Saw her again in Jan - she had improved somewhat on meloxicam, but was sore/slow without it, decreased appetite and weight loss. She was refusing to go up the stairs, owner had tried a glucosamine supplement and thought the dog was worse with it? Back legs are shaky, she spends most of her time on her dog bed by a heater. Her temp at that time was 39.4, tongue was lavender, popliteal lymph nodes were firm but still small, spleen felt enlarged but smooth. She was lethargic, and seemed painful in multiple joints - suspicion was Lyme disease.
Bloodwork was mostly normal, except for slightly increased ALP (309) and tbili (16). 4DX snap was neg for tick diseases. For financial reasons, dog was put on doxycycline for 4 weeks and meloxicam to watch for response. After 2 weeks, dog was doing much better according to owner, and at that time I started her on Xiao Chai Hu Jia Qin Jiao Tang, based on what I thought was a Shao Yang syndrome. A week later dog was having more trouble, appeared to me to be sore everywhere. We did Xrays of hips and stifles - no changes, joint taps of carpi, hocks and stifles and FNA of lymph nodes revealed very mild neutrophilic polyarthritis - like a low grade septic arthritis and reactive lymphoid hyperplasia. Tongue at this point - 1 month of doxycycline and meloxicam and 2 weeks of XCHJQJT is lavender, pulse is superficial, not easy to compress, wiry?
Now, as I look back on my notes on Bi Syndrome, I would classify her as a Painful Bi, and suspect my formula is too cooling - I was thinking too Western - thinking immune-mediated, fever, favorable response to NSAIDS and antibiotics = heat, ignoring the fact that she is heat seeking, and joints never felt warm, only swollen. So, I am thinking of changing to something like Du Huo Ji Sheng Tang to warm channels and eliminate cold? Or would you suggest something else? Yi Yi Ren Tang for Damp Bi, or Juan Bi Tang?