Andrew, There is a young woman, 23, who has all the signs of liver invading the spleen. Alternating constipation with diarrhea, although tends towards the constipation. Experiences nausea and lack of appetite. Very thin and pale, not the best eating habits. Her tongue is pink, slightly red in liver areas, and a little puffy in spleen area, but nothing pronounced. I really expected to see her tongue look differently than it did based on her symptomology. One of her main complaints is of heart palpitations. I felt her pulse and detected a PVC. She has night sweats (but cold the rest of the time), experiences fatigue regularly, and fights anxiety. She's also been battling chronic EBV (resulting in bouts of splenomegaly) and high cortisol. You reiterated several times that when there are palpitations, you must consider the heart. I'm assuming she has a heart qi deficiency in addition to liver invading the spleen. Would resolving some of the liver/spleen issues resolve the heart qi issues, or would you treat the heart in addition? I read somewhere (but can't remember where!) that spleen qi deficiency can lead to a heart qi deficiency. Needing some words of wisdom:) Jami

Andrew said: Hi Jami, Yes, I did say you should consider the heart. There is a close relationship between the "lesser fire" contained within wood element (because it burns) and the "greater fire" of the fire element. Consider the fact that the liver generates heart on the five element sequence. So, if there is a wood pathology it can overact on the spleen. Additionally, an out of balance liver generates a heart that is not optimal. The solution could be to address all three at the same time= liver, heart, and spleen. You could consider starting with liver and see what clears up. It is possible that wood is the root imbalance. In clinical practice, it is common to take a peel-the-onion approach and tackle the patterns in phases. Which approach you would pick depends upon what you see fit for the client and the situation.