Kidney Yin Deficiency Leading To Thoracolumbar Bi Syndromes With Qi And Blood Stagnation 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 GB 29 BL 54 Hua-Tuo-Jiaji paralysis of pelvic limbs paralysis of pelvic limbs paralysis of pelvic limbs 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 1. Cheng, H. TCVM Treatment of Neurologic Disease. Taiwan. 2014:19-25. 2. Kerttula L. Magnetic resonance imaging of the intervertebral disc: post-traumatic findings and the value of diffusion-weighted MR imaging. Dissertation University of Oulu. 2001:17-27. 3. Tow BPB, Wellington KH, and Jeffrey CW. Disc regeneration: a glimpse of the future. The Congress of Neurological Surgeons. 2007. 54:122-128. 4. Xie H, Preast V. Fundamental Principles. Traditional Chinese Veterinary Medicine. Chi Institute Publishing. 2007:149-451. 5. Xie H, Preast V. Xie s Chinese Veterinary Herbology. Blackwell Publishing, USA. 2010:21-271. 6. Xie H, Preast V. Xie s Veterinary Acupuncture. Blackwell Publishing, USA. 2007:129-204.