When TCVM modalities are incorporated into a multimodal treatment plan for dogs with DM, patients respond faster and more consistently.

Canine degenerative myelopathy (DM) is a progressive, fatal neurodegenerative disorder with characteristic clinical signs beginning in late adulthood.₁ This article will look at the benefits of using Traditional Chinese Veterinary Medicine (TCVM) when treating degenerative myelopathy, and why this therapy is important to include in every case of DM.

Prevalence and signs 

DM is best known for its incidence in German Shepherds, Pembrook Welsh Corgis and Boxers, but has been reported in a variety of breeds and mixed breeds with no sex predilection.₂ The onset of neurologic signs can occur as early as five years, with a mean of nine years old in large breed dogs.₃ Owners often first notice their dogs scuffing their nails or toes when walking, and experiencing difficulty rising; signs that can easily be confused with other chronic arthritic disorders in older dogs.  Clinical signs are consistent, beginning in the pelvic limbs as a spastic upper motor neuron paresis and general proprioceptive ataxia, and progressing to lower motor neuron disease, tetraplegia and respiratory muscle dysfunction prior to death.₁ Recent studies have demonstrated that, like some forms of familial amyotrophic lateral sclerosis (ALS) in humans, DM is caused by mutations in the gene encoding Cu/Zn superoxide dismutase 1 (SOD1), a key antioxidant enzyme.1,4 Affected dogs are homozygous for the A allele of an SOD1 missense mutation (amino acid substitution): SOD1:c118G>A and c.52A>T. The DM-associated SOD1:c118G>A appears to be widely distributed in the overall canine population, with the allele present in 124 different breeds, while c.52A>T appears to be restricted to Burnese Mountain Dogs._2,3  Homozygosity for the genetic mutation is a major risk factor for canine DM; however, many dogs homozygous for the mutation will not develop the disease, suggesting an age-related incomplete penetrance.₃  Genetic testing is commercially available (www.caninegeneticdiseases.net), but the results shed light on “risk” and are not diagnostic for the disease.₃ Definitive diagnosis can only be made at postmortem through identification of characteristic histopathologic spinal cord lesions. Antemortem diagnosis is one of exclusion, depending on typical breed/age and characteristic clinical signs, combined with no abnormalities on EMG (electromyography) or CSF (cerebrospinal) imaging that would suggest other neurological diseases.₅ 

Clinical treatment options for DM in dogs

DM is a slowly progressive degenerative disease that invariably results in non-ambulatory paresis with progression to tetraplegia. A prospective study investigating conventional DM treatment (antioxidant supplements) noted that some dogs advanced from Stage I neurological defects (mild to moderate ataxia) to Stage IV (paraplegia, no voluntary movement) in as few as six months.5  Currently, there is no validated effective treatment for the disorder, although various modalities have been proposed to slow its progression. With variable progression through neurologic dysfunction by DM-affected individuals, disease staging (Table 1) along with attention to effective treatments for each stage, can be helpful when designing an integrative therapy protocol.6 For example, the use of water treadmill treatment would be inappropriate for a Stage IV tetraplegic dog with respiratory distress. Clinical treatment can be divided into five main areas: 

1. Conventional therapy
2. Physical rehabilitation/physiotherapy
3. Medical manipulation
4. Photobiomodulation (laser therapy)
5. Traditional Chinese Veterinary Medicine (TCVM).₆ 

Each has benefits, with physiotherapy the only treatment that has been evaluated and shown to apparently slow progression (i.e. increased time spent in ambulatory status).₇ Best practice for DM treatment should be a multimodal approach, with a combination of therapies that best fit the individual dog and stage of disease. 

TCVM for DM in Canines 

Traditional Chinese Veterinary Medicine is an ancient form of medicine that has evolved over the past 3,000 years. It encompasses a variety of treatment modalities, all of which are beneficial for DM treatment, including acupuncture, Chinese herbal medicine, Tui-na (medical massage), and Chinese food therapy._6,8,9,10  Xie and Dewey published three cases of DM-affected dogs treated with TCVM.₁₀ The cases included a nine-year-old German Shepherd (dragging rear toes when walking), a ten-year-old German Shepherd (eight-month history of moderate to severe paraparesis), and a nine-year-old Corgi (unable to rise without aid, and knuckling both pelvic limbs). 

• At the six-week follow-up exam after starting the treatment, TCVM for DM in canines, the nine-year-old German Shepherd was able to walk almost normally, now placing his hind feet and using the toes. 
• Ten days after starting TCVM for DM in canines, the ten-year-old German Shepherd showed improved ambulatory status and ability to rise from recumbency. At ten weeks, with ataxia continuing to improve, this dog was able to go on 45-minute walks and rise unassisted. The dog was still on TCVM maintenance at 16 months. 
• At the six-week follow-up, the Corgi was also able to rise unaided and go on walks for 20 minutes each day. 

In this TCVM for DM in canines study, from first presentation for TCVM evaluation and treatment, the three dogs maintained mobility and had survival times of two years, 18 months and 15 months, respectively, at which point euthanasia was elected due to poor quality of life associated with loss of mobility.₁₀  A recent presentation at an international meeting reviewed the results of six confirmed DM cases presented to a canine rehabilitation center in the fall of 2022. The patients (three German Shepherds, two Boxers, and one Corgi) were six to 11 years old and ranged from having mild neurological deficits to severe paresis and being wheelchair-bound.₉ All patients were enrolled in physical therapy, which included laser, and received integrated TCVM for DM in canines (acupuncture, Chinese herbal medicine). The goal of this multimodal treatment approach was to slow the progression of DM, assess the efficacy of a new Chinese herbal medicine formula, and improve quality of life. The investigator conjectured that in its florid phase, DM is a Liver/Kidney Yin Deficiency disorder or Shao-Yang Disharmony Syndrome.  The study results were positive. The two German Shepherds, which were wheelchair-bound, showed significant improvements in three weeks. The oldest patient started to wag his tail and show fecal tone, which had been absent for six weeks prior. Another wheelchair-bound dog experienced a decreased need for the device, and enjoyed improved mobility more than a year after diagnosis. It was concluded that TCVM for Dm in canines, such as acupuncture and Chinese herbal medicine, help transform rehabilitation in patients. Dogs respond faster and more consistently when these therapies are incorporated into the physical therapy protocol.₉

TCVM patterns associated with DM

A genetic abnormality underlying spinal cord degeneration, often seen as early as five years of age, is consistent with a TCVM pattern diagnosis of Kidney Jing Deficiency (premature aging, congenital defects). Additionally, typical first clinical manifestations of DM involve difficulty rising and weakness in the pelvic limbs. From a TCVM for DM in canines perspective, this is Wei Syndrome (limb weakness/flaccidity, without pain), commonly associated with a Spleen Qi Deficiency. The deficient Spleen Qi fails to generate Qi and Blood, resulting in muscle atrophy and weak limbs. Supporting the Spleen Qi is also important to promote strong postnatal Jing to spare the prenatal Kidney Jing, and to halt/delay disease progression.8 As the disease progresses, rear weakness becomes pelvic limb paresis (Kidney Qi Deficiency), then paralysis (Tan-Huan Syndrome). With greater disease, further complicating patterns of imbalance, associated with an animal’s individual constitutional weakness, can occur (e.g. Kidney Yang Deficiency, Kidney Yin Deficiency). The development of Kidney Yin Deficiency is usually quickly followed by Liver Yin Deficiency (sick mother creates sick child, Five Elements Theory). It has also been suggested that DM is associated with Phlegm obstruction of the Dai Mai (Girdle Vessel) arising from Damp created by Spleen Qi Deficiency. The addition of acupoints to open the Dai Mai may help improve response to treatment.₈ Four primary TCVM patterns are considered when treating DM-affected dogs: 

1. Kidney Jing, Spleen Qi and Kidney Qi Deficiencies
2. Kidney Jing, Spleen Qi and Kidney Yang Deficiencies
3. Kidney Jing, Spleen Qi, Kidney Qi and Kidney/Liver Yin Deficiencies
4. Kidney Jing, Spleen Qi, Kidney Yang and Kidney/Liver Yin Deficiencies.₇ 

This can be simplified to primarily:

1. Qi Deficiency (Jing, Spleen, Kidney)
2. Qi + Yang Deficiency (Spleen Qi Deficiency gets worse and leads to Yang Deficiency — Cold animal)
3. Qi Deficiency + Yin Deficiency (Qi Deficiency so severe can’t move fluids, leads to Yin Deficiency)
4. Yang Deficiency + Yin Deficiency (Yin Deficiency worsens and fails to support Yang).₁₀

Acupuncture for DM Treatment

Acupuncture can be a beneficial therapy in TCVM for DM in canines. In a survey of 190 neurology and 79 rehabilitation veterinary professionals from 20 countries, 71% used acupuncture as part of their current treatment practice for DM.₁₁ Although no research has looked at acupuncture therapy for DM, work has been done on the closely-related ALS in humans.₁₂ Clinical studies investigating ALS have reported on acupuncture treatment and its positive effects of relieving clinical symptoms and improving quality of life.₁₃  A review of 92 studies (1,388 patients), most of which were conducted in China, explored the safety and efficacy of acupuncture for treating patients with ALS.₁₂ Improvements were reported in muscle strength and clinical symptoms (e.g. fatigue, dysphagia, respiratory difficulty, fasciculations). Investigators suggested the following mechanisms of action for acupuncture treatment of ALS: ability to antagonize the excitotoxicity of glutamate, protection of the motor neurons, suppression of neuroinflammation, and delayed disease in animal models._12,14,15  Recommended protocols for acupuncture treatment are based on TCVM pattern diagnosis (Table 2). When selecting an acupuncture technique, electro-acupuncture (EAP) is considered more effective than the dry-needle technique for treating DM.₈ Although DM is not a painful disease, many affected animals have concurrent Bi Syndrome (i.e. arthritis pain). Therefore, the EAP protocol, considering both pain and neurological deficits, uses 20 Hz (cycles/sec) for ten to 15 minutes and 80-120 Hz for ten to 15 minutes. The EAP treatment is usually combined with dry-needle (DN) and aqua-acupuncture (aqua-AP).  The total number of acupoints per session will vary depending on the age and condition of the dog. The aqua-AP injections (0.25-0.5 ml, vitamin B12) are performed after Tui-na massage is completed during a treatment session. Acupuncture treatments are usually performed weekly for three to five sessions, then reduced to once a month long-term.8,10  The canine rehab center study noted that most dogs improved when the researchers used acupoints BL-21 through BL-24 and GB-34.9 Acupoints consistently used in the study included BL-11, BL-23, Hua-tuo-jia-ji through the lumbar spine, and GV-1 for fecal incontinence, as well as the previous acupoints listed.

Chinese herbal medicine for DM treatment

The clinical application of Chinese herbal medicine in veterinary practice should have a similar clinical approach as the many other therapeutic modalities a veterinarian uses daily. Similar to acupuncture, Chinese herbal medicine formulas are based on the TCVM pattern(s) identified. 

• Kidney Jing Deficiency can be treated with Epimedium Formula,b which is a good selection for early in the disease process when numerous complicating pattern imbalances haven’t occurred yet. 
• This herbal formula can be combined with Bu Yang Huan Wu, especially as pelvic limb paraparesis develops. 
• Qi Performanceb (modified Si Jun Zi Tang) is a good Chinese herbal medicine formula to select when marked muscle atrophy accompanied by anorexia is present (Spleen Qi Deficiency) and can also be given along with Bu Yang Huan Wu. 

As the disease progresses and Kidney/Liver Yin Deficiency accompanies the Qi Deficiency pattern, two Chinese herbal medicine formulas may be used:

• Hu Qian Wan should be considered when Yin Deficiency > Qi Deficiency. 
• If Qi Deficiency > Yin Deficiency, then Hindquarter Weakness Formulab is used.₁

Finally, if Kidney/Liver Yin Deficiency is complicated by Kidney Yang Deficiency, two herbal formulas can be considered: 

• Yang Deficiency > Yin Deficiency (Di Huang Yin Zi) 
• Yin Deficiency > Yang Deficiency (Rehmannia 14b). 

These Chinese herbal formulas are usually given twice daily. Start at a half dose for one week, followed by a full dose (1gram/10 kg body weight). They can be given for two to six months depending on the formula; however, they should be changed if the TCVM pattern changes.   A new herbal medicine formula was incorporated into the treatment protocol for the six dogs enrolled in the canine rehab clinic DM study. This particular formula uses Xiao Chai Hu Tang, which has been modified by adding Da Huang and Dan Shen, along with an increased percentage of Ren Shen and decreased Ban Xia.9 There is no mention as to which TCVM patterns would optimally be addressed by this herbal formula, but the study had good results with it. The researchers noted that one dog experienced quick exacerbation of hind limb weakness when off the formula for ten days, while another had improved tail tone and less fecal incontinence after starting the formula.

Food Therapy and Tui-na 

A whole food, minimally processed diet, with low glycemic index, is recommended for DM dogs._9,16,17 Research on ALS in humans shows correlation between high fat/starch diets and expression of the disease. Both highly processed foods and carbohydrates increase the glycemic index, which drives endothelial dysfunction. In addition, a TCVM pattern imbalance should be addressed using Chinese food therapy.6 Foods to consider adding to the diet should include those that tonify:

• Jing (e.g. liver, kidneys, quinoa, black beans, seaweed)
• Spleen and Kidney Qi (e.g. beef, sardines, eggs, rice, oats)
• Kidney Yang (e.g. chicken, lamb, pumpkin, sweet potatoes)
• Kidney and Liver Yin (e.g. turkey, pork, duck, crab, eggs, string beans, pears, peas, bananas, watermelon).

Tui-na is a form of traditional Chinese medical massage that involves applying pressure, kneading, rolling, shaking and stretching the body to move Qi and Blood. It involves stimulation along specific pathways (i.e. meridians) and regulates Zang-fu organ function (e.g. Spleen, Kidney, Liver). It restores balance to Yin and Yang in a DM-affected animal. Simple Tui-na exercises (two or three techniques) can be taught to owners for daily use at home with their dogs. Tui-na can be as helpful for the owner as for the dog, since it strengthens the human-animal bond during a time of stress.6 In addition, the clinician can perform Tui-na while examining the dog (e.g. range of motion, trigger points, areas of contraction).  The proper education of clients on whole food nutrition, appropriate exercise, and pelvic limb awareness training could make a huge improvement in the longevity and orthopedic health of these patients. TCVM for DM in canines is helping transform DM rehabilitation, as patients respond faster and more consistently when these therapies are incorporated into a multimodal treatment plan. It’s never too early to start “at-risk” dogs on a lifelong path of prevention!

1 Kobatake Y, Nakata K, Sakai H et al. The Long-Term Clinical Course of Canine Degenerative Myelopathy and Therapeutic Potential of Curcumin. Vet Sci 2021; 8:192. doi.org/10.3390/vetsci8090192.

2 Zeng R, Coates J, Johnson G et al. Breed Distribution of SOD1 Alleles Previously Associated with Canine Degenerative Myelopathy. J Vet Intern Med 2014; 28:515–521, https://onlinelibrary.wiley.com/doi/10.1111/jvim.12317.

3 Coates J. Canine Degenerative Myelopathy. Delaware Valley Academy of Veterinary Medicine.  www.delawarevalleyacademyvm.org

4 Morgan B, Coates J, Johnson G et al. Characterization of thoracic motor and sensory neurons and spinal nerve roots in canine degenerative myelopathy, a potential disease model of amyotrophic lateral sclerosis. J Neurosci Res 2014; 92(4): 531–541. doi:10.1002/jnr.23332.

5 Polizopoulou Z, Koutinas A, Patsikas M et al. Evaluation of a proposed therapeutic protocol in 12 dogs with tentative degenerative myelopathy. Acta Veterinaria Hungarica 2008; 56 (3): 293–301 doi.org: 10.1556/AVet.56.2008.3.3.

6 McDowell C. Integrative Treatment of Canine Degenerative Myelopathy. 26th Annual International Conference on TCVM, Reddick, Florida. September 20, 2024. 

7 Kathmann I, Cizinauskas S, Doherr M et al. Daily controlled physiotherapy increases survival time in dogs with suspected degenerative myelopathy. J Vet Intern Med 2006; 20(4):927-932. doi.org 10.1892/0891-6640(2006)20[927:dcpist]2.0.co;2 

8 Chrisman C. Traditional Chinese veterinary medicine for small animal neurological disorders. Practical Guide to Traditional Chinese Veterinary Medicine, Small Animal Practice. Xie H, Wedemeyer L, Chrisman C (eds). Reddick, FL. Chi Institute Press 2014:201-210.

9 Sacks H. Treatment of Canine Degenerative Myelopathy with Herbs, Acupuncture, and Rehabilitation. In Proceedings from the 25th Annual International Conference on TCVM. Reddick, FL: Chi University Press 2023:72-74.

10 Xie H, Dewey C. Traditional Chinese veterinary medicine for degenerative myelopathy in dogs. Am J Trad Chin Vet Med 13(2):57-63. doi.org/10.59565/001c.125268.

11 Bouché TV, Coates JR, Moore SA, Faissler D, Rishniw M, Olby NJ. Diagnosis and management of dogs with degenerative myelopathy: A survey of neurologists and rehabilitation professionals. J Vet Intern Med. 2023;37(5): 1815‐1820. doi:10.1111/jvim.16829.

12 Peng S, Tian Y, Chang W et al. Current state of research on acupuncture for the treatment of amyotrophic lateral sclerosis: A scoping review. Front Neurol 2022; 13:1019156. doi: 10.3389/fneur.2022.1019156.

13 Sudhakaran P. Amyotrophic lateral sclerosis: an acupuncture approach. Med Acupunct 2017; 29:260–8. doi: 10.1089/acu.2017.1241.

14 Zhao D, Xu N, Yu T et al. Research advances in the mechanism of acupuncture treatment for amyotrophic lateral sclerosis (Chinese). Shanghai J Acupuncture Moxibustion. (2019) 38:1310–4. doi: 10.13460/j.issn.1005-0957.2019.11.1310.

15 Yang E, Jiang J, Lee S et al. Electroacupuncture reduces neuroinflammatory responses in symptomatic amyotrophic lateral sclerosis model. J Neuroimmunol. (2010) 223:84–91. doi: 10.1016/j.jneuroim.2010.04.005.

16 D’Antona S, Caramenti M, Porro D et al. Amyotrophic lateral sclerosis: A diet review. Foods 2021; 10(12):3128. doi.org: 10.3390/foods10123128.

17 Lavi T, Karasik A, Koren-Morag N et al. The acute effect of various glycemic index dietary carbohydrates on endothelial function in nondiabetic overweight and obese subjects. JACC 2009; 53(24):2283-2287.  doi.org/10.1016/j.jacc.2009.03.025. a DM Formula, Gold Standard Herbs, La Jolla, California. b Jing Tang Herbal Inc, Ocala, Florida.   Table 1: Stages of neurodegeneration associated with disease progression in canine DM6

  Table 2: TCVM patterns, examination, and clinical signs with commonly-used acupuncture points for treating DM 6, 8,10

*Rotate through acupoints listed; use them for EAP, DN and aqua-AP   Table 3: Chinese herbal medicines used for treating DM