This Doctor Is Too Wealthy-Chapter 523 - 460 Completely confused syndrome differentiation_2
Upon examination, the patient’s body temperature is 37.6℃, with a pale tongue, a white and slightly greasy coating, and a floating yet slightly rapid pulse.
Please write a complete medical record in a standard format.
Requirements: State your diagnosis, syndrome differentiation, treatment methods, and the names of the prescribed formulas. Please begin."
Then, Du Heng once again repeated the patient’s physical signs and check-up results.
Soon, both students submitted their answers, and Xiao Su conscientiously collected them.
Du Heng glanced at the papers and expressionlessly handed them to Li Jianwei and Xiao Su.
After Li Jianwei and Xiao Su finished reading, their expressions also became impassive.
The answer from the student who had not asked questions:
Diagnosis: Common cold.
Syndrome differentiation: Yang deficiency with external contraction.
Treatment methods: Warming yang to dispel cold.
Prescription: Modified Ginseng and Perilla Drink.
The answer from the student who had been asking questions:
Diagnosis: Common cold.
Syndrome differentiation: Qi deficiency with external contraction of wind evil.
Treatment methods: Boosting qi and relieving the exterior.
Prescription: Modified True Warrior Decoction.
Except for the correct diagnosis of the common cold, everything else the two students wrote was wrong; even their syndrome differentiation and prescriptions didn’t align.
Du Heng first took the answer from the student who hadn’t asked questions. "Classmate, I ask you, what are the characteristics of the Ginseng and Perilla Drink formula?"
"It treats common colds caused by wind-cold, with symptoms such as aversion to cold, fever, headache, nasal congestion, chest tightness, and nausea."
The student in question replied fluently; he felt everything he said was correct.
However, he was puzzled as to why all three interviewers wore expressions as if they’d swallowed something foul.
Du Heng took a deep breath, pursed his lips, and said, "The function of Ginseng and Perilla Drink is to boost qi, relieve the exterior, regulate qi, and resolve phlegm. Your treatment method is to warm yang and dispel cold. The two are completely mismatched, like apples and oranges."
Du Heng didn’t want to say more, but after a pause, he added, "By the way, did you invent your syndrome differentiation? Did you listen carefully to the symptoms described just now?"
Uh... The honest student was dumbfounded. Everything was wrong?
Meanwhile, the other, rather scheming student, gave a quick, secret smile, then hastily composed himself and sat up straight with a solemn expression.
Du Heng clearly saw his subtle movements. He picked up the paper the student had written, his expression pained, as if constipated. "This classmate, your syndrome differentiation is qi deficiency with external contraction of wind evil. Your treatment method is boosting qi and relieving the exterior. Can you explain why, after diagnosing an external contraction of wind evil, you chose not to dispel wind and scatter cold, but only to boost qi and relieve the exterior?
Are you implying that one only needs to open the exterior, and the wind evil will exit on its own?"
The scheming student was also dumbfounded, staring blankly at Du Heng.
Du Heng sighed and asked again, "Do you know what the Green Dragon Decoction is used for?"
As the student was about to speak, Du Heng continued, "The Green Dragon Decoction is divided into Major Blue Dragon Decoction and Minor Green-Blue Dragon Decoction. Tell me, is the one you’re thinking of major or minor? Or do you believe the effects of the two formulas are identical?"
The scheming student immediately shut his mouth.
"The Major Blue Dragon Decoction can induce sweating and relieve the exterior. If you had used the Major Blue Dragon Decoction, you might have gotten lucky and stumbled upon a somewhat appropriate prescription, even if not perfectly matching the symptoms. But what if you were thinking of the Minor Green-Blue Dragon Decoction?"
Du Heng sighed. "Two students, a simple case of the common cold, and you both got it completely wrong."
What’s the use of learning well if you can’t apply it?
"Teacher, then what is the correct answer?" the scheming student asked, unconvinced. He wanted to know how far off his answer was.
Du Heng turned to look at Xiao Su beside him. "You take this?"
Xiao Su also sighed, then nodded. "Allow me."
He then faced the two students and said, "Diagnosis: Common cold. Syndrome differentiation: Wind evil complicated by dampness invading the exterior syndrome. Treatment methods: Disperse wind, expel dampness, and relieve the exterior. Prescription: Modified Notopterygium Decoction to Overcome Dampness."
Wind evil complicated by dampness invading the exterior syndrome? Is this really a common cold?
The two students looked at each other, bewildered.
Du Heng sighed. "I had prepared a slightly more difficult question, but it seems unnecessary now. Let’s just move on to the final question."
What does that mean? Did one question invalidate them entirely?
For graduate student interviews, admitting an extra person could be a hassle, but deciding not to admit someone? That wasn’t difficult at all.
Thinking about the possible consequences, the usually honest student was no longer so reserved and hurriedly said, "Teacher, please, ask the next question. Give us another chance."
At this point, Li Jianwei also chimed in, "Xiao Du, just ask them. It’s alright if they can’t answer perfectly. It’s good for young people to broaden their knowledge."
Hearing Li Jianwei say this, Du Heng naturally had to give him face. "Then I’ll follow your guidance, Teacher."
Clearing his throat, Du Heng slowly began, "Listen carefully. A 30-year-old female patient presented with fever and chills of no apparent cause, along with a slight dry cough. She sought treatment at the local hospital’s Emergency Department. Despite repeated treatment with antibiotics and hormones to reduce the fever, it kept recurring, worsening in the afternoon.
Upon examination, the patient reported no nausea, vomiting, abdominal pain, or diarrhea, and no urinary frequency, urgency, or pain. She experienced a dry mouth with a desire to drink. Her tongue was dark with a thin, greasy, slightly yellow coating. Her pulse was moist and rapid. Her body temperature fluctuated between 37.5℃ and 40℃. I want to emphasize: the patient showed no signs of inflammation or infection."
After finishing, Du Heng looked at the two students. "You don’t need to write down your answer for this question. Whoever has an answer can raise their hand."
Two minutes later, the scheming student was the first to raise his hand. "Teacher, you mentioned the patient had a fever without an obvious cause and no internal inflammation or infection. This suggests she might have inadvertently contracted an external wind evil. The initial symptoms were perhaps not obvious, and it only developed into this state after a prolonged period. Therefore, I diagnose it as externally contracted fever."
Du Heng showed no reaction, merely asking, "What is your reasoning for the syndrome differentiation?"
"A failure in harmonizing construction and defense."
"Very good. Sit down."
The scheming student was a bit bewildered. He didn’t understand Du Heng’s response or whether his answer was right or wrong, as Du Heng offered no feedback.
However, after his earlier experience, he dared not ask.
Just then, the honest student also raised his hand. "Teacher, may I speak?"
"Certainly, go ahead."
"The patient exhibits no external disease manifestations but has characteristics of recurrent fever and a dry mouth with a desire to drink. I believe this is internal damage fever."
Du Heng’s eyes lit up slightly. "There are many types of internal damage fever. Which specific one is it?"
"Fire depression syndrome."
"Sit down."
The brief light in Du Heng’s eyes faded, and his expression returned to calm.
He hadn’t intended to say more, but they had insisted, and now, he was disappointed yet again. What was the point of all this trouble?
"Please compose yourselves. We will proceed to the final question."
"Teacher, you haven’t told us how we did on the last question!"
"Teacher, please give us some comments."
The two students were genuinely panicking. Du Heng’s attitude clearly indicated disappointment.
But even if we’re doomed to fail, we deserve to know why, don’t we?
The two students looked at Du Heng with pleading eyes. Even Li Jianwei spoke up from the side, "Xiao Du, please explain it to these two children. Otherwise, they won’t be convinced and might think we’re deliberately making things difficult for them."
Du Heng habitually reached out to tap the table but suddenly remembered Li Jianwei, his teacher, was beside him, and quickly withdrew his hand.
After clearing his throat, he said, "Comprehensive analysis of pulse and symptoms—I trust you two are not unfamiliar with this. Your teachers should have mentioned and emphasized it in class.
However, in the case just presented, you failed to apply this comprehensive analysis. Instead, much like in Western medicine, you attempted to deduce the cause of the patient’s illness based solely on the symptoms."
Du Heng spoke softly, without loud reprimands or lighthearted ridicule, merely stating the facts calmly.
"The patient’s current symptoms are not prominent. Aside from the fever, there are no other readily apparent symptoms to go by. However, I described the patient’s physical signs very clearly.
A dark tongue with a thin, greasy, slightly yellow coating indicates the presence of damp-heat in the patient’s body, with heat being predominant.
Texts such as ’Pinghu Pulse Studies,’ the ’Pulse Canon,’ and ’Plain Questions’ all record that a rapid pulse indicates Yin being unable to overcome Yang; a rapid pulse pertains to the Fu organs; if strong, it indicates True Fire, and if weak, Deficiency Fire. Furthermore, a rapid pulse is Yang, signifying heat. As the saying goes, ’Address the Sovereign and Minister fires, and use fire to treat.’ Or, there’s the concept of stomach heat at the Guan position [of the pulse] combined with liver fire.
As for pulse characteristics, generally, deficient, faint, fine, and weak pulses all fall under the category of moist pulses. A moist pulse is often seen when stomach qi is insufficient or due to external contraction of yin-dampness."
Du Heng paused briefly, took a breath, and continued, "Coupled with the patient’s dry mouth and desire to drink, these signs corroborate that the patient is suffering from internal damage fever caused by spleen and stomach qi deficiency.
Of course, there’s also the detail of the condition worsening in the afternoon. This relates to the principles of Stem and Branch Point Selection, specifically the time correspondence of the Spleen with the Si hour and the Stomach with the Chen hour, but I won’t elaborate further on that now."
