional discussion and friendly debate. To submit an opinion piece, please follow these guidelines and submit through our form here.
Jingduan Yang
Jingduan Yang
M.D.
Dr. Jingduan Yang, FAPA, is a board-certified psychiatrist specializing in integrative and traditional Chinese medicine for chronic mental, behavioral, and physical illnesses. Dr. Yang is also the founder and medical director of the Yang Institute of Integrative Medicine and the American Institute of Clinical Acupuncture and the CEO of Northern Medical Center in New York state. He contributed to the books "Integrative Psychiatry," "Medicine Matters," and "Integrative Therapies for Cancer." He also co-authored "Facing East: Ancient Secrets for Beauty+Health for Modern Age" by HarperCollins and "Clinical Acupuncture and Ancient Chinese Medicine" by Oxford Press.
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