A 19-year-old Quarter horse gelding was presented for chronic osteoarthritis of the distal hock joints. He had been previously diagnosed in 2001, since then the owner had been giving him Phenylbutazone intermittently for pain, and he had hock injections performed in the early years.
Recently, the patient had started developing bilateral golf-ball-sized swellings over the hock joints.
Western Physical Diagnosis
The patient had a body condition score of 4/9. He was a grade 4/5 lame in both the right and left hind with the right being more noticeable. He had severe tarsocrural effusion in both hocks. He displayed a paddling motion with both his right and left forelimb.
He had contracted front heels and a higher than normal upright angle to his front feet.
TCVM Exam and Diagnosis
He was a friendly, pushy horse who loved treats. He retired from the competitive trail and was put out to pasture with five other horses. He hated to be separated from the herd, and paced the stall nickering for his friends. He was not sensitive to regular vaccination and handled acupuncture needles generally well. His personality was a mix of Fire and Earth.
A scan showed sensitivity at GB-27, BL-35, SP-13 and BL-54, all bilateral. His tongue was pale, purple and swollen. Pulses were deep and weak on the left. The Bai-hui area was warm to the touch and the remainder of his body was neutral.
His age, chronicity of the disease, plus the deep and weak pulse on the left all suggested a Yin Deficiency pattern with an interior component - Kidney Deficiency. The pale, purple swollen tongue was indicative of Qi deficiency and local Qi Stagnation. And often, a chronically deficient Kidney, unable to nourish the bones and joints, will lead to Bony Bi Syndrome.
My TCVM diagnosis was a Kidney Yin Qi Deficiency with local
Qi Stagnation in the hocks and coxofemoral region.
1st Treatment on October 23rd, 2012
Dry needled Bai-hui, Shen-peng, Shen-jiao, BL-23 bilateral, BL-60 bilateral, BL-40 bilateral, GB-44 bilateral, LIV-1 bilateral, LIV-3 bilateral, KID-3 bilateral, ST-36 bilateral, BL-11 bilateral, GV-14 bilateral, LI-4 bilateral. Electro-acupunctured (bilateral unless noted otherwise) Shen-shu, BL-35, GB-27, Qi-hai-shu, BL-26 and BL-23. Aquapuncture was given at GB-27 bilateral, BL-54 bilateral, Lu-gu bilateral, with 2cc of vitamin B12 at each site, post dry needling. Prescribed Di Gu Pi 15g BID as top dressing on feed.
2nd Treatment on November 13th, 2012
After his initial treatment the owner was very happy to tell us that she saw him running in the pasture the following day, something she hadn’t seen him doing in years. It seemed that the treatment had made him more comfortable, but had not reduced his lameness score or degree of effusion present in the hind limbs. He was shod in the past week and was showing discomfort walking on hard surfaces. He was hoof tester positive over the entire sole of both front feet.
The patient was sensitive at LI-18, PC-5, BL-54 and Lu-gu, all bilateral. We were able to resolve the local Stagnation in his hocks despite the excess tarsocrural effusion and the unwavering hind-end lameness. However, the Kidney Yin Deficiency continued, and the local Qi Stagnation moved to at the front feet. Dry needled BL-54, LIV-1, BL-40, LI-4, SI-3 (all bilateral) and Bai-hui. Electro-acupunctured BL-11, BL-23, Shen-shu, BL-26, ST-42 + KID-4, Qi-hai-shu and Qian-ti-men (all bilateral).
Prescribed Di Gu Pi, two scoops BID for 30 days.
3rd Treatment on January 25th, 2013
After his second treatment, he did show improvement on his hind-end lameness and comfort level. In the interim period between the treatments the owner had his hocks injected to help combat the large amount of inflammation present. His hindlimb lameness had improved by a grade, but with no significant difference in the amount of tarsocrural effusion present. He was sensitive at BL-35 left, and LI-15 right. His tongue was pale and wet, with a thin white coating. His pulses were deep and weak, with the right side being more difficult to palpate.
His TCVM diagnosis was a Kidney Qi Deficiency. The Yin Deficiency had resolved.
Dry needled Bai-hui, Shen-shu, BL-23 bilateral, BL-26 bilateral, BL-21(left), BL-35(left), LI-10 bilateral, SI-9(right) and GB-21(right). The patient’s Fire constitution became more apparent on this day as he quickly started showing resistance to being needled. Ideally, I would have liked to treat Qi-hai-shu, BL-11 and GB-34 to further nourish his Qi and Bone and support Kidney Yin as a preventive measure. Continued with Di Gu Pi to nourish Kidney Qi.
This case was seen over a period of 3 months. The initial complaint was lameness due to Bony Bi Syndrome, Kidney Yin Deficiency and local Qi Stagnation. By his second visit, we were able to clear the Qi Stagnation in his hocks. It was evident that the Kidney Yin Deficiency and Bi Syndrome were still an issue. Due to the severity and chronicity of his disease, it was not surprising that he was still exhibiting signs showing Bony Bi Syndrome. Our strategy was focused on tonifying Kidney Yin and Qi to strengthen Bone, move Qi, reduce inflammation and resolve Stagnation. His hocks were injected after the second visit to reduce the large amount of chronic inflammation presented in the tarsocrural joints. This was a temporary measure to help improve his quality of life before we are able to get him more sound with acupuncture and herbals. At his third treatment we had successfully resolved his Kidney Yin Deficiency, but he continued to exhibit an underlying Kidney Qi Deficiency. Future treatments will focus on tonifying Kidney Qi and resolving any Qi Stagnation that may arise. Although he continues to show signs of hind-end lameness, his owner is quite happy with his progress.