Rebirth 1977 Great Era

Chapter 917 Taking a Holistic Approach to Treat Different Diseases with the Same Method: Hokkaido Scleroderma (Two Chapters Combined)
As Fang Yan began writing the patient's medical record, she was also considering how to treat the situation.

If one were to take a more conservative approach, one would first observe the progression of the eye disease after treatment before deciding which medication to use to treat the stones.

However, given his current condition with kidney stones, there isn't much time left for that.

The Western medicine acetazolamide plus vitamin C used to treat eye diseases essentially lowers intraocular pressure at the cost of depleting kidney qi. This leads to a vicious cycle between upper jiao eye disease and lower jiao stones. Every day that treatment is delayed, the kidney qi is depleted by one point.

The patient mentioned that his hydronephrosis was continuously worsening, and he himself noticed that the hydronephrosis was getting more and more serious, but the stones were still in the same place and had not moved. This indicated that there was a risk of kidney damage and the obstruction needed to be relieved in a short period of time. Therefore, the treatment plan must be formulated to protect the kidney qi while simultaneously addressing the systemic problems of the eyes and kidneys.

Now, Fang Yan plans to develop a treatment strategy that addresses both the symptoms and the root cause, aiming to resolve the issues of kidney stones and hydronephrosis while protecting kidney qi and improving eye condition.

The patient also had retinal detachment ("upper burner eye disease") and ureteral stones and hydronephrosis ("lower burner urinary stones"), both of which are closely related to kidney deficiency.

The pulse being "short and weak in both feet" and the tongue having "white and greasy coating" indicate insufficient kidney yang and dysfunction of qi transformation, leading to water metabolism disorders, hydronephrosis, damp-heat stagnation forming stones and gravel, and kidney essence failing to nourish the eyes, causing retinal lesions.

First, the use of Western medicine should be stopped immediately to break the vicious cycle.

Then, warming and tonifying kidney yang is key, because insufficient kidney yang is the root cause of the disease.

Warming and tonifying kidney yang is intended to restore the kidney's qi transformation function and fundamentally resolve metabolic disorders, stones, and eye problems.

It aims to clear heat, promote diuresis, expel stones, unblock meridians, improve eyesight, quickly relieve kidney obstruction, and improve retinal blood supply.

Fang Yan thought for a moment and suggested that she could choose to modify Jin Kui Shen Qi Wan, adding Achyranthes bidentata and Plantago asiatica to enhance the diuretic effect.

Secondly, for stones, it is necessary to dissolve them and promote urination, using medications such as Lysimachia christinae, Lygodium japonicum, and chicken gizzard lining.

At the same time, add eye-brightening herbs such as goji berries and chrysanthemums to nourish the eyes.

His condition also requires the addition of acupuncture.

Regarding acupuncture, Fang Yan thought for a moment and suggested selecting the Shenshu and Taixi acupoints to warm and tonify the kidney qi, as well as the Jingming and Taiyang acupoints to improve eye circulation.

Finally, it is necessary to consider the possible stone expulsion reaction during the treatment process and prepare a pain-relieving formula such as Shaoyao Gancao Tang to deal with possible lower back pain.

In summary, the treatment approach should revolve around warming and tonifying kidney yang, promoting diuresis and expelling stones, nourishing blood and improving eyesight, while adjusting Western medicine. Through comprehensive measures, the vicious cycle can be broken, kidney qi restored, and the problems in the upper and lower jiao (upper and lower burners) resolved.

Then Fang Yan took out the prescription and started writing:
Main prescription: Jisheng Shenqi Formula.

The formula used is Jin Kui Shen Qi Wan, with the addition of Achyranthes bidentata and Plantago asiatica.

The prescription is as follows:

Prepared Rehmannia Root 15g, Cornus Fruit 12g, Dioscorea Rhizome 15g, Poria 12g, Alisma Rhizome 10g, Moutan Bark 9g, Cinnamon Bark 6g (added later), Prepared Aconite Root 6g (decocted first), Achyranthes Root 12g, Plantago Seed 15g (wrapped and decocted).
After finishing writing, Fang Yan paused slightly, then continued to add the following below the prescription:

Fossilized herbs for urinary incontinence: Add 30g of Lysimachia christinae, 15g of Lygodium japonicum (wrapped and decocted), and 10g of chicken gizzard lining (powdered and taken with water).
To clear heat and promote diuresis: add 12g of talc and 10g of Pyrrosia lingua.

To nourish blood and improve eyesight: add 15g of wolfberry, 10g of chrysanthemum, and 12g of cassia seed.

He was satisfied after writing this part, and then he wrote down the method of decocting and taking it.

First decoct the aconite root for 30 minutes, then add the cinnamon, and decoct the remaining herbs as usual.

Lygodium japonicum and Plantago asiatica should be wrapped in gauze before decocting to prevent the dregs from irritating the throat.

Grind the chicken gizzard into powder and take it in two doses.

Take one dose daily, divided into two warm doses, one in the morning and one in the evening.

After he finished writing the prescription, he added another prescription:
If acute lower back pain occurs after taking the above prescription, which is a stone expulsion reaction, you can use Shaoyao Gancao Tang (30g of white peony root and 10g of roasted licorice root) to relieve the pain.

Then, Fang Yan wrote down the acupuncture method, which was then handed over to Lao Fan to perform:

To warm and tonify kidney qi: Select Shenshu (bilateral) and Taixi (bilateral) points, apply moxibustion or warm needling once a day.

Improve vision by stimulating acupuncture points such as Jingming, Taiyang, and Fengchi to improve microcirculation in the eyes and help lower intraocular pressure.

After recovery, Liuwei Dihuang Pills combined with Wuzi Yanzong Pills are used to nourish the kidneys and strengthen the body to prevent recurrence.

After finishing writing, Fang Yan began to write his explanation of the prescription and the treatment logic on the medical record.

Jisheng Shenqi Pill uses aconite and cinnamon to warm and tonify kidney yang, and rehmannia and cornus to replenish kidney essence, restoring the kidney's qi transformation function and fundamentally solving water metabolism disorders.

Achyranthes bidentata guides the medicine downwards, while Plantago asiatica promotes diuresis and reduces swelling, thus alleviating hydronephrosis.

Lysimachia christinae and Lygodium japonicum clear heat and dampness, and dissolve stones; chicken gizzard lining eliminates stones and is specifically for ureteral stones.

Talc and Pyrrosia lingua clear damp-heat from the lower burner, improving symptoms such as yellow urine and scanty urine.

Goji berries, chrysanthemums, and cassia seeds nourish the kidneys and liver, clear the liver and improve eyesight, and promote retinal repair.

Then he wrote at the end of the medical record:
This formula addresses both the upper and lower burners by warming the Yang, promoting diuresis, dissolving stones, and improving eyesight. Its main purpose is to break the vicious cycle of "kidney deficiency, stones, and eye diseases," treating both the symptoms and the root cause.

The four classmates behind him saw the dialect's treatment logic and quietly wrote it down one by one.

The style of dialects has changed many times over the years.

They already knew this when I taught it in class, but seeing how fluently they used dialect during the live broadcast gave them a completely different feeling.

That's what a master is like; they can use various styles with ease and do whatever they want.

After writing it down, Fang Yan said to the patient:
"You should immediately stop taking acetazolamide and vitamin C to avoid further depleting your kidney energy. While taking these medications, drink plenty of water, at least 2000 ml per day, and incorporate jumping exercises to help expel the stones."

"In addition, if you experience acute lower back pain, it means you need to pass stones. Please notify our on-duty nurse immediately, and they will help you."

After hearing the dialect spoken, the patient nodded repeatedly:
"Okay, okay."

At this moment, Fang Yaozhong returned from outside and saw that Fang Yan was already tearing up the prescription.

He was also surprised by the speed at which Fang Yan could see patients. All the people here had been screened abroad and had returned. Except for a few, most of them had difficult-to-treat conditions, yet Fang Yan was able to do it so quickly, which was truly amazing.

"Go and complete the admission procedures now. Remember to drink plenty of water and jump around a lot, but don't drink too much at once, or you'll vomit when you jump," Fang Yan instructed the patient.

The patient should reply:
"Ok!"

Then his wife took a box out of her bag and handed it to Fang Yan.

"This is a little something I brought back from abroad, Dr. Fang. Please accept it."

Fang Yan glanced at it; it looked somewhat like a jewelry box.

He nodded and said:
"grateful!"

The sixth patient then went out with his wife.

As he left, he nodded to Old Fang at the door.

When Fang Yan saw Lao Fang return, she said to him:
"Didn't you want to check out the traditional Chinese medicine pharmacy at Peking Union Medical College Hospital? You're back so soon?"

The prescription states:
“I’ve seen it, and there are many things worth learning. Later, I asked them, and they said that you made all those rules, so I just came back. Asking them is not as good as asking you, the person who made the rules.”

Fang Yan suddenly realized and said:
“These are all safety guidelines for decocting medicine. You know I like to use poison, and it’s easy to cause trouble if I’m not careful, so these rules must be strictly followed.”

Fang Yaozhong nodded, then went to Fang Yan's side, looked at the medical record, and asked:

"So, what's the story with this patient?"

Fang Yan pointed to the contents of the medical record and said:

"It's a problem with the eyes and kidneys. Look, I just prescribed a formula that uses the opposite method of 'treating different diseases with the same method' (see Chapter 834), namely 'treating the same disease with different methods'."

After reviewing Fang Yan's medical records, Fang Yaozhong understood the situation very clearly. Even though he wasn't there just now, he clearly understood what had happened.

The patient's physical condition and dialect of thought were clearly described in the medical records.

The so-called "treating different diseases with the same method" is actually the principle of treating the root cause of disease in the Yellow Emperor's Inner Classic.

The dialect focuses on "warming and tonifying kidney yang," which is achieved by enhancing the kidney's qi transformation function, regulating the lower burner, and nourishing the upper burner.

When the body's vital energy is properly transformed, the water passages become unobstructed, stones dissolve, kidney hydrops are relieved, and when kidney essence is sufficient, the eyes receive adequate blood supply, allowing retinal detachment to be gradually repaired.

“Brother Fang, I’ll deliver the prescription this time,” Yuan Qingshan stepped forward again.

People here today will definitely need to make an extra trip.

Yuan Qingshan didn't feel like he was at a disadvantage. If he worked hard now, Brother Fang would definitely be more willing to take him out in the future.

This is just one of his little tricks.

However, Fang Yan said to him:
"Old Fan has been a bit too busy lately. How's your acupuncture skill? Why don't you come and help Old Fan out? I'll pay you the same salary as Old Fan."

"Great!" Yuan Qingshan felt like he had been hit by a pie falling from the sky. He was just thinking about taking a loss, but now Brother Fang was giving him a benefit right away.

Suffering a loss is a blessing in disguise!
Especially with Brother Fang, the benefits came too quickly.

"Okay, then go to the pharmacy." Fang Yan handed the prescription to Yuan Qingshan.

The latter took it and ran out happily.

Even when leaving, he didn't forget to invite the people outside in.

Apart from Fang Yaozhong, everyone else looked on with envy.

This basically means that Brother Fang recruited him into the group.

Fang Yan hadn't really thought that much about it. He just thought that Lao Fan had a lot of things to do, and Yuan Qingshan happened to be of similar skill level, so why not use him? Besides, the kid was very perceptive, eager to do the work, which meant he didn't refuse this kind of labor. So Fang Yan thought he'd ask him if he wanted to do it or not.

As it turned out, Yuan Qingshan was indeed very willing.

Now, the only two Taoist doctors in the class have started helping with acupuncture here.

Old Fan can finally relax a bit.

At this point, the seventh patient had already entered with his family.

I've heard this family speak the same dialect before; they are overseas Chinese from Japan who do business in Hokkaido.

Hokkaido is rich in fishery resources. In their early years, their family was engaged in the seafood trade, exporting Hokkaido's seafood and other specialties to other countries. After becoming wealthy, they started to grow vegetables and flowers, and later went into the agricultural product processing business, turning agricultural products into canned goods, pickled foods, and so on.

I came back this time with the intention of starting a seafood canning company in the country.

Of course, there's also the matter of getting medical treatment for family members.

Their family name is Gu, and the person who needs to see a doctor this time is Gu Zhilan, the 26-year-old daughter of the Gu family.

The patient's face looked thin, with shiny skin and little facial expression.

After her father, Mr. Gu, entered the room, everyone else in the family greeted Fang Yan, but this woman only nodded, as if she couldn't even open her mouth. Then, Mr. Gu, the patient's father, spoke on Fang Yan's behalf:

"Here's what happened. It all started in May 1976. One day, Zhilan noticed that the skin on her hands and feet was swollen and sometimes turned purple. It felt cool to the touch. At the time, we thought it was because she had been in contact with seafood too much, so we told her to rest at home. But we didn't expect that the condition would gradually worsen and even her forearms would swell up."

"Then we went to the local hospital for a checkup. The Western doctor said it was called Raynaud's disease and that it was a typical symptom."

"It's because the fingers and toes turn white, purple, or red under cold or stress, accompanied by pain and numbness."

"Then we started treating her as if she had Rello disease, but after a year, she developed difficulty opening her mouth, and the skin on her chest and abdomen gradually hardened, to the point that it was even impossible to pinch it."

"Moreover, after switching to another hospital, they said it wasn't Raynaud's disease, but rather systemic sclerosis with Raynaud's phenomenon. The skin biopsy showed dermal collagen hyperplasia and hyalinization of small arteries."

“We changed treatment locations last year, and although it was effective, the situation wasn’t very good. It only stopped the deterioration and never fully healed. Every so often, they would inject her with several kinds of medications, such as vasodilators and immune regulators. This year, her condition not only did not improve, but she also developed kidney damage.”

"Later we stopped treatment and tried to find traditional Chinese medicine practitioners at home, but they said the situation was not good and we could only try it. After more than two months of treatment, there was really no effect. Finally, we heard about you and came back."

"I want to try a genuine traditional Chinese medicine doctor to see if there is any hope of a cure."

Fang Yan nodded. Since he had come to see a doctor, it was bound to be something serious; he had been mentally prepared for that.

According to their description, Gu Zhilan's condition has been going on for almost two years.

He was initially diagnosed with Raynaud's disease, and later with systemic sclerosis with Raynaud's phenomenon, which is actually a term used in Western medicine.

This is a vascular dysfunction characterized by intermittent pallor, cyanosis, and flushing of the skin at the extremities, often triggered by factors such as cold or emotional fluctuations.

The etiology of primary Raynaud's phenomenon is still unclear, but it is speculated that it may be related to abnormal vascular endothelial cell function, increased sensitivity of vascular smooth muscle to vasoactive substances, and genetic factors.

Most patients are young women, and their conditions are relatively mild.

That was their initial diagnosis from Western medicine.

The subsequent diagnosis was secondary Reynolds phenomenon.

This means it is secondary to other diseases, such as connective tissue diseases like systemic lupus erythematosus, rheumatoid arthritis, and scleroderma, as well as vascular diseases like thromboangiitis obliterans and atherosclerosis, and then there are also neurological diseases, endocrine diseases, and certain medications such as birth control pills.

The attack can be divided into three stages.

The first stage begins with the skin on the extremities, such as the fingers or toes, suddenly turning white.

This is due to severe spasm of the small arteries, leading to local ischemia.

In the second stage, the skin color turns bluish-purple as oxygen deficiency increases the amount of reduced hemoglobin in the blood.

In the final third stage, the skin gradually turns flushed, which is due to vasodilation and restoration of blood flow.

The attack usually starts from the fingertip and gradually spreads to the proximal part, which can affect the entire finger or even the palm. In severe cases, the toes, tip of the nose, earlobe and other parts may also be affected.

This basically matches what Mr. Gu said.

Fang Yan began to investigate Gu Zhilan's condition.

Her extremities were cyanotic and felt cold to the touch. There were also scars left from ulceration on the middle and ring fingers of her left hand.

"Can't you open your mouth?" Fang Yan asked the patient.

Mr. Gu said to the dialect:

“Zhilan’s mouth can only open a very small crack, and she can only eat liquid food. When we were in Japan, we brought her here with IV fluids and liquid food at the same time, otherwise her body couldn’t handle it.”

He said in dialect:

"If you can open it a little, that would be fine too. Let me see your tongue."

Upon hearing this, Gu Zhilan cautiously opened her mouth, revealing only a gap large enough for a finger to pass through.

"Is this the maximum?" Fang Yan asked.

Gu Zhilan opened her eyes a little wider again before nodding.

Fang Yan took out a flashlight and shone it into Gu Zhilan's mouth, seeing that her tongue coating was thin and white and her tongue body was pale.

There was no other unusual smell in her mouth. After looking at it from a few different angles, Fang Yan noticed that there seemed to be some kind of inflammation in her mouth, which was white in color.

However, it can't open its mouth very wide; this is the maximum it can go.

Next, Fang Yan turned off the flashlight and said to Gu Zhilan:
"Alright, now give me your hand, I'll take your pulse."

Gu Zhilan obediently did as she was told, and then after taking the pulse with both hands, Fang Yan found that the pulse was deep and thready.

In Western medicine, systemic sclerosis is actually scleroderma.

The systemic sclerosis diagnosed by Western medicine falls under the category of "skin paralysis" in traditional Chinese medicine, which is highly consistent with the statement in the "Suwen·Bi Lun" that "when paralysis is in the bones, it is severe; when it is in the vessels, it causes blood stagnation."

The patient's hardened skin and difficulty opening his mouth are consistent with the characteristics of "skin rough and uneven" in the "Essential Prescriptions of the Golden Chamber" which is a result of phlegm and blood stasis.

I had seen the local dialect for this disease in the notes that Xiao Chengzhi had given him. Those notes were about the strange and difficult diseases that Xiao Chengzhi had encountered in Guangzhou. They included not only his treatment methods but also the advice given by his master, Deng Tietao.

The first page contains information about a 48-year-old patient surnamed Xiong who was treated for scleroderma in Guangzhou in April 1974. It includes Xiao Chengzhi's first prescription and Deng Tietao's revised prescription from a follow-up visit.

Deng Tietao's explanation of the mechanism of scleroderma is described in great detail. (See Chapter 587)
According to Deng Tietao's classification, Gu Zhilan's condition should not be classified as systemic sclerosis, but rather as diffuse cutaneous systemic sclerosis.

Because it clearly starts from the distal extremities and gradually affects the proximal skin and internal organs.

Systemic sclerosis includes calcification, Raynaud's phenomenon, esophageal dysfunction, finger sclerosis, and telangiectasia, which begin simultaneously, unlike what the patient's family described.

However, in traditional Chinese medicine, this phenomenon is called "skin numbness".

She was in a cold place in Hokkaido, and coupled with her weak yang constitution, she was exposed to cold and frost, which caused her qi and blood to stagnate. When problems appeared on her fingers, she did not receive timely and proper treatment, which is why they have developed into what they are now.

Judging from her various behaviors, things have now developed to a very serious stage.

The patient's extremities were cold and purple, and his pulse was deep and thready, which is consistent with the description in "Jingyue Quanshu" that those with Yang deficiency have insufficient Qi.

The skin is hardened like leather, and the tongue is pale and lackluster, which confirms the pathological mechanism in "Corrections of Errors in Medical Classics" that blood congeals into lumps when exposed to cold.

This is all because the kidneys' yang energy is insufficient, and pathogenic factors such as wind, cold, and dampness block the body's meridians, preventing the normal coordination of nutritive qi and defensive qi. As a result, qi and blood are obstructed in the meridians and cannot circulate smoothly.

In the 1974 medical case, Deng Tietao used Yanghe Decoction to treat scleroderma. Three months later, the patient's skin softening rate improved. When he had a follow-up examination six months later, the only remaining symptom was cyanosis of the limbs, fingers and toes, and the skin of the body had basically returned to normal.

But then again.

That patient's condition was far less serious than Gu Zhilan's.

Now, if someone needs to prescribe medicine in a dialect, we can only follow Deng Tietao's line of thinking, but we can't prescribe it using his methods.

The medical case from 1974 was mainly due to cold-dampness obstruction, with skin symptoms as the primary symptom.

The current dialect case involves kidney yang deficiency combined with cold stagnation and blood stasis, along with internal organ damage, which is on a completely different level.

His was in the early stage, while Gu Zhilan's was in the later stage of development.

Therefore, the warming and dispersing effects of Yanghe Decoction, as well as its ability to resolve phlegm and unblock the meridians, are no longer effective.

We need to make something even more powerful.

At this moment, seeing Fang Yan reflecting after finishing his medical case, Fang Yaozhong looked at his diagnostic description and reminded him:

"The patient's illness has lasted for 2 years and has resulted in kidney damage. Simply warming the yang and dispelling cold is not enough to solve the fundamental problem. It is necessary to strengthen the kidney and replenish essence."

Fang Yan nodded and said:
"Yeah, that's what I mean too."

After speaking in dialect, he said to Mr. Gu:
"In addition, the cold environment in Hokkaido will definitely aggravate the Yang deficiency after returning home, no matter how you treat it. I suggest that you live in a warmer place in the south to avoid relapse."

Hearing the suggestion in dialect, Mr. Gu asked with some surprise:

"You mean...there's a cure?"

Fang Yan nodded:
"Yes, there must be a way."

Upon hearing this, Mr. Gu waved his hand dismissively:
“Okay, as long as it can be cured, our family will invest in a factory in Guangzhou and let Zhilan manage it.”

Upon hearing this, Fang Yan basically figured out how to treat the condition.

He picked up his pen and started writing again.

Everyone behind them looked over and saw that it was written in dialect:

External treatment methods, including herbal fumigation and washing:

Aconitum carmichaelii 15g, Aconitum kusnezoffii 15g, Clematis armandii 60g.

Boil the ingredients in water, add 50ml of white wine, and use the liquid to fumigate and wash the affected area once a day. The water temperature should be ≤45℃ to prevent burns.

Apply moxibustion to the Du meridian, from Dazhui to Yaoyangguan.

Apply 200g of ginger paste to the Du meridian from Dazhui to Yaoyangguan, sprinkle with 0.1g of musk, and perform moxibustion with ginger for 30 minutes, twice a week.

This is the first time in today's dialect prescriptions that external treatment methods have been written first.

Just when some people thought that dialects were no longer a prescription.

Then they saw that it was written in dialect:

prescription:

熟地黄30g、山茱萸12g、山药15g、茯苓15g、泽泻10g、牡丹皮9g、附子9g（先煎1小时）、肉桂6g（后下）、鹿角胶9g（烊化）、白芥子6g、麻黄3g、牛膝12g、地龙10g、鸡血藤30g、六月雪30g、积雪草15g、炙甘草6g。

Prepare the aconite root separately and decoct it for 1 hour to remove the numbing taste. Then, decoct the remaining herbs as usual (the water should cover the herbs by 2cm, bring to a boil over high heat, and then simmer over low heat for 30 minutes).

Add the cinnamon 5 minutes before turning off the heat, and add the deer antler gelatin to the decoction after it has been simmered until dissolved.

Take one dose daily, divided into three administrations, one hour after breakfast, lunch, and dinner.

There are a total of seventeen medicinal ingredients, including aconite and earthworm.

PS: I've gained another 200 monthly votes. After finishing this chapter, I currently owe everyone 135000 words.

The basic chapter of 6000 words has been updated.

There will be an extra chapter later.

(End of this chapter)