Ladybug, a 2-year old intact female Boxer, was adopted from Boxer Rescue in 2006 with a severe case of generalized demodectic mange. She had whole body pruritus, erythema and alopecia. After treatment for the demodicosis and concurrent pyoderma with ivermectin and cephalexin, Ladybug’s severe pruritus remained and was poorly controlled with hydroxazine (50mg TID) and omega-3 fatty acid supplementation (3V Caps). She was diagnosed with atopy. Her owners were looking for additional treatment for her comfort and quality of life. She was presented for TCVM treatment on October 17, 2006.
Western Physical Exam:
Ladybug was bright, alert and responsive on her initial exam. She was very active, playful and friendly to examine. She had normal lungs and a grade 2/5 heart murmur. Her skin was hot to touch and she had significant alopecia and pruritus on her whole body, especially on her face and feet. Ladybug was currently taking 500mg of cephalexin twice daily for her superficial pyoderma, as well as 50mg hydroxazine (antihistamine) every 8 hours and 3vcaps (fatty acid supplement) twice daily. She was eating dry and wet fish based food and poached chicken.
TCVM Exam, Diagnosis and Analysis:
Upon presentation, Ladybug was found to have excellent shen and energy. She was a fire dog, very excited, friendly and playful, always needing to be touched and at the center of every event. She had an excessive, loud bark and had some separation anxiety. She had normal thirst but a finicky appetite with occasional early morning anorexia. Her urine stream was short (she liked to mark her territory) and her feces were normal.
Ladybug’s tongue was dark red with no coat and her pulse was deep and weak, more prominently on the left side. Her whole body was hot to touch. Her skin was red and her hair coat was very thin. She tended to wake early in the morning (5 am) to scratch. She was submissive to other dogs in general but also showed some leash aggression towards dogs. She was extremely friendly with all people. She had no deficient or sensitive diagnostic points. Ladybug had a normal body weight and had good muscle mass. She was eating a cooling fish based diet (kibble and canned) as well as poached chicken (more warming).
In general Ladybug presented as an excess dog with some deficiencies. Her excess pattern was severe External Wind – Heat. Her deficiencies included Kidney Jing deficiency and Wei Qi deficiency. She also had some mild signs of Liver Yin deficiency, Lung Yin deficiency, Stomach Qi deficiency and Heart Yin deficiency.
Ladybug’s initial TCVM diagnosis was External Wind-Heat (severe itching, hot skin surface, red skin, red tongue) and Kidney Jing Deficiency (heart murmer, deep weak pulses) with Wei Qi deficiency (severe systemic demodicosis suggesting general immune deficiency). The increased pruritus at her ears and feet as well as her weaker left pulse are suggestive of a Liver Yin deficiency secondary to the Kidney Jing deficiency (mother/earth not nourishing child/wood) as well as excess heat damaging Liver Yin. Ladybug’s separation anxiety and excessive loud (and inappropriate) bark was suggestive of some Heart Yin deficiency leading to mild Shen disturbance.
Ladybug’s 5 am scratching and generalized demodex infection is suggestive of a Lung deficiency. The time of 3am-5am is the time corresponding to the Lung meridian on the Chinese clock. The Lung meridian controls the surface and protects the body from Xie Qi invasion. Excessive Heat can damage Lung Yin. Her poor early morning appetite is suggestive of a Stomach Qi deficiency because the Stomach Qi should be descending at this hour and appetite should be good (7-9 am is the time of the stomach meridian).
Ladybug’s initial TCVM treatment plan was designed to clear Wind and Heat, nourish Kidney Qi, support Wei Qi, nourish Liver Yin and calm Shen.
First TCVM treatment (Oct 17, 2006):
Ladybug’s initial exam was as described above. She had a dark red tongue, and slightly deep and weak pulses (esp left). She had whole body pruritus and erythema. Dry needle acupuncture was performed at the points GV-20, LI-11/4, LU-5 (R), BL-13, 18, 21 (tender), GV-1, GB-20, ST-36 (tender), Bai-hui using 34 gauge one inch needles and 36 gauge one-half inch needles.
Needles were left in place for 30 minutes. The Chinese herbal formula External Wind (Jing Tang Herbals, classical antecedent Allergy Formula 1) was prescribed to clear external Wind, detoxify, alleviate itching and cool Blood. The Chinese herbal formula Wei Qi Booster (Jing Tang, classical antecedent Si Jun Zi Tang) was prescribed to Tonify Qi and Blood and boost Wei Qi. Both formulas were to be given 3 grams every 12 hours starting slowly with External Wind.
Second TCVM treatment (Nov 7. 2006):
Three weeks after the first treatment, Ladybug was seen again for acupuncture. She had been on External Wind for 3 weeks and Wei Qi booster for 1 week. She had less face scratching and no facial bleeding. Her face was less red and her energy level MUCH higher. Ladybug’s pulse was slightly deep, weak and equal. Her tongue was pink to red. She was still taking Cephalexin twice daily. Dry needle acupuncture was used to relieve Wind and Heat, support Wei Qi, nourish Liver and calm Shen at GV20, An-shen, BL-13/15/18, PC-6 (L), GV-14, LI-11, LU-5(R), HT-7, LV-3 and Bai-hui. Needles were left in place for 30 minutes. Ladybug relaxed very well during her treatment. Both Chinese herbal formulas were continued.
Third TCVM Treatment (Nov 27, 2006):
Ladybug was doing well on both herbal formulas (External Wind and Wei Qi Booster). She was still scratching at her face periodically but there was no further bleeding. Her energy level continued to be very high. She was very warm to touch and her skin was red. She was still on cephalexin twice daily. Ladybug’s tongue was pink and her pulses were slightly deep and weak, again more prominently on the left. She had a slight depression at BL-17 bilaterally (deficiency at Back Shu point for Blood). Needles were placed to relieve heat, calm Shen and tonify Liver Yin and Blood at GV-20, An-shen, GV-14, LI-11 (L), LI-4(L), BL-13/17/18, LIV-3, SP-10, SP-6 (L), HT-7 (L), LU-1 (L), Bai-hui. Chinese herbal formulas were continued at the same dosages.
Fourth TCVM Treatment (Dec 5, 2006):
Ladybug had ovariohysterectomy surgery the day before this treatment. Her Shen was slightly depressed and her energy was low. Her ear tips were cool and her feet were sensitive to the cold. Her antibiotics had been changed to Baytril (enrofloxacin) and she was not drinking and had vomited during the morning. Prior to her spay surgery, the owner reported that Ladybug was extremely energetic and playful with a great appetite. Her itching was mild and her ears and face were much improved. Her tongue was pale pink and her pulses were weak and deep. Ladybug was treated for Spleen Qi deficiency (post anesthesia) with GV-20, BL-21, Bai-hui, ST-36, SP-6, and PC-6 (dry needle) for 30 minutes. Her External Wind was continued as before. She was weaned off the Wei Qi Booster over the 2 weeks after her spay surgery.
Fifth TCVM Treatment (May 8, 2007):
This was five months after her last acupuncture treatment. Ladybug was started on allergy desensitization injections in January of 2007 (with her regular DVM.) She had not needed antibiotics since discontinuation of the Wei Qi Booster. In April of 2007, Ladybug started chewing at her feet with resulting pododermatitis. Four Paws Damp Heat (Jing Tang Herbals, classical antecedent Qing Shi Re Tang) was prescribed to clear Damp and Heat , detoxify and cool Blood (dosage 3 grams twice daily). She was taking diphenhydramine 50 mg every 8 hours. Her owner reported that her itching was approximately 75% better than the previous spring. She was panting heavily and was warm to touch with a thin hair coat.
Ladybug also had some residual pruritus and moisture between the toes of her feet. Her tongue was dark red and cracked and her pulse was equal and slightly superficial. Ladybug’s TCVM diagnosis was external Wind with Heat, local Damp Heat (feet) and Liver Yin Deficiency. She was treated with dry needle acupuncture at GV-20, GB-20, GV-14, BL-17/18(L), LIV-3, SP6, LI-11/4(L), LIV-8, SP-9(R), and SP-3(R). External Wind and Four Paws Damp Heat formulas were continued.
Ladybug was treated for external Wind and Damp Heat monthly for four treatments and continued on both herbal formulas. After this second set of acupuncture treatments, Ladybug’s clinical signs were controlled mostly with External Wind and Four Paws Damp heat herbal formulas. She would have breakthrough pruritus once to twice yearly and her clinical signs would resolve with one acupuncture treatment. Between August 2007 and November 2011 (over four years) she only required five acupuncture treatments. She was treated with points similar to her previous acupuncture on October 4, 2007 and May 26, 2009. On March 2, 2010 Ladybug was also experiencing some pain and stiffness in her lumbar spine and points were added for local Qi stagnation and she was referred for chiropractic care. Boswellia SOD was added to her herbals and supplements. On October 18, 2011 and November 21, 2011 she was treated for pruritus and bladder Damp Heat. External Wind and Four Paws Damp Heat formulas were continued during this time. Ladybug’s dosage of herbals was able to be decreased during the winter months and increased as her signs returned in the spring and summer. When the herbal formulas were stopped, clinical signs returned within two weeks.
Ladybug has received TCVM treatments for severe allergies with pruritus for over six years. Her treatments have been very integrative including acupuncture, Chinese herbal therapy, western desensitization injections, improved diet/food therapy, omega three fatty acids and antihistamines and antibiotics as needed. The Chinese herbal formula Wei Qi Booster was prescribed to tonify Qi and Blood and boost Wei Qi. This herbal was only needed at the beginning of Ladybug’s therapy. The Chinese herbal formula External Wind was prescribed to clear external Wind, detoxify, alleviate itching and cool Blood. Four Paws Damp Heat, was prescribed to clear Damp and Heat, detoxify and cool Blood.
I believe the success of Ladybug’s treatment has a lot to do with the owner’s interest and willingness to approach her therapy in such an integrative way. That being said, I also believe that the Chinese herbal formulas that Ladybug has been maintained on (External Wind and Four Paws Damp Heat) are what have allowed her to have such a good quality of life despite suffering from severe atopy. Every time she is weaned off the Chinese herbal formulas her symptoms worsen. As she ages certainly her need for these Chinese herbal formulas may change. Traditional Chinese Veterinary Medicine is such a powerful tool precisely because our treatment changes as the animal’s pattern (symptoms) change to always address the specific deficiencies or excesses of that specific animal.
- Xie H. Chinese Veterinary Herbal Handbook, second ed. Reddick, FL: Chi Institute of Chinese Medicine 2008: 76, 228, 232.
- Xie H, Preast V. Xie’s Veterinary Acupuncture. Ames, Iowa: Blackwell Publishing 2007: 3-347.
- Xie H, Preast, V. Xie’s Chinese Veterinary Herbology. Ames, Iowa: Blackwell Publishing 2010: 5-598.