What’s Your Diagnosis?
Chronic Gingivitis in an Eight-year-old Domestic Short
Haired Cat
Debra Voulgaris DVM, MA
Signalment: 8 year old, neutered female, domestic
shorthaired cat (Figure 1).
Primary Complaint and duration: Gingivitis of 6
months duration
History: The cat was found abandoned at approximately
2 weeks of age. She was bottle-fed and has been cared
for by her current caretakers since that time. As soon as
she could walk, her gait appeared hypermetric. She
rarely jumped, and would climb onto the couch, chairs or
bed by pulling herself up with her front limbs. Her pelvic
limbs and tail appeared slightly hyper-extended when
walking, but her neurological signs never progressed. An
in-utero panleukopenia virus infection causing cerebellar
degeneration was suspected. Over the past year, she
developed progressive lameness that appeared to involve
the left front shoulder, scapula or elbow. The cat was
spayed at 6 months of age and has lived in a multi-cat
household for the past 7.5 years. Her diet had been dry
organic chicken-based cat food for the past 2 years, but
she preferred wet food. The caretaker reported that she
had a good appetite that was sometimes ravenous. When
her food bowl was empty, she would be very vocal and
demand more food, but would occasionally vomit,
because she ate too quickly. Thirst, urination and
defecation were normal. She had been rubbing the
corners of her mouth incessantly on any available object
for approximately the past 2 years, but the caretaker only
noticed gingivitis 6 months ago. Recently, they also
noticed that the cat would lick the moist cool surface of
the bottom of the bathtub. In general the cat was reported
to adapt well to new environments, groom the other
animals in the house and like her routine. She would
hide from strangers, but enjoyed attention from her
family. She loved being stroked and would allow the
family to pick her up initially, but then quickly struggled
to get away. Although usually calm, she startled easily
with quick movements and loud sounds. Though not
From: The Department of Small Animal Medicine, College of
Veterinary Medicine, The University of Tennessee Knoxville, TN
AJTCVM Vol 6, No.2, August 2011
aggressive, she would hiss and strike if cornered by any
of the other animals in the house. She often sat on the
periphery of the room, patiently watched and then
cautiously entered. She was occasionally restless during
the night. Last year a Grade II/VI heart murmur was
auscultated, but normal cardiac structure and function
were found on an echocardiogram.
Conventional and TCVM Examinations: On physical
examination, the patient was bright, alert and responsive.
Her coat was soft and shiny and her eyes clear. Her
heart rate was 140 beats/minute and a II/VI left systolic
murmur was audible. Lung auscultation and all other
vital signs were normal. Abdominal palpation was
normal and her body condition score was 5/9. Left
thoracic limb lameness was present, but there was full
range of motion through all the joints. Although the cat
was hesitant to allow shoulder manipulation initially,
palpation was normal and did not elicit a painful
response. On oral examination, markedly inflamed
maxillary gingiva that extended to the molars was found,
but her pharyngeal arches appeared normal. On
neurologic examination her gait was hypermetric and she
had mild hyper-reflexia of the pelvic limb spinal
reflexes. On the TCVM examination, reactivity at BL-20
and BL-21 bilaterally and BL-23 on the right side was
found on acupoint palpation. The tongue was dry with
no coating and appeared red at the tip. Her pulses were
thin, soft and wiry.
Conventional Diagnostic Tests: A CBC, serum
biochemistry profile and T4 were normal and the urine
specific gravity was 1.051.
Questions:
What Five Element constitution best fits this patient?
What is the TCVM diagnosis?
What is the TCVM treatment strategy?
What acupuncture treatment, herbal medicines, Tui-na
techniques and foods would be indicated?
63

Figure 1: 8 year old neutered female, domestic
shorthaired cat with chronic gingivitis.
Five Element Constitution: The cat appeared to
predominantly be a Water constitution because she was
introverted and fearful of unfamiliar people and
situations, loud noises and quick movements.1 Also she
would hiss and strike at the other cats when frightened.
Other Water characteristics were the tendency to
observe quietly from the sidelines and enter only when
she felt safe.
TCVM Diagnosis: The cat had at least four related
TCVM patterns including Kidney Jing Deficiency,
Stomach Yin Deficiency, Heart Blood and Qi Stagnation
and Damp Bi Syndrome (shoulder Qi and Blood
Stagnation). The diagnosis of Kidney Jing Deficiency
was made based on the abnormal gait, present since
walking began.1 A Stomach Yin Deficiency was
diagnosed because of the gingivitis, dry tongue with no
coating and a red tip, the soft thin pulses and occasional
bouts of restlessness during the night.1 The diagnosis of
Heart Blood and Qi Stagnation was based on the red
tongue tip, heart murmur (with no other clinical signs of
heart disease) and wiry pulses.1 The diagnosis of Bi
Syndrome (shoulder Blood and Qi Stagnation) was
made based on the limping, stiff gait and wiry pulses.1 A
Damp Bi (fixed) pattern was suspected due to the lack of
pain on palpation and the full range of motion of the
limb. Dampness from an overworked or unbalanced
64
Spleen was also suspected because of the incessant
rubbing of the corners of her mouth on objects. The first
imbalance in this cat was a Deficient prenatal Kidney
Jing. Since the Kidney controls the Heart, any Kidney
Deficiency can lead to an under-restrained Heart Yang.1
In this cat, the Kidney had a compromised ability to pass
Yin to the Heart to cool it, which made it difficult for the
Heart to descend Yang to warm the Kidney. The
fundamental creation of Yuan (Source) Qi was therefore
compromised, resulting in the subsequent Yin and Yang
imbalance. The Heart Qi and Blood Stagnation were
most likely due to the lack of Yin (Body Fluid) and
subsequent increase in Blood density. The increased
Blood density then caused a non-laminar (turbulent)
blood flow through the heart, leading to Stagnation and
an audible murmur. Since HT Blood and Qi Stagnation
can lead to pain in the back and thorax, it is possible that
the lameness was a manifestation of this imbalance,
potentially causing a localized Stagnation in the
shoulder. Further, the Heart in an attempt to quell and
balance its under-restrained and rising Yang, consumes
Stomach Yin, leading to a false Heat in the Spleen/
Stomach organ system and in the Upper Burner (Shang
Jiao). The prenatal Jing Deficiency caused the Spleen to
work harder, to produce post-natal Jing from Gu Qi in
order to replenish prenatal Jing. The Damp signs were
most likely due to a Spleen/Stomach imbalance caused
by the long-term compensatory post natal Jing
production, a dry kibble diet and the Kidney under-
restraining the Heart Qi leading to Stomach Yin
consumption.
TCVM Treatment Strategy: The treatment strategy
was to tonify Kidney Jing and Stomach Yin, move Qi
and Blood, activate the Channels and drain Damp. The
treatment protocol consisted of Tui-na, Chinese herbal
medicine and Food Therapy since acupuncture was not
possible for this cat, due to her fearful temperament.
TCVM Treatment: The treatment protocol consisted of
Tui-na, Chinese herbal medicine, and Food Therapy. Tui
-na was performed three times a week utilizing a variety
of techniques for 25 to 30 minute sessions (Table 1). Mo
-fa, Gun-fa, Rou-fa, Yi-zhi-chan, Yao-fa and Nie-fa
techniques were used in the office and successfully
taught to caretakers, so that they could continue therapy
at home.2 Acupuncture points were chosen as focal
points during Tui-na sessions in order to maximize the
efficacy of treatments. During in-office Tui-na
treatments, BL-11, BL-20, BL-21, BL-23, SP-6, LI-4,
ST-44, LI-10 and LI-11 were emphasized using the Yi-
zhi-chan and Dian-fa techniques (Table 2).2,3 Caretakers
were taught the locations of BL-11, BL-21, BL-23, KID-
3, LI-10 and LI-11 and were sent home with written
instructions on both Tui-na techniques and acupoint
locations. Tui-na was ideal in this patient and caretakers
enjoyed being able to give treatments at home. The
AJTCVM Vol 6, No.2, August
Table 1: Tui-na Techniques used and their actions2

Tui-na Techniques Actions

Rou-fa Rotary kneading Regulates Yin, Qi and Wei Qi, unblocks Qi and Blood, eliminates swelling,
relieves pain
Mo-fa Touching skin Harmonizes, regulates Qi, removes accumulation and dispels Stagnation
and muscle
Moo-fa Daubing or Opens orifices and calms the spirit, awakens the brain and benefits eyes
massage
Gun-fa Rolling Invigorates Blood, smoothes tendons and joints, warms Channels and expels Cold
Yi-zhi-chan Single thumb Regulates Zang-fu organs, promotes circulation of the Channels and Collaterals
and smoothes muscle attachments
Yao-fa Rocking Unblocks Channels and smoothes joints
Dian-fa Knocking Opens obstructions and invigorates Blood, relieves pain, balances Zang-fu organ
function
Nie-fa Pinching Invigorates Blood and Qi, regulates Spleen and Stomach

Table 2: Acupoints focused on using Yi-zhi-chan and Dian-fa techniques during Tui-na treatments and their actions3

Acupoint Attributes and Actions

BL-11 Influential point for Bone, nourishes Blood and Qi, soothes pain
BL-20 Spleen Back Shu-Association point, transforms and dispels Dampness
Stomach Back Shu-Association point, benefits the descending function of the Stomach and dispels
BL-21
and transforms Dampness
BL-23 Kidney Back Shu-Association point, tonifies KID Yin and Qi
KID-3 Yuan (Source) point, nourishes Yin, clears Heat
SP-6 Clears Damp, tonifies Yin and Blood
Master point for face and mouth, Yuan Source point, clears Heat, tonifies Wei Qi, Stomach/Large
LI-4
Intestine disorders, toothache, stomatitis
ST-44 Ying-Spring Point, clears ST Heat, very useful for gingivitis
LI-10 Qi tonification, local acupoint for shoulder or elbow pain, gingivitis/stomatitis
LI-11 He-sea point, clears Heat, resolves Damp, local point for shoulder and elbow

initial Chinese herbal medications used were Bing Peng
San and Jade Ladya (classical antecedent Yu Nu Jian
from Jing Yue Quan Shu).4,5 Bing Peng San is a topical
dressing used to clear Heat and resolve swelling (Table
3). Bing Peng San was mixed with feline salmon
flavored toothpaste and applied to the teeth and gums
twice daily. Jade Ladya was chosen to nourish Stomach
Yin and clear Heat and was dosed at 0.5 g (1 capsule)
twice a day (the capsule was broken and the powder was
mixed with food). Dietary modifications were
recommended, as both the chicken and dry kibble are
Hot and probably contributed to the Stomach Yin
Deficiency.6 The caretakers were able to modify the
cat’s diet, but could not realistically discontinue the dry
food because of the other cats in the household and the
caretaker’s schedule. The cat would not eat everything
offered, so her diet was adapted according to her taste
and choices. The caretakers were able to decrease the
total dry food consumed by 50%. The dry kibble was
changed to an organic turkey based (cooling) and grain
free (cooling) to help neutralize the Heat.6 Fresh turkey
(cooling) or crab (cooling and resolves Stagnation) and

AJTCVM Vol 6, No.2, August 2011 65

Table 3: Ingredients and Actions of the Chinese Herbal Table 5: Ingredients and Actions of the Chinese Herbal
Medicine Bing Peng San Medicine Stomach Happya

Pin-yin English Pin Yin English

Actions1 Actions
Name Name Name Name

Clears Heat, dissipates Angelica Nourishes and activates

Bing Pian Borneol Dang Gui
Stagnation, relieves pain Blood
Ku Fan Alum Clears Heat, reduces swelling Bai Shao Paeonia Nourishes Liver Yin and
Yao Blood
Peng Sha Borax Clears Heat, detoxifies
Chai Hu Bupleurum Soothes Liver Qi
Table 4: Ingredients and Actions of the Chinese Herbal Aurantium Moves Qi, relieves pain
Zhi Shi
Medicine Jade Ladya
Trichosanthes Promotes Body Fluids,
Gua Lou
Pin Yin English transforms Phlegm
Actions
Name Name
Pinellia Dries Dampness,
Ban Xia
transforms Phlegm
Mai Men Moistens and nourishes
Ophiopogon
Dong Yin Chen Pi Citrus Moves Qi, relieves pain
Niu Xi Achyranthes Descends Qi Gan Cao Glycyrrhiza Harmonizes
Shi Gao Clears Heat and cools Pu Gong Taraxacum Clears Heat
Gypsum
(Sheng) Stomach Ying
Shu Di
Rehmannia Nourishes Yin and Jing
Huang ACKNOWLEDGEMENTS
Clears Heat and Thank you to Dr. Christine Egger for her guidance in
Zhi Mu Anemarrhena this case and to Dr. Carolina Medina for helping with
nourishes Yin
Herbal therapy selection. Thank you to Greg Hirshoran
for photographing the cat.
small amounts of plain yogurt (Yin tonification) were
added daily. Finely chopped celery (drains Damp) was REFERENCES
offered daily and was eaten intermittently.
1. Xie H, Preast, V. Traditional Chinese Medicine.
Clinical Outcome: One month after TCVM treatment Beijing, China, 2nd Ed. Reddick, FL:Jing Tang
was initiated, the cat’s lameness had resolved and the 2005:43, 378, 359, 321, 418, 31-35.
caretakers reported the cat was more active. The 2. Xie H, Ferguson B, Deng X. Applications of Tui-na
nighttime restlessness had not been observed and the in Veterinary Medicine 2nd Ed. Reddick, FL:Chi
face rubbing had decreased by at least 50%. The Institute 2007:16,18, 29,12,9,57,36,39.
gingival inflammation had decreased by 50-75%. The 3. Xie H, Preast V. Xie’s Veterinary Acupuncture.
tongue was now pink and the pulses were broader and Ames, IA:Blackwell Publishing 2007:129-215.
no longer wiry. The heart murmur was inaudible. The 4. Xie H, Preast V. Xie’s Chinese Veterinary
Bing Peng San was reduced to once a day. The Jade Herbology. Ames, IA:Wiley-Blackwell Publishing
Ladya was discontinued and Stomach Happya (classical 2010:540, 380.
antecedent Xiao Yao San with Er Chen Tang), a Chinese 5. Xie H, Preast V. Chinese Veterinary Herbal
herbal medication for mild gingivitis, was prescribed Handbook 2nd Ed. Reddick, FL:Chi Institute
(Table 5). The caretakers were advised to continue with 2008:191, 217, 216.
the previously established Tui-na and Food Therapy 6. Xie H. Personal communications.
protocols until the next re-check in one month.
_____________________________________________

FOOTNOTES
a
Jing-tang Herbal, Reddick, FL www.tcvmherbal.com
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66 AJTCVM Vol 6, No.2, August

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