Rebirth 1977 Great Era

Chapter 1308 Still Combining? Almost Killed Someone! (Bonus Chapter for Monthly Tickets)

The patient is a 60-year-old woman who is currently in a coma, experiencing fever, sweating, and vomiting.

Lin Hongjun was a little flustered, not expecting to encounter such a situation right away, but he quickly calmed himself down and began to take the patient's pulse.

Then he found a tongue depressor, pried open the mouth, and looked at the patient's tongue.

Then he asked the patient's family:
"How many days is this?"

The patient's family responded:

"It's been almost 100 days since the cerebral hemorrhage, more than 90 days since the overdose of chlorpromazine, and the vomiting started on the fourth day."

Lin Hongjun scratched his head, all three things piled up at once. He glanced at Fang Yan, who, unlike before, spoke to him:
Are you confident you can cure cerebral hemorrhage and the aftereffects of chlorpromazine?

Lin Hongjun shook his head with a serious expression:
"No."

His first patient encountered this disease, and the knowledge he learned in school directly hit a blind spot.

Fang Yan nodded. This person was honest and didn't try to hide anything.

However, as soon as he said this, the patient's family members became a little anxious.

Isn't Peking Union Medical College Hospital (PUMC) supposed to be very prestigious?
Why can't even the doctor help?
However, before the family members could speak, they heard someone in a dialect say:

"Let's deal with the sweating, fever, and vomiting first! I'll handle the rest."

The patient's family glanced at Fang Yan and had no idea who this young man was.

Although the dialect is already quite famous, it's normal for people who don't pay much attention to traditional Chinese medicine not to know about it. Even in the internet age with such advanced information, some very famous people are still unknown to some people.

Or perhaps you know the name, but don't recognize the person.

"Are you the doctor specifically in charge of this department?" the patient asked in dialect.

"Well, you could say that," Fang Yan nodded.

The patient's family lingered on Fang Yan's young face for several seconds before finally nodding. The entire TCM department at Peking Union Medical College Hospital was staffed by young people; outsiders said the doctors here were very skilled, all university graduates. So they didn't say anything more, turning to Fang Yan and Lin Hongjun:

"Then you should get treatment quickly!"

It doesn't matter who treats the patient; what matters is that the patient can be cured.

After hearing the patient's words, Fang Yan gave Lin Hongjun a look, signaling him to begin the treatment.

Lin Hongjun quickly wrote down the following in the medical record book:

"The patient is a 60-year-old woman who suffered a cerebral hemorrhage more than three months ago. She was in a coma and paralyzed due to an overdose of chlorpromazine. In the past four days, she has had a cold with fever, sweating, and persistent vomiting. Western medicine administered via nasogastric tube has been ineffective. Her pulse is floating and rapid, and her tongue is pale with a thin yellow coating."

He then picked up a pen and began writing a prescription, explaining his thought process in dialect as he did so:

"Fever and sweating indicate wind-heat attacking the exterior. Use Sangju Decoction: 10g mulberry leaf, 10g chrysanthemum, 6g apricot kernel, 8g forsythia, 6g platycodon, 3g licorice, and 12g reed rhizome. This formula is mild and can dispel wind-heat and stop sweating without damaging the body's vital energy. For persistent vomiting, observe the tongue coating and pulse. It indicates that the pathogenic factor is attacking the Shaoyang meridian and the stomach qi is rising. Use Xiaochaihu Decoction with modifications: 10g bupleurum, 6g scutellaria, 8g pinellia (washed), 3 slices of ginger, 5g ginseng, 3 jujubes, 3g licorice, 6g bamboo shavings to descend the rebellious qi and stop vomiting, and 6g tangerine peel to regulate qi. The two formulas can be administered slightly at different times. Use a nasogastric tube to slowly administer the medicine and observe whether the vomiting is relieved and whether the fever subsides."

The analysis is spot on; there's nothing wrong with that point alone.

Sangju Drink and Xiao Chaihu Decoction are both classic prescriptions. Xiao Chaihu Decoction is even known as a panacea and is ranked alongside Guizhi Decoction, which is considered the top prescription among all prescriptions.

There's a saying: "When there's nothing to do, use Guizhi Tang; when in doubt, use Xiao Chaihu."

His judgment was correct, Fang Yan nodded, but Lin Hongjun was still a little nervous, mainly because he couldn't handle the first patient.

After writing down the prescription, he carefully checked the dosage again, and specially noted, "Sangju Decoction should be taken warm, and Xiaochaihu Decoction should be taken slightly cooled. Each nasal feeding should not exceed 50 ml, with an interval of one hour." He then handed it to the nurse next to him and turned to the family member to instruct, "After you get the medicine, first decoct Sangju Decoction. Bring it to a boil over high heat, then simmer over low heat for 15 minutes. Do not simmer it for too long. Simmer Xiaochaihu Decoction for 20 minutes. The Pinellia should be washed to remove the alum taste beforehand to avoid irritating the stomach and intestines."

Before he could finish speaking, he said in dialect:
"Just give this prescription to the nurse. This patient needs to be hospitalized. The Chinese medicine pharmacy will prepare it and send it over, and then they will be responsible for feeding it to him."

After speaking in dialect, he walked to the patient's side:
"I'll do it now!"

Lin Hongjun quickly handed the medical case notes in his hand to Fang Yan.

Fang Yan waved his hand dismissively, then bent down to re-examine the patient's pulse. He found that the pulse, besides being floating and rapid, was also deep, thin, and weak. He also noticed the patient's pale eyelids, dry skin, and even with a fever, cold extremities. He pressed on the patient's abdomen, finding it soft and without resistance. He then opened the patient's eyelids, finding no conjunctival congestion, before speaking:

"Three months after the cerebral hemorrhage, an overdose of chlorpromazine damaged the central nervous system. Now it is a case of 'deficiency of the root and excess of the branch'. The root deficiency is the deficiency of qi and blood and the depletion of kidney essence, while the branch excess is the obstruction of phlegm and blood stasis and the disorder of qi."

He turned to look at Lin Hongjun, his tone calm:
"The Sangju Decoction and Xiaochaihu Decoction you prescribed are appropriate for your condition."

After hearing Fang Yan's words, Lin Hongjun nodded and asked:

"So what's the next step in the treatment?"

Fang Yan said to Lin Hongjun:
"Follow your prescription first. Once the fever subsides and the vomiting stops, we'll treat the root cause in two steps. The first step is to 'resolve phlegm and open the orifices,' trying to wake the patient. The second step is to 'invigorate qi and blood,' gradually restoring the paralyzed body."

"The patient's tongue is pale with a thin yellow coating. In addition to the Shaoyang syndrome, there is also some phlegm and dampness. After drinking Xiao Chai Hu Tang for two days, the vomiting was relieved. Then, An Gong Niu Huang Wan was added. Half a pill was ground into powder and mixed into rice water for nasal feeding every day. This medicine can clear heat from the pericardium, resolve phlegm and open the orifices. It can help with coma after central nervous system damage."

"However, Angong Niuhuang Wan has a cooling effect and cannot be used for a long time. Stop using it once the patient shows signs of opening their eyes or slightly moving their limbs."

Lin Hongjun quickly took out a pen, wrote it down in the blank space of the medical record, and then asked:

"What formula should I use to invigorate qi and promote blood circulation? Buyang Huanwu Decoction?"

Fang Yan glanced at him, tilted her head, and said, "That works too."

"However, the original formula of Buyang Huanwu Decoction is Astragalus membranaceus, Angelica sinensis tail, Paeonia lactiflora, Pheretima aspergillum, Ligusticum chuanxiong, Carthamus tinctorius, and Prunus persica. The patient is now severely deficient in Qi and blood, so Astragalus membranaceus should be used starting from 30 grams and gradually increased to 60 grams to avoid the patient being unable to tolerate the tonic. Acorus tatarinowii and Polygala tenuifolia should also be added to enhance the effect of resolving phlegm and opening the orifices. She has been bedridden for a long time, and her intestinal peristalsis is slow, so 10 grams of stir-fried radish seeds should be added to regulate Qi and prevent constipation. If there is constipation, the turbid Qi will rise and it will aggravate vomiting."

"You can see it that way, but I have a better way, and we'll adjust it as needed."

Lin Hongjun suddenly realized.

The dialect is clearly different from their prescription.

Then, speaking in dialect to the nurse, he instructed her:

"Tell the inpatient department not to feed too much today. Give 50 ml of rice water each time, along with the Chinese medicine prescribed by Dr. Lin, every two hours, and observe for any vomiting. If the vomiting stops tomorrow, gradually increase the amount and add some steamed egg custard to supplement the protein."

After the nurse agreed, Fang Yan looked at the family members again: "Don't be too anxious. The patient's condition won't get better in a day or two. First, treat her cold and vomiting. Once she can open her eyes and respond, then we can start practicing limb movements. You can talk to her more these days and talk about things at home. Although she is not responding now, she may still have hearing, which can stimulate her to wake up."

The family members nodded repeatedly, their anxiety greatly alleviated by Fang Yan's organized arrangements. One of the middle-aged men couldn't help but ask, "Doctor, how long will it take for her to wake up?"

"It's hard to say. It depends on the reaction to the medication. If the patient shows signs of opening their eyes after three days of using Angong Niuhuang Wan, the recovery will be faster. If there is no reaction, the prescription will be adjusted, and Suhexiang Wan will be added to warm and open the orifices. However, as long as the qi and blood can be replenished and the phlegm can be cleared, there is always hope for waking up."

The patient's family nodded, and then they and the nurse took the person to the hospital.

After the patient left, Lin Hongjun said to Fang Yan:

"Director Fang, it's my medical skills that are inadequate; I encountered a problem right from the start today..."

Fang Yan patted Lin Hongjun on the shoulder, his tone not reproachful at all, but rather relaxed: "It's normal for your medical skills to be lacking. You just graduated and haven't seen such complicated cases before. Being able to correctly diagnose fever and vomiting and prescribe Sangju Yin and Xiaochaihu Yin correctly is already better than many people. I've seen new doctors encounter comatose patients right after they start treating patients, and their hands were shaking more than yours."

He pointed to the door of the consultation room, where patients were already peeking out from the corridor, clearly having registered for Lin Hongjun's appointment: "Don't worry about what wasn't done properly, there are other patients waiting. That last case was a special case, most patients have common illnesses, just treat them with confidence."

Lin Hongjun was taken aback. Looking at Fang Yan's composed demeanor, his guilt and nervousness lessened considerably. He had expected criticism for his lack of ability, but Fang Yan hadn't said anything; instead, she had comforted him. He nodded.

"I understand, Director Fang. I'll go call the next patient now."

It was obvious that Lin Hongjun sensed Fang Yan's goodwill towards him, and he immediately thought of what he had said before going upstairs.

The treatment continued, and Fang Yan checked back and forth until about 11 a.m. He could almost confirm that everyone's basic skills were up to par, and no one made any mistakes when using classical prescriptions. Fang Yan felt a bit like he was when he had just graduated.

The guy who encountered a comatose patient while practicing medicine after graduation, and whose hands were shaking, was Fang Yan's good roommate.

Seeing Lin Hongjun was like seeing that scene again.

For the remaining hour, they continued seeing patients, with Fang Yan making rounds as usual. Just when everyone thought the assessment was about to end, Pu Shijie almost caused a medical accident for Fang Yan.

The patient is a 55-year-old woman who has long suffered from hypertension and takes Western antihypertensive drugs. Recently, she went to Peking Union Medical College Hospital for treatment due to fever, chills, chest tightness and palpitations caused by a cold.

The patient's condition appears to be "Taiyang cold damage," manifesting as chills without sweating, headache and neck stiffness. However, the pulse is deep and thready, the tongue is dark with a greasy coating, accompanied by night sweats, dry mouth without thirst. In reality, it is a case of Shaoyin yin deficiency with blood stasis and water retention (which is the "reverse fever" syndrome of Shaoyin disease in the Treatise on Cold Damage).

Before coming here, a Western medical examination showed that I had heart failure and fluctuating blood pressure.

When Pu Shijie prescribed medication, he mechanically applied the Western medicine antihypertensive and Chinese medicine diaphoretic model, directly continuing the patient's original Western antihypertensive medication.

Traditional Chinese medicine practitioners are using Ephedra Decoction based solely on the symptoms of "chills without sweating," attempting to "rapidly reduce fever by combining Chinese and Western medicine."

Fang Yan had just entered Pu Shijie's clinic when he caught a glimpse of the three characters "Ma Huang Tang" written under his pen. After glancing at the medical record, which stated "long-term hypertension, heart failure, deep and thready pulse, night sweats," he immediately remarked:

"This prescription cannot be given!"

This was the first time Pu Shijie had heard Fang Yan speak while he was seeing patients. He looked up at Fang Yan with a puzzled look in his eyes: "Director Fang? The patient has chills without sweating and stiff neck. It is clearly a case of Taiyang typhoid fever. Ma Huang Tang can relieve the exterior and dispel cold. If we combine it with her original antihypertensive medication, wouldn't the combination of Chinese and Western medicine bring down the fever faster?"

Fang Yan asked with a serious expression:

"You only saw the chills and lack of sweating, but didn't you see the weak, thready pulse and heart failure?!"

Pu Shijie was taken aback. He opened his mouth to argue, but Fang Yan pointed to his medical record and said:

"A deep and thready pulse, night sweats, and a dry mouth without thirst!"

"Have you remembered anything?" Fang Yan continued to ask.

Pu Shijie still looked bewildered.

Fang Yan was unlikely to say much in front of the patient at this moment, but simply said:
"The Treatise on Cold Damage says, 'In Shaoyin disease, if fever occurs at the onset and the pulse is deep, the Ephedra, Aconite, and Asarum Decoction should be administered.' But the problem is, this is not a simple case of Taiyang cold damage; it is Shaoyin yang deficiency. The deficient yang escapes outward, causing the fever, hence the deep and thready pulse. Night sweats and a dark tongue with a greasy coating indicate blood stasis and water retention. Heart failure is a manifestation of water retention affecting the heart! Do you understand?"

Pu Shijie remained bewildered upon hearing this, not understanding what the dialect was trying to say.

Why ramble on and on? Why not just say what you really mean?
Seeing this, Fang Yan had no choice but to pick up the prescription for Ephedra Decoction written by Pu Shijie, and then pointed to the patient's blood pressure record:
"The ephedra in Ma Huang Tang can induce sweating and relieve exterior syndromes, but it can also raise blood pressure and stimulate the heart. She already has long-term hypertension and heart failure. After taking Ma Huang Tang, her blood pressure will spike even higher, increasing the burden on her heart. In mild cases, this can worsen palpitations, and in severe cases, it may induce heart failure..."

With a "boom," Pu Shijie felt his mind go blank, his face turned deathly pale, and his fingers holding the pen began to tremble uncontrollably.

Just now, my mind was full of "rapid fever reduction with integrated traditional Chinese and Western medicine", and I completely ignored the effects of ephedra on blood pressure and heart. I also failed to connect the patient's deep and thready pulse and night sweats with the pathogenesis of Shaoyin disease, and forgot the contraindications of the patient's underlying heart failure!
This isn't treating an illness, it's taking a life!
Fang Yan shook his head. "Combined? We almost killed someone!"
P.S.: I still owe you 8000 words after finishing this chapter.

Please come early tomorrow.

(End of this chapter)