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Lab With Liver Enzyme Elevations

by rmtran - September 12, 2009

Hi Steve,

I have a 10 years old FS lab with skin problem and liver enzyme elevations.

She had such a severe allergic skin disease for over 5 years. She was treated with cyclosporine, but it was discontinued due to the liver enzyme elevations (ALT-226, ALP-322). She is currently on Long Dang Er Miao San, and she is doing very well on her skin; however, recent blood work showed worsening of liver enzyme elevations (no values available yet; done at rDVM). The client also recalls that rDVM mentioned that her serum was lipemic even if she was fasted.

I saw her today and her tongue was pink with a hint of lavender, and her pulse was wiry. She has shu point sensitivities along BL-18 thru 23, and her mid back is sugging (always be that way as long as I have seen her for the past 3 months). The client do not think that she is in pain and she does not have any obvious lameness, but she has a history of arthritis on her left front elbow.

Needling BL-18/19/23 helped to improve her pulse at some degree.

I am wondering if I can add something to her regimen to help her liver enzyme elevation, beside recommending SAM-e/Milk Thistle as supplements.
I am thinking about Bu Gan Tang here, and do you think it is compatible with LDEMS (Kan)?

I also recommended abdominal ultrasound, just to be sure about what is going on.

Thanks for the advise.

Rieko

by naturevet

September 14, 2009

Hi Rieko,

Hopefully the ultrasound will illuminate things for us. Meanwhile, if there are Blood deficiency signs, Dang Gui Shao Yao San is a better choice when you have had such success with Damp draining and drying formulas. Blood deficiency is one sequela of strongly drying formulas. If you see many other dryness symptoms (e.g. coat, thin taut pulse, dry eye, dry tongue, pale tongue), then a Blood tonifying approach is called for.

If the effect at the acupuncture points was actually one of sedating, then you may be dealing with Blood stasis, seconary to Damp Heat. That is an alternate explanation for the deeper pulse, and more likely if that deep pulse was quite strong (entrapment of Blood in the interior can create superficial pallor). In this case, Ge Xia Zhu Yu Tang would be the likely choice.

Hope that's of some benefit in helping you sort it out. If the liver looks big and hyperechoic, it's Blood stasis. If it looks normal to small and hypoechoic, it's Blood deficiency. So an ultrasound can be of benefit to both Eastern and Western analysis.

Good luck!

Steve

by rmtran

September 15, 2009

Hi Steve,

This patient's pulse was not deep, but wiry ( I am sorry for not being clear).

For now, I am going to use Dang Gui Xiao Yao San for this patient.

Thanks!

Rieko

P.S. I am able to read my threads (the one I get on my e-mail account), but I cannot open forum from there or website.
There is a word said: Unable to configure forum data for display: Table 'displayThreads' already exists on top, and rest is blank.

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