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

Liu Zhuoyun left Chen Yang's residence with mixed feelings.

As Chen Yang watched Liu Zhuoyun's retreating figure, he understood that the problems at the Central Province Traditional Chinese Medicine Hospital were different from those in Hebei Province, but the root causes were similar, both involving an imbalance between efficiency and efficacy, and between rules and principles.

Liu Zhuoyun's statement seemed more like a test and a request for help, but Chen Yang's main purpose for this trip was not to eliminate the threat, but to "spread the flames" and "train troops."

In fact, if it weren't for the involvement of officials like Zhang behind the scenes of the Xinglin Competition in Hebei Province, Chen Yang wouldn't have planned to interfere in Hebei's affairs. Organizing a special training session that caused widespread panic was not good for subsequent training.

This training tour will serve as a warning to some localities, and Chen Yang's goal will have been achieved.

Chen Yang walked to the window, looked at the bustling crowd below, and couldn't help but sigh.

Change cannot be achieved overnight. What he can do is to ignite the lamp of "the original aspiration of a doctor" in the hearts of more people, and to make the sparks of Zhuang Qiwen and Yu Shiyun shine brighter, enough to illuminate more corners.

In the following days, Chen Yang adjusted his strategy.

Chen Yang no longer simply involved trainees in discussions of difficult cases, but instead immersed them more deeply in the daily work of various departments. He required each of them to select at least two typical cases, track them throughout the entire process from initial consultation, diagnosis, treatment, prescription to efficacy observation, and write detailed analysis reports.

Zhuang Qiwen was assigned to rotate between the nephrology department and the ICU, which suited him perfectly.

The elderly patient with uremia and heart failure became Zhuang Qiwen's key observation subject. Zhuang Qiwen stayed in the ICU almost every step of the way, carefully observing every subtle change after the patient took the medication, recording the changes in tongue and pulse, and repeatedly discussing the significance of the monitoring data with the attending physician, Ma Bin.

Yu Shiyun chose the Department of Endocrinology and the Department of Geriatrics.

Yu Shiyun is meticulous and pays particular attention to the impact of patients' emotional factors and lifestyles.

She noticed that many patients with diabetes and hypertension in the department had similar treatment plans and frequently used traditional Chinese medicine, but lacked fine-tuning to address individual differences. Therefore, with the permission of her supervising teacher, Yu Shiyun tried to conduct more detailed consultations and diagnoses with several patients who were willing to cooperate, offered suggestions on diet and emotional regulation, and made minor adjustments to the traditional Chinese medicine prescriptions.

Xia Hongliang works in the cardiology department, Li Chengjie in the acupuncture and massage department, Gu Yingyin in the obstetrics and gynecology department... Each person is like a sponge, desperately absorbing knowledge and experience from different fields. At the same time, they also bring in the "precise diagnosis" and "TCM-based thinking" taught by Chen Yang, which has sparked many beneficial discussions and reflections within the department.

Chen Yang acted as a pillar of strength, listening to the trainees' reports every day and offering guidance on their questions and cases. His office lights were often on late into the night, filled with lively discussions.

That evening, Zhuang Qiwen found Chen Yang with a thick notebook in his hand, his brow furrowed.

"Director Chen, that uremia patient has been taking the medication for three days. His bowel movements have returned to normal, his urine output has increased to about 800ml per day, his edema has subsided slightly, and his spirits seem to have improved somewhat. However, he started hiccuping incessantly last night, has a poor appetite, his tongue has changed from dark purple to dark red, the coating has peeled off, and his pulse is becoming thin, rapid, and weak."

Zhuang Qiwen handed the record to Chen Yang, his tone filled with anxiety and self-reproach: "Did I use too strong a medicine and damage the stomach qi? Or has the pathogenic factor penetrated too deeply and caused complications?"

Chen Yang carefully reviewed the records, especially the photos of the tongue and the description of the pulse. After a moment of contemplation, he asked, "Where do you think the problem lies?"

"I think it's possible that the strong purgatives, rhubarb and Glauber's salt, while clearing the bowels and expelling toxins, also depleted the body's vital energy. Leeches and horseflies have strong blood-breaking properties, which may have further damaged the yin and blood. The patient was already deficient in both qi and yin, and now the stomach qi is weakened, causing the deficient yang to rise, hence the hiccups, poor appetite, and tongue peeling," Zhuang Qiwen analyzed.

"The analysis is reasonable."

Chen Yang nodded, then asked, "But do you remember that the *Neijing* says, 'All upward rushing of qi belongs to fire'? This fire can be real fire or deficient fire. What do you think is the nature of this patient's hiccups?"

Zhuang Qiwen pondered for a moment, then a flash of inspiration struck him: "Deficiency fire! It's caused by the depletion of stomach yin, leading to upward rushing of deficiency fire! It's not simply a matter of stomach qi damage!"

"Yes."

Chen Yang looked at him approvingly: "Your actions of clearing away the stagnation and turbidity are like dredging a blocked river, but the fundamental problem of the river drying up (depletion of yin fluids) has not been solved. On the contrary, the process of 'dredging' has exacerbated the evaporation of water."

"At this moment, the symptoms of deficiency have lessened, but the underlying deficiency has become more prominent, especially the deficiency of stomach yin, which causes deficiency fire to disturb the diaphragm, hence the persistent hiccups. This is not a mistake in medication, but an inevitable stage in the progression of the disease, and the strategy needs to be adjusted in time."

"Then how should I adjust?" Zhuang Qiwen asked anxiously.

"Defend, but be flexible."

Chen Yang picked up his pen and made slight modifications to Zhuang Qiwen's original prescription: "The dosage of rhubarb and Glauber's salt can be reduced or removed, and the dosage of leeches and horseflies can be temporarily suspended. Add Adenophora stricta, Ophiopogon japonicus, Dendrobium nobile, Polygonatum odoratum, and Eriobotrya japonica leaves, and increase the dosage to 30 grams to quickly nourish the stomach yin and relieve nausea and vomiting. At the same time, Evodia rutaecarpa powder can be mixed with vinegar and applied to the Yongquan acupoint to guide the fire back to its source."

Zhuang Qiwen suddenly realized, the fog in his mind cleared, and his respect for Chen Yang deepened.

Director Chen not only affirmed his previous diagnosis and medication, but also accurately pointed out the key to the problem and the solution when he encountered a bottleneck. This ability to manage complex diseases and adapt to changing circumstances is exactly what he needs to learn.

"I understand! I'll adjust the plan right away!" Zhuang Qiwen said gratefully, "Thank you, Director Chen."

"Dr. Zhuang, you're too kind."

Chen Yang smiled and said, "Dr. Zhuang, actually your skill level is not low. In my opinion, looking at the whole country, including those well-known TCM experts and professors, Dr. Zhuang, your skill level can be ranked in the top 100. You should have confidence in yourself."

"Top 100?"

Zhuang Qiwen's mouth opened slightly: "Director Chen, please don't tease me. How could that be?"

Zhuang Qiwen was indeed confident in his abilities. He had met many geniuses and experts during this period, but Chen Yang said he could rank in the top 100.

How can this be?

Being in the top 100 is a remarkable achievement anywhere.

"Dr. Zhuang, what you lack right now is confidence, and also a mindset problem."

Chen Yang said, "If you had some patients in your own clinic, you might have given them your all and been very meticulous. But once they're in the hospital, you feel like there are people with even higher skills, especially lately. You always feel like I'm there for you."

Zhuang Qiwen: "..."

"Dr. Zhuang, no matter what, you must first tell yourself that there is no way back, only in this way can you improve yourself."

Chen Yang said with a smile, "You shouldn't be a flower in a greenhouse."

Zhuang Qiwen was certainly not a hothouse flower; it was just that because he had always lived in small places, he always felt that he should be relegated to the back after arriving in Kyoto. This was Zhuang Qiwen's biggest problem.