Signalment: 28-lb, 9 ½ year old fs beagle mix
Owner’s Complaint: 10-month history of cough plus 2-year history of vomiting.
Initial Assessment: Approximately ten months ago, the patient had developed a non-seasonal, loose cough that had been increasing with excitement or barking. The cough had been worse in the evening and when she first awakened in the morning. She also had experienced episodes of gagging. She also had been having episodes of reverse-sneezing at least once a week. CBC and Chemistry had been unremarkable. She had tested negative for lungworms using Baermann Centrifugation. A series of chest radiographs had demonstrated collapsing trachea and a bronchointerstitial pulmonary pattern. Bronchoalveolar lavage with culture and sensitivity had revealed chronic bronchitis due to mixed inflammation with increased mucus and the presence of Pasteurella multocida and non-enteric gram negative rods (unspeciated). The rods had tested sensitive to all antibiotics. Nevertheless, the cough had proven non-responsive to cephalexin, enrofloxacin, prednisone, benadryl, and theophylline. Two years ago, the patient had begun having waxing/waning episodes of vomiting, responsive to 5 mg Pepcid AC BID in combination with a bland diet. Vomitus had been either bile or partially-digested food and would occur at any time of the day or night. She also had been having borborygmus and burping after eating. The patient had been eating Purina Sensitive Stomach dry kibble, fed free choice; Purina One biscuits; and occasional table scraps, such as chicken, beef, pork, and bread crusts. She had been anorectic during the day then would eat her food around 8-9 pm. The owner described the stools as normal. No panting, sneezing, polyuria, polydipsia, polyphagia, lameness, pruritus, insomnia, restlessness, or cold-/warm-seeking behavior was reported.
Physical Examination: BAR, well-hydrated, initially cautiously friendly but quickly became nervous and ran away when physical examination was attempted. HR120, no murmurs or arrhythmias, RR panting, with slightly increased respiratory noise on inspiration and expiration, no wheezing, bronchovesicular sounds, or coughing even with tracheal manipulation. Examination of the head was resented. A brief oral examination revealed severe tartar and several missing premolars. Tongue was pale pink and thin at the edges with a purplish-lavender center and clear water on the surface. Pulses were deep and weak with no appreciable differences between the right and left sides. The patient was visual despite bilateral nuclear sclerosis. External ear canals were covered with brown dry crusty material containing live earmites. Body temperature was neither warm nor cold. The abdomen palpated enlarged and firm. She was overweight by about 8 lbs. The haircoat had been trimmed with a shaver, revealing greasy, dirty skin with plentiful 2 mm diameter white dry scale.
Assessment: The patient’s Western diagnoses were collapsing trachea and chronic bronchitis with inflammation and colonization by multiple bacterial species. Vomiting had not been clinically worked up, as it was assumed she had a “sensitive stomach.” The patient presented as a Water Constitution (fearful, fleeing) with Lung Qi Deficiency (chronic cough, pale wet tongue), Spleen Qi Deficiency (chronic vomiting, pale wet tongue), Dampness (overweight, greasy skin), Lung Yin Deficiency (cough worse in the evening), Qi Stagnation and Rebellion (central purplish-lavender region on tongue, burping, vomiting, coughing, reverse sneezing), and Kidney Jing Deficiency (bilateral nuclear sclerosis).
Plan: Due to time constraints, the owner was instructed to begin treatment by changing to a more digestible, Qi-tonifying homemade diet.
First Treatment and Response (3 weeks after last visit): The patient was still coughing and burping. However, she loved the new diet and had begun eating when fed (she was no longer eating only at 8-9 pm). She had lost a little weight and had been running around much faster than before the diet change according to the owner. She had not vomited since the last visit. On physical exam, the lungs ausculted quiet and clear. Despite weight loss, the patient was still very overweight. Her haircoat contained less scale but was still dirty and greasy. Tongue: slightly more pink in general and the center of the tongue was less purple, pulse: no change.
Assessment: mild improvements in body condition, haircoat, energy level, and quality of life (enjoying eating, exercising more vigorously). Mild increase in the patient’s Qi (improvement in appetite and energy level) with less Qi Stagnation and Rebellion (tongue less purple, no vomiting, no reverse-sneezing).
Plan: Due to the patient’s fearful nature and the owner’s inability to restrain, Tui-na rather than acupuncture was chosen. Tui-na to Tonify Lung and Spleen Qi and to Resolve Qi Stagnation was performed. The herbal formulas Bu Fei San (for Lung Qi Deficiency) and Bai He Gu Jin Tang* (for Lung Yin Deficiency) were prescribed, with a recommended starting dose of ¼ tsp of each BID. Continuation of the home-cooked diet was prescribed.
Follow-up visits: Over the next four months, the owner fed the home-cooked diet religiously, however, she allowed the herbal formulas to run out several times without refilling them, resulting in treatment gaps of several weeks at a time. The patient’s cough improved when she was taking herbs and worsened after several weeks without herbal treatment.
Discussion: The patient had presented with significant chronic inflammation of her respiratory system extending all the way from the trachea down into the parenchyma of the lungs. Western Medical intervention had failed to reverse this inflammation, despite good quality diagnostic tests and polypharmacy. TCVM, on the other hand, achieved significant improvement with no side effects. The cough decreased in frequency and intensity when the patient was on regular administration of Bu Fei San + Bai He Gu Jin Tang. Bu Fei San was chosen for this patient because of her clinical signs of Lung Qi Deficiency: chronic cough, pale wet tongue, and deep weak pulses. Bai He Gu Jin Tang* was chosen for this patient, because at first her cough increased in frequency and intensity in the evening, which suggested that she had a Lung Yin Deficiency. Later, although it may not have been essential, the formula was continued in a ratio of 2:1, Bu Fei San:Bai He Gu Jin Tang, as a preventative against Lung Yin Deficiency. Lung and Spleen Qi Deficiency and Lung Yin Deficiency improved with home-cooked diet and herbs. Stomach Qi Stagnation and Rebellion (burping and vomiting) resolved with a home-cooked diet alone, as these clinical signs had not returned during periods in which herbs had not been administered.
Over the next year, the client grew to better appreciate the relationship between the diet, the herbal formulas, and the decrease in cough. Accordingly, her compliance in refilling herbal prescriptions increased. The patient was treated with Bu Fei San and Bai He Gu Jin Tang* for a total of one year. The cough improved by 80% after six months, and herbs were continued for six additional months until the cough had completely resolved. She was on a home-cooked diet for the remainder of her life. The vomiting episodes never returned. The patient went on to live an active, happy, healthy life. She passed away at 16 years of age due to an aggressive oral malignant melanoma.
1. Lecture Notes, Application of Tui-na in Veterinary Medicine, September 29-October 2, 2005.
2. Lecture Notes, TCVM Clinical Approach: Cardiovascular & Respiratory Disorders/Herbology, September 22-25, 2005.
3. Xie, Huisheng. Chinese Veterinary Herbal Handbook, 2nd Edition, 2008 by the Author.
4. Xie, Huisheng. Ferguson, Bruce. Deng, Xiaolin. Application of Tui-na in Veterinary Medicine, 2nd Edition, 2007 by the Chi Institute.
5. Xie, Huisheng. Preast, Vanessa. Xie’s Veterinary Acupuncture, 2007, Blackwell Publishing, Ames, Iowa.
*You may also use Jing Tang’s Lily Combination