TCVM for the Treatment of Hind Limb Weakness and Urine Incontinence in a Dog
Pitchayanin Chomsiriwat, DVM, MS, CVA, CVTP, CVFT, CVCH
Charoensuk Animal Hospital, Bangkok, Thailand
History: A 15-year-old, 14.5 kg, spayed, female, mixed breed dog with dribbling urine and hind limb lameness was referred for acupuncture. The owner reported that the dog had previously been in a car accident.
Western Physical Exam and Treatment: Her physical exam and mentation were normal. She was thin with body condition score of 4/9. She had alopecia (bald patches) and very dry skin with pustules all over her back and perineal area. The urine dribbling made her skin condition worse and affected her behavior. Her blood tests were unremarkable. A radiograph showed degenerative joint disease of both the hip joints, subluxation of the left hip joint, and an old fracture of the left scrum. She has been on Bethanechola 10 mg orally three times daily for almost 2 years, and her urine incontinence had still not improved. Her skin problem was evaluated and she had been given medicated shampoo.
TCVM Exam, Diagnosis and Analysis: Her Shen was disturbed, and she was aggressive. Her tongue was pale purple and wet (Figure 1) with thready and fast pulses. Her skin was clearly irritated (Figures 2 and 3.) She was diagnosed with Kidney Qi/Yin Deficiency with Spleen Qi Deficiency. Kidney Qi Deficiency arose from prolonged illness and old age which gradually damages Kidney Jing that led to a deficiency in Kidney Qi, Yin and/or Yang. In addition, urine incontinence is a sign of Kidney and Spleen Qi Deficiency because there is not enough Qi to hold urine. Her Kidney Yin Deficiency caused a history of cool-seeking behavior and excessive panting.
Figure 1: Tongue examination on first visit
Figure 2: Skin conditions on first visit.
Figure 3: Skin conditions on first visit.
TCVM Treatment Plan: The treatment plan consisted of acupuncture and herbal therapy; the owner elected not to proceed with Western medical treatment. The desired outcome was to improve the overall Qi, tonify Yin, and tonify Water and Earth elements. The initial herbal therapy was designed to tonify the Water element and weakness of hind limbs. Over the course of treatment, the following acupuncture points were used: Dry needle acupuncture was performed on Da-Feng-Men, Bl-11, BL-23, Bai Hui, KID-1, KID-10, KID-3, HT-7, GV-1, BL-40, and An-Shen. Electro-Acupuncture was used on BL-23, Shen-Shu, BL-40 and ST-36. Aqua-acupuncture was used on BL-23, Bai-Hui and ST-36.
The herbal formula prescribed was Wu Bi Shan Yao Sanb and Hindquarter Weaknessb. She was given 1 capsule (0.5 grams) orally twice daily of each formula. She was calmer and less aggressive after her first visit. Her urine incontinence was resolved by the fifth visit (week 6) and the Hindquarter Weakness herbal was discontinued. On the sixth visit, her urine was normal without any dribbling. Her attitude had improved. She loved to be petted, and her hair had grown to cover her body (Figure 4.) She was calmer and socialized more with people and other dogs.
Figure 4: Skin condition completely improved after sixth visit (3 months).
The acupuncture appointment was now once a month, continuing with the same doses of Wu Bi Shan Yao San with orthopedic vet follow-ups every 3 months. The urine incontinence problem was resolved. She could hold her bladder and get up to do daily activities. Her skin and hair were normal, and she was less aggressive when coming to the hospital.
Case Summary: From a TCVM perspective, urine incontinence is called Lin syndrome. 2 The primary cause of urine incontinence is mostly from neurological problems. After a long treatment period with Western medicine, the symptoms had not improved so the owner sought other options. The dog also had chronic skin irritation which affected her behavior. The herbals combined with acupuncture can be an effective treatment for urine incontinence patients.
1) Xie H. Chinese Veterinary Herbal Handbook. Reddick, FL: Jing Tang Publishing 2011: 86, 131.
2) Xie H, Preast V. Xie’s Veterinary Acupuncture. Ames, IA: Wiley-Blackwell 2007: 298.
aM & H Manufacturing Co.,Ltd.
b Dr.Xie’s Jing Tang herbal