How A Chinese Herbalist Treats Covid-19: A Case Study

In this post, we want to walk you through the step-by-step process Suzanne Connole, LAc, a classical Chinese herbalist here at Five Seasons, took in diagnosing and treating a suspected Covid-19 case. In this account, you will get a taste of how our medicine views acute viral infections and see the special challenges that come with treating coronavirus. Even in cases that are considered mild and do not require hospitalization, one can experience a great deal of pain, discomfort and prolonged illness. Furthermore, since there is still so much unknown with this virus, every symptom can be a cause of great anxiety due to the uncertainty of recovery.
We have learned in a short period of time that caring for coronavirus patients involves very close monitoring of symptoms and frequent check-ins. For the Chinese herbalist, this means continual amendments of the herbal formula so that the prescription addresses the current signs and symptoms and speeds up recovery.
As mentioned in a previous post regarding Chinese medicine’s view of Covid-19 and ways to stay healthy during this pandemic, coronavirus can present with a variety of symptoms or little to no symptomology at all. Classical Chinese medicine understands that each individual body responds differently to disease and therefore the symptoms will vary from person to person. There is never a one-size-fits-all approach to treating the same illness.
It is precisely because different bodies can respond differently to the same disease that we are seeing such variety in Covid-19 presentations. While there may be some shared and overlapping symptoms, the patient’s comorbidities, body shape, genetics, response to internal and external stressors, as well as the patient’s external environment are all carefully considered. Altogether, this information helps us as Chinese Herbalists determine how to holistically treat the disease and predict how the illness will develop so that we can effectively interrupt its course.

Our Unique Approach: Restore The Body’s Proper Functions

What we believe distinguishes the approach of the Chinese herbalist is that in order to treat a pathogen like Covid-19, our focus is not necessarily to rid the body of the virus. Instead, our aim is to restore the body’s physiological functions that have been impaired by its response to the illness. Once these normal processes are restored, the body will heal and will no longer be susceptible to the deleterious effects of the virus. While people who come down with coronavirus are understandably focused on ridding themselves of this pathogen, many accounts of its progression indicate that some symptoms can linger for a long time even after it has supposedly run its course and the patient tests negative. This indicates that proper body functions have not recovered. From a classical Chinese medicine point of view, having a singular, primary focus on killing or ridding the body of a pathogen is not an effective means of healing. The most potent and sustainable healing that does not leave lingering symptoms nor side effects comes from taking a holistic, restorative approach.

A Suspected Covid-19 Case Study: Missing Symptoms, Misdiagnosis, then Hitting The Mark

The following is a description of a suspected Covid-19 case treated by Five Seasons practitioner, Chinese Herbalist Suzanne Connole, LAc.. This case illustrates the meticulous process a Chinese herbalist undertakes to gather a complete health history–including taking into account the incorrect herbal supplements that the patient had previously taken prior to seeking her care–followed by the continuous care for evolving symptoms.
Please note, for the sake of being thorough, we have included each herb in the patient’s herbal formulas. This information may be overwhelming and unfamiliar to the lay audience but we believe it is important to include in order to illustrate the thought process that goes into Chinese herbal formula writing and its many amendments.
Stage 1 Presentation:
Day 1: A 43-year-old woman woke with a mild cough, mild sore throat, chills, body aches, extreme fatigue, headache, runny nose and fever.
Stage 1 Treatment:
Patient took the following herbal supplements prior to seeking Suzanne’s care:
  • 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:
Day 4: The illness continued to come and go, with some days better, some worse. The fever broke but she began to feel delirious with dizzy vision. Day 5: She felt much worse. She had a fever of 103F, lethargy, difficulty moving, nerve pain in her extremities, a deep, dry, burning and painful cough.
Stage 2 Treatment:
She continued to take the same herbal supplements and added a Ban Xia formula.

Analysis 1: Missing Symptoms

The herbal supplements that this patient took are very popular ‘anti-viral’ cold and flu formulas, such as Yin Qiao San, that have become even more in demand since the pandemic. The majority of the herbs are cold-natured herbs that have a ‘wind-heat releasing’ effect. These types of formulas can be appropriate in some cases of colds and flus, but when misused, will either not work, or entrench an illness deeper into the body. From our experience with treating Covid-19 cases thus far, these ‘wind-heat releasing’ herbal formulations have not been seen to be the appropriate solution in most cases. When this patient eventually sought Suzanne’s care as a Chinese Herbalist (see below under Stage 4), she noted that she always had chills even when she had a fever and that she desired warm drinks. This tells us that her presentation was also cold in nature and explains why the ‘wind-heat releasing’ herbs did not effectively resolve the symptoms. The patient also reported that at this time, her tongue coat was very thick, slimy and white and she felt dry and thirsty. These symptoms tell us of an imbalance in her fluid physiology. The presence of pathological fluids such as the thick slimy tongue coat prevents the availability of beneficial physiological fluids resulting in her experience of dryness and thirst. Very few of the many herbs in her formulations were directed at re-regulating fluid physiology and therefore her symptoms worsened.
Stage 3 Presentation:
Her condition continued with some days better, some worse. She had a low-grade fever, especially in the afternoon.
Stage 3 Treatment:
Under the guidance of another clinician, she took the formula Liu Wei Di Huang Wan.

Analysis 2: Misdiagnosis

The patient was incorrectly given the formula Liu Wei Di Huang Wan, the representative formula for the diagnosis of Kidney Yin Deficiency. A hallmark symptom for Kidney Yin Deficiency is low-grade afternoon fevers. However, were all of her symptoms to be taken together as a whole, it is quite clear that the patient does not present with this pattern and giving a tonifying formula such as this one could actually worsen the condition.
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:
Suzanne prescribed the formula, Xiao Chai Hu Tang, and made the following modifications:
  • 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
Two packs of raw herbs were prescribed and filled at a local pharmacy and the patient was able to receive the herbs immediately.

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:

Because the city was shutting down at the same time as when this patient became sick, the patient no longer had easy access to the local herbal pharmacy. Suzanne therefore partnered with an herbalist upstate who lived near the patient and who had his own herbal apothecary. They began to co-treat the patient together.
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.

***Please be aware that we do not condone nor encourage the reader to try to base their own care on the formulas presented above. This is only the experience of our practice and each case requires individualized care. Please seek the help of a licensed and qualified Chinese herbalist should you suspect a Covid-19 infection.***

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