This month’s installment features an intriguing case study highlighting the complex interplay between recovery from respiratory illness and the role patient emotions play in delayed recovery.
It is not a surprise when I encounter lingering cough post-viral infection in the clinic. The majority of patients commonly treat viral infections with fever-reducing over-the-counter remedies, which allow the pathogens to penetrate deeper into the body, often remaining active for weeks to months. Combined with the use of over-the-counter cough suppressants, which repress cough, yet do not clear the pathogen, the acute viral infection can turn into a recalcitrant, long-term health challenge.
When this situation is colored by chronic stress and anxiety, the recovery becomes delayed further. The following case reflects such a scenario.
Patient Presentation
“I don’t know if I’m depressed because of this nagging cough, or if I’m coughing because I’m depressed.”
My patient expressed the above in the initial stages of his examination. I found it an incredibly insightful expression, reminding me of one of my favorite quotes: “Listen to your patient. He or She is telling you the diagnosis,” by William Osler. Outside of the patient’s chief complaint of chronic cough, he also expressed his frustration with being “sick with COVID and all the drama that goes along with this.” He expressed that he was experiencing mild depression, as his chronic cough made him feel “paranoid that others will think I’m sick with COVID.” He also expressed “constant paranoia about being sick.”
His initial contraction was mild, with low-grade fever and chills for one day and then mild fatigue. After a week, all his initial symptoms cleared and a mild cough became the main concern. His primary treatment modalities had been rest, hydration, and an over-the-counter pain reliever.
My patient’s cough was lingering for two weeks post-covid and his primary care physician cleared him of any serious cardiopulmonary issues. The cough was dry and not painful; tongue was extremely red and dry with significant cracks; pulse was thready and fast. Overall, digestion and energy were unaffected; however, in his words, “Now the depression seems to be worse than my cough.”
TCM Diagnosis
Taking into account the key phrases the patient expressed concerning his emotions, I instantly thought of the Chinese medical concept of “Lily syndrome” first mentioned in the important medical classic, Synopsis of the Golden Chamber, by Zhang Zhongjing.
The concept of “Lily syndrome” is complex, but fundamentally the syndrome centers upon heat within the heart / lungs resulting from yin deficiency; with the etiological factors being both internal and external damage. In such nuanced conditions, it can often be quite challenging to determine what came first, the internal or the external disorder; often they occur concomitantly. In this particular patient, he clearly expressed anxiety and frustration prior to contracting a viral infection, with constant worry and anxiety concerning “being sick.”
Herbal Formulation
The patient clearly showed signed of significant yin deficiency and potential liver qi stagnation, yet was optimistic about recovery and was seeking help. The tongue and pulse clearly leaned toward yin deficiency of the lungs and heart, and his subjective symptoms leaned toward liver depression. I created a formula with the following herbs as a tea based upon the formula “Lily Bulb and Rehmannia Decoction” created for “Lily Syndrome”: bai he, sheng di huang, wu wei zi, chen pi, and da zao.
This was administered as a simple decoction, with the focus being nurturing yin, clearing heat, gently coursing the qi, and astringing the qi. Bai He is cool, sweet, moistens the lungs, stops cough, and clears heat. Sheng di huang is sweet, bitter, generates fluids, moistens yin, and clears heat. Chen pi gently courses the qi, while wu wei zi expresses all five flavors, astringes the qi, and enters the liver meridian. Da zao is sweet and nourishes the spleen without being cloying.
The tea was dosed at two cups daily and ingredient dosages were subtly modified based on pulse and the patient’s subjective expression.
Outcome / Discussion
After one week on the tea, the patient expressed a more relaxed mood and improved sleep, stating, “I did not realize I was not sleeping well, but sleep is much deeper now.” The cough had also lessened. After two weeks on the tea, the cough had completely resolved and the patient’s mood was dramatically improved.
We continued the tea for a final week, after which all symptoms had improved and cough was nonexistent. The patient also expressed, “I feel much less scared of being sick now.”
This case is a beautiful example of how formulas from classic texts can effectively treat modern conditions. It is particularly important to always consider the emotional state of the patient in every condition, even acute ones. This is expressed succinctly in a 2020 article titled, “Insights From the Perspective of Traditional Chinese Medicine to Elucidate Association of Lily Disease and Yin Deficiency and Internal Heat from Depression”:1
“Covid-19 patient medical therapy should be paid not only to the treatment of pneumonia itself but also to the psychological state of patients. The patients’ mood changes will affect the treatment and prognosis of disease. So, it is necessary to carry out psychological intervention and drug therapy for emotional diseases. In addition, Covid-19 patients still have different psychological problems after recovery and discharge from hospital, and follow-up and psychological intervention after discharge is still an urgent task.”
Reference
- Shang B, et al. Insights from the perspective of traditional Chinese medicine to elucidate association of Lily disease and yin deficiency and internal heat from depression. Evid-Based Compl Alt Med, Volume 2020:Article 8899079.
