Seemed like a classic damp heat case, so changed her diet to low carb fresh food and sent home on Si Miao San. It was a little chaotic with little kids running around, and I did not write down pulse/tongue, but I seem to remember thinking it fit close enough, especially season of onset.
Client thought maybe improved a little, then came back with a vengeance, making the dog crazy in about 2 weeks. I thought, okay, not responsive to diet change/SMS, must be a XCHT/SWT case. They were about to leave on a camping trip for Labor Day weekend. She drove a couple hours to pick up the herbs because dog was so desperate.
Dog did really well on camping trip, but rash/itching/licking got bad again when they got home. Since on ventral surface, we went over (second time) where she lies down, household chemicals, etc. Discussed a trial of keeping her off the grass. Dog is more and more desperate, a dose of benedryl no longer taking the edge off, so I encouraged her to get another cyctopoint shot to buy us some time. Meanwhile she has taken up her rug (which had been replaced since problem started anyway) but says that the dog only sleeps on the couch anyway.
Zari tends towards over the top immune reactions-- had big reaction to wasp sting when she was younger, recently her face blew up playing with a toad. Her feet are not affected, so contact dermatitis seems less likely-- but possibly an additive layer? Seems like she "read the book" on itchy dogs, but only skimmed the table of contents? What do you think? Time and persistence with the XCHT/SWT approach? Food allergy testing? (I suggested avoiding chicken/lamb as proteins) One of your Gold Standard mixes?