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

At the same time, Yu Shiyun also encountered a rather tricky case in the Department of Endocrinology.

The patient is a middle-aged woman in her forties who was diagnosed with type 2 diabetes. She has been taking oral hypoglycemic drugs for a long time, but her blood sugar control is very poor and fluctuates greatly.

The patient was thin, with a sallow complexion, extreme thirst but little fluid intake, irritability, insomnia, hot palms and soles, a red tongue with no coating, and a thready, rapid, and forceful pulse. The TCM diagnosis given by the department was "Xiao Ke - Yin deficiency with exuberant fire," and the treatment was a modified Zhi Bai Di Huang Tang formula.

After taking over the case, Yu Shiyun carefully inquired about the patient's medical history and found that the patient also had obvious symptoms of rib pain, irritability and anger, and irregular menstruation. She felt that the simple "yin deficiency and fire excess" could not fully explain all the symptoms.

So Yu Shiyun consulted a lot of information and thought about it repeatedly. She vaguely felt that it was related to the "liver", but she was not sure.

The attending physician in the department, a deputy chief physician surnamed Liu, was dismissive of her "outlandish ideas".

"Xiao Yu, this is a typical case of yin deficiency with excessive fire. Zhi Bai Di Huang Tang is the right choice. The slow effect is because the patient's illness has lasted for a long time."

Director Liu patted her on the shoulder: "Don't overthink it, just follow the steps."

Yu Shiyun was resentful, but dared not contradict him.

During the team's debriefing that evening, Yu Shiyun mustered up the courage to bring up this case and express her doubts.

"Director Chen, fellow students, I think this patient, besides having Yin deficiency, may also have liver stagnation transforming into fire, which damages Yin fluids. The liver governs the free flow of Qi and regulates the body's movement; liver stagnation leads to Qi stagnation and abnormal distribution of body fluids, which can also cause thirst. Could we consider simultaneously soothing the liver, clearing heat, nourishing Yin, and generating fluids?"

After Yu Shiyun finished speaking, she looked at Chen Yang with some nervousness.

Xia Hongliang, Li Chengjie, and others also showed thoughtful expressions.

Chen Yang did not answer directly, but instead asked Yu Shiyun, "What is your basis for judging that there is liver stagnation transforming into fire? Is it merely the distending pain in the hypochondrium and irritability?"

Yu Shiyun composed herself and tried to organize her thoughts: "It's not just these things. Her pulse is thin and rapid with a slight wiry quality; her mouth is dry, the kind of thirsty feeling where she wants to drink water but can't, as if her Qi is not flowing smoothly and her body fluids cannot rise; also, her palms and soles are hot, but sometimes she feels cold, like a mixed cold and heat pattern in the Jueyin Liver Meridian... Although it's not obvious, all things considered, I think we can't ignore the liver factor."

A hint of surprise and admiration flashed in Chen Yang's eyes.

Yu Shiyun's observations are so meticulous that she can capture these easily overlooked details and connect them to theories. This keenness and critical thinking ability are rare among her peers.

"very good!"

Chen Yang praised him generously: "Your observation and thinking are very insightful! This patient's condition is definitely not simply due to yin deficiency and excessive fire."

"The core pathogenesis lies in 'liver stagnation transforming into fire, scorching the yin of the lungs and stomach,' leading to severe disorder of body fluid metabolism. Liver fire disturbs the heart, hence irritability and insomnia; wood fire attacks metal, hence dry mouth and thirst; liver qi flows in reverse, hence hypochondriac distension and irritability. While Zhi Bai Di Huang Tang (Rehmannia and Phellodendron Decoction) is good at nourishing yin and reducing fire, it neglects the crucial link of soothing and clearing the liver, which is like watering without extinguishing the fire, so the effect is naturally poor."

Chen Yang then turned to everyone and used this as an example to explain: "Diabetes is called 'Xiao Ke' in traditional Chinese medicine. Traditionally, it is treated from the perspective of the lungs, stomach, and kidneys. However, modern people face great life pressures, and emotional factors are becoming increasingly prominent in causing the disease. Treating Xiao Ke from the perspective of the liver is gradually gaining attention. When the liver fails to regulate Qi, it affects the flow of Qi, which in turn affects the metabolism of fluids and the distribution of essential substances. This is very common in clinical practice."

"Then... how should it be prescribed?" Yu Shiyun asked excitedly, her eyes sparkling.

"We can optimize your original prescription. The main prescription can be Danzhi Xiaoyao San combined with Shashen Maidong Tang. Danpi and Zhizi clear liver fire; Chaihu, Baishao, and Danggui soothe and soften the liver; Baizhu and Fuling strengthen the spleen to prevent the liver wood from overpowering the earth; Shashen, Maidong, and Tianhuafen nourish the yin of the lungs and stomach. You can also add a small amount of Wumei and Wuweizi, which are sour and sweet and can nourish yin, generate fluids and quench thirst."

Chen Yang paused for a moment, then added, "At the same time, it is essential to coordinate emotional guidance and tell patients about the impact of emotions on the disease. This is sometimes more important than medication."

Yu Shiyun treasured the poem and wrote it down carefully.

The next day, Yu Shiyun persuaded Director Liu, who was mentoring her, to try using this new approach.

Director Liu was skeptical, but given the reputation of Chen Yang's team, he reluctantly agreed.

The result was surprisingly good.

After taking three doses of the medication, the patient experienced significant relief from rib pain, improved mood, greatly reduced thirst, and better sleep. Even more surprisingly, a follow-up blood glucose test a week later showed a significant decrease in both fasting and postprandial blood glucose levels, allowing for a reduction in the dosage of hypoglycemic medication.

Director Liu stared in disbelief at the test results. When he looked at Yu Shiyun, his expression changed completely, from slight disdain to genuine admiration.

"Dr. Yu, oh no, Professor Yu... your diagnosis is amazing!" Director Liu exclaimed, "It seems I need to change my old ideas."

Yu Shiyun felt a great sense of accomplishment and joy.

This was not just about curing a patient, but also a great affirmation of her own abilities and theoretical knowledge. She finally proved that even without a prominent family background, she could go far on the path of traditional Chinese medicine through her own efforts and thinking.

......

After adjusting the medication, the uremia patients under Zhuang Qiwen's care experienced a cessation of hiccups, a gradual improvement in appetite, and further improvement in their mental state. Although still in critical condition, their vital signs stabilized, and various indicators showed a positive trend. This created a small miracle in the ICU of Zhongzhou Provincial Hospital of Traditional Chinese Medicine.

Yu Shiyun's successful treatment of diabetes cases caused quite a stir in the Department of Endocrinology. More and more young doctors, and even some middle-aged key personnel, began to actively seek out trainees from Chen Yang's team to exchange ideas and ask for their diagnostic thinking and methods.

The refreshing and rigorous academic atmosphere brought by Chen Yang's team is like a pebble thrown into a lake, creating ripples that continue to expand.

Dean He Zhiqun could no longer sit still.

He keenly sensed that the value of Chen Yang's team's trip went far beyond solving a few difficult cases; it lay in elevating the hospital's overall academic level and the development of its TCM expertise. This, perhaps, was also an opportunity to address the hospital's deeper problems.

That day, He Zhiqun personally approached Chen Yang, his attitude even more sincere and enthusiastic than before.

"Director Chen, you and your team have truly brought about tremendous changes to our hospital!"

He Zhiqun held Chen Yang's hand: "I see that the young doctors' enthusiasm for learning is unprecedented, which is something that money can't buy!"

"I have a favor to ask: could Director Chen please give a large-scale academic lecture to all of our staff? Could you share your academic thoughts, especially your experience in treating acute, critical, and difficult-to-treat diseases with traditional Chinese medicine?"

After a moment's thought, Chen Yang agreed, which was one of the effects he hoped to achieve on this trip—to spread his ideas and influence more people.