My patient is an 18 yo fs dsh with iris stage 4 renal disease, we’ll-managed hypertension, a grade2/6 heart murmur, and a recent history of suspected tooth root abscess. Her dental disease is severe and a course of abx and buprenorphine improved her appetite and reduced cheek swelling. Since then, she continues to act painful when chewing periodically but is eating 8oz of canned food per day, drinking more water than usual, and still is slightly less social than usual. She tends to get constipated and takes miralax daily. Her energy level is more normal now and she still jumps and grooms normally. Her mouth is painful on exam and the way she moves her tongue after taking a salmon flake, I wonder if there’s a sublingual lesion, but can’t see the area clearly. BCS is 4/9, but she is gaining weight after having lost 1lb during the tooth root abscess.
On TCVM exam she has a pale pink, slightly dry tongue, pulses are thin and rapid, her head and ear tips are warm, and she’s warm over BL 23. She likes to be curled up or in a sunbeam at home. I see her as kidney yin deficient, heart yin deficient, spleen qi deficient, and possibly a bit blood deficient with oral heat and dampness.
She is a poor anesthetic candidate and I’m hoping to help with her oral pain, renal disease, and CV disease.
I had thought about stating with zhi bai di huang. Any advice is appreciated!