How to Use Acupuncture and Herbal Medicine for Treatment of

Chronic Renal Failure

WORLD SMALL ANIMAL VETERINARY ASSOCIATION CONGRESS PROCEEDINGS, 2018
R. Koh1
1VeterinaryTeaching Hospital, School of Veterinary Medicine, Louisiana State University, Baton
Rouge, LA, USA; 2Veterinary Medical Center, College of Veterinary Medicine, University of
Florida, Gainesville, FL, USA

I. Introduction
Chronic renal failure (CRF) is a common renal disorder in both dogs and cats. There is
little treatment available from a Western perspective, other than fluid therapy and a
protein-restricted diet, for the end stages of CRF. Other recommended dietary changes
include reducing quantities of phosphorus and sodium and increasing caloric density,
potassium, dietary fiber, B-vitamin content, and magnesium.1,2 Recent studies have
shown that antioxidants and Ω-3 polyunsaturated fatty acids (PUFAs) may benefit
patients with renal failure. Antioxidants relax smooth muscle and increase glomerular
filtration rate.8 Fish oil reduces plasma lipids and intraglomerular pressure.9 Ω-3 fatty
acids heal glomerular and tubulointerstitial lesions, which may offer some protection of
glomerular function, thereby minimizing renal disease progression.10 Other mechanisms
of Ω-3 fatty acids include anti-inflammatory, anti-coagulant, and antioxidant effects, as
well as reducing intrarenal calcification.3,4
Traditional Chinese Veterinary Medicine (TCVM) has more to offer patients with CRF, as
it has been used in animals for thousands of years in China.5 Clinical anecdotal evidence
indicates acupuncture and Chinese herbals may greatly benefit patients with renal failure
and slow the disease progression.6,7 Acupuncture has shown to significantly improve the
renal functions on the recovery from ethylene glycol-induced, acute renal injury in dogs.11
These improvements in renal functions are likely due to acupuncture’s neuromodulatory
influence on autonomic tone.12 Many Chinese herbs or herbal mixture (formula) have
been shown to lower the serum creatinine level, increase inulin clearance, decrease
urinary protein excretion, and attenuate lipid derangements in human or animal models
with CRF.13
II. General TCVM Treatment
In the theory of TCVM, the notion of the ‘Kidney’ is not the same as that of the kidney in
Western medical science. Kidney in the TCVM perspective is ‘the place where the true
Yin and true Yang hibernate; it is the base of hiding and the place for storing the refined
energy and essence. Its quintessence appears on the hair, and its function is to enrich
the marrow of bone, and it associates with water.14 Thus, abnormalities of ‘Kidney’ are

14
believed to cause multiple disturbances of the body.14 Several clinical signs related to
CRF were recorded, such as edema, ‘guan-ge’ (anuria with vomiting), ‘ni-du’ (stranguria),
and ‘long-bi’.14
The general treatment principle for CRF is to:
Drain Dampness to regulate immune system and promote urination
Activate and nourish Blood
Resolve Stasis
Replenish vital energy
Coordinate Yin and Yang
Common acupoints for seizures and its functions:
Strengthen Kidney Qi: BL-23/52, BL-26, KID-3, Shen-shu
Warm Kidney Yang: GV-3/4, BL-24, CV-6, Bai-hui, Shen-shu/peng/jiao
Nourish Yin: BL-23, KID-1/3/7, SP-6/9, Shen-shu
Benefit urination: BL-22/28, SP-9/15, GB-25, ST-28, CV-9
Additional acupoints for clinical signs:
Poor appetite: Shan-gen, Jian-wei, BL-20/21, ST-36
Poor digestion: BL-20/21, ST-25/36
Nausea/vomiting: PC-6, BL-20/21, ST-36, GB-34
Diarrhea: ST-36, SP-6, BL-25, GV-1
Edema: GV-4, SP-6
Stranguria: CV-3, BL-39
Heat: LI-4, LI-11, GV-14, Er-jian, Wei-jian
Abdominal pain: SP-6
Restlessness/abnormal behavior: PC-6, HT-7
Panting/coughing: CV-17, BL-43, BL-13
Hearing loss: SI-9
Anemia: BL-17, BL-20, BL-23, SP-10
Hypertensive: PC-6, LI-4, KID-1, LIV-3, GB-20, GB-34
Itchy skin: LI-11, St-36, GB-20, SP-10
Methods of stimulation:
Dry needle for 20–30 minutes
Electroacupuncture, 20 Hz for 10–15 minutes, followed by 80–120 Hz for 10–15
minutes
Aquapuncture, vitamin B12 injected into 5–10 acupoints, 0.1–0.3 cc per acupoint
Moxibustion at GV-4, BL-23/24, CV-6, KID-3, SP6 for patient with Kidney Yang
deficiency or edema
Acupressure or laser acupuncture
Tui-na massage:
Mo-fa (touching Skin and Muscle) or Ca-fa (rubbing) along the back-shu Bladder
meridian (BL-28 to BL-11) and along the Conception Vessel meridian (CV-8 to CV-
2) for 3–5 minutes
Rou-Fa (Rotary-kneading) along the back-shu Bladder meridian (BL-28 to BL-11)
from caudal to rostral and along the Governing Vessel meridian (GV-2 to GV-14)
back and forth 12 times
Rou-fa along the Conception Vessel meridian (CV-8 to CV-2) back and forth 12
 times
Clockwise thumb Rou-fa to stimulate GV-4, GV-14, and GV-20 for 1–3 minutes
Ca-fa and Rou-fa along the medial thigh over the 3 Yin channels (Kidney, Spleen,
and Liver) of the hind limbs, following the flow of the meridians (from foot to upper
limb) for 3–5 minutes
Clockwise thumb Rou-fa to stimulate KID-3 and KID-7 for 1–3 minutes
Single-finger Ji-dian-fa (dotting) to stimulate ST-36 for 1–3 minutes
Ten common Chinese herbs for CRF:
Huang-qi (Astragalus membranaceus or Astragalus mongholicus), Chuan-Xiong
(Ligusticum chuanxiong), Dang-gui (Angelica sinensis), Da-huang (Rheum
palmatum), Dan-shen (Radix salvia miltiorrhiza), Dong-cong-xia-xao (Cordyceps
sinensis), Di-huang (Salvia miltiorrhiza), Fang-ji (Stephania tetrandra), Fu-ling
(Poria cocos), Lei-gong-teng (Tripterygium wilfordii)
There are hundreds of Chinese herbs used to treat chronic kidney diseases. Many of
them have been shown to improve renal function in patients with CRF in a number of
studies. Their mechanisms of action are mainly related to antioxidation, anti-fibrosis, and
improvement of metabolic disturbance in CRF. Unfortunately, the effective components or
chemical compounds in most of these herbs remain unknown due to the difficulty of
pharmacodynamic studies of herbs and the isolation of active ingredients from herbs or
herbal mixtures.
Huang-qi (Astragalus membranaceus or Astragalus mongholicus) has multiple beneficial
effects on stimulation of the immune system, promotion of diuretic activity, antioxidation,
anti-inflammation, and renoprotection. It decreases glomerular hyperperfusion and
proteinuria, and improves the plasma levels of total cholesterol and albumin.
Da-huang (Rheum palmatum L.) plants have been studied extensively in China.15 It was
found that rhubarb lowers the serum creatinine level, increases inulin clearance,
decreases urinary protein excretion, and attenuates lipid derangements.15 Some studies
reported that rhubarb not only has a renoprotective effect by itself, but it also may have
an additive beneficial effect with ACE inhibitors.15 In a systemic review of 18 randomized
or quasi-randomized trials from 15 Chinese journals, rhubarb showed a positive effect on
relieving uremic symptoms, lowering serum creatinine, improving hemoglobin levels, and
adjusting disturbance of lipid metabolism in 1,322 human patients with CRF.16
Among other kinds of Chinese herbs used to treat CRF, Dan-shen (Radix salvia
miltiorrhiza) relaxes vessels by enhancing microvascular protein synthesis of endothelial
nitric oxide synthase, leading to an increase in nitric oxide production.17 Danshen, in
combination with seven other herbs including Chinese rhubarb, confers nephroprotection
in chemical-induced acute and chronic renal failure in rats.18 Animal studies have shown
that Dong-cong-xia-xao (Cordyceps sinensis) delays progression of worsening kidney
function in 5 of 6 nephrectomized rats, through the inhibition of glomerular hypertrophy,
reduction of proteinuria, and reversal of metabolic abnormalities of protein and the lipid
profile.19 Fang-ji (Stephania tetrandra) decreases the accumulation of extracellular matrix
and reduces glomerulosclerosis in Adriamycin-induced nephrotic rats.20 Lei-gong-teng
(Tripterygium wilfordii) has been known for protein excretion in many types of CRF.21
III. Pattern Differentiation and Treatment
Kidney Qi Deficiency
Signs: Dysuria, polyuria, stranguria, lower back pain, hindlimb weakness, exercise
 intolerance, tires easily, urinary incontinence, uremia, prefers warm area. Tongue is
pale and wet. Pulses are deep and weak (right pulse is weaker).
Acupuncture treatment: Strengthen Kidney Qi (BL-23/52, BL-26, KID-3, Shen-shu);
benefit urination (BL-22/28, SP-9/15, GB-25, ST-28, CV-9); add additional points
above to manage clinical signs, if needed.
Herbal formula:
Suo Quan Wan, 0.5 g per 1,020 lb bodyweight BID–TID, to treat renal failure
with mild urinary incontinence
Jin Suo Gu Jing, 0.5 g per 1,020 lb bodyweight BID–TID, to treat renal failure
with chronic urinary incontinence and weakness
Kidney Yang Deficiency
Signs: Often older animals or end-stage CRF; low body temperature; cold ears,
back and extremities; aversion to cold; warm-seeking behavior; subdued manner;
lower back or lumbar region soreness; hearing loss; copious/long clear urine;
urinary incontinence; general debility/weakness; morning diarrhea; edema in limbs
or ventral abdomen. Tongue is pale, wet, and swollen with teeth marks. Pulses are
weak, deep, and slow (right pulse is weaker).
Acupuncture treatment: Warm Kidney Yang (GV-3/4, BL-24, CV-6, Bai-hui, Shen-
shu/peng/jiao); benefit urination (BL-22/28, SP-9/15, GB-25, ST-28, CV-9); add
additional points above to manage clinical signs if needed; use less acupoints
(typically 5–10 needles in total) for debilitated patients.
Herbal formula:
Jin Gui Shen Qi Wan or Rehmannia 11, 0.5 g per 1,020 lb bodyweight BID–
TID, to tonify Kidney Qi and Yang; nourish Yin, Blood and Jing; drain Damp;
and strengthen the Spleen. Jin Gui Shen Qi Wan is slightly warmer than
Rehmannia 11.
Zhen Wu Tang, 0.5 g per 1,020 lb bodyweight BID–TID, if edema is noted. It
tonifies Kidney Yang, drains Damp, and promotes urination.
Caution should be taken when using either formula in cats or geriatrics, as
they both contain Fu Zi (Aconite).
Kidney Yin Deficiency
Signs: Dysuria, stranguria, polyuria, easily dehydrated, dry coat with dandruff, warm
to the touch, cool-seeking behavior, excessive panting, generalized erythema,
restlessness or abnormal behavior at night, signs often worse at night. Tongue is
red and dry with cracks and little to no coating. Pulses are weak, deep, thready, and
fast (left pulse is weaker).
Acupuncture treatment: Nourish Yin (BL-23, KID-1/3/7, SP-6/9, Shen-shu); benefit
urination (BL-22/28, SP-9/15, GB-25, ST-28, CV-9); clear Heat is needed (LI-4, LI-
11, GV-14, Er-jian, Wei-jian); add additional points above to manage clinical signs, if
needed.
Herbal formula:
Liu Wei Di Huang Wan, 0.5 g per 1,020 lb bodyweight BID–TID, to nourish Yin
and Jing, tonify Kidney Qi, and drain excess Damp.
Zhi Bai Di Huang, 0.5 g per 1,020 lb bodyweight BID–TID, to nourish Yin and
Jing, tonify Kidney Qi, drain excess Damp, and clear Heat; it is used when
apparent Heat signs are noted.
In CRF patients with both Kidney Qi and Yin deficiency, use Jin Gui Shen Qi
 Wan or You Gui Wan in the morning to tonify Kidney Qi-Yang; in the
afternoon, use Liu Wei Di Huang Wan or Zuo Gui Wan to nourish Yin and
Jing. The dosage is 0.5 g per 1,020 lb bodyweight of each formula.
Kidney Jing Deficiency
Signs: Renal failure at a young age, other congenital problems from an early age,
congenital defects, poor neonatal growth and development, developmental bone
diseases, premature aging, poor dentition, failure to thrive, often also show signs of
Kidney Yin or Yang deficiency. Tongue is pale or red but can be normal. Pulses are
usually weak but can be normal.
Acupuncture treatment: Benefit urination (BL-22/28, SP-9/15, GB-25, ST-28, CV-9);
for Qi deficiency, use BL-23/52, BL-26, KID-3, Shen-shu; for Yang deficiency, use
GV-3/4, BL-24, CV-6, Bai-hui, Shen-shu/peng/jiao; for Yin deficiency, use BL-23,
KID-1/3/7, SP-6/9, Shen-shu; add additional points above to manage clinical signs,
if needed.
Herbal formula: Sheng Jing San or Epimedium powder, 0.5 g per 1,020 lb
bodyweight BID–TID, to tonify Qi, nourish Kidney Yin and Yang, Jing and Blood.
Because this formula is warm, if the patient shows more signs of Yin deficiency with
Heat, treat it as a case of Kidney Yin deficiency initially.
IV. Summary
There is little treatment available for chronic renal failure from a Western perspective. In
contrast, Traditional Chinese Veterinary Medicine has treatment options for patients with
CRF, which may minimize the progression of disease and may help maintain quality of
life. The combination of herbal medicine, acupuncture, and dietary management—in
addition to Western treatments—can be a very effective therapeutic approach to treat
chronic renal failure in small animals.
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SPEAKER INFORMATION
(click the speaker's name to view other papers and abstracts submitted by this speaker)
R. Koh
Veterinary Teaching Hospital
School of Veterinary Medicine
Louisiana State University
Baton Rouge, LA, USA