By Emi Puspitoningrum DVM
Small Animal Practitioner
At Vetnic Care small animal clinic
Bekasi, Indonesia
Cell phone: +62 81 387 951 858
Abstract
Max, 8 year old male dachshund dog, very playful and active dog. The owner took him to a small animal clinic for the weakness in his both hind limbs. Physical examination observed for the curved back, paralyzed in both hind limbs, and back pain during palpation. Acupuncture treatment was performed every two days for about one month and maintenance acupuncture treatment once in every two weeks. Acupuncture treatment combined with herbal medicine and food therapy intensively for one month did a great work for Max recovery. After one month, Max was able to walk and run.
History and Western Medicine’s Diagnostic
05/08/2015, Max, 8 year old male dachshund dog, very playful and active dog. The owner took him to a small animal clinic for the weakness in his both hind limbs. Physical examination observed for the curved back, paralyzed in both hind limbs, back pain during palpation, good appetite, able to urinate and defecate. Max went for X-Ray examination, lateral side positioning revealed thoracic vertebrae disc space narrowing. The owner decided for acupuncture treatment combined with herbal medicine. After two weeks acupuncture treatments, Max was able to do his first step and was completely able to walk after a month acupuncture treatments. Max continued his acupuncture treatment once in every two weeks until three months.
19/01/2016, Max had got his second attack, Max suddenly got paralyzed in both hind limbs, back pain was worse on palpation, poor appetite, was not able to urinate and defecate, and fever. Max went to a small animal hospital on the same day to get the emergency help; Max was prescribed antibiotic, anti pyretic, painkiller and urinary catheterization procedure to collect urine. Acupuncture treatment was performed the next day, the treatment didn’t seem really help with his condition; Max got worse the next day and Max passed away four days later.
Physical Examination
Medical Examination
Paralyzed in both hind limbs, curved back and back pain on palpation.
X-Ray image revealed thoracic vertebrae disc space narrowing.
Western Medicine’s Diagnostic: Intervertebral Disc Disease Type I progressed to Myelomalacia
Western Prognosis: successfully recovery – poor prognosis
Western Treatment: antibiotic, anti pyretic, painkiller, urinary catheterization procedure
Fig 1. Max X-Ray image – lateral side view for thoracolumbar areas
Fig 2. Max X-Ray image – lateral side view for cervicothoracic areas
Traditional Chinese Medicine Examination
05/08/2015
Max was a playful dog, like to greet strangers, but very sensitive to loud noise and thunder. The tongue was purple, rapid and forceful pulse. He was presented with paralysis in both hind limbs, very sensitive to touch on thoracolumbar region, especially in BL 22 and BL 23, cool ear, dry nose, shedding hair, and flaky dry skin. Body temperature was normal, but very thirsty with cool seeking behaviour, good appetite with dry kibble dog food.
19/01/2016
Max had got his second attack in one morning, with pale purple tongue, rapid and forceful pulse. He was presented with paralysis in both hind limbs, very sensitive to touch on thoracolumbar region, especially in BL 20/ 21/ 22/ 23, lost of sensation and reflexes from the digits in both hind limbs, poor appetite, body temperature slightly warm with warm ear. He didn’t have bowl movement and urination within these periods.
Traditional Chinese Medicine Diagnosis
Kidney Yin Deficiency leading to thoracolumbar bi syndromes with Qi and Blood Stagnation
Eight principles: Interior Pattern, Heat, Excess, Yin
Zang-Fu: Kidney
Tongue Pale and Purple: Deficiency and Cool Pattern, Qi/ Blood Stagnation
Pulse rapid and forceful: excess heat pattern
Back pain: Local Qi and Blood Stagnation
Flaky skin, cool seeking behavior: Yin Deficiency
Paralyzed in both hind limbs: Zang-Fu Kidney
Traditional Chinese Medicine Treatment Principles
Remove Qi and Blood Stagnation
Relieve Pain
Tonify Kidney Yin
Acupuncture Treatment Method
Permission Points
Baihui support pelvic limb paresis/ paralysis
GV 20 calm point
Local Points
GB 30 paralysis of pelvic limbs
GB 29 paralysis of pelvic limbs
BL 54 paralysis of pelvic limbs
Hua-Tuo-Jiaji back pain; intervertebral disc disease
Balanced Points
KID 3 Kidney source point
KID 7 Jing River point (metal), mother point for deficiency and paralysis pelvic limb
BL 11 influential point for bones
BL 17 influential point for blood
BL 20 Spleen associate point
BL 21 Stomach associate point
BL 23 Kidney associate support bone recovery
SP 6 Yin/ Blood deficiency
GV 14 high fever, false heat
LI 10 general tonic, immune regulation
Digital Points
LIV 3 Liver Yuan point, remove stagnation and pain
ST 36 master point for gastrointestinal tract, general tonic
BL 40 master point for caudal back/ hips, dysuria
GB 34 influential point for tendons/ ligaments
KID 1 rear weakness
Electro acupuncture:
20-50 Hz 15 minutes, three times per week
Selected Herbal Formula
Double P II
Selected Herbal Formula: herb was introduced to the dog slowly to avoid any problem such as vomiting and diarrhea
Dosage: 0.5 gram per 20 lb. body weight twice daily
Given daily, BID, up to 2 months
Western Medicine Indication: Intervertebral Disc Disease (IVDD) Type I progressed to Myelomalacia
TCVM Indication: paralysis and paresis due to stagnation, very sensitive to touch on the back.
Chinese Principle: move Qi, relieves pain and break down stasis in the spines
Ingredient and Actions
Morinda Ba Ji Tian tonifies Kidney Yang and strengthens the bones
Eucommia Du Zhong tonifies Liver Kidney, strengthens tendons, sinews and bones
Psoralea Bu Gu Zhi tonifies Kidney Yang, strengthens sinews and bones
Paeonia Chi Shao Yao cool blood, invigorates blood and clear heat
Cyathula Chuan Niu Xi invigorates blood, dispel stagnation direct Qi-Blood down to rear limbs
Ligusticum Chuan Xiong invigorates blood, moves Qi and relieves pain
Angelica Dang Gui nourishes, replenishes and invigorates blood, relieves pain
Pheretima Di Long clear heat activates the Channels and subdue Endogenous Wind
Drynaria Gu Sui Bu tonifies Kidney, nourishes Liver and invigorates blood
Astragalus Huang Qi replenishes Qi and raises Yang to strengthen Spleen
Myrrh Mo Yao invigorates blood, relieves pain, regenerates tissue
Buthus Quan Xie extinguish Endogenous Wind and relieves pain
Olibanum Ru Xiang invigorates blood, relieves pain, regenerates tissue, promotes Qi flow
Notoginseng Tian Qi/ San Qi relieves stagnation, invigorates blood, and relieves pain
Dipsacus Xu Duan promotes blood circulation, tonifies Kidney and strengthens bone
Glycyrrhiza Gan Cao clear heat and harmonizes all herbs
Lindera Wu Yao regulates Qi, warm Kidney and relieves pain
Aconite Fu Zi warm and strengthens Kidney Yang and Heart Yang
Carthamus Hong Hua invigorates blood, removes stasis and relieves pain
Strychnos Ma Qian Zi unblock the Channels to relieve pain
Draconis Xue Jie dissipates stagnation, relieves pain, promotes healing
Progress Report
05/08/2015, Max was suddenly paralyzed in both hind limbs and generated back pain. Max could wag his tail. The owner brought Max to a small animal clinic to get acupuncture treatment combined with herbal medicine. Acupuncture treatment was performed every two days for about one month and maintenance acupuncture treatment once in every two weeks.
Fig 3. Max got his first attack, was suddenly paralyzed in both hind limbs and generated back pain
20/08/2015, Max started to stand up on his both hind limbs. Change the diet from dry kibble dog food into homemade food therapy based on salmon, carrot, and pear fruit combined with dry dog food kibble
24/08/2015, Max was able to try his first step and extended into two three steps in one try.
01/09/2015, Max was able to walk and run but sometimes got problem to stabilize his movement.
15/09/2015, Max was completely a normal playful dog.
Fig 4. Max was completely a normal playful dog
19/01/2016, Max got his second attack early in the morning. He was paralyzed in both hind limbs, with very sensitive to touch in the Bladder Channel area (BL 20, BL 21, BL 22, BL 23), difficult to urinate, difficult to defecate, poor appetite, fever, could not wag his tail, lost sensation and reflexes in his digits from both hind limbs.
20/01/2016, Max got weaker and poor appetite. Max accepted urinary catheterization procedure for not being able to urinate.
24/01/2016, Max passed away.
Discussion of TCVM Treatment
IVDD type I is a progressive disease characterized by degeneration of the annulus fibrosus as outer layer and mineralization of nucleus pulposus as the inner layer of affected discs. The outer layer eventually ruptures acutely, letting the inner layer press against the spinal cord, result in pressure, inflammation and nerve destruction. The mechanism of disc degeneration is thought to be caused by the inability of the nucleus pulposus to maintain a fluid pressure in the disk and the consequent loss of ability to resist external loads placed on the disc. As the disc degenerates, it loses its compressive abilities, placing strain on the annulus fibrosus. This strain causes disruption of the lamellae and eventually nuclear material to erupt dorsally through the annulus fibrosus and impacts the spinal cord. Some IVDD cases could progress to Myelomalacia, a condition which the nerve tissue of the spinal cord begins to die. The most common way it occurs is from a result of hemorrhaging or inadequate blood supply to the spinal cord, making it weak and susceptible to damage. Dogs with myelomalacia that have no deep pain perception and neurologic signs may progress cranial and caudal to the original injury. Myelomalacia will be accompanied by fever and very painful on palpation to the rupture areas.
Max was diagnosed Kidney Yin deficiency leading to thoracolumbar bi syndromes with Qi and Blood Stagnation. Kidney Yin deficiency manifesting with severe empty fire with steaming sensation from the bone. Purple tongue, rapid and forceful pulse, acute pain and stiffness on thoracolumbar region were belonged to blood stagnation, but Liver Qi stagnation was the underlying problem, which could be seen from the condition of sensitivity to the loud noises of people or thunder. It was a stressful emotion. If Qi stagnated, Blood stagnation followed. In Chinese Medicine point of view, Qi is the commander of Blood; Blood is the mother of Qi.
Conclusion
Max responded to acupuncture treatment very well, Max healed very quick and being a completely normal playful dog after one month acupuncture treatment combined with herbal medicine. However, Max disease progressed to a more severe stage that led to his death.
Reference
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