Records of Several Consultations, February 6, 1998

Records of Several Consultations, February 6, 1998

Around the Spring Festival, I was invited several times to consult at other hospitals. The records are as follows:

Case 1: Consultation at the Provincial Railway Central Hospital

At the end of the Year of the Ox, I was invited to the Railway Hospital for consultation. The patient was an 82-year-old woman. One week earlier, she had an acute attack of cholecystitis and underwent surgery. Seven days later, her abdomen was as large as a water buffalo, with fluid flowing out of the incision. The attending physician was shocked and asked, "Where did this ascites come from?" They called for Chief Surgeon Xu to consult, who said, "Could this be cirrhotic ascites?" They urgently requested a hepatology specialist to consult, and the hospital invited me. Upon examination, my pulse was deep, fine, and irregular; auscultation revealed a weak first heart sound and frequent premature beats; the liver was enlarged, there was a large amount of ascites, and the lower limbs were swollen. Preoperative ultrasound and CT scans showed no signs of cirrhosis; the spleen was not enlarged, and the density of all liver layers was uniform, ruling out cirrhosis. I concluded, "Could it be heart failure? (Cardiac ascites)" When I inquired about the treatment, I learned that she received 8 bottles of intravenous fluids per day, totaling 4,000 mL, at a drip rate of 80–100 drops per minute. I warned, "This is too much for an elderly person like her, and such a high volume and speed of infusion can easily lead to heart failure, especially considering her postoperative condition!" I advised reducing the fluid volume to 500 mL per day and only administering antibiotics. The drip rate should also be controlled at 20 drops per minute. The next day, the patient's condition improved significantly: urine output increased, ascites decreased, her spirits lifted, and she was discharged after a week, going to Xinjiang to recuperate at her children's home.

Case 2: Consultation at the Provincial People's Hospital

Mr. Liu had been experiencing chest pain for three months and was diagnosed with coronary heart disease, but medication had no effect. His condition worsened, and he requested the hospital to invite me for consultation. Upon examination, I found a mass in the upper abdomen, measuring 3 cm × 4 cm. I ordered a gastroscopy and biopsy, which confirmed lymphoma. I determined that it was non-Hodgkin's lymphoma and promptly initiated COHP chemotherapy. After one course of treatment, his condition greatly improved, and the pain subsided, allowing him to be discharged. The lesson from this case is that abdominal malignant lymphoma can infiltrate the stomach's serosa and cause spasmodic pain. Since the patient already had coronary heart disease and had experienced angina pectoris before, the provincial hospital's cardiac examination showed myocardial ischemia, leading to a diagnosis of coronary heart disease. However, when I arranged for a gastroscopy, I failed to anticipate the possibility of non-Hodgkin's lymphoma. Initially, I suspected gastric cancer causing the stomach pain, but the biopsy confirmed non-Hodgkin's lymphoma—a rare outcome indeed!

Case 3: Consultation at the First Hospital of Lanzhou University

The patient was an 80-year-old man suffering from high fever, cough, and chest pain. X-ray showed bilateral pneumonia. After antibiotic treatment, the fever subsided and the condition improved, but he frequently hiccuped. Intramuscular injections of Weifuan and Motilium were ineffective, and acupuncture at Zusanli was also ineffective. I was invited for consultation. Using Dingxiang Shidi Tang combined with Xuanfu Daizhe Tang for three doses, his hiccups significantly reduced. Then, using Xiangsha Liujun Tang for two doses, he fully recovered and was discharged.

Case 4: Consultation at the Provincial Cadre Sanatorium

Ms. Xue suffered from urinary tract stones, with excruciating pain in both flanks, hematuria, and dysuria. Renal pelvis imaging showed no contrast in the left kidney, while the right kidney had stones. CT scans revealed stones in both kidneys. I formulated a prescription: Chicken Gizzard Membrane, Moneywort, Sea Sand Gold, Turmeric, Talc, Floating Stone, Stone Fern, Rhubarb, Sanleng, Ezhushi, Processed Frankincense, Myrrh, Pangolin Scales, Soapberry Spines, Red Peony, Raw Job's Tears, Achyranthes, White Flower Snake Tongue Grass, and Half Branch Lotus. After taking three doses, the hematuria stopped, and the pain eased. The stone was successfully broken up.