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

"First, let's welcome the first patient."

An elderly male patient in a wheelchair was pushed up.

The patient was about seventy years old, with a pale and puffy complexion, listless spirit, slightly rapid breathing, and a faint smell of hospital disinfectant on his body.

The large screen simultaneously displays the patient's basic information and a summary of some Western medical examinations:

Patient Li, male, 71 years old

[Western medicine diagnosis: Chronic obstructive pulmonary disease (severe), pulmonary heart disease, NYHA Class III heart failure]

[Brief Medical History: A history of recurrent cough, sputum production, and shortness of breath for over 20 years, worsening with bilateral lower extremity edema for one month. Long-term home oxygen therapy. Recently admitted to the hospital due to a worsening infection. After treatment with antibiotics, bronchodilators, and diuretics, the acute symptoms have been somewhat controlled, but persistent cough with excessive sputum, shortness of breath upon exertion, and unsatisfactory reduction in edema.]

A senior resident physician stepped forward and briefly explained the patient's main symptoms: cough with copious, white, sticky phlegm that was difficult to expectorate; chest tightness and shortness of breath, which worsened with slight activity; pitting edema in both lower limbs, which left no mark when pressed; poor appetite, abdominal distension, oliguria, sensitivity to cold, and cold extremities.

The audience could clearly see that this was a typical critically ill patient with chronic respiratory disease affecting the heart. The condition was complex, the patient's vital energy was depleted, and the pathogenic factors lingered, making it extremely difficult to treat.

"Both teams, please send your first player onto the field!"

On the provincial team's side, Cheng Yi and his teammates quickly discussed the matter in hushed tones and then dispatched a middle-aged doctor, about forty years old, with a calm demeanor. He was the deputy chief physician of the respiratory department at the Provincial Hospital of Traditional Chinese Medicine, surnamed Liu, and had rich clinical experience, especially in treating pulmonary diseases.

On the Kyoto team's side, Zhuang Qiwen was about to get up when Zeng Yunhui spoke first: "Brother Zhuang, let me go first this time!"

Zeng Yunhui's eyes gleamed with determination and longing.

Since the Xinglin Competition, Zeng Yunhui has met many talented young people.

Looking back, he felt superior when he first met Chen Yang, but now he seems to be at the bottom of the team. Zeng Yunhui is eager to prove himself further in this challenging clinical trial process.

Zhuang Qiwen pondered for a moment, then looked at Chen Yang. Seeing Chen Yang nod slightly, Zhuang Qiwen also nodded to Zeng Yunhui and said, "Alright, be careful and grasp the core."

Zeng Yunhui nodded vigorously, took a deep breath, and steadily walked towards the patient on the stage.

Dr. Liu and Zeng Yunhui came to the patient's sides and began their examinations almost simultaneously.

Both of them were fully focused on the consultation, tongue examination, and pulse taking, not daring to slack off in the slightest.

Zeng Yunhui asked very detailed questions, including not only the color, texture, and amount of phlegm, but also details such as whether the person was thirsty, preferred hot or cold drinks, sweating, and sleep quality.

Afterwards, Zeng Yunhui bent down to carefully observe the patient's tongue, which was pale and swollen with a thick, greasy white coating and teeth marks on the edges. Then, she focused her mind and placed three fingers on the patient's wrist, carefully feeling the pulse beneath.

The pulse is deep, thready, and slippery, but weak when pressed firmly.

Twenty minutes passed quickly, and the two returned to their respective areas to begin writing their diagnostic plans.

The entire room fell silent; everyone held their breath, awaiting their answer.

Soon, the two proposals were displayed on the big screen.

Bulk Provincial Team Doctor Liu's Plan:

[Diagnosis: Pulmonary distension (due to Yang deficiency and water retention, with phlegm obstructing the lungs)]

[Diagnostic Analysis: The patient has been ill for a long time, resulting in deficiency of the lungs, spleen, and kidneys, weakened Yang Qi, and internal retention of dampness. This dampness ascends to the heart and lungs, causing cough and wheezing, and overflows to the skin, causing edema. Phlegm obstructs the interior, leading to stagnation of lung Qi.]

[Treatment Principle: Warm the Yang and resolve phlegm, purge the lungs and relieve asthma, supplemented with strengthening the spleen and resolving phlegm.]

[Prescription: Modified Zhenwu Decoction combined with Sanzi Yangqin Decoction and Tingli Dazao Xiefei Decoction. Ingredients: Aconite (decocted first), Poria, Atractylodes macrocephala, White peony root, Fresh ginger, Perilla seed, White mustard seed, Radish seed, Tingli seed, Jujube, Codonopsis pilosula, Astragalus membranaceus...]

Dr. Liu's treatment plan closely addresses the "Yang deficiency and water retention" issue. It primarily uses Zhenwu Decoction, which warms Yang and promotes diuresis, combined with Sanzi Yangqin Decoction, which resolves phlegm and lowers Qi, and Tingli Dazao Xiefei Decoction, which clears the lungs and relieves asthma. The approach is clear, the prescription is extensive, and it reflects the idea of ​​combining attack and tonification, which is quite in line with the style of the Wu School of Medicine in dealing with such complex diseases.

Several veteran experts from the Wu School on the judging panel nodded slightly.

Next up is Zeng Yunhui's proposal.

Kyoto team Zeng Yunhui's proposal:

Diagnosis: Lung distension (deficiency of lung, spleen, and kidney qi, with phlegm, blood stasis, and fluid retention)

[Analysis of the syndrome: The patient has been ill for a long time, with deficiency of Qi in the lungs, spleen, and kidneys as the root cause, and water retention as the superficial manifestation. However, upon closer examination, the Qi deficiency weakens the body's ability to propel fluids, leading to the accumulation of phlegm and sluggish blood circulation. The phlegm, blood stasis, and water retention intertwine, obstructing the lung channels and hindering the airways, which is the key to the pathogenesis. Simply warming Yang and promoting diuresis may not be enough to resolve the congealed pathogenic factors.]

Treatment principle: Tonify Qi and invigorate blood circulation, resolve phlegm and promote diuresis, unblock the meridians and relieve asthma.

[Prescription: Modified Buyang Huanwu Decoction combined with Linggui Zhugan Decoction and Shegan Mahuang Decoction. Ingredients: Raw Astragalus, Angelica sinensis (tail), Red Peony Root, Earthworm, Ligusticum chuanxiong, Peach Kernel, Safflower, Poria cocos, Cinnamon Twig, Atractylodes macrocephala, Licorice Root, Shegan, Ephedra, Asarum, Schisandra chinensis, Pinellia ternata, Fresh Ginger...]

As soon as Zeng Yunhui presented his proposal, a murmur of gasps rippled through the audience!

Buyang Huanwu Decoction? Isn't that a formula for treating qi deficiency and blood stasis in the sequelae of stroke?

He actually used such a prescription to treat pulmonary edema?

Even the experts on the judging panel showed expressions of surprise. Lu Yuanmin leaned forward slightly, carefully examining the prescription ingredients on the screen.

Wu Yongping frowned and said in a low voice, "Using Buyang Huanwu Decoction to treat lung distension? This... is a rather unconventional approach."

A faint smile appeared on Chen Yang's lips. It seemed that Zeng Yunhui had made great progress this year. Although his ranking hadn't improved much, that was because there were many geniuses and Li Haofei and Wen Manlu had been playing exceptionally well. Zeng Yunhui's own level had improved significantly.

Zeng Yunhui began to explain his thoughts in a clear voice, though with a hint of nervousness, his logic was clear.

"Although the patient exhibits signs of Yang deficiency, such as aversion to cold and cold limbs, his tongue is pale and swollen rather than pale and tender, with a thick, greasy white coating, and his pulse is deep, thready, and slippery. This indicates an accumulation of phlegm and turbidity, with internal stagnation. Qi deficiency weakens the body's ability to circulate blood, and coupled with water retention, this inevitably leads to poor blood circulation and internal blood stasis. The intertwining of phlegm, water retention, and blood stasis is the root cause of the prolonged illness and the ineffectiveness of conventional methods of warming Yang and promoting diuresis."

After a pause, Zeng Yunhui continued, "Therefore, I used Buyang Huanwu Decoction with a heavy dose of raw Astragalus to greatly replenish the vital energy, so that when the energy is strong, the blood will flow smoothly. I combined it with a large amount of blood-activating, stasis-removing, and meridian-clearing herbs such as Angelica sinensis tail, Paeonia lactiflora, Pheretima aspergillum, Ligusticum chuanxiong, Prunus persica, and Carthamus tinctorius, aiming to break through deep-seated stagnation and clear the obstruction of the water passages and the flow of Qi. I then combined it with Linggui Zhugan Decoction to warm and resolve phlegm and fluid retention, and Shegan Mahuang Decoction to promote lung function and relieve asthma. In this way, I replenish Qi to treat the root cause, and activate blood, resolve phlegm, and promote diuresis to treat the symptoms. I address both the root cause and the symptoms, and the key is the word 'unblock,' giving the pathogenic factors a way out!"

Zeng Yunhui's argument completely breaks away from the framework of "yang deficiency and water overflow". He introduces the key pathogenesis of "phlegm and blood stasis" and chooses the seemingly unrelated "Buyang Huanwu Decoction" as the main prescription. He is extremely bold, but also very reasonable!

A heated discussion ensued in the room.

"Using blood circulation and removing blood stasis to treat pulmonary bloating? Unheard of!"

"But he has a point. These types of patients do have blood stasis problems."

"Is Buyang Huanwu Decoction... safe to use? Wouldn't it be too aggressive?"

"This Dr. Zeng is so young, but his way of thinking... is terrifying!"

Cheng Yi looked at Zeng Yunhui with a complex expression. He had to admit that the young Dr. Zeng's active thinking and unique insights far exceeded his expectations.