To view Issue 46 of the WATCVM Newsletter in its entirety, please click here.

Treatment of Equine Anhidrosis with TCVM
Emily Mangan DVM, CVA, CVCH, CVTP

WATCVM UPDATES
World TCVM Dat and IVM-GO

CASE REPORT
Global Qi Deficiency in a Senior Cat
Carlie Gillespie, DVM, CVA

WATCVM EVENTS
Live Virtual TCVM Case Study Presentation with Dr. Cindy Lankenau, DVM, RH (AHG), CVA, GDVCHM, AACHVM, MSTCVM

CASE REPORT
An Integrative Medicine Approach to Treating Kidney Failure in a Dog
Julia Grossman DVM, CVA

COMMENTARY
Separation Anxiety: Please Don’t Go!
Gregory Todd DVM

With the coming of the late summer, Summer Heat, consisting of Heat and Damp, now starts to injure the Yin. This can manifest in many ways.

This Heat and Damp may accumulate in the Exterior creating an obstruction to the flow of Qi, fluid (Jin-ye) and Blood in the channels and collaterals of the Exterior. This can manifest as Damp-Heat in the skin. Damp-Heat is considered a severe dermatology pattern compared to a mild External Wind or moderate Wind-Heat we see in the springtime.

As the Xie Qi or Pathogenic Qi (Damp) moves Interiorly it impairs the Spleen Qi and Yang. The Spleen prefers dry and the Damp hinders the  Spleen transforming and transporting function by impeding the ascending aspect of the Spleen Qi and Yang.  This leads to a poor appetite, diarrhea, and/or a painful or bloated abdomen as well as a slippery pulse.

With the Stagnation in the Exterior and as the Damp and Heat move Interiorly, the muscles and organs can become affected. Damp can be difficult to resolve.  Patients’ may present with complaints such as stiff or weak movement, bloody or mucoid feces, as well as skin lesions.

Hypothetical Case 1 (Bovine)

Species: Bovine
Breed: Holstein
Age: 3 years
Gender: F

Clinical Diagnosis (conventional): Bovine Viral Diarrhea Virus (BVD)

Conventional Indications:

Diagnosed two days ago with Bovine Viral Diarrhea (BVD).  The diagnosis was based on clinical signs. A rapid test with a commercially available test is available and may be the next step. The primary concern with this diagnosis is to prevent wide spread infection within the herd. Infection with this disease can lead to “Transitory” or “Persistent” infections depending on a variety of factors. This patient presents with acute diarrhea. There is tenesmus with a malodorous stool. Her appetite is decreased. She has been isolated from the herd and is presently being treated. She is presently open and may soon be culled unless she responds to this treatment.

Traditional  Indications:

Acute onset of disease with malodorous diarrhea and tenesmus. Decreased appetite and decreased to stopped milk production.

Viral infections may start as Wind-Cold Invasions, while bacterial infections are considered more Heat or Heat Toxin. With viruses, this quickly progresses to Heat or Damp-Heat as the Wei Qi engages and the Exterior stagnates. As the virus enters the Qi level (Shao-yang level) clinical signs become more organ specific.

Tongue: Red

Pulse: Rapid and Full

TCVM Diagnosis:  Large Intestine Damp-Heat/Heat Toxin

TCVM Assessment:

• Acute onset-Excess condition
• Diarrhea-Spleen Qi Deficiency and decreased Large Intestine function due to the presence of External Pathogenic Factors (Damp and Heat).
• Malodorous stool-Indicates Heat
• Tenesmus-Heat
• Decreased appetite-Spleen Qi Deficiency
• Red tongue- Heat
• Rapid and Full pulse- Heat and Damp

Treatment Principles:

• Clear Heat
• Resolve Damp
• Release the Exterior
• Tonify the Spleen
• Stop diarrhea
• Improve Appetite

Acupoint Prescription:

LI-4, LI-11, ST-25, ST-36, SP-6, SP-9, BL-20+BL-20, BL-21+BL-21, BL-25+BL-25, GB-34, GV-1, GV-14, Wei-jian, Shan-gen

Note: Moxibustion is contraindicated in this pattern. Electroacupuncture is recommended.

• Clear Heat-LI-4, LI-11, GV-14, ST-25, GB-34, Wei-jian, Shan-gen
• Resolve Damp- LI-11, ST-25, ST-36, SP-6, SP-9, BL-20+BL-20, GB-34
• Release the Exterior-LI-4, LI-11, GV-14
• Tonify the Spleen- ST-36, SP-6, SP-9, BL-20+BL-20
• Stop diarrhea-GV-1,
• Improve Appetite-ST-36, Shan-gen

Chinese Herbal Prescription:

• Great Saussurea Coptis
• Dose: 90 grams twice daily until diarrhea stops
• This formula was created by Dr. Huisheng Xie. It’s classical antecedent is Da Xiang Lian Wan.

Hypothetical Case 2 

Species: feline
Breed: DSH
Age: 7 years
Gender: male neutered

Clinical Diagnosis (conventional): severe food allergies and atopic dermatitis

Conventional Indications:

Chronic ear infections (cytology predominantly yeast) and facial dermatitis since early adulthood. Limited protein prescription diets and varying protocols with steroids and/or cyclosporines to allow for good quality of life. In addition he has also receives hyposensitization injections to address his atopic allergies.  Antibiotics (Baytril most effective) have been needed on and off to keep him comfortable. 

Seasonally though, usually in late July or August (hot and humid Western Pa), his facial lesions  get so severe that  he stops eating and becomes very lethargic and miserable. His lip commissures  split and bleed, his lips swell, most of his skin around his eyes and cheeks develop miliary dermatitis and his yeast ear infections become overwhelming. Intense pruritus prevails despite steroids.

Traditional Indications:

Simon is a rather metal constitution. He is a finicky eater, which has made it difficult finding an appropriate diet for him. He is very set in his routines and reserved towards strangers. His coat is a tad greasy and not very shiny. His tongue is red with a yellow coating. He feels damp and hot on palpation of his face and ears. He prefers cool environments and is quite thirsty. Pulses are deep and slippery, weaker on the left.

TCVM Assessment:

Greasy coat – damp

Red tongue with yellow coating  - damp heat

Hot and damp to touch – damp heat

Pruritus – external wind

Slippery pulses – damp

TCVM Diagnosis:

Damp Heat Skin

Treatment Principles:

• Clear Heat
• Resolve Damp
• Clear Wind
• Release the Exterior

Acupuncture – was not performed in this patient, as owner was not willing to commit to regular treatment sessions at the hospital. Cat does not travel well.

Chinese Herbal Prescription:

Damp Heat Skin 0.2 g capsules, 1 po sid, starting beginning of July in anticipation of seasonal worsening of symptoms, staying on formula until first frost (mid to end October usually)

Edited by Greg Todd, DVM, CVA. Hypotherical Cases by Greg Todd, DVM, CVA

Cat Photo Credit: Adult png from pngtree.com/

It has been a great 2021 for WATCVM so far.  A lot of new updates and projects are in the works that we are excited to share with you!

Our website homepage has gotten a facelift and has up-to-date information and events. The user’s menu has also been updated for easier access to account and membership information. After logging in, simply hover over the person icon or your name and menu will appear. We are still in the process of updating other menu tabs and pages, so keep an eye out on the new changes.

New member benefits have been added and updated. The new member menu makes it faster and easier to find the benefit you are looking for. Some new benefits added this year are: TCVM E-library, quick access to sponsored research papers, updated membership certificate, updated TCVM exam forms and new digital exam forms for uploading, and herbal abstracts.  There are more benefits coming soon, so be sure to check your member menu and email often! 

A great new WATCVM project is the Virtual TCVM Case Study Presentation! We have had two successful webinars so far with Dr. Judy Saik and Dr. Lorena Lloret. Be sure to check out our new Events menu to see the next TCVM case presentation. Upcoming events are also featured on the homepage. These presentations are a great way to gain more knowledge about cases that may be similar to ones in your clinic. Each presentation is followed by a Q&A session, giving you and opportunity to Have your questions answered by the presenter. Veterinarians from around the world attend the virtual presentations, providing a great networking opportunity. Veterinarians from Australia, France, Germany, Romania, Spain, Switzerland, the United States and more have all attended at the same time!

The Pet Memorial page has been updated to include a photo gallery and easy-to-complete online form. We are honored by all the donations to WATCVM in memory of these beloved pets who have passed away. We can continue to honor these loved ones with your generous support. 

Another update is what you are reading now: the monthly blog! If this is the first WATCVM blog you have read, thank you for taking the time to read it! Be sure to check out previous blogs to learn about different aspects of TCVM including hypothetical cases and treatment.

Last but not least is one of our biggest projects: Integrative VetMed Grassroots Outreach (IVM-GO)! This new program allows WATCVM member volunteers to provide free TCVM treatment for pets in shelters, rescues, and other non-profit organizations. We are so happy to be able to bring TCVM to these pets who otherwise may not have access to it. Our first location is starting in Ocala, FL with Dr. Suzy Brannan at the Marion County Humane Society. We are in the process of starting up more locations internationally. Check it out by visiting the IVM-GO section.

We appreciate all of our members and hope you have enjoyed all the hard work put into WATCVM to improve benefits, offer more support, and help pets in need. We hope to continue to provide the best support possible thanks to the continued support of our members.

To view Issue 45 of the WATCVM Newsletter in its entirety, please click here.

TCVM APPROACH TO AUTOIMMUNE DISEASES IN SMALL ANIMAL
Mitsie Vargas, DVM, CVA, MSTCVM, CTCVMP, CVBMA, CVMMP, CVFT, CVTP, CVCH, CCRV, FAAVA

WATCVM UPDATES
New outreach program, events, and more

CASE REPORT
TCVM for Idiopathic Groaning when Changing Positions in a Gordon Setter
Emily Mangan, DVM, CVA, CVTP, CVCH, CVFT, CTCVMP

CASE REPORT
Integrative Therapy for Intra-abdominal Abscessation with Diarrhea in a Thoroughbred Foal
Lauren Javernick, DVM, CVA, CVCH

CASE REPORT
The Use of TCVM in a German Shepherd Dog with Hip Dysplasia
Brijesh Raj, MVSc, CVA

TCVM RESOURCES
WATCVM members have updated benefits to enjoy!

Ever feel like you’re stuck? Whether it’s on an idea, job tasks, or daily life, sometimes we feel as if things are getting stagnant. Stagnation comes from an obstruction, perhaps due to fatigue, frustration, lack of communication, stress, or uncertainty. If the flow of Qi is no longer free and flowing, there is Stagnation. Sometimes this Stagnation can reflect as pain, though this is not always the case. While any organ can experience stagnation, the most common are Liver, Stomach and Large Intestines. It occurs most commonly in the Liver as the one of the Liver’s jobs is to insure a smooth and harmonious flow of Qi. Invasion of the channels by Cold, Wind, Damp, Heat, Summer Heat or Phlegm can lead to stagnation. Additionally, Deficiency in the vital substances of organs such as Blood, Qi, Yin, or Yang can lead to Qi Stagnation.

It’s important to note that Blood and Qi are dependent on each other. The old adage is that “Qi moves the Blood and Blood carries the Qi.  The motive force of Qi moves the Blood, and the nourishing aspect of Blood helps to create Qi. Blood Stagnation occurs when there isn’t enough Qi to move the Blood. Cold, Trauma, Heat, Qi Stagnation, and Qi Deficiency can all cause Blood Stagnation.

The Stomach Qi moves the food to the Middle Jiao. The Spleen’s Qi  holds the food there while the Stomach’s fire “cooks” the food. The Spleen then transforms and transport the vital energy of the food, the Gu Qi, to the Upper Jiao where is undergoes further refinement and transformation.  Stomach Qi Stagnation occurs when the downward flow of Qi to the Stomach is disrupted. This causes a disturbance in the normal process of digestion and can lead to lack of appetite, vomiting, or indigestion. Vomiting is the presenting complaint when this occurs.

The Large Intestine received waste materials and moved it through the rest of the digestive track. When the movement of Qi is obstructed, it causes Large Intestine Stagnation. This is usually occurs in coincidence with other issues. It will cause constipation.

Hypothetical Cases

Case 1

Species: Iguana iguana (Iguana)
Age: 9 years
Gender: F

Clinical Diagnosis (conventional): Hepatic Lipidosis

Conventional Indications:

The patient presented with a history of inappetence, lethargy and in general a failure to thrive. On examination, there was evidence of moderate dehydration. There was cranial coelomic cavity distention, lethargy and irritability as well as abnormal posturing suggesting abdominal pain. Clinical pathology revealed an elevation in alanine aminotransferase (ALT) as well as aspartate aminotransferase (AST) and bile acids. Endoscopic examination of the coelomic cavity revealed that the liver appeared enlarged with rounded edges.

Traditional  Indications:

The patient demonstrated an abnormal posture on examination. Her skin lacked vibrant color.

TCVM Diagnosis: 

Phlegm Syndrome with Liver Qi Stagnation and Spleen Qi Deficiency

TCVM Assessment:

• Inappetence, lethargy-Spleen Qi Deficiency
• Coelomic cavity distenstion/Abdominal pain-Qi Stagnation
• Elevated ALT, AST-Liver
• Enlarged liver with rounded edges-Liver, Phlegm, Stagnation (which includes Qi)

Treatment Principles:

• Move Liver Qi
• Resolve Phlegm
• Tonify Qi, strengthen the Spleen
• Drain Damp
• Clear Heat

Acupoint  Prescription:

ST-36, ST-40, ST-44, BL-18, BL-19, BL-20, GB-34, LIV-3, LIV-13

• ST-36-Tonify Qi, He-sea point: clear Damp and Heat, Master point for the abdomen
• ST-40-Resolve Phlegm
• ST-44-Ying-stream point: Clears Heat and Damp-Heat
• BL-18-Back-Shu Association point for the Liver
• BL-19-Back-Shu Association point for the Gall Bladder
• BL-20-Back-Shu Association point for the Spleen
• GB-34-Earth point on GB channel, He-sea point, resolve Damp and Heat, aids in descending the Liver Qi
• LIV-3-Shu-stream and Yuan Source point for the Liver. Resolves Stagnation, tonifies
• LIV-13- Front-mu Alarm point for the Spleen, Influential point for the Yin Intersection of the Liver and Gall Bladder Channels. Beneficial for Liver over-regulating Spleen.

Chinese Herbal Prescription:

Chai Hu Shu Gan

• Moves Liver Qi Stagnation, moves Blood, stops pain. Harmonizes the Liver and Spleen.
• Dose at 200mg /kg PO BID

Wei Ling San

• Drains Damp, strengthens the Spleen, harmonizes the Spleen and Stomach. Helps to regulate Qi in the Middle Jiao.
• Dose at 300mg/kg PO BID

Food Therapy

• Ensuring an appropriate diet is key for this condition
• Foods to supplement include marrow soup, chicken, dandelion greens, cilantro, white fish

Case 2

Species: Lagomorph 
Breed: Mini lop
Age: 8 years
Gender: N

Clinical Diagnosis (conventional): Anorexia, Colic

Conventional Indications:

The patient presented with a history of anorexia for 3 days. Subsequently the patient demonstrated no stool and a painful abdomen as evidenced by abdominal splinting and tooth grinding. The history revealed that the rabbit was being fed a low fiber diet. He was recently added to this household.

Traditional  Indications:

Bright, alert and responsive. The pet was in good flesh (BCS 5/9).  There was moderate discomfort on palpation of the abdomen in the flank region. Additionally, there was evidence of much gas and fecal matter in the colon.

TCVM Diagnosis: 

Liver Qi Stagnation and Stagnation of Qi in the Large Intesting.

TCVM Assessment:

• Recently rehomed-Liver Qi Stagnation
• Pain on palpation of the abdomen with splinting-Qi Stagnation, generally Liver
• Constipation-This may come from a number of causes such as Qi Stagnation, Qi Deficiency, Blood Deficiency. Here the history and the presence of abdominal pain along with no signs of Deficiency support Qi

Treatment Principles:

• Resolve Stagnation
• Help Large Intestine Qi move
• Resolve constipation
• Improve appetite

Acupoint  Prescription:

LIV-1, LIV-3, LIV-14, CV-17, HT-7

• LIV-1-Promote the function of the Liver in directing the smooth flow of Qi and Blood.
• LIV-3- Promote the function of the Liver in directing the smooth flow of Qi and Blood.
• LIV-14-Relieve abdominal pain
• CV-17-Relieve abdominal pain
• HT-7-Calm the mind

Chinese Herbal Prescription:

Xiao Zhang San

• Breaks down Qi Stagnation
• Especially beneficial in cases of colic and bloat.
• Dose at 0.1g/kg PO BID

Food Therapy

• Immediately begin to feed appropriate high fiber diet. Force feed if necessary to avoid hepatic lipidosis.
• Add foods such as dill, fennel, ginger, plantain, basil, carrot, and turmeric.

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

There are days where it seems times flows too quickly or to slowly. Some days feel as thought here are not enough hours, while other days seem to have too many. Humans and animals both have internal clocks, and likely you’ve heard the phase ‘biological clock’ which refers to the circadian rhythm of the body which informs the inner body to do specific tasks at certain times of the day.

Qi is constantly and endlessly flowing through the 12 main channels. It is present in each channel in its greatest amount for two hours each day.  So, according to the Nei Jing Su Wen, it completes its cycle through all 12 channels every 24 hours.  This is also known as the Ying Qi cycle. The Qi flows throughout the day, growing in amount in each channel in a specific order, following this circadian rhythm colloquially called the biological clock. Different symptoms in a patient occurring at a specific time can be used to assist with a TCVM diagnosis, such as waking each night restless between 1 am and 3 am which is the time of the Liver.

The flow of the Qi energy dominates each channel for two hours. It goes from wife to husband, husband to wife, starting at the Lung Channel at 3 am. From there it goes from the wife Lung (thoracic Yin) to the husband Large Intestine (thoracic Yang) before continuing to husband Stomach (pelvic Yang) to wife Spleen (pelvic Yin). This pattern continues throughout the day, and repeats every 24 hours.

Thypothetical Case 1

Species: Equine
Breed: Thoroughbred
Age: 5 years
Gender: Mare

Clinical Diagnosis (conventional): Recurrent Airway Disease

Conventional Indications:

This patient developed a chronic cough.  Initially, the cough was seasonal and worse in the Summer.  Recently, the cough is present from Spring until mid-winter. Additionally, the mare demonstrates some degree of exercise intolerance. There is minimal nasal discharge but it is sticky. Even at rest there is an increase in her respiratory rate. She now demonstrates a “Heave” line. The owner has been treating her by managing her environment to reduce molds, wetting her hair and has been managing her condition by utilizing oral prednisolone.

Traditional  Indications:

The patient demonstrates a chronic cough which is worse at night. The cough is dry. The mare has a good appetite. She still has trouble maintaining her weight.  Her stools occasionally can be somewhat dry. Her hair coat is slightly dull.  Her nares flare even at rest with inhalation. Her ears are 3 finger warm.  She demonstrates a “Heave line” along her ventral edge of her ribs.

Tongue: Pale-red and dry.

Pulse: Rapid, thready, weaker on the left.

TCVM Diagnosis: 

Lung Qi and Yin Deficiency

TCVM Assessment:

• Chronic cough- Most likely Deficiency
• Cough worse at night-Yin Deficiency
• Trouble maintaining weight-Qi Deficiency
• Dry stools- Yin or Blood Deficiency
• Dry hair coat-Yin Deficiency
• Warm ears-Heat
• Rapid pulse-Heat
• Thready pulse-Yin or Blood Deficiency
• Tongue: Pale, red, dry-Pale-Qi Deficiency, red indicates Heat, Dry suggests Yin or Blood Deficiency

Treatment Principles:

• Nourish Yin
• Tonify Qi
• Stop cough
• Resolve Phlegm

Acupoint Prescription:

LU-8, LU-9, SP-6, SP-9, BL-13, KID-3, CV-22, Ding-chuan

• LU-8- Jing-river, metal point for sore throat
• LU-9-Yuan source point. Nourishes Yin and Qi
• SP-6-tonifies Qi and Blood
• KID-3-Yuan source point for the Kidney, tonifies Qi and Yin. Can help with sore throat and strengthen inhalation.
• CV-22-used to stop cough
• Ding-chuan-used to stop cough

Chinese Herbal Prescription:

• Bu Fei San + Bai He Gu Jing Tang (Lily Formula)
• Use these formulas together
• Bu Fei San tonifies Lung Qi, dose 15g orally twice daily.
• Bai He Gu Jing Tang (Lily Formula) tonifies Yin and transforms Phlegm, dose 15 g orally twice daily.

Thypothetical Case 2

Species: Canine
Breed: Blue Heeler
Age: 6 years
Gender: N

Clinical Diagnosis (conventional): Behvavioral Issue-Insomnia/Restlessness

Conventional Indications:

The patient was recently rescued through a local shelter.  Shortly after coming into the home the owners noted that the pet would awaken every night at 1am, restless.  Offering water and allowing the pet to go outside to urinate and defecate did not alleviate the restlessness. It was also noted that the pet would occasionally vomit a small amount of billous fluid in the early am before breakfast.  While always happy to see the owners, he was beginning to behave in a more aggressive manner with visitors.

Traditional  Indications:

Bright, alert and responsive. The pet was in good flesh (BCS 5/9).  There was slight discomfort on palpation of the abdomen in the flank region. Stools were formed but had a very strong smell.  The patient also had a sour odor to his breath.

Tongue: Red, especially along the edges.

Pulse: Wiry and slightly fast.

TCVM Diagnosis: 

Liver Qi Stagnation

TCVM Assessment:

• Waking at 1am-this is the hour of the Liver
• Restlessness-Liver/Gallbladder Stagnation
• Vomiting bilous fluid-Liver overcontrolling Stomach
• Strong smell to stool-Heat
• Sour smell to breath-Liver Qi Stagnation
• Red tongue, especially along the edges-Liver Qi Stagnation
• Wiry pulse-Liver Qi Stagnation
• Fast pulse-Heat (from Stagnation)

Treatment Principles:

• Resolve Stagnation
• Help Stomach Qi descend
• Calm the Mind

Acupoint Prescription:

GV-20, BL-14, BL-18, BL-19, BL-21, PC-6, LIV-3, GB-34, An-shen *

*aquapuncture with vitamin B-12 3ml bilaterally

• GV-20-Calm the Mind
• BL-14-Back shu point for the Pericardium
• BL-18-Back shu point for the Liver
• BL-19-Back shu point for the Gallbladder
• BL-21-Back shu point for the Stomach
• PC-6-Master point for the cranial abdomen, calms the Mind, helps Stomach Qi descend
• LIV-3-Shu-stream point for the Liver, smooths the flow of Liver Qi, resolves Stagnation
• GB-34-Earth point on the GB channel, moves Liver Qi, helps Stomach Qi descend
• An-shen-Calms the Mind

Chinese Herbal Prescription:

• Shen Calmer concentrated (Jing Tang Herbal)
• Classical antecedent Tian Wan Bu Xin Wan
• Nourish Heart Yin, calm the Shen, soothe Liver Qi.
• Dose: 0.5g/20 lbs. by mouth twice daily.

Edited by Greg Todd, DVM, CVA. Hypotherical Case by Greg Todd, DVM, CVA

Spring is a wonderful time of year. Winter is melting, and life is remerging from the recesses. The temperature is warming, and the spring wind brings with it the scent of fresh air and flowers. However, with spring comes an array of allergies that affects both humans and animals.

Likely your allergy patients will be coming through the door soon with the usual hair loss, hot spots, pustules, and red itchy skin. Some of the most common conditions vets see during this time is pruritus, allergic dermatitis, alopecia, and flea allergies.

Some common dermatology patterns include External Wind (mild), Wind-Heat (moderate), and Damp- Heat (severe). Even further severe patterns are Blood Deficiency and Yin Deficiency.

Hypothetical Case 1

Species: Canine
Breed: Irish Setter
Age: 5 years
Gender: S

Clinical Diagnosis (conventional): Atopic dermatitis with secondary superficial pyoderma

Conventional Indications:  Diagnosed two weeks ago with superficial pyoderma.  The patient just completed the first week of a combination of apoquel and clavamox tablets.  The pruitus has decreased from a 10/10 to a 2/10.  The ventrum, however, still shows multifocally diffuse erythematous scales. Skin scrape was negative for mites.  Skin cytology reveals TNTC cocci, no Malassezia.

Traditional Indications: This pet has a good appetite.  Her stools occasionally can be soft and may contain a small amount of mucus. Her hair coat is slightly dull with multifocal areas of alopecia with numerous, greasy, erythematous scales on the ventrum. Prior to the apoquel this pet was chewing her feet and licking her flanks and ventrum excessively. There is a strong smell to the skin.

Tongue: Red

Pulse: Slippery

TCVM Diagnosis:  Damp-Heat Skin

TCVM Assessment:

• Soft stools- Spleen Qi Deficiency
• Mucus in the stool- Damp
• Pruitus- Wind
• Lesions on the ventrum-Suggest Damp as Damp is heavy and sinks
• Red, greasy scales-Damp and Heat
• Strong smell to the skin- Heat
• Red tongue- Heat
• Slippery pulse- Damp

Treatment Principles:

• Clear Heat
• Resolve Damp
• Clear Wind
• Release the Exterior
• Tonify the Spleen

Acupoint Prescription:

LI-4, LI-11, GV-14, SP-6, SP-10, BL-18, BL-20, LIV-3

• Clear Wind, Release the Exterior- LI-4, LI-11, GV-14
• Clear Heat-LI-4, LI-11, GV-14, SP-10, LIV-3 (Cools the Blood)
• Resolve Damp- LI-11, SP-6, BL-20
• Benefit the Spleen-SP-6, SP-10, BL-20, (LIV-3 and BL-18 by harmonizing the middle jiao and helping to move Qi to move Damp).

Chinese Herbal Prescription:

• Damp Heat Skin concentrated*

Dose: 0.5g/ 20 lbs of body weight

*This formula was created by Dr. Huisheng Xie and is based on the classical formula Qing She Re Tang.

To view Issue 45 of the WATCVM Newsletter in its entirety, please click here.

REHABILITATION AS THE 5TH TCVM BRANCH?
Ronald B. Koh, DVM, MS, CVA, CVCH, CVFT, CCRP, CVMMP 

CASE REPORT
Integrative therapy to treat Kidney Qi Deficiency Leading to Urine Incontinence in a Guinea Pig
Wen Ling Wu, DVM, MS

GET INVOLVED
Learn ways to support WATCVM’s mission

CASE REPORT
Chinese Herbal Medicine for Degenerative Myelopathy
Joanna Gardner, DVM, CVA, CVCH, CVFT

ANNOUNCEMENT
New 2021 Board of Directors Members Have Been Selected

NEW BENEFITS
WATCVM members have updated benefits to enjoy!

During 2020, finding balance may have seen hard and out of reach with so much uncertainty. An important aspect of both life and TCVM is a balance between Yin and Yang energy within the body. We see Yin and Yang in every aspect of life and our daily routine; hot and cold, night and day, up and 

down, yes and no. Yang represents sky, energy, warmth and light while Yin is ground, passive, cold, and dark. If there is an imbalance, there is disease.

The concept of Yin and Yang and assignment of these terms are based on perspective of external factors such as Summer Day (Yang) and Winter Day (Yin) verses Spring Day (Yang) and Spring Night (Yin). By following what each half of the whole represents one can assign Yang or Yin aspects.

A tree’s branches and leaves are Yang, they face the sun and reach towards the sky. The roots are Yin, they are in the earth, hidden from the sun in darkness. The trunk represents the Yin within Yang, and Yang within Yin. The leaves and branches hide the sun from the trunk and puts it in shadow, but the trunk also reaches upward towards the sky. There are also moments within the day where sunlight will hit the trunk (Yang side) on one side verses the darkness on the other side (Yin side). Even the leaves can be Yin and Yang, the top of the leaves that face the sun (Yang) verse the bottom of the left that faces the ground (Yin).

In TCVM there are four pathological states of Yin and Yang imbalances. Yin Excess, Yang Excess, Yin Deficiency and Yang Deficiency. It is natural for the deposition of both a person or pet to be fall within one of these four characteristics of imbalance. By providing support for the imbalance disease can be prevented or reduced. These imbalances can be support by both external and internal methods from food to environment. Example a client might report their Yang Excess (Excess Heat) canine constantly trying to lay down on the cool kitchen tiles, perhaps a location the owner does not want their furry companion in. Providing a cooling dog sleeping pad for a Yang Excess canine would be one way to support this imbalance along with a cooling diet. This will prevent the canine from being in the kitchen and give the canine a way to cool down, making both happy.

Hypothetical Cases

Case 1

Species: Feline
Breed: DSH
Age: 15 years
Gender: N

Clinical Diagnosis (conventional): Chronic Kidney Disease
Conventional Indications: Somewhat inappetant. Most recent laboratory findings include: BUN-60 mg/dL, Creatnine-3.6 mg/dL, Phosphorus-6.0 mg/dL. PCV-30%, Total Protein-7.5. BCS 4/9.  Slightly dehydrated. Blood Pressure- 130 mm Hg (Doppler, front leg)
Conventional Treatment: Low phosphorus diet, Subcutaneous fluids twice weekly, Phosphorus binder

Traditional Indications: This patient has a decreased appetite.  Ears and back are cool to the touch.  This patient will follow the sun from window to window throughout the day. Stools are formed but slightly dry. There is appreciable muscle wasting present overall. Tongue - Pale. Pulse - Weak
TCVM Diagnosis: Kidney Yang Deficiency
TCVM Assessment:

• Chronic Kidney Disease-Kidney Deficiency, BUN increased, function affected (Yang/Qi), Remember, this diagnosis will reflect the most appropriate pattern. At this point most patients will have a decreased corticomedullary ratio via imaging.  This means the structure is damaged, which would be Yin. However, the overall pattern for this pet is Yang Deficiency.
• Cool ears and back-Yang Deficiency
• Pale tongue-Qi or Yang Deficiency
• Weak pulse-Qi or Yang Deficiency
• Warm seeking-Yang Deficiency

Treatment Principles: Tonify Kidney Yang, Improve appetite

Acupoint Prescription:

Chinese Herbal Prescription:

• Jin Gui Shen Qi, 0.5g per 10lbs of body weight twice daily

Case 2

Species: Equine
Breed: Clydesdale
Age: 2 years
Gender: Mare

History:  recently sold and transported to new barn facility across state lines from Florida to Texas during summer months. The new owner noticed horse's inability to sweat upon arrival and his excessive body temperature of 104.5, tongue was red with a thick yellow coating, pulses were urgent and fast, defecation was dry and sparse and urine was scant and dark yellow

Case 3

Species: Canine
Breed: Labrador Retriever
Age: 10 years
Gender: S

Clinical Diagnosis (conventional): Bilateral Hip Dysplasia with Lumbar Spondylosis Deformans
Conventional Indications: Diagnosed 1 month ago with bilateral coxofemoral dysplasia and spondylosis deformans at L2-3, L4-5, L5-6 after demonstrating difficulty rising and reluctance to go on walks.  Difficulty getting into the car.  Present medications include carprofen at 2.2 mg/kg PO BID, chondroitin sulfate supplement, and Fish oil 1000mg PO BID.

Traditional Indications: Historically this pet has a good appetite.  She is slow to move in the morning but anxious to go for her walks.  Very stiff initially but then moves better.  Some increased thirst, but seems to drink larger quantities. This patient will often wake in the middle of the night and move to a cool floor and pant. Her stools are somewhat dry.  She has some difficulty holding her posture to defecate. Difficulty rising with pain when moving.  On palpation, there is difficulty extending the rear limbs.  Pain is demonstrated when rising and when the pelvic limbs are extended. There is pain on palpation of the lumbar spine.  The skin is slightly dry with small flake dandruff. Acupoints BL-23, BL-18, BL-54 are hollow on palpation.  Acupoint Jian-jiao is painful when palpated. There is some sarcopenia symmetrically over the lumbar spine and both pelvic limbs. Tongue: Pale and dry. Pulse: Thin, slightly fast and weaker on the right.

TCVM Diagnosis:  Kidney Qi-Yin Boney Bi

TCVM Assessment:

• Skin is dry with small flake dandruff, stool is dry.-Yin or Blood Deficiency
• Boney change- Kidney Deficiency
• Pain, decreased range of motion- Stagnation of Qi and Blood (Bi Syndrome)
• Pale tongue- Qi Deficiency
• Dry tongue- Yin Deficiency
• Difficulty holding posture to defecate- pain-Qi-Blood Stagnation
• Difficulty holding posture to defecate- weakness- Qi Deficiency
• Pain at Jian-jiao-Pain in the lumbar, pelvis region.

Treatment Principles:Resolve Stagnation of Qi and Blood, Tonify Qi, Tonify Yin

Acupoint Prescription:

Chinese Herbal Prescription:

• Di Gu Pi San concentrated 0.5 g capsules: 1 capsule per 20 lbs of body weight
• Body Sore concentrated 0.5g capsules: 1 capsule per 20lbs of body weight

Case 4

Species: Equine
Breed: Welsh pony
Age: 12 years
Gender: Mare

History: Living in North East USA, first frost overnight affecting her acutely, off food in the morning, loose stool and prolonged urination, high peristalsis, mare is restless and appears crampy, kicking at abdomen, muzzle is cold to touch, tongue is purple with white coating, pulses are slow and deep
Pattern: stomach cold/yin excess
Treatment Principle: warm the middle jiao
Acupuncture: Bai hui, GV-4, BL-21, ST-36, LI-10
Herbal Formulas: Gui Zhi Tang, cinnamon concoction, to warm the channel, dispel the cold  and pain and regulate the stomach. Components are: Gui Zhi (Cinnamon), Sheng Jiang (Ginger), Bai Shao Yao (Paeonia), Da Zao (Jujube) and Gan Cao (Licorice).

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