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Anxiety And Dermatitis

by carolgifford - March 18, 2010

1.5 yo NM Greyhound/Afghan/Terrier mix
Comes across as a water personality: nervous, runs away, timid
Was runt of litter, heat seeker, borborygmus but good appetite and normal stools, enjoys massage.
Pruritic especially prepuce, also anus and tail, anxious/separation anxiety, coprophagic. Intermittent pustules on distal prepuce, otherwise skin appears healthy. O reports dog will "attack" prepuce especially around 6am.
T: narrow, pink with lavender edges, thin white coating
P: deep, slippery
Active BL 15, improved pulse with GV14, BL 18, 20, 21, HT7

Suggestions on herbs? I was considering: Si Wu Xiao Feng Yin. Thoughts?

Thanks,
Carol Gifford

by naturevet

March 19, 2010

Hi Carol,

SWXFY is a good first thought, and may be what resolves the problem. The 'attacking' of the lesion makes it sound a bit more 'excessive' than a deficiency formula can address however. Unless that is as much a reflection of the owner's annoyance as the true nature of the problem (this happens a lot). Any lesions there now? If not, how bad have they been in the past? More of a flaking collarette? Or more of an actual pustule?

These are rhetorical questions, to some extent. We also have the oddly dark tongue to contend with. It might even be dark all the way through, with just a thin white coat washing out the color in the center (this also happens a lot. The underside of the tongue is much easier to assess true tongue color by). At any rate, dark indicates stasis. So, there is also an excess hinted at in the tongue. These two 'excess' symptoms would make me swing away from a simple tonic like SWXFY. We need something moving.

At the same time as we're looking for a moving formula, we're looking for something that can harmonize and/or nourish the Liver, Spleen, and Stomach; as well as support the Heart (Qi or Blood), given the success of your points. In retrospect, since penile lesions indicate a Liver disorder, I'm wondering about Liver Qi stagnation in general, and in the Liver channel in particular.

There are a couple of formulas that fit this general characterization: Xiao Yao San (Rambling Ease Powder; Bupleurum and Chinese Angelica (Dang Gui); and Bu Zhong Yi Qi Tang. The former is a bit more Damp draining, but doesn't do as much for the psyche. The latter is a bit more potentially Dampening, but improves anxiety more quickly, and is an immune stimulant to help eradicate that latent infection. You could even use both together if you couldn't decide. Or you could start with XYS to address problems in general, then follow up with BZYQT to finish resolving things once the middle burner was substantially more healthy. At any rate, those are the directions I'd move in.

Hope that's useful advice.

Steve

by flaviaz

March 20, 2010

If I might chime in, Carol and I are working together on this case. This dog belongs to one of our employees, and I saw him about 2 weeks before Carol did.
The owner brought a video of the preputial chewing and it is real, he really goes at it. (He is so neurotic it could be behavioral). She says he chews so hard that sometimes the everted penis is purple. She is also very nervous around him and it is obvious she feds his anxiety. He was the runt of the litter, is one of 3 unrelated dogs, and his coprophagia is not selective. He has an ongoing endoparasite infection, either he keeps reinfecting himself, or he is Wei Qi deficient. His separation anxiety is worst when he is away from the alpha dog in the house, but he is very anxious when the owner is out of sight as well. He is afraid of noises from the trash bags, the hairdryer, but not thunder. He is a heat seeker. A wisdom panel showed Afghan, greyhound and wired haired fox terrier. He looks like Jar Jar Binks.
When I saw him 2 weeks before Carol, I saw a narrow, pale lavender tongue, and his pulses were weak, thready and a bit fast. His prepuce was swollen and the penis very red at the urethral opening.
I felt a big buzz (that thermo/mechano cloud of which you speak in class) at BL 15, Deficiency at BL 28 and strikingly cold at GV 14. Sensitivity once at CV 4 which I could not repeat, inguinal area is very hot.
I needled GV 20 Yin Tang, An Shen, HT 7 CV 17 BL 15 BL 28 LIV 5 SP 6, and saw absolutely no change in pulse. Then GV 14 and his left pulse went almost to normal and his right stayed weak.
I put him on a hypoallergenic diet to start off. The owner said he was much more relaxed for a few days.
When Carol came to look at him, I didn’t touch him until she did her exam, and when she needled him I palpated the pulses and felt them change very significantly with each needle. I am solo, so I don’t usually get to feel that instantaneous change (you rock, Steve). As Carol said, GV 14 was most dramatic.
The pustules are not collarettes, they are raised with what looks like purulent material, but they come and go, so I am not sure if they are sterile or infected. Carol and I discussed Jing Deficiency, Yang Deficiency and lord knows what else.
So we will get together to discuss what to try, unless this information changes any of your ideas
Thanks for the help
flavia

by naturevet

March 20, 2010

Hi Flavia,

If GV 14 is very high yield, it must be for one of the following reasons:

too much Yang

too much heat in the Heart

too little Yang

The prepuce and genitalia are associated with the Liver channel, so we can guess it's involved.

The dog's behaviour is on the deficient side. If the dog is deficient, and you're not seeing a lot of redness, thirst, and heat, then GV 14 must be adding Yang.

Another way I can put all this together is to see the pustules as self-inflicted, due to the dog trying to address a deep-seated sense of groin pain. The pain is probably arising from cold in the lower abdomen.

It's a working hypothesis, anyway, and if we're wrong and GV 14 is cooling the dog, we'll soon find out, as the dog will get hot with treatment. The formula I'd recommend is the one I discussed for Qi Lin, known as Wu Yao Tang (Lindera Combination).

I'd start with that. It warms, nourishes Liver blood, and relieves pain in the lower body. So based on our first take here, it fits well enough that we might see an improvement.

Hope that helps,

Steve

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