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Acu in Practice: 6 Stages, Level 6

Happy Halloween and welcome to Acu in Practice! Today we are reviewing the 6th and “scariest” level of the 6 Stages of disease in TCM. The Jue Yin level is the deepest layer of the body and disharmony at this level involves severe deficiency and virtual exhaustion of the body’s defensive mechanisms or Zheng Qi. The Jue Yin is associated with the Pericardium and Liver and the pattern classically presents as Upper Heat and Lower Cold. The spookiest part about disease at this level is that there is significant separation of Yin and Yang, with lack of ability for the two to connect, and the risk that life will cease if the pattern persists. In Western terms, this is the inability to reach and maintain homeostasis. However, with appropriate treatment the possibility of restoring the Zheng Qi, expelling the pathogens, and returning to balance does exist.

The typical symptoms seen in Jue Yin cases are those of mixed Heat and Cold and will indicate dysfunction in the Liver and Pericardium/Heart. Signs could include thirst, hunger with no desire to eat, digestive disorders related to the pattern of Liver overacting on Spleen, diarrhea and retching, chest pain, shen disturbances. The upper body and extremities will present with Heat while the lower body is Cold. Pulses will vary based on the specific patterns present in the individual.

Clinical examples include equine metabolic syndrome with laminitis and uveitis, certain cases of chronic dysuria in cats, uncontrollable seizures, and perfuse vomiting of roundworms with diarrhea.

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

Acupuncture points:

CV 4 – meeting point for Liver, Spkeen, Kidney and CV Channel.

PC 6 – support Pericardium/Heart, calm Shen, treat nausea

LIV 3 – warms the channels and dispels cold from the Jue Yin.

CV 8 – moxibustion only. Dispels Cold.

CV 12- warms middle burner, dispels cold. Consider moxibustion.

CV 14 – regulates Qi circulation, relieves nausea

ST 36 – tonifies Qi and Blood, harmonizes digestion

SPECIFIC to PARASITE cases: classical point Bai Chong Wo, 1 cun proximal to SP 10

There are 3 main patterns at the Jue Yin layer. The herbal formula suggested for the pattern of focus, Upper Body Heat/Lower Body Cold, is Wu Mei San. Upper body Heat signs include heat affecting the extremities, such as laminitis. This formula clears Heat in the upper body, injects Yang back into Yin, warms the interior and dispels cold, tonifies Qi and Blood and promotes the expansion of Jue Yin. This formula also helps to expel or reduce parasite load.

This concludes our review of the 6 Stages of Disease according to Chinese Medicine.

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.

This post was created by Nell Ostermeier, DVM, CVA (IVAS) and is intended for informational use, not to replace medical advice.

Photo courtesy of Craig T. Roberts, DVM as found on

For further information, members can access IVAS conference proceedings ( or consider purchasing The Practice of Chinese Medicine: The Treatment of Diseases with Acupuncture and Chinese Herbs by G. Macioca.


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