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

The second round has ended, and today is the day for the judges to score the results.

The top 100 contestants gathered again at the main venue of the National Convention Center, awaiting the crucial moment that would determine the final rankings.

On the judges' panel, Chen Yang sat in the center, with Mo Xinzhi, Sun Zhiren, Li Liren, Qiu Yimin, Feng Huanzhang, and others sitting on either side.

On the giant electronic screen, each contestant's final score and ranking will soon be displayed one by one. But before that, the judges need to have a final discussion and ruling on controversial cases. This is not just about scoring, but also a direct clash of different medical philosophies.

Qiu Yimin spoke first, directly targeting Yu Shiyun: "In the seventh assessment room, contestant Yu Shiyun proposed using an external fumigation formula containing processed aconite and processed cassia to treat patients with arthralgia. I think this is inappropriate!"

His voice carried throughout the venue through the microphone, and everyone's eyes instantly turned to Yu Shiyun, who was sitting in the contestants' seat with a pale face.

"Aconitum carmichaelii and Aconitum kusnezoffii are extremely pungent, hot, and highly poisonous!"

Qiu Yimin said sternly, “Even for external use, extreme caution is required. In a competition where standards and safety are emphasized, suggesting the use of such drugs could easily set a bad example for young doctors, causing them to neglect medication safety! This trend must not be allowed to continue! I believe it should be reflected in their clinical practice scores to serve as a warning to others!”

Feng Huanzhang immediately chimed in: "Professor Qiu is absolutely right. The competition is selecting the future pillars of traditional Chinese medicine, and stability and standardization are the top priorities. The contestants may have family backgrounds in traditional Chinese medicine, but using toxic folk remedies in the assessment shows a disregard for 'rules,' which is not the way to become a talent."

This criticism was quite harsh, almost characterizing the proposed poetic scheme as "non-standard" and "dangerous."

Yu Shiyun bit her lower lip tightly, her fingers twisting together so hard that her nails dug deep into her palms, but she stubbornly raised her head and looked at the judges' panel, especially the chief judge Chen Yang.

A murmur arose from the audience.

Many contestants from academic backgrounds nodded in agreement, feeling that Professors Qiu and Feng made sense. Others, however, felt that Yu Shiyun was being treated unfairly and that the criticism was too harsh.

Zhuang Qiwen frowned slightly and glanced at Yu Shiyun with concern.

Xiao Jingyun lowered his eyelids, as if he were detached from the matter.

"Professor Qiu, Professor Feng, please allow me to state my different opinion."

Sun Zhiren slowly began to speak: "Yu Shiyun's proposal is a typical example of a combined internal and external treatment approach. She clearly put forward strict requirements for the processing of the medicine, the decoction method, and the contraindications, demonstrating her awareness and ability to control the risks involved."

"Traditional Chinese medicine's external treatment methods have a long history. When used properly, methods such as fumigation, washing, and applying plasters can often achieve effects that oral medications cannot. Although Aconitum carmichaelii and Aconitum kusnezoffii are poisonous, when properly processed and applied externally in appropriate amounts, their potent effects can be used to directly reach the affected area and overcome chronic and stubborn diseases. We should not throw the baby out with the bathwater and deny them outright."

Sun Zhiren looked at Yu Shiyun with encouragement in his eyes: "I think that under pressure, Yu was able to stick to the treatment plan that was most effective for the patient and take the initiative to standardize the process. This courage and responsibility based on clinical practice is exactly the quality that an excellent doctor needs. The rationality and value of the treatment plan should not be completely denied just because the drug itself is toxic."

Mo Xinzhi nodded slightly: "Professor Sun is right. To judge a plan, we should look at whether its theory, method, prescription and medicine are complete, whether it conforms to the pathogenesis, and whether the risks are controllable. The contestant's plan has no obvious deficiencies in these aspects."

There was a clear division among the judges.

Qiu Yimin's expression was not good, and he was about to argue again when Chen Yang raised his hand to stop the argument.

"Professor Qiu, it seems you didn't listen to what I said yesterday. There are many people watching," Chen Yang said slowly.

Qiu Yimin's expression changed, he opened his mouth, but then fell silent.

Chen Yang's words made it very clear: "Have some shame."

"Let's discuss Xiao Jingyun's plan now."

Seeing that Qiu Yimin had fallen silent, Mo Xinzhi smiled, let the matter drop, and moved on to the next topic of discussion.

Chen Yang had previously raised objections to Xiao Jingyun's proposal, and this renewed discussion was also for the purpose of finalizing the decision.

Yu Shiyun let out a long sigh of relief.

"First assessment room, contestant Xiao Jingyun."

Qiu Yimin spoke slowly, his tone filled with obvious respect: "Faced with a critically ill patient, his diagnosis of 'Yang deficiency with water retention, water retention affecting the heart and lungs, accompanied by blood stasis' was accurate and flawless. The prescription combined and modified Zhenwu Decoction, Tingli Dazao Xiefei Decoction, and Xuefu Zhuyu Decoction, especially the dosage of Aconitum carmichaelii reaching 60 grams, demonstrating extraordinary courage and showcasing the style of a master of classical formulas. The theory, method, prescription, medicine, and acupuncture were all perfectly integrated, and the judging panel unanimously awarded him the highest score in the clinical practice segment."

As soon as he finished speaking, enthusiastic applause erupted from the audience.

The older contestants and some of the spectators were particularly impressed with Xiao Jingyun's performance.

Apart from Chen Yang raising objections, everyone else highly praised Xiao Jingyun's performance, saying that he was indeed very skilled and courageous, worthy of the title of a great doctor.

Xiao Jingyun nodded slightly, accepting the praise with composure. He was extremely satisfied with his performance yesterday; the plan was the culmination of his life's work, and he was confident that no one could surpass it.

However, just as the applause was fading, Chen Yang slowly spoke.

"Professor Xiao's solution is indeed a classic and effective treatment, demonstrating profound expertise."

Chen Yang first affirmed the point, then changed the subject and said in a steady voice: "But as the chief judge, in the spirit of being responsible to the patients, to the competition, and to every contestant, I have a question that I would like to discuss with Professor Xiao and also with my colleagues."

The entire room fell silent instantly; everyone held their breath. Was Chen Yang finally going to give Xiao Jingyun a direct answer?

Xiao Jingyun narrowed his eyes and looked at Chen Yang: "Director Chen, please feel free to speak your mind."

"I dare not presume to offer such insightful opinions."

Chen Yang was humble, but his gaze was sharp as a knife: "The patient is old and frail, suffering from multiple failures of the heart, lungs, and kidneys. His vital energy is exhausted, and he is showing signs of 'the lamp running out of oil.' Dr. Xiao's treatment plan focuses on warming the yang, promoting diuresis, and invigorating blood circulation to remove blood stasis. It emphasizes eliminating pathogens with strong and forceful methods, like cooking oil over a raging fire, aiming to turn the tide. This approach is undoubtedly the best choice when the patient's vital energy can still sustain him."

Chen Yang paused briefly to allow everyone to process his words before continuing, "However, what if the patient's vital energy is extremely depleted and unable to withstand such a strong attack of medicine? The Inner Canon of Medicine states, 'When the vital energy is abundant within, evil cannot invade'; 'Where evil gathers, the vital energy must be deficient.' When the vital energy is extremely weak, should we continue to vigorously expel the evil, or should we first consider 'strengthening the vital energy and consolidating the body' to stabilize that sliver of life?"

Chen Yang's question, like a pebble thrown into a calm lake, created ripples in everyone's hearts.

Xiao Jingyun's expression darkened slightly: "Is Director Chen questioning my diagnosis, or my medication?"

"It's not about questioning, but about exchanging ideas."

Chen Yang smiled and said, "Old Xiao's diagnosis and treatment are impeccable. What I question is whether we might be limited by 'perfect' theories and 'classic' treatments, and overlook the most crucial variable of the patient's 'extreme weakness'? The essence of traditional Chinese medicine lies in 'tailoring treatment to the individual' and 'tailoring treatment to the three factors.' In this patient's case, the 'deficiency' has reached a critical point."