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

"Set up a challenge? How will the competition be conducted?" Xia Hongliang's interest grew even stronger.

"It's basically like seeing a doctor on-site."

The young man found Xia Hongliang to be a nice person and quite talkative: "The organizers will find some patients with difficult cases, or even pretend to be patients themselves. This is called 'testing the doctors,' where participating doctors will diagnose and prescribe medicine on the spot. Experts watching, and even the patients themselves, can judge. Sometimes they argue until they're red in the face, it's quite a show, but..."

The young man lowered his voice: "It's a deep pool in there. There are real experts, but also those who are just muddling through. And some are sent by various pharmacies to 'challenge' or 'make a name for themselves'."

"You are experts from out of town. It's fine to go and see what's going on, but please don't get involved too easily."

Xia Hongliang thanked him and returned to his room, his mind already racing.

"The Grassroots Medical Association"? That sounds interesting. Should we tell Chen Yang?

Should we go and explore the area ourselves first?

Xia Hongliang glanced at the calendar. Coincidentally, tomorrow was the fifteenth of the lunar calendar.

The following morning, accompanied by Vice President Liu Zhentao, Chen Yang's team visited the First Affiliated Hospital of Jiangdong University of Traditional Chinese Medicine.

The First Affiliated Hospital is large in scale, with a towering outpatient building and a constant stream of patients. Unlike the refined and quiet atmosphere of the scattered Provincial Hospital of Traditional Chinese Medicine, the atmosphere here is more "lively" - the waiting area is bustling with noise, the information desk is crowded with people, the air is filled with a stronger aroma of Chinese medicine, and there is also some noise from local dialects.

"Our hospital sees more than 12,000 outpatients every day, which ranks among the top in the country among traditional Chinese medicine hospitals."

Liu Zhentao proudly introduced, "Especially the acupuncture and massage department, the orthopedics department, the gastroenterology department, and the oncology department are our trump cards."

During the visit, Chen Yang noticed some interesting phenomena.

The TCM treatments at the First Affiliated Hospital seem to emphasize "rapid results" and "strength".

In the acupuncture department, Chen Yang observed that the doctor's needling techniques were quite swift and powerful, and the acupoints selected tended to be "heavy and strong." In the pharmacy, some prescriptions appeared to have larger dosages than usual. Even in the corridor's bulletin board, he saw slogans such as "Three doses to know, five doses to cure" and "Instant results."

"People from Jiangdong are impatient; when they get sick, they want to get better quickly."

Liu Zhentao explained, "Therefore, our treatment style is relatively 'aggressive,' emphasizing 'powerful' effectiveness. This is quite different from the 'light and gentle' approach of the Wu School of Medicine."

Chen Yang nodded in understanding, saying that regional climate and cultural characteristics can influence the style of medical schools of thought, which is normal.

After visiting the outpatient clinic, the group went to the conference room for a small case discussion.

The First Affiliated Hospital has prepared three difficult cases and hopes to exchange ideas with Chen Yang's team.

The first case was a patient with intractable eczema, with erythema, papules, and exudation all over the body, and severe itching. The patient had a five-year history of the disease and had visited many hospitals, but both traditional Chinese medicine and Western medicine treatments were ineffective.

The director of the dermatology department of the First Affiliated Hospital first introduced the situation. Their current diagnosis is "damp-heat accumulation in the skin, blood heat and wind dryness". They are using the approach of clearing heat and dampness, cooling blood and dispelling wind, with modifications of Gentianae Radix et Rhizoma Decoction and Rhinoceros Horn and Rehmannia Decoction. However, the effect is inconsistent and cannot be cured.

"Director Chen, experts, do you have any new ideas?" the head of the dermatology department asked sincerely.

Chen Yang looked at his teammates.

Yu Shiyun hesitated for a moment, then raised her hand.

After receiving permission, Yu Shiyun got up and walked to the projector. She carefully looked at the patient's tongue and skin lesion photos, and asked a few more questions: "Is the patient usually sensitive to cold or heat? What is her bowel movement like? Is her menstruation normal?"

The doctor from the First Affiliated Hospital added: The patient is sensitive to cold and dares not use air conditioning even in summer; her stools are loose for a long time; her menstrual flow is scanty and dark in color, with blood clots.

Yu Shiyun pondered and said, "Judging from the skin lesions and tongue appearance, it is indeed a case of damp-heat and blood-heat. However, the patient also has symptoms of yang deficiency and cold-dampness, such as aversion to cold and loose stools. This may be a case of 'mixed cold and heat,' or even 'true cold with false heat.'"

Yu Shiyun proposed a new approach: "Could we consider that the patient's underlying condition is spleen and kidney yang deficiency, with internal cold and dampness that stagnates and transforms into heat, manifesting on the skin? In terms of treatment, perhaps we cannot simply focus on clearing heat and eliminating dampness, but rather on warming yang and resolving dampness, guiding the fire back to its source, while also cooling the blood and dispelling wind. Perhaps the prescription could be modified from the approach of combining Ephedra, Aconite, and Asarum Decoction with Cinnamon Twig and Poria Pill and Rhinoceros Horn and Rehmannia Decoction?"

This approach is completely different from the current treatment methods of the First Affiliated Hospital, and even somewhat "goes against the grain," which immediately sparked a low discussion in the conference room.

The head of dermatology frowned: "Use Ephedra, Aconite, and Asarum Decoction? This formula is pungent, warm, and dispersing. The patient already has blood heat and wind dryness. Using hot medicine would be like adding fuel to the fire."

Yu Shiyun said calmly, "Director, although the patient has symptoms of heat, the root cause may be a deficiency of Yang Qi, with cold and dampness causing stagnation and preventing the heat from being released."

“Using ephedra, aconite, and asarum to open up the interior and exterior, and release stagnant heat, combined with Guizhi Fuling Wan to warm and unblock the blood vessels, and Xijiao Dihuang Tang to cool the blood and detoxify, may provide an outlet for stagnant heat, rather than simply suppressing it. Of course, the dosage and compatibility need to be carefully considered.”

Chen Yang nodded slightly. Yu Shiyun's line of thinking grasped the key point of doubt about "true or false cold and heat," demonstrating her delicate dialectical thinking.

Several senior experts from the First Affiliated Hospital were talking in hushed tones, seemingly moved by what they were seeing.

The head of dermatology also fell into deep thought, and finally said, "Dr. Yu's perspective is very novel and worth reflecting on. We will go back and conduct a more detailed four-step examination to re-diagnose this patient."

The second case is a stroke sequelae patient who was paralyzed on one side for a year. After acupuncture and rehabilitation treatment, he recovered to some extent, but recently he has experienced stiffness and pain in the affected limb, which worsens at night, accompanied by irritability and insomnia.

The current treatment at the Department of Neurology of the First Affiliated Hospital is to continue acupuncture combined with modified Buyang Huanwu Decoction, but the symptoms have not improved significantly recently.

This time, Zeng Yunhui volunteered.

Zeng Yunhui carefully examined the patient's condition, especially the state of the affected limb and the tongue and pulse. The tongue was dark purple with ecchymosis, the coating was thin and white, and the pulse was deep and hesitant.

"The Buyang Huanwu Decoction invigorates qi and promotes blood circulation, which is correct for the basic pathogenesis of qi deficiency and blood stasis after stroke."

Zeng Yunhui said, "But the patient's main problem right now is 'stiffness and pain,' which worsens at night. This suggests that there is not only blood stasis, but also 'wind' and 'cold'."

"'Blood stasis generates wind' means that blood stasis obstructs the meridians, hindering the flow of qi and blood, which can generate internal wind and cause muscle spasms. In addition, prolonged illness can lead to yang deficiency, internal or external cold pathogens, causing cold to congeal blood stasis and aggravating pain. Therefore, in addition to tonifying qi and promoting blood circulation, treatment should also include medications that dispel wind, unblock the meridians, warm the meridians, and dispel cold."

"I think that based on Buyang Huanwu Decoction, we can add insect-based medicines such as scorpion and centipede to dispel wind and unblock the meridians, and add cinnamon twig and asarum to warm and unblock the meridians. We can even consider adding a small amount of processed aconite to dispel cold and relieve pain."

Listening to Zeng Yunhui's proposal, the directors present all pondered for a moment, seemingly lost in thought.

Although the level of traditional Chinese medicine practitioners in Jiangdong Province is indeed higher, it must be admitted that this specialized path of dividing departments is not suitable for traditional Chinese medicine, or rather, not entirely suitable for traditional Chinese medicine. Therefore, the difference in the diagnosis and treatment of diseases is obvious, and the superiority of one over the other is immediately apparent.