Don, an 8-year-old Oldenburg gelding, was given away to the client who was a trainer because of behavior issues. He had started in dressage training but couldn't progress due to dangerous behaviors including rearing and falling over backwards. Don had a procedure done on his left stifle when he was about 2 years old, but the current owner was not sure what the procedure was. So far nobody had ridden the horse because of safety issues and he had been mostly turned out and allowed to relax. The current owner would like to train the horse until he was safe, so he could be sold to an appropriate rider. His concern was that there might be a physical issue impeding Don’s performance and he felt that this horse was very confused and
Physical exam and TCVM exam
Don had dry skin with small flakes. His body and ears were warm, tongue was reddish purple and dry. He had thready and weak pulses, with the left significantly weaker than the right.
He showed sensitivity over the back Shu points including BL-18 3+, BL- 25 to BL- 27 2+ bilateral.
As he walked up and down the barn isle, he dragged his hind feet, right worse than left. When lunged, he was reluctant to move forward and when he did he would stop frequently and kick at his flank. His face was very angry, frustrated, and fearful. It was difficult to determine his constitution as he was so distant and unstable. I suspected Fire constitution at the
time but was not sure.
Heart Yin/Blood Deficiency. Liver Qi Stagnation. Local Stagnation at lower back or sacroiliac junction. Phlegm misting the Mind.
My plan was to work on the Excess first with herbal medicines. I would then use acupuncture points for the Yin and Blood Deficiency and deal with the back pain later as he was not being worked and he had so many issues all at once.
First Visit on Nov 15, 2012
Dry needled Bai Hui, Shen Shu, Shen Peng, Shen Jiao for lower back pain, Aquapunctured An Shen at KID-6, SP- 6, LIV-1/3/13, HT-9, KID-1, SP-10, BL-17/18/23/47/54, ST- 40 and BL-10. The patient was very accepting of the needles and fell asleep with his head low to the ground.
Prescribed Zhen Xin San 900g 15g BID to clear Phlegm misting the mind, and Liver Happy 900g 30g BID for 2 weeks to treat Liver Qi Stagnation with Heat. I asked the owner to have Don not work until his next recheck, only grooming and feeding, and turning out as much as possible.
Second visit on December 6th
The purple color to his tongue had resolved, but still 1+ sensitivity at BL-18, and 2+ sensitivity over the entire lower back area. His body temperature felt neutral. He was much more friendly - he was constantly nuzzling my pocket where I had hidden some treats and trying to play silly games with his tongue. His expression and reactions were much more normal. His overtly friendly nature shown this time confirmed a Fire constitution that was out of balance.
The exam showed Heart Yin and Blood Deficiency, and unresolved Local Qi/Blood Stagnation at the lower back. I also suspected Liver Blood Deficiency from prior ongoing stress and possible improper nutrition. So I adjusted my strategy to nourish Heart Yin and Blood, nourish Liver Blood, and calm the Shen.
Dry needled BL-15/17/18/44/47/54, Bai Hui, Shen Shu, Shen Peng, Shen Jiao, SP-6/10, KID-1/6, HT-3/9, PC-6 and LIV- 3/8. Aquapunctured An Shen with 50/50 B12/saline mixture 5cc each side. Electro-punctured Shen Peng to Shen Jiao bilateral and BL-54 to BL-54, for 15 minutes 30hz. Don was wonderful for his treatment and became very relaxed.
Prescribed Shen Calmer 15g BID for Heart Yin and Blood Deficiency and mild Liver Qi Stagnation, plus Si Wu Tang 15g BID to nourish Liver Blood. Recommended starting lunging and round pen work, and light riding if he was behaving well.
Third visit on January 8th
There had been an overall improvement. Don had a good attitude and no signs of kicking his side or rearing. He was playful with the other horses, seemed to be happy with his new routine, and had been ridden 3-4 times a week for the past 3 weeks. He seemed to try hard at training. Though still having a difficult time performing some of the movements, he did not become frustrated anymore. When pushed to do things other than basic walking and trotting, he appeared lame mostly in the right hind. He still often got scared at noises or movements in the bushes, and occasionally would try to run away with a rider on the back. Don’s pulses improved but were still thready/weak, worse on the left. Skin improved, with no flakes, and the dryness was almost completely gone! Tongue was still pale/pink and dry, but the pale color had improved a bit. 3+ sensitivity over BL-25 to BL 36, 2+ sensitivity over BL-54, Huan Huo, Huan Tiao and Huan Zhong at the right side. He dragged both of his hind legs when walking, more on the right.
Heart Yin and Blood Deficiency was improving, as well as the Liver Blood Deficiency. Local Qi/Blood Stagnation still presented at the low back and right hip.
Dry needled BL-15/17/23/44, SP-10, KID-6, HT-9, PC-9, LIV-3, BL-60, Huan Tiao and Huan Zhong right. Electroacupunctured BL-54 to BL-54, Shen Jiao to Shen Peng, GB-29 to GB-30 right side, 15 minutes 30 hz; then Shen Jiao to Shen Peng, 10 minutes 80-120 hz.
Prescribed Double P II (Da Huo Luo Dan) for deep hip/back pain, 15g BID. The owners wanted only two herbal prescriptions for cost consideration. So I mixed Shen Calmer and Si Wu Tang 450g each, prescribed 15g BID.
Fourth visit on March 5th
A chiropractic adjustment was performed last month on the patient and although he was already improving the trainer felt that there was a significant increase of right hind lameness caused by the combination of therapies. Don was able to perform some movements of first level dressage with minimal lameness but still not quite sound on his right hind leg. He had not kicked at his side at all since the last time I saw him and seemed very content with his work. He no longer ran away with riders when he was frightened, and only occasionally appeared to spook and evade training. His skin was normal at this point. Still scanned positive over BL-25 to BL-36 right side, but reduced to 1-2+ and the right hip area was no longer sensitive. Body temperature was neutral. Pulses overall improved. He still dragged feet when walking but the right side was no longer that pronounced. Under saddle, he was improving picking up his feet. Good Shen. The exam showed that his global Blood Deficiency had resolved, mild Qi/Blood Stagnation still persisted at low back right side, and some Heart Yin/Blood Deficiency.
Electro-acupunctured BL-54 to BL-54, GB-29 to GB-30 right side, Shen Peng to Shen Jiao bilateral 15 minutes 30 hz, then 10 minutes 80-120 hz. Dry needled HT-7, BL-15, Huan Brothers right side, SP-10, BL-17 and BL-23.
Prescribed Shen Calmer 900g 15g po BID and Double P II 900g 15g po BID, until finished and then discontinue. Recommended full training 4-5 days a week.
The plan was to continue training with multiple riders to assure that the horse was safe and had no signs of lameness, until the owner could sell him.
Case Progress and Final assessment
I was not asked to work on Don after the fourth visit. I did check on him while working on another horse at his barn and he had been doing great. He had no more signs of pain and his behavior was normal. The patient was eventually sold to a dressage trainer and has been very content and working well at his new home.