Our Unique Approach: Restore The Body’s Proper Functions
A Suspected Covid-19 Case Study: Missing Symptoms, Misdiagnosis, then Hitting The Mark
Stage 1 Presentation:
Stage 1 Treatment:
- Tincture: Jin Yin Hua, Lian Qiao, and Huang Qin
- Premade Isatis Blend: Ban lan gen, xia ku cao, bai hua she she cao, chuan xin lian, jin yin hua
- Custom Herbal Formula: xin yi hua, bai qian, qiang huo, zi su ye, jing jie, fang feng, zhi ke, jie geng, chuan xiong, ban lan gen, huang qin, gan cao
- Ginger juice, various supplements.
Stage 2 Presentation:
Stage 2 Treatment:
Analysis 1: Missing Symptoms
Stage 3 Presentation:
Stage 3 Treatment:
Analysis 2: Misdiagnosis
Stage 4 Presentation:
Day 13: It is at this point that the patient consulted with Chinese Herbalist Suzanne Connole, LAc
Thirteen days into her illness, the patient’s symptoms were the following:
- Dry cough with burning pain, very little sputum that is difficult to expectorate. Cough comes in fits
- Difficulty taking a deep breath
- Chest tightness
- Tickle in the throat and upper chest
- No sore throat, no swollen glands
- Chills often alternating with a low grade fever especially in the afternoon
- Intermittent clammy feeling on skin but very little sweating overall
- Dull, heavy headache
- Very achy and tight neck and shoulders
- Thirst with no desire to drink
- Nausea, poor appetite, eating lots of rice porridge and broth
- Watery diarrhea, no pain, no bloating, 1x in the morning
- Fullness in epigastrium, ribs very tender and constricted
- Very ‘spacey’ and weak.
- Tongue: pale, puffy, scalloped thin white coat/watery. Red tip.
Stage 4 Treatment:
- Replaced Ban Xia with Tian Hua Fen
- Both herbs resolve phlegm but Tian Hua Fen does not cause excess dryness which Ban Xia does.
- Replaced Sheng Jiang (fresh ginger) with Gan Jiang (dried ginger)
- Dry ginger was used instead of fresh ginger to address digestive weakness as seen with the diarrhea and pale tongue.
- Added Gua Lou and Hou Po to open chest
- Added Xing Ren and Jie Geng to stop cough and open the upper chest
Diagnosis: Concurrent Shaoyang and Taiyin Patterns
The patient presented with many of the key symptoms needed to diagnose her with a Shaoyang stage pattern disease. This form of diagnosis is based on the classical Chinese medicine approach known as the Six Conformations methodology founded by the 2nd century physician, Zhang Zhong Jing.
In a Shaoyang pattern presentation, one of the Six Conformations, one often sees cyclical symptoms that come and go such as fluctuating temperature changes. One also sees tightness and constriction in the chest and rib cage, dizziness in the head and eyes, nausea and poor appetite.
Broadly speaking, in this pattern, there is an energetic blockage at a central fulcrum in the body around the solar plexus or diaphragm. This blockage prevents qi, or life force, from moving downward in the proper direction. Thus, we see many counterflow symptoms (in this case, upward flaring symptoms) such as nausea, fever, dizziness, and headache. We also see many ‘stuck’ signs at this pivotal area like chest tightness and ribside constriction. Below this area on the torso, we then see hypofunctioning such as the poor absorption of nutrients as seen with the diarrhea symptom.
In hindsight, Suzanne realized that she missed an important diagnostic sign with the tightness in the neck and shoulders and might have considered a variation of the prescribed formula which also addressed another concurrent pattern, the Taiyang pattern presentation. Because the consult was virtual, she could not rely on her usual palpatory exam of the neck and shoulders to determine the extent of pain and discomfort there.
Stage 5 Presentation:
Day 13: After beginning the herbs that Suzanne prescribed, the patients symptoms were as follows:
- weak but improved cough; cough worse in the afternoon
- more ease with breathing
- less watery diarrhea, now just loose
- less tightness in the chest, easier to inhale
Day 14:
- feeling stronger
- increased appetite
- less diarrhea
- symptoms still worse in the afternoon with coughing fits, difficulty breathing and low-grade fever
Day 16:
- less dry, more productive cough
still had constricted breathing - yellowish green phlegm that was scanty and thick
- low-grade fever and chills
- aversion to wind
neck and shoulders still tight - Tongue: pale scalloped, puffy, thick greasy coat
Special Circumstances due to Enforced City Closures:
Stage 5 Treatment:
Although the patient’s overall strength had improved, chest constriction reduced, and the cough became more productive–a sign that the ‘stuck’ phlegm was loosening up. The patient still had residual chest tightness and constricted breathing.
In partnership with a fellow herbalist, the following amendments were made to the same base formula:
- Added Ma Huang and Xing Ren to strongly expand the chest and stop coughing and relieve difficulty breathing
- Added Sang Bai Pi and Zhe Bei Mu to cool and transform phlegm
- Added Jie Geng and Gua Lou to open the chest and resolve phlegm
- Added Wu Wei Zi to protect the lungs
- Added Huo Xiang to aid in digestion
Over the next few days, the patient continued to improve. The cough became weaker and less frequent. The headache, shoulder and neck pain went away. The stools became more solid, the nausea abated. Physical energy increased, although mental energy was still low.
Treatment focused on relieving pre-existing anxiety and residual phlegm and itchiness in the throat so another formula was prescribed. The patient was finally out of the woods and prescribed a subsequent formula until she made a full recovery.
Conclusion: Hitting the Mark in Real Time
Much of the herbal details included in this account may be more suitable to those familiar with the medicine, but what we want to draw attention to are Suzanne’s consistent monitoring of symptoms and her frequent modification of the patient’s herbal prescription as the symptoms change. From a Chinese herbalist’s perspective, continually treating the most current symptoms is the key to effective care and regular amendments to a patient’s herbal prescription will most accurately resolve and shorten the length of the illness.
In the news, it is not uncommon to hear of coronavirus cases lasting for a month or more with the virus potentially leaving scarring in the lungs. With the Covid-19 and suspected Covid-19 cases we have treated thus far, symptoms are not nearly as protracted and improvement begins almost immediately after starting a course of herbs, greatly increasing the chances of protecting lung tissue. By dynamically addressing the pathomechanism behind the symptoms at all stages of the illness, Chinese herbal medicine can bring the body back into a balanced state and prevent further and lasting damage.
We’d love to know if you found this helpful and if you have any comments to share. If you or a loved one has suspected coronavirus, please reach out with questions or for care.
