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ITP In A Dog

by jenmercier - August 3, 2024 View Case Report

Hi Steve,
Trying my hand with a case of ITP!

Jasmine was first diagnosed with ITP in Feb 2023. At the same time she was having voluminous stool and rapid weight loss and was also diagnosed with EPI. She had recently been treated with clavamox for a AG infection
She was eating a fresh food diet
She responded well to steroids and pancreatic enzymes. We also started Gui Pi Tang. With higher dosing of steroids she eventually had some hair thinning and LE elevation but both resolved with taper.
By the end of September 2023 she was down to 2x week low dose steroid and doing great. Stool and appetite normal with pancreatic enzymes. She had d/c'd the Gui Pi Tang
Feb 2024 she had been off steroids for a few months and during AG expression I noted some bleeding. Recheck of CBC revealed thrombocytopenia again.
Steroids were restarted along with Gui Pi Tang (owner has been giving "when she remembers"). Platelets are back to normal but her hair is thinning quickly and skin is becoming thin as well. She has mild pruritus of the paws with a light yeast infection. The skin of the paws is not erythematous nor moist, rather the skin is thin with very light scale and alopecic.
She had a brief bout of what appeared to be gastritis with grass eating and belching but resolved with course of pepcid.
July 26 we repeated full labs. LE are normal as are platelets.
She is eating great, stools are normal, weight is stable.
Her tongue appears a bit dry and a muddy pink color
Pulse is wiry and somewhat forceful, moderate depth, normal rate
She is not seeking cool or warm. Has worsening alopecia and has mild pruritus.

I am working through the immune mediated lectures for the herbal course and am having trouble locating her pathogen invasion. It seems like long standing Damp Heat accumulation with underlying Spleen Qi deficiency (diarrhea followed but EPI) has led to Wind Damp Heat invasion and damage of Blood and poor circulation to the periphery to nourish the skin as the pathogen invaded deeper (to the Ying/Xue layer?).
She doesn't seem to fit exactly into one layer.
I can see arguments for treating with Si Miao San, Xiao Chai Hu Tang, or Qing Ying Tang.
How do I sort this out?!?

by naturevet

August 4, 2024

Hi Jen,

The pulse you describe is classic for Shao Yang disharmony, which commonly occurs as a seasonal disorder in the spring. The time of onset is also typical of a Jue Yin excess, another up/down disharmony. Bu Zhong Yi Qi Tang treats the Jue Yin excess while Xiao Chai Hu Tang treats the Shao Yang disharmony. Between the two of them, the up/down are harmonized within both Yin and Yang. Those are the two formulas I would suggest.

Not all adverse reactions to steroids suggest Damp Heat and a need for Si Miao San. Only the symptoms of Damp Heat itself (thirst, appetite, heat intolerance, etc.). The adverse reaction of steroids here smacks of Blood and Wei Qi deficiency. Plus, it would be unusual for a fresh fed dog to be afflicted with Damp Heat. A relatively pure Spleen deficiency is more likely, without secondary Dampness, given the symptoms of malabsorption. That same lack of gathering and assimilation is what is causing the "Blood to escape the Vessels".

From a symptom interpretation perspective:
- the skin lesions are typical of Blood deficiency (despite the use of Gui P Tang)
- the involvement of extremities and the secondary infection signal a Wei Qi deficiency, despite the Gui Pi Tang
- the tongue color and dryness suggests a degree of Heat from Yin deficiency, perhaps calling for Qing Ying Tang
- EPI suggests Spleen deficiency (based on the lack of assimilation)
- Both Shao Yang disharmony and the type of Jue Yin excess that responds to BZYQT result in a condition of Blood stasis which can aggravate the bleeding tendency. Additionally, they can predispose to anal gland infection and unresolved inflammation. The anal glands are actually part of the upper burner, explaining why many dogs with issues there responding to Upper Burner formulas like Modified Xue Fu Zhu Yu Tang
- a favourable response to steroids implies either Blood deficiency or Shao Yang disharmony
Given all of the above, I think a complete curative solution probably calls for Bu Zhong Yi QI Tang and XIao CHai Hu Tang to be used together.

Hopefully this helps you out!

Steve

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