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

The audience fell silent, everyone captivated by this unexpected and high-level academic exchange.

Li Haofei, Liu Xi, and others held their breath in suspense, while Xun Jiahong and Lin Yi showed their appreciation.

Yu Shiyun listened with shining eyes. Zhuang Qiwen's analysis of "dampness obstruction" subtly coincided with the "heat stagnation" theory recorded in her family's medical records, which made her admire Zhuang Qiwen even more.

Xiao Jingyun's expression darkened slightly. He hadn't expected that this seemingly unassuming village doctor would not only have such a flexible clinical approach but also such a solid theoretical foundation, capable of citing classical texts to argue with him. In particular, the other party's mention of Ye Tianshi further proved the correctness of his argument.

Seeing this, Qiu Yimin interjected at the opportune moment, his tone biased: "Dr. Zhuang, theoretical discussions are important, but ultimately, efficacy should be the standard. Although your prescription seems ingenious, the medicinal properties are somewhat complex, and there are considerable risks if it is used clinically. As Elder Xiao said, we should prioritize safety."

These words, though seemingly fair, were actually putting pressure on Zhuang Qiwen, implying that his method was "highly risky" and not as "safe" as Xiao Jingyun's.

"Xiao Jingyun still can't change his old habits."

Mo Xinzhi couldn't help but sigh inwardly.

In fact, given Xiao Jingyun's skill level, he could easily handle this illness. Xiao Jingyun's questioning just now was entirely directed at Zhuang Qiwen.

It's like when you have a bad impression of someone, and no matter what they say, you have to refute them first, but unexpectedly, Zhuang Qiwen's rebuttal puts Xiao Jingyun in a somewhat passive position.

However, Qiu Yimin clearly favored Xiao Jingyun.

Chen Yang sat on the main judge's seat, watching silently until he finally spoke up: "Professor Qiu, the theoretical analysis session is meant for everyone to express their own opinions and speak freely."

"Dr. Zhuang's analysis is well-founded, methodical, clear in its thinking, and rigorous in its logic, and there is nothing wrong with it. As for the efficacy, we will naturally see the results when there is an opportunity for clinical verification. At this moment, we should still encourage this kind of in-depth discussion based on the pathogenesis."

Chen Yang's voice was calm, yet carried an undeniable tone of conviction, directly affirming Zhuang Qiwen's statement and steering the discussion back to the academic debate itself, thus defusing the pressure exerted by Qiu Yimin.

Xiao Jingyun snorted coldly and said nothing more.

He knew that Zhuang Qiwen had already established a firm foothold in pure theoretical analysis, and continuing to argue would only make him appear petty.

The debate continued, and as Qiu Yimin asked questions, the contestants eagerly rushed to answer.

Li Haofei, Liu Xi, Wu Mengmeng, Xun Jiahong, and others also showed their talents.

In this final, the first debate round was quite crucial because the debate topics were randomized, and not every contestant could answer some of them.

Whether you can answer first, and whether you can give a perfect answer after answering first, will all be included in the scoring criteria.

........

The next day, the final competition entered its second and more crucial stage – the clinical skills assessment.

This segment divides the contestants into ten groups of ten, who enter different simulated clinics to face either "standard patients" played by experienced actors or real recruited volunteer patients. Judges will observe and score the contestants through one-way glass or real-time monitoring.

The assessment includes a comprehensive evaluation of the four diagnostic methods (inspection, auscultation, inquiry, and palpation), analysis of etiology and pathogenesis, and formulation of treatment plans (including external treatments such as acupuncture and massage). Some simple operations may even need to be performed on-site.

This is the moment to truly test one's skills; any armchair theorist will be exposed as utterly incompetent.

The group assignments have been announced, and Zhuang Qiwen and Yu Shiyun were not placed in the same group.

Xiao Jingyun and An Yunfan, as the strongest players, were specially placed in different groups to avoid them clashing too early.

Li Haofei, Liu Xi, Wu Mengmeng, and others also entered their respective assessment rooms.

Judges Chen Yang, Mo Xinzhi, and Sun Zhiren, among others, were stationed in the central monitoring room and could switch between the ten examination rooms in real time via a large screen.

In the third assessment room where Zhuang Qiwen was stationed, he faced a middle-aged male volunteer in his fifties who complained of "recurrent epigastric bloating and pain for five years, worsening in the past month." The patient was thin, with a sallow complexion, and reported that the bloating and pain worsened after meals and when he was emotionally upset, accompanied by belching, poor appetite, and alternating loose and dry stools. He had previously undergone a gastroscopy, which indicated "chronic superficial gastritis," and had not responded well to various Western and traditional Chinese medicines.

Zhuang Qiwen calmed himself down and carefully examined the patient's pulse (which was wiry and thin) and tongue (which was pale red with a thin, slightly greasy white coating). He learned that the patient usually experienced a lot of work pressure and was rather irritable.

After a moment's thought, Zhuang Qiwen had already made his judgment.

This condition should be classified as "liver stagnation and spleen deficiency, with qi stagnation and dampness obstruction".

The patient suffered from long-term emotional distress, leading to stagnation of liver qi, which then invaded the stomach, causing epigastric distension and pain, and belching. Liver qi stagnation also weakened the spleen, resulting in poor appetite and loose stools. Spleen deficiency generated dampness, hence the slightly greasy tongue coating. The key pathogenesis lies in the coexistence of liver qi stagnation and spleen deficiency, with qi stagnation and dampness obstructing each other.

However, Zhuang Qiwen did not rush to prescribe a medicine. Instead, he first gave the patient a detailed explanation to ease his emotions. Then, he wrote a prescription with modifications of Chaihu Shugan San and Liu Jun Zi Tang to soothe the liver, relieve depression, strengthen the spleen, resolve dampness, and promote qi circulation to relieve pain. At the same time, considering that the patient's illness had been prolonged and that "prolonged illness has penetrated the collaterals," he also added a small amount of blood-activating and stasis-removing herbs such as Danshen and Ezhu.

Zhuang Qiwen's diagnosis and treatment process was standardized and meticulous, his diagnosis was accurate, and his medication strategy was clear. He grasped the main contradictions while also taking into account the course of the disease and potential pathogenesis, which made Sun Zhiren, who was watching through the monitoring, nod repeatedly.

Meanwhile, the seventh examination room, where Yu Shiyun was located, encountered a rather tricky situation.

Her patient was an elderly woman in her sixties who complained of "swelling and pain in the joints of both fingers and morning stiffness for more than a year," suspected to be rheumatoid arthritis. The elderly woman also had symptoms such as chills and weakness in the lower back and knees.

Yu Shiyun examined the patient carefully and found that the pulse was deep and thready, and the tongue was pale with a white coating. She diagnosed this as "Wang Bi due to deficiency of liver and kidney, and obstruction by cold and dampness." The treatment should focus on nourishing the liver and kidney, dispelling cold and dampness, and clearing the meridians to relieve pain.

Just as Yu Shiyun was preparing to prescribe a modified version of Du Huo Ji Sheng Tang (Angelica and Loranthus Decoction) and considering whether to combine it with warm acupuncture, the old lady suddenly sighed and began to ramble on: "Alas, I'm getting old, I'm useless... This hand hurts terribly, I can't sleep well at night... Back in my hometown, there was an old doctor who used a fumigation and washing formula for me, it seemed to help a little, but the smell was strong, and I lost the formula later..."

He does not mean that.

Yu Shiyun's heart stirred, recalling a fumigation and washing prescription her grandfather used to treat cold-dampness arthralgia. It mainly consisted of mugwort, *Clematis chinensis*, *Clematis armandii*, *Aconitum carmichaelii*, and *Aconitum kusnezoffii*, possessing powerful effects of warming the meridians, dispelling cold, eliminating wind and dampness, promoting blood circulation, and relieving pain. This prescription, combined with oral decoctions, often yielded remarkable results through a holistic approach.

However… Yu Shiyun hesitated.

While Aconitum carmichaelii and Aconitum kusnezoffii are highly effective, they also have a certain degree of toxicity, requiring extreme caution in their use. The dosage and decoction method are extremely critical, especially considering the patient's advanced age...

In such an assessment setting, would using toxic medicinal materials be considered "non-standard" or "high-risk"?

The camera overhead felt like the judges' gaze, putting Yu Shiyun under a lot of pressure.

Yu Shiyun's heart began to pound violently again.

Should we proceed with caution and prescribe only internal medicine? Or should we trust ourselves and the wisdom passed down in our family and propose a combined internal and external treatment approach?

Yu Shiyun bit her lip, recalling the earnest look in her grandfather's eyes when he handed her the medical records, recalling Director Chen Yang's words, "Everything is based on the effectiveness of the treatment," and recalling Zhuang Qiwen's dignified demeanor when facing Xiao Jingyun...

A surge of courage suddenly rose from the bottom of my heart.