the therapeutic effect of acupuncture and chinese herbal ... case series...

55AJTCVM Vol. 12, No. 1, February 2017

copyright © 2017 by AJTCVM All Rights Reserved

Case Series

The Therapeutic Effect of Acupuncture and Chinese Herbal Medicine in 12 Dogs with Hyperadrenocorticism

Ronald Koh DVM, MS, Huisheng Xie DVM, PhD, May-li Cuypers DVM, DACVIM

ABSTRACTMedical records of all dogs diagnosed with hyperadrenocorticism and treated with acupuncture and Chinese herbal medicine between 2004 and 2013 were reviewed. Twelve dogs met inclusion criteria and 8/12 also had pre-treatment adrenocorticotrophic hormone (ACTH) stimulation tests, urine cortisol-creatinine ratios (UCCR) and/or basal serum cortisol levels. Dogs had received acupuncture for 5-42 months at the time of review. Mai Men Dong (Ophiophogon Formula®) alone or combined with modified Jin Gui Shen Qi (Rehmannia 14®) or combined with modified Chai Hu Shu Gan (Liver Happy®), or modified Xia Xiao Fang (Rehmannia 11®) alone were administered to all dogs for 12-45 months. No adverse side effects were seen. Following treatment, polyuria, polydipsia and panting resolved in all 12 dogs. Lethargy improved more than 50% in all dogs. Polyphagia resolved in 7/12 dogs and improved over 50% in 5/12 dogs. Skin and hair changes and distended abdomens were more resistant, but improved more than 50% in 7/12 and 5/12 dogs respectively. Following a mean± standard deviation (M±SD) of 21.9±13.35 months of treatment, 8/8 dogs studied had significantly (p<0.05) reduced post-ACTH stimulation test results and 7/8 had returned to normal levels. All 5 dogs studied had significantly (p<0.05) improved UCCR following 20.8±13.27 months of treatment and 3 dogs had normal values. Basal cortisol levels returned to normal levels in 2/2 dogs studied after a M±SD 8±4.24 months of treatment. Based on the treatment results in 12 dogs, acupuncture and Chinese herbal medicine may be a safe and effective alternative to conventional medication and surgery for the treatment of some dogs with hyperadrenocorticism.

key words: Hyperadrenocorticism, Cushing’s disease, dogs, acupuncture, electroacupuncture, Chinese herbal medicine, Mai Men Dong, Jin Gui Shen Qi, Xia Xiao Fang, Chai Hu Shu Gana

From: Louisiana State University School of Veterinary Medicine, Baton Rouge, LA (Koh), University of Florida College of Veterinary Medicine, Gainesville, FL (Xie), Veterinary Mobile and Diagnostics, Largo, FL (Cuypers)

ABBREVIATIONS

ACTH Adrenocorticotrophic hormoneALP Alkaline phosphataseALT Alanine aminotransferaseM±SD Mean± standard deviation TCM Traditional Chinese medicineTCVM Traditional Chinese veterinary medicineuCCR Urine cortisol-creatinine ratio

Hyperadrenocorticism (Cushing’s disease) is a common endocrine disorder in dogs associated with excessive secretion of glucocorticoid hormones by the adrenal cortex.1-3 Approximately 85% of dogs with hyperadrenocorticism have pituitary-dependent hyperadrenocorticism with hyperplasia or neoplasia of the pituitary gland. The other 15% have a cortisol-secreting

adenoma or carcinoma of the adrenal gland.1-3 Iatrogenic Cushing’s syndrome has similar clinical signs and is associated with the chronic overzealous administration of glucocorticoids with suppression of adrenal gland function. The clinical signs and diagnostic test results associated with hyperadrenocorticism vary based on the duration and severity of the hypercortisolemia. Typical history, physical examination, clinicopathological and other diagnostic findings are outlined in Table 1. The diagnosis can be challenging to confirm, but typical clinical parameters can lead to a strong suspicion.1-3

Conventional medical and surgical treatments are aimed at eliminating the increased secretion of cortisol. Mitotane (o,p’-DDD [1,1-dichloro-2-(2-chlorophenyl)-2-(4-chlorophenyl) ethane]) and trilostane (4α, 5α-epoxy-17β-hydroxy-3-oxoandrostane-2α-carbonitrile), are 2 medications currently recommended.4-12 Adverse reactions, however, are common.4-7 In one study of 200 dogs receiving mitotane, approximately 25% of dogs exhibited one or more adverse effects during induction including: weakness, vomiting, anorexia,

56 AJTCVM Vol. 12, No. 1, February 2017


diarrhea and ataxia.4 Diarrhea, vomiting and lethargy have been reported in 63% of dogs receiving trilostane.5 Hypoadrenocortical crisis and deaths associated with adrenal rupture and necrosis have also been reported with mitotane and trilostane treatment.1,6,7 Further, some dogs with pituitary-dependent hyperadrenocorticism are not well controlled with trilostane.5-10 In some cases surgical removal of adrenal and pituitary tumors can be performed, but availability of equipment and trained veterinary surgeons are limited and the procedures involve risk and are expensive.13-14 Stereotactic radiosurgery and radiotherapy of pituitary tumors are also being performed at specialized centers.15 Radiosurgery is non-invasive and less risky than conventional surgery, but the availability and cost may be limiting factors for many clients.

Originating 2,500 years ago in China, traditional Chinese medicine (TCM) especially acupuncture is becoming one of the most widespread forms of complementary and alternative medicine in the United State and Europe.16-21 In TCM and traditional Chinese veterinary medicine (TCVM), disease patterns can be identified (Bian Zheng) and are associated with imbalances (Excesses and Deficiencies) in the musculoskeletal and nervous systems and internal organs of the body.17-22 Acupuncture and Chinese herbal medicines correct these imbalances so normal healing processes can be mobilized to restore health. People are becoming more interested in effective alternative treatment options with fewer side effects and risks than those of conventional medical or surgical treatments.16 Acupuncture has rare side effects that include bleeding, bruising and local infection in the area where the needle is inserted.17 Chinese herbal

medicine can be safe and effective for many disorders, when prepared and administered properly.19-21 Occasional side effects are vomiting and diarrhea, which can usually be curtailed by reducing the dose. Typical TCVM patterns associated with hyperadrenocorticism include: Kidney Yin Deficiency initially leading to Kidney Qi Deficiency and then resulting in Kidney Qi-Yin Deficiency.19,20 In later stages of hyperadrenocorticism, Kidney Yang Deficiency often develops.

Although acupuncture and Chinese herbal medicine have been suggested for the long-term medical management of hyperadrenocorticism in dogs, scientific data regarding therapeutic effects is limited.18-21 At University of Florida Veterinary Medical Center (UFVMC), acupuncture and Chinese herbal medicine has been used to treat suspected and confirmed cases of hyperadrenocorticism in dogs for over 15 years. There are currently no English published clinical studies of the treatment of hyperadrenocorticism in humans or animals with acupuncture and Chinese herbal medicine. The purpose of this retrospective study was to investigate the long-term effectiveness of acupuncture and Chinese herbal medicines for the treatment of hyperadrenocorticism in dogs. Based on anecdotal information, the hypothesis for this study was that hyperadrenocorticism could be effectively managed in some dogs with acupuncture and Chinese herbal medicine without adverse side effects.

MATERIALS ANd METhOdS Medical records of 20 dogs diagnosed with

hyperadrenocorticism and treated with a combination of acupuncture and Chinese herbal medicine at the UFVMC

Table 1: Signalment, history, physical examination, clinicopathological and other diagnostic test findings in dogs with hyperadrenocorticism1,3,4

Signalment and History

Physical Examination

CBC, Serum Chemistry and Urinalysis

Other Clinicopathological and diagnostic Tests

• Middle age or older

• Polydipsia• Polyuria• Polyphagia• Lethargy • Excessive

panting• Bruising• Cool-seeking

behavior

• Obesity• Pendulous

abdomen• Muscle atrophy• Alopecia• Thin skin• Comedones• Calcinosis cutis• Hyperpigmentation• Hepatomegaly• Hypertension

• Neutrophilia• Lymphopenia• Monocytosis• Eosinophilia• Lipemia• Elevated serum ALT• Elevated serum ALP• Mild hyperglycemia• Hypercholesterolemia• Decreased BUN• Glucosuria• Urinary tract infection

• Hypercortisolemia• Increased urine cortisol- creatinine ratio• Exaggerated increase in serum cortisol

following ACTH stimulation test• No reduction of serum cortisol with low-dose

dexamethasone suppression test • Lowered or unchanged serum cortisol with

high dose dexamethasone test (PDH)• Normal to increased plasma ACTH with PDH• Low plasma ACTH in adrenal tumors• Adrenal tumor visualized with abdominal

ultrasound, CT or MRI• Pituitary tumor visualized on brain CT or

MRIALT =alanine aminotransferase; ALP= alkaline phosphatase; BUN= blood urea nitrogen; ACTH= adrenocorticotrophic hormone; PDH= pituitary-dependent hyperadrenocorticism; CT= computerized tomography; MRI= magnetic resonance imaging



between 2004 and 2013 were reviewed. Inclusion criteria included: 1) middle aged and older dogs, 2) a typical history and physical examination, complete blood count, serum biochemistry and urinalysis findings for hyperadrenocorticism, 3) acupuncture and Chinese herbal medicine treatment of the disease for at least 5 months and 4) Follow-up information available about resolution or improvement of clinical signs. Cases of suspected hyperadrenocorticism were excluded if: 1) Records were incomplete as to clinical signs, treatments or outcomes, 2) Treatment was less than 5 months and 3) No follow-up information was recorded or could be collected from clients.

Two veterinarians certified in veterinary acupuncture and Chinese herbal medicine treated all patients. Dry needle acupuncture, electroacupuncture and aqua-acupuncture were performed during acupuncture sessions. All dogs received one or more Chinese herbal medicines.19-21 Clinical response to treatment of dogs was based on the history and physical examination findings during subsequent visits, and follow-up information via telephone. Dogs with resolution of clinical signs were classified as 100% improvement. Moderate improvement was characterized by greater than 50% (>50%) improvement, but not resolution of clinical signs. Dogs that had between 50%-30% improvement of clinical signs were considered to have mild improvement. Dogs considered to have less than 30% improved were classified as unimproved.

Although not an inclusion criteria, 8 dogs included in the study had pre-treatment adrenocorticotrophic hormone (ACTH) stimulation testsa, urine cortisol-creatinine ratiosb (UCCR) and/or basal serum cortisol concentration assaysc. The same 8 dogs had post treatment testing every 3-6 months after commencement of acupuncture and Chinese herbal medicine. The same laboratory ran all tests. Accepted normal values were a serum cortisol level post-ACTH stimulation test of 6-17 μg/dld, UCCR of 15 or lessd, and basal serum cortisol concentration of 0.5-6 μg/dld.

Comparisons of pre and post-ACTH serum cortisol concentrations and UCCR on individuals before and after treatment were performed by boxplots. The mean ± standard deviation (M±SD) of all dogs before and after treatment was analyzed using the Student paired t test. Differences were considered significant at p values equal to or less than (<) 0.05. Standard statistical softwaree was used for all computations.

RESuLTS Twelve dogs, 7-14 years old (average age 10.5

years), met the inclusion criteria (Table 2). There were 10 neutered females and 2 neutered males with 7 pure breed and 5 mixed breed dogs represented (Table 2). The most common initial clinical signs reported were polyuria (n=12), polydipsia (n=12), polyphagia (n=9),

lethargy (n=11), excessive panting (n=10), cool-seeking behavior (n=11), exercise intolerance (n=9), weight gain (n=8), and pendulous abdomen (n=7) (Table 2). Thin skin, alopecia and hyperpigmentation occurred in 9 dogs and calcinosis cutis in 1 dog. All 12 dogs had moderate to marked elevations of serum alanine aminotransferase (ALT) and alkaline phosphatase (ALP). Other abnormal findings included: mild leukocytosis (7 dogs), mild hypercholesterolemia (4 dogs) and marked hepatomegaly on abdominal radiographs (5 dogs). The duration of clinical signs prior to treatment ranged from 2-8 months with a M±SD of 4.75±1.71 months (Table 2).

Concurrent illnesses were present in 8/12 dogs and included: 2 dogs with hypothyroidism, 2 dogs with chronic renal failure, 1 dog with atopy and pyoderma, 1 dog with epilepsy, 1 dog with keratoconjunctivitis sicca, cataracts, Grade III/VI left apical systolic heart murmur and urinary tract infection, and 1 dog with diabetes mellitus and urinary tract infection (Table 2).

A presumptive conventional diagnosis of hyperadrenocorticism had been made on the 12 dogs based on the typical historical and physical examination findings, but 8 dogs also had testing done more specifically to support the diagnosis of hyperadrenocorticism. All 8 dogs had ACTH stimulation tests, 5/8 dogs also had UCCR and 2/8 dogs had basal serum cortisol assays (Table 2). Based on the TCVM pattern diagnostic system, 8/ dogs had Yin Deficiency, 2 dogs had Qi and Yin Deficiency, 1 dog had Yin Deficiency with Liver Qi Stagnation, and 1 dog had Yin and Yang Deficiency on presentation (Table 2).

Acupuncture treatment entailed the insertion of sterile 13 mm or 25 mm acupuncture needlesf, based on the size of patient and the location of the acupuncture points treated. Generally 8-14 acupuncture points were treated. Needles were left in place for 10-20 minutes. Electrical stimulationg for 10 minutes was administered to 6/12 dogs at different sessions. Aqua-acupuncture with injection of diluted vitamin B12h with salinei at acupuncture points was also performed in 10/12 dogs at different sessions. Aqua-acupuncture was performed at acupoints BL-23, KID-3, SP-6, SP-9, SP-8 ST-36, in addition to acupoints selected based on pattern diagnosis. Initially, all 12 dogs received acupuncture therapy every 2-4 weeks. The time between sessions was progressively lengthened to every 2-6 month intervals as the severity of clinical signs decreased. The number of acupuncture treatments per dog ranged from 6-21, with a M±SD of 12.42±4.7 treatments. Acupuncture treatment duration ranged from 5-42 months with a M±SD of 19.41±11.74 months (Table 3).

Modified Mai Men Dong (Ophiophogon Formula®j) alone was administered to 8 dogs with Yin Deficiency (Tables 2-4). Modified Mai Men Dong (Ophiophogon Formula®j) and modified Chai Hu Shu Gan (Liver Happy®)

j) were administered to 1 dog with a combination pattern of Yin Deficiency and Liver Qi Stagnation (Tables 2-5). Modified Mai Men Dong (Ophiophogon Formula®j)



Table 2: Signalment, primary clinical signs, duration of signs prior to treatment, concurrent disease, TCVM pattern and special diagnostic tests of 12 dogs with hyperadrenocorticism

Case Signalment Clinical Signs

Duration of Signs

Concurrent Disease

Initial TCVM pattern(s)

Diagnostic Tests for Hyperadrenocorticism

1

10 year old, female spayed,

Labrador Retriever

PU, PD, PP, L, EP, CS,

EI, WG, SC5 months Hypothyroidism Yin Deficiency

ACTH Stimulation testUCCR

Basal serum cortisol

211 year old,

female spayed, Dachshund


EI, WG, PA6 months None recorded Qi-Yin

Deficiency


Basal serum cortisol

310 year old,

female spayed, mixed breed

PU, PD, L, EP, CS, EI,

SC4 months Chronic renal

failure Yin Deficiency ACTH Stimulation testUCCR

47 year old,



EI, WG, PA, SC

8 months HypothyroidismYin Deficiency and Liver Qi Stagnation


510 year old,


PU, PD, PP, EP, CS, WG,

PA, SC4 months Atopy, pyoderma Yin Deficiency ACTH Stimulation test

UCCR

6

11 year old, male neutered,

American Eskimo

PU, PD, PP, L, CS, EI,

WG7 months Epilepsy Yin Deficiency ACTH Stimulation test

710 year old,

female spayed, Chinese crested


PA, SC4 months Chronic renal

failure Yin Deficiency ACTH Stimulation test

88 year old,

female spayed, Pekingese


PA, SC6 months

Keratoconjunctivitis sicca, cataracts, Grade III/VI left

apical systolic heart murmur, urinary tract infection

Yin Deficiency ACTH Stimulation test

9

9 year old, female spayed,

Yorkshire Terrier


EI, WG, PA, SC

4 months None recorded Qi-Yin Deficiency None performed

109 year old,

female spayed, Dachshund

PU, PD, PP, L, EI, WG,

PA, SC2 months None recorded Yin-Yang

Deficiency None performed

1110 year old,

female spayed,mixed breed


WG3 months None recorded Yin Deficiency None performed

1211 year old,

male neutered,mixed breed


EI, SC4 months

Diabetes mellitus, urinary tract

infectionYin Deficiency None performed

Mean±SD 9.67±1.23 N/A 4.75±1.71 N/A N/A N/A

PU= polyuria, PD= polydipsia, PP= polyphagia, L= lethargy EP= excessive panting, CS= cool seeking, EI= exercise intolerance, WG= weight gain, PA= pendulous abdomen, SC= skin changes; N/A= not applicable



Table 3: Signalment, number and duration of acupuncture treatments, duration of Chinese herbal medicine treatment and clinical outcomes of 12 dogs with hyperadrenocorticism

Case SignalmentNumber of

Acupuncture treatments

Duration of Acupuncture Treatment**

(months)

Chinese Herbal Medicine

Duration of Herbal

Medicine**(months)

Clinical Signs Resolved**

1 10 year old, female spayed, Labrador Retriever 14 11 Ophiopogon

Formula 14PU, PD, PP, L, EP,

EI, WG, SC

2 11 year old, female spayed, Dachshund 6 5 Rehmannia 11 12

PU, PD, PP, L, EP, EI, WG, PA

3* 10 year old, female spayed, mixed breed 21 39 Ophiopogon

Formula 45 L, EP, EI, SC

4 7 year old, female spayed, mixed breed 7 24

Ophiopogon Formula,

Liver Happy 36PU, PD, PP, L, EP, EI, WG, PA, SC

5 10 year old, female spayed, mixed breed 9 25 Ophiopogon

Formula 30PU, PD, PP, EP,

WG, PA, SC

6* 11 year old, male neutered, American Eskimo 15 42 Ophiopogon

Formula 46PU, PD, PP, L, EI,

WG

7 10 year old, female spayed, Chinese crested 17 18 Ophiopogon

Formula 18 L, EP, EI, PA, SC

8 8 year old, female spayed, Pekingese 12 11 Ophiopogon

Formula 20PU, PD, PP, L, EP,

PA, SC

9 9 year old, female spayed, Yorkshire Terrier 12 12 Rehmannia 11 18

PU, PD, PP, L, EP, EI, WG, PA, SC

10 9 year old, female spayed, Dachshund 8 10

Ophiopogon Formula,

Rehmannia 14 26PU, PD, PP, L, EI,

WG, PA, SC

11 10 year old, female spayed, mixed breed 18 24 Ophiopogon

Formula 24PU, PD, L, EP, EI,

WG

12 11 year old, male neutered, mixed breed 10 12 Ophiopogon

Formula 17 L, EP, EI, SC

Mean± SD 9.67±1.23 12.42±4.7 19.41±11.74 N/A 25.5±11.53 N/A

* Clients indicated the dog had died at the final communication (all others were alive); ** final client communication time after onset of treatment; PU= polyuria, PD= polydipsia, PP= polyphagia, L= lethargy EP= excessive panting, CS= cool seeking, EI= exercise intolerance, WG= weight gain, PA= pendulous abdomen, SC= skin changes.

Table 4: Ingredients of the Chinese herbal medicine modified Mai Men Dong (Ophiopogon Formula®f) and their actions19 Pin Yin Name English Name Actions

Mai Men Dong Ophiopogon Nourishes YinLu Gen Phragmites Clears Heat, promotes Body FluidsZhi Mu Anemarrhena Nourishes Yin, clears HeatTian Hua Fen Trichosanthes Clears Heat, promotes Body FluidsBei Shan Shen Glehnia Nourishes YinZhu Ye Bambusa Clears HeatGe Gen Pueraria Promotes Body FluidsWu Mei Mume Astringently consolidatesHuang Qin Scutellaria Clears HeatYu Li Ren Prunus Moves BloodShan Zha Crataegus Resolves Food StagnationShen Qu Massa Fermentata Resolves Food Stagnation



Table 5: Ingredients of the Chinese herbal medicine modified Chai Hu Shu Gan (Liver Happy®f) and their actions19

Pin Yin Name English Name ActionsXiang Fu Zi Cyperus Soothes Liver, resolves StagnationQing Pi Citrus Moves Qi, soothes Liver, resolves StagnationBai Shao Yao Paeonia Soothes Liver, nourishes Liver Yin and BloodChen Pi Citrus Dries Dampness, moves QiBo He Mentha Moves QiChai Hu Bupleurum Soothes LiverMu Dan Pi Moutan Cools Blood, clears Heat, dissipates StagnationZhi Zi Gardenia Clears HeatDang Gui Angelica Moves BloodGan Cao Glycyrrhiza Harmonizes the formula

Table 6: Ingredients of the Chinese herbal medicine modified Jin Gui Shen Qi (Rehmannia 14®f) and their actions19

Pin Yin Name English Name ActionsSheng Di Huang Rehmannia Nourishes Yin and JingShan Yao Dioscorea Tonifies Qi and JingBai Shao Yao Paeonia Nourishes Liver Yin and BloodHuang Qi Astragalus Tonifies QiZhi Mu Anemarrhena Clears Heat, promotes Body Fluids and YinHuang Bai Phellodendron Clear Heat, nourishes YinWu Wei Zi Schisandra Consolidates and nourishes Lung YinMai Men Dong Ophiopogon Nourishes YinFu Ling Poria Drains Damp, strengthens SpleenZe Xie Alisma Drains DampGui Zhi Cinnamomum Warms and tonifies Kidney YangFu Zi Aconite Warms and tonifies Kidney YangShan Zhu Yu Cornus Nourishes YinMu Dan Pi Moutan Cools Blood, clears Heat, dissipates Stagnation

Table 7: Ingredients of the Chinese herbal medicine modified Xia Xiao Fang (Rehmannia 11®f) and their actions19

Pin Yin Name English Name ActionsHuang Qi Astragalus Tonifies QiRou Gui Cinnamomum Warms and tonifies Kidney YangShu Di Huang Rehmannia Nourishes Kidney Jing and YinShan Yao Dioscorea Tonifies QiShan Zhu Yu Cornus Nourishes YinMu Dan Pi Moutan Cools Blood, clears Heat, dissipates StagnationFu Ling Poria Drains Damp, strengthens SpleenZe Xie Alisma Drains DampFu Pen Zi Rubus Astringently consolidatesJin Ying Zi Rosa Astringently consolidatesSang Piao Xiao Mantidis Astringently consolidates



and modified Jin Gui Shen Qi (Rehmannia 14®j) were administered to 1 dog with a combination pattern of Yin and Yang Deficiencies (Tables 2-4 and 6). Modified Xia Xiao Fang (Rehmannia 11®j) alone was administered to 2 dogs with a combination pattern of Qi and Yin Deficiencies (Tables 2, 3 and 7). Chinese herbal medicine treatment duration ranged from 12-46 months with a M±SD of 25.5±11.53 months at the time of review.

No adverse side effects were noted with either the acupuncture or Chinese herbal medicine treatments. An overview of resolution or improvement of clinical signs on re-evaluations at median time periods after the onset of therapy is outlined in Table 3. At the first re-evaluation (median of 3 weeks) after initiation of acupuncture and Chinese herbal medicine, 12/12 dogs (100%) had moderate improvement (>50%) of polyuria, polydipsia, panting and activity levels. At the second re-evaluation (median of 6 weeks), 5/12 dogs (42%) had resolution of polyuria, polydipsia and excessive panting, and 6/12 dogs (50%) showed moderate improvement (<50%) in polyphagia and skin and hair coat condition. By the forth re-evaluation (median of 12 weeks), all 12 dogs had resolution of polyuria, polydipsia and excessive panting. At this time there was also resolution of polyphagia in 6/12 dogs (50%) and mild improvement (>50%) of the distended abdomens in 6/12 dogs (50%) and 2/12 dogs

(17%) respectively. At the fifth re-evaluation (median of 18 weeks) further improvement of skin and distended abdomens had increased to 7/12 dogs (58%) and 5/12 dogs (42%) respectively. At a median time of 2 years of treatment 9/12 dogs (75%) were described by caretakers as having resolution of clinical signs, 2/12 dogs (17%) had overall moderate improvement, and 1 dog (8%) had only slight improvement (30%-50%). Long-term follow-up information on 10/12 dogs was obtained from phone calls to clients. After 18 and 24 months respectively, no contact could be made for follow-up with clients with Cases 7 and 11. Cases 2 and 6 had succumbed to renal and cardiac failure respectively after 12 and 46 months of treatment for hyperadrenocorticism. The 8 surviving dogs where client contact could be made were still receiving acupuncture every 3-6 months and daily Chinese herbal medicine. At the time of contact, the mean survival time for the 10 dogs had been M±SD of 31±2 months.

The ACTH stimulation test was used to monitor the response to acupuncture and Chinese herbal medicine in 8/12 dogs (67%) in this study (Table 8). Following a M±SD of 21.9 ± 13.35 months of acupuncture and Chinese herbal medicine, all 8 dogs had significantly reduced post-ACTH serum cortisol concentration (p<0.05) compared to pre-treatment values. Further 7 dogs had post-ACTH stimulation test results that had returned to accepted

Table 8: Data of 8 dogs monitored with post-ACTH stimulation tests following acupuncture and Chinese herbal medicine treatments

Case number Signalment Post-ACTH cortisol before

treatment (μg/dl)Length of

treatment (months)Post-ACTH cortisol

after treatment (μg/dl)

1 10 year old, female spayed, Labrador Retriever 27.3 11 15.1*

2 11 year old, female spayed, Dachshund 38.6 5 19.4*

3 10 year old, female spayed, mixed breed 28.9 39 13.9*



6 11 year old, male neutered, American Eskimo 29.5 42 8.4*

7 10 year old, female spayed, Chinese crested 23.5 18 11.2*

8 8 year old, female spayed, Pekingese 21.2 11 14.5*

Mean ± SD 9.6 ± 1.41 year old 25.6 ± 7.09 21.9 ± 13.35 13.1 ± 4.21*

Length of treatment was measured from the beginning of treatment until the dog died or records reviewed for the study; *significant decrease (p<0.05) after treatment compared to pre-treatment values; Seven of the eight dogs had normal post-ACTH stimulation serum cortisol levels of 6-17 ug/dld after treatment



Figure 1: Post ACTH serum cortisol concentrations of 8 dogs before treatment (blue bars) and after treatment of 11, 5, 39, 24, 25, 42, 18 and 11 months (Cases 1-8) respectively of acupuncture and Chinese herbal medicine (red bars); *= significant reduction after TCVM treatment (p<0.05)

Figure 2: Mean ± standard (M±SD) deviation of ACTH stimulation test results in 8 dogs before treatment (blue bar) and after treatment of a M±SD of 21.9 ±13.35 months of acupuncture and Chinese herbal medicine (red bar); *= significant reduction after TCVM treatment (p<0.05)



normal values range (serum cortisol levels 6-17 ug/dl) (Table 8, Figures 1 and 2).

The UCCR was used to monitor 5/12 dogs (42%) in this study (Table 9). All 5 dogs had significantly (p<0.05) improved UCCR following a M±SD of 20.8 ± 13.27 months of acupuncture and Chinese herbal medicine treatments. Further, 3/5 dogs (60%) had UCCR within normal values range (less than 15) (Table 9, Figure 3).

The basal serum cortisol levels were monitored on 2/12 dogs (17%) (Table 10). The basal serum cortisol concentrations before and after treatment were significantly (p<0.05) different. In both dogs basal cortisol levels returned to normal values range (0.5-6 μg/dl) after a M±SD of 8±4.24 months of acupuncture and Chinese herbal medicine treatments.

dISCuSSION From a conventional perspective the wide spread

effects of excess glucocorticoids in animals with

hyperadrenocorticism include gluoconeogenesis, immunosuppression, anti-inflammatory responses and protein catabolism.22 Uncontrolled hyperadrenocorticism markedly affects the quality of life of both dogs and clients and can lead to a number of complications including infections, life-threatening thromboembolism, generalized catabolism and muscle fibrosis.1-3

From a TCVM perspective hyperadrenocorticism is a Lower Burner (Xia Jiao) thirsting and wasting disorder as exemplified by the clinical signs of polydipsia, polyuria, polyphagia and loss of muscle mass.20 Early stages of the disease may be a mixed Excess and Deficiency disorder. Liver Qi Stagnation and Lung and Stomach Yin Deficiency cause Heat, as evidenced by panting (especially at night) and cool-seeking behavior. A purple tongue and wiry pulse is often found in dogs with Liver Qi Stagnation and a red tongue and a rapid, thready pulse in dogs with Yin Deficiency.20 Global Yin and Qi Deficiency follow and affected dogs also develop lethargy, exercise intolerance

Table 9: Data of 5 dogs monitored with urine cortisol-creatinine ratio (UCCR) following acupuncture and Chinese herbal medicine treatments

Case number Signalment uCCRbefore treatment

Length of treatment (months)

uCCRafter treatment

1 10 year old, female spayed, Labrador Retriever

20 11 12*

2 11 year old, female spayed, Dachshund 19 5 13*3 10 year old, female spayed, mixed

breed22 39 18*

4 7 year old, female spayed, mixed breed 26 24 19*5 10 year old, female spayed, mixed

breed29 25 14*

Mean ± SD 9.6 ± 1.52 year old 23.2 ± 4.20 20.8 ± 13.27 15.2 ± 3.11*Length of treatment was measured from the beginning of treatment until the dog died or records reviewed for the study; *significant decrease (p<0.05) after treatment compared to pre-treatment values; three dogs had normal ratios of less than 15d after treatment

Table 10: Data of 2 dogs monitored with basal serum cortisol concentration following acupuncture and Chinese herbal medicine treatments

Case number Signalment Serum cortisol before

treatment (μg/dl)Length of treatment

(months)Serum cortisol after

treatment (μg/dl)

1 10 years old, female spayed, Labrador Retriever 9.5 11 6.0*

2 11 years old, female spayed, Dachshund 7.5 5 3.0*

Mean ± SD 10.5 ± 0.71 years old 8.5 ± 1.41 8 ± 4.24 4.5 ± 2.83Length of treatment was measured from the beginning of treatment until the dog died or records reviewed for the study; *significant (p<0.05) reduction of basal serum cortisol concentrations after treatment compared to pre-treatment values; both dogs in normal cortisol levels between 0.5-6 μg/dld after treatment



and loss of muscle tone.19,20 Once Kidney/Spleen Yang Deficiency develops the liver is palpably enlarged, the hair coat and skin are thin, the ears, back and limbs are cool and the dog has warm seeking behavior. 19,20 At this stage the tongue is pale and swollen and pulses are weak deep and slow.19,20 In the study, 8/12 dogs (67%) had Yin deficiency. These dogs showed signs of panting, red tongue, fast pulses, red skin, and cool seeking. A pattern diagnosis of a combination of Qi and Yin Deficiency was diagnosed in 2/12 dogs (17%) based on lethargy, exercise intolerance, or pale tongue, in addition to Yin Deficient signs. A combination of Yin deficiency with Liver Qi Stagnation was made in 1 dog (8%) based on clinical signs of Yin Deficiency along with a wiry pulse and irritable behavior. A combination of Yin and Yang Deficiency was made in 1 dog (8%) with a pale tongue, slow pulse, lethargy and cool body.

Acupuncture points treated vary with the TCVM pattern. Therefore all dogs with a conventional diagnosis of hyperadrenocorticism will not receive the same treatment, as they do in conventional medicine. As typical in TCVM practice, acupuncture was performed at different acupuncture points in different dogs in this study. Also different acupuncture points were treated at subsequent treatment sessions for the same dog, based on the individual’s current pattern and response to previous treatments. Typical acupoints for hyperadrenocorticism with Yin Deficiency include: BL-23, BL-52, KID-3, KID-7, KID-6, KID-10, SP-6, SP-9, SP-8 and LIV-3.18,20 Typical acupoints treated for Qi-Yin Deficiency

hyperadrenocorticism include: ST-36, SP-6, SP-9, SP-10, BL-17, BL-23, BL-26, KID-3, KID-7, LIV-2, LIV-3, CV-4 and CV-6.18,20 Typical acupoints treated for Yang Deficiency hyperadrenocorticism include: ST-36, SP-6, BL-23, KID-7, KID-13, GV-3, GV-4, CV-4, CV-6 and moxibustion at CV-8.20 The general acupoints that were treated in the 12 dogs of the study included: GV-20 (for calming), BL-23, KID-7, SP-6, SP-9, ST-36 and LIV-3, in addition to the acupoints that were selected based on pattern differentiation. Acupoints, such as GV-14, LI-4, LI-11, Er-jian were added if the dog had Heat in the body that needed to be cleared. For electroacupuncture, the connections of leads also varied among dogs for each session, but in general lead included: BL-23 bilaterally, ST-36 bilaterally, and SP-6 to KID-3 on each limb.

Like acupuncture, the selection of the appropriate Chinese herbal medicine is based on the underlying TCVM pattern. Modified Mai Men Dong (Ophiopogon Formula®) nourishes Yin, clears Heat and promotes Body Fluids so is often used in Yin Deficient hyperadrenocorticism (Table 4).19-21 Modified Chai Hu Shu Gan (Liver Happy®)) is used to soothe Liver and resolve Qi Stagnation, so may also be combined with modified Mai Men Dong (Ophiopogon Formula®) in TCVM patterns where Liver Qi Stagnation is apparent (Table 5). Modified Xia Xiao Fang (Rehmannia 11®) tonifies Qi and nourishes Yin so may be prescribed in Qi/Yin Deficient hyperadrenocorticism (Table 7). Modified Jin Gui Shen Qi (Rehmannia 14®) is used to warm and tonify Kidney Yang while also tonifying Kidney Yin so may also be combined with modified Mai Men

Figure 3: The urine cortisol-creatinine ratio of 5 dogs before treatment (blue bars) and after treatment evaluated after 11, 5, 39, 24 and 25 months respectively (Cases 1-5) of acupuncture and Chinese herbal medicine treatment (red bars); * = significant reduction after treatment (p<0.05)



Dong (Ophiopogon Formula®) in Yin/Yang Deficiency combination patterns (Tables 4 and 6) .19-21 All 12 dogs in the study were administered the correct Chinese herbal medicine based on their pattern differentiation (Table 3). Typically these Chinese herbal medicines are administered at a dose of 0.5g/10-20 pounds body weight twice daily for 6 months. In this study, the herbal treatment continued beyond 6 months (12-46 months) with no adverse effects because of the need for long term control of a disease that can not be cured.9,3,20

Polyuria, polydipsia, polyphagia, lethargy and excessive panting are the most common initial signs of hyperadrenocorticism, as evidenced by all 12 dogs in the current study, and affect the quality of life for both the animal and caretaker.1-3 At a median of 3 weeks after the onset of acupuncture and herbal treatment all dogs had a greater than 50% improvement of polyuria, polydipsia, panting and activity levels and by 3 months polyuria, polydipsia and panting had resolved, with no adverse side effects (Tables 3 and 11). Such improvements can resolve many quality of life issues such as urinary accidents in the house and panting at night which disturb clients that sleep with their dogs. In additions, clients feel less stressed, when their pets have improved activity levels and are less lethargic.

All 8 dogs in the study that were monitored by ACTH stimulation tests had a significant (p<0.05) reduction of post ACTH stimulation serum cortisol levels following treatment. Further in 7/8 dogs (87.5%), the post treatment levels had returned to normal (Table 8). The one dog that had post ACTH serum cortisol levels that was still above the normal range had only been treated for 5 months

compared to the 11-42 months of treatment in the other dogs. The UCCR was significantly (p<0.05) lower in all 5 dogs evaluated, but remained slightly elevated above the normal 15 or less range in 2 dogs (ratios of 18 and 19 in Case number 3 and 4 respectively, Table 9). Both of those dogs however had normal post ACTH stimulation serum cortisol levels (Case numbers 3 and 4, Table 11). Case number 2 that still had an elevated post ACTH stimulation serum cortisol level following 5 months of treatment had a normal UCCR and basal cortisol levels after treatment (Tables 8-10).

While monitoring tests give an objective indication as to what is occurring inside the body, they do not give any indications as to how well the patient appears physically or clinically, which may be a more reliable indicator of the patient’s condition.1-3 Overall acupuncture and Chinese herbal medicine treatment of the 12 dogs with hyperadrenocorticism in the study resulted in a 100% improvement of polyuria, polydipsia and panting, a greater than 50% improvement in activity and resolution of polyphagia in 58% of dogs (Table 3). Skin and hair changes improved greater than 50% in 58% of dogs and 42% of dogs had improvement in distended abdomens. The inclusion criteria of long-term follow-up did bias the results however, as only clients that saw improvement would have returned for further acupuncture treatments and administered herbal capsules twice daily.

Whether from a conventional or TCVM perspective, the primary goal of treatment of dogs with hyperadrenocorticism is aimed at controlling and achieving resolution of clinical signs associated with hypercortisolemia rather than curing the disease.3,9,20

Table 11: Percent improvement of clinical signs on re-evaluations; median re-evaluation periods of 3-18 weeks of treatment of 12 dogs.

Clinical SignsNumber of dogs and percentage Improved at Median Re-evaluation periods

3 weeks 6 weeks 12 weeks 18 weeks 25.5±11.53 months

Polyuria 12 dogs >50% 5 dogs 100%7 dogs >50% 12 dogs 100% 12 dogs 100% 12 dogs 100%

Polydipsia 12 dogs >50% 5 dogs 100%7 dogs >50% 12 dogs 100% 12 dogs 100% 12 dogs 100%

Panting 12 dogs >50% 5 dogs 100%7 dogs >50% 12 dogs 100% 12 dogs 100% 12 dogs 100%

Activity 12 dogs >50% 12 dogs >50% 12 dogs >50% 12 dogs >50%

Polyphagia No change 6 dogs >50% 6 dogs 100%6 dogs >50%

7 dogs 100%5 dogs >50%

Skin/Hair No change 6 dogs <50% 6 dogs <50%6 dogs no change

7 dogs >50%5 dogs <50%

Distended abdomen No change No change 2 dogs <50%

10 dogs no change5 dogs >50%7 dogs <50%



It has been reported that 80-86% of dogs with hyperadrenocorticism are well controlled with mitotane, but 46% relapse.23 Reports on the efficacy of trilostane vary from 62-100% and 69% with ketoconazole.5,8,11,23,24 The adverse side effects of both mitotane and trilostane are well-documented and observed in approximately 25% of treated dogs.25 Therefore treatment with mitotane or trilostane involves frequent monitoring by the veterinarian and a vigilant caretaker who is willing to closely monitor the dog for signs of adverse side effects.8 There were no side effects associated with the acupuncture and Chinese herbal medicine in the 12 dogs with hyperadrenocorticism in the current study and there was greater than 50% improvement of polyuria, polydipsia and panting in just 3 weeks with resolution in 3 months.

The exact mechanisms of the therapeutic effect of acupuncture and Chinese herbal medicine in hyperadrenocorticism are unclear. It has been suggested that acupuncture promotes natural functional homeostasis and possesses such effects as modulating neurotransmitter function in the central nervous system as well as adjusting hormonal imbalances.26,27 A well-known action of acupuncture is that it induces release of endogenous endorphins resulting in analgesia.28 The endogenous opioid system and pituitary-adrenal axis have a close physiological link.28 One therapeutic mechanism of acupuncture and Chinese herbal medicine for hyperadrenocorticism may be associated with feedback inhibition of pituitary ACTH or hypothalamic corticotrophin releasing factor by beta-endorphin following acupuncture.28,29 An inverse relationship between cortisol and endorphin was reported as early as the 1980s.29 Taylor et al found that cortisol levels decreased below the basal level in response to infusion of beta-endorphin in normal humans and proposed that beta-endorphin might suppress cortisol release.

There is a growing body of studies that support acupuncture associated changes in the hypothalamic pituitary axis with serum cortisol increasing or decreasing dependent on the clinical situation. 30-34 Two studies looked at the effect of electroacupuncture on humans with increased levels of stress related serum cortisol due to orthopedic surgery and pain associated with chronic osteoarthritis in the knee. Both studies demonstrated statistically significant decreases of stress related serum cortisol in the treated group and increased beta-endorphins in the one study where this parameter was measured.31,32 In two other studies, electroacupuncture was associated with increases in serum cortisol in normal individuals or increased plasma ACTH during surgery and was shown to be blocked by pre-treatment with hydrocortisone. In a different clinical situation, iatrogenic hypofunction of the hypothalamic pituitary axis was created by pre-treatment of study dogs with intramuscular prednisone acetate 2mg/kg/day injections for 3 weeks.35 At the end of the 3 weeks, four dogs then received electroacupuncture at acupuncture point ST-36 and 4 dogs at a sham acupuncture point for

30 minutes, 3 times a week for 3 weeks. At the end of 3 week experimental treatment period, all 4 dogs treated at ST-36 had significantly increased post ACTH stimulation cortisol concentrations (p<0.05) and the 4 dogs with sham acupuncture showed no significant change. The authors concluded that electroacupuncture of ST-36 can regulate the hypothalamus-pituitary-adrenal axis to restore function in experimentally created adrenocortical hypofunction in dogs.

This is the first study of the outcome of dogs treated with acupuncture and Chinese herbal medicine from hyperadrenocorticism. Acupuncture and Chinese herbal medicine resolved or improved some or all of the clinical signs of hyperadrenocorticism and significantly decreased basal and post-ACTH cortisol levels and UCCR in the 12 dogs in this study. Although further studies are needed with greater numbers of dogs, the study hypothesis was supported by the results. Therefore treatment with acupuncture and modified Mai Men Dong (Ophiopogon Formula®), modified Chai Hu Shu Gan (Liver Happy®)) modified Xia Xiao Fang (Rehmannia 11®), and/or modified Jin Gui Shen Qi (Rehmannia 14®) may be an alternative to conventional medication and surgery for the control of hyperadrenocorticism in some dogs.

fOOTNOTESa. Nichols Advantage ACTH Assay, Nichols Institute

Diagnostics, Bad Vilbel, Germanyb. DPC Corporation, San Diego, California, USA

(UCCR measured in Metrolab Autoanalizer Merck, Germany)

c. Coat-a-Count cortisol assay, Diagnostic Products Corp, Los Angeles, CA

d. University of California Davis School of Veterinary Medicine Teaching Hospital data base

e. SPSS, version 14.0, SPSS Inc., Chicago, IL 60606f. Tai Chi, Lhasa OMS, Inc., Weymouth, MAg. Donghua Electronic Instrument Factory, Beijing

100083, PR Chinah. Vedco, Inc., St. Joseph, MO 64507i. Hospira, Inc., Lake Forest, IL 60045j. Dr. Xie’s Jing Tang Herbal Inc., Reddick, FL

REfERENCES 1. Feldman E, Nelson R. Canine hyperadrenocorticism

(Cushing’s syndrome). Canine and Feline Endocrinology and Reproduction. Feldman E, Nelson R (ed). St. Louis, Mo:Saunders 2004:252-357.

2. Herrtage M. Canine hyperadrenocorticism. BSAVA Manual of Canine and Feline Endocrinology. Mooney C, Peterson M (eds). Quedgeley, Gloucester: British Small Animal Veterinary Association 2004:50-171.

3. Reusch C. Hyperadrenocorticism. Textbook of Veterinary Internal Medicine. Ettinger S (ed).Oxford:Elsevier 2005:1592-1610.



4. Kintzer PP, Peterson ME. Mitotane (o, p‘-DDD) Treatment of 200 dogs with pituitary-dependent hyperadrenocorticism. J Vet Internal Med 1991;5(3):182-190.

5. Neiger R, Ramsey I, O’Connor J et al. Trilostane treatment of 78 dogs with pituitary-dependent hyperadrenocorticism. Vet Rec 2002;150(26):799-804.

6. Ramsey I, Neiger R. Canine hyperadrenocorticism. Kirk’s Current Veterinary Therapy XIV. Bonagura JD, Twedt DC, Kirk RW (eds). St. Louis, Mo:Elsevier Saunders 2009:224-227.

7. Ruckstuhl NS, Nett CS, Reusch CE. Results of clinical examinations, laboratory tests, and ultrasonography in dogs with pituitary-dependent hyperadrenocorticism treated with trilostane. Am J Vet Res 2002;63(4):506-512.

8. Clemente M, De Andres PJ, Arenas C et al. Comparison of non-selective adrenocorticolysis with mitotane or trilostane for the treatment of dogs with pituitary-dependent hyperadrenocorticism. Vet Rec 2007;161(24):805-809.

9. Reine NJ. Medical management of pituitary-dependent hyperadrenocorticism: mitotane versus trilostane. Clinical Techniques Small Anim Pract 2007:22(1):18-25.

10. Alenza DP, Arenas C, Lopez ML et al. Long-term efficacy of trilostane administered twice daily in dogs with pituitary-dependent hyperadrenocorticism. J Am Anim Hosp Assoc 2006;42(4):269-276.

11. Braddock JA, Church DB, Robertson ID et al. Trilostane treatment in dogs with pituitary-dependent hyperadrenocorticism. Australian Vet J 2003;81(10):600-607.

12. Ruckstuhl NS, Nett CS, Reusch CE. Results of clinical examinations, laboratory tests, and ultrasonography in dogs with pituitary-dependent hyperadrenocorticism treated with trilostane. Am J Vet Res 2002;63(4):506-512.

13. Sato A, Teshima T, Ishino H et al. A magnetic resonance imaging-based classification system for indication of trans-sphenoidal hypophysectomy in canine pituitary-dependent hypercortisolism. J Small Anim Pract 2016;57(5):240-6.

14. Mamelak AN, Owen TJ, Bruyette D. Transsphenoidal surgery using a high definition video telescope for pituitary adenomas in dogs with pituitary dependent hypercortisolism: methods and results. Vet Surg 2014; 43(4):369-79.

15. Zwingenberger AL, Pollard RE, Taylor SL et al. Perfusion and volume response of canine brain tumors to stereotactic radiosurgery and radiotherapy. J Vet Intern Med 2016; 30(3):827-35.

16. Mitchell B. The professionalization of acupuncture and oriental medicine in the United States Contemporary Chinese Medicine and Acupuncture.

Cassidy CM (ed). New York:Churchill Livingstone 2002:375-388.

17. Schoen AM. Veterinary acupuncture:ancient art to modern medicine. St. Louis, Mo:Mosby, 2001:12-17,98-99.

18. Xie H, Preast V. Xie’s Veterinary Acupuncture. Ames Iowa:Wiley Blackwell 2010:246,304-306.

19. Xie H, Preast V. Chinese Veterinary Herbal Handbook. Reddick, Fl: Chi Institute 2008:65,120.

20. Beebe S. Diseases of the endocrine system. Practical Guide to Traditional Chinese Veterinary Medicine. Xie S, Wedemeyer L, Chrisman C, Trevisanello L (eds). Reddick, Fl:Chi Institute 2013:783-797.

21. Xie H, Priest V. Xie’s Chinese Veterinary Herbology. Ames Iowa:Wiley Blackwell 2010:48, 427.

22. McGavin MD, Zachary JF. Pathologic Basis of Veterinary Disease. 4th ed. St. Louis, Mo: Elsevier Mosby 2007:660-97.

23. Brown CG, Graves TK. Hyperadrenocorticism: treating dogs. Compendium: Cont Ed 2007;29(3):132-134.

24. Lien YH, Huang HP. Use of ketoconazole to treat dogs with pituitary-dependent hyperadrenocorticism: 48 cases (1994-2007). J Vet Med Assoc 2008;233(12):1896-1901.

25. Plumb DC. Plumb’s Veterinary Drug Handbook. Ames, Iowa:Blackwell Publishing 2005:1120-1122.

26. Kim EH, Kim YJ, Lee HJ et al. Acupuncture increases cell proliferation in dentate gyrus after transient global ischemia in gerbils. Neurosci Lett 2001;297(1):21-24.

27. Stener-Victorin E, Waldenstrom U, Tagnfors U et al. Effects of electro-acupuncture on anovulation in women with polycystic ovary syndrome. Acta Obstet Gynecol Scand 2000;79(3):180-188.

28. Kotani N, Hashimoto H, Sato Y et al. Preoperative intradermal acupuncture reduces postoperative pain, nausea and vomiting, analgesic requirement, and sympathoadrenal responses. Anesthesiology 2001;95(2):349-356.

29. Taylor T, Dluhy RG, Williams GH. Beta-endorphin suppresses adrenocorticotropin and cortisol levels in normal human subjects. J Clin Endocrinol Metab 1983;57(3):592-596.

30. Brown ML, Ulett GA, Stern JA. Acupuncture loci: techniques for location. Am J Chin Med 1974;2(1):67-74.

31. Ahsin S, Saleem S, Bhatti AM et al. Clinical and endocrinological changes after electro-acupuncture treatment in patients with osteoarthritis of the knee. Pain 2009;147(1-3):60-66.

32. Georgieva T, Maleeva A. The effect of electroacupuncture analgesia on the plasma levels of cortisol and aldosterone in orthopedic operations. Khirurgiia (Sofiia) 1991;44(2):32-36.

33. Masala A, Satta G, Alagna S et al. Suppression of



electroacupuncture (EA)-induced beta-endorphin and ACTH release by hydrocortisone in man. Absence of effects on EA-induced anaesthesia. Acta Endocrinol 1983;103(4):469-472.

34. Lee SC, Yin SJ, Lee ML et al. Effects of acupuncture on serum cortisol level and dopamine beta-

hydroxylase activity in normal Chinese. Am J of Chin Med 1982;10(1-4):62-9.

35. Lin JH, Su HL, Chang SH et al. Treatment of iatrogenic Cushing’s syndrome in dogs with electroacupuncture stimulation of stomach 36. Am J Chin Med 1991;19(1):9-15.

About the Author

Dr. Vargas received her DVM from Tuskegee University in 1994. In 1996 she established her AAHA accredited Orchid Springs Animal Hospital in Winter Haven, FL. In 2009 she started her studies at Chi Institute, eventually garnering certifications in acupuncture, Chinese herbal medicine, food therapy and Tui-na. She is pursuing her Master’s Degree in TCVM at Chi Institute, FL where she works as a teacher assistant and as a lecturer for Chi Latin America. In addition, she has worked as a TCVM consultant for Disney Animal Kingdom. Dr. Vargas was honored by the American Veterinary Foundation as “America’s Favorite Veterinarian” in 2015.

Dr. Vargas is also a certified veterinary journalist and a prolific author of both scientific and motivational articles.

Her love for Traditional Chinese Veterinary Medicine coupled with her desire to educate the public manifested in her book Alt-Vet: The Revolutionary Pet Care and Longevity Solution. In her practice she experienced unexpected successes treating terminal diseases and conditions that were poorly responsive to allopatic medicine. The hope and emotional response of the owners that came to her as the last option for their beloved pets ignited a desire to spread the word about TCVM as a valid medical option. The book is full of advice on responsible pet ownership and holistic pet care. Food therapy and Acupuncture are heavily featured as Dr. Vargas considers them the basis of preventative medicine for pets.

She lives in sunny Winter Haven, Florida, with her husband, two daughters and a menagerie of pets.

Alt-Vet The Revolutionary Pet Care and Longevity Solution explores the TCVM

therapies that are available for companion animals

Preface by Dr Huisheng Xie

Contains real life stories of pet owners that were searching for any hope of saving their

pet, reducing their pain, and increasing their quality of life.

Alt-Vet offers chapters on pet acupuncture, massage, healing diets, prevention care

and more!

Available in bookstores, amazon.com & www.mitsievargas.com

the therapeutic effect of acupuncture and chinese herbal ... case series...

Documents