By Rikke Hansen DVM
Acupuncture was used successfully to treat gastric ulcer and aggressive behaviour in a young Danish Warmblood. Weekly dry needle acupuncture over one month time was performed along with western medication. The horse responded well to the treatment, and the aggressive behaviour quickly disappeared. The horse was cured of the gastric ulcer, and within the month the horse could return to full dressage training.
ND´s Shotgun is a 4-year-old Danish Warmblood gelding, which was presented with a history of aggression towards people and aversion to training. Shotgun had been in a professional dressage stable for about 2 months. He had developed well in training, but in the last 14 days the horse has started to show aggression when the girth was tightened and aversion to being ridden. The owner was nervous because Shotgun was in general a very sensitive horse, and had started being a little aggressive around humans. The owner noted that the horse was used to be on pasture every day with other young horses, before he was put in training. The owner was the breeder of the horse and informed that the horse had a pedigree with a lot of “hot” blood. The horse was on a sand paddock for 1 hour every day, and was trained 6 out of 7 days a week. The teeth had been checked and floated by another DVM without any significant findings. A saddle fitter had checked the saddle, and had not found any explanations for Shotgun’s resistance to being ridden. No prior medical treatment had been used, and the owner wanted to try TCVM treatments to eliminate the stress and pain the horse was experiencing.
Clinical Signs/Diagnosis – Conventional (Western):
November 30, 2020 Shotgun was bright and alert, and a normal TPR was found on the general physical examination. The horse had a good body condition score of 5 out of 9, and had a good muscular composition in relation to his age. He was very tense when he was observed in his stall, and had a tendency to wander and kick against the box wall. No other abnormal behaviour was observed such as crib biting etc. When put in the grooming area the horse would appear almost aggressive towards people passing by. The horse would pin his ears when approached, and lift the hind legs when groomed. Sign of pain was noted on palpation of the girdle area, and the horse seemed annoyed when touched in general. A full lameness examination was performed without any significant findings. The stool was soft but without foul smell. A faecal equine blood test was performed, and showed signs of blood in the stool. The owner declined to have a full gastroscopy examination done on the horse. Based on its previous history and the clinical signs, Shotgun was diagnosed with a gastric ulcer. The aggression was believed to be caused either by pain or stress, or possible both.
Clinical Signs/Diagnosis – TCM (Eastern):
November 30, 2020. Shotguns behavior had changed from a content horse to a stressed/irritated horse. His normal environment had been drastically changed from several hours on pasture, to only 1 hour on a sand paddock without any company by other horses. The horse was stressed when he was in his box, and irritated when handled by humans. He had started to show resentment when ridden, and was in general reacting aggressively when feeling pressured. Shotguns appetite had changed, and the horse would often have pellet leftovers in the crib by time of next feeding. No change in thirst was noted. On examination Shotguns tongue appeared slightly lavender, and with a white moist tongue coat. No teeth marks were visibly. Shotguns pulse was wiry and equal between right and left. The faeces were loose but without any strong smell. No urinary change was noted. The horse showed sign of pain on palpation of the abdomen around the girdle area, and back towards the umbilicus. On palpation of the Back Shu points, reactivity was found primarily around Bladder 18 and 47. Bladder 21 also showed signs of sensitivity. On palpation of the Mu points a strong reaction was found at LIV 14. In addition sensitivity was found from CV 12 to CV 17, and on both sides of the neck at ST 10. Shotgun’s constitution was identified as Wood. A diagnosis of Liver Qi stagnation caused by emotional disturbance was made based on the irritability, aggression, hypochondriac pain, wiry pulse, and slightly lavender tongue4,5 . Based on the symptoms of loose stool, decreased appetite, epigastric pain, and blood found in the faecal blood test, I derived that the Liver Qi stagnation caused an over control on the Earth element, leading to Spleen Qi deficiency and Stomach fire4 .
Conventional (Western) Treatment:
First treatment session – November 30, 2020: Shotgun was put on Gastrogard 1 tube SID PO for 1-month duration. In addition, the horse was fed an ad libitum diet of roughage. At the same time, it was arranged that the horse could be put on pasture with another horse for up to four hours a day (maximum capability at the dressage stable). For the first 2 weeks of treatment the training intensity was minimized, so that no unnecessary pressure was put on the horse but only ridden as light exercise.
TCM (Eastern) Treatment:
The treatment strategy was to resolve the Liver Qi Stagnation, eliminate the Stomach heat and tonify the Spleen Qi. All the treatments were performed with dry needle acupuncture using Cloud and Dragon silicone coated acupuncture needles with guide tube. The needle size was 0,3mm x 30mm. The needles were placed at a depth of about 0,5cm using an even needle technique for all the points. The needle was left in for 20 minutes for each acupuncture session. Used acupuncture points for all four sessions:
Treatment at the first session –
November 30, 2020: HT 7, PC 6, BL 47 was used to address the emotional aspect of the case by calming the mind and Shen. LIV 3 in combination with LI 4 was used to resolve the Qi stagnation. ST 44 was used as a water point to address the heat in stomach. CV 12 was used to move stagnation in the middle burner and benefit the stomach because it is the Alarm point. GB 34 was used because it is useful for LIVST Qi Stagnation. LIV 13 was used because it is the alarm point of Spleen, and therefore benefits both the SP and Liver function. SP 6 is the meeting point of Liver, Spleen and Kidney, and was used because of its multiple effect on both Liver and Spleen. BL 21 is the association point of stomach and was used to manage the gastric ulcer.
Results and treatment at the second session – December 7, 2020:
The owner noted that the horse had responded well to the first treatment. There had been signs of diminished irritation/aggression when handled, and had showed no sign of reluctance when ridden. The horse still showed sign of sensitivity when palpated along CV 12 to CV 17, and on examination of ST 10. The reaction of BL 18, BL 47 and BL 21 was still present on palpation of the Back Shu points. HT 7 and PC 6 were repeated again for the emotional effect. ST 36 was added to benefit the gastrointestinal tract and tonify Qi. BL 18 was used this time instead of BL 47 to promote Liver function. LIV 3 and LI 4 were used again to address the Qi stagnation. BL 21, ST 44, CV 12, SP 6 was all used again to address the gastric ulcer. LIV 14 and GB 34 were discontinued.
Results and treatment at the third session – December 15, 2020:
Owner was still happy with Shotgun’s improvement. The horse was less irritated when handled, and did not pin his ears anymore or threaten with a raised hind leg when groomed. He still had a tendency to stress a bit in his box, but his appetite had returned to normal. On examination his pulse felt normal and tongue was pink and moist. A little sensitivity was still found on palpation of BL 18 and BL 21. The Mu point of Liver (LIV 14) was not reactive. On palpation of the ventral abdomen, CV 12 was reactive but the rest of the Conception vessel point felt normal. SP 6 was discontinued because the stool had a normal consistency. The rest of the points from the second treatment session were applied again (HT 7, PC 6, ST 36, BL 18, LIV 3, LI 4, BL 21, ST 44).
Results and treatment at the fourth session – December 23, 2020:
According to the owner Shotgun was back to his normal self. 2 days prior they had started to train the horse more intensively, and Shotgun had showed no resistance. The horse could be touched everywhere, and no sign of aggression were shown. On examination the Shu and Mu points felt normal. Only a little sensitivity was felt at CV 12. A faecal equine blood test was performed once more, and was found negative. PC 6 and HT 7 were repeated again just as an extra support to calm the mind of a young horse in a big dressage stable (possible stressful environment). BL 18 was used to promote the Liver function (Qi flow). LIV 3 was used to support BL 18 with the flow of Qi. ST 36 was used to promote GI function and build Qi. CV 12 and BL 21 were repeated to benefit the stomach function. LI 4 and ST 44 were discontinued. Medication with Gastrogard was changed to ½ a tube SID PO for 14 days after which it should be discontinued. It was recommended that Shotgun still should have access to daily pasture time with another horse. The owner agreed to a follow-up with acupuncture after one month, to make sure that there was no relapse.
Shotgun was treated with acupuncture because he was diagnosed with gastric ulcer and had behavioral changes such as irritability and aggression when handled. Prior to consultation, Shotgun had been moved to a big dressage stable and had started intensive training. On the clinical examination from a TCVM standpoint it was made clear that Shotgun had developed: Liver Qi stagnation • Irritability, aggression, hypochondriac pain, wiry pulse, and slightly lavender tongue5 .Liver Qi stagnation making over control of the Spleen and Stomach • Loose stool, decreased appetite, epigastric pain, blood found in the faecal blood test4 . Shotguns history of symptoms is really clear to understand when you see it from a TCVM point of view. It is easy to recognize why a young horse can be irritated and aggressive when it is experiencing a major environmental change not in favor of the horse (hectic environment, no pasture time, and increase in the training). Combine that with the knowledge of how emotions can highly impact the Liver, Liver Qi stagnation is an expected cause. According to the five elements theory, when the Liver Qi stagnate it has a tendency to invade the grandchild, which is Earth4 . Spleen and Stomach will thereby be weakened leading to the gastric ulcer. I did not find any other heat signs or phlegm that could be expected with stomach fire and Liver Qi stagnation. The treatment consisted of four acupuncture sessions in combination with medication of Gastrogard. The points chosen: Move Liver Qi stagnation1, 5: • LIV 3 – Source point and resolve Qi • LI 4 – Source point and move Qi with LIV 3 (Four gate) • BL 18 – Association point of Liver – Benefit liver function • GB 34 – He sea point, useful for LIV-ST Qi Stagnation. Benefit the emotional aspect1, 6: • HT 7 – Source point of the heart Calm the mind • PC 6 – Master point for the Chest and Cranial Abdomen, calms the Shen • BL 47 – Outer association point for Liver, Emotional point. Addressing the Stomach fire1, 2,7: • ST 44 – Water point, good for Stomach fire • CV 12 – Alarm point for stomach, moves stagnation in middle burner. • BL 21 – Association point for Stomach. Benefits the Stomach function of descending. Benefit the gastrointestinal tract and tonify Qi1 . • ST 36 – Master point for gastrointestinal tract. Benefit the Liver and Spleen function5 :• SP 6 – Meeting point of 3 Yin on hind leg, harmonizes the Liver and spreads LIV Qi. Benefits the spleen function. • LIV 13 – Alarm point for the Spleen, benefits the Liver functions of patency of flow of Qi, and Spleen function of transportation. By the end of the fourth session Shotgun showed no signs of aggression, and was returned to his training schedule without showing any resistance. The owner declined to have a full gastroscopy examination performed. It must be clarified that equine faecal blood test is not the gold standard to diagnostic gastric ulcer. A gastroscopy is the only way to be sure where in the stomach the problem is occurring, how deep the ulcer is, and thereby give the best indication for how long a treatment should be, and if the treatment is successful. With that said, equine faecal blood test can still be used as a valid test especially in conjunction with a physical examination. It is not possible to say what the outcome of the treatment would have been without acupuncture. Gastrogard alone clearly has a good effect on gastric ulcer, but I think the healing time was improved by the acupuncture. Another thing with TCVM is that you can actually target the emotional aspect of this case. In western medicine aggression can only be dealt with if it is triggered by pain, but in this case, it is equally frustration and irritation that is leading to the complaint. For this reason I find that TCVM is a very powerful tool to use in daily praxis, especially when working with equine, as I believe there is a lot of triggered emotion caused by the way we keep and breed our horses.
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9.- Notes of BEVAS Acupuncture course. Dr. Emiel Van den Bosch, Dr. Albert Snijders, Dr. Kati Van den Bosch, Dr. Juliet Decaestecker, D. Puertas.
A continuación el caso clínicoVanessa-Bentanachs-Martín_0