The patient is an eight-month-old, female intact, mongrel dog. She was hit by a car one week before her presentation, unable to stand and walk after the accident. She had no voluntary urination and the owner had to compress her caudal abdomen to help her urinate. Also, she showed depression, anorexia, and hindquarter paralysis.
She used to be a stray dog and was adopted by the middle house a couple of months ago. The vertebral fracture, left radial fracture and ulnar distal transverse fractures were diagnosed by the referring veterinarian. She was not responsive to conventional pain controlling medications, including analgesics and non-steroidal anti-inflammatory agents which were prescribed by the referring vet. The vet suggested that a surgery was needed to treat the fractures, but the middle house could not afford. So the vet recommended TCVM therapy as an alternative option.
The mucous membranes were pink with a capillary refill time of less than 2 sec. No abnormality was detected on the auscultation. The mentation was lethargy. Her body temperature was normal, and the hematological and biochemical panels were within normal range. The left foreleg had no ability to bear the weight due to the fractures. No deep pain was detected on either of the rear limbs in the neurological examination. The cutaneous trunci reflex was cut-off at the thoracic lumbar junction. The spinal reflex had increased in both hind-limbs. The bladder palpation revealed Upper Motor Neuron bladder. Radiographic examination findings showed stepping, shortening and fracture on the T12 Vertebral Body (Fig1). The left radius and ulna had distal transverse fractures (Fig 2).
The dog exhibited Earth characters. She displayed strong sensitivity at BL-19 to BL-23 on palpation. The left foreleg was swollen, hot, and very sensitive and painful. Her Shen was low. The tongue was purple, slightly red and dry, and the pulse was wiry. Her ear tips and four limbs were warm. She preferred cool places, panted heavily, and had increased thirst. She was also easily frightened by loud noises recently. Her stool was normal.
Local Qi-Blood Stagnation with Kidney Qi-Yin Deficiency, Spleen Qi Deficiency, and Tan-huan Syndrome were diagnosed. The acute onset of the spinal fracture led to the blockage of Qi-Blood in the back, resulting in severe pain, paralysis, hunched back and purple tongue. Qi-blood Stagnation also presented at the left radius and ulna fractures. The excess Stagnation was also caused by the underlying Kidney Yin Deficiency and Qi Deficiency. Kidney Yin Deficiency was shown in her behavior of noise phobia, panting, increased thirst and cool-seeking. Kidney Qi Deficiency was related with her fracture and urine retention. General weakness and anorexia indicated Spleen Qi Deficiency.
TCM Treatment Goals and Plan
The goal of the treatment was: to activate Blood, dissipate Stagnation and resolve Stasis; to promote the Qi flow and stop pain; to tonify the Kidney and Spleen in order to strengthen the bones and enhance her mobility and self-healing ability; and to resolve urine retention.
The acupuncture treatment was scheduled to be performed twice weekly, for a total of 12 times. A combination of Dry Needle (DN) Acupuncture, Electro-acupuncture (EA) for 20 min at 20 Hz, and Aqua-puncture (AP) with diluted B12 (1:3 with saline, 0.3cc per point) was performed. Based upon the TCVM diagnosis, the following points were selected for the treatment:
Local points: Hua-tuo-jia-ji (HTJJ) at T10-L1, GV-4, LI-4, TH-5, LI-11, SI- 9, LIU-8, GV-14 and GB-21.
Patterns Points: BL-11, BL-23, BL-28, BL-39, BL-54, ST-36, GB-30, GB-34, Bai-hui and GV-1.
Distal points: LU-8, SI-3, SP-6, SP- 9, KID-1, KID-3, Liu-feng and LIV-3.
Besides the acupuncture treatment, three herbal formulas were prescribed to the patient:
Shen Tong Zhu Yu Tang 2 g/10 Kg BID for 3 months.
Bu Yang Huan Wu 1.5 g/10 Kg BID for 3 months.
Eight Gentlemen 1.5 g/10 Kg BID for 3 months.
First Treatment and Response (August 31, 2013 )
DA at GV-20 for helping the dog to calm the mind. DA was performed at GV-14, Bai-hui, GV-1, SI-9, LI-11, GB-21, BL-39, LIV-3, Liu-feng bilateral, LI-4(right), SI-3(right), TH-5(right), LU-8(right). EA was performed at BL-23 to BL-54, Bai-hui to GV4, ST-36 to GB-34, KID-1, SI-9 bilateral. AP was performed at HTJJ at T-10/12/13/L-1, BL-23, BL28, BL-39, Bai-hui, GV-1, ST-36, GB-30, GB-34, KID-1, KID-3, Liu-feng. Additional instruction was given to the owner to switch to home-made food instead of the commercial diet. After 3 days, the owner reported that the dog’s appetite was normal and her spirit was getting better. On the second admission, the pain appeared much reduced and the tongue was less purple and red; the pulse was less wiry.
Second Treatment and Response (September 2, 2013)
DA at GV-20, GV-14, Bai-hui, GV-1, SI-9, LI-11, GB-21, BL-39, LIV-3, Liu-feng bilateral, LI-4(right), SI-3(right), TH-5(right), LU-8(right). EA at BL-23 to BL-23, Bai-hui to GV-4, ST-36 to GB-34, KID-1 bilateral, SI-9 to LI-11, HTJJ at T-12 bilateral. AP at HTJJ at T-10/12/13/L-1, BL-23, BL-28, BL-39, Bai-hui, GV-1, ST-36, GB-30, GB-34, KID-1, KID-3, Liu-feng. Additional instructions were given to the owner to massage her lower back at home for 20-30 minutes every day. Following this treatment, the owner reported that the dog could urinate by herself; and the rear limbs’ deep pain perception showed mild response on the neurological examination after the third admission.
Sixth treatment and response (September 18, 2013)
DA and EA the same points as for the previous treatment. AP at HTJJ at T-10/12/13/ L-1, BL-23, BL-28, BL-39, Bai-hui, GV-1, ST-36, GB-30, GB-34, KID-1, Liu-feng, SP-6, SP-9.
After the sixth admission the owner was excited to report that the dog was able to stand for a while. On the seventh admission, the deep pain perception had gone. The tongue was red and mild dry with no purple, and the pulse less tense.
Tenth treatment and responds (October 9, 2013)
DA at GV-20, GV-14, Bai-hui, GV-1, SI-9, LI-11, GB-21, BL-39, LIV-3, Liu-feng bilateral, LI-4(right), SI-3(right), TH-5(right), LU-8(right). EA at BL-23 to BL-23, Bai-hui to GV4, ST-36 to GB-34, KID-1 bilateral, SI-9 to LI-11, HTJJ at T-10 bilateral, HTJJ at T-12 bilateral. AP at HTJJ at T-10/12/13/L-1, BL-23, BL-28, BL-39, Bai-hui, GV1, ST-36, GB-30, GB-34, KID-1, KID-3, Liu-feng, SP-6, SP-9, SI-9, LI-11.
Good news came after the tenth admission. The owner reported that the dog was able to stand and walk for a few minutes, though they wouldn’t let the dog walk too long. They were careful to look after the dog in case of falling. After the twelfth treatment, the owner claimed that the dog had regained complete mobility in walking, and the affected limbs had almost recovered 100% normal functions.
This case represented a common fracture which generally requires surgical intervention and conventional medications, but the dog was not responsive to the conventional medications. The owner decided to try the TCVM therapy, considering the cost and complications of the surgery. Initially, I worried that the severe spinal damage without deep pain perception could cause poor prognosis for the TCVM treatment. However, this concern turned out to be vain. The young dog went through two months of TCVM treatment without surgery, and had excellent results. I did the TCVM treatment twice a week for 12 times. On the right foreleg, GB-21, SI-9, LI-11, TH-5, SI-3, LU-8 and LI-4 were dry-needled; on the left foreleg, only GB-21, SI-9, LI-11 were dry-needled because of the splint fixation. Instructions were given to the owner to change to a home-cooked diet, which was a mixture of pork, brown rice and fresh vegetable. The diet can strengthen the Spleen and stomach functions. The owner also learned to massage the rear limbs for 20-30 minutes at home every day to enhance the extremities peripheral blood circulation and to help nervous function recovery.
Because of the effective therapy of TCVM, the great care provided by the owner and the young age of the dog, after sixth treatment, the dog was able to stand a while, not only on the rear limbs but also on the left foreleg. The deep pain perception on the rear limbs was recovery. After the twelfth treatment the dog was able to take a long time walk. For the economic consideration of the owner, no admission had been made after 12th treatment. The dog was still function well at telephone following up at 3 months and 6 months later, respectively. One year later, the dog was admitted again due to gastrointestinal problem. It was still walk well at that time of admission.