What's your TCM diagnosis --- by Dr. Pamela Wood-Krzeminski

Annie, a four year old mixed breed Chow/Shar Pei spayed female, weighing 24 kilograms, was presented for abnormal rear leg gait and pain after exercise. The dog was adopted from a local humane shelter at age 1-2 years old, no previous history was available. She's lived in South Florida (a hot damp climate) since birth. Based on first examination, due to her almost bunnyhopping rear end gait, hip dysplasia was suspected. Survey radiographs taken revealed early degenerative changes and anatomy consistent with hip dysplasia. The dog at that time was switched to a more natural raw diet, consisting of half commercial dry food, the other raw beef, cooked chicken, various vegetables and occasional rice and oatmeal. She was also placed on Cosequin, the glucosamine/chondroitin supplement used for arthroses. The patient lived four hours away from the author, so acupuncture was not used. She did well on limited walks, the above diet and supplements but continued to show some stiffness and pain after even 2 mile easy walks over a golfcourse adjacent to her home. Last fall, 1998, her physical exam revealed some hip pain bilaterally, a red tongue with a clear scant tongue coat, strong pulses except that the pulse in Kidney Yin position (left third finger) was weak. Her personality is friendly and outgoing if she knows you, and is a little aggressive towards animals other than dogs.

What's your TCM diagnosis? If you want to find the Dr. Pam's answer, please see below...

What's your TCM diagnosis-answer

In TCM, Annie can be considered as Bi syndrome. She had Kidney Yin deficiency as shown by her weak kidney yin pulse, her mild heat signs, her reddish tongue and scant clear tongue coating, and her condition improving in slightly cooler weather. Kidney yin deficiency could derive from weak Kidney Jing or Essence (a lot of dogs adopted from humane shelters have weak Kidney Jing). On the other hand, Annie also had Kidney Yang deficiency because of the degenerative hip and stiffness in the hindlimbs. Thus, the TCM diagnosis is Kidney Yang and Yin deficiency. The treatment principles would be to tonify kidney yang and yin to strengthen the bones, activate the channels to stop pain. Therefore, Ba Ji San with modifications was selected.

Formula/gms/reasons:

Ba Ji Tian 15gm- kidney yang tonic, strengthen bones and sinews, wind-damp-bi

Eucommia Du Zhong 15gm- liver/kidney tonic, strengthen bone/sinew, sore lower back and legs

Achyranthes Niu Zi 11gm- strengthen sinew/bone, sore lower back/legs, clear damp heat in lower burner that ends up in knees

Cistanche Ru Cong Rong 11gm- kidney yang, pain in lower back/knees

Angelica Dang Gui 11gm- activate blood to stop pain from blood stasis seen in bi syndrome

Salvia Dan Shen 11gm- move blood stasis

Morus Sang Zhi 10 gm- dispel wind, unblock channels, benefits joints, wind damp bi

Corydalis Yan Su Huo 10gm- invigorate blood, relieve pain, move Qi

Licorice Gan Cao 6gm- harmonizer

The above modified Ba Ji San was purchased from ITM in Portland Oregon. Dosage was 2 grams BID. She has been on this formula for close to six months, and after the first two weeks her owners saw less pain and stiffness on rising, and less pain after short walks than previously noted. Her coat is thick and shiny, she enjoys her diet, and is able to lay on her stomach with her rear legs behind her, something she used to do as a much younger dog. I used only herbs as this dog lives four hours away (there is no acupuncturist in the owner's town). I could have used more kidney yin tonics such as Rehmannia to counter her yang signs, but at the time I was less experienced with herbs and put together this mixture early in my training. So far, it has worked well!