doi: 10.

12032/psmr2020-0620-025 CASE REPORT

The physical and mental adjustment of recovered patients affected by

COVID-19: a report of 3 cases

Bao-Cai Chen1

1
Medical Department of Cangzhou Medical College, Cangzhou, 061000, China.

*Corresponding to: Bao-Cai Chen, E-mail:649184513@qq.com.

Highlights

Posttraumatic stress disorder among COVID-19 survivors should be should be enough attention. Traditional
Chinese medicine has advantages on adjusting mental health.

60 Submit a manuscript: https://www.tmrjournals.com/psmr

CASE REPORT doi: 10.12032/psmr2020-0620-025

Abstract
The coronavirus coronavirus disease 2019 (COVID-19) outbreak a pandemic. As of 18 June 2020, more than
8,406,660 cases were confirmed, 451,429 deaths and more than 4,417,386 recovered around the world. Here we
report the three recovered patients affected by COVID-19 received traditional Chinese medicine treatments to
stabilize mood, adjust the status both in body and mind, as well as improve the quality of life. This report calls for
attention to early intervention and prevention of posttraumatic stress disorder among COVID-19 survivors.
Traditional Chinese medicine has advantages on adjusting mental health.
Keywords: COVID-19, Posttraumatic stress disorder, Mental health, Traditional Chinese medicine

Abbreviations:
PTSD, Posttraumatic stress disorder; TCM, Traditional Chinese medicine; CHM, Chinese herbal medicine.
COVID-19, Coronavirus coronavirus disease 2019.
Competing interests:
There are no conflicts of interest.
Citation:
Bao-Cai Chen. The physical and mental adjustment of recovered patients affected by COVID-19: a report of 3
cases. Psychosomatic Medicine Research 2020, 2(2): 60-65.
Executive Editor: Cui-Hong Zhu.
Submitted: 22 May 2020, Accepted: 15 June 2020, Online: 19 June 2020.

Submit a manuscript: https://www.tmrjournals.com/psmr 61

doi: 10.12032/psmr2020-0620-025
Background
The coronavirus coronavirus disease 2019 (COVID-19)
has become a worldwide pandemic, which is affecting
213 countries and territories around the world and 2
international conveyances. As of 18 June 2020, more
than 8,406,660 cases were confirmed, 451,429 deaths
and more than 4,417,386 recovered around the world
[1]. According to previous epidemic studies, the
prevalence rates of posttraumatic stress disorder
(PTSD) among people exposed to the trauma resulted
from an infectious disease epidemic are very high. It
was reported that PTSD was the most prevalent
long-term psychiatric condition among SARS
survivors [2]. Even after 2 years, the cumulative
proportion of survivors of acute respiratory distress
syndrome patients with PTSD was 22%-24% [3, 4].
Experiencing the suffering related to COVID-19 may
result in high prevalence of PTSD. PTSD is a mental
disorder leading to serious distress and disability
among survivors. If the psychological stress response
exceeds people's psychological tolerance limit,
psychological problems will occur, resulting in
psychological symptoms and / or somatization
symptoms. The symptoms of somatization are varied,
such as dizziness, numbness, nausea, chest distress and
shortness of breath. However, there is no
corresponding abnormal finding in medical
examination.
According to some patients' feedback information,
recovered patients affected by COVID-19 still had
symptoms of shortness of breath and fatigue after one
month of discharge. In addition to obvious asthenia
and shortness of breath, severe patients also had night
sweat, chills, bad wind, loose stools, throat discomfort
and other symptoms. Besides, all patients with
feedback information had insomnia, dreaminess and
anxiety of different degrees. Particularly when some
patients were reexamined regularly after discharge, it
was found that pulmonary fibrosis and pulmonary
dysfunction existed in different degrees, which was a
heavy blow to the body and mind of the patients.
Therefore, survivors of COVID-19 need to be
physically and mentally conditioned. The present
report described three cases who received Chinese
traditional medicine treatments to stabilize mood,
adjust the status both in body and mind, as well as
improve the quality of life.
Case report
Case 1 is a 42-year-old male. He is a survivor of
COVID-19. He fully recovered before two weeks. on
April 3, 2020, he first sought traditional Chinese
medicine (TCM) treatment in our hospital because he
felt, fatigue, stomach bloated, wake up early, night
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CASE REPORT
sweating, obvious spontaneous sweating after daytime
activities, throat irritation, loose stool. The tongue was
dark red and the tongue coating was white and greasy
(Figure 1A). There was crackle on tongue. He received
Chinese herbal medicine (CHM) treatment,
composition of which are as follows: Chai Hu (Radix
Bupleuri) 10g, Xiang Fu (Rhizoma Cyperi) 10g, Yu Jin
(Rhizoma Cyperi) 10g, Dan Shen (Radix Salviae
Miltiorrhizae) 15g ， Fu Ling (Poria) 15g, Shan Yao
(Rhizoma Dioscoreae) 15g, Qing Ban Xia (Rhizoma
Pinelliae Preparata ) 9g ， Hou Pu (Cortex Magnoliae
Officinalis) 10g， Zi Su Geng (perilla stem) 10g, Di Yu
(Radix Sanguisorbae) 15g ， Lizhi He (Semen Litchi)
20g，Dang Shen (Radix Codonopsis) 15g，Mu Hu Die
(Semen Oroxyli) 10g ， Jie Geng (Radix Platycodonis)
6g， Bai He (Bulbus Lilii )30g，Fu Xiao Mai (Fructus
Tritici Levis) 30g ， Ji Nei Jin (Endothelium Corneum
Gigeriae Galli) 12g，Gan Cao (Radix Glycyrrhizae) 6g.
Patient dissolved the herbal granul in boiled water
according to instructions. The herbal granulas were
taken orally 3 times a day, 30 minutes after meals. This
patient received a TCM monotherapy for 7 days, with
no other drug used during this period. He took
cordyceps preparation after discharge. I advised him to
stop taking cordyceps preparation.
On April 10, 2020, the patient second visited to the
hospital. The patient reported no night sweating and
physical strength and sleep slightly improved. But he
still felt stomach bloated, throat irritation, loose stool.
Tongue fur got better. The second CHM composition
are as follows: Chai Hu (Radix Bupleuri) 10g, Xiang
Fu (Rhizoma Cyperi) 10g, Yu Jin (Rhizoma Cyperi)
10g, Dan Shen (Radix Salviae Miltiorrhizae) 15g ， Fu
Ling (Poria) 15g, Shan Yao (Rhizoma Dioscoreae) 15g,
Qing Ban Xia (Rhizoma Pinelliae Preparata ) 9g，Hou
Pu (Cortex Magnoliae Officinalis) 10g ， Zi Su Geng
(perilla stem) 10g, Di Yu (Radix Sanguisorbae) 15g ，
Lizhi He (Semen Litchi) 20g, Dang Shen (Radix
Codonopsis) 12g ， Mu Hu Die (Semen Oroxyli) 10g ，
Bai He (Bulbus Lilii )30g, Fu Xiao Mai (Fructus Tritici
Levis) 15g ， Gan Cao (Radix Glycyrrhizae) 6g. Yu Zu
(Rhizoma Polygonati Odorati) 10g，Zhi Qiao (Fructus
Aurantii) 6g. Continuous took 7 days.
On April 18, 2020, The patient occasionally felt
throat irritation, dizzy and loose stool, without other
symptoms. Tongue fur disappeared. The patient
received a third treatment. CHM composition are as
follows: Chai Hu (Radix Bupleuri) 10g, Xiang Fu
(Rhizoma Cyperi) 10g, Dan Shen (Radix Salviae
Miltiorrhizae) 15g ， Fu Ling (Poria) 15g, Shan Yao
(Rhizoma Dioscoreae) 15g, Qing Ban Xia (Rhizoma
Pinelliae Preparata ) 6g ， Hou Pu (Cortex Magnoliae
Officinalis) 10g， Zi Su Geng (perilla stem) 10g, Di Yu
(Radix Sanguisorbae) 10g ， Lizhi He (Semen Litchi)
20g， Dang Shen (Radix Codonopsis) 15g, Mu Hu Die
(Semen Oroxyli) 10g，Bai He (Bulbus Lilii ) 15g，Gan
Cao (Radix Glycyrrhizae) 6g, Tian Ma (Rhizoma
Gastrodiae) 10g. Continuous took 28 days. All kinds
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CASE REPORT
of discomfort gradually disappeared. During the period,
the patient returned to the hospital for reexamination.
There was fibrosis in the lung and low pulmonary
function.
Case 2 is a 33-year-old female, a survivor of
COVID-19. On April 4, 2020, she visited our hospital
first due to fatigue, palpitation, stomach bloated,
belching, acid regurgitation, night sweating, throat
irritation accompanied by hands and feet edema and
loose stool. The tongue was light red and fat with tooth
prints. The tongue coating was white and thin (Figure
1B). He received CHM treatment. CHM composition
are as follows: Chai Hu (Radix Bupleuri) 10g, Xiang
Fu (Rhizoma Cyperi) 10g, He Huan Pi (Cortex
Albiziae) 15g, Ye Jiao Teng (tuber fleeceflower stem)
15g ， Di Gu Pi (Cortex Lycii) 15g, Dan Shen (Radix
Salviae Miltiorrhizae) 15g, Fu Ling (Poria) 15g, Shan
Yao (Rhizoma Dioscoreae) 15g, Che Qian Zi (Semen
Plantaginis) 15g ， Long Gu (Os Draconis) 10g, Mu Li
(Concha Ostreae) 10g, Xuan Shen (Radix
Scrophulariae) 10g, Dang Shen (Radix Codonopsis)
10g, Gui Zhi (Ramulus Cinnamomi) 10g, Bai Zhu
(Rhizoma Atractylodis Macrocephalae) 10g, Bai Shao
(Radix Paeoniae Alba) 15g, Ji Nei Jin (Endothelium
Corneum Gigeriae Galli) 10, Gan Cao (Radix
Glycyrrhizae) 6g. Continuous took 28 days.
When she second visited, the patient reported she
felt weak, palpitation, belching, acid regurgitation,
burning sensation in throat accompanied by shortness
of breath and loose stool, anaemia. The tongue was
light red and fat. CHM composition are as follows:
Chai Hu (Radix Bupleuri) 10g, Xiang Fu (Rhizoma
Cyperi) 10g, Dan Shen (Radix Salviae Miltiorrhizae)
15g ， Fu Ling (Poria) 15g, Shan Yao (Rhizoma
Dioscoreae) 15g, Long Gu (Os Draconis) 10g ， Mu Li
(Concha Ostreae) 10g，Dang Shen (Radix Codonopsis)
10g, Huang Jing (Rhizoma Polygonati) 15g, Dang Gui
(Radix Angelicae Sinensis) 10g, Ji Xue Teng (Caulis
Spatholobi) 15g, Hai Piao Shao (Os Sepiellae seu
Sepiae)12g ， Wu Yao (Radix Linderae) 12g ， Bai He
(Bulbus Lilii) 30g ， Ji Nei Jin (Endothelium Corneum
Gigeriae Galli) 15g，Gan Cao (Radix Glycyrrhizae) 6g.
Continuous take 28 days. She was advised not eat too
much food.
B C
A
Figure 1 Tongue image
A: tongue image of case 1, B: tongue image of case 2, C:tongue image of case 3
Submit a manuscript: https://www.tmrjournals.com/psmr
doi: 10.12032/psmr2020-0620-025
When her third visit, the patient reported belching
was much less than before. But she steel felt obvious
shortness of breath, Occasionally tight throat, dry
throat. CHM composition are as follows: Chai Hu
(Radix Bupleuri) 10g, Xiang Fu (Rhizoma Cyperi) 10g,
Dan Shen (Radix Salviae Miltiorrhizae) 10g ， Fu Ling
(Poria) 15g, Shan Yao (Rhizoma Dioscoreae) 15g,
Dang Shen (Radix Codonopsis) 10g, He Huan Pi
(Cortex Albiziae) 15g，Bai He (Bulbus Lilii) 15g，Che
Qian Zi (Semen Plantaginis) 15g ， Bai Zhu (Rhizoma
Atractylodis Macrocephalae) 15g ， Long Yan Rou
(Arillus Longan)10g ， Gui Zhi (Ramulus Cinnamomi)
30g， Yu Zhu (Rhizoma Polygonati Odorati) 15g， Sha
Ren (Fructus Amomi Villosi) 3g, Gan Cao (Radix
Glycyrrhizae) 6g. After two months of treatment, all
kinds of discomfort disappeared gradually, but the
physical strength was not as good as before.
Case 3 is a 45-year-old female. Patient with
COVID-19 was cured. On April 5, 2020, the patient
reported she had poor quality of sleep and dreaminess
with heartburn and weak, feverish feeling in palms and
soles, lower limbs edema. The blood sample displayed
anaemia. The tongue was red and the tongue coating
was thin (Figure 1C). He received CHM treatment.
CHM composition are as follows: Chai Hu (Radix
Bupleuri) 10g, Xiang Fu (Rhizoma Cyperi) 10g, Yu Jin
(Rhizoma Cyperi) 10g, Fu Ling (Poria) 15g, , Long Gu
(Os Draconis) 15g，Mu Li (Concha Ostreae) 15g， He
Huan Pi (Cortex Albiziae) 15g ， Ye Jiao Teng (tuber
fleeceflower stem) 30, Huang Jing (Rhizoma
Polygonati) 15g, Su Geng (perilla stem) 10g, Dang
Shen (Radix Codonopsis) 12g, Dang Gui (Radix
Angelicae Sinensis) 10g， Shou Di (Radix Rehmanniae
Preparata) 15g ， Chuan Xiong (Rhizoma Ligustici
Chuanxiong) 10g ， Bai Zhu (Rhizoma Atractylodis
Macrocephalae) 10g，Bai Shao (Radix Paeoniae Alba)
15g, Hai Piao Shao (Os Sepiellae seu Sepiae) 10g ，
Gan Cao (Radix Glycyrrhizae) 6g. This patient
received the above CHM for 7 days.
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doi: 10.12032/psmr2020-0620-025
When her second visit, the patient reported
heartburn symptom reduced, occasionally swelling of
lower limbs, still dreaminess, Sweating easily after
daytime activities. The tongue was red and tongue
coating was thin. CHM composition are as follows:
Chai Hu (Radix Bupleuri) 10g, Xiang Fu (Rhizoma
Cyperi) 10g, Yu Jin (Rhizoma Cyperi) 10g, Fu Ling
(Poria) 15g, Long Gu (Os Draconis) 15g ， Mu Li
(Concha Ostreae) 30g ， He Huan Pi (Cortex Albiziae)
15g，Ye Jiao Teng (tuber fleeceflower stem) 30g，Zhen
Zhu Mu (Concha Margaritifera)30g，Dan Shen (Radix
Salviae Miltiorrhizae) 15g, Bai He (Bulbus Lilii) 30g，
Di Huang (Radix Rehmanniae Recens) 3g ， Fu Xiao
Mai (Fructus Tritici Levis) 30g ， Dang Gui (Radix
Angelicae Sinensis) 10g ， Ji Nei Jin (Endothelium
Corneum Gigeriae Galli) 10g, Gan Cao (Radix
Glycyrrhizae) 6g. Above CHM was taken for 7 days.
When her third visit, the patient still felt weak and
sweating easily, heartburn symptom reduced,
occasionally swelling of lower limbs, still dreaminess,
sweating easily after daytime activities. The tongue
was red and tongue coating was thin. She was
diagnosed with pulmonary fibrosis by the clinical
reexamination. Chai Hu (Radix Bupleuri) 10g, Xiang
Fu (Rhizoma Cyperi) 10g, Yu Jin (Rhizoma Cyperi)
10g, Dan Shen (Radix Salviae Miltiorrhizae) 15g， Bai
He (Bulbus Lilii) 30g ， Di Huang (Radix Rehmanniae
Recens) 20g ， Bei Sha Shen (Radix Glehniae) 15g ，
Dang Shen (Radix Codonopsis) 10g, Mai Dong (Radix
Ophiopogonis) 10g ， Wu Wei Zi (Fructus Schisandrae
Chinensis) 6g，Shan Yao (Rhizoma Dioscoreae) 15g，
Fu Ling (Poria) 10g, Ji Nei Jin (Endothelium Corneum
Gigeriae Galli) 10g, Gan Cao (Radix Glycyrrhizae) 6g.
Above CHM was taken for 7 days.
When her fourth visit, physical strength improved
and sweating reduced. The patient still felt feverish
feeling in palms and soles, dreaminess. The tongue
was red and tongue coating was thin. Chai Hu (Radix
Bupleuri) 10g, Xiang Fu (Rhizoma Cyperi) 10g, Yu Jin
(Rhizoma Cyperi) 10g, Dan Shen (Radix Salviae
Miltiorrhizae) 15g, Bai He (Bulbus Lilii) 30g, Di
Huang (Radix Rehmanniae Recens) 30g, Bai Shao
(Radix Paeoniae Alba) 15g, Zhi Shi (Fructus Aurantii
Immaturus) 10g, Long Gu (Os Draconis) 15g, Mu Li
(Concha Ostreae) 30g, He Huan Pi (Cortex Albiziae)
15g, Ye Jiao Teng (tuber fleeceflower stem) 15g, Di Gu
Pi (Cortex Lycii) 15g, Chu Shi Zi (Fructus
Broussonetiae) 15g, Ji Nei Jin (Endothelium Corneum
Gigeriae Galli) 10g, Gan Cao (Radix Glycyrrhizae) 6g.
All kinds of symptoms disappeared after taking above
CHM for more than one month.
Discussion
Although some patients affected by COVID-19 have
been cured and already walked out of the hospital, this
does not mean that the treatment is at the end. The
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CASE REPORT
modern research thinks that the negative emotion
stimulation degree is too deep or the time is too long, it
may cause the human body's neuroendocrine immune
function disorder, the material and energy metabolism
abnormality. It often induces and aggravates anxiety,
hypochondriac, obsessive-compulsive disorder,
depression, somatization disorder and PTSD.
Experiencing the suffering related to COVID-19 may
result in high prevalence of PTSD. Their psychological
impact is difficult to recover in the short term.
In traditional Chinese medicine, we believe that the
heart and the body are closely connected. Joy, anger,
worry, thinking, sorrow, fear and shock are the
emotional responses of the internal organs and Qi to
the external environment, which are called seven
emotions. Traditional Chinese medicine focuses on
soothing liver depression, nourishing lung Yin,
clearing heart, removing troubles and calming nerves,
and never warming and tonifying for emotional illness.
Tonics is not recommended. In Case 1, I found that
after taking cordyceps preparation, the symptoms of
night sweat and fidgety became worse, and asked him
to stop taking cordyceps preparation, the symptoms
decreased.
Shutiao Qiji decoction established by Zhang Zhen, a
master of Chinese medicine, is a proven recipe of
relieving Qi stagnancy in Liver. It has the functions of
soothing the liver and regulating Qi, tonifying the
spleen and kidney, promoting blood circulation. The
composition of Shutiao Qiji decoction are as follows:
Chai Hu (Radix Bupleuri) 10g, Xiang Fu (Rhizoma
Cyperi) 10g, Yu Jin (Rhizoma Cyperi) 10g, Dan Shen
(Radix Salviae Miltiorrhizae) 10g, Zhi Shi (Fructus
Aurantii Immaturus) 10g, Bai Shao (Radix Paeoniae
Alba) 12g, Chuan Xiong (Rhizoma Ligustici
Chuanxiong) 10g, Bai Zhu (Rhizoma Atractylodis
Macrocephalae) 10g, Fu Ling (Poria) 15g, Shan Yao
(Rhizoma Dioscoreae) 20g, Xian Ling Pi (HERBA
EPIMEDII ) 15g, Bo He (Herba Menthae) 6g, Gan
Cao (Radix Glycyrrhizae) 6g. Zhi Shi (Fructus
Aurantii Immaturus) has the function of improving
gastrointestinal contraction. Dan Shen (Radix Salviae
Miltiorrhizae) has a certain protective effect on gastric
mucosa, and Yu Jin (Rhizoma Cyperi) has the function
of protecting liver and promoting gall. Xiang Fu
(Rhizoma Cyperi) has weak estrogen effect. Gan Cao
(Radix Glycyrrhizae) has adrenocorticotropic hormone
effect in large dosage. Bai Shao (Radix Paeoniae Alba),
Fu Ling (Poria), Chai Hu (Radix Bupleuri) and Zhi Shi
(Fructus Aurantii Immaturus) have sedative effect. The
treatment of the three patients is based on Shutiao Qiji
decoction, modification according to symptoms. The
symptoms of insomnia, dreaminess and night sweat
gradually disappeared and physical strength slowly
recovered.
In the process of communication with patients,
patients have obvious anxiety. Some of the symptoms
described by patients belong to typical self-conscious
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CASE REPORT doi: 10.12032/psmr2020-0620-025
symptoms. Therefore, in addition to traditional
Chinese medicine conditioning, try to use language to
comfort patients, desalinate the severity of the disease,
and enhance patients' confidence in comprehensive
recovery. In addition, the patients are advised to take
appropriate activities during the day, and can practice
Qigong, Baduanjin, Taijiquan, etc. and listen to
Chinese classical music before going to bed, which is
helpful to improve sleep quality. Three meals should
be light and nutritious. After the outbreak, some
patients' relationships with friends and neighbors were
destroyed, and their inner shocks were hard to recover
in a short time. The patient was advised to look at it
correctly, think it in a new way, and take time to clear
up the gap.

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3. Sheehy LM. Considerations for Postacute
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4. Herridge MS, Moss M, Hough CL, et al.
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