Part 2 of 6 in the "Stress, sleep and TCM theory" series. The list of the other five is at the foot of this part.

Part 1 gave the definitions: 「肝主疏泄」 is about whether qi is flowing. This part answers a different question — why, in TCM theory, mood, appetite and the menstrual cycle sit under the same word.

The answer is in 「疏泄」 — the free flow — and in what it governs: qi movement.

The short version

• The WHO's 2022 standard terminology for TCM describes qi movement as classifiable into four basic forms: ascending, descending, exiting and entering. 「肝主疏泄」 is, in the theory, the functional system that keeps those four from jamming — that reading is this article's, not the standard's own words.
• The mood thread: the same standard records 「怒伤肝」 — excessive anger damages liver qi and impairs the function of liver in maintaining the free flow of qi.
• The appetite thread: the standard's 「脾主运化」 and 「胃主通降」 are two digestive qi movements, and two pattern definitions join them to the free flow.
• The menstrual thread reaches only as far as 「肝藏血」. The standard does not spell out the step between the free flow and the cycle, and this article does not fill it in.

A note: this section is general information only. For conditions like these, follow your doctor's diagnosis and treatment, and seek medical attention when you need it.

First, the things that cannot wait

⚠️ A safety note: TCM and Western medicine complement each other; it is not a choice between them. Difficulties with mood and sleep have a layer that needs professional assessment, and a TCM consultation does not substitute for that assessment. Asking for help is not weakness — there is professional support for this.

Thoughts of harming yourself — this is not something to wait on. Call 999 now, or go to the nearest hospital emergency department. To talk to someone, the Ministry of Health's Talian HEAL 15555 is open every day from 8 am to 12 midnight, public holidays included; Befrienders KL is open 24 hours on 03-7627 2929. You can also contact your doctor.

All seven items, and why each one means seeing a doctor first, are in part 5.

A note: this section is general information only. For conditions like these, follow your doctor's diagnosis and treatment, and seek medical attention when you need it.

I. The seven emotions: where stress enters the discussion of 「肝」 and 「心」

Hong Kong's Chinese Medicine Regulatory Office writes, in its article on maintaining a healthy mental state, that TCM theory calls joy, anger, worry, overthinking, grief, fear and fright the seven emotions, and holds that an emotion taken to excess affects its corresponding organ system — anger the liver, joy the heart, for example.

This is where stress enters the TCM discussion of 「肝」 and 「心」.

Worth noting: the seven emotions are a set of correspondences, not a checklist. They do not tell anyone which one they are.

II. What the free flow governs: "qi movement" (气机)

① What qi movement is. The WHO standard describes qi movement as classifiable into four basic forms: ascending, descending, exiting and entering. It carries a separate entry for 「升降出入」, described as the basic forms of qi movement.

「肝主疏泄」 — in the same standard, the liver maintains free flow of qi over the entire body — is, in the theory, the functional system whose job is to keep that ascending, descending, exiting and entering from jamming.

That is why the theory says 「肝喜条达而恶抑郁」: the standard's description is that liver qi needs to be soft and unobstructed. The 「郁」 in 「肝气郁结」 is this flow being held down.

The phrase "keep that ascending, descending, exiting and entering from jamming" is this article's reading of the two definitions above, not the standard's own words.

III. The three threads: mood, appetite, the cycle

② The mood thread. The WHO standard records 「怒伤肝」: excessive anger damages liver qi, impairs the function of liver in maintaining the free flow of qi, causes the qi to rise, and results in disordered qi and blood.

The direction runs: an emotion taken to excess → the free flow impaired → qi movement disordered. This is the path by which stress enters 「肝」 in the theory; the seven emotions in section I are the same idea. That line of arrows is this article's compression of the standard's sentence, not the standard's own form.

③ The appetite thread. In the theory, digestion is qi movement too. In the same standard, 「脾主运化」: the spleen digests water and food, absorbs and distributes nutrients; 「胃主通降」: stomach qi needs to be unobstructed and flow downward, so as to pass the primarily digested chyme down to the small intestine.

Two patterns in the standard join these up: its description of the liver–spleen disharmony pattern is that the pattern often occurs when liver qi stagnation affects the transportation and transformation of the spleen; its description of the liver–stomach disharmony pattern is that it often occurs when liver qi stagnation affects the descending of stomach qi.

In other words, in the theory's model, when the free flow jams, the two digestive qi movements are affected with it — which is why appetite and digestion file under 「肝」. That sentence is this article's reading of the definitions above, not the standard's own words.

④ The menstrual thread. In the standard, 「肝藏血」: the liver stores blood, regulates blood volume. The standard's description of the liver qi stagnation pattern also lists irregular menstruation in women.

That is the only item this article takes from that description, and it is here to show the concept's reach in the theory, not as a list to check against. The standard does not spell out the step between the free flow and the cycle, and this article does not fill it in.

All three threads are the theory's model, not a laboratory mechanism. What the Western account of stress says, and why the two languages do not translate into each other, is set out side by side in part 3. Which pattern applies, if any, is the practitioner's judgement after seeing the whole picture, and it is not in these passages.

Remember: one concept, three threads — mood, appetite and the cycle all hang, in the theory, on whether qi is flowing.

A note: this section is general information only. For conditions like these, follow your doctor's diagnosis and treatment, and seek medical attention when you need it.

The words used in this part

All four are the WHO standard's own vocabulary.

• Qi movement (气机) — the standard's description: the movement of qi, classifiable into four basic forms, namely ascending, descending, exiting and entering.
• Ascending, descending, entering and exiting (升降出入) — a separate entry in the standard: the basic forms of qi movement.
• Transportation and transformation (运化) — the two characters inside 「脾主运化」: in the standard, the spleen digests water and food, absorbs and distributes nutrients.
• Smooth downbearing (通降) — the two characters inside 「胃主通降」: in the standard, stomach qi needs to be unobstructed and flow downward, passing the primarily digested chyme down to the small intestine.

Frequently asked

Why does stress affect appetite? What does TCM say? In the theory's model, digestion is qi movement: the WHO standard's 「脾主运化」 and 「胃主通降」 are two of those movements, and the standard's descriptions of the liver–spleen and liver–stomach disharmony patterns join those two movements to liver qi stagnation. So the theory files appetite under whether qi is flowing. That is the theory's account, not a laboratory mechanism; what the Western account says about stress and stomach problems is in part 3.

Does liver qi stagnation make periods irregular? The standard's description of the liver qi stagnation pattern lists irregular menstruation in women, and this article takes only that one item, to show the concept's reach in the theory. The standard does not spell out the step between the free flow and the cycle, and this article does not fill it in — so there is no "the theory says it does" answer to this question. A change in your cycle needs a doctor's assessment in its own right; a pattern name does not explain it.

Does 「怒伤肝」 mean I am not allowed to get angry? No. That entry is about anger taken to excess impairing the liver's function of maintaining the free flow of qi. It states a correspondence inside a theory, not a rule of behaviour, and it is not a judgement about you.

Better not to: read the three threads as a self-test. The theory uses them to explain why several things are looked at together — not to decide who has what.

A note: this section is general information only. For conditions like these, follow your doctor's diagnosis and treatment, and seek medical attention when you need it.

The other five parts in this series

• Part 1: What 「肝气」 and 「心神」 mean — two definitions, and what they are not
• Part 3: The two languages side by side, and one crunch-season week
• Part 4: What TCM theory arranges day to day — six habits in one table
• Part 5: See a doctor first in these situations — seven signs, and the reason for each
• Part 6: What actually happens at the consultation — routine first, then the pattern, then the direction

👉 If you are not sure where to begin with your own stress and poor sleep, you are welcome to book an online consultation with HansMed, where a practitioner registered under the T&CM Act 2016 can assess it with you; if anything in part 5 applies, see a doctor first.

Sit with a licensed TCM practitioner from wherever you are.

HansMed Modern TCM

Sources

• World Health Organization, WHO international standard terminologies on traditional Chinese medicine, 2022 (entries 116 · 136 · 138 · 141 · 193 · 231 · 245 · 325 · 1240 · 1310 · 1315) — https://www.who.int/publications/i/item/9789240042322
• Chinese Medicine Regulatory Office, Department of Health, Hong Kong, "Health Preservation in Chinese Medicine — Maintain a Healthy Mental State" — https://www.cmro.gov.hk/html/gb/useful_information/public_health/feature_articles/Health_Preservation_in_Chinese_Medicine-Maintain_a_Healthy_Mental_State.html
• Ministry of Health Malaysia, Hospital Pendang (Kedah State Health Department), Info Kesihatan 2024 (the Talian HEAL 15555 number and its hours) — https://jknkedah.moh.gov.my/hpendang/index.php?option=com_sppagebuilder&view=page&id=139
• Befrienders Kuala Lumpur (the 24-hour line) — https://www.befrienders.org.my/

本文是「压力、睡眠与中医理论」系列的第 2 篇，共 6 篇。另外五篇的清单在文末。

第 1 篇给了定义：「肝主疏泄」讲的是气通不通。这一篇回答另一个问题——为什么在中医理论里，情绪、胃口、月经会被放在同一个词底下。

答案在「疏泄」两个字，以及它管的东西——气机。

一分钟看完

• 世界卫生组织 2022 年的中医术语标准把「气机」说明为气的运动，分为升、降、出、入四种基本形式。「肝主疏泄」在理论里就是让这四个方向不卡住的那个功能系统——这一句是本文对标准两条定义的整理，不是标准的原句。
• 情绪这条线：同一份标准记录「怒伤肝」——过怒会损害肝气，损害肝维持气顺畅流动的功能。
• 胃口这条线：标准里的「脾主运化」与「胃主通降」是消化的两个气的动作，两个证的定义把它们和疏泄接起来。
• 月经这条线只走到「肝藏血」。标准没有写出疏泄与月经之间的那一步，本文也不替它补。

小提醒：本段仅为一般知识说明。相关情况请以西医的诊断与治疗为主，并在需要时及时就医。

先说不能等的几件事

⚠️ 安全提醒：中医与西医是互相补位的关系，不是二选一。情绪与睡眠的困扰有需要专业评估的层面，中医问诊不能取代那个评估。寻求协助不是脆弱，这是有专业支援的范围。

出现伤害自己的念头——这不是可以等的事。请立刻拨打 999，或前往最近的医院急诊部。若想找人谈一谈，卫生部的 Talian HEAL 15555 每天早上 8 时至午夜 12 时开放，包括公共假期；Befrienders KL 24 小时热线：03-7627 2929。您也可以联络您的医生。

完整的七项，以及每一项为什么要先看医生，见第 5 篇。

小提醒：本段仅为一般知识说明。相关情况请以西医的诊断与治疗为主，并在需要时及时就医。

一、「七情」：压力从这里进入「肝」与「心」的讨论

香港卫生署中医药规管办公室的〈怡神养心〉一文写道：中医理论把喜、怒、忧、思、悲、恐、惊称为「七情」，认为情志太过会影响相应的脏腑，例如「怒伤肝」「喜伤心」。

压力在中医理论里，就是从这里进入「肝」与「心」的讨论。

要留意「七情」说的是一套对应关系，不是一份清单——它没有告诉任何人「您是哪一种」。

二、「疏泄」管的是「气机」

① 气机是什么。 世界卫生组织的标准把「气机」说明为气的运动，分为升、降、出、入四种基本形式。标准另有一条「升降出入」，说明它是气运动的基本形式。

「肝主疏泄」——按同一份标准，肝维持全身之气的顺畅流动——在理论里，就是负责让这套升降出入不卡住的那个功能系统。

所以理论说「肝喜条达而恶抑郁」：标准的说明是，肝气需要柔和、无阻。「肝气郁结」的「郁」字，讲的就是这个流动被压住。

这一句「让这套升降出入不卡住」是本文对上面两条定义的整理，不是标准的原句。

三、三条线：情绪、胃口、月经

② 情绪这条线。 世界卫生组织的标准记录「怒伤肝」：过怒会损害肝气，损害肝维持气顺畅流动的功能，使气上逆，导致气血紊乱。

方向是这样的：情绪太过 → 疏泄受损 → 气的流动失序。这是理论里压力进入「肝」的路径，上面第一节的「七情」讲的就是它。这一行箭头是本文对标准那一句的压缩，不是标准的写法。

③ 胃口这条线。 理论里，消化也是气的运动。按同一份标准，「脾主运化」：脾消化水谷、吸收并输布营养；「胃主通降」：胃气需要通畅并向下运行，把初步消化的食物送往小肠。

标准里有两个证把这两件事接起来：它对「肝脾不和证」的说明是，这个证常发生在肝气郁滞影响脾的运化时；对「肝胃不和证」的说明是，常发生在肝气郁滞影响胃气下降时。

换句话说，在理论的模型里，疏泄一卡，脾胃的两个气的动作跟着受影响——胃口和消化因此挂在「肝」底下。这一句是本文对上面几条定义的整理，不是标准的原句。

④ 月经这条线。 按标准，「肝藏血」：肝贮藏血液、调节血量。标准对「肝郁气滞证」的描述里，也列有女性的月经不调。

这是本文从那段描述里唯一取用的一项，用来说明这个概念在理论里的范围，不是让读者对照的清单。标准没有写出疏泄与月经之间的那一步，本文也不替它补。

三条线都是理论的模型，不是化验室的机制。 西医的压力模型怎么说、两套语言为什么不互译，第 3 篇并排放给您看。哪一个证成立、成不成立，是医师看过整体之后的判断，不在这几段里。

记住：一个概念，三条线——情绪、胃口、月经在理论里都挂在「气顺不顺」上。

小提醒：本段仅为一般知识说明。相关情况请以西医的诊断与治疗为主，并在需要时及时就医。

这篇出现的几个词

四个都是世界卫生组织那份标准自己在用的词。

• 气机（qi movement）——标准的说明：气的运动，分为升、降、出、入四种基本形式。
• 升降出入——标准列为一条独立条目：气运动的基本形式。
• 运化——「脾主运化」里的两个字：按标准，脾消化水谷、吸收并输布营养。
• 通降——「胃主通降」里的两个字：按标准，胃气需要通畅并向下运行，把初步消化的食物送往小肠。

常见问题

为什么压力会影响胃口？中医怎么说？ 在中医理论的模型里，消化是气的运动：世界卫生组织标准的「脾主运化」与「胃主通降」是其中两个动作，而标准对「肝脾不和证」「肝胃不和证」的说明，把这两个动作和肝气郁滞接了起来。所以理论把胃口放在「气顺不顺」底下。这是理论的说法，不是化验室的机制；西医怎么讲压力与胃部不适，见第 3 篇。

肝气郁结会让月经不准吗？ 标准对「肝郁气滞证」的描述里列有女性的月经不调，本文只取了这一项，用来说明这个概念在理论里的范围。标准没有写出疏泄与月经之间的那一步，本文也不替它补，所以这个问题没有一个「理论说会」的答案。月经的变化本身需要医生评估，不是靠一个证名就能解释的。

「怒伤肝」是不是说我不能生气？ 不是。标准那一条讲的是「过怒」会损害肝维持气顺畅流动的功能，说的是一套理论里的对应关系，不是一条行为规定，也没有在判断您。

不要这样做： 不要把这三条线读成一张自测表。理论用它们解释为什么几件事被放在一起看，不是用它们判断谁有什么。

小提醒：本段仅为一般知识说明。相关情况请以西医的诊断与治疗为主，并在需要时及时就医。

这个系列的另外五篇

• 第 1 篇：「肝气」与「心神」是什么——两个定义，和它们不是什么
• 第 3 篇：两套语言并排看，和加班季那一周的读法
• 第 4 篇：中医理论怎么安排作息——六个习惯的一张表
• 第 5 篇：这些情况请先看医生——七项信号，和每一项的理由
• 第 6 篇：看诊时实际会做什么——先作息，再辨证，然后才是方向

👉 如果您不确定「我这种压力大、睡不好，该从哪里谈起」，欢迎透过汉方中医的线上问诊，由依 2016 年 T&CM 法令注册的医师为您评估；若您有第 5 篇列出的情况，请先看医生。

无论身在何处，与持证中医师对坐。

汉方现代中医

资料来源

• 世界卫生组织，《WHO international standard terminologies on traditional Chinese medicine》，2022（条目 116 · 136 · 138 · 141 · 193 · 231 · 245 · 325 · 1240 · 1310 · 1315）— https://www.who.int/publications/i/item/9789240042322
• 香港卫生署中医药规管办公室，〈中医养生之“怡神养心”〉— https://www.cmro.gov.hk/html/gb/useful_information/public_health/feature_articles/Health_Preservation_in_Chinese_Medicine-Maintain_a_Healthy_Mental_State.html
• 马来西亚卫生部，Hospital Pendang（吉打州卫生局），Info Kesihatan 2024（Talian HEAL 15555 的号码与开放时间）— https://jknkedah.moh.gov.my/hpendang/index.php?option=com_sppagebuilder&view=page&id=139
• Befrienders Kuala Lumpur（24 小时热线号码）— https://www.befrienders.org.my/