Rebirth 1977 Great Era

Chapter 1363 The Second Idiopathic Pulmonary Interstitial Fibrosis (Combined Chapter)
Idiopathic pulmonary interstitial fibrosis (IPF) is a diffuse inflammatory disease of the lower respiratory tract of unknown cause. In Western medicine, it is considered one of the world's most difficult and intractable diseases.

Globally, this disease affects approximately two out of every 100,000 people, with the onset age typically between 40 and 50 years old, and slightly more men than women.

Like rabies, Western medicine believes that this disease is irreversible once it develops, unless a lung transplant is performed. Even after a lung transplant, the survival time is not very long, and it is possible that the patient will still not be able to leave the hospital.

Generally, the time from onset of the disease to death is about two to four years.

Before dialect therapy, Western medicine had always considered it an incurable disease.

However, it is worth noting that idiopathic pulmonary interstitial fibrosis is different from pulmonary interstitial fibrosis. The latter has a identifiable cause, while the former does not.

Just like Zhou Zhaoqin's illness, she took local diet pills while traveling, and then got diarrhea and started to fall ill. According to Western medical examinations, the two were completely unrelated, so it was uncertain what caused her illness.

This is called idiopathic pulmonary interstitial fibrosis.

Generally speaking, this disease is difficult to detect in its early stages and is easily misdiagnosed as chronic bronchitis. The person who came today was in the early stages and has already been diagnosed abroad.

That's quite something; it at least proves that he made the right choice in choosing a hospital.

Otherwise, by the time he was diagnosed, he would basically be in the same condition as Zhou Zhaoqin: heart failure, respiratory failure, spontaneous pneumothorax, loss of lung function, and pulmonary heart disease.

When Fang Yan treated Zhou Zhaoqin last time, he used the Po Ge Jiu Xin Tang for emergency treatment, and then used Gua Lou Xie Bai Ban Xia Tang and Dan Shen Yin for conditioning. He added and subtracted the prescriptions according to the patient's symptoms and the climate, and adjusted the prescriptions many times. Before Zhou Zhaoqin was discharged from the hospital, he added Pei Yuan Gu Ben San to her prescription for long-term use. After going to Hong Kong, Fang Yan added Xuan Fu Dai Zhe Tang to her prescription. The whole treatment process was adjusted many times. What those people abroad want is his treatment method, but it is too complicated. It is not so easy for them to learn it.

The patient who is coming soon is a relatively rare early-stage patient. In theory, the treatment should be easier than that of Zhou Zhaoqin, who was in the late stage. However, we haven't met the patient yet, so it's hard to say.

All the information we have now is relayed through Director Liao, so there is very little intelligence. Fang Yan doesn't even know how old this person is.

All I knew was that it was a man.

Fang Yan started preparations at the hospital that very afternoon to receive this person.

Prepare a room, prepare any necessary medications, and arrange a dedicated team of nurses to care for him.

The flight from Hong Kong to Beijing will start at 4:30 PM. Based on the current flight capabilities, it will take approximately three hours and forty minutes to reach Beijing airspace. If there are any further delays due to weather, it will take even longer.

Then, after getting off the plane at the Capital Airport, I took a special car to Xiehe Hospital, which took about an hour and a half, arriving around 9 or 10 pm.

So today is another day of working overtime.

However, Fang Yan could have dinner at home before coming.

No panic at all.

Even after getting off work in the afternoon, Fang Yan picked up Lu Wangyou, the little girl.

Tomorrow is National Day, and she will be going to the zoo with her parents. So today, we've brought her here to spend some time with her grandfather, Lu Donghua.

We can just have a meal together, and I can take her home later; it's not far anyway.

Lu Wangyou hadn't been to Fangyan's place for a long time. Now that her child was in elementary school, she immediately showed off her amazing ability to recite texts to everyone as soon as she arrived.

I memorized all the texts I had recently learned.

Then she wrote some more words, and everyone praised the child for being capable. Only Lu Donghua thought that Lu Wangyou should skip a grade, as these things obviously didn't put any pressure on her.

You should learn something more difficult.

After all, the things he taught Lu Wangyou to memorize earlier had already laid a solid foundation, so these things for first graders were too simplistic.

However, this matter requires the consent of his parents, and Fang Yan shouldn't interfere. But he was thinking that if Zhengyi finds first grade too easy when he starts elementary school next year, he could skip a grade.

After dinner, Fang Yan drove Lu Wangyou back home.

It was already eight o'clock when I got home. I guess the patient's plane should be near Beijing by now.

Fang Yan told her family and then went to Peking Union Medical College Hospital. Lu Donghua and An Dong also went with her. Little Zhao Zhengyi originally wanted to go too, but it wasn't appropriate for a child to be there in this kind of setting.

He was told to watch TV at home and that he would explain it to him later.

Upon arriving at the hospital, Dean Cui Jingyi and Vice Dean Lin Qi, who was on duty, were already waiting in the inpatient lobby. This visit was not just about Fang Yan; they also attached great importance to it.

Today we are here to prepare to receive the patient. Fang Yan thought they knew something about the patient, but it turns out they knew very little, about the same as Fang Yan.

I wonder what kind of person they are who keeps things so secret.

Next, everyone waited in the lobby on the first floor of the inpatient department. A few minutes later, someone from the Traditional Chinese Medicine inpatient department came down. The nurse on duty said to Fang Yan:

"Director Fang, Director Liao called from the airport. The plane has landed, and they'll be here as soon as they pick up the people."

Fang Yan said after hearing this:
"Okay, got it."

Then everyone waited, and after about an hour, the convoy arrived.

All the cars were Hongqi sedans. Director Liao got out first and quickly walked to Fang Yan and the others: "The patient's condition is relatively stable, he's in the back."

As soon as he finished speaking, a group of people in white coats came down from behind. They carefully carried a middle-aged man out of the car. The man looked to be around fifty years old, thin, wearing a loose coat, clutching a portable oxygen bag tightly in his hand. His face was slightly pale, and his breathing was a little rapid than normal. He was placed in a wheelchair by the group.

"This is Mr. Ma Guoliang, who was diagnosed with early-stage IPF three months ago abroad," Director Liao introduced, then pointed to the doctor in the white coat next to the man, "This is his accompanying doctor, who brought the complete examination report."

The doctor quickly handed over a thick stack of medical records and said in fluent Chinese, "Mr. Ma had a persistent dry cough for two weeks three months ago, followed by a fever. He was diagnosed with chronic bronchitis and peribronchitis in the right lower lobe of his lung at a German hospital."

"At that time, antibiotics, expectorants, cough suppressants, and ultrasonic nebulizer inhalation were used for treatment. Although the body temperature dropped, the dry cough was not controlled and shortness of breath, severe and frequent cough, sticky phlegm that was difficult to expectorate, cyanosis of the fingers and toes, blood gas analysis showed low arterial blood oxygen partial pressure, and chest X-ray showed that the infection in both lungs continued to worsen. After expert consultation, it was diagnosed as interstitial lung disease with pulmonary interstitial fibrosis and respiratory failure."

"Then a tracheotomy was performed, and a ventilator was used. Antibiotics and high-dose hormones were used for treatment, and the patient was fed through a nasogastric tube. After treatment, the patient improved and is currently able to breathe with oxygen, but the condition of the lungs continues to deteriorate."

Fang Yan was taken aback and looked at Director Liao:
"Why is this different from what you said before?"

Director Liao said:
“Mr. Ma’s condition suddenly worsened once during his treatment in Germany, which led to a tracheotomy and ventilator support. Although he has now been weaned off the ventilator, his lung function is much worse than when he was first diagnosed. Although it is called ‘early stage’, it is actually close to the middle stage.”

Fang Yan frowned, took the latest test report from the accompanying doctor, and quickly scanned the key data: arterial oxygen partial pressure 65 mmHg (normal should be ≥80 mmHg), chest CT showed that the peripheral reticular shadows in both lungs had expanded compared to three months ago, and a small number of ground-glass opacities had also appeared. He looked up at Ma Guoliang in the wheelchair, who was clutching his chest and coughing softly, his fingertips indeed showing a faint cyanosis, a clear sign of hypoxia.

Fang Yan said to them:

"The 'early stage' I mentioned earlier refers to the stage before respiratory failure occurs. Now, there is a history of respiratory failure, and the degree of pulmonary interstitial fibrosis is more severe than expected."

"Yes," the accompanying doctor nodded.

He spoke in dialect:

"We've heard that you've treated critically ill patients in the late stages of the disease. We believe Dr. Fang definitely has a way to solve this problem."

Fang Yan glanced at the accompanying doctor, then at Director Liao.

I wonder what's going on with this person, and whether he'll be involved in the treatment?

Just as I was about to ask Director Liao, Mr. Ma's family arrived. Director Liao quickly greeted them, as it was another family coming for treatment.

This definitely needs to be made clear before treatment, Fang Yan said loudly in front of everyone:

"After we take over Mr. Ma's case, the subsequent treatment involves a secret formula, and this gentleman will also be involved?"

Upon hearing this, everyone looked over, and the accompanying doctor said:

"I'm only responsible for escorting and handing over the medical records. I'll leave the subsequent treatment to Dr. Fang's arrangements, so I won't bother you any further."

“Okay, I’ll take over the person. You’ve worked hard.” Fang Yan said to him.

Upon hearing this, Director Liao also said:

"Idiopathic pulmonary interstitial fibrosis is a confidential matter, so I'm really sorry, but the rest of the treatment will be handled by our domestic TCM team."

At this moment, the patient's family member, namely the patient's wife, also came over.

She was still clutching a cloth bag in her hand, her face filled with anxiety and anticipation.

"Dr. Fang, we're so glad to finally meet you! When we were in Germany, the doctors said this disease was incurable and we could only wait... Later, we found out that you had cured someone with the same disease, so we rushed back immediately. You must save him!"

Fang Yan nodded and said:
"Let's go upstairs without delay."

Then he had someone send it upstairs. Although Mr. Ma's situation was more complicated than he had thought, Fang Yan believed he could still handle it.

Unlike what was expected, Fang Yan went upstairs and arranged for Mr. Ma to be placed in a ward, and immediately dismissed the medical team members who had brought him.

Those doctors in white coats came back from Germany with them; it must have cost them a lot of money.

Upon examining Mr. Ma, Fang Yan found that he was conscious but breathing heavily and his chest and abdomen were damp with slight sweat.

"Mr. Ma, do you feel a tightness or pain in your chest right now?" Fang Yan asked, gesturing for Anton to take notes.

Ma Guoliang, panting, replied, "It feels stuffy...like a stone is pressing on my throat. Coughing relieves it a little, but I can't cough up the phlegm; it's stuck there." As he spoke, he couldn't help but cough twice more. After coughing, his chest heaved more noticeably, and the cyanosis on his fingertips deepened. Fang Yan reached out and lifted his collar to check his neck: "Do you feel thirsty? Do you want some water?"

"I have a dry mouth, especially when I wake up in the morning. No matter how much water I drink, it doesn't quench my thirst." Ma Guoliang nodded while panting. "The German doctor said I was dehydrated, but the more I drink, the more bloated I feel in my chest."

Fang Yan took a flashlight from the drawer and shone it on him, saying:
"Open your mouth and stick out your tongue."

Ma Guoliang did as instructed.

Fang Yan looked at Ma Guoliang's tongue. The tongue was dark purple in texture, with a grayish-black coating and a thin layer of sticky substance on the surface.

He put down his flashlight, went behind Ma Guoliang, and said to him:
"Don't move. Just breathe in when I tell you to."

Ma Guoliang nodded.

Then he saw Fang Yan lean over and press against his back.

"Inhale!" Fang Yan said.

He's listening to lung sounds from behind.

When Ma Guoliang was asleep, obvious "rales" could be heard at the base of both lungs, and the rales were clearer at the end of inspiration. This is a characteristic sign of pulmonary interstitial fibrosis leading to decreased alveolar elasticity.

Fang Yan asked him:
"When you were using hormones in Germany, did you notice that your appetite improved but your strength didn't keep up?"

Ma Guoliang paused for a moment, then nodded, panting as he said, "Yes! He eats a lot, but he gets out of breath after walking just a few steps, and he's always sweating profusely. When he wakes up at night, his pillow is wet."

Then Fang Yan began to take his pulse.

After taking the pulses of both hands, confirm that the pulse is wiry, slippery, and rapid.

"How old are you this year?" Fang Yan asked him.

Ma Guoliang coughed twice before responding:

"Fifty-two."

He asked in dialect:

What did you do before the onset of the illness?

"Nothing much, right? Just the same as before." After being asked so many questions, Mr. Ma was clearly getting impatient and frowned as he spoke.

He glanced at his wife as he spoke.

The latter nodded in agreement.

He asked in dialect:

"When did you develop this chronic bronchitis?"

When Ma Guoliang heard the question about "chronic bronchitis," his brows furrowed even more, and he thought for a long while before slowly speaking:
"About three or four years ago? I always coughed in winter, and the cough would last for a month or so. I went to the hospital for a checkup, and the doctor said it was chronic bronchitis. He prescribed some cough medicine, which made me feel better, but it would come back the following winter. I didn't take it seriously."

His wife added from the side, "That's right! Back then, he always said that coughing in winter was normal, and he didn't stop smoking and drinking. I told him to go to a big hospital for a thorough check-up, but he kept putting it off until this time when he was coughing so badly that he couldn't breathe, and that's when he realized how serious the problem was."

Fang Yan nodded, then continued to ask:

"Before you fell ill in Germany, besides smoking and drinking, did you have any long-term exposure to special dust or chemicals, such as asbestos, metal dust, pesticides, moldy environments, or keeping birds as pets?"

Mr. Ma took a few deep breaths and said:

"No, no, our business doesn't involve these things. The German doctors you asked have also asked these questions. They just want to find the cause, but they haven't found it."

Fang Yan nodded. Idiopathic pulmonary interstitial fibrosis, but the cause can't be found.

However, he continued to ask:
"Do you have any relatives who have had similar lung diseases or rheumatic immune diseases?"

"No... I don't think so?" Mr. Ma said uncertainly.

Then he said with certainty:
"should not!"

Mrs. Ma said to Fang Yan:

"Dr. Fang, my husband is not feeling well. Why don't you just ask me your questions? I know quite a bit about it."

Fang Yan waved his hand and said:
"That's about it. Let me take a look at his previous medical records."

Speaking in dialect, Mrs. Ma opened the medical record the doctor had given her earlier. It listed Mr. Ma's medications, though not in Chinese. After seeing it, Mrs. Ma said to the person in dialect:

"Why don't we call the doctor who came with us and have him translate?"

Fang Yan waved his hand and said:
"It's okay, I can understand it."

Mr. Ma and his wife were somewhat surprised to hear Fang Yan's words.

However, Fang Yan was already quickly flipping through Ma Guoliang's medication records in Germany. The records clearly showed the specific times and dosages of antibiotics, high-dose glucocorticoids, and ventilator support. There were indeed no records related to "clear pathogenic factors".

Idiopathic pulmonary interstitial fibrosis has been confirmed.

After a while, Fang Yan put down his notes and said to Mr. Ma:
"I'll go get the medicine first, and it will be delivered in half an hour."

He also asked the nurse to put him on hospital oxygen.

After Mr. Ma started receiving oxygen, his complexion gradually improved while he lay in bed.

Fang Yan had already arrived outside, where Director Liao and other hospital leaders were waiting for him.

"How is it? Is there any way to treat it?" Director Liao asked bluntly.

Fang Yan nodded and said:

"Yes, although she needs oxygen to breathe, her condition is much better than Zhou Zhaoqin's at that time."

Fang Yan walked up to Director Liao and the hospital leaders, still holding Ma Guoliang's medical record in his hand, and began to analyze in a calm tone: "Based on the examination and medical history just now, Ma Guoliang's condition can be summarized as 'deficiency of vital energy as the root cause and excess of pathogenic factors as the manifestation.' The core pathogenesis is deficiency of both qi and yin, accompanied by phlegm and blood stasis, and obstruction of the lung collaterals."

"Mr. Ma is 52 years old this year. His kidney qi is gradually weakening. In addition, he previously used high doses of hormones, tracheotomy and ventilator support in Germany, which depleted a lot of qi and yin. Now he is short of breath with the slightest movement and sweats profusely in his chest and abdomen, which are manifestations of qi deficiency and inability to retain fluids. His dry mouth and thirst, red tongue with little coating are symptoms of yin deficiency and fluid depletion. His wiry, slippery and rapid pulse with weakness indicates that the deficiency has affected the function of the internal organs. This is the core of the 'root deficiency'."

“He felt a tightness in his chest, like a stone was pressing on it; he had sticky phlegm that he couldn’t cough up; there was a sticky substance on his tongue; and rales could be heard at the base of both lungs at the end of inhalation. These are all signs that phlegm is blocking his lungs. His dark purple tongue and history of respiratory failure indicate that blood stasis has blocked the lung channels. The phlegm and blood stasis are intertwined, causing the lung’s ventilation function to deteriorate. This is the key to the ‘excess’ condition.”

“When Zhou Zhaoqin came, she was already suffering from heart failure, respiratory failure, and pulmonary heart disease, which was a case of ‘extreme weakness leading to danger’; while Ma Guoliang, although close to the middle stage, did not have these serious complications, but was only ‘weak with excess’. As long as we stabilize the body’s vital energy first and then slowly eliminate the pathogens, we can control the condition.”

"The German doctors thoroughly investigated the patient's history of exposure to dust and chemicals, and there was no related medical history in the family. After ruling out all the obvious causes, they determined it to be idiopathic interstitial pulmonary fibrosis. There was no need to worry about 'targeting the cause'; they could focus on conditioning the lungs and kidneys and repairing lung damage, which gave them a clearer direction."

"Tonight I plan to treat him using the method of 'strengthening the body's resistance and eliminating pathogens, resolving phlegm and clearing the meridians' and observe his reaction."

None of the leaders here are practitioners of traditional Chinese medicine, and they only understand a fraction of what they hear. Only Anton and Lu Donghua seem to understand. Director Liao asked in the dialect:

"So the treatment method is different from the previous treatment of Zhou Zhaoqin?"

Fang Yan nodded:
"There is definitely a difference."

He began by discussing Zhou Zhaoqin's case: "When Zhou Zhaoqin arrived, she was already in a critical late stage, suffering from heart failure, respiratory failure, and pulmonary heart disease. It was as if her vital energy was about to give out, so the first step was to provide emergency treatment. At that time, we used 'Breakthrough Heart-Saving Decoction,' which is a large dose of warming and tonifying Qi medicine to stabilize her rapidly depleting vital energy and save her life. Once her condition stabilized slightly, we used 'Trichosanthes, Allium macrostemon, and Pinellia Decoction' and 'Salvia miltiorrhiza Drink' to regulate Qi and blood and promote chest Yang. Finally, we added 'Nourishing the Original Qi and Strengthening the Root Powder' to gradually replenish her foundation. The whole process was about 'saving her life first, then regulating her body,' with the emphasis on 'treating the symptoms in an emergency.'"

Then the conversation shifted to Ma Guoliang: "But Mr. Ma is different. He is now close to the middle stage. Although he needs oxygen, he does not have any critical complications. His heart, kidneys and other organs have not been seriously damaged. His 'vital energy can still hold up,' so there is no need to 'save his life' first. Therefore, his treatment does not require strong medicine for emergency relief, but rather 'supporting the body' and 'eliminating pathogens at the same time': on the one hand, we use Astragalus membranaceus, Codonopsis pilosula and Ophiopogon japonicus to replenish the qi and yin he has consumed and stabilize his vital energy; on the other hand, we use Fritillaria thunbergii, Pheretima aspergillum and Angelica sinensis to resolve phlegm, unblock the meridians and disperse blood stasis, and slowly clear away the 'pathogenic qi' blocking the lungs."

"Later, depending on the situation, we will add kidney-tonifying medicine, such as dodder seed, to help him consolidate the function of 'absorbing qi'. The whole approach is to 'treat both the symptoms and the root cause,' with the emphasis on 'treating the root cause gradually'."

Fearing the leaders still wouldn't understand, he gave another simple example:

“It’s like a leaky house. Zhou Zhaoqin’s house is like ‘the roof is about to collapse.’ First, we need to find something to hold up the roof, and then slowly repair the leak. Ma Guoliang’s house is like ‘the roof hasn’t collapsed, but water is seeping into the cracks in the walls and there are mold spots.’ Instead of holding up the roof first, we can repair the cracks in the walls while reinforcing the roof. It’s safer to take it slow.”

At this point, Fang Yan added:

“Another key difference is the nature of the ‘pathogenic factors’. Zhou Zhaoqin had the problem of ‘yang deficiency and water retention’ in the late stage, and there was ‘dampness’ in her body; Ma Guoliang mainly had ‘phlegm and blood stasis’, and the nature of the pathogenic factors was more ‘sticky’, so the medications were different. Zhou Zhaoqin needed to warm yang and promote diuresis, while Ma Guoliang needed to resolve phlegm and unblock the meridians. They could not use the same prescription.”

After listening, Director Liao suddenly realized, "So that's how it is!"

He said:
"Then write the prescription. By the way, go directly to the Chinese medicine pharmacy to get it. Make sure to keep it confidential."

Fang Yan nodded, agreeing that it should indeed be kept secret.

He led Anton and his master Lu Donghua directly to the traditional Chinese medicine pharmacy.

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

(End of this chapter)