Rebirth 1977 Great Era

Chapter 1085 Treatment of Gangrene, The Great Treatise on Yin-Yang Correspondence (Two Chapters Combined)
Fang Yan and the others entered Zhang Yanchang's consultation room. Lei Lian, who was also seeing patients, greeted Fang Yan as soon as he entered.
"Brother Fang."

Fang Yan waved his hand and said:
"It's alright, you go ahead and look after the patient here."

Then everyone came to the patient that Zhang Yanchang had treated. The first thing they saw was a very young girl, and quite pretty, but the purple bruises on her body were indeed a bit shocking.

There are scattered purple bruises about the size of copper coins on the earlobes of both ears, and even more on the hands, including the backs of the hands and fingers.

The further down you go, the more frightening it becomes. She came wearing cloth shoes, and after taking off her socks, you can see that her feet have formed a whole patch of bruises. Her big toe and second toe have turned into the shape of a dehydrated date, dark purple and the skin looks sunken. Fang Yan also noticed that her whole foot looks like it is dehydrated, without the plumpness of a normal person.

Zhang Yanchang's medical records were too conservative; the situation was more serious than Fang Yan imagined.

Dry gangrene and multiple occlusive arteritis are both terms used in Western medicine.

The similarity lies in the connection between symptoms and the underlying pathology.

Western medicine believes that the core issue here is ischemic pathology.

Both are caused by vascular occlusion or blood flow obstruction leading to tissue ischemia and hypoxia, which in turn causes local tissue necrosis.

Typical manifestations include color changes at the lesion site, such as purplish-black or pale, abnormal sensations, pain, numbness, and tissue atrophy.

These conditions commonly occur in the limbs, especially the hands and feet, because the blood vessels at the extremities of the human body are small and the blood flow is slow, making them susceptible to vascular lesions.

The patient's toes are "blackish-purple and sunken," which is consistent with the ischemic necrosis characteristics of dry gangrene. If multiple occlusive arteritis involves the small arteries at the extremities, it can also cause similar symptoms.

In traditional Chinese medicine, this condition can be categorized as "gangrene" and "obstruction of blood vessels".

The causes are nothing more than insufficient Yang Qi, inadequate Qi and blood, stagnation of cold and dampness, Qi stagnation and blood stasis, and damage to the collaterals by heat toxins.

Of course, the patient's condition is quite serious right now.

The diagnosis needs to be accurate before treatment can begin quickly and be effective. Otherwise, her two toes will be the first thing to be lost, followed by her entire foot.

Next came the hands and ears.

Keep in mind that she only started having symptoms at the end of April, and by the beginning of June she was in this state, which shows how quickly the condition progressed.

At this moment, Zhang Yanchang introduced the situation to the patient and their family:
"This doctor, Fang, who speaks in dialect, is the director of the Department of Traditional Chinese Medicine at Peking Union Medical College Hospital."

The patient and their accompanying family members were somewhat surprised upon hearing this:
"Oh, I've heard of him... he's very capable."

"Hello, Dr. Fang!" The patient's family member came up and shook hands with Dr. Fang.

He looked like he had found a savior, clearly someone who had heard the local legends.

After greeting them in dialect, he turned to Zhang Yanchang and asked:
Did you just have your pulse and tongue examined?

"No...no." Zhang Yanchang said nervously. After seeing the patient's condition, he was completely numb and couldn't care less about other diagnoses. Finding Fang Yan was the thing he wanted to do most.

Fang Yan waved her hand to signal him not to get agitated. It's normal not to know how to treat an unfamiliar illness. Besides, Fang Yan had already said this morning that if he didn't know how, he should notify Chen Weiwen first and then contact him.

Actually, dialects were used to treat gangrene in the past, by the old soldier who came back from Changjin Lake.

However, the reasons and conditions of the two people are obviously quite different.

Fang Yan didn't immediately take the patient's pulse. Instead, he went to the patient's feet, gently touched the blackened toes, and asked:

"Can you feel it now?"

"I can feel it!" The other person nodded.

“I’ll use a little force, and you can tell me if it hurts,” Fang Yan said to the patient.

The patient nodded.

Fang Yan then touched the toe that looked like a dried-up date. He wanted to test how badly the toe was doing, but when he applied a little force, the patient recoiled in pain.

"It hurts so much!" the patient said in Fangyan.

"I'm sorry," Fang Yan apologized to the patient.

The patient shook his head and said:

"It's okay, my foot is like this, it hurts terribly if I put even a little pressure on it."

Fang Yan suddenly realized, and then asked the patient:

Do these dark spots on the instep hurt?

The patient thought for a moment and said:

"There shouldn't be as much pain as in the toes."

"I'll press down, and slowly increase the pressure. If it hurts, pull away," Fang Yan said to the patient.

The patient nodded.

Then, Fang Yan slowly pressed down on the instep of her foot with his fingers until he applied normal pressure, but the patient did not pull away.

"Doesn't it hurt?" Fang Yan asked the patient with a serious expression, noticing that the black areas hadn't changed color.

The patient shook his head and said:

"It doesn't hurt, it's just normal force."

In this dialect, they are actually performing palpation and pain testing to assess the blood circulation, nerve function, and degree of tissue necrosis in the patient's extremities.

This is a technique from Luo's Bone Setting Method, and the use of dialect is quite flexible.

The patient experienced severe pain upon even the slightest touch to his toes, indicating that the local nerve endings were still sensitive, but the tissue had already died due to ischemia, presenting as "dark purple and sunken" dry gangrene.

If there is no obvious pain when pressing on the black ecchymosis on the instep, and the skin color does not fade when pressed, it indicates that the tissue in this area may have entered a more serious stage of ischemia and necrosis, and the blood vessels are completely blocked, making it impossible to drain the local blood by pressing.

Normal tissue will turn pale briefly when pressed, and then turn red again after releasing the pressure, but hers showed absolutely no such signs.

Severe pain in the toes but no pain in the instep indicates that the necrosis of the toes is more serious and has affected the deep tissues, while the instep is still in the stage of ischemia but not complete necrosis.

Fang Yan felt the temperature of her toes just now, and it was alright.

Then, speaking in dialect to the patient:
"I'm going to check your pulse now. If it hurts, you can leave immediately."

The patient noticed that Fang Yan's treatment plan was completely different from others. She nodded curiously and let Fang Yan do as she pleased.

Fang Yan touched the fuyang pulse points on the insteps of both feet and confirmed that the pulses were normal and there was no cold or hot sensation. Only then did he breathe a sigh of relief.

A normal pulse at the tai chi position indicates that the main arterial blood flow in the foot has not been completely blocked, and there is still a certain foundation for blood circulation in the foot.

This means that treatment may improve local blood circulation, promote tissue repair and regeneration, and offer hope for saving the patient's toes, soles, and other parts of the foot.

If the pulse at the tai chi position weakens or disappears, it usually indicates a more serious condition, with severe blood circulation disorders, and the area of ​​tissue necrosis may further expand, increasing the difficulty of treatment.

The fact that the pulse at the groin is now normal indicates that the patient's condition has not yet progressed to its most severe stage, and there is still an opportunity for active treatment.

Next, Fang Yan stood up and sat down in Zhang Yanchang's consultation seat, then said to the patient:
"Stick your tongue out so I can see it."

The patient did as instructed. Fang Yan originally thought he would see petechiae on both sides of the tongue, but he saw that the patient's tongue was red with little coating.

Fang Yan looked at the medical record, which stated that she had previously received treatment with antibiotics, hormones, compound Danshen tablets, and vasodilators at the hospital.

It is speculated that the tongue appearance may be related to this.

Next, Fang Yan took her pulse in both hands again and touched the bruises on her fingers. The bruises there were painful to the touch, but unlike her toes, they were not dry and shriveled.

The pulse pattern obtained after pulse diagnosis in a local dialect is described as wiry and rapid.

I started to think about what the cause of her illness was.

A red tongue with little coating indicates damage to yin fluids, along with internal accumulation of blood stasis and heat.

A wiry and rapid pulse indicates that the wiry pulse signifies pain and blood stasis, while the rapid pulse signifies heat, suggesting obstruction of the meridians and internal generation of heat toxins.

Fang Yan recalled the situation from the inspection and the information collected by Zhang Yanchang.

In the early stages of the patient's illness, external cold and dampness obstructed the meridians, causing poor circulation of qi and blood. Since the meridians were not warmed and unblocked in time, cold and dampness stagnation occurred.

Her limbs were covered in bruises, and the pain upon touch was like being pricked with needles; these are typical manifestations of blood stasis obstructing the meridians.

The earlobes and extremities are areas where Yang energy is difficult to reach, making them more prone to blood stasis.

The disease progressed rapidly, with localized heat generation in the necrotic tissue, accompanied by a red tongue with little coating, which is what traditional Chinese medicine calls "yin deficiency and excessive fire".

However, these are all symptoms, not the root cause.

The patient's tongue was red with little coating, and her pulse was wiry and rapid. Based on her dialect and her history of using hormones in Western medicine, it was determined that this would inevitably deplete the body's yin fluids, leading to insufficient yang qi and weak qi propulsion.
The progression of the disease is that after the Yang Qi is insufficient, the invasion of cold and dampness causes obstruction of the meridians, which in turn leads to blood stasis and heat, resulting in the decay of body tissues due to heat toxins, thus forming a vicious cycle.

Her necrosis has spread from her toes to her soles and hands, progressing rapidly within 40 days. Without timely intervention, she may face the risk of amputation.

Although the ecchymosis on the back of the hand was not dry, it was extremely painful to the touch, indicating that the small artery occlusion was progressing proximally.

The core principle of traditional Chinese medicine is to treat the symptoms in acute cases.

The most important thing is to preserve the blackened areas on her body first, and then slowly treat the underlying cause of her illness.

Therefore, the focus now should be on clearing heat and detoxifying, and promoting blood circulation and removing blood stasis.

Externally, it should promote blood circulation and unblock the meridians.

Moreover, short-term improvements are necessary.

A method that yields quick results... Fang Yan pondered.

Insecticides, in the end, we still have to use insecticides.

Insect-based medicines are good at clearing the meridians and have a strong ability to break up blood stasis and remove blood clots. They can penetrate small blood vessels and improve blood flow in a short period of time.

Thinking of this, Fang Yan immediately picked up the prescription and started writing:
Leech 6g (powdered and taken with water), ground beetle 9g, centipede 2 (head and feet removed), scorpion 6g (powdered and taken with water).

Honeysuckle 30g, Scrophularia ningpoensis 30g, Angelica sinensis 15g, Licorice 10g.

桃仁12g、红花9g、川芎12g、赤芍15g、生地20g。

15g of Ophiopogon japonicus and 12g of Dendrobium nobile.

One dose per day, decocted in 400ml of water, taken in two divided doses (200ml in the morning and 200ml in the evening).

Leeches and scorpions are ground into powder and taken with the decoction to enhance the utilization of the insect-based medicine.

Aside from insect-based medicines, the other herbs clear heat and toxins from the blood, while also nourishing and invigorating the blood. They target the pathogenesis of yin deficiency, which involves heat transformation in necrotic tissue and a red tongue with little coating. They also break up blood stasis and improve microcirculation, addressing blood stasis syndrome characterized by ecchymosis on the limbs and a wiry, rapid pulse. Ophiopogon japonicus and Dendrobium are added last to alleviate yin deficiency caused by hormones, and when combined with Scrophularia ningpoensis and Rehmannia glutinosa, they enhance the yin-nourishing and dryness-moistening effects.

After finishing writing, Fang Yan thought for a moment, then took out another prescription and continued writing:
Traditional Chinese medicine fumigation and washing formula:
药物：川芎30g、红花20g、桂枝15g、细辛6g、鸡血藤30g、透骨草30g
Usage: Boil 2000ml of water, and when the temperature drops to about 40℃ (avoid scalding necrotic tissue), soak hands and feet for 20 minutes, twice a day.

It warms the meridians and dispels cold, invigorates blood circulation and unblocks collaterals, improves microcirculation in the extremities, and enhances efficacy when combined with oral medication.

Combining moxibustion with bloodletting:
Acupoints selected: Zusanli (ST36), Sanyinjiao (SP6), Taichong (LR3), Xuehai (SP10) (primarily on the healthy side, avoid necrotic areas on the affected side).

operate:

Apply gentle moxibustion to Zusanli and Sanyinjiao acupoints for 15 minutes each to warm the Yang and replenish Qi.

Use silver needles to gently tap and puncture the blood vessels at Taichong and Xuehai points to release a small amount of stagnant blood and unblock the local blood and qi.

After finishing writing, Fang Yan added another sentence:
Note: This product is only applicable to painless bruises.

Next, he handed over the prescription, and Zhang Yanchang said to him:
"Go get the medicine now, and try to drink a dose later, then do a fumigation bath."

"I'll give her acupuncture right now."

"Once the medicine from the Chinese medicine pharmacy is ready, have someone deliver it directly to the inpatient floor. While you're at it, take this medical record with you and have the nurses there prepare it."

Zhang Yanchang nodded when he heard Fang Yan's words.

Then he went to the Xiehe Traditional Chinese Medicine Pharmacy to coordinate the work, since he was very familiar with this job and had done it before.

At this moment, the students from the other clinics saw what was happening and came over to join in the fun.

It's almost lunchtime, and everyone has basically finished seeing their patients.

After finishing the medical case and summary, I saw a crowd gathered at the door. One person led to another, and then the crowd grew.

In no time, the place was completely surrounded.

Everyone was reading the local dialect as they performed moxibustion and acupuncture on the patient.

This acupuncture session was a little different; Fang Yan didn't use his own needles, but rather the standard silver needles provided in the clinic.

The patient is instructed to lie supine with their lower limbs naturally extended and a thin pillow under their back, exposing the Zusanli and Sanyinjiao acupoints; the upper limbs are placed flat on the treatment bed, with the palm facing up to expose the Xuehai acupoint and the dorsum of the foot facing up to expose the Taichong acupoint, ensuring that the muscles at the treatment site are relaxed.

Fang Yan said to Chen Wenwei:
"Close the window. The patient is weak and susceptible to cold and dampness. We must prevent him from getting cold during the procedure, which could worsen the blockage in his meridians."

Chen Wenwei didn't think there was anything wrong with Fang Yan's command. Although they were senior students in their fifth year, in front of Fang Yan, they were his subordinates.

After walking to the window and closing it.

Fang Yan holds the needle at a 90° angle and taps the acupoints on the patient's body, gradually increasing the force until the local skin bleeds slightly. This is to avoid deep punctures that could damage blood vessels.

After tapping, everyone could see fine, pinpoint-like bleeding points appearing on the skin at the bruise site. Initially, the blood was dark purple, but after about 10 seconds, the color gradually turned dark red.

This is the release of stagnant heat.

Next, Fang Yan gently pressed the acupoints with a sterile dry cotton ball to guide the stagnant blood out. The amount of bleeding from each acupoint was not much. Fang Yan knew that the small amount was due to the slow local blood flow caused by blood vessel blockage.

Next, the color of the ecchymosis on the earlobe and back of the hand changed from dark purple to light purple after tapping. The edges of some small ecchymosis began to fade, and the edges of the coin-sized ecchymosis on the earlobe faded most noticeably.

In other areas, the purple bruises also faded away in a short while.

However, the amount of blood drawn was a bit small, and the dialect was only used in a few places.

Next, take pure moxa sticks, cut them into sections about 5cm long, put them into a moxibustion box, and fix them above the acupoint.

Begin igniting the moxibustion device 2-3 cm away from the skin.

And he even said to the patient:
"Just make sure it feels warm. If it hurts a little, let me know."

The patient nodded and said in dialect:

"That's the best way."

In fact, if the patient's sensitivity to heat decreases in this situation, the doctor needs to test the temperature with their own finger.

However, based on dialect experience, this distance should be about right.

After all, he's an experienced practitioner of moxibustion.

The moxibustion time for this acupoint is shortened, unlike the usual moxibustion time. This is mainly because the local blood circulation in the necrotic tissue of the patient is poor, and prolonged moxibustion can easily cause skin burns, which can lead to more problems later.

After finishing his performance in dialect, he looked at his watch and said to the students watching at the door:
"Go eat in the cafeteria."

"Brother Fang, should I bring you some food?" Du Heng was the first to jump out.

Fang Yan shook his head and said:
"Need not."

"You guys go quickly."

After the dialect was spoken, no one left; they all wanted to see what was going on.

I'm too lazy to talk about their dialects anymore; I'll just watch it for ten minutes if I want.

At this point, a student asked:

"Brother Fang, is it normal for the amount of bleeding to be so small after pricking?"

Fang Yan glanced at it and realized it was Song Jianzhong from her class.

He said in dialect:

"Of course it's not normal. The patient has extensive occlusion of small arteries, and local blood flow is almost stagnant, so there is little blood stasis. Of course, it's not that bloodletting is ineffective. It's just that the condition is quite severe, and bloodletting alone is definitely not enough. Insect-based medicines need to be taken orally to break up the blood stasis. Right now, it's just being used in conjunction with bloodletting to gradually improve the condition."

Then Yan Yifan, who was standing to the side, asked:

"What is the purpose of applying moxibustion to the healthy side?"

He said in dialect:

“When the meridians are severely blocked, the medicine cannot reach the affected side. We first regulate the qi and blood and strengthen the foundation on the healthy side, and then influence the affected side through the meridian conduction. This is called ‘treating the right side with the left and treating the left side with the right.’”

At this moment, Li Zhengji, the deputy squad leader, said:

The theory in "The Yellow Emperor's Inner Classic: Basic Questions - The Theory of Yin-Yang Correspondence" states: "...Therefore, those who are skilled in using acupuncture draw yang from yin and yin from yang, treat the left with the right and the right with the left, know the enemy with themselves, know the interior with the exterior, and observe the principles of excess and deficiency; they see the subtle signs of excess and use it without fail."

Upon hearing this, everyone suddenly understood.

It's great to have so many top students in your class. You don't even have to recall things yourself; they can just rattle off the answers and explain everything clearly.

After a while, ten minutes were up.

Fang Yan took the moxibustion box down.

"Such a short time?" someone exclaimed in surprise.

Knowing someone would ask, he said:
“Necogenic tissue is less sensitive to heat, and prolonged use can easily cause low-temperature burns; moreover, the patient’s yin fluids have been damaged, and excessively warm moxibustion will deplete yin blood, so the principle of ‘using a little fire to generate qi’ is used, with the aim of warming and unblocking for a short time.”

He asked the patient in a dialect:
"How do you feel now?"

The patient gently wiggled her toes, and the tension between her brows and eyes eased somewhat. She said:

"My toes don't hurt as much as before. It feels like I'm in warm water, with a slightly tingling and warm sensation."

She looked down at the back of her foot, where the edges of the clusters of purplish-black bruises were tinged with a dark red:
"And the color is different now. The spot where I was pricked is a little swollen, but it doesn't feel like I'm being pricked with a needle like before."

She paused, then pointed to the Zusanli acupoint where moxibustion had been applied; the skin was flushed.

"It's warm here, like there's a breeze going down. My feet used to feel like they were on ice, but now I feel warmth coming out from my bones."

As she spoke, she tentatively curled her toes and said with some surprise:
"Before, I would break out in a sweat from the pain if I strained, but now I can actually hook it up!"

The patient's family member leaned forward and gently touched the daughter's instep, then suddenly widened their eyes: "Hey? It used to be so hard here, but now it seems a bit softer!"

Fang Yan gently pressed the bruise on the patient's earlobe with his fingertips, and the originally stagnant purple color slowly faded by half. After releasing his hand, although the color did not fully recover, it was no longer the dead black color it had been before.

He spoke to the patient in a dialect:
"You'll be admitted to the hospital now. After lunch, the medicine should be ready, and someone will administer it to you both internally and externally."

Upon hearing the dialect spoken, the patient and their family nodded repeatedly.

Then, the dialect continued to remind them:
"By the way, avoid lamb and chili peppers. Eat more things like white fungus, hawthorn, and brown sugar."

"Don't wash or drink cold water. There are special hot water dispensers in the corridors of our inpatient department, the kind imported from abroad, so there is always hot water available. There are also 24-hour hot water showers in the wards, just turn on the water and you can use it."

Unfortunately, the wards at Peking Union Medical College Hospital have become quite luxurious thanks to crowdfunding.

Hearing the dialect, the patient and his family were clearly shocked. What kind of conditions are there in the Peking Union Medical College Hospital's TCM inpatient department?

Such a high configuration is amazing.

Actually, the dialect hasn't even mentioned the configuration yet, but it already includes a TV and a radio.

"Did you understand?" Fang Yan asked the dazed patient and his family.

The two then realized what was happening and nodded repeatedly.

Then Fang Yan told them to go through the admission procedures, and the medicine would be delivered directly to the TCM ward floor.

After seeing the person off, Fang Yan looked at the crowd that hadn't left yet and asked:

"What's wrong? Aren't you hungry?"

Only then did everyone realize what was happening, and Song Jianzhong took the lead in shouting:

"Come on, let's go eat. Brother Fang went home to eat!"

As he tidied up, Fang Yan addressed the crowd:

"After you finish eating, go to the conference room to rest and think about any questions you might have. We'll have a summary session this afternoon."

"Okay!" everyone agreed.

Then, the group left the TCM department together, and the hospital director, who saw this scene from outside, smiled with satisfaction.

PS: The basic chapter of 6000 words is now complete. There will be an extra chapter later.

(End of this chapter)