The Twenty-Four Hours from COVID Onset to Recovery

Doctor zhou December 19, 2022

On Thursday, a cluster outbreak occurred at my nephew's school, and he was infected. My father has been staying with my sister's family these days; after the nephew came home, my sister and father also developed throat discomfort. Friday was cold back in my hometown; father rode his electric bike from my sister's apartment in the county town back out to the countryside.

Friday night, there was a night of strong wind in both Hubei and Beijing. Father fell ill that night, quite severely: dressed in many layers, he still shivered uncontrollably, with no sweat, whole-body pain, a high fever of 39°C, profound weakness, and dizziness so severe he could barely walk; his voice was hoarse too. I was very worried, because after he left my sister's place for the countryside, he lives alone, with no one to care for him.

When I spoke with him that night, father had barely the strength to talk. Luckily, while he could still move, he had boiled a lot of ginger-scallion water, put it in three thermoses at the foot of the bed. He could struggle up beside the bed to sip it and soak his feet, which helped a little.

I told father to use the hairdryer, but he was too weak to pick it up and could only lie in bed with an electric heater on. Saturday daytime his symptoms worsened: chills, whole-body pain, and a misery so bad he wanted to die. The old man struggled up and built himself a bonfire in the kitchen; after roasting until he sweated, he felt better.

When father returned to Hubei from Beijing in 2020, I packed his suitcase with many kampo (Japanese herbal) granules I'd brought back from Japan, among them Mahuang Tang (Ephedra Decoction). Judging by his symptoms, I thought father fit the Mahuang Tang pattern. Considering he was home with no one to care for him, my sister's family was also ill, and even if I rushed back it would be too late.

This infectious disease had scared my hometown relatives half to death; the county shops were all closed, and not a soul could be seen on the streets. Asking someone else to care for him, they'd be afraid too. So I told father: if he couldn't hold on Saturday night, to drink two sachets of Mahuang Tang. At night he could take it at most three times, two sachets each, six sachets in all.

As night fell and the weather turned colder, father indeed could not hold on, and mixed two sachets of Mahuang Tang in boiled water. After drinking it he sweated, wave after wave; once the sweat came out, he was altogether well. The body pain and chills were gone. Sunday was a bright, sunny day back in Hubei. Father took his quilts up to the second-floor balcony to air and sunned himself there all day. When I video-called him Sunday, he had returned to normal.

Friday night the wind in Beijing was so strong that the glass and doors rattled. Saturday morning around five, I sat at the computer writing when my son ran over bare-chested, excited to chat about the World Cup. From his room to mine he passes the living room, which opens to the kitchen and dining area, whose windows were left cracked open. Fearing he'd catch cold, I hurriedly had him dress. That morning he had no reaction, happily watching the World Cup. At lunch he suddenly said he was dizzy; getting up from bed the room spun, and the thermometer read 38.5°C. I quickly used the hairdryer on his back, focusing on the coccyx. Within three minutes he began to sweat, and once the sweat came, the fever broke. But it rose again after a while; each time it returned, I blew again, and it broke quickly.

That afternoon I cared for him while replying to patients' consultations, and a few times I even touched his skin a bit hot. Besides fever, he had body aches, nausea, headache, and dizziness. Once, when he hit 39°C, I tried an ice pack to cool him; after a while, rather than dropping, his temperature rose to 40°C, and the child cried out in misery, saying his breathing was paralyzed and his hand wouldn't move. I quickly switched back to the hairdryer; after a few minutes the fever broke and his hands and feet moved again.

Caring for the child, I didn't wear a mask—first because I felt it was too late anyway, and second because, since I study COVID myself, I felt it necessary to experience what patients feel. How can you catch a tiger cub without entering the tiger's den? Others' accounts can never replace your own experience.

Besides, I suspect no one can dodge it anyway. In the afternoon, when my child was relatively stable, considering I'd probably fall ill soon myself, I thought I should buy some groceries and stock them at home, so I went to the market. At checkout, a woman ahead was on the phone with her family discussing how to break a fever, and the cashier kept coughing and breaking into a cold sweat. Of everyone we know in Beijing, without exception, they've all caught it. Living in such an environment, how easy is it to dodge?

After buying groceries I also fetched purified water home, then went back to caring for the child and replying to patients. For anyone under 40°C I could only have them induce sweat by the methods I taught; I only replied in earnest to those spiking above 40°C, because there were simply too many fever patients, and I could only spare energy for the most dangerous.

Friday night I went to bed after eight; Saturday I was up after three in the morning. With father and son ill and a flood of fever consultations, I couldn't nap at noon. By eight that evening I began to feel bone-deep cold, sore throat, and gradually whole-body aching, aching finger joints, and weakness so great I couldn't even lift the hairdryer. Luckily, once the child fell ill I'd moved my wife away from him and forced her to her room to rest, so that if the child and I were both sick, someone could cook for us.

Once the child's fever broke he was fairly well; he took my temperature: 37.2°C, not yet feverish. I had him point the hairdryer's hot air into the covers, leaving a gap, set it on the bed, and let it blow on its own. The temperature under the covers quickly got very high, and I sweated, and so did he. That night the two of us slept in one bed; whenever the covers weren't hot enough, we blew hot air in, two or three minutes and it was hot again, sometimes sweating, sometimes not. An electric blanket might have been easier, but in the North, with central heating, few households keep one.

I didn't wait until the child or I fevers to blow hot air; I did it on a schedule. The great majority of COVID patients in Beijing have chills and no sweat, and severe ones develop respiratory paralysis. My experience is that the moment the warmth under the covers drops, the sore throat and body pain return and breathing grows hard; if the covers stay consistently hot, these symptoms don't appear.

Once at night I got up to use the toilet and could barely stand, feeling I'd topple over, and had to lean against the wall. I also felt nauseous; prodding my throat to vomit brought nothing. Our family never had such severe symptoms; an ordinary cold in the family I can usually cure within an hour or two. But this time was truly miserable, and I prepared to be sick for days.

Sunday morning, my son and I stayed in bed, blowing hot air. Neither of us had much appetite but we forced down a little. My sense of taste was gone—everything tasted of nothing—while he was okay. After breakfast we stayed in bed, now him, now me, occasionally turning on the hairdryer and blowing hot air into the covers, no longer aimed at any body part; this warmed the whole bed. We sweated from time to time and monitored temperature. I never ran a fever; the child, though feverish, generally only reached about 38°, never over 39° again, and basically sweated it out within minutes each time. Body aches eased a lot.

Sunday around ten in the morning, the child's temperature was basically normal and his appetite returned; he hunted around for food and ate a pile of fruit. But after eating raw fruit, his temperature rose again, so he burrowed back under the covers to blow hot air and sweat. By lunchtime he had basically recovered. I spent the whole morning dozing, with a slight aching all over—tolerable, but unpleasant.

At lunch, my taste loss was worse; nothing tasted as it used to, and my appetite was poor. I could barely finish the half bowl my wife served, and felt nauseous toward the end. After eating I crawled back under the covers to blow hot air; after blowing so long I could feel the air coming from my nostrils was burning hot. At most we blew hot air into the covers over ten times in an hour.

In the afternoon I began to sweat often, and each sweat left me feeling lighter than before. By three-something, except for a still-aching head and aching finger joints and fatigue, the other symptoms had basically vanished. By five I got out of bed, because my wife had begun to fall ill and I had to care for her. The viral load throughout the house was high, so it was no surprise she'd fallen ill: sore throat, headache, fatigue, and whole-body pain. The child was well, so I returned to my own room to care for his mother.

We acted as soon as her symptoms appeared. She lay under the covers while I blew hot air in; because she had a headache, I focused on her Fengchi and Fengfu points. By then my strength had mostly returned, so I could also massage her Fengchi and Fengfu. Afterward her headache eased, but as soon as the hot air stopped, her head ached again, so I gave up the massage—it wasn't helping—and just blew hot air into the covers until she was warm all over, at which point the headache eased.

Around six or seven, I felt the chills were gone: I couldn't stand the hairdryer's heat, found it too hot, and had to move away—whereas before, I'd felt I couldn't live without it. My strength had fully returned and I felt no discomfort anywhere. I ate an orange, but it tasted bitter. The taste loss from COVID differs subtly from that of an ordinary cold: not only do you not taste the food, but your mouth feels numb.

TCM's Xiaochaihu Tang (Minor Bupleurum Decoction) treats a bitter taste in the mouth, so I thought I'd test it. We happened to have an opened but unfinished packet of Xiaochaihu granules, so I mixed one and drank it. Half an hour later I felt ravenous and especially wanted food, so I heated up some leftovers and ate. My taste had completely recovered; everything tasted good. I don't know whether it was Xiaochaihu Tang's effect or my taste recovering on its own.

My wife hadn't overexerted herself over the weekend and had acted the moment symptoms appeared, so by about nine Sunday night her symptoms had eased considerably, leaving only slight pain in the head and brow ridges. Like me, because she'd sweated before fever set in, she never ran a fever throughout.

At two Monday morning I got up to use the toilet and felt a swallowing pain, like swallowing a blade. Oddly, I'd had this symptom once last year and once in the first half of this year. I'd never felt this sharp swallowing pain before COVID, and I suspect it appeared only after vaccination gave my body specific immunity to COVID.

The first time, I was cured by drinking Mahuang Tang; the second, by drinking boiled water. So after using the toilet I boiled a kettle and drank about 300 ml of hot water; as I drank, the sore throat noticeably eased. Afterward I went back to bed, blew some hot air into the covers, and broke a little sweat. On waking, the sore throat was gone.

Monday morning my wife got up, her strength restored, but she had the "swallowing a blade" symptom—throat pain on swallowing. I had her drink very hot soy milk; right after drinking, the pain eased.

That time I had a sore throat last year, I tried Lianhua Qingwen and Yanbian granules and it worsened, but Mahuang Tang worked instantly; I even wrote the case up as a medical report on my official account. In the first half of this year, plain boiled water did it. So this time, for both my wife and me, I didn't use Mahuang Tang, only boiled water.

All four of us basically recovered within about twenty-four hours; only my father took one dose of Mahuang Tang, while our small family of three used no medicine at all. This firsthand experience taught me that COVID's symptoms belong to TCM wind-cold cold, absolutely not wind-heat. Moreover, over these years, COVID's symptoms, by TCM pattern differentiation, have not changed much.

On lunar New Year's Eve 2019, a friend of mine working at a Wuhan hospital fell ill; by New Year's Eve night he was nearly gone. Wuhan hospitals then had no beds to be had, even for staff who fell ill. The symptoms he had then were very similar to ours this time.

His home had no usable medicine at the time; he turned to me, and I immediately suggested the hairdryer. But to avoid exposing his family, he was renting a place elsewhere, and the rental had no hairdryer. Luckily the bathroom had a heat lamp (yuba); he turned on its radiant heater and the hot-air blower, sat in the bathroom roasting under the lamp and in the hot air, and got through it.

That year, some Wuhan patients who came to me described basically the same symptoms—chills, body pain, respiratory paralysis—very much matching the indications of Mahuang Tang and Gegen Tang (Pueraria Decoction). I don't know why the National Health Commission experts actually recommended treating it as wind-heat. If my father had followed their advice and used heat-clearing, toxin-resolving and acrid-cool exterior-releasing herbs, he might have died this time; luckily he used Mahuang Tang.

Over three years, through the data reported in the media, my understanding of COVID has deepened. COVID and its variants all invade human cells through the ACE2 receptor; a common side effect of COVID vaccines is clotting, and one of the most common clinical symptoms in COVID patients is clotting problems.

Now it seems it shouldn't be called "COVID pneumonia," because the pneumonia it causes is no longer highly lethal; the vascular disease it causes is more lethal. COVID causes many cardiac sudden deaths and cerebral thrombosis deaths. Foreign research also shows that, after recovery, some COVID patients have a markedly increased risk of death from heart disease and stroke. Long COVID is also closely tied to thrombosis.

So from the TCM angle, the more accurate disease mechanism of COVID is "cold congealing and blood congealed (xue qi)." Patients have both a clear cold pattern and a "blood congealed" pattern; by TCM, "xue qi" means impaired blood flow. COVID patients have both chills and clotting from onset; some who die quickly mostly do so from cardio-cerebrovascular embolism, and the respiratory paralysis of some critical patients may be due not to pneumonia but to pulmonary embolism.

Even after recovery, COVID patients still carry a risk of abnormal clotting. So treating COVID and its aftereffects should follow the principle of warming yang and invigorating blood. This is why Mahuang Tang works instantly on COVID, and why hot air heals it. If cold-cooling herbs are abused—especially those that worsen vascular embolism—the patient not only fails to be saved but is hastened to death by the wrong medicine.

To prevent long COVID, one should likewise, after infection, follow the idea of warming yang and invigorating blood: keep warm, and can focus heat therapy on the vertebral artery, which is the warming-yang, blood-invigorating method with the fewest side effects. COVID's whole set of symptoms can be cured by warming yang, and so can its aftereffects.

After infection, patients can try to stay asymptomatic, but within two weeks they must live especially carefully: avoid wind-cold and avoid exertion, until IgG antibodies develop. Only with IgG antibodies is it safe. My father and son both failed to avoid wind-cold within the fourteen days, so they fell ill first. Once ill, they shed the virus into the room through breathing and coughing; when the viral load is high, others at home can barely avoid falling ill. After recovery, if patients fail to keep warm and rest before IgG develops, relapse is easy.

But I see it's hard for the whole nation to do this now, especially medical staff, as patient numbers swell like a tsunami and they must work while sick. Other key departments also need people working; with large numbers down, only the mildly ill and recovered can return to the post, or society as a whole stops running. So the cashier at our market works while coughing violently, and my brother-in-law, feverish at 40°C, was still required to unload cargo at the depot. For Chinese compatriots today, rest and avoiding wind-cold are truly a luxury.

Finally, why did our family recover so fast? I believe continuous heat therapy is the key. After falling ill with COVID, an urgent desire for warmth is almost instinctive, because the illness makes you feel cold to the bone; even with central heating at home and under the covers, you feel strangely cold.

Without a method like the hairdryer that rapidly raises the temperature to keep the covers warm, we might have struggled against that cold. I didn't wait until fever to blow hot air; I continuously blew hot air into the covers to keep them hot enough.

This treatment resembles the methods for febrile disease in Zhang Zhongjing's Shanghan Lun (Treatise on Cold Damage) of the Han dynasty. In his Guizhi Tang (Cinnamon Twig Decoction) line, Zhang also has the patient take the medicine continuously—not, like modern doctors, just two or three times a day, but nine or more doses of Guizhi Tang over a day and night. Only such treatment gives ideal results; if you delay, the course is inevitably long. Every time I treat my child's cold, I follow this idea, so his ordinary colds are always cured within two hours.

Because of our continuous heat therapy, the normal 3–7 day course was shortened to one day. The only downside may be a little internal heat—the air from the nostrils may feel scalding—but once you stop the hot air after recovery and replenish some fluids, normal returns within hours.

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