Question Details
Herbal Choice For Dog With Epilepsy
by CDolan - August 2, 2021
I have recently started seeing a 7yo FS Dalmatian who has been dealing with epilepsy since age 4. She was initially put zonisamide, and then Keppra was added, and these reduced the frequency but did not adequately control the seizures (decreased from 1-2x/week to 1x/2-3 weeks). Phenobarbitol was added, and all seizures stopped, and Keppra and zonisamide were gradually discontinued. For about a year she had no seizures, and then about a year ago she started having breakthroughs – they started ~1x/month, and increased to ~1x/week. Her medication dose was modified, and Keppra was re-started, and her owners tried a CBD supplement for ~2 months, but none of these seemed to affect the frequency, so her owner stopped the Keppra and CBD (still on phenobarb).

The severity of the seizures remains the same – for most seizures, she has a short pre-ictal phase of disorientation and ataxia, the seizures lasts about 1 minute and is full tonic-clonic with loss of consciousness, and within 10 minutes she fully recovers to normal activity.

I first saw her about 6 weeks ago, and she was having ~2 seizures each week. I started acupuncture, which we have continued every 10-20 days depending on scheduling, and started her on Tian Ma Gou Teng Yin. I also recommended she switch off of the lamb kibble she was eating, and she is now on half pork kibble and half raw (a chicken formula). The seizures have decreased in frequency (once the first week, then only once in the following 3 weeks, but then back to two one week, and another 9 days later). So – I am wondering if I need to just hold course and allow more time for her body to balance, or if my herbal formula (and possibly point prescription) are not getting all of what is going on for her.

Other than the seizures, she doesn’t have much medical history – her temperature preference is fairly neutral, her digestion is stable with no tendency toward soft stools or vomit, normal thirst, good sleep, athletic body condition, and good energy and gets a lot of exercise. She had some skin allergies (hives) when they moved from Florida to Utah in 2016, but it resolved and hasn’t recurred, and she is occasionally leash aggressive toward other dogs, but generally friendly with other dogs. The seizures have happened at all times of the day/night – sometimes they seem to pattern as all evening or all morning for a while, but I can’t find any pattern to this (seasonal, etc). I also don’t find a seasonal pattern – her first seizure was in July and then they picked up in August through September (then started on anticonvulsants), and her breakthroughs started in January and picked up steam through the summer (when dosing was adjusted in response, etc.).

Physical exam is largely unremarkable. She had a superficial ulceration on her left hock where she had been licking a scrape she got while hiking, she had a tiny amount of fine powdery dandruff, and mild radiant warmth over her dorsal lumbar area. Her personality is aloof, independent, mellow, and stubborn. Her tongue is dark pink, medium width, and initially had a very few microcracks and now seems a little more wrinkled. Her pulse was initially slightly narrow with lower tone, and now seems medium width and higher tone but more superficial.

Would a different herbal formula be better? Maybe Chai Hu Jia Long Gu Mu Li Tang? Ban Xia Bai Zhu Tian Ma Tang crossed my mind, but to me doesn’t seem to fit her signs as well. Or, are there other things I should consider (more CBD, push harder for low-processed diet, homeopathics)? I’ve been using points to expel internal wind (LV 3 and LI 4, GB 20 or BL 10, etc.) and strengthen Blood and Liver. Thoughts/input/feedback would be much appreciated. Thank you!

-Cate
Replies
by naturevet
August 6, 2021
Hi Cate,

The pulse you're seeing, especially at this time of year, might be a Drum Skin pulse, signifying a Tai Yang excess (i.e., an excess in the head and also the dorsum), which fits with the history of seizures and palpable heat along the dorsum. It fits with breakthrough seizures beginning in July and also happening in the evening, which are both times when Yin starts to internalize during the day, leaving Yang unopposed in the head. Eventually, Yang internalization completes around 1 am, and seizures can stop for a while around then.

The main cause of a Tai Yang excess, especially at those times and when the problem is seizures, is a Shao Yang disharmony. The Shao Yang is the gate through which Tai Yang passes. If it is stuck closed, Yang is trapped on the surface and in the upper reaches of the body, which are the Tai Yang regions. The gate can also be trapped in the mornings, when Yang is trying to externalize. If it can't move, it stays trapped in the Yang Ming, which likewise can cause too much Yang in the Heart, creating seizures, since the Stomach (Yang Ming) and the Heart are in direct communication. Seizures from this type of Shao Yang disharmony can start in late January and go through most of the spring. They are also more likely to happen in the morning.

Could a dog have both presentations? Since the same single 'sticky gate' can cause both problems, the answer is yes. Based on that, herbally speaking, the next thing I would try is:
Chai Hu Gui Zhi Gan Jiang Tang, with about 20g of Tian Ma added per 100g of the base formula. KPC Herbs sells the base formula and the Tian Ma. A postage scale would allow you to add the Tian Ma quickly and easily to the bottle the formula comes in. I think I have seen the formula on (Crane Herb's website. Mix it with broth or something and then pour it on the food.

Using acupuncture, you can confirm if the above explanation is just a pretty little theory or something actually helpful. If you tonify GB 20 and you feel the pulse become less superficial and toned, then you know what the problem is. Tonify other Shao Yang points, too, in that instance, and go ahead and order the herbs. Points to use include GB 34 and BL 19. To encourage Yang to leave the head, you can sedate GV 20 and tonify GV 3. I would bet the warm spot on his back is either at BL 19 or around GV 3 or 4. It could also be BL 15. If that's true, then the theory is further corroborated.

Hopefully this helps you out. Please let us know how it goes

Steve
by CDolan
August 10, 2021
Hi Steve,

Thank you so much for your reply, and explanations of how the signs may fit in to a Shao Yang disharmony, testing pulses, etc. – that makes sense.

I saw her again just before I got your response, and after reading a reply you’d made to another epilepsy post on the forum, I did experiment a little with pulse response to needles at my last treatment – checking BL 19, GB 33, and GB 41, I thought I could feel an improvement, but wasn’t sure. I didn’t needle or check pulses for GB 20 or GB 34 at that treatment, so I can try those the next time I see her.

Since the Tian Ma Gou Teng Yin that I’d had her on for ~4 weeks didn’t seem to be making any changes, I switched her last week to Chai Hu Jia Long Gu Mu Li Tang (the Kan Essentials “Settle the Yang” formula), since I had it on hand and had started thinking about a Triple Burner issue. It looks like this formula has the same core as the Chai Hu Gui Zhi Gan Jiang Tang that you suggested, but also has some added Heat and Damp drainers (??)…would it be better to switch to the Chai Hu Gui Zhi Gan Jiang Tang? I can also add in the Tian Ma to either, that makes sense.

Thank you again for your help!
-Cate
by naturevet
August 11, 2021
Hi Cate,

Maybe continue on with the CHJLGMLT and use the TMGTY as well. See if that makes a dent in the case. If it does, using Chai Hu Gui Zhi Gan Jiang Tang with Tian Ma added may work even better. Even with herbs, patients exhibit dose:response relationships. Using a more concise formula allows for greater exposure to the plants and minerals that will help the most, creating a better therapeutic effect. But if we are on the right track, my hope is that you will see at least a modest improvement.

If not, though, we'll have to try the CHGZGJT + TM before we know for sure it's not a Shao Yang case

Steve
by CDolan
August 13, 2021
Thanks, Steve. It sounds like she may be doing a little better with the CHJLGMLT (no seizures since starting it, but still within her recent variation). I'll work on getting the CHGZGJT and TM to try for her -- that makes sense that it is more concise/focused, so may hit the core issue more powerfully. I'll let you know how it goes over the next few weeks as a longer term response becomes more clear.

Thanks!
-Cate
by CDolan
August 13, 2021
Thanks, Steve. It sounds like she may be doing a little better with the CHJLGMLT (no seizures since starting it, but still within her recent variation). I'll work on getting the CHGZGJT and TM to try for her -- that makes sense that it is more concise/focused, so may hit the core issue more powerfully. I'll let you know how it goes over the next few weeks as a longer term response becomes more clear.

Thanks!
-Cate
by CDolan
August 13, 2021
Thanks, Steve. It sounds like she may be doing a little better with the CHJLGMLT (no seizures since starting it, but still within her recent variation). I'll work on getting the CHGZGJT and TM to try for her -- that makes sense that it is more concise/focused, so may hit the core issue more powerfully. I'll let you know how it goes over the next few weeks as a longer term response becomes more clear.

Thanks!
-Cate
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