Acupuncture and Tui-na for the Treatment of Damp Bony Bi Syndrome
Rosemarie Niznik, DVM, CVA, CVFT, CVTP, CVSMT, FCoAC

COXOFEMORAL JOINT DISLOCATION

Luxation or dislocation of the coxofemoral joint is one of the most frequent types of dislocation experienced by dogs and cats. The femoral head is usually dislocated dorsal to the acetabular rim, with a craniodorsal position the most common. Blunt trauma is the most common cause of hip dislocation with most cases unilateral.

In acute cases, the animal may have a non-weight bearing lameness. Animals with a chronic luxation may be minimally lame, especially small dogs and cats. On manipulation of the hip joint, crepitus and pain may be noted. Muscle atrophy may be present in the affected limb.

The luxation or dislocation can be treated by a closed reduction or surgical procedure. Closed reduction should be attempted in every case because it is very often successful. Even if unsuccessful, an attempt at closed reduction does not affect the outcome of subsequent surgery.

Many surgical techniques and modifications have been described to address chronic hip luxations and hips that reluxate after closed reduction. Most surgeries fall into five categories:

1) Internal Supportive Techniques
2) Joint Capsule Reconstruction
3) RoundLigamentReconstruction
4) Triple Pelvic Osteotomy
5) Salvage Procedure

Total hip replacement and femoral head and neck excision or femoral head ostectomy are also surgical options for chronically-luxating hips. These surgical methods may be the only successful methods for treating spontaneous, atraumatic hip luxations, or luxations associated with underlying hip dysplasia.

CASE REPORT

HISTORY

Bubico, a 14-yr old male castrated Terrier mix breed dog, presented for treatment of left hip arthritis and hind limb weakness. In 2020, Bubico dislocated his left hip and was treated at a local Veterinary Emergency/Veterinary Specialty Center. The left hip dislocation could not be reduced and a femoral head ostectomy surgery was performed. He did well with post operative physical rehabilitation and home exercise program. Recently, the owner noticed that the dog would not lay down on his left side. He is also losing muscle mass and strength in the hind limbs. There is a history of pancreatitis with low Cobalamin (vitamin B-12) levels, Cushing’s Disease (untreated), and partial seizures or cervical intervertebral disc disease with muscle pain.

Owner Goals of treatment- Holistic approach to improve function hind limbs and senior health wellness

CONVENTIONAL EXAMINATION

Eyes: Lenticular Sclerosis OU
Oral: Mild dental tartar
Heart: Grade II/VI murmur
Lungs: Clear fields, panting
Coat: Moderate hair loss on dorsal body and tail, multiple subcutaneous lipomas on ventral thorax and abdomen, small skin mass ventral to right eye
Musculoskeletal: Moderate muscle loss on epaxial muscles and hind limbs. Decreased ROM and pain on hip extension bilaterally, mild crepitus in both stifles, shortened stride with decreased flexion in hip and stifle joints with weight shift forward. Hind limb pain is worse on damp rainy days

Recent blood tests: increased liver tests of aspartate aminotransferase and alkaline phosphatase, cholesterol and triglycerides.
Chest radiographs: Vertebral heart score of 11 and arthritic changes in the left acetabulum
Previous Treatments: Laser therapy left hip

Diet - All Provide turkey, chicken, pork protein sources with added whole foods: eggs, sweet potatoes, green beans, oatmeal, strawberries, and bananas
Medication - Galliprant, Gabapentin, Methocarbamol for neck stiffness in June 2022 Supplements - Glucosamine, Adored Beast Fido’s Flora Probiotics, Digestive enzymes, Turmeric, Wellbeing Melatonin, Cobalamin B-12, Yu Derm Omega 6.

TRADITIONAL CHINESE VETERINARY MEDICINE (TCVM) APPROACH

TCVM EXAMINATION
Shen: Good, friendly, greeted at the door then aloof in house. Fire Constitution.

TCVM DIAGNOSIS
Kidney Yin and Qi Deficiency, Bony Bi Damp coxofemoral joints, Heart Qi Deficiency, Xiao Ke (Cushing’s Disease)

TCVM TREATMENT PRINCIPLES
Dispel Wind and Damp
Move and Tonify Blood and Qi
Tonify Kidney Yin and Qi

TREATMENT

Laser Therapy
Unwind therapy, MultiRadiance Laser Protocol and local therapy to sacrum and hip joints.

TCVM TREATMENT

Acupuncture
Acupuncture Points: GV-14, BL-17, BL-18, BL-20, BL-21, BL-23, BL-24, GB-30, Bai-hui, BL-54.

Bubico would only allow for acupuncture needles at GV-14 and Bai-hui but would not sit or stand still for the placement of additional acupuncture needles. Aqua- acupuncture was done at listed acupuncture points with dilute Vitamin B-12 at 0.2 mL per acupoint.

Tui-na treatment and demonstration for home care

Opening techniques

Moo fa - daubing or massaging - facial area around eyes, GV-20 to GV-17 for general calming effects for 2-3 minutes twice daily
Moo-fa - daubing or massaging - back and coxofemoral area for 2-3 minutes twice daily
Mo-fa - touching skin and muscle - dorsal and lateral sides of body for 3-5 minutes twice daily

Coxofemoral joint treatment techniques

Rou-fa - rotary kneading - Bladder channel starting at the lumbar spine and ending on caudal hind limbs at BL-40 for 3 repetitions twice daily
An-fa - pressing - GB-29, GB-30, BL-54, BL-40, KID-1 for 1 minute each acupuncture point twice daily
Ca-fa - rubbing - hip area for 2-3 minutes twice daily

Closing techniques

Ba-shen-fa - stretching - gentle stretching and flexion of all joints of each limb for 3 repetitions twice daily
Dou-fa - shaking - gentle shaking of all limbs for 1-2 minutes twice daily
Refer to Table 1 for Tui-na Techniques and TCVM effects

Home Exercise

Continue daily walks around yard and neighborhood.
Recommend shortening the length of the walk if any lameness or stiffness occurs following daily walks
Incorporate “sit to stand” exercises and figure 8 walking around objects in yard, and backward walking to strengthen hind limbs

TCVM Food Therapy
Continue with current diet of All Provide, cooked eggs, vegetables, and fruit Food items from the following categories can be added to the diet on a rotational basis:

Support Deficiencies
Yin Deficiency - Neutral to cooling food - turkey, beef, rice, watermelon
Qi Deficiency - beef, sweet potatoes, eggs, carrots

Organ Support
Kidney Organ - eggs, black beans, kidney beans, seaweed, bean sprouts, chicken kidney organ
Heart Organ - beef, red beets, tomatoes, cherries, beef heart organ
Liver Organ - celery, green beans, collard greens, dehydrated liver treats, chicken liver organ

Damp Bony Bi
Drain Damp - anchovy, mackerel, aduki beans, black and kidney beans, celery Circulate Qi - carrots, radish, mustard greens, basil, chive, marjoram, turmeric, licorice Circulate Blood - crab, mustard greens, kale, chive, turmeric, vinegar, brown sugar Food to avoid: Damp engendering food such as dairy, high carbohydrate processed food, fatty foods

Chinese Herbal Medicine

Recommended Jing Tang Herbal Formulas:

Jing Tang Body Sore
Invigorates Qi and Blood, resolves Stagnation, and relieves musculoskeletal pain

Du Huo Ji Sheng Wan
Expels Wind-Dampness, tonifies the Liver and Kidney and invigorates Blood, strengthens tendons and ligaments.
Indicated for arthritis pain that is worse in the Damp and Cold.

Di Gu Pi San
Nourishes Yin, clears Deficient Heat, tonifies Kidney Yang and dispels Wind-Damp.
Indicated for arthritis with thirst, dry coat, panting, weak rear, lethargy, stiffness, and pain.

FOLLOW UP

There was a great response to initial treatment with increased movement in lumbar spine and hip joints. Bubico also had more energy and was generally happier and interacted more with family members. They were happy to see him romping around the back yard and climbing the stairs with ease. He was still not wanting to lay down on the left hip area.

Bubico was treated for 3 more visits. At an evaluation at the primary care veterinarian, screening chest radiographs were done and a lesion was noted in the lungs. Owner declined further treatment of the Bony Bi Syndrome to pursue advanced diagnostics of the lung lesion.

CONCLUSION

Aqua-Acupuncture and Tui-na can be effective TCVM treatments for Damp Bony Bi Syndrome. This case demonstrates that correct TCVM Pattern diagnosis and knowledge of Tui-na therapies for the Channels flowing through the affected body area contributes to a comprehensive treatment plan for acupuncture needle phobic animals. Food Therapy and Chinese Herbal Medicine are excellent additions and/or future options for a comprehensive TCVM treatment plan.

Tui-na, also called An-Mo, is a Chinese manual therapy used to increase local circulation and vasodilation of treated regions resulting in warmth (beneficial heat) and pain relief for the affected tissues. In addition, Tui-na encourages the caretaker to participate directly in the healing of their animal companion. This cultivation of the human-animal bond contributes significantly to a more successful outcome for the patient.

Table 1 - Tui-na techniques and TCVM Actions

References

Xie, H. Preast, V., Traditional Chinese Veterinary Medicine Fundamental Principles 2nd Ed, Chi Institute Press, Reddick, FL, 2013

Xie, H., Preast, V., Xie’s Veterinary Acupuncture, Blackwell Publishing, Aimes, IA, 2007

Xie, H., Wedemeyer, L., Christman, C., Trevisanello, L., Practical Quide to Traditional Chinese Veterinary Medicine - Small Animal Practice, Chi Institute Press, Reddick, FL 2014

Xie, H., Ferguson, B., Deng, X., Application of Tui-na in Veterinary Medicine, 2nd Edition, Tianjin Jincal Arts Printing Co., Ltd, 2008

Fowler, M., Xie, H., TCVM Veterinary Medicine Food Therapy, Chi University Press, Reddick, FL, 2020

Xie, H., Clinical Manual of Chinese Veterinary Herbal Medicine, 5th Edition, Ancient Art Press, Gainesville, FL, 2020

Harasen, G., Pavlosky, G., Canine Hip Luxations, Veterinary Information Network, www.vin.com, 2021