COVID-19 infection with a warm-heat disease presentation
Female patient, 39 years old — tested positive for COVID-19
Symptoms began on 20 March 2021 — telephone consultation on 22 March 2021.
-
Burning sensation in the nose and upper chest
-
Dry nose without congestion, slight thick discharge
-
Marked thirst (+++), preference for cool/ambient drinks
-
Frontal and maxillary sinus headache
-
No fever, but sensations resembling hot flushes with occasional light sweating
-
Occasional slight shivering, but no aversion to cold or aversion to wind
-
Fatigue
-
Urination 5–6 times/day, normal quantity, slightly yellow
-
No nausea, no cough
-
Loose, unformed stools (habitually constipated with hard stools)
-
No anosmia, no ageusia
-
Tongue: slightly red at the borders and tip, slightly swollen at the borders, fissured with a deep central crack; coating white, geographic and rootless
Prescription:
Modified Yin Qiao San:
Jin Yin Hua 9, Lian Qiao 6, Jie Geng 6, Niu Bang Zi 9, Bo He 6, Dan Dou Chi 6, Jing Jie Sui 6, Dan Zhu Ye 6, Lu Gen 15, Gan Cao 6, Ge Gen 9, Huang Qin 6, Tian Hua Fen 9.
Decoction — one sachet per day for 3 days (Bo He added at the end of the decoction).
24 March 2021: Onset of anosmia and cough with sputum. Start of the herbal treatment.
26 March 2021: After three days of treatment:
-
The burning sensation in the nose and chest has resolved, as has the headache
-
The nose is dry, slightly congested; anosmia and ageusia are present
-
Slight cough without sputum
-
Some residual fatigue
-
Thirst reduced but still marked (greater than before the infection)
-
Slight shivering with mild aversion to wind and cold
-
Stools have returned to normal
-
Tongue: borders and tip slightly red, small amount of rootless white coating, fissures unchanged
Prescription:
Modified Yin Qiao San:
Xing Ren 6, Sang Ye 9, Jie Geng 6, Dan Dou Chi 6, Jing Jie Sui 6, Dan Zhu Ye 6, Lu Gen 18, Gan Cao 6, Ge Gen 15, Tian Hua Fen 9, Sheng Ma 6.
Decoction — one sachet per day for 4 days.
At the end of this course of herbs, only a slight reduction in the sense of smell remained. All other symptoms had resolved.
Commentary:
This is a case of COVID-19 infection whose expression conforms to the patient's underlying yin-deficient constitution, producing a warm-heat type of presentation — with burning sensations, absence of aversion to cold, and pronounced thirst. In this situation, it is appropriate to release the pathogenic factor with light, acrid and cool medicinals, while supporting yin and the body fluids (jin ye) with sweet and cool medicinals.
Among all the COVID-positive patients treated by my colleagues and myself (approximately 700 to date), very few presented with a warm-heat type of pattern. This can be explained by the fact that yin-deficient constitutions are relatively uncommon in Western populations, whereas yang-deficient constitutions largely predominate.
The first prescription focused on releasing the pathogenic factor from the surface and supporting the fluids, while preventing penetration of the pathogen into the Lungs and airways, and into the Stomach and intestines. By the time the treatment could be received and started, the pathogen had already slightly penetrated into the airways (anosmia, mild cough). Nevertheless, this prescription was able to address the marked signs of heat in the upper body. In the second prescription, therefore, the medicinals that strongly clear heat were removed, and medicinals were added to open the airways and restore Lung function. At the end of the herbal course, only a slight reduction in the sense of smell remained — to be addressed subsequently if necessary.