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

Zhu Gaoyuan said: "The patient had been treated many times in other hospitals before coming to our hospital. She was diagnosed by Western medicine as having rheumatic heart disease, mitral stenosis with regurgitation, heart enlargement, heart function grade IV, lung infection, pleural effusion, and abnormal liver function." (The previous chapter said it was Gu Yingyin, but it was changed to Zhu Gaoyuan. Gu Yingyin is a doctor at the Children's Hospital)

"Considering the patient's heart failure, it is a typical case of Qi and Yin damage, combined with stagnation of phlegm, fluid, turbidity and toxins."

Zhu Gaoyuan continued, "So the method used in treatment is to invigorate Qi, drain the lungs and relieve asthma. At that time, considering that the patient had a cough and shortness of breath, it was considered that water retention was stagnant in the chest and ribs; the foot yangming meridian is responsible for descending, and all turbid evil and impurities descend from the yangming meridian, and the same is true for water retention. Water retention is stagnant and should not descend, so another aspect of the treatment is to strengthen the spleen and invigorate Qi, and at the same time slightly help the foot yangming meridian to descend turbidity."

"The prescription is Astragalus, Codonopsis, Polygonatum, Angelica dahurica, Purslane, Patrinia ..."

Zhu Gaoyuan also gave the prescription, and said: "During the treatment, some Western medicine treatments were not completely stopped. After three doses of the medicine, the patient's urine volume increased greatly, about three times, the symptoms of heart failure improved significantly, and the symptoms of shortness of breath also improved..."

"However, the patient's dry mouth symptoms did not decrease but increased, abdominal distension remained the same, shortness of breath and fatigue remained, appetite was poor, and there was a red glow in the tongue..."

Zhu Gaoyuan said: "However, judging from the situation at the time, the patient's overall symptoms have improved. After the patient continued to take the medicine for three doses, the urine volume increased again, the patient's leg swelling had disappeared, and the pleural effusion was significantly reduced during the follow-up examination. However, the patient was still tired, short of breath, and weak, accompanied by coughing, but could not cough up phlegm. It was better to lie flat during the day, but he still couldn't lie flat at night because he was short of breath."

Zhu Gaoyuan paused at this point and said, "The patient's condition is basically like this now."

After listening to Zhu Gaoyuan's talk about the patient's condition, the conference room fell silent, and many people turned their eyes to Xun Jiahong and Song Luojun.

The patient is Zhu Gaoyuan's patient. Most people are aware of Zhu Gaoyuan's level. Zhu Gaoyuan is in trouble now, so what clues can others have?

It is estimated that only Xun Jiahong and Song Luojun were at this level among those present. As for Chen Yang, many people did not pay attention to him.

Even though Chen Yang has attracted some people's attention in the past two days and his analysis of the symptoms just now was also very good, everyone still feels that Chen Yang cannot be compared with Zhu Gaoyuan.

Xun Jiahong stepped forward and examined the patient carefully.

The patient's current symptoms are dry mouth, lack of appetite, fatigue, shortness of breath, inability to lie flat, and nausea from time to time. The tongue is very red and dark in color, with no saliva, normal bowel movements, and a thin tongue.

The abdomen is soft and weak when palpated, and there is no obvious chest and rib pain...

After examining the patient, Xun Jiahong sat back and told everyone about his examination results.

"What does Director Xun think?" Zhu Gaoyuan asked.

"The patient has both Qi and Yin damaged, and is obviously lacking in body fluids. Can the dosage of Polygonatum odoratum in the prescription be increased? I think it can be increased from the previous 12 grams to 25 grams, and then we can try the effect." Xun Jiahong said after a moment of hesitation.

In Xun Jiahong's opinion, there was no big problem with Zhu Gaoyuan's previous treatment. Even if he were to treat this patient, he might also be Zhu Gaoyuan's treatment plan.

However, after the first three doses of medicine, the patient felt dry mouth and lack of saliva, and the urine volume increased, so the prescription needs to be changed. Polygonatum odoratum is soft and fluid, and has the function of nourishing yin and moistening dryness, promoting body fluid and quenching thirst, so the dosage can be increased.

"The dosage of Polygonatum odoratum was increased to 24 grams in the next three doses."

Zhu Gaoyuan said: "But the patient's condition remains the same, and Yuzhu is not friendly to patients with spleen deficiency and phlegm and dampness."

Xun Jiahong: “….”

Zhu Gaoyuan kept this secret from him.

Zhu Gaoyuan didn't mention the increase in the dosage of Polygonatum odoratum just now, but now that he mentioned it, Zhu Gaoyuan said that the dosage of Polygonatum odoratum would be increased in the future. This was obviously intentional.

Among the young doctors in Kyoto, Xun Jiahong is the first and Zhu Gaoyuan is the second. Zhu Gaoyuan obviously has a competitive attitude towards Xun Jiahong. This time, he took out this patient, perhaps because he wanted to see Xun Jiahong's level.

At present, it seems that Xun Jiahong’s idea is the same as Zhu Gaoyuan’s.

"Chen Yang, what do you think?"

Seeing that Xun Jiahong was silent and thinking, Wen Haodong shouted as if he was afraid that the world would not be in chaos.

In fact, Wen Haodong was not far from Chen Yang, so he didn't need to speak too loudly, but Wen Haodong's voice was quite loud, and many people in the conference room heard Wen Haodong's voice.

"What does Doctor Chen think?" Xun Jiahong glanced at Wen Haodong and asked Chen Yang.

Xun Jiahong was indeed thinking just now, and he did not ask other people's opinions for the time being. In fact, Xun Jiahong felt that no one should have any opinions, after all, he was still considering it.

This is like a problem. The top student in the class has no idea how to solve it. He certainly doesn't think anyone else in the class can solve it.

However, since Wen Haodong said this, Xun Jiahong had no choice but to ask Chen Yang.

"From the patient's tongue, it is thin and thin, with little Yin fluid on the tongue surface. The patient is obviously suffering from Yin damage."

Chen Yang said: "There is Astragalus in front of us. We have used six doses in a row. The dosage of Astragalus has been steadily increasing, and it has reached 30 grams. Although there are many supervised drugs, the Western medicine treatment has not stopped. There must be diuretics in the Western medicine treatment, which will inevitably damage the Yin. If the Yin is damaged, the Qi will be attached. No matter how much you replenish it, it will be in vain. Even if the dosage of Polygonatum odoratum is increased, it still cannot replenish the Yin."

After Chen Yang finished speaking, Zhu Gaoyuan was the first to look at Chen Yang with his mouth slightly open. Xun Jiahong also looked at Chen Yang, as if thinking about something.

The person who knew the patient's condition best at the scene was Zhu Gaoyuan. Considering that it was a traditional Chinese medicine exchange, Zhu Gaoyuan did not mention Western medicine treatment too much. He just said that Western medicine doctors were involved in the treatment and there was no change in the Western medicine treatment after taking the medicine.

However, Chen Yang was able to judge based on the situation that Western medicine treatment must use diuretics and combine it with Astragalus, considering that the combination of the two would damage the yin.

"Excuse me, Doctor Chen, what should be the follow-up treatment?" Zhu Gaoyuan asked.

"You can adjust the prescription and use the Qingre Buqi Decoction from the Kouchi Leiyao by Xue Ji, a physician from the Ming Dynasty."

Chen Yang said: "The Qingre Buqi Decoction in the original prescription is used to treat deficiency-heat in the middle qi, skin-like mouth and tongue, or fever and thirst. The patient has deficiency of middle qi, damage to both qi and yin, and obvious thirst. Although the mouth and tongue are not skin-like, a bright red tongue without coating is also suitable for the symptoms."

"Qingre Buqi Decoction is a small prescription with a small dosage. Are you sure, Doctor Chen, that such a small prescription can be used to treat such a disease?" Xun Jiahong frowned slightly.

Chen Yang said: "The patient's spleen and stomach are already severely deficient, so only a small prescription can be used, otherwise it will put a greater burden on the patient's spleen and stomach, and the condition will become more serious."

"well."

Xun Jiahong was about to say something else when Song Luojun, who was sitting next to him, suddenly spoke.