This Doctor Is Too Wealthy-Chapter 598 - 500 Medication is like using soldiers
The profoundness of the Chinese language was truly manifested at this moment.
However, Du Heng did not appreciate it.
"Teacher, can we go see the patient?"
"Sure, let's go now."
As the three of them headed out, Li Jianwei added, "The renowned Qing Dynasty doctor Gao Jinting mentioned in his book, 'Experience Gained in Treating External Diseases,' that all external diseases, if their symptoms are in the upper body, are caused by wind-dampness, wind-heat, or the upward movement of wind. Moreover, in traditional Chinese medicine, there's a saying: 'Only wind can reach the head and face.' So, I diagnosed it as wind-heat and used medicine to expel wind and clear heat. It's now the second day of treatment. The patient's itching has eased somewhat, but the erythema hasn't subsided. Xiao Heng, did I make a mistake in my diagnosis?"
Li Jianwei consulted Du Heng without any reservation, not minding his own status as a Teacher. He treated Du Heng as a peer.
Xiao Su, who followed closely, dared not even breathe too loudly, fearing he might make a sound, be noticed by Li Jianwei, and then be promptly dismissed.
Du Heng listened as he walked, mulling over all the characteristics before saying, "I can't say for sure right now. Let's take a look at the patient's specific situation first."
Li Jianwei didn't press further and led the way towards the hospital room.
Du Heng watched Li Jianwei's back from slightly behind and felt a great deal of admiration. This was precisely why he had chosen to become Li Jianwei's graduate student; he valued this quality.
If it were other doctors of the same rank, they would never have consulted a young doctor like Du Heng, especially since Du Heng was still a student. They simply wouldn't have asked for his opinion. Instead, they would rather spend time finding doctors at their own level, or even more experienced seniors, for consultations.
When they arrived at the hospital room, the patient's condition was indeed similar to what Li Jianwei had described. The sides of the patient's nostrils were very thick and covered in erythema. Upon closer inspection, this erythema was mainly concentrated on the LI-20 acupoints on both sides of the nostrils.
The LI-20 acupoint is where the hands and feet yang brightness large intestine channel and stomach meridian converge.
Looking at the tongue, the coating was yellow and dry, the tongue itself was slightly red, and the pulse was deep and strong.
A yellow tongue coating indicates a heat pattern.
Dryness indicates exuberant heat damaging Yin.
A red tongue with a yellow coating indicates excess heat.
A deep and strong pulse indicates interior excess.
Combining all these symptoms, it was clear the patient had an internal excess heat syndrome. How could it possibly be a wind disease? One can't diagnose wind or dampness syndromes just because the patient has itching and erythema.
However, Du Heng couldn't say this out loud. As for the patient's actual illness, he certainly couldn't discuss it in front of the patient. Otherwise, no matter how willing Li Jianwei was to learn from his juniors, he would still lose face.
"Teacher, I've finished my examination."
"Do you have a conclusion?"
"Not yet. Allow me to go back and think it over."
Li Jianwei's eyelids twitched. He could tell Du Heng wasn't being entirely forthright, and of course, he understood why Du Heng was acting this way.
So, he didn't reject Du Heng's considerate gesture and went along with it. "Alright, let's return to the office and think it over carefully."
With that, the three of them went back to the office, leaving the patient quite puzzled as to the purpose of their visit.
As soon as they returned to the office, Li Jianwei eagerly asked Du Heng, "Xiao Heng, have you figured out what the illness is?"
Du Heng nodded. "The patient likely has pathogenic heat accumulated in the large intestine, which has then surged upwards along the Yangming meridians, manifesting as a rash and itching on the face. It's a syndrome of yin deficiency heat."
"Yin deficiency heat?" Li Jianwei immediately furrowed his brows. "So my diagnosis was wrong? It's not wind-heat?"
Du Heng wasn't sure what expression to wear, so he maintained a serious look and said, "The illness indeed presents with a rash on both sides of the nostrils, accompanied by a burning sensation and itching. If it weren't for the fact that the condition worsens with constipation and alleviates with regular bowel movements, it could be diagnosed and treated as wind-heat. But given these current circumstances, and the rash being concentrated around the LI-20 acupoints, the root of this illness can only be in the large intestine."
At this moment, Xiao Su suddenly asked, "Du, why would constipation cause erythema to appear on the sides of the nostrils and the face, along with a burning, itchy sensation?"
Prompted by Du Heng's analysis, Li Jianwei had a moment of clarity, understanding where he had gone wrong. Without waiting for Du Heng to reply to Xiao Su, he explained, "This relates to meridian theory. Within the meridians, the Large Intestine Meridian of Hand-Yangming originates at the tip of the index finger, travels up the arm... and finally connects to the philtrum, flanking the nostrils. Meridians are the pathways for qi and blood in the human body, connecting the external musculoskeletal system with the internal viscera. In this case, the illness is in the large intestine. Because of the heat in the large intestine, yin humor has been consumed, leading to dry stools and constipation. This obstructs the pathways. The pathogenic heat, having no downward route, travels upwards along the meridians, reaching the terminus of the Yangming channels—the nostrils. As the pathogenic heat escapes from the nostrils, a burning, itchy rash appears on both sides of the nostrils."
Li Jianwei sighed. "If the syndrome differentiation is wrong, the treatment method will also be wrong. We shouldn't be expelling wind and clearing heat to open the upper body. Instead, we must clear the lower pathways to allow the heat to descend. That is the correct approach."
Li Jianwei could be somewhat rigid in his diagnostic approach, lacking flexibility. However, his foundational skills were truly impeccable.
Li Jianwei looked at Du Heng and said slowly, "Xiao Heng, since you've figured it out, go ahead and write the prescription."
Du Heng agreed, took a pen and paper from Li Jianwei's desk, and quickly wrote out the prescription.
Li Jianwei took the prescription, glanced at it, and nodded repeatedly. Then he handed it to Xiao Su, telling him to study it carefully.
Xiao Su was now very clear about his role: he was a student. Whether beside Li Jianwei or Du Heng, he was there to learn.
After reading Du Heng's entire prescription, he fully exercised a student's prerogative to ask when confused. "Du, this prescription is intended to moisten the intestines and promote bowel movements. So why add Unripe Bitter Orange and White Atractylodes Pill? Unripe Bitter Orange and White Atractylodes Pill is for spleen tonifying and resolving dampness. That doesn't seem to fit this prescription, does it?"
Du Heng laughed. "Constipation is related to disrupted intestinal function. Unripe Bitter Orange and White Atractylodes Pill not only tonifies the spleen and resolves dampness, but it also has an excellent effect on regulating intestinal function. Once intestinal function is regulated, bowel movements will naturally become smooth."
Xiao Su was taken aback. "Does Unripe Bitter Orange and White Atractylodes Pill really have that effect?"
Li Jianwei glared at Xiao Su. "You should read the latest pharmacological research. Many common medicines we use have additional effects that weren't previously noted."
Meeting Li Jianwei's gaze, Xiao Su immediately lowered his head and muttered defiantly, "I have so many books to read and so much homework every day. Where would I find the time to look at these unrelated things?"
Li Jianwei heard him clearly, and his eyes narrowed. "You don't have time? Then how does your Senior Brother Du find the time? He has to manage the hospital, concern himself with its development, see patients in the outpatient service, and write papers. How does *he* find the time to look at those 'unrelated things'? Lazy is lazy. Don't make excuses for yourself."
Xiao Su felt resigned. He knew a scolding was inevitable, but he hadn't expected it to come so swiftly.
"Du, do you have any secret study tips? Please share them with me," Xiao Su pleaded, looking at Du Heng with a pitiful expression.
Du Heng smiled faintly. "Time... well, if you squeeze it, you can always find some. And every evening, I make sure to study for two hours. It's about consistent effort, day by day."
Xiao Su looked at Du Heng in astonishment. "Du, you're already a Dean, and your skills are so advanced, yet you still study for two hours every night? How are the rest of us supposed to keep up?"
Hearing Xiao Su's lament, Li Jianwei chuckled. "See? People more outstanding than you are still working hard every day. What right do you have to slack off? You can't just focus on Du's public successes and ignore the sweat he pours in behind the scenes."
Du Heng broke out in a cold sweat from this praise.
Xiao Su looked at Du Heng with a hint of grievance and asked his final question. "Du, I understand the Unripe Bitter Orange and White Atractylodes Pill, and that makes sense. But isn't this pear cream a bit too abrupt?"
Instead of answering directly, Du Heng smiled and asked Xiao Su, "Take a closer look. What did I write next to the pear cream?"
Xiao Su looked puzzled. Had anything been written there?
He looked down at the prescription again and saw two words written next to the pear cream: "Additional."
"Additional?"
"Yes. Do you know why it says 'Additional'?"
Xiao Su thought for a moment, then said uncertainly, "Does it mean the pear cream isn't part of the main prescription but is to be taken separately? But why add it? A medicine for treating the lungs doesn't have much to do with the large intestine, does it?"
Du Heng smiled gently, trying not to pressure Xiao Su. "In traditional Chinese medicine theory, there's a concept that 'the lung is connected to the large intestine.' Simply put, for the intestinal function to be normal, it requires the cooperation of the lung function. Furthermore, as our Teacher mentioned earlier regarding Meridian Study, the large intestine meridian, in its circulation, connects to the lung and pertains to the large intestine. Pear cream has the effect of nourishing Yin and moistening the lungs. When lung Yin is sufficient, it can then moisten the large intestine. Therefore, adding pear cream also helps to moisten the intestines and promote bowel movements."
Xiao Su nodded blankly.
Meridian Study, traditional Chinese medicine theory... he'd studied these things, read books on them. But in front of Du Heng and Li Jianwei, he always felt the books he'd read weren't the same kind as theirs. The things they discussed never seemed to appear in the books he was familiar with. And he'd been studying for eight years! Yet, before these two, he always had the disorienting feeling that he'd read counterfeit books and attended a sham university.
Could it be that Li Jianwei hadn't taught him properly?
Xiao Su secretly glanced at Li Jianwei.
Li Jianwei, however, let out a long sigh. "In traditional Chinese medicine, everyone says syndrome differentiation is difficult, but what they often don't realize is that prescribing medication is even harder. We have a saying in our field: 'Using medicine is like deploying troops.' Treating diseases with medication is like fighting a war; to achieve victory, one must consider everything thoroughly. Many of our doctors can talk a good game, but when it comes to the critical moment of treatment, they often fall short. This is a clear sign of not knowing how to use medication properly."
After a brief pause, he took the prescription back, signed it, and said to Xiao Su, "Get this prescription filled. Have the patient's medicine changed tonight."
"I understand, Teacher."
