Chinese Medicine: Starting with Daily Intelligence-Chapter 89: Determining the Plan
In the dean’s office at the Guanghe District Hospital of Traditional Chinese Medicine, Dean Sun rubbed his temples, an application report spread out before him.
"Old Guo, are you sure this golden toad skin will work?" He looked up at Guo Yu. "Fifty thousand yuan is no small sum. If it all goes down the drain..."
Guo Yu stood ramrod straight. "Dean, I can’t guarantee it, but the *Supplement to the Compendium of Materia Medica* clearly records that golden toad skin has a miraculous effect on ’Water Gu.’ Compared to the half-million yuan the family is demanding in compensation, it’s worth a shot."
Dean Sun sighed deeply and signed the application form. "Go on, then. Let’s hope it works... By the way, where’s the patient who’s causing all this trouble?"
"Still in the outpatient lobby..." Guo Yu gave a bitter smile. "His son brought a few relatives and they’re holding up a banner..."
In the outpatient lobby, the patient, fifty-something Zhao Daqiang, was slumped on a bench. His abdomen was severely swollen, and his face had a sallow, waxy complexion.
His son, Zhao Lei, held up a sign that read "QUACK DOCTORS KILL," surrounded by several relatives who occasionally shouted curses.
The security guards stood at a distance, not daring to get closer.
"Everyone, you be the judge!" Zhao Lei shouted at the top of his lungs. "Half a year ago, my dad could still work in the fields! It’s because he took this hospital’s medicine that he can’t even walk now!"
The crowd of patients whispered among themselves, and some took photos to post on social media. 𝗳𝚛𝗲𝕖𝚠𝚎𝚋𝗻𝗼𝕧𝗲𝐥.𝚌𝚘𝐦
Guo Yu walked over quickly, and Zhao Lei immediately rushed forward. "Guo! If you don’t give us an explanation today, I’m not done with you people!"
"Zhao Lei, calm down." Guo Yu held up his hands. "We’ve found a highly effective medicine. It’s a rare golden toad skin, specifically for your father’s condition..."
"What toad skin? Trying to fool us again?" Zhao Lei sneered. "Today, you either pay up, or I’m calling the TV stations to expose you!"
Guo Yu suppressed his anger. "How about this: the hospital will pay for the medicine. If it doesn’t work, we can discuss compensation then. How does that sound?"
Zhao Daqiang weakly tugged on his son’s arm. "Son... why don’t we... give it a try..."
...
That afternoon, Guo Yu went to the clinic to pick up the medicine.
Li Xu handed him the golden toad skin, hesitated for a moment, then finally spoke up. "Director Guo, this golden toad skin is good, but I’m afraid it might not be enough to cure his ascites from liver cirrhosis."
Guo Yu was taken aback. "What do you mean?"
Li Xu explained, "From a TCM perspective, the pathogenesis of ascites from liver cirrhosis is essentially liver depression and blood stasis, spleen-kidney yang deficiency, and the internal retention of water and dampness. The main effects of golden toad skin are clearing heat, detoxifying, promoting diuresis, and reducing swelling. It’s suitable for damp-heat type ascites, like that caused by late-stage liver cancer or acute hepatitis. But this patient’s situation is different—"
The day before, Guo Yu had described the patient’s condition in detail.
Li Xu had committed it to memory and was now using it for comparison.
He opened his notebook and drew a simple diagram:
Liver Depression and Blood Stasis: The patient has suffered from prolonged emotional distress, leading to liver qi stagnation. This impedes blood circulation, resulting in blood stasis.
Spleen-Kidney Yang Deficiency: Post-cirrhosis, the spleen has lost its transportive function and the kidney yang is insufficient. The body is unable to metabolize water and dampness, which then accumulate as ascites.
Yin-Blood Deficiency: With a long-term liver disease, the liver yin is depleted, causing hyperactivity of liver yang. This further exacerbates the blood stasis and water retention.
"The golden toad skin can promote diuresis, but it can’t solve the core problems of liver yin deficiency and internal obstruction from blood stasis," Li Xu concluded. "So even if you use it, it will likely only provide temporary relief, not a complete cure."
Guo Yu frowned. "So what you’re saying is...?"
Li Xu handed him a slip of paper. "I came across an ancient formula this morning called Turtle Garlic Soup. It might be a better fit for his condition."
Guo Yu took it and glanced at it, his frown deepening. "Soft-shelled turtle stewed with garlic? This... isn’t this just a folk remedy?"
Li Xu shook his head. "It’s not an ordinary folk remedy. It’s a modified formula from the *Essential Prescriptions of the Golden Cabinet*, specifically for ascites from liver cirrhosis. The turtle nourishes yin and softens hardness, while the garlic breaks up stasis and clears the collaterals. The combination directly targets the patient’s liver yin deficiency, internal obstruction from blood stasis, and accumulation of water and dampness."
Guo Yu was still uneasy. "But the patient’s condition worsened precisely because he was using unproven folk remedies. What if something goes wrong again..."
Li Xu understood his concern but insisted, "TCM emphasizes treatment based on syndrome differentiation. Not all folk remedies are bad. This formula is well-founded and worth a try."
Guo Yu hesitated for a moment, then finally sighed. "I’ll try the golden toad skin first. If it doesn’t work... I’ll consider your proposal."
...
On the third floor of the inpatient department at the Guanghe District Hospital of Traditional Chinese Medicine, Guo Yu stood by the window, staring at the prescription in his hand with a deep frown.
He had just completed the admission procedures for Zhao Daqiang and now needed to formulate a detailed treatment plan.
He went to Dean Sun’s office.
Dean Sun had just hung up the phone. "There can’t be any more problems this time. I’ve swallowed my pride and specially invited liver disease experts from other hospitals for a joint consultation."
"Even so, he’s our hospital’s patient. When the time comes, you’ll still need to decide on the final plan."
Guo Yu felt an immense weight of pressure. He took a deep breath. "Dean, I understand."
「That afternoon.」
In the video conference room, a remote consultation for the liver cirrhosis and ascites case began.
In attendance were Xue Shuheng, an internal medicine expert from the City Hospital of Traditional Chinese Medicine; Chen Ming, the Director of the Hepatobiliary Department at the City People’s First Hospital; and others.
Dean Sun also attended, his expression grave.
Guo Yu stood before the projector screen, giving a detailed report on Zhao Daqiang’s condition.
"The patient, Zhao Daqiang, 56, has post-hepatitis B cirrhosis that has now progressed to ascites, accompanied by an enlarged spleen and portal hypertension. He was treated at our hospital six months ago. At that time, the diagnosis was liver depression and spleen deficiency with internal obstruction from blood stasis. He was prescribed a treatment to soothe the liver, strengthen the spleen, activate blood, and resolve stasis. However, the patient did not follow medical advice and took folk remedies on his own, which led to a deterioration of his condition..."
The projector screen displayed the patient’s various test results: abnormal liver function, low albumin, massive fluid accumulation, and an abdomen distended like a drum.
"Currently, the patient’s ascites is severe..." Guo Yu paused. "The family has refused Western medical intervention like paracentesis and is demanding TCM treatment."
A low murmur of discussion filled the conference room.
Chen Ming, the Director of the Hepatobiliary Department at the City People’s First Hospital, pushed up his glasses and was the first to speak. "In a situation like this, what can TCM possibly do? The ascites is this severe; we have to drain the fluid as soon as possible, supplemented with albumin and diuretics. Otherwise, he could slip into a hepatic coma at any moment!"
"Director Chen is right," an expert from another hospital chimed in. "Once cirrhosis reaches this stage, TCM conditioning is too slow. The focus should be on Western medical intervention."
Guo Yu didn’t immediately argue. Instead, he brought up another set of data. "The patient previously received treatments like diuretics and albumin supplements at a top-tier hospital, but the results were poor, and the ascites kept recurring. Moreover, his constitution is weak. After multiple fluid drainages, he developed an electrolyte imbalance, which actually worsened his condition."
The conference room fell silent for a moment.
Just then, Xue Shuheng, the internal medicine expert from the City Hospital of Traditional Chinese Medicine, spoke slowly. "Director Guo, what is your current proposed treatment plan?"
Guo Yu took a deep breath and clicked to the next slide. "We plan to use a modified Lower Rib Trauma Decoction, combined with golden toad skin for both internal and external treatment."
"Golden toad skin?" Several experts looked surprised.
"Yes." Guo Yu nodded. "Golden toad skin has a special therapeutic effect on ascites from liver cirrhosis. It can promote diuresis, reduce swelling, activate blood, and resolve stasis. We plan to apply half of it externally over the liver region and grind the other half into a powder for the patient to take orally, in conjunction with the herbal decoction for overall conditioning."
Xue Shuheng mulled this over for a moment. "Golden toad skin is indeed rare, but can it alone control such severe ascites?"
"That’s why it needs to be combined with a modified Lower Rib Trauma Decoction." Guo Yu displayed the prescription:
Chaihu, Peach Kernel, Red Flower, Danggui, red peony, Chuan Xiong, Nutgrass Rhizome, Agrimonia Pilosa, Yanhusuo, Danshen, Ligusticum Chuanxiong, Trogopterus Dung, licorice, and Astragalus Root.
"This formula soothes the liver and regulates qi, activates blood, and resolves stasis. Combined with the diuretic effect of the golden toad skin, it should be able to alleviate the ascites and improve liver function."
The conference room once again broke out in discussion.
Chen Ming shook his head. "Director Guo, your plan is too risky! For ascites this advanced, TCM conditioning is likely to be a drop in the bucket."
"But it’s also the only plan the patient will accept," Guo Yu said.
After some discussion, Dean Sun spoke slowly. "Experts, since the patient’s family insists on TCM treatment, we might as well give it a try. If there are no results within three days, we will consider other options."
In the end, the committee decided to proceed with Guo Yu’s plan.
