Successful treatment of an older patient with COVID‐19 pneumonia using herbal medicine—especially saikanto

New antiviral drugs for COVID-19 have been launched with special approval. However, as there may be a shortage of drugs in the future, it may be difficult to provide appropriate medical intervention. Herein, we describe our experience of successfully treating COVID-19 pneumonia in an older patient using a Japanese herbal medicine without new antiviral drugs. A 94-year-old woman was diagnosed with COVID-19 and received home care. However, dyspnea appeared on day 4 of home treatment, so she visited the emergency department of our hospital. Her SpO2 then increased to 97% after oxygen delivery at a rate of 7 L/min via a mask. On physical examination, the patient presented with tachypnea (24 breaths per minute) and stable hemodynamics. Her blood pressure, heart rate, and body temperature were 104/65 mm Hg, 68 beats/min, and 37.5 C respectively. She had clear consciousness. Her height and body weight were 146 cm and 47 kg respectively. Laboratory test results are presented in Table 1. Computed tomography (CT) scan revealed infiltrates in the bilateral lower lungs with ground-glass signs. The qSOFA was one point and sepsis was not actively suspected, but the A-DROP was three points and the patient was indicated for hospitalization for severe pneumonia. Given her history of hypertension and stroke, she usually spent most of her time lying in bed, except for eating and defecating. Aspiration was not confirmed during home care. CT imaging showed mainly a groundglass appearance rather than an infiltrating shadow, so aspiration pneumonia was not actively suspected. Based on the course and CT imaging, typical bacterial pneumonia was not actively suspected and the use of antibiotics was withheld. Her respiration was stabilized with oxygen therapy; however, she was frail and old, and neither she nor her family wanted active treatment. As she could drink water, a Japanese herbal treatment for pneumonia was initiated. Her Kampo medical findings indicated that she had a deficiency. She complained of bitterness in her mouth and chest pain when coughing. Her pulse was weak