Looking for input on a case with Internal Wind and a strong stress-triggered component. Still very new to TCM as I've only done an intro course.
Signalment / Brief History
Jolene – 3-year-old FS Husky mix, ~22.6 kg.
Adopted July 2024.
Two generalized seizures (July 2024, April 2025). On phenobarbital since April.
Since adoption she has had occasional focal tremor episodes, but in early October they suddenly escalated, becoming daily and more prolonged.
Episode Description
Initially both random and stress-triggered (October).
Now, after treatment changes, she has only stress-triggered tremors.
Current episodes:
Always associated with sudden noises / stressors (machinery booms, startling sounds).
Last 30 min–2 hrs, most often in the evenings.
Jolene remains alert and responsive.
Tremors in front + hind limbs, panting, hides in dark spaces.
No urination, defecation, vocalizing ? not generalized seizure-like.
Medication & Treatment Response
Keppra (500 mg q8h) was added in October.
Stopped the random/spontaneous focal tremors completely.
Owner reported behavioral suppression: she became overly subdued, excessively sleepy, flat, not herself.
Owner discontinued Keppra 1 week ago.
After stopping Keppra:
Random focal tremors have NOT returned.
She now experiences daily stress-triggered tremors only.
Slight post-episode fatigue.
Tian Ma Gou Teng Yin was started ~2 weeks ago.
Also contributed to resolving the random focal tremors.
No adverse effects.
Phenobarbital level therapeutic.
Repeat CBC/chem normal.
TCM Examination prior to starting Tian Ma Gou Teng Yin
Tongue: pink, slightly dry mid-body, thin white coat.
Pulse: superficial, slightly tense/bounding.
Chronic itch (6–7/10) and recent otitis but no active Damp-Heat today.
TCM Pattern
Liver Yang Rising ? Internal Wind, with emerging Liver Yin deficiency now that Wind is controlled.
Current TCVM Treatment
Tian Ma Gou Teng Yin BID × 2 weeks (chosen because tremors were focal, seizure-like, consistent with Liver Wind).
Considering adding a Yin tonic, likely Yi Guan Jian.
Diet: salmon kibble + wet; owner considering raw.
Progress
No generalized seizures since April.
No random tremors since TMGTY or Keppra.
Now only noise-triggered/startle tremors, occurring daily.
Questions for guidance
Is now the right time to add a Yin tonic?
Yi Guan Jian?
Was Tian Ma Gou Teng Yin the correct base formula for focal-seizure-type tremors?
Thank you — we’ve had partial improvement but now have a pure stress-triggered tremor pattern, and I’d appreciate guidance on next steps.
Martha