#95 How Emotional Stress Shows Up in Digestion (Liver Qi Invading the Spleen)

Hey everyone, Dr. Richard Lai here with Study Acupuncture With Me. If you’re prepping for the NCCAOM, trust me—this is one of those patterns you’re absolutely going to see, both on the exam and in the clinic.

Let me start this post just like I started my recent podcast episode: Have you ever had one of those days where you’re absolutely pent up? You’re stressed, maybe you just got off a tough work call, or you’re dealing with something heavy emotionally—so you hold it in rather than let it out. Suddenly, your stomach feels off by lunchtime: heavy, tight, bloated. You don’t feel like eating, or you lose your appetite altogether.

Most people call it “butterflies,” but in Traditional Chinese Medicine (TCM), we see it differently. When you’re feeling emotionally bottled up, your body isn’t ignoring it—it’s responding. That heaviness in your gut is a physical sign that your emotions and your body are deeply connected.

Liver Qi Invading the Spleen: What’s Going On?

Let’s get into the meat of the topic, because this one is a staple for board review.

In TCM, your liver’s job is to keep Qi moving smoothly throughout your body—emotionally and physically. When the liver is doing its job, emotions flow, digestion works smoothly, and you feel energised. The spleen, meanwhile, is your internal “factory.” It transforms what you eat into Qi and blood, nourishing your whole system.

Most days, the liver and spleen play nice—they work hand in hand. The liver keeps things moving, the spleen keeps things steady. But then comes stress. Emotions get stuck, the Qi stops flowing, and now the liver starts “invading” the spleen.

What does that look like in real life? Patients walk into the clinic saying, “I’ve been so stressed lately. I feel bloated every time I eat, sometimes I just lose my appetite.” Or they say, “When I’m really emotional, I either eat my feelings and stuff my face, or I can’t eat anything at all.” Sound familiar? You’ve probably felt it too. This is textbook liver Qi invading the spleen.

Why Does This Happen?

Let’s break it down simply—because this is how I like to explain it, and how you should remember it for the NCCAOM exam.

Your liver makes Qi move. Your spleen transforms food into Qi and blood. When you’re stressed, the liver Qi starts stagnating—it stops flowing smoothly. Instead of supporting the spleen, it actually starts to push against it, disrupting how your digestion works.

In TCM, there’s a classic analogy: the liver is the general, spleen is the officer. When the general is angry and shouting, the officer can’t do their job—they withdraw. That’s literally what’s happening in your digestive system when you’re under stress. Your emotions compress your ability to digest and process nutrition.

Clinical Signs and Diagnosis: What Should You Look For?

When you’re in the clinic—or the exam room!—these are the classic markers:

Symptoms:

• Abdominal distension

• Bloating

• Poor appetite or overeating (depending on the emotional trigger)

• Tiredness, loose stools

• Mood swings, irritability

Tongue and pulse:

• On the tongue: you might see purple or red sides, possibly a thin white coat (unless dampness has set in).

• Pulse: on the left, typically wiry (liver). On the right, weak or soft (spleen). If you find a wiry pulse on the left and a weak pulse on the right, that’s classic liver overacting on spleen.

I love this about Chinese medicine—the body doesn’t draw walls between emotions and physical issues. When liver Qi gets stuck, you see both emotional and physical symptoms. That mind–body connection is real.

How Can This Pattern Transform Over Time?

If it goes on and on, things change. Stagnation can create heat (now you have irritability, heartburn, a bitter taste in the mouth). If the spleen stays weak, dampness builds up—patients complain of tiredness, brain fog, and even weight gain.

So, even though this starts as an emotional issue, it branches out into all sorts of physical symptoms if you don’t address it.

What Triggers It?

Let’s be real: modern life is a trigger. Constant emotional stress, overthinking, irregular meals—skipping, eating late, multitasking—all of this throws your system off. Cold drinks, raw foods (like salads and smoothies), not enough rest or breaks, working through meals…all of these things stress out your liver and spleen, making the pattern worse.

What Can You (and Your Patients) Do About It?

Now I want to break this down into two parts—lifestyle and clinical treatment—just like I do when I’m teaching or treating.

Lifestyle Tips (Tested in Real Life)

• Move: Even a short walk after meals—five, ten minutes—moves that liver Qi and helps out the spleen.

• Breathing: Slow, gentle breathing (with the out-breath longer than the in-breath) calms the liver and spleen.

• Eat warm meals: Soup, stews, congee—your spleen loves warmth, hates cold. Skip those cold smoothies and iced coffee, especially when you’re stressed.

• Mindful eating: Eat without distractions. Taste your food. Be present—this helps the spleen transform food into Qi more effectively.

Clinical Approach (Exam & Practice Essentials)

For the acupuncture side, I want to hit the points you’ll need for board study—and for real patients:

• Liver 3 (Taichong): Moves liver Qi, relieves stagnation.

• LI4 (Hegu): Regulates Qi (and calms the mind).

• Spleen 6 (Sanyinjiao): Strengthens spleen, harmonizes liver.

• Stomach 36 (Zusanli): Tonifies Qi, supports digestion.

• Ren 12, Ren 6: Harmonize the middle burner, help digestion.

Clinical tip: If you only move liver Qi (without supporting the spleen), your patient might feel better at first but then crash later—they’re not getting the support they need. If you only tonify the spleen (without moving liver Qi), you’re planting seeds in really hard, dry soil: nothing improves, because the Qi isn’t moving.

You have to balance both—move what’s stuck, support what’s deficient. That’s what works, and that’s the answer every time this pattern shows up on an exam question.

Bringing It All Together

So next time you, a patient, or a case study says, “Every time I’m stressed, my digestion acts up”—now you know what’s going on. That’s liver Qi stagnating, invading the spleen, and you know the emotional stress isn’t just “in their head.” It’s the body expressing that stress through the channel system.

That’s the magic of TCM in practice—the mind and body are always connected, and we have powerful tools to restore the balance.

One Last Study Tip

If today’s post helped you, please share it with a classmate or patient who needs to hear it. If you want more NCCAOM-style review, sign up for my weekly Quick Win newsletter—a five-minute read with an exam-style question and answer every week. The small things, done daily, are what lead to real expertise.

Success, whether on boards or in clinic, is the sum of small efforts—repeated day in and day out.

Until next time, God bless and happy studying!

Is this pattern one you’ve seen in clinic? Or maybe struggled with on practice tests? Leave me a comment - let’s study acupuncture together.

Want to practice study questions? Subscribe or check out www.studyactewithme.com/quickwin for the newsletter and more mind-body practicals!