TCVM for RAO in Horses

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Learn how acupuncture and Chinese herbal medicine can effectively treat recurrent airway obstruction in equines.

Recurrent airway obstruction (RAO) is one of the most common pathologies leading to respiratory diseases in horses.1 Conventional Western therapy requires both long-term medication and an adjustment of the stable environment to remove the likely inciting cause.2 Clinical studies indicate that acupuncture and Chinese herbal medicine are useful in controlling the clinical signs of heaves, dyspnea and cough in horses.3-6 This article reviews how to use acupuncture and herbal medicine to treat RAO in horses.

Evidence-based studies

Tai, et al, demonstrated that electro-acupuncture (EA) at acupoints LU-1 and CV-22 significantly increased the rate of tracheal mucociliary transport in quails when compared to a control group. EA at these acupoints significantly reversed the decrease in mucociliary transport caused by the administration of human neutrophil-derived elastase.7 The analgesic and anti-inflammatory effects of acupuncture (AC) and EA are well recognized in both somatic and visceral tissues.8,9 Major acupoints indicated for these purposes include LI-4, LI-10 and ST-36.8,10,11 EA reduced inflammatory cell infiltration in the peribronchial tissue and in the pulmonary perivascular spaces.12

AC at LI-11, GV-14, ST-36 and SP-10 in healthy human volunteers reduces circulating leukocytes and lymphocytes without affecting the level of circulating corticosteroid.13 Another study demonstrated that EA at LI-4 and LU-6 normalizes the patterns of leukocytes in granulocytosis/ lymphocytopenia and granulocytopenia/lymphocytosis.14 EA at ST-36 corrects the spleen NK cell activity suppression induced by a lesion at the anterior hypothalamus.15 Several studies suggest that acupuncture treatments normalize the population of circulating leukocytes. Besides this, acupuncture stimulation at ST-36 has been demonstrated to increase phagocytic activity of rat peritoneal macrophages and to attenuate TNF-a release in vitro.16 The suppression of activated macrophage TNF-a production by EA can be partly antagonized by naloxone, the opioid antagonist.17 EA at LI-11 significantly increases the respiratory burst of peripheral-circulating neutrophils.18 Neutrophils possess a highly phagocytic activity and are capable of eliminating pathogens. This innate immunological activity is an important primary immune response in both peripheral circulation and local tissues. A clinical study of human asthma found that acupuncture stimulation at LU-7, LI-4, PC-6, ST-40, LI-11 and PC-3 for 15 minutes induces bronchodilation manifested by an increase in forced expiratory volume in the first second (FEV1).19

A total of 60 patients with acute upper respiratory tract infection were randomly divided into group A (n=30) and group B (n=30). Each patient in Group A received granules of the newly developed herbal medicine Chaige Qingre, while each patient in Group B received Fufang Shuanghua granules. The patients in each group took their assigned formula 30 minutes before a meal, 6 g four times daily for three consecutive days. After three days of herbal treatment, the overall response rates of Chaige Qingre and Fufang Shuanghua were 93.10% and 96.55% respectively.20

TCVM pattern differentiation and treatment

In Traditional Chinese Veterinary Medicine (TCVM), the Lung dominates Qi, and respiration regulates the water pathway and controls the body surface. The pathological changes of the Lung affect the physiological activities leading to respiratory disorders. Main clinical signs include cough, asthma, dyspnea, nasal discharge or congestion; these are considered TCVM Lung pathogenic changes. The most commonly seen patterns of respiratory disorders include Wind-Cold, Wind-Heat, Lung Heat, Damp-Phlegm, Lung Yin Deficiency, Lung Qi Deficiency, Lung Qi+Yin Deficiency, and Kidney+Lung Qi Deficiency (see table below). 

Pattern Type

Clinical Signs

Acupuncture point/herbal medicine



• Allergic heaves, worse in summer

• Cool-seeking, tongue red and dry

•  Pulse: strong and fast

GB-20, LU-5/10/11, BL-10/13, GV-14, LI- 1/4/11, CV-22, Ding-chuan

Schisandra 5

Lung Yin


• Chronic heaves/asthma, emaciation

• Dry and thick nasal discharge

• Dry cough, cool-seeking, dry skin

• Tongue: red/dry

• Pulse: thready/rapid

LU-7/9, SP-6/9, KID-3, BL-13/42,CV-22, Ding-chuan, Fei-men, Fei-pan 

Lily Combination

Lung Qi


• Chronic heaves/asthma

• Dyspnea worse when moving

• Weak voice, fatigue

• Tongue: pale/wet

• Pulse: deep/weak

CV-17, ST-36, SP-6/9, ST-40, BL-13, LU-7/9, LU-8, CV-22, Ding-chuan Bu Fei San

Kidney & Lung Qi


• Prolonged course of asthma

• Feeble asthma with weak respiration

• Exercise intolerance, loss of breath

• Worse asthma when moving

• Obvious heaves/asthma groove

• Tongue: pale

• Pulse: deep/weak

Shen-Shu, Shen-peng, Shen-jiao, BL-13/26, CV-17, ST-36,LU-7/8/9, CV-22, Ding-chuan Breathe Easier B

Acupuncture points based on clinical signs3-6

Nasal congestion or/and discharge: LI-4, LI-11, LU-9, LI-20, Bi-tong, Long-hui

Cough: LU-1, LU-6, LU-7, LU-9, CV-17, CV-22, BL-12, BL-13, BL-42, Ding-chuan

Heaves: LU-1, LU-7, CV-17, CV-22, BL-13, BL-23, BL-26, Ding-chuan, Fei-men, Fei-pan



Top herbal medicine for RAO in horses

Four major herbal formulas commonly used to treat chronic respiratory diseases in horses are Wei Wu Zi 5 (Schisandra 5), Bai He Gu Jin (Lily Combination), Bu Fei San, and Ren Shen Ge Jie (Breathe Easier B).21

  1. Schisandra 5 is the most recently developed formula. Its TCVM indications include heaves, heat-associated allergy, and general allergies.
  2. Lily Combination is modified from the classical antecedent Bai He Gu Jin Tang from Yi Fang Ji Jie written by Wang Ang in 1682.21 The TCVM indications for Lily Combination include dry cough without phlegm, cough due to Lung/ Kidney Yin deficiency, red tongue without coating, and fast thin pulse. Indications for its use in conventional veterinary medicine include dry cough, chronic bronchitis, and recurrent airway obstruction (RAO).
  3. Bu Fei San is modified from the classical antecedent Bu Fei Tang from Yong Lei Qian Fang (Everlasting Categorization of Seal Formulas), written by Li Zhong Nan in 1331.21 Its TCVM indication includes Lung Qi deficiency, shortness of breath, chronic cough or asthma, pale wet tongue, deep weak pulses, and exercise intolerance. Chronic cough and/or asthma are indications for its use in conventional veterinary medicine.
  4. Breathe Easier B is modified from the classical antecedent Ren Shen Ge Jie San from Yuan Heng Liao Ma Ji (Yuan Heng’s Therapeutic Treatise of Horses), written by Yuan Heng in 1608.21 Its TCVM indications include dyspnea/asthma/ cough due to Lung/Kidney Qi deficiency, pale and swollen tongue, and weak, deep pulse. Contemporary veterinary medicine indications include RAO and dyspnea.

Concluding points

  • Acupuncture and herbal medicine are effective for the treatment of equine “heaves” or recurrent airway obstruction.
  • Basic acupoints are GV-14, BL-13/42, 12/41, 23/52, Feimen, Fei-pan, Ding-chua, CV-22/17 and LU-1/7. Dry needle, aquapuncture, or electro-acupuncture can be used.
  • The basic herbal medicine is Ren Shen Ge Jie modifi cation (Breathe Easier B) which can be used for any bad heaves cases, especially with Kidney/Lung Qi Deficiency.
  1. Add Bai He Gu Jin (Lily Combination) for coughing horses (Lung Yin Deficiency/Phlegm), or
  2. Add Wu Wei Zi 5 (Schisandra 5) during summertime when horses are presented with Yin Deficiency and Heat.

Case Examples

Case #1

 Joe was a 15-year-old Arab gelding. He had been a 50-miles endurance riding horse, but was retired to pleasure riding due to worsening RAO, which had been diagnosed four years prior. He had an acute onset of coughing, high fever and severe heaves for two weeks. The two-week course of antibiotics helped control Joe’s body temperature, but the cough and heaves were getting worse. He was referred to TCVM on October 16, 2006.

On initial examination Joe’s body felt hot. His cough was loud and deep. His breath was superfi cial and labored with a respiratory rate of 45 per minute. He showed a cool-seeking behavior and stayed under a tree. His pulse was thin and fast, and his tongue was red and dry.

The TCVM pattern diagnosis was Lung Yin Deficiency with Heat. Treatment was as follows:

  • Dry needle: LU-7, LU-5, LI-11
  • Electro-acupuncture: at pairs of Fei-men + Fei-pan, Dingchuan + BL-13 and CV-22+LU-1 (20 Hz for 30 minutes).
  • Herbal medicine: Schisandra 5, 45 g twice daily by mouth, and Lily Combination, 30 g twice daily by mouth.
  • Food therapy: The Cold foods, including watermelon rind, cucumber, celery and barley, were recommended. Joe was not fed sweet feed, oats or corn.

At Joe’s second TCVM visit on October 30, his dyspnea was significantly improved, with a respiratory rate of 20 per minute. His body felt much cooler. He had no more coughing. His tongue was pink and his pulse was fast. The same TCVM treatments were given again.

Outcome: Joe did not show any dyspnea and had a respiratory rate of 15 per minute after three months of herbal medications and two more acupuncture sessions (on November 29 and January 17). He remained a pleasure riding horse until 2014 during which time his heaves were well controlled by the herbal meds and acupuncture (three to four sessions during the summertime). Since 2015, Joe has been a pasture horse and is now aged 25.

Case #2

Jan, a nine-year-old Thoroughbred stallion, presented with a three-year history of COPD. He was a pleasure riding horse (45 minutes twice a week). He appeared to wheeze during the summertime, and his heaves seemed to worsen over time. Jan wheezed so loudly that he could be heard outside the barn.

Upon examination, he looked strong and perspired normally, yet both front hooves were cracked and his eyes were red and dry. His urine was thick and stinky and he drank large amounts of water. His appetite and defecation were normal. No cough or lameness was noticed. His ears were warmer than normal and he blew hot air from the nostrils. Severe dyspnea was observed (both his nostrils moved very violently and fast). A “heaves line” was obvious on both sides. No sensitivity at Back Shu Association or Front Mu Alarm points was found. Jan’s tongue was red and dry, and his pulse was thready, weak and rapid.

The TCVM Diagnosis was Lung Heat with Yin Deficiency.

The following acupuncture treatments were given once a month for three sessions:

  • Dry needle: LU-11, LI-1, LI-4, LU-5, GV-14
  • Electro-acupuncture: Ding-chuan (bilateral) and BL-13 (bilateral)
  • Aquapuncture: vitamin B12 applied 5 cc per point at LU-5, LI-11, GV-14
  • Herbal medicine: Lily Combination, 15 g PO BID for three months (nourishes Lung Yin) and Schisandra 5, 15 g PO BID, for two months (clears Heat).

Outcome: The owner noticed Jan was breathing more comfortably about two weeks after the initial acupuncture treatment and daily herbal medication. He was breathing almost normally six weeks after the TCVM treatment, and his wheezing significantly decreased in the summer of 2000. The same treatment plan helped manage Jan’s heaves throughout the summers of 2001, 2002, 2003 and 2004. He was then retired and has been a pasture pet since 2005.

1Tangjitjaroen W, Xie H, Colahan P. “Possible mechanisms of acupuncture for the treatment of chronic inflammatory disorders of the equine lower airway”. American Journal of Traditional Chinese Veterinary Medicine. 4(2): 37-48, 2009.

2Leguillette R. “Recurrent airway obstruction — heaves”. Vet Clin North Am Equine Pract 2003;19:63-86, vi.

3Zheng, YC. “Acupuncture and Yin Qiao San for treatment of upper airway infectious diseases in horses”. Chi J of Trad Vet Sci. 2: 23, 1994. (In Chinese).

4Li, ZW, Li ZQ. “Acupuncture and Chinese Herbal Medicine for the treatment of influenza in horses”. Chi J of Trad Vet Sci. 3: 7, 1994. (In Chinese)

5Liu, YH. “The Traditional Chinese Veterinary Medicine for cough” in The Complete Works of Secret Recipe of Chinese Veterinary Medicine, C. Yu and L. Zhang (eds). Shanxi Science & Technology Press, Shanxi, China, 1992, p.230231. (In Chinese).

6Chen GJ. “The Traditional Chinese Veterinary Medicine for dyspnea in horses” in The Complete Works of Secret Recipe of Chinese Veterinary Medicine, C. Yu and L. Zhang (eds). Shanxi Science & Technology Press, Shanxi, China, 1992, p.226-227. (In Chinese).

7Tai S, Wang J, Sun F, et al. “Effect of needle puncture and electro-acupuncture on mucociliary clearance in anesthetized quails”. BMC Complement Altern Med 2006;6:4.

8Baek YH, Choi DY, Yang HI, et al. “Analgesic effect of electroacupuncture on inflammatory pain in the rat model of collagen-induced arthritis: mediation by cholinergic and serotonergic receptors”. Brain Res 2005;1057:181-185.

9Schneider A, Streitberger K, Joos S. “Acupuncture treatment in gastrointestinal diseases: a systematic review”. World J Gastroenterol 2007;13:3417-3424.

10Maenaka T, Tano K, Nakanishi S, et al. “Positron emission tomography analysis of the analgesic effects of acupuncture in rhesus monkeys”. Am J Chin Med 2006;34:787-801.

11Barlas P, Ting SL, Chesterton LS, et al. “Effects of intensity of electro-acupuncture upon experimental pain in healthy human volunteers: a randomized, double-blind, placebo-controlled study”. Pain 2006;122:81-89.

12Carneiro ER, Carneiro CR, Castro MA, et al. “Effect of electro-acupuncture on bronchial asthma induced by ovalbumin in rats”. J Altern Complement Med 2005;11:127-134.

13Kou W, Bell JD, Gareus I, et al. ”Repeated acupuncture treatment affects leukocyte circulation in healthy young male subjects: a randomized single-blind two-period crossover study”. Brain Behav Immun 2005;19:318-324.

14Mori H, Nishijo K, Kawamura H, et al. “Unique immunomodulation by electro-acupuncture in humans possibly via stimulation of the autonomic nervous system”. Neurosci Lett 2002;320:21-24.

15Hahm ET, Lee JJ, Lee WK, et al. “Electro-acupuncture enhancement of natural killer cell activity suppressed by anterior hypothalamic lesions in rats”. Neuroimmunomodulation 2004;11:268-272.

16Zhao R, Ma C, Tan L, et al. “The effect of acupuncture on the function of macrophages in rats of immunodepression”. Zhen Ci Yan Jiu 1994;19:66-68.

17Aoki E, Kasahara T, Hagiwara H, et al. “Electro-acupuncture and moxibustion influence the lipopolysaccharideinduced TNF-alpha production by macrophages”. In Vivo 2005;19:495-500.

18Karst M, Scheinichen D, Rueckert T, et al. “Effect of acupuncture on the neutrophil respiratory burst: a placebocontrolled single-blinded study”. Complement Ther Med 2003;11:4-10.

19Chu KA, Wu YC, Ting YM, et al. « Acupuncture therapy results in immediate bronchodilating effect in asthma patients”. J Chin Med Assoc 2007;70:265-268.

20Chang J, Zhang Y, Mao B, Wang L, Li TQ, Zhang RM. “A double-blind, randomized controlled trial of Chaige Qingre Granule in treating acute upper respiratory tract infection of windheat syndrome”. J Chin Integr Med/ Zhong Xi Yi Jie He Xue Bao. 2007;5(2):141-146.

21Ma A. Clinical Manual of Chinese Veterinary Herbal Medicine. Ancient Art Press, 2016. p 60-70, 272-280.

Dr. Huisheng Xie is a clinical associate professor of the Integrative Medicine Service at the College of Veterinary Medicine, University of Florida; and founder and president of the Chi Institute of Chinese Medicine, where over 3,000 licensed veterinarians have studied acupuncture, herbal medicine, and other TCVM disciplines since 1998. He has lectured around the world on veterinary acupuncture and herbal medicine. Dr. Xie has authored 12 books. His textbooks, including Xie’s Veterinary Acupuncture, Xie’s Veterinary Chinese Herbology and Traditional Chinese Veterinary Medicine: Fundamental Principles, have been used for TCVM training programs in many countries.