Use of a Traditional Chinese Medical Herbal Formula to Treat a Dermatological Disorder of Unknown Aetiology in a Domestic Cat
A 4 year old white domestic short hair (DSH) cat presented with a 4 month history of excessive abdominal grooming with extensive hair loss and auricular self-trauma of 4 months duration. The cat had a prior history of perfect health and was vaccinated once for the core feline diseases (FVRCP) as well as rabies (Imrab-3). This indoor-outdoor cat lived on 9 rural acres in a two cat household. A female Great Dane puppy had been adopted into the household 4-5 months prior to the owner presenting the cat for examination. The owner reported that the puppy playfully (from the puppy's viewpoint) chased and harassed the cat most of the cat's waking hours. The cat responded by hissing, raising his hair and occasionally swatting at the dog.
A combination of manufactured feline diet (Felidae) and raw foods (chicken necks, chicken gizzards, various fruits and soy products) was fed to the cat. Insecticidal medication specific for fleas (AdvantageTM) was applied by the owner whenever fleas were detected on the cat. This application occurred about 3-4 times annually. The owner reported that the cat commonly was found licking its abdomen and medial thighs. Less commonly the cat would scratch at its ears with its hind feet causing trauma and bleeding.
Western Physical Examination
The cat weighed 13.8 pounds and was in good flesh. His eyes, ear canal, nose and throat appeared normal. He had normal heart rate, rhythm and lung sounds. His fur appeared dense and beautiful except around the ears and ventral abdomen and medial thighs. He had periauricular excoriations with some scabs and some fresh blood, apparently from self trauma. His ventral abdomen and medial thighs had only a fine layer of very short and sometimes nonexistent hair. The abdomen and thighs were neither excoriated nor was the skin inflamed. This area was also apparently alopecic due to extensive self-grooming.
The ears had no signs of either ear mites or otitis externa. No mites were found on the ventral abdomen. A flea combing revealed neither fleas nor flea dirt (flea faeces). There was no history of stool changes or vomiting or diarrhoea that might be related to adverse reactions to food.
Traditional Chinese Medicine Examination
All of the physical parameters of the Western Physical Exam were confirmed in the TCVM exam. Further, the tongue body was bright red with a thin clear coating. The pulse was tight and slightly thin with the greatest tight quality in the left middle position. The cat had traumatized its ears in the area of the Shaoyang Channels (Triple Heater and Gallbladder). The ventral abdomen was excessively groomed along the Conception Vessel, Kidney Channel, Stomach Channel, Spleen Channel, and Liver Channel. The medial thighs were excessively groomed along the Liver and Spleen Channels.
Overall the cat seemed to have a heightened sensitivity to sound, movement, and other stimuli. Although relatively calm and friendly around people, the cat responded very defensively to other quadrupeds. There was increased sensitivity to touch at the back Shu or Association points of the Liver and Spleen and Stomach.
The Western diagnosis included: flea allergy dermatitis, ear mites, otitis externa, food allergy, atopy, idiopathic self-trauma and endocrinopathy. The flea allergy dermatitis was unlikely due to the absence of fleas, flea dirt, and the use of anti-flea chemicals. The ears were free of both mites and infection. Lack of seasonal association made atopy less likely, Food allergy remained a possibility as well as idiopathic self-trauma. Lack of any other symptom of endocrinopathy significantly reduced the probability of this diagnosis, although no blood chemistries were done in order to rule it out (Messinger 2000)
Traditional Chinese Medicine Diagnosis
The red tongue indicated Heat in the body, particularly the Middle Jiao (upper digestive tract) and Heart. The tight pulse suggested Qi stagnation, particularly in the Middle Burner and Liver. The thin pulse quality suggested a mild Blood or Yin deficiency (Ferguson 2002).
The periauricular trauma suggested Damp Heat or Stagnation in the Shaoyang (GB, SJ) Channels leading to self-mutilation. The excessive grooming of the ventral abdomen and medial thighs is relatively common in small quadrupeds that have Wood-Earth or Liver-Stomach/Spleen disharmonies. The reactive Bladder Shu points along the dorsum suggested problems in the Liver and Stomach and Spleen. The reactivity to stimuli and harassment by the Great Dane puppy suggested irritability due to Liver Qi Stagnation.
The TCVM diagnosis was Liver Qi Stagnation with Damp Heat manifesting in the GB and SJ channels leading to extensive self-grooming and self-mutilation.
One of the most elegant yet simple principles of energetic medical systems such as TCVM is that, once identified, the Bian Zheng (Pattern Differentiation) is treated heteropathically. Thus in the case of Liver Qi Stagnation, the Liver Qi is smoothed and spread or coursed. Damp Heat in the Liver, Gallbladder and SJ Shaoyang Channel is Drained. The root cause should always be addressed, and to that end the owner was asked to attempt to inhibit the puppy from harassing the cat.
Formula and Individual Herb Selection
The TCVM herbal formula Xiao Yao San (Rambling Powder), is commonly used if emotional problems predominate with Liver Qi Stagnation. This cat had both the emotional problems with Liver Qi Stagnation (including appropriate Tongue and Pulse characteristics), but also showed signs of Gallbladder Damp-Heat. Long Dan Xie Gan Wan (Gentiana Longdancao Decoction to Drain the Liver), was chosen This herbal formula is indicated for Heat Excess in the Liver and/or Gallbladder Channels (Bensky and Barolet 1990). Typical symptoms in a human would include: pain in the hypochondria, headache, read and sore eyes, swelling in the ears, irritability, short temper, wiry, rapid and forceful pulse, and a red tongue with a yellow coating. Small carnivores typically have very subtle to nonexistent changes in their tongue coating, possibly due the relatively short gut and limited time that food remains in the stomach, since in humans the tongue coat is mostly the "residue" of the stomach contents.
This cat was given a dose of one 175 mg patent tea-pill crushed in food every 12 hours. Tea-pills are usually dosed at one per 10 pounds of body weight in small carnivores. They should be crushed to facilitate digestion and absorption.
Within one week of beginning the herbal formula the cat had stopped traumatizing his ears and significantly reduced abdominal and thigh grooming. Within one more week all of the cat's self-grooming had stopped and the caretaker reported that the cat seemed more peaceful and relaxed. He reacted less to the puppy and would lay about the house without his usual vigilance. By the end of the third week the owner stopped giving the herbal formula due to absence of clinical signs and the cat has been normal for the ensuing two years.
In veterinary practice it is common to see patients who have clinical signs of disease with no obvious aetiology. Particularly in Florida, dampness, heat, and parasites seem to combine to cause many companion animals constant anguish over their skin. Most veterinarians treat such disharmonies with steroids and or antibiotics. These treatments, in the experience of many of us, leads to short term suppression of the clinical signs (symptoms are subjective self-reports by humans, while signs are the objective anatomical and physiological date) with attendant exacerbation a short time thereafter. Thus, the "diagnosis" of many disorders is termed "idiopathic", which literally means disease to oneself. I sometimes tell my clients that idiopathic actually means that we DVMs are idiots with respect to the pathoetiology of the disease.
Energetic medicine allows the practitioner to inquire directly to the animal as to its overall disharmony. Whether an animal is Hot or Cold, Excess or Deficient, or has an Interior or Exterior disorder is easily discovered with a short history and access to the tongue and pulse. Further, palpation of BL Channel Shu points, analysis of the coetaneous regions involved, and further refinement of the pulse diagnosis allows the experienced practitioner to identify the relevant Chinese organ system involved (Xie 1996).
In the case of this cat, all clinical signs pointed to a stress-related disharmony that led to the problems for which he presented. Not only were the clinical signs then reduced and eventually eliminated, but this was done without suppression and with apparent long-term cure. The caretaker was very pleased, the cat seems more at ease in his home, and the practitioner feels a sense of actually facilitating long-term health rather than contributing to future problems by the use of strong Western drugs.
Bensky, D. and Barolet, R. 1990. Chinese Herbal Medicine Formulas and Stragies. Eastland Press, Inc. Seattle, WA.
Ferguson, B. (2002). ‘Chinese Pulse Diagnosis Part I: Qualities’, Journal of the American Holistic Veterinary Medical Association, 21:2, pp.33-37.
Messinger, L.M. (2000). Prutitus Therapy in the Cat. In Kirk's Current Veterinary Therapy, XIII, Bonagura, J.D. (ed.), W.B. Saunders Company, Philadelphia.
Xie, H.S. (1994). Traditional Chinese Veterinary Medicine. Beijing Agricultural University Press, Beijing, PRC.