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

There was no competition or rivalry between the Jiangdong group and Chen Yang's group; everyone was simply exchanging ideas, and the atmosphere was indeed quite pleasant.

The directors also seriously considered Zeng Yunhui's statement, and did not send any of their key figures to provoke him.

After listening, the head of the neurology department nodded repeatedly: "That makes sense! We have indeed focused too much on the root cause of 'qi deficiency' and not enough on the symptoms of 'wind' and 'cold'. Dr. Zeng's line of thinking has given us a wake-up call."

After discussing the two cases, the doctors at the First Affiliated Hospital were very impressed with Chen Yang's team.

These young people not only have a solid theoretical foundation and active thinking, but their proposed solutions are also closely related to clinical challenges, and are both groundbreaking and in line with established principles.

The third case is more complex. It involves a patient with advanced pancreatic cancer who, after surgery and chemotherapy, developed extensive metastasis and is currently in a state of cachexia, experiencing severe pain and relying on high-dose painkillers. The patient also has severe jaundice, ascites, nausea, and vomiting.

The oncology department of the First Affiliated Hospital has concluded that the treatment is "palliative care." Currently, the main focus is on pain relief and nutritional support. Traditional Chinese medicine has been used to treat some cases of tonifying the body's resistance, eliminating pathogenic factors, promoting bile secretion, and reducing jaundice, but the effects are limited.

In this case, the doctors at the First Affiliated Hospital were more interested in hearing the opinions of Chen Yang's team than expecting any major breakthroughs.

Zhuang Qiwen examined the patient's photos and information closely. In the photos, the patient's face was emaciated and withered, his eyes were sunken, and he had a distended abdomen and sallow skin...

After reviewing the case, Zhuang Qiwen did not immediately propose a treatment plan, but instead asked a series of questions.

What is the specific location and nature of the pain?

Is the color of jaundice bright yellow or dark yellow?

What is the nature of ascites?

What does vomit look like?

What is the most painful thing?

Is there any unfulfilled wish?

The head of the oncology department answered each question: The pain is a persistent dull ache, sometimes with a tearing sensation; the jaundice is smoky in color.

The ascites is a transudate, but it has become somewhat cloudy recently; the vomit is mostly clear phlegm.

The most painful symptoms for patients are pain and a feeling of tightness.

My wish... is to eat another bite of rice noodles from my hometown.

Zhuang Qiwen paused for a moment, then slowly said, "This condition is a combination of 'mass accumulation,' 'jaundice,' 'abdominal distension,' and 'consumption' in traditional Chinese medicine. The pathogenesis is complex, the body's vital energy is extremely depleted, and pathogenic factors (cancer toxins, dampness, and blood stasis) are rampant."

"Conventional methods of supporting the body's resistance and eliminating pathogens, and combining attack and tonification, are unlikely to be effective. The patient's current greatest suffering is twofold: cancer pain and the distension caused by ascites and jaundice."

After a moment's thought, Zhuang Qiwen said, "Perhaps we can temporarily set aside the almost impossible goal of 'fighting cancer' and concentrate all the medicine's power on solving the patient's two most painful symptoms—pain relief and swelling reduction."

"To minimize the suffering of patients in their final days, and even to help them fulfill a small wish."

"In terms of pain relief, in addition to Western analgesics, traditional Chinese medicine can consider using insect-based drugs and highly toxic drugs that promote blood circulation, remove blood stasis, clear the channels, relieve pain, and have anti-cancer effects, such as toad skin, gecko, corydalis, and cynanchum paniculatum, and combine them with tonifying drugs to reduce toxicity."

"In terms of relieving bloating and promoting bile secretion, on the basis of strengthening the spleen and promoting diuresis, add blood-activating, diuretic, bowel-clearing and turbidity-eliminating drugs, such as motherwort, lycopus lucidus, rhubarb, and mirabilite, while also using heavy doses of jaundice-reducing drugs such as artemisia capillaris, red peony root, and turmeric."

"The prescription may be very large, very 'complex', and even somewhat 'unconventional'. The goal is not to cure, but to 'reduce symptoms' and improve the final quality of life."

After Zhuang Qiwen finished speaking, the conference room fell silent.

This approach completely breaks away from the framework of "anti-cancer" and turns to pure "palliative care and symptom reduction," and the use of drugs is extremely bold.

The head of the oncology department finally spoke after a long silence, his voice somewhat hoarse: "Dr. Zhuang... your approach is indeed... very practical."

“We used to think about ‘fighting cancer’ even if it was just symbolic, but we overlooked the fact that what patients need most at this moment is to alleviate their pain.”

After a pause, the other person continued, "The medication used here... carries a high risk, but if the combination is appropriate and the monitoring is close, perhaps... it really is worth a try."

He then turned to Chen Yang and asked, "Director Chen, what do you think?"

Chen Yang pondered for a moment and said, "In the terminal stage of a disease, the goal of medicine sometimes needs to shift from 'cure' to 'care'."

"Dr. Zhuang's approach reflects a high degree of concern for patients' suffering and humanistic care. Under the premise of strictly adhering to the indications and ensuring safety, it can be regarded as a beneficial exploration."

This case discussion deepened the understanding of Chen Yang's team among the staff and staff of the First Affiliated Hospital.

The discussion ended at noon.

Liu Zhentao warmly invited everyone to lunch.

During the gathering, doctors from the First Affiliated Hospital came over to exchange ideas with members of Chen Yang's team, creating a lively atmosphere.

Taking this opportunity, Xia Hongliang leaned close to Chen Yang and whispered what he had learned about the "Grassland Medical Association" the night before.

Chen Yang also became interested after hearing this: "A grassroots, spontaneous medical skills exchange platform? That's interesting. Today happens to be the fifteenth..."

Chen Yang glanced at the expectant looks in his team members' eyes and smiled slightly: "The afternoon was originally scheduled for free exchange time. If you are interested, you can go and see for yourselves. But remember, observe more, listen more, think more, speak less, and don't rush into the game. We are guests, and we must respect the local customs."

Xia Hongliang and the others nodded excitedly.

Liu Zhentao also smiled and said, "This is indeed a rare scene for us. Director Chen can go and take a look if he wants to."

After lunch and a short rest, Chen Yang, along with Zhuang Qiwen, Xia Hongliang, Yu Shiyun, Zeng Yunhui, and five or six others, led a doctor arranged by Liu Zhentao to the old street area behind the City God Temple.

Li Chengjie, Qu Wenxuan, and others stayed at the hospital to continue in-depth exchanges with doctors from the First Affiliated Hospital.

The old streets of Jiangzhou are completely different from the modern urban landscape.

The cobblestone streets, the mottled arcade buildings, the narrow alleyways, and the various time-honored shops, snack stalls, antique shops, and many shops with signs for "medicine" and "pharmacy" are all lined up on both sides. The air is filled with the aroma of food, the smell of herbs, and the damp scent of moss.

The doctor who led the way was surnamed Sun. He was the deputy chief physician of the acupuncture department at the First Affiliated Hospital. He was in his forties and a native of Jiangzhou, very knowledgeable about local history and stories.

"This 'grassroots medical association' is said to have originated in the Ming and Qing dynasties, when itinerant doctors and resident doctors often exchanged ideas here."

As Dr. Sun walked, he explained, "Although it's not as formal now, there are still many folk TCM practitioners and even some doctors from hospitals coming here on the fifteenth of each month. Some come to exchange skills, some to make a name for themselves, and some just out of pure hobby."

As they talked, the group walked through several alleys, and suddenly the view opened up to a small square with a huge banyan tree in the center, its shade spreading wide.

By this time, a crowd of people, probably numbering in the hundreds, had gathered three or four layers deep under the banyan tree.

In the center of the crowd, there were several simple tables and chairs with pulse pillows, needles, paper and pens on them. Next to them stood a wooden sign with the four characters "Caize Medical Association" written in calligraphy.