Page 205 - WSAVA2018
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R. Koh1
1Veterinary Teaching Hospital, Louisiana State University School of Veterinary Medicine, Baton Rouge, USA
2Veterinary Medical Center, University of Florida College of Veterinary Medicine, Gainesville, USA
Intervertebral disc disease (IVDD) is commonly seen in dogs in veterinary practice. The clinical signs of IVDD are back or neck pain, trouble walking, lameness, trouble urinating, paresis and/or paralysis. The most common types of thoracolumbar IVDD, are caused by herniation of the nucleus pulposus into the spinal canal (Hansen’s Type I), and protrusion of the intervertebral disc into
the spinal canal, with the dorsal annulus still coving
the disc material (Hansen’s Type II). Acupuncture and rehabilitation can be effective at returning to dogs to an ambulatory state, and return of normal function, when used alone or in combination with Western medicine and surgery, for both types of IVDD. Several studies have shown promising effects of using electroacupuncture at treating IVDD in dogs and rat models. This presentation explains the Traditional Chinese Veterinary Medicine (TCVM) etiology and effective treatment modalities, which include physical rehabilitation used in IVDD cases.
TCVM Etiology and Pathophysiology in IVDD
The nervous system is related to the Kidney (bones and spinal cord), the Liver (joints and smooth flow of
Qi and blood), and the Spleen (muscle strength). IVDD are often also considered as a Bi syndrome and are usually accompanied by a Wei (weakness) syndrome. There are 2 Excess Patterns and 3 Deficiency Patterns that are associated with various forms of IVDD. The Excess conditions are invasion of WindColdDamp and QiBlood stagnation, which are often associated with acute trauma in chondrodystrophic dogs (Type I). The Deficiency Patterns, often associated with chronic, Type II IVDD in nonchondrodystrophic breeds, include Qi/ Yang Deficiency, Yin Deficiency and combined YinQi Deficiency (Table 1).1
TCVM Treatment for IVDD
1) Acupuncture: Acupuncture has been proven to be an
effective therapy for IVDD.2-8
A general acupuncture treatment plan for a patient with IVDD is as follows:
a) Dry needle: GV-20, Liu-feng, BL-60, KID-3, SP-10, LIV-3, BL-40, ST-41, GV-1
b) Electro-acupuncture: (20-40 Hz for 10 minutes, 80-120 Hz for 10 minutes, 200 Hz for 10 minutes) at the following pairs of acupoints:
• GV-14 to Bai-hui or GV-1
• Left BL-11 to right Shen-shu
• Right BL-11 to left Shen-shu
• Hua-tuo-jia-ji at or proximal and distal to the suspected or diagnosed disc space, bilateral
• ST-36 to GB-34, or ST-36/GB-34 bilateral
• KID-1 to BL point proximal to IVDD lesion, or KID-1/ Liu-feng, bilateral
c) Aqua-acupuncture (Vitamin B12) at Hua-tuo-jia-ji at or proximal and distal to the suspected or diagnosed disc space, KID-1, BL-40, LIV-3, LI-4, Liu-feng
d) Hemo-acupunture: use acupuncture needle or 24G hypodermic needle to puncture Jing-well points on the affected limbs and Wei-jian acupoint and get a few drops of blood.
2) Scalp Acupuncture:
a) Motor area: A line starts at GV-22 and extends cranial
and ventral to TH-23 on the lateral eyebrow
• GV-22: In the small triangular area formed by the ridges of the frontal crest
• TH-23: In the depression on the rim of the orbit at the end of the eyebrow were it extended to the lateral canthus
b) Sensory area: Starts at GV 20 and extends cranial and ventral to Nao-shu
• GV-20: On dorsal midline on a line drawn from the tips of the ears level with the ear canals
• Nao-shu: Over the temporalis muscles 1⁄3 the way along a line from the cranial ear base to the lateral canthus
c) Long insertion methods: use 32-38G acupuncture needle (1⁄2” for small dogs and cats; 1” for big dogs) to penetrated subcutaneously the entire motor line (from GV-22 through TH-23) and sensory line (from GV-20 through Nao-shu). Rotate, lift and thrust, or EA the needles every 2-3 minutes.
3) Herbal Medicine: General herbal dosage for dogs is 0.5 g per 10-20 lb body weight BID for 2 to 4 months, and then as needed. (Table 1).
a) Da Huo Luo Dan or Double P II (Da Hua Luo Dan modification) is the primary herbal medicine used to treat IVDD. It may cause loose stool in some cases. It can be used as long as the gut is able to tolerate it. Do not give if patient is sensitive to herbal medications or is prone to diarrhea.
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