Question Details
Dysuria In A Dog
by bfellis - March 4, 2023    View Case Report
Socket is a 5 yr old MN bully type breed with history of allergic skin disease, can be a little snippy/ guarding/ offer to bite if restrained. Socket is a military family pet and has recently been living between homes with mom or dad depending upon need/availability- anxiety with owners leaving him in crate has increased since Spring of 2022 and he has escaped from their yard several times , one event resulted in being hit by a car January 2023. He was seen by an associate on 8/8/22 for annual exam and for separation anxiety and dysuria. He was Rx'd Clomipramine which did not help with behavior modification.
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 ,

by naturevet
March 5, 2023
Hi Brett

I'm wondering if the dog has a comprehensive Blood and Yin deficiency (KI, LV, HT) that is underpinning the anxiety (from KI def), leading to over the top reactions (HT Fire) such as escaping. The overall dryness also means the Yang Ming can get hot, driving thirst, appetite and facial redness. The tongue redness with the thin pulse and lower body score support Yin deficiency as well. Low ALP supports LV Blood def.

Your acupuncture points would seem to support the notion of comprehensive Blood and Yin deficiency. Tonifying HT 7 (Heart), SP 4 (Sea of Blood and Qi), CV 3 and KI 6 (both major Yin tonification points). When Yin is deficient, Yang can disengage and rise, to create both heightened anxiety but also a lack of awareness or control over the Bladder.

My thought would be to try Tian Wang Bu Xin Dan to comprehensively tonify Yin, and Sang Piao Xiao San (or NPHC HRUI Combination) to address the rising of Yang and the lack of conscious control over urination. Let us know how it goes!

by bfellis
March 13, 2023
Thank you! I will see if I can get Mrs Cheow to sign on for some more herbs!! I will definitely let you know where this goes.


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