In Traditional Chinese Veterinary Medicine (TCVM), seizures and epilepsy belong to Nei-feng (Internal Wind) syndrome.1 The earliest literature on Internal Wind can be found in Su Wen published during the 3rd century BC.2 Internal Wind is often related with hyperactivity of Liver Yang and manifested by altered consciousness, muscle tremors and convulsions.1 This paper will focus on how to select Chinese herbal medicine, acupuncture points, and techniques for treatment of different patterns of seizures and epilepsy in dogs. Clinical case studies will also be presented.
Etiology: From the conventional perspective, seizures are caused by an electrical storm in the brain or a paroxysmal disturbance of the electrical activity of the brain.3,4 From a TCVM perspective, seizures are directly caused by Liver Yang Rising. Liver Yang Rising generates Heat, which flares up and disturbs the brain and Shen (Mind), leading to Internal Wind (seizures). Liver Yang Rising can be caused by Liver Yin Deficiency, Liver Blood Deficiency, Phlegm, Blood Stagnation and Liver Fire. Liver Qi Stagnation can trigger Liver Yang Rising as well. The detailed information of etiology of Internal Wind is illustrated in Figure 1.
Pattern Differentiation and Treatment The Internal Wind is often divided into Excess and Deficiency Patterns. The Excess Pattern refers to Phlegm (Wind-Phlegm, Phlegm-Fire) and Stagnation (Blood); the Deficiency Pattern includes Liver Yin, Blood and Yin+Blood Deficiency. Excess and Deficiency Patterns may mingle together and make seizures more complicated. 3
Clinical Signs: Detailed information on differentiation of various patterns of seizures can be found in Table 1.
Acupuncture Treatment: Includes GV-20, GB-20, Nao-shu, BL-17, BL-18, SP-10 and LIV-3 for any Pattern of seizures. 4-5The following acupoints should be added for each Pattern:
- Wind-Phlegm Pattern: BL-20, BL-21, ST-40 and GV-1
- Phlegm-Fire Pattern: GV-14, BL-20, LIV-13, LIV-2 and Wei-jian
- Blood Stagnation: An-shen, GV-17, LI-4, GB-41 and BL-40
- Liver Yin Deficiency: BL-23, LIV-8, SP-6, SP-9 and LIV-14
- Liver Blood Deficiency: CV-15, HT-7, LIV-8, SP-9 and ST-36
- Liver Yin + Blood Deficiency: BL-23, SP-6, SP-9, LIV-13 and LIV-14
Dry-needling and/or aqua-acupuncture can be performed once every month initially for 3-6 sessions. After the seizures are under control, acupuncture can be per-Toruk, a two year old male Leucistic Bengal Tiger enjoys his happy life with the caretaker Ms Deborah Warrick at the St. Augustine Wild Reserve, Florida. Aituan Ma is a professor at the College of Traditional Chinese Veterinary Medicine, Agricultural University of Hebei, China. Dr. Ma graduated from the College of TCVM, University of Hebei, China in 1987 and from there she became a teaching assistant at her hometown University. She received her Master of TCVM in 2005 and got her PhD from the College of Veterinary Medicine, China Agricultural University in 2008. Now she is a visiting professor at Chi Institute. Meeting Toruk in Spring 2012 inspired Dr. Ma to write this article. In the Chinese culture a tiger stands for power and wind. Excessive wind in the spring leads to seizure.
Figure 1. TCVM Etiology of Internal Wind(Seizures)
formed once every 6-12 months for maintenance. Please note that electro-acupuncture is contraindicated in any seizure case.4-5
Herbal Treatment: Detailed information on how to select herbs can be found in Table 1. If seizures are mild (one episode every 10 days or longer), the TCVM treatments - including acupuncture and herbal medicine - can be the sole treatment protocol. If seizures are more severe, it may be necessary to use both conventional western medicine (CWM) and TCVM treatments. If animal is 8 year old or under and is seizure-free for three months or longer, the dosage of western drugs can be reduced by 25% monthly over the next three-month period; if the animal continues to remain seizure-free, the western drugs may be discontinued. If there are two drugs, it is very important to wean off one drug each period, typically over three to six months. It is too risky to discontinue drugs too rapidly in dogs known to have episodes of status epilepticus or cluster seizures, as seizures may worsen and cause adverse consequences for the dog and caretaker.4
1) Avoid the Yang meats (including beef and lamb) and seafood.8 Yang meats intend to generate Heat, which enhances Liver Yang Rising and potentially leads to Internal Wind (seizures). Seafood tends to generate Phlegm which may also cause Internal Wind.
2) Avoid chemicals and drugs which could make them more susceptible to seizures. These drugs include Heartgard® or Heartgard Plus®, Program® and Advantage®, which may lower the seizure threshold.
Case 1: 10 year old, 68 pound, spayed female Rhodesian Ridgeback
Current Complaint: Grand mal seizures that started one year ago. The frequency of seizures had gradually increased from every three months to every two weeks; the most recent incident to the time of presentation included clusters of three seizures over 36 hours. The time of occurrence was variable in the beginning, but at the time of presentation consistently started at 4 am. No western medication had been used for seizures.
History: The only abnormality on screening lab work was severe hypoglycemia (21mg/dL) preceding and shortly after the first seizure episodes. Insulin to glucose ratios were normal. She also had a persistently high normal T4 level initially. All these abnormalities had been rechecked subsequently and are well within normal range at the time of presentation. She was very healthy and normal on western physical examination (except for seizures).
TCVM Physical Examination: She was a typical Fire Constitution (outgoing, active, happy, playful, no phobias and not dominant). The dog had Back-Shu sensitivity from BL-17 to BL-19. She was also sensitive at LIV-14. There was dark fur coloration around the eyes with evidence of recent graying of the haircoat in that area (the owner believed this coincided with the initial occurrence of the seizures). She had a dry haircoat with dandruff. Her tongue was pale and dry, and pulse was weak in general, being weaker on the left side.
TCVM Diagnosis: Liver Blood Deficiency. Seizures along with sensitivity at BL-17, BL-18, BL-19 and LIV-14 indicated Liver. Blood Deficiency was diagnosed on the basis of dry skin, dandruff, pale and dry tongue, and weaker pulse on the left side. Change of the color of the haircoat around the eyes may have also indicated Liver Blood Deficiency, as the eye is the window of the Liver.
Acupuncture Treatment: GV-20, GB-20, Da-feng-men, BL-15, BL-17, BL-18, BL-19, SP-10, SP-9 and LIV-3. Dry needling was conducted about 20 minutes each session, one session every month for three sessions.
1) Di Tan Tang: 5 capsules (0.5 gram per capsule), given orally twice daily for three months
2) Bu Xue Xi Feng: 5 capsules (0.5 gram per capsule), given orally twice daily for three months
Outcome: The dog responded well to the TCVM treatment. Her seizures had completely resolved after three acupuncture sessions (each session one month apart) and three months of herbal medication. She then received acupuncture once every 3-12 months and Tian Ma Plus II (3 grams twice daily) for her rest of seizure-free life until she passed away at the age of 13.
Case 2: 5 year old, 60 pound, castrated male Mixed Breed
Major complaints: Uncontrolled seizures
Current medications: Phenobarbital and Potassium Bromide (KBr)
History: Clusters of seizures started 10 days after receiving a vaccination seven months previously. Clusters of seizures had resolved using phenobarbital and KBr, but the dog still had seizures every 15 to 30 days. One week before presentation, the dog had five seizures within one hour - starting early in the morning - with severe disorientation. The seizures were strong and each seizure lasted about five to six minutes. The dog received the increased doses of phenobarbital and KBr, but he still had a cluster of seizures daily for the next week. He had occasional diarrhea and was slightly overweight.
TCVM Examination: He was a very sweet, laid-back and food-motivated dog. His ears and body were hot. He showed cool-seeking behavior. He panted excessively and it became worse at night. His skin and paws were dry. His tongue was red with white foam and a greasy, white, thick coating. His pulse was thin and fast, weaker on the left side.
TCVM Diagnosis: Internal Wind due to Liver Yin Deficiency
Acupuncture Treatment: GB-20, BL-10, BL-12, GV-14, LIV-3, BL-18, BL-19, BL-20, BL-21, BL-23, SP-6, KID-3 and ST-40. Dry needling acupuncture was conducted 20 minutes each session, with one session every two weeks.
1) Di Tan Tang: 7 capsules (0.5 gram per capsule), given orally twice daily for three months
2) Tian Ma Gou Teng: 7 capsules (0.5 gram per capsule), given orally twice daily for three months
Outcome: The dog responded well to the TCVM treatment. He only had one to two seizure episodes per week for the first month, and only one seizure episode in the second month following treatment. He then required only one session of acupuncture every 3-12 months and Tian Ma Plus II (3.5 grams twice daily) for maintenance. He has not had any seizures over the past six years (until the time this paper was written).
Conclusion: The combination of the TCVM and CWM is a very effective therapeutic approach to control seizures and epilepsy. CWM is effective to control severe seizures initially and to identify the cause of the disease. TCVM can be effectively used for the treatment of milder seizure cases and help control those cases that fail to respond to CWM.
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