TCM Patterns Linda Boggie, DVM

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1 TCM Patterns Linda Boggie, DVM

2 Hyperthyroidism in Cats A disease of increasing occurrence Rarely seen 15 years ago and is now routinely screened for in every old cat Progresses over time TCM Pattern changes with the progression of the disease Credit to Steve Marsden, D.V.M., N.D., M.S.O.M., L.Ac.

3 Classic Hyperthyroid Cat Thin, Polyphagic, Polydypsic, Polyuric Behavioral changes: restless, increased or constant vocalization, loss of house habits Digestive problems: vomiting, diarrhea, constipation May have secondary compromised kidney function

4 TCM Pattern End Stage is one of Kidney Yin and Kidney Yang Deficiency Development begins with compromised Spleen function and accumulation of Dampness Different than Hyperthyroidism in people that begins with an underlying Liver Yin Deficiency

5 Steve Marsden quoted Thyroid tumors are an accumulation of Phlegm and Blood arising from a constitutional tendency to the accumulation of Dampness. Yin Deficiency occurs only in the latter stages of the imbalance. There are Four Phases

6 Phase I Accumulation of Dampness arising from the inability of the Spleen to completely Transform and Transport Food and Qi Dampness in turn damages the SP Vicious cycle sets up As Dampness accumulates it can congeal into Phlegm and obstruct flow of Blood

7 Clinical Signs Usually these are the cats with fairly recent and very subtle changes Thyroid levels may be high normal or slightly above normal range May have a small palpable tumor

8 TCM Signs Abdominal distention Vomiting after eating; slimy consistency Poor thirst and appetite Sometimes Damp-Heat will be present and cat my be eating more Predominantly signs of a SP Qi Deficiency

9 Tongue and Pulse Tongue: Swollen, wet, scalloped edges and stringy saliva; color lavender Pulse: Slippery

10 Treatment Resolve Dampness and aid SP T-n-T Correct Rebellious Qi and control Liver Points: SP 6, ST 36, CV 12, ST 40, BL 20, BL 21, BL 18, LIV 2, LIV 3 Herb: Er Chen Tang Diet: foods that support SP

11 Phase II Accumulation of Phlegm-Heat in the San Jiao Channel Dampness in Middle Jiao As Damp accumulates Phlegm which impairs function of San Jiao to move Qi Qi Stasis Friction Heat Heat Congeals the Phlegm in the channels Palpable tumor and elevated T 4

12 Meridians: San Jiao and Stomach San Jiao travels from the hand to the scapula where it dives interiorly Reemerges above the supraclavicular fossa in people at ST 12 Similar area in animals: just above the junction of the neck and chest cavity

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17 TCM Signs Continued signs of Dampness New Signs of Heat and Qi Stagnation Irritability, slight Shen disturbance Increased heart rate Intolerance of heat Increased appetite and thirst to put out ST Fire

18 Tongue and Pulse Tongue: Swollen, wet, slimy saliva and scalloped edges SP now may have redness due to Heat or lavender due to stagnation of Qi Pulse: slippery Damp, wiry Stasis and/or rapid Heat

19 Treatment Benefit SP: SP 6, BL 20,SP 3, KI 3 Transform Damp: ST 36,SP 6,ST 25,ST 40, CV 12,LIV 13 Move Qi: ST 36 & CV 17, LI 4,GV 14,PC 6 Clear Phlegm-Heat: ST 40,CV 12, GB 34, BL 39 Lower He-Sea Pt of San Jiao Support San Jiao: SJ 4, SJ 6, BL22, BL 39 Herbs: Modified Wen Dan Tang

20 Phase III Heat continues to build due to Stagnation Consumption of Kidney Yin begins With that signs of Deficiency Heat develop Original pattern of Dampness has left the building

21 TCM Signs Yin Deficiency Heat added to the Heat and Dryness Thin, emaciated, increased thirst and appetite Restless, irritable, restless sleep/dreaming, behavioral changes Dry coat and skin Increased heart rate

22 Tongue and Pulse Tongue: red, dry, small Pulse: rapid, floating, wiry as a remnant of Damp may be slippery

23 Treatment Clear Heat: LIV 2, ST 41, ST 44, ST 45, HT 7, GV 14, LI 4, LI 11, PC 8 Nourish Yin: CV 4, CV 12, ST 25, ST 36, SP 6, KI 3, KI 6, BL 23 Calm Shen: PC 6, GV 20, HT 7, BL 15,KI 6 Herb: Zhi Bai Di Huang Wan

24 Phase IV Kidney Yin and Yang depletion with Empty Heat and Fire KI Yang rises from KI Yin Thus as KI Yin is depleted so becomes KI Yang Blood work will probably also show azotemia

25 TCM Signs Severe emaciation, dry skin and coat, excessive thirst and hunger or inappetance Irritability, restlessness, wanting to be left alone Cold extremities, heat seeking, polyuria with dilute urine

26 Tongue and Pulse Tongue: red, dry small in late stages may be pale (Yang Def) Pulse: floating, rapid, wiry and very weak

27 Treatment Nourish KI Yin: KI 6, KI 3 Nourish Yin: CV 12, CV 4, SP 6 Warm KI Yang: ST 36, KI 3, GV 4, BL23 MOXA! Clear Heat: LIV 2, LIV 3, TH 5,GV 14,HT 7 Calm Shen: PC 6, GV 20, HT 7 Protect Liver from Heat: LIV 3, BL 18

28 Extraordinary Vessels Ren Mai Nourishes Yin Yin Wei Mai Connects all Yin channels and is the Preserver of Yin

29 Herbs and Diet Herb: Er Xian Tang Diet: Accelerated Pace thus need easily digestible and cooling foods that Yin Meats: beef, cod, eggs, chicken, clams Grains: brown rice, polenta, barley, millet Veggies: string beans, aduki beans, lentils, kidney beans, potatoes, yams, spinach, celery Avoid high fat foods!

30 Reference AHVMA Conference Proceedings. Treatment of Feline Hyperthyroidism using Chinese Medicine, Steve Marsden, pg 87-93, 1999.

31 Summary A disease with increasing occurrence A disease of progression Difference between DM and HT as both end in KI Yin Deficiency Heat and to some extent KI Yang Deficiency THE BEGINNING

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