Case Report: Relieving Pneumonia Complicating COVID Infection in a Leukemia Patient

Doctor zhou January 13, 2023

Patient Xie, female, born September 1949, a native of Wuxi, Jiangsu. Due to her work she had long been exposed to toxic and hazardous chemicals. In July 2018 she was examined at the Hematology Department of Wuxi Second People's Hospital (admission no. 180055750) and diagnosed with B-lymphoproliferative disorder (i.e., chronic lymphocytic leukemia). Her mediastinal, cervical, submandibular, and supraclavicular lymph nodes enlarged markedly in 2022. From May 31, 2022 onward she came to me for TCM treatment, and has been treated by me ever since.

On December 19, 2022, the patient's husband developed a sore throat and then a fever. On December 22, the patient herself began to feel unwell; on the 23rd she took a COVID antigen test, which was positive. That evening her temperature was 37.3°C, and the next morning 37.5°C. Her usual baseline temperature was 36.3–36.5°C. On December 24 she felt chest pain and went to the local hospital for CT and blood tests, which showed no pneumonia. Myoglobin was 172 (normal 23–112). High-sensitivity C-reactive protein was 5.13 (normal 0–4). The local doctor prescribed a local Chinese herbal medicine for COVID and told her to go home and take it.

The local hospital's Chinese formula was: Shanyao (Dioscorea) 12 g, Zhishi (immature bitter orange) 6 g, Guizhi (cinnamon twig) 9 g, Zexie (Alisma) 9 g, Jiangbanxia (ginger-processed Pinellia) 9 g, Chenpi (tangerine peel) 6 g, Zhigancao (honey-fried licorice) 6 g, Shegan (Belamcanda) 9 g, Fuling (Poria) 15 g, Xingren (apricot kernel) 9 g, Kuandonghua (coltsfoot flower) 9 g, Zhuling (Polyporus) 9 g, Huangqin (Scutellaria) 9 g, Ziwan (Aster) 9 g, Chao Baizhu (fried Atractylodes) 9 g, Huoxiang (Agastache) 9 g, Xixin (Asarum) 6 g, Mahuang (Ephedra) 9 g, Chaihu (Bupleurum) 16 g, Sheng Shigao (raw gypsum) 15 g, Shengjiang (fresh ginger) 9 g.

After taking this medicine, her temperature rose that afternoon to 37.8°C (the highest since falling ill). Over the following days the temperature fluctuated around 37°C. After several days of the medicine the temperature did not fall but rose, hovering around 37–37.5°C. Her sleep was poor; she awoke at 2 a.m. She sweated in her sleep, had hot dry cough, abundant sputum, and an itchy throat. The sputum came from deep in the throat, some of it white and sticky. The patient had pre-existing lung problems—lung nodules and fibrosis, with occasional chronic inflammation—so she was prone to developing acute pneumonia.

My prescription on December 31 was: Guizhi 9 g, Huangqin 9 g, Renshen (red ginseng) 9 g, Zhigancao 6 g, Fabanxia (processed Pinellia) 12 g, Baishao (white peony) 9 g, Chaihu 24 g, Sangbaipi (mulberry bark) 9 g, Jiegeng (platycodon) 9 g, Maidong (Ophiopogon) 6 g, Wuweizi (Schisandra) 6 g, Ziwan 9 g, Kuandonghua 9 g, Pipaye (loquat leaf) 9 g, Dazao (jujube) 12 pieces, Shengjiang 7 slices.

From December 31, 2022 to January 2, 2023, the patient took the above formula, but her temperature still did not fully fall, remaining basically at 37–37.3°C. During this period she was examined at Wuxi Second People's Hospital, which found inflammation in both lungs; she received IV drips at the hospital. She was allergic to multiple antibiotics, so few Western anti-inflammatory options were available. From January 2 to January 3 her temperature fell below 37°C. But she still had abundant sputum and cough, a hoarse voice, poor sleep (waking many times each night), a thick greasy tongue coating, and aversion to cold.

That day I adjusted the prescription as follows: Chaihu 6 g, Huangqin 9 g, Jinqiaomai (golden buckwheat) 15 g, Renshen (red ginseng) 9 g, Dangshen (Codonopsis) 30 g, Huangjing (Polygonatum) 30 g, Fabanxia 6 g, Dannanxing (bile arisaema) 6 g, Guizhi 15 g, Rougui (cinnamon bark) 15 g, Fuling 30 g, Baizhu 15 g, Han Fangji (Stephania) 20 g, raw Huangqi (Astragalus) 30 g, Zhigancao 6 g, Pipaye 9 g, Maidong 9 g, Wuweizi 9 g, Tiandong (Asparagus radix) 15 g, Dilong (earthworm) 15 g.

From January 3 to 5, 2023, the patient continued to receive hospital IV drips while taking the Chinese medicine. But recently her gastrointestinal reaction was severe, with heavy diarrhea; on the 4th she had three near-watery stools. She had a prior history of gastrointestinal disease and took Bifidobacterium year-round to control it. Her sore throat had clearly improved, but her nose was still uncomfortable and she still coughed sticky white sputum, waking each night covered in sweat. By then I had begun to emerge slightly from the enormous workload, and I treated my long-term cancer patients with a method of daily observation.

January 5 prescription: Guizhi 10 g, Huangqin 10 g, Renshen 10 g, Zhigancao 6 g, Baishao 10 g, Chaihu 15 g, Fabanxia 10 g, Juhong (tangerine exocarp) 15 g, Huoxiang 5 g, Peilan (Eupatorium) 5 g, Sharen (cardamom) 5 g, Qianghuo (Notopterygium) 5 g, Chuanxiong (Sichuan lovage) 5 g, Cangzhu (Atractylodes lancea) 5 g, Houpo (Magnolia bark) 5 g, Zhiqiao (aurantium fruit) 5 g, Baizhi (Angelica dahurica) 5 g, Manjingzi (Vitex) 5 g, Fangfeng (Saposhnikovia) 5 g, Jingjie (Schizonepeta) 5 g, Pipaye 5 g, Sangbaipi 5 g, Jineijin (chicken gizzard lining) 5 g, raw Shanzha (hawthorn) 15 g, Gegen (Pueraria) 15 g, Jiegeng 10 g, Dilong 10 g, Roudoukou (nutmeg) 6 g, Buguzhi (Psoralea) 6 g, Wuweizi 6 g, Wuzhuyu (Evodia) 6 g, Maidong 10 g, Tiandong 10 g, Baihe (lily bulb) 5 g, Huangjing 15 g, Dazao 7 pieces, Shengjiang 7 slices.

This combined Guizhi Chaihu Tang, Jing Fang Baidu San, and Sishen Wan. On the same day, I also couriered some of my Chai Gui Jiedu Wan (Bupleurum-Cinnamon Detox Pills), which I had asked a pharmacy to make for my family (see my article My Pill Formula for COVID: Chai Gui Jiedu Wan), and told her to take the pills once they arrived.

On January 7, the patient reported that after taking the above formula the diarrhea stopped and she had not had a bowel movement all day on the 6th. On the morning of the 7th she had a sticky stool; her sleep at night was better than before. Her cough had improved, her dry mouth was better, but she still sweated a lot. That day she received the Chai Gui Jiedu Wan; I told her to stop the decoction and take only the Chai Gui Jiedu Wan.

On January 9, she reported that after taking Chai Gui Jiedu Wan she felt generally stable, slept better than before, and her stools were normal. She still coughed, sometimes in paroxysms, and the sputum was stickier than before. Overall she was better than before. In addition, on January 8 she had a follow-up CT, which showed slow absorption of the pneumonia. Because she was allergic to antibiotics and had almost none available, plus poor white blood cell function and defective B lymphocytes, her recovery was slower than others'.

I therefore advised her to take the following formula in addition to Chai Gui Jiedu Wan: Guizhi 9 g, Huangqin 9 g, Renshen 9 g, Zhigancao 6 g, Tianhuafen (Trichosanthes root) 12 g, Baishao 9 g, Chaihu 24 g, Dazao 12 pieces, Shengjiang 7 slices, one packet, decocted in water. This was Chaihu Guizhi Tang with Fabanxia replaced by Tianhuafen.

After taking one packet of this formula, the effect was obvious: she basically stopped coughing, but developed diarrhea, which is a side effect of Tianhuafen. Since the cough had stopped, I stopped the decoction and had her take only Chai Gui Jiedu Wan. The pills should resolve the diarrhea; if not, she could take the patent medicine Sishen Wan (Four Spirits Pills).

Thereafter she kept taking Chai Gui Jiedu Wan, and her condition improved day by day. Because she is immunocompromised, I also had her take my self-formulated Yiqi Huayu Pills (see my article My Experienced Formula for COVID-Induced Cough and Wheezing: Yiqi Huayu Pills) to strengthen the effect.

The patient's condition is now stable: she no longer has fever or cough, no longer has diarrhea, her sleep has improved greatly, and she can now sleep seven hours at night. She is gradually recovering. But leukemia patients have low immunity, and complete recovery is expected to take a long time; I told her to keep taking Chai Gui Jiedu Wan and Yiqi Huayu Pills for a while.

Incidentally, a few days ago I published another case report of a cancer patient with COVID: A Cancer Patient with Fever and Dizziness for 18 Days After COVID. That cancer patient also began taking Chai Gui Jiedu Wan three days ago and stopped taking decoctions. Since taking the pills, his condition has continued to improve; his dizziness is no longer as severe as before, and he can cook for himself. He is now also taking both Chai Gui Jiedu Wan and Yiqi Huayu Pills, and no other Chinese or Western medicines; his condition is temporarily stable.

In addition, the daughter of a Sichuan lung-cancer patient I treat developed severe cough after infection; a few days ago she went to the hospital and was diagnosed with pneumonia. She had tight, aching pain over the chest and back and continuous cough. After taking one dose of Chai Gui Jiedu Wan, the pain disappeared and the chest tightness improved markedly. She then continued taking Chai Gui Jiedu Wan for three more days, and the cough was almost completely resolved. She is now continuing to take Chai Gui Jiedu Wan to consolidate the effect.

The above experiences prove that my Chai Gui Jiedu Wan does have definite clinical efficacy for COVID. All three patients were diagnosed with pneumonia after COVID, and two were immunocompromised cancer patients. They were treated with pills made according to my original Chai Gui Jiedu Wan formula, and all showed some effect, showing that this medicine does indeed relieve various symptoms after COVID infection.

The original Chai Gui Jiedu Wan formula is as follows:

Guizhi 10 g, Huangqin 10 g, Renshen 10 g, Zhigancao 6 g, Baishao 10 g, Chaihu 25 g, Tianhuafen 15 g, Huoxiang 5 g, Peilan 5 g, Sharen 5 g, Qianghuo 10 g, Chuanxiong 5 g, Cangzhu 5 g, Houpo 5 g, Zhiqiao 5 g, Baizhi 5 g, Manjingzi 15 g, Fangfeng 5 g, Jingjie 5 g, Pipaye 10 g, Sangbaipi 15 g, Jineijin 6 g, Shanzha 15 g, Gegen 15 g, Jiegeng 10 g, Dilong 10 g, Dazhaorou (jujube flesh) 25 g, Ganjiang (dried ginger) 5 g.

Grind all herbs into fine powder, mix with refined honey to form soybean-sized pills; take 20–60 pills per dose. According to feedback so far, adults taking 30 pills get very good results; reduce the dose for children. This formula is for patients after COVID infection who sometimes feel hot, sometimes averse to cold, sometimes have night sweats, recurrent low fever, reduced appetite, loss of taste and smell, frequent cough, body aches, and headache that is hard to relieve.

Yiqi Huayu Pills are as follows:

raw Huangqi 50 g, Xiyangshen (American ginseng) 10 g, Maidong 20 g, Tiandong 20 g, Wuweizi 20 g, Dilong 10 g, Rougui 5 g, Danggui 10 g. Grind all herbs into fine powder, mix with refined honey to form soybean-sized pills; take 15–30 pills per dose.

Those who wish to use the above two formulas should find a local pharmacy or TCM hospital pharmacy to prepare them according to the prescription; I myself have no extra pills.

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