A Case of Treating Renal Insufficiency and Post-COVID Sequelae in a Lung Cancer Patient with Chinese Medicine
Patient Ms. Zhong, female, born in Guangzhou in 1955, now residing in New York, USA, is a lung cancer patient. Post-lung-cancer surgery, she is taking the targeted drug Tagrisso (osimertinib). She has had renal insufficiency since surgery, with elevated serum creatinine. The renal insufficiency caused hyponatremia, weak legs, cold intolerance, foamy urine, and easy breathlessness when walking. Local American doctors gave hormone therapy with poor results.
After the COVID outbreak, the patient contracted COVID a second time, and her renal function worsened. Besides renal insufficiency, she also had frequent belching after meals and gastric distension. Her cholesterol was also high; residual lung lesions remained; she coughed occasionally with thin, profuse sputum; her sleep was poor; she could not eat cold or raw foods; too much meat disagreed with her; and she was prone to oral ulcers.
The renal insufficiency had plagued her for years. Local Chinese and Western treatments in the US had all been unsatisfactory. Introduced by a friend, she first consulted me remotely on January 6, 2024, hoping I could guide her in using Chinese herbs to restore renal function and relieve her symptoms. On inquiry, she reported no dry or bitter mouth, but loose teeth, pain in the right axilla, and a tight, constricted sensation around both surgical scars. Her energy was not great. She had been making soup with raw Huangqi (Astragalus), Dangshen (Codonopsis), Danggui (Angelica), and red dates, which improved her energy.
Based on her symptoms, I first decided to try Guipi Tang combined with Xuanfu Daizhe Tang and Erzhi Wan, modified. I advised her to buy the herbs locally in the US and take them per the prescription below.
Raw Huangqi (Astragalus) 30 g, Dangshen (Codonopsis) 15 g, stir-fried Baizhu (Atractylodes) 15 g, Huangjing (Polygonatum) 15 g, Danggui (Angelica) 10 g, Fuling (Poria) 10 g, stir-fried Suanzaoren (Ziziphus seed) 10 g, Muxiang (Aucklandia) 10 g, Dingxiang (clove) 6 g, Pipaye (Eriobotrya leaf) 6 g (wrapped for decoction), vinegar- Xiangfu (Cyperus) 10 g, Xuanfuhua (Inula) 6 g (wrapped), Daizheshi (Hematite) 6 g (wrapped), Mudanpi (Moutan) 6 g, Zexie (Alisma) 6 g, Yimucao (Leonurus) 15 g, Shayuanzi (Astragalus complanatus seed) 10 g, Tusizi (Cuscuta) 10 g, Mohanlian (Eclipta) 10 g, Nüzhenzi (Ligustrum) 10 g, raw Shanzha (Crataegus) 6 g, Zhi Gancao (honey-fried Licorice) 6 g, jujube 5 pieces, fresh ginger 5 slices.
Decoct in water; one dose daily, taken morning and evening. Start with 3 doses; if improved after 3, continue with 4 more. Concurrently take Chinese patent medicines: (1) Shugu Hewei Wan, one dose after breakfast and after lunch; (2) Zhibai Dihuang Wan, one dose in the evening.
On February 2 the patient returned, reporting a cold in between. After taking the first prescription, her sleep improved, belching decreased, and gastric discomfort lessened. She added symptoms she had forgotten at the first visit: a heavy sensation on the left side of the head; sweating between 11 p.m. and 1 a.m., mostly on the head and neck. This existed before the cold but worsened after it; the recent cold was controlled only by taking Lianhua Qingwen capsules. Since the cold she had felt phlegm in the right lung that she could not cough up. Her mouth tasted bland when eating. After the decoction, foamy urine decreased and she felt improvement. During morning meditation she produced much white sputum; local doctors suspected acid reflux, which improved after stomach medicine. No acid regurgitation or heartburn. Water tasted sweet. She was cold-intolerant with bodily aching. Mouth was not dry. After the recent cold she felt weak, easily fatigued, prone to shock, and had leg cramps.
Based on her current response, I adjusted the approach and decided to use Guizhi Jia Gegen Tang combined with Huangqi Shengmai Yin and Yuping Feng San, modified. The second-visit decoction: Guizhi (Cinnamon twig) 15 g, Baishao (white Paeonia) 15 g, Zhi Gancao (honey-fried Licorice) 10 g, Gegen (Pueraria) 30 g, raw Huangqi (Astragalus) 30 g, Dangshen (Codonopsis) 15 g, Huangjing (Polygonatum) 15 g, Maidong (Ophiopogon) 10 g, Wuweizi (Schisandra) 10 g, Fuling (Poria) 10 g, Fabanxia (processed Pinellia) 10 g, Yimucao (Leonurus) 15 g, stir-fried Suanzaoren (Ziziphus seed) 10 g, Yuanzhi (Polygala) 10 g, Baizhu (Atractylodes) 10 g, Fangfeng (Saposhnikovia) 10 g, Manjingzi (Vitex) 10 g, Fuxiaomai (light wheat) 30 g, fresh ginger 5 slices, jujube 5 pieces.
Decoct in water; one dose daily, morning and evening. Start with 3 doses; if improved, continue 4 more. Dietary restrictions: milk, pickled foods, spicy and greasy foods, seafood, fish, shrimp, and crab.
On February 7, worried about access to care over the New Year holiday, she returned for adjustment. After the second prescription, coughing stopped, bowel movements normalized, sleep improved only slightly, and appetite was acceptable. But she still produced white sputum during morning meditation; after taking the medicine she felt dizzy, and sweating stopped. The sweet taste in the mouth and bland taste had improved, but she had slight dry mouth. Cold intolerance persisted; bodily aching had markedly improved but was still present, and exposure to wind outdoors still worsened it. Energy improved and leg cramps resolved. Neck tightness was much improved but not fully gone. The left side of the head still felt heavy. Foamy urine had decreased greatly, and renal function seemed markedly improved.
Since the second prescription was working but symptoms were not fully resolved, I decided to make slight adjustments on that basis. I used Guizhi Jia Gegen Tang combined with Guipi Tang, Jing Fang Baidu San, and the "Four Kidney Herbs" (Sha Yuan Zi, Tu Si Zi, Nü Zhen Zi, Mo Han Lian), modified. The third prescription: Guizhi (Cinnamon twig) 10 g, Baishao (white Paeonia) 10 g, Zhi Gancao (honey-fried Licorice) 6 g, Gegen (Pueraria) 20 g, raw Huangqi (Astragalus) 50 g, Dangshen (Codonopsis) 30 g, Huangjing (Polygonatum) 30 g, Maidong (Ophiopogon) 10 g, Wuweizi (Schisandra) 10 g, Fuling (Poria) 10 g, Yimucao (Leonurus) 15 g, Cheqianzi (Plantago seed) 10 g, Huainiuxi (Achyranthes) 10 g, stir-fried Suanzaoren (Ziziphus seed) 10 g, Yuanzhi (Polygala) 10 g, Baizhu (Atractylodes) 10 g, Danggui (Angelica) 10 g, Jingjie (Schizonepeta) 10 g, Fangfeng (Saposhnikovia) 10 g, Manjingzi (Vitex) 10 g, Shichangpu (Acorus) 10 g, Tianma (Gastrodia) 10 g, Rougui (cinnamon bark) 10 g, Mohanlian (Eclipta) 10 g, Nüzhenzi (Ligustrum) 10 g, Shayuanzi (Astragalus complanatus seed) 10 g, Tusizi (Cuscuta) 10 g, Cangzhu (Atractylodes) 6 g, Houpo (Magnolia bark) 6 g, Chenpi (tangerine peel) 6 g, fresh ginger 5 slices, jujube 5 pieces.
On March 8, 2024, the patient contacted me a fourth time, reporting that all symptoms had markedly improved; recent tests showed renal function had also returned to normal. White sputum was no longer much; post-meal belching had decreased (it still occurred but far less—previously she often belched until she had to stop); sleep had improved; bowel movements were more voluminous and regular. Bodily pain was markedly reduced; cold and wind intolerance were lessened, though she was still a bit colder-intolerant than normal. Hemoglobin was slightly lower than before; cholesterol had improved but still not at target.
Current main symptoms: post-COVID tachycardia continued to trouble her—her heart rate rose above 100 with slight activity, and blood pressure was rather low. Sleep had improved but was still not good, with nighttime waking. Sweating had stopped. Lower back was sore; urination was still not fully smooth; foam had decreased but persisted. Because she is allergic to Gegen and Chenpi, she removed those herself. She tired easily; eating pork or beef chops caused a tip-of-tongue pain. Mouth was not dry; she drank a lot, but water made her lower back uncomfortable.
Since renal function had recovered, the treatment focus shifted to the post-COVID tachycardia. This time I decided to use Danzhuru Tang combined with Erzhi Wan, modified.
The fourth prescription: Maidong (Ophiopogon) 10 g, wheat 10 g, Zhi Gancao (honey-fried Licorice) 6 g, Dangshen (Codonopsis) 15 g, Huangjing (Polygonatum) 15 g, Fuling (Poria) 10 g, Fabanxia (processed Pinellia) 6 g, Mohanlian (Eclipta) 10 g, Nüzhenzi (Ligustrum) 10 g, Shayuanzi (Astragalus complanatus seed) 10 g, Tusizi (Cuscuta) 10 g, Cangzhu (Atractylodes) 3 g, Houpo (Magnolia bark) 3 g, Yimucao (Leonurus) 15 g, Zhizi (Gardenia) 6 g, Wuweizi (Schisandra) 10 g, raw Huangqi (Astragalus) 30 g. Three packages, decocted in water, twice daily, morning and evening. If improved after 3 doses, continue with 7 more, taking 5 days on and 2 days off. Concurrently use Zhibai Dihuang Wan and Siwu Tang granules or Bazhen Tang granules.
Cancer patients often have all kinds of tricky complications. This patient's renal insufficiency had complex causes—possibly constitutional, possibly a side effect of treatment. She had previously tried hormones for it without success. She had also tried Chinese herbs, but without the right method the problem was not solved.
In my experience, combining Yimucao (Leonurus) with Erzhi Wan (Eclipta and Ligustrum) can treat kidney damage in some patients. This patient had many other problems besides renal insufficiency, so other formulas had to be combined to address her symptoms comprehensively. Here, TCM pattern differentiation—selecting herbs according to clinical symptoms—has a definite effect.