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EQUINE VETERINARY EDUCATION


Equine vet. Educ. (2018) 30 (9) 464-465 doi: 10.1111/eve.12709


Clinical Commentary


Traditional Chinese veterinary medicine: Basis for treatment of iatrogenic rectal paralysis


P. R. Morresey Rood and Riddle Equine Hospital, Lexington, Kentucky, USA. Corresponding author email: pmorresey@roodandriddle.com


The case report in this issue (Sleeper et al. 2018) details the treatment of rectal paralysis, secondary to administration of an alcohol tail block, with traditional Chinese veterinary medicine (TCVM). The use of alcohol to paralyse the movement of the tail is not sanctioned by the American Association of Equine Practitioners (AAEP). As stated within the report ‘.. .The AAEP condemns the alteration of the tail of the horse for cosmetic or competitive purposes.. .’ rendering the practice unethical. However, this practice continues due to the perceived benefit from having the tail of certain show horses rendered less likely to move in response to noxious stimuli. Regrettably, complications of the procedure while relatively rare can be devastating as noted within the case report and the literature (Stewart et al. 1990). In human medicine, ethanol sclerotherapy has several


therapeutic applications. Ultrasound guided injection of alcohol is frequently used in the treatment of neuroma (Pasquali et al. 2015), ligamentous structures to control pain (Dagenais et al. 2006) and intravascularly with the aim of sclerosing abnormal vascular structures (Lee et al. 2003; Qiu et al. 2013). Neurological structures can also be targeted as in the desensitisation of the coeliac ganglion to curtail emesis and pain caused by peritoneal inflammation and abdominal neoplasia (Collazos et al. 1996). However, numerous complications have been reported due to leakage of alcohol from the intended site of application even with the guidance of ultrasonography (intravascular, intralesional). Complications include skin necrosis and fibrosis of tissue (Prasetyono and Kreshanti 2010). Regionally dissipating alcohol led to damage to adjacent peripheral nerves either through direct nerve toxicity or ischaemia. In the horse, conventional treatment options for


complications of alcohol tail blocking are limited. As detailed in the report, supportive care (faecal softeners, fluids) with manual evacuation of rectal and bladder content is all that is available to alleviate faecal impaction and urinary retention. Anti-inflammatories and, where tissue necrosis occurs, antimicrobials with possibly surgical debridement may also be required. None of these management procedures or therapies can be considered restorative in any way, either of structure or neuromuscular function. In TCVM, the underlying philosophy is to bring the patient


back into a state of normal function by restoring balance between the agents or processes causing dysfunction, and the physiological homeostasis of the patient. Organ systems and their interrelationships are modelled upon theories of hierarchies and interactions observed in the natural world. Disease is considered the result of ‘external pathogens’. Pain or loss of function is considered to result from disruption to, or stagnation causing cessation of, Qi flow. A restoration of normal function was therefore dependent upon relief of stagnation of Qi. Application of both physical and nutrient


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therapies is used to achieve and maintain this restoration of balance. In the horse that is the subject of this case report, TCVM


would seek to address stagnation of Qi flow inherent in the loss of function of the caudal gastrointestinal tract and supporting perineal tissue. As the gastrointestinal tract, neurological system, and musculoskeletal system are affected, the organ systems in which Qi flow would be ‘tonified’ (restored to normal and hence balance) would include spleen (Qi production and flow, passage of solid and liquid wastes, muscle function), kidney (central nervous system i.e. spinal cord structure and function, water balance), and liver (maintenance of Qi flow, connective tissue integrity). Complicating the understanding of this concept, in TCVM, the organ systems are not necessarily of physical form, and do not necessarily relate to established anatomical concepts. Both systemic (constitutional) and local treatments would be co-ordinated in an overall plan involving the various modalities noted (dry needle, electroacupuncture, aqua-acupuncture and moxibustion) in this case report. Dry needling and electroacupuncture have been detailed in the report. Aqua-acupuncture used autogenous blood to chronically stimulate the acupuncture point in this case report, however any tolerated liquid can be used. Moxibustion applies heat to the acupuncture point, similarly prolonging the effect while promoting Qi flow. Herbal therapies are considered useful to continue the stimulatory effects detailed above, in a more tolerable fashion over an extended treatment period, by directly addressing the same deficiencies. In human medicine, with respect to colonic function,


electrical stimulation has been shown to have beneficial effects. Transcutaneous electrical stimulation was shown to improve faecal incontinence by increasing the myogenic response to distension (Bouguen et al. 2014). Interestingly, in patients suffering constipation, electrical stimulation experimentally over an 8-week period caused enhancement of parasympathetic nervous system activation leading to improvement in clinical signs (Chen et al. 2013). While reports of the effectiveness of TCVM techniques on equine gastrointestinal motility deficits are rare, considerable research in laboratory species is supportive of its use. Gastric motility and emptying, and duodenal motility, have been shown to be improved by electroacupuncture (Ouyang et al. 2002; Chen et al. 2008; Yin and Chen 2011). While this case was approached using TCVM principles,


there are physiological foundations that may indicate that a more conventional understanding of effects is possible. Acupuncture has been shown to cause supraspinal analgesia at a segmental level by inhibition of ascending pain fibres by both presynaptic and postsynaptic methods (Anderson and Holmgren 1975), and endorphin release (Han 2003, 2004).


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