Western medicine will sometimes accept chronic conditions as a variant of “healthy” if they’re not life-threatening or debilitating. It has become routine to treat symptoms as they appear, but to disregard the underlying immune system dysfunction that leads to the allergy symptoms in the first place.
When functioning properly, the immune system defends the body against foreign antigens and assists in maintaining healthy cell populations by removing dead and damaged cells. In order to do this, it must learn to distinguish “self” from “non-self”. Immune system dysfunction allows stimulation of an immune response directed against innocuous environmental antigens, and the resulting set of signs and symptoms are collectively termed “allergies”.
The two main categories of chronic allergy syndrome in horses, not including immediate hypersensitivity or anaphylaxis reactions, are respiratory and dermatological. Conventional treatment frequently includes topical and/or parenteral application of corticosteroids, designed to suppress the overactive immune system. Owners and practitioners find inconsistent and variable responses to this therapy, and chronic use of corticosteroids is contraindicated due to adverse side effects. Owners frequently search for complementary therapies to help these horses.
TCVM medical theory In Traditional Chinese Veterinary Medicine (TCVM), a symptom complex such as “allergies” is broken down into a pattern differential. Each individual animal has a different underlying pathology leading to his physical manifestations of respiratory or skin “allergies”.
The Qi, or vital energy, involved in immune system function overall is called Zheng Qi. Zheng Qi incorporates properties of several other types of body Qi, including Yuan Qi (Source Qi), Gu Qi (Food Qi), Ying Qi (Nutrient Qi), and Wei Qi (Defensive Qi).
• Yuan Qi is the energy an animal is born with; it is related to the energy of DNA and cellular processes in the embryo, and to the genetics of the animal. Yuan Qi is supplemented throughout life by Gu Qi.
• Digestion provides the body with Gu Qi, and nutrition plays a large factor in the amount and quality of Gu Qi an animal possesses at any time.
• Ying Qi circulates in the blood and nourishes the body, and is derived from Gu Qi. In other words, Ying Qi is all the molecular products of digestion that are utilized for the normal function of all body cells.
• Wei Qi is also derived from Gu Qi, and circulates superficially in the body to protect the integument from external pathogenic invasion.
All these types of Qi correlate to various parts of the immune system. Normal Yuan Qi nourishes bone marrow so that the correct number and type of stem cells are present to produce appropriate white blood cells. Gu Qi assists in transforming undifferentiated cells into lymphocytes, neutrophils, macrophages, etc. These cells enter the bloodstream, and are thereby part of the Ying Qi in the body. Some of these cells, as part of their normal function, will exit the bloodstream and penetrate other tissues. At this point, they become part of the Wei Qi. These cells may reenter the bloodstream, becoming part of Ying Qi again.
TCVM accounts for this flow of energy throughout the body by naming and describing the various types of Qi, while Western physiological theory identifies individual types and functions of cell. As with much of TCVM, we can correlate its unfamiliar terms and logic to known parts and functions of the body as we know it.
The major organs involved in the TCVM theory of immune system function are the Lung and Kidney. Kidney is involved as the source of Yuan Qi and the Jing (root essence) for the individual animal. Kidney also pulls Qi down from the Lung, and therefore is in charge of inhalation, thus it’s directly related to respiratory allergy syndromes. Additionally, Kidney rules the bones and nervous system, and thus is responsible for proper bone marrow physiology and its production of white blood cells. The Lung dominates Qi and respiration. The Lung also has a protective role for the rest of the body, distributing Wei Qi to the body surface and sending Qi down to the Kidney.
Acupuncture in action The first step in a TCVM approach to a horse with allergies is the physical exam. Similar to Western medicine, the TCVM exam systematically assesses different body systems and notes any abnormalities. But unlike the standard physical exam in Western medicine, this exam will assess individual acupuncture points for sensitivity, swelling or temperature change. Many acupuncture practitioners will also assess the animal’s tongue and pulse to enhance the TCVM pattern differentiation and diagnosis. A detailed history of the horse’s nutrition, housing, behavior, exercise and interactions with other equines or humans will also assist the practitioner in achieving the best TCVM diagnosis.
Two of the most common TCVM pattern diagnoses for horses with “allergies” are Kidney and/or Lung Qi Deficiency, and Lung Heat.
1. Kidney Qi Deficiency is frequently implicated in older animals; the underlying cause of allergic symptoms in these patients is the inability of the Kidney to properly nourish the bone marrow and pull the Qi of the lungs downward into the body. Kidney and/or Lung Qi Deficiency patients present with a history of a prolonged course of disease, exercise intolerance, and loss of breath. These horses may present with either respiratory or skin symptoms, or sometimes both. Treating a Kidney Qi deficient animal includes points to support the Kidney, as well as general Qi tonic points, and points directed specifically at the particular symptoms the animal displays. 2. The Lung Heat TCVM pattern often presents as an animal with chronic dry cough and dyspnea, often worse in the summer. There may be a dry and/or thick nasal discharge. Heat signs in the skin manifest as redness and thick, sticky, malodorous discharges. Treatment for Lung Heat pattern should focus on clearing heat in general, and from the Lung in particular; clearing Phlegm (a TCVM term for any thick, “congealed” fluids within the body or on the body surface); and opening the Lungs to facilitate clearing Heat. As the Lungs control the body surface, these techniques will also clear Heat signs in the skin.
Chronic cases should be treated at one to two-week intervals until resolution of symptoms, at which point frequency of treatment may be titrated down to whatever interval best fits that individual horse. Acute cases respond best when initially treated several times per week, gradually tapering off to an appropriate maintenance schedule or discontinued entirely.
Implementing acupuncture therapy into equine allergy protocol Acupuncture therapy for both respiratory and skin allergies in horses is rewarding given the owner’s commitment to following the prescribed schedule of treatments. It can reduce or eliminate the need for corticosteroid treatment, especially when performed in conjunction with appropriate environmental and husbandry changes. In general, acupuncture therapy for allergies in horses is most successful when begun before the allergy trigger is present in the environment.
There is no downside to adding acupuncture to your arsenal for treating these frustrating symptom sets that cause our equine patients and their caregivers much distress.
Case study Time is a 26-year-old Arabian gelding with a chronic history of progressively worsening allergy symptoms. He is very sensitive to insect bites, and reacts with large swellings, purulent discharge, hair loss and intense itching. He has also been diagnosed with chronic obstructive pulmonary disorder (“heaves”).
Both symptom sets have been previously treated with corticosteroids of various types and administration schedules, over several summers. The summer prior to beginning acupuncture therapy, Time was continuously medicated the entire warm season. These medications do not work well, as he continues to display both skin lesions and respiratory dysfunction while medicated. He is worse during the summer, as both the presence of insects and the number of warm and humid days are increased. Interestingly, Time does not seem to have a significant hay allergy as part of his “heaves” symptoms since he does well in the winter despite being on an all-hay diet during that season.
Time began acupuncture treatment in the spring, preceding the emergence of biting insects and hot/humid weather. He was diagnosed as a Kidney Qi Deficiency patient, and treated with dry needle acupuncture at the following points: lumbar Bai Hui, Shen shu, Shen jiao, Shen peng, BL 23, BL 13, LU 1, CV 22, ST 36, KI 3 and GV 4. Needles were left in place for 20 minutes per session, and he received treatments approximately every two weeks throughout the insect season. A few points varied per session, depending on other issues (Time also presented with a carpal lameness and was treated with acupuncture and Adequan for DJD of the carpus) and the degree of respiratory difficulty at each session. Other points that were sometimes added include GV 14, LU 7, LU 5, KI 1 and CV 17.
During this complete season of treatment, Time did not require any corticosteroid administration to control either respiratory or skin allergies. He was maintained throughout the summer on bi-weekly acupuncture as his sole therapy. He did so well he was even being lightly ridden — a marked improvement over the previous summer when he was medicated continuously with corticosteroids and was not rideable due to his allergy symptoms.
Time continues to do well and requires fewer acupuncture sessions to maintain his comfort without medication. He continues to develop other health issues as an aging horse, yet his “heaves” and insect hypersensitivity are not among them.
Each individual animal has a different underlying pathology leading to his physical manifestations of respiratory or skin “allergies”.
References Schoen, Allen M. Veterinary Acupuncture: Ancient Art to Modern Medicine, 2nd ed., Mosby, 2001. Xie, Huisheng and Preast, Vanessa. Traditional Chinese Veterinary Medicine: Volume I, Fundamental Principles, Jing Tang, Reddick, FL, 2005. Xie, Huisheng and Preast, Vanessa. Xie’s Veterinary Acupuncture, Blackwell Publishing, 2007.