As the body’s largest organ, the skin is prone to disruption, and as a detoxification organ, many internal imbalances will manifest in the skin. According to VPI Pet Insurance, the top three reasons why dogs are brought to see their veterinarians are due to ear infections, skin allergies, and "hotspots." (For cats, skin allergies are the number five reason.) Almost every veterinarian can commiserate with having those nightmare skin cases in their career, those patients that never seem to improve, despite all the Western medications used. It is no wonder that veterinarians are challenged by skin problems; they are ubiquitous, chronic, and hard to resolve.
Modern dermatology has made significant contributions to way we treat skin problems, and is especially useful in garnering an accurate diagnosis. However, for those skin disorders that are not responsive to conventional medicine and/or for those clients who prefer more natural methods of treatment, Traditional Chinese Veterinary Medicine (TCVM) provides a safe and effective alternative. In applying the principles of TCVM, it can offer the frustrated practitioner and client more options for successful treatment and resolution. TCVM involves not only deciphering the dominant pattern of the patient, which can differ based on the patient’s unique personality, signalment, clinical signs, and temperature preferences, but also involves an integrative treatment plan involving acupuncture, herbal formulas, and a therapeutic diet.
Issues with the skin arise from a number of causes, the most common involve one or more of the following factors: poor quality diet, parasites, toxins, hormonal imbalances, hypersensitivities, stress and infections (often secondary). TCVM can help the body become balanced against the onslaught of these etiologies. Although the Western Diagnosis can be a helpful clue as to the source of the problem, in general, TCVM patterns are determined by evaluating the clinical signs and determining: whether it is of internal or external origin, shows signs of heat or cold, and if there is an Excess or Deficiency present.
The more acute skin conditions tend to be caused by an Excess pattern, often due to external pathological factors, such as Wind, Dampness, Dryness, or Heat, which invade the body and cause a skin disturbance. Common external pathogens in pets include invasion of Wind and Heat, or invasion of Damp and Heat. Another Excess pattern of skin problems is Blood Heat or Blood Stagnation. Internal imbalances that are often manifested on the skin, tend to be more chronic and Deficiency-associated, and are differentiated into patterns such as Blood Deficiency or Disharmony of Liver and Kidney Yin. When skin problems are generated by an internal imbalance, the underlying problem must first be addressed in order to clear the surface disruption. It is important to have patience and apply an integrative treatment plan when treating skin problems, especially if the pattern is chronic, internal and/ or associated with a deficiency.
The Excess patterns commonly associated with veterinary skin problems, are invasion of Wind-Heat, invasion of Damp-Heat, and Blood Heat (due to Blood Stagnation). Patients with a Wind-Heat pattern tend to be worse in Spring/Summer, have a dry hair coat and skin, and they are cool-seeking. Most often these are young to middle age individuals, with allergic hypersensitivities and Atopic Dermatitis. Their tongues are red and dry, and they tend to have superficial, wiry, and/or rapid pulses.
The treatment goal for this pattern is to "move the blood in order to make the wind commit suicide," or in other words, utilize Blood tonifying acupuncture points and herbs to move Blood to expel the Wind from the body. Points such as GB-20, BL-10/12, can be used to extinguish the Wind, while points BL-17 and SP-10, are potent points for moving Blood. Other points that will help expel Heat include GV-14, LI-4/11, Er-jian, and Wei-jian. An excellent herbal formula that addresses Wind-Heat is Jing Tang’s Wind Toxin (Xiao Feng San), which can be especially useful preceding or during an acute pruritic phase. The importance of cooling diets cannot be over-emphasized, and the client can add various cooling foods to help supplement the patient’s diet (Table 1). Not only will diet modification help rid the Heat, but real, fresh foods will also add nutrients, antioxidants, and Qi to the patient’s food. For these types of patients, adding Krill Oil to their diet can not only help cool the heat, but also can aid the dryness of the skin and coat by supplying an optimal balance of Omega Fatty Acids. In addition, supplementing the food with local honey can also be an effective adjunctive treatment, as honey is not only cooling, but can have a hypo-desensitization effect with the minute exposure to local pollens.
Another common Excess pattern seen in veterinary medicine is the invasion of Damp and Heat. This pattern is commonly encountered in damp climates and exacerbated during periods of high humidity. These are the classic greasy, malodorous dogs, the stinky Golden Retriever or the oily Cocker Spaniel. These patients tend to have sebaceous, waxy exudates from their skin and ears, with generalized skin papules/ pustules, pyodermatitis, and wet "hot spots." Often these cases have chronic otitis externa, complicated by secondary pathogens such as bacteria and yeast. Similar to the Invasion of Wind-Heat, these patients are also cool-seeking, tend to have a red tongue with a yellow coating, and have a superficial, forceful, slippery and fast pulse.
The goal of treatment for these cases is to clear the Heat and tonify the Spleen to rid the Damp. Beneficial acupuncture points for this pattern include: BL-20, SP-6/9/10 (tonify the Spleen), ST-40 (rid damp), GV-14, Er-jian, and Wei-jian (clear heat). One of two herbal formulations is commonly used: Damp Heat Skin for lesions that tend to be ventrally focused, and are erythematous, hot, inflamed, and exudative, or Long Dan Xie Gan Wan, for pyoderma and/or "hot spots" that tend to be located around the lower jiao, flank and genitals, or manifests as hot, greasy discharge from ears. It is especially important to eliminate dampness from this patient’s diet, as a common culprit of Damp for dogs is peanut butter and dairy foods. Be aware that fatty substances can also add damp; therefore it is crucial to limit Omega Fatty Acid supplements in cases of Damp Heat. Other modifications to the diet can include foods that are cooling and eliminate damp (Table 1).
The third and least common Excess pattern is Blood Heat due to Blood Stagnation. When the blood becomes stagnant it tends to heat up and cause abnormal skin manifestations. This pattern is often seen in patients with biopsies showing immune-mediated dermatologic disorders, such as Systemic Lupus Erythematosus, Dermatomyositis, Pemphigus, and Erythema Multiforme. It is often characterized by erosions, ulcerations, crusting, erythema, and/ or depigmentation. These patients tend to have tongues that are very red or purple in color, and the pulse tends to be rapid, superficial, and surging. Treatment principles for Blood Heat involve invigorating the blood (breaking up stagnation), tonifying the Spleen, boosting Qi, and clearing the Heat. Points that can be useful for this pattern include: GB-20, SP-6/10, ST-36, GV-14, LIV-3, BL-17, GB-34, Er-jian and Wei-jian. The most common herbal formula to use for this pattern is Jing Tang’s Blood Heat Formula, which helps smooth the flow of Blood, cool the Blood, and banish stagnation. It is important to add foods to the diet that are cooling and tonify Blood (Table 1).
Deficiency patterns are often more chronic in nature and tend to be seen in middle-aged to older animals. Two of the most commonly observed deficiency patterns seen in veterinary dermatologic disorders are Liver Blood Deficiency and Liver and Kidney Yin Deficiency. The classic Liver Blood Deficiency patient has a pronounced dry, brittle hair coat and skin with dandruff, alopecia, often with hyperpigmentation and/or lichenification. These patients also tend to be pruritic, have frayed, cracked nails or hooves, and appear anxious. The clinical signs often resemble Yin Deficiency patterns, but Blood Deficiency patient’s clinical signs are more severe and they are warm-seeking (rather than cool-seeking that is seen with Yin Deficiency). Often endocrinopathies, such as hypothyroidism or hyperadrenocorticism, which can result in dermatological disorders, manifest as a Liver Blood Deficiency pattern. These patients have a pale, dry tongue and a deep, thready, and weak pulse (weaker on the left side). Treatment aims at tonifying the Blood by nourishing the Liver. An shen, BL-17, SP-6/10, ST-36, HT-7, GB-20, and GV-14 are common acupuncture points used for this pattern. Si Wu Xiao Feng Tang, is an ideal herbal formula choice, because it is most often used for general Liver Blood Deficiency with pruritus from wind invasion. Food therapy involves supplementing the diet with foods that have neutral and warming properties, as well as blood tonics (Table 1).
The other common Deficiency pattern seen in skin disorders in animals is Liver and Kidney Yin Deficiency. This tends to be characterized as a chronic dermatopathy in geriatric animals, with skin dryness and fine dandruff. These patients are often polydipsic, pant a lot, are cool-seeking and display anxiety and restlessness, especially at night. Their tongues tend to be deep red, dry and cracked, and their pulses are thready, thin, and rapid (weaker on the left side). The primary goal in treatment is to tonify and support Yin. Excellent points to use for this condition include: BL-12, SP-6/9/10, BL-18/19/23, HT-7, An shen, GB-20, GV-14 and KID-3. The herbal medicine most often used for this pattern is Zhi Bai Di Huang, as its main indication for use are in elderly animals with chronically inflamed, pruritic skin (especially feet), powdery dandruff, and heat intolerance. Interestingly, this formula is also often used to address the heat due to Yin Deficiency in hyperthyroid cats and menopausal women. Cooling diets can be used to help expel the Heat and tonify Yin (Table 1).
So next time you are confronted with a frustrating skin case, do not forget the advantages of utilizing TCVM in your treatment plan. Not only can it be a safe and effective treatment for dermatological cases, but it can also help restore the body’s balance offering a more permanent resolution to these chronic, re-occurring cases. When approaching these cases, remember to thoroughly evaluate the entire individual, in order to determine the primary pattern involved, and develop a treatment protocol that encompasses all aspects of TCVM, including acupuncture, herbs, and DIET. Even in those cases where the animal is not an acupuncture candidate, or is intolerant to herbs, diet can make a tremendous difference in the overall balance and detoxification of the skin. It is important in dermatologic disorders to start your TCVM treatment early, and use as a preventative in cases prone to skin issues, such as at the onset of clinical signs, or prior to Spring/Summer (if seasonal). Most importantly, be persistent and thorough when treating skin problems, especially in cases of long standing chronicity. It took a long time for the animal to become imbalanced, so that it will take some period of time to restore health, but with patience, and an integrative approach, balance can be achieved.