Rebirth 1977 Great Era

Chapter 919 Cured but Relapsed, How Should Pediatricians Treat This? (Bonus Chapter for Monthly Tickets: 3K Chapters)

Actually, the fact that she was able to sit at the same table as Fang Yan last time proved that the higher-ups still valued her quite a bit.

Fang Yan thought she would see a doctor the next day, but she has been waiting until now.

They even scheduled her for the last day of the day.

It seems that the cooperation negotiations between the two sides are not progressing as quickly as expected.

However, the matter was eventually settled.

"Hello Dr. Fang, we meet again." Ms. Xu greeted Fang Yan.

The current owner of this Singaporean shipbuilding company is surnamed Xu and his name is Xu Jian.

It sounds like a very neutral name.

Although she is already in her thirties, she takes good care of herself and looks like she is in her twenties.

Her outstanding appearance immediately attracted the attention of several people behind Fang Yan as soon as she entered the door.

Fang Yan nodded to her and said:
"Hello, Ms. Xu."

Xu Jian explained in the dialect:
“I just arrived here a few days ago when the company ran into some problems, so I went back to Hong Kong and only got back last night.”

Fang Yan suddenly realized that Fang Yan had gone to Hong Kong again for some business.

"No wonder Ms. Xu is only arriving today. Please come in and have a seat."

Fang Yan pointed to the chair, inviting Xu Jian and her daughter to sit down together.

Xu Jian said to Fang Yan:

“I already mentioned this at the dinner table before; my child has a heart problem.”

“I didn’t explain it in detail at the time. Her problem started five years ago, when she was five years old.”

“Her father had just passed away, and I was dealing with things at home and at work. I didn’t have much time to take care of her, so I left her with the nanny. After I had been busy at work for a month and had almost finished dealing with everything, the nanny said that the child was starting to show some abnormal symptoms.”

“At first, she was talking nonsense at night and dreaming about her father for several nights in a row. At the time, I thought it was because the child missed her father, so I didn’t take it seriously. But after a week, she started to have itching all over her body and pustules on her skin.”

“Back then, I took her to the hospital for a checkup, and in addition to discovering that she had psoriasis, they also found that she had a heart condition.”

"However, the attending physician said that this might be a complication of psoriasis, and told us to observe it first. Then he prescribed us a Western medicine specifically for treating psoriasis called thiamphenicol..."

At this point, Fang Yan interrupted her and asked:
Are you sure it's thiamphenicol?

Xu Jian glanced at his female assistant beside him, who quickly said:
"Yes, Dr. Fang, I can confirm that, because we went to the hospital to check the treatment records before we came."

Xu Jian asked Fang Yan:

Is there something wrong with this thiamphenicol?

He said in dialect:

"Thymexycin can be used to treat psoriasis, but it is usually used in some special cases."

"Western medicine treatments typically use methotrexate and cyclosporine."

"Thiampycin can only be used as an alternative treatment for severe types of psoriasis, such as pustular psoriasis and erythrodermic psoriasis, when other conventional treatments are ineffective or patients cannot tolerate drugs such as methotrexate and cyclosporine."

Xu Jian said with some surprise:
"So there's such a saying?"

Then, as if remembering something, she said:

"I knew it! It worked at the time, but then it suddenly got worse."

"Later, we sought treatment from many people, and they all had some effect at first, but then it would get worse and worse. Now her whole body is covered in this kind of skin, red and peeling, and pustules are growing, especially on her chest, back, arms and thighs. It's particularly severe. Whenever it gets severe, her heart starts to have problems, such as chest tightness, vomiting, palpitations, and nightmares."

As she spoke, Xu Jian also pulled open the child's collar to show Fang Yan the skin under the little girl's neck, which indeed looked just as she had described.

"Do these boils hurt?" Fang Yan asked the little girl.

The little girl looked at the dialect with a blank expression, as if she didn't understand it.

At this moment, Xu Jian said:

“She works with our nanny and hasn’t learned much Chinese.”

Fang Yan suddenly realized, and then asked the little girl again in English, this time the other girl understood.

He nodded and said it hurt.

And he also told Fang Yan:

"When there are many pustules on the skin, the heart condition is more serious, but as long as there are fewer pustules, the heart condition will not be affected."

Upon hearing this, Fang Yan spoke to her in English:

"Stick your tongue out, and place your left and right hands on the table."

The little girl obediently did as instructed, and then Fang Yan saw that her tongue was reddish-brown with a cracked coating, and after taking her pulse, he found that the pulses in both her hands were thin and weak.

"Is this period considered serious or not serious?" Fang Yan asked the child.

“It’s not serious,” the child replied.

Fang Yan frowned slightly. This isn't serious?

What would it look like in a severe case?
Fang Yan composed himself, picked up his pen and began writing down the medical case, while his mind quickly began to analyze it.

In addition to the face, the child has reddish skin lesions all over the body, especially on the chest, back and limbs, with scales and pustules, which is consistent with the characteristics of pustular psoriasis.

She described her cardiac symptoms as chest tightness, palpitations, vomiting, and nightmares, which were positively correlated with the severity of her skin pustules.

After examining the tongue and pulse, we found that the child's tongue was red and dark, which indicates that the child has excessive internal heat and toxins. In addition, the cracked tongue coating is a symptom of yin deficiency and internal heat.

Based on the thready and rapid pulse and the tongue appearance, the diagnosis is yin deficiency with excessive fire.

From the perspective of traditional Chinese medicine, psoriasis may be related to blood heat and blood stasis, while heart problems may be related to excessive heart fire or yin deficiency.

Based on the fact that the child fell ill after the father's death, Fang Yan believes that emotional factors led to liver stagnation and fire, which in turn affected the heart.

The pustules on her body were related to damp-heat toxins. The damp-heat accumulated on the skin and attacked the heart internally, causing poor blood circulation.

Furthermore, the child's long-term treatment at various hospitals has also damaged his vital energy, leading to recurring illnesses. Current symptoms indicate yin deficiency and internal heat, which is supported by his tongue and pulse.

One of the side effects of thiamphenicol is that it can suppress bone marrow hematopoiesis, causing cardiotoxicity and increasing the burden on the heart.

In addition, her pustular psoriasis can trigger a systemic inflammatory response and also affect heart function.

Thinking of this, Fang Yan began to write his own dialectical approach:
The child suffered from emotional problems due to the grief of losing his father, which led to liver stagnation and internal fire. The stagnant fire burned the yin fluids, resulting in a constitution of yin deficiency and fire excess.

Based on the diagnosis, the pustules on the child's body are a sign of external manifestation of damp-heat toxins. If the heat toxins are not fully released, they will invade the heart vessels, causing obstruction of heart qi and resulting in chest tightness and palpitations.

The scaling of psoriasis is a sign of blood heat generating wind and blood stasis generating dryness, which is consistent with a red tongue and a thready and rapid pulse.

Therefore, it can be concluded that skin lesions are the symptoms, while cardiac symptoms are the root cause.

In summary, the child has pustular psoriasis complicated by drug-induced cardiac injury, and according to traditional Chinese medicine diagnosis, the condition is characterized by yin deficiency with exuberant fire and heat toxin attacking the heart.

Treatment methods should focus on clearing heat, detoxifying, and cooling the blood as the primary approach, while nourishing yin and unblocking the meridians as the fundamental principle. At the same time, attention should be paid to emotional factors and drug toxicity to avoid a singular approach.

After finishing writing in dialect, I scratched my head.

He then realized another problem: the person in front of him was a child, not an adult.

Treatment presents a dilemma: both skin pustules (symptoms) and cardiac symptoms (root cause) need to be controlled simultaneously. However, heat-clearing and detoxifying drugs may worsen cold stagnation and blood stasis, while warming and invigorating drugs may promote heat toxicity. Since the child is young, long-term medication requires avoiding damage to the spleen and stomach's vital energy.

Otherwise, even if you cure this place, another one will sprout up on the other side.

He wasn't just using dialects to complete a task; he had to be responsible to the patients.

He put down his pen and began to think about the pediatric medical cases he had previously read.

Seeing that Fang Yan had stopped speaking but hadn't written a prescription, Xu Jian immediately asked:
"Dr. Fang, how is it? Do you have a better understanding of this illness?"

Fang Yan wasn't angry that the other person had interrupted his train of thought; he simply said:

"Yes, but I need to consider the child's constitution. She's still young, so the treatment methods can't be the same as for adults. Let me think about it..."

Xu Jian was slightly taken aback upon hearing this, and said:

"Dr. Fang, no wonder you are a renowned doctor. Others have never considered these things, and they have never said this to me."

Fang Yan smiled; this kind of situation is very common abroad.

They are also very fair, treating everyone the same, whether they are adults or children. Especially in cases like this little girl's, where many people cannot be cured, people instinctively use strong medicine to treat her.

It turns out that their treatment does have some effect, but later drug poisoning occurs, making the situation worse.

If dialects continue to use their methods, then it's truly like knowingly forcing a dead end.

Now he must use the right methods to avoid damaging the child's heart with the medication and then cure the child.

Fang Yan thought about it for a moment, and since internal administration didn't work...

Then we really have no choice but to change some of the stronger irritants to topical use, just like before.

With that thought in mind, Fang Yan already had the answer.

He quickly picked up his pen and began writing again:
External treatment:
For external application to psoriasis lesions: Mix 10g of indigo powder and 10g of phellodendron powder with sesame oil to form a paste. Apply a thin layer to the affected area after cleansing the skin in the morning and evening. Leave it on for 1 hour and then wash it off. Do not use on broken skin.

药浴疗法：苦参15g、地肤子15g、白鲜皮10g、丹参10g，水煎取汁2000ml，加温水至37-38℃，浸泡15分钟，每周3次。

After finishing writing the prescription, Fang Yan began writing the actual prescription:

Rhinoceros horn (decocted first) 15g: Crush and decoct for 30 minutes. Used to clear heat, cool blood and calm the nerves.

9g of raw Rehmannia root: Nourishes Yin and clears heat, nourishes kidney water to reduce heart fire.

Red peony root 6g: cools the blood, disperses blood stasis, unblocks the meridians, and relieves pain.

6g of peony bark: Clears latent heat in the Yin aspect, invigorates blood circulation and eliminates blemishes.

Ophiopogon japonicus 6g: Nourishes Yin and clears the heart, moistens the lungs and promotes the production of body fluids.

Schisandra chinensis 3g: It astringes Yin, calms the mind, and protects the body's vital energy.

Danshen 6g: Promotes blood circulation and removes blood stasis, improves myocardial blood supply.

Forsythia suspensa 6g: Clears heat and detoxifies, reduces swelling and dissipates nodules.

Prepared licorice root 3g: harmonizes the effects of other herbs, relieves spasms, and protects the stomach.

Preparation method: First decoct the rhinoceros horn separately for 30 minutes, then decoct the other herbs as usual, ensuring the water covers the herbs. Bring to a boil over high heat, then simmer over low heat for 20 minutes.

Take one dose daily, 30 minutes after breakfast and dinner, in two warm doses.

After finishing writing, Xu Jian couldn't wait to come over.

Although she couldn't understand it, she still wanted to ask Fang Yan how he planned to treat her.

After all, she had already gone through quite a few treatment options before.

Seeing the methods of external treatment and internal administration written in the dialect, she realized that she had never seen them before.

At this moment, Fang Yan tore off the order form and said to Xu Jian, who had come closer:

"Next, I will use a combination of external and internal treatments for seven consecutive days, and then have a follow-up visit to adjust the prescription."

"Dr. Fang, could you explain your method?" Xu Jian asked Fang Yan eagerly.

Fang Yan thought for a moment, nodded, and said:
"Okay... The situation is like this now. After my examination, I found that the child's heart was too damaged by the medication, which caused the current situation. I will adopt a strategy of 'treating the symptoms externally and the root cause internally', combining clearing heat and detoxifying, nourishing yin and unblocking the meridians, and regulating emotions, taking into account both the child's constitution and the toxicity of the medication."

"This treatment plan first changes the previous strategy of using strong drugs and focuses on safety by using external treatments to bypass the metabolism of internal organs. The goal is to control skin lesions to indirectly improve heart function, while gradually repairing the root cause of the child's yin deficiency and fire excess."

“In terms of time, it may take a while, but I am confident that I can cure the child’s illness and prevent it from recurring.”

PS: I got another 100 monthly votes, so I'll finish this chapter. I currently owe everyone 134000 words.

That's all for today, please come early tomorrow!

Happy Labor Day to everyone! Wishing you good health and a happy mood every day!
Lao Feng is working hard to write tomorrow's!

(End of this chapter)