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  • September: TCVM Integrated Therapy for a Painful Geriatric Dog

September: TCVM Integrated Therapy for a Painful Geriatric Dog

Friday, 01 September 2023 17:45

By: Janice Huntingford, DVM, MS-TCVM, DACVSMR, CVPP, CVA, cAVCA

Chronic painful conditions, such as osteoarthritis, are common in veterinary practice. Many of these are treated using non-steroidal anti-inflammatory drugs (NSAIDS), however as time passes, higher doses are required to maintain a pain-free state for the animal. Gastrointestinal side effects such as vomiting, diarrhea and inappetence are common with this class of drug. Other more concerning side effects, such as elevation of liver and kidney enzymes or gastrointestinal ulcers, are not uncommon and given that many of these animals are geriatric and have co-morbidities, NSAIDs are not always a wise choice. Medications such as tramadol or gabapentin may help with the pain but do nothing to treat the underlying pathology.

Many veterinary practitioners study TCM to find an alternative to treat their patients and to improve their success in the treatment of chronic disease. Combining acupuncture, herbal medicine and physical medicine techniques can improve the treatment of painful patients, often with superior results to those achieved with conventional medication alone.


Case Report



Rocko, a 9-year-old, 92-pound, male neutered Rottweiler with a body condition score (BCS) of 6/9 was presented for pain management for chronic intervertebral disc disease. He had been examined by a neurologist who diagnosed him with a T3-L3 myelopathy. An MRI confirmed Hansen Type II Disc Disease at T8-12, and L2-3. At the time of presentation to the neurologist, Rocko had mild hind end weakness and peripheral neuropathy as well as back pain. The neurologist determined that surgery was not an option at this time and started Rocko on an NSAID (meloxicam), methocarbamol and gabapentin. One month later, Rocko was presented to the local emergency clinic for diarrhea and vomiting blood. He was diagnosed with an NSAID-related bleeding ulcer that required surgery. Rocko recovered from this incident, but NSAID-sparing pain management was recommended. 

Owner’s goal was to manage Rocko’s pain as it was not well managed and improve his neurological function.


Conventional Examination

Ocular exam revealed lenticular sclerosis and oral exam showed Grade 2 dental tartar. Rocko was 10% overweight. His pain score on the Canine Brief Pain Index was 5/10. The rest of the abnormalities were confined to the musculoskeletal and nervous system.

Neurological Examination

T3-L3 myelopathy was confirmed with positive crossed extensor response in the pelvic limbs.

Mildly decreased conscious proprioception in both hind legs.

Withdrawal reflexes and cranial nerve examination were normal.

Pain event on palpation of thoracolumbar spine.

Orthopedic/Myofascial Examination

Decreased range of motion evident on both hips bilaterally.

Mild crepitus of left stifle.

Mild muscle atrophy of hamstring group and gluteal muscles bilaterally.

Gait exam revealed weight shifting forward and mild scuffing of toes with decreased hind end stride length.

Myofascial exam identified trigger points in paraspinals, iliopsoas, quadriceps and triceps muscles.

Laboratory findings

Mild resolving anemia, previously elevated alanine transaminase (ALT) and alkaline phosphatase (Alk Phos)

Current Diet, Medications and Supplements

Chicken-based kibble, free fed

Gabapentin, tramadol and omeprazole since ulcer diagnosis

No supplements or nutraceuticals


Traditional Chinese Veterinary Medicine (TCVM) Exam and Approach

Shen: Good but reserved, can be aloof. Not always happy to be touched. Wood personality. The tongue was pale and wet, and the pulse was deep and weaker on the right. Dry coat with large flake dander and cracked paw pads.

TCVM Diagnosis

Kidney Qi/Yang Deficiency, Liver Blood Deficiency, Local Qi/Blood Stagnation with Bony Bi of the coxofemoral joints and stifle.

TCVM Treatment Principles

Move and tonify Blood and Qi

Tonify Kidney Qi/Yang

Integrative Treatment


Manual therapy—massage/Tui-na


Underwater treadmill

Exercise therapy

Chinese herbal medicine

Food therapy

Laser treatment

Companion Laser to T-L spine and both hips and stifle. 10 J/cm2. Bi-weekly therapy x 4 weeks

Underwater Treadmill Therapy

Rocko was treated with hydrotherapy twice weekly for 4 weeks and then once weekly for an additional 4 weeks. The water was 88 degrees F, at the height of the point of the shoulder and the dog walked for 3 sessions of 3 minutes at a speed of 1.0 mph. This was increased as he improved.

Manual therapy

Massage and Tui-na were recommended, however Rocko did not like to be touched while in the clinic due to his Wood personality, so at home Tui-na was recommended.

Home Tui-na treatment

Moo-fa to open orifices and Calm Shen—this was done from GV17- 20 and at An-shen for 5 minutes

Mo-fa was done to harmonize the Middle Burner (Zhong Jiao), regulate Qi and resolve stagnation. This was done from T3-L3 for 3 to 5 minutes.

An-fa was done to move Blood and Qi along the Bladder Meridian. It was recommended to do this on GV-14, Bai-hui, BL-11 and BL-23 as well as on the hip points of GB-29, GB-30, and BL-54.

The owner was recommended to rub the hip and back area for 2 to 3 minutes twice daily (Ca-fa) to unblock the collaterals.

The owner was instructed to end with Mo-fa as a way to relax the dog.


The following points were considered:

GV-14, BL-17, BL-18, BL-20, BL-21, BL-23, BL-24, GB-30, Bai-hui, BL-54, BL-11 and BL-60 

Electroacupuncture was connected from GV-14 to Bai-hui and a 15-minute treatment at an intensity of 1 and 60 Hz was conducted.

The dog would only allow dry needling at GV-14, Bai-hui, BL-54 and BL-60. Aquapuncture with dilute Vitamin B-12 0.2ml per site was used for the other points.

Home Exercise Therapy

Cavalettis—5 minutes twice daily

Sit to Stand—15 per session twice daily

Weave cones—5 minutes twice daily

Continue daily walks—watch for scuffing of feet and put on boots if needed.

TCVM Food Therapy

It was recommended that Rocko lose weight. A diet was prescribed of homemade food to give 700 kcal per day. Foods were chosen to support Qi, and tonify Blood and resolve Stagnation. Recommended proteins were chicken (warming), barley (Damp draining to resolve Stagnation, Qi tonic), beef liver (Blood tonic) mushrooms (Damp draining) and green beans (cooling and for additional fiber). The food was balanced with the iVi Blend.


Undenatured collagen Type-II was started

Chinese Herbal Medicine

Du Huo Ji Shen TangThis is a Bony Bi formula. It invigorates Blood, expels Wind-Cold-Damp and is used for Liver Blood Deficiency, Kidney and Liver Yin Deficiency and Qi Deficiency. This formula is used for back pain, hind limb lameness and muscle spasms as well as upper and lower motor neuron deficiency disorders.

Xiao Huo Luo Dan (Minor Invigorate the Collaterals Combination): For treating Blood Stasis, Yang Deficiency and Stagnation in the Channels. This formula is used for iliopsoas muscle tears, intervertebral disc disease, degenerative joint disease, partial cruciate tears, soft tissue injuries, osteoarthritis that is worse with cold weather. It is helpful when NSAIDS no longer work well and is an important geriatric formula.

Shen Tong Zhu Yu Tang: Invigorates Qi and Blood, resolves Stagnation, and relieves musculoskeletal pain.


Follow up treatments

Rocko was treated twice weekly with acupuncture, aquapuncture, therapeutic laser and hydrotherapy. His pain was well controlled after the first week of therapy and he discontinued the tramadol. After 1 month on Duo Huo Ji Shen Tang, he developed loose stool so it was discontinued in favour of Xiao Huo Luo Dan and Shen Tong Zhu Yu Tang. After 1 month, he had lost 3 pounds and continued with weight loss until his goal weight of 83 lbs. He allowed more acupuncture points to be dry needled as his treatment progressed.

After 1 month, laser therapy was discontinued and he was seen on weekly basis for hydrotherapy and once a month for acupuncture. He allowed manual therapy at this time and chiropractic was added to his monthly regime. After 2 months, hydrotherapy was discontinued as was Shen Tong Zhu Yu Tang and Rocko was maintained with acupuncture and chiropractic every 4 weeks and his Chinese herbal of Xiao Huo Luo Dan at half the recommended dose. 



This case demonstrates the efficacy of TCVM integrated therapy for pain control in geriatric dogs. This case involved multi-modal therapy integrating TCVM principles and conventional therapies. Involving the owner in at home Tui-na and home exercises allowed her to assist with Rocko’s healing and improve the outcome.


About the Author

Dr. Janice Huntingford is a 1984 graduate of the Ontario Veterinary College, University of Guelph, in Guelph, Ontario. She is certified in chiropractic, acupuncture, rehabilitation, and pain management She is the owner and medical director of the Essex Animal Hospital, Canine Rehab and Fitness in Essex, Ontario Canada. In 2015, she became a Diplomate of the American College of Veterinary Sports Medicine and Rehabilitation (DACVSMR) and received a Master’s in Traditional Chinese Veterinary Medicine (TCVM) from the Chi University. In 2023, she became an Assistant Professor for the Chi University in Reddick Florida. She is a consultant for the VIN Rehab/Sports Medicine/Chronic Pain board and sits on many boards including an International Osteoarthritis Task Force and the World Association of TCVM. She is currently the Director of Chi Canada and teaches acupuncture, pain, and rehabilitation courses in Canada and internationally.