A Case of Covid-19 Presenting with Chest Oppression and Irregular Blood Sugar

Mrs. M. is 65 year-old Middle Eastern Baker living in New Jersey. She was referred to me on 2/2/21 for a telemedicine consult for symptoms related to a recently confirmed Covid infection.

Initial Consultation • February 3, 2021

Mrs. M appeared petite and pale in our video consultation on 2/3/21. She reported a suspected exposure to the virus on 1/6/21 after a visit to the dentist. Initially, her PCR test was negative, but 10 days later she woke with strong chills, fatigue and a headache believing it was a head cold. As symptoms worsened, she re-tested positive one week later.

At the time of our consultation, approximately one month post exposure and 2 1/2 weeks after initial symptoms, she reported the following: Mild feverishness, chills mostly resolved, chest oppression, “whole body aches from the head down”, loss of smell and taste, and no appetite. This last symptom was of great concern as she is a Diabetic, typically well managed by Metformin (Glucophage), but was waking with elevated blood glucose around 183 which surged to 223 the prior evening (less than 140 mg/dL is normal). She reported having a brief phone consult with her physician who suggested she go to the ER if this did not stabilize soon. Other current complaints included mild nausea, sinus congestion, thirst with a dry mouth, less frequent urine, and though she had earlier in the infection suffered diarrhea, she was more gassy with less bowel movements she believes because she is really not eating now. She is constantly sleeping and exhausted, with the slightest exertion making her body feel even more achy heavy and tired. She denied cough, shortness of breath, dizziness, palpitations and any unusual sweating.

Upon observation, her tongue appeared dark with a very thick white gray coat, but we were limited to observation over the video call, and consequently have no other objective signs.

Mrs. M’s pattern had some exterior symptoms with the achy body and mild feverishness, but appeared to be affecting fluid metabolism in all three burners on the interior as well, primarily in the middle. Due to her thick tongue coat, heavy achy body, poor appetite, gas, bloat and nausea the dampness was impairing movement through the middle Spleen-Stomach pivot with retained turbid damp-phlegm in the upper causing sinus congestion, loss of smell and taste, and chest oppression, but she did not have much Upper Burner reversal cough as seen in many Covid presentations. Poor fluid transformation through the lower burner resulted in scant urine and less bowel movements which had earlier been diarrhea. Though she had thirst, it appeared more from the damp-phlegm obstructing body fluids which are unable to moisten and nourish the mouth, rather than heat as her tongue was thickly coated, but not yellow, her feverishness was mild, and there were few other heat signs other than these from accumulation of damp. The impairment in the middle and little food intake made it difficult to create enough Qi to sustain her energy and until this was opened, she would be at increasing risk for her blood sugar to continue worsening upward and a potential emergency situation arising.

In order to get her herbs as soon as possible, we agreed her husband would drive to pick up a granular formula that same day but that if her blood sugar did not stabilize within a day of starting, she should follow the advice of her MD and go to the nearest emergency room, sooner if she felt worse.

Diagnosis

My diagnosis was a Three Yang Tai Yin pattern, focusing on the Shao Yang and Tai Yin.

Many of the Covid patterns I have seen over the last year do not seem to stay long if at all on the Exterior and often present in the Shao Yang. Due to her poor appetite, chest oppression, dry mouth, inhibited urine and bowels, mild fever, aches and poor energy, I chose to start with the Shang Han Lun classic formula, Xiao Chai Hu Tang (Lesser Bupleurum Decoction), to harmonize and strengthen the center, nourish body fluids and clear mild heat, but had some urgent concern about her blood sugar so made the decision to dispense this without the usual Zhi Gan Cao (honey fried Glycyrrhizae Radix) and Da Zao (Jujube Zizyphus Fructus) due to their excess sweetness. However, she had so much blocked fluid transformation in all 3 burners that I added San Ren Tang (Three Nut Decoction), classically used for early stage damp warmth in the Wei and Qi levels from the Wen Bing Xue. Her symptoms of body aches and heaviness with generalized pain, chest oppression, loss of appetite, extreme fatigue, and inhibited urine and bowels along with the thickly coated tongue demonstrated that her Clear Yang was unable to rise and turbid not descend due to fluid accumulation and blockage in all three burners. I chose to only mildly drain from the lower and left out Hua Shi (Talcum) as the patient was weak and I was concerned about draining her excessively. I also added two modifications: Lu Gen (Phragmitis Rhizome) to reduce nausea and generate normal jin-ye body fluids without being too sticky, and help drain tan-yin turbid damp via urination; and also Tao Ren (Persica Semen) to assist in the opening of the upper and lower, and move blood to assist with damp elimination via bowels and open the chest with Xing Ren (Armeniaca Semen). Her tongue looked quite dark and I was concerned that static blood would become a quick complication if she didn’t improve soon which is an issue with both diabetics as well as covid patients.

Treatment Principles

Harmonize the center, Rectify the Sp-St pivot, Resolve Dampness in the 3 Burners by Opening the Lower, Arouse the Appetite, Mildly Generate Fluid and Move Blood

Prescription: Xiao chai hu tang + San Ren Tang Jia JIan

The patient was instructed to contact me if there was any issue tolerating the herbs immediately and, at the latest, by the next day to confirm her blood sugar was more stable and if not, that she would go to the emergency room.

Outcome

I was delighted to hear from Mrs. M early the next day reporting that she “loved” the herbs and that she felt she was “coming back to life” after a few doses. Her elimination and appetite seemed to be improving and blood sugar stabilizing fairly quickly. Although there could have been many other approaches to treating this patient, I’m pleased that the right formula at the right time made such a remarkable difference for her as it could have gone in a very different less positive direction very quickly.

My approach was to restore her Shao Yang pivot to help the Middle transform pathological damp accumulation. Her body aches and chest oppression improved as did her appetite so her blood sugar was more stable and she wrote to say she felt like she was “coming back to life” again after a few days of the herbal formula.