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. Our focus this week is the 5th Level, the Shao Yin, which is associated with the Heart and Kidney organs and is the second deepest level in the body.

The Heart and Kidney are closely connected and possibly the two most critical organs in the body. Disease patterns in the Shao Yin typically manifest with a pattern of Heart and/or Kidney deficiency with cold symptoms due to Kidney Yang deficiency. These patterns or diseases can be a result of direct penetration by a pathogen into the Shao Yin layer, from Heart-Kidney constitutional deficiency, or as a progression of Shao Yang (3rd layer) or Tai Yin disease (the 4th Layer). Because of the multiple ways in which patterns develop in this level and because dysfunction of Heart and Kidney effect virtually every other function in the body, I will narrow the specific patterns down to focus on 2 of the most clinically relevant in veterinary medicine.

1. Kidney Yang Deficiency with secondary Spleen Yang Deficiency and an accumulation of water. Clinical examples: Chronic renal failure with edema, nephrotic syndrome, amyloidosis, cardiomyopathy, dilated cardiomyopathy, hypertrophic cardiomyopathy, pericardial effusion, ascites secondary to cardiac failure, one of the patterns of equine cushing’s disease.

Helpful acupuncture points:
BL 23, GV 4, CV 4 – tonify Kidney, tonify Kidney Yang
BL 20 – Tonify Spleen
ST 36 – Tonify Spleen/Stomach
LIV 13 – Alarm for Spleen, Tonifies Spleen and Moves Spleen Qi, relieves abdominal pain
CV 4 – meeting point of Spleen, Liver and Kidney, assists Kidneys with water metabolismAcu
CV 5 – opens water passages, tonifies original Qi
CV 6- Tonifies Yang and Qi
PC 6 – Benefits the Heart, relieves chest congestion

Suggested Herbal Formula:
Zhen Wu Tang (True Warrior Decoction) – warms Yang and regulates water metabolism

2. Progression of pathogen from Shao Yang to Shao Yin, the disease causes stagnation in the Liver and Gallbladder Channel on its way in, weakening the Spleen and blocking Qi circulation to extremities. *pulse will be wiry, not weak as in other Shao Yin patterns. Clinical examples: cold extremities, dysuria, abdominal pain, diarrhea, chronic hepatitis, chronic cholecystitis, pancreatitis, gastritis, peptic ulcers, uveitis.

Helpful acupuncture points:
TH 4 – regulates Qi of the Shao Yang
PC 6 – relieves chest Congestion, moves stagnation
LIV 2, LIV 3, LIV 13 – regulates liver Qi
GB 34 – assists with flow of Liver Qi, removes obstructions
ST 36/Sp 6 – move Qi and Blood, relieve abdominal pain, strengthen Spleen

Suggested herbal formula:
Si Ni San (Four Frigid Powder) – ventilates pathogens outward, spreads Liver Qi and harmonizes the Spleen and Liver.

Join us next week for the final stage – the 6th Level or Jue Yin!

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.