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

Chen Yang looked at the patient's medical records.

The patient had a cholecystectomy five days ago and started vomiting on the second day after the operation. After several days of active treatment, the vomiting was still not under control and jaundice also appeared. Today is the fifth day after the operation.

In addition to vomiting, accompanied by abdominal distension, the stomach and intestines of silkworm chrysalis were decompressed, and neither abdominal distension nor vomiting were relieved.

"I was just going to call you."

Ma Qiang said from the side.

As the director of the department, it is impossible for Ma Qiang to pay attention to every patient's condition at all times. Patients in the hospital have their own attending physicians. As long as the situation is controllable, lower-level doctors rarely take the initiative to ask higher-level doctors for help.

This is why it is said that shaking people is the patent of interns and the explosion skill of interns.

Logically speaking, every doctor can make decisions. The hospital implements a hierarchical system. If lower-level doctors cannot solve the problem, they will naturally have to ask higher-level doctors for help.

However, as a formal doctor, especially a doctor who has been working for several years, if you can't solve some problems and go to a superior doctor casually, you will be scolded.

In other words, interns are the only ones who talk. Experts won't say much when they come. After all, they are interns. If they don't know or don't understand, that's normal. It's the learning stage.

Otherwise, will the superior doctor do anything else if he shakes people off at every turn?

The patient's situation is not uncommon in clinical practice, and the attending doctor in charge has been taking treatment measures. It was only when Ma Qiang did his ward rounds today that he learned that the patient had been vomiting for several days after the operation.

After checking the situation, Ma Qiang was about to call Chen Yang over, but before he could, Chen Yang came over on his own initiative.

"Liu Xi, what do you think?" Chen Yang asked Liu Xi.

"The patient is in poor spirits, is emaciated, has jaundiced scleral skin, has low appetite, feels bloated after eating even a little bit, and urinates like strong tea. He rarely has bowel movements after surgery..."

Liu Xi was also looking at the medical records and observing the patient. He said, "The patient is in this condition after surgery. It should be due to liver stagnation and spleen deficiency, damp-heat obstruction, and stomach qi going up and down."

"Ah."

Chen Yang nodded and said: "The reason for the patient's vomiting should be two-fold. On the one hand, it is mild reflex intestinal paralysis. It is recorded in the medical record that the patient has weak bowel sounds and rarely defecates. These are all due to long-term stagnation of spleen deficiency. "

"Secondly, the patient underwent cholecystectomy, which caused inflammation of the bile duct. The disease was in the gallbladder and in the stomach."

As he spoke, Chen Yang sat down on the edge of the hospital bed and stretched out his hand to check the patient's pulse. While checking the pulse, Chen Yang said: "I feel that when treating post-operative patients, one thing cannot be ignored, and that is the patient's pre-operative symptoms. , what was the reason for the surgery?”

Liu Xi's eyes lit up, Chen Yang said it well.

"Traditional Chinese medicine is based on syndrome differentiation as a whole, and the patient's preoperative symptoms involve the overall judgment." Liu Xidao.

"good."

Chen Yang said: "I have seen some cases of postoperative treatment before. Many doctors often ignore the patient's preoperative condition and only focus on the postoperative period. This often leads to incomplete judgment."

When a patient undergoes surgery, a series of conditions may occur postoperatively, including infection or other complications, but the cause of the patient's surgery is also critical.

Although Western medicine surgery removes the affected part of the patient, in traditional Chinese medicine, it does not mean that if there is a problem with the diseased part, there will be no problem with other parts.

For example, in the patient's condition, the reason for cholecystectomy is bile duct inflammation, and the cause of bile duct inflammation is also very important.

"Of course, the patient's condition will definitely change after surgery, but we must also start judging from the antecedents."

Chen Yang said: "Even without surgery, the patient's condition can easily cause nausea and vomiting."

"Uh-huh."

Liu Xi hurriedly took a notebook and wrote down what Chen Yang said.

Since we are a group, we need to summarize some experiences. Postoperative patients are relatively a special group of patients.

Before modern surgery, it can be said that the patients faced by traditional Chinese medicine did not have postoperative patients. Now with the popularization of surgery, the number of postoperative patients can be said to be a relatively large base.

Postoperative patients have their own characteristics.

The first is the loss of qi and blood and the loss of righteousness after the operation. The second is that depending on the operation, the coordination and balance of the internal organs are broken.

Just like the total splenectomy patient treated by Chen Yang yesterday, due to splenectomy, the balance of yin and yang is broken, and the balance between the internal organs is different from that of healthy people.

These situations all need to be considered during treatment.

"So gallbladder stagnation, spleen deficiency, damp-heat obstruction, and stomach-qi ascending are the root causes of vomiting in patients." Liu Xidao.

"Correct."

Chen Yang nodded, Liu Xi's judgment was still correct.

"Pulse thin and stringy."

Chen Yang stood up and checked the patient's tongue coating. The coating was yellow and thick.

“You can start by promoting gallbladder and spleen, clearing away heat and dampness, and promoting qi and stagnation.”

As he spoke, Chen Yang wrote a prescription and handed it to Ma Qiang.

"You are experts in this area, just follow this treatment plan."

Chen Yang's level was recognized by Ma Qiang, so Ma Qiang did not interfere and directly handed the prescription to the attending doctor: "Treat according to Dr. Chen's plan, pay attention to the patient's condition at all times, and communicate with Dr. Chen in a timely manner ”

"I understand, Director Ma."

The attending doctor was a middle-aged man in his early forties. Hearing this, he nodded hurriedly and looked at Chen Yang in surprise.

Is this Chen Yang, who has been making a lot of noise in the hospital these days?

"Xiao Chen, I'm glad you can come."

After Chen Yang opened the prescription, Ma Qiang and Chen Yang came out of the ward together. As they walked, Ma Qiang said: "Just based on your analysis just now, I know I have found the right person."

Liu Xi: "......".

"Director Ma, do you understand?" Liu Xi muttered in his heart.

Ma Qiang really recognized Chen Yang.

"Thank you, Director Ma." Chen Yang thanked him.

"You're welcome."

Ma Qiang smiled and said: "Let's go, let me take you to understand the situation of other patients first. From today on, you have the right to participate in the treatment of all patients in our department, and I will explain it."

You Junhui opened his mouth, and I was so surprised.

Director Ma has completely delegated his power. Can Chen Yang be fully responsible for all patients in the hepatobiliary surgery department?

"Thank you, Director Ma." Chen Yang thanked him again.

"Don't be polite to me."

As he spoke, Ma Qiang took Chen Yang around the ward, and then called the doctors in the department for a small meeting to explain his decision just now.

"From today on, the medical team of Chen Yang and Liu Xi has cooperated with our department. The medical team has the right to intervene in all patients in the department. The treatment plan is based on the medical team's plan. If you have any objections, you can Come to me directly.”

All the doctors in the Department of Hepatobiliary Surgery were shocked.