For Andrew: I hope it is ok for me to share another case - I'm trying to apply what we are learning in the clinic :) I am seeing a patient on Monday and I am trying to sort out what the patterns might be - obviously I will need to assess tongue and pulse at that time but I'm just going through the exercise based on the intake form. I'm not looking for any treatment recommendations just to practice pattern identification. I will stick with the tools I have for now until we learn more about herbal formulas. Any suggestions on assessing a cat's tongue? lol 6 year old female spayed domestic shorthair cat Current issues: Chronic skin disease alternating between dry and flaky skin to red/inflamed skin lesions - not sure if there is any discharge/oozing Obsessive licking/pruritis/skin lesions - caudal abdomen, axillary areas, ears, eyes Mild intermittent clear/mucoid ocular discharge Occasional soft stool - pudding like Rare vomiting hairballs Mild snoring Historical issues: Vomiting with diet change Questionable dry eye syndrome that cleared up with herbal treatment Skin twitching Prefers to sleep on cool, hard surfaces. Prefers heavy touch when snuggling/petting. The patient is independent, relaxed and friendly at home. 8 principles: External/XS/heat/yang I questioned whether this would be internal or external - I put external because I think there are signs of heat, maybe damp and wind invasion. But it has been chronic for years so I'm also wondering about this being internal....What if the EPF is not treated and then moves inwards? Is this still considered external or would it then become internal? How would environmental or food allergies correlate with TCM EPFs or other patterns? Organs affected: Skin/lung Spleen Liver Substances affected: Blood/shen/yin Western diagnosis: food intolerance vs environmental allergy, atopic skin disease, likely some component of OCD type behaviour with self mutilation Chinese diagnosis: Wind invasion, lung dryness, Liver blood deficiency/Qi stagnation, Spleen Qi deficiency with possible damp heat, liver heat/yang rising? Any thoughts would be appreciated. Thank you in advance! Dana

Andrew said: Hi Dana, I couldn't imagine guiding you on animal tongue diagnosis... I have no idea of the normals and abnormals! You may have to consult a TCM vet colleague and/or text for this. Internal- this is too chronic to call external, hot, deficient, yin. I think you have the right organs! Although lungs control the skin in the correspondences, we generally do not use lung pattern to treat skin unless there is a concurrent chronic respiratory illness or there is an acute allergic issue (recent hives, for example). There is a spleen deficiency present because of the soft stool and sensitivity to food changes. However, the organ that jumps out at me most is the Chinese liver. Skin twitching and itching are liver wind symptoms. The alternating nature of the skin presentation is a liver symptom. As far as substances: You could say shen needs treatment if the OCD is a large component and she needs an anxiolytic addition to the formula. However, blood deficiency is very likely. There is a saying in TCM: To put out the wind, you must nourish and move the blood. Imagine pipes rattling in a drafty old house. If you fill the pipes with the right amount of water, they become more solid and the wind has nowhere to go. So we will nourish blood- which fits for the dry flaky skin presentation. However, if she is on the edge of blood deficiency becoming more deficient, it might turn into a yin deficient situation- (maybe) hence the red inflamed state. So you could consider the pattern liver blood or liver yin deficiency based upon the current presentation of the skin. I might pick a formula for that and modify it to add an element of spleen qi strengthening in order to help the GI function (since it is the root of so many things!). Just curious (because of my lack of vet knowledge)- how do you differentiate between OCD behavior and response to an itch? Do you believe in raw meat diets? I have seen this do miracles several times for atopy in pets. I think it helps the spleen function by unburdening the GI. How would environmental or food allergies correlate with TCM EPFs or other patterns? We can't really translate these western concepts into TCM patterns. It truly depends upon the presentation of the individual. I have patients who have food allergies that manifest as GI upset, others as joint aches, some as rashes, and others as brain fog and fatigue. This means that any pattern is fair game (haha vet joke)!

Thank you for the reply! Fortunately I have a great TCVM mentor to help with with the tongue stuff :) Can you give any examples of an inciting cause for liver wind? The owner is quite anxious herself and I wonder if some of her mental and emotional issues could be rubbing off on the cat? I have heard of another veterinarian who is also a certified herbalist for people and treats pets by treating their owners! I love that old house analogy - makes total sense. The skin was quite damp looking and I ended up putting the cat on Hoxsey like formula and Si Miao San for spleen support - we shall see. As far as OCD behaviour - I find that this presents more as over grooming rather than scratching (this cat does both). I usually look closely at the environment to see what 'stressors' or sources of frustration can be identified. If people are doing a really good job with environmental enrichment it might be more likely true itch. Also rule out the possibility of external parasites first! Cats can often have fleas and they are hard to find because they groom so well and just eat them - gross right? I always recommend whole food diets for my patients. This owner has time to cook so we decided to do home cooked - I thought it might be easier to digest than raw initially. My first choice was home cooked with raw coming in close second. We unfortunately have quite a few atopy patients on raw diets that still have skin issues but that is why I'm writing my 1st year project on this. There is a US company called Animal Biome that does fecal microbiome testing and fecal transplant treatment for pets - I'm hoping that restoring the microbiome might help some of these 'non-responders'.

Andrew said: Hi Dana, Liver wind usually occurs because of a constitutional predisposition or chronic dysfunction. Generally it happens when there is a background of liver blood deficiency. Alternatively, it can happen in excess situations where emotions (anxiety, stress, or any strong emotion) when liver fire/yang rising turns into wind symptoms. Traditional causes also include high fever, for example febrile seizures, and exposure to wind (various EPFs).