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Skin Question

by Rose Mary - July 12, 2009

Hi Steve,
I hope that things are going well with you and Karen. I hope that you remember me - I spent a week at your clinic in December 2006 as part of the IVAS course.
I was wondering if anything comes to mind herb-wise for this dog?
I have a 7 year old Border Collie FS who has had a history of chronic skin problems for years. The owner noted that the dog was separated from the mother at a young age and may have lived as a stray before she adopted her. The dog always has a nervous tendency in the office and is a fear biter, but I manage to get the needles in with a bit of food motivation (blood deficiency?).
The main reason why we are doing acupuncture is for this dog is to curb the skin tendencies - mainly of licking the paws and anal area for 2-3 hours at a time. The owner feels that when the dog is stressed, she licks which seems to be all of the time. The dog is an agility dog and the owner owns a boarding kennel so there is alot of exposure to other dogs.
In my opinion, the tongue is pale with no coat and dry. The pulse is the same bilaterally and no obvious pattern is apparent to me. During the treatment, the tongue becomes noticeabely pinker and moist and the dog becomes more relaxed with a relaxed facial expression. Four treatments have been completed, and we managed to make a vast improvement - the licking has stopped except for a few seconds a day when the dog gets stressed, the dog listens better, more interactive with the other dogs - more relaxed, she is also not as reactive in a negative way.
The owner is feeding raw diet - I can give you more details if needed. Some points treated were: BL 20, 21, LI11, ST 36, SP10, BL40, LIV13 (active), LIV 14. First treatment, BL17 was active and ST 36 was very sensitive. Also, the dog is very thin with a difficulty to gain weight and the dog has gained weight over the last month with the treatments (a few pounds).
I am suspecting a Spleen Qi deficiency with a Blood deficiency. I am wondering that although the raw diet is great for the dog, if it is too cooling for this dog and if the spleen is deficient if it is not able to transform this food adequately? The owner has been on numerous food trials with various dermatologist with no skin improvement and this is the only improvement that the owner has had yet! I do not want to switch off the raw diet especially with what you have told me about the carbohydrates and allergies.
Do you have a herb to recommend?
Rose Mary Garrett
Charlottetown, PEI

by Rose Mary

July 12, 2009

Hi Rose Mary,

Off the cuff, for dogs with a lot of anxiety creating their licking, Chai Hu Jia Long Gu Mu Li Tang has been very helpful for us, but it doesn't fit the points or the case in general.

Blood and even Yin deficiency is a possibility. Yin deficiency is almost for certain if the dog has trouble holding its weight on raw, and if stools and appetite are normal. In such a case, a small amount of grains (e.g. cooked rolled oats, cooked barley) is probably needed to be mixed into the food. Try to avoid other grains. Potatoes are an option, however. If this sounds like the dog, Spleen deficiency is not likely. If stools are soft, or appetite is low, then the Spleen deserves a look.

Otherwise, continuing with cooling Blood and Yin tonics is the way to go. I do see what you see as the dogs get better - less reactivity and a better ability to think. Yi Guan Jian is a very good option if the dog fits the Yin deficiency description I mentioned above. Rehmannia Six (Liu Wei Di Huang Wan) is also safe to try, because it drains Damp in the event we're wrong about the dryness.

Hope that helps!
Steve

by Rose Mary

July 12, 2009

(Question 5 months later - Jan. 2009)

Hi Steve,

I just have a further question to a case that I had asked you about earlier in the summer. I find it soo helpful when you provide your insight into these cases. Please see the below notes on this dog from previous e-mails.

I began treating this dog in June for a skin problem - licking constantly and things have been going well. Based on the previous signs, we had determined that she was most likely a Yin Deficiency as she was having difficulty holding her weight on raw with stools and appetite that were normal. The owner tried adding cooked rolled oats to the raw diet and this seemed to help. Based on previous herb recommendations, I chose Yi Guan Jian - she has been taking this since mid August.

Now I think that the dog may be moving to a slightly different pattern as the symptoms are changing. The dog is now obsessively hungry - she will steal food off the counter - anything - even if she does not like it - tomato, etc. She even swallowed a squeaky dog toy whole the other day. Her personality is still desirably changed - she will approach anyone even me in the office in a pleasant way that she never would before.

She has an increased appetite, increased weight on a dog that always could never gain weight, she begs for food, stool is normal...Tongue - top pale, underside pink, becomes moist and pink with AP treatment but generally pale and dry. Pulse seems wide and wiry now (not sure). Some of the licking has started again - no longer feet licking, but anal licking has started again. There is gas with no odor. New points for last treatment: BL 17, BL 23, ST36, SP10, SP21, HT 7, and LIV 13. She is on a 90% rae chicken diet with veggies - romaine lettuce, berries, apples, oranges, etc.. Do you think that it is time to move on to another herb or change the AP treatment in some way?

Thank you,
Rose Mary

by Rose Mary

July 12, 2009

Hi Rose Mary,

As for the itchy dog, I'm wondering if you've dealt with the Yin deficiency, and now have the root cause (Spleen deficiency and Damp Heat) emerging. This is where the food fixation and pleasant temperament comes in. It also matches the points.

In this case, YGJ will cease to work, and may even aggravate symptoms. All you have left that suggests dryness is the tongue, and I don't know that's enough. Of course, we don't want to derail the case, in the event we're wrong. So you would continue YGJ but add in a second formula and see if things stabilize again. Maybe cut back on the YGJ a little.

Find out if the dog likes warmth (e.g. lies in the sun, etc.). If it does, try modified Wei Ling Tang (Chu Shi Wei Ling Tang). K'an makes this and so do Mona and I. If the dog is definitely HOT and aggravated from warmth, trying something like San Ren Tang, Si Miao San, or even Zhi Bai Di Huang Wan is your best bet. The latter tonifies Yin, doesn't touch the Spleen, but drains Damp and clears Heat from the lower burner (where the itch is). SMS is quite cooling and drying, so it may aggravate Yin deficiency, but if you're continuing YGJ it will be minimal. It also has an affinity for where the itch is. Otherwise, you can 'dip your toe in the pool' by trying San Ren Tang.

Hope that helps! Continued good luck with this case!

Steve Marsden

by Rose Mary

July 12, 2009

Hi Steve,

It turns out that the dog is a cold dog and seeks heat. I just wanted to confirm that you recommeded that we try the Chu Shi Wei Ling Tang which is the modified Wei Ling Tang?

Rose Mary

by Rose Mary

July 12, 2009

Yes, try that first.

Cheers,

Steve

by Rose Mary

July 12, 2009

(Question 1 month later - Feb. 2009)

Hello Steve,

I had an e-mail from the gal that is on the two herbs: YGJ and Chu Shi Wei Ling Tang. She identified a problem of coprophagia which has been ongoing in one of her young dogs and has now started in Lola - the dog takling the herb.

I responded to her already with the usual response of adding things to the diet and behavior modification, but she is wondering if this could be realted to something lacking in the diet. Lola is on a raw diet that is described in her original e-mail at the bottom.

Do you think that it could be a deficiency in the diet?

Thanks,
Rose Mary

by Rose Mary

July 12, 2009

Hi Rose,

Greeting from Oz. Coprophagy is a Spleen deficiency symptom mostly, so I'd try weaning off the YGJ a little. Its moisture level may be aggravating the Spleen a little, leading to coprophagy as a result.

Cheers,

Steve

by Rose Mary

July 12, 2009

(Question 2 months later - March 2009)

Hello Steve,

Regarding the dog - Lola that we have been discussing which we thought was originally a Yin Def and now may be a Spleen Deficiency with Damp Heat due to what I had previously described. I have another question regarding this dog who is on the two herbs:
Chu Shi Wei Ling Tang - 1 tsp BID and Yi Guan Jian - 1/2 tsp. BID.

It seems that the dog has a real preference for the YGJ and does not eat the CSWLT as readily, plus the symptoms (feet licking, chewing) has gotten much worse since the addition of the new herb and the reduction in the previous one. The owner noted that now the dog still has her pleasant temperament, but she is now seeking cold. I am wondering if she is on the right herb or maybe just the dose needs to be adjusted. In a previous e-mail, you mentioned SMS as an option, but at that time she was a cold dog seeking Heat.

For now, I recommended that both herbs be given at the 1/2 tsp BID each to see if there is any improvement. I am not sure whether the CSWLT should be completely removed or just maintained at the lesser dose.

I saw the dog last week:
tongue - purplish underside - very slight white coat, wet
pulse - seemed thin and wiry, but not sure on that one
points - LI 11, BL21, BL 17, GB31, SP10, LIV13. The two most noticeable points were the BL 17 and GB 31.

Any suggestions would be welcomed.

Rose Mary

by Rose Mary

July 12, 2009

Hi Rose,

BL 17 and GB 31 are definitely Blood deficiency points. Or points that relate to Blood anyway. If the dog is getting hot on CSWLT, then either you just return to a Blood strategy (maybe we try Qing Ying Tang to relieve itch?), or you try another Damp Heat formula.

I guess now I'm curious about Blood Heat, for which Qing Ying Tang is appropriate. Damp Heat leads to Blood Heat (which leads to Blood deficiency) given enough time in skin dogs, which might explain why the two conditions are juxtaposed in the same animal. Just a thought.

Anyway, the response to CSWLT is good information in figuring things out. When skin problems develop, they either come from Dryness (Blood deficiency) or Dampness. If the dog doesn't respond well to one avenue of treatment, then the opposite problem is going on. And if Yi Guan Jian seemed insufficient, then Qing Ying Tang is the next logical step.

Hope that helps!

Steve Marsden

by Rose Mary

July 12, 2009

Hello Steve,

Thank you for your patience with this case! I find that this is a real learning process for me, and your comments are extremely helpful. Also when I have a client willing to try herbs, it is nice to be able to follow it through with help! Thank you!

From your response, I think that the logical thing to do would be to start the Qing Ying Tang. Would you recommend that the other herb Yi Guan Jian be gradually weaned away or completely stopped? As of now the CSWLT is completely stopped.

Please see below the additonal comments from Sarah yesterday:

Hi Rose Mary,

Lola has been off of the second herb (CSWLT) for about two weeks now.

I have seen a renewed interest in stool eating (Spleen deficiency). Last night she retched for hours and eventually vomited up a fluid which stank of feces. She has been out in the yard as much as possible hunting for stool.

I am not sure how this ties into the other herb. All I know is that I had trouble getting her to consume all of the herb (CSWLT). Now that we took her off of it I am second guessing myself. She still consumes her other herb willingly (YGJ). She has not been chewing her feet but I have been using the Nizoral twice a week. She has been licking although not quite as much.

Not sure what we should do at this point. I have also not seen any heat seaking behaviours from her and her appetite has veered to the normal side rather than the obsessively hungry side.

Sarah

Looking forward to your comments!

Thank you, Rose Mary

by Rose Mary

July 12, 2009

Hi Rose,

The coprophagy says Spleen deficiency; the vomiting says Stasis (Stomach and Intestinal Qi); and the appetite says Heat. Fungal infection says Damp Heat.

Rolling all that together, San Ren Tang is a good choice, or some other Spleen Damp Heat approach. Si Miao San with added Dang Gui might end up being what you use, since Blood tonification has also been helpful for the dog.

Start one of those while continuing Yi Guan Jian for now. If you finally see improvements, then you can slowly scale back and wean off the Yi Guan Jian.

Hopefully the dog will consume the herbs this time as it's definitely the way to go. You may have to explore different formats (pills, liquids from K'an, for example). Good luck!

Steve

by Rose Mary

July 12, 2009

(Question June 2009)

Steve,

This is just a follow-up to the Lola dog that you have been giving me advice on re: herbs.

After the last e-mail, I elimnated the Chu Shi Wei Ling Tang, but continued with the Yi Guan Jian as before. I then added in the San Ren Tang. I gradually increased it up to 1 tsp. (SRT) - the dog seemed improved for the first month and then not as good.

Now Lola is on Yi Guan Jian 1/4 tsp BID and San Ren Tang 1/2 tsp. BID. On these she is seeking COLD again. She prefers the cool water, the basement, etc. She is licking her anal area - long term licking, but not so much the paws anymore. The appetite is fair, but not ravenous. She will eat her own food if offered but not the strange things anymore. Also, she is doing the occassional urinating as well submissively around other dogs. She is still personable with people whereas in the beginning she was very shy.

The main concern is the longterm anal licking for hours at a time and the new submissive behavior. Do you think that we still have a heat condition and why did the San Ren Tang appear to make it worse? At one time you mentioned trying Qing Ying Tang, but the last time we e-mailed, you mentioned that if the YGJ and the SRT did not work then maybe try Si Miao San with Dang Gui. The tongue appears to be pale more of the time now as well unless the dog is vigorously exercising.

Do you have any other insights?

Thank you,
Rose Mary

Rose

by Rose Mary

July 12, 2009

Hi Rose Mary,

Since you saw a favorable response, I think you should try SMS with Dang Gui next. YGJ is quite moistening, so it may have reached a point of diminishing returns and created some Damp Heat. If this is correct, then you should see things improve a little bit just by cutting back on YGJ. If you back off to, say, a half or third dose, and things improve, then the way forward is clear. Certainly increased Damp Heat would create that pruritis ani marked by obsessive licking. The submissive urination may be more an issue with excitation. If so, relieving Damp Heat will help. Damp can also kill the appetite, especially if the thirst is strong or increased. The only thing that doesn't fit is the tongue color, and given that tongues occasionally surprise us or don't immediately seem to fit, I think it's okay to experiment with cutting the YGJ (and maybe even increasing SRT) and see if things budge in a positive direction.

Hang in there. Skin cases are definitely tough but with persistence you can get there. Also, we've found Hypericum (herb or homeopathic) can reduce perineal licking. If you use herbs, be aware that it can cause photosensitization. If the dog is outdoors all the time, the homeopathic may be better.

Good luck,
Steve

by Rose Mary

September 10, 2009

Hello Steve,

I am a bit puzzled by this case. We are now on our second bottles of both the herbs: SMS and Dang Gui and the owner does not think that she sees an improvement anymore. At first she thought that she saw a reduction in clinical signs, but now she is not sure. To quote the owner: "Her personality is still great but I cannot say that I have seen a decrease in her anal licking. She does still occasionally chew her feet but on average not as much as she used to."
The dog is a 40 pound dog, and I have her on 1/2 tsp. twice a day of each of the herbs. Do you think that I should alter the dose of either of the herbs or change them in any way or is there anything else that we could do to improve?
Thanks,
Rose Mary

by naturevet

September 12, 2009

Hi Rose Mary,

Hypericum is a thought for the anal irritation. I do have one more, which is to try Xue Fu Zhu Yu Tang. That might seem an odd choice, but we've seen it effective for anal gland tumors - it could help with other anal gland pathology. It tonifies Blood, which matches the tongue, and moves Blood out, which matches the pulse. This enhancement of peripheral circulation can help resolve chronic digital infections. In addition, I've come to realize foot-licking is often associated with chronic Liver problems, Liver Blood deficiency or Stasis among them. Lastly, it fits the submissive behaviour because of its Blood tonifying properties. It also can succeed here beyond what YGJ was able to accomplish, since to adequately tonify Blood, you sometimes must move it, which YGJ does not do.

So I would suggest trying that. It would be a really interesting case if it worked. Please continue to follow up.

All the best,

Steve

by Rose Mary

September 13, 2009

Hello Steve,

I certainly can understand your reasoning on using this herb Xue Fu Zhu Yu Tang. Would it be best to stop the SMS and the Dang Gui Shao Yao San and begin this new herb by itself?

Thanks,
Rose Mary

by naturevet

September 13, 2009

As a general rule, I stop anything that has not been helpful at all, or that seems contraindicated by the points and your analysis.

So if not much has happened in both yours and the owner's estimations, then I'd just move on to the XFZYT and stop the other treatments.

Good luck!

Steve

by Rose Mary

December 14, 2009

Hello Steve,

As an update, we have stopped all herbs over about the past month because the owner did not think that she saw an improvement on the last two herbs.

A few of the old symptoms are worse including feet chewing and anal licking, but now there are new symptoms including vulva licking, wretching, and the copraphagy is back again.

This dog is on a 100% raw diet, great appetite (40-60 % chicken with the rest being organ meats). A blood panel and CBC were conpletely normal and the dog was dewormed last week. Her personality is still pleasantly changed! Her mouth and tongue are all extremely pale unless she has just eaten and she is still seeking heat.

Any thoughts on where to from here?

Thanks,
Rose Mary

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