Welcome to Acu in Practice! This week we continue our “refresher” on the 6 Stages Model of Traditional Chinese Medicine. This diagnosis and treatment model can be especially useful for infectious and chronic inflammatory disease. In short, the model theorizes that disease begins on the most external level of the body where the immune system (Wei Qi) combats it and either wins by expelling the pathogen or allows the pathogen deeper into the next levels. The deeper the pathogen or disease is allowed to go, the more difficult it is to diagnose and treat. So far, we have covered the first 2 levels – Tai Yang and Yang Ming – and today we are touching on the next level in, the Shao Yang. This is an important and complicated level, as imbalance here presents as a mix of an Interior and Exterior Pattern.
The Shao Yang level is associated with the Gallbladder (GB) and Triple Heater (TH) Channels. It is especially relevant to our veterinary patients as it is where “cold” vaccination pathogens and vector borne diseases such as Lyme like to get trapped and result in chronic disease for the patient. Other clinical examples include immune mediated hemolytic anemia, immune mediated thrombocytopenia, and glomerulonephritis. Signs can include many Exterior Excess or Interior Deficiency symptoms as this is a mixed pattern level and the Shao Yang governs the movement of Qi to different regions of the body, resulting in multiple locations for the signs to show up. However, some common presentations include: bitter taste and dry mouth, alternating aversion to cold and heat, dizziness, reduced or blurred vision, joint pain, pain in the extremities, reduced appetite, retching and depression. The pulse is typically fine and wiry, while the tongue may have little to know change or become lavender.

Acupuncture points and herbal formulas will vary based on the individual patient and signs, but some examples include:

Acu points:
GB 34 – helps to expel retained pathogens
TH 4 – Harmonizes the Shao Yang
TH 5 – removes obstructions from the Channel, Luo Connecting point
GB 40 – Yuan Source point on the GB Channel, sedates Heat in the Shao Yang
GB 25, 34, BL 19, 22 – may be reactive, used as diagnostic points.
LIV 3 – source point on the Liver channel, moves Liver Qi and can clear Stagnation and Heat from the GB channel
ST 36 – relieves nausea and vomiting, can stimulate appetite. Protects Spleen Qi.
BL 16 – Association point for the Du Channel, regulates Shao Yang disorders

Herbal Formulas:
The classical formula for the Shao Yang pattern is Xiao Chai Hu Tang (Minor Bupleurum). It harmonizes the Shao Yang layer when there are mixed signs of Exterior invasion and Interior imbalance. It moves Qi stagnation and clears the subsequent Heat that will arise in the GB channel. Caution must be used in patients with Yin or Blood deficiencies as the formula is drying and it should not be used long term for this reason.

Chai Hu Jia Long Gu Mu Li Tang (Calm Dragon) is a modification of the above formula that is used when there is evidence of long standing TH obstruction and a weakening of the Kidney.
This post was created by Nell Ostermeier, DVM, CVA (IVAS) and is intended for informational use, not to replace medical advice. You can learn more about the author and additional cases at: www.peopleandpet.com

A special thanks and reference to: THE SIX STAGE: A WAY TO UNDERSTAND TODAY’S CHRONIC DISEASES Cynthia J. Lankenau, DVM, RH (AHG), CVA, GDVCHM, ACCHVM presented at IVAS Congress 2018.