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Pemphigus Foliaceous

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Hi Steve,
I have a pemphigus case I have been treating integratively for 9 months. We have one week to go tapering off prednisone completely, and will continue XCHT for 3 weeks after pred is finished. The dog looks awesome- absolutely no skin lesions. Today the tongue is red with sl purple center, kind of dryish seafoam lines. Pulses are weaker on the right than the left, deep at Spleen, not really wiry. Mild heat still at GB34/40. A: Yin damage from chronic Heat, some stagnation or Blood deficiency, weak Spleen.
I am going to recheck in a month and see what's left after pred is gone. As this is the first case I have gotten to the point of "finishing off", from the course notes it looks like either Si Miao San with Dang Gui or Dang Gui Yin Zi (including Yu Ping Feng San) would be the options based on TCVM exam. Overlapped with tapering XCHT, as it seems in my hands abrupt changes don't work as well.
Is this how you do it?
PS. I added an addendum to my refractory seizure case I previously posted. The Tou Nong San and Keppra did the trick!
Thanks again,
Jodi

by Nate Heilman

July 27, 2009

Jodi,

I'm new to the forum, and am certainly no Steve. So forgive me if my two cents come out of left field.

I'm just curious as to the signalment and general body condition of this pemphigus case that you're treating. The Dang Gui Yin Zi + YPFS is filled with blood and Qi tonics with a smattering of wind expellents. The dogs that I have seen respond favorably to this would have little evidence of Dampness in their history. I have had success using DGYZ in thinner, timid shepherds that appear dry, for example. The sort of dog that you would expect to develop discoid lupus or pemphigus. In contrast, I typically think about SMS in dogs with indications of Dampness preceding the development of the pemphigus folliaceous. Labs, terriers, dogs more predisposed to chub and grease, if you will. Is this dog one of those?

One last note; I find that if I try to sub in some angelica in one of these Damp creatures during Summer Heat season, it's problematic. I'm in Vermont, which is not exactly tropical, but I often wait until late September before adding in the angelica, unless the patient is really dry. Am I out to lunch here? Sorry, not trying to coopt your query with my own insecurities.

Are there any adverse side effects to the pred which might suggest Dampness, and therefore a benefit to the use of Si Miao San.

Again, I apologize if you've covered this ground previously.

Nate Heilman

by naturevet

July 29, 2009

Hi Jodi,

I think your idea of SMS with Dang Gui is the optimal choice of the two. The 'sea foam' on the tongue often indicates a lingering degree of Damp. The purple-red tongue indicates Stasis plus Heat, which Damp tends to cause. So this formula choice seems appropriate.

From a western perspective, Dang Gui Yin Zi is more likely to re-awaken inflammatory changes than SMS, so given the dog's current tongue state, we should probably still err on the side of caution regarding any provocation of the immune system and go with SMS. It, as you know, is anti-inflammatory and so, biomedically, would have the best chance of preventing a lesion resurgence.

Have fun and continued good luck!

Steve

P.S. Also continue the XCHT, naturally, given the points you're seeing.

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