Case Report: Rescuing an 81-Year-Old Critically Ill COVID Patient with the Warming-Yang-and-Activating-Blood Method

Doctor zhou January 25, 2023

Patient Chen, male, 81 years old, a native of Gutian, Fujian. On December 26, 2022, the patient caught COVID, with fever of 38.5°C, clouded consciousness, and inability to recognize family members; he was admitted to Gutian County Hospital, Fujian. CT at Gutian County Hospital showed: 1. cerebral atrophy with white-matter degeneration; further MR recommended; 2. possible mild chronic inflammation in both lower lungs; 3. aortic and coronary arteriosclerosis with enlarged heart; correlate clinically.

After hospital treatment, the fever was basically controlled but still recurred, and he could not sleep all night. At night he had marked cough with yellow thick sputum. The family on their own used Qingfei Tang; on the evenings of January 5–7, 2023, after drinking Qingfei Tang, his cough clearly improved, the frequency of coughing decreased, and the sputum decreased; in the small hours of the 7th he could sleep peacefully, but his consciousness had not fully recovered. He had not had a bowel movement for three days (he had been bedridden since admission), his urine was red, and his feet and scrotum were edematous.

But from January 6 onward, the patient's high fever would not abate and oxygen saturation was very low; without oxygen it often dropped below 90. By January 12, his temperature rose above 39°C. On January 13 he had a high fever of 39.4°C, was unconscious, and had breathing difficulty requiring oxygen. Gutian County Hospital gave antipyretics and laxatives, all ineffective; the high fever never abated, and urination and defecation were both difficult. The patient was in critical condition, and his family urgently turned to me for help.

The patient's relatives had achieved some results with me for lung cancer and had built a relationship of mutual trust. The patient's son repeatedly begged me to help. When I saw on video that the patient was dying and unconscious, I was deeply torn and dared not take the case; but finally, at the family's pleading, I decided to try.

Although this elderly patient had many heat signs, I believed cold and cooling herbs must not be used recklessly; I considered him to have the Shaoyin syndrome described in Shanghan Lun, suitable for treatment with formulas such as Mahuang Fuzi Xixin Tang.

But in this epidemic, many elderly people have had severe side effects after taking Mahuang (palpitations, incessant sweating), and Xixin (Asarum) is also a toxic herb. At such a moment there could be no room for the slightest error; one accident could kill the old man. So after much thought I decided to emulate the formula-building strategy of Mahuang Fuzi Xixin Tang without using the formula itself.

Initial prescription: Fuzi (aconite) 15 g (decoct first for half an hour), Rougui (cinnamon bark) 15 g, Guizhi (cinnamon twig) 15 g, Renshen 10 g (decocted separately and mixed in), Dahuang (rhubarb) 6 g, Roucongrong (Cistanche) 90 g, raw Huangqi (Astragalus) 30 g, Tianhuafen (Trichosanthes root) 10 g, Huangqin (Scutellaria) 10 g, Chaihu (Bupleurum) 15 g, Shengma (Cimicifuga) 6 g, Sangbaipi (mulberry bark) 15 g, Shengjiang (fresh ginger) 7 slices, Dazao (jujube) 7 pieces. One packet, decocted in water, taken 2–3 times daily.

After taking one packet of the above formula, the patient's consciousness somewhat recovered; when family called him he could respond; the fever finally abated, and his temperature stayed around 37.9°C all night. He slept from 11 p.m. to 8:30 the next morning, his state clearly improved, and he could now cough up sputum on his own. But there were still recurrences and he still could not pass stool.

Since the initial prescription had worked, the basic strategy was correct. On the evening of January 13, 2023, I adjusted the formula: Fuzi 30 g (decoct first for half an hour), Rougui 15 g, Guizhi 15 g, Renshen 10 g (decocted separately and mixed in), Dahuang 6 g, Roucongrong 90 g, Suoyang (Cynomorium) 60 g, Shudihuang (prepared Rehmannia) 30 g, Shengdihuang (raw Rehmannia) 30 g, raw Huangqi 30 g, Tianhuafen 10 g, Huangqin 10 g, Chaihu 15 g, Shengma 6 g, Sangbaipi 15 g.

On the evening of January 14, the patient's consciousness further recovered, his speech was clearer than before, and he could communicate simply with family. But his bowels still would not move; the hospital arranged an enema, which failed. The family discussed the next day's medication with me; I judged the old man's constipation was not an excess condition but qi deficiency with too little strength to defecate. I decided to add large-dose qi-boosting herbs to the above formula while strengthening the action of activating blood and resolving stasis.

Adjusted formula: Fuzi 30 g (decoct first for half an hour), Rougui 15 g, Guizhi 15 g, Ganjiang (dried ginger) 15 g, Renshen 10 g (decocted separately and mixed in), Chuanjiao (Sichuan pepper) 10 g, Roucongrong 60 g, Suoyang 60 g, Shudihuang 30 g, Shengdihuang 30 g, raw Huangqi 90 g, raw Baizhu (Atractylodes) 60 g, Tianhuafen 10 g, Huangqin 10 g, Chaihu 15 g, Shengma 6 g, Sangbaipi 15 g, Dangguiwei (Angelica tail) 6 g, Taoren (peach kernel) 6 g, Honghua (safflower) 3 g, Chuanxiong (Sichuan lovage) 10 g, Dilong 10 g, Tubiechong (Eupolyphaga) 15 g, Chao Zhiqiao (fried aurantium fruit) 6 g, Xiangfu (Cyperus) 10 g. I also told them to use a hair dryer to induce a slight sweat and to feed water frequently.

At the same time I told the family to smash a clove of garlic and apply it externally to the patient's navel to help defecation. By then I had realized the patient's constipation might be related to lack of probiotics in the elderly gut; I told the family to quickly order some probiotics online for the old man. But with the New Year approaching and logistics poor, the probiotics would take a while to arrive, so before they arrived we would try Chinese medicine.

On the morning of January 15, the patient's son reported that, while on hospital duty the previous night, he found the patient's breathing had clearly improved, and heart rate and blood pressure were basically stable. The temperature was not yet fully normal but had improved, peaking at 38.4°C. But the bowels still would not move. Having used many laxatives without effect, I judged further use to be of little meaning; the old man had eaten little for days, his abdomen was not rigid, and though he had not defecated for days it did not threaten his life; we could wait for the probiotics. The bowel-moving herbs in the formula could be reduced, so I adjusted again.

Fuzi 30 g (decoct first for half an hour), Rougui 15 g, Guizhi 15 g, Ganjiang 15 g, Renshen 10 g (decocted separately and mixed in), Chuanjiao 10 g, Roucongrong 60 g, Suoyang 60 g, Shudihuang 30 g, raw Huangqi 90 g, Tianhuafen 10 g, Huangqin 10 g, Chaihu 24 g, Shengma 6 g, Sangbaipi 15 g, Dangguiwei 6 g, Taoren 6 g, Honghua 3 g, Chuanxiong 10 g, Dilong 10 g, Tubiechong 15 g, Chao Zhiqiao 6 g, Xiangfu 10 g.

On the morning of January 16, the family reported that the patient's oxygen saturation had risen markedly; even without the oxygen mask it stayed above 90. Temperature fluctuated between 37.7 and 38.2°C. The cough sputum was no longer as yellow and thick as before; urine output had increased and the urine was no longer reddish. The tongue coating was black. The hospital performed two more enemas, both failing to produce a bowel movement. By noon on January 16, the patient's ability to cough up sputum had further improved, his consciousness was clear, he could express himself clearly, and breathing was stable. I therefore had him continue the January 16 formula on the 17th.

On the afternoon of January 17, except for unresolved edema of the feet, the patient's mental state was close to normal; yang had returned. The family asked for my next treatment opinion; I judged that after days of continuous yang-supporting treatment he had now turned the corner and no longer needed Fuzi and Rougui. I therefore adjusted the formula: Chaihu 24 g, Huangqin 10 g, Guizhi 10 g, Baishao (white peony) 10 g, Tianhuafen 12 g, Renshen 10 g, Sangbaipi 15 g, Digupi (Lycium bark) 15 g, Zhigancao (honey-fried licorice) 6 g, Shengjiang 7 slices, Dazao 7 pieces.

The patient took one dose of the above formula at 8 p.m. and slept peacefully until 10 p.m., snoring normally and sleeping deeply. The temperature fell further, peaking at 37.7 and never again exceeding 38. The probiotics had also arrived, so I told them to start immediately.

On the evening of January 18, the family reported that after taking the above formula and probiotics, the patient passed a large amount of urine and could also pass gas in the afternoon (previously he could not). The edema of the feet and scrotum resolved overnight, sleep quality further improved, and he slept 12 hours straight, waking in much better spirits.

I further reduced the dose, adjusting the formula: Chaihu 12 g, Huangqin 10 g, Guizhi 10 g, Baishao 10 g, Tianhuafen 12 g, Renshen 10 g, Sangbaipi 6 g, Digupi 6 g, Zhigancao 6 g, Shengjiang 5 slices, Dazao 5 pieces.

After three days of modified Chaihu Guizhi Tang, the patient's temperature returned to normal, basically 36.5°C. Stamina returned, consciousness was clear, and his right leg's mobility was close to normal; his left leg, however, had been fractured before and could only be lifted off the bed surface. The patient was observed in hospital until January 20, with no recurrence, and was discharged home for the New Year on January 20. I told him to finish at home with my Chai Gui Jiedu Wan and Yiqi Huayu Pills, keep taking probiotics, and take a small amount of senna leaf tea.

On January 24 (the third day of the Lunar New Year), the patient was already passing stool normally, and his spirit and stamina were recovering day by day.

This patient was critically ill when I took him on, but improved after one dose; after a week of treatment he had basically escaped danger. During this process I basically communicated with the family 2–3 times daily and adjusted the prescription on the fly. Of course, the Western treatment given in the hospital also played a role; this is a case rescued through integrated TCM-Western medicine.

When I first took on these critically ill patients, I was also uneasy. But among my long-term patients and their families at the end of last year, many developed serious conditions, and after careful treatment every one of them escaped danger. These treatment experiences gave me a new understanding of COVID: although it is a new disease, strongly pathogenic and even fatal, it is not so terrifying; as long as one has the correct treatment strategy and can carefully observe the patient's every reaction after medication, severe COVID can be rescued.

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