Owner reports dysuria is getting worse-no triggers have been identified- he doesn't do it everyday, but will urinate in crate when owners are more frequently. He happily goes into his crate- even when not asked. He does not gain confidence in his crate and is overall a pretty happy guy-good with people, children, ok with dogs, no major phobias, not a vivid dreamer. Socket's UA is unremarkable (Sp Gr 1.040, pH=8, sediment is quiet) on 2/17/23. Patient was not brought in for TCVM, but I can't shut my big mouth so we gave it a try.
Tongue is red to purple and dry, he is a little thin (BCS 4/9), no evidence of Damp, but this dog has VERY thick skin (Tai Yang excess?) , esp on dorsum- I had to use a 25 GA AP needle to penetrate skin on GV20 and GV 3. His pulse is thin to normal, not floating or superficial as I would expect with Tai Yang excess, but a middle deep toned pulse that seemed to soften with pressure at GB 30. I decided this must be a Shao Yang case and Rx Chai Hu Jia Long Gu Mu Li Tang 2:1 with Yi Guan Jian- he also has a history of eating ravenously at night and always been a big drinker, he has mild redness around muzzle in Stomach and Conception vessel meridians- ventral surface of abdomen/thorax is not inflamed.
3/4/2023- no change in behavior or dysuria on CHJLGMLT w YGJ.
We did blood work today and no significant findings other than a mildly low ALKP (19 ; 23-212 normal range) T4 =2.3
Tongue= red to purple, dry, Pulse=Thin to normal, toned, middle deep depth that did not respond to pressure @ GB 30 today or with distal to proximal massage of ST37. SP 4 and HT7 seemed to really soften the toned pulse with tonification, GV 20 was sedated and CV 3 and KID 6 were tonified and pulse is much more moderate. What the hell does this all even mean? no diarrhea or constipation , just atopy that is worse in Spring.He has some Yang Ming signs with redness on muzzle and rapid eating, excess drinking- and does not appear as an excess patient. Wouls Bu Zhong Yi Qi Tang be appropriate? Just worried with red tongue and rapid appetite that internal Heat could make a mess of the BZYQT, would Yi Guan Jian be a safer place to start? Needles seem to have a more profound change in the pulse than just pressure or massage, at least that is my impression-possibly due to really thick skin?
Any thoughts about where to go with this case would be greatly appreciated
Thank you ,