Panel Discussion Pt. 2
In the Winter 2014 issue of IVC Journal, we looked at the various definitions of wobbler and the five-pronged integrative approach to healing acute episodes and helping to prevent future problems. Part 2 of this article focuses on the Traditional Chinese Medicine (TCVM) approach.
Dr. Ihor Basko: “What I love about TCVM is that it includes the healing of the ‘whole being’, not just ‘the parts’, and studies the dynamic relationship of internal and external environments. Organ function (Liver, Spleen, Kidney systems), Blood and Immune system (Wei Qi) function, the ‘state of energy’ (Qi) and energetic and nutritional deficiencies are included in the evaluation.
“TCVM (as well as homeopathy) relates the patient to his or her environment. Cold, Wind, Dampness, and sudden changes that stress the body will affect the physiology. Herbs and acupuncture used to ‘Dispel Wind, Cold, or Dampness’ help adapt the patient to these environmental stresses that aggravate neck problems in general.
“Pain is treated with herbs and acupuncture to help relieve ‘obstructions’ caused by Blood Stagnation, by improving Blood and Qi (energy flow) through the affected areas.”
Dr. Cindy Lankenau: “Herbal medicines help open the channel obstructions in the neck, and balance the tension within the tendons, ligaments and osseous structures in the neck, to balance the underlying causes of cervical spondylomyelopathy.
“The Pattern of Disharmony found in these cases tends to be classified as stagnation in the neck with either secondary Qi stagnation or kidney Qi or yang deficiency.”
Blood stagnation
The TCVM treatment for pain is to relieve Blood Stagnation and Obstruction of the Channels that Qi travels through.
Dr. Lankenau: “Due to the severe Blood stagnation, secondary Heat is produced (inflammation). Ehman, et al, did studies on the anti-inflammatory effects of Heat-clearing Chinese herbs. The targets comprised cyclo-oxygenases 1 and 2 (COX), MAP kinase, c-Jun terminal-NH(2) kinase (JNK) and type 4 cAMP-specific phosphodiesterase (PDE4). The results revealed that multi-target inhibitors are common in Chinese herbs1. These patients tend to have a normal or pale tongue with a taut pulse.
“The basic Chinese formula to relieve Blood Stagnation is Xue Fu Zhu Yu Tang, which activates blood circulation, dispels stagnation, activates Qi circulation and relieves pain. This herbal formula helps when severe muscle spasms are encountered. Qiang Huo Sheng Shi Tang (Decoction of Notopterygium to Dispel Dampness) is another formula used for patients that have pronounced rigidity and pain in the back of the neck.
“Xiao Huo Luo Dan (Minor Invigorate the Collateral Special Pill) is a Damp-Cold dispelling formula that contains Zhi Cao Wu (prepared wild aconite root) to dispel the Wind, dredge the collateral and relieve pain; Zhi Chuan Wu; Tian Nan Xing (Jackin- the-pulpit root) to resolve any Dampness and Phlegm; Ru Xiang (gum olibanum); Mo Yao (myrrh) to activate Qi and blood circulation and remove blood stasis; and Di Long (earthworm) to open the channels and collaterals. This formula can be used when there are severe neurologic signs or Wind Stroke (Zhong Feng) with blood stasis and obstruction in the channels and collateral with numbness in the extremities. Due to the use of prepared aconite root, a maximum of two months length of use is recommended.
“’Neck formula’ is a Patent Chinese Medicine with multiple ingredients. This formula has been found to be very helpful in these cases as it contains herbal carriers to the neck, Ge Gan, and Heat-clearing herbs.”
Dr. Basko: “Locally, I like to use ‘moving or vitalizing’ liniments such as the patent medicine Zhen Gu Shui (pseudo-ginseng root croton seed, cinnamon bark, angelica root, gentiana, inula flower, menthol, camphor and alcohol). Applied locally to the neck, the aromatic character helps facilitate absorption into the fascia and muscles with a little massage.
“In TCM terminology, this formula ‘dispels fluid stagnation, invigorates Qi, relaxes tendons and muscles, promotes healing and stops pain’.”
Dr. Barbara Fougere: “I recommend supporting the animal with adaptogens to reduce the impact of stress. Use herbal antioxidants to reduce free radical damage. Use circulatory herbs to improve blood fl ow and oxygenation of inflamed tissues. Use herbal anti-inflammatory and analgesic herbs. Consider the patients’ individual needs and formulate accordingly.
One possible formula:
• Dan shen (Salvia miltiorhiza) – Neuroprotective, antiinfl ammatory, improves microcirculation; 2 parts.
• Corydalis (Corydalis ambigua) – anodyne, spasmolytic; 1 part.
• Kava kava (Piper methysticum) – Anxiolytic, sedative, antispasmodic; 1 part.
• Ashwaganda (Withania somnifera) – Nervine, sedative, antiinfl ammatory; 1 part.
• Gotu kola (Centella asiatica) – Anti-rheumatic, microcirculation support, neuroprotective, antiinfl ammatory, anxiolytic; 1 part.
Give 1 ml per ten pounds of the tincture twice daily in food, or give ¼ cup twice daily of the tea.”
Adapting to environmental changes and stresses
Stressful weather and climatic changes sometimes referred to as “pathogenic evil infl uences or factors” will precipitate sudden onsets of pain attacks in susceptible dogs.
Dr. Basko: “Any patient whose symptoms are aggravated by Cold, Wind and Cold, or Hot and Damp weather has a form of Bi Syndrome.
“The immediate cause of Bi Syndrome is environmental: the result of the body being ‘invaded’ by the climatological factors of Wind, Cold, Heat, or any combination which are said to penetrate the body’s defenses (Wei Qi) and lodge in the muscles, tendons and joints in susceptible individuals, such as when the body is deficient.”
“A deficient Wei Qi (protective immunity system) is due to stress, anemia, poor nutrition, or genetic weaknesses and defects such as cardiomyopathy, hypothyroidism, dysplasia, etc. The patient will be more susceptible to negative physiologic changes that accompany Wind, and/or Cold penetration of the neck.”
“This is a common condition in geriatric animals, overworked animals (racing Greyhounds), animals with lack of exercise, and those with acquired genetic problems (Von Willebrand, hypothyroidism, bone cancer genes). These deficiencies make animals more susceptible to changes in the environment, especially weather.”
“Another cause of Bi Syndrome is when ‘pathogenic factors’ obstruct the fl ow of Blood and Qi, causing tissues to ‘stagnate’ through muscle tension and vasoconstriction (buildup of metabolic toxins), or causing aching or burning pain, numbness, heaviness, reduced mobility of the bones, joints and sinews. In more severe cases, there may be swelling and edema.”
“If ‘wind’ is a major factor, causing neck spasms, pain in the limbs, and difficulty in movement, the AP points ‘Wind Gate’ BL12 and ‘Wind Pool’ GB 20 are very important to treatment, along with Juan Bi Tang/Chiang huo (Notopterygium) and Curcuma Combination by Sun Ten Co.”
Treat deficiency
TCVM specifies which deficiency is present that needs to be treated with special foods, herbs and acupuncture treatments. In conventional medicine, these conditions or “deficiencies” are limited to hypothyroidism, cardiomyopathy, IBD, and anemia. Until the deficiencies are supplemented with herbs, diet and acupuncture, the problems will re-occur.
Dr. Lankenau: “For animals with an underlying Kidney yang deficiency, a general Kidney yang tonifying herb such as Shen Qi Pills, or Rehmannia 8, Ba Wei Di Huang Wan can be very helpful for strengthening the underlying Kidney, genetic predisposition. Kim, et al, showed that Chinese herbal yang tonics had a protective effect on nervous tissue2, mostly due to decreasing oxidative stress that accelerated nerve regeneration.”
Dr. Fougere: “Bu Gan Tang is useful in quite a few of the Doberman dogs with Liver Blood deficiency, having dry coats, dry food and dry nails.”
Dr. Basko: “Bu Gan Tang contains tonics (rehmannia, angelica, paeonia and ligusticum) to nourish muscles and cervical vertebrae. The herb Chaenomelis (Chinese quince fruit) relieves painful obstruction due to Dampness, comforts the sinews, and relieves cramping. Zizzyphus nourishes the Liver and Heart, and calms the Spirit.
“Mobility 3 by Health Concerns (similar to Bu Gan Tang) is useful when there is a deficiency of Blood and Energy Qi (with Cold, Wind and Dampness). The addition of Kirin Ginseng root to the formula creates a strong Qi tonic effect that’s especially good for chronic IBD dogs, and old geriatric dogs with recurrent episodes.”
Summary
The treatment plan for wobbler should be based on the individual’s specific needs and situation. Treat the individual, not the disease. The holistic perspective includes many more treatment options that not only help alleviate pain, but facilitate healing and strengthening, improve flexibility and support future prevention of the condition.
Case Studies
No. 1 – Barbara Fougere A six-year-old neutered male Doberman (owned by a breeder who has had several dogs with wobbler over many years) presented with ataxia and ventral flexion of the neck, progressively deteriorating in mobility over one to two years. There was nail wear consistent with dragging, and proprioceptive losses to the hind legs. Previous radiographs were consistent with vertebral malformation. The dog was treated previously with prednisolone, then Metacam and a neck brace. His skin was dry, with dry scurf over the lower back (Blood deficiency – poor circulation to skin), and he had muscle spasms in the neck and hind legs (Blood deficiency).
His owner elected to try gold wire implantation to the dorsal neck, and took home Bu Gan Tang. Within one week, the dog’s mobility returned with no foot dragging. Improvement continued over six months, during which he was continued on Bu Gan Tang and an improved diet (whole food and supplements). There was no recurrence of lameness, and he showed general signs of improved health such as clear skin and glossy coat.
No. 2 – Cynthia Lankenau Ali is a five-year-old intact male great Dane initially diagnosed with cervical instability, from radiographic survey films, in February of 2012. The owner was treating him with a cervical collar and NSAIDs, and gentle chiropractic care from an AVCA-certifi ed chiropractor.
In August of 2012, Ali began gagging up “buckets” of strings of tough viscid mucus during the evening hours when he was asleep, leading to a concomitant diagnosis of megaesophagus. He presented to me with proprioceptive deficit in all four legs. He had a complete blockage of Qi, Blood, Phlegm, food, and in his chest area.
Ali received acupuncture every week for three weeks, with gentle traction of his neck, then monthly treatments to open the channels of his neck and move the obstruction. His curative herbal formula was Yue Ju Wan, the basic formula for treating the six stagnations.
It was felt that the initial Qi stagnation from the wobbler had created “Heat” which then congealed the fluids, creating phlegm and more obstructions. Ali is currently doing well on a small dose of Yue Ju Wan.
No. 3 – Cynthia Lankenau Shadow Dancer was diagnosed as a “wobbler” from survey radiographs in April 2002, when he was a two-year-old Thoroughbred gelding. He was unable to be ridden safely. His tongue was purple and his pulse was tight. He was diagnosed with Blood stagnation. Shadow received monthly acupuncture treatments for several months, and was placed on Xiao Huo Luo Dan for four months. He became pleasure-riding sound.
1 Ehram TM, et al. “In silico search for multi-target anti-infl ammatories in Chinese herbs and formulas”. Bioorg Med Chem, 2010: March 15; 18(6):2204-18.
2 Kim TH, et al. “Protective eff ect og GCSB-5, an herbal preparation, against peripheral nerve injury in rats.” J Ethnopharmacol, 2011: June 22; 136(2); 297-304.
