Why Back Pain May Start in the Liver (TCM View)

April 25, 2025

Introduction

Back pain is one of the most common health issues worldwide, affecting people of all ages and lifestyles. In Western medicine, back pain is usually attributed to muscular strain, disc degeneration, or structural abnormalities.

But in Traditional Chinese Medicine (TCM), back pain is not always a musculoskeletal issue. Sometimes, the Liver—yes, your internal organ—can be the hidden source of discomfort.

TCM connects physical pain with organ systems, emotional states, and the flow of Qi (vital energy). The Liver, in particular, plays a crucial role in regulating energy movement, blood storage, and emotional balance. When Liver Qi is stagnant or Liver function is disrupted, it can cause tension, stiffness, or pain—especially in the back and sides of the body.

This blog explores how back pain may actually begin in the Liver, how TCM diagnoses these patterns, and what treatments can restore balance.

Understanding the Liver in Traditional Chinese Medicine

The Liver’s Functions in TCM

The Liver in TCM has broader responsibilities than in Western anatomy. It is responsible for:

Ensuring the smooth flow of Qi throughout the body
Storing blood, especially during rest
Supporting tendons and sinews, including those in the back
Regulating emotions—especially anger and frustration
Influencing the eyes and nails

"When Liver Qi flows freely, the whole body functions smoothly. When it is stagnant, pain and disease arise." — The Yellow Emperor’s Inner Classic (Huangdi Neijing)

A disrupted Liver system can affect digestion, sleep, mood—and yes, physical pain.

How the Liver Affects the Back

1. Qi Stagnation Leads to Muscle Tension

When the Liver fails to move Qi smoothly, it results in stagnation. This shows up as:

Muscle stiffness or tightness along the spine or flanks
Pain that moves or fluctuates
Discomfort that worsens with emotional stress

Back pain rooted in Liver Qi stagnation may feel more like tension or tightness than sharp pain.

2. Liver Blood Deficiency Affects the Tendons

The Liver stores blood and nourishes the tendons. When Liver blood is weak, symptoms can include:

Dull, achy pain in the lower or mid-back
Cramps, spasms, or weak muscles
Worse pain after exertion or during menstruation

This is common in people who are overworked, sleep-deprived, or recovering from illness.

3. Liver Yang Rising Can Cause Upper Back Tension

When emotional stress or constitutional heat pushes Liver Yang upward, it can lead to:

Neck and upper back tension
Headaches or dizziness
Irritability and restlessness

This type of back discomfort is often paired with emotional symptoms.

Related Meridian Pathways

The Liver meridian runs from the foot through the inner leg to the genitals and lower abdomen. It connects internally with the Liver organ and travels up to the ribs and chest.

While it doesn't run directly along the back, its organ-level imbalance affects the:

Bladder meridian, which does run along the spine
Gallbladder meridian, which runs along the side of the body and shoulders

Liver Qi stagnation often impacts these connected channels, leading to tension and pain along the back.

"Meridians connect not only organs, but emotional and structural functions. One imbalance can affect many pathways." — Journal of Chinese Medicine, 2021

Diagnostic Signs of Liver-Related Back Pain

A TCM practitioner may look for:

Wiry pulse, especially on the left side
Tongue with thin or peeled coating (blood deficiency) or red edges (Liver heat)
Emotional symptoms: mood swings, frustration, depression
Menstrual or digestive irregularities

The back pain itself may:

Appear with no clear injury
Fluctuate with mood or stress
Coexist with other signs of Liver imbalance (e.g. PMS, headaches)

TCM Patterns Involving Liver and Back Pain

1. Liver Qi Stagnation

Symptoms: tight back muscles, mood swings, rib-side discomfort
Causes: stress, overwork, lack of movement
Treatment: acupuncture, Qi-moving herbs, lifestyle changes

2. Liver Blood Deficiency

Symptoms: dull backache, fatigue, poor memory, dry eyes
Causes: overwork, poor diet, blood loss
Treatment: blood-nourishing herbs, dietary support, acupuncture

3. Liver Yang Rising

Symptoms: neck/back tension, irritability, red eyes, headaches
Causes: emotional repression, heat constitution
Treatment: acupuncture to subdue Yang, calming herbs

4. Liver-Gallbladder Damp-Heat

Symptoms: flank pain, bitter taste, bloating, irritability
Causes: greasy diet, alcohol, suppressed anger
Treatment: herbs to clear heat, acupuncture, diet therapy

How TCM Treats Liver-Related Back Pain

Acupuncture

Stimulates points to:

Move Liver Qi (e.g., LV3, GB34, LI4)
Tonify Liver blood (e.g., SP6, BL17)
Relax the back muscles along Bladder and Gallbladder channels

Studies in Pain Medicine (2020) show acupuncture reduces muscle tension and stress-related pain more effectively than NSAIDs in many cases.

Herbal Medicine

Common formulas:

Xiao Yao San: for Qi stagnation with emotional stress
Dang Gui Shao Yao San: for Liver blood deficiency and cramping
Long Dan Xie Gan Tang: for Liver heat or damp-heat

Cupping & Gua Sha

Often used along the Bladder and Gallbladder meridians to:

Release muscle tension
Improve blood flow
Clear heat or stagnation

Diet & Lifestyle

Recommendations:

Avoid greasy, spicy, or overly processed foods
Eat leafy greens, beets, and sour foods to support the Liver
Practice gentle movement (yoga, walking, Tai Chi)
Journal or express emotions to reduce Liver stagnation

When to See a TCM Practitioner

If your back pain:

Appears without injury
Comes and goes with emotional stress
Is accompanied by digestive or menstrual changes
Doesn’t improve with massage or stretching

...it may be rooted in Liver imbalance. A qualified TCM practitioner can assess your overall constitution and create a personalised treatment plan.

What Research Says

Journal of Integrative Medicine (2021) found Liver Qi stagnation to be a dominant pattern in stress-related back pain among women aged 25–45.
Harvard Osher Center (2020) reported that acupuncture targeting Liver-related points lowered cortisol and improved sleep and pain scores.
Chinese Medicine Journal (2019) showed herbal formulas like Xiao Yao San significantly improved back pain in patients with Liver stagnation patterns.

Final Thoughts

Not all back pain is due to physical injury. In Traditional Chinese Medicine, the Liver plays a key role in maintaining energetic balance, emotional flow, and musculoskeletal health. If you’ve tried stretching, painkillers, or physiotherapy with little relief, it may be time to consider your Liver.

Academic References

Journal of Chinese Medicine. (2021). Meridian Theory and Organ Pathways
Journal of Integrative Medicine. (2021). Liver Qi Stagnation in Women’s Health
Pain Medicine. (2020). Acupuncture and Muscle Tension Relief
Chinese Medicine Journal. (2019). Herbal Medicine for Liver Qi Stagnation
Harvard Osher Center. (2020). Acupuncture and Stress Hormone Regulation

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