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

The academic lecture hall of the Affiliated Hospital of Henan University of Traditional Chinese Medicine is antique in style and full of scholarly atmosphere.

However, the atmosphere here today is quite different. Not only are all the experts from our institute present, but also many professors and graduate students from the provincial university of traditional Chinese medicine, as well as famous TCM doctors from surrounding cities, have come after hearing the news, making the venue extremely crowded.

Chen Yang led a team that attracted many TCM doctors and enthusiasts wherever they went.

Everyone wanted to witness firsthand what kind of sparks would fly when the rising star "Yang Shen" Chen Yang clashed with the profound Wu School of Medicine.

On the stage, Vice President Wu Yongping sat in the center, flanked by several highly respected senior experts from the Wu School of Medicine, as well as Chen Yang and his team members.

The first difficult case of the day was displayed on a huge electronic screen.

The patient is a 62-year-old woman diagnosed with "active systemic lupus erythematosus (SLE), lupus nephritis, and renal insufficiency".

The patient presented with a prominent butterfly-shaped rash on the face, generalized joint pain, persistent low-grade fever, moderate edema in both lower extremities, proteinuria (+++), and elevated serum creatinine. Western medicine treatment with hormones and immunosuppressants was administered, but the condition was poorly controlled, with significant side effects, leaving the patient lethargic and in considerable distress.

"This patient has a clear diagnosis from Western medicine, but the condition is complex and the side effects of hormones are significant."

Wu Yongping explained: "In terms of traditional Chinese medicine, many experts from our hospital participated in the diagnosis and treatment in the early stage. The diagnosis was 'yin deficiency with fire excess and heat toxin accumulation.' We used formulas such as Rhinoceros Horn and Rehmannia Decoction and Artemisia annua and Turtle Shell Decoction with modifications to clear heat, cool blood and detoxify. However, the effect was inconsistent, and the patient's deficiency symptoms gradually appeared, which was quite difficult to treat."

An elderly man with silver hair and a ruddy complexion, surnamed Lu, was a renowned Wu family elder who had been rehired by the hospital. He spoke slowly and in a loud voice.

"This patient's illness is located in the Yin aspect, with deep-seated heat toxins, which certainly need to be cleared and resolved. However, observing that his tongue is swollen and has teeth marks, and although his pulse is thin and rapid, it is weak when pressed deeply, this is a sign that his spleen and stomach have been damaged, and that both Qi and Yin are deficient. As our Wumen sages said, 'If you can preserve even a little bit of stomach Qi, you will have a little bit of life force.'"

"In the early stages, the medication may have been too cold and cooling, which weakened the spleen and stomach, causing the heat toxins to remain unresolved and the body's vital energy to collapse. The most urgent task is to support the spleen and stomach, replenish qi and nourish yin, supplemented by clearing and resolving toxins. A formula such as Ginseng, Poria and Atractylodes Macrocephala Powder combined with Shengmai Decoction can be used to gradually restore the stomach's qi before addressing the pathogenic factors."

Master Lu's views fully reflect the characteristics of the Wu School of Medicine, which emphasizes the spleen and stomach, uses mild and gentle medicines, and does not advocate strong and aggressive remedies.

After Lu finished speaking, someone agreed: "What Lu said is very true. However, the patient's symptoms of heat toxicity are obvious. If we over-strengthen the body, it may be like closing the door to let the enemy in. I think we can add heat-clearing and detoxifying herbs such as Oldenlandia diffusa and Scutellaria barbata to the body's support, but the dosage should be light and not excessive."

Both opinions lean towards conservatism, prioritizing strengthening the foundation and addressing the root causes while considering purging and resolving issues as secondary measures.

Many of the Wu School disciples in the audience either echoed or pondered, clearly agreeing with this line of thinking.

Wu Yongping turned his gaze to Chen Yang: "Director Chen, in this situation, how should we balance supporting the body's resistance with eliminating pathogens? Your team is based in Kyoto and must have extensive experience in handling such complex immune system diseases."

This is an extremely tricky question, as it both asks for opinions and implies a comparison.

Everyone's eyes were focused on Chen Yang.

Chen Yang did not answer directly, but looked at Zhuang Qiwen again and said gently, "Dr. Zhuang, what are your thoughts on this case?"

Let Zhuang Qiwen lead the charge once again!

A slight commotion arose from the audience.

At the headquarters of the Wu School of Medicine, facing such a highly respected senior, Chen Yang still chose to let Zhuang Qiwen, who came from a village doctor background, speak first. This courage and trust in his team members moved many people.

Zhuang Qiwen took a deep breath and stood up.

He could feel the doubt, curiosity, and even a hint of disdain in the eyes of those below the stage.

Having followed Chen Yang to so many places, Zhuang Qiwen also knew that his background had always been his biggest weakness, and Chen Yang was mainly trying to train him.

Zhuang Qiwen walked to the front of the stage, first bowing slightly to experts such as Elder Lu and Wu Yongping, his attitude respectful but not humble. Then, he turned to the electronic screen, his sharp eyes scanning over the various examination data and tongue and pulse information.

"I benefited greatly from listening to the opinions of several senior colleagues just now."

Zhuang Qiwen spoke, his voice clear and steady: "Old Master Lu's emphasis on the spleen and stomach and his protection of vital energy are the essence of traditional Chinese medicine, and I wholeheartedly agree with them."

Zhuang Qiwen first affirmed the other party, demonstrating his demeanor, which also eased the expressions of the Wu School of Medicine members in the audience.

"but......."

Zhuang Qiwen changed the subject, his tone becoming firm: "In my opinion, the patient's main problem is not 'deficiency of vital energy,' but rather 'stagnation of heat toxins, obstructing the three jiaos'!"

As soon as these words were spoken, there was an uproar in the audience!

"Arrogant!" someone whispered.

"Young man, you don't know your own limitations!" Another senior expert shook his head.

Old Master Lu frowned slightly, but did not say anything, only looking at Zhuang Qiwen.

Zhuang Qiwen remained unmoved and pointed to the tongue image, saying, "Please take a close look. The patient's tongue is not simply reddish-brown, but rather reddish-purple, with dark purple and tortuous veins under the tongue. This is clear evidence of blood stasis!"

"The pulse is thready and rapid, but upon closer examination, it is not a hollow pulse, but rather like a knife scraping bamboo, with a clear hesitant quality! This indicates that the heat toxin has penetrated deep into the blood, scorching the body fluids, causing blood stasis and numbness!"

Zhuang Qiwen further pointed to the symptoms: "The severe joint pain is not simply heat pain, but rather obstruction and blockage; the edema is not simply spleen deficiency, but rather the result of the water passages in the Triple Burner being blocked by stagnant heat; the persistent low-grade fever is due to the stagnation of heat toxins, which cannot be released. The previous attempts to clear and resolve the symptoms were ineffective not because the medicine was not appropriate, but because the two key aspects of 'stasis' and 'obstruction' were overlooked!"

"Heat toxins and blood stasis are intertwined, like oil mixed with flour, difficult to separate and separate. Simply clearing heat will not eliminate the root of the toxins; simply supporting the body's resistance is tantamount to aiding the enemy!"

Zhuang Qiwen's diagnosis is like a skilled butcher dissecting an ox, accurately dissecting the deeper pathogenesis hidden beneath the surface of "yin deficiency and fire excess"—"heat toxin stagnation"!

"Therefore, the core of treatment should be 'clearing heat and detoxifying, cooling blood and dispersing blood stasis, and clearing away obstructions and expelling pathogens'!"

Zhuang Qiwen slowly said, "I suggest using Rhinoceros Horn and Rehmannia Decoction (using concentrated water buffalo horn powder instead of rhinoceros horn) combined with Peach Blossom and Four Substances Decoction as the main prescription, with heavy use of red peony root, peony bark, and rehmannia root to cool the blood and dispel blood stasis, and adding smilax glabra, tripterygium wilfordii, and sinomenium acutum to clear heat, detoxify, dispel wind, and relieve numbness. At the same time, add a small amount of astragalus and codonopsis to support the body's vital energy and expel the pathogenic factors! Insect-based medicines, such as earthworm and scorpion, should be used to dispel wind, clear the collaterals, break up blood stasis, and relieve numbness!"

This approach almost completely contradicts the Wu School of Medicine's philosophy of "lightness and gentleness" and "emphasis on the spleen and stomach"!

In particular, the use of highly toxic Tripterygium wilfordii and insect-based medicines was proposed, something that would not have been even considered in previous discussions!

"Nonsense!"

A middle-aged expert couldn't help but slam his fist on the table and exclaimed, "Tripterygium wilfordii is extremely toxic, and the patient already has renal insufficiency. You're making things worse! Insect-based medicines are invasive and cause further damage to qi and blood! Master Lu emphasized protecting the stomach qi. How can the spleen and stomach withstand such treatment?"

"Dr. Zhuang, are you being too aggressive and neglecting the patient's safety?" Wu Yongping asked in a deep voice, his sharp gaze fixed on Zhuang Qiwen and then glancing at Chen Yang.

The atmosphere inside the arena instantly became extremely tense.