Moxibustion for Cold Colic in an Appaloosa Gelding
Emily Mangan, DVM, CTCVMP, CCRV, CVMMP
The Magic of Moxibustion
December is here and as the winter rolls in (at least in the Northern hemisphere), it brings with it the cold and the damp and it makes me think of one thing: how much I really love moxibustion.
Moxibustion is a wonderful tool that seems to be underutilized in the West. Moxa is considered a topical herb, and consists of dried mugwort (Artemisia siensis or vulgaris) that is ground into a powder and used as is or is formed into cones or sticks. The moxa is then burned above the skin or on top of an acupuncture needle where the warmth and herbal effects are absorbed transdermally. Moxa promotes the circulation of Qi and Blood, relieves Stagnation and pain, and reduces swelling. In horses, it is commonly used for musculoskeletal pain as well as for stocking up in the distal limbs. In geographical regions that see freezing temperatures, the warmth of moxibustion is a welcome addition for both the patient and the practitioner. It can be used to stimulate acupuncture points and channels and warm the body to dispel Cold, and is especially useful for stimulation of abdominal points. Speaking of which, let’s talk about Cold Colic.
What is Cold Colic?
TCVM Etiology and Pathology
In TCVM, the direct cause of colic is simply Qi/Blood Stagnation in the abdomen, which may result from one of five common Patterns: Cold, Damp-Heat, Qi Stagnation, Food Stagnation, and Obstruction. Cold Colic results with invasion of exogenous pathogenic Cold via cold food, water, environment, and weather, and is therefore most common in the winter months and in areas of the world with severe cold weather. Animals with deficient Qi or Yang, geriatrics, and those with comorbidities are more susceptible to invasion of Cold. Cold causes contraction, and when Cold invades the stomach, it causes Stagnation and pain which result in colic signs.
Clinical signs of Cold Colic include acute onset of colic or intermittent abdominal pain with classic colic signs (repeatedly lying down and standing up, pawing, kicking or biting at the abdomen, looking at the flank, or rolling).
The tongue is typically pale or purple, and the pulse is slow and deep. The ears and body may feel cold, especially over the back and abdomen.
Treatment principles are to warm the middle Jiao, dispel the Cold, promote Qi flow, and move Stagnation to stop pain.
A Case of Cold Colic
Zippy, a 26-year-old Appaloosa gelding, presented for acute onset of colic signs at the 6pm feeding. Zippy had eaten his breakfast and lunch normally, and upon coming in from pasture for dinner, took one bite of hay, lost his appetite, and displayed a flehmen response. He moved to the far side of his stall where he repeatedly watched his flanks and shifted his weight.
Zippy had history of two previous episodes of spasmodic colic, 14 years and 12 years ago respectively, that resolved with conventional medical management. He had a history of a good appetite, intermittent fecal water in the summertime, chronic right hindlimb lameness, and chronic recurrent airway obstruction. His diet consisted of a mix of valley and orchard grass hays, free access to pasture, a ration balancer, and flax oil. The whether had been colder than expected for the region with recent and unexpected snowfall. He had 24/7 access to the barn and heated water supply.
Zippy had historical diagnoses of Lung Yin Deficiency, Kidney Qi Deficiency, and Bony Bi Syndrome, managed with herbal medicine and acupuncture.
The gelding was a Wood/Metal constitution, as evidenced by a history of aloofness, desire for routine, tidy stall, and very strong opinions. His ears and back were cold to the touch, his tongue was pale purple and wet, and his pulses were slow and deep bilaterally. His temperature was 99.8 °F (37.7 °C), his respiratory rate was 12 breathes per minute, and his heart rate was 28 beats per minute. He displayed abdominal tucking, intermittent flehmen response, and intermittent flank watching. He had increased borborygmi in all quadrants. As his body felt cold, especially around the middle Jiao, his tongue was purple, and his pulses were slow and deep, as well as history of recent onset of cold weather, he was diagnosed with Cold Colic.
Treatment principles were to warm his middle Jiao, dispel Cold, and move Qi, and relieve Stagnation. The gelding received acupuncture at Bai-hui, GV-4, Jiang-ya, BL-20, BL-21, ST-36, ST-37, and SP-4, with electroacupuncture at 80/120Hz at BL-20 + BL-20, BL-21 + BL-21, and GV-4 + Bai-hui. He received moxibustion 3-5 minutes per acupoint at GV-4, Bai-hui, BL-20, BL-21, and CV-12.
He also received 500mg flunixin meglumine IV at the beginning of treatment.
He was prescribed 2 teaspoons ground dried ginger to his food twice daily to warm the Stomach, and continued moxibustion treatment daily.
Zippy’s colic resolved within 45 minutes of treatment. He was fasted the remainder of the night, and provided a warm mash the following day that he ate with vigor. At recheck examination one week after his colic episode, his ears and back were warm despite the ambient temperature being similar to the night of presentation. His pulses were bilaterally weak and deep, but with regular rate, and his tongue was pale and wet but not purple. He had normal manure and appetite with no recurrence of colic signs. He continued treatment for his chronic deficiencies.
This gelding is an example of how the invasion of exogenous Cold can result in abdominal Stagnation and colic. As Zippy was an older gelding with known Qi Deficiency, he is more susceptible to invasion of exogenous pathogens. Warming of his middle Jiao with moxibustion and food therapy, along with acupuncture, dispelled the Cold and relieved his colic. While his colic resolved with these therapies alone, in a patient that has repeat colic episodes due to Cold or severe Cold Colic, the herbal medicine of choice would be Ju Pi San.
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