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Chronic Itch In A Dog

by ajerger - May 15, 2025 View Case Report

Hi there!

Elsa is a 4.5yr old FS German Shepherd Dog, whose itch I have not been able to control for about 2 yrs now.

Prior to me caring for her she had been to a dermatologist, with some improvement using steroids, antibiotics and bathing.

I began seeing her in April 2023, after seeing my associate in February 2022 for itchiness and received a cytopoint injection which seemed to help.

Shortly after the itchiness the patient began to exhibit weakness in the hind end, which was ultimately diagnosed as a partial ACL tear of the R hindlimb.

I began treating her soon after:
4/2023
Tongue: red
Pulse: highly toned, somewhat slippery, somewhat superficial
I thought this was a Shao Yang patient. given the partial ACL.
Patient was eating Farmer's Dog, had still been using heart worm , flea/tick etc..
The pattern of skin inflammation was and still remains the ventral abdomen, ventral thighs and legs and caudal aspect of the ante brachium bilaterally. The patient has and still has an odor of yeast and slight film to her coat which you can appreciate on your hands when she is pet.

At this point I chose to start with Xiao Chai Hu Tang and microbiome restoration.
Slight improvement.

Patient was subsequently placed on a commercial raw food diet and seemed to do well, skin flare ups were still an issue.
I then added Si Wu tang with Xiao Chai, no real change.

I added Bu Zhong Yi Qi Tang with a low dose of steroids. The patient improved but still had a slight smell.

By September 2024- the hindlimb weakness worsened some ( reluctant to go up stairs, bunny hopping), so we started Laser/acupuncture and that improved. Skin seemed to be stable at that time.

A short time later the skin flared up again, I added Qing Yin tang. Little improvement.

So by October 2024, I stopped all herbs because the patient had some soft stools, I think unrelated to the herbs.
The owner was advised to restart the Xiao Chai when the patient partially tore the the other ACL 3/2025.

As of 5/2025, this is her pattern TCM:
1. Tongue is pink with lavender center
2. Pulses are somewhat superficial, toned, resists compression, normal rhythm/rate.
3. Spleen Qi Deficiency
4. Shao Yang Disharmony
5. Damp Heat- The pattern of skin lesions are ventral but I don't know why the diet change did not resolve this or at least make it markedly better?

My main issue is identifying a clear pattern for this patient, her diet is great, but the itchiness is almost as bad as when I met her, and still in the same location ( ventral abdomen, medial aspect hind limbs, caudal/medial aspect of forelimbs). Bathing does not really help right now..

Seasonally, it used to be fall and winter she would worsen, but now she has gone through all seasons without much improvement.

Thank you in advance for any advice!

~Allison

by naturevet

May 16, 2025

Hi Allison,

I'm not sure I would do anything differently, apart from doing everything together: Xiao Chai Hu Tang, Qing Ying Tang, Si Wu Tang, and Bu Zhong Yi Qi Tang. For some animals they need all of it to get where they need to go, in full doses. Ensure your XCHT contains Ginseng, not Codonopsis (Dang Shen).

Also, it's important that the food is at least 1/6 and up to 1/3 plant material, to provide the soluble fiber and preventable carbs to support the portion of the microbiome population that regulates the immune system. Many foods fall short.

While you're looking at food, try using novel protein versions, while still sticking to a fresh food diet that is at least 2/3 meat.

Lastly, probiotics should be explored. Something with Lactobacillus and Bifidobacterium, since those two genera utilize the plant material to seal the gut wall and regulate the immune system. Meanwhile, adding colostrum and/or bone broth can help seal the gut wall and bolster the immune response in the gut to help repel pathogens and heal the gut up.

If all else fails, then maintaining the dog on a low dose of prednisone may be necessary. It can even be given as needed, taking days off when the itch is less. It sounds to me, though, that if you implement all of the above simultaneously, and then keep it up for several months, you should be able to break the cycle. Note that Shao Yang cases commonly have Damp Heat appearing abdomens, but Damp Heat is exceedingly rare in real food fed dogs. If there is a little Damp there, the Qing Ying Tang should help dry it.

Steve

by ajerger

December 6, 2025

Hey there,

So since I last posted, she continued to be itchy despite my treatment plan and the owners wanted to use APOQUEL to reduce itch and subsequently her odor. She also had developed a slightly greasy coat.

So I reluctantly provided the apoquel and of course, she improved dramatically no itch with bathing the greasy coat also improved as well as the odor
They maintained her on the apoquel throughout the summer and she did well when the fall arrived she began to get a little itchy. They agreed to add back to herbs, so I added back XCHT from natural path, and she improved some.

Then most recently her stools became a little softer than normal, and right before Thanksgiving, she had full-blown diarrhea and one episode of vomiting.
I perform basic labs her albumin, total protein and cholesterol were all low and are continuing to drop.

I advised to cook her raw food with added greens and fiber, animal biome gi relief supplement, and digestive enzymes, and a short course of metronidazole.

So far, she still has diarrhea once or twice daily with some mucus, low appetite, slightly lethargic, and losing weight

I ran a UPC, which is normal, so I am waiting on a GI panel from Texas A/M TLI/PLI etc..

I am worried she has developed a protein, losing enteropathy.

Her tongue is pink with a lavender center. Pulses are mid depth, normal rhythm and rate not very toned, but resists compression.

She seems to be cool and deficient

Itching is not an issue currently.

I am seeing her today, if her protein continues to drop do I add steroids?
And I am struggling with understanding a clear TCM pattern with her.

Thank you as always,
~ Allison

by naturevet

December 7, 2025

Hi Allison,

My immediate instinct is to add Xiao Yao San to your protocol. XCHT usually needs some Blood or Yin tonics to work well in itching anyway. XYS supports the Spleen, which is at a low ebb at this time of year, yet also Liver Blood. Liver Blood deficiency is suggested by the low cholesterol and low albumin.

XYS will potentially help heal the PLE. Otherwise, consider Yi Guan Jian, though it doesn't offer the Spleen support. I'm guessing with the deficient presentation including her tongue and pulse, Xiao Yao San should help.

The other possibility is Bu Zhong Yi Qi Tang, since the main adverse event of Apoquel is Wei Qi deficiency and associated Spleen deficiency. Keep that one in mind, too, especially if the microbiome appears disturbed when you get your labs back.

I would not personally rush to prednisone if ascites is not yet present, though low dose prednisone can greatly help some Blood deficient animals and restore immune competence if it is lacking.

Hopefully, one of these herbal formulas will rectify the problem

Steve

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