Brett F. Ellis, DVM, CVSMT, CVA
Question Details
Acute Diarrhea With Bu Zhong Yi Qi Tang In A Dog
by
bfellis
-
January 26, 2021 View Case Report
Brett F. Ellis, DVM, CVSMT, CVA
Replies
by
naturevet
January 27, 2021
Hi Brett,
I can tell from your case analysis that you are an excellent practitioner, but I will see if I can shed some light on what might be going wrong.
The full pulse in this dog, remedied by GB 41, confirms your suspicions of a Shao Yang disharmony, as does the history of ACL tear; spinal cord inflammation from cervical instability; food sensitivity; and atopic dermatitis. Although you've yet to treat that disorder, Winston has tolerated herbs that treat other problems, so, why the problem with Bu Zhong Yi Qi Tang and with Ginger?
Looking at Body Sore and Cervical Formula, they both act similarly - as tonics that also disperse, either by Moving Blood, expelling Wind, or both. Bu Zhong Yi Qi Tang, on the other hand, has the opposite effect, meaning that it astringes and contains, thanks to its content of Huang Qi (Astragalus). Presumably if you had given this dog Wei Qi Booster, you would have seen a similar adverse reaction. The full pulse, especially occurring in January, tells us that this dog has bottled up Yang due to its Shao Yang disharmony. The outer Tai Yang layer acts like a shell and pushes inwards. Using a Tai Yang tonic like Huang Qi would just worsen problem of bottled up Yang, to the point of causing clinical signs.
How should we make sense of that reaction from a biomedical perspective? You may have heard the concept of Astragalus and other Wei Qi tonics 'trapping the thief inside the house' if the animal already has a pathogen invasion when they are introduced. Putting that in western terms, Astragalus ramps up local immune and inflammatory responses. In immune deficiency, that is a good thing, but in sub-clinical inflammation, that is a bad thing. This dog almost assuredly had an inflammatory bowel problem going on, on a subclinical basis, that Astragalus simply fanned the flames of. Cold bitter anti-inflammatories are the solution, at least in the near term, through use of drugs like Tylan, metronidazole, etc.; and through use of herbs like Huang Qin (a major ingredient in Xiao Chai Hu Tang).
Why was Huang Qin included in Xiao Chai Hu Tang? When Yang is trapped from moving outwards by a rusty Shao Yang 'gate', it builds in the Yang Ming. Yang or Heat in the Yang Ming (Stomach, Large Intestine) causes an increased predisposition to inflammation, manifesting commonly as IBD, which Huang Qin treats. Thus, the association of a lurking IBD in patients prone to Shao Yang disharmony has been known for a couple of thousand years. Shao Yang disharmonies are often equated by people to 'trapped pathogens', and a sub-clinical tendency to IBD is just one more example of that.
Given the foregoing, you can now see why Ginger was a problem. It warms the Yang Ming, which was already too hot due to all that trapped Yang.
I think the way is clear for you to start Xiao Chai Hu Tang. It is not a Spleen cooling formula, so if you're worried about that being present, there should be no issues. The only diagnosis XCHT can aggravate is Blood and Yin deficiency, which often occur in tandem with Shao Yang disharmony, making it necessary to eventually introduce the appropriate Blood or Yin tonic to see full improvements. In GI cases, we use Yi Guan Jian, which cools the Yang Ming, taking all that heat away, and subsiding the tendency to GI inflammation. I generally start with XCHT to pull the Heat out of the Yang Ming first and subdue the pulse, then as the pulse becomes thinner and weaker (which I suspect it will in this dog), add in the Yi Guan Jian to finish the case.
In summary, adverse events are clues as to what we have been missing that can propel us ahead in resolving a case once we have taken the time to dissect and understand them. Hopefully that proves true for you here. Please let us know if that is what actually happens
Steve
I can tell from your case analysis that you are an excellent practitioner, but I will see if I can shed some light on what might be going wrong.
The full pulse in this dog, remedied by GB 41, confirms your suspicions of a Shao Yang disharmony, as does the history of ACL tear; spinal cord inflammation from cervical instability; food sensitivity; and atopic dermatitis. Although you've yet to treat that disorder, Winston has tolerated herbs that treat other problems, so, why the problem with Bu Zhong Yi Qi Tang and with Ginger?
Looking at Body Sore and Cervical Formula, they both act similarly - as tonics that also disperse, either by Moving Blood, expelling Wind, or both. Bu Zhong Yi Qi Tang, on the other hand, has the opposite effect, meaning that it astringes and contains, thanks to its content of Huang Qi (Astragalus). Presumably if you had given this dog Wei Qi Booster, you would have seen a similar adverse reaction. The full pulse, especially occurring in January, tells us that this dog has bottled up Yang due to its Shao Yang disharmony. The outer Tai Yang layer acts like a shell and pushes inwards. Using a Tai Yang tonic like Huang Qi would just worsen problem of bottled up Yang, to the point of causing clinical signs.
How should we make sense of that reaction from a biomedical perspective? You may have heard the concept of Astragalus and other Wei Qi tonics 'trapping the thief inside the house' if the animal already has a pathogen invasion when they are introduced. Putting that in western terms, Astragalus ramps up local immune and inflammatory responses. In immune deficiency, that is a good thing, but in sub-clinical inflammation, that is a bad thing. This dog almost assuredly had an inflammatory bowel problem going on, on a subclinical basis, that Astragalus simply fanned the flames of. Cold bitter anti-inflammatories are the solution, at least in the near term, through use of drugs like Tylan, metronidazole, etc.; and through use of herbs like Huang Qin (a major ingredient in Xiao Chai Hu Tang).
Why was Huang Qin included in Xiao Chai Hu Tang? When Yang is trapped from moving outwards by a rusty Shao Yang 'gate', it builds in the Yang Ming. Yang or Heat in the Yang Ming (Stomach, Large Intestine) causes an increased predisposition to inflammation, manifesting commonly as IBD, which Huang Qin treats. Thus, the association of a lurking IBD in patients prone to Shao Yang disharmony has been known for a couple of thousand years. Shao Yang disharmonies are often equated by people to 'trapped pathogens', and a sub-clinical tendency to IBD is just one more example of that.
Given the foregoing, you can now see why Ginger was a problem. It warms the Yang Ming, which was already too hot due to all that trapped Yang.
I think the way is clear for you to start Xiao Chai Hu Tang. It is not a Spleen cooling formula, so if you're worried about that being present, there should be no issues. The only diagnosis XCHT can aggravate is Blood and Yin deficiency, which often occur in tandem with Shao Yang disharmony, making it necessary to eventually introduce the appropriate Blood or Yin tonic to see full improvements. In GI cases, we use Yi Guan Jian, which cools the Yang Ming, taking all that heat away, and subsiding the tendency to GI inflammation. I generally start with XCHT to pull the Heat out of the Yang Ming first and subdue the pulse, then as the pulse becomes thinner and weaker (which I suspect it will in this dog), add in the Yi Guan Jian to finish the case.
In summary, adverse events are clues as to what we have been missing that can propel us ahead in resolving a case once we have taken the time to dissect and understand them. Hopefully that proves true for you here. Please let us know if that is what actually happens
Steve
by
bfellis
February 16, 2021
Thank you for your kind words and prompt and informative response. The XCH w/ QJ was started and patient had his first normal stool in weeks after a week on half dose and 2-3 days on full dose. His weakness has progressed as owner has discontinued Meloxicam in the hopes to see an improved response to low dose prednisolone-5mg SID (as I have seen in several giant breed dogs with similar weak GI constitution , I often find suboptimal cortisol production in these guys). So we are better, but should i add Xiao Huo Luo Dan for Blood stagnation? I have not seen Winston yet to re-evaluate pulses on XCH w/QJ, maybe that should be the next step. Thanks again, I really learned and was able to grasp the function of BZYQT from your description..after I met Dr. Signe Bebe, I felt I could solve most of my problems with BZYQT and Shen Ling Bai Zhu,I now realize what a Shao Yang pathology is and why tonifying the Spleen before eliminating/clearing the pathogen works against you. Looking forward to hopefully meeting you at Nate's some time for herbal courses when we can finally get together without fear of making yourself or others sick. We took IVAS together and were roomates, very proud of all he has done at A Time To Heal.
Brett
Brett
by
naturevet
February 17, 2021
Hi Brett,
Absolutely you can try Xiao Huo Luo Dan to replace the Meloxicam. I wouldn't assume it would aggravate a Heat condition in the Yang Ming, but watch for that as a possibility, and be prepared to pull back on the dose if it happens (leading to a return of loose stools).
You may also find that as you introduce a combination tonic/mover like Yi Guan Jian, the dog gains strength as well.
Hopefully that helps. I look forward to seeing you at Nate's course someday. Meanwhile, continued good luck and let us know how this case goes!
Steve
Absolutely you can try Xiao Huo Luo Dan to replace the Meloxicam. I wouldn't assume it would aggravate a Heat condition in the Yang Ming, but watch for that as a possibility, and be prepared to pull back on the dose if it happens (leading to a return of loose stools).
You may also find that as you introduce a combination tonic/mover like Yi Guan Jian, the dog gains strength as well.
Hopefully that helps. I look forward to seeing you at Nate's course someday. Meanwhile, continued good luck and let us know how this case goes!
Steve
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