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TCVM Treatment of Intervertebral Disk Disease

TCVM Treatment of Intervertebral Disk Disease

by Huisheng Xie, DVM PhD MS

Author: Chi Institute/Friday, April 1, 2011/Categories: TCVM Articles, TCVM Newsletter, 2011 Spring Issue

Intervertebral disk disease: (IVDD) is commonly seen in small animal clinics. Traditional Chinese Veterinary Medicine (TCVM), including acupuncture and herbal medicine, can be the effective sole therapy, or part of integrated therapy with Western medicine and surgery. This paper explains the TCVM etiology/ pathology and treatment of IVDD, and predicted outcome along with clinical case studies.

 

TCVM Etiology & Pathology for IVDD: IVDD is often considered as a Bi syndrome and is often accompanied by a Wei (weakness) syndrome. IVDD is related to the Kidney (bones and spinal cord), the Liver (joints and smooth flow of Qi and blood), and the Spleen (muscle strength). There are 2 Excess Patterns and 3 Deficiency Patterns that are associated with various forms of IVDD. The Excess conditions are invasion of Wind-Cold-Damp and Qi-Blood stagnation, which are often associated with acute trauma in chondrodystrophic dogs (Type I). The Deficiency Patterns, often associated with chronic, Type II IVDD in non-chondrodystrophic breeds, include Qi/Yang Deficiency, Yin Deficiency and combined Yin-Qi/Yang Deficiency (Table 1- on page three). 1

 

TCVM TREATMENT FOR IVDD

1) Acupuncture:

Acupuncture has been proven an effective therapy for IVDD. 2-8 A general acupuncture treatment plan for a patient with IVDD is as follows:

 

Dry needle: GV-20 and Electro-acupuncture (20 Hz for 5 to 10 mins + 80-120 Hz for 15 to 20 mins) at the following pairs of acupoints: Left BL-11 + right Shen-shu, Right BL-11 + left Shen-shu, Hua-tuo-jia-ji at or near the suspected or diagnosed disk space, bilateral; ST-36+GB-34, or Liu-feng, bilateral; KID-1 + BL point proximal to IVDD lesion

Aqua-acupuncture (Vitamin B12) at Hua-tuo-jia-ji at or near the suspected or diagnosed disk space, BL-40, LIV-3, LI-4, Liu-feng

 

2) Herbal Medicine (see Table 1).

General herbal dosage for Dog is 0.5 g per 10-20 lb body weight BID twice daily for 2 to 4 months, and then as needed.

 

Double P II (Da Hua Luo Dan modification) is the primary herbal medicine used to treat IVDD. It may cause loose stool in some cases (10%). It can be used as long as the gut is able to tolerate it.

Add Cervical Formula for wobbler syndrome or if the lesion is localized in the cervical region;

Add Bu Yang Huan Wu for Qi Deficiency (rear weakness, pale and wet tongue, and deep/weak pulse)

Add Di Gu Pi San for Yin Deficiency (cool seeking)

Add Hindquarter Formula for Qi+Yin Deficiency (cool-seeking, rear weakness, red or pale tongue, and fast/weak pulse);

Add Stasis Breaker if a tumor or mass is present in the spinal cord;

Add Jie Gu San + Bone Stasis for fracture(s) of the vertebra(e).

 

 

3) Tui-na

Massage (Moo-fa) using both palms from Da-feng-men to GV14 to Bai-hui to Wei-gen, then from BL-13 to BL-35, and fromBL-42 to BL-52. Repeat 10-20 times.

Pressing (An-fa) + rotary-kneading (Rou-fa) from the lumbosacral area to the thoracolumbar junction to GV-14 using both palms clockwise 12 times, then counter-clockwise 12 times.

Pressing (An-fa) + pushing (Tui-fa) from BL-26 to BL-13, 12 times

Rubbing (Ca-fa) the back from caudal to cranial until the local tissues become warm.

Single-thumb (Yi-Zhi-chan) + rotary-kneading (Rou-fa) at BL-40, KID-1 and LIV-3, clockwise 6 times and counter-clockwise 6 times.

Pinching (Nie-fa) along the spine: holding and pinching the skin and moving forward from the tail bone to the shoulder blade 12 times

Wrenching the back (twisting the lumbar-sacral areas) 5 times

Pulling the tail 12 times

Stretching the front limbs and rear limbs 12 times

Rotary-kneading (Rou-fa) at Bai-hui and BL-40, clockwise 2 minutes and counter clockwise 2 minutes

 

4) Owner Follow-up Care for IVDD

Massage the lumbosacral area and rub from the tailbone to the shoulder blade until heat is generated once a day for 21 days

Pinch (Nie-fa) along the spine: holding and pinching the skin and moving forward from the tailbone to the shoulder blade 2 times once a day for 21 days

Pulling the tail 12 times, once a day for 21 days

Stretching the front limbs and rear limbs 12 times, once a day for 21 days.

 

 

5) Food Therapy

Home cooked meals are recommended for the IVDD dogs. Ideally the following recommended foods are the entire diet. If this is a challenge because of time and convenience, the 50% home-made foods can be used to supplement a 50% commercial diet.

 

Basic foods for IVDD dog:

Brown rice, oatmeal, barley, Yi Yi Ren (coix seed) Spinal cord, bone marrow

Eggs with shell

Beef, chicken, turkey, liver, salmon, sardines

Yam, sweet potato

Dates, eggs, leafy greens, kelp

 

 

For Qi or Yang Deficiency with Stagnation:

 

Lamb, liver, veal, chicken, eggs, heart

Oatmeal, quinoa, sweet potato, roots

Shrimp, sardines, salmon

Alfalfa, kale, mustard leaf

Nutmeg, cinnamon, cardamom

 

For Yin Deficiency with Stagnation:

Turkey, organ meat, a little beef, fish, rabbit

Millet, barley, brown rice

Asparagus, green beans, broccoli

Thyme, basil

 

PREDICTED OUTCOME

Using a 0 to 5 grading scale to evaluate clinical neurological signs of IVDD (Table 2) is a valuable tool to help choose the mode of treatment, determine the prognosis, and assess the outcome of treatment. 9 In general, IVDD with Grades 1 to 4 can be successfully treated with TCVM alone. It is better to use TCVM with surgery and with Western medicine for cases with grade 5.

 

 

           Table 1. TCVM Treatment of the most common Patterns of Intervertebral Disc Diseases

 

                          Table 2. Neurological Grading Scale in Canine Intervertebral Disc Disease

 

One retrospective study conducted to assess outcome after surgical decompression of forty-six dogs with thoracolumbar intervertebral disk disease graded as a 5 (with loss of deep pain perception) prior to surgery was reviewed. 10 Nineteen dogs (41.3%) recovered with a median follow-up period of 12.5 months. Recovery was defined as an ambulatory paraparesis, or better, with urinary and fecal continence. There was a better outcome in dogs with loss of deep pain for less than 24 hours prior to surgery (19/41; 46.3% recovered) than in dogs without deep pain perception for more than 24 hours (0/5; 0% recovered). Dogs with deep pain perception present at two weeks postoperatively had significantly higher success rates (8/12; 66.7%) than dogs without deep pain perception at this time period (1/10; 10.0%). The return of deep pain perception by two weeks postoperatively can be a useful positive prognostic indicator. For grades 1 to 4, the prognosis using TCVM was very good (Table 3). For grade 5 IVDD, a combination of surgery and TCVM can be a good option.

 

                                                         Table 3. Predicted TCVM Treatment outcomes

                                                          

  

 

CASE EXAMPLE

Tachia, a 14 year old spayed female Lab Retriever/Chow mix was presented with limping on the left hip and on the right front leg for the previous year. On March 29, 2003, she developed an acute onset of back pain along with urinary incontinence and was non-ambulatory. She was diagnosed with T12-T13 IVDD. Degenerative joint disease was noted on radiographic studies of the left hip and lumbar spine performed on March 30, 2003. Surgery was not an option because of age. The DVM prescribed oral medication of Prednisone and Rimadyl to Tachia. After two months of Western medication, owner reported no noticeable improvement, and the DVM recommended Tachia to seek service at the local University/small animal hospital.

 

June 3, 2003 (Initial TCVM Visit)

Problem List:

Hindlimb paresis

Non-ambulatory

Urinary incontinence

Back/hip pain

TCVM Exam:

Seeking cool surfaces;

Panting a lot and had increased thirst;

Limping appeared worse when it was damp outside;

Thoracolumbar areas: very sensitive on palpation;

Osteoarthritis at hip and lumbar regions;

Urinary incontinence without odor;

Hind limb weakness/non-ambulatory;

Pulse: fast and weak on both sides;

Tongue: red and dry.

TCVM Diagnosis: Kidney Qi-Yin Deficiency with Qi-Blood Stagnation of the back and left hip.

 

Acupuncture Treatment:

 

Dry needle: KID-3/7 (tonify Kidney Yin), GV-20 and

Bai-hui (to calm), BL-11 (an influential point for bone)

Electro-acupuncture:

BL-19/20/21 (bilateral): local points for moving Qi to resolve pain;

Jian-jiao (bilateral) for hip pain;

GB-29/30 (left): local points to help treat hip pain due to osteoarthritis;

ST-36 (right) + GB-34 (right): to strengthen the rear limbs

Aqua-acupuncture using vitamin B12 (0.3 cc per point) at LIV-3, ST-41 and KID-1 to resolve Stagnation and tonify Qi.

Herbal Medicine:

1) Bu Yang Huan Wu, 1.5 tsp, BID for 2 months.

2) Double P II, 1.5 tsp, BID for 2 months

Food Therapy: 40% meat (turkey, alternately with rabbit), 40% millet (alternatley with brown rice), and 20% vegetables including asparagus, green beans, broccoli) were recommended

 

Owner Daily Care: Owner was instructed to massage Tachia every day by: rolling the back at T12/T13, holding/walking the back skin 12 times, stretching the rear limbs and massaging the toes and paws for 5 minutes per toe to help promote Qi flow throughout the body. In the meantime: Stop giving Prednisone and Rimadyl.

June 16, 2003 (Second TCVM Visit)

Tachia was able to walk for up to two minutes at a time. Her appetite and attitude were improved, more alert and attentive. However her urinary incontinence had not improved.

 

TCVM Exam: Tongue is dry. Pulse is fast and slippery.

TCVM Diagnosis: Kidney Qi-Yin Deficiency with Qi-Blood Stagnation of the back and left hip.

 

Acupuncture Treatment: The same dry needling and electro-acupuncture procedures were given. Aqua-acupuncture using vitamin B12 (1.0 cc per point) at BL-39 bilaterally to stop urinary incontinence.

 

Herbal Medicine: The same herbal treatments were given.

 

July 1, 2003 (3rd TCVM Visit)

Owner reported that Tachia was more ambulatory and less painful (70% improvement). She was able to walk about ten minutes without resting. Her appetite was good. Owner also noticed that urinary incontinence had been stopped for four days after the second TCVM visit (June 16). But she started to have urinary incontinence again on June 21.

 

TCVM Exam: Shen was good. Pulse was deep and weak. Tongue was purple and moist.,

 

TCVM Pattern: Kidney Qi Deficiency

 

Acupuncture:

Dry needle: GV-20, Bai-hui

Electroacupuncture:

Hua-tuo-jia-ji T-11/12 from the left to right (bilateral)

Hua-tuo-jia-ji T-12/13 from the left to right (bilateral)

Hua-tuo-jia-ji T-13/L-1 from the left to right (bilateral)

Left BL-23 + left Shen-shu

Right BL-23 + right Shen-shu
Left ST-36 + left KID-1
Right ST-36 + right KID-1
Aqua-acupuncture using vitamin B12 (1.0 cc per point) at BL-39 bilaterally

Herbal medicine:  
1) Continue with Bu Yang Huan Wu to build overall strength.
2) Start giving Suo Quan Wan  6 .5g capsules BID for  urinary incontinence/leakage.
3) Stop giving Double P II unless it was needed for pain or paresis.

October 2, 2003 to July 15,2005
One acupuncture session every three to six months was given from November, 2003 to July 2005 or as needed. Tachia was always on the herbal medications based on pattern differentiation.

Tachia had been doing very well (walking 30 min SID to TID) with no urinary incontinence until July 15, 2005 (at age of 16 years old) when she died of acute onset of renal failure and congestive heart failure.

 

CONCLUSION:


Thoracolumbar intervertebral disk disease (IVDD) is commonly seen in small animal clinics. Traditional Chinese Veterinary Medicine (TCVM), including acupuncture, food therapy and herbal medicine, is an effective sole therapy, or part of integrated therapy with Western medicine and surgery, based on a grading scale of clinical signs and  type of IVDD.

 

References:


1. Huisheng Xie. Chinese Veterinary Herbal Handbook  (2nd edition). Chi Institute of Chinese Medicine. 2008: page 6.
2. Joaquim JG et al: Comparison of decompression surgery. Electro-acupuncture, and decompressive surgery followed by electroa-cupuncture for the treatment of dogs with inter vertebral disk disease with long-standing neurological deficits. JAVMA 236, 1225 - 1229 June 1, 2010.
3. Hayashi AM, Matera JM, Fonseca Pinto AC. Evaluation of electro-acupuncture treatment for thoracoulmbar intervertebral disk disease in dogs. J Am Vet Med Assoc 2007; 231:913-918.
4. Hayashi AM, Matera JM, da Silva TS, Pinto AC, Cortopassi SR. Electro-acupuncture and Chinese herbs for treatment of cervical inter vertebral disk disease in a dog. J Vet Sci 2007; 8:95-98.
5. Janssens LA, Rogers PA. Acupuncture versus surgery in canine thoracolumbar disc disease. Vet Rec 1989; 124:283.
6. Janssens LA. Acupuncture for the treatment of thoracolumbar and cervical disk disease in the dog. Probl Vet Med 1992; 4:107-116.
7. Lai A, Chow DH, Siu WS, Holmes AD, Tang FH, Leung MC. Effects of electro-acupuncture on a degenerated intervertebral disk using an in-vivo rat-tail model. Proc Inst Mech Eng [H] 2008; 222:241-248.
8. Lubbe AM. Auriculotherapy in canine thoracolumbar disk disease. J S Afr Vet Assoc 1990; 61:187.
9. Björn Meij.  Cervical and Thoracolumbar Disk Disease: Diagnosis and Treatment. The proceedings of 30th World Congress of the World Small Animal Veterinary Association (WSAVA), May 11-14, 2005, Mexico City, Mexico.
10. Outi M Laitinen and David A Puerto. Surgical Decompression in Dogs with Thoracolumbar Intervertebral Disk Disease and Loss of Deep Pain Perception: A Retrospective Study of 46 Cases. Acta Vet Scand. 2005; 46(2): 79–85.

 

Double P II TM                                                                   

  

General Dosage:

Horse: 7.5-15 g BID as top dressing on feed   

Dog/Cat: 0.5 g per 20 lb body weight BID

 

Contraindications:

Do not use in pregnant or weak patients.

Use only for a short time at a low dosage, this medication may cause drug testing to be positive.

 

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