Rebirth 1977 Great Era

Chapter 1383 Lupus Erythematosus, Rare Post-Swallowing Syndrome-like Atrial Tachycardia (Two Chapters Combined)
"So it's Comrade Shen, please come in!" Fang Yan immediately invited Shen Zhanyao into the house.

The man in front of me was about 1.7 meters tall, somewhat thin, and looked to be around fifty years old. He wore round-framed tortoiseshell glasses and spoke rather quickly. This man was Shen Zhanyao.

Behind him was another person of similar age and build. Shen Zhanyao took two steps into the room and then immediately turned to Fang Yan to introduce him.

"This is my cousin, Ma Xinghua. He was also one of my previous patients. I heard that Dr. Fang was going to do a publicity campaign, so I invited him along to help with your promotion."

Fang Yan nodded repeatedly, then shook hands with Ma Xinghua:
"Hello Comrade Ma, it's really kind of you to make this trip."

Ma Xinghua was a little reserved, and said to the dialect:

"Director Fang, you're too kind, you're too kind..."

It was clear that he was not a very eloquent person, and he greeted them in the clinic with a dialect.

Then he said:

"Thank you both for traveling all the way to Beijing. I still have five patients to see this morning. They will be here soon. I'll have someone take you to your accommodations first, and then you can rest for a bit. I'll come to the guesthouse to find you after I'm done with my work."

Fang Yan had originally planned to arrange for them to receive treatment together here, but after thinking about it, she decided against it. They were here to cooperate in promoting rabies treatment, not to study. Besides, Fang Yan didn't know them well enough, and who knew what they would say about this place when they got back.

So, to avoid any unforeseen complications, Fang Yan simply decided not to let them get involved in today's medical appointment, which also allowed them to finalize their accommodation arrangements.

Upon hearing Fang Yan say this, Shen Zhanyao and his cousin Ma Xinghua naturally had no objections.

"I will follow Director Fang's arrangements," Shen Zhanyao said to Fang Yan.

Then Fang Yan called over a nurse and asked her to take the two people to the Xiehe Hospital's guesthouse and arrange rooms for them.

Before leaving, Fang Yan signed a stack of cafeteria meal tickets for them.

These days, you need ration coupons to buy food; you can't just buy it whenever you want if you have money. Shen Zhanyao and Ma Xinghua came to Beijing from Zhejiang. Before they left, they had to ask their work unit's logistics department for "travel ration coupons." If Shen Zhanyao was a government employee, his ration would be calculated according to his position; if Ma Xinghua came along, his ration would be calculated according to the temporary travel ration. How much they could get depended entirely on how many days they were there.

These grain coupons were either deducted from their monthly grain rations or obtained by their work units from the local grain bureau and then issued to them.

When they return to Zhejiang to claim their expenses, they need to bring all the receipts from the guesthouse and canteen (such as meal receipts and stubs for food coupons) and go to their work unit or the Ministry of Health to claim the expenses.

The reimbursement process was simple: first, it was calculated based on the grain price corresponding to the grain coupons (at that time, a pound of grain cost about 13.8 cents); second, if a handling fee was paid when receiving the national grain coupons, that fee could also be reimbursed.

To put it simply, the company reimburses them for the money they spent on food during their business trips.

Fang Yan signed the canteen meal tickets for them before they left, in case they didn't have enough food coupons or couldn't find a place to exchange them for food coupons usable in Beijing. With these meal tickets, they could go directly to the canteen to eat without having to pay for their own food coupons, which was much more convenient.

Since they arrived so quickly, we can't be stingy with our local customs; we should still give them the care they deserve.

As expected, Shen Zhanyao and Ma Xinghua were quite happy to receive the meal tickets and thanked Fang Yan repeatedly. This was a time when even a hero could be brought down by a penny, and not everyone had as much financial income as Fang Yan.

Even someone like Shen Zhanyao, who has dozens of rabies cure cases in his hands, still has no chance to get ahead if his superiors don't give him opportunities and Fang Yan doesn't name him.

This situation is very common in this era. For example, Li Ke, the old master, only began to be known in the 1990s. He didn't really become famous until the Internet age.

That's all about luck.

……

After Shen Zhanyao left, today's patients arrived.

Fang Yan could see clearly from upstairs that the people were brought over by the Overseas Chinese Affairs Office, and the leader was Director Liao's former secretary, Zhou.

Moreover, among the patients' family members today, Fang Yan saw that old rascal Wang Zhenlin was also there.

Yesterday, they were taken to visit the Summer Palace, and today he came along as a patient's family member.

When Secretary Zhou came up, he first greeted Fang Yan.

He was warned that Wang Zhenlin was among those involved, and that he should be on guard.

He didn't even need to remind him; the information that Wang Zhenlin had already gathered was enough to prove that he had a problem.

We'll see what he's up to in a bit.

Once the five patients and their families had arrived outside, Fang Yan asked a nurse to call them.

The reason was to avoid greeting Wang Zhenlin.

Unexpectedly, just after Fang Yan called in the first patient, An Dong, who was accompanying his master Lu Donghua next door, came in and told Fang Yan that Wang Zhenlin had arrived in their clinic.

I'm chatting with Lu Donghua right now.

They weren't targeting me?

Fang Yan was somewhat surprised, but he quickly composed himself and told Anton to go over and keep an eye on things, and to come and report back to him if anything happened.

Anton immediately agreed and went over.

After everyone else left, Fang Yan greeted the first patient.

The patient was a woman whose age was difficult to discern from her dialect. She was swollen all over, her stomach was distended like a jar, her face had dark patches of brown like butterflies, and she looked extremely tired. The swelling in her lower body was even more severe, and she could only walk barefoot.

After a brief greeting, her family brought out the report.

Upon closer inspection, it was a medical report. The results showed a hemoglobin level of 69.5 g/L, urine protein (+), pus cells (+), blood urea nitrogen of 22.3 mmol/L, and creatinine of 411.0 μmol/L. The diagnosis was systemic lupus erythematosus.

The dialect above also revealed the patient's name: Wang Yi, who is forty-seven years old.

The report was issued by a hospital in Singapore, and it was published within the last month.

Seeing that the patient was having difficulty speaking, Fang Yan asked her family:
"The swelling must have started recently, right?"

The patient's family member, presumably the patient's husband, said:

"Yes, I was only diagnosed with lupus two years ago, and the swelling all over my body started a month ago."

"Recently, I've also been experiencing difficulty urinating. Our doctor prescribed some medication, but it hasn't been effective."

As he spoke, he handed the medicine he was using to Fang Yan. Fang Yan glanced at it and saw that it was a type of Western medicine, such as corticosteroids and diuretics.

Fang Yan reviewed the patient's treatment records again, which did indeed record the problem of difficulty urinating, with a daily output of less than 400 milliliters.

Fang Yan came to examine the patient and chose to examine him from bottom to top.

The patient's lower limbs were severely swollen. Fang Yan pinched them and felt a fluctuation. Then he noticed that her abdomen was swollen.

Fang Yan pointed to the examination bed and said to the patient in the wheelchair:
"Come on, lie down on the bed, bend your legs a little, and relax your abdominal muscles."

Ms. Wang followed the instructions in the dialect and, with the help of her family, managed to get onto the bed. The dialect speaker put his hands together and began percussing from the navel on the midline of the patient's abdomen to the left side, tapping repeatedly. At first, he heard a drum-like sound.

This is intestinal gas. In some dialects, this is called "listening to the abdomen to see if you have ascites."

After only two taps, the percussion sound changed from a tympanic sound to a dull sound.

After silently memorizing the location, Fang Yan said to the patient:
"Come on, turn over and lie on your left side."

At this point, the free fluid in the abdominal cavity would flow to the left side of the abdomen due to gravity. Fang Yan tapped the area he had previously memorized and found it had become tympanic. Then he tapped the original tympanic area on the right side of the abdomen and found it had become dull due to the fluid flowing over. He nodded at the new dull area and then said to the patient:
"Turn to the other side."

The patient didn't know what Fang Yan was doing, so he just did as he was told. Fang Yan tapped again and found that the liquid had moved back.

He has now confirmed that the patient has ascites, which is called "positive shifting dullness".

Simply put, in order to detect shifting dullness, both conditions must be met:

The first requirement is that there must be enough fluid. If there is only a little water in the abdominal cavity, such as less than 500 ml, this little water will be separated by the intestines and will not flow even when you turn over. You cannot see the dullness moving when you percuss it. Generally, you need to accumulate more than 1000 ml of water, enough to flow with the body position, before you can clearly see the dullness moving.

The second requirement is that the fluid must be able to "flow freely." For example, ascites is in the abdominal cavity with nothing blocking it, so it can flow wherever it wants. But if the fluid is trapped, such as when inflammation causes the fluid to be encased in adhered tissue and cannot flow, then no shifting dullness can be detected on percussion.

In general, shifting dullness is a signal to check if there is a lot of fluid in the abdomen that can flow out easily. It is achieved by having the patient turn over and seeing if the dullness on percussion moves to a different position.

If this happens, it's almost certain that there's a large amount of free ascites in the abdomen.

The situation is more serious than Fang Yan thought.

Fang Yan started taking the patient's pulse again. Fortunately, the swelling in her hand was not too serious, and Fang Yan could feel that there was still a pulse on the cun, guan, and chi positions.

Then, speaking in dialect to the patient:
"Open your mouth and stick your tongue out so I can see it."

The patient stuck out his tongue as instructed in the dialect. The dialect expert saw that the tongue was reddish with a thin, greasy coating and a slightly yellow center. Just as the dialect expert finished looking at it, he noticed something else in the patient's mouth.

"Open your mouth wider," Fang Yan said to the patient.

The patient obediently followed the instructions, and it was then observed that there were still scattered ulcers in her mouth, not a large, continuous area, but rather a wide range of ulcers.

In medicine, this is called a scattered ulcer.

Fang Yan asked the nurse to bring a flashlight to help her see more clearly. However, the light revealed that the ulcers weren't just inside her mouth; they were also present in her right nasal cavity. Fang Yan then switched hands to take the patient's pulse, asking her as she did so:

"How long have you had these mouth ulcers and nasal ulcers? Were they there when you were first diagnosed with lupus, or did they appear after they started swelling up a month ago? Do they hurt? Do they affect your eating or blowing your nose?"

The patient said:
"It definitely hurts, but I can't remember when. It's been there for a long time, and it gets better on and off, but I don't know exactly when it relapsed."

Fang Yan nodded, taking the patient's words to heart. The oral ulcers were "intermittent and had recurred before," indicating that the active phase of lupus had been recurring and had not only worsened in the past month.

His fingertips remained on the pulse, feeling its fine, rapid flow, and he pressed on with further questions:

"In the past month, besides swelling and reduced urination, have you experienced any chest tightness or shortness of breath? Is it more uncomfortable lying down at night than sitting up?"

Wang Yi shook her head weakly, and her husband added from the side: "She can breathe well, but she always says she has no energy. She gets tired even after sitting for a while. In addition, she has been feeling nauseous for the past few days and can't eat anything. She feels like throwing up after eating a little bit."

"Do you experience acid reflux or heartburn when you feel nauseous? How are your bowel movements? How often do you poop?" Fang Yan continued to ask, as these details could help determine whether the patient's spleen and stomach functions were affected.

"I don't have acid reflux, but my stomach feels bloated. I only have bowel movements every two or three days, and they're very dry," the patient continued.

Fang Yan nodded; he had already made his judgment.

Fang Yan withdrew his hand from taking the pulse, the smooth, thready pulse still lingering on his fingertips. He said to Mr. and Mrs. Wang Yi, “You have a syndrome of ‘deficiency of both spleen and kidney, and stagnation of damp heat’. Long-term lupus erythematosus has depleted your spleen and kidneys. The spleen is weak and cannot transport and transform water and dampness, and the kidneys are weak and cannot promote urination. The dampness and turbidity stagnate for a long time and turn into heat. The heat evil burns the mucous membranes, which is why you have recurring oral ulcers and nasal ulcers. When the dampness and turbidity stagnate in the body and cannot be expelled, it will lead to edema throughout the body, ascites, and even reduced urination.”

Wang Yi's husband hurriedly asked, "Dr. Fang, can this disease be cured? When we were in Singapore, the doctor said her kidney function was already damaged and told us to be prepared..."

“It can be cured!” Fang Yan picked up the prescription and paused before saying:
“Your condition is quite urgent. We need to drain the water first, otherwise the ascites and edema will continue to compress your internal organs and worsen kidney damage. I’ll use ‘Wu Ling San’ as a base, which is a classic diuretic formula from the ‘Treatise on Cold Damage’, specifically for edema and difficulty urinating caused by internal retention of dampness.”

The patient and his family nodded. Although they didn't understand the prescription, they understood the dialect and what they were supposed to do next: drain the water and reduce the swelling.

At this time, the dialect began to be written down as prescriptions.

This recipe is actually quite classic.

The formula consists of 12g of Polyporus umbellatus, 20g of Poria cocos, and 15g of Atractylodes macrocephala. These three herbs promote diuresis from different angles: Polyporus umbellatus clears the urinary tract, Poria cocos strengthens the spleen and promotes diuresis, and Atractylodes macrocephala dries dampness and strengthens the spleen. The combination of these three herbs not only drains water but also protects the spleen, preventing diuresis from harming the body's vital energy. 15g of Alisma plantago-aquatica enhances the diuretic effect, expelling dampness and turbidity from the lower abdomen through urination. 6g of Cinnamomum cassia warms the yang and promotes qi circulation, helping to clear the channels for water and dampness movement. Otherwise, simply draining water without regulating the body's qi will lead to recurring dampness.

After writing the basic formula for Wu Ling San, Fang Yan considered it and added 10g of Astragalus membranaceus to replenish Qi, which can promote the flow of water and help expel dampness and turbidity; she also added 3g of Salvia miltiorrhiza to invigorate blood, as her long-term edema is prone to blood stasis, and Salvia miltiorrhiza can clear the blood vessels and make the excretion of dampness smoother; in addition, for oral ulcers and damp heat, Fang Yan added 5g of Lonicera japonica to clear heat and detoxify, which can relieve inflammation of the mucous membrane without damaging the spleen and stomach.

After writing it down, Fang Yan looked at the prescription and decided to give it to Wang Yi first, and then they would discuss the rest later.

Wang Yi's husband leaned closer to look at the prescription and whispered, "Dr. Fang, how long do we need to take these medicines? Will the swelling go down after we finish them?"

"Take three doses first, one dose a day, divided into two warm doses, morning and evening," Fang Yan folded the prescription and handed it to him. "During the medication period, record the amount of urine every day. If it can increase from 400 ml to more than 800 ml, it means that the diuretic effect is working; the ascites and edema should be noticeably reduced in about three to five days. In addition, we will boil winter melon peel in water for your wife to drink every day, without adding salt, which can help with diuresis and has no side effects."

"Winter melon peel?" The patient's family was dumbfounded.

Fang Yan nodded to them and said:

"Yes, it's winter melon peel, which is actually a traditional Chinese medicine."

After saying that, he gave some dietary advice: "Also, don't eat foods that are high in salt, and don't eat potatoes or sweet potatoes, as these can cause bloating. Bloating will worsen abdominal distension. You can eat some millet porridge or steamed yam, which can strengthen the spleen and stomach and help the body recover."

"Anyway, when you order lunch, just tell the hotel what the taboos are, and they will give you a menu."

Upon hearing this from the dialect, the patient and their family nodded.

Then Fang Yan told them to hurry up and get admitted to the hospital.

The longer their condition drags on, the more dangerous it becomes; they need to take their medicine as soon as possible.

Fang Yan hopes that after drinking it, she will start to drain the water immediately, and try to reduce some of the swelling by noon.

Otherwise, he would have to change the prescription and use stronger medicine.

After seeing the first patient, Fang Yan went outside for a quick look.

Wang Zhenlin is still with his master, and he hasn't even paid attention to the patients who came with him. What is this old man up to?

"Next!" Fang Yan said to the patient outside.

The second patient of the day came in. He walked in; he was a man, probably in his thirties, not yet forty.

His complexion looked normal, and he even looked like he had been working out.

He also had the fewest people around him.

"Hello Dr. Fang, this is just a small token of my appreciation, please accept it." The patient immediately handed over a small box to Fang Yan.

This person is the first among so many who wasn't influenced by Wang Zhenlin, and actually brought a gift.

"My surname is Lu, and my name is Lu Wen. I was introduced to this clinic by Mr. Ma," the other person introduced himself first.

"Mr. Ma?" Fang Yan was taken aback. He was certain that he had not encountered this Lu Wen at the reception dinner table.

“Mr. Ma Youxin from Haojiang,” Lu Wen added.

Fang Yan suddenly realized that it was Brother Ma Wenying, introduced by Ma Laosan.

No wonder they weren't affected; they weren't even from the same place.

"So, you didn't come back with them?" Fang Yan asked.

Lu Wen said:

“I came back with them, but I didn’t go to the hotel first. Instead, I went to do something for Mr. Ma.”

Then he added:
"I also heard what Wang Zhenlin said on the plane, but I don't believe it."

Fang Yan listened to his words and carefully examined the man.

asked:

"You look perfectly normal, not like you're sick."

Lu Wen waved his hand and said:
"No, no, I really do have a health problem, I just look normal. Whenever I eat or drink, there is a chance that the illness will flare up."

"Huh? What do you mean?" Fang Yan frowned.

Lu Wen said:

"I started having this problem about two weeks ago. Once, I was having dinner with a business friend. As soon as the food was served, I took a bite and felt like I had been punched in the chest. I felt like I couldn't breathe. But it was fine after a while."

“I didn’t know what was going on at the time. Nothing else happened that night. Then, two days passed without any reaction. I thought it was just a minor problem I had occasionally. Then, on the third night, when I was about to go to sleep, I drank a glass of warm water, and suddenly the problem occurred again.”

"Then, for the next two weeks, this would happen randomly. Whenever I ate, drank water, or drank anything else, this would happen. It was like there was an invisible person next to me, ready to punch me when I wasn't looking."

“I went to a hospital in Haojiang for a checkup, but they couldn’t find anything wrong. Then I went to a hospital in Hong Kong, but they still couldn’t find anything wrong. Later, at Mr. Fok’s private hospital, we were monitored 24 hours a day. My meals and water were constantly monitored by machines. That’s when they finally found out the problem.”

"It only lasts for a very short time, during which blood pressure rises and the heart rate increases from 82 beats per minute to 164 beats per minute. They call this post-swallow paroxysmal atrial tachycardia."

“At the time, Mr. Ma happened to be in Hong Kong. After he came to see me, he asked me to apply for the overseas Chinese business procedure and then come to Beijing. He also asked me to deliver something to Ms. Ma for him.”

“My family happens to have investments here, so I meet the criteria and came here.”

Hearing this, Fang Yan finally understood what was going on.

This disease is very rare in clinical practice. It manifests as sudden palpitations, dizziness, and chest tightness when the patient swallows.

If we had to categorize it in Traditional Chinese Medicine, it should fall under the category of "palpitation".

What's strange about his illness is that his heart rhythm and heart rate are normal most of the time, but he suddenly starts having an attack after eating.

Then the illness lasts very short time, and the patient will return to normal immediately after the illness subsides.

But it might come back the next time you eat or drink.

It's like a ghost that follows you everywhere, never knowing when it will strike.

It took about half a month for Mr. Lu in front of us to show any signs of illness.

If this illness lasts a little longer, the patient's mental state will definitely be affected. They may become afraid of eating and drinking, or even afraid of swallowing.

This disease was first reported in 1926, but it has been rarely seen in clinical practice since then.

However, there are indeed records of this in traditional Chinese medicine.

The "Ling Shu Jing Mai" chapter of the "Huangdi Neijing" mentions that "after eating, one vomits, experiences stomach pain, abdominal distension, and frequent belching. After eating, one feels relieved as if weakened, and the body feels heavy." Although it does not explicitly mention palpitations, it points out the pattern of "physical discomfort triggered after eating," which is consistent with the characteristics of symptoms triggered after swallowing.

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

(End of this chapter)