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

"However, breakthroughs do not equate to recklessness, and exploring boundaries does not mean ignoring them. How to grasp the 'degree' in this regard is the core issue I want to discuss with you today."

Chen Yang's opening remarks were concise and powerful, directly stating the theme and instantly capturing everyone's attention.

"Next, I will elaborate on my views by combining some of the typical cases that our team has encountered recently, including those provided by your institute yesterday." Chen Yang operated the computer, and a PPT presentation began to appear on the large screen.

The first person to appear on the screen was the female diabetic patient that Yu Shiyun had treated in Zhongzhou Province.

Chen Yang recounted in detail the patient's symptoms, signs, the initial diagnosis of "yin deficiency and fire excess," and the poor efficacy of Zhi Bai Di Huang Tang.

"At that time, Dr. Yu Shiyun discovered the problem. She noticed that in addition to the symptoms of Yin deficiency, the patient also had obvious distending pain in the hypochondrium and irritability. She began to think that this was not just a problem with the lungs, stomach, and kidneys, but could it be related to the 'liver'?"

Chen Yang looked at Yu Shiyun below the stage, and Yu Shiyun lowered her head slightly, looking a little embarrassed.

"Her supervising physician, an experienced associate chief physician, believed that this was a typical case of yin deficiency and excessive fire, and that the slow effect was due to the long course of the disease. This is a common way of thinking in clinical practice, and following the steps seems to be perfectly reasonable."

Chen Yang changed the subject: "However, Dr. Yu did not give up on her doubts."

“She observed carefully and found that the patient’s pulse was thin and rapid with a wiry quality, his mouth was dry but he didn’t drink much water, and his palms and soles were hot but occasionally felt cold… These details pointed to the key pathogenesis of ‘liver stagnation transforming into fire, scorching yin fluids,’ which led to stagnation of qi and the inability of body fluids to ascend.”

"Therefore, she boldly proposed the idea of ​​'soothing the liver and clearing heat, nourishing yin and generating fluids' in parallel. Later, we jointly optimized it into Danzhi Xiaoyao San combined with Sha Shen Mai Dong Tang with modifications. As everyone knows, the patient's symptoms were quickly relieved and blood sugar dropped significantly."

Chen Yang concluded, "What does this case tell us?"

"It tells us not to let 'typical' diagnoses limit our thinking. Modern people face great pressure in their lives, and emotional factors are prominent in causing diseases. The influence of the liver in many chronic diseases, including what is traditionally considered 'diabetes,' cannot be ignored."

"Dr. Yu's breakthrough lies in her breaking out of the inherent framework of treating 'Xiao Ke' (a traditional Chinese medicine term for diabetes) from the perspectives of the lungs, stomach, and kidneys, and keenly capturing the often-overlooked boundary of the 'liver,' thus successfully expanding the boundaries of treatment."

Many doctors in the audience, especially endocrinologists, wore thoughtful expressions. This case was highly enlightening for them.

Next, the information of the second patient from yesterday, a middle-aged woman diagnosed with generalized anxiety disorder, appeared on the big screen.

Chen Yang reiterated the patient's condition and presented the treatment plans proposed by Cheng Yi and Xia Hongliang.

"Dr. Cheng Yi's combination of Danzhi Xiaoyao San with Suanzaoren Tang and Banxia Houpu Tang demonstrates accurate diagnosis and sound prescription, representing an excellent approach to treating this type of disease. It fully reflects the meticulous skill of the Wu School of Medicine in regulating Qi." Chen Yang first affirmed Cheng Yi's plan, showcasing his magnanimity.

Cheng Yi, sitting in the audience, was slightly moved, his feelings complicated.

"And Dr. Xia Hongliang..."

Chen Yang looked at Xia Hongliang, who grinned and said, "He took a more 'unconventional' path. He grasped the characteristics of the patient's symptoms: 'unpredictable,' 'mixed cold and heat,' and 'disrupted pivot mechanism.' He connected these symptoms with the 'Bupleurum and Dragon Bone and Oyster Shell Decoction Syndrome' in the Treatise on Cold Damage and the 'Lily Disease' framework in the Synopsis of Prescriptions of the Golden Chamber, and proposed a treatment plan based on the 'Shaoyang Pivot Mechanism.'"

Chen Yang explained in detail Xia Hongliang's diagnostic approach and the ingenuity of his prescription.

"This solution may seem bizarre, even absurd, but it is rooted in classics and represents a profound insight and high-level summary of the complex nature of the patient's condition."

"It breaks through the conventional approach of treating 'depression' primarily from the perspective of the liver and heart, elevating the location of the disease to the level of the 'Shaoyang pivot,' which governs the ascending, descending, entering, and exiting of Qi throughout the body, thus providing a broader perspective."

"Dr. Xia's breakthrough lies in his courage to creatively link seemingly ancient classical prescription theories with modern complex mental and psychological symptoms, and find an inherent high degree of compatibility."

"This reminds us that the value of classics lies not only in the prescriptions and medicines they record, but also in the profound thinking behind them that reveals the laws of human physiology and pathology. Our thinking cannot stop at simple prescription-symptom correspondence, but must deeply understand the logic of their pathogenesis in order to flexibly apply it to the ever-changing clinical practice."

These words drew frequent nods from many experts and students in the audience who were familiar with classical formulas, and their eyes were filled with admiration as they looked at Xia Hongliang. To be able to so skillfully apply classical formula theory to solve modern intractable diseases is no easy feat.

Finally, the information of the critically ill patient with decompensated cirrhosis and refractory ascites appeared on the big screen. The patient's tongue appearance, abdominal circumference photograph, and various critical laboratory indicators were all alarming.

The atmosphere in the auditorium became heavy.

Chen Yang, with a solemn expression, reviewed once again the patient's critical condition and the treatment plan proposed by Cheng Yi and Zhuang Qiwen.

"Dr. Cheng Yi's Tiaoying Yin combined with Wuling San is a common method for treating abdominal distension. It promotes blood circulation and diuresis, and the approach is clear. Under normal circumstances, or when the condition is mild, it is a feasible solution."

"but,"

Chen Yang emphasized, "For this critically ill patient whose life is ineffective with conventional treatments, 'conventional methods' are no longer sufficient."

"Dr. Zhuang Qiwen keenly observed that the core pathogenesis of this patient was no longer a simple case of 'internal retention of dampness,' but rather a deep-seated combination of 'water toxins' and 'blood stasis,' which obstructed the three jiaos, causing the qi transformation function to almost cease and the yin and yang to be on the verge of separation!"

As he spoke, Chen Yang once again displayed Zhuang Qiwen's "fierce" prescription, which contained leeches, horseflies, rhubarb, Glauber's salt, aconite, and ginseng.

"This plan caused huge controversy and concern at the time. Many people thought it was risky, or even... reckless."

Chen Yang's gaze sharpened: "However, Dr. Zhuang withstood the pressure."

"What is the basis for his diagnosis? It is his dark purple tongue, his dry and cracked gray-black tongue coating, and his pulse that is deep and weak, yet contains a hidden astringent quality! This is the ultimate manifestation of 'excessive strength with signs of weakness,' where extreme external weakness masks an extreme accumulation of internal pathogenic factors!"

"If we do not 'burn our boats' at this moment and use the power of thunder to break through the stagnation and turbidity, and open up the blocked triple burner, then the righteous qi will not be able to return to its proper place, and we will only be sitting and waiting for death!"

"Dr. Zhuang used insect-based medicines to break up the stubborn blood stasis and strong purgatives to clear the bowels, giving the pathogens a way out; at the same time, he used ginseng and aconite to greatly replenish the vital energy, restore yang and consolidate the body, supporting the patient through the difficult period. This is not recklessness, but a 'precise diagnosis' based on a deep understanding of the pathogenesis!"