This doctor is not short of money

"Dr. Ling, I have a question."

Classmate Ling, who was standing in front, heard Du Heng suddenly interrupt and panicked for no reason.

The case he chose this time was carefully selected by him. It is a very rare condition that is worthy of discussion. Therefore, his preparations were very sufficient and complete, and the PPT was even more exquisite.

With such preparation, he thought he could handle all the questions and in-depth discussions, but as soon as Du Heng opened his mouth, he immediately felt that there was something he might not have done well.

Self-doubt immediately skyrocketed!
It's not that he is a coward, but that Director Du Heng in front of him is a bit too scary, and the impression left on him is also very domineering.

The first time he met Du Heng was in the second month after he came to Guipei last year. At that time, he saw Du Heng cleaning up Dr. Li.

In front of the whole department and the patients, he mercilessly exposed Dr. Li's pretensions to Pisine, and even heard that he wanted to drive Dr. Li away.

Who is Dr. Xiao Li?

That was the son of the director of the No. [-] department in the hospital: the Department of Integrated Traditional Chinese and Western Medicine.

Although he was not actually fired later, he completely saw what happened to Dr. Li during that time.

Later, Director Du went abroad and heard less news. But when he heard the news again, it was Director Du who tested the medicine himself and single-handedly solved the local infectious disease outbreak.

What's even more incredible is that he actually donated his own life for a prescription that was said to be worth several million.

If he's so awesome, why doesn't he go to heaven?
And before they could digest the news, Du Heng suddenly became their director, the man who could decide their careers.

Although he only lasted two months as the director, and the time they got together was only three weeks, no, not even two weeks because of the holiday, but as long as this person appeared in the hospital, every time he asked questions or commented on others, At all times, I always speak to the point and speak from the bottom of my heart.

Look at the current attending doctors in the department. Which one of them would not tremble when they see Du Heng?

Especially those who switched jobs with Director Yang and jumped back some time ago. Judging from the way they walked with their legs crossed after seeing Director Du, it is estimated that the two bells have shrunk.

Fortunately, this person usually doesn't make things difficult for interns and trainees like them, so when he saw Du Heng sitting down today, he was still in a very relaxed mood.

But now that Du Heng was the first to stand up and ask himself a question, he was really trembling.

Regular employees probably only get scolded a few times, but since I am a graduate student, my life is really in their hands.

If you don't perform well today and don't sign on the training form, then you will really be in trouble.

At this time, Du Heng was also a little dumbfounded. He only said one sentence, and the student Ling standing in front of him had his eyes blank and his hands were trembling.

Could it be that this young man had a medical emergency?

Du Heng also trembled in his heart.

My bad luck has disappeared recently, but could it have been transferred to the people around me?

First, he met Lou Guozhang for the first time. Lou Guozhang's plan that had not been formed for three years suddenly came into being. Then, Master Li was beaten to the point of hemiplegia by his grandson and others.

Now it was this classmate Ling again, and the drama in Du Heng's heart suddenly doubled.

Fortunately, at this time, Dr. He suddenly said in a deep voice, "Xiao Ling, are you okay?"

Student Ling came back to his senses instantly, put on a stiff smile and said, "Teacher He, I'm fine."

Then he took a deep breath, turned to look at Du Heng and said, "Sorry, director, I was a little nervous just now, but I'm fine now. You can ask."

He was quite nervous and even spoke with vibrato.

Du Heng also took back his inner drama, and said softly with a smile, "Don't be nervous, I just didn't hear your dialectic of the case clearly just now, so I want you to explain the dialectical relationship again. Is there any problem?"

Student Ling took a deep breath again, silently cheered himself up, and then said, "No problem, director, I'll say it again."

"The patient, a 36-year-old woman, had trismus and was unable to make sounds one month ago. She was diagnosed as 'massive muscle spasm' by the previous hospital. She was discharged after ten days of medication without effective treatment."

"After seeking medical treatment for many days without any results, he came to our hospital for treatment four days ago. He was diagnosed with mutism and was admitted to the hospital for treatment."

"The patient has stiffness in the temporomandibular joints on both sides, pain, difficulty opening his mouth, a loose and tight pulse, and a pale tongue. The above symptoms are consistent with the characteristics of cold syndrome, which is contraction and stagnation."

"Cold regenerates dampness, and dampness regenerates phlegm. Excessive phlegm and dampness will block the meridians. This is consistent with"

"Based on the comprehensive consideration of the above characteristics, the final syndrome is cold-damp stagnation and phlegm paralyzing the meridians."

At the beginning, classmate Ling was still quite nervous and spoke intermittently with a touch of vibrato, but as he spoke, the young man adjusted his state back.

In addition, I was fully prepared beforehand, so in the later stage, I can say that I spoke fluently.

After listening to it, Du Heng asked directly, "The whole dialectical process is logically clear and smooth from front to back, which is very good.

But have you ever considered where this 'cold' comes from? "

Classmate Ling was nervous again.

Where does the cold come from?

Of course it's because of the cold.

But he didn't dare to say that, so he could only secretly glance at Doctor He who was not far away from him.

Dr. He was actually a little confused.

He is Ling's superior doctor, so Ling's patient treatment was completed under his supervision and guidance. So what Ling is talking about now can actually be said to be his treatment ideas.

Student Ling doesn't know this now, so of course he doesn't know either.

But now the director asked, what should we do?

Fortunately, Du Heng had no intention of embarrassing Student Ling at this time. Seeing that Student Ling did not speak, he directly said, ""Su Wen. Wind Theory" said: Wind is the cause of all diseases.

According to the symptoms seen in daily life, it can also be found that evil spirits such as cold, dampness, dryness, and heat are mostly attached to wind evil and invade the human body.

This is the first reason why I ask you where the patient's cold comes from. "

If there was the first reason, then there must be the second reason. Ling, who was standing in front, immediately calmed down and focused all his attention on Du Heng.

"You just said that the patient has obvious pain in the temporomandibular joint, but he also has wandering pain in other parts of the body, accompanied by mild itching that comes and goes. This feature makes sense when it comes to cold syndrome, but It’s not very accurate, but it’s very responsive to rheumatism.”

Du Heng was neither impatient nor impatient, and slowly explained, "The nature of wind changes due to good deeds, so wind evil has the characteristics of coming and going quickly and changing frequently.

Therefore, when suffering from wind syndrome, most patients will have traveling pain all over the body, which is classified as wind paralysis.

As for the itching that comes and goes, you didn’t mention it just now, but if I’m not mistaken, you treat it as eczema on the basis of cold and dampness, right? "

Student Ling nodded directly.

Du Heng chuckled and said, "The skin is itchy and has red rashes, and there is moisture in the body, so it is easy to mistake it for eczema.

However, the characteristic of this patient's rash is that it appears and disappears one after another, which is different from the characteristic of eczema that does not go away easily.

This disease is rubella caused by wind evil. "

It turned out to be the case.

Classmate Ling and Dr. He nodded lightly together.

The issue Du Heng is talking about now is the point they want everyone to discuss today.

After several days of treatment, the patient's dyslexia has been relieved and he can already produce some monosyllabic words.However, the rash on the patient's body never went away and kept recurring.

Now they know that their treatment direction was wrong.

Get rid of the wind.

This time, the two of them listened more seriously.

Du Heng took a breath and then continued, "The third feature you ignored is the location of the patient's disease.

Wind is a yang evil with the characteristics of rising, upward, and outward, so it is very easy to invade the head, face and skin of the human body. This is consistent with what I just said.The patient's muteness is caused by the wind phlegm formed by this characteristic of wind nature.

Why is it said to be caused by wind and phlegm? There is another reason, that is, the onset is rapid.If it is cold phlegm, it will not develop so quickly.

The rapid onset of wind phlegm is actually very common. For example, some patients suddenly experience facial paralysis or palms turning into chicken claws as soon as they wake up or after sweating and walking, which are caused by wind phlegm.

The mouth and eyes of patients with facial paralysis are crooked, and the fingers and arms of chicken-clawed hands are spasmodic and twitching. This is another characteristic of wind nature and is prone to movement, which is very common in strokes. "

At this point, Du Heng suddenly stopped for a moment, then shook his head gently and stopped elaborating.

Unknowingly, he expanded the topic to the field of stroke paralysis.

At this time, seeing that Du Heng didn't look angry, classmate Ling bravely said, "Then my treatment is in the wrong direction?"

Du Heng smiled noncommittally, "It's not right, but it's not wrong either."

What do you mean?
Classmate Ling was a little confused, and so was Dr. He, who had been silent next to him.

"To be precise, the dialectic of this patient is the evil of wind and cold, stagnant Qi and blood. Wind syndrome is the main cause, but there is also cold syndrome, so it will definitely be useful if you follow the path of treating cold syndrome."

Du Heng said with a smile, "But it will take a little longer, and the patient will suffer more if the rheumatism persists.

But as the cold and dampness recedes, the wind evil becomes rootless water, and will naturally heal as the body's ability to adjust itself increases.

Okay, now that the dialectics is over, let’s move on to your treatment methods and medications. "

Student Ling's face immediately fell.

How can you say this? You have rejected the dialectical results, so how can the treatment and medication be correct?

Even if half of it is right, half is still missing.

But after quietly glancing at Du Heng who was staring at him, Ling sighed softly and had to say, "Based on the previous dialectics and the fact that the patient's lower limbs are slightly swollen, the original treatment method is to remove dampness and phlegm and warm Yang. To diuresis, use Zhenwu Decoction.

But now that the director has said this, this idea and medication are obviously wrong. "

Classmate Ling has already started brainstorming. He wants to find the most suitable method and prescription in the shortest time.

However, this kind of thing requires him to be quick-thinking and have a flash of inspiration, otherwise the more hasty he is, the more likely he is to make mistakes, and Ling is now trapped in this strange circle.

The more anxious he is, the less clear he can think, and the less clear he is, the more anxious he is.

But fortunately, his basic skills were very solid, and he suddenly thought of a more reliable method, "I think I can try it with the 'Duhuo Jisheng Soup'."

Du Heng's eyes lit up, "Yes, Duhuo Jisheng Decoction, which heavily uses Duhuo, Sanji, Eucommia and other medicinal materials, is a very good prescription for dispelling wind and dampness, and it also has the effect of relieving paralysis and pain.

You said before that the patient had edema in both lower limbs. This was probably caused by the use of muscle relaxants such as eperisone or baclofen during previous treatment.

This type of medicine has one thing in common, that is, it can cause damage to the liver and kidneys, so there will be symptoms of slight edema and loss of water.

Duhuo Jisheng Decoction uses medicinal materials such as locust, eucommia, and achyranthes bidentata that can nourish the liver and kidneys, which can play a role in strengthening the body and strengthening the body.

Very good, this prescription was chosen very well. "

Upon hearing Du Heng's approval and praise, student Ling, who had been looking confused and nervous just now, suddenly beamed with joy and could hardly hold back his lips.

I just randomly picked up a prescription name that popped up in my mind, but I didn't expect it to be completely correct.

So happy.

But within two seconds of raising the corners of his mouth, Du Heng continued, "But it's not that interesting, the patient is mute and has paralysis of the temporomandibular meridians on both sides.

However, this prescription is not very effective in softening the meridians, so it is only half as effective as the Zhenwu Decoction you used before.

Is there any better choice? "

Student Ling's smile froze on his face, and he didn't know whether to laugh or cry for a moment.

Can't you finish it in one breath? Why do you have to take a big breath?

Classmate Ling cursed, then secretly glanced at Dr. He.

Dr. He ignored Mr. Ling, pondered for a moment and then said to himself, "The director just said that this patient should be suffering from the invasion of wind and cold, which stagnates the qi and blood.

Considering that she is mute, I think the treatment should be to dispel wind, relieve external symptoms, and soften meridians and relax collaterals. "

Everyone remained silent, waiting for his next words.

Director He did not let everyone wait, but paused slightly before continuing, "Wind evil is the main symptom, and muteness is also caused by wind, phlegm, and wind paralysis, so dispelling wind should be the primary goal.

The best way to dispel wind is to sweat and relieve inflammation, so I think using kudzu soup to dissolve the wound is the most appropriate choice. "

Du Heng didn't say anything, but looked at the others with a smile. After all, it was a discussion meeting. What would it be like if he was just talking alone.

As soon as Du Heng glanced at it, Cao Binghe immediately took it, "I agree with what Dr. He said about the treatment method, but in terms of usage, I think it would be better to use 'Zhuifeng Tougu Pills'.

It can dispel wind and dampness, unblock meridians and activate meridians, dispel cold and relieve pain, especially for wind-cold paralysis. "

With the participation of Cao Binghe, the symposium truly had the appearance of a symposium, and several attending physicians present expressed their own opinions.

Some people proposed new treatment plans, some agreed with Dr. He's methods, and others agreed with Cao Binghe's medication, but slowly, in the end, only Dr. He and Cao Binghe's prescriptions were left.

In the end, Deputy Director Di, who was still sitting next to Du Heng and kept silent, made the final decision, "Whether it is Pueraria lobata soup or Zhuifeng Tougu Pills, they are the best choices as long as there are no accidents.

But when you discuss it, it seems that you only focus on the superficial effects of the medicine and ignore the patients themselves.

And the issue you ignored is exactly the issue you just discussed and the director also mentioned, which is that this patient suffered damage to his liver and kidneys because he took muscle relaxants.

It just so happens that Zhui Feng Tougu Pills can also put a burden on liver and kidney function.

Although this burden is not very heavy and the impact on this patient should not be great, but to choose the best among the best, Gegen decoction is more suitable. "

Du Heng smiled softly. He was very satisfied with the result. This kind of scene had never been seen before when Director Wu was in charge. Everyone basically went their own way.

If there are disputes, that means there are ideas. If there are ideas, that means there is thinking. If there is thinking, that means we are learning and making progress. This is good.

Especially Deputy Director Di's final call at the end made Du Heng extremely happy.

What is the biggest advantage of veteran comrades?
Of course it comes from experience.

Zhuifeng Tougu Pill is not a commonly used medicine, because there are better choices among the same type of medicine, so this is also the reason why Cao Binghe chose the right medicine, but it is slightly inferior.

With Deputy Director Di, the discussion on this case is basically over.

But now that it has been discussed, Du Heng's idea is to do the best so that everyone can really gain something.

So after coughing lightly to attract everyone's attention, Du Heng said, "The best way to treat the disease of mutism is to treat it both internally and externally.

Oral decoction is used to dispel wind and cold, external acupuncture is used to unblock the meridians and soften the meridians, and the five internal organs and meridians are treated at the same time. A two-pronged approach should quickly improve the meridian paralysis. "

Du Heng then turned to look at Tang Jinhan, who was acting as a transparent person in the corner, "Xiao Tang, if you were asked to come, what acupuncture point would you choose?"

Tang Jinhan was a little surprised that Du Heng called him, but he reacted quickly and stood up immediately, and answered very fluently, "I will use the nearest acupuncture method, directly selecting Shangguan, Xiaguan, Jiache, and Zhongliao on the face ( quan liao), Daying. It can unblock meridians and relieve paralysis, activate blood circulation and disperse blood stasis.

It also plays a very good role in relieving the patient's facial swelling and pain.

Finally, I will massage the Yifeng points on both sides to connect the meridians on the face and neck. "

Du Heng was happy, really happy.

This student is very proud of himself.

But when the discussion ended and Du Heng and Tang Jinhan returned to the office, Du Heng's heart felt cold. (End of chapter)