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Thrombocytopenia And Anemia

by LJH - October 22, 2020 View Case Report

Hi Steve, This 6 yr M(N) 70lb shep x has a history in 2018 of partial ACL tear and ear pinnae vasculitis along with masseter muscle pain/ atrophy and inability to fully open mouth though tested neg for MMM. Improved with Benefit Hips and Knees and Bu Gan Tang. In late January 2019 low grade thrombocytopenia flared up PLT 67 (N 165-500) rDVM started higher dose steroid and I reintroduced Benefit Hips and Knees as pulse was moderate strength, sl.deep and wiry and tongue was sl pale pink with lavender tinge. Added Bu Gan Tang back in when RBC numbers were also dropping and hair didn’t regrow after abdominal ultrasound was done. Platelet and RBC numbers have improved and held fairly stable except for a dip in early spring. They haven’t been able to reduce the steroid much however. He has had fairly mild side effects from the steroid in terms of PU/PD, panting, etc though liver enzymes have increased. The rDVM concurred that vaccination this year was not advised. In the past couple of months he has been having scabs forming again on his ear pinnae, bridged of nose and in Gui all region. They tend to be fairly dry but reddened. His rDVM is starting him on mycophenolate. Is there an issue with using the herbs with it. He is currently getting 3 Tab Ben Hip and Knee BID and 3/4 tsp BGT BID. I also wondered about trying DGSYS instead of BGT or adding a bit of SMS +/- DG in case we are starting to see a bit of Damp emerging. He will get soft stool if increase the Ben Hip and Knee above current dose. Look at CH. J LGMLT though pulse not superficial or slippery ? He has never shown much in the way of Damp previously. On steroids tongue is pink and moist though. Pulse still moderate strength, moderate to sl deep and a bit wiry. Your thoughts would be appreciated. Thanks in advance. Llewanda

by naturevet

October 22, 2020

Hi Llewanda

Even though the pulse doesn't fit CHJLGMLT, if you do acupuncture, try tonifying GB points. If the pulse improves then that is your formula.

Even if it doesn't, we should probably try it. A big benefit probably comes from its content of Da Huang, which acts to reduce extravasation and sequestration of platelets and RBCs in the spleen. So given that you've managed to hold him with just pred when using XCHT, adding in or replacing the XCHT with CHJLGMLT might take him to the next level, and reduce the need for immune suppression. The response can be fairly rapid, so if he is not in immediate danger, maybe give him another week or two to respond, before giving up and using immune suppressants. Note that Bupleurum formulas do not interfere with immune suppressant drugs, but often lower the dose required for them to achieve full effect. In other words, there is a natural synergy there that can be exploited.

For the soft stools, consider concomitant Bu Zhong Yi Qi Tang, especially once you get the indices under control. Another option is Yi Guan Jian. Both can work with Bupleurum formulas to address loose stools

Hopefully this helps you out!

Steve

Chai Hu Jia Long Gu Mu Li Tang

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