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

The next morning, the academic lecture hall of the Central Plains Provincial Hospital of Traditional Chinese Medicine was once again packed to capacity.

Not only were all the experts from our hospital present, but many doctors from other hospitals also came to listen in, all wanting to catch a glimpse of the "Yang God" Chen Yang.

It must be said that Chen Yang and Xiao Jingyun's idea of ​​leading teams to tour the country, train students, and exchange ideas with major hospitals, taking advantage of the Xinglin Competition, is indeed very good.

There is a Chinese saying: "If the name is not correct, the words will not be proper." Many things need a reason to be done.

On the stage, Dean He Zhiqun presided over the meeting, while Chen Yang and his team sat on the right. On the huge electronic screen, the first critical case to be discussed today was displayed.

The patient is a 78-year-old male diagnosed with "chronic renal failure in the uremia stage, heart failure, and lung infection".

The patient had severe edema throughout his body, especially in his lower limbs and scrotum, which were swollen and shiny. He had rapid breathing and relied on high-flow oxygen and non-invasive ventilation. His consciousness fluctuated between being clear and confused.

Western medicine has already implemented comprehensive treatments, including cardiotonics, diuretics, vasodilators, anti-infection drugs, and continuous renal replacement therapy (CRRT), but the effects have been poor, the condition continues to deteriorate, and the family is almost in despair.

"Experts and colleagues,"

He Zhiqun introduced in a heavy tone: "This patient is one of the most critically ill patients in our ICU. We have almost exhausted all Western medicine methods, but the patient's heart failure and kidney failure are difficult to correct, the lung infection is not well controlled, and the electrolyte imbalance is severe."

"In terms of traditional Chinese medicine, we have intervened in the early stages, diagnosing the condition as 'Yang deficiency with water retention' and using modified Zhenwu Decoction and Jisheng Shenqi Pill, but the diuretic effect was not obvious, and the patient became even weaker. Today, we earnestly request Director Chen and the experts from Beijing to provide us with guidance and see if we can find a glimmer of hope for the patient."

As soon as He Zhiqun finished speaking, Ma Bin, the attending physician in charge of the patient and the deputy chief physician of the ICU, began to give a detailed account of the Western medicine treatment process and various monitoring data, his words filled with helplessness.

Subsequently, several TCM experts from our hospital began to speak.

An elderly expert with thinning hair adjusted his glasses and said slowly, "This patient is old and frail, and has been depleted by long-term illness. The root cause is the decline of spleen and kidney yang. Excessive water retention is affecting the heart and lungs, which is the manifestation. The previous ineffective diuresis may be due to the severity of the illness and the weakness of the medicine. I think we should increase the effect of warming yang and promoting diuresis. We can consider using Ji Jiao Li Huang Wan to forcefully expel water retention."

Another middle-aged director offered a different opinion: "The patient is critically ill, his vital energy is extremely weak, and his pulse is weak and almost imperceptible. This is a sign of the separation of Yin and Yang. At this time, to administer strong purgatives would be tantamount to kicking someone when they are down. I believe that we should use large doses of Ginseng and Aconite Decoction and Shengmai Powder to restore Yang and consolidate the body's vital energy, and save the patient from collapse. Once the vital energy has recovered somewhat, we can then focus on promoting urination."

There were two opposing opinions: one advocating a fierce attack, and the other advocating a defensive strategy. The debate was deadlocked.

There was a lot of discussion and a heavy atmosphere among the audience.

Everyone knew that this patient was on the verge of death, and that any treatment plan carried extremely high risks.

He Zhiqun turned his gaze to Chen Yang, his expression a mixture of anticipation and a barely perceptible challenge: "Director Chen, do you think... in this situation, traditional Chinese medicine has any better solutions?"

All eyes immediately focused on Chen Yang.

Chen Yang did not answer immediately, but looked at Zhuang Qiwen beside him and said gently, "Dr. Zhuang, what do you think of this case?"

Chen Yang once again had Zhuang Qiwen lead the charge?

A low murmur rippled through the room.

This case is more complex and critical than the cirrhosis patient in Hebei Province, yet Chen Yang still let Zhuang Qiwen speak first?

It seems that Chen Yang values ​​and trusts this Dr. Zhuang quite a bit.

Zhuang Qiwen took a deep breath, stood up, and walked to the front of the stage.

Zhuang Qiwen's expression was solemn, but his eyes were unusually focused and calm. After his experience in Hebei Province, Zhuang Qiwen's mindset when facing big events had become much more composed.

Zhuang Qiwen did not rush to refute either side's viewpoint. Instead, he carefully observed the tongue image on the screen, checked the pulse record, and combined it with all the laboratory tests and monitoring data.

After a moment of contemplation, Zhuang Qiwen slowly spoke: "Thank you for your opinions, teachers. I believe that the pathogenesis of this patient is not simply 'Yang deficiency and water retention,' nor is it simply 'separation of Yin and Yang.'"

After Zhuang Qiwen said this, the audience fell silent again.

"Please pay attention to a few details."

Zhuang Qiwen pointed to several key data points with an electronic pen: "Although the patient has severe edema throughout the body, it is not all pitting edema; some areas are firm to the touch. Although the patient's skin is cold and clammy, the palms and soles of the feet are faintly warm. Although the tongue is large, the tongue body is dark purple with ecchymosis, and the sublingual veins are tortuous and engorged. Although the pulse is described as 'fine and thready,' there are occasional signs of 'intermittent' pulse."

After a pause, Zhuang Qiwen's gaze swept over the faces below the stage, some puzzled and some deep in thought, before finally returning to He Zhiqun and Chen Yang.

"Therefore, I believe that the key to this syndrome lies in 'the decline of Yang Qi, the retention of water toxins, the obstruction of blood vessels, and the blockage of the Triple Burner'! The reason why water and dampness are difficult to remove is not only because of insufficient Yang Qi and weak propulsion, but also because of the obstruction of blood vessels and the blockage of water passages! The severe impairment of the Qi transformation function of the Triple Burner leads to the spread of water toxins throughout the body, further damaging the five internal organs."

This dialectic is more profound and complex than any previous analysis, directly addressing the root cause of the problem.

"Therefore, in treatment, simply warming the yang and promoting diuresis will leave the water with nowhere to go; simply restoring yang and consolidating the body will leave the pathogens with nowhere to escape. We must use all four methods together: warming the yang and promoting diuresis, activating blood circulation and removing blood stasis, clearing the bowels and eliminating turbidity, and opening the stagnation and consolidating the body!"

Zhuang Qiwen spoke firmly as he began to explain his treatment plan: "I suggest using Zhenwu Decoction combined with Xuefu Zhuyu Decoction as the base formula, heavily using ginseng and aconite to warm the yang and consolidate the body, while simultaneously adding rhubarb and Glauber's salt to purge the bowels and eliminate turbidity, providing an outlet for the water toxins..."

"Add leeches and horseflies (powdered and taken with water) to break up blood stasis and clear water passages; then add shepherd's purse flowers, corn silk and other experienced medicines to enhance diuresis and reduce swelling. Throughout the process, moxibustion should be applied to acupoints such as Guanyuan, Qihai, and Shenque to restore Yang and reverse the collapse."

This proposal is incredibly audacious!

Combining warming, purging, blood-activating, and diuretic effects into one may seem contradictory, but it actually aligns with the supreme principle of "supporting the body's resistance and eliminating pathogens, addressing both the root cause and the symptoms."

The audience erupted in chaos!

"This...this is too risky! Rhubarb and Glauber's salt are strong, and leeches and horseflies break the blood. How can the patient, who is so weak, withstand this?"

"This is utterly outrageous! Isn't this just hastening the patient's death?"

"But... Dr. Zhuang's explanation of the pathogenesis seems to make some sense..."

Questions, opposition, and discussions were all mixed together.

He Zhiqun frowned and looked at Chen Yang: "Director Chen, isn't Dr. Zhuang's plan... a bit too... aggressive? The patient might not be able to withstand such a fierce attack!"

Everyone held their breath, waiting for Chen Yang's conclusion.

(Yes, this is the last plot point in the book. There are probably about 200,000 words left before it ends. Thank you all for your support. I will try my best to write a good ending.)