Rebirth 1977 Great Era

Chapter 1103 Tang Jun's Pulse Diagnosis Method: Observing the Renying Pulse and Counterattacking Huang Qiming (Two Chapters Combined)
He paused slightly in dialect, then his first instinct was to check the patient's pulse on his foot; that's how he diagnosed someone who had no pulse last time.

However, Fang Yan had already seen that she also had similar injuries on several parts of her feet.

Moreover, the skin has already scabbed over, making it difficult for Fang Yan to touch it.

Fang Yan thought for a moment, then wondered what other places could be used to take a pulse?
The Imperial Medical Prescriptions Collection, a collection of military medical texts from the Tang Dynasty, and the fragment of the Kaiyuan Guangji Prescriptions from the Yongle Encyclopedia, both record two methods.

The first method involves using the Renying pulse in the neck as a substitute when the patient's pulse cannot be felt in the limbs. This is used as an auxiliary diagnostic method in modern Chinese medicine. The method of pulse diagnosis is relatively complicated. The local dialect knows how to diagnose it, but has never used it.

The Ling Shu also records that this is one of the pulse points used to monitor the body's yang energy.

In addition, there is a relatively hidden location in the groin, where the femoral artery is called the "Qi Chong Mai" in traditional Chinese medicine. However, the operation requires the patient to cooperate by exposing the area, and it is quite private, so there are many practical limitations and it is generally not a preferred choice.

However, the pulse on the carotid artery may not be accurate enough with dialects.

Alternatively, there must be experts in this field on site.

Unfortunately, even if they were there, they might not be willing to help.

So I have to do this myself; I'm just being forced into it.

The Cun, Guan, and Chi points are located on the transverse crease of the radial artery at the wrist. They are divided into three parts: Cun, Guan, and Chi, which correspond to the internal organs on the left (heart, liver, and kidney) and the right (lung, spleen, and mingmen). They comprehensively reflect the state of Qi, blood, Yin, and Yang in the internal organs.

The Renying pulse is different. It is located 1.5 inches (about two finger widths) to the side of the Adam's apple. It is the pulsation point of the common carotid artery and belongs to the pulse that observes the Yang Qi. It focuses on the strength and weakness of the Yang Qi on the body surface.

Unlike the three pulse positions (cun, guan, chi) used for palpation, the Renying pulse, being located superficially and close to major blood vessels, requires gentle and slow palpation.

By lightly touching the surface of the skin with the fingertips, one can initially determine whether the pulse is rapid or weak. Then, by applying slight pressure under the skin, one can assess the strength of the pulse.

"Dr. Fang, this might be difficult to diagnose!" Huang Qiming suddenly said quietly.

Fang Yan turned her head and glanced at him; the old man was being somewhat sarcastic.

But he smiled and said:
"Professor Huang is right, it is indeed not easy to take a pulse, but it is not impossible."

"I happen to know a pulse diagnosis method used by the Tang Dynasty army, which is specifically for patients whose hands and feet are injured and who cannot have their pulses taken."

"Oh?" Huang Qiming was taken aback, then looked at him with suspicion.

Looking at the patient's body, which was almost completely rotting, he wondered where Fang Yan intended to take the pulse.

As a result, the person speaking in dialect ignored him, stood up, went to the patient's side, and said to her:
"Come on, lift your head up a little and breathe slowly."

The patient didn't know what Fang Yan was planning to do, so he had no choice but to do as he was told.

Fang Yan held his breath and focused intently, his fingers avoiding the tiny blood clots on the side of the patient's neck, gently hovering about two fingers' width away from the throat.

Then I closed my eyes and began to truly feel it.

Those around were slightly taken aback by this move. The pulse at the Renying point is for assessing Yang Qi, which is not the same as the pulse at the Cun, Guan, and Chi points when the patient is injured. To make a clear diagnosis here, one must have a separate set of diagnostic experience.

In other words, it means being able to transform the feelings here into judgments that can be felt and grasped.

If not, then you can only feel the strength of the Yang energy, and you can't simply apply the judgment experience of the cun, guan, and chi.

At this moment, Fang Yan carefully felt the pulse and found that when the patient's pulse was touched, it was like a piece of wood floating on water, empty and without foundation. If the pressure was increased by half a finger, the strength would suddenly dissipate, like the last leap of a candle before it went out. It was strong on the outside but weak on the inside, and it would soften when pressed hard, and the pulse was also slow.

This is a pulse that is "floating and hollow," similar to the characteristics of a "hollow pulse." In dialects, it can be felt that it is more like "floating, large, and weak."

In traditional Chinese medicine theory, the Renying pulse reflects the Yang Qi. A floating pulse indicates superficial Yang Qi or Yang Qi overflowing outwards, while a hollow and throbbing pulse suggests that although the pulse channel is full, the internal Qi and blood are insufficient, indicating a strong exterior but a weak interior.

A weak and feeble pulse indicates a deficiency of Yang Qi, which is unable to support a full pulse. This is different in nature from a "thready pulse," but it also reflects insufficient Qi and blood.

A slow pulse directly corresponds to a "slow pulse," which indicates spleen deficiency, dampness, or insufficient yang energy.

The "empty and throbbing" feeling when taking the pulse superficially at the Renying point can be understood as the Yang Qi floating outwards, similar to "false heat." The "sudden and dissipated force" when taking the pulse deeply at the Cun, Guan, and Chi points corresponds to the "slight, slow, and weak" feeling when taking the pulse deeply at the Cun, Guan, and Chi points. Based on experience from Tang Dynasty books, these are all different manifestations of "deficiency syndrome" at different locations.

Fang Yan silently began to think.

Among the five visceral deficiencies, spleen deficiency is most closely related to skin diseases. When spleen qi is deficient, its function of transportation and transformation is impaired, the essence of water and grain cannot be distributed, and it cannot nourish the vital energy, thus causing various diseases to arise internally.

In addition, if the spleen is weak and its function of transportation and transformation is impaired, water and dampness will stagnate. Therefore, if the judgment is correct, her illness is related to "dampness".

External dampness leads to water retention, which in turn weakens the spleen. Prolonged dampness can cause spleen deficiency. Pediatric eczema presents as persistent, oozing blisters with large areas of erosion.

The patient's condition relapsed after long-term use of prednisone (a hormone) and cyclophosphamide (an immunosuppressant). The Western medical mechanism is that "insufficient immunosuppression leads to a rebound in inflammation."

From the perspective of traditional Chinese medicine, hormones are considered to "excessively ignite fire and deplete qi." Long-term use can damage the spleen yang, leading to spleen yang deficiency, which manifests as a weak and shallow pulse, a pale tongue, and internal dampness and toxins, resulting in blisters, erosions, and recurring aggravation.

Based on the above conclusions, the dialect made its own judgment by combining its experience.

"The patient likely suffers from spleen deficiency and dampness, compounded by infection with pathogenic toxins!" he told the crowd.

"What do you mean?" Huang Qiming was the first to step forward and ask.

Fang Yan glanced at him and said:

"I believe that the patient's long-term illness and medication have led to spleen deficiency, resulting in oozing of blisters, erosion and crusting, and external release of dampness and toxicity into the skin."

After hearing this, Huang Qiming thought for a moment and said:

“I see that her eroded surface is covered with greasy scabs. In my experience, this is usually related to damp heat. Why do you judge it to be more of a spleen deficiency than damp heat?”

After saying that, he noticed everyone was looking at him, so he added:
"I don't mean anything by it. This is the information I saw, so I'm just saying it to remind everyone. If it's wrong, everyone can point it out. We're here today to exchange ideas!"

Talk to your mother!

Fang Yan thought to himself.

However, on the surface, he still smiled and said:

"Professor Huang, you are joking. The patient's red and swollen skin lesions may seem like a 'heat sign,' but the pale tongue and weak pulse reveal that the true nature of the condition is a false heat caused by 'spleen yang deficiency and external dampness and toxins.' The oily crusts are due to the outward spread of dampness and turbidity. The root cause is still spleen deficiency and poor function. You may have misdiagnosed it as excessive damp heat."

At this moment, Lin Wenfeng nodded, agreeing for the first time:

"False heat and true cold, which seem contradictory, but Dr. Fang has grasped the essence of the disease mechanism!" After saying that, he gave Fang Yan a thumbs up.

Just as he finished speaking, He You, who had been in a daze, walked over at some point and said to Fang Yan:

"To be able to make such a judgment based on the pulse at the Renying point shows great skill in handling such subtle differences!"

After saying that, he turned to Huang Qiming and said:
"I've treated so many people with dialects, and I've never heard of anyone making such a mistake. Old Huang, your questioning is completely unnecessary."

Huang Qiming was stunned for a moment when he saw He You recover.

Why did this person, who had just recovered, start standing on the other side?

He's even started criticizing himself.

His expression remained unchanged, and he nodded, saying:

"Sorry, it's an old habit at school; people abroad just say whatever comes to mind! I hope Dr. Fang won't mind."

Fang Yan stared at him and said coldly:

"I mind."

"..." The audience fell silent at the sound of the dialect's words.

Huang Qiming was stunned when Fang Yan suddenly turned hostile.

Sensing Fang Yan's undisguised hostility towards him, he suddenly felt a little short of breath.

Just then, Fang Yan laughed again:
"Haha, just kidding, Professor Huang shouldn't mind, right?"

Upon hearing this, everyone looked at Fang Yan in astonishment.

Then Jin Wubing was the first to laugh:

"Hahaha...that's hilarious, his face turned blue just now, hahahaha..."

Seeing Huang Qiming's expression, which looked like he had eaten a dead rat, the others around couldn't help but laugh.

Even the patients laughed along.

Fang Yan's initial "I mind" to Huang Qiming, followed by a joking remark, was essentially a response to Huang Qiming's continued provocation.

This straightforward response instantly shattered Huang Qiming's pretense of "mild discussion," exposing his awkward situation to everyone. It then ended with a "joke," which not only prevented the direct conflict from escalating into a personal feud, but also turned the tables on him by asking if he minded.

Huang Qiming was forced to passively accept the teasing, which only made his previous criticisms seem petty.

This is about using a "tough stance" to counter malicious provocations and using "soft skills" to avoid escalating conflicts.

Huang Qiming has targeted dialects multiple times before, and now his public questioning of the dialectical conclusions, while ostensibly an "academic discussion," is actually an attempt to undermine his authority. Now that dialects have launched a counterattack against him, it's finally a real blow.

Huang Qiming's face turned from pale to ashen, then flushed a sickly red under the suppressed laughter of the crowd. He stiffly forced a smile.
"No... I don't mind!" Huang Qiming said somewhat awkwardly.

Watching Fang Yan's rebuttal to Huang Qiming, Lin Suxin smiled and said:

"Dr. Fang is really witty."

"Hahaha..." Jin Wubing seemed to have been tickled when he saw Huang Qiming's expression, and he couldn't stop laughing.

His smile made Huang Qiming feel even worse.

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

After writing down the judgment I had just made, I started writing down the medical case.

When the people saw him, they wrote:
100g raw Astragalus membranaceus, 10g raw Atractylodes macrocephala, 10g raw Citrus aurantium, 30g raw Coix lacryma-jobi, 15g winter melon peel, 15g Poria cocos peel, 15g Plantago asiatica, 15g Alisma plantago-aquatica, 15g Codonopsis pilosula, 30g Dictamnus dasycarpus root bark, 15g Sophora flavescens root, 30g Isatis indigotica root, 15g Glycyrrhiza uralensis and Plantago asiatica, 30g Smilax glabra, 30g Hedyotis diffusa. After writing it down, I checked the dialect and added 10g each of Dioscorea hypoglauca and Glycyrrhiza uralensis.

The entire prescription contained seventeen herbs. After writing it down, Fang Yan paused and glanced at Huang Qiming and He You, wanting to see if they still had any questions.
At this moment, the two of them stood quietly to the side, without making any move.

Then Fang Yan turned around and continued writing on the medical record:
The patient's prolonged illness and long-term medication led to spleen yang deficiency and internal accumulation of dampness and toxins, which is a case of deficiency in the root and excess in the branch.

The formulation principle is based on strengthening the spleen and supporting the body's resistance, while using dampness removal and detoxification as its functions, combining both tonifying and purging methods to strengthen the spleen, resolve dampness, detoxify, and eliminate rashes.

Astragalus is used in large quantities as the principal ingredient. It is sweet and warm, replenishes qi, raises yang and lifts prolapse. It not only replenishes the deficiency of spleen qi, but also strengthens the skin surface to expel toxins.

The assistant herbs, Codonopsis pilosula, invigorate the spleen and replenish qi, while Atractylodes macrocephala, dry dampness and invigorate the spleen. The three herbs combined enhance the spleen and stomach's digestive function, fundamentally eliminating the source of dampness, which corresponds to the pathogenesis of "spleen deficiency and inability to transport and transform."

Raw immature bitter orange peel regulates qi and relieves chest congestion, assisting astragalus and codonopsis in replenishing qi without causing stagnation, promoting the flow of qi, enhancing the ascending and descending functions of the spleen and stomach, and avoiding abdominal distension caused by qi-tonifying herbs.

This method strengthens the spleen and replenishes qi, protecting acquired constitution to address the root cause!

Job's tears are sweet, bland, and slightly cold in nature. They strengthen the spleen, eliminate dampness, and clear heat, and are especially good at removing dampness from the skin and muscles.

Poria peel and winter melon peel are mildly diuretic and promote diuresis, specifically targeting the skin and muscles to expel dampness and toxins through urination. Combined with Job's tears, they enhance the dampness-removing power, targeting symptoms of "external dampness" such as blisters, oozing, and erosion.

Plantain seed and Alisma plantago-aquatica promote the flow of water through the three jiaos, allowing dampness to be expelled from the lower jiao. Together with Poria cocos peel and winter melon peel, they form a "separate elimination of dampness from the exterior and interior," enhancing the dampness-removing effect.

This method promotes diuresis and eliminates dampness, and regulates the three jiaos (upper, middle, and lower burners
Dictamnus dasycarpus root bark is bitter, cold, and drying, clearing heat and detoxifying. It is especially good at treating skin dampness, itching, and erosion. The "Treatise on the Nature of Medicinal Herbs" states that it "treats all kinds of heat toxins, wind, evil wind, and wind sores."

Sophora flavescens has a strong ability to clear heat and dry dampness, which can remove damp-heat toxins from the blood and relieve redness, swelling and exudation of skin lesions;

Smilax glabra (Tufuling) detoxifies, removes dampness, and promotes joint mobility, making it an essential medicine for treating skin sores caused by dampness and toxins.

Isatis root clears heat and detoxifies, cools the blood and soothes the throat, and targets the dampness and toxins that accumulate in the skin.

Hedyotis diffusa is bitter and cold, clears heat, and also promotes diuresis. When combined with Isatis indigotica, it enhances the detoxification effect.

This is for clearing heat and detoxifying, cooling the blood and drying dampness to expel pathogens!
Smilax china is bitter, neutral, and promotes diuresis, dispels wind, and unblocks the meridians. It is especially good at clearing dampness and turbidity in the lower burner. When combined with Smilax glabra, it can enhance the effects of removing dampness and detoxifying, and promoting joint mobility. It is effective for patients with dampness and toxins deposited on the skin lesions of the lower limbs.

Raw licorice harmonizes the effects of various medicines, clears heat and detoxifies, and moderates the irritation of bitter and cold medicines on the spleen and stomach!

Treating the root cause, addressing the symptoms, eliminating pathogens, and harmonizing the various herbs—each step of the prescription is interconnected and meticulously formulated. It targets both the root cause of spleen deficiency and the symptoms of dampness and toxicity, while also taking into account the depletion of spleen yang caused by long-term medication.

Lin Suxin also came up at this time, and analyzed Fang Yan's prescription:

"Astragalus and Codonopsis pilosula tonify Qi and strengthen the spleen, which is called 'tonifying'; Coix seed and Poria peel promote diuresis and eliminate dampness, which is called 'eliminating'. They tonify without causing stagnation and eliminate without harming the body's vital energy. Citrus aurantium regulates Qi, which is called 'moving'; Atractylodes macrocephala strengthens the spleen, which is called 'stilling'. The combination of movement and stillness restores the ascending and descending functions of the spleen and stomach. In addition, Poria peel and winter melon peel promote diuresis and eliminate dampness from the surface, which is effective for skin blisters and exudation. Coix seed and Alisma plantago-aquatica promote diuresis and eliminate dampness from the three jiaos, so that dampness can be eliminated through urination and defecation. The formula combines tonification and elimination, movement and stillness, treats both the exterior and interior, and takes care of both the skin and muscles. It's amazing! Amazing!"

As a pharmacist, Lin Suxin also has insightful ideas about drug compatibility and clinical pathogenesis analysis.

The idea only flashed through Fang Yan's mind for a moment, and then he began writing down the prescription for external use:
Smilax glabra 60g, Phellodendron chinense 30g, Sophora flavescens 30g, Dictamnus dasycarpus 30g, Kochia scoparia 30g, Cnidium monnieri 30g, Rheum palmatum 15g, Alum 10g, Glycyrrhiza uralensis 15g.

usage:

Add 2000ml of water to the above herbs, bring to a boil, then simmer for 20 minutes. Filter out the dregs and let the liquid cool to a warm temperature (about 38-40℃). Soak a sterile gauze in the liquid and apply it to the affected area for 15-20 minutes each time, twice a day (once in the morning and once in the evening).

She tore off the prescription and handed it to Chen Wenwei, who was waiting nearby.

At the same time, he said to the patient:
"I've written the prescription. There are a few things I need to remind you of, so you and your family should take notes."

"Okay!" The patient nodded and called to the assistant from before.

He said in dialect:

"First and foremost, never use hot water to wash the affected skin!"

With a serious expression, he said:
"Damp heat already weakens the spleen. While hot water can relieve itching temporarily, it will promote the spread of dampness and toxins, worsening the erosion. The temperature of the medicine must be controlled to a level that is not too hot to touch. Test the temperature on the inside of your wrist before applying the medicine."

"In addition, avoid using alkaline detergents such as soap and bar soap."

He looked at the patient's assistant:
"Use the decoction to gently wipe the normal skin around the lesions every day instead of bathing; this will both cleanse and detoxify the skin."

The patient's assistant nodded repeatedly. She had just vomited, which her boss must have noted down. But if she handled this well, she should be able to turn things around.

Therefore, she was overjoyed by the opportunity given to her by Fang Yan and quickly made sure to remember it carefully.

After the patient's assistant finished writing, he continued:

"You can order food at Yanjing Hotel during your hospital stay, but you must absolutely avoid seafood, beef, mutton, and spicy foods during the initial treatment period."

Fang Yan pointed to the medical record and said:

"Your tongue coating is white and greasy, indicating severe dampness in your spleen. Eating these things is like pouring oil on a fire of dampness."

The patient nodded repeatedly, clearly frightened by the dialect's tone.

In fact, this attitude is necessary for learning dialects, otherwise you won't remember them at all. Even if the nurses are watching, if the patient doesn't listen, they might still sneak off to eat, and if they get sick from it, they might deny it. That would be a real problem.

He paused, then softened his tone, "You can eat more winter melon, barley, and yam porridge to strengthen your spleen and remove dampness."

After saying that, he reminded the patient's assistant:
"Remember, the best yam to eat is Huai yam, the Huai of 'pregnancy,' not the Huai of 'Huai River.' Remember to remind the restaurant staff when you order!"

The assistant suddenly realized and nodded:
"The 'pregnant' part! I've written it down!"

"Is there anything different?" the patient asked, somewhat bewildered.

At this moment, Lin Suxin took over the conversation and said:

"Of course they are different. In traditional Chinese medicine, only Huai yam has medicinal value. The others are just vegetable yams, which are edible."

After saying this, he sighed:
“We also grow yams in Malaysia, but the medicinal effects are not good, so we can only import dried yams from the country.”

"So it's a blessing to get medical treatment in the country!"

The patient suddenly realized.

Fang Yan continued:

"In addition, drinking a cup of warm, lightly salted water every morning, using half a spoonful of salt mixed with 500ml of warm water, helps to promote the rise of spleen yang."

"However, you must stop drinking it if you experience significant edema."

The patient nodded repeatedly, praising the detailed use of dialects, and instructed her assistant to write them down immediately.

"Make sure it's written clearly, and remind me whenever needed!" the patient emphasized to the assistant.

Hearing his boss's words, the assistant knew that his job was secure again.

She nodded repeatedly, hoping the dialect would be explained in more detail.

Fang Yan thought for a moment and then added:

"Also, choose loose-fitting, pure cotton clothing to avoid friction from synthetic fibers that could worsen the skin damage." Fang Yan pointed to the skin around the patient's neck, where body fluids had already begun to leak out, looking somewhat unsettling. He helped clean it as he spoke:
"Especially in the folds of skin such as the armpits and groin, the gauze should be changed frequently and kept dry. After you have prepared the external medicine for me, you can keep a small bowl of it to cool down and apply it to the folds with a cotton swab to prevent infection."

The patient nodded.

"Also, don't stay up late. The period from 11 PM to 1 AM is the critical time for the spleen meridian to repair itself. Staying up late will make the spleen yang even weaker and make it difficult to eliminate dampness and toxins. You must go to bed before 10 PM every day. Even if you can't fall asleep, you should close your eyes and rest."

"Your pulse is weak and feeble, which is definitely related to the long-term depletion of your spleen yang from staying up late. No matter how good your business is, you only have one life," Fang Yan earnestly advised her.

The other party agreed.

Fang Yan paused, looked directly into the patient's eyes, and said:
"You've been suffering from this illness for three years, you must be feeling really frustrated."

"Anger injures the liver, and liver stagnation exacerbates spleen deficiency, making it even harder to expel dampness and toxins."

"Spend half an hour each day sunbathing, around 9-10 am, with your back to the sun and your chest exposed to the sunlight, using the yang energy of the sun to help your spleen function."

Then Fang Yan took out a thread-bound book from the drawer:

"Our inpatient department has the facilities. You can play some relaxing songs on the radio when you have nothing to do. In addition, you can copy the 'Huangdi Neijing' when you have nothing to do. You don't need to understand it. It's not about making you study medicine. It's just to help you calm down. There's a saying in traditional Chinese medicine: 'If the mind is not calm, the pulse will not be stable. If the pulse is not stable, the medicine will not be effective.' So, keeping a good mood is the most important thing!"

The patient took the Yellow Emperor's Inner Classic and said:
“I’m in a good mood. I have someone at home keeping an eye on my business. They send me a telegram every week.”

Fang Yan nodded and said with a smile:

"Alright, that's all."

After saying that, he remembered something else and said to Xie Chunrong who was standing beside him:
"Oh, right, arrange for someone to put dried mugwort under her mattress in her hospital room later."

"Okay!" Xie Chunrong nodded.

The patient asked his assistant:
"Did you write down everything Dr. Fang said?"

"I've written it all down!" The assistant nodded and handed the written notes to the patient.

Seeing that the written record and the dialect spoken were exactly the same, she forgave the assistant for her earlier outburst.

However, Fang Yan's writing is indeed very detailed, taking into account every aspect. This kind of doctor is much more responsible than the people she encountered abroad.

Moreover, the person just wrote down the entire treatment process clearly and plainly, and the old man who questioned him was proven wrong.

At this moment, she was extremely satisfied with Fang Yan.

After thinking for a moment, as if she had made up her mind, she turned to her assistant and said:
"Oh right, did you bring the gift I prepared?"

"I brought it with me," the assistant said.

The patient said:
"Bring it here, and bring my jewelry box along with it."

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

(End of this chapter)