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

Everyone's eyes were instantly focused on him.

Cheng Yi stood up, his tone calm and his explanation clear: "For this condition, the 'Xiaoyao San' formula is chosen as the base. Its composition is as follows: Bupleurum is the chief herb, used to soothe the liver and relieve stagnation; White peony root and Angelica sinensis are the assistant herbs, used to nourish the blood and soften the liver; Atractylodes macrocephala, Poria cocos, and prepared ginger are the adjuvant herbs, used to strengthen the spleen and dispel dampness; a small amount of peppermint helps Bupleurum soothe the liver and clear heat; and licorice root is the guiding herb, used to harmonize the other herbs. The rationale behind this formula is: when liver stagnation is relieved, blood deficiency is nourished, and spleen weakness is strengthened, all symptoms will naturally disappear."

Cheng Yi accurately selected all the core ingredients of Xiaoyao San, completely avoiding any distracting factors. The principal, assistant, adjuvant, and guiding ingredients were clearly labeled, and the explanation was clear.

A chorus of praise immediately erupted from the audience.

"As expected of Dr. Cheng, her reaction was incredibly quick!"

"Your fundamentals are so solid!"

"The score is going to be tied now!"

On the judging panel, several veteran experts from the Wu School also showed expressions of satisfaction.

Wu Yongping nodded slightly, his gaze toward Cheng Yi filled with approval.

The host looked at the judges, awaiting their decision.

Lu Yuanmin was about to announce the results.

Suddenly, a voice rang out: "Wait!"

Everyone looked in the direction of the voice and saw that it was Zhuang Qiwen from the Kyoto team who spoke!

Zhuang Qiwen then pressed the buzzer in front of him.

The rules allow for additions or questions, and it's clear that Zhuang Qiwen has something to say.

After obtaining the host's permission, Zhuang Qiwen said in a deep voice: "Dr. Cheng's choice of Xiaoyao San is indeed the right prescription. However, the patient's 'blood deficiency' symptoms are obvious. The list includes 'Shengdihuang' (Rehmannia glutinosa), which has a better effect on nourishing yin and blood than Angelica sinensis, and can also cool the blood, which can prevent liver stagnation from turning into heat over time."

"However, I think that in this prescription, Rehmannia glutinosa could be replaced with Angelica sinensis, or Rehmannia glutinosa could be added to enhance its blood-nourishing power, making it more comprehensive."

As soon as Zhuang Qiwen said this, the room fell silent!

He actually offered suggestions for improvement when the other party had already provided a perfect answer?

Is this a provocation, or does it demonstrate genuine insight?

Cheng Yi frowned slightly and looked at Zhuang Qiwen: "Dr. Zhuang, the use of Angelica sinensis in Xiaoyao San is for its blood-nourishing and blood-activating effects. It is combined with Paeonia lactiflora to combine movement and stillness. Rehmannia glutinosa is cold and moist in nature. Although it can nourish the blood, I am afraid that its cloying nature will hinder the spleen, which is not in line with the mechanism of 'spleen weakness' in this case. Therefore, the original prescription is more prudent."

The two started arguing on the spot!

Zhuang Qiwen remained calm: "Dr. Cheng's words make sense. However, looking at the main symptoms, blood deficiency is the root cause, and prolonged stagnation may not necessarily eliminate heat. Rehmannia glutinosa is indeed yin in nature, but the formula already contains Atractylodes macrocephala, Poria cocos, and roasted ginger to strengthen the spleen and warm the middle jiao, which is sufficient to counteract its cloying nature. Adding Rehmannia glutinosa will enhance its blood-nourishing power and also incorporate 'cooling the blood' into 'soothing the liver,' preventing problems before they arise, which seems to better align with the nature of 'the liver is yin in substance but yang in function.'"

Zhuang Qiwen's argument is rich in classical references and considers not only the current symptoms, but also the development of the pathogenesis and the physiological characteristics of the internal organs, demonstrating a deeper level of thinking.

On the judging panel, the experts whispered among themselves and discussed the matter in hushed tones.

Lu Yuanmin's eyes gleamed. He looked at Chen Yang and found that Chen Yang remained calm, seemingly unsurprised by Zhuang Qiwen's "sudden idea".

"This young man... his clinical thinking is indeed flexible, and he doesn't stick to old methods," Lu Yuanmin thought to himself.

Finally, after deliberation by the judging panel, Lu Yuanmin announced the results.

In the second round of the "prescription speed competition", Dr. Cheng Yi from the provincial team with the bulk prescriptions gave the correct answer and reacted quickly, making him the one with the highest basic score in this round.

"Dr. Zhuang Qiwen's optimization approach from the Kyoto team is based on a deep analysis of the pathogenesis and has its merits. Although it is not the standard answer, it demonstrates a higher level of clinical thinking. Therefore, we award him bonus points. Based on the overall assessment, the Kyoto team wins again in this round!"

"Wow!"

The crowd erupted in chaos!

The members of the bulk provincial team all looked extremely grim.

Cheng Yi gave a perfect answer, yet he still lost? This...

Cheng Yi himself was stunned, his face showing obvious astonishment and resentment for the first time.

He believed his answer was flawless, but he lost because of the opponent's deduction of "possibilities".

Wu Yongping's expression also turned serious.

He realized that the group of young people brought by Chen Yang not only had solid basic skills, but what was even more frightening was their "active" thinking that allowed them to delve into the pathogenesis of diseases and dare to question and optimize classic prescriptions.

This contrasts sharply with the Wu School's emphasis on "adhering to tradition" and "lightness and tranquility."

Two consecutive losses put the bulk provincial team in a very passive position, and the atmosphere on site became increasingly tense and delicate.

The audience, especially the local doctors and students from the province, had mixed feelings. They were anxious about the local team's defeat, but also impressed by the Kyoto team's strong performance and unique thinking.

"This Kyoto team is just too strong!"

"That Zhuang Qiwen looks calm and collected, but I didn't expect him to be so sharp-tongued!"

"Senior Brother Cheng performed very well, it's a pity..."

"There's one last round, there's still a chance!"

The host's voice rang out again, silencing the noise in the room: "After two rounds of fierce competition, the Kyoto team is currently in the lead! Next up is the third round that will determine the final outcome—'Clinical Treatment'! Let's wait and see!"

The air inside the auditorium seemed to freeze.

Two consecutive defeats weighed heavily on the hearts of every member of the provincial team.

Cheng Yi's gentle demeanor had been replaced by solemnity, and the team members behind him were even more tense, their eyes filled with the determination to fight a desperate battle.

Losing at home is an unacceptable result for them.

In contrast, the Kyoto team, including Zhuang Qiwen and Yu Shiyun, also felt the pressure, but more than that, they felt a surge of fighting spirit and confidence.

Winning two games in a row proved their strength and gave them a deeper understanding of Chen Yang's teachings on "precise dialectics" and "daring to establish arguments".

The atmosphere on the judges' panel was equally subtle. Lu Yuanmin and several senior members of the Wu School remained calm, but their exchanged glances revealed underlying tension.

Wu Yongping's fingers tapped unconsciously on the table, revealing his inner turmoil. Chen Yang, on the other hand, remained calm and composed, as if the outcome of the competition on stage was irrelevant to him. Only occasionally, when he glanced at the trainees, did he reveal a hint of barely perceptible concern and encouragement.

"The third round, 'clinical treatment,' is now beginning!"

The host's voice carried a hint of solemnity: "In this round, we will invite three real patients with complex conditions and clear diagnoses. Each team needs to send three members to conduct the four diagnostic methods of 'inspection, auscultation, inquiry, and palpation' on the three patients, with a time limit of twenty minutes."

"After the consultation, each patient independently provided a TCM diagnosis, syndrome differentiation analysis, treatment principle, and specific prescription. Finally, the judging panel evaluated and scored each patient's treatment plan based on its rationality, innovation, and expected efficacy."

The rules were announced, causing an uproar throughout the venue.

Using real patients, independent diagnosis?

This is very close to actual clinical work, and it greatly tests a doctor's true skills, psychological qualities, and ability to adapt to changing circumstances. Any slight oversight or misjudgment can be magnified infinitely.