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Muscle Weakness

by swaneysue - August 27, 2009

Steve I could use some help with Ember a 10-year-old chow mix female spayed.

2-year history of weakness in all four legs, generalized muscle atrophy and gagging, trouble swallowing. A neurologist worked her up and diagnosed immune mediated cranial nerve ds or polymyositis.

She presented to me on 1/09 on Dex. 0.5 mg 2 eod, duralactin, glucosamine, with msm, L-carnitine, trental,
T=pale pink wet P=deep weak wiry hard to feel
Active pts Bl 22, possible Gb points -unclear.
PUPD, panting all time, cool seeking very warm to the touch, bloated abdomen, crabby, dry coat and hair loss, stool soft but formed with episodes pudding stool.

Dx Damp heat with Qi def and stagnation. Suspected underlying blood def.

Started: Cool the Blood and 4 marvels acupuncture

Responded well and were able to reduce the dex dose
Did well improved strength, much atrophy better.

March started having bad diarrhea episodes that left her weaker. Rx Increase the 4 marvels weaned off cool the blood and added xiao chai hu tang half dose. .Alkphos elevation 800
Better for a while 2 months then more episodes of diarrhea-tried Shen Ling Bai Zhu San –helped initially but then stopped

Currently: increase in panting, feels little warmer, most pressing problem is the progressive increase in weakness and episodes of diarrhea (every 4-6 weeks). Stools are mostly normal but some are soft to pudding (3-4 weekly) some odor. Coat great, muscle atrophies same.

T= black chow tongue, moisture ok thin
P=deep wiry confined upper middle range very weak and def
Active pts Bl 20 and Bl 18
Pulse improve with Tonify Bl 20, GV 4 , St 36, Sp 4
Worse if drain Bl22, or tonify Ki3 Ki 6 sp 6
No change if sedate or tonify Bl 40

Acupuncture Tonify Bl 20, Gv 4 St 36 Sp 4 , pulse rose up could feel in all levels stronger.

Thinking Qi def with stagnation and heat. They also felt that stress emotional and too much activity lead to more weakness. So there may be a Liver over acting component.

I need to address the stools and weakness. Any weakness formulas I have looked at I feel are too warm and could aggravate the stools. I am thinking Xiao Yao San may be good but not sure if it’s strong enough.
Then today they called and reported she passed some very large dark blood clots. So blood stagnation, Qi not holding, Gi bleeds. She is getting blood work with reg vet.

Any advice would be great thanks sue

by naturevet

August 27, 2009

My thought is that you've worked your way back to the root, which sounds like a form of Spleen Qi deficiency. The Spleen generates the flesh of the muscles, and its deficiency would be reflected as soft stools. Worsening with 'worry' and overexercise are classic signs of Spleen and Qi deficiency, respectively.

Stemming from Spleen deficiency, you can have a host of sequelae, including Liver Blood deficiency. You're seeing that reflected in the points. A form of Spleen Qi and Liver Blood deficiency is Spleen Qi Sinking. In this case, the Spleen Qi is too weak to rise, and sinks to the lower abdomen. Blood deficiency follows, and from that Liver Qi stagnation. The sunken Qi then stays where it is in the lower abdomen, creating signs like diarrhea and the passage of clots of Blood.

The formula for this is Bu Zhong Yi Qi Tang. Interestingly, it is one of the formulas advocated for Wei Syndrome, and for myasthenia gravis in particular. So it finds use for autoimmune neuromuscular conditions in China, making it extra worthy of consideration here. I'd give it a try.

All the best,

Steve

by Nate Heilman

August 31, 2009

Bensky and Barolet state a modification of BZYQT that includes Er Miao San, and one that I've found helpful if there is Heat in a patient with profound Qi deficiency. Might be appropriate here.

Nate Heilman

by swaneysue

September 16, 2009

Update on Ember,57#

She responded very well to the Bu Zhong Yi Qi Tang –increase energy and attitude, playful, appetite great, but weakness in legs are the same. Coat soft and silky

Currently on 4 marvels 3 bid, Bu Zhong Yi Qi tang 1 gram twice daily, and Xiao Chai Hu Tang/Schisandra compound mix.

T= black chow, normal moisture
P= much easier to find, does not disappear as easily, can feel middle and deep, rolling
Pulse improve with tonify BL 22, 18, 40. Pulse worse with GB34, St36, St 41, Sp 3,

I was going to wait till next acup treatment and see where things were before making any changes. She really looks great, Any ideas about next step – increase the Bu Zhong Yi Qi Tang ??? Thanks Sue

by naturevet

September 17, 2009

Hi Sue,

Tonification of BL 40 can increase the Wei Qi, but also tonify the Kidney Yang. Sour herbs tonify the Wei Qi, but also tone the pulse to improve the power of circulation. Improved Qi and Blood flow improves power. So one idea I have is to add something like Mu Gua or Bai Shao and see what happens. Using something sour would fit BL 18 and the sense of rolling in the pulse. A need for astringing or sour is often accompanied by a sense of rolling or slipperiness, that we sometimes misinterpret as signalling Damp.

Use of either of the above herbs would have an antispasmodic effect. If muscle spasms or fasciculations are present along with the weakness, I would expect them to improve.

Continued good luck! And, yes, increasing BZYQT is a good idea as well.

Steve

by mikemesley

December 13, 2009

Hi Sue and Steve,

This is a great case and really interesting to see the technical details that seem to have heralded such success.
I was wondering about the continued use of the XCHT - do you think it is necessary, and what was it that made you introduce it initially Sue? Repeatdly it seems that GB/TH points haven't improved the pulse any, but maybe only because she is already on XCHT!

How is she going now??

Mike

by swaneysue

December 23, 2009

Hi sorry it took a while to reply. Ember is doing well as of today . Saw her yesterday. She has up and down days with her weakness but overall doing well. Strength improves with acupuncture and slowly declines til next treatment ( 3wks). She also does the underwater treadmill and this makes a noticable improvment too. I put her on the XCHT based on the elevated liver enzymes from the chronic Dexamthasone use. we have been able to taper its dose but not eliminate its use. We also will increase the dose temperarily if she has a decline. I believe the XCHT helps with the damp heat obstruction side effects with chronic steroid . I checked my notes and I have not found active GB points. Will keep you posted . Happy holidays Sue

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