The objective of this prospective, blinded, controlled clinical study was to determine the common TCVM patterns associated with fibrous osteodystrophy in horses and the 60-day clinical outcomes, when the appropriate Chinese herbal medicine, for the pattern, was administered. Based on the TCVM examination, 3 TCVM patterns were found. Group 1 consisted of 22 horses with Spleen-Kidney Yang Deficiency and was treated with Yi Zhi Tong Guan San. Group 2 consisted of 81 horses with Spleen-Kidney Yin Deficiency and was treated with Jian Bu Tong Guan San. Group 3 consisted of 13 horses with Spleen-Kidney Yin-Yang Deficiency and was treated with Yi Zhi Di Huang San. Group 4 served as a control group and consisted of 30 horses with 1 of the 3 patterns, but all were treated with Yi Zhi San. Each horse was also treated with dry needle acupuncture (DN) at Bai-hui, Shen-shu and ST-36 bilaterally every other day for 4 times. Dietary adjustments and appropriate rest and exercise were provided. The recovery rate for Groups 1 (90.91%) and 2 (91.36%) respectively were significantly greater (p<0.05) than the control Group 4 (63.33%). The percent treatment response (combined recovery and improvement rates) for Groups 1-3 was 97.03% compared to 83.3% for the control Group 4. The conclusion of the study was that identification of the correct pattern and administration of the appropriate Chinese herbal medicine for that pattern, along with DN and diet correction significantly increase the success of TCVM treatment for fibrous osteodystrophy in horses.