Rebirth 1977 Great Era

Chapter 1097 Lung Cancer Treatment with No Room for Error: You Question Fang Yan? (Two Chapters Combined)
Fang Yan's heart skipped a beat when he heard He You's words.

This time, I really need to push myself to a higher level.

However, he remained quite calm on the surface and nodded to He You.

Then he opened the drawer, took out a mask, and gave one to everyone present.

It's best to be cautious about this patient's lung problems, especially since their accompanying medical staff are also wearing masks.

The others took the masks and put them on.

Fang Yan saw that Mr. Wei, whom she had met yesterday, also came in.

He is a family member of this patient.

After entering, I first walked over and shook hands with Fang Yan.

Then he pointed to the person on the hospital bed and said, "..."
"This is my cousin."

“He fell ill three months ago and received treatment in Hong Kong, but his condition was not very good. We know that you are a very good doctor and are famous for treating lung diseases, so we came back this time.”

"Let my sister-in-law tell you the details."

After he finished speaking, he called up a middle-aged woman who looked plump.

This woman looks like the kind of pampered rich housewife.

Her clothes and accessories were adorned with jewels.

It seems like they're not short of money at home.

Judging from Mr. Wei's dialect, he works in the imported car business in Hong Kong.

He makes both complete vehicles and parts.

They also invested in a car factory in China.

His ranking first is likely due to his contributions, in addition to the fact that the patients he brought were critically ill.

“Mrs. Wei, tell me about your husband’s specific situation!” Fang Yan said to the patient’s wife.

The patient's wife thought for a moment and said in dialect:

"When my husband was younger, he had tuberculosis abroad. He recovered after treatment, but his health has never been very good. He can't participate in strenuous exercise or get too tired."

Fang Yan nodded, signaling her to continue.

"Our business started having some problems about six months ago. My husband was checking the accounts every day and also had to travel abroad. He was very tired during that time. I could clearly feel that his complexion was not as good as before. About three months ago, he told me that he had a dull pain in his left chest, like he had caught a cold, and he felt weak all over."

"Then when I cough, there is white phlegm with some blood streaks, and I also have a low-grade fever and chills."

"However, there were still many unresolved business issues during that period, and given that his health wasn't very good to begin with, it's not surprising that he experienced these problems. I told him to go to the hospital to get checked out, and he agreed, but then forgot about it the next day."

"As it turned out, the situation was getting worse and worse. Not only did it not get better, but the amount of blood in my cough increased."

"He also couldn't eat, kept having nightmares, had dark urine, and was constipated. He sensed something was wrong, so he took the time to go with me to a hospital in Hong Kong for a checkup."

"When the medical examination report came out, we felt like the sky had fallen. He had tuberculosis lesions in his upper right lung and lung cancer metastases in his upper left lung."

"The hospital's CT scan showed a lung cancer lesion in the left middle lung."

"On May 30th, we went to another hospital for a pathological examination. The report said that squamous cell carcinoma cells were found, and the bronchoscopy results were consistent with the characteristics of moderately differentiated squamous cell carcinoma."

"Then, at the new hospital, after being diagnosed with 'left central lung cancer,' he was hospitalized and underwent a course of chemotherapy. However, recently, due to a significant drop in his white blood cell count after chemotherapy, it dropped to... well, I'm not good at saying it, but anyway, he couldn't continue chemotherapy, so they asked us to be discharged."

"Someone recommended you, Dr. Fang, saying that you could come back and give it a try."

After saying that, she pointed to the accompanying medical team and said:

"Oh, and they also brought the medical report."

Fang Yan asked curiously:
"Didn't you say the hospital asked you to be discharged? Then what are they..."

At this point, the medical staff explained:
"Dr. Fang, we are the medical support team dispatched by the Huo family's private hospital. This time, we are mainly responsible for Mr. Wei's health monitoring during his journey back to Beijing."

Fang Yan suddenly realized that it turned out he was from Huo Family Hospital, so he could be considered a colleague.

Then he asked the medical staff:

What kind of IV fluids are you all giving him?

The medical staff brought over a box, opened it, and showed it to the person speaking in dialect:
"Mr. Wei's chemotherapy caused a sharp drop in white blood cells. He was given a drug that stimulates the production of white blood cells. This recombinant human granulocyte colony-stimulating factor rhG-CSF was developed in a laboratory invested in by Mr. Huo. It is currently only in the experimental stage, and the effect is not very stable and it has not yet been launched on the market."

"But there's no other way right now, so we have to use it for the time being."

"In addition, his immunity was extremely weak after his white blood cell count dropped, so we added antibiotics to prevent secondary infections."

"Finally, Mr. Wei suffered from poor appetite, constipation, and weakness, so we supplemented his diet with nutritional fluids to maintain his energy, which included amino acids and glucose solution..."

Fang Yan glanced at the bottle of recombinant human granulocyte colony-stimulating factor imported from the UK. If his memory served him right, this stuff was first announced in the newspaper in 1986 and was not approved for market release until 1991.

No, do rich people enjoy technology ahead of time?

"By the way, this is Mr. Wei's medical report." Just then, the accompanying medical staff handed over another file bag.

Once the dialect is opened, it contains the patient's various examination reports.

The report indicates that it is: Queen Mary Hospital, Hong Kong.

Imaging examinations (CT scans):
Right upper lung: Old calcified lesions of pulmonary tuberculosis are clearly visible, with fibrosis at the edges.

Left middle lung: A space-occupying lesion with a diameter of about 3.5 cm, with spiky edges and uneven internal density, consistent with the imaging characteristics of primary lung cancer.

Left upper lung: Multiple small nodular shadows (maximum diameter 1.2cm), suggesting metastatic lesions.

Pathology report:
Bronchoscopic biopsy revealed moderately differentiated squamous cell carcinoma with cancer cells arranged in nests, and keratin pearls and intercellular bridges were visible.

Immunohistochemical markers: P40 (+), CK5/6 (+), TTF-1 (-), supporting the diagnosis of squamous cell carcinoma of the lung.

Laboratory data:
血常规：白细胞计数1.8×10/L（显著低于正常值），中性粒细胞绝对值0.6×10/L，血红蛋白92g/L（中度贫血）。

Liver function: Alanine aminotransferase (ALT) was slightly elevated (68 U/L), and albumin was 32 g/L (malnutrition).

Tumor marker: Squamous cell carcinoma antigen (SCC) 15.7 ng/mL (significantly higher than normal).

Fang Yan's eyelids twitched when she saw the white blood cell count in their test report.

When the white blood cell count drops to 1.8 × 10/L, death from sepsis is highly likely.

This was practically sending him back someone who was about to die.

Fang Yan looked at the patient lying on the bed and asked him:
"Mr. Wei, can you hear me?"

"Hmm." The patient on the bed nodded weakly.

Fortunately, he was conscious and able to communicate.

Fang Yan touched his hand, began to take his pulse, and then said to the patient:
"Please stick out your tongue so I can see it."

The patient stuck out his tongue, and the dialect showed that his tongue was red with a slippery white coating.

Then, Fang Yan diagnosed the pulse in both his left and right hands and found that the right pulse was wiry and the left pulse was weak.

Then he started to think.

Traditional Chinese medicine classifies lung masses, coughs, and asthma under the category of "Xi Ben". The patient has lung cancer lesions and symptoms such as cough and chest pain, which are consistent with the description of "wheezing and coughing with shortness of breath, sometimes spitting blood" in "Xi Ben".

As the patient's wife just mentioned, the patient has a history of tuberculosis.

Traditional Chinese medicine believes that tuberculosis easily depletes qi and yin. In addition, his previous auditing, travel abroad, and business problems have affected his emotions, which may have further weakened his vital energy. Therefore, he is deficient in both qi and yin. Traditional Chinese medicine also says, "When the vital energy is abundant, evil cannot invade; where evil gathers, the vital energy must be deficient."

His red tongue with a slippery white coating indicates yin deficiency with internal heat and phlegm-dampness; his right pulse is wiry, indicating liver stagnation or phlegm turbidity, while his left pulse is weak, indicating kidney deficiency or insufficient qi and blood. This is consistent with the pathogenesis of qi and yin deficiency and spleen and stomach weakness.

In traditional Chinese medicine, the lungs are also called "Huagai" and are responsible for governing the surface of the entire body.

Insufficient lung qi and weak skin and hair can lead to spontaneous sweating. Dysfunction of the spleen's digestive function can cause the production of phlegm and turbidity. Symptoms such as loss of appetite, abdominal distension, fatigue, weakness, and shortness of breath are all caused by spleen and stomach qi deficiency.

However, the causes and mechanisms of cancer are very complex, and protecting the spleen and stomach must be the primary principle in subsequent treatment.

Because of the sudden drop in white blood cells, poor appetite, and physical weakness after chemotherapy.

Traditional Chinese medicine believes that "the spleen and stomach are the foundation of acquired constitution and the source of qi and blood production." If the spleen and stomach are weak, there will be no source for the production of qi and blood, and the immune system will be difficult to restore.

Strengthening the spleen and stomach can not only improve digestive function, but also lay the foundation for subsequent cancer treatment and strengthening the body's resistance. This is the treatment principle of "strengthening the earth to generate metal" by regulating the spleen and stomach to nourish the lungs.

In addition, the patient had moderately differentiated squamous cell carcinoma of the lung with intrapulmonary metastasis. Modern medicine believes that its occurrence is related to gene mutations, environmental factors, etc.

However, Traditional Chinese Medicine (TCM) can classify it as a combination of "phlegm, blood stasis, and toxins." It should be noted that although squamous cell carcinoma grows slowly and metastasizes late, the patient has already metastasized to the left upper lung. From the perspective of TCM, this indicates that the "toxic evil" is strong, and the diagnosis should focus on clearing heat and detoxifying, softening hardness and dispersing nodules.

In addition, the white blood cell count was extremely low after chemotherapy (1.8×10/L), which is considered "bone marrow suppression". In traditional Chinese medicine, this can be regarded as "deficiency of essence and blood". It is necessary to take care to nourish the kidney and replenish essence, because the kidney governs the bones and produces marrow. Immunity is also closely related to this.

Treating patients with dialects now is like walking a tightrope; there's no room for trial and error. You can't afford to make a mistake, because if the treatment goes in the wrong direction, the patient will die instantly.

So he went over his thoughts again in his mind.

Check to make sure there are no errors or omissions.

To be honest, it did give him a clue.

The patient's constipation and yellow urine may indicate accumulated heat in the gastrointestinal tract. In this case, simply using tonifying medicine may worsen the "stagnation," so it is necessary to combine it with qi-regulating and heat-clearing medicine.

In other words, although traditional Chinese medicine emphasizes "treating the symptoms in urgent cases," it is precisely at such times that we must protect the spleen and stomach while being wary of "being unable to tolerate tonics when the body is weak."

"So? Any ideas?" A voice suddenly rang out beside Fang Yan. He turned around and saw that it was He You.

Fang Yan glanced at him and said:

"I haven't finished my checkup yet."

He You nodded and gestured for Fang Yan to continue.

His current identity is that of the maternal great-uncle of the dialect group, and he is also a practitioner of traditional Chinese medicine, so no one felt it was inappropriate for him to say these things.

At this point, Fang Yan confirmed with the patient again the symptoms that his wife had just described.

And ask him if he has anything to add.

"Yes, after chemotherapy, my skin is itchy and I have rashes. I feel very uncomfortable now," Mr. Wei, the patient, added in dialect.

Fang Yan nodded and said:

"Okay, I've written it down." "Is there anything else you'd like to add?"

The patient thought for a moment, then shook his head to indicate that he didn't.

Fang Yan then returned to his seat, picked up the medical records, and began to write.

After writing down the patient's information, chief complaint, and family's complaint, as well as the medical history, the patient began writing the TCM diagnosis in dialect.

The group of traditional Chinese medicine practitioners around him immediately widened their eyes, staring at the medical record in Fang Yan's hand, wanting to see how he would write it.

All that was seen was a sentence written in dialect:

Disease name: Lung cancer, complicated with pulmonary tuberculosis.

Syndrome: Qi and Yin deficiency, phlegm, blood stasis and toxin accumulation, and heat accumulation in the stomach and intestines.

Pathogenesis analysis:

Prolonged tuberculosis depletes qi and yin, and further damage from overwork and emotional distress leads to a deficiency of vital energy. This allows pathogenic factors (cancer) to invade and accumulate in the lungs, forming "xiben".

A red tongue with a mottled, peeled coating indicates lung and stomach yin deficiency with upward flaring of deficient fire; a slippery, white, and greasy tongue coating indicates internal retention of phlegm and turbidity; stabbing pain in the left chest and a wiry pulse indicate phlegm and blood stasis obstructing the lung collaterals; low-grade fever and night sweats indicate yin deficiency with internal heat; poor appetite, constipation, and yellow urine indicate spleen and stomach qi deficiency combined with gastrointestinal heat accumulation; red rashes and itching after chemotherapy indicate drug toxicity damaging the blood, blood deficiency, and wind-dryness.

Treatment principle: In acute cases, strengthen the spleen and stomach to restore their function, while also nourishing yin, resolving phlegm, detoxifying and dispersing nodules, and supplementing with cooling blood and dispelling wind.

Upon seeing what was written in dialect, everyone looked thoughtful, except for Jin Wubing, who looked bewildered.

Unfortunately, my skill level is limited, and I'm struggling to keep up.

However, the kid picked up a pen and started writing. Upon closer inspection, it turned out he was copying medical records in dialect.

Everyone was surprised:

No, are you being this blatant?

However, Fang Yan glanced at him but ignored him. After thinking for a moment, she began to write down the treatment methods.

prescription:

Raw Astragalus 30g, Codonopsis pilosula 15g, Ophiopogon japonicus 12g, Schisandra chinensis 9g, stir-fried Atractylodes macrocephala 15g, Poria cocos 15g, Citrus reticulata peel 9g, processed Pinellia ternata 9g, Angelica sinensis 12g, Spatholobus suberectus 30g, Hedyotis diffusa 30g, Scutellaria barbata 30g, Trichosanthes kirilowii seed 15g, Cannabis sativa seed 15g, prepared Glycyrrhiza uralensis 6g.

Modifications to the prescription:

Cooling the blood and dispelling wind: Add 12g of peony bark, 12g of red peony root, and 15g of white peony bark.

To stop bleeding and resolve phlegm: add 15g of Bletilla striata, 30g of Agrimonia pilosa, and 9g of Fritillaria cirrhosa (powdered and taken with water).

To clear heat from the bowels: add 6g of rhubarb (added later) and 9g of immature bitter orange.

Decoction method:
One dose per day, decocted in 400ml of water, taken warm in two divided doses.

Upon seeing the prescription written in dialect, the expressions of those around them immediately became quite interesting.

There are just too many medicines in this prescription.

The basic formula alone contains fifteen herbs, and there are even more when you add or subtract herbs later to address specific symptoms.

There are a total of twenty-three kinds of herbs.

The first to raise a question was He You, who lowered his voice and said to Fang Yan:

"The classic prescriptions in the Treatise on Cold Damage contain only seven or eight ingredients, and we usually use a maximum of thirteen ingredients... Aren't you worried about confusing the principal, assistant, adjuvant, and guide herbs with your twenty-three ingredients?"

Upon hearing this, the Wei family members looked at Fang Yan with some surprise and suspicion.

As for the other TCM doctors present (except for Jin Wubing, who looked completely bewildered), they also wanted to ask this question, but it was best for He You, in his capacity, to ask it.

Everyone turned to look at Fang Yan, wanting to see how he would answer.

Fang Yan glanced at He You and uttered two words indifferently:

"Not afraid."

Then he started writing the explanation on his own.

He You was simply left standing to the side.

Xie Chunrong, however, explained to them:
"Some people have questioned Director Fang's prescriptions before, but his medicines have always been used to treat difficult and complicated diseases. Moreover, there are also classic prescriptions with more than thirteen ingredients in the *Jinkui Yaolue*, Hou's Black Powder has fourteen ingredients, Dioscorea Pill has twenty-one ingredients, and Turtle Shell Decoction Pill has twenty-three ingredients,"

"These prescriptions containing more than thirteen herbs are relatively few in number, but they are mainly used to treat complex diseases such as general debility, abdominal masses, and stroke. The one prescribed by Director Fang is no exception."

Jin Wubing, who was standing to the side, understood the situation. He immediately stood up, like a defender of dialects, and said unhappily:

"What's there to question? He's cured so many people, surely no one would think he'd prescribe random medications?"

Jin Wubing scanned the entire room, searching for anyone who dared to step forward.

Just then, the dialect explanation was written out.

Solution:

Strengthening the spleen and stomach: Raw astragalus, codonopsis, stir-fried atractylodes macrocephala, poria cocos, and prepared licorice root (modified Sijunzi Decoction) invigorate the spleen and replenish qi. Combined with tangerine peel and pinellia to harmonize the stomach and resolve phlegm, it embodies the principle of "strengthening the earth to generate metal".

Nourishing Yin and reducing internal heat: Ophiopogon japonicus and Schisandra chinensis (Shengmai San) nourish Yin and astringe sweat, while Angelica sinensis and Spatholobus suberectus nourish and invigorate blood, thus addressing blood deficiency after chemotherapy.

Detoxification and Nodule Reduction: Oldenlandia diffusa and Scutellaria barbata clear heat, detoxify, and fight cancer; Trichosanthes kirilowii seed resolves phlegm and dissipates nodules, combined with Fritillaria cirrhosa to enhance the lung-clearing and phlegm-reducing effects.

Clearing heat from the intestines: Hemp seeds moisten the intestines and promote bowel movements; rhubarb and immature bitter orange drain accumulated heat in the stomach and intestines, allowing the pathogenic factors to have an outlet; peony bark and red peony root cool the blood and disperse blood stasis; dictamnus root bark dispels wind and relieves itching, alleviating the toxic reactions of chemotherapy drugs.

Fang Yan then wrote a note on the key points of dialectical analysis:

The key to this case lies in the "mixture of fact and fiction":
Qi and Yin deficiency is considered a deficiency, phlegm, blood stasis, and toxin accumulation is considered an excess, and heat accumulation in the stomach and intestines is considered a superficial manifestation.

Treatment that relies solely on tonification will exacerbate the pathogenic factors, while treatment that relies solely on attacking will harm the body's vital energy. Therefore, the foundation should be strengthening the spleen and replenishing qi, nourishing yin without causing dampness, fighting cancer without harming the body's vital energy, and clearing the bowels without damaging the stomach.

Be wary of "being unable to tolerate tonics":
When using Astragalus membranaceus, the dosage should be increased to 30g. It is necessary to observe whether abdominal distension or internal heat occurs. If so, the dosage should be halved. When using Rheum palmatum (processed with wine), only 6g should be used, taking advantage of the principle that "lightness can remove excess". Once the symptoms are relieved, the dosage should be stopped.

Then Jin Wubing started chanting loudly.

This guy had a loud voice. After reading aloud what he had written in dialect, he looked around at everyone and said:

"See? Is there something wrong with this recipe?"

"Still have any questions?"

Fang Yan discovered that Jin Wubing really has the same personality as Aji.

Although his medical skills are lacking, he's quite adept at providing assists.

Just now, He You questioned me, and I couldn't say anything in Fang Yan's words, but this guy jumped in just the right time.

Jin Wubing's actions silenced the room. No one else spoke, since they hadn't said anything anyway. The only one feeling awkward was He You, who coughed lightly and said:

"I'm just reminding you."

"No harm meant."

Huang Qiming said from the side:
"The intention is good; I am often asked these questions by students when I am abroad."

The two of them worked together to smooth over the awkward situation.

Fang Yan ignored him and continued writing the external treatment plan.

My maternal great-uncle doesn't seem like a good person...

Although I spoke in a very low voice, quite a few people heard me.

Although the questioning seems reasonable, it always feels a bit ill-intentioned, just like the question asked by Jin Wubing, that naive young man: Does Fang Yan have cured so many people before, why would he be worried about Fang Yan prescribing medicine indiscriminately?
However, to be fair, Jin Wubing jumped out too quickly.

Fang Yan actually wanted to see what other people thought, but he just jumped out and started ranting, and no one else dared to add fuel to the fire.

After calming down, he continued writing in dialect:
External treatment options include acupuncture, external washing, and auricular acupuncture, which I haven't used in a long time.

The patient's condition is very bad right now. We not only need to be stable, but we also need to speed up the treatment. Right now, we are like firefighters, trying to be both stable and fast, managing the side effects of chemotherapy and pulling the patient back from the brink of death.

This internal and external coordination is also crucial.

The acupuncture and moxibustion program mainly focuses on strengthening the three gates and reversing the deficiency.

There are not many acupoints.

Zusanli (bilateral): The spleen and stomach are the source of qi and blood production. Needling this point can quickly activate the spleen and stomach's function of transformation and transportation, paving the way for internal administration of Huangqi Baizhu Decoction.

Dazhui (single) is the meeting point of all Yang meridians. Tapping and cupping can stimulate Wei Qi. Patients may experience spontaneous sweating and susceptibility to infection. This procedure is like urgently repairing a breach in a city wall.

Patients with bilateral Xuehai (Blood Sea) syndrome experience rashes and itching after chemotherapy, which is considered a sign of "drug poisoning damaging the blood." Xuehai (Blood Sea) is used to regulate blood and dispel wind.

Next is the external wash formula of traditional Chinese medicine, the purpose of which is to detoxify through the skin and expel pathogens through two pathways.

Kochia scoparia fruit 30g, Cnidium monnieri fruit 30g, Dictamnus dasycarpus root bark 30g, Paeonia suffruticosa root bark 20g, Paeonia lactiflora root bark 20g, Sophora flavescens root 15g, Mentha haplocalyx bark 10g (added later), Glycyrrhiza uralensis root 15g.

Usage: Boil in 400ml of water, let it cool to a warm temperature, then use gauze to wash the affected area for 10 minutes each time, 3 times a day.

Next is auricular acupuncture, the acupoints are:
Lungs (bilateral), spleen (bilateral), kidneys (bilateral), endocrine system (bilateral), subcortex (bilateral).

The Lung acupoint corresponds to the respiratory system and regulates cough and hemoptysis; the Spleen acupoint corresponds to gastrointestinal function and improves poor appetite and constipation; the Kidney acupoint corresponds to bone marrow hematopoiesis and assists in increasing white blood cell count (the Kidney governs bone and produces marrow).

The patient experienced frequent nightmares. Applying pressure to the subcortical area can regulate the cerebral cortex and improve sleep faster than oral administration of Polygala tenuifolia.

After writing it down, Fang Yan handed two prescription slips to Chen Wenwei:

"Take them to the pharmacy. One for internal use and one for external washing. Don't mix them up."

"Understood." Chen Wenwei took it and immediately ran out.

Then Fang Yan took out the ear acupuncture needles made by the research institute and the Tiangong needles that hadn't been used for a long time from the drawer, preparing to treat the patient with external therapy first.

The reason we used Tiangong needles instead of Hailong needles is mainly because this person's illness is really worrying.

When Huang Qiming saw Fang Yan take out a different set of silver needles, his eyes lit up.

After a careful examination, he swallowed hard, a hint of envy flashing across his face.

Can't help but admire:
"The heavens have their seasons, the earth has its energy, the materials have their beauty, and the craftsmanship has its skill. This... this must be the Heavenly Craft Needle from the Hua family of Suzhou!"

"This is one of the most famous needles in the world. You have quite a few treasures in your hands! It's truly enviable!"

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

(End of this chapter)