Question Details
Barking In An Old Feeble Dog
by pindvm - April 9, 2021    View Case Report
Diesel is an 18y old mn, pitbull mix I have been treating for many years. He is a Fire Wood dog vocal and opinionated. He is currently driving his owners crazy barking. He has chronic left front lameness and hind end weakness, tremors in the head and hind legs, many SC masses (all checked have been fatty), cataracts ( almost blind) and is almost deaf. He sees a chiropractor regularly, which generally helps for a few days with limping. He loves his walks but limps more if he goes too far. He eats well and has normal stool now but did have diarrhea Dec/Jan after antibiotic for skin infection which took weeks to stop. Pumpkin was the most helpful. Two weeks ago was vomiting yellow in the morning (possibly new turmeric supply (he has been on turmeric for years) or an L-theanine supplement which I saw had xylitol in it - both stopped). He was on Qi Ju di Huang Wan until they ran out a week ago. He is currently on Shen Tong Fang (Body Sore), Rimadyl, Hemp glucosamine supplement, Hemp calming treats, CBD oil, a mixed mushroom supplement, melatonin, probiotics and Zen treats. He eats Origin Six fish. He use to love raw veggies but has been refusing lately. Tongue pale, paler at the tip. Pulse very weak on Right. I see Spleen and Kidney Qi/Yang deficiency, possible blood deficiency and Stagnation patterns. The barking may be a Shen disturbance but he has always been like this, it is just worse since he went blind and deaf. Considering Shen Ling Bai Zhu and either Xiao Chai Hu Jia Qin Jiao Tang or Supple Spine. I was thinking BHK because if Yang isn't integrating it could be disturbing Shen. The rest of his life he was Yin deficient so this is a new pattern.
by naturevet
April 10, 2021
Hi there,

Longstanding Yin deficiency commonly exacerbates any latent Shao Yang disharmony, leading to Yang rising tendencies that can produce the restlessness and agitation of canine cognitive dysfunction as well as things like head tremors. Dysbiosis in response to antibiotic use is also a common Shao Yang complaint.

If Shao Yang disharmony continues, with Yang not able to fully integrate into meager Yin reserves, Source Qi declines, reducing stamina and producing the pale tongue. Qi deficiency itself creates agitation as the patient gives voice to their discomfiture at their loss of confidence and the ease with which they are overwhelmed.

In summary, then, we likely have three intersecting concerns: Yin deficiency (potentially causing neck tightness and spasm that creates forelimb lameness, especially with extended use); Shao Yang disharmony; and Source Qi deficiency. Each can be a cause of one of the others, so rather than trying to 'treat the roots' by working out their sequence in this dog, let's focus on treating 'branches'. In other words, treat the layer that presents itself, then wait for the pulse, tongue and symptoms to shift, exposing the next layer of concern. Only once all key layers are addressed will symptoms subside on an enduring basis.

Normally, my temptation is to start with Shao Yang and Yin deficiency, but given the pale tongue and weak (Qi) pulse, I would suggest something basic like Liu Jun Zi Tang first. See if restoration of Qi helps quell his agitation. If you like, you can target the psyche a bit more specifically, by using Tian Wang Bu Xin Dan. Eventually, though, I can see that complete resolution might require use of a Shao Yang formula. The pulse should become stronger with the use of tonics, eventually signaling the need for Minor Bupleurum or one of its derivatives.

Regarding current therapy, if Yang is rising, then it will do so even more (thus aggravating the dog) with Body Sore and any other Wind expelling formula. These formulas contain aromatics, which drive Yang energy upwards and outwards. They would be contraindicated in a Yang rising case, or a case where Yang is trapped in the exterior layers.

Regarding the forelimb lameness and response to chiropractic, that signals a neck issue. Rather than using Body Sore to address it, consider Bu Gan Tang instead. It is a muscle relaxant and Blood and Yin tonic, but will astringe rather than expel, helping to draw Yang inwards and downwards rather than pushing it outwards. In other words, it should help the dog as a whole, and not just the neck. If you use it, then probably just Liu Jun Zi Tang is fine to use in tandem with it to address the Qi deficiency.

Regarding pain relievers, if the dog is prone to dryness, NSAIDs will aggravate that tendency, risking GI ulceration. Normally I would recommend Yi Guan Jian as a treatment, but if the morning vomiting signaling Stomach Yin deficiency has subsided, then focus your Yin and Blood tonifying efforts on the musculature, Kidneys, and Heart instead, using Bu Gan Tang. The response to chiropractic suggests the forelimb issue is arising from nerve impingement, so trying something like gabapentin instead of the NSAID may be more useful and better tolerated. St. John's Wort alleviates both anxiety and nerve root impingement and is a consideration here as well.

Hopefully all these ideas are helpful and the assessment accurate. Let us know how it goes!

by pindvm
April 29, 2021
Diesel actually looks worse. His barking hasn't changed. Very demanding still. But he has started falling more since stopped Body Sore and started Bu Gan and 6GP. Tremoring is definitely worse. Almost intention tremors - like Parkinsons. He has fallen twice when trying to lower his head to pick something up - once with a full somersault. He pants most of the time. BM are normal now. TC pale lavender, pulses deep weak and hard to find. Right was weaker than Left. SP6 and BL 20 helped pulse a little. It seems like there is Liver Wind, due to Liver blood and Qi deficiency. But also Kidney Qi and Yin deficiency, all allowing Fire to rise and create Liver wind. Bu Gan and 6GP are Supplementing Liver Yin and Blood and Qi, but he is hot. Maybe should add either Zhi Bai Di Huang Wan or Long Dan Xie Gan Tang?
by pindvm
May 11, 2021
Owner texted - has been on 6GP and Bu Gan tang for two weeks, Slightly better after Acupuncture but didn't last. Owners felt he was so bad off Body sore that they restarted it. Vomiting and GI seem better, stool is normal, Tremoring the same and he is weaker in the hind end. Barking and anxiety are slightly improved. I'm not sure where to go from here. I am going to increase the dose on the Bu Gan to 3 BID and see if it helps. He's about 45 lbs. Any suggestions appreciated.
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