TCVMNews2012Fall

TCVM News: Voice of Dr. Xie’s Jing Tang Herbal, Issue 18, Summer/Fall 2012

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The 15th Annual TCVM Conferencewill be held in the beautiful San Lorenzode El Escorial, Madrid, SPAIN from the12-15th of September, 2013 and hostedby the Chi Institute Europe. The maintheme of this conference will be TCVMfor Oncology, Geriatrics and Quality ofLife in small animals, horses and farm orexotic animals.

The Chi Institute strives to support theTCVM community. Chi has made nu-merous contributions to this communityand has recently donated to Dr. MargoRoman’s DrDoMore Project as well asthe AHVMA Foundation.

Congratulations to Dr. Justin Shmal-berg who successfully completed therequirements to attain diplomate statusin the American College of VeterinaryNutrition. His small animal nutritionresidency at the University of Floridawas funded in part by a grant from theChi Institute, and we are pleased to seethat he has been hired as the third facultymember of the integrative medicine ser-vice at UF which now incorporates acu-puncture, rehabilitation, and nutrition.Congratulations on Dr. Haleh Siahpolo'sgraduation from the UF AcupunctureInternship and welcome to the new in-tern, Dr. Jessie Burgess.

The Chi Institute is very exited to pub-lish more new TCVM educational aids:Rabbit Acupoints Chart, TCVM ForEmergency and Critical Care Chart, Chi-nese Veterinary Herb Cards, TCVMFundamental Principles in SpanishBook, iPad App for Canine AcupuncturePoint.

Icterus, or HuangDian syndrome, theyellow color to themucous membranesassociated with theaccumulation of bili-rubin, is the most sig-nificant physical

finding in hepatobilliary disease. 1 Fromthe western medicine view, the causes ofjaundice can be divided into three catego-ries: (1) prehepatic, (2) hepatic, and (3)posthepatic.1 If a large amount of heme isneeding to be processed, as in the case ofhemolytic anemia, a prehepatic increase inbilirubin production (hyperbilirubinemia)will clinically manifest as jaundice.1 He-patic causes of jaundice include problemswith the uptake, conjugation or excretionof bilirubin, as well as intrahepatic choleo-stasis and any severe extrahepaticinfection.1 Disruption of the normal flowof bile in the extrahepatic bile ducts willcause posthepatic hyperbilirubinemia.1 Inthe presentation of an icteric patient, it isvery important to obtain a western diagno-sis to determine the presence of an acuteinfection, toxicity, or other potentially life-threatening conditions such as a gallblad-der mucoceole. 1

Once initial western diagnosis have beenperformed and acute treatment provided,the road to recovery of the jaundiced pa-tient can be long and frustrating for thepatient, the owner and the veterinarian.This article discusses the treatment of thejaundiced patient through Traditional Chi-nese Veterinary Medicine (TCVM).

TCVM Physiopathology of Huang DianIn TCVM the Gallbladder plays a role inthe health or free flow of Liver Qi espe-cially as it relates to the Spleen andStomach.2 It also controls decisiveness,provides Qi to the sinews and influencesthe quality and length of sleep. 3

The pathogenesis of jaundice is three-foldin TCVM, Liver Damp Heat, Dampness inthe lower Jiao (Cold-dampness) andSpleen Qi Deficiency with Liver QiStagnation.2,3,4 Diet, emotional strain andexternal pathogens, such as Damp andDamp-Heat, are the main etiologies be-hind the pathogenesis of jaundice.5

TCVM Pattern Differentiation andTreatment

Yang Jaundice (Liver Damp Heat)Yang Jaundice, also known as Liver DampHeat or Toxic Heat, includes symptomsincluding acute onset of rapid and severejaundice (often described as a golden-yel-low or fresh yellow color), a high fever,bleeding (including epistaxis or hemato-chezia), constipation or diarrhea, nausea

HEADLINE NEWS

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Voice of Jing Tang Herbal

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TCVM

- by Haleh Siahpolo DVM, MPVM, CVA

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or vomiting, abdominal distension, warm limbs, extremelymalodorous stool/urine and injected sclera.4,5 Besides theassociation with acute onset hepatitis (due to viral, iatro-genic or other cause), this pattern is also associated withGallbladder mucoceles or cholelithiasis.5 The tongue is adeep red with a yellow dry coat and the pulse is wiry.Treating the Damp Heat is done by clearing Liver Heat andgeneral purging; acupoints to clear heat include GV-14,LI-4, LI-11, and Wei-Jian. 4 Clearing the Liver Damp Heatcan be done using acupoints such as BL-19, BL-20, LI-11and TH-6.2,4 Herbal recipes to treat this pattern includeLong Dan Xie Gan or Artemisia Combination (modifiedYin Chen Hao Tang).6 Food therapy would include foodsto cool, tonify Yin and drain Damp.3,4

Yin Jaundice (Cold-Damp)Dampness is accompanied by a dull yellow jaundice andprevents the Spleen Qi from descending, causing symptomsincluding diarrhea (especially watery stools), poor appetiteand pain on abdominal palpation.4 Chronic course ofDampness is often combined with Cold, leading to YinJaundice. Edema and coldness in ears and back can also beseen with this pathology. "Yin jaundice" occurs during theadvanced or fibrotic stages of chronic hepatitis.2 Thetongue is swollen with a greasy coat and the pulse is weakand thin or soft and wiry.4 The treatment protocol involvesclearing Dampness and warming the Interior with acupunc-ture points BL-18, BL-19, BL-20, LIV-13, GV-3, GV-4 andSP-6.2,4 The herbal therapy of choice is Yin Chen Zhu Fu;food therapy should include foods to drain Damp and warmthe Interior.3,4,6

Spleen Qi Deficiency with Liver Qi StagnationSpleen Qi Deficiency with Liver Qi Stagnation is a promi-nent pattern in veterinary patients. Clinical symptomsinclude an acute onset of bright yellow jaundice, generalmalaise, inappetance, vomiting and diarrhea.4 Behavioralchanges such as increased aggression, irritability, restless-ness and hyperactivity indicate Liver Qi Stagnation; subse-quently, patients with a Wood Personality (already prone todisplaying these behaviors) are more susceptible to Liver QiStagnation.4 Pain on palpation of the Liver channel, espe-cially around LIV-13 and LIV-14 is indicative of Liver QiStagnation.4 If the Spleen Qi Deficiency is the dominatingpattern, the tongue is pale and the pulse will be deep andweak. If the Liver Qi Stagnation is the dominating pattern,the tongue is red and the pulse is fast and thin.4 Acupunc-ture points include those to tonify Spleen Qi includingBL-20, CV-6, ST-36 and SP-3; acupuncture points to clearthe Liver Qi Stagnation include LIV-3, GB-34, GB-39 andGB-41.2,4 Herbal therapies for the Spleen Qi Deficiencyinclude Si Jun Zi Tang or Shen Ling Bai Zhu. For the LiverQi Stagnation, herbal therapies include Chai Hu Shu Gan,Xiao Yao San or Liver Happy (modified Chai Hu ShuGan).4,6 To treat with food therapy, choose Qi tonics andneutral foods.Case Example

Stretch, a seven-year-old neutered English Bulldog, pre-sented for a TCVM evaluation following an acute hepaticcrisis that resulted in persistent jaundice and general mal-aise. His history was as follows. Stretch presented to anEmergency veterinary practice on Christmas with a 24-hourhistory of icterus, hematochezia, vomiting and inappetance.Stretch had possibly been exposed to building/roofing ma-terials a few days prior. His physical exam was normalwith the exception of severe jaundice of all mucous mem-branes, loose stool on the rectal exam (no blood was noted)and palpable liver margins beyond the costal arch. Stretchweighed 24.1kg.

The initial assessment was a hepatopathy with differentialdiagnoses of toxic, infectious or inflammatory cause. Theinitial diagnostics performed were bloodwork, radiographsand abdominal ultrasound. The bloodwork showed ele-vated Alkaline Phosphatase (ALPK) (1457 U/L), AlanineAminotransferase (ALT) (1718 U/L), Cholesterol (406mg/dl), and extremely elevated total bilirubin (TBILI) (26.1mg/dl). The radiographs confirmed the palpable hepato-megaly. The abdominal ultrasound revealed a mottled liverwith enlarged hepatic lymph nodes; no gallbladder or bil-iary obstruction was noted. FNA’s for cytology and culturewere obtained. The initial western medical treatment in-cluded fluid therapy, IV antibiotics (Unasyn) and oral liversupport (Ursodiol and Denosyl). The culture of the liverFNA was negative for both aerobic and anaerobic growth.The cytology revealed lymphoplasmacytic hepatitis andintrahepatic cholestasis. Stretch was sent home with Clava-mox, Hill’s Science Diet L/D was started and an anti-in-flammatory dose of Prednisone was suggested if Stretchwas not improving at the re-check.

Two weeks later, Stretch remained icteric at his recheckthough his appetite had markedly improved since the anti-biotics had finished. Repeat bloodwork was performed tomonitor Stretch’s hepatic parameters. The following val-ues remained elevated though decreased from the blood-work at initial presentation: ALKP (1100 U/L), ALT (1124U/L), Cholesterol (678 mg/dL), and TBILI (12.9mg/dL).Stretch was discharged with Prednisone and Famotidine.At his one-month recheck, Stretch remained icteric, thoughimproved; his weight was 20.7kg (a 3.4 kg loss in onemonth). Bloodwork revealed ALKP, ALT and Cholesterolelevated from the two-week recheck, however, the TBILIdecreased by 50% to 6.3 mg/dL. Prednisone and Famoti-dine were continued. A repeat ultrasound and liver biopsywas performed at the six-week recheck. The biopsy re-vealed vacuolar hepatopathy. At that time, the Prednisonewas decreased to 0.24mg/kg dose twice a day. Over twomonths later, bloodwork showed little to no change in livervalues. A fasting panel was sent in 5 days later, again, littlechange was noted in the liver values. Stretch remainedunderweight.


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To order, please visit www.tcvmherbal.com (save 5%), call 800-891-1986 or email [email protected].

iPad App - Canine Acupuncture Point HD Pro PublishedAfter 16 months of development, the Chi Institute Canine Acupoint software is finally published on iPad. This interactive app was designedby Huisheng Xie, DVM, PhD and Cheryl Chrisman, DVM, EdS, ACVIM-Neurology, CVA to assist canine acupuncturists study, review andpractice the transpositional and classical acupoints in the dog. Each acupoint is accompanied by the Pin Yin name and pronunciation, ananatomical description, the needling method, indications and pictures.

• Cover All 361 Canine Transpositional Acupoints• Cover All 77 Canine Classical Acupoints• Acupoints Selection by Syndromes and Patterns• Learn Pronunciation of the Classical Name of Each Point• Electro-Acupuncture Demonstration Video• Acupoint Quick Search - Find a Point in Seconds• Multiple Pictures for Each Acupoint for Better Illustration

The PC version of software has been used by over 1,000licensed veterinarians from all over the world since 2007. Weare very excited to publish the HD iPad version of thissoftware for TCVM practitioners' convenience to better helptheir patients with the latest technology.

How To Order (Price: $129.99):

Purchase app on iPad directly: go to iTune Store and search“Canine Acupuncture Point HD Pro”

OR use following steps to purchase app on your computerand then sync to iPad.1) Open iTune on your computer and Click iTune Store Link

on the left.2) Click App Store Link on the top.3) Input “Canine Acupuncture Point HD Pro” in the search text

box on the top right corner and then press enter key.4) Click Buy button to order and download the app to your iPad.

Website: www.tcvm.comEmail: [email protected]: 800-891-1986 352-591-5385


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Pattern Clinical Signs Acupuncture Herbal Medicine

Liver Damp Heat(Yang Jaundice)

Acute onset of severe jaundiceHigh feverBleedingConstipationDiarrheaVomitingGallbladder mucoceles or cholelithiasis

GV-14, LI-4, LI-11,Wei-Jian, BL-19, BL-20,LI-11, TH-6

Long Dan Xie Gan orArtemisia Combination(modified Yin ChenHao Tang)

Cold-Damp(Yin Jaundice)

JaundiceWatery diarrheaAnorexiaAbdominal pain on palpationEdemaColdness in ears and back

BL-18, BL-19, BL-20,LIV-13, GV-3, GV-4,SP-6 Yin Chen Zhu Fu

Spleen QiDeficiency with

Liver QiStagnation

JaundiceLethargyAnorexiaVomitingDiarrheaAggression/irritabilityHyperactivity

BL-20, CV-6, ST-36,SP-3, LIV-3, GB-34,GB-39, GB-41

Xiao Yao San + LiverHappy (modified ChaiHu Shu Gan)

Three months after the initial hepatic insult, Stretch pre-sented for an acupuncture and herbal therapy consultation.The owner reported that normally Stretch bosses around theother dog (who is much bigger and younger than him) in thehousehold; he is also notoriously stubborn about listeningto commands—both his owners reported that even theirfriends know how stubborn he can be. He is generallyactive for a Bulldog breed but he has not been active sincehe first presented to theemergency room in De-cember. Once Stretch be-gan the Prednisone, hisappetite returned, thoughhe still was not the vora-cious eater he had beenprior to the initial insult tohis liver.

On TCVM Exam Stretch’s Shen was depressed and theowners reported this was abnormal, that he is usually muchmore active about greeting newcomers. Stretch had be-come cool seeking since the initial onset of liver diseasesymptoms. He had a soft coat, dry footpads and a wet nasalplanum. His tongue was red, swollen and had a thin greasycoating; his gums and conjunctiva were extremely jaun-diced. He had sensitivities along BL-18/19/20/21. Hispulses were thin and weaker on the right.The bossy, assertive and stubborn behavior traits point toStretch being a Wood constitution; thereby potentially pre-disposing this patient to liver or gallbladder diseases. Theinitial insult to the Liver (either toxic or immune-mediated)manifested as Gallbladder Toxic Heat—seen by the acute

onset of bright yellow jaundice, vomiting and bloodystools. Stretch was also on Prednisone, considered a “hot”drug in TCVM and likely contributing to the heat symp-toms seen in Stretch after the initial Toxic Heat insult. TheGallbladder Toxic Heat (Yang jaundice) led to Dampness inthe Lower Jiao and Spleen Qi Deficiency—seen as weightloss, inappetance and diarrhea. The treatment plan forStretch was to clear heat, drain the damp, smooth Liver Qiflow, and tonify Spleen Qi.

The TCVM treatment included acupuncture, herbal andfood therapy. Dry needles included GV-20, GV-14, BL-18/19/20/21, GB-34, and ST-36. Aqua acupuncture wasperformed with Vitamin B-12 at LIV-13, LIV-14 andGB-33. Liver Happy (1 gram twice a day) was prescribedto treat the Liver Qi Stagnation with Heat. Liver Happy(modified Chai Hu Shu Gan Wan) contains Cyperus (XiangFu Zi) and Citrus (Qing Pi) to soothe Liver Qi flow andresolve stagnation, as well as Paeonia (Bai Shao Yao) andBupleurum (Chai Hu) to soothe the Liver Qi flow, andGardenia (Zhi Zi) to clear Heat. Xiao Yao San (2 gramstwice a day) was prescribed to soothe Liver Qi flow, resolveStagnation and strengthen the Spleen. Xiao Yao San con-tains, among other ingredients, Atractylodes (Bai Zhu) andPoria (Fu Ling) to dry up Dampness and tonify Spleen Qi.It was decided that the goal was to wean Stretch slowly offof the Prednisone; at this visit the Prednisone was decreasedfrom 5mg twice a day to 5mg once a day for one month.Denosyl (425mg) and Milk Thistle (300mg) were contin-ued. Stretch was placed on a home cooked diet of cool andneutral foods with Qi and Yin tonics. This included turkey,rabbit, duck, barley, celery and carrots.


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Stretch was evaluated one month later. The owners haddecreased the Prednisone as directed with no ill effect orregression of disease. His bloodwork showed improvementin liver parameters, though all remained significantly ele-vated with TBILI at 8.4mg/dL. The owners reported thathis appetite had been very good, his stools normal and novomiting had occurred. His weight had increased by 2pounds.

Stretch’s Shen was much brighter than his first visit and heactively greeted anyone he met. His tail (or nub) waswagging. The owners reported that though he continued tobe cool seeking, some of the panting had decreased as thePrednisone had been decreased. He continued to have a softcoat, dry footpads and a wet nasal planum. His tongueremained swollen and red; his gums and conjunctiva weremarkedly improved with just a slight yellow color to them.He continued to have sensitivities along BL-18/19/20/21.His pulses were slow and strong.

The jaundice had improved markedly and the heat signs hadstarted resolving; therefore, the Gallbladder Heat hadstarted to clear. The inappetance and diarrhea seen previ-ously have resolved, therefore, the Lower Jiao Dampnessand Spleen Qi Deficiency were resolving. Stretch was alsogaining weight—this also supported the resolution ofSpleen Qi Deficiency. The treatment plan for Stretch con-tinued to be to clear damp, smooth Liver Qi flow, and tonifySpleen Qi.

Treatment included dry needles at BL-18, BL-19, GB-34,LIV-3, LIV-13, Bai-hui, Shen-shu, and Shen-jiao. Aqua-puncture with Vitamin B-12 was done at BL-20, BL-21,ST-36 and LIV-13. Both the Xiao Yao San (2 grams twicea day) and the Liver Happy (1 gram twice a day) werecontinued. The owners were directed to decrease the Pred-nisone to 2.5mg once a day for 1 week, then 2.5mg everyother day for 1 week, then to discontinue. If they saw anynegative changes, they were advised to be in contact imme-diately. The Denosyl and Ursadiol were continued.

At the third TCVM visit, Stretch’s owners reported that hecontinued to improve. His weight had increased by 4pounds. Prednisone had been discontinued for two weekswith no negative repercussions His bloodwork showedcomplete resolution of all abnormal liver values and allliver function values were normal. The owners reportedthat his appetite continued to be very good, his stoolsnormal and no vomiting had occurred. Stretch’s Shen wasbright—in fact, so bright that he was hard to needle. Theowners reported that though he continued to be cool seek-ing, he was no longer panting in the house.

The resolved jaundice (both clinically and numerically)indicated the resolution of Gallbladder Heat and the Lower

Jiao Dampness. Stretch continued to be eating well,gaining weight and producing normal stools; thus, hisSpleen Qi Deficiency had also resolved. The treatmentplan for Stretch at this point was to maintain the currentherbal therapy for another month; if he continued to dowell, Stretch would then be weaned from the herbal thera-py. Also at this visit, a nutritionist formulated a formalrecipe to ensure that Stretch’s long-term, home-cooked dietwas nutritionally balanced.

ConclusionTCVM has three dominant patterns when diagnosing apatient displaying icterus: Liver Damp Heat (Yang Jaun-dice), Cold-Damp (Yin Jaundice) and Spleen Qi Deficiencywith Liver Qi Stagnation. 2,3,4 All of these patterns can beassociated with elevated hepatic enzymes and a decrease inhepatic function parameters, as well as a variety of otherclinical symptoms. Of course, as integrative practitioners,it is very important to evaluate the acute onset of jaundicewith proper diagnostics and treat hepatic emergencies assuch. As seen with Stretch, in the long-term managementof the icteric patient, pattern diagnosis through TCVM andsubsequent acupuncture, herbal and food therapy will aidin their recovery.

References1. Ettinger SJ, and Feldman EC, Textbook of Veterinary Internal Med-

icine, Seventh Edition. St. Louis: Saunders, 2010.2. Giovanni M, The Foundations of Chinese Medicine: A Comprehen-

sive Text for Acupuncturists and Herbalists. Philadelphia: Elsevier,2005.

3. Lu HC, Chinese Natural Cures: Traditional Methods for Remedyand Prevention. New York: Black Dog & Leventhal Publishers, Inc.,2005.

4. Xie H, and Preast V, Traditional Chinese Veterinary Medicine:Fundamental Principles. Reddick: Chi Institute Press, 2007.

5. Phelps K, and Hassed C, General Practice: The Integrative Ap-proach. Philadelphia: Elsevier, 2011.

6. Xie H, Chinese Veterinary Herbal Handbook 3rd Edition. Reddick:Jing Tang Publishing, 2012.

The Chi Institute is very proudof Chi graduate, Dr. RuthieCorbo! The readers of theSanta Maria Sun voted her forthe second year in a row for the2012 Best Alternative Healer ofthe Northern Santa BarbaraCounty. This is an amazing featas the pool included physicians, chiropractors, acupuncturists,naturopaths, nutritionists, veterinarians, herbologists, TCVMpractitioners, veterinary chiropractors, pharmacists, etc. “Thereaders could vote on any of those healers and they chose heras a veterinarian! Wow! It really says something about herhealing skills! Thanks Chi Institute for giving her thealternative medicine foundation to make this happen.” – RickCorbo, Dr. Corbo’s husband.

CHI GRADUATE SPOTLIGHT


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- By Skip Hightman DVM, DOM, CVA, CVCH, CVCT

After 19 years of practicingconventional veterinarymedicine, I becamefrustrated with challengingmedical cases that did notrespond to allopathicmedical treatments. Thepatients would respondonly so far, and I wasunable to accomplishcomplete wellness. I felt

that there had to be more that I could do to promotecomplete healing and a positive quality of life for ouranimal friends.

The first complicated case was “Sito” in 1994, aJacksonville Sheriff’s Office police canine who was shotin the line of duty. The fragmented bullet raked Sito’s lefteye and lacerated the surrounding orbital tissue. He wasinstantly blinded in the left eye. Surgery was successfulrepairing the periorbital tissue but his blindness in the lefteye persisted.”Sito” was treated by several veterinaryophthalmologists for a period of two and one-half months.Although the specialists used every conventional therapyavailable; their treatments did not alleviate the blindness.

It was during this time that I had started attendingacupuncture classes. I explained “Sito’s” history to myinstructor. He recommended a point selection with localand distal points: GB-1, BL-1, BL-2, LI-4, LU-7. Withhope and a positive mind “Sito” received the firstacupuncture treatment. Three days after the first treatment,a recheck on “Sito”’s eye revealed the cornea had cleared

two-thirds of the way from the lateral to the medial canthus!Examination further revealed a convergent strabismus ofthe left pupil. This was the first time in three months, thatthe pupil and iris could be visualized!

The second acupuncture treatment consisted of the samepoints plus GB-14, which should center the pupil to itscorrect anatomical position. The second recheck, three dayslater revealed the pupil in the normal anatomical position!

After three months of allopathic treatments with littleimprovement, acupuncture corrected “Sito”’s pupil andvision returned to his left eye in only 6 days. “Sito” wasreturned to his full police duties as a canine patrol dog.

This case defined to me on a deep personal level, thestrength of TCVM. Since that time, I have dedicated my lifeto further my knowledge to honor and help our animalfriends with Eastern medicine.

ChiFaculty Spotlight

Dr. Hightman is a 1975 Illinois CVMgraduate and has practiced TCVMsince 1994. He has lectured and beenan instructor for the Chi Institutesince 2007. He is also certified anduses chiropractic, Tui-na,homeopathy, allergy eliminationtreatment, and healing touch inconjunction with acupuncture,herbal medicine and nutritionaltherapy. Picture on the left shows hetreated a 14 year old lion, Mufasso,with Aqu-Acupuncture on GV-20 incombination with many other pointsto balance the entire body bothphysically and emotionally with theSpleen Yang Deficiency pattern.

Post-conference Tour in Barcelona, SpainEuroforum, Congress Palace in San Lorenzo Post-conference Tour in Madrid, Spain

Conference Location: San Lorenzo de El Escorial, Madrid, Spain Conference Date: Sep 12th - 15th, 2013Theme: TCVM for Oncology, Geriatrics and Quality of Life Hosted by: Chi Institute EuropePost Conference Luxury Tour in Spain: Barcelona, Madrid, Toledo, Aranjuez City Tour Date: Sep 16th - 23rd, 2013All-inclusive conference and tour service - registration fee covers: Transportation in Spain, accommodations (4-stars hotels),3 meals per day, conference and proceedings, tours and Tai-Ji etc.

Please visit Chi Institute Europe website http://www.mvtc.es for conference details.

Go to Spain with Dr. Xie in 2013 TCVM Annual Conference and Spain Tour

Dr. Hightman (left) teaches canineacupoints to a student in Chi S.A.Acupuncture Class wet lab.


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- By Kate Steinhacker, DVM, CVA, CVCH, CVTP,CVFT, Portland, ME

On Mar 5th, 2009, a 14-year-oldtortoise shell indoor-outdoor domes-tic short hair cat had presented ex-cessively vocal, somewhatinappetant, underweight with fullbody muscular atrophy, and tachy-cardic with a new III/VI left systolicheart murmur. Normally a fastidiousgroomer, the patient had ceased self-care. Bloodwork had been run [T4

5.1 ug/dL (0.8-4.0)], and a diagnosis of hyperthyroidismhad been made. She had been started on methimazole 2.5mg BID for the first month, with an increase to 5.0 mg BIDfor the past 2 months.

Physical Examination: BAR, yowling loudly throughoutPE. HR 200, RR 30, III/VI left systolic murmur. Good bodycondition, shedding prolifically. The tongue was red, andpulses were rapid and thin with a weaker pulse on the leftside. Pinnae, back, and paws were warm to the touch.

Assessment: The patient was hyperthyroid, tactile-defen-sive, tachycardic with a persistent left systolic heart mur-mur, and shedding excessively. Weight and body conditionhad improved since initial diagnosis. Ddx included un-masked kidney disease, uncontrolled hyperthyroidism, andother chronic disease processes, such as neoplasia. Natu-rally aloof, the cat was a Metal Constitution. Her redtongue, warm ears/back/paws, and thin rapid pulse with aweaker pulse on the left indicated a Kidney Yin Deficiency.Her excessive shedding was likely due to Kidney Qi Defi-ciency. Her increased vocalization reflected a Shen Distur-bance, due to a Heart Yin Deficiency.

Diagnostic Plan: CBC/Chemistry/T4/UA (via cystocente-sis).

Results: The patient was azotemic [BUN 42 mg/dL (14-36)creatinine 2.8 mg/dL (0.6-2.4)], iatrogenically hypothyroid[T4<0.2 ug/dL (0.8-4.0)], mildly immunosuppressed[WBC 3.2 X 103/uL (3.5-16.0), neutrophils 2016/uL(2500-8500), lymphocytes 768/uL (1200-8000)], and bor-derline isosthenuric [SG=1.016].

Treatment Plan: The patient’s dose of methimazole wasreduced to 2.5 mg BID, and she was started on Liu Wei DiHuang Wan, 1/8 tsp BID, with a gradual increase to a goaldose of ¼ tsp BID. The owner declined subcutaneous fluidtherapy and treatment with acupuncture.

Follow-up and Case Summary: The patient was main-tained on Liu Wei Di Huang Wan ¼ tsp BID for 2 ½ years.The owner provided regular email and phone updates. Thepatient was rechecked every 3-6 months, and her bloodwork was rechecked once a year. She maintained an activelifestyle, mostly good appetite, normal grooming habits, anormal sleeping schedule, and she had normal stools withno vomiting. Unfortunately she was attacked and killed bya neighborhood dog in Nov. 2011 at 16 ½ years of age. Shewas still very busy and energetic at the time of her death.

Discussion: Hyperthyroidism in cats can be described byfour different TCVM Diagnoses:

1. Stagnant Liver Qi with Stagnation of Blood andPhlegm. These patients are irritable, anxious, and de-pressed. They resent being touched on the cranial abdomen(hypochondriac region). Tongues are deep purplish redwith a thin white coating. Pulses are wiry and slippery.

2. Qi Deficiency. These patients are emaciated, lethargic,with vomiting and loose stools. Tongues are pale and wet.Pulses are deep and weak.

3. Yin Deficiency with Yang Floating. These patients areemaciated, irritable, restless, hyperactive, polyphagic, poly-dipsic, with vomiting and loose stool. Tongues are red anddry. Pulses are wiry, rapid, floating, and thin.

4. Qi and Yin Deficiency. These patients are emaciated,with waxing and waning appetites, variable stools, reducedgrooming behavior, dry dull haircoat, weak painful backand stifles, cool-seeking, depressed and irritable, and rest-less at night. Tongues are red and dry or pale to light purple,swollen, with a light white coating. Pulses are rapid,thready, weak, and deep.

This patient’s presentation contained many of the hallmarksof Qi and Yin Deficiency: she was thin, with rare, periodicepisodes of waxing/waning appetite and reduced self-carebehavior. She did not like to be picked up, which may havereflected discomfort and/or may have been in keeping withher Metal Constitution. She exhibited irritable behavior attimes. Her tongue was red, and her pulses were consistentlyrapid, and thin. This patient was treated with Liu Wei DiHuang Wan (Rehmannia 6).

Herbal Formula Used and Rationale: Liu Wei Di HuangWan was a good formula for this cat, because she neededthe Shu Di Huang (Rehmannia), Ze Xia (Alisma), and ShanZhu Yu (Cornus) to Nourish Kidney Yin and to reduce FalseHeat in the body. Shan Zhu Yu (Cornus) and Shan Yao(Dioscorea) helped to Tonify Qi. The Fu Ling (Poria) wasgood for her appetite and GI function, and the Mu Dan Pi(Moutan) helped balance her emotions by Resolving Stag-nation.


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Ingredients and Actions of Liu Wei Di Huang Wan (Rehmannia 6)Shu Di Huang (Rehmannia) Nourish Kidney and Liver Yin, Nourish BloodShan Zhu Yu (Cornus) Nourish Kidney and Liver Yin, Tonify Blood and QiShan Yao (Dioscorea) Tonify Yang and Qi, Nourish Kidney JingZe Xia (Alisma) Drain Damp, Clear Kidney False FireFu Ling (Poria) Drain Damp, Strengthen SpleenMu Dan Pi (Moutan) Cool Blood, Resolve Stagnation, Cool Liver

References1 Lecture Notes, TCVM Clinical Approach: Renal/Geriatric/Urinary/Reproductive Disorders/Herbology, Dec 4-7, 2008.2 Lecture Notes, TCVM Clinical Approach: Liver/Endocrinology Disorders/Herbology, February 26-March 1, 2009.3 Xie, Huisheng. Chinese Veterinary Herbal Handbook, 2nd Edition, 2008 by the Author.4 Xie, Huisheng. Preast, Vanessa. Xie’s Chinese Veterinary Herbology, 2010, Blackwell Publishing, Ames, Iowa.

100-0.5g Capsules1 to 2 months supply for a dog

180g Powder (3gx60 bags)One month supply for a horse

90g Powder (3gx30 bags)Half month supply for a horse

Or 2 months supply for large dogs

Each FormulaAvailable In

50-0.25g Capsules1 to 2 months supply for a cat

or a small dog

3 Oz Biscuits (60 ct)*1/2 to 2 months supply for a dog

Available Sizes Application General Dosage (concentrated formulas allow lower volume per dose)

3g x 30 Bags Powder

3g x 60 Bags Powder

Large Animals

or Dogs

For Horse: 3 g (1 bag)twice daily as topdressing on feed

For Dog/Cat: 0.1-0.2g per 10 lb body weight BID10 lbs: 1/16 bag BID 20 lbs: 1/8 bag BID40 lbs: 1/4 bag BID 80 lbs: 1/2 bag BID

100-0.5g Capsules Dogs 1 capsule per 20-40 lbs of body weight BID50-0.25g Capsules Cats 1 capsule once a day for cat or small dog3 Oz Biscuits Dogs 1 biscuit per 20 lbs body weight BID

www.tcvmherbal.com (800) 891-1986 [email protected]

Distributed through veterinarians only

* Concentrated Tendon Ligament Biscuits 3 Oz is not available until 2013.


10

k- By Antonio Alfaro DVM, CVA, CVTP, Costa Rica

A six week old Arabian filly injuredherself while the handlers were takingher to the pasture and putting on thehalter. She struggled with them and felldown sideways, fighting tremendouslyto get up in several attempts, while thehandlers were holding her by the halter.The halter generated enough bruisinginto the nasal and facial crest skin area

that it generated a compressive-tearing lesion over the tractof the facial nerve on the left side. Western Examinationshowed a mouth deviation towards the right side, withpartial inability to close the left eye, saliva drooling fromthe mouth mostly on the left side and lower lip ptosis. Thedeviation was really noticeable as can be seen on Fig. 1.Local sensitivity was diminished but it was tender over asmall raised area that could be felt immediately below theleft facial crest and skin bruising over the nasal and facialcrest area (Fig.1).

Pulse is fast and superficial and the tongue has a normalpeach color, slightly purplish. She is playful, happy butdifficult to handle and when she gets tired of acupuncturetreatment. I was able to insert needles and perform 20 to30 minutes of EA treatment on a weekly basis. FacialParalysis in this case was caused by trauma; this blocksthe free flow of Qi and Blood: the TCVM diagnosis is QiDeficiency with local Qi-Blood Stagnation.

Tui-na was given on the first session to nourish Qi andBlood, activate the channels and relieve stagnation.

Mo-fa was given to first ask permission, on the neckfollowing the ST and LI channels and over the SI, toremove stagnation at the same time.Moo-fa was then given over the frontal and supraorbitalareas and Da-feng-men, to calm the Shen and to benefitthe eye.Ca-fa was given on the affected cheek until warm, andalso behind the poll area at GB-20, TH-17 area.

Nie-fa was then given over the affected cheek area andmandible to invigorate Qi.Rou-fa and Tui-fa were then introduced over the smallraised area below the facial crest to dispel stagnationusing Relief Salve.Yi-zhi-chan was then applied to ST-6 bilateral, ST-7,ST-5, ST-36, LI-18, 17, 16 and SI-19.

Ban-fa was accomplished by opening the mouth andstimulate chewing by placing fingers on the labialcommissure.Mo-fa, Ca-fa, Moo-fa and Nie-fa were given on dailybasis for 10 minutes by owner and handler. Rou-fa,Tui-fa; Yi-zhi-chan and Ban-fa were applied by us everyweek for 9 weeks.

Fig 1. Filly before treatment Fig 2. Moo-fa 6th session.

The main channels involved were ST, LI and SI. 9 weeklyacupuncture treatments were given. Improvement was seenafter the 6th session (Fig.2) and the points used were: Dry Needle at ST-2 towards SI-18 affected side. EA: GV-26 to LI-18, CV-24 to LI-17, ST-4 to ST-7,

ST-5 to ST-10 same side, and ST-6 to ST-6. EA was setat 40 Hz for 10 minutes and a Dense/Disperse mode at40/120 Hz for 10 to 20 minutes.

Herbal formula Facial P Formula by Jing Tang Herbal wasadded to the treatment for 3 months.

This filly is valued at a high pricesince she has an Endurance racingpotential. Her deformity was ofgreat concern to the owners sinceher price had dropped considerably.As seen in Fig. 3, she does not lookas a filly that just recently had afacial paralysis. Tui-na wasimportant because the handlerscould do it, assuring the greatoutcome of this TCVM strategy.

By restoring normal circulation of Qi and Blood, channelscan be unblocked and the body can heal faster. Tui-natechniques accomplish that, assuring a better outcome andgreater satisfaction for the TCVM practitioner, who seesmuch better results than when using one branch of TCVMalone. Owners and handlers become more aware of thegreat results when looking at before/after pictures,becoming themselves promoters of TCVM practice. In thiscase, Tui-na showed its remarkable therapeutic effect in, forso many times, a neurological disorder difficult for westernapproaches.

Fig 3. Great recoveryat 9th session


11

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The front of each herb card shows a full colorbotanical picture and a full color photo of eachherb and part used, the Chinese (mandarin)character, Chinese Pin-yin name, Latin name, original reference and aclassical formula that uses this herb. The back of each card shows the herb properties (tastes,temperature, etc.) and Channel-entered symbols, actions, dosage for different animals, cautionsand contraindications, and side effects. To see the master index, category list and first 12 flashcards, please visit http://www.tcvm.com/herbcards.

Published by Chi Institute PressPrice: $99. To order, please visit www.tcvmherbal.com (save 5%), email [email protected] or call 800-891-1986.


12

Kidney/Geriatric/Urinary/Reproductive Module

$300 Chi/JT Gift Certificate*for Registrations by Nov. 6, 2012 26 Individual Herbs

Taught by Dr. Xie

Seeking TCVM approaches for Kidney Diseases, Geriatric Patients and Sports Medicine?

Find your answers in this Kidney Module 24 Hrs Lectures and 5 Hrs WetLab Demo by Drs. Xie, Perkins,Clemmons and Pasteur

Herbal Sample Kit & Handout Homework Assignment Email Mentorship Eligible for the Diploma ofCertified Veterinary ChineseHerbologist (CVCH)

28 C.E. Hours by Most States $300 Gift Certificate* forregistrations by Nov. 6, 2012

* Tuition for this class starts from $650. The giftcertificate is good only for the tuition of futureclass offered by the Chi Institute of ChineseMedicine (Reddick, FL) or orders at Dr. Xie’sJing Tang Herbal. This offer can not becombined with any other special offers ordiscount.

Kidney Module Herbal Sample Kit(26 single herbs) for students

Lecture 1-3 and Blood Tonic Herbs and Formulas

Lecture 4-6 Tonic Herbs and Formulas

Lecture 7 Kidney Physiology and Kidney Pathology

Lecture 8 How to Treat Renal Failure

Lecture 9-10 How to Treat and Syndrome

Lecture 11 How to Treat IVDD

Lecture 12 TCVM Geriatric Medicine

Lecture 13-14 How to Treat Equine Lameness

Lecture 15-16 How to Promote Performance and TreatInfertility/Inflammatory Genital Diseases

Lecture 17-20 How to Treat Pediatric Diseases, KidneyDeficiency, Ear Problems

Lecture 21 How to Treat Syndrome and BladderInfections

Lecture 22-24 Canine Sports MedicineWet Lab Demo: Small Animal Real Case Study (4 cases)

Wet Lab Demo: Equine Real Case Study (3 cases)

(On-site Class: Dec 6-9,2012; On-line Class: Dec 17,2012 - Mar 17,2013)

For more info, visit www.tcvm.com,email [email protected] or call 800-891-1986.

Serving Veterinarians Exclusively Since 1999800-891-1986 www.tcvmherbal.com [email protected]

Canine Wet-lab Demo by Dr. Perkins

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