Acupuncture for Neurological Disorders Associated with the Liver

1. Acupuncture for Neurological Disorders Associated with the Liver It matters not whether medicine is new or old, it only matters that it is applied for the benefit of the patient.

2. Neurologic Assessment • Is it a neurologic disease? • Seizures • Intention tremor • CN deficits • Head tilt • Nystagmus • CP deficits • Dysmetria • Paralysis

3. CBC Chemistry Bile acids Cholinesterase Urinalysis Chest and abdominal radiographs Abdominal ultrasound Heartworm test Fecal Minimum Database

4. Electrodiagnostics EEG EMG BAER CSF tap & analysis Cells & protein Pressure Cholinesterase Titers Radiographs Skull & spinal films Myelography CT scan MRI Muscle Analysis Enzymes 2M antibody Anti-ACH receptor antibody Biopsy Ancillary Neurologic Tests

5. When all else fails… Look at the patient!!!

6. Seizures in Small Animals • It is estimated that the overall incidence of seizure disorders in dogs and cats is around 1% • In pure breed dogs, this incidence may increase to 15-20%, due to the presence of inherited, primary epilepsy in those breeds

7. Lesion Localization in Seizures • Cerebral Cortex • Diencephalon • Thalamus • Hypothalamus • Mesencephalon

8. Seizure Diagnoses

9. Seizures- -TCM • Represent various aspects of the Liver (Wood) system • Excess (3 types) • Deficiency (3 types)

10. Minimum Database Abnormal in Reactive Epilepsy CSF tap & analysis Abnormal in Active Secondary Epilepsy CT or MRI Scan Abnormal in Active Secondary Epilepsy EEG Abnormal in Secondary Epilepsy Seizure Diagnosis • All test are normal in Primary Epilepsy

11. Asymmetrical Seizures

12. Licking Seizure

13. Seizures and Signalment • Primary Epilepsy- purebred dogs 1-3 years of age • Secondary Epilepsy- any age but especially under 6 months and over 3 years

14. Seizure Treatment • Acupuncture alone • Acupuncture in conjunction with drugs • Traditional Chinese herbs • Western herbal medicine • Valerian Root • Kava Kava • Oats • Hops • Passionflower • Western drugs

15. Vitamin E 10 IU/lb daily Vitamin C 5-10 mg/lb twice a day Selenium 2 µg/lb daily Beta carotene 250 IU/lb daily B Complex 2mg/kg twice a day Vitamin E 100-400 IU daily Vitamin C 100-250 mg twice a day Selenium 50 µg daily Vitamin A 1000-5000 IU daily B Complex 10 mg twice a day Basic Antioxidants Dogs Cats

16. Probably safe parasite control Interceptor Frontline Top Spot Revolution Should avoid Heartgard Proheart 6 Program Sentinel Frontline Spray Advantage Advantix Additional Considerations

17. Diet Low-carbohydrate food Supplements Ginkgo biloba 2-4 mg/kg q8-12h Ginkoba or Publix brand Tofu or Lecithin 20 mg/kg daily Acetylcysteine 25 mg/kg q8h qod Additional Considerations

18. Phenobarbital • Cheap and effective • Dose 2-4 mg/kg for a serum level 20-40 mcg/ml • Takes 3-5 days to reach steady state • Safe but can effect the liver in a few cases • Controls 80% of seizures

19. KBr (Bromide) • Compounded by pharmacist dissolved in H2O at 250mg/ml • Dose at 22 mg/kg q12h • Blood level in 2 months between 1500-4000 µg/ml • Use alone or in conjunction with Phenobarbital • Bypass liver • Good for cluster seizures

20. With Efficacy Diazepam 1 mg/kg q12h Primidone 15-22 mg/kg q12h Felbamate 15-45 mg/kg q8h Phenytoin 3-5 mg/kg q8h Gabapentin 30-60 mg/kg q8-12h Topiramate 15-25 mg/kg q8-12h No Efficacy Valproic acid Nimodapine Chorazepate Lamotrigine Other Anticonvulsants Note: TOXIC to Dogs

21. Excess Wind-Phlegm Tongue pale & greasy Pulse wiry & slippery Phlegm-Fire Tongue red & greasy Pulse rapid, wiry & slippery Blood Stagnation Tongue & Pulse like Wind-Phlegm History of head trauma Deficiency Liver Blood Def. Tongue pale & dry Pulse weak & thready Liver & Kidney Yin Def. Tongue red & dry Pulse weak & thready Kidney Jing Def. Tongue pale or red & dry Pulse weak & thready < 1 year of age Seizures- -TCM

22. Excess Wind-Phlegm expel phlegm, extinguish the wind, open the orifice and stabilize the seizures Ding Xian Wan Phlegm-Fire clear the liver, drain the heat, transform phlegm and open the orifices Di Tan Tang and Long Dan Xie Gan Tang Blood Stagnation expel phlegm, extinguish the wind, open the orifice, stabilize the seizures and invigorate blood Ding Xian Wan and Tao Hong Si Wu San Deficiency Liver Blood Def. tonify Qi and Blood and quiet the wind Bu Xue Xi Feng San or Di Tan Tang plus 8 Treasures Liver & Kidney Yin Def. nourish Yin and extinguish wind Yang Yin Xi Feng San or Di Tan Tang and Left Side Replenished (Zuo Gui Wan) or Tian Ma Gou Teng plus Kidney Jing Def. extinguish the wind and astringe or nourish the kidney jing Di Tan Tang and Epimedium Powder Seizures- -TCM

23. Wind Phlegm Spleen Disorder or Chronic Illness Emotional/Drug Stress Liver Qi Stagnation Accumulation of Phlegm (Tan) Liver Yang Rising Liver Wind (Feng) Obstruction of Shen/Mind Sudden Onset of Seizures

24. Hz Acute Seizures Tongue pale & greasy Pulse wiry & slippery Rx Principle expel phlegm, extinguish the wind, open the orifice and stabilize the seizure AP CV-15, ST-40, PC-5, GV-1, GV-26, HT-7, ST-6, LIV-3, An Shen, Da Feng Men TCM Herbal Ding Xian Wan Horse: 15 g twice daily as top dressing on feed Dog/Cat: 0.5 g per 10 to 20 lb body weight twice daily Wind Phlegm

25. Ding Xian Wan Pinellia Ban Xia Transform phlegm Citrus Chen Pi Move Qi, transform phlegm Bambusa Zhu Ru Transform phlegm Fritillary Chuan Bei Mu Transform phlegm Arisaema Dan Nan Xing Transform phlegm Juncus Deng Xin Cao Clear Heat Bombyx Jiang Can Extinguish Wind, stop seizure Scorpion Quan Xie Extinguish Wind, stop seizure Gastrodia Tian Ma Tranquilize Liver, extinguish Wind, stop seizure Ophiopogon Mai Men Dong Nourish Yin Polygala Yuan Zhi Nourish Yin, calm Shen Salvia Dan Shen Move Blood Poria Fu Ling Drain Damp Poria Fu Shen Calm Shen Magnolia Hou Po Move Qi Licorice Gan Cao Harmonize Zingiberis Gan Jiang Harmonize

26. Phlegm Fire Emotional/Drug Stress Wood Personality Spleen Disorder or Chronic Illness Liver Qi Stagnation Accumulation of Phlegm (Tan) Liver Yang Rising Liver Fire Obstruction of Shen/Mind Sudden Onset of Seizures

27. Hz: Acute Seizures Wood Personality Tongue red & greasy Pulse Fast, wiry & slippery Rx Principle Clear the liver, drain the heat, transform phlegm and open the orifices AP CV-15, ST-40, PC-5, HT-7, LI-11, LIV-3, An Shen, Da Feng Men TCM Herbal Di Tan Tang Long Dan Xie Gan Tang Phlegm Fire

28. Di Tan Tang Pinellia Ban Xia Transform phlegm Citrus Chen Pi Move and transform phlegm Arisaema Dan Nan Xing Transform phlegm Acorus Shi Chang Pu Open the orifice, eliminate Damp Bambusa Zhu Ru Transform phlegm Uncaria Gou Teng Extinguish Internal Wind, clear Liver Heat Lumbricus Di Long Extinguish Internal Wind, stop seizure Haliotis Shi Jue Ming Clear Liver Heat Poria Fu Ling Drain Damp Aurantium Zhi Shi Move Qi Ginseng Ren Shen Tonify Qi Licorice Gan Cao Harmonize Zingiberis Gan Jiang Harmonize

29. Long Dan Xie Gan Tang Gentiana Long Dan Cao Clear Liver Heat, Clear Damp-Heat Gardenia Zhi Zi Clear Damp Heat Scutellaria Huang Qin Clear Damp-heat Plantago Che Qian Zi Drain Damp-heat Alisma Ze Xie Drain Damp Akebia Mu Tong Drain Damp-Heat Angelica Dang Gui Nourish Blood Rehmannia Sheng Di Huang Nourish Yin, clear Heat Bupleurum Chai Hu Soothe Liver Qi transporter Licorice Gan Cao Harmonize

30. Mansion of Mind Damp-Heat Encephalitis, SRME, GME Lonicera Jin Yin Hua Clear heat, Expel wind 20 gm Forsynthia Lian Qiao Clear heat, Detoxify 20 gm Isatidis Ban Lan Gen Clear heat, Cool blood 20 gm Astragalus Huang Qi Move Qi (stimulate immune system) 20 gm Akebia Mu Tong Drain Damp-Heat 10 gm Platycodon Jie Geng Transporter 15 gm Licorice Gan Cao Harmonizer 10 gm

31. Meningoencephalomyelitis • Infectious Diseases • Species Specific • Steroid Response ME (SRME) • Necrotizing Vasculitis (SRMA) • Necrotizing ME (NME) • Granulomatous ME (GME)

32. Meningoencephalomyelitis • Pain to paresis to plegia • Dx with CSF tap • Spinal radiographs normal • Myelography normal (might be contraindicated)

33. Meningoencephalomyelitis

34. CSF Tap • Collection site for seizures is at the cisterna magnum. • Allows analysis for cells, protein and pressure. • Cytology and titers for infectious organisms can be obtained.

35. CSF Analysis may be normal or show increased pressure, protein and/or cells. CSF Titers species specific tests many must be paired with serum titers. Meningoencephalomyelitis CSF cytology form a dog exhibiting a mixed reaction withneutrophils, lymphocytesand macrophages.

36. Meningoencephalomyelitis • Infection • virus • rickettsia • protozoa • fungus • bacteria • Inflammation • GME • NME • SRME • SRMA

37. Can be: peracute acute & progressive chronic In brainstem, tends to be a multifocal inflammatory disorder Responds temporarily to steroids. GME Patient with GME presenting with vertical nystagmus, long tract signs, and circling with incoordination.

38. GME GME histologically causes multifocal meningoencephalitis due to proliferation ofreticulohistiocytic cells.Lesions also showmultinucleated giant cells.

39. Depends upon whether infectious or inflammatory Prednisolone Find minimum daily dose and then used 2 times MDD QOD Primor (activated sulfadimethoxine) 15 mg/kg BID Doxycycline 5-10 mg/kg QD Herbal Support Bromelain/Curcumin 2.5/5 mg/kg TID Treatment of ME

40. Sugar Bear • 5 year old, female/spayed Jack Russell Terrier • Acute onset of dementia, change in behavior, seizures, progressing toward coma in 72 hours • Tongue: Red • Pulse: Fast & Wiry

41. Sugar Bear • CSF Analysis • Increased Cells & Protein consistent with inflammation • CT scan • Focal mass in the cerebral cortex

42. Sugar Bear • Biopsy confirmed GME • Western Treatment • Prednisolone • Procarbazine • TCM Treatment • Di Tan Tang • Mansion of Mind Damp-Heat

43. Blood Stagnation Traumatic Injury Emotional/Drug Stress Blood Stagnation Qi Stagnation Liver Qi Stagnation Fire/Heat to Cook Body Fluids Liver Yang Rising Accumulation of Phlegm (Tan) Liver Wind (Feng) Obstruction of Shen/Mind Sudden Onset of Seizures

44. Hz: Acute Seizures Head Injury Tongue red & greasy Pulse Fast, wiry & slippery Rx Principle expel phlegm, extinguish the wind, open the orifice, stabilize the seizures and invigorate blood AP CV-15, ST-40, PC-5, HT-7, LI-11, LIV-3, An Shen, Da Feng Men TCM Herbal Ding Xian Wan Tao Hong Si Wu San Blood Stagnation

45. Tao Hong Si Wu San Use up to 1 month Paeonia Chi Shao Yao Nourish Blood, clear Heat Ligusticum Chuan Xiong Move Blood, resolve stagnation Angelica Dang Gui Move and Nourish Blood Rehmannia Sheng Di Huang Nourish Yin and clear Heat Carthamus Hong Hua Break Blood stasis Persica Tao Ren Break Blood stasis

46. Stasis in Mansion of Mind Use up to 6 months with Wie Qi Booster Angelica Bai Zhi Warm the Channel, relieve pain Pinellia Ban Xia Transform phlegm Ligusticum Chuan Xiong Move Blood Salvia Dan Shen Move Blood Lumbricus Di Long Clear Wind, invigorate Channel Ligusticum Gao Ben Relieve pain Pueraria Ge Gen Bring Qi upward Carthamus Hong Hua Break down Blood Stasis Bombyx Jiang Can Transform phlegm, resolve nodule Scorpion Quan Xie Break down Blood Stasis Cimicifuga Sheng Ma Ascend Qi Fritillary Zhe Bei Mu Transform phlegm, resolve nodules Scolopendra Wu Gong Detoxify, resolve nodules

47. CNS Neoplasia- -Dogs • Common Types • Meningioma • Astocytoma • Oligodendroglioma • Choroid plexus papilloma • Lymphoma • Neuroectodermal tumors • Metastatic tumor

48. CNS Neoplasia- -Dogs • Dog has 1-18 months average survival time • 1-3 with nothing • 6-9 with surgery • 12-18 with radiation treatment • All tumors are invasive (malignant)

49. CNS Neoplasia- -Cats • Most common is meningioma • Usually extra-axial and benign • Seen in aged cats • Present with depression and dementia

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