In October of 2011, R., a 12 year old male castrated mixed breed dog was presented with rear limb paresis and weakness which had progressed over several weeks. R. had been diagnosed with multiple thoracolumbar disc disease and had undergone hemilaminectomy at T13-L13 years before. He was under no medication.
Integrative P.E and Diagnosis:
This Earth dog showed bilateral ambulatory posterior paresia and weakness, with moderate muscle atrophy and local discomfort at the thoracolumbar area. The first day the tongue was red, with a purplish center and a paler back, slightly swollen and dry. The patient kept panting and the ear tips were warm. The pulse was thready and slightly wiry. A neurological examination, complete blood count and chemistry were performed. The owner did not want to pursue any further Western diagnostic tests and wanted to try TCVM. A presumptive diagnosis of chronic IVDD was made. TCVM diagnosis was Kidney Qi and Yin Deficiency, Spleen Qi Deficiency and local Qi/Blood Stagnation at the spine. Heat signs (red dry tongue, panting, warm ears) could be due to a combination of Stagnation and false Heat from Yin Deficiency. TCVM Treatment and Follow-Up:
Treatment principles were tonification of Kidney Qi and Yin, tonification of Speen Qi, and dispersing local Stagnation. Acupuncture was performed using dry needle, aqua-acupunture and electroacupuncture. Sessions were first spaced 7-10 days, then 15 days, then 3-4 weeks.
The Tui-na techniques described below were progressively demonstrated during the sessions to the owner, who was instructed to perform them at home for 20-30 minutes at least 4 days a week:
Mo-fa (touching skin and muscle): often used as an introduction to the other techniques, it regulates Qi and the Middle Burner and drains Stagnation.
Nie-fa (pinching) from the lumbosacral area up to the cervical spine. This gentle technique regulates the Earth element and invigorates Qi/Bood circulation. It helps release postoperative adherences, which are often found at sites of previous surgical decompression, as was in this case.
Rou-fa (rotary kneading) was applied with the heel of the hand at both sides of the spine to reduce Stagnation.
Tui-fa (pressing) was applied over the inner and outer Bladder meridian, following the fibers of the epaxial myofascial groups to soften the connective tissues, relax tendons and invigorate circulation.
Dou-fa (shaking) on all four extremities, with a high frequency short range of vibration and supporting the limb under the elbow/stifle to minimize tissue stress. This technique helps regulate Qi and Blood and smoothens the joints
Ba-shen-fa (traction or stretching): applied to limbs, neck, thoracolumbar spine and full spine. It stretches the tendons, regulates the channels and corrects malpositions.
Initial Herbal medicine consisted of Double P II (Da Huo Luo Dan modification) at 0.5g/KG BID, with the aim of moving the Qi/Blood Stagnation at the spine. This would help with both the paresis and the discomfort.
After the third session there was a 95% improvement in hindquarter weakness and paresia, although there was still some thoracolumbar discomfort. By this time, the dog was able to tolerate up to 15 minutes of walking. The tongue became paler and more swollen, and the right pulse weaker, which indicated more Qi Deficiency, and Bu Yang Huan Wu was selected at a dose of 1 g/10 Kg BID.
After the fifth session (6 weeks after beginning of treatment), the dog was able to take 30-minute walks, and the tongue became red, dry, with no purple left, and the pulse became thinner and less tense, weaker on the left side, showing overall an increasing component of Yin Deficiency in the Wei syndrome. Herbal medicine was switched to Hindquarter Weakness Formula 1 g/10 Kg BID. Five months after the beginning of treatment, the pattern changed to a Bony Bi Syndrome with Kidney Qi and Yin deficiency, and the herbal treatment was changed to Di Gu Pi San 1gr/10Kg BID.
By the time of this report, in February 2013, R. is turning 14. He gets monthly acupuncture, Di Gu Pi San at 0.5gr/10 Kg BID, and no Western medication. His progress has been excellent and he has a high quality of life.
IVDD often presents initially as a Bi syndrome with Qi/Blood Stagnation, but in chronic cases it generally progresses into a Deficient Wei syndrome, with both types of pattern sometimes combining in clinical relapses.