Three TCM Case Reports: Worsened Cardiovascular Disease After COVID

Doctor zhou January 23, 2023

Case One

Patient Xia, a native of Weihai, Shandong, now 87. She was diagnosed 20 years ago with arteriosclerosis and heart disease; in 2014 she had coronary bypass surgery with two stents implanted, and she felt the bypass surgery did not improve her clinical symptoms. In recent years she has been hospitalized several times, diagnosed with tachycardia, ventricular premature beats, atrial premature beats, and arrhythmia. She also has lacunar cerebral infarction, with a history of more than 20 years.

The patient developed fever on the evening of January 5, 2023 after COVID infection, peaking at 37.3°C. She took Gegen Tang granules at home; the next day her fever reached 37.6°C, and she then took Fenghan Ganmao granules to bring the fever down. But because the medicine contained Mahuang (ephedra), after taking it she felt palpitations and her heart raced to 101 beats per minute (she feels severely unwell whenever her pulse exceeds 75); after 2 hours the rhythm gradually stabilized. But after COVID infection she had been weak all over and had poor appetite. On the afternoon of January 6 she went to the hospital; chest CT showed no pneumonia, and blood oxygen saturation stayed around 95.

From January 9 to 11 she had diarrhea for three straight days; on the evening of the 11th her stomach felt uncomfortable and she felt listless, so she was admitted. On the morning of the 12th blood tests showed severe sodium deficiency, so sodium was supplemented; other results were normal. Her appetite has now returned, but she is weak, arrhythmia occurs from time to time, and she is receiving IV myocardial-protective drugs in the hospital with poor effect. She still has one or two episodes of arrhythmia daily causing paroxysmal cardiac discomfort. Blood pressure is unstable, fluctuating up and down with a wide pulse pressure. Two-hour postprandial blood glucose is 8.9/9.0/11/12, measured once weekly, different each time. She takes no glucose-lowering drugs and relies on diet control.

The patient's sleep is usually poor: she has difficulty falling asleep at night and naps about half an hour at noon; now she needs alprazolam tablets at night to help her sleep. At age 50 she had colitis and had her gallbladder removed; she originally always had loose, bile-colored stools, but for the past three years has been constipated, taking Maren Zipi Wan for nearly two years, with hard stools at the start. She sometimes has a bitter taste in the mouth and sweats when her heart is uncomfortable. She urinates frequently at night, at least 4–5 times; recently she has had difficulty urinating, frequency, and small volume; hospital tests showed urinary tract inflammation, and she is taking anti-inflammatory drugs, but urination has not improved. She also has chronic pharyngitis and often coughs up sputum.

Current medications: aspirin 100 mg one tablet daily; Betaloc (metoprolol) 47.5 mg one tablet each morning; rosuvastatin 10 mg one tablet daily; Wenxin granules three packets daily; Zhixiong capsules 12 capsules daily (for cerebral infarction). But the various symptoms have not improved markedly.

The patient's husband was treated by me for lung cancer many years ago, so the patient's family knows and trusts me well. On January 18, 2023, feeling that hospital treatment had not improved much, the patient asked to be discharged; her daughter asked me to give TCM treatment. By video consultation I learned that the elderly woman had shoulder and neck discomfort, aversion to cold, palpitations and chest tightness, cardiac discomfort after talking too much, and marked eyelid edema. Based on her condition, I judged she had the chest impediment syndrome caused by water qi attacking the heart in TCM, suitable for treatment with Guizhi Jia Gegen Tang combined with Ling Gui Zhu Gan Tang and Guizhi Gualou Xiebai Zhishi Tang.

Initial formula: Gegen (Pueraria) 30 g, Guizhi (cinnamon twig) 15 g, Fuling (Poria) 30 g, Baizhu (Atractylodes) 15 g, Zhigancao (honey-fried licorice) 10 g, Xiebai (Allium macrostemon) 10 g, Zhishi (immature bitter orange) 6 g, Houpo (Magnolia bark) 6 g, Tianhuafen (Trichosanthes root) 15 g, Baishao (white peony) 10 g, Shengjiang (fresh ginger) 7 slices, Dazao (jujube) 7 pieces. One packet, decocted in water, taken 2–3 times daily after meals.

At the same time she took Jinkui Shenqi Wan (Tong Ren Tang small honey pills) morning and evening, 20–30 pills each time. I told her to stop all the drugs the hospital had prescribed.

The patient took one dose that evening and developed diarrhea. Her daughter contacted me to report this; I judged it to be a side effect of Tianhuafen. I told her not to panic and not to take any remedial measures. This side effect would not last long; we would observe until the next morning to see whether the cardiac discomfort improved. The next time she took the medicine, reduce Tianhuafen in the formula to 6 g.

That night the daughter was still worried about the diarrhea and on her own had the patient take smectite powder, which stopped the diarrhea. The next morning, the patient felt a comfort she had not known in a long time: her cardiac discomfort was gone, she no longer had palpitations, and her puffy eyelids had clearly subsided. That day she was full of energy, frequently contacting friends to celebrate the Spring Festival. The initial prescription had worked, showing the pattern differentiation was correct. I therefore told the patient to finish with Jinkui Shenqi Wan, and if her heart was comfortable, not to use decoctions again.

Case Two

Patient Zhang, a native of Shouyang County, Shanxi. On January 9, 2023 she caught COVID and developed fever peaking at 38.5°C. She took Xiao Chaihu, Tongxuan Lifei Wan, and ibuprofen on her own, and the fever resolved after three days. Thereafter she had chest tightness, cough, expectoration (white), dry throat, and pain in the groin, feet, and hands. On January 15 she developed fever again, peaking at 37.5°C; she took ibuprofen, had sternal pain, and felt generally unwell. At Shouyang County People's Hospital (outpatient no. 00110000024173) she was found to have fibrotic lesions in the right upper lung, increased lung markings in both lungs, and partial white lung. The patient had chest pain; the local hospital doctor thought she had prodromal coronary heart disease and prescribed coronary-heart-disease medication with poor effect.

The patient's husband is a gastric-cancer patient I treat, and at home they have the Chai Gui Jiedu Wan I previously formulated for COVID infection (the Chai Gui Jiedu Wan formula is given in my article My Pill Formula for COVID: Chai Gui Jiedu Wan). On the 16th the patient's temperature rose again to 38.2°C, and blood oxygen saturation was between 91 and 93—already dangerous, though without breathing difficulty for the moment. The daughter, via the internet, asked me to prescribe remotely.

I judged the patient to have viral pneumonia combined with chest impediment syndrome, with low oxygen saturation; the chest impediment problem had to be solved first. I decided to use Gualou Guizhi Xiebai Zhishi Tang combined with Danshen Yin (two formulas for chest impediment), adding Chuanxiong and Dilong.

Initial formula: Xiebai 10 g, Guizhi 3 g, Tianhuafen 15 g, Houpo 15 g, Zhishi 10 g, Chuanxiong (Sichuan lovage) 10 g, Dilong (earthworm) 10 g, Danshen (Salvia miltiorrhiza) 30 g, Tanxiang (sandalwood) 3 g, Sharen (cardamom) 3 g. One packet, decocted in water; at the same time take Chai Gui Jiedu Wan, three times daily, 30 pills each time. Stop all the drugs the hospital had prescribed.

After taking the above formula for one day, the patient's temperature returned to normal, she felt much more relaxed all over, her bitter taste improved, she felt hungry, and oxygen saturation stabilized at 93. But that day her lung CT result came out showing partial white lung. Not daring to delay, I decided to treat her with the Chai Gu Jiedu Tang I use for viral pneumonia and its complications (the formula-building rationale of Chai Gu Jiedu Tang is given in my article My Chai Gu Jiedu Tang for Viral Pneumonia and Its Complications).

Second-visit formula: Chaihu (Bupleurum) 15 g, Guizhi 10 g, Pao Fuzi (blast-fried aconite) 15 g (decoct first for half an hour), Rougui (cinnamon bark) 15 g, Shudihuang (prepared Rehmannia) 30 g, Baishao 10 g, Renshen 10 g, Huangqin (Scutellaria) 10 g, Tianhuafen 12 g, Chuanxiong 10 g, Dilong 10 g, Xiebai 10 g, Chao Zhishi 6 g, Houpo 6 g, Cangzhu (Atractylodes lancea) 10 g, Sangbaipi (mulberry bark) 15 g, Digupi (Lycium bark) 15 g, Zhigancao 6 g, Shengjiang 7 slices, Dazao 7 pieces.

On January 20, the daughter reported that after taking Chai Gu Jiedu Tang, the patient's urine output had increased markedly, her cough and sputum had clearly decreased, she basically no longer coughed, oxygen saturation had returned to 93–95, and her energy and spirit had improved a lot. I therefore told her to continue Chai Gu Jiedu Tang through the Spring Festival.

Case Three

Patient Deng, a native of Anxiang, Hunan, 71 years old.

The patient fell ill at the end of December 2022 and then took Chai Gui Jiedu Wan, with symptoms almost completely resolving. But after days of overwork, she recently often felt aversion to cold and chest tightness. Examination at Anxiang County People's Hospital (no. US00192804) showed: mild mitral regurgitation, slightly enlarged left atrium, slightly thickened left ventricular wall, reduced left ventricular diastolic function with normal systolic function, uniform thickening of the bilateral carotid intima-media, and a solitary plaque in the right subclavian artery.

Incidentally, many elderly patients have been found on post-infection checkups to have arterial plaques, though not necessarily in the same location. This patient previously had normal blood pressure, but recently her systolic has at times exceeded 200 and her diastolic at times exceeded 150; oxygen saturation is often below 93. Her lungs show inflammation, suspected viral pneumonia.

The patient was hospitalized and treated with vasodilators and coronary-heart-disease drugs, with alternating improvement and worsening: better by day, worse at night, often with chest tightness, aversion to cold, and shortness of breath. Her family asked me to treat her remotely. I judged she had the syndrome of vascular stasis blockage due to COVID, and should be treated with my original Chai Gu Jiedu Tang.

I therefore prescribed Chai Gu Jiedu Tang: Chaihu 15 g, Guizhi 10 g, Pao Fuzi 15 g (decoct first for half an hour), Rougui 15 g, Shudihuang 30 g, Baishao 10 g, Renshen 10 g, Huangqin 10 g, Tianhuafen 12 g, Chuanxiong 10 g, Dilong 10 g, Xiebai 10 g, Chao Zhishi 6 g, Houpo 6 g, Cangzhu 10 g, Sangbaipi 15 g, Digupi 15 g, Zhigancao 6 g, Shengjiang 7 slices, Dazao 7 pieces.

On January 21, 2023, the patient was hospitalized by day for Western treatment and did not take Chinese medicine; that evening at home her symptoms recurred: aversion to cold, chest tightness, oxygen saturation dropping below 93, breathing affected. At night she took Shengmai Yin oral liquid on her own, with slight improvement in chest tightness. On January 22 (New Year's Day), she did not return to hospital for IV drips, and at home took Chai Gu Jiedu Tang.

After one day of medication, on the evening of New Year's Day, the family reported: oxygen saturation was 99 in the left hand and 97 in the right—better than she had had in recent memory. Blood pressure was 128/68, back to normal. Her mental state after taking the medicine was good and vital signs were stable, but each dose only lasted two or three hours; I therefore told her to take the medicine every two or three hours and continue for a week.

The family reported that the patient had had low back and leg pain for years and hoped I could relieve it too. On the second day of the first lunar month I adjusted the formula as follows: Chaihu 15 g, Guizhi 10 g, Pao Fuzi 15 g (decoct first for half an hour), Rougui 15 g, Shudihuang 30 g, Baishao 10 g, Renshen 10 g, Huangqin 10 g, Tianhuafen 12 g, Chuanxiong 10 g, Dilong 10 g, Xiebai 10 g, Chao Zhishi 6 g, Houpo 6 g, Cangzhu 10 g, Sangbaipi 15 g, Digupi 15 g, Zhigancao 6 g, Gegen 30 g, Qianghuo (Notopterygium) 6 g, Duzhong (Eucommia) 10 g, Xuduan (Dipsacus) 10 g, Yimucao (motherwort) 30 g, Danshen 15 g, Mugua (Chaenomeles) 30 g, Huainiuxi (Achyranthes) 10 g, Honghua (safflower) 3 g, Taoren (peach kernel) 3 g, Shengjiang 7 slices, Dazao 7 pieces.

These three cases were basically all treated on the basis of Gualou Guizhi Xiebai Tang and Guizhi Jia Gegen Tang, with additions of various symptom-specific formulas and herbs. The COVID virus greatly damages the heart and brain blood vessels, and many elderly patients with pre-existing cardiovascular or cerebrovascular disease see those diseases worsen after infection. Some classic TCM formulas have definite efficacy for the cardiovascular and cerebrovascular stasis blockage caused by COVID, and they act faster and more reliably than Western drugs, markedly improving patients' symptoms and quality of life.

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