Chronic renal failure (CRF) is the most common renal disease in both dogs and cats. A protein-restricted diet has been emphasized in the treatment of CRF for many years. Other recommended diets are modified from typical maintenance diets in several ways, including reducing quantities of phosphorus and sodium, and increasing caloric density, potassium, dietary fiber, B-vitamin content, and magnesium.1,2 In addition, omega-3 polyunsaturated fatty acids (PUFAs) offers promise in minimizing renal disease progression.3
Chinese herbal medicine has been used in animals for thousands of years in China.4 Clinical anecdotal evidence indicates that Traditional Chinese Veterinary Medicine (TCVM), including acupuncture and herbal medicine, benefits patients with renal failure.5,6 TCVM patterns of diagnosis and treatment of chronic renal failure will be discussed in this presentation, along with clinical case studies.
TCVM Patterns of Renal Failure
1. Kidney Qi Deficiency
Clinical Signs: Dysuria, stranguria, weakness in back, urinary incontinence, warm-seeking behavior, pale and wet tongue, deep and weak pulse (especially on the right side).
Acupuncture Treatment: BL-23, KID-3, KID-7, KID-10, CV-4, CV-6, BL-22 and BL-39
Herbal Medicine: Suo Quan Wan
2. Kidney Yang Deficiency
Clinical Signs:pale complexion, aversion to cold, warm-seeking, cold extremities, quiet, sore lumbar region, poor dentition, hearing loss, copious clear urine or enuresis, urinary incontinence, general debility/weakness, edema in limbs or ventral abdomen, swollen and pale tongue with a wet coating, weak and deep pulse (especially on the right side).
Acupuncture Treatment: GV-3, GV-4, Bai-hui, Shen-shu, Shen-peng, Shen-jiao, BL-26, KID-7, KID-10, CV-4, CV-6, BL-22/39
Herbal Medicine: Jin Gui Shen Qi Wan or Rehmannia 14
3. Kidney Yin Deficiency
Clinical Signs: dysuria, stranguria, and weakness of back, thin and shriveled (dehydrated) appearance, dry throat, warm palmar surfaces (hot five hearts), cool-seeking, panting, night sweating, generalized erythema, hearing loss or infertility problems, red and dry tongue, deep, thready, weak pulse (especially on left).
Acupuncture Treatment: KID-3, BL-23, SP-6, KID-7, KID-10, CV-4, CV-6, BL-22 and BL-39
Herbal Medicine: Liu Wei Di Huang Wan (Rehmannia 6)
4. Kidney Jing Deficiency
Clinical Signs: premature aging, poor dentition, brittle bones, poor neonatal growth and development, inadequate skeletal development, developmental bone diseases, congenital defects, a preponderance of signs towards either Kidney Yin or Kidney Yang Deficiency, pale or red tongue, weak pulse.
Acupuncture Treatment: KID-3, BL-23, BL-26, SP-3, ST-36, BL-21, BL-20, CV-4, CV-6, BL-22 and BL-39
Herbal Medicine: Yin Yang Huo San (Epimedium Powder).
Case Example 1
A 13 year old, male castrated Alaskan Malamute was presented with an onset of acute renal failure fourteen days prior. After intensive care and IV fluids, he barely survived. However, he was still anorexic and very weak, as he had lost about 30 pounds during the past two weeks. His BUN was 98 and creatinine was 7.7 upon presentation. He had a three-year history of urinary incontinence at night, and had to wear diapers. His ears and back were cool to the touch. He preferred to be warm. His pulse was deep and weak. The tongue was pale and wet. He was able to walk about 1/2 mile a day (used to walk about 3 miles daily).
TCVM diagnosis: Spleen Qi and Kidney Qi Deficiency
Acupuncture treatments: 1) Dry needle at GV-20, Bai-hui and Shan-gen; 2) Electro-acupuncture for a total of 20 minutes (10 minutes of 20 Hz + 10 minutes of 80–120 Hz) with stimulation at the following pairs of points: BL-20, bilateral; BL-21, bilateral; BL-26, bilateral; ST-36 + GB-34
Herbal Medicines: 1) Xiang Sha Liu Jun Zi (Eight Gentlemen), 10 pills PO twice daily for 4 weeks; and 2)You Gui Wan, 5 pills PO twice daily for 4 weeks.
Follow-up Visit: The dog responded to acupuncture very well and ate an entire bowl of food immediately after withdrawal of needles (first time after the onset of this illness). After two biweekly acupuncture sessions and one month of daily herbal medicine, his appetite became normal, he was able to walk about 1.5 miles once daily, and he gained about 10 pounds.
Third Visit: Four weeks after the initial visit he was doing well with a normal appetite and water intake. He looked very happy and was able to maintain regular exercise (1.5 miles once daily). He weighed 100 pounds and had gained 10 pounds. However, he still had episodes of urinary incontinence, and still had to wear a diaper. His tongue was pale and pulse was still weak. His BUN was 88 and creatinine was 8.1
TCVM Diagnosis: Kidney Qi Deficiency
Acupuncture Treatment: 1) Dry Needle: BL-23, BL-26, KID-3, KID-10, KID-7, ST-36; 2) Aquapuncture (Vitamin B12 0.2 cc per point): CV-4, CV-6, BL-39, BL-22
Herbal Medicine: 1) You Gui Wan, 5 pills PO twice daily for 3 months; 2) Suo Quan Wan, 8 pills PO twice daily for 3 months; 3) Discontinued Xiang Sha Liu Jun Zi
Outcome: The urinary incontinence stopped (owner noticed dry diapers) after three months, then he was treated with acupuncture once every three to five months as needed for maintenance. Overall, he had a great quality of life (enjoying a long walk daily) and normal appetite and water intake, although his BUN ranged from 80 to 100 and creatinine ranged from 8 to 12. He died three years later at the age of 16, due to congestive heart failure.
Case Example 2
A 10 year-old, female spayed, mixed breed dog was presented with a one year history of chronic renal failure on December 21, 2002. Her BUN was 95 and creatinine was 4.7. Her body felt hot to the touch. She was panting more than normal and she preferred cool places. Her skin and hair coat were dry and flaky. She had recurrent ear and skin infections. Her stifles were stiff bilaterally due to osteoarthritis. She was very sensitive on palpation of BL-23. Her tongue was red and dry. Her pulse was fast and weak. Her stool, appetite, and water intake were within normal limits. Her TCVM diagnosis was Kidney Yin Deficiency. She was prescribed the herbal medicine Liu Wei Di Huang Wan, seven pills PO twice daily (her body weight was 71 pounds) with acupuncture treatment. Acupuncture therapy included dry needling at GV-20, BL-23, Shen-shu, KID-3, KID-7, KID-10, and SP-6. Her panting, hot body, dry skin, and red tongue were much improved after two monthly acupuncture sessions and two months of daily herbal medication. She was given acupuncture treatments once every two to four months and Liu Wei Di Huang Wan, four pills twice daily for another six months. On September 16, 2003, her kidney levels had decreased to a BUN of 51 and a creatinine of 3.1.
Conclusion
The combination of Chinese herbal medicine, acupuncture, and dietary management, is a very effective therapeutic approach to treat renal failures in small animals.
References
1. Polzin DJ, Osborne CA, Adams LD, O'Brien TD. Dietary management of canine and feline chronic renal failure. Vet Clin North Am Small Anim Pract 1989;19(3):539–560.
2. Finco DR, Brown SA, Crowell WA, Groves CA, Duncan JR, Barsanti JA. Effects of phosphorus/calcium-restricted and phosphorus/calcium-replete 32% protein diets in dogs with chronic renal failure. Am J Vet Res 1992;53(1):157–163.
3. Brown SA, Finco DR, Brown CA. Is there a role for dietary polyunsaturated fatty acid supplementation in canine renal disease? J Nutr 1998;128(12 Suppl):2765S–2767S.
4. Zhongjie Liu, Jianqin Xu (ed). Traditional Chinese Veterinary Medicine (3rd Edition, In Chinese). Beijing: China Agricultural Press. Beijing, China. 2005.
5. Xie S, Yao Y, Zhu J. Evaluate curative effect of chronic renal failure by methods of Bushen Jianpi Huoxue Paidu Zhongguo Zhong Yao Za Zhi. 2009 Aug;34(16):2097–2100.
6. Liu J, Song KH, You MJ, Son DS, Cho SW, Kim DH. The effect of oculo-acupuncture on recovery from ethylene glycol-induced acute renal injury in dogs. Am J Chinese Med 2007;35(2):241–250.