October 2026
Dr. Denette O. Cooke, DVM
Signalment
Willow is a three-year-old spayed female Cavalier King Charles Spaniel with a history of suspected seizure activity beginning at 17 weeks of age.
October 18, 2023 — 17 Weeks of Age
Subjective:
The owner reported unusual seizure-like activity that morning. Willow appeared “frozen,” with shaking of one paw. The duration of the episode was unknown.
Objective:
Willow was bright, alert, and behaving normally during her examination.
Bloodwork was normal except for giant platelets, a finding commonly recognized in this breed.
Assessment:
Possible seizure activity. Otherwise clinically healthy.
Plan:
The owner was instructed to monitor Willow and maintain a seizure log.
March 12, 2024 — Approximately Nine Months of Age
Subjective:
The owner reported another possible seizure episode four days earlier. Willow appeared “drunk and stiff” for several minutes, with difficulty balancing on all four limbs. She also vomited, was difficult to rouse, and had a slight head tilt.
Willow had been evaluated at another local veterinary hospital several days earlier.
She had vomited bile the night before the episode and had not eaten that morning. She was experiencing her first heat cycle.
Objective:
During the examination for suspected seizure activity, the veterinary team identified a vulvar cyst. Vulvar enlargement consistent with estrus was also noted. The remainder of her physical examination was unremarkable.
Bloodwork and urinalysis were reported as normal.
Assessment:
Probable seizure activity. Otherwise clinically healthy between episodes.
Plan:
Continue monitoring and maintaining a seizure log.
August 21, 2024 — Approximately 14 Months of Age
Subjective:
Willow presented for a wellness examination and preventive care updates. No further seizure activity had been reported since March 2024.
Objective:
Willow was experiencing her second heat cycle, with associated vulvar enlargement. The remainder of her examination was normal.
Assessment:
Clinically healthy, with no additional reported seizures.
Plan:
Schedule spay surgery after completion of the heat cycle. Continue monitoring for seizure activity.
March 28, 2025 — Approximately 21 Months of Age
Subjective:
Willow presented for her scheduled spay surgery.
Objective:
Willow appeared clinically healthy. Mammary development associated with her previous heat cycles was noted.
Assessment:
Clinically healthy for the planned procedure.
Plan:
Proceed with spay surgery. Continue monitoring for seizures or other unusual neurologic activity.
December 22, 2025 — Approximately 30 Months of Age
Willow experienced a seizure at home, which the owner documented in her seizure log. Details regarding duration and severity were not available.
Willow was not evaluated by a veterinarian for this event.
January 21, 2026 — Emergency Evaluation at Bay Beach
Subjective:
Willow presented to Bay Beach Emergency Hospital following additional seizure activity.
Episode description documented by the ER:
Willow experienced three separate episodes that day. Reported signs included an ataxic, wobbling gait, hindlimb stiffness, and twitching on the right side of her face.
The episodes occurred approximately 10–15 minutes apart and lasted two to three minutes each. The signs appeared predominantly localized to one side of her body.
Assessment:
Suspected focal seizures occurring in a cluster, representing an increase in seizure frequency.
Plan:
Further evaluation through a neurology service and follow-up with Cooke Veterinary Medical Center were recommended. Epilepsy was considered, although other underlying causes remained possible.
January 23, 2026 — Follow-Up and TCVM Consultation
Willow was evaluated by Dr. Cooke following her emergency visit for three seizure episodes on January 21.
The owner retrospectively associated Willow’s earlier episodes at 17 weeks and nine months of age with stress or excitement. The recent clustered episodes occurred at night while Willow was asleep.
Because her seizure activity had progressed to clustering, treatment intervention was recommended.
Conventional diagnostic and treatment discussion:
A referral to a veterinary neurologist was discussed, including brain MRI and cerebrospinal fluid analysis to investigate inflammatory, structural, and other causes of central nervous system disease.
The working diagnosis was presumptive epilepsy of undetermined cause. A congenital or inherited cause was considered because of the early onset, but had not been confirmed. Further diagnostic testing could help clarify the underlying cause.
Conventional antiseizure treatment, including levetiracetam, was discussed. TCVM herbal therapy was also discussed as a treatment option, and the owners elected an herbal trial at this time.
TCVM examination:
- Tongue: Pale pink to pale, with a thin appearance.
- Pulses: Deep and weak.
TCVM pattern diagnosis:
Kidney Jing Deficiency causing Internal Wind.
Assessment:
Presumptive epilepsy of undetermined cause.
TCVM pattern: Kidney Jing Deficiency with Excess Internal Wind.
Plan:
Begin Epimedium Formula and Di Tan Tang, supplied by Jing Tang Herbal, Inc.
Weight at initiation: 18.2 lb.
Initial doses:
- Epimedium Formula: 0.5 grams once daily.
- Di Tan Tang: 0.5 grams once daily.
Continue the seizure diary and follow up with Dr. Cooke in four to six weeks.
Epimedium Formula
TCVM Principles: Tony Kidney Yang, nourish Yin and Jing
Contraindications: Do not use in patients with acute inflammation or infections (Excess Heat)
Directions: Use as directed by a veterinarian herbalist
Classical Antecedent:
Sheng Jing San
| English Name | Latin Name |
| Bai Shao Yao | Paeonia |
| Bu Gu Zhi | Psoralea |
| Chen Pi | Citrus |
| Dang Gui | Angelica |
| Dang Shen | Condonopsis |
| Gou Qi Zi | Lycium Chinensis Fructus |
| He Shou Wu | Polygonum |
| Huang Qi | Astragalus |
| Mai Men Dong | Ophiopogon |
| Shu Di Huang | Rehmannia |
| Suo Yang | Cynomorium |
| Tu Si Zi | Cuscuta |
| Xu Duan | Dipsaus |
| Xuan Shen | Scrophularia |
| Yang Qi Shi | Actinolite |
| Yin Yang Huo | Epimedium |
Di Tan Tang
TCVM Principles: Transform phlegm, Clear Internal Wind
Contraindications: Caution during pregnancy
Directions: Use for up to 6 months or as directed by a veterinarian herbalist
Classical Antecedent:
Di Tan Tang from Ji Sheng Fang (Formulas from Aid the Living) by Yan Yong-He, dates back to year 1253 AD.
| English Name | Latin Name |
| Chen Pi | Citrus |
| Dan Nan Xing | Arisaema |
| Dang Shen | Codonopsis |
| Fu Ling | Poria |
| Gan Cao | Glycyrrhiza |
| Gan Jiang | Zingiberis |
| Gou Teng | Uncaria |
| Hai Zao | Sargassum |
| Kun Bu | Laminaria |
| Shi Jue Ming | Haliotis |
| Shi Chang Pu | Acorus |
| Zhi Shi | Aurantium |
| Zhu Ru | Bambusa |
February 27, 2026 — First Herbal Follow-Up
Subjective:
The owner reported that Willow was doing very well and taking the herbs readily. No seizure activity had been observed since beginning herbal therapy. Weight loss was also noted.
Objective:
- Tongue: Pink; no longer pale and thin in appearance.
- Weight: Loss of 1.5 lb.
Assessment:
No reported seizures since initiation of herbal therapy. Weight loss noted. Otherwise doing well.
Plan:
Continue both herbal formulas and maintain the seizure diary.
Willow’s Fire constitution, a Yang constitution, was discussed within the TCVM framework. Seasonal influences were also discussed, including the traditional association of Wind with spring and the importance of monitoring for changes during seasonal transitions.
Introducing a home-prepared diet was discussed, including the use of Balance IT to help ensure nutritional completeness and balance.
Continue herbal therapy and follow up in approximately three months.
July 23, 2026 — Second Herbal Follow-Up
Subjective:
Willow presented for a wellness examination. The owner reported that she continued to do very well, with no seizure activity.
Her diet included a variety of foods, including some Primal raw bricks.
Objective:
- Tongue: Pink.
- Pulses: Strong and even.
Assessment:
No reported seizure activity since herbal therapy began in January 2026.
Plan:
The regimen documented at this visit was:
- Epimedium Formula: 0.5 grams once daily.
- Di Tan Tang: Three teapills each evening.
Continue the current regimen and seizure diary. Follow up in six months.
Once Willow had remained seizure-free for one year, gradual reduction of herbal therapy would be considered under veterinary supervision.
October 16, 2026 — Owner Follow-Up
During a verbal follow-up, the owner reported that Willow remained on the same herbal regimen documented in July and had experienced no further seizure activity.
Plan:
Continue the current regimen and seizure diary.
If Willow remains seizure-free for one year, consider gradually withdrawing one formula under veterinary supervision, with continued monitoring.
Ongoing Case Summary
Willow’s history progressed from isolated suspected seizure episodes in puppyhood to clustered episodes in January 2026. Her owners elected TCVM herbal therapy following a discussion of diagnostic and treatment options.
Epimedium Formula and Di Tan Tang were initiated on January 23, 2026. Through October 16, 2026, her owner reported no further seizures—approximately nine months without observed seizure activity.
During follow-up, Willow’s TCVM findings also changed from a pale, thin-appearing tongue and deep, weak pulses to a pink tongue and strong, even pulses.
This case documents a sustained period without owner-observed seizures following initiation of herbal therapy. The underlying cause of her episodes remains unconfirmed, and this individual case cannot establish treatment causation. Because she has responded well to seizure therapy, our working diagnosis is congenital epilepsy.
Our goals in managing seizure activity are the same whether we use conventional medication, TCVM herbal therapy, or an integrative approach: reduce seizure frequency and severity, prevent clusters, minimize adverse effects, and support a good quality of life.
Willow’s case remains ongoing.