Cozee is a 25 year old Arabian mare used for light pleasure riding. She has been my patient for over 10 years and been a healthy horse except for a bout of hoof abscesses in her front feet, approximately seven years ago. At that time, Cozee had two surgeries at a local equine hospital for hoof abscesses, but the abscesses reoccurred shortly after the second surgery. Cozee was treated successfully with acupuncture and Chinese herbal formula Hot Hoof II, and the abscesses never returned. Previous medical history included mild allergic dermatitis in the summer, involving her tail and ventral midline.
In March of 2007, the owner noted that Cozee felt hot, was drinking significantly more water and was off in the left front. Also, she was spending more time lying down. Cozee was examined on March 15, 2007. She appeared alert and mildly overweight. Although her body temperature was normal at 100 degrees F, she felt warmer to the touch than did other horses on the same property. Her skin and hair coat appeared normal. On a lunge circle to the left, Cozee was grade 2 lame on the left front leg. No digital pulse was noted and the foot was not sensitive to hoof testers although some mild bruising was noted. There was a bilateral digital pulse in the front hooves. The front legs were normal to palpation and joint flexion tests. A complete blood panel was taken, indicating an elevated blood glucose of 167 mg/dl (normal 70-120) and a decreased RBC at 6.3 (normal=6.5 to 10.5), and a decreased HCT of 31 % (normal=35 to 52). The rest of her lab work was unremarkable. Early Cushing’s Disease was suspected.
Overall, Cozee’s shen and physical condition were good. Her personality was mildly aloof but easy to work with and a little stoic, probably a Metal constitution. Her tongue was reddish, normal size, and her mouth dry. Her pulses were stronger on the right than the left. A scan of her meridians showed a reaction at LI 18 on the left side but otherwise no other sensitivities.
My TCVM diagnosis was Kidney Yin Deficiency with Qi/Blood Stagnation with Heat in the left hoof. Acupuncture points were chosen to nourish Yin and clear deficiency Heat; to promote body fluids; to clear Heat and move Qi in the hooves and to activate Blood and relieve pain. Points chosen included SP 6 and 9, LIV 8 and KID 3 and 7, for Kidney Yin deficiency; Bai Hui and Shen Shu, to tonify the Kidney; front ting points as local points and front limb points for stagnation and pain such as SI 3 and 9, GB 21 and LI 4.
Cozee’s treatment consisted of acupuncture given once weekly for three treatments then a fourth given one month later. Chinese herbal formulas Ophiopogon Powder and Hot Hoof I started on 3/28/2007, after the second acupuncture treatment. Blood tests run after the first week of herbal formulas showed elevated blood glucose of 133 mg/dl, which was lower than her initial blood glucose. A month later, in early May, at Cozee’s fourth acupuncture treatment, her blood glucose was still elevated at 134 gm/dl. She continued to show signs of Yin Deficiency, with a red tongue and increased water consumption. Since she was now completely sound on lunge circle at the trot, herbal treatment only was continued.
On a recheck in August, Cozee looked great! Her coat was lustrous, her weight was down and she no longer felt warm to touch. She was sound at the trot both on the straight and on circle. At this point, her tongue appeared a paler pink, no longer red. Her pulses were now thin and somewhat hard to find. Blood work showed normal blood glucose but an HCT of 28%, down from 31% in March. As the initial Yin deficiency responded to acupuncture and herbal treatment, then an underlying Qi and Blood deficiency became apparent. Hot Hoof II was discontinued and Gui Pi Tang was started, and Cozee continued to take Ophiopogon Powder.
In November, Cozee continued to do well and was sound. Although her tongue was still pale pink, her pu
lses were stronger. Her blood glucose
was still normal and her HCT had climbed to 33%. Si Wu Tang was substituted for Gui Pi Tang
for stronger Blood tonification, and the Ophiopogon Powder dosage was lowered by half. At present time, Cozee continues to do well with only a slight increase in water consumption noted.
In Southern California, Yin deficiency is often exacerbated by the hot, dry high desert climate of the area. As the seasons change from winter to spring and summer it will be important to monitor Cozee’s water consumption and body heat to
adjust her herbal formulas. This case illustrates a successful management of early Cushing’s disease in a geriatric horse with acupuncture and Chinese herbal formulas.