Chinese medicine: from rural hospitals to top three hospitals in Kyoto

"Dr. Zhuang, please." Qiu Yimin looked at Zhuang Qiwen with a scrutinizing gaze.

Qiu Yimin didn't have much affection for this village doctor who was promoted "exceptionally" thanks to Chen Yang and who was said to prescribe "reckless" medication.

All eyes immediately focused on Zhuang Qiwen.

Xiao Jingyun also looked up, wanting to see what abilities this person, whom Chen Yang valued so highly, possessed.

Zhuang Qiwen stood up, his expression calm and his gaze focused, as if he were in his humble clinic, facing his patients.

After a moment's hesitation, Zhuang Qiwen spoke slowly, his voice not loud, but clearly reaching everyone's ears:

"This condition is not simply fever due to yin deficiency. Observing the symptoms, there is a persistent low-grade fever that worsens in the afternoon, hot palms and soles, irritability and insomnia, dry mouth without thirst, red tongue with little coating, and a thready and rapid pulse... It seems to be a complete picture of yin deficiency and excessive fire. But the key is—'dry mouth without thirst'!"

After a pause, Zhuang Qiwen emphasized, "If it were purely a deficiency of Yin and body fluids, one would naturally experience a dry mouth and thirst. This patient's lack of thirst indicates that it is not simply a deficiency of body fluids, but rather that there are pathological products such as dampness or blood stasis obstructing the flow of body fluids, leading to abnormal distribution and an inability to reach the mouth. Furthermore, the ineffectiveness of conventional methods to clear heat and nourish Yin further corroborates this point."

This analysis was like clearing away the clouds to reveal the sun, making many contestants who were stuck in a fixed mindset suddenly realize the truth!

"Therefore, its core pathogenesis should be yin deficiency with dampness, which stagnates and transforms into heat. Dampness is sticky and obstructs the flow of qi, and when it stagnates for a long time, it transforms into heat, which intertwines with the internal heat of yin deficiency, hence the lingering fever; damp heat disturbs the heart, hence the irritability and insomnia; dampness obstructs body fluids, hence the dry mouth and lack of thirst." Zhuang Qiwen's thinking is clear and progressive.

"Great!" Sun Zhiren couldn't help but whisper a word of praise from the judges.

Chen Yang smiled slightly and nodded.

Mo Xinzhi nodded slightly.

In fact, Mo Xinzhi, Qiu Yimin, and Xiao Jingyun were all from the same school of thought. Qiu Yimin, in particular, was an academic expert. Although Xiao Jingyun was a traditional Chinese medicine practitioner, some of his views were quite similar to Qiu Yimin's.

However, compared to Xiao Jingyun and Qiu Yimin, Mo Xinzhi values ​​facts more. After getting to know Chen Yang, Mo Xinzhi reflected on many issues.

A hint of surprise flashed across Qiu Yimin's face, but he remained calm: "So, Dr. Zhuang, what do you think is the best course of treatment? Conventional methods of nourishing yin may exacerbate dampness, while clearing heat may harm the body's vital energy. It's quite a tricky situation."

This is precisely where the difficulty lies.

Zhuang Qiwen pondered for a moment and said, "It is indeed a difficult case, but we should not be deterred by difficulties. The treatment should focus on nourishing yin and resolving dampness at the same time, and clearing heat and expelling pathogens simultaneously. We can use the Artemisia annua and Turtle Shell Decoction combined with the Three-Kernel Decoction from the Treatise on Febrile Diseases, with modifications."

"In this formula, turtle shell, rehmannia root, and anemarrhena rhizome nourish yin and clear heat; artemisia annua and peony bark promote the expulsion of heat and lead the pathogenic factors out of the body; apricot kernel, white cardamom, and coix seed (three kernels) promote the upward, smooth the middle, and drain downward, thus eliminating dampness; bamboo leaves and tetrapanax papyriferus can be added to enhance the effects of promoting diuresis and clearing heat. When all the herbs are used together, they nourish yin without being cloying, resolve dampness without damaging yin, and clear heat without being stagnant. With the pathogenic factors having an outlet, the heat will naturally subside."

As soon as Zhuang Qiwen presented his proposal, a murmur of discussion arose from the audience.

This approach to medication is truly ingenious, combining a famous prescription for treating yin deficiency and febrile diseases with a prescription for promoting qi circulation and clearing damp heat. It addresses this complex pathogenesis with boldness and meticulousness, something that those who adhere to conventional methods could never have come up with.

“Absurd!” A deep and authoritative voice suddenly rang out, drowning out the murmurs of the crowd.

Everyone looked in the direction of the voice and saw that it was Xiao Jingyun who had spoken!

Xiao Jingyun's face was solemn, his eyes sharp as he stared directly at Zhuang Qiwen: "Dr. Zhuang's argument sounds reasonable, but it is actually far-fetched! The Treatise on Cold Damage clearly states, 'Observe the pulse and symptoms to know what kind of adverse condition has been committed, and treat accordingly.'"

"This patient's pulse is thready and rapid, and his tongue is red with little coating, clearly indicating yin deficiency. 'Dry mouth but no desire to drink'—how can we be sure it's not heat in the blood level, consuming yin fluids, rather than what you call 'dampness'? Artemisia annua and turtle shell decoction is acceptable, but combining it with Sanren decoction, a combination of fragrant, drying, and diuretic ingredients, wouldn't that further damage his yin?"

"To treat the root cause of the disease, one should focus on large doses of yin-nourishing herbs, supplemented with herbs that clear away deficiency heat. For example, Huanglian Ejiao Decoction or Qinghao Biejia Decoction without Anemarrhena asphodeloides and with the addition of Baiwei and Digupi are the correct approaches! Your indiscriminate use of various herbs will not only fail to cure the disease, but may also draw the pathogens deeper and worsen the condition!"

Xiao Jingyun's voice was loud and clear, full of quotations, and his imposing manner was compelling.

He directly refuted Zhuang Qiwen's core pathogenesis diagnosis of "yin deficiency with dampness" and severely criticized his approach to medication as "indiscriminate use of various drugs," which could worsen the condition.

The atmosphere in the room instantly became tense!

Everyone's hearts were in their throats as they looked at Zhuang Qiwen.

Xiao Jingyun's questioning was not sophistry, but rather a legitimate viewpoint based on his profound knowledge of typhoid fever, and thus carried considerable weight.

Can Chuang Chi-Wen withstand the pressure from this renowned medical master?

Faced with Xiao Jingyun's overwhelming questioning, Zhuang Qiwen took a deep breath and, instead of backing down, his eyes became even more determined.

Zhuang Qiwen knew that at this moment he represented not only himself, but also the "unconventional" concept advocated by Chen Yang, and the dignity of countless TCM practitioners like him who did not have a distinguished background but made their way up through hard work.

He met Xiao Jingyun's sharp gaze and spoke neither humbly nor arrogantly, his voice still steady: "Senior Xiao is right. Paying attention to protecting Yin fluids is indeed a basic principle in treating deficiency-heat syndrome. I have learned a lot."

He began by acknowledging the reasonable aspects of Xiao Jingyun's viewpoint, demonstrating the courtesy expected of a junior, before abruptly changing the subject:

"However, clinical practice is ever-changing and the symptoms are complex, which cannot be fully covered by textbook theories."

"This patient had been ill for three months with persistent low-grade fever. If it were truly a case of pure yin deficiency or heat in the blood, Huanglian Ejiao Decoction or conventional methods of nourishing yin and clearing heat should have provided some relief, even if they did not have a rapid effect. However, the fact is that the effect was not obvious."

Zhuang Qiwen seized upon the four key words in the case description as a fulcrum for his counterattack: "This suggests that the pathogenesis is not so simple. 'Dry mouth without thirst' is an important differentiating point. Heat in the blood can certainly cause a lack of thirst by consuming yin and blood, but this is often accompanied by symptoms such as rashes, bleeding, and coma, which this patient does not exhibit. On the contrary, 'lack of thirst' caused by dampness obstructing the flow of qi and preventing fluids from rising is more common in clinical practice."

Zhuang Qiwen spoke calmly, yet his logic was rigorous and his approach was methodical: “As for Elder Xiao’s concern that the aromatic and drying properties of the herbs would damage Yin, I have chosen ‘three kernels’ in the prescription. Apricot kernel is bitter and pungent and promotes lung function, white cardamom is aromatic and resolves dampness, and coix seed is sweet and bland and promotes dampness elimination. The properties of these three herbs are not extremely pungent or drying, but rather focus on promoting the flow of Qi and opening up pathways for dampness and stagnation.”

"Moreover, the formula contains a large number of yin-nourishing ingredients such as turtle shell, rehmannia root, and anemarrhena rhizome, which are sufficient to counteract its dryness and achieve its diuretic effect. This is just as Ye Tianshi said, 'Promoting yang does not lie in warming, but in promoting urination,' and here it is also 'Nourishing yin does not lie in being greasy, but in opening up the path of evil.'"

"Once the dampness is gone, the Qi mechanism will be unblocked, the Yin fluid will be distributed naturally, and the deficiency heat will also be resolved. If one insists on pure Yin and pure deficiency and ignores the existence of the real evil (dampness), and only nourishes and tonifies, it may close the door and let the enemy in, causing the damp heat to clump together, making the disease even more difficult to cure."

Zhuang Qiwen's argument not only responded to Xiao Jingyun's questions, but also cited the views of Ye Tianshi, a master of the Wenbing School, to support his treatment method, elevating the debate to the level of a clash of ideas between different academic schools of thought on typhoid fever and Wenbing!