How to Use Acupuncture for the Treatment of IBD
World Small Animal Veterinary Association World Congress Proceedings, 2011
Huisheng Xie, DVM, PhD
Clinical Associate Professor, Acupuncture Service, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA

Inflammatory Bowel Disease is commonly encountered in clinical practice. Because of the multifactorial etiology, Western medical diagnosis and treatment can be time consuming, costly, and ineffective. Chinese Medicine, including acupuncture and herbal medicine, is an effective therapy for IBD in dogs, cats and horses, including chronic forms of IBD which are unresponsive to typical western medical therapies.

Pattern Differentiation and Treatment

1. Damp-Heat Pattern (Excess)

 Clinical signs: Mucoid feces with a foul odor, lethargy, fever, loss of appetite or no appetite, abdominal pain, scant and dark urine

 Tongue: deep red, malodorous

 Coating: yellow and greasy

 Pulse: deep and rapid

 Treatment principles: Eliminate Heat and dry up Damp, drain water and stop diarrhea

 Acupuncture treatment: GV-1, BL-20, BL-21, LI-4, SP-6, LI-11, GV-14, Wei-jian, BL-25, ST-25, LI-10, ST-36, GB-34

 GV-1: Local point to stop diarrhea, balance water (body fluids) and regulate the middle jiao

 BL-20, BL-21: Back associate points to strengthen the spleen and stomach

 LI-4, SP-6: Clear Damp-Heat

 LI-11, GV-14,Wei-jian: Clear Heat

 BL-25, ST-25: LI associate and alarm points to regulate LI function, stop diarrhea

 LI-10, ST-36, GB-34: Strengthen the spleen and stomach

 Herbal medicine: Great Saussurea Coptis (Da Xiang Lian Wan)

2. Disruption of GI by Liver Qi Stagnation (Disharmony of the Liver and Spleen)

 Clinical signs: Hyperactive Wood personality, irritability, vomiting small amounts frequently, acid regurgitation or eructation, very sensitive to palpation along the flank (LIV-GB Channel regions)

 Eyes: Red

 Tongue: Purple

 Pulse: Wiry

 Treatment strategies: Disperse Liver and eliminate stagnation, regulate liver and stomach

 Acupuncture treatment: PC-6, BL-14, HT-7, GB-34, ST-36, GB-41, LIV-3, BL-18, BL-19

 PC-6, BL-14,HT-7: Calm the Shen and inhibit vomiting

 GB-34, ST-36: Regulate stomach Qi to stop vomiting

 GB-41, LIV-3: Soothe liver Qi and resolve liver Qi stagnation

 BL-18, BL-19: are the LIV and GB associate points and regulate liver Qi flow

 Herbal medicine: Liver Happy (modified Chai Hu Shu Gan Wan)

3. Spleen Qi Deficiency Pattern

 Clinical signs: Chronic diarrhea with soft, coarse, or watery feces, undigested grain in the feces, anorexia, emaciation, dry or burned hair, weariness, decreased strength in limbs

 Tongue: Pale or yellow

 Pulse: Deep and thready.

 Treatment principles: Tonify Spleen Qi, Drain Damp, resolve diarrhea

 Acupuncture treatment: GV-1, BL-20, BL-21, LI-10, ST-36, SP-6, SP-9, Qi-hai-shu, Pi-shu

 GV-1: Local point to stop diarrhea, balance water (body fluids), and regulate the middle jiao

 BL-20, BL-21: Spleen and stomach back associate points to strengthen the stomach

 LI-10, ST-36: Strengthen the spleen and stomach

 SP-6, SP-9: Strengthen the spleen and eliminate Damp to stop diarrhea

 Qi-hai-shu, Pi-shu: Classical points to tonify spleen Qi in horses

 Herbal treatment: Shen Ling Bai Zhu San

4. Kidney Yang Deficiency Pattern

 Clinical signs: Chronic diarrhea (especially at night just before daybreak), soft stool with undigested grain, coldness in the limbs, weakness of the lumbar and limb muscles

 Tongue: Pale

 Pulse: Deep and weak

 Treatment principles: Warm and Tonify Kidney Yang; resolve diarrhea

 Acupuncture treatment: GV-1, BL-20, BL-21, LI-10, ST-36, GV-4, GV-3, Bai-hui, BL-23, Shen-Shu, KID-7, KID-3, Qi-hai-shu, Pi-shu

 GV-1: Local point to stop diarrhea, balance water (body fluids) and regulate the middle jiao

 BL-20, BL-21: Spleen and stomach back associate points to strengthen the stomach

 LI-10, ST-36: Strengthen the spleen and stomach; GV-4, GV-3 and Bai-hui warm kidney Yang

 BL-23, Shen-shu, KID-7, KID-3: Tonify the kidney

 Qi-hai-shu, Pi-shu: Classical points to tonify spleen Qi and stop diarrhea in horses

 Herbal treatment: Four Immortals (Si Shen Wan)

Case 1

A 12 year old, 80 lb. spayed female Great Dane presented with severely decreased appetite and body weight loss. She became anorexic and had loose feces several months ago. No vomiting, pruritis, or lameness seen. Recently, she has refused any food. She has been getting weaker and more lethargic. She lost about 35 lb in the past three months, and has been losing hair for the past two months. She is a laid back dog, but barks to let the owner know when someone visits the house; she will use a different tone to bark if there is another dog. She is a friendly dog and has never bitten any people or dogs. Her Shen was low; her tongue was pale and swollen, her pulse was deep and weak. She was sensitive to palpation at BL-20, BL-21, and BL-23. She was diagnosed as having Spleen Qi Deficiency and was given the herbal medicine Si Jun Zi Tang pill (Four Gentlemen), 8 pills, PO BID for 3 months. She also received dry needles at LI-10 and Shan-gen, and electro-acupuncture (20 Hz, 20 min) at BL-21 (bilateral), BL-20 (bilateral), ST-36 (bilateral). She showed great improvement after three biweekly acupuncture sessions and six weeks of daily herbal medicine. She gained 15 lbs, had hair regrowth and more energy. After another four acupuncture treatments (one treatment every two months) and eight months of daily herbal medicine, her body weight was 116 lb, and her appetite, hair coat, stool became normal. She died of congestive heart failure and renal failure when she was 15 year old.

Case 2

A 4 year old intact male 77 lb Doberman Pinscher presented with a chronic history of inflammatory bowel disease (IBD) and vomiting of yellow fluids/undigested food. The current owner had owned him since 7 weeks of age. He started to have digestive issues at 10 months old. He is a dominant dog, and wants to be in charge when in the company of other dogs. He will fight or attack another dog. He chases and barks at squirrels excessively, leading to many complaints from the neighbors. He also competes as in conformation. He licks his right front and left rear feet. He is a finicky eater. He vomits yellow liquid before eating. He barked at every dog on the way to the exam room. He appears thin, but very bright and alert (great Shen). On palpation, his flank areas, LIV-14, BL-18 and BL-19 seemed more sensitive. His eyes were red, tongue was red purple and his pulses were very wiry. He was diagnosed with liver Qi stagnation with stomach Qi stagnation (or disharmony between liver and stomach). He was treated with herbal medicine Liver Happy (modified Chai Hu Shu Gan Wan), (7 pills, PO BID for 2 months) and acupuncture. Acupuncture treatments included dry needling at GB-20, LIV-3, LIV-2, PC-6, BL-14 and electro-acupuncture (20Hz and 20 minutes) at ST-36 + GB-34, BL-21 (bilateral), BL-18 (bilateral), BL-19 (bilateral). His vomiting was under control after 4 biweekly acupuncture and 2 months of daily herbal medication.

Table 1. TCVM treatment of IBD.

Pattern type

Clinical signs

Acupoints/ herbal medicine*

Heat-Toxin
Damp-Heat

Bloody/watery diarrhea or malodorous mucoid feces
Colitis, enteritis, Potomac fever, salmonellosis and non-specific gastroenteritis
Hot ears/nose
Increased thirst
Tongue: Deep red with yellow coating
Pulse: Deep and rapid

GV-1, BL-20, BL-21, LI-4, SP-6, LI-11, GV-14, Wei-jian, BL-25, ST-25, LI-10, ST-36, GB-34
Da Xiang Lian Wan

Liver Qi Stagnation

Hyperactive Wood personality, irritability, vomiting small amounts frequently, acid regurgitation or eructation, very sensitive to palpation along the flank (LIV-GB Channel regions)
Eyes: Red
Tongue: Purple
Pulse: Wiry

PC-6, BL-14, HT-7, GB-34, ST-36, GB-41, LIV-3, BL-18, BL-19
Liver Happy (modified Chai Hu Shu Gan Wan)

Spleen Qi Deficiency

Chronic diarrhea with undigested grain
Anorexia
Loss of body weight
Exercise intolerance
Tongue: Pale or yellow
Pulse: Deep and weak

GV-1, BL-20, BL-21, LI-10, ST-36, SP-6, SP-9, Qi-hai-shu, Pi-shu
Shen Ling Bai Zhu

Kidney Yang Deficiency

Prolonged diarrhea
Diarrhea at night or early morning (day break)
Cold and painful back
Rear weakness and stiffness
Tongue: Pale
Pulse: Deep and weak

GV-1, BL-20, BL-21, LI-10, ST-36, GV-4, GV-3, Bai-hui, BL-23, Shen-Shu, KID-7, KID-3, Qi-hai-shu, Pi-shu
Four Immortals

Case 3

A 10 year old spayed female Lhasa Apso presented with chronic diarrhea. She began having loose, dark stools 5 months ago. She strains to defecate and produces large amounts of loose feces with no increase in frequency. She was being fed a home-made diet based on a variety of raw meat, rice and vegetables. She has two masses over her right coxofemoral/sacral area, which are firm and static. Over the past three months, the diarrhea has persisted, in spite of diet modification (increased fiber, varying meat sources from chicken to beef to turkey, and finally switching to Hill's w/d). She has now quit eating and is losing weight. Both CBC and chemistry panel were unremarkable. Empirical use of Trimethoprim/Sulfa and Metronidazole have been ineffective, and a fecal exam was unremarkable.

On exam, she was bright and alert initially, and became more reserved. Heart/lung sounds were normal, abdominal palpation was normal with no masses or pain, but with slightly gassy/fluidy guts. Peripheral lymph nodes were also normal. She vomited a small amount in the exam room. Her tongue was pale lavender, and the pulse was deep and weak. She was very quiet on the exam table and seems depressed. She seeks warmth, and seems more perky in the evenings. The owner is reluctant to do radiographs or exploratory surgery, and prefers a TCVM approach.

She was diagnosed as having Spleen Qi Deficiency based on clinical signs such as weight loss, loss of appetite, diarrhea, depression, lethargy, deficient pulse, and pale lavender tongue. Her increased energy in the evening or greater lethargy in the morning also indicates spleen deficiency since the morning belongs to the Earth time (7 to 11 am). Vomiting indicates that spleen Qi deficiency has allowed the "husband" stomach Qi to rebel as the SP and ST are like a seesaw. If one side (SP) is up, the other side (ST) automatically goes down. If one side (SP) is deficient or going down, the other side (ST) will rebel (or be stagnant). Thus, regulating the ST is needed in addition to tonifying SP Qi.

The dog was given both acupuncture treatments and the herbal formulation Xiang Sha Liu Jun Zi Wan (Eight Gentlemen), 1 pill per 10 lb PO BID for two months. Acupuncture treatments included dry-needling at ST-36, BL-20, BL-21, CV-4, CV-6, CV-12, GV-1, and Shan-gen. According to the owner, her clinical signs (including appetite and stool) were 75% resolved after four weekly acupuncture and 1 month of daily herbal medication. Complete resolution was achieved after another 2 biweekly acupuncture sessions and 1 more month of daily herbal treatment.

Summary

The combination of Chinese herbal medicine, acupuncture and dietary management is a very effective therapeutic approach to control inflammatory bowel disease in small animals. Antibiotics, steroidal anti-inflammatory drugs and non-steroidal anti-inflammatory drugs (NSAIDs) are not usually necessary to treat IBD given the high percentage of positive outcomes, including complete resolution of clinical signs, obtained by using TCVM therapies.

  

Speaker Information
(click the speaker's name to view other papers and abstracts submitted by this speaker)

Huisheng Xie, DVM, PhD, MS
College of Veterinary Medicine
University of Florida
Gainesville, FL, USA


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