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Dog with Pulmonary Effusion

First- for those who don’t know me, I’m a veterinarian who does acupuncture (Sa’am, classical acupuncture, balance method) and Chinese herbal and Food therapy. I mostly do internal medicine cases.

She is a middle aged spayed female Visla.

I have a dog that presented to me a couple of months ago, dyspneic, sent home to die from Specialty/Referral Clinic She was very thin, wet mouth, with small salivary glands on palpation. Her tongue was pale pink at the edges with a lavender center. Her respiration was clearly labored with clear intercostal and diaphragmatic excursions. Energy was significantly reduced. Her pulses were similar bilaterally and were slippery w/ faint wiry component. Pulse size was smaller than expected. In a dog, because of motion and anatomy, I usually don’t attribute an organ component unless it’s really profoundly different. There is no comment in my chart, so I suspect that she felt similar in all positions. Hair coat was slightly greasy and was underpigmented.

She was eating (not a lot and reluctantly) a processed food diet. Her personality was a sweet, engaging Earth dog with a slight TH component from a Sa’am perspective.

She had 1.7 liters of chylous fluid drained from her pleura (in a 35lb dog) the previous day.

I switched her to a cooked food diet with the addition of fresh Shitake mushrooms and fresh ginger. I did a double LI Sa’am treatment and started her on Wu Ling San at a big dose.

And she got better. Not fixed, but progressively better over a period of 2-3 months. Pleural tap volume reduced. Dog regained normal body condition score, coat quality improved and color became rich. Dyspnea resolved, energy back to normal. She loved the food, appetite returned to normal dog appetite. Tongue lost lavender center and became a uniform pale pink but thin, it was still slightly wet. Pulses became soft, still a little superficial, still a little small and weak as compared to the dog’s vitality.

And then the pleural tap volume started to creep up. The rest of the physical exam remained improved, so I added in a low dose of Jin Gui Shen qi in the hopes that Kidney would start grasping a little more of the fluid from the Lung. I switched over to Sa’am ST on the Left, Kidney on the right because she was no longer greasy on the outside. I also did a treatment, approaching it with a Jeffrey Yuen meridian sequence approach using LU/KID/TH, which also helped but not fixed.

The herb change helped her drop her pleural tap volume a bit, but it started creeping up a bit.

Then, I broke my hand and the owner threw his back out and I didn’t get to treat her for about a month.

She has maintained her progress, but I would like to help her completely clear this pleural effusion which is trying to creep back up in volume.

What am I missing from an herbal perspective? Herb Gurus please weigh in. She’s still on a biggish dose of Wu Ling San extract granules with the addition of a 1/2 dose of Jin Gui Shen Qi. I can modify herbal formulas as needed if we do it in extract granules.

Hi Patricia,

So awesome to hear that our animal friends are getting so much benefit from your skillful services.

Even though you didn’t ask about more perspectives on Saam: You do want to be careful about using Saam Kidney supplementing when there is fluid accumulation and phlegm. Here is a quote direct from Toby on the subject:
“I’m always cautious to use Kid+ if there is actual dampness because I don’t want to consolidate such a sticky pathogenic factor.”

I wonder what is causing the fluid to accumulate again. Does she run on the cool side or crave warmth? Did her mouth become wet again? If all of these thin clear fluids are accumulating you have to consider cold as a factor. With Saam, H+ could be helpful. Herbally, for accumulation of thin fluids in the Lungs from cold you could consider including elements of
Ling gan wu wei jiang xin tang:
fu ling 12
gan can 9
wu wei zi 6
xi xin 9
gan jiang 9

Doses are classical. You probably would use less xi xin 3-6 (or however that works out proportionally). Maybe a little less gan jiang too. These hot medicinals are really baking the fluids away.

Now she is in better condition, and since you have already supplemented Kidney with Saam, SI+ would be an option to use movement to help drain the fluids.

Please let us know how she does.
Best wishes for your hand, too!

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She is actually tolerant of both heat and cold. Possibly running a little on the hot side, but we’re in Texas in July sooooooo…

Her mouth didn’t become wet again. The drool is gone. I’ll see her tomorrow and check again.

So, actually the fluid isn’t clear, this is a chylous effusion, so to view it, it would be white and not as thin as an exudate. The white might be cold though. I do like the idea of SI in Sa’am. I don’t think I’ve tried that on her yet.

I’ll read up on Ling Gan Wu Wei Jiang Xin Tang. I’m guessing this would be a substitution for what I’m giving currently? I’m wondering if I need to simply modify the Wu Ling San with some Gan Jiang and some Wu Wei Zi and stop the Jin Gui Shen Qi.

So, I woke up and understood more about the description of this problem. She has Turbid Fluids in the Upper Jiao where they don’t belong. This does sound like a Small Intestine/Stomach problem of not separating clear from turbid.

I’m going to try SI Sa’am on her today. We should know if it helps as soon as I insert the needles.

Thanks for the clarification. If the fluids are turbid then maybe more er chen tang- which traditionally is prepared with sheng jiang and wu mei, which could be swapped out for gan jiang and wu wei zi. With the volume of fluids she is producing, a more strongly drying herbal approach seems valid.

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I just saw Sadie. For a dog who recently had an extra 1.5 L of turbid fluid pulled from her pleura, she looked pretty damn good. Happy, interactive, bouncy, well muscled. Her muscling seems to get better every time I see her.

Tongue was a little on the red side (it was 95 degrees outside) and wet. Mouth had pretty normal moisture. Pulse was small bilaterally moderate to deep in location with slightly soft vessel walls and too narrow for a dog her size.

So, I did do SI Sa’am unilateral on right, she quieted for a few minutes during treatment but did not get completely conked out. This is not unusual for Sadie, because she really feels like needs to be interacting with everyone in the room at all times. Perhaps I should consider her more of a Heart/TH excess than I do. Her tongue quality did shift to a more normal pinker during treatment and less red.

I looked on the shelf. I had Evergreen extract granules of Er Chen Tang and some Wu Wei Zi extract granules, so I modified the Er Chen Tang with an additional 10% of Wu Wei Zi. A true modified Er Chen Tang will require me to order all of the components and I didn’t have Gan Jiang on the shelf. I advised the owner to switch out the fresh ginger in her food for some dry ginger.

Right now, her quality of life is excellent. I just want her to be completely better now.

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Update on Sadie-

Still looking good. Tongue is less red this week, Pulses maybe not so small (using my imaginator) and slightly stronger on the right.

She responded to Sa’am SI this time with falling asleep for a short time, which is not like Sadie, who usually fights her acupuncture drunkenness.

Fluid removed this week 1.1 l, down from 1.5l last week.

I’m holding the course with current herb therapy and food therapy. We’ll see how this goes.

Thanks for the update. Interesting that she settled more with this week’s SI+, compared to last week’s. Next week definitely do a different treatment since you already did 2 SI+ in a row.
Glad to hear that she is doing better but 1.1 l still sounds like sooo much fluid to have to drain for anyone, never mind a 35 lb being. She has enough fluid to warrant LI+ again for sure. If she likes to be covered up in air conditioning, you may consider H+. Consider upping the gan jiang.

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Update on Sadie-

Most recent pleural tap down to 700cc from 1.1L the previous week. Owner needed a refill on herbs so I added 15g of WuWeiZi to the 100g container of Er Chen Tang (all extract granules) and advised owner to increase the dried ginger in her food by 50%, so from 1 tsp in a large crockpot to 1 1/2 tsp in a large crockpot.

I’ve got an appointment with her on Thursday evening, she will have had her pleural tap that day. Fingers crossed.

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