Rebirth 1977 Great Era

Chapter 872 Radial Artery Ligation, Professor Tamagawa's Acupuncture Techniques (Combined Chapter)
Logically speaking, if one cannot feel the pulse, such as Liu Yu's pulseless condition, then one should not be able to feel it in either hand.

It's impossible for it to be something you can touch with one hand and not with the other.

Even Wang Yuchuan had never encountered such a situation.

Upon hearing Li Zhengji's words, he also came up to take Li Zhengji's pulse.

It turned out that they really couldn't feel a pulse at all.

I pressed down hard, but I couldn't feel anything anymore.

At this moment, Song Jianzhong returned and, seeing the scene of everyone staring at each other in bewilderment, walked over and whispered to Du Heng:

"What's the matter?"

Du Heng lowered his voice and said:
"I can feel the pulse at the cun, guan, and chi positions on my left hand, but I can't feel it at the cun, guan, and chi positions on my right hand."

"Huh? Is that so?" Song Jianzhong was also shocked.

"Could it be a congenital vascular malformation?" Li Zhengji made his judgment at this time.

In rare cases, there may be congenital abnormalities in the development of blood vessels in the right hand, such as the absence or abnormal course of the radial artery in the right hand, which makes it impossible to feel the pulse in the right hand in conventional locations.

"No way, I could feel the pulse when I was examined before!" At this moment, the patient Zhang Shen was also puzzled. He reached out his left hand to his right hand and searched back and forth for a long time, but he still couldn't find it.

Somewhat surprised, he said:

"Wait a minute, how come it's really gone? I even checked my own pulse when I was a kid!"

It was obvious that he was getting a little anxious.

Fang Yan then comforted him:

"Don't get excited. In certain extreme emotional states, the sympathetic nervous system is excited and blood vessels constrict, which may cause temporary changes in the pulse. Occasionally, the pulse in the right hand may be difficult to feel."

"In addition, external compression of blood vessels in the right upper limb and prolonged poor posture can cause blood vessels to become constricted, affecting blood circulation in the right hand and potentially leading to a weakening or disappearance of the pulse in the right hand."

"This situation is usually temporary. Don't worry, there must be a reason, which we have definitely overlooked."

Professor Wang Yuchuan nodded and quickly said:

"Yes, what the dialect says makes sense. I know there's another reason: when the effective circulating blood volume decreases, the body constricts peripheral blood vessels to ensure blood perfusion to vital organs. At this time, the peripheral pulse, including the pulse in the right hand, may become weak or even undetectable. Also, when the temperature drops, the body constricts peripheral blood vessels to reduce heat loss, which can also cause the pulse in the right hand to become weak and difficult to feel."

Li Zhengji, who was standing to the side, realized that he had been too excited and had made the patient panic.

He thought for a moment and then said:

"Sometimes, when the body loses water and causes insufficient blood volume, it can also weaken the peripheral pulse, making it impossible to feel the pulse in the right hand. This requires careful judgment."

As everyone knows, if you could feel a pulse before but can't now, then the chances of those things mentioned earlier are actually not very high.

The examination has already begun here. They can't feel the pulse on the right hand. They need to figure out what's going on, otherwise who knows if the patient has any other problems?

Congenital vascular malformation can be ruled out, compression of blood vessels in the right upper limb can be ruled out, the patient's previous lack of agitation can also be ruled out, and he doesn't seem to be dehydrated or anemic, so the last two can also be ruled out.

In addition, the body constricts blood vessels to reduce heat loss, and this can actually be ruled out in the current weather.

So all the scenarios we can think of now have been ruled out.

Fang Yan glanced at the patient, who was clearly also flustered at this moment.

If you suddenly lose your pulse in one hand, it would be strange not to panic.

Fang Yan said to him:
"Don't panic. Tell me when was the last time you took my pulse?"

Upon hearing the dialect spoken, the patient glanced at his wife and gave her a pleading look.

He really couldn't remember right now.

The latter took out his notebook and started flipping through it.

“It was right before the surgery,” the patient’s wife said to Fang Yan.

Fang Yan frowned:

"More than ten years ago? When you had mitral valve dialysis treatment in Japan for rheumatic heart disease and mitral valve damage?"

If that's the case, then it's too early.

The patient's wife shook her head:
"No, we had surgery when we were in Japan last time."

"That was before I went back to China to find you."

Fang Yan, Li Zhengji, and Wang Yuchuan were all taken aback.

He asked in dialect:

"You mean, you had surgery before returning to China?"

The patient's wife nodded:

"Yep."

Fang Yan asked her:
"Then why didn't you say anything just now?"

The patient's wife said somewhat awkwardly:

"Because it's the same hospital as last time. They didn't do a good job ten years ago, so we went back to them to do the surgery again."

"That's why I didn't say anything earlier."

Fang Yan asked her:
Do you have the surgical records?

“This…” The patient’s wife looked at her husband.

Patient Zhang Shen said:
"Because we chose to be discharged before completing our treatment, we did not receive the surgical records."

After hearing this, Fang Yan didn't say anything, but instead said to him:
Give me your right hand again.

The patient was a little confused, but still obediently placed his right hand back on the examination table.

Fang Yan first touched the patient's Taiyuan acupoint and found that there was no pulse at all.

Then he said to the patient:
"Bring up your left hand too."

The patient was somewhat confused, but still did as instructed.

Li Zhengji and Wang Yuchuan looked at each other, wondering what Fang Yan was up to.

Then I saw Fang Yan place his left and right hands on the patient's left and right hands, and then began to palpate the left and right Jingqu acupoints at the same time, pressing hard on the deep arteries there.

Then it was discovered that the right pulse had disappeared while the left pulse was normal.

Then Fang Yan stood up again, came behind the patient, and began to feel for the carotid arteries on both sides of his body.

The pulse here was found to be completely normal.

Then Fang Yan picked up the flashlight and began shining it on the patient's right hand.

No one knew what he was up to, so they could only watch.

After glancing at it, Fang Yan picked up a pen and began writing on the medical record:
The subcutaneous veins on the right thenar eminence show signs of collapse, pale color, and some are bluish-purple and tortuous, with thrombi present.

The palm of the right hand was colder than the left hand, the fingertips were icy, and the nail beds were pale.

The Taiyuan acupoint showed no pulsation. The Jingqu acupoint showed no pulse on the right side but normal pulse on the left side. The Renying acupoint showed no pulse on the right Cunkou acupoint but normal pulse on the Renying acupoint.

After finishing writing in dialect, he looked at Wang Yuchuan and said:

"I think what they did was not mitral valve diastasis treatment, but a complication management surgery, mainly to treat portal hypertension caused by cardiogenic cirrhosis, and they also performed radial artery intervention."

Wang Yuchuan frowned slightly upon hearing this.

Then, after seeing the records of the dialect, it dawned on me:

"You mean the radial artery was ligated due to surgical complications or treatment needs?"

Fang Yan nodded:
"Yes, that's the only way to explain why he could feel the pulse before the surgery but not after it was performed. Only a ligation of the radial artery could cause the inability to feel the pulse in the cun, guan, and chi positions of the right hand."

“I compared the left and right Jingqu acupoints. His right pulse disappeared while his left pulse was normal, which is consistent with the characteristics of unilateral radial artery ligation.”

"Moreover, although the patient's right pulse disappeared, we observed that he spoke clearly and breathed steadily, indicating that his vital energy had not declined. The absence of the pulse should be a local problem."

Li Zhengji agreed at this moment:

"The Medical Mirror also states that 'If the pulse is not visible, it is not because the vital energy of the internal organs is exhausted, but because the meridians are blocked.' Combined with the patient's dark red tongue and thin yellow coating, which excludes organ failure, this supports the judgment that the pulse channels are artificially blocked."

Wang Yuchuan nodded as well:
"Well, that makes sense!"

"The consequence of radial artery ligation is that it directly blocks the flow of Qi and blood in the right Taiyin Lung Meridian, resulting in the disappearance of pulse values ​​in the right Cun (lung), Guan (spleen and stomach), and Chi (mingmen) positions. Combined with other diagnoses, this is consistent with the judgment that the radial artery was ligated due to surgical complications or treatment needs."

At this moment, Song Jianzhong spoke up:

"If we want to definitively confirm Brother Fang's guess, we can just do an ultrasound imaging!"

At this point, the patient also said:

"Yes, yes, it's better to do an ultrasound imaging!"

Instead of guessing here, why don't you just take a picture and see for yourself?

The patient's wife also said:
“That’s right, let’s do an ultrasound imaging first, that way we’ll feel more at ease.”

Hearing the patient say this, Fang Yan nodded and said:
“Okay, Jianzhong, then you take them to get an ultrasound imaging scan.”

“Brother Fang… I…” Song Jianzhong felt like he had said something wrong.

Isn't this questioning the judgment of dialect?

Fang Yan said to him:
"Go ahead, it'll be good to confirm it."

“Yes, go ahead,” Wang Yuchuan said.

Song Jianzhong shrank back and had no choice but to bite the bullet and call the two of them to do an ultrasound imaging.

Preliminary results can usually be obtained in just a few minutes with ultrasound imaging.

Actually, it won't take long.

Song Jianzhong felt he might have offended the dialect, but he didn't really care about the dialect.

He has now ruled out all possibilities and is confident that his judgment is correct.

However, others, such as Song Jianzhong and the patients' families, will not believe it without seeing the specific data. This has nothing to do with dialect technology. Everyone wants to find out the truth when they have the ability to do so.

“Actually, there’s no need to verify it at all. Just prescribe the medicine based on the previous judgment,” Li Zhengji said.

Fang Yan smiled:
"It's okay, I'm also curious whether my judgment is correct."

Wang Yuchuan looked at Fang Yan and said:

"This situation is indeed relatively rare at present. However, as time goes on, there will be more cases where Western medicine cannot cure the disease, and we Chinese medicine practitioners will continue to treat it. In the absence of surgical information, patients are not at ease, and doctors are not at ease either. It is better to do an examination for everyone."

Fang Yan laughed, feeling as if he were witnessing a historical event of traditional Chinese medicine practitioners reviewing reports.

However, what Professor Wang Yuchuan said is also true.

In cases where only traditional Chinese medicine is used, unless the other party has not used Western medical physical surgery intervention, you will not know what they have cut or blocked on the patient.

Dialect can be accurately diagnosed using skillful observation, auscultation, inquiry, and palpation, as well as the process of elimination. What about other doctors?

At the very beginning, even doctors of Li Zhengji's and Wang Yuchuan's caliber were somewhat bewildered by this counterintuitive phenomenon, let alone others.

If it were Du Heng and Yan Yifan instead, their brains would be completely overloaded, leaving them utterly dumbfounded.

In other words, after all this time, the source of the reports that traditional Chinese medicine practitioners rely on actually lies with Western medicine.

In essence, it is about dialectical reasoning and tracing back to the source.

Fang Yan felt he had finally understood and suddenly began to comprehend the behavior of the TCM hospital in reviewing reports.

……

The news of the ultrasound contrast imaging done there quickly reached the ears of the hospital director. After inquiring, he learned that the patient had undergone surgery in Japan, but did not know the specific procedures performed. Although Fang Yan had already made a judgment, the patient insisted on verification.

The dean had a different opinion; he felt that this was exactly the right thing to do.

Only with a report can we prove the patient's condition. We don't want Fang Yan to take over the treatment and then claim that the right pulse stopping was a problem caused by Fang Yan's treatment.

At that time, without evidence, things got complicated.

Before addressing dialect-related issues, identifying potential risks is crucial to ensure that dialects are not unfairly blamed.

Dialects are also both funny and frustrating.

Indeed, things change when you look at them from a different perspective.

Li Zhengji believed that the use of dialects was a problem that challenged the technology, while the dean believed that prevention was better than cure. Both sides had their own opinions.

A while later, Yan Yifan returned.

Upon hearing Du Heng mention this, he carefully observed Fang Yan and found that he couldn't tell whether Fang Yan was angry or not, so he decided to follow Brother Fang later.

If someone criticizes Song Jianzhong, he will definitely follow suit.

Then, not long after, Song Jianzhong returned with his men, and they obtained the results in the shortest possible time.

"It's confirmed. Dr. Fang's guess was correct. Radial artery ligation was indeed performed." Accompanying them were the ultrasound angiography doctor and a Western medicine cardiac surgeon.

They confirmed the dialect identification.

The head of the Department of Cardiac Surgery at Peking Union Medical College Hospital praised Fang Yan, saying:
"It's only because Director Fang is so familiar with Western surgical techniques that he could make such an accurate judgment. It would be hard for anyone else to have thought of that!"

"Brother Fang is amazing!" Song Jianzhong gave Fang Yan a thumbs up.

Fang Yan smiled and cupped his hands in greeting to them.

Others also looked at Fang Yan with admiration.

That's a true master!

You can determine what Western medicine surgery did just by feeling the pulse.

This proves that he is not only proficient in traditional Chinese medicine, but also knows a lot about Western surgical procedures.

Although this was an accident, it also proves that dialects are indeed quite powerful.

This unexpected situation was no problem for him at all.

The dean's mouth was practically agape with a smile. Once this report gets out, won't the dialect's fame increase even more?

At this point, the patient couple found themselves in an awkward situation, as they hadn't gathered all the previous treatment information and ultimately had to rely on their local dialect to make the diagnosis.

After all that trouble, this has now been proven.

Luckily, the dialect was powerful, otherwise I would have been led astray by them.

"Then let's continue the treatment now!" the dean said to Fang Yan, breaking the awkward atmosphere.

At this moment, the patient's wife spoke in dialect:

"Dr. Fang, I'm so sorry! It's all my fault for not understanding it clearly."

Fang Yan shook his head:
"It's alright, you didn't do this on purpose."

The dean, who was already preparing to have a reporter cover the story, said with a smile:
"You're right about the dialect. You're not professionals, so don't worry about it too much."

What he was really thinking was, 'You guys do the first day of the month, I'll do the fifteenth.'

We can't let you almost ruin our doctor's life for nothing.

If dialects get stuck on this issue, it could affect the cure rate.

This should be exposed so that others can bring their own medical records before coming.

The people here didn't think too much about it and had already started prescribing medicine for the patients.

He wrote his analysis in the medical record:
The patient suffered mitral valve damage due to rheumatic heart disease, and postoperative complications included atrial fibrillation, heart failure, and cardiac cirrhosis, which fall under the categories of "palpitation," "edema," and "phlegm retention" in Traditional Chinese Medicine.

Based on the symptoms of palpitations, abdominal distension, hypochondriac pain, lower limb edema, oliguria, dark red tongue with thin yellow coating, and no pulse in the right hand (due to radial artery ligation), the diagnosis is deficiency of heart and kidney yang, internal retention of dampness, and blood stasis.

When the Qi and Yin of the heart are both deficient, the heart is the child of the liver. When the child is sick, the mother is affected, and the liver becomes disordered.

There is no quick fix for organic lesions; the only solution is to adjust their function and alleviate their symptoms, focusing on soothing the liver and strengthening the heart, promoting diuresis and eliminating phlegm, while also taking into account warming yang and replenishing qi, and promoting blood circulation and unblocking collaterals.

Based on Zhenwu Decoction (Aconite, Poria, Atractylodes macrocephala) combined with Tingli Dazao Xiefei Decoction, the treatment aims to warm the Yang and promote diuresis to address the root cause. It is supplemented with Astragalus membranaceus and Codonopsis pilosula to replenish Qi and promote diuresis, and Salvia miltiorrhiza and Carthamus tinctorius to invigorate blood and unblock collaterals, which is in line with the patient's pathogenesis of deficiency of heart and kidney Yang, blood stasis and water retention.

Since the absence of a pulse in the right hand was due to local vascular obstruction caused by surgery, no medication was prescribed targeting the right pulse; instead, the treatment focused on systemic diagnosis.

Therefore, the following prescription was given:
Prepared aconite root 12g (decocted first), cinnamon twig 9g: warms the kidneys and promotes yang, strengthens the heart and regulates qi.

Poria cocos 30g, Atractylodes macrocephala 15g, Alisma plantago-aquatica 12g: Strengthens the spleen, promotes diuresis, eliminates dampness and reduces swelling.

Astragalus membranaceus 30g and Codonopsis pilosula 15g: Tonify the Qi of the heart and lungs and enhance the body's ability to promote water metabolism.

Salvia miltiorrhiza 20g, Carthamus tinctorius 9g, Leonurus japonicus 15g: Promotes blood circulation and removes blood stasis, improves liver blood stasis.

15g of Lepidium seed and 10 jujubes: to clear the lungs and relieve asthma, and to promote diuresis (for cough, asthma, and inability to lie flat).

Plantain seed 15g (wrapped and decocted), Polyporus umbellatus 12g: promotes urination and relieves oliguria and lower limb edema.

9g of immature bitter orange peel and 6g of dried tangerine peel: to regulate qi, relieve abdominal distension, and alleviate abdominal bloating.

Licorice 6g: Harmonizes the effects of other herbs.

After the dialect was written down, Professor Wang Yuchuan, who was watching him prescribe the medicine, nodded.

As an expert in cardiovascular and cerebrovascular diseases, Fang Yan's prescription for this medicine is impeccable.

Zhenwu Decoction warms the Yang and promotes diuresis, which is in line with the root cause of "deficiency of Yang in the heart and kidneys and retention of dampness in the body".

The Lepidium and Jujube Lung-Clearing Decoction clears the lungs and eliminates phlegm, targeting the symptoms of "water retention affecting the lungs".

The combination of qi-tonifying herbs (Astragalus membranaceus and Codonopsis pilosula) and blood-activating herbs (Salvia miltiorrhiza and Carthamus tinctorius) embodies the treatment principle that "when qi flows, blood flows, and when blood flows, water is eliminated naturally."

Moreover, the dialect did not use raw aconite, but processed aconite, which was obviously a restraint. He also wrote down the policy in his medical records, which was to take it slowly.

However, Wang Yuchuan still raised a suggestion.

He spoke softly into the dialect:

"The Hand Yangming Large Intestine Meridian and the Hand Taiyin Lung Meridian are internally and externally related. They can compensate for the stagnation of Qi and blood caused by radial artery ligation. By focusing on stimulating the acupoints of the Hand Yangming Meridian, collateral circulation can be stimulated. You can use acupuncture to regulate the Yangming Meridian and rebuild the Qi and blood pathway."

Fang Yan was taken aback.

At this point, Wang Yuchuan continued:

"I'll teach you a needle technique; it's very simple and you'll learn it in no time."

Upon hearing this, Fang Yan immediately became serious.

Professor Wang Yuchuan spends all his time with Professor Cheng. He has been developing acupuncture techniques for so long, but no one has ever seen him use acupuncture. Even his students Xie Chunrong, Zhao Qingkai, Chen Wenwei, and Su Yue are not very good at acupuncture. However, he is definitely not ignorant of acupuncture, otherwise he would not be so close to Professor Cheng.

Moreover, Wang Yuchuan was someone the Japanese specifically requested to go on exchange programs with, and not just once, but many times.

He was later selected as one of the first batch of National Masters of Traditional Chinese Medicine, which proves that his medical skills are definitely not weak.

Upon hearing this, Fang Yan immediately knew that he was about to teach her the technique.

I quickly listened attentively to the lecture.

As expected, Wang Yuchuan said as soon as he opened his mouth:

"For the first needle, insert the needle obliquely 0.5 cun into the Pianli acupoint on the Large Intestine Meridian of Hand Yangming, and use the Green Dragon Wagging Tail method to stimulate the anterior interosseous artery, a collateral branch of the radial artery, to promote blood flow to the hand."

"The second needle is inserted through the Waiguan point on the Sanjiao Meridian of Hand-Shaoyang, penetrating to the Neiguan point, using the tonifying and rotating technique to regulate the Qi transformation of the Sanjiao."

"The third needle is inserted into the Taichong point on the Foot Jueyin Liver Meridian, penetrating towards the Yongquan point, using a balanced tonifying and reducing technique to soothe the liver and gallbladder, and relieve his symptoms of cirrhosis."

"Then apply moxibustion to the Xuehai point on the Foot Taiyin Spleen Meridian for 3 cones to warm and unblock blood stasis and improve microcirculation."

"Using the 'Flying Meridian and Flowing Qi' needling method from the 'Golden Needle Ode', the needle is inserted to guide the Qi and blood, and combined with breathing to tonify and reduce, that is, inhaling to insert the needle and exhaling to withdraw the needle, to enhance the effect of Qi reaching the disease site."

"Okay!" Fang Yan nodded.

Having dealt with overseas Chinese businessmen for so long, this is the first time I've received guidance and even technical assistance from a big shot.

Today's last patient had a rather bumpy journey, but in the end, it wasn't a bad deal.

He spoke to the patient in a dialect:
"Then let's start with acupuncture."

This time, the patients did not doubt Wang Yuchuan's identity. They had heard Song Jianzhong mention Wang Yuchuan's identity during the ultrasound imaging.

This is a highly respected traditional Chinese medicine expert, even in Japan. It is an honor for them to have a consultation here.

Fang Yan took out three needles.

They went to the patient's side.

The first acupuncture point is Pianli (偏历).

Fang Yan picked up the needle and inserted it obliquely 0.5 inches into the Pianli acupoint. At that moment, Zhang Shen's index finger suddenly twitched uncontrollably, and a burning, ant-like sensation came from the radial styloid process.

The itching made him almost think that some real insects were crawling on him.

Then, following the dialect, using the technique of "Green Dragon Wagging its Tail," after inserting the needle and obtaining the Qi according to his breathing, the needle is lifted to the subcutaneous layer, and then the needle is made to swing in a semi-circular or arc shape under the skin, like the shape of "Green Dragon Wagging its Tail."

After swinging the needle 20-30 times, Fang Yan slowly inserts it into the deeper layers, then pulls it back to the subcutaneous layer, repeating the above operation.

"It feels like warm water flowing through my bones!" said patient Zhang Shen.

"Don't talk, watch your breathing!" Fang Yan reminded him.

Zhang Shen quickly shut his mouth, and then he was surprised to find that his right palm was turning blood red.

After performing this five times, Fang Yan left the needles on his acupoints and then took out a second silver needle.

The second acupuncture point is located at Waiguan (Outer Gate) and then at Neiguan (Inner Gate).

As the second needle was inserted, it pierced through the outer gate and reached the inner gate, making Zhang Shen's hair stand on end.

Then, unable to resist taking a deep breath, the next second, dialect pierced through the air.

He said in surprise:

"This... feels like someone has opened a window in my chest..."

“I told you not to talk!” His wife slapped him on the back of the head.

Zhang Shen quickly shut up.

Fang Yan shook his head speechlessly and began to exert force with his thumb forward and his index finger backward (to the left) to gently rotate the needle while simultaneously making slight lifting and inserting movements.

The needling site produces a gentle sensation of Qi, which stimulates Qi and promotes the circulation of Qi and blood.

Zhang Shen felt increasingly comfortable in his chest.

He let out a long breath, and the chest tightness that had been building up for ten years began to dissipate like a floodgate being opened.

Fang Yan then took out the last injection.

This needle went straight to the Yongquan point.

After taking off his shoes, Zhang Shen was somewhat afraid to look at himself.

After disinfecting his feet with alcohol, Fang Yan inserted a needle into Taichong (LR3). As the needle tip trembled and pointed towards Yongquan (KI1), fine beads of sweat appeared on the soles of Zhang Shen's feet.

After passing through the sac, the dialect begins, with even lifting, thrusting, and twisting.

The patient's right flank, which had been experiencing some pain, made a "clicking" sound.

Zhang Shen suddenly felt a lot of relief under his ribs.

She let out a comfortable groan.

"Hiss... Ah! That feels so good..."

Then his wife slapped him on the back of the head again, and he cursed speechlessly:

What are you yelling about?

Zhang Shen said awkwardly:
"I...feel very comfortable..."

At this point, Fang Yan had finished, then took out his moxibustion box, attached the moxa sticks, lit them, and tied them to Zhang Shen's Xuehai acupoint.

Then he said to them:

"If you feel comfortable, I will send someone over to give you acupuncture every day from now on."

At this moment, Zhang Shen felt his calf muscles throbbing rhythmically, like spring soil thawing, and a warm, tingling sensation began to travel up his legs—it was truly amazing.

He had tried acupuncture before, but it wasn't this miraculous.

Hearing that he could do it every day, he immediately agreed.

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

There will be an extra chapter later!

(End of this chapter)