I have been procrastinating on the Six Stages and Four Levels according to TCM for a long time. The reason is simple—it’s a deep, difficult subject. Whenever I teach these concepts in school, my students often have that deer-in-the-headlights look, as if to say: “What is this about? I’m so confused!”

Back in TCM school, we were introduced to the Six Stages and the Four Levels way too early—during our foundation theory courses. Looking back, I think that was a mistake. These are vast subjects rooted in the classical texts of Chinese medicine, and those texts are huge—the Shang Han Lun alone is over a thousand pages. No wonder we all felt overwhelmed!

When we first see this material, it can feel intimidating, complicated, and impossible to apply in practice. I know, because I felt exactly that way as a student.

But here’s the good news: today, I’m going to make it simple, approachable, and—dare I say—fun. We’ll cover the basics of the Six Stages and the Four Levels, why they matter, and how you can use them in clinic to track the progression of disease.

So take a deep breath. You might need to read this more than once before it sinks in, but don’t give up—because this material is truly powerful, clinically relevant, and one of the great gifts of TCM.

👉 Are you ready? Let’s do this.

Clara
TCM Geek

Links mentioned in this video:

📗 Chinese Medicine Made Easy Book

🤓 AcuExams Made Easy PDF

☯️ TCM Diagnosis Masterclass

📺 Meridian Pathways Video

📺 Meridian Theory Video

The 6 Stages ( Shang han Lun) and 4 Levels (Wen Bing) in TCM

The Six Stages (Shang Han Lun) – Cold Damage

The Shang Han Lun, written during the Han Dynasty by Zhang Zhongjing, remains one of the cornerstones of Chinese medical thought.

💡 TCM Rock Star Fact: Zhang wrote this text after losing many family members to epidemic illness—so his work is both intellectual and deeply personal.

The Six Stages describe how a Cold pathogen contracts, stagnates, and penetrates the body layer by layer.

The Six Stages Explained

1. Tai Yang (Greater Yang)

   • First line of defense.

   • Symptoms: chills, fever, stiff neck, aversion to cold, floating pulse.

   • Treatment: Release the exterior (LI4, LU7, BL12).

2. Yang Ming (Bright Yang)

   • Cold transforms into interior Heat.

   • Symptoms: high fever, big thirst, profuse sweating, constipation, dry yellow tongue coat.

   • Treatment: Clear Heat (LI11, ST44, DU14).

3. Shao Yang (Lesser Yang)

   • The “half-interior/half-exterior” stage.

   • Symptoms: alternating chills and fever, bitter taste, dry throat, rib-side pain.

   • Treatment: Harmonize Shao Yang (SJ5, GB41).

4. Tai Yin (Greater Yin)

   • The pathogen sinks into the Spleen.

   • Symptoms: abdominal fullness, poor appetite, fatigue, loose stools.

   • Treatment: Warm and tonify (ST36, SP6, Ren12).

5. Shao Yin (Lesser Yin)

   • Deeper deficiency of Yin or Yang.

   • Yin Deficiency: insomnia, dry mouth, palpitations.

   • Yang Deficiency: cold limbs, diarrhea, fatigue.

   • Treatment: Warm Kidney Yang (e.g., Ren4, KD3) or nourish Yin (KD6, HT7).

6. Jue Yin (Terminal Yin)

   • The most complex stage.

   • Symptoms: mixed Heat and Cold—heat above/cold below, thirst, diarrhea, wasting.

   • Treatment: Balance and harmonize (LV3, PC6).

🔥 The Four Levels (Wen Bing Theory) – Warm Disease

In the 1700s, epidemic febrile diseases swept through China. Scholars like Wu Ju Tong expanded on Zhang Zhongjing’s work and created the Wen Bing Lun.

💡 TCM Rock Star Fact: Wen Bing theory was so forward-thinking that it’s still used today in managing modern viral illnesses.

Instead of Cold, this model focuses on Warm pathogens—heat, fever, dryness—that burn through the body, consuming fluids and Yin.

The Four Levels Explained

1. Wei Level (Defensive Qi)

   • The pathogen is still at the surface.

   • Symptoms: fever, mild chills, sore throat, slight thirst, floating rapid pulse.

   • Treatment: Release the exterior and expel Heat (LI4, LU7, DU14, Yin Qiao San).

2. Qi Level

   • Heat moves inward, creating strong Yang signs.

   • Symptoms: high fever, intense thirst, profuse sweating, irritability, red tongue with yellow coat.

   • Treatment: Clear Qi-level Heat (LI11, ST44, Bai Hu Tang).

3. Ying Level (Nutritive Qi)

   • Heat reaches the Ying level, affecting the mind.

   • Symptoms: fever worse at night, restlessness, insomnia, crimson tongue, thin rapid pulse.

   • Treatment: Clear Heat, cool the Ying, protect Yin (HT7, PC6, Qing Ying Tang).

4. Xue Level (Blood)

   • The deepest and most severe stage.

   • Symptoms: bleeding (nosebleeds, blood in stool), delirium, tremors, skin eruptions, purple tongue.

   • Treatment: Cool Blood, stop bleeding, calm Shen (SP10, BL17, Qing Gong Tang).

❄️ Six Stages vs. 🔥 Four Levels

💡 Clinical Relevance for Today

Why should modern practitioners still study these models? Because colds, flus, and febrile illnesses are still common in clinic—and these maps help us track their progression.

• Tongue and pulse guide you to the current stage or level.

• Points and formulas shift based on progression:

  • Tai Yang: LI4 + LU7, release the exterior.

  • Yang Ming: LI11 + ST44, clear Heat.

  • Wei Level: Yin Qiao San + LI4, LU7.

  • Xue Level: SP10, BL17, Qing Ying Tang.

• Adapt treatment over time — a patient may move from Wei Level sore throat → Qi Level fever → Ying Level restlessness in just a few days.

Final Thoughts

The Six Stages (Shang Han Lun) and Four Levels (Wen Bing Theory) remind us of one of the core truths of TCM: disease is dynamic. Pathogens move, change, and transform, and our role as practitioners is to meet them at every stage.

By understanding these classical frameworks, you stop treating symptoms in isolation and start seeing the bigger picture: where the pathogen is, where it’s heading, and how to guide the body back to balance.

Next time you see a patient with fever, chills, sore throat, or alternating hot and cold sensations—think: Are they in a Stage or a Level? That answer will shape everything you do next.