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Diarrhea/inappetance/occasional Vomiting

by ajerger - October 20, 2023

2.5 yr old Shih tzu mix FS 10lbs.

Christy has a 1.5 year history of decreased appetite, frequent loose stools, burping often throughout the day and intermittent vomiting.

These signs/symptoms seem to be much more pronounced after her spay and 1st Lyme vaccine at the post op recheck in March 2022.

She progressively got more picky with food, especially in the morning. If she ate at all it would be later in the afternoon. The owner resorted to chasing her around offering her different foods.
On the upside she has always eaten fresh with home made or freeze dried foods.

The vomiting got so bad the owner was advised to see a specialist 8/22 where endoscopy was recommended and turned down by owner, so they elected to use gastroprotectants and steroids.

The steroids made the patient worse, more lethargy, and would not eat or drink per the owner.
(Another thing that made her really worse was the Parvo vaccine early this year, she was vomiting and having diarrhea the next day post vaccine.)

Once she was weaned off over time she got back to her usual picky eating habits and normal energy levels.

She was dewormed as well due to history of Giardi which she has tested negative for a few times recently.

Historically her BUN and ALT are up and down, currently they are up. Recently her lymphocytes elevated, so I am tracking those.

Her stools are dark and soft and she has been having more bouts of diarrhea. No PU/PD, seems alert but not overly excited.

She initially responded to metro and then not, same with amoxicillin. Sucralfate helps a little.

8 parameters:
Internal
Deficient
Cold? ( will not drink, soft stools)

Spleen Qi deficient
Qi deficient ( reluctant to eat in the am)
Liver blood deficient ?

I originally tried Si Mao San, owner said she got worse, so to me that confirmed she was cold or at least not hot, so I stopped that and tried Wei Ling Tang , owner said she wasn’t worse but not any better.
Then I used Happy Wanderer tincture and the owner thinks it may have helped her slightly with appetite in the morning, but not much else.

Not sure what the next steps should be?

Thank you in advance...

by ajerger

October 20, 2023

Forgot to add
Pulse: Mid depth, toned, resists compression, normal diameter
Tongue: Light pink/lavender
Thank you!

by naturevet

October 20, 2023

Hi there! It seems you've at least ruled out Damp, paving the way for use of tonics. Even better than Happy Wanderer might be Yi Guan Jian (Glehnia and Rehmannia if using Kan). It fits a few findings:
- the slight improvement on sucralfate
- the slight improvement on Happy Wanderer
- the worsening on SMS, which is both cooling and drying (with YGJ being a Yin tonic)
- being worse in the morning (when Liver Blood deficiency is strongest)
- worsening on pred, which would damage mucosal blood supply through prostaglandin inhibition
- vomiting, regurgitation and (yes, even) diarrhea (which can very occasionally be due to Blood or Yin deficiency in the Yang Ming, causing it to overheat and produce inflammation or colitis)
If you're nervous about trying it, you could use a low dose first, or try the western herb Slippery Elm. If it similarly soothed the dog at least partly, then YGJ is likely going to help a lot.

The only other thing that springs to mind given the association with vaccines is Bu Zhong Yi Qi Tang (Lift the Qi) since it bolsters the immune response, which can become weakened during the initial immune suppressive effect of almost all vaccines. It may be that you'll need to add it later to get a full resolution of all symptoms.

As for the 8 parameters, you could add Hot, since it responded at least at first to metronidazole. Overall, the use of WLT and SMS were good ideas and important to try. So was XYS (Happy Wanderer) a good idea to test. You did well

Steve

by ajerger

October 30, 2024

Hi there,
So this case is ongoing. The stumbling block is the owner, mostly. Every time there is a latent tendency that arises, she stops the herbs. So, I can't really evaluate whether or not my herbal rx is appropriate for this patient. She is totally fine with herbs but is afraid of upsetting the patient.
So, since I last updated, the patient has remained on metronidazole, sucralfate, and omeprazole. Additionally, we have continued the Xiao Yao San, that's the one she will allow consistently for some reason. Her liver enzyme (ALT) continues to be elevated , occasionally the BUN rises as well, and recently the liver enzyme has doubled despite eating freeze dried, and herbs/supplements.
I am stuck between not having compliance and not knowing what to do next. I tried YGJ- owner thought she vomited from that and stopped the herb and is afraid to try it again.
The tongue is pale pink lavender, pulses are somewhat superficial, moderate finger lift, somewhat wirey, with normal rhythm and rate.
All of her symptoms are basically the same, reluctance to eat in the am, and throughout the day has a variable appetite, on and off soft stool, burping is consistent.
Thank you as always...

by naturevet

November 3, 2024

Hi there,

I would be tempted to try Minor Bupleurum (e.g., Natural Path's Xiao Chai Hu Tang, Kan's Harmonize the Qi, etc.) as several findings are consistent with a Shao Yang disharmony, namely:
- worsening in the fall months
- potential for Dampness and Phlegm (because the dog is potentially worse on YGJ)
- despite that last bullet point, a potential for Yang Ming Dryness, which is a corollary of Shao Yang disharmony, and occurs in the morning, causing loss of appetite
- the wiry and/or superficial toned pulse, both of which are consistent with Shao Yang disharmony, depending on where Yang is trapped. Overall, the formula has the dispersing effect which seems needed given the worsening on SMS and on pred
- the potential involvement of the immune system
- peristaltic issues like burping, vomiting, etc.
The owner keeps coming back to you, so even though she is non-compliant, she keeps giving yo uan opportunity to intervene. The nice thing about the Kan product is that you can start with tiny, label-sized doses, but increase to much higher ones if it proves helpful

Lastly, if you made some headway, we can take the success of Minor Bupleurum as indicating their is likely a microbiome issue, giving her a perhaps more comfortable non-Chinese medical diagnosis and treatment to work with. A way to promote this approach is that it's perhaps one of the fastest ways to telling if there is an issue with gut bacteria, since that is very much how the formula acts with respect to the GI tract.

Hopefully this helps you out!

Steve

by ajerger

July 14, 2025

Hi there!
So I ended up trying the Xiao Chai Hu tang and the owner noted diarrhea right away. That was in December of 2024. I gave all the herbs a break for a little while, performed an ultrasound ( normal essentially), added in Ozone rectal insufflation ( no real change in liver enzyme). I measured Haptoglobin and CRP from VDI and both were normal. I also Measured protein C activity at Cornell, which was concluded most likely Microvascular dysplasia. All of that to define clearly to the owner what my thoughts have been from the beginning. The owner does not want proceed with biopsy at this time and we have already seen an internist with all the conventional therapies as I mentioned earlier.
The Alt and occasionally the BUN are chronically elevated, right now the ALT is mid 300's.
I ended up admitting the patient back in May 2025 for a few days on Nacl IV fluids, and by the 3rd day her ALT was much improved.
So my thought process was adding in a Yin tonic/blood mover, essentially. I started with Bu Gan Tang. It's been a few weeks, no improvement. She is still on Happy Wanderer.
I was considering adding Ba Wei Di Huang Wan, since her BUN is intermittley elevated which it is currently.
Her pulses have improved some on the Bu gan tang. They are usually mid depth, toned and somewhat wirey. lately a tad more superficial and less wirey.
Her tongue color is light pink to pale with lavender center usually, it's a tad bit more pink lately.
Her TCM is:
1. Liver blood deficiency
2. Spleen Qi Deficiency
3. Qi Deficiency
She continues with taking a while to get going in the am, not hungry in the am, needs coaxing to eat, then she gets going. I finally got her off of metronidazole, sucralfate and omeprazole and stools have been formed but soft. She is eating mostly freeze dried and some home made food. She has put on weight and looks good.
She doesn't like to too hot or too cold climates.
Please let me know your thoughts! Thank you as always..
~Allison

by naturevet

July 15, 2025

Hi Allison,

Sure, that sounds like a benign thing to try and may help, given the morning symptoms. You're doing an excellent job riddling this out. Odd that she would tolerate Bu Gan Tang, but not Yi Guan Jian!

Yi Yi Ren Tang can double as a Kidney and Spleen tonic, so that is a consideration as well, although WLT in the past did not help and supports the Spleen in a similar manner.

Here's another idea. You could try Bu Zhong Yi Qi Tang in addition to what you're doing. It supports the Spleen and the Source Qi. It also helps Blood tonic and moving formulas work better by increasing Blood in the upper burner, from which it can then be distributed everywhere, including to the liver. In western medicine we similarly note a direct correlation between improved peripheral circulation and improved liver (portal) circulation. I would be tempted to give that a try!

Steve

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