During 2020, finding balance may have seen hard and out of reach with so much uncertainty. An important aspect of both life and TCVM is a balance between Yin and Yang energy within the body. We see Yin and Yang in every aspect of life and our daily routine; hot and cold, night and day, up and 

down, yes and no. Yang represents sky, energy, warmth and light while Yin is ground, passive, cold, and dark. If there is an imbalance, there is disease.

The concept of Yin and Yang and assignment of these terms are based on perspective of external factors such as Summer Day (Yang) and Winter Day (Yin) verses Spring Day (Yang) and Spring Night (Yin). By following what each half of the whole represents one can assign Yang or Yin aspects.

A tree’s branches and leaves are Yang, they face the sun and reach towards the sky. The roots are Yin, they are in the earth, hidden from the sun in darkness. The trunk represents the Yin within Yang, and Yang within Yin. The leaves and branches hide the sun from the trunk and puts it in shadow, but the trunk also reaches upward towards the sky. There are also moments within the day where sunlight will hit the trunk (Yang side) on one side verses the darkness on the other side (Yin side). Even the leaves can be Yin and Yang, the top of the leaves that face the sun (Yang) verse the bottom of the left that faces the ground (Yin).

In TCVM there are four pathological states of Yin and Yang imbalances. Yin Excess, Yang Excess, Yin Deficiency and Yang Deficiency. It is natural for the deposition of both a person or pet to be fall within one of these four characteristics of imbalance. By providing support for the imbalance disease can be prevented or reduced. These imbalances can be support by both external and internal methods from food to environment. Example a client might report their Yang Excess (Excess Heat) canine constantly trying to lay down on the cool kitchen tiles, perhaps a location the owner does not want their furry companion in. Providing a cooling dog sleeping pad for a Yang Excess canine would be one way to support this imbalance along with a cooling diet. This will prevent the canine from being in the kitchen and give the canine a way to cool down, making both happy.

Hypothetical Cases

Case 1

Species: Feline
Breed: DSH
Age: 15 years
Gender: N

Clinical Diagnosis (conventional): Chronic Kidney Disease
Conventional Indications: Somewhat inappetant. Most recent laboratory findings include: BUN-60 mg/dL, Creatnine-3.6 mg/dL, Phosphorus-6.0 mg/dL. PCV-30%, Total Protein-7.5. BCS 4/9.  Slightly dehydrated. Blood Pressure- 130 mm Hg (Doppler, front leg)
Conventional Treatment: Low phosphorus diet, Subcutaneous fluids twice weekly, Phosphorus binder

Traditional Indications: This patient has a decreased appetite.  Ears and back are cool to the touch.  This patient will follow the sun from window to window throughout the day. Stools are formed but slightly dry. There is appreciable muscle wasting present overall. Tongue - Pale. Pulse - Weak
TCVM Diagnosis: Kidney Yang Deficiency
TCVM Assessment:

• Chronic Kidney Disease-Kidney Deficiency, BUN increased, function affected (Yang/Qi), Remember, this diagnosis will reflect the most appropriate pattern. At this point most patients will have a decreased corticomedullary ratio via imaging.  This means the structure is damaged, which would be Yin. However, the overall pattern for this pet is Yang Deficiency.
• Cool ears and back-Yang Deficiency
• Pale tongue-Qi or Yang Deficiency
• Weak pulse-Qi or Yang Deficiency
• Warm seeking-Yang Deficiency

Treatment Principles: Tonify Kidney Yang, Improve appetite

Acupoint Prescription:

Chinese Herbal Prescription:

• Jin Gui Shen Qi, 0.5g per 10lbs of body weight twice daily

Case 2

Species: Equine
Breed: Clydesdale
Age: 2 years
Gender: Mare

History:  recently sold and transported to new barn facility across state lines from Florida to Texas during summer months. The new owner noticed horse's inability to sweat upon arrival and his excessive body temperature of 104.5, tongue was red with a thick yellow coating, pulses were urgent and fast, defecation was dry and sparse and urine was scant and dark yellow

Case 3

Species: Canine
Breed: Labrador Retriever
Age: 10 years
Gender: S

Clinical Diagnosis (conventional): Bilateral Hip Dysplasia with Lumbar Spondylosis Deformans
Conventional Indications: Diagnosed 1 month ago with bilateral coxofemoral dysplasia and spondylosis deformans at L2-3, L4-5, L5-6 after demonstrating difficulty rising and reluctance to go on walks.  Difficulty getting into the car.  Present medications include carprofen at 2.2 mg/kg PO BID, chondroitin sulfate supplement, and Fish oil 1000mg PO BID.

Traditional Indications: Historically this pet has a good appetite.  She is slow to move in the morning but anxious to go for her walks.  Very stiff initially but then moves better.  Some increased thirst, but seems to drink larger quantities. This patient will often wake in the middle of the night and move to a cool floor and pant. Her stools are somewhat dry.  She has some difficulty holding her posture to defecate. Difficulty rising with pain when moving.  On palpation, there is difficulty extending the rear limbs.  Pain is demonstrated when rising and when the pelvic limbs are extended. There is pain on palpation of the lumbar spine.  The skin is slightly dry with small flake dandruff. Acupoints BL-23, BL-18, BL-54 are hollow on palpation.  Acupoint Jian-jiao is painful when palpated. There is some sarcopenia symmetrically over the lumbar spine and both pelvic limbs. Tongue: Pale and dry. Pulse: Thin, slightly fast and weaker on the right.

TCVM Diagnosis:  Kidney Qi-Yin Boney Bi

TCVM Assessment:

• Skin is dry with small flake dandruff, stool is dry.-Yin or Blood Deficiency
• Boney change- Kidney Deficiency
• Pain, decreased range of motion- Stagnation of Qi and Blood (Bi Syndrome)
• Pale tongue- Qi Deficiency
• Dry tongue- Yin Deficiency
• Difficulty holding posture to defecate- pain-Qi-Blood Stagnation
• Difficulty holding posture to defecate- weakness- Qi Deficiency
• Pain at Jian-jiao-Pain in the lumbar, pelvis region.

Treatment Principles:Resolve Stagnation of Qi and Blood, Tonify Qi, Tonify Yin

Acupoint Prescription:

Chinese Herbal Prescription:

• Di Gu Pi San concentrated 0.5 g capsules: 1 capsule per 20 lbs of body weight
• Body Sore concentrated 0.5g capsules: 1 capsule per 20lbs of body weight

Case 4

Species: Equine
Breed: Welsh pony
Age: 12 years
Gender: Mare

History: Living in North East USA, first frost overnight affecting her acutely, off food in the morning, loose stool and prolonged urination, high peristalsis, mare is restless and appears crampy, kicking at abdomen, muzzle is cold to touch, tongue is purple with white coating, pulses are slow and deep
Pattern: stomach cold/yin excess
Treatment Principle: warm the middle jiao
Acupuncture: Bai hui, GV-4, BL-21, ST-36, LI-10
Herbal Formulas: Gui Zhi Tang, cinnamon concoction, to warm the channel, dispel the cold  and pain and regulate the stomach. Components are: Gui Zhi (Cinnamon), Sheng Jiang (Ginger), Bai Shao Yao (Paeonia), Da Zao (Jujube) and Gan Cao (Licorice).

Edited by Greg Todd, DVM, CVA and Alex Kintz-Konegger, DVM, CVA, CVTP. Hypotherical Case by Greg Todd, DVM, CVA and Alex Kintz-Konegger, DVM, CVA, CVTP.