ABSTRACT

Dog. Female, boxer, 7,5 years old with nephrotic syndrome by Leishmania, treated for Leishmania and Qi Deficiency with good results.

HISTORY

Astra is a 7,5 years old female boxer, not-sterilized, with regular heats. She has been given all the recommended vaccinations and heartworm prophylaxis. She is feed with homemade food (pasta, rice, vegetables, meat- not tinned food).
She had never had any health problems until the day she was taken to the clinic. Her symptoms were: inappetence, polydipsia, polyuria with loss of urine, especially during the night, dribbling after urination, frequent and copious clear urination, loss of weight, depression. She craved for warm places, she lied in the sun, she did not want to go for the daily walk.

EXAMINATION FINDINGS

When she was brought to the clinic, the Western medical physical examination showed that Astra was weak and thin. The temperature was normal, the auscultation of heart and lungs was normal, the palpation of abdomen showed no irregular findings, as well as the examination of the eyes, no otitis, regular stool, pale membrane mucosae, regular nodes, oral tract and pharynx normal, no neurological problems, the coat was dry and lustreless, the muscles were hypo-tonic. With the TCM examination, the constitutional type related to the five elements of Astra was "earth type" (1). The patient had normal shen, she was thin, weak, with lustreless coat, tired with slow movements, lethargic, with cold extremities. Her tongue was pale, thin. The pulse was deep, slow, empty. At palpation of points BL 20 and BL 23 were painful.

DIAGNOSTICS

A complete blood check was carried out (Haemachrome, biochemical and haemostatic profile, see table 1). These values showed some alterations: creatine, BUN, phosphorous, RBC and some coagulation values were abnormal.

All these values showed that Astra suffers from kidney deficiency with anemia. A urine check was carried out (see table 2) which showed an abundant proteinuria with low specific weight. We carried out an echocardiography that showed no irregularities. The abdominal ultrasound showed only a cortical slightly hyperechoic and small anechoic areas with the volume of suprarenal glands slightly bigger (see table 3 and 4).

We performed a fine needle aspiration of the node and a bone marrow biopsy. These revealed the presence of Leishmaniosi. We performed a serologic test for Ehrlichia canis, which was negative. The IFAT test (direct immunoflourescence) for Leishmaniosi, performed by an external laboratory, resulted positive with an antibody title of 1:640.

WESTERN MEDICAL DIAGNOSIS
After all the tests and complete examination, we diagnosed a nephritic syndrome by Leishmaniosi. The canine Leishmaniosi is a systemic protozoal disease of mononucleate phagocytes. The most important characteristic of this disease is how and in which degree the immunity system of the host is affected. There can be various clinical manifestations of the disease and the disease can attack numerous different organs and the symptoms can be varied.

EASTERN MEDICAL DIAGNOSIS
The Leishmaniosi infection indicates a heat/dampness attach as a consequence of Wei Qi deficiency. Inappetence and depression account for the results of pulse examination that showed a Qi deficiency. The urine loss especially during the night reveals a Yang deficiency in the kidney. The pain felt at palpation of BL 20 reveals that the spleen is affected (Leishmaniosi affects the reticuloendothelial system) and palpation of BL 23 reveals that the kidney is affected (nephritic syndrome). According to the eight principles, the pathology presented by Astra is internal, cold, deficiency Yin with Qi deficiency in the spleen.

TREATMENT PRINCIPLES/TREATMENT RESULTS

The main treatments are:

• to benefit Qi and especially Wei Qi
• to benefit Spleen transformation and transportation function and dispel Heat and Dampness
• to benefit kidney water metabolism function
• to benefit kidney marrow functions
• to heat kidney Yin and Yang

Main points used:

• BL 20 (Pi Shu) 1.5 cun lateral to the caudal border of the spinous process of the 12 th thoracic vertebrae. Spleen shu point, benefits spleen function of transformation and transportation, nourishes blood.
• BL 23 (Shen Shu) 1.5 cun lateral to the caudal border of the spinous process of the 2nd lumbar vertebrae. Shu point of kidney, tonifies the Kidney Yin strengthens the marrow, benefits kidney function of dominating water metabolism, nourishes the blood.
• BL 28 (Pang Guang Shu) lateral to the 2nd sacral foramen, in the depression between the medial border of the dorsal iliac spine and the sacrum. Shu point of bladder, regulates water passages in the Lower Burnes.
• ST 36 (Zu San Li) 3 cun below ST 35, one finger-breadth from the cranial crest of the tibia, in the belly of the m. tibialis cranialis. Earth point, He point, Horary point. It is major tonification point. Tonifes Yin and Yuan Qi, tonifes Qi and blood. It strengthens the body, regulates Yin and Wei Qi
• CV 3 (Zhong Ji) 4 cun caudal to the umbilicus, on the midline. Allarm point of Bladder Meridian, resolves urogenital problems.
• CV 6 (Qi Hai) 1.5 cun caudal to the umbilicus, on the midline. Sea of Qi, regulates and tonifes Qi. It tonifes Yuan Qi, blood, Yin.
• SP 3 (Tai Bai) on the medial aspect of the second toe, distal to the tarso-metatarsal joint, on the postero-medial aspect of metatarsal II. Earth point, Source point, Horary point. Major point to tonify the spleen. Benefits spleen transformation and transportation.
  

Chronology of treatments:

At first, before the diagnosis of Leishmaniosi was confirmed, we started treating Astra for the kidney pathology with fluids-therapy (physiological saline solution, ringer lactated solution and glucose solution) in total 60ml/kg die in the first four days, and than a maintenance treatment of 35ml/kg die. Astra was given also albumin as the tests still revealed a considerable hypoalbuminemia. (Albumina Umana Baxter 20%®) 150 ml / die for 4 days.
Astra was given also essential fatty acid omega 3, ACE inhibitors Benazepril cloridrato 10 mg/ die (Fortekor 20®), and Astra had to follow a diet with reduced quantity of phosphorous (Prescription Diet K/D Hill's Pet Food).

The dog showed no improvement. She was still without much appetite also because she did not like the new food. She was thin, lethargic and was still loosing urine. I started to treat her with acupuncture: I administered moxibustion on BL 20, BL 23-28, CV 6 and CV 3. The day after the costumer told me that the dog had not lost urine during the night and so I continued to perform acupuncture with two more treatments, one five days after the other. The dog started eating again and was more lively.

Once we had the results from the laboratory we began with the treatment for Lesmaniosi: allopurinol twice a day (Zyloric®) to be continued for 12 months, metrodinazole (25mg/kg) and spiramycin(1.500.000UI/kg) twice a day (Stomorgyl 20®) to be continued for 3 months. I continued with the acupuncture treatments and the fourth treatment included moxibustion on BL 20-23 and CV 6, I used Seirin needles number 8 (0,30 x 30mm) in the points ST 36 (with depth of 1mm) and Spleen 3 (with depth 0.5mm) with tonification method (rapid-heavy thrust, slow-gentle lift, slow-small amplitude, clockwise, push needle slowly to proper depth, then rapidly pull it up to just beneath the skin, pressure, with channel course). In the meantime the dog had suspended fluids-therapy so she was treated only with oral therapy at home and she was taken to the clinic exclusively for the acupuncture treatments. The fifth and sixth treatment have been performed weekly with the same methodology and same points of the fourth treatment.

At the end of the acupuncture treatment, while still doing oral therapy, the dog's weight increased and the dog recovered appetite, did not lose urine anymore, was lively, was not craving for warm places, the mucosae were not pale and she was willing to play again. The tongue recovered colour and the pulse was fuller.

I must say that the owner of the dog is very happy with the results, as the dog, after six months, is still healthy. The blood examination still shows a creatine (3.00 mg/dl) and BUN (38.3 mg/dl) values are altered but stable. The antibodies title has gone down to 1/80.

DISCUSSION

When Astra arrived to the clinic she showed symptoms that could possibly refer to a kidney pathology, confirmed afterwards by the lab tests. Considering that the dog lived in an endemic area for canine Leishmaniosi, we thought of this possible differential diagnosis, taking into account that the ultrasound did not reveal major anomalies and the Ehrlichia test was negative. After Leishmaniosi had been ascertained by FNA of the node and IFAT test, we deduced that the kidney pathology was connected to Lehsmaniosi.

Considering that, when she arrived to the clinic, the dog was weak, depressed, showed little desire to move, while at the same time her Shen was normal, it was plausible to think of Qi deficiency. Qi deficiency is characterized by: pale face, pale tongue, lethargy, little desire to move, weak pulse(2). The kidney Yin does not nourish the kidney Yang anymore and therefore we have nocturia which is a consequence of kidney Yang deficiency. Kidney Yang Xu is characterized by frequent urination, some dripping, increased frequency at night, urine pale colour, increased volume(3).

With tonification and by benefiting the deficiencies through moxibustion and with needles in tonification on BL 20,23,28- CV 3,6, -SP 3, ST 36, the deficiency symptoms disappeared. The animal's energy and tonicity had been restored, and even though the animal was still under maintenance treatment and the values were still slightly altered but stable, Astra recovered her normal health as before the disease.

Considering that Leishmaniosi is a disease that affects the immune system, I believe that an acupuncture treatment is very useful as it acts upon the balance of the body, it succeeds in restoring energy, in increasing immunity. So the animal can produce an effective and protective immunitary response, which is able to stop the disease from developing even if the animal has already been infected.

TABLE 1

HEMOGRAM

LEUKOCYTE FORMULA

BIOCHEMICAL PROFILE

HEMOSTATIC PROFILE

TABLE 2

URINALYSIS

TABLE 3

ECHOCARDIOGRAPHY

TABLE 4

ABDOMINAL ULTRASOUND

HOURS ATTENDED
1999- Acupuncture course organized by SCIVAC- Cremona with IVAS speakers (C.Robinson, C.Muller, J.Still, U.Wurther, L.A.A.Jansen, A.M.Shoen, D.H.Jagger) (23-27 February, 26-29 May, 27-30 October).

2000- International Seminar S.I.A.V. on "Main locomotorium pathologies in the dog Diagnosis and therapy in the Traditional Chinese Medicine" held by Emil Van Den Bosch. (11 June)

2000- Bevas Course - Lectures of 28-29 October with Marvin Cain on "Five Elements and equine acupuncture"

2001- Veterinary acupuncture seminar on "Medical bio-cybernetic approach in the competition horse" held by Andreas Roesti. (17 February)

2001- Veterinary acupuncture seminar on "San Jiao syndrome in the dog" held by Andreas Roesti. (18 February)

2001- Workshop on "Practical bovine acupuncture" held by Oswal Kothbauer (11-12-13 May)

2001- Bevas Course - Lectures of 26-27 May with J.B. Limehouse and P.Taylor-Limehouse on "Urinary diseasy, Bi syndromes, 8 principles"

2001- Second International Seminar S.I.A.V. "Clinical use of the five elements with horses" held by Peggy Fleming and Are Thorensen. (9 June)

2001- Second International Seminar S.I.A.V. "Clinical use of the five elements with small animals" held by Peggy Fleming and Are Thorensen. (10 June)

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(1) Second International Seminar S.I.A.V. "Clinical use of the five elements with small animals" held by Peggy Fleming and Are Thorensen (10 June 2001).

(2) Jim Skoien C.A. Dipl. Ac. "The Eight Principles" The I.V.A.S. Veterinary Acupuncture Course notes Page 4-5-16

(3) John B. Limehouse D.V.M."Urinary Disease" The I.V.A.S. Veterinary Acupuncture Course Notes Page 8.1.4