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

Seasonal Allergies from a TCVM Perspective 
Dijana Divjak, DVM, CVA

Pathophysiology

      A. Pathogen - WIND HEAT

The pathogen that brings seasonal allergies is Wind, which carries Heat deeper under the skin. The entrance points of the Wind are on the dorsal neck, so wearing a scarf that covers the back of the neck during windy times will help prevent invasion of the Wind pathogen. Clinical signs are most pronounced during the spring time, when allergens like pollen are present and Wind is dominant in the air. Spring time is when the Wood element is most active.

When the Wind moves just past the exterior and deeper into the myofascia and muscles, then signs of the Wind in these location can include itchiness, twitching, tremors, and muscle fasciculations. Clinical signs are pruritus, skin rash, wheals or urticaria, or sudden onset of skin lesions, especially on the head or neck.

     B. Organs and systems included

Because the Metal element rules the skin and allergic changes are seen in the skin, the Metal element/Lung Organ must be involved in seasonal allergies. Skin is allowing air to enter through the pores and Heat, which is Yang in energetic quality, will have an effect on perspiration. Animals do not perspire, but the hair that animals produce insulates and similarly provides necessary temperature regulatory functions.

Wei Qi (Immune or Defensive Qi) is part of the pathology as well, since the Immune system is required to create itchiness and redness. The Lung and Wei Qi are both said to control the body’s surface and the Lung functions assist the spread of Wei Qi. The Lung is responsible for the skin and the process of breathing. When the Lung’s energy is balanced, Wei Qi is strong, and the immune system can defend against External Pathogens. When the Lung’s energy is out of balance, the body is vulnerable to the attack of Pathogens and allergens.

The Wood Element governs the eyes, and the East (the Wood's direction) generates Wind. The Liver, being a Wood organ, is sensitive to Wind, especially during the Spring, which is Wood's season.

Liver is responsible for moving Qi throughout the body, also works as a filter. If there is blockage of Qi movement in the Liver, toxins will accumulate and combined with the invasion of Wind, results in general itchiness, restlessness, conjunctivitis and watery eyes and tension in tendons and ligaments. In susceptible patients, Wind may cause seizures to occur. The Spring can also create agitation and anger which are the emotions governed by Wood.

Symptoms of Wind Heat

     A. SKIN/EARS/EYES

Allergic reactions on the skin include pruritus, contact dermatitis, scratching the upper part of the body mostly and licking of the feet (feet are governed by the Liver). Ear infections may cause headshaking, there may be tearing of the eyes, and sneezing is common.

     B. TONGUE

The tongue can be red, pink and slightly dry, since Wind and Heat can damage Body Fluids and Blood.

     C. PULSE

The pulse is wiry, fast and superficial. The pulse at the Liver position (left side, middle) may be wiry and at the Lung position (right side, first) may be superficial.

Chinese herbal medicine

External Wind herbal formula

The herbs in the formula perform synergistically, balancing the systems and meridians in the body.

Principle of treatment: clear External Wind, detoxify, alleviate itching, cool and activate Blood

The main ingredients in the External Wind herbal formula are:

Bai Xian Pi (Dictamnus) clears Damp-Heat and kills scabies.
Cang Er Zi (Xanthium) clears Wind, opens the Lungs
Jiang Can (Bombyx) clears Wind, detoxifies
Mu Dan Pi (Moutan) cool and activates Blood
Chi Shao (Paeonia) cools Blood and clears Heat.
Jing Jie (Shizonepeta) clears Wind, opens the skin, and alleviates itching.
Di Fu Zi (Kochia) clears Wind and benefits the skin

Research: studies indicate that this herbal formula has following effect:

• Inhibits production of IgE
• Inhibits the release of mast cell contents

However, External Wind works best when combined with Eastern Food Therapy, plenty of water, and moderate exercise.

Acupuncture therapy

Acupuncture points: GB-20, BL-10, BL-12, BL-17, SP-10, Er-jian, Wei-jian.

Treatment: Blood and Qi must be moved to clear Wind from the myofascia so it is important that the animal has enough Qi present.

We use acupuncture points that:

Clear Wind and Heat from the body: GB 20, BL 10 and BL 12, Er jian and Wei-jian

Calm the Shen: An-shen and HT 7

Move Qi and Blood: BL 17 and SP 1

Food therapy

The desired effect of the food therapy is to clear Heat, soothe the Liver and support the Lung

Cooling (Yin) food:  duck, turkey or fish,  consider novel protein source

Green sour food for the Liver Element: leafy greens or broccoli

White and pungent food for the Lung Element: radish and turnip

The difference between the LUNG and LIVER part of pathology and why PUNGENT and SOUR food are used together

Weather the animal is suffering mostly from the Lungs or the Livers part of pathology can be determined  by the time of the day the itching or pruritus is most active.

When the Lungs are primarily affected activity or itching might be stronger in the midday and evening: “those who suffer from a disease of the lungs are animated and quick witted during evening, their spirits are heightened in noon and they are calm and peaceful at midnight”– The Yellow Emperor's Classic of Internal Medicine.”

In the case of dominant Lung pathology, use sour food to strengthen and soothe the Lungs and pungent food to expel Pathogens (Wind).

If the Liver is the part of pathology that is more affected, the animal will be more active and irritated in the morning. “One uses pungent food in connection with the liver in order to supplement its function and to stop leaks, and one uses sour food in order to drain and expel.”– The Yellow Emperor's Classic of Internal Medicine.”

Other supplements: Flax seed oil, barley green powder.

1. Xie, Preast, Xie’s Veterinary Acupuncture, 2012.

2. Translated by Ilza Veith, The Yellow emperor’s classic of Internal Medicine, Book 7, 22. Treatise on the Seasons as patterns of the Viscera, 2016.

3. World Small Animal Veterinary Association World Congress Proceedings, “Traditional Chinese Veterinary Medicine for Itching Dogs “ S.H. Xie, DVM, PhD, MS 2015.

4. Xie, Chinese Veterinary Herbal Handbook 3rd edition, 2008.

To view Issue 53 of the WATCVM Newsletter in its entirety, please click here. 

Lead Article
TCVM Perspective on Endocrine Disorders in Equine Athletes
Kerry Pride, DVM, MPH, CVA, CVMMP, DACVPM

WATCVM Updates
TCVM Around the World 

Case Reports
Acupuncture to Treat Liver Qi Stagnation and Behavioral Issues in a Chihuahua
Stephanie Alevizon Daigle, DVM, CVA

The Foods of Summer  
Constance DiNatale, DVM

Tributes to Dr. Fowler
Dr. Margaret Fowler died January 12, 2023. Her fellow TCVM practitioners, friends and coworkers share their tributes to her.

TCVM for Hit by Car Accident in a Geriatric Cat
Princesse Theresa, DVM, CVA 

History:

A 11 year old castrated male domestic short hair cat was involved in a hit by car accident and subsequently developed mild swelling of the left hind limb from the thigh distally. He was difficult to stand up and walked normally and he was in pain. His front limb are found normal but his lower back to hind limb were stick to the ground. He tried to walk as he was very stubborn, by pulled his body glides to front with his front limb. He was fed kibbles and 1 can of 85gr wet food daily. His appetite was good, no urine and defecating since the accident (2 days).

Western Examination:

The patient was unable to stand with his pelvic limb, paraparesis, and no decreased muscle tone found. The hair on the caudodorsal aspect of the back was ripped off due to the accident. The hock joint of the left pelvic limb found injured. So, he was limping when he tried to walk. There was a mild open wound at bottom part of left limb, and there was hematoma signs on the belly flap or primordial pouch. Radiographs of the spine and hind limb were made at the time. There was no evidence of bone abnormalities found.

TCVM Examination:

The patient is an alpha cat in the family. He is very aggresive and very strict about his territory. He is a dominant cat (Wood constitution). He has an athletic body, and is fearless. TCVM examination found he has wiry pulse on left limb, and weak pulse on the right. His tongue was pale, and the tip of the ears were cold and the back also felt cold. He like to sleep on the couch or chair. Sensitive points include BL-26, Large Intestine Shu point (BL-25), Bladder Shu point (BL-28), and local sensitivity the permission point Bai-Hui.

TCVM Diagnosis and Treatments

The problem in this patient was a Kidney Yang deficiency with Blood and Qi stagnation at lumbar area. The blockage of Qi can occur from a trauma at a particular location.⁵ The weak pulses and pale tongue color indicated that Qi and Blood stagnation was the reason of the lumbar pain. The wiry pulse on left limb means Qi stagnation. Pale tongue means either Qi deficiency or blood deficiency and also Kidney Yang deficiency. Cold ears and back means excess cold or Yang deficiency. He was showing signs of deficiency like prefer to sunbathed, and took nap on the carpet or couch. He is in the geriatric age which would make Kidney Yang Deficiency problem more likely especially after a major stress event. This case is exterior pattern, because the sudden onset of symptoms and came from external attack of exogenous factor.

Plan strategy including Tonify Kidney Yang, move Blood and disperse Qi. Eight confluent channel/ special channel used are Dai-Mai GB-41 for lumbar area. Pattern points used are BL-26 for Kidney Yang/ Qi deficiency, BL-40 master points back and hips, BL-54 master points hind limb, ST-36 major point for tonifying Qi and Blood point in pelvic limb and KID-3 to Tonify Kidney and also a Yuan source point for Kidney. Local points applied is Bai-hui, local point for lumbar pain.

Combination of dry needles, Electro acupuncture of 20 Hz for 15 minutes was performed. Treatments are 5 sessions in total, once a week. TCVM herbal formulation was prescribed Tendon Ligamen Formula, and Bu Yang Huan Wu that useful for tonify Qi and strengthen the rear weakness⁴, once daily for a month.

Clinical Outcome:

The local points were the most important points in this case. They were to stimulate nerves and to support blood circulation. It takes one to two acupuncture treatments to see an improvement. The patient showed good response to TCVM treatments. On the fourth month after last session, He was back to his nature trait. Aggresive, chase away cats whose come to his territory, and fight. He finally is happy and get his quality life back.

Reference:

1. Cahyono, T. Comparison of Conventional Medical Treatment to Electro-Acupuncture Combined with Chinese Herbal Medicine for the Treatment of Hind Limb Paresis and Paralysis in Dogs and Cats: A Retrospective Study. American Journal Traditional Chinese Veterinary Medicine. 2020 (15): 1
2. Negrin A, Schatzberg S, Platt SR. The Paralyzed Cat: Neuroanatomic Diagnosis and Spesific Spinal Cord Published 2017 Feb 3. doi:10.1016/j.jfms.2009.03.004.
3. Khan C, Line S. The Merck Manual for Pet Health Home Edition. 2007. Merck and Co Inc: Westford, MA.
4. Cahyono T. The use of Chinese herbal medicine and acupuncture for neurological disease unresponsive to Western medications in 94 small animal cases. Am J Trad Chin Vet Med 2015; 10(2):43-61
5. Xie H, Preast V. Traditional Chinese Veterinary Medicine: Fundamental principles.

Moxibustion and Herbal Therapy for Damp-Cold invading the Spleen with Liver Qi Stagnation in a Harsh Winter Climate
Kerry Pride, DVM, MPH, CVA, CVMMP, DACVPM

History

Blue was an 8-year-old quarter horse mare that presented for traditional Chinese veterinary medicine (TCVM) because of softer than normal manure with excess water at the end of defecation and an increased frequency of defecation. The mare lived in Montana where this winter had been particularly long, damp, and cold. The mare was housed with two companions and was blanketed. She had free choice grass hay and a heated water bowl. She had not had any prior medical issues except a corneal ulcer as a 4-year-old. She was also fed one pound of Triple Crown Senior once a day with a mineral and oil supplement.

Western Evaluation

Her heart and lungs ausculted within normal limits and her temperature was also normal. Her body condition was within normal limits with no muscle loss noted. She had no visible lameness. The only abnormality found was the presence of fecal material on her tail and softer than normal feces. A Succeed Fecal Occult Blood test was performed, which was negative for gastric and colonic ulcers. Probiotics were added to her diet in a pelleted form.

TCVM Evaluation

Blue was a Wood mare who was very opinionated about things. She was the boss of the other two herd mates and was showing some increased aggression. Her Shen was great, but she demonstrated some anger. Her pulses were deep, but also slightly wiry. Her tongue was pale to slightly purple with red sides. Her ear temperature was slightly cold, but her back temperature was normal. TCVM Diagnostic Scan showed reactivity at the following points: 1+ LIV 13, 3+ LIV14.

TCVM Diagnosis

Exogenous Pathogenic Cold leading to Damp-Cold invading the Spleen with Liver Qi Stagnation.

TCVM Treatment

The treatment focused on warming the middle burner, expelling cold, supporting Spleen Qi, and moving the Liver Qi Stagnation. Blue would not tolerate needles being placed at the first treatment, so Moxibustion was used on Bai-hui, GV4, BL 20/21, CV 5, and ST36. She was started one Equine GI^a to tonify the Spleen Qi, stimulate Qi, and dry Damp. She was also started on Xiao Yao San^a to address the Liver Qi Stagnation and Liver Spleen Disharmony. She was treated twice with Moxibustion one week apart. The third visit she allowed needles to be placed. Dry needles were placed in Bai-hua, LIV3, ST 40, and GB44. Electroacupuncture was done at 30 Hz for 10 minutes at BL20 to BL20, BL21 to BL21, ST36 to ST36, and BL22 to BL22.

Treatment Outcome

Within the first two Moxibustion treatments, her manure returned to normal consistency and frequency. The reactivity of the Alarm Points also resolved. The herbal therapies were continued for a total of 6 weeks with complete resolution of the clinical signs including the increased anger.

Discussion

The treatment resolved the Exogenous Pathogenic Cold leading to Damp-Cold invading the Spleen with Liver Qi Stagnation. The Cold was able to invade the Spleen in this mare most likely because of the underlying Liver Qi Stagnation that was leading to overcontrolling of the Spleen. Moxibustion in this case had the dual effects of tonification and purgation. Because of the Liver Qi Stagnation the mare wouldn’t tolerate needles, so Moxibustion offered another method of treatment. Moxibustion functioned to warm the Yang, dispel Damp, and eliminate stagnation. The two herbal therapies were added to address the underlying patterns. The combination therapy resolved the clinical signs which also made the mare more amenable to needle placement on the third visit. Moxibustion should be considered as an alternative for horses rejecting needle placement if no signs of Heat are present. In addition, Moxibustion should be considered a routine therapy in the winter for horses living in cold climates.

                                    Acupoint:  GV5                                                   Acupoint:  BL 20/21
                  

                                                                                                           One (1) Week after First Treatment,
                                   Before Treatment                                                   at Second Treatment
               

Footnotes

1. Xie’s Jing Tang Herbal, Inc., Ocala, FL, USA

References

1. Xie H, Wedemeyer L, Chrisman CL, Kim MS. Pratical Guide to Traditional Chinese Veterinary Medicine Equine Practice. Chi Institute Press, Reddick FL; 2015:164-166.

Acupuncture and Herbals for Global Treatment of Damp Heat

Stacey Sheahan VMD, MS-TCVM

History:

Beda is an 8-year-old female spay black Labrador retriever that presented for TCVM after failure of Western medicine to manage Horner’s syndrome, otitis externa, recurrent urinary tract infections, diabetes, and interdigital cysts.  Her medications initial on presentation included forty units twice daily of Novalin N, Enrofloxacin as needed for urinary tract infection, ophthalmic cyclosporine, Pilocarpine and Loradatine. Beda’s quality of life over the past year had become significantly decreased due to compounding illnesses and lack of response to conventional treatments. TCVM care was sought to determine if her chronic conditions could be managed versus if euthanasia should be considered.  

Western Evaluation:

Beda had drooping eyelids with right being worse than the left, miosis of both pupils, and elevated third eyelids with increased ocular discharge. Dry, crusted nose worse on the right potentially indicating neurogenic KCS and bilateral suspected otitis media. Enrofloxacin at the time of her initial consultation was started for a four-week duration due to otitis media. Interdigital cysts were present on all four feet that were being treated with Epsom salt soaks.

TCVM Evaluation:

Beda is a loyal, calm, and relaxed Earth personality. Her temperature preferences were for cold areas. On presentation, her Shen seemed reduced for her age and her tongue was pink, cracked and had a thick white coating.  Her pulses were superficial and slippery bilaterally and her haircoat had a damp texture. Painful, ulcerated, interdigital cysts were present on all four feet.

TCVM Treatment:

Beda’s initial treatment was to clear heat, damp and phlegm focusing primarily on treating Horner’s syndrome. Dry needle treatment consisted of GV20, GV14, LI4,11, GB14,1, BL1,2, Bi-tong, SP6, ST40, BL20,21, Wei-jian, LIV2,3, KID3. Improved heat and brightness of eyes over course of treatment. Started Damp Heat Skin and topical Coptis powder for the open lesions on her feet.

Beda prior to treatment:

Beda during first treatment:

After first treatment:

After Fifth Treatment:

Treatment Outcome:

Response to initial treatment was profound. Beda vomited large piles of phlegm the night and next day after her first treatment. Her eyes showed dramatic improvement in the drooping and she was less painful on her feet.

Treatments have continued with changes in needles varying depending on sensitivities. Overall her pattern has remained consistently Damp Heat. By the third treatment her miosis resolved, the fourth treatment her KCS and nasal crusting was resolved. Her glucose levels have remained in the low 300s as compared to her previous normal of 400-500. By the fifth treatment the interdigital cysts on the back feet resolved with persistence on the front feet. Herbals were changed at that time to Four Paws Damp Heat resulting in recurrence of all previous clinical signs. An addition 2 weeks of Enrofloxacin had to be reintroduced, the Four Paws Damp Heat discontinued and the Damp Heat Skin restarted. Progression toward resolution of clinical signs has been much faster with improvement in the front feet. Laser treatment and honey wraps with Coptis have been introduced.  

Discussion:

Beda’s quality of life has improved dramatically within the two months that she has been receiving treatment for a process that had been going for over a year prior. Beda continues to make improvements with every other week acupuncture treatments and continued used of Damp Heat Skin. The use of laser treatment on the front feet will be continued as needed to facilitate healing of the interdigital lesions. Other considerations given to potentially adding Damp Heat Ear or Four Paws Damp Heat. Additionally, as Beda continues to improve would be to treat her underlying pattern and continue to improve her diabetic control.  

References: 

Xie, Huisheng. Chinese Veterinary Herbal Handbook. Jing Tang Publishing: Reddick, FL. 2012.

To view Issue 52 of the WATCVM Newsletter in its entirety, please click here.

Lead Article
TCVM Approach to Canine AggressionTCVM Approach to Canine Aggression

Ashley Geoghegan DVM, CVA, CVFT, CVCH, CCRT, CCRV

WATCVM Updates
TCVM Around the World 

Case Reports
TCVM for Ataxia and Fecal Incontinence in a Geriatric Dog
Brenna N. Burkett DVM

The Foods of Springtime
Margaret Fowler, DVM, CTCVMP, MSTCVM

2023 New Board of Directors

WIND - The Spring Pathogen
Rosemarie Niznik, DVM, CVA, CVSMT, CVFT, FCoAC 

Wind, cold, summer heat, damp, dryness, and fire (heat) are the six climatic changes found in nature. Under normal conditions, they do not produce pathological changes in the body and are thus known as the “Six types of Qi” in the natural environment.

These six types os Qi will cause disease only when the climate changes are sudden or extreme or the body’s resistance to them fails. When these six types of Qi are able to cause disease, they become known as the Six Excessive Qi: Wind, Cold, Summer Heat, Dryness, Damp, and Fire (heat). The Six Excessive Qi may affect the body alone or in combination. Diseases due to the Six Excessive Qi are closely related to the nature of the individual’s environment and the weather, especially seasonal changes.

Spring is the time for Wind; thus we will will discuss Wind as a climate change and pathogen.

WIND - The Primary Pathogen
“Wind is adept at movement and many changes.” —Nei Jing

The Chinese character of Wind is composed of two parts: the outer housing representing the sound of ‘feng’ and the inner part representing insects. There is no better description or simile for microbes as insects - small creatures that can multiply rapidly, are blown apart by the wind and can emerge in plagues that destroy communities.

Photo - “The Uncharted Body”

Wind is produced in nature by differences in temperature accompanied by pressure differences, with the Wind flowing from high to low pressure and back again to find balance. Many of us know how it feels to have our faces slapped by a strong wind, or the eerie sensation that arises when the wind howls loudly and violently that the whole house shakes. But we also know the pleasure of a soothing breeze on a hot day.

“Wind in and of itself is not some inherently evil spirit as some may suggest; its impact depends upon the constitution and resiliency of the landscape through which it blows”.

Wind is the predominant Qi of spring but it may occur in other seasons. Many exogenous diseases are concerned with Wind, thus, Wind is considered the primary cause of disease. Wind is Yang in nature and tends to injure the Blood and Yin.

Wind is the number one pathogenic factor. Other pathogens, Cold, Heat, and Dryness all depend on Wind in order to invade the body. Wind transports the other Xie Factors into and around the body. Common TCM Patterns caused by Wind are Wind-Heat, Wind-Cold, or Wind-Damp.

“Wind is considered the “spearhead of all disease”, for it serves as a vehicle to carry other undesirable Influences into the body; yet, it’s worth noting, that with a shift in perspective, Wind can also be regarded as the spearhead of all growth.”

Wind is a Yang pathogenic factor. It distributes itself in an upward and outward fashion. It easily invades the body surface and the upper parts of the body including the head and face. The superficial attack results in abnormal opening and closing of the pores. Clinical manifestations include nasal obstruction, itching, sweating, and aversion to Wind.

Wind rapidly changes and moves. A disease due to Wind has no fixed place. Also, the clinical signs have an acute onset and subsequent changes in the course of the disease vary very quickly. Wind diseases resemble a sudden storm striking the woods leaving the trees swaying and trembling. Shifting leg lameness is an example of Wind- Damp. Skin hives due to Wind are swellings that may arise suddenly in many locations on the body.

Wind is characterized by constant trembling. And Wind can cause the opposite of paralysis and rigidity. The diseases due to Wind exhibit tremors and convulsions of the limbs or rigidity and stiffness of the neck.

“States of illness are akin to patterns of poor weather in the landscape of our bodies, and are named as such.”

The TCM practitioner must differentiate an Exogenous Wind disease from an Internal Wind Disease. Exogenous Wind is often related to the Lungs as they are the “tender organ” and easily affected by Exogenous Qi Factors carried by the Wind. Internal Wind resonates with the Liver Organ. The causes, clinical signs of External and Internal Wind Disease Patterns are summarized in following table:

Acupuncture Points for Treating Wind

Treatment of External Wind involves extinguishing the wind by both strengthening the Qi to push out the Wind and allowing the Wind a route out. Not surprising, the points to clear acute wind are found on the external channels of the Du, Gallbladder and Bladder. Wind tends to affect the upper parts of the body and these points are found on the top of the body. They have the character ‘wind’ in their names:

Du 16 - ‘Feng Fu’ - Wind Mansion Bladder 12 - ‘Feng-Men’. Wind Gate Gallbladder 20 - ‘Feng Chi’ - Wind Pond

THE WINDS OF CHANGE

“As the emblem and instigator of Change, Wind is a constant force in our existence - one we habitually respond to in an effort to maintain balance. Our perception of its motive - as invasion or invitation, the nature of our response, and our internal landscape, accounts for any symptoms that may arise.

Our internal milieu, including immune health, as well as our relationship to change and chaos, influences how Wind affects us. When our defenses are compromised or we insist on control, Wind’s penetrating, capricious, urgent nature renders us more susceptible to its fickle threat.”

References

Xie, H. Priest, V., Traditional Chinese Veterinary Medicine Fundamental Principles 2nd Ed, Chi Institute Press, 2013, p. 164-167.

Xie, H. Priest, V., Traditional Chinese Veterinary Medicine Fundamental Principles, First Edition, Chi Institute Press, 2007, p. 210-213.

Maciocia, G., The Foundations of Chinese Medicine, Third Edition, Elseiver, 2015, 727-732.

https://mydaolabs.com/blogs/the-way/wind-chinese-medicine-theory

Kaptchk, T., The Web That Has No Weaver, Understanding Chinese Medicine, McGrall- Hill, 2000, p.150-152.

Kenown, D., The Uncharted Body: A New Textbook of Medicine, Original Medicine Publications, Tunbridge Wells, U.K., 2018, p. 126-131.

Rosemarie A. Niznik, DVM, CVA, CVFT, CVSMT

Lymphoma and TCVM of Neoplasia

Lymphoma is the most common malignancy of cats, accounting for as much as 30 percent of all feline cancers. Lymphoma is a cancer made of lymphocytes and these lymphocytes readily travel throughout the body via the lymph system. Renal lymphoma is lymphoma in the kidneys and is one of the worst forms of lymphoma for a cat to contend with. In most cases, the cat is brought to the veterinarian for symptoms related to insufficient kidney function: poor appetite, excessive water consumption, weight loss, and possibly vomiting. Unlike the more typical cases of kidney insufficiency where the kidneys are shrunken and small, the cat with renal lymphoma will have symmetrically large kidneys. A needle aspirate of the kidney usually reveals lymphoma cells.

With chemotherapy, the kidney enlargement reduces and often kidney

function improves until remission is lost. Median survival is only 3 to 6 months, though a recent case report highlighted a cat who lived many years, so long remission times are not impossible. Approximately 50 percent of cats with renal lymphoma are also positive for the feline leukemia virus, which carries the potential for other complicating issues. Unlike other forms of lymphoma, renal lymphoma has a strong association with tumor spread to the nervous system (brain or spinal cord). This makes for an unpleasant complication and, unfortunately, this occurs in up to 40 percent of renal lymphoma cats.¹ 

TCVM for Chemotherapy Patients

Modern chemotherapy drugs are less toxic and more effective, however, chemotherapy still has significant side effects such as fatigue, body aches, joint pain, anorexia, nausea, vomiting, fever, insomnia, low blood cell counts, dermatitis, kidney and liver organ damage, peripheral neuropathy, depression, decreased immune system function.

While the actual clinical signs vary, the effects of chemotherapy can be seen from a TCVM perspective as Spleen Qi and/or Liver Blood Deficiency with associated Qi and Blood Stasis, Stomach Yin Deficiency, Kidney Yin or Yang Deficiency, Liver Yin Deficiency, and local Toxic Heat from skin contact with chemotherapy drugs.

Immunosuppression is a common problem in patients receiving chemotherapeutic agents. Acupuncture can directly affect the immune system, and so it can be used to treat these adverse side effects. Human clinical trials have shown that electrical acupuncture can significantly enhance immune system function after chemotherapy.²

Appropriate acupuncture points for common issues in chemotherapy are listed in the following chart.

Lymphoma and leukemia patients often receive high doses of combination chemotherapy. They require foods to tonify Qi, nourish Blood, supplement the bones and generate marrow. Food items to supplement: Chinese dates, eggs, spinach, mushrooms, milk, walnuts, bone broth, and green tea. Research found significant improvement in the signs that accompany cancer in patients treated with epigallocatechin gallate, found in green tea. This extract has been shown to kill leukemia cells.³

Single herbs can be beneficial to prevent and minimize the side effects of chemotherapy. These herbs are listed in Chapter 8, Table 8.10 in book referenced.⁴

Jing Tang Herbal Formulas commonly recommended for Lymphoma patients are: Stasis Breaker, Max’s Formula, Wei Qi Booster.⁵

Case Report

Perseus, a 10 yr old MN Bengal cat, was seen as a housecall appointment for consultation for holistic support while undergoing chemotherapy at local Veterinary Specialty Center. He was referred to the specialty center for diagnostic work up for lethargy and anorexia. Blood tests at primary care DVM showed elevations in ALT, ALP, GGT, Total Bilirubin. Urinalysis showed hematuria, bilirubinuria, ad proteinuria.

At the Specialty Center, Perseus was diagnosed with renal lymphoma and hepatopathy: combination of hepatic lipidosis, possible lymphoma. He has been receiving weekly chemotherapy CHOP protocol. He was very stressed with travel to the Specialty Center and agitated for his diagnostic

testing and chemotherapy that he required light sedation and anti-nausea medications for the chemotherapy appointments. Currently, he has an PEG tube to assist with feedings. He originally had an esophagostomy tube but that was removed as it was causing excessive drooling and potential nausea. Owners are feeding him 75 ml three times a day through the PEG tube. He is also offered small amount of cooked chicken, turkey, and salmon at meal times and will take a few bites of food at each meal.

Activities of daily living are normal and he is comfortable in his home environment with his housemate, Orion, another Bengal cat.

Current medications are: Prednisolone 5 mg SID, Cereniaa16 mg SID, Buprenex 0.6ml(0.3mg/ml) TID or as needed, Ursidiol 250 mg 1/4 tablet SID, Hepato TruBenefitsb 1 capsule SID, Zoftran 8 mg 1/4 tablet BID/TID dissolved in water (alternative to Cerenia).

Supplements administered: Fortiflorac PRN for diarrhea, Liver Tonic 3 drops BID, Artenisinin 1 capsule SID.

Diet: Hill’s A/Dd, Hill’s I/Dd, Fancy Feaste.

Herbal Formulas: The owner had purchased herbal formulas on line but was not current administering them: Si Maio San, Modified Hoxsey, Bu Zhong Yi Qi Tong, Xiao Chai Hu Tang.

TCVM Examination

Personality: Water Cat; Shen: Good; Tongue:Pink with a pale center, moist, no coating; Pulses: weak and deep bilaterally; Appetite: decreased but attempting to eat; Skin/Coat: Dry; Urine and feces: Normal, Temperature: Normal

TCVM Diagnosis

Spleen and Kidney Qi Deficiency, Liver Blood Deficiency, Liver Qi Stagnation, Liver-Spleen Disharmony, Qi/Blood Stagnation in Kidney, Shen Disturbance

Treatment Principles

Tonify Kidney and Spleen Qi, Tonify Spleen, Tonify Liver Blood, Move Liver Qi, Pacify Shen

Acupuncture Treatment⁶

Dry Needle: GB-30, ST-36, BL-60 to KID-3, LI-10, PC-6R, SP-6L, GB-21 GV-14, Bai Hui, GV-17

Jing Tang 36 x 1/2 inch for 10 minutes while siting on owner’s lap

Aqua-acupucture: Diluted B-12 0.1 ml at GV-14, GB-21, SP-10R, ST-36L Note: Unable to access Bladder channel in thoracic and lumbar area due to PEG tube wrap.

Acupressure: Shan gen with demonstration for owner to perform daily

Owners perception

They were surprised and happy to see Perseus sit still for the acupuncture treatment and he seemed to be very relaxed during the treatment.

Herbal Consultation with Jing Tang Herbal

Owner did good with picking herbal formulas but recommended the following Jing T formulas with known sourcing and ingredients:

• JT Wei Qi Boosterg - Tonifies Qi and Blood, boosts Wei Qi, and inhibits mutation
• Max’s formulag - Soften the hardness and clear nodules
• Six Gentlemeng - Tonify Qi, strengthen Spleen, transform phlegm, and dry up Damp
• Six Gentle Petsh - Strengthen Spleen and Lung Qi, transform phlegm

Food Therapy

Recommend recipe formulation with Balance-Ii, Green Tea, reshi and shiitake mushroom blend

TCVM Diet: Food to Support Qi and Blood - beef, chicken, rabbit, beef bone broth, eggs, pumpkin, squash, shiitake mushrooms, kidney beans.

Owner feedback: Perseus looked great at his oncology appointment the next day. His ALT liver test was only mildly elevated and the total bilirubin value was WNL on repeat blood test the next day to the surprise of the oncologist.

Additional treatments

Perseus was treated with Dry Needle Acupuncture and Aqua-acupuncture with B12 for three additional weekly appointments. Additional Acupuncture points treated: Shen Shu, HT-7, SP-10, LIV-3, Shen Gen.

Perseus did well with his acupuncture treatments and the Shen improved. He was more interactive with the family and was eating some more bites of canned food at meal times.

Unfortunately, after receiving Doxorubicin as a chemotherapy, Perseus took a turn for the worse. He was lethargic and nauseous. He developed facial swelling on his chin. He was becoming more difficult to handle during oncology appointments and heavy sedation was now a requirement for future appointments. Shen was depressed. One last acupuncture treatment was administered to help with nausea and support Spleen and Kidney Qi, tonify Liver Blood, and calm the Shen.

One week later, Perseus was still lethargic and mentally depressed. He was being fed small meals and was still nauseous after meals. Blood tests showed improvement in liver enzymes. He started to exhibit normal behaviors and interact with pet owners. However, the owners made the difficult decision to discontinue chemotherapy treatments especially doxorubicin treatments. They spent quality time with Perseus before humanely euthanizing him two weeks later.

Summary

This case illustrates that acupuncture can be utilized to tonify Spleen and Kidney Qi, Liver Blood, Shen, and improve comfort in cancer patients. The veterinary acupuncturist can be of assistance as a liaison between the oncologist and pet owners and a valuable member of the treatment team. Housecall visits were a wonderful option for Perseus as he was able to be treated in the comfort of his home in his owner’s arms.

Perseus - More than a Cat - A Part of the Family

About the Author

Dr. Rosemarie Niznik received her Bachelor of Science Degree with Honors from the Pennsylvania State University and her DVM degree from the University of Georgia. Dr. Niznik is certified in Mixed Animal Veterinary Acupuncture and Food Therapy from the Chi University and Veterinary Spinal Manipulative Therapy from the Healing Oasis Wellness Center. She founded Harmony Rose Animal Wellness, a housecall integrative practice in 2015 that serves clients in Illinois and Wisconsin. She currently is a Chi University MS-TCVM student and Acupuncture Lab Teaching Associate and President-Elect of AHVMA. She goes by the nickname of “Dr. Rose” and lives on a 5-acre farm in Wisconsin with Chip, her husband, Grace, a Bernese Mountain Dog, and Wendy and Willa, two rescue cats.

Footnotes

1. Cerenia, Zoetis United States, Parsippany, NJ
2. Hepato Tru Benefits, Veterinary Recommended Solutions, Blue Bell, PA
3. Fortiflora, Purina ProPlan Veterinary Supplements
4. Hill’s Fortiflora, Purina ProPlan Veterinary Supplements, Louis, MO
5. Fancy Feast, Nestle Global, Vevey, Switzerland
6. Kingdom of Basil Healing Herbs for Animals, Seattle, WA
7. Jing Tang Herbal, Ocala, FL
8. Kan Herbal, Santa Cruz, CA
9. BalanceIT, balanceIT.com

References

1. Brooks, , Lymphoma in Cats, www.veterinarypartner.com

2. Ye F, Chen S, Liu W, Effects of electro-acupuncture on immune function after chemotherapy in 28 cases. J Trad Chin Med 2002; 22(1): 21-3.

3. Hazawa M, Takahasha K, Sugar S et al. ( - ) Epigallocatechin-3-O- gallate induces nonpoptotic cell death in leukemia cells independent of the 67 kDa Laminin receptor. J Nat Prod 2011; 74(4): 695-700.

4. Xie, , Wedemeyer, L., Christman, C., Trevisanello, L., Practical Quide to Traditional Chinese Veterinary Medicine - Small Animal Practice, Chi Institute Press, Reddick, FL 2014, 610-612.

5. Ma, , Clinical Manual of Chinese veterinary Herbal Medicine, Fifth Edition, Ancient Art Press, Florida, 2020

6. Xie, , Preast V., Xie’s Veterinary Acupuncture, Blackwell Publishing, Iowa, 2007, p 143-234