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

In the afternoon, Hao Rencai personally arranged for Chen Yang's team to participate in tomorrow's hospital-wide consultation on difficult cases so that the experts from Beijing could "gain a deeper understanding of the situation."

The lecture hall of the Hebei Provincial Hospital of Traditional Chinese Medicine was packed to capacity.

Almost all the doctors with associate senior titles or above in the hospital were present, and the back row was even crowded with many resident doctors and trainees.

Everyone knows that today's consultation is no ordinary event, as the "Yangshen" team from Kyoto will be directly confronting the experts from our hospital.

On the stage, Dean Hao Rencai sat in the center, with several highly respected senior experts and department directors on his left and Chen Yang and his team, including Yu Shiyun and Zhuang Qiwen, on his right.

On the huge projection screen, the first difficult case to be discussed today was displayed.

The patient is a man in his fifties who was diagnosed with "decompensated cirrhosis with massive ascites and electrolyte imbalance." His condition is critical, and he has been in the ICU for nearly two weeks.

Western medicine provided symptomatic supportive treatments such as diuretics, albumin supplementation, and maintenance of internal environment stability, but the effect was not good. The ascites subsided slowly, the patient was lethargic, and the jaundice continued to worsen.

In terms of traditional Chinese medicine, the initial diagnosis was "abdominal distension - dampness trapping the spleen". Formulas such as Shipi Yin and Wuling San were used with modifications, but the diuretic effect was not obvious. Instead, the patient showed signs of yin deficiency and heat, such as dry mouth, irritability, and red tongue with little saliva.

"Everyone is already aware of the situation."

Hao Rencai chaired the meeting, his tone somber: "This patient's condition is complex. Western medicine treatment has reached a bottleneck, and the initial effects of traditional Chinese medicine have not been ideal. Today, we would like to take this opportunity to invite Director Chen's team from Beijing and our hospital's experts to brainstorm together and see if we can find a breakthrough."

As soon as Dean Hao finished speaking, a chief physician from the Department of Gastroenterology of our hospital took the lead in speaking, emphasizing again the patient's pathogenesis of "deficiency of the root and excess of the branch" and "abundance of water and dampness". He believed that the diuretic effect in the early stage was not strong enough and suggested increasing the dosage of diuretics, such as considering the use of strong purgatives like Zhouche Pill.

This suggestion was immediately echoed by several middle-aged doctors.

Yu Shiyun, listening from below, frowned and couldn't help but whisper, "The patient already shows signs of yin deficiency and heat. If we continue to use strong purgatives to expel water, wouldn't that be like draining the pond to catch all the fish? It will only weaken the body's vital energy further!"

Li Zhuangqiwen nodded slightly, his eyes fixed on the tongue and pulse data on the screen, his brain working at a rapid pace.

Chen Yang remained calm and silent. He was waiting for the experts from the institute to fully express their opinions, and he also wanted to see how the trainees would respond.

At this moment, an elderly expert with gray hair who had been silent all along from the Hebei Provincial Hospital of Traditional Chinese Medicine slowly spoke up. He was a retired expert who had been rehired by the hospital, surnamed Sun, and had a high reputation within the hospital.

Old Sun coughed softly, and the room immediately quieted down.

"This case is indeed difficult to diagnose. While the symptoms of water retention are urgent, the patient has been ill for a long time, and his spleen and stomach have deteriorated, and his liver and kidney yin have been damaged. His pulse is thin, rapid, and weak, indicating a deficiency of both qi and yin, and a floating of deficient yang. If we were to use strong remedies at this time, it could lead to complications and even a serious collapse!"

Sun Lao's views are relatively conservative, tending to focus on strengthening the body's resistance and consolidating its foundation, supplemented by gentle diuretics.

The two opinions remained deadlocked, and there was much discussion in the meeting room.

Hao Rencai looked at Chen Yang and asked with a smile, "Director Chen, what do you think? You are a nationally renowned expert. What are your thoughts on this thorny situation?"

All eyes immediately focused on Chen Yang.

Chen Yang did not answer directly, but turned to Zhuang Qiwen beside him and asked in a calm tone, "Dr. Zhuang, what do you think?"

This move stunned everyone present.

Should Zhuang Qiwen speak first?

What does Chen Yang mean by this? Is he being arrogant, or does he have some other intention?

Although Zhuang Qiwen is older than Chen Yang, everyone knows that Chen Yang is the most skilled.

Zhuang Qiwen stood up, walked to the projection screen, and picked up the electronic pen.

"I have listened carefully to the opinions of the experts and teachers just now and benefited a lot. As for this patient, I believe that the key to the pathogenesis is not simply dampness trapping the spleen, nor is it simply a deficiency of both qi and yin, but rather 'dampness, heat, blood stasis, and toxins mutually binding, resulting in damage to both qi and yin'!"

These words immediately sparked a murmur among the audience.

This dialectic is more complex and incisive than the previous two viewpoints.

Ignoring the discussions below, Zhuang Qiwen pointed to the tongue image and said, "Everyone, please look. The patient's tongue is red and swollen, not pale and swollen. Although the tongue coating is greasy, the root is yellow and dry, which indicates that damp heat has accumulated and penetrated deep into the blood. The pulse is thin, rapid, and weak, which is indeed a deficiency of both qi and yin. However, upon closer examination, there should also be a hesitant pulse, which indicates internal obstruction of blood stasis."

"In addition, the patient has a long history of alcohol consumption, and physical signs include a sallow complexion and spider angiomas. Laboratory tests show extremely high bilirubin levels and poor coagulation function..."

"Therefore, I believe that the reason why the early treatment was ineffective in promoting diuresis and even damaged Yin is that the core pathogenesis of 'damp-heat and blood stasis' was ignored. Simply warming Yang and promoting diuresis is like adding fuel to the fire; simply nourishing Yin may hinder the elimination of dampness. It is necessary to clear heat and promote diuresis, cool blood and remove blood stasis, detoxify and dissipate nodules, and replenish Qi and nourish Yin in a parallel manner!"

After a pause, Zhuang Qiwen's gaze swept over the experts from his institute who were looking at him with skepticism, and finally settled on Hao Rencai and Chen Yang.

"My initial idea is to modify a combination of Rhinoceros Horn and Rehmannia Decoction, Artemisia capillaris Decoction, and Five-Ingredient Powder, and heavily use herbs such as Paeonia lactiflora, Paeonia suffruticosa, Salvia miltiorrhiza, Hedyotis diffusa, and Scutellaria barbata to cool the blood, promote blood circulation, clear heat, and detoxify. At the same time, American ginseng, Ophiopogon japonicus, and Schisandra chinensis can be added to replenish qi, nourish yin, and consolidate the body. For diuresis, herbs such as Poria cocos, Polyporus umbellatus, and Alisma plantago-aquatica can be selected to avoid further damage to yin due to heat and dryness."

Zhuang Qiwen's arguments are well-reasoned and supported by evidence, his diagnosis is meticulous and insightful, and his prescriptions are ingeniously conceived. He organically combines supporting the body's resistance with eliminating pathogens, promoting diuresis with nourishing yin, and clearing heat with removing blood stasis, demonstrating a solid foundation and broad thinking far beyond his peers.

The room fell silent for a moment, then erupted into even louder discussions.

There was surprise, and there was deep thought.

Old Sun nodded slightly, his eyes showing appreciation, while the director who had previously advocated for rushing downhill into the water looked rather unpleasant.

A hint of surprise flashed in Hao Rencai's eyes. He hadn't expected Zhuang Qiwen to be so skilled. No wonder he was the third-place winner in this medical competition; his achievement was truly remarkable.

A barely perceptible smile appeared on Chen Yang's lips.

"Hehe, that's a novel idea."

Hao Rencai chuckled twice and turned to Chen Yang: "Director Chen, what do you think of Dr. Zhuang's insights? Aren't they a bit... too radical and risky?"

Chen Yang slowly stood up, walked to the front of the stage, and stood side by side with Zhuang Qiwen.

"I think Dr. Zhuang's diagnosis is basically accurate and has grasped the key to the pathogenesis."

Chen Yang first affirmed Zhuang Qiwen's point, then changed the subject: "As for the medication, the idea is correct, but we still need to consider the specific drug selection and dosage."

Chen Yang did not simply copy Zhuang Qiwen's plan, but instead made more subtle adjustments and improvements based on it.

"This patient is critically ill due to a deficiency of vital energy and lingering pathogenic factors. Treatment must be carried out with extreme caution, proceeding step by step. We must be bold in using prescriptions to expel the pathogenic factors, while also constantly protecting the patient's vital energy to prevent further deterioration. Only in this way can we save this patient from this serious illness."