Chapter 645: Trust

Chapter 645: Chapter 645: Trust

Director Si of the ICU walked over, frowning, his tone grave. "Dean Li, I admire your courage. But according to hospital regulations, we cannot administer a decoction with a dosage ten times the limit set by the Materia Medica. This would be considered improper use of medication. If anything goes wrong, our entire ICU, and even the whole hospital, will be held legally responsible."

This was a regulatory red line; Director Si’s hands were tied.

The atmosphere became deadlocked once again.

"I can sign a liability waiver."

The patient’s wife spoke up again.

Li Xu looked at her, his expression one of surprise.

Director Si was also taken aback.

The patient’s wife looked at Li Xu and said slowly, "I’m not an unreasonable person, and we’re not the type to cause trouble at a hospital. My husband was a soldier. He lived his whole life by his principles. I’m not sure if you can really cure him, but I can feel your sincerity and medical ethics. That’s enough."

"I believe that a doctor who dares to say ’I’ll drink it first’ would never harm my husband."

"Whatever the outcome, we will only be grateful. We will not hold you responsible."

After she finished speaking, the patient’s wife stood up from her chair and gave Li Xu a deep bow.

This bow moved Li Xu deeply.

It also moved all the other doctors present, some even feeling a sense of shame.

This was what a patient’s trust truly meant.

They were entrusting a life to them.

...

Ever since the 1981 excavation of Han dynasty metrological artifacts confirmed that the "one liang" in Zhang Zhongjing’s classic formulas was approximately 15.625 modern grams, the debate over dosages in the world of traditional Chinese medicine has never ceased.

The previously used conservative conversion of "one liang to three grams" was proven to have greatly weakened the original potency of the classic formulas.

Many veteran TCM doctors campaigned and called for a return to the true nature of these classic formulas.

A number of bolder TCM doctors also began to clinically experiment with large dosages approaching those of the Han dynasty, often achieving astonishingly effective results, especially in the emergency treatment of critical and severe cases.

However, when it came to potent drugs with significant toxicity like Aconite, those who dared to use them freely were still few and far between.

The reason was simple: the Materia Medica was as good as law.

Within the dosage range specified by the Materia Medica, if a medical accident occurred, it was called "individual variation" or "force majeure." The law and the hospital would protect the doctor.

But if the dosage was exceeded, even by a single gram, any resulting incident would be deemed "improper medication use." The doctor would bear legal responsibility and could even face prison time.

This was also why, for so many years, despite the TCM community constantly criticizing the Materia Medica as rigid and out of touch with clinical reality, little had changed.

Because those who compiled the TCM Materia Medica were often not frontline clinical TCM doctors, but rather pharmacologists who focused on chemical analysis.

They looked at chemical components and toxicity indicators, not the TCM principle of treating based on pattern differentiation.

...

Li Xu picked up his pen and began explaining as he wrote out the prescription:

"The patient’s pattern is very clear: Yang deficiency with cold coagulation, deep-seated cold, and stagnation causing blockage. His body is trapped by pathogenic yin-cold, leading to the concurrent onset of true heart pain and thromboangiitis obliterans."

"In Chinese medicine, we say that Qi is the commander of blood; where Qi moves, blood follows. Because of the stagnation, blockage, cold coagulation, and blood stasis, the primary task is to supplement Qi and move the blood. Therefore, Astragalus Root must be used as the sovereign herb, and in a large dose."

"Raw astragalus is excellent at expelling toxins, discharging pus, astringing sores, and generating new flesh. It is a sacred herb for treating carbuncles and the first choice for thromboangiitis obliterans. However, its medicinal nature is mild. Without using an exceptionally large dose, it’s difficult to move the stagnant, dead blood. Therefore, a heavy dose of raw astragalus—240g."

grams!

The observing TCM doctors, especially the few interns, exchanged glances, their eyes filled with shock.

Normally, a prescription for Astragalus Root would be 30 grams, 60 at the absolute most. This was practically half a jin!

But they didn’t ask any more questions. Instead, they quickly lowered their heads and furiously took notes.

Every word Li Xu spoke was a practical lesson, a clinical pearl that couldn’t be learned from textbooks.

Li Xu’s pen never stopped moving as he continued,

"The yin-cold in the patient’s body is profound. The cold pathogen is lurking deep within the meridians and has penetrated the blood level, causing his limbs to be ice-cold and his pulse to be fine and on the verge of expiring. Therefore, we must use Four Reversals Soup with Danggui to restore yang, rescue from rebellion, nourish the blood, and unblock the vessels."

"Four Reversals Soup with Danggui primarily treats coldness of the hands and feet and a fine pulse on the verge of expiring, which perfectly matches the patient’s current symptoms. The pulse on the dorsum of his foot has disappeared, and the cun-kou pulse is deep, fine, slow, and faint. It’s a perfect fit for the diagnosis."

"Within this formula, both Aconite and Danggui must be used in heavy doses of 60g each. Aconite is extremely acrid and hot, able to move through all twelve meridians and retrieve the scattered primordial yang. Danggui supplements and invigorates the blood, moves Qi, and stops pain."

"Furthermore, the patient has numbness in his hands and feet, with cold entering the meridians, and he experiences severe, electric shock-like pain in both legs. This is due to cold congealing in the liver channel, causing the sinews to cramp. We need to combine this with ’Wuzhuyu and Ginger Decoction’. Wuzhuyu excels at warming the middle, dispelling cold, downbearing Qi, and relieving spasms. Paired with Four Reversals Soup with Danggui, it can effectively alleviate this severe neuropathic pain."

At this point, Li Xu paused, his gaze solemn.

"Finally, the most crucial step. The patient has been ill for too long, and the degree of cold coagulation is like solid ice. At this stage, nothing short of the extremely acrid and hot ’Aconite Decoction’, which moves through the interior and exterior of all twelve meridians, can vanquish the enemy and expel the cold."

"Therefore, we will combine it with Aconite Decoction. The method of use should respect Zhang Zhongjing’s original intent but must be modified according to modern conditions."

"The amount of baked licorice must be double that of the Aconite. For 30g of Aconite, you need 60g of baked licorice. This dosage of baked licorice is sufficient to control the toxicity of both types of Aconite and moderate their medicinal strength."

"Additionally, we must add 30g each of black soybeans and ledebouriella root. These two are key herbs for counteracting the toxicity of aconite. Although they are not in Zhang Zhongjing’s original formula, this is an antidote method based on the cumulative experience of physicians throughout history."

"When I have personally tested Aconite, I always keep this soup on hand as an antidote. I have also used this combination to save a patient who was poisoned by accidentally ingesting Aconite. Adding these two makes the formula much safer, ensuring the Aconite herbs only exert their therapeutic effects without causing harm."

"Nowadays, it’s difficult for pharmacies to stock raw Aconite, so we can’t completely replicate Zhang Zhongjing’s method of decocting raw Aconite with honey. However, we can directly add 150g of honey to the decoction and cook them together. Honey is sweet and moderating, and it also has detoxifying properties."

Li Xu put down his pen and looked at the prescription in his hand as if he were gazing upon a mighty army.

"All of this comes from the hard-won experience of our TCM predecessors in using aconite-type drugs. Only by learning how to command these ’fierce generals’ can TCM practitioners have a decisive weapon in their hands when treating critical and severe cases, instead of just prescribing placebos."

At this, Li Xu looked up, his gaze sweeping over everyone present, especially the young interns and Hu Qiming.

"All of you must remember this: what you might see as unconventionally using these toxic, potent herbs is not being reckless. It requires the utmost caution! Only by tasting them yourselves will you truly understand."

"I also suggest that, if you have the chance, you should try tasting Aconite yourselves after work. Experience that feeling of a numb tongue and a racing heart—the sensation of being poisoned. Then try the feeling of counteracting it with a decoction of ledebouriella root and black soybeans. Only after you have experienced it firsthand will you know its limits, and your hands won’t tremble when you prescribe it."