Dr. Shana Buchanan, MBA, Certified in Veterinary Acupuncture, Certified in Veterinary Chiropractic, Veterinary Food Therapist, Certified in Chinese Veterinary Herbal Medicine

What is an Herbal Formula:

              Herbal prescriptions are composed of a either a single or, more commonly, a combination of herbs/plants that are specifically chosen for their unique properties, and are individually tailored to your pet’s specific needs. Many of the formulas are very safe for long term use.

What conditions can be treated with Chinese Herbal Medicine?

              Herbal therapy is well suited for many diseases and conditions. It is of particular benefit in conditions that have occurred for long periods of time and that may likely require prolonged treatment.  Skin diseases, Allergies, Pain management, Arthritis, Cancer, Autoimmune disorders, Respiratory and Cardiovascular conditions, Endocrine diseases, Eye problems, Liver Diseases, Kidney problems, Gastrointestinal disorders, Neurological diseases, Urinary issues and Behavioral problems all benefit from herbal medications. 

Are there side effects?

             Many diseases are complex in nature, requiring the use of a few herbal formulas to achieve the final goal of maximal health. During the treatment process, various perceived side effects may occur, such as a change in appetite or changes in bowels. These will be discussed during your pet’s examinations and are important to discuss with your veterinarian as they can be a positive sign of a pattern change requiring a modification to your pet’s protocol. As the treatment progresses, your pet’s condition will change and evolve.  Just as his/her condition changes, so too can the treatment(s) required.  Please contact the clinic should any concerns arise during treatment as we may need to alter or change the treatment protocol over time. Please contact the clinic should you have any concerns or questions about the formula(s) your pet may be taking.

How long will it take to see a noticeable improvement in my pet?

Improvements can take as little as two to three days to two weeks to see an improvement.  These improvements can be gradual or can be dramatic, depending upon the nature of your pet’s disease.  Even if you do not see an immediate improvement, this does not indicate that the herbal formula is not working and improving your pet’s health.

Why is it important for frequent follow-ups?

            Follow-ups are important when your pet is taking Chinese herbal formulas since the necessity to change or modify the herbal prescription can change as your pet gets better.  Viewing your pet’s condition as layers of an onion that are peeled away as the condition is successfully treated, attempts to explain the need for continual evaluation since your pet’s needs change.  Follow-ups do not necessarily equate to your bringing your pet in for frequent re-evaluation examination, even though this might be essential at times.  A follow-up can be as simple as a telephone conversation or e-mail correspondence.  Regardless, the owner’s participation in your pet’s health is vital for treatment success with herbal medicine.

How are herbal prescriptions supplied and how do I give it to my pet?

             Herbal formulas come in many different prepared forms:  Liquids (known as Tinctures), Pills, as well as, Fine Granular Powder formats are available. They are commonly administered with food to allow for the proper absorption of the herbal components.  Additional methods of herbal administration other than oral administration can consist of enema preparations if your pet is vomiting or has no appetite.  Also, putting the herbs into an empty capsule and then giving it to your pet might be an option for your family.   Safety and effectiveness are of prime consideration when using herbal medicine and the herbal medicines prescribed are from reputable herbal companies that exceed the pharmaceutical’s standards of safety. Formulas may be used for a few days up to many months depending on the condition being treated.

             Chinese herbal medicine can be used effectively on its own or in combination with acupuncture and/or Traditional Medicine as well as in conjunction with various drugs and supplements.

Behavior Case Report

Dr. Shana Buchanan, MBA, Certified in Veterinary Acupuncture, Certified in Veterinary Chiropractic, Veterinary Food Therapist, Certified in Chinese Veterinary Herbs

Pet "P" is a 14 yr FS Papillon that has a long history of excessive barking, restlessness and agitation.  Recently, the owner has noticed that the dog will spend most of her days at the corner in the yard where a tree and a cat were found a last year.  Both the tree and the cat are no longer there, but the pet continues to bark at the fence corner throughout the day as if she has recently trapped the cat.  The owner has inspected the area, and nothing is present. Blood work was in January and revealed a slight elevation in ALKP 330 (3-131 Normal) and microablumineuria > 30 (< 2.5 Normal).  No Eastern examination was performed at that time.    This is almost exactly the same laboratory abnormalities that was noted in her other small breed dog that was diagnosed with a Triple Burner (TB) obstruction.  Her other dog was prescribed Xiao Chai Hu Tang (XCHT) for this problem, and since the herbs had enough to share between the two dogs, the owner started Pasqualli on the XCHT as well.   XCHT seemed to have helped with the pet’s hyper-activity and eliminated the pet’s tendency to dream; however, Pet "P" became stubborn and agitated again since the warm, weather allowed the pet to explore the yard again.  An Eastern examination revealed superficial and wiry pulses and a red tongue.  The only active acupuncture point was found at GB 34. 

 A Western diagnosis of an early stage of senility was diagnosed since the pet is unable to distinguish between past and present events of a nonexistent cat in a tree.  An Eastern diagnosis of a deeply entrenched TB obstruction was made as a result of XCHT partially alleviating some of the pet’s symptoms.   Additionally, the superficial and wiry pulse is indicative of an excess and stagnant condition, and the red tongue indicates heat.  The active gallbladder point is also indicative of heat and stagnation. 

 Since the patient seems to have a long term TB obstruction that has trapped Yang in the upper burner causing Heart Fire, Chai Hu Jia Long Gu Mu Li Tang (CHJLMT) was prescribed.  The pet has a long history of restlessness, agitation, and anxiety.  Additionally, the partial response to XCHT is indicative that CHJLMT might restore circulation within the TB thus alleviating the heat signs seen in the upper burner.  The following are the herbs in the formula.  Bupleurum expels pathogens from the GB and TB channel.  Scutellaria descends Yang from the upper burner to reintegrate with the lower burner to generate Qi to give more limb strength and stamina.  Ginseng, Jujube and Licourice relieves Qi deficiency from the failure of Yang and Yin to merge as a result of the TB obstruction.  Pinellia removes Phlegm.  Ginger harmonzies the middle burner.  Long Gu and Mu Li descend Yang to the lower burner.  Da Huang aggressively cools the upper burner and has a descending action.  Gui Zhi restores normal descent of water to the KI and BL.

Urinary Case Report

Dr. Shana Buchanan, MBA, Certified in Veterinary Acupuncture, Certified in Veterinary Chiropractic, Veterinary Food Therapist, Certified in Chinese Veterinary Herbs

Pet "P" is a 10 yr old FS Calico DSH that weighs 13.4lbs (6.1kg).  Pet "P" presented in February 2011 for a presumed UTI. The patient started to have multiple urinary tract infections since September 2010.  The symptoms that the pet exhibits during these episodes are urinating outside of the litterbox, hematuria and stranguria with pain and irritability.  Prior to the February visit, the pet was restarted on oral antibiotics without the relief of symptoms.  Diagnostics included a CBC/Chemistry Panel , radiographs, urinalysis, and a urine culture and sensitivity (C&S).  In order to do a thorough examination and diagnostics, the pet had to be sedated due to the aggressive behavior.  Radiographs did not reveal masses nor stones, blood work was normal, urinalysis was normal, except for the high specific gravity of >1.050, and the urine C&S did not reveal bacterial growth in 24 and 48 hours.  While waiting for the results, the pet was started on an anti-inflammatory that has helped with the hematuria and stranguria.  A Western diagnosis is Feline Lower Urinary Tract Disease. 

The Eastern exam was limited due to the pet’s temperament .  Pulses were not able to be felt, active acupuncture points were not palpated, and the tongue seems red when the cat hissed.  Abdominal palpation elicited pain or was an aggressive reaction.  The patient’s Eastern diagnosis is Liver Yang Rising due to the aggression, Liver over controlling the Stomach and Spleen causing Dampness to be produced, and Damp Heat leading to Blood Stasis within the Bladder causing severe pain and hematuria.  The treatment goal for the pet was to drain damp, cool the bladder, relieve the stasis and tonify the Stomach and Spleen.  Recommendations for this pet was to replace the dry food with a low carbohydrate, high protein wet food to reduce the Damp being produced by the Spleen on dry, processed kibble and to reduce the urine specific gravity, continue with anti-inflammatories, and to begin with Long Dan Xie Gan Tang (LDXGT).  LDXGT was chosen since it is typically used for “excessive” cases, irritability, Liver Yang Rising, Damp accumulations and Damp Heat symptoms.    The owner is aware that an herbal formula change might be needed after either the pet’s symptoms subsides or gastrointestinal side effects occur indicating the pet needs Spleen support and a proper diet is not adequate.  As a result, the next formula to try that supports the Spleen and drains Damp Heat will be Si Miao San (SMS) due to the Spleen support of Atractylodes in this formula.  LDXGT was the first choice since Gentian, Scutellaria and Gardenia clear Heat from the Liver and Heart while drying Damp in the lower burner.  Bupleurum and Angelic prevent Qi and Blood stasis.  Rehmannia cools the Blood while protecting and replenishing Yin.  Plantago, Alisma and Poria drain Damp from the lower burner and cool the upper burner.  If the owner can give this cat the herbal formula, a recheck is scheduled two weeks after starting the herbs or sooner if the pet shows any gastrointestinal problems.

Neurologic Case Report

Dr. Shana Buchanan, MBA, Certified in Veterinary Acupuncture, Certified in Veterinary Chiropractic, Veterinary Food Therapist, Certified in Chinese Veterinary Herbs

Pet "P" is a 9yr, FS English Bulldog.  She has a long medical history which includes recurrent otitis externa that resolves with SMZ TMP oral tablets and topical medications; uncontrolled hypothyroidism even on levothyroxine; urinary urgency with hematuria that revealed a sterile cystitis via a C&S in October 2010 and which is alleviated with intermittent Meloxicam; seasonal pruritis that is controlled with Hydroxyzine; seizures that are controlled with Phenobarbital; and a tendency to gain weight despite being on controlled feedings.   The pet is heartworm and fecal negative and eats a commercial dry dog food. 

On physical exam, the dog is very friendly, has upper respiratory stridor and has flatulence.  The ears at this time are fairly controlled with the current medications.  The pet’s allergies have recently flared with slight control with Hydroxyzine.  The urinary urgency and hematuria has not recurred in two months, thus the dog has not needed Meloxicam.    The pet has gained three pounds since the last visit and remains obese.  The owner was instructed to give the levothyroxine on an empty stomach one hour prior to meals to help increase absorption and hopefully eliminate more weight gains.  Due to the pet’s obesity, the pulses were difficult to palpate but seems to be slippery.  The tongue was a purplish color with tenacious saliva. 

The Western diagnosis is otitis externa, hypothyroidism, sterile cystitis, allergies, seizures, and obesity.  Eastern diagnosis is: 1) phlegm/damp disguised as seizures, recurrent otitis externa,  weight gains, upper respiratory stridor, slippery pulses, and the tenacious saliva; 2) heat disguised as otitis externa that is alleviated with oral antibiotics, flatulence, and sterile cystitis with hematuria that is alleviated by NSAIDs; 3) wind that is disguised as seizures,  seasonal pruritis that worsens during windy times of the year; and 4) blood deficiency with stagnation that is expressed as a purplish tongue and hypothyroidism.

The majority of this dog’s symptoms could be explained by a SP/ST being overwhelmed with an inappropriate diet, thus causing heat symptoms, blood deficiency and stagnation, and phlegm symptoms.  Therefore, a change to a low grain-high protein diet would benefit this pet tremendously.  The wind and phlegm seen in this pet as seizures and allergies can be alleviated by Ban Xia Bai Zhu Tian Ma Tang since it is indicated in dogs that have a history of weight gains, cystitis, and otitis externa.  It will also strengthen the stomach and spleen to prevent further damp and phlegm accumulation. Secondarily, the formula will drain damp and clear heat.  The main ingredients in the formula that will help pet "P" are Er Chen Tang that helps eliminate phlegm, gastrodia that extinguishes wind, alisma that drains damp, phellodendron that clears heat, and atractylodes that supports the spleen. 

Case Report: Equine Infertility

Equine Infertility

Dr. Shana Buchanan, MBA, Certified in Veterinary Acupuncture, Certified in Veterinary Chiropractic, Veterinary Food Therapist, Certified in Chinese Veterinary Herbs


History

Mare “P” is a 14-year-old Quarter horse that has failed to cycle and become pregnant four out of the five years.  2009 was the first time the mare foaled.  The owner disclosed that the mare always has had a long winter coat during the spring and is under lights.  She is not housed around cycling mares and a teaser stallion is not available for estrus testing.  The mare conceived her only pregnancy after an acupuncture treatment.

Western Examination, Diagnosis, and Treatment

The mare is presumed to have “Cushing’s” or pituitary pars intermedia disorder (PPID).  This condition prevents the mare from cycling as a result of an abnormal.  This condition is recognized as the mare having a long hair coat, not cycling, and infertility.   As a result, the mare’s body is not in sync with the natural cycle of fertility that coincides with the increased spring daylight hours.  The increased daylight hours signals the pituitary to produce increasing amounts of lutenizing hormone (LH) and follicle stimulating hormone (FSH) that leads to a normal cycle and ovulation allowing a successful pregnancy to occur.   The Western treatment for this mare’s disorder is to be placed “under lights” to mimic the increased daylight hours observed during the spring and summer, be placed around other cycling mare and a teaser stallion, and be given Altrenogest (Regu-mate).  Altrenogest is a synthetic progesterone that will suppress release of stored LH and FSH in the pituitary.   Although it suppresses the release of luteinizing hormone (LH) and follicle stimulating hormone (FSH), it does not suppress the production of the two.  After discontinuing the medication, these increased hormone levels will be released and mares will cycle shortly after discontinuation. This time frame is the most fertile time frame for the mare to conceive. 

Eastern Examination, Diagnosis, and Treatment

Since the owner’s only success with this mare’s fertility concurred with acupuncture, the owner elected to treat this mare with conventional and nonconventional medicine.  The use of acupuncture in reproduction has been documented as an adjunct to help an aging mare to cycle and become pregnant.  The Chinese view conception as a result of pre-heaven, post-heaven, and kidney-essence.  Pre-heaven essence is equivalent to the sperm and ovaries successfully uniting.  Post-heaven essence is equivalent to the nutrition consumed.  Kidney-essence is equivalent to an individual’s constitution.  The goal of acupuncture for this mare is to nurture and strengthen the pre-heaven essence and improve the kidney-essence.  As a result, the mare most likely will become pregnant. 

The best way of strengthening the two essences is to perform acupuncture on the meridians that passes through the reproductive organs and unique acupuncture points that are known to strengthen the uterus and help with conception.  Most of these points lie on the Bladder (BL), Liver (LIV), Kidney (KI), and Spleen (SP) channels.  There are a few extra-ordinary points known to strengthen the reproductive system in general such as Stomach (ST), Small Intestine (SI) and Heart (HT) points.  The following points in the table below were used.  Most of these points were injected with vitamin B12 complex to stimulate the acupuncture points long-term because the mare was being shipped and most likely not able to return for follow-up treatments.  The asterisks (**) indicates the points that were stimulated at each of the three sessions.  The nonasterisks indicate that the point was used once during the three sessions.

Acupuncture Point	Point Function
LI 10	Qi deficiency
LI 11	Tonification point
ST 36  (**)	Xue tonification point
ST 44	Mammary gland tonification
ST 45	Clears heat
SP 1 (**)	Regulates blood
SP 6	Master point for the lower abdomen and urogenital system
SP 9	Drains damp
SP 10 (**)	Regulates estrus
HT 9	Tonification
SI 1	Lactation
BL 10	Tonification of the bladder meridian
BL 16 (**)	Invigorates blood
BL 18 (**)	Regulates liver blood
BL 20 (**)	Dispels and transforms damp
BL 21	Dispels and transforms damp
BL 23 (**)	Nourishes essence
BL 67	Labor
KI 1 (**)	Tonifies yin
KI 3	Infertility
GB 41 (**)	Urogenital disorders
LIV 1 (**)	Urogenital problems
LIV 3 (**)	Promotes LIV Qi flow
LIV 4 (**)	Urogenital problems
LIV 8 (**)	Nourishes liver blood
Bai-Hui (**)	Any rear  end problems
Da-Feng-Men	Sedation
Xue Fu (**)	Ovary point

Pain Case Report

Dr. Shana Buchanan, MBA, Certified in Veterinary Acupuncture, Certified in Veterinary Chiropractic, Veterinary Food Therapist, Certified in Chinese Veterinary Herbs

Pet "P" is a 14 yr old FS Jack Russell Terrier weighing a lean 15 lbs.  The patient has a history of a partial RACL of the right rear limb that occurred when the pet was three years old.  As the pet ages, the pain during cold weather worsens and is almost nonexistent during warm weather.  NSAIDs occasionally alleviate the pain but not consistently.  The pet is known to sleep deeply and dream excessively to the point of waking up self and seeks cool places after lying next to the owner after marked panting.  The tongue is red and dry and the pulses are very deep and wiry.  Previous radiographs do not reveal any bone cancer but does reveal effusion and arthritis in the stifle joint.  Recent blood work abnormalities reveal a slightly elevated ALKP 330 (3-131 Normal) and microabluminuria > 30 (< 2.5 Normal).  Active points are located at BL 20, 21, 23 and GB 34. 

A Western diagnosis is arthritis due to a partial RACL at the age of three.  An Eastern Diagnosis is a Triple Heater (TH) obstruction and Cold Bi.  The TH obstruction is evident by the mixed hot and cold symptoms of a red tongue, cool seeker and cold aggravating the pain in the rear limb.  Additionally, blood deficiency is evident by the deep sleep and dreaming which can be caused by continual heat and a TH obstruction.  The appropriate formula for this patient is Xiao Chai Hu Tang (Minor Bupleurum Combination) twice daily.  This herb will harmonize the patient with the mixed hot and cold symptoms and will relieve the obstruction of the TH.  Bupleurum expels pathogens from the GB and TH channels by forcing upward and outward.  Scutellaria descends Yang from the upper burner to reintegrate with the lower burner to generate Qi to give more limb strength and stamina.  Ginseng, Jujube and Licourice relieves Qi deficiency from the failure of Yang and Yin to merge as a result of the TH obstruction.  Pinellia removes Phlegm from the GB channel.  Ginger harmonzies the middle burner.   After the patient was on the herb for two weeks, the pet no longer needed NSAIDs for the Cold Bi symptoms, even during a severe cold front.  Additionally, the pet no longer has excessive dreaming.  The pulses are becoming stonger but still have a wiry feel to them, and the tongue is still red.  These symptoms indicate that the formula is appropriate, but the 9 year deep seated TH obstruction followed by Cold Bi will take more than two weeks to completely resolve. 

Nutritional Case Report

Dr. Shana Buchanan, MBA, Certified in Veterinary Acupuncture, Certified in Veterinary Chiropractic, Veterinary Food Therapist, Certified in Chinese Veterinary Herbs

Pet "P" is a 13yr old, MN, tall and lean, broken-coated, Jack Russell Terrier that weighs 22lbs (10kg).  His chief complaint is intermittent loose, cow-pile stools found in the morning by the owner.  His disposition has always been very docile and attention seeking.  When he was 5 years old he injured his right rear limb and has a partial ACL tear that is now causing constant nightly lameness.  His tongue is red with no coating and no excessive moisture, and his pulses are so deep they are difficult to palpate.  Upon deep palpation, the pulses are wiry.   The pet will seek out the owner to lay next to her, but then quickly starts panting and then lays on the cold wood floor.  After cooling down, the pet will then move to the dog cushion.  Occasionally, the pet will have a deep, dry, hacking, cough that worsens if the leash is pulled. Active points palpated are at BL 20, 21, 23 and GB 34.  The pet’s diet consists of Purina ProPlan Small Breed Formula.  The ingredients are listed below.

Chicken, brewers rice, corn gluten meal, poultry by-product meal (natural source of glucosamine), whole grain corn, animal fat preserved with mixed-tocopherols (form of Vitamin E), corn bran, fish meal (natural source of glucosamine), animal digest, dried egg product, potassium chloride, calcium phosphate, salt, L-Lysine monohydrochloride, Vitamin E supplement, taurine, choline chloride, zinc sulfate, ferrous sulfate, L-ascorbyl-2-polyphosphate (source of Vitamin C), manganese sulfate, niacin, calcium carbonate, Vitamin A supplement, calcium pantothenate, thiamine mononitrate, copper sulfate, riboflavin supplement, Vitamin B-12 supplement, pyridoxine hydrochloride, garlic oil, folic acid, Vitamin D-3 supplement, calcium iodate, biotin, menadione sodium bisulfite complex (source of Vitamin K activity), sodium selenite.
D-4450

Pet "P" has a Western diagnosis of a partial right rear ACL tear, arthritis, and intermittent gastritis.  An Eastern diagnosis of Liver Blood Deficiency causing blood stagnation, heat and lameness; Liver overacting on the Spleen and Stomach causing loose intermittent stools; and Lung  Qi not descending to assist the Large Intestine properly  is appropriate.  The following recipe is recommended to correct the Liver Blood Deficiency, cool the patient by tonifying Yin, tonify the Lung and Large Intestine, and tonify the Spleen and Stomach.  It should be added all together and cooked in a crock pot until the potatoes are soft.  A half of an adult multi-vitamin should be given daily.

Protein source:  Beef Liver (tonifies the Liver, nourishes the Blood, source of Vitamins and Minerals)

Carb source:  Sweet potatoes (Spleen tonic, Liver tonifying)

Vegetable source:  Kidney beans pre-soaked at least 8 hours prior to cooking to ensure easy digestion and palatability (drains and dries Damp, high fiber source, tonifies Yin).  Kidney beans are recommended over Barley due to availability.

Fruit source:  Strawberry (helps with indigestion, strengthens Spleen). This should be added at the end of cooking.

Fat source:  Almonds (for coughing, strengthens Stomach and Spleen)

Supplements:  Nettle (tonifies Yin and clears heat) and a small amount of honey (tonifies Yin and strengthens Spleen and Stomach)

Liver Failure Case Report

Dr. Shana Buchanan, MBA, Certified in Veterinary Acupuncture, Certified in Veterinary Chiropractic, Veterinary Food Therapist, Certified in Chinese Veterinary Herbs

Pet "P" is a 9yr, intact male Miniature Schnauzer that presented for vomiting and anorexia for the past three days.  Upon presentation the patient was very icteric and lethargic.  The tongue was yellow and dry and the pulses were bounding.  Abdominal palpation revealed a soft, fluid-filled abdomen and an enlarged liver.  A severe heart murmur was ausculted at a grade V/VI holosystolic murmur with synchronous pulses.  Blood work was performed and revealed the following

 Anemia:  HCT 17.2% (N=37-55%) RBC 2.21 (N=5.5-8.5)

 Leukocytosis:  WBC 29.11 (N=5.5-16.9) Monocytes 2.75 (N=0.3-2) Neutrophils 19.88 (N=2-12) Basophils 0.11 (N=0-0.1);

Hypoalbuminemia:  1.6 (N=2.2-3.9)

Increased liver enzymes:  ALT 701 (N=10-100) GGT 11 (N=0-7) Total bilirubin 17.6 (N=0-0.9)

Azotemia:  BUN 54 (N=7-27) Creatinine 1.9 (N=0.5-1.8)

Hypercholesterolemia:  354 (N=110-320)

A Western Diagnosis of Liver Failure was made.  An Eastern Diagnosis of Liver Blood and Qi Deficiency, Qi and Blood stasis, and Damp Heat was made.  This patient was exhibiting classic liver blood deficiency due to the anemia, dry tongue, and bounding pulses, Qi and Blood stasis due to the cholesterol elevation and marked liver enzyme elevations, Damp Heat due to the profound icteric state, bounding pulses, and leukocytosis, and Qi Deficiency due to the pet’s inability to walk due to weakness.   At this point any Qi tonic, Blood tonic or Damp Heat clearing herb might help but doubtful.  Unfortunately, the pet died shortly after presentation.

The interesting aspect of this case is that the pet presented previously for vomiting and diarrhea after the pet received a human NSAID.  At that point blood work was performed and revealed the following

Slight anemia:  HCT 36% (N=37-55%), RBC 4.64 (N=5.5-8.5)

High normal BUN: 27 (N=7-27)

High normal Creatinine:  1.6 (N=0.5-1.8)

It was assumed that the patient had the beginning of renal insufficiency due to the ingestation of the NSAID and vomiting and diarrhea. Intravenous fluid therapy with antibiotics and anti-emetics corrected the problems but made the anemia more pronounce HCT 24.4 % (N=37-55) RBC 3.14 (N=5.5-8.5) HGB 9.9 (N=12-18).  Conventional thinking dictated that the patient was in renal insufficiency and an appropriate kidney plan was put in place that included a low protein diet and phosphorous binders.  Over the course of the next few months, the pet became more hyporexic by refusing to eat the kidney diet and take the medications, thus revealing a progressive Spleen deficiency instead of a worsening of the kidney disease.  

Retrospect evaluation of the pet's condition both Eastern and Westerrn perspective reveals a different possible outcome.  Since the pet had anemia, this would indicate Liver Blood Deficiency.  Also, since the pet was having vomiting and diarrhea, a Spleen Deficiency would have been made.  Since Blood Deficiency can lead to heat and possible dampness, it would have been interesting to see if an appropriate Blood Tonic and Spleen Tonic, such as Xiao Yao San, could have prevented the severe stasis and heat that caused the jaundice, liver failure, suppurative hepatitis, and anemia.  No doubt the pet would have succumbed to jaundice and liver failure, but I wonder how much more quality of life the pet would have  if started on Xiao Yao San.  Xiao Yao San would have been an appropriate choice in the beginning of the disease because it contains Bupleurum that moves stagnant Liver Qi, Angelica and White Peony that tonifies Liver Blood and Yin, Mint that clears heat, and most of the herbs in Four Gentlemen, White Atractylodes, Poria and Licorice, that supports the Spleen and Stomach.