Rebirth 1977 Great Era

Chapter 1376 A Man Driven Crazy by His Wife, You'd Better Not Take Care of Him or It Will Affect My Reputation (Two Chapters Combined)
The treatment of prickly heat is actually recorded in "Huangdi Suwen Xuanming Lunfang": Rehmannia Decoction treats prickly heat with aphonia, kidney deficiency and cold extremities, loss of voice, and paralysis of the feet.

This shows that the ancients had already established a certain theoretical basis and treatment methods for prickly heat.

Besides the Rehmannia Decoction in the "Huangdi Suwen Xuanming Lunfang", many traditional Chinese medicine classics from the Han Dynasty to the Qing Dynasty have detailed records of wind-heat, and the treatment approaches have different focuses. The earliest record is in the "Huangdi Neijing", which records "fleshy atrophy" and "bone atrophy". Although it does not use the name "wind-heat" directly, the description of "weakness of limbs, inability to stand for a long time" and "relaxation of tendons and veins, inability to hold" are actually the early symptoms of wind-heat.

In the Tang Dynasty, Sun Simiao's "Essential Prescriptions Worth a Thousand Pieces of Gold" first explicitly mentioned the disease name "wind prickly heat" and also recorded prescriptions such as "Aconite Decoction" and "Saposhnikovia Decoction".

The Song Dynasty book "Shengji Zonglu" classifies wind-induced eczema into three types: "predominance of wind evil", "deficiency of qi and blood", and "obstruction of phlegm and blood stasis".

In Wang Qingren's "Corrections of Errors in Medical Classics" from the Qing Dynasty, he proposed the use of "Buyang Huanwu Decoction" for prickly heat caused by "blood stasis obstructing the meridians".

Therefore, there are many treatment options available in Traditional Chinese Medicine for treating this person's condition.

Actually, if this patient sought treatment from a traditional Chinese medicine practitioner elsewhere, he shouldn't even need to use a local dialect to get his illness cured.

Fang Yan has already picked up a pen and started writing a prescription.

Cinnamon twig 8g, prepared aconite root 8g, dandelion root 10g, morinda root 10g, polygala root 6g, cornus fruit 10g, dendrobium 10g, asparagus root 10g, schisandra fruit 8g, raw calamus root 10g, poria cocos 10g, earthworm 10g.

This prescription is modeled after the Hejian Dihuang Decoction.

The original formula of Hejian Dihuang Yinzi mainly focuses on "nourishing kidney yin, tonifying kidney yang, and opening the orifices to resolve phlegm", targeting "aphasia" and limb weakness. After the adjustment and modification of the formula, the Rehmannia glutinosa and Ophiopogon japonicus in the original formula were removed. This is mainly because Mr. Wang mainly treated "cold-dampness obstruction". Rehmannia glutinosa is greasy and can easily hinder dampness, and Ophiopogon japonicus is yin-nourishing but too cold. It was replaced with Cinnamomum cassia and Aconitum carmichaelii, which are more focused on "warming and unblocking", to avoid "greasy and dampness-obstructing".

Then he added earthworm. The original prescription did not contain any medicine to clear the meridians. Mr. Wang had symptoms of "numbness in the legs and blocked meridians." Earthworm can enhance the ability to clear the meridians, making the combination of "tonifying" and "clearing" more closely integrated.

Finally, the core formula logic is retained. The combination of Evodia rutaecarpa, Schisandra chinensis, Acorus tatarinowii, and Polygala tenuifolia continues the characteristics of Rehmannia Decoction: "nourishing without stagnation and unblocking without harming." It nourishes the liver and kidneys while unblocking the meridians, which is the treatment approach of "first eliminating pathogens and then tonifying the body."

Fang Yan handed the prescription to Mr. Wang, lightly tapping the words "attached slices" with his fingertip, his tone more solemn than before:

"Let me first mention a few points to note. This formula contains aconite, which is key to warming the yang and dispelling cold and dampness. However, it is quite potent, so there are a few points to keep in mind."

He held up his fingers and listed them clearly, one by one:
"First, the medicine must be taken warm after it is decocted. It cannot be cooled down, as this will affect the efficacy of the medicine and may also irritate the stomach and intestines. Moreover, within two hours after taking the medicine, do not touch any cold water or iced drinks, and do not even eat cold fruit. Otherwise, the warming properties of the aconite will be counteracted, making it more difficult to dispel the cold and dampness in the waist. In severe cases, poisoning may occur, with symptoms such as numbness of the lips and difficulty breathing. In severe cases, it may even be life-threatening. Please remember this."

Upon hearing this, Mr. Wang nodded quickly. His assistant took out a notebook and quickly wrote it down. He continued in dialect, "Secondly, if you feel slightly warm or sweat a little after taking the medicine, this is normal. It means that the aconite is working and expelling the cold. But if you sweat too much, or feel palpitations or severe dry mouth, you must stop taking it immediately and have the nurse contact me so we can adjust the dosage."

He glanced at Mr. Wang's suit jacket and added, "If the weather gets cool lately, especially with the temperature fluctuating greatly in the morning and evening, remember to wrap a thin cotton back brace around your waist to prevent it from getting cold. Otherwise, the medicine will only expel some of the cold and dampness before new ones come in, making the treatment pointless."

Mr. Wang nodded seriously: "Dr. Fang, don't worry, I'll remember all of this and do exactly as you say. I won't be careless." Fang Yan smiled and nodded: "If you cooperate well, you'll recover faster. If the cold and dampness dissipate quickly, the dosage of aconite can be gradually reduced."

Then he glanced at his watch and said:
"Now you should go and complete the admission procedures. The medicine will take about two hours to brew, and someone will bring it to you then."

"Okay, let's go check in then." Mr. Wang said, then greeted his assistant.

Then the two of them went out. Fang Yan also gave the prescription to the nurse and told her to go to the Chinese medicine pharmacy. The prescription had already written down the precautions for decocting the medicine. She just needed to tell them to follow the instructions.

After Fang Yan finished revising the medical record, it was time for the last patient.

This was a man in his thirties who looked indifferent. After being called into the consultation room by Fang Yan, he never looked at Fang Yan and seemed to be daydreaming.

Fang Yan had no choice but to ask his family what had happened.

"Schizophrenia, the Western medical diagnosis is schizophrenia," the patient's family member said succinctly in the dialect.

Upon hearing this, Fang Yan asked them:

"Could you be more specific?"

At this moment, a middle-aged woman stood up and said:
“I am his wife. Last October, we had a fight over money, and then he started acting strangely. At first, he kept hearing other people's voices around his ears. For the first few days, he couldn't hear what they were saying, but later they became clearer and clearer. He even relayed what they were saying to us, and it was very detailed. We took him to the hospital for treatment, and they said that he was under a lot of mental stress and needed to relax.”

"Then our family arranged for a professional manager to replace him, but he was still unhappy all the time, saying that we didn't understand him and that he was under a lot of pressure. We didn't know what to do, so we took him on a trip to relax. However, we argued with him several times during the trip, and after we got home, he said he wanted a divorce."

"Of course I couldn't agree to this, and his parents didn't agree either. Then a lot of people in the family tried to persuade him, and then he stopped talking and started talking to himself, saying that a lot of people around him were talking to him. So we took him to the hospital for a checkup, and this time the checkup said it was neurosis."

"Then we sent him to a mental hospital. That night, he tried to slash his own neck with a knife. Luckily, we caught him. We got scared and sent him to a mental hospital for treatment. After a while, they said it wasn't neurosis, but schizophrenia."

"I've been receiving treatment for quite some time, but it's still not cured."

"On the contrary, the symptoms are getting more and more severe. I can only sleep for two hours a day, and I often have inexplicable fears, or suddenly become indifferent to everything around me, just like now."

At this moment, another person in his family handed over the treatment documents and examination reports from abroad.

Fang Yan frowned slightly and opened the document to read it.

He quickly flipped through the overseas medical reports, his gaze lingering on keywords such as "auditory hallucinations, emotional apathy, and sleep disorders." His fingers lightly tapped the examination table as he turned to the family for further questioning:
"After he started experiencing auditory hallucinations, besides saying that someone was talking to him, did he say that these voices were criticizing him or ordering him to do something? For example, telling him not to eat, or feeling that the people around him wanted to harm him?"

The family member paused for a moment, then nodded: "Yes! A while ago, he kept saying that 'someone was criticizing him for making dirty money,' and that we had put something in his food. He would rather go hungry than eat it. Later, we could only watch him eat with his bowl in hand before he would pick up his chopsticks."

"When he feels fear, in what situations does he usually experience it? For example, when he sees a specific thing or hears a certain sound and suddenly becomes afraid?" Fang Yan continued to ask, her eyes always focused on the patient's state. The patient kept his head down, his fingers unconsciously picking at the hem of his clothes, and he did not respond to the conversation around him.

“Most of the time it happens at night!” another family member added. “Sometimes he would suddenly sit up in the middle of the night and say that ‘someone is watching him outside the window.’ He would hug his blanket and huddle in the corner, trembling. We would turn on the light to show him, but he wouldn’t believe us no matter what we said. He would only dare to lie down when it was almost dawn, so he could only sleep for two or three hours a day.”

Fang Yan frowned, walked to the patient's wheelchair, and took the patient's hand to take his pulse.

After feeling with both hands, I found the pulse to be floating and slippery.

Next, Fang Yan decided to examine the patient's tongue coating. He first tried speaking to the patient:
"can you hear me?"

The patient did not speak or react in any way.

Next, Fang Yan addressed the patient's family:
"I need to check his tongue coating. Can any of you help me open his mouth?"

Upon hearing the dialect, the patient's wife immediately stood up.

Speaking in dialect:

"Let me do it."

The patient's wife gently held his chin and carefully pried open his mouth, seemingly doing this before.

Fang Yan picked up a flashlight, bent down to observe, and saw that the patient's tongue tip was red and the coating was white and dry.

At this point, Fang Yan began to have some doubts about the conclusion that the person was schizophrenic.

Typical schizophrenia is often accompanied by "phlegm-heat disturbing the heart," which is usually characterized by a yellow and greasy tongue coating, mania, and irritability. This patient's symptoms clearly do not match these characteristics. Moreover, based on what the patient's family members just said, the symptoms are highly correlated with emotional stimulation, which leans more towards the category of "depression."

The patient's tongue appearance—red tip, white and dry coating, and floating and slippery pulse—is consistent with the TCM pathogenesis of "liver stagnation transforming into fire and yin deficiency with internal heat."

In detail, according to traditional Chinese medicine, the tip of the tongue corresponds to the "heart and lungs". A red tongue tip often indicates "heart fire or liver fire rising", while a white and dry tongue coating is a manifestation of "yin deficiency and insufficient body fluids".

In traditional Chinese medicine, typical schizophrenia is often classified as "mania" or "epilepsy" because long-term phlegm and heat obstruct the mind. The tongue appearance is often characterized by a yellow and greasy coating and a dark red tongue body, which are features of internal phlegm and heat.

However, the patient's tongue coating was white and dry, without any greasy coating, indicating that there was no obvious "phlegm turbidity" in the body, but rather "depletion of body fluids," which contradicts the core pathogenesis of schizophrenia, "phlegm-heat disturbing the heart."

A floating pulse indicates "exterior syndrome or qi stagnation." While a slippery pulse may suggest "phlegm turbidity," combined with a "white and dry tongue coating," the "slippery pulse" here is more likely due to "prolonged liver stagnation transforming into fire, causing qi stagnation and resulting in a floating pulse," rather than the solid slippery pulse of "phlegm and blood stasis obstruction." In typical schizophrenia accompanied by phlegm and blood stasis, the pulse is often deep and slippery or wiry and slippery, which does not match the "floating and slippery pulse" in this patient, which indicates "qi stagnation in the upper body and initial internal heat."

Fang Yan recalled what the patient's wife had just said.

The initial trigger was an argument with his wife over money, followed by an argument over travel and family opposition to divorce. The symptoms progressed from auditory hallucinations to fear and apathy, without the typical schizophrenia symptoms of thought disorder and abnormal behavior, such as unprovoked violence or illogical thinking.

He subsequently exhibited poor sleep, sleeping only 2 hours a day, and night terrors. This was due to restlessness caused by "liver stagnation transforming into fire disturbing the heart, and yin deficiency failing to restrain yang," rather than persistent mania or apathy caused by "phlegm-heat disturbing the heart day and night" in schizophrenia.

Moreover, the patient's wife herself said that after the patient was treated for "schizophrenia" in the mental hospital, his symptoms "became more and more severe," such as increased fear and worse sleep. In addition, the sedative drugs commonly used in Western medicine may further deplete body fluids and suppress the flow of qi, leading to "more intense internal heat and more restlessness."

His condition is indeed schizophrenia, which is caused by phlegm and heat disturbing the mind. Sedatives can temporarily suppress the phlegm and heat disturbing the mind, and the symptoms should be relieved.

Therefore, this situation of "treatment being ineffective and even worsening" also suggests that the diagnosis may have deviated from the true pathogenesis.

Fang Yan straightened up and said to the family members in a firm tone:
"Judging from his tongue appearance, pulse condition and symptom development, he is most likely not schizophrenia, but more likely depression caused by 'liver stagnation transforming into fire and yin deficiency with internal heat,' which is closer to what we usually call 'problems caused by long-term suppressed anger.'"

The moment these words were spoken, the consultation room fell silent. The patient's wife was the first to react, frowning as she pressed, "Dr. Fang, but hospitals and psychiatric wards abroad have diagnosed him with schizophrenia. How could it not be? He's experiencing auditory hallucinations and self-harm; aren't these all symptoms of schizophrenia?"

Other family members nodded in agreement. The patient's mother's voice trembled with anxiety: "Yes, Dr. Fang, we also hope it's not true, but he doesn't even recognize us now, and he says someone wants to harm him. What else could this be but schizophrenia?"

Fang Yan did not directly refute, but instead picked up a pen and drew two comparison boxes on the paper, writing "schizophrenia (phlegm-heat disturbing the heart)" on one side and "depression (liver stagnation transforming into fire)" on the other.

Then, each point will be explained:

“Look, this is a typical case of schizophrenia. Whether it’s what traditional Chinese medicine calls ‘phlegm-heat disturbing the heart’ or what Western medicine calls cognitive impairment, it has two core characteristics: First, ‘sudden onset without cause,’ for example, suddenly experiencing auditory hallucinations and confused thinking, which have nothing to do with emotional stimulation; second, ‘illogical symptoms,’ for example, the content of auditory hallucinations is wildly imaginative, sometimes saying that someone is chasing him, sometimes saying that he is a god, which has no connection to reality.”

He pointed at the patient and continued, “But yours is different. His auditory hallucinations are all about ‘being scolded for making dirty money’ and ‘poisoning his food.’ These are all directly related to the ‘argument over money’ last year. Moreover, his symptoms have worsened step by step, from feeling bad after the argument to auditory hallucinations, and then to fear. Each step has the shadow of emotional stimulation. It didn’t happen suddenly. This is more in line with the pattern of ‘depression’.”

Then, he pointed to the tongue:
“Look at his tongue again. The tip is red and the coating is dry and white. This is a manifestation of ‘liver fire rising and body fluids being depleted.’ If it were schizophrenia, with phlegm and heat blocking the heart for a long time, the tongue should have a ‘yellow and greasy coating and a dark red body,’ as if covered with a layer of dirt. But he doesn’t have this sign of ‘phlegm and turbidity.’ On the contrary, because of long-term internal heat, even the tongue coating has become dry. This is completely inconsistent with the core pathogenesis of schizophrenia.”

The patient's wife was stunned and subconsciously asked, "Then his condition worsened during his treatment at the mental hospital. Was it also because the diagnosis was wrong?"

“Yes!” Fang Yan nodded. “The sedatives commonly used for schizophrenia are warming and drying, which will further deplete his body fluids and make his liver fire even stronger. It’s like adding fuel to a burning furnace; the fire will only burn more fiercely, which is why his fear and insomnia will worsen. If it’s depression, we can use medicines that clear liver fire and replenish yin deficiency to gradually reduce the ‘fire,’ and the symptoms will naturally be relieved.”

The family members looked at each other, their anxiety gradually replaced by doubt.

The patient's wife hesitated and said, "Then... what should we do now? Can it be cured?"

He said in dialect:

"At least if the dialectical approach is correct, then there is a way to cure it."

Upon hearing Fang Yan say this, the expressions on the faces of the family members immediately improved.

As long as it can be treated, that's fine.

At this moment, Fang Yan put down his pen, glanced at the family members present, and said in a more serious tone, "However, there are two things that must be made clear before treatment."

"Please tell me! Just tell me what you need!" the patient's family member said in a dialect.

Dialectal wave:
"It's not that I have any needs, it's about the patient. First, the treatment cycle, and second, the cooperation that you, the family members, need to do. If these two points are not met, even if the prescription is correct, the effect will be reduced."

The family members were stunned; they hadn't expected that the dialect was used in this way.

He first looked at the patient's wife, and then said:

"First, this illness cannot be cured by taking medicine for three to five days. 'Liver stagnation transforming into fire' is a problem that has accumulated for more than half a year, and 'Yin deficiency' is caused by the depletion of body fluids for so long. It will take at least 1 to 2 months of conditioning to see a reduction in auditory hallucinations and an improvement in sleep. During this period, there may be relapses, such as when you are in a bad mood and the auditory hallucinations increase again. At this time, don't panic, and don't stop taking the medicine. Just give me feedback in time to adjust the prescription. Don't change the treatment direction as before if there is no effect."

He then emphasized the importance of the family's cooperation:

"Secondly, you need to change the way you interact with him. Don't bring up things like 'money' or 'divorce' that upset him, and don't keep telling him 'Don't overthink it.' He's not 'overthinking' right now; he's just burning with anger, and the more you try to persuade him, the more irritable he'll become. Spend more time doing quiet things with him, like sitting in the yard in the sun or playing soft music. If he doesn't want to talk, don't force him; just being there for him is fine. Also, when he says 'someone insulted him' or 'there was poison in his food,' don't argue 'That's not true.' Instead, say something like, 'I know you're upset. Let's eat first. I'm here for you.' Calming him down is more important than correcting his 'mistakes.'"

After hearing the dialect spoken, the family members looked at each other, and finally their eyes fell on the patient's wife. To put it bluntly, she was the most important person.

It all basically started with her.

Fang Yan's gaze then fell on the patient's wife, and he said solemnly:
“The most crucial person here is actually you. His initial emotional trigger was arguing with you, and later the thought of ‘divorce’ added to his burden. Now, your adjustment of the way you interact is more effective than anything else you can do.”

The patient's wife's eyes immediately reddened, her fingers clenched the hem of her clothes, and her voice was filled with guilt:

"I...I always thought he was being unreasonable..."

Hearing that she was about to make an excuse, Fang Yan quickly stopped her:

"There's no need to dwell on the past now; the key is what to do next."

Fang Yan paused, and seeing that the patient's wife didn't say anything, he continued:

“You can talk to him about trivial things, such as ‘The weather is nice today, do you want to sit on the balcony for a while?’ or ‘I made some soup, would you like to have a taste?’ Don’t deliberately mention his illness, and don’t tell him to ‘cheer up.’ These everyday, stress-free things can make him feel safe around you, and his liver fire will also subside.”

He paused, then added:

“If he brings up again that ‘someone accused him of making dirty money,’ don’t argue with him that ‘that’s not true.’ Instead, you can say, ‘I know you’re upset to hear those words. If you don’t want to hear them, let’s go somewhere else.’ First, acknowledge his emotions, and then gently guide him. This is much more effective than forcibly correcting him. Before, you were ‘refuting’ him; now you need to ‘accept’ him. This is the most important thing for him.”

The patient's mother chimed in from the side:
"What can the rest of us do to help? We can't just leave her to do all the work."

“You can help create a quiet environment,” Fang Yan explained. “Don’t talk loudly at home, try to go to bed early at night, and don’t disturb him. He has trouble sleeping now, and the quieter the environment, the easier it is for him to calm down. Also, don’t always ask him ‘Are you feeling better?’ Occasionally, hand him a glass of warm water or cover him with a coat. These small gestures are more effective than talking a lot.”

The patient's wife took a deep breath, hesitated for a moment, and then said:

"Dr. Fang, I understand. I was too hasty before. I will definitely do as you say from now on. Even if he ignores me at first, I will patiently wait with him."

Fang Yan sighed inwardly upon hearing her attitude. Simply put, she was willing to do it, but not to do it well. She appeared to be very cooperative, but in reality, she lacked initiative. This would cause her subsequent cooperation to remain superficial and make it difficult to truly help the patient alleviate their emotions and activate the treatment effect.

That's why they say when looking for a wife, you only need to choose, not educate. Adults can't be educated.

Fang Yan thought for a moment and said:
"Actually, I think it's better for the patient's recovery if the family doesn't get involved and the medical staff at Peking Union Medical College Hospital take care of things."

The moment Fang Yan uttered those words, the atmosphere in the consultation room instantly changed. The patient's wife's face flushed red, her suppressed guilt tinged with a hint of grievance, and her voice lowered slightly: "Dr. Fang, did what I just said make you think I'm unreliable? I really want to cooperate..."

The patient's mother quickly chimed in:

"Yes, Dr. Fang, we know we didn't take good care of him before, but now we know where the problem lies, and we can definitely change it. Can we please stop him from becoming estranged from his family?"

Seeing the family's anxious expression, Fang Yan softened his tone and explained:
“It’s not that I think you’re unreliable, it’s just that he needs a more ‘stress-free’ environment right now. As you just heard, most of his emotional outbursts are related to his family. Letting the medical staff take over now doesn’t mean you should completely abandon him, but rather help him calm down first. Once he’s more stable, you can gradually get involved, and the results will be better.”

He pointed to the patient and continued, “Look at him now, he doesn’t react no matter what we say. It’s because he’s still ‘on edge’, afraid of arguing again, afraid of being contradicted. Medical staff are ‘neutral’, they have no past emotional entanglements with him, and can more easily help him build trust. For example, when the nurse accompanies him to sunbathe, she doesn’t have to think about ‘whether she will say the wrong thing’, she can just stay quietly. This kind of ‘unintentional’ companionship can actually help him relax.”

The patient's wife pursed her lips, her fingers unconsciously twisting the hem of her clothes. After a few seconds, she asked softly, "Then... then okay!"

Fang Yan breathed a sigh of relief after hearing the agreement.

Great, the chances of patients recovering are now doubling.

If we really let them take care of things here, I really don't know what will happen to Fang Yan.

Even if it's cured, it might drive him crazy again.

They even blamed themselves for their poor medical skills.

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

(End of this chapter)