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Interpretation Of Skin Case

by mikemesley - October 27, 2009

Knowing the S.Marsden skin disease flow chart - with Damp Heat on one side, and Blood Deficiency on the other, I was wondering how to interpret the following Pe findings on a dog with consistant low-grade skin issues that respond quite well to low doses of cortisone (won't go away, just keeps dog happy) with minimal side effects seen.
PE - groin region and cranial to prepuce seem worst affected. ST channel on back leg also notably hot along its length - chews feet, back ones only. Real focus of heat eminating from both shoulders - maybe some heat in LI11, but really amazing amount of heat in shoulder region - over the joints almost. Must be LI15 or TH 14 I'm guessing?
Pulse - tight or wiry, a bit floating but also a bit empty - if this combination is possible. The best way i can describe it!
Tongue - lavender all over. Centrally and towards the back has thick white and a bit sticky coating. Not much coating elsewhere - notably less on sides and at tip.
Coat - fine dander present.
Speaking to O - tends to be worse in summer. No other really telling items on Hx except Blood
Deficiency behavioural issues.

So my take was - Blood Deficiency seems certain. Excess of Heat but without significant amount of Dampness signs was I suppose where I found it hard. Stomach channel and LI channel normally would suspect Damp but doesn't really seem right in this case. A Tai Yang layer Wind-Heat pathogen? Does this happen. Another thought re the amazingly hot shoulder was that the Yang Qiao Mai might be involved?? I think the Yang Stepping Vessel can get overly full when other Yang channels get overheated etc?
So - external pathogenic factor eg Wind-Heat (maybe) versus internally derived "empty heat-like" symtpoms from blood deficiency and consequent Liver Yang Rising or similar?? I was thinking more liekly the former. Maybe Si Wu Xiao Feng Yin is helpful. Will it clear the Heat too, or are their additions worth making? Is there another interpretation worth considering??

I found this an interesting set of findings to try to make a pattern from!

Thanks
Mike

by naturevet

October 27, 2009

Hi Mike,

As usual, I agree with your analysis. The pulse you described I often call 'buoyant' like it's the top of a balloon trying to rise up to the skin, but not quite successful, and where you can push through it to find nothing. This is the famous 'floating tight' pulse of Wind invasion, if I've interpreted your description correctly.

Regarding the impact of the Yang Ming channels - if you tonify and the pulse improves, you're stoking the fires of digestion. If you are sedating and the pulse improves, you're removing heat. Usually, the cause of this is Damp Heat, but not always. Sometimes it's deficiency Heat or even Stasis Heat. Chronic Blood deficiency leads to deficiency Heat and eventually Blood Heat if it gets bad enough. Right now, it's not that bad by the sounds of it.

The only other big question is the heat from the shoulder region. We've been using thermography lately, and have found that some of that heat is actually coming from TB and GB points, which commonly flare up in that region only due to Wind invasion.

So, rolling that altogether, you'd have Blood deficiency with secondary Wind Heat invasion. At the same time, you have a deficiency Heat starting to build. Si Wu Xiao Feng Yin is an appropriate place to start, because it cools the Blood at the same time as it vents the pathogenic Wind Heat. Since that's what you devised, I guess we'll either both look good or both go down together.

Steve

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