Clinical Case Library · Case 049

Functional Indigestion Read as a Liver-Spleen Disharmony Pattern

Bloating and discomfort that flare with stress and ease when relaxed, with normal investigations, point to Liver-Spleen disharmony — constrained Liver Qi overrunning a digestion that cannot hold its ground.

Autonomic & Stress-Related Pattern: Liver-Spleen Disharmony (肝脾不和) Keyword: functional indigestion liver spleen disharmony

Synthetic Teaching Case This is a representative educational case, synthesized from recurring clinical patterns. It does not describe a specific patient, and no identifying information from any real patient is used. It illustrates diagnostic reasoning only — it is not medical advice, not a claim of treatment outcome, and individual situations vary. Always consult a licensed healthcare provider.

Step 1 · Presentation

The Presenting Picture

Consider a composite presentation seen repeatedly in clinic: an adult with bloating, a sense of fullness or distension after eating, irregular bowel habits, and discomfort that clearly rises and falls with stress — worse during pressured periods, better on holiday. Medical investigation has not identified a structural cause. Sighing or belching may bring brief relief.

Beyond the chief complaint, a cluster of accompanying signs recurs in this pattern:

Functional indigestion is diagnosed medically after structural causes are excluded. The classical framework reads its defining feature — the tight link to stress, with distension rather than pain — as a relationship problem between two organs rather than a fault in either alone.

Step 2 · Constitutional Reading

Reading the Pattern: Liver-Spleen Disharmony (肝脾不和)

The Liver governs the free flow of Qi; the Spleen governs digestion and transformation. When sustained stress constrains the Liver, its Qi “overruns” the Spleen — disrupting the orderly work of digestion. The result is distension (constrained Qi), digestive irregularity (disturbed Spleen), and a symptom pattern that rises and falls precisely with emotional pressure.

On the four axes this reads as an Interior disorder of relationship and flow rather than a simple deficiency or excess — the disharmony between two organs is the diagnosis. This relational reading is the framework’s signature: the pattern lives in the relation, not in either part.

Digestion that rises and falls with stress is read as constrained Liver Qi overrunning the Spleen — so the direction is to restore the relationship between them, not to treat the stomach alone.

Step 3 · Diagnostic Logic

Why This Reading — and Not Another

The differential is against a simple Spleen Qi deficiency (case 048), which is heavy and fatigue-dominant without the stress-linkage and distension, and against a Damp-Heat or food-stagnation picture, which is heavier, hotter, or tied to specific meals rather than to emotional pressure. The stress-tracking, distension-dominant quality is what marks the disharmony reading.

Digestive symptoms are medically evaluated, and warning signs require assessment. This case is strictly educational: it does not replace medical evaluation or care, and new or changing digestive symptoms should be assessed by a physician.

For this Liver-Spleen reading, the treatment direction is to soothe the constrained Liver, support the Spleen, and restore the harmony between them, alongside attention to stress and eating habits. This describes a direction of treatment, not a guaranteed outcome; responses vary by individual, and medical evaluation should continue as directed.

Step 4 · Framework Reference

Where This Reasoning Comes From

The diagnostic logic in this case applies the CALee framework — constitutional individuation, relational process, and the non-fixed self — developed in the following publications:

SSRN Working Paper · 2026 A Conceptual Framework for Diagnostic Reasoning in Korean Acupuncture

The framework paper develops the relational reading in which a pattern lives between organs rather than within one.

Book · Ch.8 · Zang-Fu Theory Korean Medicine: Theoretical Foundations, Diagnostic Reasoning, and Clinical Practice

Full treatment of Liver-Spleen disharmony and the free-flow principle.

Related Resource Learning Center — Evidence Map & Paper Database

Research literature on acupuncture for functional dyspepsia.

Educational Disclaimer Representative teaching case, synthesized from clinical patterns. Not a specific patient. This material is for educational purposes and does not constitute medical advice; no treatment outcome is promised or implied, and individual results vary. If you have a similar concern, consult a licensed healthcare provider for evaluation.