When Rosa first came to me in April 2019 with ^ ALKP (424), panting, overwt, and chronic hematuria she was truly a SP deficient, Damp, Qi stagnant girl so I put her on Xiao Yao San and a clean cooked diet. While many things got better her ALKP continued to climb (889). Her ultrasound from a few months prior suggested gall bladder “sludge” so I added ursodiol for 2 months but no real change. By fall 2019 she was really starting to drag on walks, had off/on diarrhea, and still panting so I added Si Miao San thinking I was not getting anywhere with her Damp Heat. One month later ALKP at 1666!! The owner declined further diagnostics and only wanted holistic tx. I did not see Rosa again for a few months and owner continued XYS only.
This Spring Rosa was really slowing down, panting, more Pu/pd, unwilling to go for decent walks, and her hindend was now very weak, also ALKP >2000. In April, I finally got to “see” her and (see findings at beginning of case) wonder if she’s now Cushingnoid. I added Si Miao San back as I thought her pulses were slippery. By May the owner had started to notice hyperkeritinized pads on all feet (is this Liver Bloof def?). Her hindend weakness was a real concern for the owner, she seemed duller and even depressed. I recommended a recheck and possibly further testing but o declined and wanted “another herb”. So I started on Xiao Chai Hu Tang thinking this could be a THO with hot above/cool below.
Yesterday Rosa seemed better overall but still weak in hindend. She’s also developed dry skin and dander and her fur is thinning on the sides. Her tongue is dark pink-lavender, flabby, thin, fissures, wet. Pulses are of decent tone, maybe even a little taut. Her hyperkeritinization of her digit pads may be causing her discomfort and account for her decreased joy on walks? Or it could be her hindend weakness? I’m really overwhelmed with this case and would love your opinion!!! For now I added EFAs and rec’d CBD as I don’t want to add yet another herb! She seems blood deficient now? Am I drying her out with all the herbs so far?