Question Details
Help With A Case Of Gulping
by bfellisdvm - April 8, 2022    View Case Report
Can you help me out with the case linked to this question?
Replies
by naturevet
April 8, 2022
Hi Brett,

Looking at the totality of the case, this appears to be what the Chinese described as Wei Syndrome. The character for that is a picture of corn stalks wilting in the field. The image suggests a lack of moisture due to unrelenting Heat, causing atrophy and weakness. The prescription in those days was Si Miao San

SMS certainly fits the history of heat intolerance, ravenous appetite, rapid toneless pulses, and the purple red tongue (since Damp Heat is actually a form of Stasis Heat). SMS will also help mitigate any adverse effects of the pred that is in use.

Eventually, you may need to introduce a Yin tonic like Zhi Bai Di Huang Wan to rehydrate the Yin once the Heat has been cleared. I'd try SMS by itself first, thought, since the gulping suggests a Dampness or Phlegm accumulation in the Stomach itself that may need to be drained and dried first. Otherwise, a Yin/Blood tonic could aggravate it. A decent Yin tonic to try might be Zhi Bai Di Huang Wan, once you see a drop in the gulping.

If the gulping does not stop even as the rest of the case improves, I'd wonder about Stomach Yin deficiency and dryness. I'd look at Yi Guan Jian in that csae, since it hydrates Stomach Yin.

Hope this helps you out. If not, there are many other ideas: Wu Mei Wan, Xiao Chai Hu Tang, etc., so let us know how it goes.

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Good luck!

Steve
by bfellisdvm
May 28, 2022
Thank you! Bentley is doing well, but recently started mild episodes of gulping that the owner is able to resolve early in course with massage of rectus muscles. He is taking the Four Marvels at 3 tabs bid (he is 43.3 lbs BCS 6/9 in front 4/9 in back) without issue. His pulse is actually toned on R today and softened with SP3, but not GB41. Tongue is still dry, lavender, small with central crack. He eats Rachael Ray nutrish chicken and veggie kibble with R.Ray Zero grain real chicken and apple canned. It has worked well for him in the past and I’m hopeful we can get over to home cooked diet once she gets settled in her new location. Bentley loves to travel and is her companion when she’s in the road or at home. I would love to add Bu Zhong Yi Qi Tang for sinking Spleen Qi and Liver Blood Deficiency. His stools have gotten soft yet formed and he is going 3-5 times per day as AP posed to his clockwork bid poops after each meal. Should I start small and work up or is BZYQT not a good idea? I’m concerned with Heat trapped in the middle may lead to blow out diarrhea. I also updated his last two treatments in the cases area. I’m still trying to understand how this website works. Thank you for your patience and time!
by bfellisdvm
May 28, 2022
Thank you! Bentley is doing well, but recently started mild episodes of gulping that the owner is able to resolve early in course with massage of rectus muscles. He is taking the Four Marvels at 3 tabs bid (he is 43.3 lbs BCS 6/9 in front 4/9 in back) without issue. His pulse is actually toned on R today and softened with SP3, but not GB41. Tongue is still dry, lavender, small with central crack. He eats Rachael Ray nutrish chicken and veggie kibble with R.Ray Zero grain real chicken and apple canned. It has worked well for him in the past and I’m hopeful we can get over to home cooked diet once she gets settled in her new location. Bentley loves to travel and is her companion when she’s in the road or at home. I would love to add Bu Zhong Yi Qi Tang for sinking Spleen Qi and Liver Blood Deficiency. His stools have gotten soft yet formed and he is going 3-5 times per day as AP posed to his clockwork bid poops after each meal. Should I start small and work up or is BZYQT not a good idea? I’m concerned with Heat trapped in the middle may lead to blow out diarrhea. I also updated his last two treatments in the cases area. I’m still trying to understand how this website works. Thank you for your patience and time!
by bfellisdvm
May 28, 2022
Or maybe Yi Guan Jian like you said initially? Or the Zhi Bai Di Huang Wan? Any tips on determining which one may be better? I’m thinking Yi Guan Jian to help the Stomach and pancreas get along? I don’t feel he is Hot enough for ZBDHW. THANK YOU!!
by naturevet
May 31, 2022
Hi there,

Since Bu Zhong Yi Qi Tang has an upbearing effect, it might be safest to start with Yi Guan Jian. I'd give that a try first. Since SP 3 is very close to LV 3 (for most acupuncturists), you could be looking at a case that needs Liver support. YGJ provides that without the upbearing effect.

Let me know what happens and we can go from there

Steve
by bfellisdvm
October 20, 2022
Bentley is continuing to improve with Si Miao San and Yi Guan Jian. No signs of IBD, no episodes of gulping and we are weaning off budosenide…very carefully. He is off gabapentin, phenobarbital, tramadol, carprofen, and amantadine- hard to believe he was placed on so many drugs with multiple side effects with no diagnosis. I’m working on getting transition to whole food diet to finish the treatment. I’ll keep ya posted.
by naturevet
October 20, 2022
Nicely done!

Steve
by bfellis
December 23, 2022
I saw Bentley again today. He is now living in Alabama (I’m in Ohio ) and I feel the Damp Heat is a bit tougher down there. As well as he is still on processed food-got the owner to agree to change that today. He has also been on the Kahn Herbal tablets at 3 Four Marvels BID and 2 Glenhia and Rehmannia BID.
He is off of all seizure meds and have lowered Budosenide to 0.5mg sid.
Today he has active GB and TH points (around ears and BL19&22, GB 30
Tongue is pink to purple and wet
Pulse is deep and hard to find initially
Vented Tai Yang at BL40 and pulse became broad and toned. Tonified GB30 and pulse completely softened. I then tonified ST 37 and sedated GV3 and achieved a moderate pulse. Patient still quite sensitive to rolling/traction of skin in T/L region so I opened the Dai Mai w/GB 41. Cleared Ah Shi points.
So my plan is to get over to whole food/unprocessed diet (Farmers’ Dog is what she is willing to try) and stop Kahn tablets and switch to Natural Path granules. I’m continuing Si Miao San with 20 gm/100 of Yi Guan Jian at 0.5 to 1.0 grams BID. Also adding Xiao Chai Hu at 0.5 to 1.0 gm bid.
A question I’m having trouble wrapping my brain around is he has always had a strong desire to lick anything metal. Does not eat things-no pica, but how do you rationalize that desire? Could it be related to Stomach Heat/Yin Deficiency? I remember hearing gallbladder attacks result in a metal taste in humans mouth-could treating the Shao Yang reduce or resolve this symptom?Just want to know what box to place that little nugget of information.

Eternally grateful for your time and support ,

Brett
by naturevet
December 27, 2022
Hi Brett! I'm glad you're continuing to rock this case! I do associate the licking of rocks and metal with Blood (and therefore Yin) deficiency. It's a loose connection that I wouldn't stake the entire analysis of the case on, but it seems consistent.

Note that Ferrum is a major component of heme and is of course a metal. So the licking of metal to satisfy and Blood and Yin deficiency makes sense from that perspective. It suggests the dog has a sort of 'nutritional wisdom' in its cravings.

Steve
by bfellisdvm
December 29, 2022
Makes perfect sense to me. Cheers!
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