Rebirth 1977 Great Era

Chapter 1386 The Mystery of Bone Tuberculosis: What's the Hidden Meaning Behind Wang Zhenlin's Recommendation of a Doctor? (Combined Chapter)
Upon hearing the question about dialect, the patient's family didn't seem too surprised. They exchanged glances, and then the patient addressed the dialect speaker:

“Dr. Wang is a friend of our family. Whenever someone in our family has a headache or fever, we go to him for treatment. I also went to him for treatment before, but he wasn’t good at this kind of disease. Later, he recommended other doctors in Japan to us. My coccyx tuberculosis was treated by the doctor he recommended.”

After saying that, he added:
"It was on his recommendation that we came back to China to see you this time."

They didn't completely believe what the dialect speaker said. Judging from their reaction just now, they had anticipated the dialect speaker's question and prepared this explanation.

Fang Yan didn't press further about Wang Zhenlin, but nodded and said:

"I see."

Then he said to the patient:
"Give me your left hand, I want to take your pulse."

Fang Yan's reaction clearly surprised the patient's family. Logically speaking, Fang Yan should have taken this opportunity to ask them about donating the building.

As a result, they didn't even ask about dialects.

Several people were about to say something, but then they abruptly stopped themselves.

Fang Yan then asked the patient to stick out his tongue so he could examine its appearance.

The patient's tongue coating is thin, white, and greasy.

Then Fang Yan didn't say anything or ask any questions, and just kept feeling the pulse in both hands.

The pulse is weak and soft.

After writing down the medical record in dialect, he then asked the patient:
"Can you stand up now?"

Upon hearing the question about dialect, the patient paused for a moment before replying:
"Oh, you can stand up, but you can't walk more than a few steps."

Fang Yan said to him:
"Stand up and take a look."

The patient stood up as instructed in the local dialect.

“Relax, take a few steps,” Fang Yan said.

The patient continued to do so, but the movements caused him physical pain, which made his movements distorted.

Fang Yan observed that the patient, who was originally in the same physical form as a normal person, gradually became hunched over due to physical pain. After taking four or five steps, he began to move around in small, hesitant steps.

Fang Yan didn't stop him, but the patient continued to move until cold sweat poured down his forehead. He stopped and asked Fang Yan:

"Dr. Fang, is it ready now?"

Fang Yan nodded and said:

"okay."

Hearing this, the patient felt as if he had been granted a reprieve. He quickly had the wheelchair pushed back to his side, sat down again, wiped the sweat from his brow, and said to Fang Yan:

"My ankle is very painful, and I can't walk very far without it getting like this."

Fang Yan knelt down next to the patient, lifted up his trouser leg, and examined the area where he said his ankle was painful.

The patient pointed to it, but Fang Yan didn't see any redness or swelling. Fang Yan pinched it and asked:
Will it hurt if I do this?

The patient said:
"A little, but not noticeably, not as painful as when I walk."

Fang Yan nodded, stood up, and asked the patient:
How have your eating and urination habits been lately?

The patient responded:

"I feel bloated whenever I eat, so I usually eat very little."

"Going to the toilet is still quite normal."

Fang Yan continued to ask:

"Sleeping? Dreaming?"

Upon hearing the question about dialect, the patient immediately nodded and said:

"I have dreams, and I'm always woken up by pain."

After hearing this, Fang Yan pondered for a moment and said to the patient:
"Undress."

"Huh?" The patient was taken aback, not expecting Fang Yan to suddenly make this request.

"I need to examine the bones in your upper body," Fang Yan said seriously.

Hearing that everyone in the dialect says this, the patient naturally has no choice but to follow suit.

As soon as he took off his clothes, Fang Yan noticed something was wrong: the patient's twelfth thoracic vertebra and first lumbar vertebra were clearly convex.

Fang Yan pressed on it, and the patient gasped in pain.

"Ouch...it hurts!"

He quickly moved aside.

He asked in dialect:

Is the pain more noticeable here than at the ankle? And is it worse when you lie down at night?

The patient was in so much pain that cold sweat beaded on his forehead, and he nodded vigorously.
"Yes... when I lie flat at night, my back feels like it's being pricked with needles, so I can only sleep on my side, and I always wake up in pain."

Fang Yan withdrew his hand and said:

"This is not a simple recurrence of tuberculosis in your coccyx, but rather the tuberculosis bacteria have invaded your thoracic and lumbar vertebrae. The high convexity of the twelfth thoracic vertebra and the first lumbar vertebra is a typical manifestation of 'phlegm and blood stasis intermingling and bone damage' in the late stage of 'bone consumption'. The ankle pain without redness and swelling is radiating pain caused by 'phlegm and turbidity descending', not a problem with the ankle itself."

He picked up his pen and added to the medical record:
"A thin, white, and greasy tongue coating and a weak pulse indicate the presence of 'phlegm and dampness' in the body; abdominal bloating after eating indicates 'spleen deficiency and impaired transport and transportation,' which leads to the production of phlegm and dampness. This phlegm and dampness, combined with residual toxins from tuberculosis, obstructs the meridians and erodes the bones, resulting in symptoms such as lower back pain, limited mobility, and radiating pain. The previous treatment in Japan may have only controlled the local symptoms in the coccyx, without clearing the phlegm, dampness, and residual toxins from the body. Therefore, when the immune system weakens, the symptoms spread to the thoracic and lumbar vertebrae."

At this moment, the family member asked in dialect:

"Dr. Fang, can this disease be cured?"

He said in dialect:

"This requires several steps to treat, so it takes quite a while."

"How long will it take?" the patient asked.

He said in dialect:

"At least two months."

Upon hearing this dialect, the patient and their family were taken aback.

"Two months is not a long time, no problem."

Fang Yan heard them say this and said:
"I'm referring to two months of hospitalization."

The patient nodded and said:
"Two months of hospitalization is not a long time, we can accept it. We can even accept a year, as long as the disease can be cured."

After he finished speaking, his family members all echoed his sentiments:

“That’s right, that’s what we thought too. We came back to China this time to cure this recurring tuberculosis.”

"Dr. Fang, please do your best to treat the illness. We will cooperate fully."

Fang Yan nodded and said:
"Alright, you can go to the hospital now. The medicine that has been prepared will be delivered to your ward in half an hour."

After speaking in dialect, he waved to the nurse, asking her to take the people to complete the admission procedures.

The nurse immediately greeted the patient and their family, inviting them to come over with her.

This time, Fang Yan didn't choose to write the prescription in front of them, just to see if they would wait for her to write it. As a result, the family didn't hesitate at all and followed the nurse out directly.

Fang Yan frowned after they left.

what's the situation?
Could it be that this family isn't in cahoots with Wang Zhenlin?

Fang Yan went through their conversation again in his mind, from beginning to end. Apart from their initial positive responses, it seemed that there was nothing wrong with them, and the tuberculosis was indeed real.

After all, the physical deformities are genuine.

Surely they can't have come back to spread the tuberculosis virus, right?

The key point is that bone tuberculosis is a type of extrapulmonary tuberculosis and is not contagious.

Do you really think too much?
Fang Yan began to recall many suspicious aspects of Wang Zhenlin's previous behavior in her mind.

Director Liao's investigation revealed that Wang Zhenlin's clinic in Yokohama, Japan, which had previously been struggling, suddenly had the money to renovate and buy a new car, with the source of the funds unclear.

His fabricated experiences were full of loopholes, he lacked professional knowledge of traditional Chinese medicine, and he even returned from Japan, all of which made people suspicious of his true motives.

His historical background, in particular, which suggests he may have collected traditional Chinese medicine information for the Japanese in Japanese-occupied areas, increases suspicion of espionage.

At the banquet, Wang Zhenlin tried to establish a relationship with Lu Donghua, but was rejected and still did not give up.

Later, the rumor of "rules for donating buildings" was spread among the patients, which led many overseas Chinese businessmen's families to bring up donating buildings right away. This was clearly a deliberate attempt to create chaos or test the reaction of the dialect.

This behavior doesn't resemble that of a typical patient; it seems more like someone instigated it.

Let's look at this family again. They sat at the same table as Wang Zhenlin. The patient claimed that Wang Zhenlin was a "family friend" and recommended that they return to China for treatment.

However, their reaction seemed somewhat deliberate. When they were not asked about Wang Zhenlin or the donation of the building as expected, they appeared surprised, suggesting that they may have prepared their answers beforehand.

However, the patient's condition was genuine, and the vertebral deformation and pain symptoms caused by bone tuberculosis could not be faked, and the patient's cooperation during hospitalization was also high.

What's crucial is their attitude: when asked to stay in the hospital for two months, they agreed without hesitation, and even said that "a year would be acceptable."

The family's medical condition was genuine and they were cooperative.

In addition, the patient mentioned that he was "cured" of coccyx tuberculosis in Japan through the introduction of Wang Zhenlin, but it actually relapsed and spread. This may suggest that there are defects in the treatment by Wang Zhenlin or the Japanese medical institutions he is associated with, such as not thoroughly clearing away phlegm, dampness and residual toxins.

However, there's no way to directly prove a conspiracy.

Therefore, Fang Yan currently believes that this family is most likely a genuine, "clean" patient, but was used as a "smokescreen" by Wang Zhenlin. By recommending them, Wang Zhenlin drew attention to this family, diverting attention from his true intentions.

I don't think too much about dialects; I'll deal with whatever comes my way.

Both Japan and Tianjin are still investigating Wang Zhenlin, so there's really no need for me to worry about many things.

Once the investigation is complete and it's found that Wang Zhenlin has problems, someone will naturally deal with him.

He picked up the prescription slip and began writing the prescription:

Codonopsis pilosula 10g, Atractylodes macrocephala (fried) 10g, Dioscorea opposita 12g, Coix lacryma-jobi (raw and cooked) 12g each, Alisma plantago-aquatica 10g, Poria cocos (red and white) 10g each, Plantago asiatica (fried) 15g (wrapped and decocted), Aucklandia lappa (baked) 3g, Citrus reticulata 5g, Nelumbo nucifera (dried) leaf 1 piece.

This prescription is designed to strengthen the spleen, remove dampness, and harmonize the stomach. It is mainly for patients with spleen deficiency and impaired function, where phlegm and dampness combine with residual tuberculosis toxins to erode the bones.

In short, the core of treating bone tuberculosis is to clear residual toxins, replenish vital energy, and repair bones. Although this formula does not directly kill tuberculosis bacteria, it addresses the patient's physical weaknesses by strengthening the spleen and removing dampness.

This is essentially a radical solution, addressing the most critical issue.

According to the local dialect, the problem can be resolved in about two months by taking medication.

Although this person seems to have some issues, he is, after all, a patient who has genuinely invested money, so the dialect correction treatment still needs to be implemented.

Just as Fang Yan finished writing the prescription and was about to give it to the nurse to take to the pharmacy to have the medicine prepared, Anton pushed open the door and walked in, saying to Fang Yan:

"Master, Wang Zhenlin is gone."

"gone?"

"Correct."

"The person who was with him just now called him, and he said goodbye to us and left. He should be going to the inpatient department now."

Upon hearing Anton's words, Fang Yan asked him:
"Is he doing anything for you? Or is he inquiring about me?"

Anton shook his head and said:
“It was just normal communication. We were discussing the patient’s condition the whole time. My master even asked him why he didn’t come here. He said that his donation of the building was a case of good intentions gone wrong, so he was embarrassed to come.”

Fang Yan frowned; Wang Zhenlin's sense of purpose was becoming increasingly blurred.

It seems like today's performance was specially made for people with dialects.

"Master, do you need me to go to the inpatient department and keep an eye on him? After all, there's another patient with pulmonary interstitial fibrosis there," Anton asked Fang Yan at this moment.

Fang Yan thought for a moment, then waved his hand and said:
"No need, I've already informed the people over there."

Anton nodded upon hearing this.

Next, Fang Yan called in the fourth patient.

The patient, surnamed Song, was the oldest in the group, already sixty years old. He was pushed in in a wheelchair by his assistant. Fang Yan recognized him because Mr. Song had previously appeared on Hong Kong television; he was in the clothing business and was quite well-known locally.

His son accompanied him; Fang Yan had met him at the reception banquet.

"Mr. Song, what is your current situation?" Fang Yan gestured for them to sit down and asked directly.

Mr. Song's son spoke first, his tone urgent:

“Dr. Fang, my father fell down the stairs at home ten months ago and fractured his left upper arm. The fracture healed in two months, but not long after, he started experiencing insomnia and dizziness. After a while, he would even suddenly faint when he got up in the morning. At first, we thought it was epilepsy and rushed him to a hospital in Hong Kong for examination, but they couldn’t find anything wrong.”

He paused and then said:
"The most troublesome thing is that in the last three months, my father's hands started to tremble, especially his right hand, and it's getting worse and worse. In the last two months, he has been unable to dress himself, hold chopsticks, or hold a pen. He can't even walk steadily, and his speech has become slow and he can only say a complete sentence after a long time."

“We later took him to several major hospitals in Europe for examination, and they all said it was Parkinson’s syndrome… Yes! It’s Parkinson’s syndrome!” Mr. Song’s son said, and he even repeated the name of the disease so that he might not have heard him clearly because of the dialect.

“Yes, yes, that’s the disease!” Mr. Song weakly echoed from the side, his voice slow and indistinct.

"The hospital admitted us for treatment, and we stayed for half a month, taking medicine and getting IV drips, but it didn't work at all. Later, we heard that you had a way to treat illnesses, so we rushed back from Europe to see you." After saying this, Mr. Song's son looked at Fang Yan with hopeful eyes, hoping to get a different answer.

"Parkinson's disease..." Fang Yan thought it sounded familiar. He thought for a moment before remembering that when he was in school, Western medicine had renamed it Parkinson's disease.

Note that Parkinson's disease and Parkinson's syndrome are not the same thing.

The most common initial symptom of this disease is involuntary tremor of the limbs when at rest (such as when sitting still or with the hand resting on the knee), which is relieved when active and disappears after falling asleep. The "right hand tremor" is particularly typical.

Then comes muscle stiffness and increased resistance during activity. Patients often feel that their limbs are "heavy" and "tight," which can lead to abnormal body posture (such as hunching over) in severe cases.

Then, when standing or walking, balance decreases, making it easy to fall.

Movements become slower and smaller, such as difficulty with fine motor skills like dressing, buttoning clothes, or picking up chopsticks; walking becomes difficult to start with and the steps are small and fragmented, also known as "flustered gait"; and speech becomes slower and monotonous.

In advanced stages, patients may not even be able to stand independently.

In addition to motor symptoms, patients often experience non-motor symptoms such as insomnia, dizziness, constipation, depression, anxiety, and memory loss.

The symptoms of Mr. Song in front of us do indeed match this description.

Fang Yan asked the patient, Mr. Song:

"Is your hand trembling most noticeable when you're sitting still? For example, does it tremble when you put your hand on the table before eating, and then lessen when you reach for chopsticks? Also, does the trembling stop when you lie down at night?"

Mr. Song slowly raised his right hand, his wrist trembling slightly, his fingers visibly shaking involuntarily. He spoke with difficulty:
"Yes... it's worst when I'm sitting still. It's a little better when I'm picking things up or doing things... When I'm lying in bed at night, it takes a while for the shaking to stop. Sometimes I wake up in the middle of the night and my hands start shaking again, making it hard to even turn over."

When he spoke, his expression was blank, his speech was slow and emotionless, as if he was squeezing out words little by little, and by the end, drool was already dripping from the corner of his mouth.

His assistant saw it and quickly wiped it clean.

Fang Yan pointed to Mr. Song's shoulder again and continued to ask, "Do you usually feel that your arms and legs are heavy? For example, when you want to lift your arm to reach something, do you feel weak and your movements are slow?"

Mr. Song seemed to freeze up at this moment, opening his mouth as if to react.

Mr. Song's son quickly added, "Yes, yes! I have to help my dad get dressed now. It takes him a long time to lift his arm, and he has to watch him carefully to button his clothes. If he's in a hurry, he'll button them wrong. He can't lift his feet high, and he takes small, shuffling steps forward, afraid of falling. I have to push his wheelchair with me when we go out."

Fang Yan nodded, got up and walked to Mr. Song's side, gently held his right wrist, and felt the tension in the muscles. He could clearly feel that the muscles were stiff, unlike when a normal person is relaxed. He could feel obvious resistance when he turned his wrist slightly.

He then asked Mr. Song to try making a fist. Mr. Song's fingers slowly closed, his movements stiff and uncoordinated. When he opened his fist, it was equally slow and laborious.

Fang Yan then said to Mr. Song:

"Stick your tongue out so I can see."

After hearing this, Mr. Song took several seconds to open his mouth and stick out his tongue. His dialect showed great patience as he waited patiently.

It wasn't until Mr. Song stuck out his tongue.

Fang Yan saw Mr. Song's hands begin to tremble wildly, and saliva "whooshed" down his throat.

The assistant, quick-witted and agile, immediately caught it with a handkerchief.

"I'm sorry!" Mr. Song apologized to Fang Yan.

I just saw the tongue; the front part of the tongue coating is yellow with a grayish tinge.

Overall, he was still relatively clear-headed and capable of making his own judgments, but his reaction speed was slow.

After he withdrew his hand, the trembling stopped.

If you look closely, you can still see some minor shaking.

Fang Yan shook his head and said, "It's nothing, let me check your pulse."

Then, Fang Yan began to take the patient's pulse and asked:
"Mr. Song, how are your eating, sleeping, and toilet habits?"

Just as Mr. Song's son was about to answer for him, Fang Yan waved his hand at him, indicating that Mr. Song should answer himself.

This is essentially a test.

Mr. Song's Adam's apple bobbed twice, his eyes focused slightly, and he said slowly and deliberately, "I eat... I eat very little, I have no strength to chew, it's hard to swallow, and sometimes I choke... I don't sleep well, I always wake up in the middle of the night, my hands shake when I wake up, and it takes me a long time to turn over... I only have bowel movements every few days, they're very dry, and I have to use... I have to use an enema... I urinate is okay, but I get up a lot at night, two or three times a night."

His right hand trembled slightly as he spoke. When he said words like "laborious" or "very hard," he would unconsciously clench his fist, but his fingers were so stiff that they could only bend with difficulty, and his movements were as slow as rusty parts turning.

While listening to the dialect, he felt the pulse with his fingertips; the pulse was deep, thin, and wiry.

Then Fang Yan began to feel his right pulse.

Then he continued to ask:

What medications have been used in Europe?

Upon hearing this, Mr. Song turned his gaze to his son and assistant.

The assistant quickly produced a bag containing the examination reports and treatment receipts.

According to Fang Yan, the medication used was 100mg levodopa tablets, and an adjunctive medication, an anticholinergic drug called benztropine, was also used.

Fang Yan narrowed his eyes. The side effects of this anticholinergic drug were obvious, including dry mouth, constipation, blurred vision, and slowed cognition. Mr. Song already had problems with "dry stools and slow reaction". Taking the drug might aggravate these symptoms and even make him feel "more stiff and weak". This was also an important reason why he felt that "the drug was ineffective".

After feeling with my right hand, I still felt a deep, thin, and wiry pulse.

After withdrawing his hand, Fang Yan said to the patient and his family:
"In traditional Chinese medicine, your condition is called 'tremor syndrome,' which is caused by insufficient yin and blood, malnourishment of tendons and vessels, stagnation of blood vessels, deficiency of qi and blood, internal stirring of wind, and tremors of limbs."

"To put it bluntly, you don't have enough 'nutrition' and 'strength' in your body. Your meridians aren't nourished, and your blood and qi aren't flowing smoothly, which is why your hands shake uncontrollably and your body feels stiff. The medicine used in Europe only targets the symptom of 'shaking' and doesn't improve your body's foundation. Instead, it aggravates your constipation and slow reaction problems, so it's ineffective."

After listening, Mr. Song's son said:

"Dr. Fang, can these illnesses be treated?"

Fang Yan nodded and said:

"Of course, there is a special prescription in traditional Chinese medicine for this called Dingzhen Wan. It was invented by a traditional Chinese medicine doctor during the Ming Dynasty and is recorded in ancient books."

"After making a few minor modifications, it can be used on Mr. Song."

"After stopping the Western medicine, he started taking this medicine. If all goes well, his symptoms will improve quickly."

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

(End of this chapter)