Xiao Chai Hu Tang/feline Pancreatitis-azotemia
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Patient is a 12 yr MC hyperthyroid DSH that first presented 3 years ago when the cat developed mild azotemia. The owner's goal was to preserve the Kidneys. The cat receives 2.5 methimazole BID, 100 cc SQ LRS twice weekly. I have treated the Kidney deficiency with AP q2-4 weeks, duck/chicken canned food. It won't eat or vomits fish. When I first started with this cat, I did not know that renal inflammation could be reduced by treating the Spleen/Damp, so he maintained normal renal parameters with Er Xian Tang. Interestingly, the cat developed pancreatitis 6 months ago, initially responding well to Shu Gan Formula and Jian Pi Wan. Maintenance formulas have bee Wei Ling Tang, Er Xian tang and Corydalis Formula. He has gained weight, with minimal vomiting. He did well through a dental prophylaxis 2 months ago, but lately has started showing slowly progressive azotemia. Change to BWDHW, creatinine rose from 2.3 to 2.5. Went back to Er Xian tang, combined with Wei Ling Tang and Corydalis formula and the creatinine yesterday was 2.8. His abdomen is tense again. Weight is down by 5 oz, with 3 episodes of vomiting. Tongue is swollen lavender,slimy wet, slight yellow coating. Right GB34 sl spongy, no other reactive points. Although I think that the Spleen Qi deficiency, Damp is the source of azotemia/renal inflammation (hyperthyroidism), I am afraind to discontinue the Er Xian Tang. I was thinking of discontinuing Corydalis formula and substituting Xiao Chai Hu Tang, but the cat won't take NP XCHT, and I can't find a pill form in K'an Herbs (hard to find Minor Bupleurum as all the names are descriptive and not pin yin).
I think there is Spleen Qi deficiency, Dmap/Phlegm, Liver Qi stagnation, with Kidney Damp/Heat or Qi deficiency. Would Xiao Yao San be a better choice? Maybe San Ren Tang/Xiao Yao San? Help me Mister Wizard.....