Experience in Treating a Serious Post-COVID Cold-Induced Complication in a Lymphoma Patient

Since COVID, many people have become constitutionally weaker, especially those with pre-existing chronic diseases involving reduced immunity such as hypertension or hypotension, diabetes, hyperlipidemia, and cancer. After repeated colds (some of which were likely repeated COVID infections), they have developed unusual complications. These complications are tricky to manage, and many doctors lack experience in treating such patients.

I will use a recent case of a follicular lymphoma patient, Ms. He, whom I have treated since December 17, 2017, to illustrate my approach to such conditions. Because Ms. He insisted, she has been treated with essentially pure Chinese medicine over the years. I did once persuade her to try one or two courses of chemotherapy, but she could not tolerate the side effects and stopped. Her quality of life has been good, and her condition has been basically normal.

But since her first COVID infection, her health has declined. This past Spring Festival, exhausted from the holiday and moving house, she was also infected by another person's cold. She developed severe coughing, and her strength dropped rapidly; from the first to the third day of the Lunar New Year she could barely carry on normal daily life. Taking cough medicine on her own did not help. She lives in Nanning, Guangxi, and sought local TCM treatment for the cold, but her symptoms did not improve. She then sought Western medicine; after receiving intravenous cephalosporin, her symptoms not only failed to improve but she developed generalized edema, with severe facial swelling, plus headache, dizziness, fatigue, and weakness. On February 28, 2024, she went to the hospital. Tests showed bronchitis, pneumonia, and pleural effusion; the tumor marker CA125 was elevated, but liver and kidney function were normal.

At this point the patient realized this was no ordinary minor cold and turned to me remotely. On inquiry, she reported wheezing and difficulty breathing, chest tightness, being able to sleep only on her left side (unable to lie flat or on her right side), and superficial tumors enlarging visibly fast, especially the lymphomas on her neck and behind her ears.

Bowel and urination were normal. She felt hot and dry with night sweats, sweating around 3-4 a.m. every night but afraid to push off the covers. She had previously self-taken an empirical formula of Professor Liu Duzhou's for persistent nighttime cough that I had written about, with slight but not obvious improvement. Her appetite was acceptable; on the worst days she had nausea and reflux, but this had recently stopped. Mouth was not dry; upon waking at night she occasionally felt dry eyes.

This is exactly the kind of problem many cancer patients face after COVID: because their immunity was already below average, and the COVID virus further weakened their immune systems, subsequent colds become far harder to treat. And if not properly handled and allowed to drag on for a few days, many patients develop pleural effusion. Last November, my own cousin also died suddenly from pleural effusion; I have long suspected his death was caused by a post-COVID worsening of pre-existing COPD, with a cold triggering sudden cardiopulmonary syndrome.

Such patients must not be treated lightly. The local Nanning doctors followed a routine cold-treatment approach, to no avail. Western antibiotics not only failed but worsened the condition, causing generalized edema. After COVID, we should be more vigilant with colds in these immunocompromised chronic-disease patients, closely monitoring changes during treatment and, when necessary, recommending a chest CT to screen for pleural effusion.

After reviewing the patient's reports and taking a detailed history, I decided to combine multiple approaches: use Chaihu Guizhi Tang to release the exterior and stop sweating; use Huangqi Fangji Tang plus Xiebai San, modified with Cheqianzi, Huainiuxi, Zhuling, Yimucao, and Yiyiren to drain water and reduce edema; simultaneously use Mahuang Yiyiren Xingren Gancao Tang for her "damp wheezing"; and use Dangshen and Huangjing to support the righteous root and boost immunity.

The formula: raw Huangqi (Astragalus) 30 g, Han Fangji (Stephania) 20 g, stir-fried Baizhu (Atractylodes) 20 g, Fuling (Poria) 30 g, Zhuling (Polyporus) 10 g, Tinglizi (Descurainia) 15 g, Sangbaipi (Morus bark) 15 g, Digupi (Lycium bark) 15 g, Mudanpi (Moutan) 10 g, Dangshen (Codonopsis) 30 g, Huangjing (Polygonatum) 30 g, Chaihu (Bupleurum) 10 g, Huangqin (Scutellaria) 10 g, Guizhi (Cinnamon twig) 10 g, Baishao (white Paeonia) 10 g, Fuxiaomai (light wheat) 30 g, calcined Muli (Oyster shell) 30 g, Tianhuafen (Trichosanthen root) 10 g, Zhi Gancao (honey-fried Licorice) 10 g, Cheqianzi (Plantago seed) 15 g, Huainiuxi (Achyranthes) 15 g, Yimucao (Leonurus) 30 g, Yiyiren (Coix) 30 g, Zhi Mahuang (honey-fried Ephedra) 6 g, Xingren (Apricot kernel) 6 g, Zisuzi (Perilla seed) 6 g, fresh ginger 5 slices, jujube 5 pieces.

The patient took the formula from February 29 to March 3; cough and wheezing lessened and she no longer felt as breathless, but night sweats did not improve significantly. I told her to continue the decoction and additionally take Zhibai Dihuang Wan. By March 5, the edema had completely disappeared, her strength had markedly recovered, breathlessness was much reduced, and night sweats had stopped. She still felt not fully cured, with some chest tightness when squatting, so per the principle that an effective formula should not be changed, I had her continue for several more days and observe.

Since COVID, many people no longer have colds that resolve easily; pleural effusion after a cold is very common. Once a patient has chest tightness, breathlessness, or edema, it must not be taken lightly; treating it as an ordinary cold can easily lead to death from a cold triggering serious complications.

In treating such patients, I recommend combining the strategies of supporting righteous qi, draining water, releasing the exterior, and stopping cough and wheezing. Some doctors think such cases are easy and prefer simple formulas, but they often fail to solve the problem; after a few days' delay the condition becomes more severe, complex, and intractable. In fact, such patients cannot be treated by routine methods from the very start.