Chapter 823: Lin Guorui Shows His Edge

Chapter 823: Chapter 823: Lin Guorui Shows His Edge

In the consultation room, the air was thick with the atmosphere of an intense academic debate.

Several young doctors gathered around the medical records, their expressions varying as they digested Lin Guorui’s seasoned syndrome differentiation.

"Since Director Lin has concluded that the patient’s high fever is caused by severe constipation and blocked fu-organ qi, shouldn’t we first try a saline enema to flush out the impacted stool? That would be less irritating for a frail post-operative patient," a young resident doctor tentatively suggested, clearly leaning towards the standard physical methods of Western medicine.

Lin Guorui shook his head, his eyes revealing an unquestionable decisiveness. "The patient’s current condition is not simple constipation, but an accumulation of dry stool.

"This type of dry stool, formed because the high fever injured the true yin of the Shaoyin meridian and scorched the bodily fluids, is like stubborn rocks on a dried-up riverbed, tightly sealing the lower orifice.

"Relying purely on the external force of an enema can only moisten a small part of the terminal rectum; it’s impossible to bring out the deeply accumulated dry stool. Furthermore, a blind enema might even damage the already fragile intestinal mucosa."

At this point, Lin Guorui added with a solemn expression, "I repeatedly questioned the patient’s family earlier. Before fainting and being admitted to the hospital, the patient had actually not had a bowel movement for two days. This means the waste in the intestines had been accumulating for a long time, and after being scorched by the post-operative pathogenic heat, it had already fully developed into a severe obstruction."

"That is indeed the case. The family was just muttering about it outside the door," Gao Jingyun, the chief resident, nodded in confirmation from the side.

As the deputy director of the Western medicine neurosurgery department, Peng Lixue didn’t quite understand the traditional Chinese medicine concept of "dry stool," but he deeply understood post-operative high fever caused by the "reabsorption of intestinal toxins."

He looked at Lin Guorui and asked in a deep voice, "Director Lin, how does your traditional Chinese medicine plan to specifically resolve this tricky situation? Are you going to use strong medicine?"

Lin Guorui took a deep breath and spoke slowly, "The ’Treatise on Cold Pathogenic and Warm Pathogenic Diseases - Shaoyin Chapter’ has a clear provision: ’In Shaoyin disease, if there is spontaneous discharge of clear water, pure clear in color, there must be pain below the heart, and for those with a dry mouth, purge hastily; Da Chengqi Decoction is appropriate.’ There is another record that fits this symptom even better: ’In Typhoid, if it is unresolved after vomiting or purging, and there has been no bowel movement for five or six days, up to more than ten days... if severe, during the attack the patient does not recognize people... if mild, merely fever and delirium, Da Chengqi Decoction is the primary treatment. If one dose causes a bowel movement, stop taking the rest.’"

Lin Guorui tapped his finger heavily on the table. "The patient is currently delirious, has cold extremities, a burnt yellow and dry tongue coating, and unresolved post-operative bowel movements. This is a typical Yangming Fu-organ excess syndrome. To strike at the root of the problem, nothing but Da Chengqi Decoction will do at this moment."

"Dean Li, what do you think?"

Although Zeng Yunjun also understood traditional Chinese medicine, in such a critical moment, he trusted Li Xu’s judgment more.

Li Xu had been standing quietly in the back, listening. He now stepped forward and nodded. "Yes, we can use Da Chengqi Decoction. Director Lin’s syndrome differentiation is very seasoned.

"The Yangming meridian is abundant in qi and blood. When Yangming heat is excessive, its fire qi will inevitably surge upward and disturb the mind. In mild cases, it causes the patient to become restless; in severe cases, it leads to unconsciousness and delirium, even affecting the brain’s post-operative recovery.

"In our Western medicine, this is called ’toxic encephalopathy,’ while in traditional Chinese medicine, as long as the pathogenic heat is removed and the mind is no longer disturbed by turbid qi, the patient will naturally wake up."

Li Xu’s words essentially gave Zeng Yunjun and Peng Lixue peace of mind.

In Western clinical medicine, whether a patient passed gas or had a bowel movement after surgery had always been the "gold standard" for the recovery of intestinal function.

The patient’s sudden cerebral hemorrhage and damaged nervous system would inevitably lead to autonomic nerve dysfunction and weakened gastrointestinal motility. Coupled with the suppression from surgical anesthesia, the intestinal microenvironment was imbalanced. Once toxins entered the blood, they would backlash against the brain.

It could be said that this dose of medicine to clear the bowels would save not just the stomach, but the brain as well.

Standing to the side, Li Lin watched his dean and Director Lin cooperate tacitly, his heart filled with myriad emotions. There was a time when Director Lin seemed a bit hesitant and conservative when writing prescriptions. But after spending so much time by Dean Li’s side, he had surprisingly picked up a good portion of that decisive and resolute Great Physician aura.

"Alright, we’ll do as Director Lin says and try the Da Chengqi Decoction!" Zeng Yunjun made a prompt decision.

Lin Guorui picked up his pen and rapidly wrote down the prescription on the pad.

Li Xu walked over, glanced at it, and pointed at a few key dosages. "Director Lin, 12 grams of raw Da Huang might not be enough to suppress it here. Change it to 15 grams. 20 grams of Mangxiao is also a bit light, increase it directly to 30 grams."

Lin Guorui didn’t hesitate for a second, immediately taking his pen to make the corrections.

This was trust. This kind of tacit understanding, formed on the line between life and death, needed no superfluous explanations.

Li Xu turned his head and instructed Gao Jingyun, "After the decoction is brewed, administer it through a nasal feeding tube. After the medicine is taken, you will personally observe with the nurses. Listen to the bowel sounds every half hour and record the gas passage.

"If bowel motility does not significantly increase within three hours after the first dose, immediately administer a second dose via nasal feeding until the patient exhibits bowel sounds and passes gas."

"Rest assured, Dean Li. I’ll keep an eye on it personally and won’t leave for a moment!" Gao Jingyun nodded heavily.

Upon leaving the consultation room, Zhong Dongyang walked beside Li Xu, his expression full of admiration. "Dean Li, your discussion just now combined the fu-organ qi of traditional Chinese medicine with the blood-brain barrier of Western medicine so well. If I hadn’t seen it with my own eyes, I really wouldn’t have believed that a traditional Chinese medicine doctor could have such a deep grasp of the mechanisms of post-operative complications."

Li Xu smiled. "Director Zhong, medical principles are interconnected; it’s just that the way they are expressed is different. Let’s hurry and get some rest. You’ve been busy all day, it’s been too exhausting for you."

Night fell over Feng City.

In the emergency department’s intensive care unit, Gao Jingyun stayed continuously by the bedside of the cerebral hemorrhage patient. The liquid medicine in the nasal feeding tube seeped in bit by bit.

At past eight in the evening, Li Xu’s phone vibrated. It was a WhatsApp message from Gao Jingyun:

"Dean Li, an hour after the second dose of medicine entered his stomach, the patient’s bowel sounds became active, and he just excreted a large amount of foul-smelling, dry, dark stool. His body temperature has now begun to drop significantly."

A smile touched the corners of Li Xu’s lips, and he replied, "Once the bowels are cleared, intracranial pressure will surely drop. After the high fever subsides, the patient will wake up very soon. Continue observing."

At ten o’clock at night, Gao Jingyun sent another message, excitement bleeding through his words: "He’s awake. The patient just opened his eyes and can follow simple commands. His pupillary reflexes have returned to normal. Director Peng said that we have safely passed this critical hurdle."

Li Xu put down his phone and let out a long sigh of relief.

For a cerebral hemorrhage patient, every minute earlier they woke up post-surgery meant an extreme reduction in the disability rate. This dose of Da Chengqi Decoction had truly made a massive contribution.

Early the next morning, in the traditional Chinese medicine ward of Feng City People’s Hospital.

Ju Jiahong, wearing a spotless white coat, walked briskly at the forefront of the ward round team.