Severe Post-surgical Food Stagnation in a Golden Retreiver
An eight year old spayed golden retriever female presented with a one year history of severe post-operative bloating, abdominal distension and discomfort. One year prior she had undergone an emergency surgery for a gastric torsion with volvulus. The surgery was essentially an abdominal approach to the stomach in which the torsion and volvulus was reduced. To reduce future torsions the right side of the stomach was permanently attached to the inner aspect of the right abdominal wall. From the day of surgery she has had severe bloating and abdominal distension within 1-3 hours after eating her meals.
Jessieís caretaker made a home-cooked diet for her dog with added glucosamine hydrochloride and chondroitin sulfate, and digestive enzymes. The caretaker had seen a veterinary acupuncturist for 10 months preceding my visits. Jessie had bloated 2-3 days each week for the first few months after acupunctural treatment but was now bloating 6-7 days each week after virtually every meal.
The dog, Jessie, was a state and regional champion in agility work. She presented as a bright, alert and very friendly dog. Jessie weighed about 55 pounds and thus was 12 pounds underweight for her breed, size and age. The weight loss was mostly axial and appendicular muscle mass. Her coat was long and silky and her footpads and nails were within normal limits of flexibility and strength. Jessieís tongue was slightly pale and moist with a light lavender center. Her nose was cool and moist with normal pigmentation and her ears were slightly cool to the tips. Jessie had depressed Bladder Shu points at Ganshu (UB 18), Pishu (UB 20), and Weishu (UB 21). She also had depressions at Zhongwan (DU 12) and firmness at Shangwan (DU 13). Jessieís pulse was soft, slightly thin and weak in the right middle position between meals although the right middle position had an inflated quality soon after meals. Jessie frequently belched after meals and this gas release partially relieved her bloating and discomfort.
Jessie was diagnosed with Spleen Qi Deficiency and severe Food Stagnation. Her caretaker was told to add fresh ginger, Sheng Jiang (Rhizoma Zingiberis Officinalis Recens), to each meal to enter the Spleen and Stomach and warm the middle Jiao. She was also instructed to add cooked yam, Shan Yao (Radix Dioscoreae Oppositae), to each meal to enter the Spleen and Stomach and tonify middle Jiao Qi. Lastly, Jessieís caretaker was instructed to feed each meal warm instead of cool from the refrigerator as she had done previously. Jessie was acupunctured and her caretaker was taught to do the Tui Na technique of An-fa (similar to acupressure) on Pishu (UB 20), Weishu (UB 21), Zhongwan (DU 12) and Neiguan (PC 6) daily and especially when the patient began to bloat. These changes reduced bloating from 6-7 days each week to 3-4 days each week and the caretaker was able to relieve the bloating within minutes with An-fa of the above acupuncture points.
In order to further reduce Food Stagnation, the TCM herbal formula Bao He Wan (Preserve Harmony Pill) was given as a 5:1 herbal extract at a dosage of 1.5 grams PO Q12H. Bao He Wan (Preserve Harmony Pill) is a relatively mild formula that only treats the Biao or branch clinical sign of food stagnation without treating the Ben or root. It is composed of herbs to relieve food stagnation, regulate qi, resolve phlegm, drain damp and clear heat and relieve toxicity. The Bao He Wan (Preserve Harmony Pill) addition to the patientís protocol mildly reduced the number and duration of bloating episodes.
Because Bao He Wan (Preserve Harmony Pill) did not address the Spleen Qi deficiency aspect of this Food Stagnation, Liu Jun Zi Tang (Six Gentleman Decoction) was used to replace Bao He Wan (Preserve Harmony Pill). Liu Jun Zi Tang (Six Gentleman Decoction) is Si Jun Zi Tang (Four Gentleman Decoction) plus one herb to regulate Qi and one herb to resolve Phlegm. Li Jun Zi Tang (Six Gentleman Decoction) is usually indicated for Spleen Qi Deficiency with vomiting, of which this patient had none. There was no significant change with this formula and it was changed after one week.
The most appropriate TCM herbal formula for this patient is Jian Pi Wan (Strengthen the Spleen Pill), Strengthen the Spleen Pill. Jian Pi Wan (Strengthen the Spleen Pill) strengthens the Spleen, reduces food stagnation and stops diarrhea. Jian Pi Wanís (Strengthen the Spleen Pill) thirteen herbs are an elegant mixture of Qi Tonics, Qi Regulators and Aromatic Herbs to transform Dampness. With the addition of Jian Pi Wan the patientís bloating was reduced to 2-3 days each week and not at every meal. The client considers this a very positive change given that local peristaltic neural control in the stomach was probably irreversibly injured by nerve damage as a consequence of the patientís surgery.
Jessieís case illustrates multiple important points. First, appropriate food therapy including both absolute food temperature as well as Xing or energetic thermal nature of foods is important. Second, it is always both important and feasible for either ourselves (in human cases) or caretakers to contribute to healing with techniques of manual therapy such as Tui Na. Lastly, as we understand cases more clearly from multiple visits with the patients, we commonly evolve more appropriate TCVM herbal therapy formulae.
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