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

The judging panel held a lengthy discussion.

Finally, Lu Yuanmin announced the results: "The first patient, the treatment plan of Dr. Liu from the provincial team, was accurate in diagnosis, the prescription was sound, and it deeply grasped the essence of warming yang and resolving phlegm, making it highly feasible."

"Dr. Zeng Yunhui's treatment plan from the Kyoto team is more insightful in its diagnosis, proposing the pathogenesis of 'phlegm, blood stasis, and water retention,' a unique perspective. Using Buyang Huanwu Decoction as the main formula demonstrates exceptional courage and theoretical innovation and breakthroughs. However, this plan is quite drastic and requires careful verification for elderly patients with debilitating conditions. Considering all factors, in this round… both sides are evenly matched!"

draw!

This result affirms both Dr. Liu's prudent approach and Zeng Yunhui's treatment plan.

For Zeng Yunhui, achieving a draw under such pressure and doubt was already a victory. He secretly breathed a sigh of relief, feeling his back soaked with sweat.

Zhuang Qiwen cast an approving glance at Zeng Yunhui.

After a short break and comments from the judges, the second patient was invited to the stage.

This was a middle-aged woman, her face haggard, her brows furrowed, as if she were enduring immense pain. She walked up with faltering steps, supported by her family members.

Large screen information display:

[Patient Zhang, female, 48 years old]

[Western medical diagnosis: Generalized anxiety disorder, somatic symptom disorder, menopausal syndrome]

[Brief Medical History: The patient has experienced low mood, irritability, anxiety, and worry for the past two years, accompanied by palpitations, chest tightness, insomnia, vivid dreams, headaches, migratory pain throughout the body, poor appetite, and abdominal distension. He has visited general hospitals multiple times, ruling out organic lesions, and was diagnosed with anxiety disorder. Anti-anxiety medications have been ineffective, and the side effects are intolerable.]

The resident physician added: The patient is currently fatigued, feels a sensation of something stuck in her throat that she cannot cough up or swallow (globus hystericus), and has irregular menstruation with scanty, dark-colored flow. Tongue examination shows a dark red tongue, especially at the tip and edges, with a thin, slightly greasy yellow coating. Pulse is thready, wiry, and slightly rapid.

"Please send your second team member!"

This time, the provincial team didn't hesitate at all, and Cheng Yi stood up immediately!

He must personally take the field and win this game in order to stabilize his position and preserve his chances of victory.

Meanwhile, Zhuang Qiwen was about to get up when Xia Hongliang stopped him.

"Dr. Zhuang, let me take over this round."

As he spoke, Xia Hongliang smiled at Zhuang Qiwen and casually stood up.

Zhuang Qiwen subconsciously looked at Chen Yang, and only after seeing Chen Yang nod did he nod to Xia Hongliang.

Xia Hongliang's skill level is beyond doubt; he is the strongest in the team besides Zhuang Qiwen, especially since Xun Jiahong went with Xiao Jingyun.

"Senior Brother Cheng is finally on stage!"

"Huh, it's not Zhuang Qiwen on the other end..."

"Xia Hongliang? I've never heard of him before!"

In the bulk goods province, Xia Hongliang is indeed a relatively unfamiliar figure. In fact, Xia Hongliang's ranking in the medical competition is not low, ranking seventh.

However, in many competitions, only the top three are often remembered, while the second place is often overlooked, let alone the seventh.

Moreover, Xia Hongliang was well-known within the Kyoto International Medical Center, but not to the outside world, since Chen Yang handled many acute and critical cases.

Upon seeing that it was Xia Hongliang instead of Zhuang Qiwen, Cheng Yi was also taken aback for a moment, but quickly regained his composure.

Cheng Yi and Xia Hongliang approached the patient from either side and began their respective examinations.

Cheng Yi's consultations were gentle and meticulous, his voice soft and his patience evident, fully embodying the Wu School of Medicine's emphasis on "emotional well-being." He not only inquired about the symptoms but also carefully examined the patient's work stress, family relationships, the specific triggers for emotional fluctuations, and the subtle sensations of discomfort, attempting to find clues to the source of the illness in the patient's life.

In contrast, Xia Hongliang appeared more "casual." His consultations were not impolite, but rather clear and focused, like a precise surgical scalpel, getting straight to the heart of the matter. He paid particular attention to the nature and specific location of the patient's migratory pain throughout the body, as well as key aspects reflecting the body's Qi and fluid metabolism, such as diet and bowel movements.

Both of them performed the examinations—observing the tongue and taking the pulse—with utmost care.

Cheng Yi took a long time to take the pulse, pressing lightly with his fingertips and frowning slightly, as if he was concentrating on capturing every subtle rise and fall and change in the thin pulse, trying to interpret the complex information of qi and blood behind it.

During the consultation, Xia Hongliang would frequently observe the patient's eyes, complexion, and subconscious body language with sharp eyes, as if reading a silent book.

The twenty-minute diagnosis time passed in the blink of an eye. The two returned to their seats, picked up their pens, and focused on writing furiously on the answer sheets.

When their treatment plan was clearly projected onto the big screen, a chorus of suppressed gasps erupted from the audience!

The two diagnoses surprisingly differed significantly!

Bulk Provincial Team Cheng Yi's Plan:

[Diagnosis: Depression (liver qi stagnation transforming into fire, mental confusion)]

[Analysis of the syndrome: The patient is approaching the age of 49, and his reproductive function is nearing its end. His liver and kidney yin and blood are gradually depleted, leading to a failure of water to nourish wood, resulting in stagnation of liver qi. Prolonged stagnation transforms into fire, disturbing the mind and causing symptoms such as irritability, anxiety, and insomnia. Liver fire, accompanied by phlegm, ascends along the meridians and accumulates in the throat, causing globus hystericus. Stagnant wood qi overpowers earth qi, causing disharmony in the spleen and stomach, resulting in poor appetite and abdominal distension. The generalized pain is a sign of qi stagnation and poor blood circulation.]

[Treatment principle: Soothe the liver and clear heat, relieve depression and calm the mind, supplemented with nourishing the liver and kidneys.]

[Prescription: Modified Danzhi Xiaoyao San combined with Suanzaoren Tang and Banxia Houpu Tang. Ingredients: Moutan bark, Gardenia fruit, Bupleurum root, White peony root, Angelica sinensis, Atractylodes macrocephala, Poria cocos, Mentha haplocalyx, Prepared ginger, Licorice root, Suanzaoren seed, Anemarrhena rhizome, Ligusticum chuanxiong rhizome, Poria cocos, Pinellia ternata, Magnolia officinalis, Perilla leaf, Fresh ginger...]

Cheng Yi's plan is based on Danzhi Xiaoyao San to soothe the liver, clear heat and relieve depression, combined with Suanzaoren Tang to nourish the heart and blood, calm the mind and stabilize the will, and Banxia Houpu Tang to resolve phlegm and dissipate nodules, soothe the throat and relieve nausea.

The approach is clear, the prescription corresponds to the symptoms, and the theory, method, prescription and medicine are integrated in one go. It fully reflects the delicate style of Wu School of Medicine in regulating Qi and clearing heat and calming the mind. It also takes into account the physiological basis of the patient's gradual deficiency of liver and kidney Yin and blood during menopause and adds nourishing considerations. It can be described as steady, thoughtful and appropriate.

Xia Hongliang's proposal surprised everyone and even seemed unbelievable.

Kyoto team Xia Hongliang's proposal:

[Diagnosis: 1. Depression (disruption of the Shaoyang meridian, phlegm-heat disturbing the heart) 2. Lily disease!]

[Analysis of syndrome differentiation: The patient's symptoms are numerous, indescribable, and unpredictable, which is consistent with the description of "Lily Disease" in the "Essential Prescriptions of the Golden Chamber" as "wanting to eat but unable to eat, often silent, wanting to lie down but unable to lie down, wanting to walk but unable to walk... as if there were a spirit."

However, its core pathogenesis lies in the dysfunction of the Shaoyang meridian, leading to internal stagnation of gallbladder fire, internal generation of phlegm-heat, disturbance of the mind, and external spread of heat through the meridians. Gallbladder fire invading the stomach causes poor appetite and epigastric fullness; phlegm-heat accumulating in the throat causes globus hystericus; disturbance of the mind causes irritability and insomnia; and the spread of heat through the meridians causes migratory pain throughout the body. The patient's dark red tongue (indicating heat stagnation in the blood), yellow and greasy coating (indicating phlegm-heat), and wiry, thready, and rapid pulse (indicating stagnation of heat in the Shaoyang meridian and slight damage to Yin) are all clear signs of dysfunction of the Shaoyang meridian and internal disturbance of phlegm-heat.

[Treatment Principle: Harmonize the Lesser Yang, clear the Gallbladder and resolve phlegm, calm the mind and soothe the nerves.]

[Prescription: Modified Chaihu Jia Longgu Muli Tang combined with Wendan Tang. Ingredients: Chaihu, Huangqin, Banxia, ​​Shengjiang, Renshen, Dazao, Guizhi, Fuling, Longgu, Muli, Dahuang, Zhishi, Zhuru, Chenpi, Gancao...]

Xia Hongliang actually diagnosed a disease called "Lily Disease," which is almost ancient and even somewhat mysterious in clinical practice! And the main prescription he chose was "Bupleurum and Dragon Bone Oyster Shell Decoction" from the Treatise on Febrile Diseases, which is used to treat mental symptoms such as "restlessness, fright, and delirium" that occur after typhoid fever is mistakenly treated with purgatives!