A Case: Relieving Fever and Vertigo for 18 Days in a Cancer Patient After COVID-19

Doctor zhou January 9, 2023

The patient, Ms. Yang, 65, lives in Shanghai.

Past history: in January 2012 part of her left kidney was removed for cancer; in 2015 she fainted and fractured a leg bone, treated surgically; in July 2018 a meningioma was diagnosed and surgically removed, leaving one-sided hearing loss; a year after surgery she developed hypertension and vertigo with benign paroxysmal positional vertigo. Her cerebral vessels are severely stenosed.

On December 18, 2022, she tested positive on a home COVID antigen with a high fever. She took acetaminophen and ran the high fever for two days. On December 20 the temperature fell to 37.8; from then on she had persistent low fever around 37.5, worsening dizziness, could not get up, had no appetite the first few days then gradually ate light food. At first she coughed white phlegm; around December 23 it turned yellow.

Over the ten days from December 20 to 30, she passed out twice. Once she suddenly collapsed unconscious in the bathroom, pale with cold sweat, then revived herself; after that the vertigo worsened. Her family pricked all ten fingers for bloodletting and gave her Jiuxin pills, after which she had diarrhea. The second time she was suddenly thrown as if spun out of bed, with worse vertigo and inability to move. During this time her diastolic pressure was low, so antihypertensives were paused.

On December 25 she consulted a Beijing TCM doctor online and took a seven-dose formula; no relief, and after four doses a hospital check showed abnormal liver function, so she stopped. She had diarrhea after every dose. On December 28, suspecting lung infection, she self-took roxithromycin (allergic to other antibiotics).

That TCM doctor diagnosed a pestilential damp plague and prescribed: raw Muli (oyster shell) 15 g, raw Cishi (magnetite) 30 g, Zhusha (cinnabar) powder 3 g, raw Zheshi (hematite) 12 g, Xuanfuhua (inula) 12 g, Qinghao 10 g, Digupi 10 g, Daqingye (Isatis leaf) 15 g, Chuanniuxi 15 g, fried Kuxingren 10 g, Xiakucao (Prunella) 15 g, Huashi (talc) 15 g, Zhimu (Anemarrhena) 10 g, Juluo (tangerine pith) 15 g, Qing Banxia 10 g, Quanxie (scorpion) 3 g, fried Jiangcan (silkworm) 10 g, Baijili (Tribulus) 10 g, Danggui 6 g, Baishao 15 g, Shenqu (medicated leaven) 10 g, Huangqin 10 g. Basically all cold/cool herbs; he dared not use anything warm.

On December 30 she had a lung CT and blood tests to rule out myocarditis. The CT suggested pneumonia; the doctor advised hospital admission and prescribed two injections of thymosin to be given within a week.

On December 31 she went to Shanghai Shuguang East Hospital; beds were tight, the doctor said no admission needed, prescribed levofloxacin (five days) plus seven doses of herbs, and asked her back in a week. A series of exams that day at Shuguang Hospital affiliated to Shanghai University of TCM (East; record no. 0802730935) showed abnormal liver function: ALT 67.00 (ref 0–35), AST 101 (ref 15–46).

Shuguang TCM prescription: Guizhi 12 g, Zhi Gancao 12 g, Zhi Banxia 15 g, Zhebeimu (Zhejiang fritillary) 15 g, Nan Wuweizi 12 g, Huangqin 15 g, Chishao 6 g, Jinqiaomai (Fagopyrum dibotrys) 15 g, Zhi Pipaye 15 g, Lugen 10 g, Chaihu 15 g, Ziwan 15 g, Kuandonghua 21 g, raw Shigao 15 g (boil first).

From January 1 to 5, 2023, spirit and appetite gradually returned, yellow phlegm lessened daily, strength recovered enough to slowly fetch water and go to the bathroom. Morning temperature reached 36.9, but day and evening stayed around 37.4. Hypertension and severe vertigo persisted.

On the night of January 4, just as she was falling asleep, turning over triggered violent spinning, dreadful; vertigo so severe she could not open her eyes. After diarrhea she returned to bed. On the morning of the 5th her pressure rose, so she resumed antihypertensives.

On the afternoon of January 5, 2023, her daughter—referred by the daughter of a gastric-cancer patient I treat—found me for help.

On inquiry: aversion to cold, no sweat, clear urine, vertigo, pain in chest and back, stiff neck, general malaise, poor sleep; inspecting the tongue, the surface was very dry.

The patient was on day 18 of illness, still severe and fluctuating. Her pressure was unstable; she had three prior surgeries, a history of kidney cancer and brain tumor, and prior cerebral infarction—a high-risk person. The case was complex and tricky. The previous two TCM doctors had judged it a warm-heat disease and used cooling herbs.

But I believed she still had a Taiyang exterior pattern and should be treated with Gegen Tang. She had been ill long and her upright qi was failing; Gegen Tang alone might exhaust her, so I added Shengmai San.

Prescription: Dangshen 30 g, Maidong 10 g, Wuweizi 10 g, Gegen 30 g, Guizhi 15 g, Mahuang 10 g, Baishao 15 g, Zhi Gancao 10 g, raw Shanzha 30 g, Shengjiang 7 slices, Dazao 7 pieces. One dose, decocted. If no sweating, use a hairdryer on her back to induce sweat and drink hot water in moderation.

That night she took one dose; after hairdryer heat on her back, sweat finally came. With sweating she felt whole-body relief, dizziness lessened, and her tight shoulders and neck eased a lot.

At ten o'clock that night her daughter asked what to do next. I told her: do nothing now, let the patient sleep well, and reassess in the morning. The patient had long slept badly from pain and vertigo.

Eager for a quick turn, the patient and her daughter, after asking me, took it upon themselves to drink another dose of Gegen Tang. Afterward she had palpitations, pulse fell to 90, sweating would not stop, vertigo returned; at midnight, helpless, she self-took Danshen dripping pills. Next morning the daughter reported this, deeply regretting not following instructions.

Acrid-warm formulas containing Mahuang are strong diaphoretics; once sweating succeeds they must not be repeated, or it is too much. So after relief I told her to stop, rest, observe, and decide the next day. But patient and family, over-eager, thought continuing an effective drug must speed recovery.

Though she sweated, her inherent cold was not fully cleared. Now with uncontrolled sweating, use Guizhi Tang to stop it, and Gegen to continue easing vertigo; so I decided on Guizhi Jia Gegen Tang.

January 6 prescription: Gegen 20 g, Guizhi 10 g, Baishao 10 g, Zhi Gancao 6 g, Shengjiang 7 slices, Dazao 7 pieces. One dose, decocted, twice a day; report back at any time.

Why do I prescribe only one dose at a time? Because this patient already has pneumonia, though no myocarditis, plus prior cerebral infarction and tumor, and now erratic pressure—she is exactly the high-risk person most likely to die of stroke after COVID. The earlier TCM doctors prescribing a week at once were overconfident; such a patient needs close watching, and one slip means death.

After one dose of Guizhi Jia Gegen Tang on January 6, her sweating stopped. Peak temperature fell to 37.2, spirit improved; vertigo persisted but she could now sleep, and after sleeping the dizziness improved. Her daughter asked for the next plan; I felt what she most needed was rest, and since she could now sleep, keep the same regimen—one more dose of Guizhi Jia Gegen Tang. Also, brew 3 g of Zexie (Alisma) and 3 g of Baizhu in boiling water as tea, watching for improvement in vertigo.

This time the patient was compliant, no longer rushing against instructions. On January 6–7 she took Guizhi Jia Gegen Tang; temperature occasionally rose to 37.5, but sleep greatly improved, strength and spirit clearly better after sleeping, and phlegm/cough clearly reduced—she coughed only three times all day, with slightly yellow phlegm. Only the vertigo and abnormal blood pressure still lingered.

On the night of January 7 her daughter asked for the next day prescription; aiming for better effect, I decided to try Chaihu Guizhi Tang.

Prescription: Guizhi 9 g, Huangqin 9 g, Renshen 9 g, Zhi Gancao 6 g, Fabanxia 12 g, Baishao 9 g, Chaihu 24 g, Dazao 12 pieces, Shengjiang 7 slices, decoct. Add two and a half bowls of water, boil high then simmer 10–15 min, pour out, then boil liquid to one bowl. One dose daily, decocted twice, split into 3 after meals.

On the morning of the 8th, when buying the herbs, the daughter asked whether processed Banxia meant Fabanxia; I asked whether the patient now had dry mouth. She said slightly, but not badly. So I told her to replace Fabanxia with Tianhuafen, also 12 g.

The adjusted prescription: Guizhi 9 g, Huangqin 9 g, Renshen 9 g, Zhi Gancao 6 g, Tianhuafen 12 g, Baishao 9 g, Chaihu 24 g, Dazao 12 pieces, Shengjiang 7 slices, decoct.

On the evening of the 8th the family reported: after the above Chaihu Guizhi Tang, peak temperature all day was 37.4, 37.0 before dinner; vertigo eased, blood pressure normalized, cough further reduced, and phlegm no longer as yellow as before.

The daughter asked for the next plan; I felt the drug was matching the pattern, so continue another day and observe. Meanwhile I express-mailed my own self-designed COVID pill, Chai Guijiedu Wan, to the patient, so that on receiving it she would switch from decoctions to the pills.

For the formula and preparation of Chai Guijiedu Wan, see my previous article "My Pill Formula for COVID-19, Chai Guijiedu Wan". By the way, after publishing that article yesterday, many people asked me for the pills to keep at home. I have none left myself; the less-than-a-bottle I was taking for my own skin allergy has now gone to this severe patient. Compared with her, my little allergy is mild and non-life-threatening.

So if you want to keep medicine for family, commission a pharmacy yourself from the published formula; do not ask me. Many critical patients here are waiting for this medicine to save their lives; the pills I am making for family are not ready, and even when ready they will not cover my current severe patients.

I now have many moderate/severe patients plus my longstanding cancer patients—over a hundred needing daily care, not counting ordinary inquiries—so I have no time to pack and ship parcels. Please find your own way.

I also want to explain: I now have so many tricky patients that I cannot take more. Patients at immediate risk of death like this one—fifty or sixty of them—need close watching and follow-up one to three times daily. Another sixty or seventy, milder but still tricky, need follow-up every two to three days. Add my longstanding cancer patients, and my workload is huge; I average only five or six hours rest a day, seriously overdrawn. So I can take new patients only after one eases or dies.

That is why I have no time for all kinds of mild patients, especially those outside my field. Many also message me just to chat, distracting me—in this era that is tantamount to indirectly killing the severe and moderately severe patients who need doctors. So I recently deleted six or seven hundred WeChat contacts and blocked a batch of readers who kept sending harassment messages.

Some contacts I was friendly with were deleted this time, even because they kept wanting to send me gifts. I can only say sorry: I have no time to maintain friendships as before. Let us reconnect after the peak; distracting me now is truly ill-timed.

I have repeatedly warned against taking up my energy and attention now, but many friends still do not stop. I have no choice; in these extraordinary times I must. Right now what I most want is for friends to leave me alone so I can focus on treating patients, rest and exercise to recover my strength—that is the true way to care for me.

Earlier I had 500–1,000 consultations a day; with many severe patients I could not individualize and had to work assembly-line, and some results were not ideal. I can only beg your forgiveness; in this emergency the medical crunch is simply too severe. Every doctor energy is limited, we are all working while ill, our energy and strength flag—please understand.

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