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Keratitis Sicca In A Dog

by bfellisdvm - January 4, 2023 View Case Report

Aimee has moderate dry eye and owners are unable to place anything in her eyes for one day, let alone twice daily for the rest of her life. She is all terrier-friendly but stubborn. She has a history of juvenile cellulitis at 6 weeks of age. Owner did not obtain her until 10 months. The preponderance of signs with Aimee or Heat and Dryness with very little Damp tendencies. She eats ravenously, increased thirst over the last year, without dysuria. She eat Hills T/D dry and Low Fat Hills canned. She receives annual vaccines without any untoward effects per owners. Active AP points are BL 18 and GB 23.
Her tongue is red and dry with a thin coat. Mouth and lips also dry to normal. Her pulse is superficial, full and toned. It did soften with sedation of GV20 and pressure at BL18. I couldn’t get LIV 3 in this little gal!
I used laser to treat acupuncture points-GB 23 got a big response followed by calm. I also treated GB 30 (which I could not appreciate a change in pulse quality) BL 40-maybe softened pulse a bit? BL 18 got a mild response and LU 1 was well tolerated.
My initial thoughts are Blood/Yin deficiency with Stomach Heat and Liver Blood deficiency.
I got the to start whole food with The Farmers Dog and they are awaiting my (your) herbal recommendation. I’m thinking Yi Guan Jian is a part of the treatment, but is there anything to directly benefit the eyes? Or start with treating the excess Heat (YGJ) and then reassess to evaluate pulses and active AP points?

Thank you!

Brett

by naturevet

January 6, 2023

Hi Brett!

This is looking like another Shao Yang case to me, where the Shao Yang issues are creating both immune mediated disease tendencies (i.e., microbiome disruptions) as well as a tendency for Yang to be trapped in the interior. The Yang Ming is dry as a result, calling for Yi Guan Jian, as you suggested.

I think based on the improvement with sedation of GV 20 and pressure on BL 18 (or 19??), along with the response to GB 23, the other formula to add in here to treat the Shao Yang is Chai Hu Jia Long Gu Mu Li Tang. I'd give that duo a try first!

Happy New Year!!

Steve

by bfellis

January 6, 2023

Excellent! Go 1:1 to start?

Happy New Year!
Brett

by naturevet

January 6, 2023

I usually go 2:1 CHJLGMLT to YGJ

Cheers

S

by bfellis

January 7, 2023

Got it!

by bfellis

May 3, 2023

KCS has flared on Farmers dog with CHJLGMLT w YGJ (2:1). I haven’t seen Aimee yet, but was thinking of adding Long Dan Xie Gan Tang. Would I add that as the same volume as YGJ? Or go full dose? I’m thinking I will continue the former herbs at same dose. Any indications to look for to indicate LDXGT? Other than just hotter? She did have Heat radiating from her head which owner says is frequent at night at last exam.
Thank you

by bfellis

May 3, 2023

KCS has flared on Farmers dog with CHJLGMLT w YGJ (2:1). I haven’t seen Aimee yet, but was thinking of adding Long Dan Xie Gan Tang. Would I add that as the same volume as YGJ? Or go full dose? I’m thinking I will continue the former herbs at same dose. Any indications to look for to indicate LDXGT? Other than just hotter? She did have Heat radiating from her head which owner says is frequent at night at last exam.
Thank you

by naturevet

May 3, 2023

Interesting! Yes, given the hot head, you might as well try the LDXGT. If the other herbs aren't helping at all, you could just switch all the way over.

If that doesn't help, then a dispersing Shao Yang treatment might help, such as Xiao Chai Hu Tang plus Xue Fu Zhu Yu Tang

Let us know how it goes!

Steve

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