Cindy Lankenau, DVM, RH (AHG), CVA, GDVCHM, ACCHVM, MS-TCVM
(For more indepth discussion on this case, be sure to sign up for the Dr. Lankenau's Presentation this December)

Case Presentation: April 10, 2022, Bob, a Hereford bull calf was born in a manure filled gutter.  This farm is an organic beef farm.  It was several hours before the owner was able to help the calf get up, dried off, and nurse.  His mother was in a stanchion and unable to assist her calf.  By April 11, he was septic, barely conscious, down, unable to rise, his lungs were very heavy sounding.  He had 104-degree F temperature, injected sclera, hot ears, tongue was very wet but cold to the touch; pulse was rapid and bounding, and slippery.  He had a swollen still wet umbilical cord; a presumptive diagnosis of E. coli septicemia was made.  TCVM diagnosis of invasion of an External Pathogenic Factor (EPF) of Cold/Damp, stagnating Qi creating Heat with a possible primary Heat toxin.  Bob had been moved to a box stall with his mother, and although the owner was attempting to keep him dry and clean, his umbilical cord was still wet and swollen.  His mother was very protective, and our acupuncture was fast using LI-4, LI-11; tip of ear and tail, and BI-40 which had aqua-puncture of a commercial Selenium product. His was given Gan Mao Ling and Early Comfort, a Kan tincture of Huo Xiang Zheng Qi San, 60 drops of both.  His navel was dipped with a commercial iodine-based product. After giving the herbs in a tincture form, he jumped up and started nursing.  He has continued to do well, received 60 drops of both tinctures four times a day for the next 5 days, decreasing the dose then to twice a day; on April 18, all seems well, and the herbs have been discontinued.

On April 13, Patches was born, another bull Hereford calf.  Although he was born in a bedded box stall with an attentive mother, the owner was unable to dip his navel.  On April 15, he was breathing heaving, lungs very heavy, nursing slowly, 103.5 F temperature, tongue phlegmy, pulse rapid bounding and slippery.  He was similarly treated.  Within 24 hours, he seemed normal, but his mother was extremely protective allowing no human contact, so the herbs were given to the mother with hopefully enough effect through the milk.  Herbs were continued for 5 days.  Patches, having a normal activity level and normal attitude, herbs were discontinued on April 20th.

Discussion: Both calves were invaded by an EPF with resulting Qi stagnation creating Heat and interior Dampness. They needed the exterior pathogen to be expelled and the interior dampness and turbidity to be eliminated.   It was felt that the calves’ EPF had progressed deeper than the Wei level and was already affecting the Qi Level with signs of Heat.  The initial pathogenic factor could have been Heat, E.coli or cold/damp, the microbial bouquet in the environment of the gutter. The treatment goal was to clear Heat at the Wei level and clear dampness that was accumulating in the Qi level (heavy sounding lungs).

Gan Mao Ling is a formula that addresses External Wind-Heat patters and is designed to clear Exterior Wind Heat at the Wei and Qi level.  It dispels EPF from the surface layer of the body while trying to prevent their invasion into the deeper internal layers.  The leading herb is Pubescent holly root, Mao Dong Qing, invigorates Blood and clears Heat. Evodia lepta leaf and root, San Cha Ku, clears Heat and fire invasion.  Isatis root, Ban Lan Gen, drains Heat, clears Fire, cools the Blood and benefits the throat.  Chrysanthemum flower, Ju Hua, dispels Wind, clears Heat and calms the Liver.  Simple-leaf chaste tree fruit, Man Jing Zi, clears externally contracted Wind Heat. Honeysuckle flower, Jin Yin Hua, clears Heat and fire invasions, vents, and disperses externally contracted Wind Heat.1

Huo Xiang Zheng Qi San is indicated for acute viral or bacterial gastroenteritis.2 It is best suited for treating exterior syndromes accompanied by internal dampness. The king herb, Huo Xiang, Chinese giant Hyssop, releases exterior wind-cold and dispels dampness enabling the clear Qi to ascend and turbid Qi to descend.   Zi Su Ye, Perilla leaf and Bai Zhi, Angelica dahurica releases the exterior wind-cold and dispels interior dampness and turbidity; Ban Xia Qu, processed Pinella and Chen Pi, Tangerine rind, transforms dampness, harmonize the Stomach, redirect the reversed flow of Qi.  Bai Zhu, Atractylodes and Fu Ling, Poria, strengthens the Spleen, dispels dampness, and harmonizes the middle Jiao.  Hou Po, Magnolia bark, and Da Fu Pi, Betel husk; activates Qi and dispels dampness.  Jie Geng, Platycodon ventilates the lung and resolves Dampness.  Sheng Jiang, Ginger; Da Zao, Jujube; and Zhi Gan Cao, honey roasted licorice, regulates the Spleen and Stomach, and harmonies the herbs.

The combination of these two herbal formulas Cleared accumulated Heat and Fire Toxins, as indicated by all the Heat symptoms, of elevated temperature, scleral injection, rapid pulse. Internal Damp is evident by the heavy lungs and Phlegm had obstructed Bob’s portals of his mind when he was almost comatose when first seen on April 10.  The calves responded very quickly and since no antibiotics were used, these calves did not lose their organic status.

References:

Kan Herb Company, Kan Traditionals Formula Guide, Santa Cruz, CA, 2015
Chen, Chen, Beebe, Salewski; Chinese Herbal Formulas for Veterinarians; Art of Medicine Press, City of Industry, CA, 2015

To view Issue 48 of the WATCVM Newsletter in its entirety, please click here.

A TCVM Approach to Equine Gastric Ulcers
Jérôme Vanden Eynde DVM, CVA

WATCVM Update
Tui-na Benefits

TCVM to Treat a Dog with Severe Environmental Skin Allergies
Ashley M. Ziegler, DVM, CVA, CVTP

Integrative Medicine for a Paralyzed Cat: Kidney Qi Deficiency
Lydia Cahyatrianti DVM, CVA

How Do I Face Today...Again?
Gregory Todd DVM, CVA

WATCVM MEMBERSHIP BENEFITS

The Use of Acupuncture and Conventional Drugs in the Treatment of Epilepsy in a Dog
Enikő Tokács-Máthé DVM, TCVA
Sentinel Veterinary Clinic, Budapest

Abstract: Stewie, a 5-year-old 12 kg neutered male French bulldog, was presented with severe, intractable, idiopathic epilepsy. The patient was nonresponsive to high levels of different types of anticonvulsant drugs and was presented to the author’s clinic in March 2019 for acupuncture treatment. In the year prior to acupuncture treatment, the owners took Stewie to a veterinary epilepsy specialist and tried various kinds of anticonvulsants, such as phenobarbital, potassium bromide, levetiracetam and carbamazepine. Before acupuncture treatment, Stewie had had seizures every 1-11 days. Clinical signs of seizures decreased right after the first acupuncture treatment (no seizures for 29 days). This case report documents the successful treatment of epilepsy with acupuncture in combination with anticonvulsant drugs (levetiracetam and carbamazepine).

Background
Epilepsy is a group of heterogeneous conditions that share a common feature: chronic, recurring seizures. The terms epilepsy and seizures are not synonymous. A seizure is the clinical manifestation of abnormal electrical activity in the brain. It is a specific event in time. Epilepsy refers to multiple seizures occurring over a long period of time.¹ Epilepsy is the most common chronic (long-term) neurological disorder in dogs, affecting an estimated 0.6-0.7% of all dogs (around 1 in 130 dogs).¹

Idiopathic epilepsy, the most common cause of seizures in the dog, is an inherited disorder but its exact cause is unknown. Other causes include liver disease, kidney failure, brain tumors, brain trauma, or toxins.¹

Seizures often occur at times of changing brain activity, such as during excitement or feeding, or as the dog is falling asleep or waking up. Affected dogs can appear completely normal between seizures.¹

Clinical Findings
The patient usually had seizures at night or late afternoon. He had warm ears, back and feet, dry skin and hair with small dandruff flakes. His tongue was red, and his pulse was deep-weak, worse on left and thready, wiry if having cluster seizures. Stewie preferred cool places and had a panting breathing pattern.

The traditional Chinese veterinary medicine (TCVM) examination revealed a patient with a Wood Constitution. Seizures (Internal Wind) and wiry pulse indicated a Wood/Liver disorder.

Treatment
Treatment principles were the following: dispel Internal Wind, support the Liver, tonify Liver Yin, tonify Kidney Yin.²

Dry-needle (DN) acupuncture was used for seizures and to support the Liver in the following points: GV-1, GV-17, GB-20, BL-17, BL-18, HT-7, LU-7, Nao-Shu, LIV-3, KID-6, SP-9. Aqua-acupuncture (Aqua-Ap) was used in the following acupoints: GB-20, BL-17, BL-18, BL-23, Nao-Shu.²

The DN treatment duration is usually 10-30 minutes. Aqua-AP with 0.25-0.5 ml Vitamin B12 may be administered to head and other acupoints.

The number of seizures since the beginning of treatments have significantly reduced. After 4 weeks of treatment, the seizures had decreased for 29 days. From this point, he received 1 treatment every 3-4 weeks and reached 52 seizure-free days.

Discussion
It is risky to discontinue drugs too rapidly in any dog but especially those known to have episodes of status epilepticus or cluster seizure, because the seizure frequency and severity may worsen and require emergency intervention and may cause brain damage. That is why drug administration should be continued. These results were obtained by combining anticonvulsant drugs (levetiracetam and carbamazepine) with acupuncture.

Food therapy is recommended to clear false Heat and tonify Kidney Yin. In Stewie’s case, cool and cold foods were recommended and hot foods should be avoided. Fortunately, Stewie doesn’t have any known food allergies.  He was recommended the following foods to cool and tonify Yin: turkey, pork, duck, crab, eggs, rice, wheat germ, peas, kidney beans, sweet potatoes, tomato, spinach, kiwi, lemons, bananas, watermelon.³ Hot foods to avoid: lamb, chicken, cherries, basil, sweet rice, chilies, cinnamon, ginger, rosemary.³

Conclusion
This case represents a severe case of epilepsy, treated successfully with a combination of dry needle acupuncture and aqua-acupuncture. The use of this alternative treatment has greatly improved Stewie’s quality of life in the past six months and also satisfied his owners.

Acknowledgements:
This case was submitted to the Chi Institute of Europe, Madrid, Spain as a part of the requirements to become a Certified Veterinary Acupuncturist. Due to limited space in the newsletter, this case report was shortened. For additional details on the case, please contact Dr. Enikő Tokács-Máthé at This email address is being protected from spambots. You need JavaScript enabled to view it..

References:

1. Thomas W. Veterinary Clinics: Small Animal Practice. 2010: 40 (1): 161-179.
2. Xie H, Preast V. Traditional Chinese Veterinary Medicine Fundamental Principles 2^nd Chi Institute Press 2013.
3. Xie H, Wedemeyer L, Chrisman C et al. Practical Guide to Traditional Chinese Veterinary Medicine Small Animal Practice. Chi Institute Press. 2014: 2: 81-89.

CASE REPORT

Heart Yin Deficiency with Shen disturbance and Liver Qi stagnation in a Cat

Mitsie Vargas DVM, MS, CTCVMP, CVBMA, CVMMP, CCRV, FAAVA

¹Dr. Xie's Jing Tang Herbal

TCVM for the Treatment of Hind Limb Weakness and Urine Incontinence in a Dog

Pitchayanin Chomsiriwat, DVM, MS, CVA, CVTP, CVFT, CVCH

Charoensuk Animal Hospital, Bangkok, Thailand

History: A 15-year-old, 14.5 kg, spayed, female, mixed breed dog with dribbling urine and hind limb lameness was referred for acupuncture. The owner reported that the dog had previously been in a car accident.

Western Physical Exam and Treatment: Her physical exam and mentation were normal. She was thin with body condition score of 4/9. She had alopecia (bald patches) and very dry skin with pustules all over her back and perineal area. The urine dribbling made her skin condition worse and affected her behavior. Her blood tests were unremarkable. A radiograph showed degenerative joint disease of both the hip joints, subluxation of the left hip joint, and an old fracture of the left scrum. She has been on Bethanechol^a 10 mg orally three times daily for almost 2 years, and her urine incontinence had still not improved. Her skin problem was evaluated and she had been given medicated shampoo.

TCVM Exam, Diagnosis and Analysis: Her Shen was disturbed, and she was aggressive. Her tongue was pale purple and wet (Figure 1) with thready and fast pulses. Her skin was clearly irritated (Figures 2 and 3.) She was diagnosed with Kidney Qi/Yin Deficiency with Spleen Qi Deficiency. Kidney Qi Deficiency arose from prolonged illness and old age which gradually damages Kidney Jing that led to a deficiency in Kidney Qi, Yin and/or Yang. In addition, urine incontinence is a sign of Kidney and Spleen Qi Deficiency because there is not enough Qi to hold urine. Her Kidney Yin Deficiency caused a history of cool-seeking behavior and excessive panting.

  Figure 1: Tongue examination on first visit          

         Figure 2:  Skin conditions on first visit.  

 Figure 3: Skin conditions on first visit.
                                                                                                                      

TCVM Treatment Plan: The treatment plan consisted of acupuncture and herbal therapy; the owner elected not to proceed with Western medical treatment. The desired outcome was to improve the overall Qi, tonify Yin, and tonify Water and Earth elements. The initial herbal therapy was designed to tonify the Water element and weakness of hind limbs. Over the course of treatment, the following acupuncture points were used: Dry needle acupuncture was performed on Da-Feng-Men, Bl-11, BL-23, Bai Hui, KID-1, KID-10, KID-3, HT-7, GV-1, BL-40, and An-Shen. Electro-Acupuncture was used on BL-23, Shen-Shu, BL-40 and ST-36. Aqua-acupuncture was used on BL-23, Bai-Hui and ST-36.

The herbal formula prescribed was Wu Bi Shan Yao San^b and Hindquarter Weakness^b. She was given 1 capsule (0.5 grams) orally twice daily of  each formula. She was calmer and less aggressive after her first visit. Her urine incontinence was resolved  by the fifth visit (week 6) and the Hindquarter Weakness herbal was discontinued. On the sixth visit, her urine was normal without any dribbling. Her attitude had improved. She loved to be petted, and her hair had grown to cover her body (Figure 4.) She was calmer and socialized more with people and other dogs.

                     Figure 4: Skin condition completely improved after sixth visit (3 months).

The acupuncture appointment was now once a month, continuing with the same doses of Wu Bi Shan Yao San with orthopedic vet follow-ups every 3 months. The urine incontinence problem was resolved. She could hold her bladder and get up to do daily activities. Her skin and hair were normal, and she was less aggressive when coming to the hospital.

Case Summary: From a TCVM perspective, urine incontinence is called Lin syndrome. ² The primary cause of urine incontinence is mostly from neurological problems. After a long treatment period with Western medicine, the symptoms had not improved so the owner sought other options. The dog also had chronic skin irritation which affected her behavior. The herbals combined with acupuncture can be an effective treatment for urine incontinence patients.

Acknowledgements: This case was submitted to the Chi University (formerly Chi Institute), Reddick, Florida as a part of the requirements to become a Certified Veterinary Chinese Herbalist. Due to limited space in the newsletter, this case report was shortened. For additional details on the case, please contact Dr. Pitchayanin Chomsiriwat at This email address is being protected from spambots. You need JavaScript enabled to view it..

References:

1) Xie H. Chinese Veterinary Herbal Handbook. Reddick, FL: Jing Tang Publishing 2011: 86, 131.

2) Xie H, Preast V. Xie’s Veterinary Acupuncture. Ames, IA: Wiley-Blackwell 2007: 298.

^aM & H Manufacturing Co.,Ltd.

^b Dr.Xie’s Jing Tang herbal

To view Issue 47 of the WATCVM Newsletter in its entirety, please click here.

TCVM Approach to Forelimb Paralysis
Mitchell McKee DVM, MS-TCVM 

RESEARCH GRANT AWARDEE 
Dr. Jen Bevilacqua DVM

CASE REPORT
TCVM Treatment for Chronic Diarrhea in a Cat
Vivien Leung DVM, CVA

CASE REPORT
An Integrative Surgical and TCVM Approach for Kidney Qi and Yin Deficiency in a Dog
Je hyeong Jung DVM, CVA

WATCVM UPDATES
Board of Directors Meeting
Annual Conference of TCVM
Ma Shi Huang Awardee: Antonio Alfaro, DVM, MSc, MCTCVM, CS & ELBMP

WATCVM MEMBERSHIP BENEFITS

CASE REPORT

BALANCE METHOD ACUPUCTURE TREATS REPERCUSIONS OF A SEVERE STATUS EPILEPTICUS IN A MINIATURE SCHNAUZER

Alicia López, DVM, CVA, CVBMA. Costa Rica

History: A four years old, neutered female Schnauzer, was presented on April 18 to a Veterinary Hospital facility with severe status epilepticus, the owner commented that the seizures began immediately after the spaying surgery on April 17 at another veterinary facility. The vet suspects ketamine overdose or too long anesthesia time. They did proper stabilization protocol and stop the seizures in about 12 hours.

Blood Exams: white cell count: 20,7 x 10 ⁹/mL (N: 6-17 x 10 ⁹/mL), neutrophils:  84,6 % (N: 60-83%), AST: 75,9 U/L (N: 19-70 U/L), BUN: 6mg/dl (N: 8-33mg/dl).

Physical exam and TCVM exam: body temperature 40°C, high respiratory rate, high heart rate and arrhythmia; both, eyes very reddened, poor Shen, alopecia around the eyes, no proprioception in any limb, abdomen tightness. Pulse was very irregular, strong, forceful with thrill. Tongue was pale and difficult to observe. See VIDEO 1.

According to Balance Method Strategy Step 1: Diagnosing the Sick Channel. In this case, we have to think about what Channels go to the head.^1-2 See Figure 1.

Figure 1.: Head Channels.

All the Yang Channels go to the head but in this case, LI is not considered. Step 2 determines the treating Channels based on the Six systems of the Balance Method.^1-2 See Table 1.

Table 1.: Balancing Channels according to the Six Systems

After that, the next is Step 3: Point Selection: The  Mirroring and Imaging Formats are the two most effective methods.¹ See Figure 2.

Figure2.: Point Selection Diagram

Results: After the needles were taken out, almost all points bled a lot. The animal recovers proprioception at one week after this treatment and no more fever was detected. Animal has been reported as doing great after the second treatment since she is located far from the Acupuncture Clinic. We are in contact and no more seizures nor repercussions have been seen. See VIDEO 2.

REFERENCES

1. Tan R. Acupuncture 1,2,3. San Diego, CA: Abebooks 2007:1-157.

1. López A, Alfaro A. Balance Method Veterinary Acupucture. AJTCVM. 2020; 15, 75-84.

Gratitude is defined by Oxford dictionaries as “the quality of being thankful; readiness to show appreciation for and to return kindness.”

Numerous studies conducted by researchers such as Shawn Achor, have demonstrated that being grateful can have powerful effects on our neurochemistry to help us be more positive and to turn on the higher learning centers. Acupuncture has also been shown by study to improve depression and increase positivity.

By feeling gratitude and appreciation any person or organization can “return kindness”. This appreciation leads to greater and greater energy flowing outward to accomplish goals. This is much like the upward and outward flow of Kidney Yang.

Winter is a time when each of us spend more time indoors. This lends itself to a time for introspection. May each of use these times to find gratitude and use that energy to accomplish goals that enrich the lives of all beings.

The WATCVM believes in gratitude.  We are grateful for our members, donors, sponsors, and supporters in all forms. Harnessing this gratitude has helped us achieve some great things this year and allows us to postulate more achievements for 2022. Read below to see some of the things accomplished this year!

With TREMENDOUS Gratitude,

The WATCVM Organization.

The season of fall continues into November. According to the Nei Jing Su Wen, The Yellow Emperor’s Treatise on Internal Medicine; fall is the pivot in the cycle of the seasons.  The cycle begins with spring. Spring is the time of rebirth after winter. It has an outward energy, expanding energy. It is the beginning of the Yang of the seasonal cycle. This Yang energy continues through summer, the time of abundance. All things in nature reach their full maturity. The heavenly energy cools and the wind stirs. This is when everything on Earth prepares for the winter, a time of hibernation.  Therefore, this is the time of conservation. This is the beginning of the Yin aspect of the year.ⁱ

This season belongs to the Lung. With the Yang beginning to give way to the Yin, the Lung Qi can be weaker.  The Lung is the site where Zhen Qi (Zong Qi and Gu Qi ) is refined into Ying Qi and Wei Qi. The Lung Qi both ascends and descends.  The descending function of the Lung Qi directs the Ying Qi down with the Blood in the vessels to nourish the body. It helps the Heart pump Blood from the chest.  It also helps disperse fluid back to the Kidney to moisten them and help the fluid be misted by the Ministerial Fire of the Kidney.  The ascending aspect of the Lung Qi helps disperse the Wei Qi in the space between the muscles and the skin known as the Cou-li. This really pertains to the fascial spaces and planes. The Wei Qi functions to warm the body and to protect the body from invasion by pathogens such as Wind, Cold, Hot, Dry, Damp and Summer Heat.

As the Lung Qi weakens in the month of November, the Wei Qi is less able to protect the body.  Therefore, this is a time of frequently colds and flus. TCVM provides tools to help protect patients during the fall and winter. To help protect the body, it is wise to aid the Lung and improve the descending and dispersing functions. Also tonifying the Spleen which is the foundation of Qi and Blood.

Hypothetical Case

Species: Canine
Breed: Pug
Age: 6 years
Gender: N

Clinical Diagnosis (conventional): Infectious Tracheobronchitis

Conventional Indications:

Diagnosed one week ago with tracheobronchitis after being boarded.  The patient has not yet received any treatment for the diagnosis and the cough has progressed slightly in frequency. The patient is coughing more than 15 times per day. The cough is soft but somewhat productive. The cough is elicitable on palpation of the trachea.  Three views of the thorax reveal a mild bronchial pattern which is most consistent with age related change and possibly some early chronic airway changes. Pulse, respiration and temperature are within normal limits.

Traditional  Indications:

This pet has a good appetite.  Stools are within normal limits.  The patient sleeps well except when awakened by coughing. The cough is soft and somewhat moist.  The patient’s ears are 3 finger cool. There is some mild decrease in energy. The patient feels slightly warm to the touch.

Tongue: Red

Pulse: Rapid and superficial.

TCVM Diagnosis:  Wind-Heat cough

TCVM Assessment:

• Cough-Rebellious Lung Qi
• Warm-Fever-Heat
• Red tongue-Heat
• Rapid pulse-Heat
• Superficial pulse-Wind

Treatment Principles:

• Clear Heat
• Clear Wind
• Benefit the Lung
• Stop Cough

Acupoint Prescription:

GV-14, LU-7, LI-4, GB-20, TH-5, BL-12, BL-13, LU-10, CV-22, Ding-chuan

• Clear Wind- LI-4, BL-12, GB-20
• Clear Heat-LU-7, TH-5
• Benefit the Lung- LU-7, BL-13
• Stop Cough-CV-22, Ding-chuan

Chinese Herbal Prescription:

• Yin Qiao San
• 5g PO BID

Hypothetical Case

Species: Goat
Breed: Saanan
Age: 7 years
Gender: Wether (castrated male)

Clinical Diagnosis (conventional): sinusitis, rhinitis, loss of appetite

Conventional Indications:

Saanan wether, named Bozo, 7 years old, pet goat, approximately 80 lbs, living alongside one more goat in a shared barn with other horses and chickens. Barn is open access concept, where animals can freely move between fenced in enclosure and grouped stalls (by species) to be protected from the elements. This fall has proven to be windier and wetter than usual, following an extraordinarily damp and hot summer in Western PA. Both goats are spending most of their day outside, nibbling on the last bit of grass available for the season. A week ago, we had the first night frost, daytime temperatures are fluctuating between mid-50s and some mid-60s days still.  Over the course of the last week Bozo has shown bilateral, thick mucus discharge from both nostrils, of a moderate degree and slightly yellow in color. No sneezing has been observed, but he seems to be eating less and is more lethargic than usual. His body temperature is 100.1 F.

Traditional Indications:

Bozo is a very curious and outgoing wether, making everybody laugh with his antics. He notoriously runs full speed and jumps onto obstacles (Fire constitution). He is also quite flighty and more anxious than his companion. Recently he has been more subdued and lethargic and his appetite is poor. The nasal discharge is thick and yellow.

Tongue: appears pale, lavender with a white film

Pulse: difficult to assess in a non-cooperative individual, jugular veins are notoriously deep in goats and he kicks and escapes when palpating femoral pulses.

TCVM Diagnosis: 

Nasal Damp Cold with Qi Deficiency and Blood Stagnation

TCVM Etiology and Pathology:

The upper respiratory tract is susceptible to invasion of Cold and Damp. Wei Qi and Lung Qi may be injured by prolonged Summer Heat and Damp, enabling external pathogens like Wind, Cold and Damp. Seasonal changes can be challenging for Wei Qi as well, as temperature fluctuations and fairly sudden changes from Hot to Cold can cause imbalances.

The quality of the nasal discharge suggests Cold with Damp and Blood Stagnation, as it is thick and yellow.  The white coating of the tongue also indicates Cold Damp.

Bozo’s decrease in appetite indicates Spleen Qi Deficiency.

The pale tongue and lethargy correspond with Qi Deficiency.

The slightly low body temperature is a sign of Cold and Qi Deficiency. (Goats are usually 100.5 – 103.5 F)

Treatment Principles:

• Warm the body and expel Cold
• Break up Blood Stagnation
• Remove Damp
• Support Spleen Qi and Qi overall
• Support Wei Qi

Acupoint Prescription:

Dry needle acupuncture was not feasible for this flighty goat, as needle retention was an unsurmountable issue. Aquapuncture was chosen as an alternative, using a total of 3 cc Vitamin B12 (1000 ug/ml) diluted in 3 cc of normal saline. 0.3 – 0.5 cc of liquid were deposited into each acupuncture point:

• GV 20 – permission point
• Long Hui – classical point, local point, clear sinuses
• Bi Tong – classical point, local point, clear nasal passages/sinuses
• LI-4 – masterpoint of the head – attempted, but unsuccessful, goat kicking
• GV-14 – supports Wei Qi
• LI-11 - clear the Exterior, alternative point to LI 4
• BL 13 – Lung association point
• GV 4 – support Qi
• Bl21 – support Spleen Qi

Food Therapy:

• Crimped oat - cooked overnight in slow cooker, served warm twice a day, ½ cup each feeding
• Cinnamon – 1 teaspoon sprinkled over oats, warming
• Ginger, dried powder – 1 dash mixed in with oats, very warming
• Tried fresh ginger, which is less warming than dried ginger, but goat reluctant to eat

Chinese Herbal Prescription:

Huey’s Formula – Formula to clear both Wind Heat and Wind Cold, open the nose

• 10 grams PO BID for one week, then decrease to 5 grams PO BID for 3 more weeks
• Sweetened with a teaspoon of molasses and mixed in with oats for better acceptance. Alternatively mix with applesauce or mash in with bananas.

Herbs included in this formula:

• Yu Yin – radix curcumae, Tumeric, invigorates blood, breaks up stasis, warming
• Dan Shen – radix salvia, Sage – invigorates bloods, breaks up stasis,
• Chi Shao – radix paeoniae ruba, red Peony – breaks of up stasis,
• Sheng Di Huang – radix rehmanniae, Qi and Yin tonic, clears the Exterior
• Huang Bai – cortex phellondendri, Phellodendron bark, dries Damp
• Di Fu Zi – fructus cochiae, expels Wind, clears Damp
• Xuan Shen – radix scophulariae, Scrophularia, clears the throat
• Mai Men Dong – radix ophiopogonis, Ophiopogon, Qi and Yin tonic
• Mu Dan Pi – cortex radicis Moutan, Mountain peony - activates blood, dissolves stasis

Four Gentlemen – general Qi Tonic, Spleen Qi Tonic

• 5 grams Bid for 4 weeks
• Same process of “hiding” herbal formula in food. Four Gentlemen is slightly sweet and more easily accepted.

Herbs included in this formula:

• Dang Shen – radix codonopsis, Codonopsis, general Qi tonic
• Bai Zhu – radix atractylodes, Atractylodes, general Qi and Spleen Qi tonic
• Huang Qi – radix astraguli, Astragulus, supports Wei Qi
• Fu Ling – radix poriae, Poria, drain Damp, strengthen Spleen

ⁱNi, Maoshing. The Yellow Emperor's Classic of Medicine: A New Translation of the Neijing Suwen with Commentary (p. 7). Shambhala. Kindle Edition. 

Written by Greg Todd, DVM, CVA. Cases by Greg Todd, DVM, CVA and Alex Kintz-Konegger, DVM, CVA, CVTP 

Fall is fast approaching and with Fall we enter the element of Metal (Jin 金). Metal represents not just autumn but also dryness and white coloration, and in TCVM it is considered superficial and light.

Metal is also associated with the Lung. Lung Yin support the Lung Qi which controls the Lung function. Dryness and Heat can easily damage Lung Yin causing respiratory malfunction such as asthma or coughing. The Lung ensures the entire body has sufficient Qi with the breathing process will takes in new Qi and expels stale Qi.

The Lung is the most External Zang organ and has both an ascending and descending function. When Lung Qi descends it moves Qi and Body Fluids. When Lung Qi ascends it moves Wei Qi and Body Fluids to the Exterior to warm, provide moisture and protect the body. The Lung functions include:

Case Study by Dr. Alex Kintz-Konegge

Species: Feline 
Breed: Ragdoll 
Age: 8 years 
Gender: FS, 9 lb 

History: history of seasonal allergies, usually spring and fall, living in Western PA. She is kept inside only and is a single pet, with no other cats or dogs in the household. Her symptoms include military dermatitis all over her body with intense pruritus leading to barbering of her belly and medial legs, both front and back, and traumatic alopecia. The owner maintains year round flea prevention with a topical over the counter product. 

Clinical Diagnosis (conventional): feline asthma with allergic dermatitis. 

Conventional Indications:  

She has developed a dry cough, that seems worse in the early morning. Her respiration is labored at times with an increased respiratory rate of 40 breaths a minute. Occasionally an abdominal component to her breathing is observed, but no open mouth breathing has occurred. Her appetite has diminished greatly and she is more thirsty than usual. 

Chest x-rays confirm a bronchial pattern in both lungs, leading to a Western diagnosis of feline asthma with allergic dermatitis. Her lab work demonstrates a normal white blood cell count with an increased number of eosinophils and mild lymphopenia. Her serum chemistry and thyroid levels are within normal limits. 

Western treatment approach: oral prednisolone, 4 mg sid, tapering to 2 mg once skin lesions resolved for 2 more weeks. Plan to switch to Aerocat inhaler with maintenance steroid after oral steroid course completed 

Traditional  Indications: 
Tongue: dry, red 
Pulse: deep and feel wiry, they are fairly even in strength with maybe a slightly weaker pulse on the left. 
Coat: somewhat dry and brittle 
The body surface does not feel warm, but Sarah is cool seeking, which surprises the owner, as the cat is usually looking for the warmest spot in the house. 

TCVM Assessment:  

• Seasonal allergies with itching: external wind 
• Decreased appetite: spleen qi deficiency 
• Increased thirst: yin deficiency 
• Harsh dry cough: lung yin deficiency 
• Brittle, dry coat: blood deficiency 
• Cool seeking: yin deficiency 
• Weaker pulse on left: yin deficiency 

TCVM Diagnosis:  Lung Yin deficiency with external wind. 

Treatment principles: 

• Nourish Yin 
• Stop cough 

Acupuncture: 

weekly intervals for first four weeks, then monthly for maintenance. 

Acupoint Prescription:  

• Gv20: permission point 
•  Gv14: support immune system 
•  Bl13: Back-Shu association point for the lung 
• Fei Men, Fei Pan: stop cough 
•  Sp21: stop itching 
•  Bai Hui: qi point and permission point 
•  Ki3: tonify yin 

Herbal Prescription:  

Lily Formula, one teapill (160 mg) twice a day. 

Results:  

With acupuncture and herbs Sarah was able to wean off her oral steroids within a few weeks and has not needed the inhalant steroid treatments. Her respiratory rate and effort have been normal. She still occasionally coughs. 

Further therapeutic steps include taking her off dry food and introduce wet food with cooling proteins like turkey and fish to help nourish yin. 

Hypothetical Case 

Species: Feline
Breed: DSH
Age: 3 years
Gender: N

Clinical Diagnosis (conventional): Asthma

Conventional Indications:

Roscoe presented to his family veterinarian with a history of chronic, repetitive asthma attacks which occurred weekly. These attacks have been occurring for more than 2 years.  Roscoe is being treated with prednisolone 2.5 mg PO EOD.  This decreased the frequency of attacks from 3 times per week. Radiographs were unremarkable.

Traditional  Indications:

Roscoe’s appetite is fine, but not ravenous.  His energy has been somewhat less than usual. He sneezes soft sneezes occasionally. His ears are two finger cool. He prefers warmer places to hang out such as on the rug in the sun. Occasional soft cough.

Tongue: Pale

Pulse: Soft

TCVM Diagnosis:  Lung Qi Deficiency

TCVM Assessment:

• Asthma-Asthma has a Wind component and frequently Phlegm
• Sneezes- Rebellious Lung Qi
• Soft Cough-Weak cough, Rebellious Lung Qi most likely due to Qi Deficiency
• Pale Tongue-Qi Deficiency
• Soft Pulse-Qi Deficiency, +/- some Damp

Treatment Principles:

• Tonify Lung Qi
• Stop cough/asthma

Acupoint Prescription:

LU-7, LU-9, BL-13, BL-20, BL-23, ST-36, ST-40, CV-22, Ding-chuan, Fei-man, Fei-pan

• LU-7: Clears the channel
• LU-9: Yuan (Source) Point. Tonifies both Yin and Yang
• BL-13: Back-Shu Association Point for the Lung
• BL-20: Back-Shu Association Point for the Spleen
• BL-23: Back-Shu Association Point for the Kidney
• ST-36: Called the 3-mile Point, this acupoint is a major acupoint to tonify Qi everywhere in the body
• ST-40: Influential Point for Phlegm but also opens the chest and consolidates the Wei Qi by consolidating the Exterior. It also calms the Mind.ⁱ
• CV-22: Stops cough
• Ding-chuan: Stop cough
• Fei-man, Fei-pan: Stop cough

Chinese Herbal Prescription:

Bu Fei San^P

• Dose at 0.5g/ 10 lbs of body weight twice daily.

  ⁱMaciocia, Giovanni. The Foundations of Chinese Medicine E-Book (p. 989). Elsevier Health Sciences. Kindle Edition.

  Edited by Greg Todd, DVM, CVA. Cases by Alex Kintz-Konegger, DVM, CVA, CVTP and Greg Todd, DVM, CVA