Abstract：Traditional Chinese medicine （TCM） classifies refractory hypertension as vessel distention and holds that the pathogenesis is primarily attributed to pathogenic factors including wind，fire，phlegm，stasis，and deficiency， involving zang-fu organs such as the liver， spleen， and kidney. Under the guidance of the theory that "liver qi dysregulation predominates in disorders of the five zang organs， " this study identifies liver depression as the core pathogenesis of refractory hypertension. Liver depression may further affect the other four zang organs，resulting in liver fire disturbing the heart， liver depression over-restricting the spleen， liver fire invading the lung， and upper hyperactivity of liver yang. Treatment prioritizes activating liver qi， adjusted according to individual conditions： tranquilizing mind，invigorating the spleen to resolve phlegm，regulating qi to descend lung qi，and tonifying the liver and kidney. This restores the free flow of liver qi，harmonizes blood vessels，and achieves therapeutic efficacy.