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Syringomyelia Follow Up

by Heather1 - August 17, 2009

Harry, Cavalier King Charles Spaniel, NM, DOB: 2/14/04

Tentatively diagnosed with syringomyelia

TCM diagnosis: Kidney and Spleen Qi Deficiency

Herbal history: Four Gentlemen (Si Jun Zi Tang) and Rehmannia 6 (Liu Wei Di Huang Wan)were prescribed, then changed to Rehmannia 8 based on tongue and pulse on 5/15/09.

Since the prescription of Rehmannia Eight and Four Gentlemen for Harry, his scratching during the day and at 6 am has slowly increased.

I saw him on 8/17/09. Harry looks as good as always except for his moderately pink external ear canals and reported sensitivity to humidity.

T: medium pink, wide, no coating, good thickness

P: superficial, good rhythm, slightly fast, bounding and strong, mildly thin and tight, wiry

Active points: pulse softenend when BL40 was sedated and GB points were stimulated

Are we now seeing some wind and heat invasion?

I think he still needs tonifying support, so I am considering keeping him on Rehmannia 8, and possibly adding Ban Xia Bai Zhu Tian Ma Tang. I could discontinue Si Jun Zi Tang since the BXBZTMT does support the Spleen.

Or do I need more of a mover, tonifier and wind expeller like Xiao Chai Hu Tang?

Any suggestions?

by naturevet

August 17, 2009

One way to both expel Wind and tonify is to use a formula like Du Huo Ji Sheng Tang. You wouldn't necessarily need the other tonics, then. Has the dog responded positively in any way to those herbs?

If the GB points were very prominent, then we should use Xiao Chai Hu Tang plus or minus DHJST or BWDHW.

One modification that makes XCHT a Wind expelling formula is to add Gui Zhi and Bai Shao to it. This creates Chai Hu Gui Zhi Tang.

So those are three options. It's interesting that both have a Wind invasion aspect to them. You could even try both dogs on the same formula if you had to, but it should be a Wind expeller.

Hopefully you'll see better results this time,

Steve

by Heather1

February 12, 2010

Greetings...

I started Harry on DHJST in September (2009) and then discontinued it in November due to increased intensity of his scratching (although less frequent) and increased daily screaming in the afternoon.

I started him back on BWDHW and his symptoms subsided. The owner wanted to also restart Four Gentlemen for Spleen support. He has been on this formula before with the BWDHW. But, this time, after three days on the Four Gentlemen, Harry's scratching ans screaming became worse again. His symptoms subsided once the Four Gentlemen was discontinued.

I couldn't piece together why both the DHJST and Four Gentlemen made things worse. Any ideas?

I was considering You Gui Wan instead of BWDHW for additional back and spinal support.

Thanks for your help on this one!

Heather

by naturevet

February 13, 2010

Hi Heather,

The strange response to the herbs gives me an idea to what to do next. Both contain Ginseng, which can strongly enhance blood flow in the CNS. If there was some associated nerve inflammation with the syringomyelia, it could potentially be heightened by bringing blood to the area. So the response to these 'tonics' tells me we need an anti-inflammatory formula that pulls blood away from the lesion.

My top pick, given the points you treated and the pulse you improved, given the newly identified need for an acute to sub-acute anti-inflammatory approach, is Chai Ge Jie Ji Tang (Bupleurum and Kudzu). It's my favourite for acute to subacute cord inflammation (as well as relief of meningitis). You can get it from Natural Path in powdered form, or Kan as a tablet or liquid.

It would be my next choice. I'd also wonder about St. Johns Wort (Hypericum) since it is used as a nerve anti-inflammatory and is helpful in paresthesia.

Let's explore that and see what you think. Sorry I led you on a wild goose chase before. I assumed your dog was more 'deficient' than it seems to be.

Thanks very much for keeping us posted. I really apprectiate the case feedback and assume others do, too.

Steve

by Heather1

February 14, 2010

Thank you, Steve! The ginseng ingredient is the cutprit...that makes so much sense!

FYI...we tried the Chai Ge Jie Ji Tang (Bupleurum and Kudzu) in November, 2008. At that time, it made things much worse. I'm sure it was because Harry was much more Deficient than inflammed at that time.

I'll talk to Harry's guardian and see if she is open to trying the Bupleurum and Kudzu again, or if she would rather try the hypericum/St. Johns Wort.

Thanks again for solving my little mystery!

Heather

by naturevet

February 14, 2010

Hi there,

Hypericum should be safe to try. If CGJJT was problemati and you want to try it, use only a low dose. Hypericum usually doesn't have side effects and should be okay.

If the pulse becomes very superficial, strong, yet toneless, use Si Miao San.

Good luck!

Steve

by Heather1

February 14, 2010

Hello Steve...

We are going to use a low dose of Bupleurum and Kudzu (1/4 tablet twice daily). Harry weighs 17 lbs.

We'll see how he responds in the next week. I'll consider hypericum if needed and the si miao san if the pulse reflects it.

Thanks so much! Heather

by Heather1

March 20, 2010

Hello Steve,

We tried the Bupleurum and Kudzu at a low dose, and he started yelping and scratching and chewing on one front limb.

He is currently on hypericum only. So far, his symptoms are mild...as they were when we first started herbal treatment.

I saw Harry on Friday, 3/19.

T: medium pink, slighly lavender, no coating, slightly thick

P: medium to deep position, bounding, slightly tight and thin

No change in the pulse when GB points were stimulated.

I am still looking at tonics and movers. I saw in our previous discussion that you mentioned Bu Zhong Yi Qi Tang for tonifying Qi and incresing peripheral circulation while moving blood away from the inflammatory site.

Harry's tongue and pulse would fit, but upon examination of the formula, it contains ginseng and bupleurum...both of which seem to aggrevate Harry's symptoms. That confused me.

Any suggestions?

Thanks! Heather

by naturevet

March 23, 2010

Hi Heather,

This is a tough case, but I have an idea. Everything that has aggravated the dog has had an outward push (Bupleurum, DHJST, for eg.). Everything that has helped has pulled inward (eg. Hypericum). So now I'm wondering if that is the main objective. If the symptoms are violent pain, Si Miao San can help wtih that and pulls inward. I'd wonder about that.

Maybe just give the owner enough for a few days, to see if it's well tolerated. If so, we should run with it. Maybe the dog is less deficient (i.e more exess) than we think.

S

by Heather1

March 31, 2010

Hello Steve!

Well, Harry became worse on the Si Miao San (one teapill twice daily) with scratching and crying at 3 am in addition to his normal sratching and crying at 6:30 am.

He has been on hypericum on and off without much improvement, but it doesn't make him worse.

Diane has been doing some research online and many people are using a Western herbal formula for these cases. It's called Nerve 8 by Nature's Sunshine.

Ingredients:

White willow bark (good for inflammation)
Black cohosh root
Capsicum fruit (could be a bit warming)
Valerian root
Hops flower
Ginger root (again, warming)
Wood betany
Devil's claw

Have you had any experience with this formula? It does seem interesting and I am tempted to try it.

Any thoughts?

Heather

by Heather1

May 3, 2010

Here's a Harry update...we have taken him off of all Chinese herbs. Diane is giving him hypericum as needed.

We will watch to see if his symptoms change or progress. If they do, I think we will work with Western herbs to treat his symptoms.

Thanks so much for your help and any additional thoughts are always appreciated!

Thanks again,
Heather

by naturevet

May 3, 2010

Hi Heather,

Sorry I wasn't much help to you. I do appreciate the follow up, as I'm sure do the other 1000 veterinarians using the forum. So thanks for that. If you could let us know what this western formula accomplishes, then it will likewise be good information for everyone.

All the best

Steve

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