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Proteinuria

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I am having trouble finding formulas to treat proteinuria.
I have 2 cases. One is an 8 1/2 year Bichon with atypical Cushing's. History of oxalate urolithiasis and presented 1/08 for TCVM treatment of HAC as an alternative to Lysodren. Equivocal ACTH stim, normal adrenal size, size and echotexture of the liver consistnet with endocrine dz, elevated estradiol and post-stim aldosterone.I have been using melatonin, Mai Men Don Tang (has decreased the PU/PD), and combinations of Jia Wei Xia Yao San/LDXGT/XYS with Si Miao San as indicated. Has gotten several bladder infections depsite this, treated with antibiotics, and now is on East Tao's Ling Syndrome formula with XYS/MMDT. Tongue is purple with pale lavender center, sl swollen, wrinked, thin coating. P=rapid, sl thin deep at Kid/LIV Yin/Blood.I'm thinking Blood def/stagnation, Damp-maybe XCHT+Dang Gui? I didn't find active GB points.
The second case is a 15 year Norw Elkhound who was previously treated for heartworm disease, currently has moderate laryngeal stridor, elevated amylase/lipase, cataracts/lenticular sclerosis, sens bilaterally at Jian Jiao, T-purple, bubble on tip, small crack, moist no coating, normotensive. Have not performed ultrasound or xrays yet to R/O neoplasia.
I just haven't found one place that discusses TCVM diagnoses and tx for proteinuria.
The first case obviously has chronic Damp Heat, so maybe even XCHT+Qin Jiao, or San Ren Tang. The second case is more stagnant-so would a Rehmannia-based Kidney tonic be better here? Maybe XFZYT?
Thank you, Jodi

by naturevet

May 18, 2009

Hi again,

For the first dog:
Atypical Cushing's seems to present as a Liver Blood deficiency Qi stagantion issue primarily, which I see you might agree with given your use of JWXYS in this case. I don't have a biochemical reason why Xiao Yao San and its derivatives work, except to note it has this same gonadal hormone balancing effect in humans with, say, ovarian cysts. Anyway, you've had good enough success that I'd consider Dang Gui Shao Yao San as the formula for the oxalates. It was originally developed to treat cystitis in blood deficient patients. I've used it several times to dissolve stones of the CaOx variety. Often I'll start management giving some potassium citrate as well to hasten dissolution, but I don't know that is necessary. Alisma in the formula has a decent amount of research supporting its use to reduce formation of oxalate stones.

For the second dog:
I wonder about Xiao Chai Hu Tang with Qin Jiao. The inspiratory stridor, tongue color, and evidence of middle burner disharmony (i.e. potential stasis) are all common features of dogs that benefit. Active GB points confirm the diagnosis. Certainly if there is elevated pr/cr, Bupleurum, a major component of the formula, is famous for its ability to reduce glomerular inflammation and proteinuria.

In general, if pr/cr is elevated, we think of:
San Ren Tang
Xiao Chai Hu Tang
Fang Ji Huang Qi Tang
as the main considerations.

Good luck!

Steve

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