Rebirth 1977 Great Era

Chapter 1129 Attacking one's own immune system, surgery leaves one weakened (Bonus chapter for monthly votes: 3K chapters)

Today I've caught up with the situation; either no one comes, or two come. Li Zhengji's patient even came from Shanghai.

Upon hearing Li Zhengji's question, Fang Yan said:

"Schmidt syndrome is quite rare in Western medicine. Simply put, it means that the body's immune system has 'mistakenly identified' the wrong organ and is attacking itself. Instead of protecting the body's immune system, it attacks the endocrine glands, damaging organs such as the thyroid and adrenal glands, causing them to malfunction."

"Oh? Attacking yourself?" Li Zhengji's eyes lit up when he heard this, realizing that he had indeed come to the right person; Fang Yan really did know.

Fang Yan continued:

"As for why this is the case, on the one hand, it may be related to genetics. For example, if there are similar immune problems in the family, it is easy to carry this 'sensitive gene'; on the other hand, if you are infected or under too much stress, it may also 'help' the disease and make the immune system more prone to problems."

"This patient may have had a certain 'predisposition' from birth, and with some external stimuli, the immune system went 'off track' and attacked its own glands, eventually causing several endocrine organs in the body to malfunction."

"This disease was first reported by the German endocrinologist Schmidt in 1926, hence the name."

Li Zhengji nodded, then asked Fang Yan:

"So, in traditional Chinese medicine, where does this fall under?"

The dialect responded:
“In traditional Chinese medicine, there is no concept of the immune system attacking itself. If we had to categorize it, it would fall under the categories of hyperhidrosis, diabetes, and general weakness. However, your patient… didn’t you say before that it’s not just Schmidt’s syndrome, but also has multiple endocrine adenomas?”

Hearing Fang Yan say this, Li Zhengji nodded, glanced at the group of people following behind Fang Yan, and said to Fang Yan:

"Could you come over and take a look at me when you have time?"

Fang Yan nodded and said:

"Okay, tell me more about this patient's details."

As Li Zhengji walked forward with Fang Yan, he quickly described the patient's condition to Fang Yan:
"She fell ill in 1967. At that time, a lump was found in her lower right jaw. She went to Shanghai Cancer Hospital for treatment. The pathological slide was diagnosed as 'reticular cell sarcoma'. She was quickly scheduled for surgical resection of the tumor and then underwent radiation therapy."

"Then, over the next ten years or so, lumps were found in her uterus, ovaries, breasts, and thyroid during examinations. She had to undergo surgery almost every year, and even twice in one year. The tissues removed were all diagnosed as fibrous tissue."

"She has been receiving treatment at the Department of Endocrinology in Shanghai for many years, mainly with oral thyroid tablets and licorice extract."

"She came to Beijing mainly to see if Peking Union Medical College Hospital could treat her. After undergoing Western medical examinations, she was recommended to our Traditional Chinese Medicine department by others. They said we are all university graduates, and some are about to take the postgraduate entrance exam, so our skills are exceptionally high..."

"Then she came, and she happened to be in line with my number."

Fang Yan nodded and asked:
"Besides those lumps, what other symptoms does she have? What are the results of the four diagnostic methods?"

Li Zhengji said:
"His eyes were dark and dull, his complexion was ashen and lifeless, and there were small bumps the size of millet grains scattered on his face and palms."

"The tongue is dark in color with ecchymosis on the edges and a white coating; the pulse is thin and weak, especially the radial pulse at the very bottom of the wrist, which feels particularly weak and lacks strength."

"He said he felt dizzy, had dry eyes, couldn't sleep well at night, had loose stools, and his urine was yellow when he woke up in the morning. He went to the toilet a lot during the day, and he always carried a water bottle with him and was drinking water all the time. It was a bit like diabetes mellitus."

"And she was sweating a lot. She started sweating after sitting for a while, and then she said she felt dizzy."

"What about body type?" Fang Yan asked.

Li Zhengji said:
"The body is swollen and cold."

This is a saying from traditional Chinese medicine.

My body is swollen, and I'm extremely sensitive to cold. Even when I'm wearing a lot of clothes, I always feel a chill emanating from my body, and my hands and feet feel cold to the touch. I don't feel hot at all.

As they spoke, Fang Yan and his companions arrived at the consultation room. The patient wasn't there, but Wang Zhijun, who was treating another patient, saw them and said:

"That patient went to the urinal again."

After saying this, Jin Wubing, who was following behind, said to Fang Yan:

"That sounds a bit like 'diabetes'!"

Diabetes mellitus, also known as "Xiao Ke" in Western medicine, is characterized by excessive thirst and urination.

Fang Yan nodded and said to them:

"We'll know when the patient comes back."

A condition that can be called a syndrome is a collection of ailments; if there are any combined syndromes, then it is an even more serious one.

After a while, Fang Yan indeed saw a woman in her thirties or forties and a woman with gray hair who looked to be in her seventies or eighties walk back.

Li Zhengji said to the dialect:

"coming."

Fang Yan glanced at the woman and thought, "She doesn't look sixty-six; she looks quite old."

Moreover, the skin is dark all over the body, especially the neck, cheeks, and elbows, which is a common feature of patients with severe diabetes.

In addition, she had some thread-like growths on her skin.

There were two bulges on his neck, one large and one small.

One looks like a quail egg, and the other looks like a goose egg.

You can also see the surgical marks from her previous surgery.

It must have been cut more than once.

Seeing her condition, it does seem quite serious.

"Hello, this is our Director Fang," Li Zhengji introduced to the patient and his family.

The patient and their family looked at Fang Yan, and then the patient's daughter said to Fang Yan:

"I saw it in the newspaper!"

The patient looked Fang up and down and exclaimed, "Dr. Fang is so young!"

Fang Yan nodded and, without wasting any words, said to them:

"I'm here for a consultation to give Dr. Li some advice. I already understand some of your situation, but I have a few more questions I'd like to ask."

The dialect didn't say that Li Zhengji couldn't handle it; he only said that he came to help and provide advice.

The patient's daughter said:
"Ask us anything, we'll tell you whatever we know."

After she finished speaking, she suddenly remembered something and said:
"Oh, right, I didn't give all the test reports to Dr. Li just now. I also have a report from the test in Shanghai."

After saying that, he handed the report to Li Zhengji.

Li Zhengji took it and flipped through it; it was a document of data.

Fang Yan glanced at it:
Serum cortisol (8AM): 364.3 nmol/L;

Urinary 17-hydroxycorticosteroids: 10.5 pmol/24h.

17-Ketosteroids 16.7 pmol/24h;

Triiodothyronine (Ts), thyroxine (Ta) 58.1 nmol/L, thyroglobulin (TG) 126/L, (TM) 139/L;

Blood glucose 6.5 mmol/L...

There's more stuff going on. According to the data, the patient has hypothyroidism (low T), autoimmune thyroid disease (elevated TM), and mildly abnormal blood sugar.

Others also gathered around. Apart from Chen Mike, most people could only understand that the areas marked in red were likely anomalies. At this point, Fang Yan began to speak:
"Let me check your pulse and examine your tongue again."

The patient sat down again, showing no impatience, but rather cooperating very well.

Fang Yan began to take her pulse and examined her tongue coating. The tongue coating was the same as Li Zhengji had described: the tongue body was dull, the edges were purplish, and the coating was white. In addition, Fang Yan noticed that her lips were dry and the middle of her tongue was also dry. In just a short while, she kept licking her lips and was sweating on her head.

Fang Yan looked at the millet-like growths scattered on her hands, her darkened skin, and her cold hands, and asked her:
"You're sweating, and your hands are so cold. Do you feel cold or hot?"

"Cold," the patient responded.

"Is it a chill that seeps into your bones, or is it because you're not wearing enough clothes? Will drinking hot water help?" Fang Yan asked.

The patient shrank his neck, his voice a little weak: "It's a cold that's deep in my bones. No matter how many clothes I wear, it's useless. Drinking hot water can warm me up for a while, but then I get cold again."

Fang Yan nodded, his gaze sweeping over the lump on her neck, and raised his hand in a gesture:
Are these lumps hard to the touch? Do they hurt when you press them? Have you noticed them growing recently?

The patient's daughter quickly chimed in:
"It's hard! Especially the big one, it hurts if you press it too hard. It seems to have gotten a bit bigger in the last six months. The doctor in Shanghai said he doesn't dare to cut it anymore, for fear of damaging the nerves."

He then looked at the patient's eyelids and said softly:

When your eyes are dry, do they also feel gritty and sensitive to light?

The patient nodded.

Fang Yan thought for a moment, then continued to ask:

"Does your stool become loose every morning when you wake up, or do you feel the urge to go to the toilet shortly after eating? Do you feel bloated after having a bowel movement?"

"I feel like I need to poop right after eating," the patient said, rubbing his stomach with his right hand. "I always feel like there's gas in my stomach, and I don't feel comfortable after pooping; it's sticky and I can't flush it all away."

As they spoke, Fang Yan noticed that the skin on the back of her hand was not only dark, but also had a swollen sheen.

After taking her pulse with Fang Yan's left hand, he gently pressed the back of her left hand.

As a result, a small dent appeared at the point of pressure, and it took a while for it to slowly spring back.

Fang Yan then began to feel the pulse on the right hand, and asked:

"Is your face more swollen this morning, or are your legs heavier in the afternoon?"

“Everything is swollen,” the patient sighed. “My face was so swollen in the morning that I couldn’t open my eyes, and in the afternoon my legs felt like they were filled with lead, and I was out of breath after walking just a few steps.”

At this point, Li Zhengji had already begun recording medical cases.

Fang Yan then inquired about the events of the night:

"Is your insomnia due to too many thoughts in your mind, or is it because you feel unwell and toss and turn? Is the sweating when you are awake, or does it soak your clothes after you fall asleep?"

“Yes, I have both,” the patient said.

Then the patient's daughter added:

“My mom always says she feels hot and restless at night, tossing and turning like a pancake, sweating so much that her pillow is soaked, but her skin is cold to the touch.”

The dialect still lingered on the patient's pulse; the pulse on the right hand was so thin and weak that it was like an unyielding thread, especially the weak and deep pulse at the cun position, which was almost hidden in the bones.

His gaze swept over the surgical scar on her neck, and he asked again:
"After your thyroid surgery, are you more sensitive to cold? Is it harder to speak than before?"

The patient paused for a moment, then nodded repeatedly:
"That's right! I used to be able to go out in winter, but after I had my thyroid removed, I have to wear a cotton-padded coat even when I'm indoors with the fire burning, and I always feel like I don't have enough breath to speak."

Fang Yan nodded, finished feeling Li Zhengji's pulse, and then stood up and said:
"Shall we summarize and discuss this?"

Li Zhengji was taken aback, realizing that Fang Yan was about to express a judgment, so he nodded:

"Okay, let's talk outside."

PS: After finishing this chapter, I currently owe everyone 10000 words.

That's all for today, please come early tomorrow.

(End of this chapter)