Heart failure occurs when the heart cannot pump enough oxygenated blood to the peripheral tissues, leading to inadequate cardiac output. Congestive heart failure (CHF) occurs when blood collects in organs (usually lungs), which consequently leads the organs to function abnormally or become edematous. Clinical signs include dyspnea, cough, exercise intolerance, and collapse. There are three types of heart failure: Class I in which clinical signs are seen only with the most vigorous exercise, Class II where signs are seen with minimal exercise and Class III where signs are seen even at rest. In Traditional Chinese Veterinary Medicine (TCVM), the Heart is the "King of Circulation". The Heart Qi is the power and force behind the pumping of Blood to circulate throughout the whole body. The Heart also houses the spirit (mind) or Shen. Therefore, in TCVM a deficient Heart can lead to poor circulation and Shen disturbance. TCVM has been used for treatment and diagnosis of heart conditions for over 1,000 years. The use of acupuncture and herbal medicine to diagnose and treat heart failure will be discussed in the presentation, along with clinical case studies.

I. Qi-Blood Stagnation

Clinical signs: Painful sensitivity in the back and thorax, fullness in the flank, restlessness. Overall, no significant deficient signs are seen, although this can be seen in Class I of heart failure. Pulse: deep or slow and Tongue: grey purple tongue with petechia.

Treatment strategy: Activate Qi and Blood; eliminate Stagnation to stop pain

Acupuncture: BL-14/15, PC-6, LU-7/9, HT-7, LIV-3, LI-4

Chinese herbal medicine: Compound Dan Shen (Fu Fang Dan Shen Pian)

II. Heart Qi Deficiency

Clinical signs: Shortness of breath, palpitation, spontaneous sweating, listlessness, lassitude, weak, irregular or regularly irregular pulse, and pale tongue with a white coating.

Treatment strategy: Tonify Heart Qi

Acupuncture: BL-14/15, PC-6, LU-7/9, HT-7, CV-17/14/4, ST-36

Herbal treatment: Yang Xin Tang (Heart Qi Tonic)

III. Heart Yang Deficiency

Clinical signs: Shortness of breath, palpitation, spontaneous sweating, listlessness, lassitude, fatigue, lethargy, loose stool, coolness of the ears/nose, weak, irregular or regularly irregular pulse, and pale or purple tongue.

Treatment strategy: Warm Yang and tonify Qi and Heart; eliminate Cold

Acupuncture: BL-14/15, PC-6, LU-7/9, HT-7, GV-3/4, Bai-hui (moxibustion)

Herbal treatment: Bao Yuan Tang

IV. Kidney Yang Deficiency

Clinical signs: Cough, shortness of breath, ascites, edema of the rear limbs, warm-seeking behavior, coldness of the back and limbs, deep and weak pulse, pale purple tongue.

Treatment strategy: Tonify Kidney and warm Yang

Acupuncture: BL-23/26, KID-3/7, LU-7/9, HT-7, CV-4/6 (moxibustion).

Herbal treatment: Zhen Wu Tang

V. Deficiency of Qi and Yin

Clinical signs: Fullness and pain in the chest that is worse after moving, palpitation, dizziness, weak and irregular pulse, red tongue with teeth marks.

Treatment strategy: Tonify Heart Qi and Yin, activate Blood and regulate pulse

Herbal treatment: Sheng Mai Yin

VI. Collapse of Yang Qi

Clinical signs: Spontaneous sweating, coldness of the limbs and back, urine retention or short urination, syncope or coma, feeble pulse, blue purple tongue.

Treatment strategy: Revive Yang to resuscitate collapse

Acupuncture: GV-26, KID-1, TH-5 to PC-6, LI-10, ST-36

Herbal treatment: Aconite-Ginseng Complex (Shen Fu Tang)

Case Example 1

Andi is a 13 year old male castrated Jack Russell terrier, who was presented for a persistent gagging cough of six months duration. He was diagnosed with congestive heart failure based on clinical signs and radiographic findings. The referring veterinarian noticed purple tongue and gums, and a III/VI heart murmur with tachycardia (rate over 200 BPM). The dog improved following administration of enalapril and furosemide. At presentation, his heart rate was currently 120 beats per minute and he was requiring a higher dose of furosemide to keep the cough under control, and he was progressively developing ascites.

TCVM exam: He was timid, fears other dogs, strangers, and occasionally bites. He will no longer go upstairs and can only walk for five minutes, whereas before he would walk and run for thirty minutes. He has a good appetite and Shen. His cough is persistent, but is worse in the daytime. His abdomen was distended from marked ascites. He had a III/VI heart murmur. His owner reported that he was not polyuric or polydipsic. His tongue was pale lavender. His pulse was hard to feel on both sides, but the right side was weaker. His owner noted that he would seek warm places to sleep. Upon palpation his back, ears, and extremities feel very cold.

TCVM diagnosis and treatment: Kidney/Heart Yang Deficiency. Andi received the herbal medicine Zhen Wu Tang: 3 pills PO BID and acupuncture at BL-14, BL-15, BL-23, BL-26, GV-3, GV-4, ST-36, ST-40, LU-7, CV-17, and CV-22, once per month.

Outcome: After three monthly acupuncture treatments and daily herbal medicine, his cough was significantly diminished according to his owners. After treatments, he was able to walk twenty minutes twice a day, and his abdomen returned to normal with no palpable ascites. His back and extremities felt warm. Andi's treatment plan was modified to receive the herbal "Heart Qi Tonic", three pills twice daily and one acupuncture session every six months.

Case Example 2

Randy is a 13 year old male Chihuahua, who has had hip dysplasia for several years. He had all of his teeth extracted three years ago. Randy has a IV/VI heart murmur that was diagnosed one month ago; he has mild left atrial enlargement with moderate to severe mitral insufficiency and mild tricuspid insufficiency. Enalapril was recommended at that time, but the owner opted for herbal therapy for this problem.

TCVM Exam: Upon presentation, his personality was noted to be typical of a Water animal. His tongue was red and purple; his pulse was weak on the right side. He had a IV/VI heart murmur and an occasional cough. His Shen was normal. Acupuncture points BL-14/15/54 were slightly sensitive to palpation. He favored the right rear limb, indicating Bi syndrome (arthritis), which according to the owner seemed worse with cold weather.

TCVM Diagnosis: Heart Qi deficiency, Kidney Qi Deficiency, Bi syndrome, Qi Stagnation at the right hip

Acupuncture: 1) Dry needle at BL15, GV 20, HT-7; 2) Electro-acupuncture (20 mins at 20 Hz) at BL 54 (bilateral), BL23 (bilateral), GB 29 + GB 30, Jian Jiao + ST36.

Chinese Herbal Medicine: 1) Shen Tong Zhu Yu (Body Sore): ¼ tsp PO once daily in the morning; Yang Qi Tang (Heart Qi Tonic): ¼ tsp PO once daily at night.

Outcome: Randy was able to walk much better after the first treatment. He appeared to be able to walk without pain after three acupuncture treatments. His heart function has been monitored regularly by EKG and echocardiogram and has shown improvement. He has received acupuncture once every one to three months and has received daily herbal medications for the past two years. At the writing of this presentation, Randy has an excellent quality of life as he walks for thirty minutes twice daily without difficulty and has shown no signs of coughing.

Summary

TCVM alone can be successfully used to treat Class I and II CHF patients. Combined with conventional medications, TCVM can be very useful to promote quality of life for Class III patients.

References/Suggested Reading

1.  Xie H, Preast V. Dr. Xie's Veterinary Acupuncture. Blackwell Publishing. 2006.

2.  Xie H, Preast V. Traditional Chinese Veterinary Medicine Volume I-Fundamental Principles. Reddick, FL. Jing-tang. 2002.

3.  Schwartz C. Four Paws Five Directions. Berkley, CA: Celestial Arts 1996.

4.  Schoen AM. Veterinary Acupuncture. 2nd Ed. St Louis, Mo. Mosby 2001.