Traditional Chinese Veterinary Medicine As A Method Of Treatment Intervertebral Disc Disease with TCVM Diagnosis: Kidney Qi Deficiency

with Qi/Blood Stagnation At Lumbar Area

By Lily Gunawan, CVA

Small Animal Practitioner

At Pet Clinic, Yogyakarta, Indonesia

email : lilinkecil79@yahoo.com

Abstract

Indo, 6 year old Dachshund smooth hair breed male dog, is friendly and very playful. He experienced weakness on his both rear leg and generated pain at his lumbar area. Indo was diagnosed with intervertebral disc disease and the TCVM diagnosed was Spinal Cord Qi/Blood Stagnation with Kidney Qi Deficiency. With TCVM as a method of treatment, the goal for treating IVDD patients is to eliminate the pressure on the spinal cord and resolve inflammation in order to return to free the pet’s pain and to have fully normal movement. Indo did acupuncture treatment twice a week with laser-acupuncture, dry needle and electro acupuncture, combined with a herbal medicine therapy Da Huo Luo Dan (Double P II), Tui-Na massage and rehabilitation therapy. One month after acupuncture treatment, Indo was able to walk.

Key words: ivdd, acupuncture, chinese veterinary herbal medicine, tcvm.

Abbreviations

CD ChondrodystrophicCD CSM Chondrodystrophic Cervical

spondylomyelopathy DLSS Degenerative lumbosacral

stenosisDN Dry needle acupunctureEA Electro acupunctureIVD Inter vertebral disc

IVDD Inter vertebral disc diseaseJT Jin TangNCD Non-chondrodystrophicQi EnergyTCVM Traditional Chinese Veterinary

MedicineX RAY Electromagnetic Radiation

Figure 1. 25/10/2016, Indo, 8yo, Male, Dachshund.

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Introduction

Western overview for Intervertebral disc disease is a condition which a disc develops a problems and the material insides escapes into the spinal column, ultimately causing pain, nerve damage, and even paralysis. The condition is seen more often in dogs than in cats.1

The canine intervertebral disc (IVD) is a versatile structure and responsible for the stability and flexibility of the vertebral column. Degeneration of the IVD is a common phenomenon in dogs and is characterized by degradation of the extracellular matrix, mainly proteoglycans and collagen. Once the degenerative process has started, a cascade of events is triggered that can ultimately lead to structural failure of the IVD and clinical signs of disease. Common diseases which are related to IVD degeneration in dogs include degenerative lumbosacral stenosis (DLSS), cervical spondylomyelopathy (CSM), and Hansen type I and II IVD herniation.2

The canine species can be divided into chondrodystrophic (CD) breeds and nonchondrodystrophic (NCD) breeds based on their physical appearance. In CD breeds, endochondral ossification of the long bones is disrupted, resulting in disproportionally short extremities. This trait had in the past been favored in the selective breeding programs, but unfortunately chondrodystrophy is also linked with IVD degeneration, which has resulted in breeds, such as the Dachshund, with disproportionally short legs and a high prevalence of IVD herniation. IVD degeneration in CD breeds is reported to

have developed early, often before 1 year of age. However, some large NCD breeds, such as the German Shepherd Dog and the Doberman, can also develop IVD degeneration, but then usually later in life.3.4

Dachshunds develop degenerative intervertebral disc disease and the incidence in dachshunds exceeds other dogs.5

Thoracolumbar intervertebral disk extrusion is a common cause of neurologic dysfunction in dogs. Clinical signs can range from signs of pain or spinal hyperesthesia to pelvic limb paresis or paralysis with or without deep pain perception and urinary retention.6

Animal with thoracolumbar disc disease can be divided into five categories based on their presenting neurological status.7

Neurologic

Grade

Clinical Signs

Grade I Painful, but no neurologic deficits

Grade II Recurrent spinal pain and/or mild to moderate paraparesis (ambulatory, ataxic dogs)

Grade III Severe paraparesis, non ambulatory

Grade IV Complete loss of motor function, but sensory function is intact

Grade V Loss of all motor and sensory function

Impaired urinary bladder function is also common in animals with substantial neurologic deficits (some grade II animals and most all grade III-V animals).7

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According to TCVM, IVDD is considered a painful obstruction syndrome and related to stagnation of energy (Qi) and blood (Xue). This situation is often exacerbated by cold and windy weather conditions. Vertebral column diseases are related to kidney energetic deficiency of either Yin or Yang. Other conditions can also cause IVD, such as trauma and/or repetitive exercise, latent blood deficiency in the post estrus period, and a natural decline of Kidney energy that occurs in geriatric dogs.8

In one study, 50 dogs with thoracolumbar IVD were classified based on a scale of specific neurological deficits from Grades 1-5 (Grade 1 = pain only, no neurological deficits and Grade 5 = paraplegia with no deep pain) and then randomly allocated to one of two treatment groups. The conclusion of the study was that EA/DN combined with standard conventional medical treatment was more effective than conventional medication alone and resulted in a shorter time to recover ambulation in dogs with thoracolumbar IVDD.9

History and Western Medicine’s Diagnostic

Indo, an 8 year old male Smooth Hair Dachshund was presented with laminitis of both pelvic limbs. Recently Indo has difficulty in getting up. Daily diet was dry kibble dog food. He is a happy dog, very excitable, and he actually barks all the time.

The physical exam revealed both limb paresis, and back pain at the lumbar area, urine incontinence and fecal incontinence. On the palpation at the lumbar area he felt pain at L3-L4-L5-L6, lost motor function,

no superficial but conscious deep pain perception percent from extremitas neurologist exam.

I examined him and suspected an intervertebral disk disease according to the physical and neurologist exam and the X- Ray image.

Based on the condition of Indo, with clinical signs paralysis (not able to stand and walk), decreased bladder control, conscious deep pain perception percent, he was diagnosed Interverterbral disc disease in CD breed Grade IV (IVDD Hanson type I).

As an option, Indo was suggested for acupuncture treatment.

Figure 2. X-Ray Image.

TCVM Diagnosis and Analysis

During the examination, Indo was excited and enthusiastic, a bit noisy and he still barks all the time, although he can’t walk properly, he tried to keep moving and going around.

His tongue was purple, and his pulse was wiry, strong, and rapid. His respiration was rapid. On the palpation at the lumbar area

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and Front-Mu point the sensitivity was at BL-23 and GB-25.

According to The Five Elements (Five Constitutional Types), Indo is considered to be a Fire Type Constitution. A Purple tongue and wiry pulse indicate Stagnation. The strong pulse and acute condition indicate an Excess Pattern.10

There are four pairs in Eight Principles diagnostic system. The Exterior and Interior pattern are used to differentiate the location of the disease. The Heat and Cold pattern, are used to differentiate the nature or properties of a disease. The Excess and Deficiency patterns can determine the strength or weakness of the Zheng Qi and indentify the existence of Xie Qi. 10

The categories of Yin and Yang within The Eight Principles have two meanings. Exterior, Heat and Excess Pattern belong to the category of Yang, while Interior, Cold, and Deficiency Pattern belong to the category of Yin.10

With the signs of early stage of the disease, sudden onset of symtoms, a short course, and the location of pain is on the meridian pathways, the diagnostic system according to The Eight Principles is Exterior Excess Heat Pattern; which belong to Yang category.10

Although Qi/Blood Stagnation in External Channel; may still be present in animals that have neck or back pain, once neurological deficits are present and the spinal cord is affected, the disease has become Internal.10

The excessive signs can become deficient signs in prolonged illness. In some case The

Excess with Deficiency pattern was happened if there is 2 or more excess signs with 2 or more deficient signs.10

Sensitivity to palpation of the Back-Shu (association) point and the Front-Mu point related to a Zang Fu organ. In this case, sensitivity at BL-23 and GB-25 related to Kidney unbalanced.10

Pattern identification according to the Zang Fu Organs is related to Kidney. Because the Kidney controls the bones and because the lower back is the house of the Kidney.10

The dog has a fire type constitution. A fire type of animal tends to have Excess Heat/Fire which can easily consume body fluid and gradually lead to Yin Deficiency. When a Yin Deficient body is invaded by Wind-Cold-Damp, multiple IVDD lession may occur. The sign of pain, weakness, and stiffness of the limbs are considered Bi Syndrome.10

Lameness is mainly considered as a sign of pain which result from Stagnation of Qi-Blood. Painful and lameness are Bi Syndrome sign of Qi or Blood Stagnation.10

The pathogen Wind-Cold-Damp obstructs the Qi flow along the back. When Qi does not flow freely, there must be pain.10

The sensitive back and the purple tongue are the signs of obstructed Qi. Qi Stagnation may lead to Blood stagnation.10

Identification of Channel patterns of Indo’s condition is Bladder Channel Pattern, with clinical signs of urinary incontinence, back pain, lumbar-sacral area disorder.10

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Because of no cool seeking or hot seeking, diagnosis TCVM for Indo is Kidney Qi Deficiency with Qi-Blood Stagnation at the lumbar area.

Treatment Strategy

This step is based upon the Pattern differentiation. Treatment principles include moving Qi to relieve pain and moving Blood to resolve Stagnation. Also to resolve paresis and paralysis. The treatment includes dry needle acupuncture, electro acupuncture for 20 minutes at 80Hz, laser acupuncture, Chinese herbal medicine therapy and Tui-Na massage.

I stimulated acupoints Hua Tuo Jia Ji, GV-14, Bai Hui and KID-1 by electroacupuncture in this report. The attributes and indication of Hua Tuo Jia Ji, GV-1, Bai Hui and KID-1 have been shown to improve paresis or paralysis of the IVDD by acupuncture.11

Figure 3. Dry Needle Acupuncture Treatment.

Figure 4. Electro Acupuncture Treatment.

For this case, EA administered twice a week, then gradually reduced to once a week.

General points:

BL-23, Liu Feng, KID-1, KID-3, SP-10, BL-40, Hua To Jia Ji, ST-36, GB-34, LIV-3, PC-8, Wei Jian.

Electro acupuncture points :

Hua To Jia Ji + BL points.

BL-11 + Shen Shu.

KID-1 + BL points (proximal IVDD).

GV-6/9/14 + Bai Hui/ GV-1/GV-2.

ST-36 + GB-34.

KID-1 + ST-41.

Shen Shu + KID-1(crossing).

Table 1. Acupuncture point used to permission point.

Acupuncture Point Clinical IndicationBai Hui Support pelvic limb paresis or paralysis.GV-20 Calm point.

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Table 2. Acupuncture points used to IVDD.

Acupuncture Point Clinical IndicationBai Hui Pelvic limb paresis or paralysis, lumbosacral pain, lumbosacral IVDD.Hua To Jia Ji (at the lesion area)

Thoracic and lumbar pain, IVDD.

GV-14 Clear Heat. Yin Deficiency, IVDD.GV-3 Kidney Yang and Qi Deficiency, coldness and pain of the thoracolumbar

and lumbosacral regions, lumbosacral IVDD, pelvic limb paresis or paralysis.

GV 4 Thoracolumbar pain, IVDD.BL-11 Influential point for bone, IVDD, thoracolumbar pain.Shen Shu Thoracolumbar pain, urinary incontinence.Shen Peng Pelvic limb paresis or paralysis, lumbosacral pain, IVDD.Shen Jiao Pelvic limb paresis or paralysis, lumbosacral pain, IVDD.

Table 3. Acupuncture points used to balance Kidney Qi Deficiency.

Acupuncture Point Clinical IndicationKID-1 Jing Well point. Sedation point for excess disease patterns, urinary

incontinence.KID-3 Kidney Source Point.KID-7 Mother point for Deficiency and paralysis pelvic limb.BL-23 Back Shu association point for kidney, Kidney Yin and Qi deficiency,

urinary incontinence, thoracolumbar ivdd, pelvic limb weakness.BL-26 Gate of Yuan-source Qi, urinary incontinence, lumbosacral pain.ST-36 General Qi tonic, generalized weakness.Shen Shu Kidney Qi deficiency.

Table 4. Acupuncture points used to pelvic limb weakness at distal points.

Acupuncture Point Clinical IndicationLIV-3 Remove Stagnation, pelvic limb paresis or paralysis, general painful

conditions.BL-40 Master points for the caudal back, urinary incontinence, IVDD, pelvic

limb paresis or paralysis.GB-34 Influential points for tendons and ligaments, pelvic limb lameness,

weakness and paresis or paralysis, general pain relief.SP-10 Sea of Blood. Blood deficiency, blood stagnation, pelvic limb paresis or

paralysis.PC-8 Thoracic painWei Jian Clear heat, paralysis of the tail, pelvic limb weakness

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Liu Feng (pelvic) Pelvic limb paresis or paralysis

Figure 5. Acupuncture points.

I stimulated acupoints HuaTuo Jia Ji, GV-14, Bai Hui and KID-1 and other acupoints with laser acupuncture too. The combination of dry needle, electro acupuncture and laser acupuncture works effectively and has been shown to improve paresis or paralysis of the IVDD.

Figure 6. Electro acupuncture Equipment.

Figure 7. Laser Acupuncture Equipment.

Tui-na-an-mo is Chinese manual therapy used for preventing and treating disease.

In TCVM terminology, Tui-na or An-mo can regulate meridians, soothe joins and sinews, promote circulation of Qi and Blood, balance Zang Fu organs and strengthen the body resistance.12

The purpose of Tui-Na is to stimulate Qi and Blood flow to relieve pain and promote nerve regeneration in the affected region. 12

Figure 8. Nie-fa from Bai-Hui to GV-14.

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Figure 9. Gun-fa on the back in dog.

Figure 10. Moo-fa at Da Feng Men

Tui-Na massage at the first session for this dog is simple like this. First Pinch Nie-fa along the spine, hold and pinch the skin and move forward from the tail bone to the shoulder blade 12 times. Then gently pull the tail 12 times. Gun-fa at the back. Rotary Knead (Rou-fa) at Bai Hui, BL 40, ST 36, KID 1. Press An-fa at Ting points and Rub cool paw.

Figure 11. Dou-fa, gently shake each pelvic limb

Tui-na massage at the next session is following the table below.5

Table 5. Tui-na massage for IVVD.5

Name Technique RepetitionsMoo-fa Massaging using the palms at Da-feng- men,

GV-14, Bai-Hui (L7-S1), from BL-13 to BL-35, from BL-42 to BL -52

10 -20 times

An-fa - Rou-fa Perform pressing and Rotary KneadingFrom Bai-Hui to GV-14Clockwise direction and counterclockwise

12 times

An-fa - Tui-fa Pressing and pushingBL-26 to BL-13

12 times

Ca-fa Rub the back from caudal to cranial until the tissues are warm

For 1 -3 minutes

Yi-chi-chan - Rou-fa

Single thumb and rotary kneading at BL-40, KID-1, LIV-3 12 times

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Nie-fa Pinching the skin from Bai-Hui to GV-14 12 timesNa-fa Pull the tail 12 timesDou-fa Gently shake each pelvic limbBa-shen-fa Stretch the pelvic limb 12 timesBan-fa Flex and Extend all the limb joints 12 timesRou-fa Finish with Rotary Kneading from Bai-Hui to GV-14 For 5 -10 minutes

Chinese Herbal Treatment for this case is Da Huo Luo Dan (Double P II). The purpose is to break down stasis in the spines, to move Qi, and to relieve pain. Double P II is the primary herbal medicine used to treat IVDD. It may caused loose stool in some cases (10%). Even so this can still be used as long as the gut is able tolerate it.12

Double P II (JT), is a commonly prescribed as a powerful formula for spinal cord injuries (Qi/Blood Stagnation causing paresis or paralysis).5.10. Primary formula

for IVDD (Type I) such as paralysis/ paresis due to stagnation, is very sensitive to any touch on the back, cause fast pulse and purple tongue. With the dose 0,5 g per 20 pounds bid, for 4 weeks.5.10

Figure 12. Herbal Medicine Double P II ™.13

Table5. Ingredient and actions of Chinese Herbal Medicine Da Huo Luo Dan (Double PII).

Double P II ™.13

Ingredient : Pin Yin Name

Latin Actions

Dang Gui Angelica Nourish Blood, activated blood and relieve pain

Chuan Xiong Ligusticum Activate Blood, resolve StagnationChi Shao Yao Peony Cool Blood, resolve StagnationHong Hua Carthamus Move Blood, resolve Stagnation and stasisMo Yao Myrrh Resolve stagnation and relieve pain.Ru Xiang Olibanum Resolve stagnation and relieve pain.Tian San Qi Notoginseng Move Blood stop hemorrhageXue Jie Draconis Resolve StagnationQuan Xie Scorpion Resolve StagnationDi Long Ligusticum Activates ChannelsDu Zhong Eucommia Strengthen Back, tonify Kidney YangXu Duan Dipsacus Strengthen bones and ligaments tonify

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Kidney YangGu Sui Bu Drynaria Strengthen bones and tonify Kidney YangBa Ji Tian Morinda Warm YangMa Qian Zi Strychnos Unblock ChannelsChuan Niu Xi Cyathula Tonify Kidney Yang and Strengthen the

rear limbsBu Gu Zhi Psoralea Tonify Kidney yang and Strengthen bonesHuang Qi Astragulus Tonify QiShu Fu Zi Aconite Warm Yang and ChannelsWu Yao Lindera Move Qi and relieve painGan Cao Licorice Harmonize

Clinical Outcome

After the first treatment, Indo started to stand up on his legs. For the next result, he started to walk step by step. Then he tried to run. In a month, Indo had been doing very well. He was doing great with his legs.

We can see the different of the X-ray Image before and after.

Figure 13. Improvement outcome.

Figure 14. X-ray image before and after treatment.

Conclusion

Thoracolumbar IVDD is commonly seen in CD breeds, Traditional Veterinary Medicine (TCVM), including acupuncture, Tui-Na massage, and herbal medicine, is an effective sole therapy, or part of integrated therapy with Western medicine. The outcome based on the neurological grade.

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Figure 15. Walk and Run.

Figure16. Happy dog and happy owner.

FOOTNOTES

A Jing Tang Herbal, Reddick, FL

http//:www.tcvmherbal.com

References :

1. Becker K, When Good Discs Go Bad, 2012, (www.healthypets.mercola.com).

2. Bergknut N, Intervertebral Disc Degeneration in Dogs, Uppsala & Utrecht, 12-14, 2011.

3. Hansen HJ: A pathologic-anatomical study on disc degeneration in dog, with special reference to the so-called enchondrosis intervertebralis. Acta Orthop Scand Suppl 11:1-117, 1952.

4. Bray JP, Burbidge HM: The canine intervertebral disk. Part Two: Degenerative changes nonchondrodystrophoid versus chondrodystrophoid disks. J Am Anim Hosp Assoc 34:135- 144, 1998.

5. Xie H et al, Practical Guide to Traditional Chinese Veterinary Medicine. Small Animal Practice, Chi Institute Press Publishing 2014.

6. N. J. H. Sharp and S. J. Wheeler, “Thoracolumbar disc disease,” in Small Animal Spinal Disorders: Diagnosis and Surgery, N. J. H. Sharp and S. J. Wheeler, Eds., pp. 121–135, Elsevier Mosby, London, UK, 2nd edition, 2005.

7. Bubenik L, Intervertebral disk disease- tradition versus current views on treatment, Proceedings of The North American Veterinary Conference, International Veterinary Information Service, 2005, (www.ivis.org).

8. Hayashi et al, Electro-acupuncture and Chinese herbs for treatment of cervical intervertebral disk disease in a dog, v. 8(1): 95–98, 2017, J Vet Sci.

9. Hayashi AM, Matera JM, Fonseca Pinto AC. Evaluation of electro-acupuncture treatment for thoracolumbar intervertebral disk

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disease in dogs. J Am Vet Med Assoc. 2007; 231(6):913-8.

10. Xie H, Priest V. Traditional Chinese Veterinary Medicine. Reddick, FL: Jing Tang Publishing 2002 : 1-581.

11. Xie H, Priest V. Xie’s Veterinary Acupuncture. Ames, Iowa: Blackwell Publishing 2007:3-347.

12. Xie H, Ferguson B, Deng X. Application of Tui – Na in Veterinary Medicine 2nd edition. Reddick, FL: Chi Institute of Chinese Medicine Publishing 2007 : 57-126.

13. Xie H, TCVM Treatment of Intervertebral Disk Disease in TCVM Newsletter : Voice of Dr. Xie’s Jin tang herbal, Issue 14, 2011 :1-6.

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