My Wenyang Huoxue Tang for Treating Elderly COVID Patients

Doctor zhou
In my previous article The Core Pathogenesis of COVID and Its Sequelae Is Blood Stasis with Cold Congelation, I have already explained the pathogenic features of the COVID virus. In that article I proposed that treating COVID should follow the strategy of warming yang and activating blood; some readers asked me to publish the warming-yang-and-blood-activating formula I commonly use.
Normally this treatment protocol is not yet mature enough to publish. But considering that many elderly people now truly cannot get effective treatment, I have decided to publish the Wenyang Huoxue Tang I use, for everyone's reference; after all, this formula has indeed produced results. I myself am still in the exploratory stage and cannot claim instant results. Of course, instant results are hard to achieve in elderly patients anyway. We are encountering unprecedented new problems; there is no mature protocol for treating COVID, and everyone is feeling his way across the river by touching stones. So readers must be especially cautious when reading this article and using the prescriptions it describes. If actual application shows poor efficacy or adverse reactions, stop immediately.
For the elderly, treatment should prioritize warming yang and activating blood. For young and strong people, whether or not this strategy is used makes little difference. Most young people can pull through without medicine, and even taking the wrong medicine has little effect. But the elderly are different; the COVID virus is very unfriendly to the elderly, as everyone knows, and taking the wrong medicine can cost them their lives.
So how do I myself now treat elderly COVID patients? I try to use large doses of yang-supporting and qi-boosting herbs plus appropriate blood-activating herbs, together with small amounts of exterior-releasing and heat-clearing herbs, and I have achieved results in some severe patients. Why add small amounts of exterior-releasing and heat-clearing herbs? Because elderly patients mostly have mixed cold and heat and intermingled phlegm and stasis, so exterior-releasing and heat-clearing herbs are also needed, but in small doses, and always escorted by yang-supporting herbs.
The main ingredients of the Wenyang Huoxue Tang I use are: Pao Fuzi (blast-fried aconite) 10–30 g (must be decocted first for half an hour), Rougui (cinnamon bark) 10–30 g, Guizhi (cinnamon twig) 10–30 g, Ganjiang (dried ginger) 10–30 g, Baizhu (Atractylodes macrocephala) 10–30 g, Lujiaoshuang (deer antler cream) 10–15 g, Hongshen (red ginseng) 10–15 g, Shudihuang (prepared Rehmannia) 30–60 g, raw Huangqi (Astragalus) 30–120 g, Shanzhurou (cornus fruit) 10 g, Maidong (Ophiopogon) 15 g, Tiandong (Asparagus radix) 15 g, Wuweizi (Schisandra) 10 g, Danggui (Angelica) 12 g, Baishao (white peony) 12 g, Chuanxiong (Sichuan lovage) 12 g, Xiebai (Allium macrostemon) 15 g, Dilong (earthworm) 10–30 g, Mudanpi (Moutan) 10 g, Fuling (Poria) 10 g, Zexie (Alisma) 10 g, Baijiezi ( Brassica seed) 10 g, Suzi (perilla seed) 10 g, Laifuzi (radish seed) 10 g, Chaihu (Bupleurum) 6–15 g, Huangqin (Scutellaria) 6–10 g, Shengma (Cimicifuga) 6–10 g, Tianhuafen (Trichosanthes root) 12 g, Sangbaipi (mulberry bark) 12 g, Zhigancao (honey-fried licorice) 6–10 g, Shengjiang (fresh ginger) 30 g, Dazao (jujube) 7 pieces. For edema, add Cheqianzi (plantain seed) 15 g and Huainiuxi (Achyranthes) 15 g.
Of course, not every ingredient is used in every patient; the physician must make additions and subtractions according to the patient's specific condition. Elderly patients should be treated one-on-one by a doctor, and ideally physician and patient should communicate every day, so that the patient can report the progress and any reactions to the medicine at any time, allowing the doctor to adjust the protocol.
The indications for this Wenyang Huoxue Tang are: heart failure, breathing difficulty, cough, poor appetite, low blood oxygen saturation, abnormal blood pressure, low hemoglobin, aversion to cold, cold limbs, low or high fever, fatigue, and CT showing pneumonia. If these symptoms are not present, Wenyang Huoxue Tang is not appropriate.
What kind of patient has these symptoms? Generally, they are elderly patients who, because of medical overload, did not receive timely and reasonable treatment, or who have very poor immunity. Such patients usually do not have very severe symptoms at the start of infection, but gradually progress and worsen over time, and do not respond easily to medication. Ordinary antipyretics cannot bring the fever down, or bring it down only briefly before it returns.
There are now quite a lot of such elderly patients. As far as I know, a few are hospitalized, but more are just enduring at home. Many such elderly people come to me for treatment; some have had fever for more than a month. Such people could die at any time from cerebral thrombosis, myocardial infarction, or pulmonary embolism. So our country's case fatality rate cannot be judged from the present moment; we are still on the plateau of deaths.
Many of the elderly who now come to me had previously seen other TCM doctors. Some TCM doctors still treat COVID as wind-heat cold, using acrid-cool exterior-releasing and heat-clearing-detoxifying methods, with poor results. The elderly patient's temperature rises higher and higher on the medicine, and eventually the mental state worsens day by day, with some becoming unconscious.
Wu Jutong, author of Systematicized Identification of Warm Diseases, loved using cold and cooling herbs in his early years, but only in his own old age did he realize that elderly people cannot be casually given cold and cooling herbs; in his later years he especially liked warming-yang herbs such as Fuzi and Rougui. Our contemporary renowned TCM scholar Ren Yingqiu used to say that a person must live out a full sexagenary cycle before he can truly understand TCM. Why? Because a person too has spring, summer, autumn, and winter; old age is the winter of a person. What the elderly lack most is yang qi; once yang qi is damaged, the lifespan is greatly affected. Wu Jutong himself only changed his early prejudice after living to old age and personally experiencing the physical characteristics of the elderly.
The Chaihu Guizhi Tang I previously recommended is on the acrid-warm side, but it is not strong enough for treating the elderly. Elderly patients should consider combining warming-yang and blood-activating, qi-downbearing and wheezing-calming, and meridian-warming-and-unblocking formulas such as Chaihu Guizhi Tang, Guifu Dihuang Tang, Yanghe Tang, Shengmai San, Sanzi Yangqin Tang, Guizhi Xiebai Tang, and Buzhong Yiqi Tang. My Wenyang Huoxue Tang is precisely a modification based on all the above formulas.
Treating the elderly should learn from Li Dongyuan's formula-building philosophy in Buzhong Yiqi Tang, but Buzhong Yiqi Tang alone is not strong enough. Li Dongyuan used Renshen, Huangqi, and Baizhu to boost qi, and Chaihu and Shengma to release the exterior; we call this the method of "sweet warmth eliminating great heat." The key of this method is to use heavy doses of sweet-warm herbs and light doses of exterior-releasing herbs.
The problems COVID causes in the elderly are serious; using only Renshen, Huangqi, and Baizhu is not enough. One must also use Fuzi, Rougui, Guizhi, Ganjiang, and Chuanxiong to warm and unblock the vessels and promote blood flow. After COVID infection, the great majority of elderly people do not die of respiratory failure but of cerebral or myocardial infarction; those who do die of respiratory failure mostly die of pulmonary embolism. Thrombus (called yu xue, static blood, in TCM) is the key to death.
In addition, after COVID infection, many very elderly people become severely constipated. From the TCM perspective, this is qi-deficiency constipation, not an excess condition; herbs like Dahuang (rhubarb) and Mangxiao (Glauber's salt) do not work well, and lactulose, glycerin enemas, and colonic irrigation also do not work well. In fact, the real cause of constipation in these elderly people is too few beneficial bacteria in the gut, which prevents normal bowel movements.
A considerable number of elderly people have this problem: they already strained at stool before COVID infection. What they truly need is probiotics and prebiotics. I see the National Health Commission and local health commissions all recommending various decoctions for elderly constipation, using various Chengqi Tang combinations. With respect, these formulas are useless for over 90% of patients; they are concocted by experts sitting at home and making arbitrary decisions. For an elderly person too weak to push stool, using large doses of Sheng Baizhu (raw Atractylodes) and raw Huangqi to boost qi is better than using Mangxiao and Dahuang.
My father previously had constipation; I tried every laxative without effect, and finally solved the problem with probiotics and prebiotics. We used many brands at the time; one called Pusa Xinchang (Bodhi Heart Intestine) finally worked. Patients with similar problems who have failed on both Chinese and Western medicines may also try various probiotics and prebiotics; any brand will do. I believe many constipated elderly people have already used Dahuang, Mangxiao, and Roucongrong (Cistanche) and know full well how poorly these work.
There are also elderly patients prone to diarrhea, even dawn diarrhea; generally, yang-supporting herbs clearly improve such patients' diarrhea. If yang-supporting herbs are not strong enough, the patent medicine Sishen Wan (Four Spirits Pills) may be added.
Treating elderly COVID patients, especially critically ill elderly COVID patients, is entering the deep end of COVID treatment. Young patients and elderly patients with mild illness are easy to treat; once the fever is gone, treatment is basically successful, and even ginger-scallion water without medicine can bring the fever down. But critically ill elderly patients or frail young patients are very hard to treat. Treating such patients requires what Zhang Jingyue called "the eye of an eagle and the courage of a lion": pattern differentiation must be accurate, medication must be bold, and one must also be meticulous and closely observe the patient's changes.
In this process, mutual trust between physician and patient is also important. Without trust, the patient's adherence is poor and ideal results are hard to achieve. Elderly people are stubborn, especially those with a history of cerebral thrombosis; the doctor must also communicate patiently with the patient.

You should also read: