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Polycythemia Vera

by steros - March 2, 2010

Hi Steve,

I hope you are doing well.

I have a quick question for you. I am treating a 6 year old FS Dachshund who is 4 weeks post-op hemilaminectomy T10- T11. She is LIV Blood deficient, SP Qi deficiency with Damp and has Qi/Blood stasis Heat issues.

She has a ravenous appetite, normal thirst and is very fear aggressive initially but then warms up to people although not completely. She has a history of diarrhea (blood, mucus) when diet is changed.

Pulses are thin, wiry, fast.

Tongue
Top--lavender/pale pink center
Bottom--red/lavender

She has responded great to acupuncture (BL18, BL19, BL20, ST36, GB34, BL40, BL60, also treated points in between back toes) and and treatment with Xiao Huo Luo Dan. Owner noticed marked improvement in ambulation after first session.

The dog is much improved and has just finished her Xiao Huo Luo Dan. I wanted to choose another formula for her and my initial thought was Bu Gan Tang to correct her underlying LIV Blood deficiency, Stasis issues and help with her IVDD (although it's not ideal for her dampness issues.)

My concern is that the dog has polycythemia vera and I'm thinking I don't want to give her a blood tonifier. Should I be reaching for a stasis formula first (Xiao Chai Hu Tang) or should I maybe think of Dang Gui Shao Yao San since it tonfies Blood, SP, addresses Damp and helps with Qi stasis?

From a Chinese perspective is Polycythemia a Blood stasis? Excess Blood? Or Blood Heat condition?

Thanks for your help
Steve

by naturevet

March 2, 2010

Hi Steve,

My sense would be to look at PV as a Heat condition, similar to benign conditions like leukemia. If it goes on to myelosuppression, these patients also look hot. So a formula with some bitter cold herbs in there are desirable, especially given the red lavender tongue. The lavender or purple color is suggestive of Stasis as the cause of the Heat. That fits with the irritability and rapid wiry pulse.

Given the above, I'd think of Jia Wei Xiao Yao San as a possibility, especially given the points you've been using, which address the SP, ST, LV and GB. As you know, XYS harmonizes the Liver and Spleen. So I'd try if first. Mu Dan Pi in the formula is anti-leukemic. You could think about adding Da Huang, Huang Lian or Zi Cao to further cool Blood and have that anti-proliferative effect.

Generally, if you saw symptom improvements, I would be surprised if they weren't accompanied by a more normal RBC count.

Hopefully that makes some sense. My last comment is that one of the few immunosuppressive plants in the world is Lei Gong Teng (Tripterygium wilfordii). It has been shown to be myelosuppressive, but that would probably be playing with fire.

Good luck with your case. JWXYS should be a safe place to start and test the waters.

Steve

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