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Kidney Yang Deficiency leading to Bony Bi Syndrome with
Chi Stagnation and Hind-end Weakness
Case Report for Consideration for Veterinary Acupuncture Certification
Jessica Tracy, DVM, MBA
Class of Spring 2016
Chi Institute
Signalment: 11 year old female spayed Pug
Subjective (complaint): Patient presented with chronic weakness in the hind end, with
the left rear limb being predominantly affected. Weakness was present for last 16
months but progressively worsened within last 3 months. Concern for quality of life due
to weakness and ambulatory issues.
History: Patient was noted to list and fall to the left side. Previous blood work did not
reveal any major abnormalities or tick-borne diseases. Radiographs were approved
during the acupuncture treatment. Patient had been on a regiment of Adequan
injections, initially started on a weekly basis and then decreased to monthly. Owner
noted a significant improvement when these injections were first started, but after 12
months stated each injection was less beneficial based on the owner’s observations.
Rimadyl (carprofen) 50mg was started at the same time as the Adequan injection
regiment. Patient also started on a regiment of Flexadin, a joint supplement at that
time. Patient had a history of itching which was more intense in the spring and was
treated as needed with hydroxyzine.
Physical Examination:
Patient was BAR with normal hydration. The mucous membranes were pink with normal
CRT. Her body condition score was 6/9. She displayed obvious muscle atrophy of her
left hindlimb with lack of normal flexion in stifle when standing. Excellent coat condition
was noted. Her temperature was normal at 100.8F. The pulse rate was 110 with
concurrent but slightly weak pulses. The rest of the exam was mostly unremarkable
except for slight discharge from both eyes, most consistent with breed deformation of
the globe. Grade 3 dental disease was also appreciated. Her neurological exam was
within normal limits except for mild listing and leaning toward the left side which was
intensified with prolonged activity and ambulation. She was also slower to rise when on
a slick floor, but her proprioception was all within normal limits.
Based on initial assessment, a tentative diagnosis of left hip dysplasia was made.
Sedated radiographs were pursued as well as full blood work analysis of patient
including a urinalysis. Blood values were normal with the exception of a slight
lymphopenia (0.931K/uL), mild historical elevation of platelets (472), and a slight
elevation of alkaline phosphatase which was also historical and been monitored due to
history of non-steroidal anti-inflammatory use (200). Her renal values, including SDMA,
were all within normal limits, but her urine displayed a marked amount of bacteria along

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with moderate number of white blood cells. A diagnosis of a urinary tract infection was
made, and the patient was started on antibiotics (cefpodoxime 50mg every 24 hours for
14 days) at the time.
Radiographs revealed severe hip dysplasia in the left coxofemoral joint. Slight
spondylosis existed between L7-S1. Mild narrowing of disc spaces existed throughout
the spine but there were no obvious compression lesions appreciated. The right
coxofemoral joint displayed some early signs of arthritis with bony remodeling, but was
not as severe as the left side.
Because of the history of chronic weakness, the decreased response to Western
medicine, and the concern for administering medications, the owner elected to pursue
acupuncture therapy prior to surgical discussion for hip dysplasia.
Traditional Chinese Medicine (TCM) Examination:
The patient had an outward appearance as previously described. When observed, the
patient would become excited and greet anyone who walked into the room. She would
be very engaged and interested, especially if food was offered. She had an open,
expressive face while panting. When approached or reached toward, the patient would
retreat. This impulse to retreat had become progressively more noticeable during the
past few years of her visiting the hospital, and had not been observed initially. The signs
of weakness and listing did not appear to be more pronounced during any particular
time of day, except when owner would return home after being away and patient
became excited. The canine preferred warmer environments and would seek out
sunshine, blankets, and areas of heat over cool places. Her appetite has always been
normal and no statement of increased urination was made despite urinary tract
infection. During the initial exam, the patient’s tongue appeared pale pink with evidence
of purple in the caudal tongue. Slight sensitivity was noted over BL21 - BL23 with
concurrent heat appreciated. Her pulses were deep and weak bilaterally, with the left
palpating weaker than the right only slightly. Slight sensitivity was also noted at BL54.
TCM Diagnosis:
The diagnosis was initially kidney Chi deficiency with local stagnation. As time
progressed and the examiner’s skills improved as well the patient’s response, the
diagnosis (Bian Zheng) was then transferred to a more global and chronic diagnosis of
Kidney Yang deficiency with Bony Bi syndrome and local stagnation. The dog’s
characteristics had been most consistent with Fire during the majority of her life. Fire is
considered to represent the most Yang of the constitutions, and this constitution
eventually allowed overuse and an overall Yang deficiency. As her condition
progressed, her Grandmother element Water (Kidney) became affected and her
constitution began to transition towards Water (Kidney), exemplified by shying away in
the room. This is a display of Ru, or the insulting cycle, which is stated as the
“Grandmother is weak and the Grandchild is rude and runs all over her until she is
exhausted” (Small Animal Acupuncture Training Program, Spring 2016, Session 1,
Page 129).

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TCVM Treatment:
Due to the patient’s nature and reaction in the room as well as her overall constitution,
calming points were vital. A number of different calming points were used, depending on
the patient’s response or what was presented at the time. Focus was placed on local
points for pain and stagnation as well as tonifying the Kidney element. For this patient,
many of the Heart (fire) points to sedate the child were not optional due to the patient’s
response to distal points. Bladder 60 was utilized in order to address the fire point on
the bladder channel as well as BL15. Kidney 3 was capitalized as the Yuan source point
for Kidney and for tonification. Other points were chosen in order to calm, address local
pain, balance instability, and relieve Qi stagnation. Hindquarter Weakness was added at
the third session, (1 capsule twice daily) but the owner reports inability to administer to
patient.
Calming Points: An Shen, Bai Wei, GV17/20
Constitution Points: BL15, BL60, KID3
Local Points: BL40, BL54, GB29, GB30, Shen Shu, Shen Jao
Association Points: BL11, BL23, GB34, BL21
Balance Points: SI9, GV14
Chi Stagnation Relief: LI4
First treatment and response: Because the patient was slightly nervous, the initial
needles were placed in order to focus on calming points. Bai Hui, An Shen and GV17-
20 (single needle) were utilized. Because this was the first treatment overall, only dry
needling was performed at all points. The physician attempted to rotate the needles
periodically, but the patient’s anxiety was heightened with each time the physician
entered the room and was therefore discontinued. The needles were allowed to remain
for 20 minutes total, with some needles being removed by movement of patient. BL21
and 23 bilaterally were needled on the back. BL 54, GB29, GB30 on the left side as
well as KID 40 were addressed for pain and weakness in the hind end. SI9 was
administered for balance. At this point, the patient was no longer accepting of the
needles and the addition of herbal medications was discussed. Instructions were given
to start Hindquarter Weakness at a dose of 1 capsule every 12 hours and evaluate her
response. Weight was also discussed and the importance to decrease her total weight
by feeding appropriate calories. The owner reported that the patient did very well for the
first 3 days then had the weakness return again. The herbal medication had not been
started due to client compliance but the owner stated would start the following week.
There was a 10% overall improvement appreciated at the time of the visit, but the 3
days following the treatment were noted at 50%. The owner’s main concern still
remained the patient falling to the left side with weakness of the hip. Evaluation at the
second visit showed patient as more receptive to needles overall. Pulses remained
deep and weak but there was difficulty appreciating which side was weaker. The tongue
was more pink with only a slightly purple caudal central region (Kidney).
Second treatment and response: A second acupuncture was repeated 7 days after
original visit. A mild reaction was noted at the area of BL23 bilaterally. Slight heat was
also noted around BL11. DA was performed at BL40 and BL23 bilaterally, BL54, GB30,

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SI9, GB34 (left). Needles were placed in Bai Hui and GV14 as well as 2 needles in
Shen Shu, Shen Jao, and An shen. Since the patient responded well after the previous
visit and was more calm and receptive to the needles, electroacupuncture was pursued.
EA was connected to GV14 and Bai Hui, Shen Shu left to BL53, and BL23 across L2.
Additional instructions were given to address weight and manage joint health. Patient
was then started on Hill’s Prescription Metabolic+Mobility with specific instructions on
how much to feed with the addition of green beans and chicken (considered a mild to
hot food) for any treats. The patient was overall more receptive to the needles but still
refused distal needle placement. After the treatment, the owner reported that the
patient seemed slightly worse with the electroacupuncture and held her back left paw up
for the rest of the day. The owner requested no electroacupuncture despite
conversations that it may cause a more intense initial response. She seemed to improve
after the initial 24 hours but the extent of improvement was unclear to the owner. At the
return visit, her pulses were still weak but more pronounced than any previous visits.
Heat was still appreciated at BL11.
Third treatment and response:
No further electroacupuncture was to be pursued per the owner. At this point in the
case, pneumoacupuncture would have been a suggested course of action for the hind
end weakness and muscle atrophy. However, this technique was unknown to the
physician at the time. Aquapuncture with saline was placed in an shen bilaterally to aid
with the patient accepting the needles since she seemed to exhibit more overall anxiety
than the previous visit. BL23, Shen Shu, Shen Ping, Shen Jiao were placed bilaterally.
GV17 and Bai Hui were also used for calming. SI9, BL54, KID10, and GB34 were
placed on the left side. The herbal medication Hindquarter Weakness was re-prescribed
to aid with overall weakness noted in the left hindlimb. The patient was instructed to
receive 1 capsule every 12 hours and to contact physician if any diarrhea was noted.
After this treatment, there was a noted overall improvement. Initially, the owner related a
10% improvement, but when evaluated further, she stated that the patient was now able
to walk up stairs, was no longer falling over on stable flooring, and was able to walk with
more ease on slick flooring. Overall she stated her quality-of-life had improved
significantly since her initially visit and the improvement overall may be closer to 70%.
The owner continued to decline electroacupuncture due to previous experience. She
also was unable to continue giving Hindquarter Weakness due to the patient’s
refusal to ingest the capsule or powder over food. The pulses were overall improved,
but still weaker on the right side. The overall color of the tongue had improved to a more
pink color, and no heat was appreciated along the back at trigger points.
Fourth treatment and response:
DA was performed bilaterally at BL40, BL23 , and BL11. Calming points were GV17
and aquapuncture with 0.5cc saline was placed at An Shen. Points focused on the left
hindlimb included GB34, BL54, GB29, GB30. The patient allowed a single distal point of
LI4 to improve Qi flow. After this treatment, the patient was then instructed to return
monthly for treatments or sooner if necessary. The owner became aware of changes
and progression of condition after 3 weeks. The noted improvements returned with
each acupuncture treatment. At this time, the patient returns every four to six weeks for

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maintenance sessions. Improvement of her conditions as well as the practitioners’
technique including pneumoacupuncture has continued to allow improvement with her
case and clinical signs.
Case Summary:
This case represented a common presentation which can greatly affect the patient’s
quality of life. Surgical intervention for this patient was not an option for the owner due
to financial concerns, age, and multiple affected joints. This patient was no longer
responding to conservative management. Medications, due to the patient’s
temperament and owners compliance, were not as effective as desired. Acupuncture
treatment offered an alternative option. The patient was not considered an ideal
candidate. She was initially concerned with needling treatment and her response to
electroacpuncture as well as her fire personality, but nonetheless responded very well
overall. Chronic arthritis and degenerative joint disease the patient displayed are directly
related to kidney deficiency since the bones and bony changes are considered to be
ruled by the kidney element. Yang deficiency was ultimately diagnosed since the patient
sought warm environments and her previous constitution was fire, the most yang of all
the elements. Qi stagnation in the left hip lead to pain and even weakness in this case.
The patient displayed a marginal but obvious improvement after her first three visits,
and a marked improvement after her fourth and all other subsequent visits. The
progress with Western medicine treatment had not been noted for at least six months
prior to pursuing acupuncture treatment. The diet was altered according to Western
conventional medicine, but the addition of chicken to improve the Yang as well as rice to
support the kidney were supplemented. Not all of the possible or strongest points were
used since the patient did not respond well to distal points, but a positive response was
still noted most noticeable after the third visit. During monthly visits, the owner reports
the patient as between 60 - 80% improved. Often the most marked improvement is
noted by the owner immediately after the sessions and the remark is often made when
the patient is late to the treatment how much of a difference it makes. The atrophy is
still present, but the patient is able to use the hindlimb with minimal listing or falling as
well as navigate stairs. The patient does continue to improve and has shown no relapse
to the continued treatment. The owner was impressed with the response and has made
mention of this to multiple family members and friends.
Acupuncture Points Used:
BL11: (Da shu) Located 1.5 cun from the midline between the 1st and 2nd thoracic
spinous processes. Perpendicular (or angular if the scapula is in the way) insertion 1-3
cm deep. Mater point for bony abnormalities and local point for neck and forelimb
arthritis.
BL15: (Xin-shu or Heart Association) At the tenth intercostal space, 3 cun lateral ot the
dorsal midline (in the iliocostal muscle groove). Perpendicular insertion to depth of 1
cun. Back-shu association point for heart: chest pain, palpitation, insomnia, heart failure,
sweating, seizure.

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BL21: (Wei-shu or Stomach Association) located caudal to the last rib, 3 cun lateral to
the dorsal midline. Perpendicular insertion to a depth of 1.5 cun. Back-shu association
point for stomach, promote GI motility, relieve colic pain; diarrhea, colic, constipation,
vomiting
BL23: (Shen-shu or Kidney association point): located at second lumbar intervertebral
space (L2-L3), 3 cun from the dorsal midline. Perpendicular insertion to a depth of 1.5
cun. Back-shu association point for KID; urinary incontinence, impotence, edema, ear
problems, back pain
BL40: (wei zhong) located in the center of the popliteal crease. Perpendicular insertion
(towards patella) 0.5 to 1 cm deep. Master point for the rear legs.
BL54: (Ba-shan or Zhi-bian, Attach to Mountain) located midway on a line connecting
Bai-hui and the greater trochanter of the femur. Perpendicular insertion to a depth of 2
cun. Use for hip pain and arthritis, hind limb lameness, muscle atrophy, bladder
disorders, immune mediated disorders.
BL60: (Kun lun) Located in the depression between the lateral malleolus of the fibula
and the tip of the tuber calcaneus. Perpendicular insertion 0.5cm deep. IN dogs, angling
the needle slightly distally can interconnect with KID3 which is located slightly distally on
the medial side of the rear leg opposite BL 60. The aspirin point, which is good for pain
in general.
GV14: (Da-zhui) Located on the dorsal midline in the depression in front of the dorsal
spinous process of the T1 vertebrae (the first palpable dorsal spinous process going
from the cranial to caudal). Perpendicular insertion with a greater depth of 2 cun. It is
the crossing point of the GV with the six Yang channels. It can be used to clear heat,
Yin deficiency, fever, cough, cervical pain, dyspnea, intervertebral disc disease,
dermatitis, epilepsy, immune deficiency
GV20: (Human Bai-hui) Located on the dorsal midline on a line drawn from the tips of
the ears level with the ear canals with perpendicular or oblique insertion. Crossing point
of the GV and BL Channels. Use for sedation, shen disturbances, epilepsy, sleep
disorders, and anal prolapse.
An Shen: (Pacify Shen) Located on the side of the head, caudal to the base of the ear
halfway between TH-17 and GB-20 approached with a perpendicular insertion 0.3 - 0.5
cun. Use for behavioral problems, shen disturbances, internal wind, epilepsy, cervical
stiffness, epistaxis, nasal discharge or congestion, facial paralysis, facial swelling, otitis,
and deafness.
GB29: (Ju-liao) Located at the coxofemoral joint, in a depression just cranial to the
greater trochanter of the femur (one of three ‘bowling ball’ points of hip. Perpendicular
insertion to a depth of 1.5 cun. It is a crossing point of the GB and Yang-qiao Channels.

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Use with osteoarthritis of the coxofemoral joint, pelvic limb paresis or paralysis, gluteal
muscle pain.
GB30: (Huan-tiao) Located in a depression midway between the greater trochanter of
the femur and the tuber ischii. Approach with perpendicular insertion with a depth of 1 to
1.5 cun. This is the crossing point of the GB and BL channel. Use with osteoarthritis of
the coxofemoral joint, pelvic limb paresis or paralysis, gluteal muscle pain.
GB34: (Yang-ling-quan) Located on the lateral side of the pelvic limb at the stifle, in a
small depression cranial and distal to the head of the fibula. Approach with oblique
insertion and needle at a depth of 0.5 cun. It is a He-sea point (earth) and an influential
point for tendon and ligaments. Use for ST and LIV Qi stagnation, hypertension,
vomiting, liver and gallbladder disorders, tendon and ligament disorders, pelvic limb
lameness, weakness and paresis or paralysis, general pain relief.
KID3: (Tai-xi) Located on the caudomedial aspect of the pelvic limb in the thin fleshy
tissue between the medial malleolus of the tibia and the calcaneus level with the tip of
the medial malleolus (opposite and slightly distal to BL60). May use perpendicular
insertion. This is a Shu-stream point for earth, Yuan-source point. This may be used for
renal disease, dysuria, diabetes mellitus, irregular heat cycles, infertility, impotence,
pharyngitis, dyspnea, dental pain, thoracolumbar intervertebral disc disease, otitis, and
auditory dysfunction.
SI9: (Jian zhen) Located in a depression between the long and lateral heads of the
triceps muscle and the caudal border of the deltoideus muscle. Perpendicular insertion
1-3 cm deep. Mater point for the muscles and local point for cervical pain.
Bai Hui: (Hundred Crossings) Located on the dorsal midline between L7 and S1
vertebrae. A perpendicular insertion at a depth of 0.5 cun. Use for Yang deficiency,
pelvic limb paresis or paralysis, lumbosacral pain, lumbosacral intervertebral disk
disease, coxofemoral joint pain, abdominal pain, diarrhea.
Shen Shu: (Kidney Association in Equine) Located on the dorsolateral lumbosacral
region 1.5 cun lateral to Bai-hui (L7-S1). Perpendicular insertion at a depth of 0.5 cun.
For use with Kidney Qi or Yin deficiency, renal failure, deafness, urinary incontinence,
edema, and thoracolumbar pain.
Shen Jao: (Kidney Corner) Located two cun caudal to Shen-shu. Approach with
perpendicular insertion at a depth of 1.5 cun. For use with hindquarter pain, back pain,
hindquarter paralysis, hip arthritis or contusion, Yang or Qi deficiency, overexertion
KID10: (Yin-gu) Located on the medial side of the popliteal fossa at the level of BL-40
between the semimembranosus and semitendinosus muscles. Approach with
perpendicular insertion to a depth of 0.5 cun. It is a He-sea point (water) and a horary
point. For use with impotence, hernia, dysuria, stifle pain, and lower abdominal pain.

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LI4: (He-gu) Located on the medial side of the thoracic limb between the second and
third metacarpal bones at the midpoint of the third metacarpal bone. Perpendicular
insertion to a depth of 0.5 cun. It is a master point for the face and mouth and a Yuan-
source point. For use with nasal discharge and congestion, epistaxis, facial paralysis,
dental pain, pharyngitis, tendonitis, fever, immunodeficiency, lupus, immune-mediated
skin disease, general pain syndromes. This point should never be used during
pregnancy.