Laminitis - Natural Choices for Effective Structural and Systemic Intervention
A Follow-Up Article
Laminitis is a disease of the whole horse, not just the hoof. It is a metabolic issue that manifests in the hoof and, once set in motion, requires long-term solutions to gain complete recovery. These long term solutions require both appropriate hoof care and effective systemic intervention. Both of these aspects are best dealt with by keeping in mind what is most natural to the horse.
Hoof Care – Structural Intervention
Let’s begin at the hoof with a wonderful quote by Dr. Christopher Pollitt: “Healthy hooves are very good at healing injured areas.” What I love about this quote is that he clearly states that hooves maintained in a healthy state heal well. In wild horses, this has certainly proven to be true. Through the careful observations of wild horses, made by many astute people, it has been established that the form and structure (morphology) of the wild horses’ hooves makes them undeniably healthier than our domesticated companions and that is without our helpful, or not so helpful, intervention. These observers found no laminitis and the horse’s hooves were “self-trimmed” in a “geometrical balance” through contact with the ground and the horses’ instinctual patterns of movement.
The importance of the ground environment and its impact on hoof conformation cannot be underestimated. Contact with the ground surface applies many loads and stresses to the hoof that then alter the growth and development of the entire hoof anatomy. Given this, what we put as an interface with that contact point has a whole lot to do with the creation of a “healthy hoof” or a hoof that will have a great deal of difficulty healing. That is one of the problems with shoes of any kind, especially for a laminitic horse.
Shoeing a horse’s hoof restricts the intrinsic flexibility of the hoof to contract and expand with movement as well as completely interferes with the necessary adaptation (ability to respond to the variety of external and internal forces) to changing environmental conditions. The outer hoof wall is designed to protect the hoof structure and the inner hoof wall is designed to support and disperse shock. When a horse’s hoof is shod the outer hoof wall is encumbered thereby inhibiting the hoof’s ability to dissipate shock. When the energies are dissipated correctly through the inner wall, less shock reaches the coronary band and the growth of the inner and outer walls are kept in balance.
Keeping the hoof carefully trimmed and barefoot is the best way to work in alliance with the horse’s natural patterns to build a healthy hoof. Please understand that not all trims are created equal. Correctly done, trimming is a major structural intervention technique for laminitic horses.
The sole thickness of wild horses is twice that of our typical domesticated friends. Also, the heel and frog of wild horse’s hooves make contact with the ground. This conformational aspect permits these hoof structures to be a part of the support apparatus and to also provide the horse with contact information about the nature of the ground’s surface.
Now we get to the crux of all this information. The bottom of the hoof must be trimmed so that the coffin bone is in a near ground-parallel position to both restore and prevent coffin bone rotation. Individual cases must always be considered because hard and fast rules are likely to cause harm.
This is one of the critical differences between bare foot trim and the nature of the trim for shoeing. The coffin bone ground-parallel fact is the beginning to healing the laminitic hoof, including a rotated coffin bone. This trim technique is a technique performed by bare foot trimmers and is not typically performed when shoeing a horse.
A ‘natural example’ to consider in support of this is the classic ‘founder stance’ where the laminitic horse rocks his weight back on his hind end, extends his front legs and places his weight in the front on the heels taking as much weight as possible off the toe area. The toe area is where the coffin bone is tipped downward. In the horse’s attempt to alleviate pain he is instinctively orienting the coffin bone to as near ground parallel as possible.
Systemic Intervention through Chinese Herbalism
Herbs are a natural language that the horse’s body understands. To be effective the herbs must be blended in concert to present a clear message.
Within the Chinese herbal pharmacopoeia, there are well over two thousand single herbs. These herbs have been studied and researched for their myriad properties for countless centuries. Although this form of medicine is exalted for its antiquity, the true value of Chinese herbalism is not in its ancient origins but rather in its continuing search for greater comprehension of the properties and blendings of these herbs. So much so, that for decades the research of Chinese herbs has necessarily included the science of the pharmacological properties of these herbs.
The names of herbs are in pinyin rather than English for purposes of clarity. In pinyin, the names not only indicate the herb but also the part of the plant and the preparation - e.g. whether the herb is cooked, dried, charred, the whole root, the tail of the root, the bark of the root, the flower and which parts, the seed and its preparation, and on and on and on…
My Approach to Formulating a Chinese Herbal Solution
1) to express in systematic terms or concepts
2) to form a strategy for ….
To formulate a complete herbal solution, I begin with a systematic investigation and understanding of the issue in terms of Western pathophysiology. From there I develop an algorithm to use as a conceptual framework to translate that information into the terms of Chinese medical theory. Without trying to explain this process in depth, I would like to give you an understanding of the power of herbs and the effectiveness of Chinese herbalism by describing a part of the formulation process used in our maintenance formula for horses that have a predisposition to laminitis (see Laminitis Solution, www.forloveofthehorse.com). The function of this formula is to establish a healthy glucose uptake and restore the negative feedback loop between the pituitary gland and the adrenal glands to functional integrity. Equine Metabolic Syndrome, a component of laminitis, is similar to insulin resistance and has type 2 diabetes qualities, so my combination of herbs also needs to be able to “work with” the spleen/ pancreas system, kidneys and liver.
There are a total of twenty-four single herbs in the laminitis maintenance formula. Each herb is essential to the effectiveness of the formula and each herb works in concert with the other herbs. Without trying to explain them all, I am choosing two groupings to describe a conceptual feel of how they group and relate in terms of the Chinese medical metaphors and their relationship to the western medical model.
The chief herbs deal with the primary aspect of the metabolic problem in laminitis, i.e. the dysfunctional relationship between the pituitary gland and the adrenal glands. Without this problem rectified there will continue to be an overabundance of their respective hormones, ACTH and cortisol in the blood. An overabundance of cortisol sets off the conditions that eventually lead to glucose deprivation of the hoof tissue and therefore laminae separation. It is important that the chief herbs are regulatory in nature rather than invigorating or tonifying so that the message given to the glands is to “normalize” the relationship. Also “guiding herbs” are needed to direct the intent of the chief herbs to the necessary organ areas.
From my lineage in Chinese medicine I have come to understand that the pituitary gland is “ruled” by the Yin aspect of the Kidneys, and Kidney Yang rules the adrenal glands. The nature of this feedback loop fits perfectly with the circular movement of yin and yang. For although yin and yang are often referred to as polar opposites, they are actually mutually sustaining in that “yin nurtures yang and yang inspires yin”. Given this, we now have a metaphorical representation of the glandular analog to go along with the explanation of the chief herbs.
Combining shu di huang, shan yao, tu si zi and gou qi zi guided by gan cao and jie geng will begin to influence the pituitary gland. Fu zi, rou gui and lu jiao jiao address the adrenal glands and when combined with ren shen and the influence of gan cao begin the regulatory process. The blending of these chief herbs epitomizes the nurturing relationship between yin and yang and introduces a message to the pituitary-adrenal feedback loop to self-adjust.
It now becomes necessary to augment the formula and “harmonize the middle.” Assistant herbs by definition are to enhance the chief herbs’ function while also working with the connective aspect of the presenting problem, and in this case that is the spleen/ pancreas function and the liver (these organs represent “the middle”). The pancreas makes insulin, whose primary function is to impel glucose into cells, including the basal cells of the hoof wall. Remember hoof tissue deprived of glucose results in laminae separation. The spleen is the primary organ of digestion and needs to function in a healthy manner for the effective assimilation of nutrients from food so that the organs are nurtured. This is where the enhancing of the chief herbs by the assistant herbs comes into play. When there is an overabundance of cortisol in the blood there is a concomitant overabundance of insulin and glucose in the blood as well. All the involved organs must be functioning in a healthy manner to facilitate the complete healing process.
Laminitic horses experience excessive thirst and excessive urination.
These physical responses are dealt with by assistant herbs such as
mai men dong, shan yao, xuan shen and wu wei zi as they are a combination
of kidney yin tonics and spleen/ pancreas herbs blended to enhance
the chief herbs and seriously treat the assimilating function of the
spleen. These herbs blended properly impact excessive thirst and urinating
quite effectively by dealing with the source of the problem, not the
As toxicity is a laminitic trigger, the final piece within this grouping must deal with the liver. The liver is functionally a blood filter to remove toxins. Jie geng and gan cao (also used as guiding herbs) combined with wu wei zi lower blood cholesterol through the liver. Wu wei zi has the remarkable ability to alter liver cell-membrane permeability to prevent the entry of toxic substances and is part of the grouping of herbs to strengthen “the middle.” Jie geng lowers plasma glucose and has a mild ability to prevent sharp increases in glucose levels following eating.
Clearly this is only a partial description of the herbs and the formulation process in our laminitis maintenance formulation. What I hope to have given you in this section of the article is an understanding of the process of precise formulation of a Chinese herbal mixture and how well that works with a thorough understanding of Western pathophysiology. The two worlds are very potent together.