Identifying and Treating Pathology of the Three Yang
Steve Marsden, DVM ND MSOM LAc. Dipl.CH CVA AHG
College of Integrative Veterinary Therapies, www.civtedu.org
Introduction
Veterinary acupuncturists are familiar with making diagnoses according to Zang-Fu organ
pathology, pathogen invasions and channel blockages. The Nei Jing and the Shang Han Lun
emphasize another context in which to view and treat patients, though – that of the three Yang
and the three Yin, also known as the Six Phases. This framework for diagnosis and treatment is
immensely valuable to the small animal practitioner, even though clinical applications in
modern small animal medicine are still being discovered.
This talk will review the three Yang and Yin as they function in health, then zero in on their role
in small animal disease. We’ll discuss:
 Common acupuncture points used to treat these
layers or phases
 Common pulses and symptoms indicating
pathology in each layer
 Some herbal formulas corresponding to disease in
each layer
The Three Yang and the Three Yin
There are three phases each of Yang and Yin - an outer phase, an inner phase, and an inbetween state. Outer phases are more exposed, and have the prefix of ‘Tai’. Tai Yang means
Extremity of Yang and Tai Yin means Extremity of Yin.
In between layers carry the prefix ‘Shao’. It is the job of the Shao Yang and the Shao Yin to
Figure 1. Locations of the three Yin and Yang
internalize Yang and Yin, respectively, to the body core, as the climate turns less favourable.
Innermost Yang is called Yang Ming. Ming is best interpreted here as ‘moderate’ or ‘sunlight’. It
is ‘ripening’ type of Yang ideal for the transformation of food without scorching it.
Innermost Yin is Jue Yin, variously translated as Involuting Yin, Reverting Yin or Pressurized Yin.
Compressing Yin within the lower abdomen gives it the innate ability to expand outward. It
provides impetus to the flow of Qi and Blood between heart beats that explains the association
of Jue Yin and the Liver with vessel wall tone.
Yang and Yin shift during the course of one day, but also one year. Around the summer solstice,
it is safe for both Yin and Yang to be exteriorized on the surface. The day is warm (Yang)
enough, yet the moisture (Yin) for that year has not yet been burned off from the environment.
The exteriorized Yang and Yin energy facilitate easy movement and suffuse the musculature
with Qi and Blood, helping promote physical activity when days are longest and the weather
most clement.
Around the winter solstice, the body fully internalizes Yang and Yin to protect them from both
Cold and Dryness. The body becomes less active and appetite is increased, to facilitate
hibernation.
During the spring and fall, Yin and Yang are on the move, although slightly out of step with each
other. Yin externalizes and internalizes first, followed by Yang.
Seasonal shifts are simply accentuated daily shifts. Yin and Yang are even more externalized at
noon of a summer day than of a winter day. Even at the height of summer, though, a little Yang
still remains in the interior.
Yin, Yang and the Circadian Rhythm
Yang and Yin move and shift from one phase to another during the changing of the seasons and
over the course of a day. As they shift in location, organs associated with these phases or
locations receive an extra burst of power. Later, as Yin and Yang leaves these phases and
locations, associated organ activity will subside. These shifts in Yin and Yang effectively create a
circadian rhythm of organ function that most veterinary acupuncturists are familiar with.
The basis of the circadian rhythm is a shift in the character of Yin and Yang as they change
location. For example, as Yang moves outward to become Tai Yang it becomes more hot,
forceful and protective. It is able to counter any pathogenic Cold and wet influence in the
environment. Wei Qi is thus a form of Tai Yang energy.
The dorsum is naturally angled toward inclement weather. Thus, Tai Yang gathers there, in the
Bladder, Small Intestine, and Governing Vessel channels. The Bladder takes advantage of this
energy in its channels to boil the cold wet wastes of the body. Steam rises upward as a pure
distillate while the turbid remainder is passed out of the body by the Bladder as dross.
As Yang moves to the body core to become Yang Ming, it becomes more Yin in nature. The
channel that carries it – the Stomach channel – is likewise on a Yin surface, the body ventrum.
The ventrum is the surface that organisms naturally orientate toward sunlight. When Yang
enters the Yang Ming channels coursing over the abdomen, digestive power is increased.
Shao Yang is an in-between form of Yang energy. The channels that are associated with it, the
Triple Burner and the Gall Bladder, are located on the sides of the body, midway between the
dorsum and ventrum, or Yang and Yin, surfaces. The Shao Yang mediates movement of Yang
within the body, and the median location of the channel exemplifies its role in mediating gross
musculoskeletal movement.
Figure 2. Movement of Yin and Yang through the day and year
The Six Phases in Pathology
Pathogens as a cause of illness
In the classical texts of Chinese medicine, such as the Shang Han Lun (Treatise on Cold Febrile
Disease), problems with these various layers focused upon their occupation by various
pathogens. Pathogens created an enduring Excess state in the affected layer, rendering the
other layers mute and suspending the normal succession of the body from one phase to
another was suddenly lost
Because these classical texts viewed pathogens as hostile agents that invaded from the external
environment, their writings constitute the world’s first germ theory of disease. Infections like
Lyme disease and influenza can behave clinically much as the Shang Han Lun describes.
In addition, in modern veterinary practice, we recognize pathogenic Excess from other sources.
One notable example is the Damp elaborated within the body in response to consumption of a
heavily processed diet. This Dampness can precipitate many clinical scenarios within the
context of the Six Phases, including:
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Obstruction of the Shao Yang by Phlegm to create symptoms of hip dysplasia
Accumulation of Dampness in the Tai Yin, to create gastroenteritis and dyspepsia
Generation of Heat in the Tai Yin and Yang Ming that subsequently injures the Yin to
generate symptoms of Jue Yin excess
Climate can also be an aggravating factor. Hot humid weather can precipitate Tai Yin excess or
Dampness, causing acute gastroenteritis known as the ‘summer flu’. Meanwhile, a windy dry
spring can aggravate Yin deficiency (and corresponding Yang Ming deficiency), resulting in
muscle aches and spasms.
Chinese medicine understood all of the above – microbes, climate, the products of an
unhealthy diet, and even allergens – as being included in the definition of ‘pathogen’. A
pathogenic Excess in any layer causes the normal regulatory mechanisms of Yang and Yin
movement from one phase to another to be suspended, in addition to manifesting their own
unique set of symptoms. In addition, the persistence of symptoms can lead to propagation of
further imbalances, including the pathogen penetrating more deeply. Long term resolution
involves rendering the appropriate method of support, which in turn requires the correct
identification of the phase(s) of Yin or Yang that the pathogen is lodged in.
General Symptoms of Yang and Yin Excesses
The accompanying Excel sheet lists in detail the signs and symptoms of pathological Excess in
each of the three Yang and Yin phases, and can be used to assist diagnosis. Simply find which
category of illness includes the salient symptoms of your patient. Usually, only a few of the
potential symptoms will actually be present in the patient, making diagnosis a challenge.
Knowing the general traits of a pathogenic Excess in each layer will make it easier to match
patient to diagnosis.
The symptom of pathogenic excess of each layer is based upon what that layer normally does in health.
By toning and tightening the musculature, the Tai Yang provides the shell of the body, helping to repel
external noxious influences. In pathogenic excess, the tightening is extreme, producing spasms and pain.
The Shao Yang layer regulates the movement of Yang energy into the Yang Ming interior. In Excess, Yang
is not allowed to move outwards and flow through its channels grinds to a halt. Pain in the Shao Yang
channels commonly results.
The Yang Ming layer provides the dry Heat necessary for “ripening” foods into the Fundamental
Substances that build the body. In pathogenic excess, that Heat is taken to the extreme to produce
delirium, high fever, profuse perspiration, and a flooding pulse.
The Tai Yin organs gather for distribution all the fluids that make up the body, including its various forms
of Qi (the character for which means ‘mist’). In Excess, pathological fluid accumulates, in the form of
Damp.
The interaction between the Shao Yin organs, the Heart and the Kidney, provides the central axis of
body development. If this Heat is lacking or present in Excess, the Shao Yin organs are damaged and the
entire integrity of the organism threatened.
Jue Yin is Yin that has internalized so deep and hard within the body that it acquires, under the strength
of its own weight, the ability to bounce back outwards and renew circulating (as Blood). In Excess, the
Jue Yin of the lower abdomen compresses so much that it blocks the lower abdomen and crowds Yang
Ming energy into the upper body.
More specifically, invasion of Yang pathogens through the each of the above Yang layers
produces pain, immobility, or inflammation along the path of the affected channel. Internal
organ symptoms can be seen with Yang Ming or Shao Yang involvement. Yang pathogens
increasingly produce signs of Heat as they move from the exterior to the interior, with Tai Yang
Excess patients alone acting chilly.
Invasion of Yin layers produces internal organ symptoms. Patients with Yin channel involvement
can exhibit either Cold (Tai Yin, Shao Yin) or Heat (Shao Yin, Jue Yin - through Yang Ming
displacement).
Tai Yang Excess
The Tai Yang is the main defensive layer of the body. Accordingly, the body’s Wei Qi accumulates here.
The Tai Yang is frequently the first layer to be “attacked” by a pathogen, which may then progress to the
other layers. Common symptoms include:
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Pain along the dorsum of the body, including especially the neck
Avoidance of cold exposure
Signs of heat and inflammation on the body surface
A superficial toned pulse
The most common pathogen to invade the Tai Yang is Wind Cold. Probably the most common example
in modern small animal practice of a Shao Yang invasion are acute neck pain, and chronic intervertebral
disc disease in small breed dogs.
Shao Yang Excess
The Shao Yang is the safety net of the body, and captures most pathogens that make it past the Tai
Yang. If they try to push deeper into the Yang Ming layer, Heat signs become prominent. If the body is
able to jostle the pathogen more to the exterior again, chills are created. Thus, “alternating chills and
fever” is considered the hallmark of a Shao Yang invasion, the most famous example of which is Malaria.
Other latent infections in small animal medicine, such as Ehrlichiosis and Lyme disease, are also
frequently Shao Yang disharmonies. In this way, then, the Shao Yang equates to systemic immunity and
the lymphatic system, while the Wei Qi of the Tai Yang correlates only to the immune structures lining
and protecting epithelial surfaces, such as the BALT and GALT.
Pain along the Gall Bladder channel is a common sign of Shao Yang excess, with the pain of hip dysplasia
being a common and consistent example. In addition, the Triple Burner may become obstructed,
producing a variety of symptoms including:
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Chest pain and distention
Lung congestion
Flank pain
Hepatitis
Mucocoele of the gall bladder
Epigsastric bloating, such as in GDV
Yang entrapment in the upper burner producing dry throat, thirst, restlessness, and heat
intolerance
The main pathogen to affect the Shao Yang is Phlegm. In the case of Yang entrapment in the upper
burner, it is said that Fire has accumulated in the Shao Yang. The pulse of affected animals is often deep
and toned
Shao Yang pathologies are exceedingly common in veterinary practice. They can occur in association
with Tai Yang and Yang Ming pathology. That is, the Shao Yang can trap Yang in the interior,
precipitating or aggravating Yang Ming Excess. Conversely, it can trap Tai Yang Excesses on the exterior
creating pronounced musculoskeletal disorders. Difficulty rotating the neck and spine are important
Shao Yang symptoms.
Yang Ming Excess
The Yang Ming organs include the Stomach and Large Intestine. These organs are normally warm,
supplying the ripening energy needed for adequate digestion. When Yang Ming is in Excess, there is thus
an accumulation of heat and Dryness in the digestive tract and the Stomach channel that can result in:
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Obstipation
Bleeding from the nose, stomach or intestines
Eye redness
Abdominal swelling and redness
Inflammation of the digestive organs, such as the pancreas
Pronounced thirst
High fever with perspiration and delirium in humans
You might guess that Yang Ming Excess is the diagnosis associated with most acute abdominal
inflammatory emergencies affecting the digestive tract. In veterinary medicine, Yang Ming Excess may
be the cause of at least some skin rashes affecting principally the ventral neck and abdomen; and is a
common cause of acute pancreatitis and constipation. It can be aggravated by the simultaneous
presence of a Shao Yang Excess
Tai Yin Excess
Because the Tai Yin organs, the Lungs and the Spleen, open to the external environment to receive food
and air, they are prone to pathogenic Excess. The pathogen that accumulates in the Tai Yin organs is
Damp. In modern times, Damp is most commonly a Heat pathogen, arising from excessive intake of an
energy dense and rapidly assimilable diet. The Shang Han Lun, however, generally refers to Cold Damp
pathological excesses with resultant digestive problems.
Either Cold Damp or Damp Heat pathogens obstruct normal descent, to create a constant sense of
down-bearing pressure, yet a tendency to vomit or regurgitate food or water. Stools may feel
incomplete, or be difficult to pass. Alternatively, the Cold pathogen can so damage the digestive fire of
the patient as to cause small bowel diarrhea and abdominal pain.
Other patients will manifest with primarily respiratory symptoms, in which Lung Qi is unable to descend
easily, resulting in chest fullness and dyspnea. Mucous may be expectorated.
Shao Yin Excess
Shao Yin pathogenic excess can manifest in Cold or Heat transformations. Normally, Heat is the
Heavenly Influence that helps the Shao Yin organs (i.e. the Heart and Kidneys) in their function
of nurturing gradual development and growth. In excess, though, Heat pathogens damage and
desiccate Yin, creating a picture of Empty Heat and Fire. The patient exhibits restlessness,
irritability and insomnia. Anorexia, abdominal fullness, cystitis and constipation are common
symptoms, as well as cardiac pain. Advanced cachexia in chronic disease is a good example of
Shao Yin pathology.
Because the Kidney and Heart are reliant on Heat, they can be crippled by Cold pathogens.
Since the interaction between the Heart and Kidneys provides the power for digestion, their
eclipsing by a Cold pathogen produces a collapse of GI function. The patient is often moribund,
curled into a ball, and exhibits both vomiting and diarrhea, such as in parvoviral enteritis or
panleukopenia. Alternatively, the animal may urinate profusely, be dyspneic, and exhibit
profound thirst, such as in advanced kidney failure.
Yang energy may be displaced to the body surface by the invading Cold pathogen, producing
false signs of Heat on the exterior. From the above descriptions, it becomes clear that Shao Yin
pathologies are often serious and life-threatening.
Jue Yin Excess
Yin energy retreats each night to the lower abdomen, where it occupies the Jue Yin phase. If Jue Yin is in
Excess, the Yin becomes so compressed in the lower abdomen and hard that it will not admit and enfold
internalizing Yang energy. Yang energy rebounds upwards to the Stomach and Heart, creating the
hallmark Jue Yin pattern of “Hot above and Cold below”. Hot above symptoms include:
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Continual thirst
Hunger yet difficulty eating
A sense of heat in the heart or chest
Meanwhile, the lower abdomen suffers from Stasis, where stool and urine may be difficult or
uncomfortable to pass. Alternatively, there may be urgency and incontinence. Since Yang energy is not
allowed to enter the lower abdomen, diarrhea may result. The combination of high thirst, diarrhea, and
hunger, yet abdominal distention is reminiscent of endoparasitism, and patients with Jue Yin Excess may
vomit roundworms.
The pressurization of the Yin in the lower abdomen creates an up-bearing pressure that contrasts with
the situation in Tai Yin Excess. Often this pressure is felt on the heart, and Jue Yin Excess is a leading
cause of myocardial infarction. The up-bearing pressure may also result in difficulty eating, retching, and
acid regurgitation.
Jue Yin Excess is emerging as a potentially important diagnosis in veterinary medicine, and may underpin
conditions as varied as:
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Idiopathic epilepsy that worsens at night or during the winter solstice
Urinary obstruction in cats
Chronic or recurrent endoparasitism
Cystitis
Urinary or fecal incontinence
Constipation
In humans it is a potential cause of menopausal complaints and depression.
Treating the Three Yang and Yin
Acupuncture provides an immediate means of addressing Yin and Yang pathogenic excesses that starts
to take effect immediately. Herbal medicines generally begin working after just a few days. The Shang
Han Lun focused on herbal treatment of the above pathologies.
Treating the Three Yang and Yin with Acupuncture
Problems can generally be considered in Chinese medicine to be of either an Excess or Deficient
nature. Excesses can be due to pathogen invasions (Cold for Tai Yang; Fire for Shao Yang;
Dryness and heat for Yang Ming). They can also arise from Stasis in the associated channel or
body region.
To correct an Excess in a phase or structure, associated points are ‘sedated’ or ‘drained’. The
channels and points associated with the three Yang and Yin are no exception. To correct a
Deficiency in a phase or structure, associated points associated are ‘tonified’.
Veterinary acupuncturists are familiar with these concepts already. They use Alarm (Mu),
Association (Shu), Source (Yuan), Sea (He) points to address deficiencies and excess within the
Zang-Fu organs. The same points can be used for both a tonifying and sedating effect by varying
only the method of stimulation.
The same principles apply when addressing problems amongst the three Yang and Yin.
Addressing Excesses of the Three Yang
Key points for addressing pathology arising from the three Yang include:
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Sea (He) points
o ST 36, GB 34, BL 40
Points at the level of the carpi and tarsi
o ST 41, GB 40, BL 60
Points in the digits
o LI 4, GB 41
Points of the head and neck
o GV 14, GB 20, GB 21
Association (Shu) points for the associated organ
o BL 19
Alarm points for the associated organ, or on that channel
o GB 23, CV 12, GB 25
Thus, tonification of BL 40 corrects a Deficiency in the Tai Yang layer, manifesting perhaps as
hind end and low back pain and weakness, or even as chronic renal failure. Sedation of BL 40
addresses an Excess in the Tai Yang layer, such as from a Wind Cold invasion.
Tonification of ST 36 bolsters the digestive power of the Yang Ming while sedation of ST 36
removes a pathogenic Excess of heat and Dryness.
Tonification of GB 20 addresses a Deficiency in the Shao Yang layer that causes Yang to rebel
upwards and outwards, causing idiopathic vestibular syndrome. Sedation of GB 30 and 34
address an Excess of the Shao Yang layer that entraps Yang energy in the interior, leading to
pain and immobility in a dog with dysplastic hips.
Frequently, treatment of two or more Yang layers at the same time may benefit the pulse the
most. An example of the use of two channels might be in the treatment of severe or postsurgical intervertebral disc disease. In these animals, both Tai Yang and Shao Yang excesses are
commonly present. Best results are obtained when the practitioner sedates points affecting
both, such as BL 40 and BL 19.
Even three channels can be treated simultaneously. For example, to internalize Yang in severe
epilepsy with cluster seizures:
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Tonify ST 41 to address a deficiency of Yang Ming
Sedate GV 20 to eliminate an excess of Tai Yang
Tonify GB 20 to increase the power of the Shao Yang in internalizing Yang energy
Addressing Excesses of the Three Yin
Points are stimulated and interpreted in a similar manner when treating pathology of the three Yin. In
the case of Jue Yin excess, for example, it is common to:
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Sedate LV 3, to reduce Jue Yin Excess in the lower burner
Sedate ST 36 or 37, to remove excess Yang Ming energy that is rebounding off Jue Yin and
rebelling upwards toward the Stomach, Heart and head
Points to Tonify Blood or Yin might also be selected, to emolliate the Jue Yin compressed into the lower
burner. A good choice might be SP 6, since it strengthens Tai Yin. Tai Yin supersedes and replaces Jue Yin
in the cycle; needling a Tai Yin point helps encourage that process to unfold, resulting in Yin migrating
out of Jue Yin and into Tai Yin.
Association and alarm points that address the affected internal organs can also be used. These points
are usually on channels dealing with Yang and Yin layers that are not directly involved with the apology,
so points can be stimulated as you normally would, to address the various symptoms of the patient. For
example, in the Jue Yin Excess example above, BL 27 and CV 3 might be sedated to address cystitis
resulting from Jue Yin Excess, while BL 17 might be needled to nourish Liver Blood, and thus moisten Jue
Yin.
Similar approaches are needed to manage pathologies of the other Yin. For example, in a Damp patient,
sedate SP 9, LU 7, or LU 5 to reduce Tai Yin Excess, depending on whether there are respiratory or GI
symptoms.
While certain points and methods of stimulation might be theoretically indicated, always make final
acupuncture treatment decisions based upon the pulse. Only moderation of the pulse confirms you
have used the right point and the right type of stimulus. If a needle makes the pulse feel worse,
remove it. If a certain type of stimulation makes the pulse feel worse, do its opposite. If there is
still no improvement, remove the needle completely.
The points and stimulation method that moderate the patient’s pulse, together with the season
or time of day of onset or aggravation, allow the practitioner to rapidly home in on the likely
diagnosis of a patient, even if symptoms are relatively few. At this point, an appropriate herbal
formula may be introduced, to round out the treatment plan.
Herbal Treatment of the Three Yang and the Three Yin
The Shang Han Lun is unique among classics that discuss imbalances and excesses of the three
Yang and the three Yin, in that specifies very clearly the precise herbal formula for each clinical
manifestation. The text as it exists today is only a small segment – and a digest at that – of
earlier versions and source texts that expounded in much more detail on pathology of the three
Yang and the three Yin. Its terse turn of phrase focuses on a relatively brief set of symptoms
that serve as the crux of its diagnostic algorithms, with these symptoms really only relating to
the management of infectious disease. Parts of the text are thus elusive in their interpretation
and difficult to adapt to modern clinical veterinary practice with our expanded definition of
what constitutes a pathogen, particularly since animal patients often do not manifest the same
symptoms as those in the narrow focus of the Shang Han Lun.
For these reasons, the text up until now remains a mystery to most Chinese medicine practicing
veterinarians, with clinical applications for its myriad formulas only just becoming apparent in
the last decade or so. The work of looking at animal disease through the lens of the Shang Han
Lun is even now only just beginning.
Nevertheless, certain formulas are emerging as clinically important. And if not the formulas
themselves for a given Yin or Yang Excess, at least one or two key herbs within them, which are
then appended to other simpler and more focused formulas to adapt them to more
complicated patients. The rest of this article introduces some of those herbs and formulas,
explaining the evolving clinical applications of the ones that seem most relevant to modern
small animal medicine.
Tai Yang Formulas
Du Huo Ji Sheng Tang
(Pubescent Angelica and Loranthus Combination)
Du Huo
Pubescent Angelica root
Dang Gui
Angelica sinensis
Bai Shao Yao
White Peony root
Chuan Xiong
Ligusticum rhizome
Du Zhong
Eucommia bark
Fang Feng
Ledebouriella root
Huai Niu Xi
Achyranthes root
Qin Jiao
Large Leaf Gentian root
Ren Shen
Ginseng root
Sang Ji Sheng
Loranthus
Shu Di Huang
Prepared Rehmannia root
Xi Xin
Asarum
Fu Ling
Poria
Gan Cao
Licorice root
Rou Gui
Cinnamon bark
The appropriate treatment for a pathogen
just pushing its way through the Tai Yang
layer is to expel it back outwards. The
aromatic or pungent flavor has that direction
of action, and the most important means of
producing it in Tai Yang Excess from Wind
Cold invasions is Cinnamon twig (Gui Zhi).
Cinnamon twig is rarely used alone, and is
teamed with White Peony root (Bai Shao).
Formulas containing the two, such as Gui Zhi
Tang (Cinnamon Twig Decoction) use the
sweet aromatic nature of Cinnamon twig to
expel the invading Wind Cold, and sour White
Peony to close the pores afterward, so more
pathogens cannot invade.
Since dogs and cats do not suffer from the
common cold or influenza, which are
quintessential examples of infectious agents
causing neck stiffness. Hence Gui Zhi Tang is
not commonly used by itself in veterinary
practice. While not a Shang Han Lun formula,
Du Huo Ji Sheng Tang (Pubescent Angelica
and Loranthus; Supple Spine by Kan Herb) is
used to address the most common obvious
clinic manifestation of Tai Yang excess in
small animals – the dorsal pain and
inflammation of intervertebral disc disease.
It is especially commonly used in small breed dogs with paresis, following incomplete recovery from disc
prolapse.
Many variations of Gui Zhi Tang, usually featuring small additions, are offered by the Shang Han Lun to
fit a myriad of different clinical presentations of infectious disease with Tai Yang symptoms. Future
exploration may disclose some of these as useful in veterinary medicine.
Meanwhile, Gui Zhi and Bai Shao are also added to formulas as a pair to help address more complicated
symptom pictures, of which Tai Yang Excess is a component. Some of these formulas are used in
veterinary medicine. One, Minor Bupleurum Combination, is used in this enhanced form to treat more
severe and post-operative cases of chronic disc disease. Minor Bupleurum addresses Shao Yang Excess
and turns out to be one of the real workhorses of modern small animal practice. It is discussed below.
Yang Ming Formulas
Pathogenic excess of the Yang Ming organs (i.e. the Stomach and Large Intestine) produces severe acute
abdominal crises, characterized by profound Heat. Bitter Cold herbs such as Da Huang (Rhubarb) are
needed to clear this Heat; and Zhi Shi (Bitter Orange) used to then propel it down the digestive tract and
out of the body via the Large Intestine. Where the Heat has damaged the moisture or Yin of the Yang
Ming organs, their contents may become dry, the intestinal tract bound, and the patient obstipated. In
these cases, salty emollient herbs such as Mang Xiao (Glauber’s Salt) that draw water into the inflamed
digestive tract are added.
Representative formulas to treat these ‘Yang Ming organ’ pathologies include Da Cheng Qi Tang (Major
Reorder the Qi Combination) and Xiao Cheng Qi Tang (Minor Reorder the Qi Combination), and they
are essentially powerful anti-inflammatory laxatives and motility restorers.
Where the Yang Ming Heat is producing high fever with profuse sweating and delirium, the
representative formula is Bai Hu Tang (White Tiger Decoction). This formula uses Shi Gao (Gypsum) to
clear the Heat from the Yang Ming channel and lower the fever.
As with Gui Zhi Tang, the utility for Yang Ming formulas in modern small animal practice is limited. Dogs
and cats rarely manifest profuse sweating and delirium when suffering a fever. While inflammatory
gastrointestinal tract pathologies are commonplace, they are usually either due to Damp accumulation
in the Tai Yin organs; or are Yang Ming Excess conditions that are caused by or combined with a
concomitant Shao Yang Excess. Thus, the importance of Yang Ming formulas is once again to provide us
with one or two signature herbs that we can add to other formulas, most commonly Minor Bupleurum
Combination, to extend its reach.
Shao Yang Formulas
Of the three Yang layers, the Shao Yang is by far the most clinically important in small animal medicine.
The Shao Yang layer is located midway between the body exterior, and controls both the elaboration of
Yang on the surface of the body and its return to the interior. When a patient experiences an
obstruction of the Shao Yang layer, either function may be disrupted, depending on the hour or day.
A single formula to address this dual pathology must thus have two fundamental effects: a cool bitter
draining descending herb that pulls Yang from the upper and outer body into the interior; and an
aromatic or acrid herb to expel a pathogen and open the Shao Yang to allow Yang energy to circulate
once again. Formulas that contain two such seemingly competing influences to deal with multiple
consequences of a single pathology are termed harmonizing formulas.
Minor Bupleurum Combination (Xiao Chai Hu Tang; Harmonize the Qi by Kan Herb) is one such
harmonizing formula and is the representative formula for addressing Shao Yang Excess.
Minor Bupleurum Combination (Xiao Chai Hu Tang)
Chai Hu
Bupleurum root
Huang Qin
Scutellaria root
Ban Xia
Pinellia rhizome
Gan Cao
Licorice root
Sheng Jiang
Ginger rhizome
Da Zao
Jujube
Ren Shen
Ginseng root
The acridity of its content of Bupleurum
(Chai Hu) opens the Shao Yang layer to
dissipate Yang trapped internally, but
the bitterness of Scutellaria (Huang Qin)
moves Yang trapped on the surface
downwards and inwards. It also helps
clear any Heat beginning to accumulate
in the Yang Ming organs as the pathogen
jostles deeper. Both plants are cool, to
avoid aggravating the Heat that
generally becomes more manifest as
Yang pathogens work their way through
the layers from the exterior to the interior.
Recovery from Shao Yang Excess requires the patient to have enough Zheng Qi to eventually
overcome the invading pathogen and push it to the exterior. Ginseng powerfully supplements
the Source Qi to help provide that power. Proper middle burner function is also needed to
generate Qi on an ongoing basis, yet vomiting and retching are common symptoms of Shao
Yang Excess Thus, herbs are included that support normal Spleen function while harmonizing
the Stomach. These include Jujube, Licourice, Ginger and Pinellia.
To specifically target one type of entrapment or the other, specific herbs may be added to
Minor Bupleurum.
There are many clinical applications of Minor Bupleurum, including:
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Gastric dilation and volvulus
Hepatitis
Collapsing trachea
Glomerulonephritis
Pancreatitis
Hip dysplasia
Intervertebral disc disease
The Shang Han Lun lists many single herbs that can be mixed with Xiao Chai Hu Tang to address
various symptom pictures. A modern modification important to small animal practice is the
addition of Qin Jiao (Large-leafed Gentian root). It accentuates its ability to disperse stasis in the
Gall Bladder channel, making it even more effective than the core formula in conditions like hip
dysplasia and glomerulo-nephritis. This combination is sold by Kan Herb as Benefit Hips and
Knees.
Occasionally a pathogen has not fully entered the Shao Yang from Tai Yang. Original Tai Yang
symptoms such as back and neck pain and spasm are still present, and/or the patient may have
extreme restlessness from generalized joint pain. In these cases, Gui Zhi (Cinnamon twig) and
Bai Shao (White Peony root) are added to Minor Bupleurum. This combination, called Chai Hu
Gui Zhi Tang (Bupleurum and Cinnamon Twig Combination), is especially helpful in treating
post-surgical cases of intervertebral disc disease, but could also be applied to hip dysplasia and
knee pain.
Major Bupleurum Combination (Da Chai Hu Tang)
Chai Hu
Bupleurum
Huang Qin
Scutellaria
Bai Shao
White Peony
Ban Xia
Pinellia
Da Huang
Rhubarb root
Sheng Jiang
Fresh Ginger
Zhi Shi
Unripe Bitter Orange
Da Zao
Jujube
Occasionally a pathogen has not fully
entered the Yang Ming from the Shao
Yang. Original Shao Yang symptoms are
still present, and Yang Ming Excess
symptoms are developing. These might
include repeated predispositions to
gastrointestinal inflammation; abdominal
redness; and/or a distended abdomen.
The formula for addressing a pathogen
affecting both the Shao Yang and the
Yang Ming is Da Chai Hu Tang (Great
Bupleurum Combination):
Apart from Ginseng, the entirety of Minor Bupleurum is still present, yet the handful of
additions creates a formula containing four sub-formulas – hence the moniker of “great”. The
key herbs of Minor Bupleurum Combination, Huang Qin and Chai Hu, are present. Bai Shao has
been added, to help reduce abdominal fullness and spasm; when combined with Licourice,
Bupleurum, and Bitter Orange, Bai Shao creates the formula Si Ni San (Four Cold Extremities
Powder). The latter is the quintessential abdominal Qi mover and is another formula
introduced to Chinese herbal medicine by the Shang Han Lun. Da Huang combined with Zhi Shi
creates most of Xiao Cheng Qi Tang, a formula to clear Yang Ming Excess characterized
primarily by Heat and abdominal Stasis. Lastly, as with Minor Bupleurum itself, the formula
contains Xiao Ban Xia Tang (Minor Pinellia Combination) – Ban Xia and Sheng Jiang. The two
herbs combine to stop vomiting from Phlegm accumulation in the Stomach.
The clinical uses of Da Chai Hu Tang are only just emerging, but one prominent one appears to
be degenerative myelopathy. Affected dogs that are losing ground appear to experience a
turnaround with Da Chai Hu Tang, especially if they also experience chronic or recurrent GI
symptoms such as colitis and pancreatitis.
Sometimes the disruption of Shao Yang function is not a failure to release Yang, but a failure to
internalize it. This latter condition is remedied by Chai Hu Jia Long Gu Mu Li Tang (Bupleurum,
Dragon Bone and Oyster Shell Combination; Settle the Yang by Kan Herb). This formula has
multiple applications, including as an anti-cancer formula, the resolution of pancreatitis, small
intestinal bacterial overgrowth causing inflammatory bowel disease, congestive heart failure,
hemolytic anemia, idiopathic vestibular
syndrome, anxiety and epilepsy.
Chai Hu Jia Long Gu Mu Li Tang
(Bupleurum, Dragon Bone and Oyster Shell Combination)
Chai Hu
Bupleurum root
Fu Ling
Poria
Gui Zhi
Cinnamon twig
Huang Qin
Scutellaria root
Ren Shen
Ginseng root
Ban Xia
Pinellia rhizome
Da Huang
Rhubarb root and rhizome
Da Zao
Jujube
Long Gu
Fossilized Bone
Mu Li
Oyster Shell
Sheng Jiang
Ginger rhizome
Bupleurum, Dragon Bone, and Oyster Shell
Combination contains Minor Bupleurum to
harmonize the Shao Yang, including the
Triple Burner, thus restoring the ability of the
body to internalize Yang and descend fluids
to restore normal water metabolism.
To facilitate this internalization of Yang, the
heavy mineral elements of Fossilized Bone
and Oyster Shell are added, which serve to
sink Yang energy into the interior without
depleting it. Rhubarb purges Fire downwards
and inwards to the Yang Ming, while
relieving agitation and anxiety. Poria is also
calming, and teams with Cinnamon twig to
mobilize fluids in the body and restore
normal urine production. Cinnamon twig also
helps expel any internalized Cold pathogen
back outwards through the Tai Yang layer.
Tai Yin Formulas
While Damp (Tai Yin Excess) is common in small animal practice, patients are almost invariably of a Hot
constitution, and are Dampened not by an infectious agent but by a highly processed (and thus heating)
diet. The Tai Yin Excess formulas of the Shang Han Lun are thus of limited clinical relevance, since they
deal with Cold infectious agents causing obstructing Dampness. Since the Tai Yin is essentially an
exterior layer, expulsion and warming are the treatment methods the text advocates for infectious Tai
Yin Excess, in the form of Gui Zhi Tang (Cinnamon Combination) and variants. Gui Zhi Tang is the
representative formula for treating the closely associated Tai Yang layer.
One Tai Yang formula from the Shang Han Lun that is applied to Damp patients in modern practice is
Five Herbs with Poria Combination (Wu Ling San). Water metabolism in Chinese medicine involves
descent of Fluids to the Bladder from the upper and middle burners. The Bladder then effectively boils
these Fluids, causing pure fluids to rise back up and cool the Heart Fire of the upper burner. If this
mechanism is interfered with because of obstruction by a Tai Yang (Bladder) pathogen, Water does not
descend for processing by the Bladder, urine is not produced, and thirst increases. The same formula
can also be used where Dampness is the obstructing pathogen, making the formula applicable to
conditions of Tai Yin Excess as well.
Wu Ling San contains:
Wu Ling San (Poria Five Herb Combination)
Bai Zhu
White Atractylodes rhizome
Fu Ling
Poria
Ze Xie
Alisma tuber
Zhu Ling
Polyporus
Gui Zhi
Cinnamon twig
Alisma, Poria, and Polyporus all drain
Dampness and enhance clearance of
fluids through the Bladder and Kidneys.
White Atractylodes tonifies the Spleen to
reduce the production of Damp.
Cinnamon activates the Damp draining
action of the diuretics, warms the Yang of
the lower burner to promote fluid
metabolism by the Bladder, and expels
any pathogen invading the Tai Yang and
Tai Yin.
Clinical indications of Wu Ling San include:



Diabetes
Renal failure
Urolithiasis (particularly from calcium oxalates)
Subsequent versions commonly used by veterinarians today avoid FDA concerns with Zhu Ling
by replacing it with Tong Cao (Rice Paper pith). Rather than be used alone Wu Ling San is most
commonly used by small animal veterinarians with another formula, Ping Wei San (Harmonize
the Stomach Formula) – the two combined are known as Wei Ling Tang.
Ping Wei San quells vomiting. Its indications include some of the key symptoms of Tai Yin
Excess:

Nausea

Vomiting

Clear slimy emesis

Vomiting undigested food after eating

Vomiting recently ingested food, followed by successful re-ingestion

Abdominal distention

Cranial abdominal pain
Harmonize the Stomach (Ping Wei San)
Cang Zhu
Atractylodes rhizome
Chen Pi
Citrus peel
Hou Po
Magnolia bark
Da Zao
Jujube
When paired with Wu Ling San, which
helps drain the obstructing Dampness
through the Kidneys, a formula is
effectively created that deals handily with
Tai Yin Excess despite not being mentioned
by the Shang Han Lun.
Wu Ling San is distinguished from Zhu Ling
San (Polyporus Combination), another
Sheng Jiang
Ginger rhizome
formula to promote diuresis. Zhu Ling San
addresses much the same symptoms as
Wu Ling San – even has many of the same ingredients - but is directed more to Hot patients and
is thus discussed in the Yang Ming Excess portion of the text. It is mentioned in this section of
our notes for ease of comparison.
Gan Cao
Licorice root
In Zhu Ling Tang, Zhu Ling, Fu Ling and Ze
Xie function as they did in Wu Ling San to
Zhu Ling
Polyporus
promote descent of fluids to the Kidneys
and Bladder for concentration. In Zhu Ling
Fu Ling
Poria
Tang patients, Heat obstructs the descent
of fluids and is guided out of the Bladder
Ze Xie
Alisma
and Stomach via Hua Shi. In the process,
any painful urination is resolved. E Jiao
Hua Shi
Talcum
protects the Yin of the Hot and likely
Ass Hide Glue E Jiao
dehydrated patient, so that the formula
does not prove drying and end up
aggravating the Yang Ming Excess even further. Modern day veterinarians advocate Zhu Ling
Tang for interstitial cystitis in cats, on the assumption the E Jiao will provide glycosaminoglycans
that are protective to the bladder lining. Zhu Ling Tang is also a consideration in cystitis and
dysuria associated with Kidney Yin deficiency, such as in advanced feline hyperthyroidism and
pyelonephritis.
Zhu Ling Tang (Polyporus Combination)
Another formula of potential use in Tai Yin patients is Cultivate the Center Combination (Li
Zhong Wan). It contains:
Li Zhong Wan does not expel pathogens or aggressively deal with Damp, but does warm the
center of the body. It was advocated for simultaneous vomiting and diarrhea of cholera
patients, where the patient is cold and thirstless. Ginseng becomes critical in these patients to
regenerate the Source Qi and fluids. Licourice tonifies the Stomach Qi while Bai Zhu targets
Spleen Qi deficiency. Gan Jiang restores the Yang of the middle and lower burner.
Cultivate the Center Combination
While cholera is rare in the modern era, Li
Zhong Wan does have clinical application
Ren Shen
Panax Ginseng
in chronic gastritis, particularly in animals
being fed raw diets. In humans, Li Zhong
Bai Zhu
White Atractylodes
Wan addresses severe heartburn that
persists because of or in spite of prolonged
Gan Jiang
Dried Ginger
use of proton pump inhibitors. Essentially,
these drugs can be viewed as depleting the
Gan Cao
Licourice
Yang of the middle burner. For patients
with more overt Damp tendencies secondary to longstanding Spleen and Stomach Cold, Fu Ling
(Poria) can be added to Li Zhong Wan.
(Li Zhong Wan)
Shao Yin Formulas
Shao Yin Excess comes in either Hot (Yin deficient) or Cold manifestations. Yin deficiency commonly
causes agitation, restlessness and insomnia. For this, the Shang Han Lun advocates Coptis and Ass Hide
Glue Combination (Huang Lian and E Jiao Tang). It contains:
Huang Lian E Jia Tang
(Coptis and Ass Hide Glue Combination)
Huang Lian
Coptis
Huang Qin
Scutellaria
Bai Shao
Peony
Ji Zi Huang
Egg yolk
E Jiao
Ass-Hide Glue
Ji Zi Huang and E Jiao are proteinaceous and,
in the case of egg yolk, fatty, and thus serve to
strongly supplement Yin. Coptis and Scutellaria
clear the Heat from the upper burner and
Heart that is creating agitation and insomnia.
Bai Shao closes the pores to help astringe
further loss of Yin as perspiration. The formula
can be used for any patient with pronounced
insomnia, vexation and restlessness due to
uncomplicated Yin deficiency. Where the
Heart Fire is promoting dysuria or cystitis,
consider Zhu Ling Tang (see last section).
One of the causes of a Cold Shao Yin pathogen is chronic dysentery. In modern veterinary medicine,
other forms of chronic diarrhea, even non-infectious, can be considered Cold Shao Yin pathogens as long
as they result in the same characteristic loss of Kidney Qi or Yang, resulting in lassitude, a weak pulse,
chronic diarrhea, thirst, vomiting or nausea, and potentially even polyuria.
The formula advocated for this type of diarrhea, which has been useful in small animal practice for
refractory diarrhea from inflammatory bowel disease, is Tao Hua Tang (Peach Flower Decoction). It
contains:
Once a patient’s Kidney Qi is compromised,
use of Heat-clearing anti-inflammatory and
Gan Jiang
Powdered Ginger
antimicrobial herbs is contra-indicated, even
for overtly infected patients manifesting pus
Geng Mi
Rice
and/or blood in the stool. Instead, the Shang
Chi Shi Zhi
Halloysite
Han Lun hit upon the clever solution of
employing Halloysite (or kaolin. The clay both
astringes fluid loss, and binds bacteria and toxins (i.e. pathogens), helping to soothe the intestinal tract
and restore its function as a barrier. Ginger is used to warm the Yang of the middle and lower burners.
Rice is used to tonify the Spleen and Stomach Qi and provide a readily assimilable source of nutrients for
the patient until their Kidneys and digestion are restored to full power.
Peach Blossom Combination (Tao Hua Tang)
As in conventional medicine, another sign of critical Kidney Yang deficiency is edema formation. The
Shang Han Lun advocated Zhen Wu Tang (True Warrior Combination) where a Cold pathogenic excess
has damaged the Kidneys’ ability to purify fluids through their boiling, such that the pure fluids steam
upward to cool and entrain the Heart Yang, while the remaining dross is voided.
Any edema, whether in the lungs, limbs and digestive tract, was treated with Zhen Wu Tang as long as
the primary cause was Kidney Yang deficiency. Zhen Wu Tang contains:
The time of day when the Shao Yin is in Excess
is when Yang is in the Tai Yang phase. There is
Fu Ling
Poria
thus little Yang in the interior of the body to
combat the Cold pathogen – instead Yang
Bai Shao
Peony
remains forced out onto and trapped upon the
Bai Zhu
White Atractylodes
surface. The sour taste of Bai Shao is required
to astringe and internalize Yang to where it
Sheng Jiang
Fresh Ginger
can restore Spleen and Kidney function.
Fu Zi
Aconite
Symptoms of Yang trapped on the surface,
such as a floating toned pulse in patients with
edema, is a strong indication for the use of Zhen Wu Tang. Fu Ling guides water down to the Kidneys,
which are warmed by Gan Jiang and Fu Zi. Sheng Jiang alleviates vomiting and coughing, two symptoms
of systemic edema. Bai Zhu addresses diarrhea from vomiting and edema, and with Ginger, restores
Spleen and Stomach Qi and Yang, which is inevitably impaired in Kidney Yang deficiency.
Zhen Wu Tang (True Warrior Combination)
Jue Yin Formulas
The representative formula for Jue Yin excess advocated by the Shang Han Lun is Wu Mei Wan (Mume
Plum Combination). It is advocated by the Shang Han Lun for persistent diarrhea and/or
endoparasitism, but its use is extended by modern Chinese medicine to include seizures, encephalitis,
depression and even menopausal hot flashes. In veterinary medicine, a history of chronic or recurrent
endoparasitism, especially where multiple parasites are found overtime, is a strong indication that a
patient may be greatly helped in general by Wu Mei Wan, in addition to finally becoming parasite-free.
Mume Plum Combination (Wu Mei Wan)
Wu Mei
Mume plum
Xi Xin
Wild Ginger herb
Hua Jiao
Prickly Ash bark
Huang Bai
Phellodendron bark
Huang Lian
Coptis rhizome
Gan Jiang
Ginger rhizome
Dang Gui
Angelica root
Fu Zi
Aconitum root (prepared)
Gui Zhi
Cinnamon twig
Ren Shen
Panax Ginseng
Jue Yin Excess creates such an extreme
accumulation of Yin in the lower abdomen
that Yang Ming energy becomes squeezed
out, like water wrung from a sponge.
Diarrhea and increased appetite result, yet
the body is not supported. Meanwhile,
Yang and Yin are at risk of separation,
jeopardizing Qi formation. Ginseng restores
this Qi, while Ginger, Prickly Ash bark, and
Aconitum inject Yang into the accumulation
of Yin. Bitter Cold Coptis and Phellodendron
clear Yang Ming Heat accumulated in the
upper body, and descend Yang back to
where it can be integrated. Dang Gui and
Mume soften the Yin, while Cinnamon and
Asarum promotes its expansion. The latter
are two Tai Yin and Yang herbs –
strengthening the Tai Yin and Yang draws
the body out of its Jue Yin – Yang Ming, and
restores the natural progression of Yin and
Yang phases.
Wu Mei Wan is largely free of anti-parasitic activity. It appears to conquer endoparasitism by boosting
host resistance and immunity. In Chinese medical parlance, it integrates Yin and Yang to restore Source
Qi, with the Source Qi then repelling the parasites. Until then, the parasites appear to inhabit the noman’s land between compressed Yin and displaced Yang, in the region of the diaphragm. From here they
periodically appear in the vomitus caused by the upward displacing Yang Ming energy. The warming of
the Yang of the lower burner produced by the formula also allows it to be of use in other chronic forms
of diarrhea, particularly where there is an element of spasticity and urge incontinence in small bowel
diarrhea.
The benefit of Wu Mei Wan in seizures and encephalitis comes from the emollient effect of the formula
on Jue Yin, such that it can expand and hold Yang as it is descended under the influence of Huang Bai
and Huang Lian. In practice, an additional Blood moving effect seems required to allow Yin and Yang to
be fully integrated. That effect can be supplied by Peony and Salvia in modern forms of Qing Ying Tang
(Clear the Nutritive Combination; Cool the Blood by Kan Herb). Additionally, Qing Ying Tang
supplements Wu Mei Wan in epilepsy with its added moistening and cooling effects.
Clear the Nutritive Combination (Qing Ying Tang)
Sheng Di Huang
Rehmannia root
Jin Yin Hua
Honeysuckle flower
Xuan Shen
Scrophularia root
Chi Shao Yao
Red Peony root
Zhi Zi
Gardenia fruit
Da Huang
Rhubarb root and rhizome
Huang Lian
Coptis rhizome
Lian Qiao
Forsythia fruit
Dan Shen
Salvia root
Dan Zhu Ye
Lophatherum
Mai Men Dong
Ophiopogon root