"Roxy" is a five year-old female spayed American Bulldog who was treated at the Traditional Chinese Veterinary Medicine (TCVM) Clinic at Murdoch University for chronic urinary incontinence (Lin Syndrome).10 months ago, "Roxy’s" owners noticed that she was wetting her bedding and occasionally leaving puddles of urine around the house . They observed that she was most likely to dribble or leak between 5PM and 10PM after play or vigorous exercise despite frequent toilet walks. The volumes of urine leaked were significant and would soak bedding and included sizeable puddles around the house. Her regular veterinarian ascertained that there was no detectable underlying cause and prescribed Phenylpropanolamine. This drug worked very well and decreased the instances of her incontinence dramatically. However, the owners noted that whenever "Roxy" was given Phenylpropanolamine, she developed head-shaking and tremoring episodes. This led to their disinclination to maintain "Roxy" on this drug for the rest of her life and their pursuit of alternative options for this otherwise healthy and vibrant young dog.
Her first visit to the TCVM clinic found "Roxy" in good health and her TCVM Diagnosis at the time was mild Kidney Qi Deficiency leading to Lin Syndrome. According to Zang-Fu physiology, the Kidney controls the opening and closing of the urethral sphincters and the anus, also known as the two orifices. Specifically, adequate Kidney Qi is required to ensure the steadfast functioning of these orifices. In this instance, "Roxy’s" problems with urinary incontinence or Lin syndrome, without the complications of underlying disease, likely meant that Kidney Qi Deficiency was the main issue causing the proper closure of the urethral sphincter to falter. At this stage, her TCVM Exam findings were non-specific and the Western Biomedical Diagnosis of uncomplicated urinary incontinence underpinned her TCVM Diagnosis and Treatment.
The owners elected to proceed initially with only Chinese Herbal medication. Jin Suo Gu Jing Wan was prescribed. This herbal formula is targeted at tonifying the Kidneys and astringing the Essence and is indicated in cases of chronic emissions, including urinary incontinence. The composition of herbs in this preparation of Jin Suo Gu Jing Wan is listed in Table 1. The owners were instructed to gradually wean "Roxy" off the Phenylpropanolamine and asked to provide regular updates.
Over the course of the next five months, "Roxy’s" owners provided regular updates via telephone of her progress. The first herbal formula Jin Suo Gu Jing Wan seemed to have good effect for the first four months, only requiring one dose modification in those months. As the fifth month began, "Roxy" started experiencing episodes of breakthrough incontinence and was thus seen again at the TCVM clinic to reassess her pattern.
"Roxy’s" second visit to the TCVM clinic revealed that her pattern had progressed and she was now exhibiting cool signs with cool ears and a cool nose. Her TCVM Diagnosis was now Kidney Qi Deficiency with Mild Kidney Yang Deficiency leading to Lin Syndrome which could explain the breakthrough urinary incontinence. To address the TCVM Pattern, a Kidney Yang tonic, You Gui Wan (table 2), was added to her protocol. She was given acupuncture at the following acupoints: Bai-hui, GV-4, CV-6 and BL-28. Please refer to table 3 for the reasoning behind choosing these points.
This was effective for another four months before "Roxy" began leaking again. A dose increase of You Gui Wan was implemented but when this failed to produce a satisfactory result, gold wire implantation was discussed and offered to the clients. It was emphasized that gold wire implants may provide them with the long-term solution that they sought.
Material implants have long been used in veterinary practice of Traditional Chinese Medicine. It is thought that by inserting permanent implants of metals, long-term stimulation through mild local irritation and inflammatory reactions of the acupuncture points targeted can be achieved and the therapeutic effects of those points manifested. Gold wire implants were to be inserted into BL-28 bilaterally because it is the Back-shu association point for the urinary bladder and is indicated for treatment of urinary incontinence and other urinary bladder conditions, including disorders of micturition.
There have been five follow-up telephone conversations with "Roxy’s" owners since she had the gold wire implants placed, each of these a week apart. They reported that two days after the implants were placed they were already noticing a significant decrease in the frequency of her episodes and the volume of urine each time. They began weaning her off the Chinese herbal formulae and had stopped them a week after the implantation. In the first week, there were probably three episodes of incontinence, but the volume of urine was not significant. By the third week, there were still one or two episodes of incontinence but the owners reported that she seemed to be significantly better than when she was on the herbs alone. The report by the fifth week was that leading up to this update, there had only been two episodes of incontinence and that the volumes were almost negligible. The owners were thoroughly satisfied with this outcome and will continue to monitor "Roxy’s" progress over the coming months.
Traditional Chinese Medicine offers the practitioner a multitude of means to address any given condition and it is up to the practitioner to recognize this and offer all of what Traditional Chinese Medicine has to benefit their patients and clients. A failure of dry-needling acupuncture and Chinese herbal medicines to achieve a good outcome does not necessarily mean that the scope of Chinese medicine has been exhausted as clearly learned from this case. It would seem that this ancient art of healing has much to offer the modern world and its practice of medicine.
Xie, H. and V. Preast. 2002. Traditional Chinese Veterinary Medicine, Vol. 1, Fundamental Principles. Jing Tang.
Xie, H. and V. Preast. 2007. Xie’s Veterinary Acupuncture. Blackwell Publishing.
Xie, H. and V. Preast. 2010. Xie’s Chinese Veterinary Herbology. Wiley-Balckwell.