This is part two of a several part article series on the use of traditional Chinese medicine and theories to help in resolving health and lameness events in the horse. In part one, I discussed the very basics of traditional Chinese medicine (TCM) and the concept of Qi or energy, which is a vital substance for all aspects of health and soundness in the horse. In this second part, I hope to expand on some clinical examples, helping to further explain some of the concepts as I see them, and how theories are applied to improve the conditions.
There are 5 vital substances that each contribute to one another and either create or destroy health in the horse, and ourselves. These include, as mentioned in part one: Qi, Yin, Yang, Blood, Jing Essence. Each plays a role in the health of your horse, whether if you recognize it or not.
While each substance plays a role, each can be in a state of deficiency or excess (relative). A horse can be deficient in Qi, Yin, Yang, Blood and Jing. There can also be a state of excess of each as well, which creates an overall imbalance and alters health additionally. These states of excess or deficiency are related to lifestyle habits, the diet, emotions, and other conditions or states which you subject the horse to over time repeatedly. As states of rest are imposed, for prolonged periods, it is possible for the horse’s body to recover and regain balance, but more often than not, this requires additional support in the form of a proper diet targeted to the horse’s needs (energetically) and herbal therapy for best results.
One of the biggest aspects of lameness in the horse is the concept of Qi or energy, and the idea of Qi stagnation. This Qi stagnation is really a blockage of energy in the body, a resistance to normal flow, which then creates problems in regards to health and soundness on various levels. Qi is one of the most important of the 5 vital substances mainly due to Qi being involved in almost every aspect of health, including digestion and immune function, which can help the body to regain Yin and Yang levels from food intake.
Qi stagnation can be a primary event in the horse or a secondary event. The levels of energy in the horse’s body may be normal or adequate, but normal flow is disrupted and stagnation occurs. On the other hand, there could be a depletion or deficiency in Qi energy, creating or contributing to the state of stagnation. One major contributor to Qi stagnation in the horse, pets, and people is the emotions. Emotions all result in energy blockage or improper flow, even just temporarily. The longer that emotion holds, the more persistent the Qi or energy stagnation. We’ve all felt it as humans, right? Get nervous and feel that knot in your stomach or throat? Get tense due to stress, and soon anger develops followed by a tense neck or shoulder region. All clinical manifestations of emotions result in Qi stagnation on some level, which is why in TCM uncontrolled emotions are linked to many disease conditions. The horse is no different, and in all honesty, the horse FEEDS off of you, as the owner. All emotions are energy, all thoughts are energy, and the thoughts that you have that day as an owner, are transferred to your horse believe it or not! Having a bad day?? Likely, so is your horse. Observe them and witness it for yourself.
While on the topic of emotions in the horse, think hard about the emotions that your horse expresses. You can often sense what they are feeling if you are aware enough. Then, think about a horse that is under stall rest for months due to an injury and how they are feeling. How about a horse that does not get adequate turnout, regardless of no injury? How about a metabolic horse that is confined to a dry lot and kept apart from pasture mates? These emotions that they are feeling are strong contributors to their health and lameness conditions whether if you realize it or not. They are something that must be overcome in order to improve the odds of success.
In looking at the big picture, in the first article, I mentioned the five substances, and each plays a role in the health of that horse, soundness, and Qi or energy flow. But, despite two horses having the same perceived clinical condition, more times than not, they are not the same and the contributors are different. If we approach both horses the same way, therapeutically, they often do not both respond the same or show improvement. There is a reason why! If you are able to recognize this reason and correct it, then the more improvement is evident in your horse.
Why Don’t Two Horses Respond the Same??
Let’s take a basic scenario of a damaged flexor tendon or a suspensory ligament in the horse. Now, take two horses with the same condition, maybe a little different on ultrasound in regards to severity, but nonetheless, very similar. Moving forward, let’s look at and apply traditional therapies, including icing, NSAID medications, and even regenerative therapies such as IRAP, stem cells, or PRP. In applying these therapy options to those two horses, there are several potential outcomes.
- Both horses improve, but time to improve is around 3-6 months
- Both horses fail to show improvement
- One horse improves, the other fails or gets worse
- Neither horse shows improvement
Now, let’s look at the time and money invested in those cases by yourself. On the low end, regarding therapy, you may have a few hundred dollars into therapy, but on the high end if regenerative therapy is chosen, you could be in the hole by several thousands. Regarding time, you often have a lot invested, from trips to the vet to repeated stall rest and hand walking. All of this, keeping in mind that you do not have a workable horse, as he is still lame and not being capable of being ridden or exercised. All is good, I suppose, if everything works out in the end and your horse becomes sound, but the question is whether if he does become sound, and if he does, does he remain sound??
In our facility and rehab program, I do not really worry about tendon or ligament injuries in most cases as most respond quite readily to therapies applied. Most are actually back in work in a matter of a couple of weeks with no stall rest. This applies to those horses that have battled the problem for months or even years. This does not work out with all cases, and the failure in those cases is not often due to the tendon or ligament, but another problem which is playing a major role. The success rate is not magical, but stems from the concept of seeing the underlying problem which contributed to the condition, then correcting it and allowing the body to heal or mend in the horse.
This difference applies to almost every health and lameness condition in the horse and why many horse owners note improvement with some approaches, supplements or medications, when others see no improvement or sometimes worsening of the problem. You can give two horses with laminitis phenylbutazone, an NSAID medication for pain, but this doesn’t mean they both will respond and have a reduced level of pain. You can give two horses with COPD or allergies an injection of a corticosteroid, like dexamethasone, but usually both do not always respond. You can also give two racing Thoroughbreds an injection of Furosemide for EIPH or bleeding, but both don’t always respond appropriately.
The reason for the difference in respond rate is due to the difference in underlying patterns within the horse, or the patterns could be similar but one horse is more advanced or ‘damaged’. As you begin to recognize the underlying pattern, and make changes to therapies or supplements to target this pattern, then the response rate improves. This response rate then often comes without the need for medications, as most medications do not address an underlying health or TCM pattern in the horse. This is also a reason as to why many horses, and people, are dependent on daily medications for certain conditions. Because the main pattern is not addressed!
Understanding TCM Patterns in the Horse
No two horses are alike in most instances, as outlined above. To understand a little further, one has to understand the 5 vital substances (Qi, Yin, Yang, Blood, Jing) and how they interplay with one another. This topic is complex so for demonstration purposes, I will keep it relatively simple. Let’s take a few examples to show differences.
Thin Soles and Foot Pain in the Horse:
This category is very common and poses a problem for many owners, and challenges for ourselves in our rehab program. Most owners and even farriers do not understand the concepts underlying the condition of thin soles and foot pain, thus the solution is to continue to use boots or rely on shoes. The reason or pattern is there, but often either not recognized or addressed properly. This then leads to the ongoing statement that a horse cannot go barefoot. While I do not claim to have the solution or remedy for all cases, we have certainly had some challenging ones respond very nicely, but I have lost the battle in some due to severe bone changes and corium damage.
Now, in this category, let’s assume that we have a 900 lb Thoroughbred and a 1200 lb Quarter Horse, or insert other heavy breed there. Both horses have thin soles, foot pain, and reliant upon shoes to be comfortable and do their work. If you are okay with that as an owner, this reliance upon shoes, then all is well. I have no problems either way, but the idea of being reliant upon shoes is not acceptable for me, as a veterinarian, for this signals that there is a problem present. Being who I am, I want to resolve that problem to the best of my ability as likely it is contributing to a health or lameness condition elsewhere in that horse.
If you approach both of those horses the same, you will see that they do not respond the same. One may improve, the other may not. Even with shoes, some are still sore and painful. So, what’s the deal??
When it comes to pain, this is a signal there is Qi stagnation. If the pain is ‘floating’ or shifting around, being there one minute and gone the next, or present one day, gone the next, this is Qi stagnation. If the pain is constant, stabbing or fixed in position, this is blood stagnation, which is usually due to Qi stagnation after a period of time. This blood stagnation is often evident with an increased digital pulse, being very prominent and bounding at times. So, in both horses, you have at the least Qi stagnation, if not blood stagnation. If there is blood stagnation, the situation has advanced in difficulty.
If there is Qi or blood stagnation, this is impairing blood flow, energy flow, and thus nutrient delivery to the hoof tissue, which then helps to explain why that hoof is not growing properly and developing a thicker or callused sole. The long-term blood stagnation is also responsible for the inflammatory changes on a bone and corium level, which again leads to degeneration of tissues and creates more challenges.
How does one manage each case? Well, that is dependent on the horse and what is evident.
In my world of herbs, I use specific formulas (Cur-OST EQ Plus, Cur-OST EQ Pure) to ‘move’ that energy and blood, as the herbs found in those formulas are Qi and Blood movers. Most people view them as ‘anti-inflammatories’, which they are in the scientific world, but in Chinese and Ayurvedic medicine, they have other purposes. These formulas will assist in moving that stagnated energy, which is a good thing and beneficial to both horses, however, the underlying cause of why that energy is blocked is not yet clear. If you stop here, with these therapies, the success may or may not be evident in the short and long-term.
In looking at the 900 lb Thoroughbred, we noted that he is fairly lean yet muscular. He is somewhat quite and reserved as well. His feces are formed, but contain some moisture and no odor. His hoof condition is somewhat poor, being dry, brittle and with poor overall growth. He also has a history of ulcers. In this case, Qi stagnation is present (+/- blood stagnation), but the primary problem is likely a Qi deficiency, at the digestive level, which is impairing digestion and nutrient absorption. It is also evident in his lack of energy, being very quiet and reserved. If you just use a formula to ‘move’ that Qi or energy, or even blood, he may improve in the short term, but in the long-term, he is likely to get worse. The reason for this is that you are moving stagnant energy, but once ‘moved’, there is a depletion or deficiency present behind it, which then results in more stagnation. Remember the river scenarios in article one??? So, this TB has a primary problem of underlying Qi deficiency, spleen origin, which is then contributing to his other problems. You need to address both for proper resolution to the problem and there could also be a ‘blood or Yin deficiency’ present, which may stem back to a poor nutrient load diet.
In looking at the 1200 lb QH with sore feet, things look similar but they are different. For starters, this QH is heavier, carrying more weight in the form of fat. Right off the top, this fat accumulation signals to us that there is a dampness problem present, which stems back to improper digestion on some level. This dampness is not only impairing digestion and nutrient absorption, but is impairing the circulation of Qi and potentially blood in the horse’s body, which is creating the stagnation and thus pain. Many of these types of horses either have dry stools with a foul odor, looser stools with mucous and odor, and generally culture out positive for a microbiome shift. This horse has dampness present, which poses a challenge by itself, but this dampness could be created by Qi deficiency, primary Qi stagnation, a Yin or even a Yang deficiency. Here again, if just apply an approach to ‘move’ that Qi or blood, results may follow in the short-term, but more often than not, the problem persists or re-develops.
This is one main reason as to why I personally ask each and every horse owner I consult with what is the body condition of their horse. More so, I usually ask for a photo, as most owners are not completely honest regarding their horse’s body condition. I do not mean to offend, but my rationale is honest and I’m just trying to help you to help your horse. This is also a reason as to why in most cases of ‘easy keeper’ conditions in the horse, that I rely and heavily use the Cur-OST EQ Total Support, as it helps us to ‘move’ Qi and blood, while also supporting ‘blood’, aiding digestion and Qi, while helping to reduce dampness on some levels. This formula would NOT be suitable for the TB mentioned above, as it would likely be too drying in effect, and create more problems than it would help. This is just a starting approach for the heavier horse with foot issues, and in some cases, additional herbal support is required due to the extent of the condition progression.
Now, lastly, in both horses, there is a mechanical obstruction to Qi or blood flow, and that is the foot itself. If the soles are truly thin, then there is bone pain being inflicted upon the horse. This pain then creates discomfort and an emotional response, being grief or even anger. This emotion then contributes to more Qi and potentially blood stagnation in the horse. With that being said, it is vital to properly address the foot, whether if that is with pads, shoes, or boots. Not that this is a primary solution, as it is not, but in the short-term, it can help us to overcome some major hurdles. Our goal is to not need that support apparatus in the long-term, if all is addressed properly.
This failure to address the feet properly, regarding properly balance and support, is one main reason why so many owners fail to succeed with their horse. Whether if the condition is laminitis, navicular syndrome, thin soles, pedal osteitis, thrush, or white line disease, the foot needs to be addressed for it is a strong contributor to the syndrome taking place in your horse. An owner can apply all that I advise them to in their horse with laminitis, but more often than not, one main reason for failure to respond is a lack of achieving proper balance and support in the foot. If you do not correct that facet, being the foot, then a source for ongoing Qi and Blood stagnation continues. You cannot supplement your way out of proper foot balance and support, period!
This same approach outlined for thin soles applies to the horse with back pain, neck pain, hock pain, stifle pain or even tendon/ligament recovery. Pain is pain, and what is more important is recognizing the underlying pathways leading to that event. Arthritis in any joint is due to Qi stagnation that has advanced to blood stagnation, which is creating the pain felt by the horse. The problem that comes in these cases is usually the joint is well advanced in deterioration by the time we choose to do something about it. The shear fact that the joint is damaged creates a mechanical obstruction to Qi flow in the body by itself and also through compensation mechanisms. The joint becomes damaged due to the Qi and blood stagnation, which means originally there must have been some obstruction to proper flow or movement. This could have been due to conformation, poor foot balance and travel, or simply excessive use of a joint. These then set the stage for stagnation, which progresses over time and creates the bone changes evident on radiograph, not to mention pain and lameness. Thus, relieving or better managing that Qi stagnation in the early stages is ideal and not something that is routinely done by most owners. As humans, we tend to be more ‘reactive’ than ‘proactive’, waiting for problems to develop before we put a therapy into place.
EIPH or Bleeding in the Horse:
This is another common complaint that I receive from horse owners and poses some challenges for many for sure, including myself. Here again, let’s look at two different cases, being that same 900 lb TB or the 1200 lb QH. Both are subject to bleeding, but the causes are not the same. Use the same approach for both and you could improve both, but then again, neither may improve.
In the lean TB with EIPH, this is often related to Qi stagnation and blood stagnation, but with an underlying deficiency of Yin in my experience with an excess of heat in the body. The Qi stagnation and blood stagnation contribute heavily to ‘heat’ produced in the body, like friction to an extent. This is then coupled by an empty heat produced by the Yin deficiency, relative to the Yang, with Yang being more warm in nature. Look at the Yin aspect as being the moisture or water component to the body, as well as the cooling quality. The TB’s are often fed high grain loads, which are relatively warming if not heating in nature. In addition, due to this feeding practice and being stalled a long period of time, they create high energy production, which then stagnates over time. This excess heat in their body literally dries up Yin components and body fluids. Furosemide is the drug of choice and for some and seems to help. In reality, furosemide is a diuretic and thus has a further drying effect upon the body, actually further depleting Yin in the horse. Do this long enough and the situation progresses and tissues dry out, including the lung tissues, which then contributes to more tissue compromise, vascular integrity loss, and bleeding. In addition, many of these leaner TB’s experience inflammatory airway disease, which is usually seen as a ‘dry airway’ type of condition. Here, a plan of attack would be a formula like the Cur-OST EQ Plus combined with something like the Cur-OST EQ Stomach formula. With this approach, you would be combating the Qi and Blood stagnation, while supporting Yin, as both marshmallow and aloe are moisturizing to the body. A dietary change would also be in order to help in reducing that internal heat, stabilizing Qi, and potentially supporting Yin in the horse.
In the barrel racing QH, there is evident post run bleeding as seen in the TB, however, not the same. The QH is heavier, often carrying more fat, which again is dampness. In all likelihood, the QH is experiencing Qi or Blood stagnation, but the cause is not the same. The dampness in this horse is what is creating the Qi stagnation and likely the bleeding. This gets back to digestive health and why I culture many of these horse’s feces, to see the extent of the problem. Many of these heavier breeds tend to be more responsive to a drug such as furosemide, because through the diuretic actions, it does help on a basic level with the dampness problem. Here, our approach would be something like the Cur-OST EQ Total Support +/- the Cur-OST EQ Tri-GUT. Both are moving formulas and address digestive health, helping to resolve dampness, which is the underlying problem. If you took the approach of the TB mentioned above, you could end up with some improvement, but the condition could get much worse as well, as the Yin tonics present in the Cur-OST EQ Stomach could create more dampness.
Keep in mind that these are just two theoretical examples and the solutions offered do not match every case. One can have a heavier QH that is bleeding post barrel racing which may be due to internal heat alone, exacerbated by environmental temperatures, and associated strictly with Qi stagnation or even a Yin deficiency. On that same coin, you can also have a heavier or stockier TB on the race track that demonstrates underlying digestive issues, dampness and Qi stagnation. The answers and potential solutions lie in digging deeper into your horse and making observations.
Seeing the Big Picture in the Horse
I have outlined two scenarios with two different breeds, but yet two similar problems. In both, there is a different approach for the optimal outcome, despite having similar problems. The reality is that in today’s world of veterinary equine medicine, the same approach is applied to each horse with that problem, despite differences. We treat every tendon injury the same, every case of laminitis the same, every case of Lyme the same, and every case of EPM the same. We do not see the differences because we are not looking, and honestly we don’t care to understand. Despite this, there are differences, and these differences are the reason for treatment success in one and failure in another.
These differences, these underlying contributors to disease and lameness are also why I am not a fan of medicating a horse constantly, shoeing them with corrective shoes over and over, and why I am not completely in favor of ‘regenerative’ medicine or even probiotics. These practices all have a place and do help some horses, but in the vast majority, it is time lost and money not well spent.
In the case of probiotics and regenerative medicine, while it is fascinating to see what is possible, the reality is that in order for these therapies to work properly and ‘regenerate’ tissue, the body or area of usage must be ready to accept them. In most of these horses, there is Qi stagnation or blood stagnation, which in the scientific world translates to inflammation. The body is inflamed on various levels and if you inject those therapies or infuse those probiotics, the body’s environment is not sound, and being not sound or healthy, the therapies offer little benefit. This may be a reason why so many horses have had regenerative therapies for joints or tendon conditions, but failed to respond. Think about it for a minute. You are not correcting the underlying condition that is present in that horse, which led to those negative health or lameness events.
This is also why even with many ‘whole foods’, commercial diets or even vitamin-mineral supplements, not every horse responds. For starters, a trace vitamin-mineral supplement is not perceived as a blood tonifying agent in my book. It may supply nutrients, but there is so much more that is lacking. Thus, a horse could be perceived as being ‘blood deficient’, despite being on those supplements. Foods are meant to be used as not just sources of nutrition, but sources of medicine. A food can tonify and support Qi, Yin, Yang, or even blood. What you decide to feed tonifies accordingly, and you may be tonifying or supporting a pathway that is not needed or already in excess. Foods have energy, and that energy dictates the impact on the body and health. There is much more beyond just shear nutrient value.
Indeed, another reason could be an underlying Qi deficiency, or digestive problem, where the horse is simply not capable of utilizing those nutrients, even if in whole-food form. This is also a reason why something as simple as Olive Oil, Flax Oil or even Flax seed may not be suitable for every horse. While they are all beneficial on various levels, not every horse needs or requires them. The owner that just sees the nutrient value in that food is only seeing a fraction of the equation. An easy keeper type of horse, prone to dampness, may actually react negatively to those oils or seeds, as they can contribute more to dampness. Again, another reason why I harp so heavily in my consults on the diet and making modifications.
Now, with all of that being said, I do believe that EVERY condition in the horse can be remedied or at least improved a good bit. However, it is not always easy to accomplish and often, your approach changes as time goes by and you eliminate certain factors or contributors such as dampness, heat or stagnation. In order to accomplish this, it takes observation on your end as the owner. Not just observing for lameness or bleeding, but many factor with your horse from energy to skin coat conditioning. They all play a role and signal to us whether if progress is made or there is still improvement to be gained.
Can a coffin bone impacted by pedal osteitis be restored?? Can a lower hock joint riddled with osteoarthritis be enhanced and potentially restored?? Well, my answer to both is ‘yes’, but one has to keep in mind that bone changes are slow to come, which is due to the slow remodeling rate of that tissue structure. You may experience clinical benefits even in the short-term, but it takes time for those changes to become evident on repeat radiographs. We have seen the changes here, in our facility, on radiographs, but often it is after 3-6 months or longer. Meanwhile, with the right approach, the horse with that pedal osteitis or fused hock is actually improved clinically in just a matter of a few weeks.
In the next article, I plan to discuss herbs, body work and massage, and their usage to combat different patterns.
Author: Tom Schell, D.V.M., CVCH, CHN