I'm hoping you can help me untangle some of the patterns in my case "Sunnie", particularly with regards to matching the pulse with the herb choice.
"Sunnie" is a 5 year old lab who has had 2 major abdominal surgeries in the last 4 weeks (swabs left in for desexing procedure years ago > abdominal mass found 4 weeks ago). She has had 2 x enterectomies and has not recovered well from 2nd surgery with production of huge amounts of peritoneal effusion. This is thought to be inflammatory though one aerobic bacteria was grown last week and she has been on various antibiotics (Amoxyclav, enrofloxacin, trisoprim, metronidazole). Latest bloods (yesterday) show anaemia with reticulocytosis, severe neutrophilia, monocytosis, slightly reduced albumin and slightly increased globulin levels, increased ++ ALKP with other liver enzymes normal, increased bilirubin, normal cholesterol, BUN raised++ with normal creatinine.
I first saw her 6 days ago - there was only a small amount of abdominal effusion, but she was very dehydrated with severe weight loss / sarcopenia. She wanted to lie outside on cool tiles, but felt very cold to touch, mm very pale and cold, tongue big flabby wet and blue. Pulse was strong, toned, slippery, fast, compressible, and superficial (I was surprised as I was expecting a deficient pulse with the coldness etc). My TCVM diagnosis was Global Qi, Yin and Yang Deficiency, Spleen Qi Deficiency, Damp Heat (based on pulse) and I wondered about Shao Yang Disharmony (?Yang separating from Yin - feeling hot and wanting to cool down but she felt so cold and deficient to me on exam).
I gave her LJZT (for nausea/inappetance, Qi tonic), WLT (wasn't sure on this one as wanted to use something to address the Damp and Cold, pulse didn't really fit, but clinical exam also didn't fit SMS ??) and CHJLGMLT (for possible Yang separating from Yin) via enema on Day 1.
Day 2 - Pulse was fast, slippery, toned and more mid depth (vs superficial on Day 1). Tongue the same. She was quite a bit brighter in herself so I repeated the 6G/ WLT enema AM and CHLJGMLT PM.
Day 3 - more miserable this morning. pulse was more obviously slippery and less superficial. It was still toned but less so and compressible, mid depth, still fast. I repeated 6G/WLT enema AM.
By PM the pulse and tongue was the same, so I wondered if CHJLGMLT and WLT was the wrong choice and I needed to switch to SMS (due to the pulse), but tongue didn't fit picture (still cold, wet, blue, flabby). Anyway, I gave her a SMS enema PM
Day 4 - clinically more quiet, more abdominal effusion, nausea, anorexia. Pulse was quite fast (less fast than Day 3), mid depth, compressible, toned and slightly less slippery. I thought maybe then some improvement with the SMS and continued this with 6G via enema.
I am due to see her again in the next 2-3 days and I'm really confused about herb choices.
Inflammatory effusion, ALKP ++, neutorphilia and pulse still make me lean towards SMS, but no real response (in fact worsening demeanour and more effusion).
Cold blue tongue and protein loss makes me think of WLT, but doesn't fit the pulse.
CHJLGMLT seemingly made her worse (more miserable the morning after CHJLGMLT enema), but it could (??) fit the pulse and the long standing Damp now leading to Shao Yang Disharmony.
- Is Agastache Formula something to consider that could fit the Dampness (and bacteria found in peritoneal effusion)? Instead of SMS?
- Can I use that (or SMS) WITH a SYD formula (XCHT or CHJLGMLT?) or would that be too drying in this dog with severe underlying deficiencies?
- I wondered about using YGJ with XCHT to address the possible upper GI inflammation (raised BUN, normal creatinine) but wondered if it would be too tonifying in such a Damp case? Perhaps add 1/3rd YGJ to XCHT?
Thank you for your help - getting tangled up in knots with the pulse and tongue disparities, and lack of response!!
Sophie