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Consult--wei Syndrome

by medvet - December 13, 2009

Your advice/recc'ds for herbs for this patient would be greatly appreciated!

"Danny" is a 13 y/o M/N Australian Shepherd that I have been treating for osteoarthritis and rear limb weakness. His tongue is darker red, no tongue coat although the tongue itself is moist, not dry, and slightly thin at the edges. His pulse is rapid and slightly slippery and although it is easily palpated on a superficial and deeper level, I would not call it forceful.

His active acupoints have consistently been his gall bladder points as well as BL 20, BL 23/52, LI 10, and GV20. He has responded BEST to acupuncture at the combo of GB25 & LIV2 and he is currently taking Liu Jun Zi Tang. I started him on Xiao Chai Hu Jia Qin Jiao Tang originally (with the preponderence of his gall bladder channel involvement) but he did not improve on this and he hated taking the herbs, so I discontinued the formula.

He currently eats a grain-free diet as well and although he has an appetite the owners often describe that he will start then leave his food bowl and come back later to finish. His primary "problem" of most concern is his occasional inability to rise, he often gets "stuck" sitting or laying down and at other times can get up just fine.

Thank you!

Lisa Miller

by naturevet

December 13, 2009

Hi Lisa,

Thank you for the excellent case summary. Hopefully it will translate into some good advice!

The dark red tongue and slippery pulse suggests a need to move Blood inwards, rather than outwards to the periphery. This would have an anti-inflammatory effect on any involved joints. Ordinarily, the first formula that comes to mind is Si Miao San, and it fits the questionable appetite. Particularly when animals lack appetite in the morning, but then get very hungry in late morning or afternoon, we think of Damp as being the problem. I don't know if that is the pattern here or not. If it is, then the next dietary move would be to a home-cooked or raw diet. Processing has a Dampening effect, independent of ingredients.

Apart from the appetite issue, though, the points make me think of Long Dan Xie Gan Tang as the place to start. Or perhaps Chai Hu Jia Long Gu Mu Li Tang. Both of these have a strong cooling and TB opening effect. The latter is more strong and is especially apt if the problem is in the hips. LDXGT is more general in its anti-inflammatory effects, and doesn't really 'enter' any particular joint. SMS is good for knee complaints in particular and also pain that is lumbo-sacral in origin. Has the dog had a chiropractic work up? That may be worthwhile if the dog occasionally experiences a pinch in its back that makes it plop back down again. If you suspect that might be the problem, St. John's Wort can be used alongside any of these formulas and is very good for nerve root impingement.

Hopefully that gives you enough information to choose. You can always use two at once if you're undecided: SMS plus LDXGT; LDXGT plus CHJLGMLT; or even SMS plus CHJLGMLT. Heck, you could even just start with all three to get your effect, then pull back as improvements accrue. But I'm pretty sure that's where you need to start.

Steve

by medvet

January 8, 2010

Started this dog on CHJLGMLT and he has had the most improvement on anything so far. His points yesterday were fewer (active ones) and his pulse was not as rapid. His tongue was still red and had some mild sores on the sides.

The owners report that he is still having difficulty getting to sleep (he wanders and paces restless until he finally lays down) but once he is asleep, he stays asleep and is difficult to wake in the morning. He seems a bit depressed to them even though he still participates in his "normal behaviors" like barking at strangers outside, etc.

His active points were: BL 12(sedation improved pulse, tonification worsened), BL 18, BL23, GB34, GB25 and LIV2

Does this description lend itself to adding in SMS more than LDXGT? Should we continue the Six Gentlepets that he was taking as well?

Thanks!

by medvet

January 8, 2010

Started this dog on CHJLGMLT and he has had the most improvement on anything so far. His points yesterday were fewer (active ones) and his pulse was not as rapid. His tongue was still red and had some mild sores on the sides.

The owners report that he is still having difficulty getting to sleep (he wanders and paces restless until he finally lays down) but once he is asleep, he stays asleep and is difficult to wake in the morning. He seems a bit depressed to them even though he still participates in his "normal behaviors" like barking at strangers outside, etc.

His active points were: BL 12(sedation improved pulse, tonification worsened), BL 18, BL23, GB34, GB25 and LIV2

Does this description lend itself to adding in SMS more than LDXGT? Should we continue the Six Gentlepets that he was taking as well?

Thanks!

by naturevet

January 8, 2010

Hi Lisa,

What may be emerging here is a Kidney deficiency. The hallmark trait of the Kidney deficient animal is to have very low energy in the morning, when the Kidney is at 'low tide'. Given the tremendous heat signs and restlessness, I'd try a Kidney Yin tonifying approach, such as with Zhi Bai Di Huang Wan. If the tongue is more purple now than red, I'd go with Ba Wei Di Huang Wan.

Further corroboration that there is an emerging Kidney problem would be a pulse that is now feeling deeper and weaker.

You can use the Kidney tonic simultaneously with the CHJLGMLT. The latter opens the connection between the upper and lower burners, so that Yang can mingle with Yin to generate Qi once more. The former helps to replenish the batteries more directly, which is only possible once the Triple Burner is open. Liu Jun Zi Tang is fine to continue using, but cut the evening dose. It may be keeping him awake.

Steve

by medvet

February 9, 2010

Update on "Danny"-- We started him on Zhi Bai Di Huang Wan along with his CHJLGMLT and he is the best I have seen him so far. He is much more "cool"--less heat radiating from his body over all, pulse is slower, owners report that he is less restless in the evening and that he does not "wilt" as fast when standing up and that he has even stood up to the other dog in the house (his female sibling) when she gave him a hard time this week. His tongue was also much less red/purple and is now more pink. No ulcerations noted on the sides.

Thanks for your help with this case, will continue to keep you posted!

Lisa

by naturevet

February 9, 2010

Way to go!

S

by medvet

March 18, 2010

More update(s) and possible a change needed for "Danny"-- he is less hot over all, however he is still weak in the rear, especially in the left rear, with marked active points over the gall bladder channel on that side. His pulse is slippery and surging but not as rapid; his tongue is now just pink and wet, but no TC and not ulcerated any longer.

Interestingly, what has helped him last week and this week was opening the Dai Mai. Initially his active points today were GB 20, GB 34, BL 19, BL 21 and GB 28 but when I did GB 41 his active point at GB 20 immediately disappeared.

The owners now report consistent restlessness and extreme thirst between 11pm and 1 a.m.--he will literally leave the water bowl alone all day and then drink a ton between these times. GB being at high tide and HT at low--which approach should I take herbally?

He is still taking Zhi Bai Di Huang Wan and CHJLGMLT at this time.

Thanks again!

Lisa

by naturevet

March 18, 2010

Hi Lisa,

Glad to see the dog is hanging in there. Some thoughts:

The fundamentals are still good for using CHJLGMLT - slippery pulse, heat, worse at GB high tide (trapped Yang -> strong thirst), and active GB points.

Did he pep up in response to ZBDHW? If so, there's also a Kidney component, as suspected. But another formula that may address it more completely is Er Xian Tang. It cools Liver Fire at the same time as it supports Kidney Yang and Yin. It seems a good fit here.

If there is obvious pain at the L-S junction, consider Si Miao San instead.

Overall, my thought is to switch out the ZBDHW for Er Xian Tang and see if you get better strength in the hind limbs. Also, any chance of an osteopathic or chiropractic evaluation, or did you do that already?

Thanks very much for the updates Lisa.

Steve

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