20 minute read
Chinese herbs for liver disease
Chinese herbs for liver disease
by Steve
Several Chinese herbal formulas are routinely and markedly effective for managing small animal liver disease. This article focuses on Chinese herbal treatments for cholestatic, inflammatory, neoplastic and vascular disorders of the liver.
The formulas discussed here are manufactured by the Natural Path Herb Company, but formulas with the same names from other companies, with the exception of Minor Bupleurum, will likely perform in a similar way. You can see them in action in an online presentation at civtedu.org.
Administration by enema Injectable forms of herbal medicine are not yet available, but high quantities of the appropriate formula can be delivered to an acutely ill patient via retention enema. A patient’s response is rapid and dramatic, with liver enzyme elevations subsiding and the patient stabilizing within a couple of days. Compounds in the formulas are absorbed across the large intestine mucosa into the portal circulation and from there move rapidly to the liver, bypassing any gastro paresis.
Method • 9 grams (4.5 teaspoon) in divided doses TID • Suspend each dose in a maximum of 10 to 15 ml of warm water • Instil into the transverse colon using a small rubber
French feeding tube
Mars de n, DVM, ND , MSOM , La c. Dipl. CH, CVA
• Use only granular extracts or crushed tablets, never liquid extracts
1. Biliary tract inflammation High ALP and no elevated post-prandial bile acids. Cholestasis caused by steroid hepatopathy and biliary tract inflammation leads to secondary changes, including fibrosis and apoptosis of hepatocytes and cholangiocytes.
Herbal treatment Si Miao San (Four Marvels Powder)
Cang Zhu Huai Niu Xi Yi Yi Ren Huang Bo Atractylodes rhizome Achryanthes root Coix seed Phellodendron bark
How it works: • Anti-inflammatory and antioxidant • Anti-microbial (important in cholangiohepatitis) • Promotes bile synthesis and flow • Inhibits nitric oxide synthase to limitacute inflammation
Dose: • Dose of granular extract • 1g (1/2 tsp) BID for 10kg animals • 2g (1 tsp) BID for 20kg animals • 3g (1½ tsp) BID for 30kg animals and higher
• Can be mixed in food or given in gel caps Management: • May be used along with Ursodiol • Additive or synergistic effect with other antibiotics • No long term safety concerns • Cease use if loose stools occur
2. Hepatocellular Adenocarcinoma Both ALT and ALP markedly elevated, greater than five or six times normal. Acute abdominal pain is common and often the first presenting sign. Often caused by chronic hepatitis, which leads to oxidative damage to liver DNA, potentially leading to tumor development.
Dang Gui Chuan Xiong Chi Shao Yao Zhi Ke Gan Cao Xiang Fu Wu Yao Mu Dan Pi Tao Ren Hong Hua Yan Hu Suo Chinese Angelica Ligusticum rhizome Red Peony root Bitter Orange peel Licourice root Cyperus rhizome Lindera root Peony Tree bark Persica seed Safflower flower Corydalis rhizome
How it works: • Actions contributed by several ingredients • Reduction of nitric oxide synthase, resulting in reduced hepatic blood flow • Inhibition of angiogenesis • Net effect is a reduction of acute inflammation and the deprivation of blood supply to rapidly growing tumors • Increases superoxide dismutase (SOD) levels, resulting in reduced free radical damage and lower ALT and AST levels • Inhibits fibrosis and collagen synthesis • Analgesic • Antiproliferation and apoptosis inducing effects, particularly for hepatocellular carcinoma
Dose: • Dose of granular extract • 1g (1/2 tsp) BID for 10kg animals • 2g (1 tsp) BID for 20kg animals • 3g (1½ tsp) BID for 30kg animals and higher • Can be mixed in food or given in gel caps 3. Chronic Hepatitis Both ALT and ALP mildly to moderately elevated -- usually up to three or four times normal. By the time clinical signs appear, the animal already has a cirrhotic liver. Signs include loss of appetite, vomiting, weight loss, depression or lethargy, increased thirst and urination. Laboratory changes include elevated liver enzymes, and moderate to severe inflammation without evidence of tumor or infection.
Chinese herbs inhibit fibrosis and cirrhosis development, extending lifespan usually for years. The formula discussed here is not as effective for copper toxicosis. Use instead Angelica and Corydalis discussed above, either alone or in tandem with chelation.
Possible sequelae: hepatomegaly, jaundice, coagulation problems, ascites, weight loss, hepatic encephalopathy, hepatocellular adenocarcinoma.
Chai Hu Dang Gui Bai Shao Yao Bo He Bai Zhu Fu Ling Gan Cao Bupleurum Angelica sinensis White Peony Mint White Atractylodes Poria Licourice
How it works: • Reduces inflammation by safely increasing endothelial nitric oxide production • This limits chemotaxis of neutrophils into the tissue, while increasing blood flow • Increases superoxide dismutase (SOD) levels, resulting in reduced free radical damage and lower ALT and AST levels • Inhibits fibrosis and collagen synthesis • Net effect is a reduction of inflammation
Dose: • Oral use is generally sufficient • Dose of granular extract • 1g (1/2 tsp) BID for 10kg animals • 2g (1 tsp) BID for 20kg animals • 3g (1½ tsp) BID for 30kg animals and higher • Can be mixed in food or given in gel caps Management: • If liver enzymes elevate significantly during use of this formula, then the patient has acute hepatic inflammation; use Ge Xia Zhu Yu Tang (Angelica and Corydalis) instead
4. Microvascular Portosystemic Shunt Increased ALP with elevated post-prandial bile acids. Probably most cases in dogs are due to intravascular inflammation, leading to increased blood pressure within the vessels, and secondary portal hypertension. Other causes include portal vein thrombosis, diffuse hepatic fibrosis and cirrhosis. The goal of therapy is to resolve chronic intravascular inflammation.
Associated findings: microcytosis, due to injury of erythrocytes in narrowed vasculature; mild non-regenerative anemia, which aggravates liver hypoxia and hypofunction; low BUN, creatinine, glucose, albumin and cholesterol, from reduced synthesis due to blood flow impairments; possible ALP, especially in young animals; serum bile acids not absorbed post-prandially due to shunting; liver often small in size, even in non-cirrhotic and idiopathic cases.
Possible sequelae: ascites, potential hepatic encephalopathy, GI ulceration (splanchnic vasculopathy), ammonium biurate urolithiasis
Chai Hu Dang Gui Bai Shao Yao Bo He Bai Zhu Fu Ling Gan Cao Bupleurum Angelica sinensis White Peony Mint White Atractylodes Poria Licourice
How it works: • Reduces inflammation by increasing endothelial nitric oxide production • This limits chemotaxis of neutrophils into the tissue, while increasing blood flow • Stimulates bone marrow to correct anemia and further improve blood flow • Increases superoxide dismutase (SOD) levels, resulting in reduced free radical damage and lower ALT and AST levels • Inhibits fibrosis and collagen synthesis • Net effect is a reduction of inflammation and improved liver perfusion
Dose: •Oraluseisgenerallysufficient,sincemostcasesarenotemergencies • Dose of granular extract • 1g (1/2 tsp) BID for 10kg animals • 2g (1 tsp) BID for 20kg animals • 3g (1½ tsp) BID for 30kg animals and higher • Can be mixed in food or given in gel caps Management: • No herb/drug interactions anticipated 5. Autoimmune Disease and Septicemia Liver enzyme elevations plus azotemia is a hallmark of systemic disease amenable to this formula. Liver inflammation may be a source of immune complexes that promote glomerulonephritis; autoimmune tendencies can be enhanced in both tissues by immune system malfunction; deep-seated parasitic, bacterial and viral infections can promote inflammatory responses.
Herbal treatment Xiao Chai Hu Tang (Minor Bupleurum Combination)
Chai Hu Ban Xia Gan Cao Sheng Jiang Da Zao Ren Shen Huang Qin Bupleurum root Pinellia rhizome Licorice root Ginger rhizome Jujube Ginseng root Scutellaria root
How it works: • MuchoftheeffectcontributedbyBupleurum, butadequate
Ginseng levels seem necessary for proper effect • Reduces renal and glomerular inflammation • Hepatoprotective • Inhibit liver inflammation and fibrosis • Antioxidant • Enhances macrophage activity and pathogen clearance, but reduces T cell responses involved in hypersensitivity reactions • Inhibits nitricoxide synthase inparticularorgans, including liver and kidney • Reduces acute inflammation • Promotes resolution of inflammatory problems due to infectious agents, including liver abscesses
Dose: • Dose of granular extract • 1g (1/2 tsp) BID for 10kg animals • 2g (1 tsp) BID for 20kg animals • 3g (1 ½ tsp) BID for 30kg animals and higher • Can be mixed in food or given in gel caps Management: • No herb drug interactions anticipated
Dr. Ste e Marsde is o e of the chief educators of eteri aria s worldwide i the use of compleme tary a d alter ati e therapies. He regularly lectures for the I ter atio al Veteri ary Acupu cture Society, the America Holistic Veteri ary Medical Associatio , a d the America Veteri ary Medical Associatio . He is co-fou der of the College of I tegrati e Veteri ary Therapies a d a director of the Natio al College of Natural Medici e. His textbook, Ma ual of Natural Veteri ary Medici e, has bee tra slated i to multiple la guages. Whe ot teachi g, Dr. Marsde di ides his time betwee his eteri ary a d aturopathic medical practice i Edmo to , Alberta.
spotlight
Mushroom Matrix
100% Organic, All Natural, Whole Food Supplements that support wellness and a targeted approach to supportive care in dogs, cats and horses. Scientifically blended to gain the best synergies of up to ten different medicinal mushrooms. Prevent, Protect and Perform – Naturally and Organically. Equine Matrix and Pet Matrix Brands. Contact Information: Mushroom Matrix, 1-866-740-6874,
www.mushroommatrix.com or www.equinematrix.com or www.petmatrix.us
DawggieG oPak
The ultimate hands free leash accessory, designed with the Doggie Walker in mind. All of your needs fit into this fabulous pack: ( keys, phones, poop bags and more) Variety of colors & designs with fashion in mind.
dawggiegopak.com or 727-452-0416
The Honest Kitche n
The Honest Kitchen’s gently dehydrated whole foods for dogs and cats are made without high heat or irradiation, to maintain the natural nutrition in the raw ingredients. The company’s foods are 100% human grade because they’re made in a human food facility, not in a pet food plant. When prepared with warm water according to directions, the foods provide a nourishing, high-moisture diet. Grain-free options available. Ingredients include free-range chicken, wild caught fish, some organic ingredients and NO genetically engineered ingredients. Used by holistic veterinarians for their own pets. To try a box for free, vets can email
Herbs for Horses
HYALcare for joint and cartilage protection HYALcare uses a combination of nutrients that are specific to horses, joints and joint health. HYALcare is a complete joint supplement including: Glucosomine, hyaluronic acid (HA), MSM, chondroitin, glutamine, flax oil & boswellia. A little goes a long way to aid competition horses and those that suffer from arthritis.
Is your pet look- ing for a miracle? Treat him to Life’s Miracle Water Syatem
• Healthy crystal clear water • Removes chlorine and toxic chemicals • Retains the vital minerals pets need and want •Allows full absorption of nutrients •Hydrates the cells to keep skin healthier •Saves money •Great for both pets and their parents
www.lifesmiraclewater.com Robert@lifesmiraclewater.com or call Robert: 1-623-399-0361
Dog Treader
When a patient needs an excellent support harness after surgery to rehabilitate its repaired hips/ knees, or to provide rear support and stability for weak back, hip and legs due to injury or disease, think GINGERLEAD. This unique dog support harness can significantly improve recovery time and give comfort. Keep them on hand in your clinic, or refer them to us for immediate same day shipping.
DogTreader.com 1-888-966-2824
Dr. Susan W ynn DVM, CVA, CVCH, AHG
Dr. Wynn has a special interest in educating other veterinarians about integrative medicine.
By Ann Brightman
any integrative veterinarians start their careers in conventional medicine. Often, it’s by seeing firsthand how alternative therapies can complement traditional treatments that convince doctors to start incorporating holistic ideas into their practices. When veterinarian Dr. Susan Wynn graduated from the University of Georgia’s College of Veterinary Medicine, her approach was solely conventional. “I had no interest whatsoever in integrative medicine in my first year of practice,” she says.
Dr. Wynn started out with an interest in being an equine surgeon. “I’ve always had horses and thought it would be fun,” she explains. “Then a stallion recovering from anesthesia kicked me in the leg, and I realized I could still have horses without the everyday risk, so I switched my focus back to small animals.” Dr. Wynn did an ...I realized my training gave me the resources to help veterinarians interested in the field defend those interests and advance their practices.
internship at Friendship Hospital for Animals in Washington, DC, where she was able to watch integrative veterinarian Dr. Monique Maniet at work. “What fascinated me most was the way dogs and cats experienced huge improvements in health just by changing diets,” she says. Dr. Wynn also became intensely interested in herbal medicine during her internship. “I view it as an extension of nutrition – bodies know how to interact with these natural molecules, whether they are purely nutritive or act like some plant compounds as ‘specialized nutrition for specialized cells’.”
To this day, nutrition and herbal medicine are still of major interest to Dr. Wynn. “I completed a residency in veterinary nutrition in 2010 and am working on board certification. I’m also certified in Chinese and Western herbal medicine and in acupuncture.” She currently works with Georgia Veterinary Specialists in Sandy Springs, Georgia, and also has a passion for educating other veterinarians about the benefits of an integrative approach.
“In the mid-90s, I was doing a post doctoral fellowship in viral immunology at the medical school of Emory University,” she explains. “My lab was the recipient of one of the first Office of Alternative Medicine center grant awards. We were also teaching an alternative medicine class to the second-year medical students. There was so much controversy attached to alternative medicine at the time, and so much happening in the field as the Office of Alternative Medicine changed names and became an official Center in the National Institutes of Health. The push back from skeptics was particularly strong, and I realized my training gave me the resources to
help veterinarians interested in the field defend those interests and advance their practices. At that time, there were plenty of integrative veterinarians educating the public, and I felt my chosen focus would fill an unmet need.”
Dr. Wynn has co-authored four books on alternative medicine. These include Veterinary Herbal Medicine, the Manual of Natural Veterinary Medicine: Science and Tradition and Complementary and Alternative Veterinary Medicine: Principles and Practice. “I’m proud of my books, which I understand have served as resources for many integrative veterinarians trying to put what they’ve learned into a larger context” she says. “I’ve had the pleasure of working with leading co-authors and teachers, and from them I learned the value of idea cross-pollination.
“Integrative medicine is still in early enough stages that it’s easy to think we’ve heard enough when we’ve heard from one teacher,” she adds. “I think it’s important to learn from as many as possible. After working with various authors and teachers, I realized it was important to keep the medical education frontier fresh, and to that end, I’ve worked on several conference committees for my professional organizations. This has given me a chance to reach out beyond the veterinary profession, incorporating the insights and experiences of medical doctors, food animal producers, and Dr. Wynn is a past president of the American Holistic Veterinary Medical Association (AHVMA) and PresidentElect of the American Academy of Veterinary Acupuncture. “I founded the Veterinary Botanical Medicine Association, and a local organization called PALS that helps people with chronic illnesses keep their pets. I have also worked on the boards of the Georgia Veterinary Medical Association and the American Academy of Veterinary Nutrition. Some of my most fulfilling work has been on conference committees, where I could really make a difference in the information available to local veterinarians and on a national level.”
Dr. Wynn is motivated in part by a strong desire to give back to the veterinary profession. “I believe in volunteerism. I hope that by volunteering, I can show other veterinarians by example how they can actually change the future by working in organized veterinary medicine.” Another strong motivation is her lifelong love of animals. “Apparently, I was talking about being a vet from the time I was four years old. I’ve been in practice for 24 years, working from a number of general and two specialty practices, and it’s still the animals that make it worthwhile.”
Grain free wellness
If you have patients allergic to grains, you want to recommend a diet free of these ingredients. Love™ is The Honest Kitchen’s new grain-free whole-food recipe for all breeds, sizes and life stages. It’s made with human grade beef, sweet potatoes, potatoes, organic flaxseed, organic coconut, parsley, dandelion greens, papaya, cranberries, pumpkin, honey, rosemary, vitamins and minerals. The Honest Kitchen’s products are made without high heat, pressure or irradiation, to maintain the natural nutrition in the raw ingredients. The foods are gently dehydrated and simply require the addition of warm water.
This creates a high-moisture meal that helps keep animals well hydrated. thehonestkitchen.com
Supplement source
Nutritional supplements are being used by more veterinarians as a way to help maintain patient health. i Love Dogs was founded in 2007 by businessman Eric Chan and Bill Lai, who has a background in human pharmaceuticals and nutraceuticals. “Our main product line is i Love Dogs vitamins and supplements,” says Martha Smith, General Manager. “They’re veterinarian formulated for canine physiology, and are fortified with decaffeinated green tea and reishi mushroom, which provide antioxidant and immune system support to dogs.” The supplements are being dispensed in veterinary clinics in both the US and Canada. “Our Reishi with Green Tea supplement is very popular with oncology centers. Veterinarians are also using our Glucosamine and Chondroitin with Green Tea and Reishi supplement for orthopedic issues, and the Multivitamin with Green Tea and Reishi for nutritional deficiencies and digestive balance.” The company has several information-related websites, including ilovedogs.com, which includes an Ask a Vet column where readers can write in and ask consulting veterinarians dog health
Incorporating massage into your practice can help increase your revenue and enhance your relationships with your canine patients and their owners. It can be used for wellness maintenance and as an effective complement to your rehabilitation procedures. PetMassage™ Training and Research Institute is a pioneer in canine massage training. Founded in 1998, when the institute’s first two PetMassage™ for Dogs videos were introduced (endorsed by veterinarian Dr. Michael W. Fox), it continues as a leader in the field of animal massage and bodywork. Workshop offerings include both “dry” PetMassage™ for dogs and WaterWork, which is conducted in a heated pool. Foundation level workshops are convenient four-day extended weekends; the WaterWork workshop is five
days. petmassage.com questions. Meanwhile findavet.us can help increase visibility for vet clinics. “Member clinics get detailed profiles, including photos and vet bios, as well as the opportunity to contribute content as a guest expert blogger.”
Two veterinarians work with i Love Dogs. Dr. Michelle Hoag practices at Plaza del Amo Animal Hospital in Torrance, California, and answers the Ask a Vet column. “Dr. Patrick Mahaney, who practices at Veterinary Cancer Group in Culver City, California, also answers Ask a Vet questions and frequently contributes his veterinary perspective on dog-related issues as a guest blogger.”
If you’re tired of buying companion animal oral care products that don’t work and don’t sell, try VetzLife. It’s the only professional strength product proven to soften and remove stubborn tartar buildup and reverse oral disease. Best of all, it’s 100% natural, safe and easy to use. With VetzLife, customer compliance is easy to achieve because you only need to spray or wipe the product on the teeth and the pet’s saliva does the rest. This professional grade product is available only through licensed veterinarians. vetzlife.com
Mobility aid
Wheelchairs for dogs are a godsend in cases where mobility is severely limited, whether through illness, injury or post surgery. The Walkin’ Wheels dog wheelchair is a fully adjustable canine cart that easily changes size in height, length and width to accommodate different sizes of dog as well as various levels of mobility, from partial to complete rear leg paralysis. Designed to be stocked and sold by veterinarians, the wheelchair is ideal for long term as well as canine rehabilitative use. Simply take one measurement of the dog’s height, select the appropriate size wheel (which is based on this one measurement) and snap adjust the frame accordingly. handicappedpets.com
Super gravy
Clear Conscience Pet is the Winner of the 2011 Editor’s Choice Award from Pet Product News International. All products are made from humanely, sustainably and naturally raised livestock sources from family farms, free of added growth hormones, antibiotics, steroids, GMOs, grains and glutens.
One of the company’s products, SuperGravy®, is a holistic instant dry gravy mix for animals. “I have had success getting cancer patients to eat, as well as an elderly dog with chronic pancreatitis who was refusing all food, and an elderly cat with debilitating intestinal issues who was refusing his special diet,” says Dr. Stacy Robertson, DVM. “Adding a small amount of SuperGravy got them to eat again.”
Free freight and no minimums are offered to all veterinarians in the continental US. clearconsciencepet.com or supergravy.com
Healthy vision relies on many factors, and nutraceuticals can be included among them. One example of a scientifically-formulated vision supplement for dogs is Ocu-GLO Rx™, distributed by Animal Necessity, LLC. The supplement was formulated by Dr. Carmen Colitz, a board-certified veterinary ophthalmologist with a PhD in molecular biology, along with Dr. Terri McCalla, also a board certified veterinary ophthalmologist, and Debby Smith, a compounding pharmacist and chemist.
Ocu-Glo Rx™ is a blend of 12 antioxidants including grape seed extract, lutein and omega-3 fatty acids. These ingredients may slow the progression of numerous eye diseases while also supporting the immune system and providing anti-aging support. Dr. Colitz has done extensive research on how antioxidants affect health. This formulation is especially helpful for dogs at risk of blindness from age-related retinal degeneration, cataracts, uveitis, glaucoma and dry eye.
Animal Necessity, LLC was founded in 2006 by industry professionals and combines more than 30 years of clinical experience from Dr. Norma Pestano and cutting-edge research from leading veterinarians. The company delivers a line of quality nutraceuticals for animals, with a range of products including vision support, calming aids, digestive aids, hip and joint support, liver support, skin and coat care and multivitamins. The products are guaranteed certified under FDA Good Manufacturing Practices (GMP) regulations. Animal Necessity’s nutraceuticals are designed to act as a complement to surgery and medication as well as providing natural alternatives when standard methods are not an option. animalnecessity.com or ocuglo.com
