Wei Syndrome in a Geriatric Equine
John A. Perdrizet DVM, PhD, MS-TCVM, DACVIM(LA)
HISTORY
In the early winter of 2021, I was asked to provide TCVM care to a 750 lb., 32 yr.-old Appaloosa Mare on a small farm in western New England. The owner was concerned that ‘Molly’ was having more difficulty getting up from a prone position and her movement around the pasture had gradually decreased in the past few months. Molly would spend most of the day within 10 meters of the entrance to her stall, and half of that time she was recumbent. She had been provided with nutrition consultation and the diet had been amended 3 months earlier, but the owner had not noticed any change in energy or body weight. In fact, her appetite had decreased, and her body condition score had suffered (now a 3/9).
EXAMINATION
Molly was alert and had normal sensorium (appeared to hear well, could see, and carried her extremities in a normal posture). Generalized muscle loss was the most remarkable finding – especially her gluteals, upper forelimbs, and back. Her teeth were worn but no significant dental or oral lesions were found. She had received routine dental care twice yearly for many years. She had normal heart and respiratory sounds on thoracic auscultation. Her feet were trimmed every 2 months and were in good condition. There was decreased range of motion detected upon palpation and manipulation of all four of her limbs. A CBC and serum chemistry screen showed all parameters within normal limits.
CONVENTIONAL DIAGNOSIS
A conventional diagnosis of old age resulting in less-than-optimal nutrient assimilation by the GI tract with subsequent weight loss and decreased muscle-mass was made. These were assumed to cause an overall decrease in her energy. This combined with polyarthritis had contributed to her lack of mobility and recumbency.
TCVM EXAMINATION.jpg)
A TCVM examination revealed a pale, enlarged, wet tongue with minimal coating. A deep, slow, and weak pulse was evident bilaterally. Molly’s back and ears were cold to the touch. A Body Scan showed +2/5 sensitivity over BL-20-23 on both sides. All these findings were consistent with Spleen and Kidney Qi/Yang Deficiency…Wei Syndrome.
TCVM THERAPY
The TCVM therapeutic plan consisted of weekly Acupuncture sessions, Herbal supplementation, Tui na, and Food Therapy. The goal was to Tonify Spleen and Kidney Qi/Yang and warm the Middle Jiao. (The reader should remember that it was cold and dark [season of Yin] in New England).
HERBAL: Molly was placed on the herbal Eight Gentlemen at 15gm twice daily to tonify Spleen Qi and Rehmannia 14 at the same dose to tonify Kidney Qi/Yang.
FOOD THERAPY: Molly was given steamed whole oats with cinnamon, ginger, thyme, rosemary, walnuts, and seaweed in addition to her conventional chopped hay and senior feed. These were intended to Warm the Interior, and the seaweed was to Tonify the Kidney Qi. The walnuts are also believed to strengthen cognition.
MOXA: The owner was instructed on how to use a Moxa stick; the Conception Vessel was to be warmed twice daily for 10 minutes from CV-3 to CV-21.
TUI NA: The owner was taught to perform whole body Ca-fa, and Cuo-fa on Molly’s limbs twice a day for 10 minutes.
ACUPUNCTURE: Dry needle acupuncture focused on tonifying Spleen and Kidney Qi, as well as overall Qi and Blood. The following acupoints were used:
Bai hui – Hundred meetings - Yang Tonification
Da-feng-men – Great Wind Gate – Brighten Shen
Long hui – Dragon Meeting – Brighten Shen
Shen Shu – Kidney Assoc. Point – Kidney Qi/Yang Tonification
BL-11 – Big Shuttle – Influential Point for Bone (Arthritis)
BL-17 – Diaphragm Assoc. Point – Influential Point for Blood
BL-23 – Kidney Assoc. Point – Kidney Qi/Yang Tonification
BL-20 & 21 – Spleen & Stomach Assoc. Point – Tonify Middle Jiao
BL-24 – Sea of Qi Assoc. – Global Qi Tonification
BL-54 – Attach to Mountain – Hind Limb Lameness, Muscle Atrophy, Arthritis
BL-40 – Bend Middle – Master Point for Lumbosacral and Hips, He-Point, Earth
LI-4 – Union Valley – Master Point Face & Mouth, Yuan Source Point
LI- 10 – Arm Three Mile- Front Three Mile Point, General Weakness
LI-11 – Pool on the Bend – He-sea Point (Earth)
ST-36 – Leg Three Mile – Master Point for GI Tract and Abdomen, He-Point, Earth
CV-17 – Chest Centre - Influential Point for Zhong Qi
CV-12 – Central Stomach Duct – Influential Point for Fu Organs
LIV-13 – Completion Gate – Influential Point for Zhang Organs
SP-21 – Great Embracement - Wei Syndrome, Major Luo Connecting Point
GB-34 – Yang Mound Spring – He-sea Point (Earth), Influential Point Tendon/Ligament
10 – 15 acupoints were used at each session but varied with each session depending on any subtle changes in the Bian Zheng. Many of these points received heating with Moxa, as well as tonifying techniques (e.g., thrusting and twirling).
OUTCOME
Over the next month, with weekly acupuncture sessions and continued owner-assisted therapies, Molly’s condition improved, and she became stronger. The owner was delighted with her progress. Driving back from the last session, I felt gratified with Molly’s progress. Little did I know that the Dao was soon to teach me a valuable lesson….
Four days after Molly’s last acupuncture session, I received a frantic call from the owner on a Sunday morning. Molly had wandered a considerable distance from the barn, as it was a sunny, calm, but frigid day. She was feeling much more energetic and happier. Alas, she had gotten into a low area near the stream that transected the pasture. The ground, though snow covered, had not frozen, and she was stuck in the mud. By the time I arrived 45 minutes later, Molly was exhausted from attempting to stand, and the local fire department had succeeded in dragging her to dry ground. Unfortunately, the story did not end well for Molly, as she never regained her feet.
TAKE HOME LESSON:
Sometimes even success can turn to failure. We must stay vigilant and anticipate the results of our treatments. As the Dao De Ching instructs us – pay as much attention to the end as to the beginning of any endeavor! If only I had warned the owner to keep Molly from wandering too far, if only we had erected a temporary fence, if only… it is a common and human response to doubt ourselves, question our abilities, and lose sight of the good we do as practitioners in a profession where we must contend with the vagaries of Nature.
I came across the Daoist Tale of The Old Farmer, shortly after Molly passed, and found it applicable to our everyday lives and professional challenges. So, I will share it with you here:
There was once a farmer in ancient China who owned a horse. “You are so lucky!” his neighbors told him, “To have a horse to pull the cart for you!” “Maybe,” the farmer replied.
One day he didn’t latch the gate properly and the horse ran off. “Oh no! What a disaster!” his neighbors cried. “Such terrible misfortune!” “Maybe,” the farmer replied.
A few days later the horse returned, bringing with it six wild horses. “How fantastic! You are so lucky,” his neighbors told him. “Now you are rich!” “Maybe,” the farmer replied.
The following week the farmer’s son was breaking-in one of the wild horses when it kicked out and broke his leg. “Oh no!” the neighbors cried, “such bad luck, all over again!” “Maybe,” the farmer replied.
The next day soldiers came and took away all the young men to fight in the war. The farmer’s son was left behind. “You are so lucky!” his neighbors cried. “Maybe,” the farmer replied.
And, so, my fellow colleagues, accept your present circumstances with equanimity! Keep to the center; balance is the goal.
REFERENCES
Xie H, Preast V. Traditional Chinese Veterinary Medicine: Fundamental Principles 2nd ed. Reddick; Chi Institute Press. 2013.
Xie H, Preast V. Xie’s Veterinary Acupuncture. 1st ed. Reddick: Blackwell Publishing; 2007.
Xie H, Ferguson B, Deng X. Application of Tui Na in Veterinary Medicine. 2nd ed. Reddick: Chi Institute of Chinese Medicine; 2008.
Fowler M, Xie H, editors. Integrative and Traditional Chinese Veterinary Medicine Food Therapy. 1st ed. Reddick; Chi University Press. 2020.
Ma A. Clinical Manual of Chinese Veterinary Herbal Medicine.4th ed. Gainesville; Ancient Art Press. 2016: 103-105, 121-123.
Tsu L. Tao Te Ching. Feng G-F, English J.; Translators. New York (NY); Random House Inc. 1972.