This Doctor Is Too Wealthy-Chapter 526 - 462 Evil heat obstructs spleen, stomach, liver, and gallbladder_2
"Upper right abdominal colic, body temperature 39°C, blood count showing 18,500 white blood cells/mL, 90% Neutrals—it’s clearly a gallbladder issue. If it were cholecystitis complicated by pancreatitis, the patient’s upper right abdominal pain and vomiting should at least be under control by now.
But as everyone can see, there’s no sign of improvement in the patient’s condition; in fact, it’s worsening. Moreover, the imaging clearly shows an abnormality in the bile duct, so I still maintain my diagnosis of bile duct cancer."
... 𝑓𝓇𝘦ℯ𝘸𝘦𝑏𝓃𝑜𝘷ℯ𝑙.𝑐𝑜𝓂
Listening to everyone talking at once, Xu Pinglin felt a headache coming on. He couldn’t help but knock on the table. "Everyone, let’s put aside the discussion about the bile duct and gallbladder for a moment. Let’s first address how to manage acute pancreatitis.
The patient is now hunched forward due to the pain, with worsening abdominal distension, continuous vomiting, and a persistent high fever. If this isn’t brought under control soon, it will endanger her life."
Everyone fell silent for a moment. Finally, a Deputy Director who had spoken earlier said, "We’ve already administered all the medications we can for the patient, but her high fever persists, and even an injection of duford hasn’t relieved her pain. So, the root problem still lies with the gallbladder. If we can’t identify and resolve the gallbladder issue, there’s no way we can control the pancreatitis."
Xu Pinglin looked helplessly at the people before him. He had called them here to find solutions, but their words were proving useless.
"Director, we don’t know when Director Du will arrive. Should we call for a consultation?"
"Director, my opinion is that we should operate immediately. The patient’s pancreatitis is very severe, and medication is no longer controlling it."
"I oppose surgery. The patient has pancreatitis, and it’s very severe. However, there’s currently an undefined gallbladder problem. Postoperative complications from pancreatitis would become an unavoidable issue. How would you address that?
Besides, if you perform a laparotomy and find that the condition of the gallbladder and pancreas doesn’t permit surgery, are you going to do nothing and just close her up again?"
"Alright, no—"
KNOCK KNOCK KNOCK.
Before Xu Pinglin could finish, there was a knock on the office door. Du Heng then entered, panting slightly. "Sorry, I just rushed back from the university. Am I late?"
Seeing Du Heng, Xu Pinglin felt as if he’d seen his savior; a wave of relief washed over him. "Not late at all, you’re right on time."
After finding Du Heng a chair, Xu Pinglin began to introduce the case. "A 56-year-old female patient presented with colicky pain in the upper right abdomen after breakfast, accompanied by frequent vomiting. She was admitted to the hospital at 1:00 p.m. The severe pain then extended throughout the upper right abdomen, and she went into shock once.
Subsequently, the paroxysmal colic worsened. Her entire abdomen was so tender she couldn’t bear any pressure; even a light touch caused her to cry out in pain, and there was rebound tenderness. Moreover, the patient experienced alternating chills and fever.
These are the patient’s examination report and images, Director Du. Please take a look."
Du Heng accepted them without ceremony and began reviewing them, asking, "What is your diagnostic conclusion?"
"Bile duct cancer complicated by pancreatitis. However, due to the patient’s abdominal distension and unbearable pain, some tests cannot be performed, so the diagnosis of bile duct cancer remains uncertain."
Compared to the others present, Du Heng’s skill in interpreting medical images, while perhaps not on an entirely different plane, was undeniably a couple of tiers higher.
If these people couldn’t find a definitive answer from the images, it was even less likely that he could.
Besides, interpreting images wasn’t his primary strength.
However, looking at the images before him and considering their treatment process, Du Heng also doubted that the patient had bile duct cancer.
"What are the traditional Chinese medicine examination findings?" Du Heng put down the images and looked up at Xu Pinglin.
Xu Pinglin immediately turned his gaze to Doctor Zhou, one of only two Traditional Chinese Medicine Doctors in their department, who had yet to speak. "Doctor Zhou, tell us your findings."
Doctor Zhou, who had initially seemed as timid as a quail, straightened up slightly upon seeing Du Heng seated before them. "The pulse is deep, wiry, rapid, and replete. The tongue coating is yellow, thick, and dry. She has a bitter taste in her mouth and bad breath. There has been food stagnation recently, and she hasn’t had a bowel movement for seven days.
According to her family, the patient is fond of rich, sweet, alcoholic, and dairy-based foods."
Du Heng frowned. Such dietary habits are not good; over time, they would inevitably lead to damp-heat accumulating in the body.
He looked again at the examination report and images in his hand.
Du Heng’s mind raced, integrating the information from the report with Doctor Zhou’s diagnostic findings.
A thick, dry, yellow tongue coating, a bitter taste in the mouth, bad breath—all signs of damp-heat.
And the pulse being deep, wiry, rapid, and replete—such a complex combination made Du Heng furrow his brows again.
He wasn’t doubting Doctor Zhou’s diagnosis. After all, Doctor Zhou was older than him and eligible for promotion to Deputy Director next year; how could he make a mistake in pulse diagnosis?
His frown merely reflected how acute and chaotic the patient’s condition truly was.
Du Heng let out a slow breath.
Soon, Du Heng reached a conclusion: The patient suffered from internally accumulated damp-heat. Pathogenic heat was obstructing the spleen, stomach, liver, and gallbladder, leading to a severe case of heat binding in the chest and a Yangming organ-excess syndrome.
This diagnosis wasn’t difficult, but what was causing the pathogenic heat to obstruct the spleen, stomach, liver, and gallbladder? Gallstones?
Even if Du Heng’s skill in interpreting images was lacking, he could still recognize gallstones on a scan.
The current images showed an enlarged gallbladder, dilated intrahepatic bile ducts, and common bile duct, with slight dilation of the pancreatic duct.
Overall observation revealed no high-density shadow typical of gallstones. Instead, a soft-tissue density shadow was visible in the middle and lower sections of the common bile duct, which was very strange.
A soft-tissue density shadow... could it be viscous bile?
Du Heng scratched his head in confusion.
However, that wasn’t the most critical issue at the moment. The priority was to control the progression of the patient’s condition.
The patient was already exhibiting the three major severe symptoms of pancreatitis. Every second of delay increased her suffering and the danger she was in.
Moreover, the topics Xu Pinglin and the others were discussing were entirely unrelated to his approach to treatment. Therefore, he didn’t need their conclusions to treat the patient.
"Director, may I see the patient first?"
"Yes."
Then, the large group of doctors made their way to the ward.
Just as Du Heng and the others reached the doorway of the hospital room, they saw the patient leaning over the edge of her bed, retching violently, so much so that she was struggling to catch her breath. A family member was patting her back, their face etched with worry.
Her complexion was yellowish, and she appeared listless.
After the retching subsided, she began to cry out in pain again.
Du Heng went to the front, took the patient’s wrist to reconfirm the pulse diagnosis. The findings were not much different from what Doctor Zhou had reported.
However, the woman’s fingernails, though short and neat, had a layer of grime under them—very dark, almost black grime!
Du Heng exhaled softly. Looking at Gu Ping, who had followed them in and was now standing at the back, he said, "Gu Ping, bring me the needle tool kit."
Xu Pinglin quickly asked, "Director Du, what are you planning to do?"
"The patient has internal damp-heat, with pathogenic heat obstructing the spleen, stomach, liver, and gallbladder. I am now going to perform acupuncture to drain the stagnant heat from her gallbladder and stomach. This should alleviate her pain."
As soon as Du Heng finished speaking, someone behind him frowned.
They were aware of Du Heng’s high level of skill.
But from his words, they understood he planned to use acupuncture. Did he really think acupuncture could provide better pain relief than duford?
However, being in the hospital room, even if they had doubts, they wouldn’t voice them; they possessed that much professional decorum.
At the same time, while somewhat disapproving of Du Heng’s proposed action, they remembered the past year. Du Heng had repeatedly shown them it was best not to question him casually, lest they be proven embarrassingly wrong.
Xu Pinglin didn’t overthink it. Hearing Du Heng, he hurriedly asked, "What herbal formula are you planning to use? Tell me now, and I’ll have someone prepare it immediately. We need to hurry."
Du Heng remained silent.
He knew pathogenic heat was obstructing the liver and gallbladder, but how it was blocked and why it had manifested as an excess syndrome still needed investigation. Without understanding this, he couldn’t readily prescribe an herbal formula.
"Let’s wait for now. I’ll first alleviate the patient’s pain. Once she has calmed down, I will examine her again and then decide on the appropriate herbal formula based on her condition."
