By Katerina Brzovic DVM
Acupuncture was successfully used to reduce the outcome of a Chronic Kidney Disease (CKD) and Idiopathic Epilepsy (IE) in a female domestic long hair cat. She received 5 sessions of dry needle and laser acupuncture, along with western medication, to reduce the epilepsy crisis frequency, the vomiting provoked by the renal insufficiency, to improve the prognosis of both diseases and to reduce the stress when people visited the house. The vomiting completely stopped after the first session and the cat’s stress reduced considerably after the third session. No epilepsy crisis has occurred ever since and her renal test results are stable.
Pupi is an 11-year-old female cat who presented in February 2021 with vomiting as the main clinical sign. She was diagnosed in 2013 with an Idiopathic Epilepsy (IE) and in 2019 with a stage 1 Chronic Kidney Disease (CKD). She tends to have 3 or 4 epileptic crisis a year, being in November 2020 the last one; and she has vomited 4 times in the last 2 weeks, as a result of the progression of the CKD. She had a blood work done showed a mild increase in creatinine (1.7 mg/dL) and proteinuria (UPC 0.3), and the Veterinarian recommended to keep her with the same renal diet (Hill’s). The owners decided to try an acupuncture treatment mostly to reduce the vomiting, though she was confident that TCVM could also help her cat with by reducing the frequency of the seizures and to minimize her stress when people come to the house. We agreed that Pupi would have 4 initial sessions, once a week, and then we would evaluate her response.
February 16, 2021
Pupi was quite active and alert. At the clinical exam, only a slight paleness in her gums was detected (expected as she was under stress).
February 16th, 2021
Pupi is more active in the early morning around 4 or 5 am, a moment where she plays alone in the living room. She prefers warm places, though she is never right next to the heater, and is cuddly with the owners though she is very reserved with the rest; she stresses out easily when someone arrives or hears strong noises. Her appetite had always been good but the last weeks it’s has diminished; her water intake seems normally as well as her urine. Her stools can easily get softer than normal. All the epileptic seizures have been in the early morning; around the same time when she is more active. After some questions, the owner recall that Pupi started her epilepsy episodes a month after they had moved out to her current house, as it was a very stressful moment for the cat and the whole family.
On the examination Pupi seemed quite stressed though she wasn’t aggressive. Her skin was slightly greasy and the temperature was quite uniform, with the stomach area a bit colder than the rest. Her tongue was pale with rounder borders in the middle and her pulse was thin and deep. Back Shu Points palpation revealed alteration in the following meridians: Stomach (BL 21), Spleen (BL 20), Liver (BL 18), Gall Bladder (BL 19) and Kidney (BL 23); whereas in the Mu points palpation only the Kidney (GB 25) was reactive.
Finally, diagnosis of Kidney Yin Deficiency was stablished. This was probably caused by a poor diet that lead to a Spleen Qi that, in time, lead to a Kidney Yin deficiency.
time (and probably triggered by the house moving) lead to a Rising Yang (false heat) that causes the epileptic convulsions.
Levetiracetam 100 mg/ml, 1ml twice a day (current treatment)
Kidney care Hill’s dried food (current food)
Eastern (TCVM) Treatment: Principles:
- Tonify Kidney Yin
- Tonify Spleen Qi
- Bring calmness to her Shen
A Dry Needle Acupuncture Treatment was chosen, using Seirin 0.16mm x 15mm needles, except in LV 2, GB 20 and CV 12 where laser acupuncture was used. These needles remained in place for 10-15 minutes, depending on the resistance they put when pulling. The points strategy slightly changed in each session. SP 6, ST 36, KD 3, LV 2 and HT 7 were needled unilaterally, while GB 20 were needled bilaterally
February 16, 2021:
SP 6 was used to benefit the Spleen function and to tonify the Qi and the blood, in order to reduce the nauseas and the vomiting – and increase the appetite -, to tonify the kidneys and to treat the primary cause. ST 36 was used to build up Qi, help the the Spleen and Stomach functions and to expel the wind, in order to give her more energy and reduce the vomiting. CV 12 was used to benefit the Stomach function and to dispel and transform Dampness, again to help her with the nausea and vomiting. KD 3 was used to benefit the Kidneys and improve their function. GV 20 and GB 20 (bilaterally) were used to expel the internal wind that is producing the epileptic convulsions. LV 2 was used to subdue the Liver Yang the is causing the internal wind. HT 7 was used to bring calmness to her Shen and reduce the stress.
February 23, 2021:
Pupi stopped vomiting and she was more relaxed than the first time I saw her, the owner also noted that she was less reactive when strong noises were heard and the early morning activity was later than usual. Her pulse wasn’t as thin as the last time and her tongue had more color and the border were thinner. In this session the points chosen were the following: GV 20, SP 6, PC 6, KD 3, LV 2 AND HT 7 (all unilateral). GV 20 was repeated to expel the internal wind. SP 6 was repeated to keep on boosting the Spleen function. PC 6 was used to keep on reducing the nausea and to calm the Shen. KD 3 was repeated to keep on promoting the Kidney function. LV 2 was repeated to subdue the Liver Yang. Finally, HT 7 was also repeated to bring more calmness to her Shen.
March 2, 2021:
Pupi was very welcoming when I entered the house, she was definitely more relaxed. The owner noted that her appetite is better and that her stools are more firm. She also mentioned that she is more active during the day and that she is waking up around 7am and not at 4-5am, as before we started the treatment. Her tongue had a nice pink color and the borders were normal. Her pulse still felt a bit weak, but stronger than the last time. I repeated the first treatment with the following points: ST 36, SP 6, CV 12, KD 3, GV 20, GB 20 (bilateral), LV 2 and HT 7. She was very receptive to the needles and even starting purring after a few minutes.
March 9, 2021:
Pupi was again very welcoming and I could tell the owner was very happy about it. She pointed out how different she is now when people arrive home. They even brought a dog home (Pupi already knew from the previous house) and she didn’t react much. Her tongue was pink and the borders were normal; her pulse still felt week like in the last session like in the last session. This time, Pupi was reactive in Spleen, Liver and Kidney Back Shu Points. The following points were chosen: SP 3, BL 23 (bilateral), BL 18 (bilateral), GV 20 and HT 7. SP 3 was used to strengthen the Spleen. BL 23 was used to tonify the Kidney function. BL 18 was used to strengthen the Liver function. GV 20 was used to open the door to let the internal wind out. And finally, HT 7 was used to keep her Shen in calmness. This session was to reinforce everything that has been done so far. I recommended the owner to see me in a month and do one session every two or three months, as a maintenance treatment.
I first saw Pupi in February 2021. She is an 11-year-old female, domestic long hair cat. She had been diagnosed in 2013 with an Idiopathic Epilepsy (IE) and in 2013, with a stage 1 Chronic Kidney Disease (CKD). Although she seemed in good general health to the owners, lately she had been vomiting (4 times in the last 2 weeks) and losing the appetite. Her last bloodwork, done the week before, showed a mild increase in creatinine (1.7 mg/dL) and proteinuria (UPC 0.3), therefore the cat switch to a medicated renal commercial food. Ever since she was diagnosed with the IE, she has been taking Levetiracetam (current dose: 100 mg/ml, 1ml twice a day).
The owner decided to try acupuncture as she felt that just changing Pupi’s diet wouldn’t make a big difference for her kidneys, and because she wanted to reduce, or at least keep, the epileptic convulsions frequency stable (she has 3 or 4 per year) together with bringing her more calmness. It’s important to notice that around 2 months before Pupi had her first convulsion, the whole family (and her) moved out to a new house. This event put her under a lot of stress, and the owner said the she never really got back to her previous personality (more relaxed and cuddly).
I recommended the owner to start with a 4 sessions acupuncture treatment, once a week, and evaluate her evolution.
After the Western examination, no findings could be noted. She only had some paleness and dryness is the gums, though her hydration time (in her loin) was 2 seconds, and the abdominal palpation seemed uncomfortable for her in the stomach area.
As for the Eastern examination, I found out that Pupi tends to wake up at around 4 or 5 am and stars playing around the house very energetically. This is also the moment when she has had the convulsions. She seems to prefer warm places, though she never stays next to the heater. Her appetite has decreased in the last 2 weeks and she has vomited 4 times in that same period. Her stools also changed during that time, becoming softer than usual. In terms of her behavior, before they moved in, Pupi was quite social and cuddly and would look for human contact all the time. Now she is very fearfull (but not aggressive), especially when people come over or when she hears strong noises. Her teeth had tartare, even though she had a cleaning session the year before. Her gums were slightly dry and pale and her tongue was also pale with rounded borders. Her abdomen was tight in general, with pain signs in the stomach area, which was also colder than the rest of the abdomen. Her pulse was deep and week, especially in the deepest middle third on the right leg.
In the Bladder Meridian, the sensitive Back Shu Points were: Liver (BL18), Gall Bladder (BL19), Spleen (BL20), Stomach (BL21) and Kidney (BL23); whereas the only sensitive Mu (alarm) Point was Kidney (GB25).
According to TCVM, Pupi’s signs are pointing out to a Kidney Yin Deficiency. This deficiency was probably caused by Spleen Deficiency. Her pale and swollen tongue are caused by the stagnation, her fur is greasy due to Dampness; as the Spleen is not working properly, Qi stagnation and Dampness occur, not being able to bring up Qi and blood. This in time turns into Phlegm. This Spleen Qi Deficiency also means that the Spleen is unable to produce enough Blood, affecting the Yin. This creates Heat, which together with the Phlegm weaken the Kidney and the Liver1. This explains her weak teeth and her increasing fear2. On the other hand, as the the Liver becomes insufficient in Blood, this leads to a Liver Yang Rising (false heat) and to an agitation of the Liver Wind, producing the epileptic convulsions3. It is noticeable that Pupi’s epileptic convulsion were always between 4am and 5 am, the moment where the Qi is at its lowest in the Kidneys, intensifying this Yang Rising as the Kidneys are not able to cool down the body. On the other hand, the Kidney Yin deficiency also affects the Heart, creating a false Heart Yang excess4, which increases this false heat, contributing to the symptoms.
All three Kidney, Liver and Heart Yin deficiencies were probably enhanced by the stress Pupi suffered during the house moving, where a lot of frustration and fearfulness were involved. The Dampness also affects the Kidneys by blocking the circulation of fluids5 and by insufficient production of Essence for storage in the Kidneys6, provoking even more Kidney Qi Deficiency.
Both deficiencies (Spleen and Kidney) created stagnation in the Middle Jiao, causing the nauseas and eventually the vomiting, as the Stomach Qi could not descend7. Finally, the soft stools were also caused by the Spleen deficiency.
The TCVM treatment principle was based on the tonification of the Kidney Yin, of the Spleen, and in bringing calmness to her Shen. I recommended the owner that Pupi should had 4 sessions, once a week, so we could see bigger changes and evaluate the following step.
For this treatment principle I chose the following points: SP 6, ST36, CV 12, GB20 (bilaterally), GV20, LV 2, KD 3 AND HT 7. As Pupi wasn’t used to needles and she was quite fearful, I decided to use laser acupuncture in CV 12, GB20 and LV 2; whereas the rest of the points could be easily needled. To help tonify the Spleen, I used SP 6 (and ST36 that tonify the Earth element). ST 36 was also intentioned to regulate de gastrointestinal system and to build up more Qi. CV 12 is the Mu point for the Stomach, so I chose it to regulate this meridian, thus the nauseas and vomiting. For the epilepsy symptoms, the acupuncture points chosen were GB 20, GV 20, as they both eliminate the internal wind. LV 2 subdues Liver Yang, and so the last 3 points mentioned would reduce the epilepsy symptoms. KD 3 is the source point of the Kidney Meridian, thus it benefits its function. Finally, Pupi stress (together with her Earth constitution) was probably the initial cause of both the Spleen Qi Deficiency and the Liver Yang Rising, so I chose to needle HT 7 to accompany the other points to give more calmness to her Shen and so reducing the stress of her Spleen, Liver and Kidney meridians.
The following sessions had slight changes in the points selection, just to stimulate different meridian areas. PC 6 was used instead of CV 12 to regulate the Qi in the cranial abdomen (nausea/vomiting) but also to bring calmness to her Shen. SP 3 was used instead of SP 6 to tonify the Spleen; BL 23 was used instead of KD 3 to enhance to Kidney function and BL 18 was used to regulate the Liver function.
Pupi had improvements since the first session. She stopped vomiting and the owner said she was more relaxed than before. Her pulse revealed that the deficiency wasn’t as pronounced as the week before and her tongue was less pale. Since the third session, Pupi’s appetite went back to normal and her stools were firm. Her mood kept on improving, even to the point where she was very welcoming cuddly at my arrival. After the final (4th session), I recommended the owner to continue with an acupuncture session every 3 or 4 months.
Even though the acupuncture effects can be explained by applying the TCM theory, Western Medicine can only explain some of those effects, leaving others to further study. As we know, one needle insertions may affect multiple systems: e.g. nervous system, circulatory system, immune system, endocrine-hormonal system, etc., and a therapy form which affects multiple systems can be difficult to research8. That being said, neurophysiologist nowadays define the mechanism of action of acupuncture to be through neuromodulation of the nervous system9.
As for the visceral effects of acupuncture, the afferent nerves from the viscera run in autonomic nerves, arriving at the substantia gelatinosa of the dorsal horn. This means, for example, that afferent fibres from the wall of the gastrointestinal tract accompany sympathetic nerves and terminate at segments T5 to L110. So acupuncture can inhibit nociceptive stimuli from visceral structures11. This explain why needling Pupi in BL 18 stimulated her Liver, for example; though Western Medicine doesn’t seem to find a direct relationship between the Liver and the IE, like in TVCM.
As for Pupi’s nauseas and vomiting, both symptoms are a response of the emetic center and che-moreceptor zones to a variety of stimuli; and when needling PC 6 or ST 36 this emetic response is reduced9. Unfortunately, the precise mechanisms of action are still unknown.
Acupuncture also has a normalizing effect on the autonomic nervous system12, producing general calming effects on many patients and improving their wellbeing13. This explains why Pupi became more relaxed, welcoming and cuddly since the first session.
No Western Medicine literature was found relating the Spleen (and/or pancreas) as the possible cause for a CKD, probably because Dampness or Phlegm are not concepts related to a specific structure/function/fluids, etc. of the body.
A change in her diet is recommended as this could have initially affected Pupi’s Spleen.
In conclusion, acupuncture proved to be an effective treatment for Pupi’s condition, specially by improving her quality of life and hopefully the progression of both, the Idiopathic Epilepsy and the Chronic Kidney Disease. Pupi’s family is now very open to alternative treatment and are willing to try it for them in the future.
- Van den Bosch, Emiel. Neurologic Disease. BEVAS Course: Session 5 (2019 – 2020). Slide 27.
- Puerta, Dolores; Snijders, Albert. Water Element. BEVAS Course: Session 1 (2019 – 2020). Slide 3.
- Maciocia, Giovanni. Los Fundamentos de la Medicina China: Un Texto de Consulta para Acupuntores y Fitoterapeutas. Edición Española: Aneid Press, División de Aneid Lda, 2001. 159.
- Van den Bosch, Kati. Heart and Blood Physiology and Pathology in Chinese Medicine. BEVAS Course: Session 4 (2019 – 2020). Slide 30.
- Maciocia, Giovanni. Los Fundamentos de la Medicina China: Un Texto de Consulta para Acupuntores y Fitoterapeutas. Edición Española: Aneid Press, División de Aneid Lda, 2001. 264.
- Marsden, Steven, Modified and presented by: Heilman, Nathan. 2018-2019 Internationl IVAS Course Notes, Chapter 9. Overview of Chinese Medical Physiology and Pathology. 2018-2019. 314.
- Van den Bosch, Kati. Spleen Syndromes. BEVAS Course: Session 4 (2019 – 2020). Slide 5.
- Skoien , Jim. 2018-2019 International Course Notes, Chapter 8. Neurophysical Acupuncture Mechanisms. 2018-2019. 225.
- Martin, Olga. Neurophysiology of Acupuncture. BEVAS Course: Session 5 (2019 – 2020). Power Point 1, slide 4.
- White, Adrian. An Introduction to Western Medical Acupuncture. Edinburgh: Churchill Livingstone/Elsevier, 2008. 32.
- White, Adrian. An Introduction to Western Medical Acupuncture. Edinburgh: Churchill Livingstone/Elsevier, 2008. 33.
- White, Adrian. An Introduction to Western Medical Acupuncture. Edinburgh: Churchill Livingstone/Elsevier, 2008. 56.
- S. Lindley, T.M. Cummings. Essentials of Western Veterinary Acupuncture. Blackwell Publishing, 2006. 113.
- White, Adrian. An Introduction to Western Medical Acupuncture. Edinburgh: Churchill Livingstone/Elsevier, 2008. 11.