Case Report: Treating "White Lung" in an Elderly COVID Patient with the Warming-Yang-and-Activating-Blood Method

Doctor zhou January 18, 2023

Patient Zhao, 80 years old, from Peishe Village, Wenxi County, Shanxi. The patient's mother died of cor pulmonale. The patient has no bad habits; his personality had become irritable over the past year due to a cerebral infarction. He had rectal cancer surgery 10 years ago; afterward he gradually lost weight but was still mentally alert. Surgery left intestinal adhesions causing habitual intestinal obstruction; during a hospitalization several years ago he was noted to have had heart failure. He occasionally felt palpitations and fatigue, and over the past year had intermittently taken Wenxin Granules. No drug allergy history.

On December 23, 2022, the patient developed fever and tested COVID-positive. For three straight days his temperature was over 37°C; he then took azvudine by mouth for two days, and his temperature returned to normal. But his mental state was poor and did not improve for more than ten days. His daughter is a doctor in Taiyuan and brought him to Taiyuan on January 8, 2023 to care for him.

Currently the patient has a dry mouth every night and keeps drinking water; he has frequent nocturia, cough, irritability and fatigue, and keeps moaning. During the day his appetite is fair; he coughs up sputum (mixed yellow and white) that is hard to expectorate. His daughter had read my articles and on her own used my Chaihu Guizhi Tang plus Huangqi Fangji Tang with additions to treat her father; after taking it he developed mild abdominal pain and diarrhea, which resolved when he stopped, and his cough lessened.

On January 11, 2023, the patient had a chest CT at the Department of Respiratory and Critical Care Medicine, Shanxi Coal Central Hospital (outpatient no. 0000091275). The images showed possible viral pneumonia in both lower lung lobes; nodular calcification and fibrous cord shadows in the right upper lobe; a nodular lesion in the anterior basal segment of the right lower lobe; partial wall calcification of the aorta and coronary arteries; bilateral pleural thickening; hepatic cysts; and a left renal cyst. The chest CT showed partial "white lung," more severe in the right lung.

On January 13, 2023, the patient's daughter turned to me for help and asked me to prescribe for her father. Based on his symptoms, I decided to first make a slight modification to Chaihu Guizhi Tang and see the effect.

Initial prescription: Guizhi (cinnamon twig) 9 g, Huangqin (Scutellaria) 9 g, Renshen (ginseng) 9 g, Zhigancao (honey-fried licorice) 6 g, Tianhuafen (Trichosanthes root) 12 g, Baishao (white peony) 9 g, Chaihu (Bupleurum) 24 g, Dazao (jujube) 12 pieces, Shengjiang (fresh ginger) 7 slices, one packet, decocted in water.

Because the daughter herself is a doctor and has oxygen equipment at home, the patient had mainly been treated at home recently. The patient had qi deficiency and fatigue, palpitations and shortness of breath, cough, hard-to-expectorate sputum, and edema of both legs that worsened at night. After taking the above formula, the effect was not obvious, and he felt hot and dry all over.

On January 14, 2023, I decided to change the prescription. Although he felt hot and dry, considering his age and history, I believed treatment should follow the warming-yang-and-activating-blood strategy. At the same time I asked Dr. Zhao to have her father hospitalized, so that if his life were endangered, the hospital's emergency equipment could be used in time.

Second-visit prescription: Fuzi (aconite) 15 g (decocted first for half an hour), Rougui (cinnamon bark) 15 g, Guizhi 15 g, Renshen 10 g (decocted separately and mixed in), Shudihuang (prepared Rehmannia) 30 g, raw Huangqi (Astragalus) 30 g, Tianhuafen 10 g, Huangqin 6 g, Chaihu 6 g, Shengma (Cimicifuga) 6 g, Sangbaipi (mulberry bark) 15 g, Chuanxiong (Sichuan lovage) 10 g, Dilong (earthworm) 10 g. Decoct in water; take three times daily.

This second-visit prescription is based on the Wenyang Huoxue Tang for Elderly COVID Patients I published a few days earlier, with additions and subtractions according to the patient's condition.

After taking the first dose, the patient reported stomach discomfort, but the ankle edema had largely resolved. Resolution of edema shows the medication strategy was correct; pleural fluid must also have decreased.

I therefore told Dr. Zhao to give her father only half the previous dose of decoction each time. On the 16th and 17th, after finishing the above one packet, the patient's spirit greatly improved; he was no longer as listless as before. From the video Dr. Zhao sent, her father had basically returned to normal.

According to the TCM principle of "stop once the disease is controlled," I told Dr. Zhao not to continue this formula for her father, but to switch to my previously formulated Yiqi Huayu Pills for aftercare.

There are still many patients with viral pneumonia and white lung due to COVID, and many cannot get timely treatment. I am publishing this case to prove the effectiveness of the warming-yang-and-activating-blood strategy I previously proposed.

My recent articles cover medical principles, treatment methods, prescriptions, and case reports; the case reports confirm the reasonableness and effectiveness of the principles, methods, and prescriptions I propose. Middle-aged and elderly patients with viral pneumonia and white lung who have no other recourse may refer to these articles.

Of course, I myself am still feeling my way across the river by touching stones when treating COVID viral pneumonia and white lung; the strategy is not yet mature and needs verification on more patients before its efficacy can be called reliable and reproducible. So readers must also be cautious when using my prescriptions for such patients.

Among the patients I have recently treated, there are critically ill patients even more severe than this one; treated with the warming-yang-and-activating-blood strategy, they have also done very well, and I will publish their case reports when the time is right. This has given me great confidence: although COVID causes great damage to immunocompromised patients, it can still be rescued—at least it is far more treatable than cancer.

So I no longer feel the fear of severe COVID that I felt at the beginning. If even critically ill patients covered in tubes can be rescued, then this disease is not unconquerable.

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