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

Next, Zhuang Qiwen leaned closer to observe the patient's tongue.

The tongue was dark purple, with a dry, cracked, grayish-black coating and swollen, dark purple veins under the tongue, indicating a complex and critical situation involving blood stasis, water retention, and heat in the body.

Finally, Zhuang Qiwen calmed himself down, extended three fingers, and placed them on the patient's thin, bony wrist, which was covered with edema.

The pulse is deep, weak, and hesitant, like a light knife scraping bamboo; when pressed hard, it is barely perceptible, as if it will break off at any moment.

Throughout the entire examination, Zhuang Qiwen was meticulous and composed. His focus and dedication inspired everyone present, and even the initially restless audience gradually quieted down.

Twenty minutes later, Zhuang Qiwen returned to his seat and picked up his pen to write.

On the other hand, Cheng Yi, representing the provincial team, finally stood up and walked towards the patient.

However, his movements were noticeably hesitant and sluggish, and his consultation and pulse-taking were not as smooth and natural as Zhuang Qiwen's. Fine beads of sweat even appeared on his forehead.

The immense pressure has already affected Cheng Yi's condition.

The contrast became even more pronounced when the two proposals were finally projected onto the big screen.

Bulk Provincial Team Cheng Yi's Plan:

Diagnosis: Abdominal distension (due to blood stasis in the liver and spleen, and internal retention of dampness)

[Diagnostic Analysis: The patient has been suffering from liver qi stagnation for a long time, leading to qi and blood stasis. The liver (wood element) controls the spleen (earth element), resulting in impaired spleen function and internal retention of dampness, manifesting as abdominal distension. The prolonged illness has also affected the kidneys, impairing their qi transformation function, hence the difficulty in urination.]

Treatment principle: Promote blood circulation, remove blood stasis, regulate qi, and promote diuresis.

[Prescription: Modified Tiaoying Yin combined with Wuling San. Ingredients: Angelica sinensis, Ligusticum chuanxiong, Paeonia lactiflora, Curcuma zedoaria, Corydalis yanhusuo, Areca catechu, Dianthus superbus, Lepidium apetalum, Morus alba root bark, Poria cocos, Atractylodes macrocephala, Polyporus umbellatus, Alisma plantago-aquatica, Cinnamomum cassia...]

Cheng Yi's plan followed the conventional approach to treating bloating, combining blood-activating and stasis-removing with diuresis and dampness-draining. The prescription was fairly standard, but in this critical situation, it seemed somewhat inadequate, lacking the do-or-die spirit to turn the tide.

Zhuang Qiwen's proposal, however, once again drew everyone's attention.

Kyoto team Zhuang Qiwen's proposal:

[Diagnosis: Abdominal distension (due to the accumulation of water retention and blood stasis, obstruction of the Triple Burner, and separation of Yin and Yang)]

[Analysis of the syndrome: This is not ordinary bloating, but rather a deep accumulation of 'water toxins' and 'blood stasis' in the liver, spleen, and kidneys, obstructing the water passages of the triple burner and causing the qi transformation function to almost cease!]

The water retention has nowhere to go and spreads throughout the body, hence the stubborn ascites and extreme swelling; blood stasis obstructs the collaterals, preventing the generation of new blood, hence extreme weakness and a sallow complexion; the triple burner is blocked, and the ascending and descending of qi is suffocated, hence nausea, vomiting, and difficulty breathing.

A purplish-dark tongue with a grayish-black coating, and a deep, weak, almost imperceptible pulse—this is a critical sign of a separation between Yin and Yang! Conventional methods of promoting blood circulation and diuresis are like trying to scoop up the sea with a spoon—they cannot shake the root of the problem!

[Treatment Principle: Break up blood stasis, clear the bowels and eliminate turbidity, open the stagnation and consolidate the body!]

[Prescription: Modified Didang Decoction combined with Jijiao Lihuang Pill and Shenfu Decoction. Leech (powdered and taken with water), Tabanus (powdered and taken with water), Peach kernel, Rhubarb, Stephania tetrandra, Sichuan pepper, Lepidium seed, Ginseng, Aconite (decocted first), Dried ginger, Astragalus membranaceus, Glauber's salt (taken with water)...]

Zhuang Qiwen's treatment plan is even more drastic and aggressive than the prescription used by that uremia patient in Zhongzhou Province!

He actually used leeches and horseflies, insect-based medicines with extremely strong blood-breaking power, as well as Glauber's salt and rhubarb, which have a strong purgative effect. He also used Ji Jiao Li Huang Wan, a medicine for expelling water retention, and added ginseng, aconite, astragalus, and other medicines that greatly replenish vital energy and restore yang to rescue from collapse.

This is simply pushing both attack and replenishment to the extreme, like a high-stakes gamble, betting on forcibly opening up the Sanjiao channels blocked by stagnant blood and water toxins before the patient's body collapses!

"This is insane! Absolutely insane!" an elderly expert in the audience exclaimed in shock.

"Leech and horsefly are used to break up blood stasis, and rhubarb and Glauber's salt are used for strong purgation. How could the patient, who is so weak, possibly withstand it?"

"Is this saving lives or killing them?"

"This is too risky! This plan must not be approved!"

The voices of doubt and opposition came like a tidal wave, even more intense than when Xia Hongliang was questioned before.

After all, while Xia Hongliang's plan was unconventional, the medicine was relatively mild, whereas Zhuang Qiwen's plan, if not handled carefully, could be a death knell that hastened the patient's death!

Cheng Yi looked at Zhuang Qiwen's proposal, his pupils suddenly contracted. He opened his mouth, wanting to refute, but found himself at a loss for words in the face of the other party's "do-or-die" courage.

His solution was to "cure the disease," while Zhuang Qiwen's solution was to "save a life," which is a completely different level.

Wu Yongping's expression changed drastically, and he looked abruptly at Chen Yang: "Director Chen! This... Dr. Zhuang's plan, isn't it too... dangerous? The patient might die after just one dose..."

Lu Yuanmin also frowned, staring intently at Zhuang Qiwen, seemingly trying to gauge the extent of his confidence behind his astonishing courage.

Despite the doubts and opposition from the audience, Zhuang Qiwen remained calm.

"Fellow seniors and colleagues,"

Zhuang Qiwen spoke slowly, his voice steady and powerful, carrying a kind of determination that comes from years of hardship.

"This patient is on his last legs and in critical condition. Conventional methods have proven ineffective. If we continue to be timid and stick to old ways, we will truly destroy his last chance of survival."

As he spoke, Zhuang Qiwen pointed to the tongue and pulse images on the screen: "Please take a close look. The patient's dark purple tongue is not simply due to blood stasis, but rather to stasis and toxins; the gray-black, dry, and cracked tongue coating is not simply due to yin deficiency, but rather due to internal accumulation of turbid toxins that have transformed into heat and damaged yin; the deep, weak, and almost imperceptible pulse is not simply due to yang deficiency, but rather due to obstruction by pathogenic factors, suppression of vital energy, and an inability to escape!"

"This is the ultimate manifestation of 'excessive weakness'! Outwardly, it appears frail and weak, but inwardly, it is severely congested with water toxins and blood stasis!"

"If we do not use overwhelming force to break through the blockage, clear the channels, and expel the toxins, the obstruction will not be cleared, the vital energy will not be able to return to its proper place, and the yin and yang will inevitably separate!"

"I used insect-based medicines from Didang Decoction to break up the deep-seated blood stasis and clear the blockage in the water passages; I used Jijiao Lihuang Pills combined with Glauber's salt and rhubarb to purge the bowels and eliminate turbidity, giving the water poison an outlet; I used ginseng, aconite, and astragalus not simply to tonify, but in this critical moment of life and death, to 'support the body's resistance to expel pathogens,' to lift up the vital energy, and to help the patient get through this most dangerous 'breakthrough' stage!"

"This is not recklessness, but rather 'seeking life in the face of death'! The Inner Canon says, 'In severe cases, one walks alone.' At this time, only this potent remedy can save one from this grave danger!"

Zhuang Qiwen's arguments were like a resounding bell, awakening and enlightening.

He dissected the seemingly perilous plan thoroughly, clearly demonstrating its necessity, urgency, and underlying logic to everyone.

That confidence and sense of responsibility, built upon profound theoretical knowledge and rich practical experience, completely captivated the entire audience.

The audience was completely silent; everyone was awestruck by Zhuang Qiwen's boldness and courage.

Mr. Lu Yuanmin slowly closed his eyes, then opened them a moment later, his eyes gleaming. He looked at Chen Yang and asked in a deep voice, "Director Chen, what do you think of this plan?"

All eyes immediately focused on Chen Yang.