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Elevated Liver Enzymes In A Dog

by ajerger - November 3, 2024 View Case Report

Hi there,
Chloe is an 11yr FS pitbull. Super nervous, questionable with other dogs, likes people, just very nervous.
I first met her after she ruptured her ACL in August 2023, she had had surgery on her other leg a few years back. Owner wanted to avoid surgery this time..

PE:
Nervous/shy ( Liver blood deficiency)
several lipomas/cutaneous growths (damp)
Partial ACL (Shao Yang Disharmony)
Soft white dander on coat ( Liver blood deficiency)
All else within normal limits
Diet: Was changed to Home made food
Normal drinking, normal urinations, formed stools.

Labs: mildly elevated cholesterol and ALT, normal bile acids/Ultrasound.
Pulse: Mid depth, toned, resists compression, normal rhythm and rate
Tongue- somewhat wide, lavender with pink around periphery.

TCM dx: Damp, Liver blood deficiency, Shao Yang disharmony
Acupuncture rx: Warm on GB channel, GB34, BL 60, GB29, GB20
Herbal Formula: Xiao Yao San, Xiao Chai Hu Tang

For the last year this patient is doing great with musculoskeletal, walking, great appetite, but the ALT has remained elevated. It goes down over time but never normal and then recently ( last 2 weeks) has gone up to over 300.
A recent ultrasound revealed course liver and spleen with nodular pattern.
Otherwise patient is doing well.

What role is the weather playing if any right now?
Not sure where to go from here..
Thanks so much..

by naturevet

November 3, 2024

Hi there! It sounds like you're doing a great job with this case. Regarding the ALT, it may not be possible to get it all the way back down to normal, but holding it within a narrow range year after year is a reasonable goal.

If the ALT is climbing lately, then it can signal Liver Blood deficiency, calling for more Xiao Yao San, and relatively less XCHT (or even taking a break from it entirely, if many of those original Shao Yang complaints have resolved). The two formulas do compete with each other so far as their effect on Liver Blood flow is concerned. XYS tends to increase hepatic blood flow and XCHT tends to decrease it. The result is that they might well cancel each other out, except when the seasonal influence changes.

Since winter is the time when liver circulation is weakest (because it varies directly with peripheral blood flow and portal vein circulation), it makes sense to give more XYS and reduce the XCHT. That should hopefully hold the ALT at 300 or, ideally, reduce it. In the spring and fall months, Shao Yang disharmonies flare up, so if ALT worsens at that time, you'd bump up the XCHT (at least in spring) and probably decrease the XYS. In mid-summer, Blood deficiency rears it's head again, so more XYS may be needed.

If we were to distill this into a few rules for this dog, you'd emphasize XCHT in spring and fall, and XYS during the solstices. So, a quarterly shift in the mix of the two formulas may be needed, if you want to persist with them both. That should hopefully end up holding the ALT in a narrower range, even if you don't get around to normalizing it. Let us know if that's what ends up happening.

Also, don't forget basics like Milk Thistle. It may not do a lot, but it's never going to be harmful in trying to lower those liver enzymes

Steve

by ajerger

November 26, 2024

Hi there,
We discontinued the XCHT, continued XYS and the ALT has gone down significantly, not normal but much lower!
Overall, she is doing very well. The only new development is her bark suddenly became hoarse. She is also newly hypothyroid, about a few months..managed on thyro tabs. Not sure if this is related?

by naturevet

November 26, 2024

Hi there! XCHT may have been forestalling some laryngeal paralysis. If the thyroid meds don't help or the hoarseness doesn't otherwise resolve, then perhaps either a higher dose of XYS, and/or the re-introduction of a tiny amount of XCHT is in order. Hopefully it resolves

S

by ajerger

March 25, 2026

Hi there, just an update. I added back XCHT, she was doing great on that. She began to cough about 1 year ago now, and X-rays revealed an unclassified mass either osteosarcoma or soft tissue sarcoma, X-rays are unclear. I continued Xiao Chai and added Mistletoe therapy and she has been doing very well, Liver enzymes normalized. so far so good!
Thank you as always!
~Allison

by ajerger

March 25, 2026

Also I added Xue Fu Zhu Yu Tang, forgot to mention!

by naturevet

March 25, 2026

You're just knocking these cases out of the park!

Good job

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