Traditional Chinese veterinary medicine: A primer (Proceedings)

What is Traditional Chinese Veterinary Medicine (TCVM)?

• Complete system of medicine

o Prevent, diagnose, and treat disease

• Utilized over several thousands of years

o Shang Dynasty (1600-1100 B.C.)

– Diseases of animals inscribed on bone

o Written herbal documents over 3000 years old

– 1066-221 B.C.

– Early recordings of botanical and animal medicinal substances

– Case studies and toxicity

TCVM

• Entire body assessed

o Physical, mental, emotional, spiritual

o Body and the environment

• Health = Harmony and Balance

o Promotion & maintenance of optimum health

• Disease = Imbalance

o Cure disease

o Slow the progression of disease

o Improve quality of life

Five Branches of TCVM

• Acupuncture

• Chinese Herbal Medicine

• Tui-na

• Food Therapy

• Qi-Gong, Tai-Chi

• Synergism between branches

o Improved response to treatment

Fundamentals of TCM

• Eight Principles

• Zang Fu Organs

• Five Treasures

• Five Elements

• Six Pathogens

• Meridians

Eight Principles

• Yin & Yang

• Excess & Deficiency

• Internal & External

• Hot & Cold

Zang Fu Organs

• 12 Zang Fu organs (internal organs)

o Husband and wife pairs

o 6 Zang organs (Yin, female)

– Solid structures

– Lung, Spleen, Heart, Kidney, Pericardium, Liver

• 6 Fu organs (Yang, male)

o Tubular or hollow

o Large Intestine, Stomach, Small Intestine,

o Urinary Bladder, Triple Heater, Gall Bladder

Five Treasures

• Essential fundamental substances

• Support and control life

o Responsible for the physiological activities of the Zang Fu organs and the entire body

• Five Treasures:

o Qi

o Shen

o Jing

o Blood

o Body Fluid

Qi

• ~Energy

• "Qi gives birth to human beings; where Qi exists there is life, but the absence of Qi is death."

• - Ancient Chinese philosopher, Zhuang Zi (286 BC)

• Over 32 types recognized in literature over the past 2500 years

o Different manifestations of one true Qi

• Affects the mind and body

Shen

• "Spirit" or Mind

• Rules the mind and the entire body

• Healthy Shen = Peace of Mind

• Shen Disturbance = Behavioral issues

o E.g, aggression, anxiety, abnormal behavior

Jing

• Essence

• Basis of growth, development, sexuality and reproduction

• Prenatal Jing

o Congenital

o Inherited from parents

• Postnatal Jing

o Acquired

o Extracted from food

o Can supply supplemental energy

Blood

• Nourishes and moistens the body

• Carries Qi

• "Blood is the Mother of Qi and Qi is the

• Commander of Blood"

Body Fluid

• All the normal fluids in the body

o Tears, urine, joint fluid, nasal discharge, saliva, sweat, gastric juice, etc.

Five Elements

• Wood

• Fire

• Earth

• Metal

• Water

Six Pathogenic Factors

• Six climatic changes in nature

o Wind, cold, summer-heat, damp, dryness, fire (heat)

o Do not cause pathological changes in the body under normal conditions

– "Six types of Qi" in the natural environment

o Cause disease when there are sudden or extreme changes AND the body's resistance fails

– "Excessive Qi"

• Usually invade the body from the exterior

o Via skin, mouth, nose

• Can affect the body alone or in combination

Wind

• Predominant in Spring

o However, can occur any time of the year

• Often the primary pathogen that provides other pathogens access to the body

• Affects upward and outward parts of body

• Rapid changes and fluctuations in condition

Cold

• Predominant Qi of winter

o Can occur during other seasons as well

• Prolonged exposure to a cold environment can lead to invasion of cold

o Especially after sweating

o Soaked from the rain

• Can affect Yin-Yang balance of the body

o Temperature regulation

o Metabolism

• Promotes stagnation (pain)

• Contraction/closure of body structures

o Function is impaired

Summer-heat

• Only occurs in summer

• Extreme heat

o Heat stroke

• Tends to move upwards affecting the higher levels of the body

o Pores open ◊ profuse sweating ◊ consume Body fluids and Qi

o Can affect the mind: shaking, ataxia, coma

• Often combines with Damp (high humidity)

o Fever, diarrhea, poor appetite, lethargy

Damp

• Predominant Qi of late summer

o Time between summer and fall in China is hot and rainy, with abundant dampness

• Viscous

o Think primordial ooze

• Wet and Heavy

o Clings to the body and hinders Yang activity

o Slowly erodes strength

Dryness

• Predominant Qi of Autumn

• Can occur other times of the year if the area's climate is dry year-round (e.g., Arizona)

• Body fluid is consumed (like the desert)

o Dry mouth, nose, throat, lungs

o Dry feces/constipation, skin/haircoat

o Decreased urination

• Can lead to secondary Blood deficiency

Fire (heat)

• Often occurs in summer

o Seen in other seasons as well

• Fire and heat vary in degree but have the same properties

o Fire = extreme heat

o Heat = mild fire

• Moves upwards like flames of a fire

• Burns both inside and outside of the body

• Evaporates fluids and damages tissues

o Think sunburn

Meridians

• Meridians or Channels are pathways where Qi (energy) and Blood circulate

o Continual energy flow on all the meridians, from one acupuncture point to another

• Extend over the outside of the body

• Refer to and connect all of the tissues and organs

What is Acupuncture?

• Insertion of needles

o Specific points on the body (acupoints)

o Cause a desired healing effect

• Greek: acus = needle pungare = to pierce

• Most utilized and accepted branch of Traditional Chinese Medicine (TCM)

• The 2002 National Health Interview Survey

o 8.2 million American adults had utilized acupuncture.

– National Center for Complementary and Alternative Medicine (NCCAM)

– component of the National Institutes of Heath

– National Center for Health Statistics

– part of the Centers for Disease Control and Prevention

Stimulating Methods

• Dry needle

• Electroacupuncture

• Aquapuncture

• Hemoacupuncture

• Pneumoacupuncture

• Implantation

• Moxibustion

• Laser

Chinese Herbal Medicine

• Formulas vs. single herbs

o 1-20 different components

o Most disease conditions are complex and require multiple herbs

o Proper combining of herbs reduces noxious impact

– Aconite Fu Zi and Licorice Gan Cao

o Achieve maximum benefit with minimal side effects

– Large dosage of a single herb increases potential for side effects and adverse reactions

o Can be used for relatively long periods of time with minimal to no adverse side effects when used correctly

• Misnomer?

o Plant products (over 80%)

– Chinese Ginseng Ren Shen

o Living or dead tissue

– Insects, e.g. Scorpion Quan Xie

– Reptiles, Gecko Ge Jie

– Venom, Bufo toad venom, Chan Su

– Shell, e.g. Abalone shell Shi Jue Ming

– Mammals, e.g., Chicken gizzard lining Ji Nei Jin

o Minerals

– E.g., Gypsum fibrosum Shi Gao

TCVM Food Therapy

• "...diet is such an important part of our daily life that, unless one's diet is well adjusted, no amount of herbs, acupuncture, or other medicines or treatments can achieve a complete and lasting cure." -Bob Flaws, 1998, The Tao of Healthy Eating. Reknown TCM practitioner and author

What is Chinese Food Therapy?

• Art and science combined to treat an individual on a daily basis using food

o Treatment & prevention of disease

o Promotion of better health

• Selection of foods/herbs based on

o Energetics of food/herbs

o Species +/- breed

o Food preferences/aversions

o Current disharmony

o Geographical location

TCVM Food Therapy

• TCM Food Therapy is based upon two fundamental principles

o Food Energetics

– The effect food has on digestive, metabolic, and physiologic processes

– Xing or Thermal Nature

– Five Energies – Hot, Warm, Cool, Cold, Neutral

– Five Tastes – Sour, Bitter, Sweet, Pungent, Salty

o Pattern Differentiation (Bian Zheng)

– Eight Principles

– Zang-Fu Organs

Five Energies

• Hot/Warm Foods

o Action: Tonify Yang Qi and activate channels

o Indications: Coldness, aversion to cold

o Examples:

– Lamb, venison, chicken, shrimp, trout

– Oatmeal, sweet potato

– Chestnuts, garlic, squash, cherry, raspberry

• Cool/Cold Foods

o Action: Clear heat, drain fire, cool blood

o Indications: Heat pattern. Anxiety, flushed face.

o Examples:

– Turkey, deep ocean fish, duck, rabbit (farm raised), crab, tofu

– Millet, barley, brown rice

– Celery, spinach, broccoli, mushroom, kelp, watermelon, banana, pear, orange

• Neutral

o Action: General Qi or Blood tonic

o Indications: Any condition

o Examples:

– Pork, beef, rabbit (wild), salmon, sardines, chicken eggs

– Buckwheat, corn, white rice, black beans

– Yam, carrot, asparagus, apple

• Five Elements, Five Flavors

o Wood = Sour = more Yin

o Fire = Bitter = more Yin

o Earth = Sweet = more Yang

o Metal = Pungent = more Yang

o Water = Salty = more Yin

• Extra Flavor

o Bland

Bian Zheng: Pattern Differentiation

Eight Principles

• Yin

• Yang

• Interior

• Exterior

• Deficiency

• Excess

• Cold

• Hot

Zang Fu Organs

• Heart/Small Intestine

• Spleen/Stomach

• Lung/Large Intestine

• Kidney/Bladder

• Liver/Gall Bladder

TCVM Examination

• Clinical History

• Physical Examination

• Tongue

• Pulse

• Temperature

• Standard Western minimum database recommended

o Blood work

o Urinalysis

o Rationale:

– Uncover hidden or buried issues

– Aid in directing treatment

o +/- Other diagnostics

– E.g., Radiographs, ultrasound, EKG, MRI, CT, etc.

TCVM Treatment

• Western medical diagnosis is not necessarily required

• Treatment plan is created for each individual

• Patterns of disharmonies vs. specific diseases

o Multiple patterns associated with each syndrome which require a different treatment

• Two animals with the same Western diagnosis often have completely different TCVM treatment regimens

• Western: Arthritis, Degenerative Joint Disease (DJD)

o All patients treated the same way

• TCVM: Bi Syndrome

o Painful Bi: acute, worse with cold

o Fixed Bi: sub-acute, stiffness>pain, worse with cold/damp

o Bony Bi: 2 types

– Chronic, worse with cold or damp

– Chronic, worse with heat or dryness

Clinical Applications of TCVM Including, but not limited to

• Behavior

• Cancer

• Dermatology

• Internal Medicine

• Musculoskeletal

• Neurologic

• Pain Management

• Quality of Life

• Reproduction

Integrative Case Management

• IVDD: Giorgio, 4yo MN Doxie

o Previous history of disk disease

– Several episodes of ataxia, pain

– Fully responsive to Western meds

o Presented with acute onset of paraparesis and pain

– Western DVM ◊Robaxin and steroids

– Partially responsive (remained paraparetic)

o Acupuncture, Chinese herbal medication

– Ambulation improved after first treatment of acupuncture

– Normal ambulation after 5 treatments of acupuncture

• Cancer: Lucy, 10yo FS Chihuahua

o Diagnosed with nasal adenocarcinoma

– CTX and RTX not viable options

– Treated with NSAIDs for pain

– Prognosis: 2 months

o Presented with large swelling at right muzzle, bloody nasal discharge

o Treated with acupuncture, oral Chinese herbal medication, topical Chinese herbal medication, oral NSAIDs

– Improved quality of life

– Lived 15 months after initial diagnosis

• Geriatric: Reva, 13yo FS GSD

• Lifelong hind end weakness

o Poor conformation

o Used to run hills, 4-6 miles/day

o Partial CCL rupture (bilateral)

– Cancer-TL toe #3 removed

– Mild ataxia and dragging hind feet

– Worse over past 2 years

• Western treatment?

• Acupuncture, Chinese herbs, physical therapy, chiropractic

• estern vs. Eastern

o Western medicine is the initial modality of choice for some conditions followed by TCVM

o Integration of TCVM and Western medicine often yields the best outcome

"The most beautiful thing we can experience is the mysterious. It is the source of all true art and science." - Albert Einstein