【7】A Case Reflection on Critical Vital Signs in a Patient in a Persistent Vegetative State: A TCM Supportive-Care Perspective

Important Notice
This article is for educational purposes only and reflects one historical Traditional Chinese Medicine case experience. It is not medical advice, diagnosis, treatment recommendation, or a guarantee of results.
A persistent vegetative state, extremely low blood pressure, extremely low heart rate, low body temperature, reduced or absent urination, generalized edema, and abdominal fluid accumulation are all serious medical conditions. They require evaluation and management by qualified medical professionals, such as hospital physicians, emergency medicine specialists, ICU teams, cardiologists, neurologists, nephrologists, palliative care teams, and other appropriate specialists.
Herbal medicine, acupuncture, or any traditional therapy should not replace emergency care, hospital monitoring, life-support decisions, vasopressor therapy, cardiac evaluation, infection control, nutritional support, kidney function assessment, or palliative care planning. This case is presented only as an educational reflection and should not be used for self-treatment or as a general treatment model.
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1. A Special Consultation for a Long-Term Vegetative-State Patient
This case involved an 86-year-old woman, the mother of a friend of mine. She had been in a persistent vegetative state and hospitalized in a major hospital for more than two years.
Her family asked whether I could offer a Traditional Chinese Medicine perspective to support her general condition. At that time, according to the family, her vital signs were extremely critical: her blood pressure was approximately 55/28 mmHg, and her heart rate was approximately 25 beats per minute.
She also had generalized edema, pitting edema in both lower limbs, abdominal fluid accumulation, and very little or even no urination. Her bowel movements occurred only once every three to five days. Her skin was cold to the touch, her body temperature was around 34°C, her skin was dry, her complexion was pale and dull, and her breathing was very weak.
From a modern medical perspective, this was an extremely high-risk condition. It could involve circulatory failure, cardiac conduction abnormality, kidney failure, infection, nutritional decline, multi-organ deterioration, or an end-of-life stage. Any involvement of TCM in such a situation must be considered only as supportive and individualized, and only within the context of appropriate medical evaluation and monitoring.
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2. TCM Pattern Observation
From a TCM perspective, the patient showed the following features:
cold skin and a lack of warmth;
low body temperature and weak breathing;
a pale, dull complexion and severe depletion of vitality;
generalized edema, abdominal fluid accumulation, and reduced urination;
a pale, slightly dusky tongue with a white and slippery coating;
a deep, slow, thin, and weak pulse.
These signs suggested an extremely depleted condition. The TCM pattern was considered to be spleen-kidney yang deficiency, severe depletion of original qi, and internal retention of fluids.
These TCM terms describe a pattern of severely weakened warming, moving, transforming, and fluid-metabolism functions. They do not correspond to one single modern medical diagnosis.
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3. Treatment Principle and Herbal Strategy
The treatment principle was to warm yang, support vital qi, strengthen the root, and assist fluid transformation.
The formula strategy was based on a modified combination of Zhen Wu Tang and Shen Fu Tang. The herbal direction included:
warming yang and supporting the body’s vital function;
tonifying qi and strengthening the constitutional foundation;
assisting transformation and movement of retained fluids;
supporting circulation according to TCM pattern principles.
The herbs used included Fu Zi, Hong Shen, Gui Zhi, Bai Shao, Fu Ling, Sheng Jiang, Bai Zhu, Huang Qi, Dan Shen, Chuan Xiong, and Zhi Gan Cao. Because the patient could not take herbs by mouth, the decoction was administered through a feeding tube under the circumstances of her ongoing care.
It is important to emphasize that this is not a “life-saving formula” for public use. Herbs such as Fu Zi and ginseng are strong and may carry significant risks if used improperly, especially in patients with abnormal heart rate, abnormal blood pressure, kidney dysfunction, complex medication regimens, or critical illness. Such formulas require professional assessment, individualized pattern differentiation, and careful monitoring.
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4. Clinical Observation
After the herbal treatment was started, the family reported changes in several observed indicators, including blood pressure, heart rate, urination, and edema. The patient remained alive for a further period under continued care and observation.
From a case-reflection perspective, this suggested that the TCM approach of warming yang, supporting vital qi, and assisting fluid transformation may have had supportive observational value in this particular patient’s presentation.
However, this was a single case observation. It does not prove that any herbal formula can prolong life in patients in a vegetative state, nor should it be interpreted as a general treatment recommendation. The course of a critically ill patient can be influenced by many factors, including the underlying disease, organ function, infection status, nutritional support, nursing care, medical treatment, and the natural course of illness.
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5. Clinical Reflection
This case reminded me that TCM often evaluates critically depleted patients by asking several pattern-based questions:
Is yang qi still able to warm and support the body?
Is the transforming function of qi severely weakened?
Is fluid accumulating because the body lacks the strength to move and transform it?
Are coldness, weak pulse, low vitality, edema, and reduced urination part of the same underlying pattern?
In TCM theory, yang qi is not only related to warmth. It is also associated with the movement of blood, transformation of fluids, and maintenance of organ function. When yang qi is severely depleted, signs such as cold limbs, low body temperature, weak breathing, slow and weak pulse, edema, and reduced urination may appear.
However, in modern clinical practice, TCM should not be used alone for critical conditions such as persistent vegetative state, extremely low blood pressure, extremely low heart rate, low body temperature, or absent urination. A more appropriate role is individualized supportive care, provided only with adequate medical evaluation, informed consent, risk discussion, and ongoing monitoring.
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6. Ethical Considerations and Family Decision-Making
Long-term care for a patient in a vegetative state is not only a medical issue. It also involves ethics, family communication, quality of life, prognosis, palliative care, and the patient’s own values and wishes.
Families facing similar situations should communicate carefully with the hospital team, nursing team, ethics committee, or palliative care professionals. They should understand the patient’s prognosis, goals of care, comfort-care options, and the potential benefits and burdens of continued interventions.
Any treatment decision should be centered on the patient’s best interest, dignity, and comfort, rather than only short-term changes in vital signs.
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Disclaimer
This article is for educational and informational purposes only. It describes an individual clinical experience and does not guarantee similar results for others. It is not intended to diagnose, treat, cure, or prevent any disease. Extremely low blood pressure, extremely low heart rate, low body temperature, persistent vegetative state, reduced urination, or absent urination are serious medical conditions that require immediate evaluation by qualified healthcare professionals. Herbal formulas should be used only under the guidance of a qualified practitioner with appropriate assessment and monitoring.