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Inflammatory Bowel Disease - Brody, Boston Terrier

by ahdvm - November 25, 2019 View Case Report

Hello,
I think I've added my case correctly to be able to update the progress, but please let me know if I should alter something! It's been awhile since I posted!

Brody is a 5 year old, MN Boston Terrier who was diagnosed with inflammatory bowel disease several years ago. He was managed medically for many years with omeprazole but continued to have flare ups often. I have been seeing him for the last year and we have made the following changes:
-Diet: Changes from hydrolyzed kibble to Honest Kitchen Grain Free
-Supplements: Fecal microbiome restoration therapy with animal biome, Mercola Digestive Enzymes, L-glutamine powder.
Medications: Omeprazole once daily

Current symptoms at home:
-Over the last month - has been more thirsty and will regurgitate after drinking excess water (will rarely vomit). Usually when he regurgitates it occurs in the afternoon and often will look like a tube of undigested food according to the owner.
-He will occasionally have loose stool. It is liquid without any blood or mucus. No excessive odor. Stools tend to start off formed in the morning and will progress to pencil thin, soft stools in the evening.
-His appetite is often very good in the evening, but often is reluctant to eat in the morning.
-He will wake up at night occasionally and will be restless with lip smacking
-He seeks out the sun

TCVM exam:
Pulse: Superfical, thin, toned, weaker on the left
Tongue: Pale lavender, no coating, not particularly dry or wet
Paws are cool to the touch, but ears are normal temperature
Mild fine dandruff throughout the coat
Timid in the exam room,has a history of fear aggression with strangers

I do feel that he has underlying Spleen Qi Deficiency signs and rebellious Stomach Qi, but also some liver stagnation or liver blood deficiency? The role of the liver is confusing me as to what the best supplement might be - I'm feeling like I may need 2? My thought was Wei Ling Tang and perhaps Xia Yao San? I would love your insight.

Thank you so much for your help!

by naturevet

November 26, 2019

Hi there,

Your exam findings definitely support Blood deficiency and rebellious Stomach Qi. The history of when symptoms are worse and when they are better suggests a Jue Yin (Liver, Pericardium) excess is at the bottom of both conditions.

Fall and winter are the Jue Yin times of year, so Jue Yin excess tends to worsen then. During this period, Yin becomes progressively more internalized, homing to the lower abdomen. Yang also is internalizing right now to the Yang Ming layer (Stomach, Large Intestine), and should be able to insinuate itself into the Yin. If Liver Blood deficiency exists, then the Jue Yin loses its suppleness. Yang bounces off it and instead just builds up in the Yang Ming, eventually rebelling upwards into the upper burner, producing nausea, and agitating the Heart, producing nocturnal restlessness.

As Jue Yin builds to pathological levels, it feels like a ball in the caudal abdomen, causing an increasing need to defecate (or, in FUS cats, urinate). Sometimes it is associated with constipation. More often it is associated with the frequent passage of increasingly soft and thin stools. When the animal wakes in the morning, Jue Yin is at a low ebb, producing normal stools. In human patients, they describe an upwards pressure that tends to promote food stasis, resulting in the afternoon regurgitation of undigested food.

The changes in appetite appear to be driven by changes in Yang Ming energy, which also is excessive in cases like this. In the morning, it is highest, producing what likely feels like dyspepsia and killing the appetite. In the evening it is lower, not reaching its peak again until early morning, causing the peak in appetite. The differential diagnosis for this is Dampness, but there are not many in the way of Damp symptoms here.

If all this information is accurate, then the ideal formula to try is Wu Mei Wan, which most people (wrongly) think of as an anti-parasitic formula. In the reality, it addresses the Qi deficiency caused by Jue Yin excess, where Yang is pushed up and away from Yin, creating a zone of Qi deficiency in the middle burner where parasites can reside. So, parasites are not the cause of Jue Yin excess, but rather a product of it. Other microbial imbalances can occur here following the same logic, accounting for any improvements seen with the fecal transplants.

If you don't have Wu Mei Wan on hand, you likely can initiate at least some improvements by using Yi Guan Jian, and adding a little Huang Lian, perhaps 9g per 100g of YGJ granular extract. If improvements are incomplete, you will at least know that WMW will be likely to work

Hopefully this long-winded explanation helps you out! Please let us know how it goes! I have linked your question to your case

Steve

by ahdvm

January 23, 2020

So the owner finally picked up the herbs (Wu Mei Wan). Nothing had changed as far as his presentation or tongue and pulse. Unfortunately he developing digestive upset - loud noises from his digestive tract and vomiting. The owner discontinued the herb due to the negative results.

by naturevet

January 24, 2020

In that case, I would suggest the Yi Guan Jian next, assuming there are no other changes

S

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