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

Chapter 1018 Wen Manlu's Level

Chen Yang took a sip of water and calmed down. "Everyone, please share your opinions. This child has a high fever, swollen and painful joints, mouth ulcers, a fissured tongue with a greasy coating, and a deep, thready, and agitated pulse—this set of symptoms is full of contradictions. What exactly is the cause?"

Lin Yi pushed his glasses up and said solemnly, "From a Western medical perspective, the diagnosis of systemic juvenile idiopathic arthritis is basically established, but hormonal and immunosuppressant treatments have failed and have caused serious side effects, and it has entered a difficult-to-treat stage."

“From the perspective of traditional Chinese medicine…”

Lin Yi pointed to the tongue photo and said, "The tongue is red, dry, and cracked, clearly a sign of Yin fluid depletion. However, there's a thick, greasy yellow coating at the base of the tongue, indicating lingering damp-heat. This is a classic case of 'dampness suppressing heat, impairing Yin fluid,' but it's a hundred times more complex than ordinary damp-heat syndrome!"

Xun Jiahong interjected, "The child's high fever persists, yet his hands and feet are cold. This is a sign of deep heat and severe cold. He's been using large amounts of hormones, but the fever hasn't subsided. Instead, he's developed puffiness and ulcers. This suggests that the bitter, cold, and heat-clearing drugs and hormones have depleted his vital energy, trapping the enemy within and causing internalized pathogenic heat and burning of the Yin fluids!"

"What's more troublesome is that the pulse and symptoms don't match."

Wen Manlu said, "A deep, thin pulse is a sign of internal heat due to Yin deficiency, but the presence of agitation is a precursor to the overflow of Yang deficiency! This means that not only is the child's Yin fluid depleted, but their Yang Qi is also in jeopardy. Any carelessness could lead to a separation between Yin and Yang!"

Gao Anliang sighed. "This is a classic case of a 'bad disease'! 'Treatise on Febrile Diseases' says, 'If a patient with a solar disease has been sweating for three days, but vomiting, purgation, or warm needles still do not relieve the symptoms, this is a bad disease.' This child has been mistreated so many times that his vital energy has been damaged, and the evil energy has become entangled, making the pathogenesis extremely confusing."

"The question now is, should we save the Yin first or eliminate the evil first?" Lin Yi said softly.

This is actually the most difficult decision in treating a disease.

Saving the Yin may cause dampness to cling to the evil, while removing the evil may further damage the Yin. Any slight bias may accelerate the deterioration of the disease.

"Lulu, what do you think?" Chen Yang looked at Wen Manlu.

After Wen Manlu and Zeng Yunhui entered the medical center, they were actually the two people with the least presence.

Zeng Yunhui is the worst among the group, and Wen Manlu's words...

Because Wen Manlu had been in school before, people didn't know much about her. They only knew that Wen Manlu's level was not bad, but in terms of how she was, everyone still put Wen Manlu and Zeng Yunhui on the same level.

In addition, Wen Manlu is Chen Yang's wife, and recently Wen Manlu is pregnant again. Many times, people don't take Wen Manlu into consideration and just treat her as an assistant.

However, Chen Yang knew that Wen Manlu's current level was not low.

This time, Chen Yang planned to let Wen Manlu be the attending physician and be responsible for Linlin, and by the way, let everyone see Wen Manlu's level.

Although there are many members of the Wen family in the medical center, Chen Yang also wants everyone to understand that the members of the Wen family rely on their real abilities rather than connections.

"The most critical condition for this child right now is that 'yin fluid is about to be depleted, and the weak yang is about to escape,' but damp heat and blood stasis are lingering, like a poisonous snake biting at the heart. The treatment principle must be 'saving yin and preserving yang, clearing away hidden evil,' using both attacking and supplementing methods, and taking every step carefully!"

Wen Manlu pondered for a moment and said, "The first step is to treat the symptoms first. First, restore the Yin fluid and strengthen the Yang Qi."

“方药以‘加减玉女煎’合‘清营汤’为基础：生石膏 30g（先煎）清阳明气分大热，知母 15g滋阴降火，玄参 20g、生地 15g、麦冬 15g急补阴液，黄连 6g、黄芩 10g清泻心火，丹皮 10g、赤芍 10g凉血化瘀。”

"You can specifically add 15g of Artemisia annua (taken last) and 10g of Rhizoma Bletillae. These two herbs can clear away heat from the deficiency and penetrate hidden pathogens, allowing the hidden heat and toxins to emerge from the yin to the yang, thus avoiding the enemy being trapped behind closed doors."

Wen Manlu spoke slowly, thinking as she spoke, with someone taking notes beside her.

"The dosage must be precise. Although gypsum can clear heat, it should not be taken in excess to avoid damaging yang. Yin-nourishing medicines should also not be too greasy to avoid disturbing the stomach and promoting dampness."

“It can also be combined with acupuncture.”

Wen Manlu continued, "Use Dazhui, Quchi, and Hegu to clear away heat and relieve symptoms, relieving high fever; Taixi and Sanyinjiao to nourish yin and tonify the kidneys, and quickly consolidate yin fluid; Neiguan and Shenmen to calm the mind and relieve irritability."

"Pay special attention to acupuncture techniques. Use the draining method on Dazhui, quickly withdrawing the needle to clear the area without replenishing it. Use the replenishing method on Taixi and Sanyinjiao, leaving the needle in for a long time and moving the needle slowly to strengthen the foundation."

After listening to Wen Manlu's words, Xun Jiahong, Lin Yi, Gao Anliang and others subconsciously showed surprise on their faces.

To be honest, no one expected Wen Manlu to have such a high level.

You know, Wen Manlu is the youngest among the group and just graduated with a master's degree this year.

Although Wen Manlu performed well in Lingnan, it was different from this time after all.

Everyone was thinking about this disease just now, and Xun Jiahong, Gao Anliang and others were still considering it.

When Wen Manlu told them about the treatment plan, Xun Jiahong and Gao Anliang thought about it carefully and found that Wen Manlu's plan was actually very suitable.

It’s okay that Chen Yang is powerful, but is Wen Manlu also such a monster?

Judging by their age, Wen Manlu's talent is no less than Chen Yang's.

Chen Yang smiled and nodded, then asked, "Does anyone have anything else to add?"

Xun Jiahong added, "External treatment is also essential. You can boil 30g of honeysuckle, 20g of forsythia, 30g of dandelion, and 15g of lithospermum to wash swollen and painful joints to clear away heat, reduce swelling, and relieve pain. For oral ulcers, you can apply Kangfuxin Liquid combined with Qingdai Powder to promote healing."

Chen Yang nodded. "In terms of nursing care, the room temperature must be strictly controlled to avoid overheating or overcooling. The diet should mainly consist of light liquids. You can take small amounts of pear juice, lotus root juice and other yin-nourishing and moistening products frequently, but remember not to eat anything too sweet or too cold, so as not to promote dampness and damage the spleen."

Chen Yang looked at everyone again and said, "This is a tough battle! The patient's vital energy is extremely weak, while the negative energy is rampant. Every step we take must be precise. Measure the temperature every four hours, observe changes in the tongue, and pay close attention to the patient's mental state and urine output. Report any changes immediately!"

"Yes!" Everyone responded in unison.

"Doctor Wen will be in charge of the patient." Chen Yang said to Wen Manlu with a smile.

"Well, okay." Wen Manlu nodded with a smile.

This was the first time Chen Yang called her Dr. Wen.

After the consultation, Chen Yang did not leave immediately, but went to Jiang Linlin's ward again with Wen Manlu.

When Xu Xiuxiu saw Chen Yang coming in, she quickly stood up and said, "Doctor Chen..."

Chen Yang made a gesture to keep quiet and walked to the bedside to carefully observe Linlin's condition.

The child still had a high fever and fell asleep again in a daze, but his breathing seemed to be smoother than before.

Chen Yang reached out and took Linlin's pulse again. Although the pulse was still deep and fine, the agitation seemed to have subsided a little.

"Doctor Chen, Linlin..." Jiang Yuan asked hurriedly, his voice full of anticipation and anxiety.

Chen Yang stood up and said calmly, "Mr. Jiang, Ms. Xu, the child's condition is indeed very serious, but please trust us, we will do our best."

"The first dose of medicine will be effective immediately. Give the medicine in small amounts and frequently to avoid causing vomiting. Call us at any time if there is any problem."

Chen Yang introduced Jiang Yuan and his wife, "This is Dr. Wen Manlu. Dr. Wen will be in charge of Linlin's care."

Seeing the worried look in Jiang Yuan and his wife's eyes, Chen Yang smiled and added: "By the way, Dr. Wen is also my lover."

"Hello, Dr. Wen."

Jiang Yuan and his wife hurriedly greeted Wen Manlu.

They knew that Chen Yang's lover was Wen Xiuping's granddaughter.

Since Chen Yang's lover is in charge, it is no different from Chen Yang being in charge himself.