By Dina Desiani Guntaran, DVM
Small Animal Practitioner
At Lafemur Pet House Small Animal Clinic 24hr,
Surabaya, Indonesia
ABSTRACT
Genie, 9 year old corgie female dog, quiet dog, experienced weakness on her rear legs. The owner took her to Lafemur pet house and diagnosed with lumbal area spondylosis, also urination and defecation disturbance. Genie had an acupuncture treatment twice a week and combine with herbal medicine. After third treatment, she was able to stand up and her urination defecation became normal. After fifth treatment, she was able to walk for a while. After three months treatment, ginie was able to walk normally.
Keywords :
Acupuncture, Spondylosis, Tcvm, Chinese Herbal Veteriner, Corgie
ABBREVIATION
TCVM Traditional Chinese Veterinary Medicine
KID Kidney
BL Bladder
GV Governor Vessel
SP Spleen
ST Stomatch
LIV Liver
GB Gallblader
NSAID Non Steroid Anti-Inflamatory
INTRODUCTION
According to western overview, spondylosis is described as a non-inflammatory, degenerative disease of the peripheral endplate region associated with new bone formation. Osteophytes vary from small spurs to bony bridges across the disc space, leaving at least part of the ventral surface of the vertebral body unaffected. High risk prevalency of spondylosis usually found in elderly age of German Shepherds and Boxers. Spondylosis is not generally considered to be a great clinical relevance, except in working dogs in which the diminished spinal flexibility might limit activities. Osteophyte formations extending dorsolaterally can compress spinal nerve roots at the level of intervertebral foraminae. It can be diagnosed with radiographic or (histo)pathological examination. Severe spondylosis symptomps indicated with stiffness at back, lameness, changes in gait, and pain. Spondylosis usually treated with medication or surgical3. Medication with non-steroidal anti-inflammatory drugs (Carprofen) is used to reduce pain and inflammation. However, long term of use this drugs in dogs sometimes cause gastrointestinal problems such as lack of appetite, vomiting, and inflammation of the stomach and intestines. Corticosteroid drugs also suppress inflammation, but they are usually given on short term period to avoid adverse effects of used in long term period. Surgical treatment may be necessary if medication treatment did not show any progress of healing or condition with neurological deficits or vertebral fractures1.
According to TCVM overview, spondylosis is generalised disease of ageing resulting in formation of bony osteophytes around degenerating intervertebral discs throughout the vertebral column and make severe back pain. Etiology and pathology caused stiffness and blockage of Qi circulation and Blood Stagnation at thoracolumbar vertebrae. Kidney is control of bones, patient with Kidney Deficiency are prone to this problem. Clinical sign of spondylosis are lameness, pain, difficulty raising the affected limb, tongue purple or pale purple, pulse wiry or deep and week, palpation sensitivity. Aim of the TCVM strategies are activate blood and flow the Qi, ease the back pain, and invigorate the Meridian5,6,7.
5 February 2016, Genie 9 years old corgie female dog, quite and timid dog, liked to sleep on the floor, the other dog always bully her at home. The owner took her to small animal clinic because of lameneless and paresis on her rear legs. Genie experiencing paresis at her both hind limb. Genie couldn’t stand up. She tried to walk with dragged her both hind limb. She also could not urination and defecation. She has been treated to the other acupuncturist(not tcvm) but became worse, genie could not walk, urination, and defecation. From another doctor, genie was prescribed with antibiotic and NSAID. X-Ray image for lateral positioning revealed bony spur at thoracolumbar vertebrae area.
Figure 1 : Genie first visit, paresis at her both hind limb, couldn’t stand up.
Medical Examination
Genie has paresis at rear leg , temperature, pulse, respiratory and capillary refill time within normal range. The body weight was 9 kg with body score is 3/5. She is can’t stand by her self just laying down at the floor. The tongue red, and ear warm. X-Ray image revealed bony spurs at thoracalis–lumbal vertebrae area. Western medicine’s diagnostic is quadriparesis caused by spondylosis at thoracalis–lumbal vertebrae area. Prognosis is dubious–infausta. Treatment includes anti-inflammatory drug, NSAIDS, and pain killer.
Figure 2 : X-Ray image revealed bony spurs at thoracalis – lumbal vertebrae area.
TCVM Examination
Primary complaint was paresis at both rear leg and can’t defecation and urination. Genie constitution was metal, she was quite and timid dog, dry nose, shedding of hair, dry and flakes skin, body temperature at head, ear, abdomen, paw were warm, can’t defecation and pee. She liked to sleep on the floor. Her daily diet was dog food (science diet). Tongue was red. Pulse was weak and fast.
TCVM Diagnosis
Kidney yin deficiency with local Qi stagnation at back area. Eight principles method is yin deficiency, interior pattern, heat, Zang Fu organ is kidney. Meridian channels include kidney, bladder, gall bladder, stomach, liver, and governing vessels. Bone problem belongs to kidney. Prefer cool place, dry skin, pulse fast and weak, paw and ear warm means yin deficiency. Pain, moaning, lameness, purple tongue mean Qi or blood stagnation5,6,7.
Figure 3 : Genie first visit.
MATERIALS AND METHODS
We suggested Genie for acupuncture treatment and Chinese veterinary herbal therapy. We did dry needle, electro-acupuncture, and aqua-puncture. Include remove qi and blood stagnation, relieve pain, and tonify yin. The dog received acupuncture twice a week with electro puncture used 50 Hz for 15 minutes at Baihui (-), GV 4 (+), BL 23 (-), BL 20 (+)/ BL 11(+), Hua Tuo Jia Ji (+ and -), BL 60(-), BL 40 (+), GB 34(-), BL 54(+) KID 1 (bilateral), KID 3 (-), SP 6(+). Laser-puncture 1 joule per acupoint used at BL-54, GB-29, GB-30, GV-1, Hua to jia ji . Dry needle at GB 29, GB 30, LIV 3, KID 7, ST 36, Liu Feng. Aqua puncture with vitamin B12 0.1 ml at LIV 3, ST 36, BL 23. Herbal Formula for Genie is Bu Yang Huan Wu used for weakness, tonify Qi, move blood and nourish blood, administration orally 1 tea-pill twice per day and Di Gu Pi for nourish yin, clear deficient heat, tonify kidney yang, and dispel wind-damp administration orally 1 tea-pill twice per day up to three month (Xie herbal). Then, do maintenance that is herbal formula given twice per weeks5,6,7.
Figure 4 : Genie having Acupuncture Treatment.
Table 1: Acupuncture point used for permission6,7
| Acupuncture point | Clinical indication |
| Bai-hui | Support pelvic limb paresis/paralysis |
Table 2: Acupuncture point for balance kidney yin deficiency6,7
| Acupuncture point | Clinical indication |
| BL 23 | Kidney associate support bone recovery |
| KID 7 | Mother point for deficiency and paralysis pelvic limb |
| KID 1 | Pelvic limb “root” acupoint |
| KID3 | Yuan source point for the kidney |
| SP 6 | Tonify yin |
| BL 11 | Influential point for bones |
Table 3: Acupuncture point used to spondylosis at local points (back point)6,7
| Acupuncture point | Clinical indication |
| GV 4 | Remove Qi/Blood stagnation |
| GV 1 | Luo-connecting point of GV, crossing point for GV,GB, and KID channels |
| BL 11 | Influential point for bones |
| BL 20 | Spleen Associate support blood regulation |
| BL 23 | Kidney associate support bone recovery |
| Hua to jia ji | Back pain, remove Qi/blood stagnation |
Table 4: Acupuncture point used to strengthen hind limb at distal points6,7
| Acupuncture point | Clinical indication |
| BL 40 | Master point of caudal back,paraparesi/pareplegia |
| BL 60 | Pain control, can simulataneously treat KID 3 and support kidney and marrow |
| GB 34 | Influential Point for tendon ligament |
| BL 54 | Paraparesis / paraplegia |
| GB 29 | Paralysis of the pelvic limb |
| GB 30 | Paralysis of the pelvic limb |
| ST 36 | General Qi tonic,hind limb weakness, generalized weakness |
| LIV 3 | Remove Qi/blood stagnation, pelvic limb paresis/paralysis |
| Liu feng | Remove Qi/blood stagnation |
Table 5: Ingredient and actions of Chinese herbal medicine Bu Yang Huan Wua
| English Name | Pin Yin Name | Action |
| Astragalus | Huang Qi | Warm and tonify Qi |
| Angelica | Dang Gui | Nourish Blood |
| Peonia | Bai Shao | Nourish Blood and Yin, soothe Liver Yang |
| Earthworm | Di Long | Break Blood Stagnation |
| Ligusticum | Chuan Xiong | Activate Blood and relieve pain |
| Carthamus | Hong Hua | Break stasis and relieve pain |
| Persica | Tao Ren | Break stasis and relieve pain |
Table 6 : Ingredient and actions of Chinese herbal medicine Di Gu pia
| English Name | Pin Yin Name | Action |
| Lycium | Di Gu Pi | Nourish Yin and clear deficient heat |
| Mountan | Mu Dan Pi | Cool blood, clear heat, resolve stagnation |
| Reihmania | Shu Di Huang | Nourish blood and Yin |
| Rehmania | Shen Di Huang | Clear heat, nourish Yin |
| Gentiana | Qin Jiao | Clear Wind-damp, nourish Yin |
| Psoralea | Bu Gu Zhi | Tonify kidney Yang and Yin |
| Drynaria | Gu Sui Bu | Tonify kidney Yang and strengthen bones |
| Eucommia | Du Zhong | Strengthen the back |
| Alisma | Ze Xie | Drain damp and benefit urination |
| Salvia | Dan Shen | Invigorate blood and resolve stagnation |
| Angelica | Du Huo | Dispel wind, cold and dampness, relieve pain |
| Angelica | Dang Gui | Nourish blood and relieve pain |
| Phellodendron | Huang Bai | Nourish Yin and clear heat |
- Xie H.S., Frank L.R., Preast V., Trevisanello L., 2011
CLINICAL OUTCOME
5 February 2016, We did dry needle, electro-acupuncture, and aqua-puncture on the first day of Genie acupuncture treatments. 10 February 2016, Genie came for second acupuncture treatment. At that time, she was able to stand up with four legs. Her urination and defecation became normal.
Figure 5 : After 2nd treatment, able to stand up.
19 February 2016, after the second treatment, Genie was able to walk slowly but sometimes she fell down. Owner was quite happy because she felt Genie have good progression after acupuncture therapy. We decided increase the acupuncture treatment to twice a week. 18 March 2016, Genie came for tenth treatment of acupuncture , she was able to walk faster and his hind limb look stronger. Owner said, she was almost back normal like before. So, we reduce the acupuncture treatment to once a week. Genie was doing great with her hind limb, we reduce again her acupuncture treatment into once a month. Until, 15 April 2016, Genie was very active, able to walk properly, and did not experienced any back problem.
Figure 6 : Genie able to walk properly.
DISCUSSION
Acupuncture treatment for back pain problem is the best to be performed minimum twice a week and it takes 2-3 times treatment to get a good result if the back pain without any bone disorders. Acupuncture effects are release B-endorphin, reduces muscle spasms, reduce inflammation and promote tissue healing5. Local point selection is very important to support nerve response and smooth the blood circulation surrounding back and hind leg area2. In the other hand, paresis cases use more acupoints to be more effective for the treatments because many meridians are stimulated. Combinations of dry needle, electro puncture and aqua puncture works effectively to support the healing of spondylosis problems5. Electro puncture is used to alleviate pain and smooth the blood circulation4. Aqua puncture use vitamin B12 is injected into acupuncture points. Aqua puncture also have effects such as reducing muscle spasm, increasing blood flow to a sore or stagnant area of the body and provide relaxation and natural pain relief6. Herbal medicine is preferable instead of anti-inflammatory drug because long term use of herbs is considered to be safer with fewer side effects.
CONCLUSION
Acupuncture and herbal medicine is an excellent combination therapy that works effectively on arthritis joint problems, and bone and joint health maintenance, to improve pets quality of life.
Footnotes
Xie H, Preast V. Traditional Chinese Veterinary Medicine. Reddick, FL: Jing Tang Publishing, 2002: 1-581
REFERENCES
- Aiello S, Mays A, The Merk Veterinary Manual 8th Philadelphia, Pennsylvania, National Publishing 1998 : 861-869.
- Chrisman CL. Traditional Chinese Veterinary Medicine for Neurological Diseases Proceedings Of The 13th Annual International TCVM Conference, Xie HS,
Chrisman CL, Trevisanello L. 2011, Jing Tang Publishing, FL, USA, Pp 225-322
- Hendrik-Jan C. Kranenburg, George Voorhout. Diffuse idiopathic skeletal hyperostosis (DISH) and spondylosis deformans in purebred dogs: A retrospective radiographic study, The Veterinary Journal 190 e84–e90. 2011
- Ulett GA, Han S, Han JS. Electro acupuncture: Mechanisms And Clinical Biol Psychiatr. 1998, 44: 129-138
- Xie H, Preast V. Traditional Chinese Veterinary Medicine Fundamental Principles 2nd Reddick, FL: Chi Institute of Chinese Medicine Publishing. 2013
- Xie H, Preast V. Xie’s Veterinary Acupuncture. Ames, Iowa: Blackwell Publishing. 2007: 3-347
- Xie H, Priest V. Traditional Chinese Veterinary Medicine. Reddick, FL: Jing Tang Publishing 2002 : 1-581.