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.
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