Judith E. Saik The clinical application of Chinese herbal medicine in veterinary practice should have a similar clinical approach for their use as the many other therapeutic modalities that a veterinarian uses daily. Knowledge of an herb’s therapeutic properties, as well as contraindications are as important in the practice of herbal medicine as when dispensing pharmaceuticals. A complete history, good physical exam, and appropriate conventional diagnostics are cornerstones on which to add any medical modality to an integrative practice, including Chinese herbal medicine. In addition to the foundational diagnostics, the traditional Chinese veterinary medicine (TCVM) practitioner adds a TCVM examination to their clinical evaluation. This exam, based on Chinese medicine theory, determines an individual’s pattern of disease based on unique features some of which can be pulse form, tongue appearance, coolness/heat of extremities and personality constitution. With the addition of a TCVM Pattern diagnosis (e.g., Kidney Qi Deficiency, Liver Qi Stagnation, Bladder Damp Heat), the Chinese veterinary herbalist can then form a diagnostic conclusion of the pathological changes to a body caused by a disease and then optimally select an herb or herbal formula that best treats the clinical disease that their patient presents with. For optimal prescribing of Chinese herbal medications, there are five common mistakes to avoid [1]. The first is treating the symptoms rather than the TCVM Pattern. As conventionally trained veterinarians, it is natural to treat the clinical signs presented, and this will probably help alleviate presenting problems for a short time. It will, however, not provide long-term disease resolution as the root imbalance has not been addressed. The second common mistake is using too many herbs at one time. Limit the herbal prescriptions to three or less formulas to treat the primary pattern. Third is to treat the TCVM Pattern that is identified during the clinical TCVM exam. Avoid trying to prescribe a host of herbs to treat the many symptoms that are being observed by the caretaker. With proper herbal selection, the multitude of symptoms described by an owner mostly disappear when the primary pattern is addressed. Fourth is expecting the herbal medicine to work as quickly as conventional pharmaceuticals, many of which can have significant serum blood levels in less than an hour. Chinese herbal medicine is gentler and can take longer for a physio-chemical response. The fifth mistake is to restrain from developing “tunnel vision.” It is tempting to focus on the presenting clinical signs and forget everything else that may affect an animal such as environment, emotions, constitution, and diet. There are four general goals for herbal therapy [2]. The first is to cure a disease. Examples might include soft tissue injury, UTI (urinary tract infection), IBD (inflammatory bowel disease). If the disease can’t be cured, the second category would be to stabilize a condition (e.g., Bi syndrome, chronic renal disease, congestive heart failure – Grades 1–2). Third is to use herbal medicine as an adjunct therapy (e.g., diabetes, seizures, Cushing’s disease). Fourth is to promote quality of life in severe terminal disease (e.g., cancer, end-stage renal, and heart disease). Herbal medicine therapeutic dosing covers a broad range and is dependent on a number of variables such as safety index, TCVM Pattern, age, vitality, and disease severity, just to name a few. The recommended doses below do not need to be strictly followed; these are general guidelines [2]. Companion Animal*: Low dose for long term/maintenance (0.5 g/20# BW, BID) – four weeks for results; Medium dose for most cases (0.5 g/10# BW, BID) – two weeks for results; High Dose for short term, usually Excess conditions (1 g/10#BW, BID) – 1–7 days Equine*: Maintenance/prevention dose (7.5 g, BID) – long-term use/1 year (i.e., Body Sorea for performance horse aches); Mild conditions (15 g, BID) – 1–3 months (i.e., Shen Calmera for stall anxiety); Severe conditions (30–60 g, BID) 1–4 weeks (i.e., Hot Hoof IIa for laminitis); Life threatening (200 g BID) 1–5 days (i.e., Yu Jin San for acute colitis) * = Non-concentrated formulas (Web Cases 1 and 2) Congestive Heart Failure (CHF): Chinese herbal medicines may be combined with conventional medication for the most effective treatment. There are six TCVM Patterns of CHF: Heart Qi Deficiency, Deficiency of Heart Qi/Yin, Heart + Kidney Yang Deficiency, Heart Yang Deficiency, Qi-Blood Stagnation, Collapse of Yang Qi. The first three patterns are the most common (95%), with the other three more rare (Box 24.1). Heart Qi Deficiency – Yang Xin Tang/Heart Qi Tonica Heart Qi/Yin Deficiency – Sheng Mai Yin, Zhi Gan Cao Tang Heart + Kidney Yang Deficiency – Zhen Wu Tang Qi-Blood Stagnation – Fu Fang Dan Shen Pian/Compound Dan Shena Heart Yang Deficiency – Bao Yuan Tang Collapse of Yang Qi – Shen Fu Tang Plus Anemia: Herbal selection for common TCVM Patterns of anemia (Box 24.2). Qi Deficiency –Gui Pi Tang/Dang Gui Bu Xue Blood Deficiency – Si Wu Tang or Gui Pi Tang Blood Deficiency (with Stagnation) – Dang Gui Qi-Blood Deficiency – Ba Zhen Tang/Eight Treasuresa Bleeding/Hemorrhage: Acute trauma with bleeding can be treated with the Chinese patented formula, Yunnan Bai Yao capsules. Dosing for companion animals is 1 capsule per 10–20 pounds 4 times daily (1–2 days) in severe cases; for horses give 1 bottle of powder (4 g or 1 box of 16 capsules), 3 times daily in severe cases. A single small red pill is in center of the foil package and can be used for shock (given alone or with capsules) [1]. Edema/Ascites: Ascites is most commonly seen in small animals with heart/iver disease or neoplasia. Edema is observed after trauma or with poor circulation. The herbal medicines may not act as quickly as pharmaceuticals but are safer and helpful for weaning an animal (or reducing dose) of drugs (Box 24.3) [1]. Water-fluid Retention – Wu Ling San/Wu Pi Yin/Wu Pi Yin Plusa Spleen Qi Deficiency +/− Qi Stagnation – Shi Pi Yin Spleen/Kidney Yang Deficiency – Zhen Wu Tang (Web Cases 3 and 4) Pruritis/Eruptions/Erosions/Dermatitis: This group of skin conditions is common, difficult to effectively control and frequently recurs. In TCVM, pruritis is associated with the master pathogen “Wind” which attacks the body surface causing itching. Wind tends to combine with Heat (Yang pathogen) to become Wind-Heat or Wind-Toxin or with Damp to become Damp-Heat. Wind-Heat and Damp-Heat are the major pathogens of skin diseases. Chinese herbal medicine formulas for this group of conditions have several basic actions: clear Heat (inflammation) and detoxify, clear Wind to relieve itching, minimize scab crusted eruptions, nourish Blood, and calm anxiety by increasing the smooth flow of Qi and Blood (Box 24.4) [3]. External Wind (skin allergy) – Qu Feng Zhi Yang/External Winda Wind-Heat – Shi Yi De Xiao Fang/Wind Toxina Damp Heat – Qing Shi Re Tang/Damp Heat Skina Liver Damp Heat (dermatitis) – Long Dan Xie Gan Blood Deficiency (with pruritis) – Si Wu Xiao Feng Blood/Yin Deficiency (chronic itching) – Qu Xie Fang/Dandruff Formulaa Blood/Yin Deficiency and Damp (chronic itching) – Wu Shen San Yin Deficiency (pruritis worse at night) – Yang Yin Zhi Yang Wheals, Hives, and Urticaria: This can include sudden wheals on the head/neck/body, itching and swelling of eyelids/lips. The Chinese herbal medicines used to clear Heat, address Wind-toxin and detoxify are Xiao Huang San or Lung Wind Huang a. (Web Cases 5–7) Cushing’s Disease: Herbal medicine can often be used without conventional medications in mild cases or as an adjunct to pharmaceuticals in more severe cases to lower drug doses. There are three common TCVM Patterns for dogs (Box 24.5). Dog, Horse Yin Deficiency – Mai Men Dong/Ophiopogona Qi-Yin Deficiency – Xia Xiao Fang/Rehmannia 11a Yang Deficiency – Jin Gui Shen Qi/Rehmannia 14a Horse Qi Deficiency + Damp – Er Chen Tang/Phlegm Fat Formulaa Cushing’s/Equine Metabolic Syndrome: There are four TCVM Patterns to consider for horses when adding Chinese herbal medicine to therapeutic management of cases. Early in these diseases, horses can present with Liver Qi Stagnation (insulin metabolism abnormalities) which then progresses to Spleen Qi Deficiency with Damp-Heat (obesity, laminitis, lethargy). This is followed by Yin Deficiency or Qi-Yin and last is Yang Deficiency (Box 24.5). Diabetes: In Chinese medicine, there are three primary pathways that are considered to induce diabetes: imbalanced diet (particularly overeating), emotional stress (creating chronic Liver Qi Stagnation), overwork (damage to Kidney Essence). Box 24.6
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Clinical Application of Chinese Herbal Medicine
Introduction
Five Common Mistakes to Avoid When Prescribing Chinese Herbal Medicine
General Guidance for Herbal Therapy
Goals
Herbal Medicine Dosing
Selection of Chinese Herbal Medicine Based on Clinical Conditions
Cardiovascular-Hematopoietic Conditions
Dermatological Conditions
Endocrine Disorders
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