Question Details
Pruritus In A Dog
by sophiek - October 6, 2023    View Case Report
Hi Steve,

I'm really struggling with a skin case - Curlie is a 5 year old Kelpie, the owners have had him for 2 years, and he has had severe pruritus since then. Prior to this he was at a rescue centre mainly on concrete and apparently his skin itching was not as severe.

He has a dominant personality, when he was first rehomed he mounted owners and other dogs (despite being desexed), would growl when disturbed from sleep and was generally grouchy. He was also hyperactive and hyper excitable. This has improved but he is still a strong personality, stubborn and dominant. The owners describe him as very confident, he doesn't care about danger and he will fight back if another dog has a go at him.
They have tried several different diets for his skin, most recently on a single protein goat BARF diet for last 3 months with no improvement.

I really thought he was the poster boy for Shao Yang Disharmony with underlying Blood Deficiency;
no improvement on a low carb/high protein real food diet
some signs of Blood Deficiency (dry coat dorsum with fine dander) and Stomach Yin Deficiency (heat and redness groin and ventral abdomen)
alopecia around the eyes with occasional greenish ocular discharge
irritated ears prone to dry discharge
chewing at feet++ but minimal changes to skin - mild redness only on ventral surface
tongue was pale pink with lavender centre
pulse was wiry, forceful, mid - deep level
AP BL 19

I started him on CHLJGMLT + YGJ. I recommended to add vegetables to make up 15-20% of diet and added a probiotic. he is also on omega fatty acids and zinc supplementation.

Revisit 2 months later - no improvement. At this time he also had a wound on front leg and he was on Cephalexin antibiotics. Once they finished owner noted itching worsened.
I continued CHJLGMLT/YGJ and added XCHT/SWT and BZYQT
I also left her with QYT to start if itch worsened.

Revisit 1 month later (which was today) - worse!
The owner had added in the QYT about 3 weeks ago. She also described him as being super hot on his body especially groin, and sweaty on dorsum.
He now has an E collar on all the time to stop him from chewing. If this is off he will chew his feet until they bleed - but surprisingly there is nothing to see on exam, no redness, no obvious infection.
Skin generally looks fairly normal, still dull coat on dorsum with fine dander. Pulse was still strong, toned, possibly slippery (I'm not great on diagnosing that one). AP BL 18 and BL 25.
I stopped the BZYQT in case this was worsening feet itching

I still think he fits SYD type of case, but I'm not sure where to go next - whether to continue the QYT and Halscion/Cessorex, or change tacks completely and try something like LDEMS. This could fit some of the behaviours / feet eye and ear issues, but he just didn't strike me as a Damp dog, more dry and Blood Deficient.
He's been on the QYT for 3 weeks, Halscion for 3 months, and Cessorex for 5 weeks... does he just need longer despite things looking worse? It is spring time here so perhaps this is his flare up time?

Thanks so much for your help, Curlie's a tough case!

by naturevet
October 19, 2023
Struggling with a skin case....sounds familiar!

It's extremely rare for a dog to be a Damp Heat case (calling for the likes of LDXGT) if they have not improved on a real food diet, but maybe this is the exception that proves the rule. I think you've thoroughly explored Shao Yang disharmony with nothing to show for it, so it's time to change strategies. Long Dan Xie Gan Tang seems a good place to start, and the Natural Path versions have sufficient Dang Gui and Rehmannia in them to address secondary Blood deficiency. It's probably what I would try next.

Let us know what happens, painful though it may be...

by sophiek
March 20, 2024
Hi Steve,

An update on Curlie - he went great on LDXGT and QYT! The itch dramatically reduced and his behaviour also improved - less grumpy with other dogs, more compliant and more settled. I also started him on Pentagenesis (Deer Velvet, colostrum, green lipped mussel, thymus) - which is more indicated for Blood Deficiency type cases, but seemed to really help.

I am due to see him again next week - his skin has been great for 3 months, but he suddenly started itching again 1 week ago despite no changes to herbs / supplements.

I've been thinking about his case, as I was so sure of Shao Yang disharmony when I first saw him - but he didn't respond to Halcyon or Cessoriex. LDXGT was the formula that made the difference - but this also helps to harmonise the Shao Yang - is that correct? We are just on the cusp of Autumn here (though it's been unseasonably hot), so wondering if Shao Yang Disharmony could be something to check for again. I'm wondering if now the recurrence of itch is due to underlying Yin or Blood deficiency after being on LDXGT and QYT for a long time. Or coming into cooler weather the Blood/Yin Deficiency is resurfacing as an issue. I'm wondering if Blood / Yin tonics will be the way to go with him now the itch has recurred, if pulse etc fits?

I also have a general question - if Damp is often a precursor to Shao Yang Disharmony, do you approach the case by using anti-Damp formulas first (then a Shao Yang formula after), or by 'opening the gate' with Shao Yang formula first, then the anti-damp formula?

Thank you for your guidance!
by naturevet
March 20, 2024
HI Sophie,

You might see the root condition showing itself, rather than a seasonal aggravation. In Shao Yang disharmony in dogs, Blood or Yin deficiency is often the root cause and is naturally aggravated in the fall months as circulation moves inward. If the pulse is at all deep, thin or weak, then that is likely the cause.

Damp is less common an issue in animals with Shao Yang disharmony. If co-existing, I often just treat both simultaneously.

The last possibility is if she changed the diet or just the dose of herbs she was using.

I'm pretty sure the answer is one of these and I'm so glad you saw success. Yes, the texts do often describe LDXGT as opening the Triple Burner, making it a type of Shao Yang formula

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