Acupuncture Treatment of PPID in a Horse

Acupuncture Treatment of PPID in a Horse

- by Heather Laros-Beard, DVM, CVA. TN USA

Author: Chi Institute/Tuesday, September 10, 2013/Categories: Student Case Reports, TCVM Newsletter, 2013 Fall Issue

Introduction: Blackbird is a fourteen year old Welsh pony gelding that was diagnosed with Pituitary Pars Intermedia Dysfunction (PPID) and hyperinsulinemia in May of 2012 via plasma ACTH concentration and insulin by his previous veterinarian in Southampton, NY. He was undergoing a pre-purchase exam when the veterinarian performing the exam identified clinical signs associated with PPID. He had a thick crusty neck, hirsutism, symmetrical alopecia of the lateral aspects of his rump, and abnormal fat distribution, most notably along the tail head and tuber coxae. He also had muscle atrophy along his gluteal and epaxial muscles. He was not polyuric and polydipsic according to the owner at the time; however, he mainly lived outdoors so this was difficult to determine. He had no history of lameness or laminitis. At diagnosis, his ACTH was 54.3 pg/mL (9-35 pg/mL) and his insulin was 66.94 uIU/mL (10-40 uIU/mL). For unknown reasons, Blackbird was not treated with traditional western medication after diagnosis.

He was purchased in December of 2012, and made his new home in the state of Mississippi. Right away, he was started on Pergolide (1 mg capsule orally once daily). An Endogenous ACTH was drawn four weeks after initiation of Pergolide treatment, which revealed a serum ACTH level of 40.5 pg/mL. In addition to his oral Pergolide, Blackbird is currently receiving Wellpride Omega 3 fatty acids for his dry hair coat, a feed supplement (Enrich 32), and 2 pads of good quality grass hay. He is turned out in a dry lot 6-8 hours/day depending on the weather. He is also ridden 2-3 times a week, for approximately 30 minutes per day.


Western and TCVM Exam: On presentation, Blackbird was QAR with good Shen. His temperature, heart rate, and respiratory rate were all within normal limits. His mucous membranes were pink with a CRT of <2 seconds. His body condition score is 6 out of 9. His hair coat was very coarse, dry, and lacked luster (he was recently body clipped due to the excessive length). The coat color was heterogeneous with mostly light areas, except for his face, and the upper portion of his trunk and forelimbs. He had bilaterally symmetrical alopecia on the lateral aspects of his rump, and his skin was dry and flaky. He had fat pads near his tail head and tuber coxae. His gluteal and epaxial muscles were slightly atrophied, and his hind end appeared generally weak. His appetite was decreased, however his stools were normal.

Personality: Blackbird is a classic "Metal" personality as he is an aloof gelding that does not require much interaction. He appreciates order and repetition. However, due to his advanced age, he also portrays "Water" personality characteristics. He is easily frightened and will attempt to escape certain situations.





Figure 1. Before Treatment

Tongue (T): pale, swollen, and wet

Pulse (P): deep and weak

Body temperature (BT): normal ear temperature throughout, but cool extremities and back

Scan: 1+ PC-1 on the right

TCVM Dx: Kidney Yang Deficiency with Spleen Qi Deficiency

PPID is considered to be one of the Xiao-ke or "thirst consuming" diseases. The common patterns associated with this condition are a Kidney Yin Deficiency, Kidney Qi-Yin Deficiency, and/or Kidney Yang Deficiency. The first stage of Cushing’s disease is typically a Kidney Yin Deficiency which leads to a Kidney Qi Deficiency. Kidney Yang Deficiency is the last stage of Cushing’s disease and occurs when the Kidney Yin has been Deficient for a long period of time. Blackbird’s TCVM diagnosis is a Kidney Yang Deficiency based on his TCVM examination and western medicine examination and diagnosis. His Spleen Qi Deficiency is most likely due to chronic illness, especially a Phlegm producing illness like Cushing’s disease.


TCVM treatment goals and principles: 1) Improve and control clinical signs of Cushing’s disease with acupuncture and herbal therapy. 2) Weaning off of daily Pergolide administration. 3) Tonify Kidney Yin, Qi, and Yang through the use of dry needle acupuncture (DN), aquapuncture (AQ), and moxibustion (Moxa).


TCVM plan: Acupuncture treatments were scheduled every 2 weeks for the first 4-8 treatments. This was followed by monthly acupuncture treatments for maintenance, pending that the improvement goal was achieved. Prior to each treatment session, his clinical condition was reassessed with a TCVM examination. Herbal therapy was also instituted for Kidney Yang Deficiency and Spleen Qi Deficiency.

1st treatment and response:

DN: BL-22/23/26/40, LU-5, SP-6/9, ST-36, KID-3, Shen Jiao/Peng/Shu, Mi-jiao-gan

Moxa: Bai Hui, GV-4, CV-4

Herbal medicine (Herb): Rehmannia 14, 15g BID

Response: In general, his appetite improved significantly after the 1st treatment. He had more energy and appeared less depressed. He responded to his new owner when his name was called, whereas prior to treatment he would ignore his owner. His tongue appeared slightly less pale, but his pulses, however, were still too deep and weak to palpate.

2nd treatment and response:

T: purplish red, swollen, and wet

P: slightly stronger, but still very deep and weak

BT: normal ear temperature, cool extremities and back.

Scan: 1+ LI-15 and LI-16 on the right (no lameness at this time)

DN: BL-17/23/26/40, LU-5, LI-15/16, SP-6/9, ST-36, KID-3, Shen-shu, Mi-jiao-gan

Moxa: Bai-hui, GV-4, CV-4

Herb: add Eight Gentlemen, 15g BID, for Spleen Qi Deficiency

Response: His appetite continued to improve after 2nd treatment, however 1 week post second treatment, his appetite decreased again. His energy level remained at an appropriate level since his first acupuncture treatment.


3rd treatment and response:

T: red, swollen, and still a little wet

P: weaker on the Left

BT: normal body and ear temperature throughout

Scan: No sensitivities

Dx: Spleen Qi Deficiency and Kidney Yin/Qi Deficiency

DN: BL-17/20/21/23/40, LU-11, LI-4, ST-36, ST-45, KID-3, GB-20, Bai-hui, Shen-shu

AQ (B-12): Mi-jiao-gan

Herb: Rehmannia 14 and Eight Gentlemen, 15g of each, BID

Response: His appetite remained good after the 3rd treatment and addition of Eight Gentlemen. GB-20 and LI-4 were added into the protocol due to the recent onset of occasional head shaking and generalized skin itching. Continued to focus treatment on the tonification of Kidney Yin, Qi, and Yang as well as resolving the Spleen Qi Deficiency.

4th treatment and response:

T: red, swollen, and dryer than usual

P: weaker on the Left

BT: normal body and ear temperature throughout

Scan: 1+ sensitivity at BL-22 and BL-23 on the Right

Dx: Kidney Yin/Qi Deficiency

DN: BL-22/23/40, LI-4, SP-6/8/9, ST-36, KID-3, TH-1, GB-20, Bai-hui, Mi-jiao-gan

Herb: Rehmannia 14 and Eight Gentlemen, 15g of each, BID

Response: His appetite remained good with the addition of the Eight Gentlemen. He has skin itching and head shaking which were resolved with the addition of the acupoints GB-20 and LI-4. The color, consistency, and luster of his hair coat improved significantly over the last two months. He did shed out some of his hair after the 3rd treatment. He was body clipped the rest of the way for a horse show the following week. Once clipped, a soft, shiny, and uniform coloration of his hair coat was revealed.





Figure 2. After the 4th Treatment




Case Summary:

Blackbird responded very well to acupuncture and herbal therapy. The Eight Gentlemen was discontinued after 30 days and his appetite remained good. His acupuncture treatments were decreased to once a month. He is still currently receiving Pergolide (1 mg once daily), and the herb Rehmannia 14. The treatment strategy from now on will continue to consist of Kidney and Spleen tonification points as well as herbal therapy to keep his Cushing’s under control. We are attempting to wean him off of the Pergolide. In conclusion, acupuncture and herbal therapy have been successfully used to manage the clinical signs of

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