Two TCM Cases of Post-COVID Arrhythmia
Post-COVID sequelae are hard to treat. My skill being limited, my effective rate for post-COVID sequelae is very low. Of the post-COVID patients I treated over recent months, not a single one responded; only recently have two patients shown some effect. I now record the treatment course as medical cases for the reference of other patients.
Case 1: Wang, an elderly male patient, 78 years old. He is the father of an ovarian-cancer patient I had treated.
When young, the patient served in the navy and often had severe vomiting, leaving a root of stomach pain. Thirty years ago he began taking medicine for stomach pain, including Lividile (Lizhu Dele) and Motilium. In 2005 the condition gradually worsened; by 2016 it was severe enough that he could only eat millet porridge every day, and this continued for two or three years. In 2019, examination at Yantai Liuhuangding Hospital diagnosed severe atrial fibrillation. Because his stomach disease was severe he could not take Western medicines, and surgery was indicated, but his age prevented the operation; he was switched to oral Yiguan Ning Wan. After a month or two, his heart function improved, his stomach symptoms also improved somewhat, his diet returned to normal, and he continued taking Yiguan Ning Wan thereafter.
On January 2, 2023, the patient contracted COVID-19. He rested at home for about a week, then went outside; a week later he felt chest tightness and suffocating breath, and sweated excessively on exertion, so he increased the dose of Yiguan Ning Wan. After resting at home another week, feeling somewhat better, he went out again, only to feel unwell again after activity. This repeated four times, until he first consulted me on March 13 this year. His current symptoms were: tachycardia, chest tightness and suffocation, generalized sweating, belching and gastric distension, able to eat only soft food, dizziness and nausea, afraid to lie down, able to sleep only sitting up.
I suggested he try Chai Gan Jiedu Tang, the post-COVID formula I had devised. On the first day of taking it the patient responded well and could sleep at night. But by the next afternoon his stomach felt a little off again, so I told him to halve the dose and take one decoction over two days, to see whether the side effect would disappear. After taking it again, gastric distension and pain were not relieved. He then asked me to adjust the formula; I told him to stop the decoction and switch to the patent medicine Shugan Hewei Wan (small water pills made by Tongrentang). After taking Shugan Hewei Wan, the stomach discomfort improved, but the heart still felt unwell; every night before sleeping he needed about two hours of oxygen, without which he could not fall asleep. When Shengmai Yin oral liquid (Codonopsis formula) was added, the stomach pain worsened again, and chest tightness, suffocation, nausea, stomach pain, dizziness, and inability to lie down — being able only to sit up and rest — recurred.
After several further formula adjustments, things were now good and now bad, never achieving effective relief. On May 4, when he again came to me for adjustment, I decided to try Dan Zhuru Tang, used in TCM for “zang-zao” (organ restlessness). The formula was as follows: Maidong (Ophiopogon) 15 g, Huai Xiaomai (Huai wheat) 30 g, Fuxiaomai (light wheat) 30 g, Zhi Gancao (honey-fried Licorice) 10 g, Dangshen (Codonopsis) 15 g, Fulin (Poria) 15 g, Fabanxia (prepared Pinellia) 10 g, Zhuru (Bamboo shavings) 10 g, fresh ginger 7 slices.
By May 6, the patient’s symptoms had markedly improved: the stomach no longer felt unwell, the previously felt “heat above, cold below” had eased, sleep had clearly improved, and chest tightness, suffocation and other symptoms had all improved. I therefore told him, since the formula worked, not to change it, and to continue. On May 8, the patient’s son-in-law hoped to add some herbs to boost the elderly man’s strength, so I lightly modified Dan Zhuru Tang as follows: Maidong 15 g, Huai Xiaomai 30 g, Fuxiaomai 30 g, Zhi Gancao 10 g, Dangshen 15 g, Huangjing (Polygonatum) 15 g, Renshen (Ginseng) 3 g, Fulin 15 g, Zhuru 10 g, fresh ginger 7 slices.
Dan Zhuru Tang originally comes from Sun Simiao’s Qianjin Fang of the Tang dynasty; the original formula treated “postpartum deficiency vexation, headache, shortness of breath bordering on exhaustion, and chest oppression and confusion that will not resolve.” In the Qianjin Fang, Dan Zhuru Tang consists of Maidong, Xiaomai (wheat), Gancao, Zhuru, Shengjiang (ginger) and Dazao (jujube). Later, Chen Yan of the Song dynasty, in his Sanyin Ji-Yi Bingzheng Fanglun, changed the composition to: Maimendong (pith removed) and Xiaomai, each two and a half liang; Gancao (honey-fried) one liang; Renshen, Zhuru and Baifuling, each one and a half liang; and Banxia (washed seven times in hot water) two liang. The modified Dan Zhuru Tang has the actions of nourishing the heart and calming the spirit, clearing the heart and eliminating vexation. It treats heart-qi deficiency with vexation and fullness, headache and shortness of breath, internal heat that will not resolve, chest oppression and confusion, and postpartum heart deficiency with fright palpitations, vexation and distress bordering on exhaustion, and zang-zao with unceasing sorrow. Nowadays it is commonly used for tachycardia, cardiac neurosis, and women’s zang-zao presenting with heart-deficiency fright palpitations.
I used Chen Yan’s modified Dan Zhuru Tang. Because this patient sweated much, I added Fuxiaomai to astringe yin and stop sweating; I never expected it would actually work. This patient’s formula was adjusted nearly ten times with little effect, but his family trusted me, so they could endure the repeated ineffective adjustments and persisted for over a month before we found a way to relieve him.
Case 2: Cui, a woman, 74 years old. After COVID-19 she developed high-grade atrioventricular (AV) block with bradycardia; Western doctors advised her to install a pacemaker as soon as possible to prevent sudden cardiac arrest. The patient’s daughter is a friend of the daughter of one of my gastric-cancer patients; through her introduction she came to me. Because the patient was older, the daughter was hesitant about a pacemaker and hoped to try TCM first, installing a pacemaker only if there was no improvement. The patient’s first visit was on April 26, 2023.
The patient had caught COVID-19 before the 2023 Spring Festival (around January). After the festival, dizziness gradually worsened. When she caught COVID it was like an ordinary cold, without fever and with mild symptoms. A month earlier she had received IV fluids at a small township clinic, after which her symptoms worsened.
The right half of her body, arm and leg were numb. At night she felt hot and restless, and sweated when hot; this had existed before COVID but was worse afterward. She also had a cold-aversion symptom, with dry and bitter mouth. At night her mouth was so dry she could barely open it, and she needed to sip water to moisten her throat. She used to have a bitter mouth; lately it was less noticeable. Her stools used to be regular, twice a day; now they were not very regular, at least once daily, and on this recent day only once in two days. No cough usually. She feared wind and sweated easily; she also sweated when anxious. Her shoulder and neck ached; other joints occasionally ached too. Her eyes were slightly dry, watered in the wind, and she had cataracts, always feeling as if snowflakes were drifting before her eyes. She preferred hot drinks and disliked cold water, especially could not eat cold things, and tended to diarrhea.
The patient said her most distressing current symptoms were dizziness and numbness of the right side. Yesterday she had felt chest tightness on the road; for about the past month she had had chest tightness but had not paid attention. Every morning she felt drowsy and always lay in bed. About three years earlier she had been hospitalized in her hometown, where the doctor said she had a slight cerebral infarction. The right side of her head felt numb, and she tended to fall when walking. On waking her fingers felt stiff, and after sleeping her whole right arm and hand felt numb. Her condition did not worsen on weather changes. Her appetite was fair. She used to be rather stubborn-tempered; now she was a little softer. Her blood pressure was normal back home, but she had not measured it recently; she was currently taking blood-sugar-lowering and blood-pressure-lowering medicines.
Before consulting me, the patient had been hospitalized at the Renmin Hospital of Haimen District, Nantong (hospital number 202316637). After an ECG, the local doctors considered she had high-grade AV block and needed a pacemaker as soon as possible. At the first visit, I tried two small formulas first to see whether they could improve some of her symptoms.
Formula 1:
Sheng Huangqi (raw Astragalus) 15 g, Guizhi (Cinnamon twig) 15 g, Baishao (White Peony) 15 g, Gegen (Pueraria) 30 g, Tianhuafen (Trichosanthes root) 10 g, Shengjiang (fresh ginger) 30 g, Dazao (jujube) 7 pieces.
3 doses, decocted in water, one dose daily, morning and evening.
Formula 2:
Chaihu (Bupleurum) 10 g, Huangqin (Scutellaria) 10 g, Guizhi 10 g, Baishao 10 g, Tianhuafen 10 g, Xiyangshen (American ginseng) 6 g, Gegen 30 g, Shengjiang 30 g, Dazao 7 pieces.
3 doses, decocted in water, one dose daily, morning and evening. If Formula 1 was ineffective, switch to Formula 2.
On May 6, 2023, at the second consultation, the patient’s symptoms had not clearly improved. By then she had already visited the cardiology department of Beijing Fuwai Hospital; the cardiologists there considered that, although no cardiac arrest had been detected, her bradycardia was still dangerous and advised a pacemaker as soon as possible. The daughter hoped I would try again, and would install a pacemaker only if treatment failed after a while.
Second-visit prescription: Sheng Huangqi 30 g, Xiyangshen 6 g, Wuweizi (Schisandra) 10 g, Maidong (Ophiopogon) 10 g, Fuxiaomai (light wheat) 30 g, Guizhi 10 g, Gualou (Trichosanthes fruit) 10 g, Xiebai (Allium) 10 g, Danshen (Salvia) 15 g, Chuanxiong (Sichuan Lovage) 10 g, Danggui (Angelica) 10 g, Chishao (Red Peony) 10 g, Dilong (Earthworm) 10 g, Taoren (Peach kernel) 6 g, Honghua (Safflower) 3 g, Huainiuxi (Achyranthes) 6 g, Manjingzi (Vitex) 15 g, Baizhi (Angelica dahurica) 6 g, Mudanpi (Moutan) 10 g, Gegen 30 g, Mohanlian (Eclipta) 10 g, Nuzhenzi (Ligustrum) 10 g, Sangye (Morus leaf) 10 g, Shengma (Cimicifuga) 6 g, Tianma (Gastrodia) 10 g, Gouteng (Uncaria) 15 g, Zhenzhumu (Pearl shell, decocted first for half an hour) 10 g, Sheng Muli (raw Oyster shell, decocted first for half an hour) 15 g. I also told the daughter to watch the patient closely and, if anything abnormal occurred, to hospitalize her promptly for a pacemaker.
The second-visit prescription was a modified combination of four formulas: Huangqi Shengmai Yin, Guizhi Gualou Xiebai Tang, Taohong Siwu Tang, and Erzhi Wan. Huangqi Shengmai Yin strengthens the heart; Guizhi Gualou Xiebai Tang is a famous TCM formula for chest impediment; Taohong Siwu Tang is a famous formula for activating blood and resolving stasis; Erzhi Wan nourishes yin and moistens dryness, calms the spirit and aids sleep, and reduces anxiety. Adding liver-calming, wind-extinguishing herbs such as Gouteng, Tianma, Zhenzhumu and Sheng Muli produced a formula that boosts qi and resolves stasis, strengthens the heart and calms the spirit, and levels the liver and extinguishes wind.
After taking it, the patient’s condition improved. But on May 12 she suddenly felt stomach discomfort, with head heat and sweating, cold feet, numb legs, frequent urination, dry mouth, blood pressure 186/101, palpitations and panic. Her family then cared for her, made her drink more water, soothed her with words, and massaged her feet. Her feet warmed up, her body warmed up, the panic eased, blood pressure fell to 144/88, and heart rate to around 70.
Fearing the blood-activating, stasis-resolving herbs had caused a side effect of gastric bleeding, I told her to stop the medicine and observe; after stopping, nothing abnormal occurred. To be safe, I greatly reduced the blood-activating herbs in the above prescription. The adjusted formula: Sheng Huangqi 30 g, Xiyangshen 6 g, Wuweizi 10 g, Maidong 10 g, Fuxiaomai 30 g, Guizhi 10 g, Gualou 10 g, Xiebai 10 g, Manjingzi 15 g, Mudanpi 10 g, Mohanlian 10 g, Nuzhenzi 10 g, Sangye 10 g, Tianma 10 g, Gouteng 15 g, Zhenzhumu 10 g (decocted first half an hour), Sheng Muli 15 g (decocted first half an hour).
Thereafter the patient kept taking this prescription; her symptoms markedly improved, and she felt clearly stronger than before. On May 23, 2023, an ECG at the hospital showed that the bradycardia and AV block had significantly improved, and the cardiologists considered there was for now no need to install a pacemaker. Ultrasound showed a mixed-echo plaque at the carotid bifurcation, about 2.4 x 1.4 cm.
On May 25, 2023, the daughter brought the patient for another follow-up. She reported marked improvement after the above formula, but the patient had loose stools after taking it, and the night sweating persisted. In the formula, both Gualou and Xiebai may cause diarrhea and loose stools; Huanglian was appropriate to use, to relieve the night sweating while treating the diarrhea and loose stools, and a few more herbs were added to address the night sweating.
The revised prescription: Sheng Huangqi 30 g, Xiyangshen 6 g, Wuweizi 10 g, Maidong 10 g, Fuxiaomai 30 g, Digu Pi (Lycium root bark) 15 g, Sangbaipi (Morus root bark) 10 g, Huanglian 10 g, Gegen 30 g, Chuanxiong 10 g, Guizhi 10 g, Gualou 10 g, Xiebai 10 g, Manjingzi 15 g, Mudanpi 10 g, Mohanlian 10 g, Nuzhenzi 10 g, Sangye 10 g, Tianma 10 g, Gouteng 15 g, Zhenzhumu 10 g (decocted first half an hour), Sheng Muli 15 g (decocted first half an hour).
3 doses, decocted in water. I told the patient that, if the effect was acceptable, she should have the pharmacy process three times this amount into pills, each pill weighing 10 g, taking one pill after breakfast, lunch and dinner, and no longer use the decoction. Because this patient is chronically ill, she should not take decoction long-term; the later stage should be rounded off with pills.
Post-COVID sequelae (long COVID) are harder to treat than the symptoms of the initial infection. Every post-COVID case I encountered this year has been tricky; apart from these two patients who responded, the many others who consulted me were all ineffective.