morning.
Around 8:30.
All the doctors at the First People's Hospital of Beijing have started working, and the Department of Traditional Chinese Medicine is no exception.
Su Zhengnan, dressed in a white coat, sat in the outpatient room and soon welcomed his first patient of the day.
A man who looked to be in his thirties, holding a registration slip, walked slowly into Su Zhengnan's clinic with a worried and uneasy expression on his face.
However.
When he saw four or five doctors sitting in the room, he was stunned.
Did I go to the wrong place?
Doesn't each outpatient room in the Traditional Chinese Medicine department only have one doctor seeing patients?
Why are there so many doctors here?
He Guangzhi pushed open the door and walked in, only to find four or five pairs of eyes staring at him, which made him feel quite uneasy.
Su Zhengnan glanced at him and greeted him with a smile, "You're here to see a doctor, right? Let me see your registration slip!"
"Okay, sure!"
Upon hearing this, He Guangzhi snapped out of his daze and stepped forward to hand over the registration slip he was holding.
Su Zhengnan took the registration slip and glanced at it. It read:
[Name: He Guangzhi]
Gender: Male.
Age: 34.
[Registration: General Traditional Chinese Medicine Outpatient Clinic.]
[Other information: None.]
.................
After glancing at the registration slip in his hand, Su Zhengnan skillfully typed the other person's name into the computer and asked casually:
Tell me where you feel unwell. Is it a headache? Or chest pain?
Just one glance.
Su Zhengnan was able to discern a trace of the other person's illness through observation, which is why he asked this question.
He Guangzhi blinked and replied softly:
"Doctor, for the past few days I've been feeling tightness and unease in my chest, and I also have a severe headache. I went to the Western medicine department for a checkup, but they couldn't find anything wrong, so they suggested I come here to see a traditional Chinese medicine doctor..."
Feeling tightness in the chest and anxiety?
Do you have a terrible headache?
This should be a typical sign of insufficient Qi and blood, but there are many causes that can lead to chest tightness, palpitations, and headaches.
Su Zhengnan diagnosed the cause of the patient's illness with just one glance, but he couldn't say anything directly, since there were several students following behind him!
They don't have the divine medical skills of visual diagnosis!
So after pondering for a moment, Su Zhengnan said to the patient in front of him:
"Extend your hand, let me take your pulse and check your condition."
"Okay, sure!"
He Guangzhi nodded, then raised his hand and placed it on the pulse pillow on the desk.
Su Zhengnan reached out and placed his hand on the other person's wrist, only to feel that the pulse was weak and feeble. He then looked at the other person's tongue and found that it was pale with a white coating.
The pulse is weak and feeble, the tongue is pale with a white coating, and symptoms such as palpitations, chest tightness, shortness of breath, and headache are also present.
This suggests that the patient suffers from a deficiency of heart yang and blood stasis, which prevents the heart and mind from being warmed and nourished, thus causing this condition.
When the Yang energy is deficient and unable to warm the limbs, the body becomes cold and the limbs feel cold.
A pale tongue with a white coating, and a weak or thready pulse, are all signs of insufficient heart yang.
However, there are several types of heart yang deficiency, and the treatment methods vary depending on the cause!
Thinking of this, Su Zhengnan put away his right hand that was taking pulses, turned around and said to Li Haoran, Zhao Dongyang and Cheng Jingya:
"The three of you come over here, let me take your pulses, and then we'll discuss your diagnoses and treatment plans."
As he spoke, Su Zhengnan stood up and gave up his seat, then smiled and said to Sun Huaiwei:
"After they've taken your pulse, you can go up and feel it too. You can first take your own pulse and then try to distinguish the difference between it and the other person's pulse."
"You should know how to take your own pulse, right?"
"The cun, guan, and chi positions on the left hand correspond to the heart, liver, and kidney, as well as the small intestine, gallbladder, and bladder, respectively."
"The cun, guan, and chi positions on the right hand correspond to the lungs, spleen, and kidneys, as well as the large intestine, stomach, and mingmen (gate of life), respectively."
"I know that, but I'm not very good at sensing pulses, and I'm not good at distinguishing them."
Sun Huaiwei nodded blankly.
Su Zhengnan smiled slightly and said, "It's alright, take your time. You can't be impatient when learning pulse diagnosis, otherwise it will only backfire."
As the two were talking, Li Haoran had already walked up to the patient and reached out to take his pulse.
He Guangzhi blinked, looking bewildered, and stared in disbelief at the noticeably younger Su Zhengnan, muttering a question:
"What...what's going on? Weren't you the one who treated me?"
Even if He Guangzhi were stupid, he could tell that there was something wrong with the situation. But he wasn't a doctor, so he didn't know the difference between outpatient doctors and interns. He just thought that anyone wearing a white coat in the hospital was a doctor.
So when he saw several doctors in white coats preparing to take his pulse one by one, He Guangzhi felt that his brain was clearly not up to the task.
Could it be that I have some kind of terminal illness?
Why do several doctors have to take my pulse in turn?!
Upon hearing this, Su Zhengnan couldn't help but smile and say, "Mr. He, you don't need to be nervous. Your illness is nothing serious. They are just taking your pulse for learning purposes. Don't worry, you'll be fine."
"Huh? Studying?"
He Guangzhi looked stunned and couldn't quite process what was happening. It took him a while to realize that the people in white coats in front of him weren't doctors, but medical students who had come for internships.
The three of them, Li Haoran and his companions, didn't spend much time taking each other's pulses; it was over in less than ten minutes.
"Alright, you go up and have your pulse checked too!"
Su Zhengnan smiled and said something to Sun Huaiwei, then turned to Li Haoran and the other two and asked:
"Tell me your three perspectives on this patient's diagnosis and treatment plan."
Upon hearing Su Zhengnan's question...
Li Haoran, Zhao Dongyang, and Cheng Jingya exchanged glances.
Then, Li Haoran was the first to speak: "I think this patient's weak constitution caused by insufficient heart yang, so the treatment should focus on nourishing the body and mind and warming and replenishing the heart yang."
"The patient does indeed show signs of heart yang deficiency, but how can you be sure it's caused by a weak constitution?"
Su Zhengnan smiled and continued to ask the other party.
Li Haoran blinked and said, "The patient is rather thin and weak, and shows signs of qi deficiency and palpitations, so I think it is caused by a weak constitution."
"Hmm, not bad!"
Su Zhengnan nodded, then asked Zhao Dongyang and Cheng Jingya, who were standing to the side:
What do you two think?
Zhao Dongyang thought for a moment and replied seriously, "The patient's tongue coating is pale and he has palpitations and anxiety. I think the patient is probably experiencing emotional distress and heart yang deficiency caused by emotional distress. I think the treatment should focus on calming the mind and relieving palpitations."
Upon hearing this, Su Zhengnan turned to Cheng Jingya and asked, "What do you think?"
Cheng Jingya pondered for a moment and said, "My opinion is the same as Senior Li's. I also think it should be caused by a weak constitution and a lack of heart yang."
Su Zhengnan raised an eyebrow slightly and said, "Although you did not make a mistake in taking the pulse, you did not notice that the patient's complexion was dull and that there was a thin blue vein on his forehead. This shows that your observation skills are not good enough!"
"How can you neglect the four diagnostic methods of observation, auscultation, inquiry, and palpation when you cannot be 100% certain of the cause of the disease?"
"What?"
Upon hearing Su Zhengnan say this...
Immediately, Zhao Dongyang and the other two walked up to the patient He Guangzhi and examined him closely. Sure enough, they found a slightly raised, bluish vein on his forehead.
This meridian is located slightly above the right side of the forehead, but it's hidden by the hair, so they didn't even look at it closely.
"But...but what does this mean?"
Zhao Dongyang turned to look at Su Zhengnan, his face full of eager curiosity, and asked, "I hope Teacher Su can give me some guidance."
Su Zhengnan said calmly, "The bluish-purple discoloration of the upper veins is a sign of blood stasis, so this patient not only has a problem with weak heart yang, but also blood stasis."
"This condition is generally caused by the patient's exposure to external pathogens or improper medication or diet, leading to deficiency of heart yang, blood stasis, and inability to warm and nourish the heart and spirit, hence palpitations, restlessness, chest tightness, and shortness of breath..."
"Therefore, the treatment should be based on the principles of promoting blood circulation, removing blood stasis, and warming and tonifying the heart yang."
As Su Zhengnan spoke, he went to the computer and started typing on the keyboard to open a prescription.
"Ginseng, aconite, dried ginger, cinnamon twig, salvia miltiorrhiza, chuanxiong, red peony root..."
He Guangzhi, sitting opposite him, was completely confused. Only now did he realize that the youngest, Su Zhengnan, was the real outpatient doctor, and the others seemed to have all come to learn from him.
At this time, Sun Huaiwei had also finished taking the pulse.
After writing the prescription, Su Zhengnan smiled and asked her, "How was it? How was your first time taking a patient's pulse?"
“I… I can’t quite put my finger on it, but judging from the patient’s pulse, I think it’s a sign of liver qi stagnation.”
Sun Huaiwei replied with a blank expression.
A hint of admiration flashed in Su Zhengnan's eyes as he said, "To be able to diagnose liver qi stagnation on your first pulse diagnosis, it seems you do have some talent in traditional Chinese medicine!"
"Indeed, liver qi stagnation can also affect heart function, leading to poor heart qi circulation."
"But judging from the patient's tongue coating, it is clearly not liver qi stagnation. So you must remember that when making a diagnosis, you must not make a hasty conclusion based on a single symptom. You must make a judgment based on all the patient's symptoms."
As they spoke, Su Zhengnan had already written the prescription and smiled at He Guangzhi, saying:
"Take the registration slip to pay the fee, and then go to the Chinese medicine pharmacy to pick up the medicine. Try to rest as much as possible while taking the medicine, and don't stay up late to work."
"Yes, yes, I understand, thank you, doctor."
He Guangzhi nodded and thanked him repeatedly, then took the registration slip and left the consultation room.
Watching the departing figures, Li Haoran and the other two exchanged glances, then looked thoughtfully at the prescription displayed on the computer.
...........................................
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