Chinese medicine: from rural hospitals to top three hospitals in Kyoto

Chapter 997 Joint Consultation

Ye Guoliang was lying on the hospital bed, extremely thin, his skin and the whites of his eyes were a glaring dark yellow, his abdomen was slightly swollen due to a small amount of ascites, and he was short of breath.

When he saw a group of doctors coming in, he just raised his eyelids slightly, his eyes were cloudy and without much brilliance.

"Teacher Ye, this is Director Zhong Dongyang, a leading expert in hepatobiliary surgery, and this is Director Chen Yang, the head of the Traditional Chinese Medicine Department." Chu Gaobo quickly introduced them. "They are here to consult with you."

Ye Guoliang nodded weakly, making a vague "hmm" sound in his throat.

Chen Yang sat beside the bed, gently pulled Ye Guoliang's withered wrist, placed his fingers on Ye Guoliang's pulse, and took Ye Guoliang's pulse.

The pulse is deep, stringy, fine and astringent, almost impalpable, like a faint undercurrent beneath a dry riverbed, with an obvious sense of congestion.

"Open your mouth."

After taking the pulse, Chen Yang looked at the tongue. The tongue was dark purple, with a thick, greasy and scorched yellow coating, and the veins under the tongue were tortuous and dilated, and bluish-purple.

"Teacher Ye, where do you feel most uncomfortable? Does your stomach hurt a lot? Are you afraid of cold or heat?" Chen Yang asked softly.

Ye Guoliang took a breath, his voice weak and hoarse: "It hurts... My upper right abdomen... It hurts all the time... I have no strength in my body... I feel cold... I feel cold..."

As he spoke, his body trembled slightly.

"What about the feces? What's the color?" Chen Yang continued to ask.

"...grayish white...like...lime..." Ye Guoliang answered with difficulty.

"The urine is very dark in color, like strong tea." Ye Weiqiang added hurriedly.

Zhong Dongyang carefully examined the PTCD drainage tube in Ye Guoliang's abdomen. The bile it drained was dark green and viscous, but not much. He gently pressed on Ye Guoliang's right upper abdomen, and he immediately frowned and groaned in pain.

"The situation is even worse than the information sent from Shancheng."

Zhong Dongyang whispered to Chen Yang, "The jaundice index is higher, and the nutritional status and coagulation function are worse. The Child-Pugh score is probably close to 10, the upper limit of grade B."

Chen Yang nodded solemnly.

The patient's vital energy was extremely deficient, with all qi, blood, yin and yang damaged, evil energy rampant, and dampness, heat, blood stasis and toxins mixed together, forming a critical situation of "vital energy deficiency and evil excess", which was more dangerous than Wilson's condition at the time.

Although Wilson's condition was complicated, his physical condition was relatively better and he was younger than Ye Guoliang. However, Ye Guoliang's condition was too poor - he had long-term hepatitis B, cirrhosis, advanced age, and extreme malnutrition.

After the examination, a group of people came to the consultation room. Evans also rushed over after hearing the news and stood aside to listen. He walked to Su Yunxue's side, greeted Su Yunxue politely, and asked Su Yunxue to translate for him.

Chen Yang stood in front of the projector, pointing to Ye Guoliang's latest examination data and tongue and pulse photographs. "Judging from the pulse and symptoms, the patient's condition falls into the categories of 'acute jaundice' and 'yin jaundice', with concurrent symptoms of 'ascites' and 'accumulation of symptoms'. The core pathogenesis is: internal accumulation of damp-heat and stasis in the liver and gallbladder, spleen and stomach failure, liver and kidney yin deficiency, severe deficiency of qi and blood, and stasis in the meridians."

"Unlike Wilson, although the tumor was in a tricky location, his physique was still good. He was mainly suffering from the evil and supplemented by the deficiency of the body."

"Teacher Ye's vital energy is extremely weak, and the evil toxins are deeply trapped. Damp-heat and stasis are blocking the liver and gallbladder, causing bile to overflow and cause jaundice. Stagnation is blocking the blood vessels, and the blockage causes pain. The spleen and stomach are weak, and there is no source for the production of qi and blood, so he is extremely thin and weak. The long-term illness has affected the kidneys, causing liver and kidney yin deficiency, resulting in a fear of cold (not true cold, but rather a lack of yang), a dark purple tongue, and a deep and sluggish pulse."

Gao Anliang narrowed his eyes, paused for a moment, and said, "Director Chen is absolutely right. This condition is extremely dangerous. If we attack it directly, the vital energy may collapse. If we use only tonics, we will only keep the enemy inside and make the evil poison more rampant. We should follow the general principle of 'strengthening the body's vital energy, clearing away dampness and heat, removing blood stasis and detoxifying, and clearing the bowels and alleviating jaundice'. We should treat the symptoms in an emergency and the root cause in a slow manner, taking both symptoms and root causes into consideration."

"Surgery is the only hope for a cure,"

Zhong Dongyang took over the conversation: "But given the patient's current condition, going on stage directly would be tantamount to committing suicide."

"So we need to rely on everyone to work together to provide preoperative care for the patient. The goals of our preoperative care are very clear: first, to maximize liver function, reduce the jaundice index, and especially to reduce the toxicity of direct bilirubin to systemic organs..."

"Second, correct coagulation disorders; third, increase albumin, improve nutritional status, and enhance the body's tolerance..."

"Fourth, control ascites. Fifth, stabilize blood pressure and internal environment. The time window is very tight; we only have two weeks at most!"

Lin Yi looked at the data: "Total bilirubin 385, direct bilirubin 325, this jaundice is too severe. Can Yinchenhao Decoction plus Xijiao Dihuang Decoction (using buffalo horn as a substitute) effectively reduce jaundice? But the patient's spleen and stomach are too weak, and I'm afraid he can't tolerate bitter and cold medicines."

Xun Jiahong suggested, "Could we modify the 'Yinchen Shufu Decoction' and 'Gexia Zhuyu Decoction'? Yinchen, Gardenia, and Rhubarb clear damp-heat and reduce jaundice, but with Atractylodes macrocephala and Aconite, they can warm the spleen and protect the middle burner, preventing the bitter cold from damaging the stomach. Combined with Gexia Zhuyu Decoction, they can invigorate blood circulation, dissolve stasis, promote qi flow, and relieve pain. Adding Astragalus and American ginseng can also replenish vital energy and strengthen the body's health."

Su Yunxue also added, "The patient has poor coagulation, with an INR of 1.6. Blood-activating and stasis-removing drugs like peach kernel and safflower should be used with caution. Panax notoginseng powder can be added to dissipate stasis and stop bleeding. Although the ascites is minimal, it needs to be prevented. Poria cocos, Polyporus umbellatus, and Alisma orientalis can be added to promote diuresis, but electrolyte balance should be maintained. Albumin is extremely low. In addition to intravenous supplementation, medicinal foods with rich blood and flesh, such as soft-shelled turtle soup and crucian carp soup, should be used. However, these should be stewed until very tender, and taken in small, frequent doses."

Xia Hongliang looked at the photo of the tongue coating, pondering as he slowly said, "The tongue coating is thick and greasy, indicating deep accumulation of damp-heat and toxic stasis! In addition to internal medication, I think it can be combined with a Chinese herbal enema. A decoction of rhubarb, sodium sulfate, immature bitter orange, magnolia bark, dandelion, and red peony root can clear the bowels, relieve heat and detoxify, provide a way out for pathogens, reduce the burden on the liver, and promote bile excretion."

Chen Yang listened carefully to the opinions of each member and weighed them quickly in his mind.

I have to say that three cobblers are better than one Zhuge Liang. When such a group of elites get together, everyone contributes something and the suggestions they give are all unique.

In fact, this is also the purpose of the consultation.

A consultation is when several experts communicate with each other, complement each other, and work together to find solutions.

"Everyone's saying makes sense."

Chen Yang pondered for a moment and said, "Then I will summarize everyone's opinions..."

Main prescription: Artemisia capillaris 60g (added later), stir-fried Gardenia 15g, processed Rhubarb 10g (added later), processed Aconitum 12g (pre-boil for 1 hour), stir-fried Atractylodes macrocephala 30g, Astragalus 50g, American ginseng 15g (stewed separately and taken), Angelica 15g, buffalo horn 30g (pre-boiled), Red Peony 20g, Salvia miltiorrhiza 30g, Curcuma 15g, Panax notoginseng powder 6g (taken with water), Poria 30g, Alisma orientalis 15g, malt 30g.

3 doses, decocted in water, 1 dose per day, divided into 4-6 small doses and taken warm. Closely observe the patient's reaction after taking the medicine, and be careful of the toxicity of aconite and the excessive laxative effect of rhubarb!

Enema recipe: 30g of raw rhubarb, 20g of Glauber's salt (melted), 20g of immature bitter orange, 20g of Magnolia officinalis, 30g of dandelion, and 30g of red peony root. Decoction to obtain 200ml of concentrated juice, which is retained for enema use once daily.

After enema, be sure to record the frequency, nature of bowel movements and patient reactions.

Intravenous support: Director Zhong, please ask the Western Medicine Department to administer intravenous infusion of albumin, plasma, vitamin K1, and liver-protecting drugs (such as reduced glutathione and polyene phosphatidylcholine) to correct coagulation function, supplement nutrition, and pay attention to maintaining water and electrolyte balance.

Nutritional support: Wen Manlu is responsible for customizing exclusive medicated liquid food with the nutrition department of the municipal hospital. The food should be easily digestible, high in protein, and rich in vitamins. Small meals should be taken frequently. Porridge oil can be made with astragalus, yam, coix seed, and tangerine peel.

Acupuncture-assisted treatment is performed by Li Chengjie, and the acupoints selected are: Zusanli (double, tonifying method), Sanyinjiao (double, tonifying method), Yinlingquan (double, draining method), Gallbladder Shu (double, equal tonifying and draining), Liver Shu (double, equal tonifying and draining), Qimen (double, draining method), Zhongwan (draining method), and Guanyuan (tonifying method).

Do it once a day with steady techniques to harmonize the liver, gallbladder, spleen and stomach, promote the circulation of qi and blood, and help relieve jaundice and pain.

"The core of this plan is to 'combine warmth and cooling, attack and supplement simultaneously.'"