Rebirth 1977 Great Era

Chapter 1214 "Old Child" Miraculously Resolves Ascites, Aftermath of Undercurrents at Peking Union Medical College Hospital (Two-in-One Chapter)
As people get older, they become like children, requiring special consideration in many things. They cannot be treated using methods designed for adults, and any mishap could lead to serious consequences.

I started racking my brain to see if any of the dialects matched.

His mind raced, and his hands didn't stop either, writing on the medical record:

Blood heat and toxins accumulate and form masses, blood stasis and water retention, liver and kidney yin deficiency, and spleen and stomach qi deficiency.

This illness is like tending a barren old garden. You need to clear away the weeds (heat toxins), dredge the ditches (blood stasis), irrigate with water (nourish yin), and slowly cultivate the soil (strengthen the spleen). You can't make a mistake at any step.

Fang Yan paused for a moment on the medical case, a long-standing medical case suddenly flashing through his mind.

He had seen it in his maternal grandfather's medical records.

It is a record about a five-year-old child suffering from "ascites".

The child in the medical record also had an enlarged liver and spleen, a bulging abdomen, dry mouth and red tongue, and poor appetite. Although the cause of the illness was heat generated from long-term infestation of parasites, which was different from the "heat toxin in the blood" of Grandpa Liu, the signs of deficiency heat in the tongue and pulse, as well as the core pathogenesis of "blood stasis and water retention", were somewhat similar.

Even more coincidentally, the child's spleen and stomach were extremely weak, and he would have diarrhea if he took any strong medicine. This was like a mirror image of the spleen and stomach deficiency shown by the old man's "peeling the skin".

“Children and the elderly…” Fang Yan tapped the table with his finger, a sudden thought striking his mind.

Yes, the two seem worlds apart, but in reality, they are both typical examples of "deficiency of vital energy and inability to withstand attacks".

Children's internal organs are delicate, like tender buds just beginning to sprout, so medication must be administered "as lightly as a feather"; the elderly's internal organs are failing, like a candle flickering in the wind, so medication must also be administered "as cautiously as walking a tightrope".

They could not withstand the torment of strong medicines and drastic remedies. Attacking the pathogenic factors would harm the body's vital energy, while tonifying the deficient factors would hinder the pathogenic factors. Just like in that medical case, the grandfather used the method of "gradual elimination and transformation" to combine a small amount of blood-activating medicine with spleen-strengthening and yin-nourishing products. This method did not directly attack the lesion, but could gradually eliminate the blood stasis, and in the end, the child's stagnation gradually dissipated.

How similar this is to Old Master Liu's situation!

Fang Yan stroked his chin. If the conventional method of "purging and promoting diuresis" to treat ascites is used, such as using herbs like Euphorbia kansui and Euphorbia pekinensis, although it can temporarily remove the ascites, it will inevitably damage the already weak spleen, stomach, liver, and kidney yin. Therefore, it is no different from drinking poison to quench thirst.

However, if you only use formulas that nourish yin and strengthen the spleen, it will cause the stagnant heat and turbid fluid to accumulate deeper and deeper.

'Perhaps... we can treat the old man like a 'child in his old age'?' Fang Yan thought to herself.

After thinking about it again, it seems like I could definitely give it a try...

A glint of light flashed in Fang Yan's eyes.

The core of my grandfather's pediatric medical case lies in "overcoming strength with gentleness"—using skillful means rather than brute force.

He could actually draw on his grandfather's approach to medication in his medical records, prioritizing "clearing heat and toxins from the blood," but without using bitter and cold herbs like Coptis chinensis and Scutellaria baicalensis.

Instead, use herbs with milder properties such as purple gromwell and peony bark, which can cool the blood and detoxify without damaging the spleen and stomach.

For resolving blood stasis and eliminating masses, choose products like turtle shell and turmeric, which "soften hardness and disperse nodules". Turtle shell is salty and cold and enters the liver, which can both break up blood stasis and nourish yin. Turmeric is pungent and warm and promotes qi circulation, but it is not too hot and will damage yin. The two herbs together have a balance of strength and gentleness.

For diuresis, avoid strong drugs and use "light and clear diuretic" drugs such as Poria peel and winter melon peel, which can both guide turbid water out and not deplete body fluids.

Fang Yan paused, then reorganized his thoughts.

There's another crucial point to consider here.

That is, we must always uphold the principle of "protecting righteousness".

Just like the use of yam and lotus seeds to strengthen the spleen in that medical case, he can add codonopsis and stir-fried atractylodes macrocephala to strengthen the spleen and replenish qi, while using rehmannia and ophiopogon japonicus to nourish the yin of the liver and kidneys, so that "eliminating evil" and "strengthening the body" can work in tandem, without delaying the elimination of blood stasis and diuresis, and at the same time replenishing the depleted vital energy.

Just like loosening the soil and fertilizing an old locust tree, you can't dig and water it violently; you have to slowly regulate the vitality of its roots.

Old Master Liu had been observing Fang Yan's expression closely. Seeing him sometimes frown in thought, and sometimes his eyes flicker, he couldn't help but ask:
"Dr. Fang, is the old man's illness difficult to treat? Is there some problem?"

Fang Yan snapped out of her reverie, a gentle smile spreading across her face, and said, "Grandpa Liu, don't worry. I was just thinking about a medical case of my maternal grandfather, and I realized it's quite similar to your situation."

"Oh? Your maternal grandfather?" Old Master Liu asked, somewhat surprised.

He really had never heard of who his maternal grandfather was.

The main problem is that he doesn't understand the dialect very well.

Fang Yan smiled and nodded, saying:

"That's right. My maternal grandfather's name was He Xiu. He was in charge of arranging the transfer of traditional Chinese medicine practitioners from all over the country to Beijing in 1955."

Hearing this, Old Master Liu nodded:
"I see, no wonder you're so amazing at such a young age!"

Mr. Liu thought that if someone could be in charge of such a large project in 1955, they must be a high-ranking official in the Ministry of Health by now.
However, he was also unfamiliar with the situation at the Ministry of Health, so he asked:
"I wonder what position your grandfather holds now?"

He said in dialect:

“He has been dead for many years. He passed away before I was old enough to remember anything. As for my learning of his medical skills, I learned them from the medical records he left behind.”

"I see..." Old Master Liu suddenly realized and nodded.

After the dialect interruption, Grandpa Liu no longer doubted that his illness was incurable.

I'm still wondering how Fang Yan learned medical skills.

The recipes have already been written down in the dialect section.

10g of Lithospermum erythrorhizon, 9g of Paeonia suffruticosa, 15g of Trionyx sinensis (decocted first), 6g of Curcuma zedoaria, 15g of Poria cocos peel, 15g of Benincasa hispida peel, 12g of Codonopsis pilosula, 10g of stir-fried Atractylodes macrocephala, 12g of Rehmannia glutinosa, and 10g of Ophiopogon japonicus.

After Fang Yan finished speaking, the old man finally realized what was happening and asked Fang Yan:

"This recipe is your maternal grandfather's?"

Fang Yan put down her pen, gently pushed the prescription in front of the old man, and shook her head with a smile:

"Not entirely. My grandfather's medical case was for treating intestinal parasites in children, and the prescription focused on expelling parasites and eliminating stagnation, which is different from the root cause of your 'blood heat toxin, blood stasis and water retention'."

He pointed to the names of the medicines on the prescription and patiently explained:

“I learned his method of ‘gradually eliminating and protecting the body’s vital energy. For example, the purple gromwell and peony bark are more effective at clearing heat and toxins from the blood than the artemisia annua and lycium bark that my grandfather used back then; the combination of turtle shell and turmeric is also based on his idea of ​​using tortoise shell with sparganium rhizome. They all use medicines that soften hardness and disperse nodules to slowly grind away the blood stasis. I just adjusted the properties of the medicines according to your constitution.”

"And this Poria cocos peel and winter melon peel," he said, pointing to the two herbs.

“In my grandfather’s medical records, he used plantain seeds and red beans for the child. They are more effective in clearing away damp heat and promoting urination. You are old and your body fluids are already deficient. Using bark-based medicines can draw out dampness without depleting yin fluids like seed-based medicines. It can be considered as ‘following the old method but using new medicines’.”

Finally, he concluded:
"In the end, medical records are static, but people are dynamic. My grandfather's prescription gave me the idea of ​​'using clever methods to treat stubborn diseases.' The specific medication still needs to be adjusted according to your pulse and symptoms. It's like an old carpenter making furniture. The same mortise and tenon structure will always have to be adjusted in terms of force and proportion when used on different types of wood."

After hearing the explanation in dialect and looking at the names of the medicinal herbs on the prescription, Old Master Liu suddenly smiled:

"Hey, now that you mention it, this recipe is like a suit tailored to me. It looks simple, but the stitches are full of intricacies."

Fang Yan also tried to lighten the mood, and he said with a smile:

"That's right. In traditional Chinese medicine, each person has their own treatment method. Once the body's yin and yang balance is restored, the body will naturally repair itself."

“Treating an illness is like fighting a war. You are the commander-in-chief, and the body is your soldier. I am at most an advisor who gives suggestions. If the commander-in-chief loses his strength first, no matter how good the soldiers are, it is useless.”

“Your liver problem is like sediment settling in a cup. It didn’t accumulate in a day or two. To clear it out, you have to take it slowly. The medicine I prescribe is like filtering it little by little with a fine sieve. Today it filters out some heat toxins, tomorrow it filters out some stasis. Over time, the water will naturally become clear. But the premise is that you have to believe that this sieve is effective and you have to be patient and wait.”

The old man nodded thoughtfully.

He understood that Fang Yan was afraid that he would break down mentally first, and that the patient's mental state had to be maintained for the treatment to be effective.

The dialect also says:

"Back when you were on the battlefield, fighting tough battles, did you also think, 'Just hold on a little longer, the reinforcements will arrive soon'? It's the same now. This medicine is your 'reinforcements,' twice a day, arriving on time. As the 'commander-in-chief,' you have to keep the situation under control and not let them fight alone."

He suddenly remembered something and smiled:

"Besides, you still owe me a braised pork dish. If you give up now, my hopes will be dashed. Once you can walk a few steps on your own with your cane, let's meet at the cafeteria, and I'll ask the head chef to make you a version with less oil and salt. That way, the wait won't have been in vain."

These words amused the old man; his laughter, though slightly breathless, was much louder than before.
"You little rascal, you've learned to use braised pork to manipulate people."

"Alright, I'll treat this as another long battle and wait to fulfill my promise to you."

Fang Yan then said to him:

"In your case, besides taking your medicine on time, there are a few other things you need to remember."

The old man glanced at his secretary behind him, and only after the secretary took out paper and pen did he speak to Fang Yan:

"You speak."

Fang Yan curled up his fingers and listed them off one by one: "First, you have to keep your mouth shut. Say goodbye to greasy things like braised pork belly and braised pork hock, as well as chili peppers and strong liquor for now. I read in the information that you used to like to drink a little, but now your liver is busy 'building a house,' and these things going in will be like throwing bricks into a construction site, making things worse."

Grandpa Liu smacked his lips, remembering the braised pork he had just promised, and said helplessly, "Alright, I'll have the housekeeper stew some more clear soup, just to lighten the load on my liver."

"Secondly, don't always lie down." Fang Yan changed the subject, pointing out the window, "Every morning, when the sun is just rising, have your family push your wheelchair out to bask in the sun for half an hour. Your body is weak, and the sun is the best 'tonic,' helping to smooth out your qi. Even though it's summer, there's no harm in getting some sun."

“That’s easy. I used to enjoy basking in the sun and thinking things through.” The old man nodded in agreement, then asked curiously, “Anything else?” “Third, to reiterate, relax.” Fang Yan’s tone softened a bit. “Don’t grip the armrests of your wheelchair so tightly all the time; your fingernails are practically digging in. Put aside things at home and at work if you can. The liver is sensitive to stagnant energy; the more you think about things, the more easily it gets knotted up. If you’re feeling really stifled, have someone read you a passage from the newspaper, or listen to some traditional opera—Qinqiang or Peking Opera will do—it’ll help you relax.”

The old man was taken aback by what he said, and subconsciously loosened his grip on the armrest, his palm slightly damp. He chuckled, "You, as a doctor, not only treat illnesses, but also worry about my anxieties?"

"To cure an illness, you must first cure the mind." Fang Yan handed over a cup of warm water. "Your illness is like parched land; it needs to be moistened slowly, not hastily. The medicine should be decocted twice a day and drunk warm after breakfast and dinner. When you drink it, don't gulp it down; sip it like you're savoring tea, so that your spleen and stomach can adjust first."

Grandpa Liu took the water glass, his fingertips touching the warm glass, and his heart felt a little warmer as well.

"Okay, I'll do whatever you say. If you can really get better, I'll be happy to listen to you nagging me every day, let alone avoid certain foods and sun exposure."

Fang Yan thought for a moment and then added:
"By the way, if you feel your stomach rumbling or urinate more frequently while taking the medicine, don't panic. That's just the dampness being expelled, which is a good thing. If anything seems wrong, have someone come find me immediately."

The old man nodded, and then Fang Yan saw them out.

This connection between pediatric treatment methods and geriatric diseases has given Fang Yan some ideas.

Whether it is a child or an elderly person, the essence of disease is an imbalance of "good versus evil".

Children have "delicate internal organs and insufficient physical strength," while the elderly have "exhausted internal organs and deficient vital energy." Although their ages and constitutions differ, the core problem is that "their vital energy is insufficient and they cannot withstand attacks."

For children, whose qi and blood are not yet fully developed, treatment should be stopped once the illness is cured to avoid excessive intervention; for the elderly, whose qi and blood are already weakened, treatment should be carried out step by step, focusing on eliminating pathogens without harming the body's vital energy.

Both should follow the principle of gentleness and slowness, rather than aggressive and hasty attacks.

However, this is not a mechanical copy of pediatric prescriptions, but rather grasps the core treatment principle of "gradual elimination and protection of the body's vital energy." For those who know this, it is easy to understand, but for those who do not have a solid foundation, even if they know this, it is not very meaningful.

Learning from the core concepts and copying the recipe are not the same thing.

In the following period, Fang Yan watched several more interviews with well-known retired cadres.

Even at lunchtime, people were still coming over.

Moreover, more and more people are arriving because the memorial service has just ended, and most people are only now arriving.

Since there was no other way, I had to arrange for the hospital cafeteria to treat me to a meal, and then I would continue my treatment in the afternoon.

They've already come; we can't just turn them away.

This delighted the cafeteria staff. It wasn't a rare opportunity to have so many big shots dining here, so they pulled out all the stops and prepared a table full of dishes catering to the tastes of people from all over the country.

Fang Yan was supposed to go back to eat, but since the dean wasn't there, as the main person in charge of this event, along with the other three vice deans, Fang Yan came here to have dinner with the old men.

Some elderly men who had finished their morning appointments were still eating here, and they enthusiastically recommended the process of seeing a doctor in the local dialect to the elderly men who hadn't yet seen a doctor.

Especially those who have undergone bone setting, massage, and acupuncture treatments that produce immediate results.

They're all exaggerating the importance of their dialects.

The tone was even more exaggerated than when Director Liao recommended it.

"Old Zhang, try Dr. Fang's acupuncture for your old leg pain. I had it done this morning, and now I'm walking with a spring in my step!" The speaker was a short, stout old man who was patting the shoulder of the person next to him. His ankle, which was exposed under his trouser leg, had a small piece of gauze on it.

On the other side, Mr. Li, who had just undergone chiropractic, was moving his neck. His brows, which were usually furrowed, relaxed, and his voice was loud enough to penetrate the noise:
"Before, I felt like I'd lost my soul when I turned around, so dizzy I was swaying. But Dr. Fang only needed a few strokes, and with a click, I felt refreshed! He's even more amazing than the massage therapists I had back in the army!"

Someone next to him immediately answered:

"I just heard Old Liu say that Dr. Fang's prescription is very particular, even the medicinal herbs are chosen to be mild, he said he's treating him like an 'old child', that's a novel idea!"

"That's right," said Old Master Liu slowly, taking a sip of porridge from his enamel bowl.
"They not only treat your illness, but also tell you not to overthink things. They told me to worry less, get more sun, and even told you to sip your medicine carefully. They are more attentive than your housekeeper."

Several retired cadres who hadn't yet had their turn to see a doctor listened intently, their eyes lighting up as they frequently glanced toward the direction of the dialect.

Fang Yan was helping the three vice presidents serve porridge to the elderly, and he waved with a smile:

"Gentlemen, please don't listen to their exaggeration. It's just their duty. Please enjoy your meal. If you're still hungry, feel free to ask for more. The kitchen has also prepared some mung bean soup to help you cool down in the summer heat."

By the window, two elderly men who had just finished acupuncture were rolling up their trousers and competing to see who could lift their legs higher. One said, "I can reach this high," and the other immediately retorted, "I'm half an inch higher than you," making everyone around them laugh.

A cafeteria worker in a white coat came over carrying a stack of steamed buns. Amused by the sight, he shouted in a voice as loud as a work call:

"Gentlemen, slow down, don't stretch! If you're still hungry, we have steamed buns, fresh out of the steamer, still bubbling away!"

The old men hadn't had a meal together in a long time. The sadness of the memorial service was forgotten at this moment, and everyone recalled the time they spent in the army when they were young.

The long wooden tables in the canteen were temporarily pieced together into a rectangle. The clattering of enamel bowls mingled with the laughter of the elderly, like a pot of boiling millet porridge.

After they had treated the old men to a meal, they sat down to eat.

At a small table in the corner of the cafeteria, Fang Yan had just taken a couple of bites of rice when Vice Dean Chen approached with his tray:
"Director Fang, I've already spoken with the Western medicine team. We'll expedite the physical examination process as much as possible, and send the results directly to the Traditional Chinese Medicine clinic."

Fang Yan nodded and said to Vice Dean Chen:

"Thank you for your hard work!"

Vice Dean Chen smiled and said:
"I just asked about the Western medicine side. Director Zhang and his team are overseeing it. They've opened a fast track for basic tests like blood tests and ultrasounds, so results can be available as quickly as possible." He paused, then added:
"But this afternoon... some of the checks became inaccurate, especially after we had eaten."

Fang Yan paused, picking up food with her chopsticks, then realized what was happening:

"You mean blood tests for blood lipids and liver function? Indeed, the indicators tend to fluctuate after meals."

He thought for a while and said:

"Could you please tell the Western medicine department that the old leader who came this afternoon needs to have his fasting tests registered first, and have them come back tomorrow morning on an empty stomach to complete the tests? Today, let's do some routine physical examinations, electrocardiograms, and abdominal palpations, which are not affected by diet, so as not to delay the diagnosis and prescription."

Vice Dean Chen said:

"That's a good idea. The older leaders are getting on in years, and they are prone to low blood sugar if they stay up all afternoon on an empty stomach. Let's do some basic tests first, and we can do the follow-up tests tomorrow."

Then, Vice Dean Chen stirred the vegetables in his bowl with his chopsticks and suddenly spoke slowly:
"By the way, speaking of which, I heard that the higher-ups are taking the dean's mission very seriously, and they'll probably make some changes when he gets back."

He glanced at Fang Yan out of the corner of his eye, and seeing that the other person was just eating with their head down, he added:
"Our hospital has developed rapidly in recent years, all thanks to the hospital director's leadership. With his promotion, someone has to take on the responsibilities of the hospital, don't you think?"

The gesture paused slightly.

At this moment, Vice Dean Gu chimed in:
"Before the dean left, he told me that Director Fang was young but capable. He arranged the reception for the old leader perfectly, which was much better than us old guys."

Fang Yan realized that this was aimed at him. He swallowed the food in his mouth and smiled.

"Dean Gu, you flatter me. It's all thanks to the help of all the seniors. I was just helping out."

Vice Dean Chen put down his chopsticks, took a handkerchief from his pocket, wiped his mouth, and spoke in a casual tone:
"Director Fang is too modest. Look at you in the past year or so, you've attracted overseas Chinese investment and revitalized the Department of Traditional Chinese Medicine. Now even the senior leaders recognize you. Not everyone has this ability."

He changed the subject:
"Speaking of which, you've always had ideas about things in the hospital. If you have the opportunity to take on more responsibility in the future, what aspect do you plan to focus on?"

The question was direct. Vice Dean Lin picked up his teacup, gently blew on it, and didn't reply.

Fang Yan understood perfectly what Vice Dean Chen meant, and he put down his chopsticks:
"Dean Chen, I'm not very smart, all I know is how to treat patients. If I can figure out the methods of traditional Chinese medicine and make more people trust it, that will be enough for me to keep busy for the rest of my life."

"Oh, you're being too modest!" Vice Dean Chen said with a chuckle.

Fang Yan paused, then looked at the three of them:

"I'm a complete novice when it comes to hospital management, so we need experienced seniors like you, Dean Gu, and Dean Lin. I'm better suited to staying in the consultation room, taking patients' pulses and prescribing medicine."

Vice Dean Chen's smile deepened: "You can't say that. You're young, ambitious, and highly regarded by the higher-ups. If you really have the opportunity, you can't just turn it down, can you?"

Vice Dean Gu then spoke:
“Old Chen, it’s a good thing that young people have their own pursuits. I think Director Fang doesn’t seem to have much interest in official positions.”

Vice Dean Lin echoed:
"That's right. Everyone knows that Director Fang is single-mindedly devoted to treating patients; otherwise, he wouldn't have achieved so much."

Vice Dean Chen said "oh" and didn't ask any further questions. He just picked up the bowl, picked up the remaining rice, and looked at it with a complicated expression.

Fang Yan seemed oblivious, picked up another steamed bun, broke it in half, and handed it to Vice Dean Chen:

"The cafeteria staff made some really good steamed buns today, please try them. You have a lot to do this afternoon, so you need to have something to eat."

Vice Dean Chen took the steamed bun and suddenly smiled:
"Haha... Okay, let's not talk about this anymore. Let's finish what we need to do this afternoon first."

In fact, Fang Yan understands things perfectly well.

Vice President Chen was afraid that I would take his position. After I politely declined the position of president, Vice President Chen's attitude immediately softened, which shows that what he really cared about was not the hospital's development, but to make sure that I would not become his competitor.

Fang Yan felt that he was overthinking things. Instead of guarding against himself, he should guard against the other two, or at least make a good impression in front of so many old men.

PS: The basic chapter of 6000 words has been updated.

(End of this chapter)