Tendon and ligament injury has a large economic impact on the equine industry. It is of concern to all performance horses regardless of discipline. Tendonitis or interosseous muscle desmopathy is a common injury in disciplines as varied as flat racing, cutting, dressage, barrel racing, jumping and endurance. In TCVM, tendon and ligament injury is preceded by a Liver Blood and/or Yin deficiency. Performance horses typically have a stressful life. All of this affects the Liver, and leads to Liver Yin and Blood deficiency. Treatment of tendon or ligament injury has four goals: (1) limit local edema and inflammation, (2) reduce pain, (3) improve the quality of healing and (4) shorten the healing time. Acupuncture can help achieve these goals because it is known to have anti-inflammatory and pain relieving effects. This paper reviews acupuncture points and Chinese herbal medicine to treat equine tendonitis and discussion of prevention of tendonitis in horses.