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Syringomyelia Case

by Heather1 - May 11, 2009

I just finished the second module of Mona's TCM intro course and I have just enough information to be questioning everything!

Harry, 5 year old MN Cavalier King Charles spaniel

Presented 8/08 with a tentative diagnosis of syringomyelia with symptoms of yelping and scratching at 3 am, 6 am and late afternoon (between 3-5 pm). Also a history of intermittent diarrhea since puppyhood (no blood or mucous present).

A veterinary acupuncturist at the U of M diagnosed a Kidney Qi and Spleen Qi Deficiency. She recommended a diet change from Sensible Choice chicken and rice to California Natural herring and sweet potato.

My initial findings in 8/08:
T: medium pink, wide and thin, slightly dry with no coating
P: good rate and rhythm, medium position, thin, wiry

I haven't been trained in active point diagnosis.

I prescribed (based upon other acupuncturist's diagnosis) Six Flavor (Liu wei di huang wan) and Four Gentlemen (Si Jun Zi Tang) teapills. The diet was also changed gradually.

The dog has responded nicely...essentially no digestive symptoms and occasional yelping at 6 am. Scratching is intermittent and less intense.

I'm not sure what the prognosis or progression is for dogs with this disease because I've never seen it before.

More recently, Harry's tongue and pulse have changed:

T: pale pink/purple,slightly thick with mild white coating
P: good rate and rhythm, thin and wiry, slightly tight, medium position

I was thinking of moving to Bai Hui Di Huang Wan for more Kidney Qi, Blood and Yang support.

FYI...Bupleurum and Kudzu Clearing Formula (by Kan) made his symptoms worse.

Any other thoughts or suggestions?

by naturevet

May 11, 2009

Hi Heather,

Interesting case, especially for someone who's just getting rolling. Looks like you're doing well so far. I would interpret the new pulse and tongue and indicating the possible formation of Damp and Stasis in response to the tonics. Alternatively, as you said, the tongue coloration may simply represent Kidney Qi deficiency as opposed to Kidney Yin deficiency.

The response to the Chai Ge Jie Ji Tang (Bupleurum and Kudzu) suggests that an acute anti-inflammatory approach is not the way to go. It could also mean that the condition is not a Wind invasion, but I think that given the response you're seeing to tonics, the formula was aggravating because if was too cold and damaging to the dog's Qi. From a western perspective, the response suggests the inflammatory process is a smoldering one, that responds to increased blood flow as opposed to removing it using anti-inflammatory herbs.

Given the way syringomyelia unfolds, one option in trying to anticipate formulas that might be useful in the future are those that treat Wei (atrophy) syndrome. This condition often involves Heat plus Wind invasion. Given that the dog isn't hot, it doesn't seem right to move in that direction.

Another option is to try Bu Zhong Yi Qi Tang, which increases peripheral circulation and is in sympathy with the general need to tonify Qi. It might also have the effect of moving blood away from the site of inflammation, however.

So I like your idea, which I'll call option 3: use Rehmannia Eight (Jin Gui Shen Qi Wan) instead of Rehmannia Six, and see what the response is. Many low grade MS patients benefit from Rehmannia Eight in human Chinese medicine. So it's probably the first tree we should bark up.

Lots of writing, just to end up agreeing with you. But hopefully the above discussion gives you an idea of what to watch out for.

Have fun and good luck! I sense a great case report in your future!

Steve

by Heather1

August 16, 2009

I have been using Rehmannia Eight and Si Jun Zi Tang for Harry and his scratching during the day and at 6 am has slowly increased.

I saw him on 8/17/09. Harry looks as good as always except for his moderately pink external ear canals and reported sensitivity to humidity.

T: medium pink, wide, no coating, good thickness

P: superficial, good rhythm, slightly fast, bounding and strong, mildly thin and tight, wiry

Active points: pulse softenend when BL40 was sedated and GB points were stimulated

Are we now seeing some wind and heat invasion?

I think he still needs tonifying support, so I am considering keeping him on Rehmannia 8, and possibly adding Ban Xia Bai Zhu Tian Ma Tang. I could discontinue Si Jun Zi Tang since the BXBZTMT does support the Spleen.

Or do I need more of a mover, tonifier and wind expeller like Xiao Chai Hu Tang?

Any suggestions?

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