I am trying to relate the 8 principles and lung patterns to my 4 legged patients. These are some presentations that I see commonly - am I on the right track? 1. A dog has a loud, barking type cough. Nasal discharge is minimal and clear. Appetite and energy level are normal. (Typical presentation for kennel cough). Would this be external, excess, cold, yang? Wind cold invasion? The same patient presents 5 days later for persistent cough, low energy, no appetite and vomiting white frothy fluid. When the dog 'vomits' in the exam room you confirm that it is a terminal retch and not true vomiting. (A newer version of kennel cough that is becoming more common). Would this be external, deficient, cold, yin? Phlegm fluids obstructing the lungs? 2. A Yorshire Terrier presents for a chronic goose honking cough that worsens with excitement and exercise. The patient has had the cough for a long time but it is getting worse. Now when the owners come home, he has a coughing fit that last a few minutes, where he used to only cough a few times. The owners are worried because the last time this happened his tongue turned a blue/purple colour. Other than the cough everything else seems quite normal. Xrays show narrowing of the trachea at the thoracic inlet but are otherwise normal. If there is a physical abnormality can we still use the same filters for pattern diagnosis? Would this be internal, excess, cold, yin? Would this be lung yin deficiency? lung qi deficiency? Jing deficiency? 3. A cat presents for acute onset of sneezing clear discharge, watery eyes, appetite is reduced, No temperature preference that owners can comment on. This has happened 3-4 times over the past year and seems to resolve on its own. Normal body temperature on exam - ears and feet are normal/warm temp. (I am trying to paint the picture of a cat who is prone to chronic recurrent respiratory infections - thought to result from latent infection with herpes or other virus). Would this be external, deficient, cold, yin? Wind cold invasion? With another internal chronic issue suppressing the immune system - ie. persistent viral infection or weakened immune system that cannot clear the virus? 4. A cat has a chronic dry cough that is getting worse over time. No heart murmur or arrhythmia noted on exam. Getting older, sleeps most of the day. Prefers to sleep on the heat register. No nasal or ocular discharge. Meow has become more quiet. Ears are cool to touch. (Here I am trying to paint the picture of a senior cat with asthma). Would this be internal, deficient, cold, yin? Lung qi deficiency? I realize every patient and presentation will be different but I just want to make sure I am getting the big picture. I think it helps to practice with the patients that I see on a regular basis. Any input would be greatly appreciated!! Dana

Andrew said: Hi Dana. My responses are below and based upon my limited knowledge of our four-legged friends. Are you a vet, DVM or similar? 1. A dog has a loud, barking type cough. Nasal discharge is minimal and clear. Appetite and energy level are normal. (Typical presentation for kennel cough). Would this be external, excess, cold, yang? Wind cold invasion? Yes and yes (assuming the onset is recent and the dog is not very weak or have a deficient constitution). The same patient presents 5 days later for persistent cough, low energy, no appetite and vomiting white frothy fluid. When the dog ‘vomits’ in the exam room you confirm that it is a terminal retch and not true vomiting. (A newer version of kennel cough that is becoming more common). Would this be external, deficient, cold, yin? Phlegm fluids obstructing the lungs? At this point I would presume the pathogen has gone internal and begun to cause internal disruption. Internal, excess, cold, yin. So, this is a mixed picture. Phlegm-fluid in the lungs is possible but the invasion is starting to weaken the spleen function (because of the fatigue). The correct answer for this case is from the six stages of cold damage. This is from more advanced TCM theory that we will not be able to cover. However, you can think of it like this: I would give it a combo pattern and say something like phlegm-fuids in the lungs with spleen qi deficiency. We will see spleen patterns soon. 2. A Yorshire Terrier presents for a chronic goose honking cough that worsens with excitement and exercise. The patient has had the cough for a long time but it is getting worse. Now when the owners come home, he has a coughing fit that last a few minutes, where he used to only cough a few times. The owners are worried because the last time this happened his tongue turned a blue/purple colour. Other than the cough everything else seems quite normal. Xrays show narrowing of the trachea at the thoracic inlet but are otherwise normal. If there is a physical abnormality can we still use the same filters for pattern diagnosis? Yes. Would this be internal, excess, cold, yin? This is internal and excess. I cannot make a temperature differential based upon the symptoms you provided. I need more data such as body temp (subjective from owners and objective), preference for cold vs room temp water, how much panting (more or less than expected compared to similar breed and age). More likely it is on the hot side because movement and excitement generate heat. So, internal, excess, hot, yang (probably). Would this be lung yin deficiency? No. lung qi deficiency? No. Jing deficiency? No. I would presume this is something similar to vocal cord dysfunction in humans. Physiological restriction made worse by anxiety or excitement. If I am correct, the pathology belongs to liver qi stagnation (hence the purplish tongue). Liver helps make things move smoothly and can be responsible for spasms. If the tongue is blue and you conclude that the pet has a cold constitution the constriction could be a cold pathology, as cold constricts as well. However, it sounds like there is more heat because movement/excitement generates heat, so my guess is that they saw a purplish tongue. Either way, this type of cough does not belong to the lungs from a TCM perspective. 3. A cat presents for acute onset of sneezing clear discharge, watery eyes, appetite is reduced, No temperature preference that owners can comment on. This has happened 3-4 times over the past year and seems to resolve on its own. Normal body temperature on exam – ears and feet are normal/warm temp. (I am trying to paint the picture of a cat who is prone to chronic recurrent respiratory infections – thought to result from latent infection with herpes or other virus). Would this be external, deficient, cold, yin? Wind cold invasion? With another internal chronic issue suppressing the immune system – ie. persistent viral infection or weakened immune system that cannot clear the virus? For this issue we have to look at two scenarios. The acute issue you describe is an external, cold, excess, yin phenomena with a pattern of wind-cold invasion. We cannot diagnose the more chronic aspect because as we need a complete history and physical including bowels, urine, GI, sleep, energy etc. The issue is a wei qi deficiency (immunity/defensive qi) but we need to pin down the deeper pattern that is causing the wei qi deficiency. Is it the lungs not manufacturing qi, is it the spleen not manufacturing qi, is there a genetic issue (jing and kidneys) etc. So, keep this case in mind as we go forward with the remainder of the patterns. 4. A cat has a chronic dry cough that is getting worse over time. No heart murmur or arrhythmia noted on exam. Getting older, sleeps most of the day. Prefers to sleep on the heat register. No nasal or ocular discharge. Meow has become more quiet. Ears are cool to touch. (Here I am trying to paint the picture of a senior cat with asthma). Would this be internal, deficient, cold, yin? Lung qi deficiency? Yes- internal, deficient, cold, yin. Could be lung qi deficiency but I presume there is something deeper going on. I might consider kidney yang deficiency. There is a combination pattern of kidney not grasping the lung qi that might fit nicely here as well. To be continued for all of these cases. As you will see, it is not always one organ and combination patterns are very common. You will understand the concept more as we finish the other organ patterns. Thank you for your thoughtful cases!

Thank you for taking the time to respond. I look forward to going over the cases in the homework posted for this week's class! Yes, I have a DVM degree and I am currently transitioning from conventional veterinary practice to holistic practice. Thanks again! Dana