The purpose of this retrospective study was to determine the prevalence of equine patients treated with traditional Chinese veterinary medicine (TCVM) in a veterinary teaching hospital (VTH) and to investigate the relationship between their clinical signs, signalment and prescribed treatment. A total of 3,604 equine patients with a total of 8,123 appointments were seen over a 4-year period. The prevalence of horses receiving TCVM treatments was 4.9% and accounted for 7% of all equine appointments. Musculoskeletal disorders were the most common clinical presentation for both TCVM treatment (51%) and Western Medical (WM) treatment (29%). Study results demonstrated the proportion of musculoskeletal cases treated with TCVM was significantly higher (p <0.01) than WM proportional caseload. There were also significant differences (p<0.01) in proportional caseload when comparing TCVM and WM for dermatology, behavior, surgeries and ophthalmology along with significant differences (p<0.05) for reproduction and dental disorders. Additionally, all horses with emergency appointments (n = 23) were significantly more likely to be treated with WM compared to treatment with TCVM (p <0.01). Evaluation of Chinese herbal medicine (CHM) prescription patterns revealed 8 clinical categories where 75% of horses were CHM treated and in categories such as dermatology, behavior and reproduction, there was 100% treatment of clinical cases. Though still a small percentage, TCVM is seeing an increase in VTH equine treatment prevalence. The authors conclude that TCVM is experiencing increased acceptance by both VTH and equine owners as a standalone or adjunct therapy to conventional medicine to treat common equine problems.