Baker, a six-year-old male neutered mixed breed dog, was presented for acupuncture consultation for treatment of a seizure disorder. The patient had experienced two seizures over the previous two months. There were no other past medical problems noted in the history.
Clinical Signs/Diagnostics/Diagnosis – Conventional
The patient was presented for an examination with a history of two recent seizure-like episodes. There was no obvious cause for the seizures on examination. No diagnostics were performed and the owner declined neurology referral. The conventional diagnosis was an idiopathic seizure disorder.
Clinical Signs/Diagnosis – TCVM
Baker had experienced two seizure-like episodes. The first event was two months before presentation. The pet woke up at 3 a.m., and was crouching and running around for several hours. During that time he was non-visual and would not respond to the owners. The second episode was not as long or as severe as the first, and the pet experienced more muscular tremors. There was no history of trauma or exposure to toxins. The pet had been vaccinated four months prior to the onset of seizures.
The patient was presented on March 15, 2007 with the complaint of a seizure-like disorder. The patient’s tongue was lavender in color and dry. The pulses were bilaterally wiry and stronger on the left. The balance of the exam revealed an athletic dog in very good physical condition. The owner described Baker as being a gregarious dog with no outstanding imbalances, though he did not like his feet touched. During initial acupuncture treatment the patient was found to be very sensitive to needling and would snap at the practitioner.
A diagnosis was made of Liver Yang Rising causing Internal Wind with Phlegm Fire. The diagnosis of Liver Yang Rising was based on the Liver Qi Stagnation symptoms of wiry pulses, tremors, seizures, and biting behavior during acupuncture. The lavender tongue color could also indicate stagnation. The strange behavior that typified the seizures most resembled Phlegm Fire.
The TCM treatment principle for Liver Yang Rising with Phlegm Fire is to clear the Liver, resolve stagnation, drain Fire, and transform Phlegm. Treatment was performed with 0.25mm x 15mm needles placed to a depth of 5 mm or to achieve De Qi.
Treatment consisted of an initial series of four treatments over a three-month period. The first treatment was on March 15, 2007, the day of presentation. Points used were LU 11, BL 10/12/18, GB 13/34, and GV 20. Herbal treatment consisted of Long Dan Xie Gan Wan and Di Tan Tang. Long Dan Xie Gan was chosen to clear Liver Fire. Di Tan Tang was chosen to transform Phlegm, clear Internal Wind, and stop the seizures.
The second treatment was performed on March 28, 2007. The owner reported that Baker was feeling very well and taking his herbs with no problem. The patient was much more relaxed in the exam room and did very well when needled. Acupuncture point selection was exactly as above and the patient tolerated the needles better.
The third treatment was performed on May 1, 2007. The pet had done very well with no seizures since acupuncture therapy was initiated. On examination the pet was found to have wiry pulses bilaterally and again, he tolerated his treatment very well. Acupuncture treatment was repeated as in the previous treatment. It was decided to wean Baker off herbs by discontinuing Di Tan Tang. Long Dan Xie Gan Wan was continued to address ongoing although improving Liver Qi Stagnation.
Within one month the owner reported that the pet had occasional tremors, and by the end of the month Baker had experienced one short seizure. During this episode he was whining and restless, unable to settle down or to lie down. The patient was treated with a single session of acupuncture on May 24, 2007 and Di Tan Tang was re-instituted at the previous dose. The acupuncture prescription was identical to the previous treatment. Baker also continued to take Long Dan Xie Gan Wan. These herbal therapies were continued over the next four months.
The next time the patient was seen was on September 27, 2007, six months after initial presentation. Baker had experienced only one daytime seizure-like episode during this time and was otherwise well according to his owner. On examination the pulses were wiry and on this occasion the pet again snapped on needling, notably at BL 18. The acupuncture prescription was repeated as above. It was decided to discontinue herbal and acupuncture therapy as the patient’s initial complaint appeared to have resolved. Baker has experienced no further tremors or seizures.
Though the pet was friendly, his personality and physique represented a Wood personality, and so he would be susceptible to injury to his Liver constitution. The wiry pulses and lavender tongue, as well as the biting behavior during acupuncture, indicated Liver Qi Stagnation. Liver Qi Stagnation can lead to Liver Yang Rising, which causes Internal Wind, or seizure. This patient was a young and otherwise strong patient, so an Excess condition was suspected. An Internal Profusion of Phlegm Fire was diagnosed as the symptoms of abnormal behavior during the seizure were noted. Besides the patient’s predisposing Wood constitution, a triggering factor may have been the vaccination prior to the onset of seizures. The recurrence of the seizures after discontinuing one of the herbal medicines was convincing evidence that this was not a self-limiting disorder. Of interest too was the “Liver time” occurrence of the initial seizures. In the Circadian Cycle of Qi, the time for the Liver is 1 a.m. to 3 a.m., corresponding to the time of Baker’s seizures.