This Doctor Is Too Wealthy

”These diseases are extremely difficult to deal with and cause great suffering to the patients. However, they can be categorized under the symptoms of diabetes insipidus in traditional Chinese medicine, and the elderly who have used my prescription have generally had good results.”

Li Jianwei listened in confusion. ”I understand what you’re saying, but what point are you trying to make?”

”What I mean is, I searched online and found very few papers on treating the three highs and diabetes with methods for diabetes insipidus. The few that exist focus on a particular medicinal ingredient or dietary therapy that can alleviate symptoms, but no papers offer comprehensive control through treatment methods and prescriptions. After a difficult search, I found a few papers on some obscure web pages. In these hard-to-find articles, only terms like ’diabetes insipidus’ are mentioned as keywords; things like hypertension and diabetes aren’t the focus, which I find quite strange.”

”That’s not strange at all.” Li Jianwei visibly relaxed, having understood.

”You just said that diabetes insipidus is divided into upper, middle, and lower types. But this distinction alone baffles eighty percent of doctors. The symptoms of these conditions are basically the same—for instance, both might cause dizziness or vertigo—but one could be upper wasting while another is lower burner dispersion-thirst. Furthermore, the cause of each patient’s illness differs. Take upper wasting, for example: some patients experience thirst, some a bitter taste in the mouth, some physical weakness, and others blood heat. This diversity makes it difficult for many doctors to diagnose.

The treatment of the three highs is different from other diseases. If even one medicinal ingredient is used inappropriately, or if the dosage is incorrect, blood pressure and blood sugar can shoot up, and the patient might not be able to tolerate it. Consequently, patients rarely give doctors a second chance. This, in turn, leads to a lack of case studies for research, so there are fewer papers on the subject. As for the papers that do get published, they are usually speculative articles lacking empirical evidence or data support. It’s quite normal to find them tucked away on obscure websites.”

Although what Li Jianwei said seemed reasonable, Du Heng still felt something was amiss.

He shook his head, contradicting Li Jianwei for the first time. ”No, I don’t think that’s it.”

He frowned, thought for a moment, then continued, ”Distinguishing the syndromes of diabetes insipidus is certainly challenging, but for experienced old Chinese medicine practitioners, it’s not an issue at all. As for diagnosing other symptoms and the subsequent use of medication, that mostly just requires some extra effort. Moreover, the Three Dispersers Beverage is a very mature prescription that isn’t complicated to use. It’s generally applicable to all symptoms related to diabetes insipidus. While it may not be precisely targeted, it is definitely effective. Given this, there should be more papers on diabetes insipidus, and they shouldn’t be considered mere marginalia. So, I believe there must be an underlying problem here.”

Li Jianwei still disagreed with Du Heng’s perspective. ”You’re just being stubborn. Let me use myself as an example. Although my main focus is on cardiopulmonary issues, I am a graduate tutor in Chinese Medicine, so my fundamental skills are solid. However, if you gave me a patient with diabetes insipidus right now, I couldn’t guarantee an accurate diagnosis of whether they fall into the upper, middle, or lower category. And given the dangers of hypertension and hyperglycemia, I can only prescribe based on whether the patient’s overall condition is, say, qi deficiency or some other problem. Such prescriptions might help improve the patient’s overall condition but are insufficient to control blood pressure and blood sugar.”

Du Heng was silent for a moment. He wasn’t persuaded by Li Jianwei; rather, he was carefully mulling over the inconsistencies that had been troubling him for several days. Having no one to confide in, he had kept these concerns to himself. He had hoped to discuss them with Li Jianwei today, but his teacher’s words left him somewhat disappointed.

”Diabetes insipidus symptoms, typically manifesting when a person is in their prime, are often caused by factors such as excessive indulgence, a fondness for alcohol and rich, greasy foods, leading to a depletion of kidney water and excessive heart fire. The external manifestations are commonly observed symptoms like intense thirst, excessive appetite and constant hunger, frequent and copious urination, or even sweet-tasting urine. These symptoms are also key to differentiating the upper, middle, and lower types of diabetes insipidus, which can be summarized as distinguishing issues related to the lung, stomach, and kidney meridians. It’s understandable that teachers not frequently encountering such diseases might overlook or misdiagnose them. However, doctors who regularly treat issues of the spleen, stomach, and kidney should be able to discern these patterns.”

Du Heng’s brow was tightly furrowed as he spoke. ”Teacher, I still think there’s a problem here.”

Hearing Du Heng’s concise summary of the characteristics of diabetes insipidus, Li Jianwei was momentarily stunned. He knew Du Heng was very talented and had always held him in high regard. But listening to Du Heng summarize a complex disease so simply, his inner surprise was such that he no longer felt any displeasure from Du Heng’s blunt rebuttal.

Before Li Jianwei could speak, Du Heng continued, ”The *Orchid Chamber Secret Treasury*, in its chapter on Diabetes Insipidus, has long recorded that diabetes insipidus is a disease caused by latent fire in the blood, insufficient bodily fluids, and pathogenic dryness and heat. And Ye Tianshi, a master from Nanyang during the Qing Dynasty, once stated, ’The syndrome of Three Wasting-Thirsts, though differentiated into upper, middle, and lower, is fundamentally nothing more than Yin deficiency and Yang exuberance, with depletion of bodily fluids and rampant heat,’ was his assertion.

The Three Dispersers Beverage, made with Chinese yam, radix trichosanthis, wolfberry root bark, medlar, and other medicines, has the effect of clearing heat, reducing fire, quenching thirst, and moistening dryness. Among these, rehmannia, medlar, and black plum, being acidic and sweet, transform Yin and act as minister medicines. Moutan, wolfberry root bark, and radix scrophulariae serve as adjuvant medicines, clearing latent fire from the blood. The combination of wolfberry root bark and medlar wonderfully harmonizes the body’s Yin and Yang, ensuring the smooth circulation of qi, blood, and bodily fluids. These are all well-documented in medical texts. We only need to summarize and refine this knowledge to master it. That’s why I can’t believe that in such a large country, with hypertension and diabetes being such serious diseases, the number of papers on them could be so low.”

Instead of refuting Du Heng, Li Jianwei thought for a moment and then suddenly asked, ”Are you thinking of publishing a paper on this topic yourself?”

”Yes, I am. And I already have a large number of cases on hand. By the time I return from the May Day holiday, these patients will have been taking the medication for more than three weeks. Once the data is compiled, I can start writing the paper.”

”Good. If you achieve results, you must let me know. I want to read your paper.”

”Yes, Teacher, I will.”

Nearby, Xiao Su’s eyes widened. How had the conversation shifted to something he couldn’t understand at all? It even seemed like his own teacher was struggling to keep up with his senior brother’s train of thought.

His shock hadn’t yet subsided when he heard Li Jianwei beside him say, ”Alright. Since you’re here today, I have a patient I’d like you to look at for me.”

As Li Jianwei changed the subject, Du Heng set aside his doubts, chuckled, and said, ”What kind of patient could stump you, Teacher?”

”The patient is a woman in her forties. Her nostrils have inexplicably thickened, and she presents with erythema and itching.” Li Jianwei described the patient’s condition: ”The symptoms fluctuate, sometimes severe, sometimes mild, and are unpredictable.”

Seeing that Li Jianwei wasn’t joking, Du Heng became serious as well. ”Teacher, when do the symptoms worsen, and when do they ease?”

”According to her, when she is constipated, the erythema becomes more pronounced and redder, and the itching intensifies. After a bowel movement, all symptoms start to improve.”

Speaking of this patient, Li Jianwei’s brow furrowed deeply. ”She said she was treated for a skin condition before, but it had no effect. Furthermore, applying topical ointments exacerbates the itching of the erythema. Last Friday, the erythema on her face increased, and she was also constipated, so she was admitted directly to our hospital’s dermatology department. After three days of treatment, the patient’s bowel movements became regular, but the symptoms on her nostrils didn’t improve. Consequently, she was transferred to our Chinese Medicine Department.”

Du Heng pursed his lips. What Li Jianwei said made him uncomfortable. The Chinese Medicine Department was like a dumping ground; any patient other departments couldn’t cure, or for whom they had no other options, was ultimately tossed to the Chinese Medicine Department like refuse. Sigh, this was the general state of affairs, and Du Heng could only lament it.

”Has your treatment over the past two days also had no effect, Teacher?”

Li Jianwei gave a wry smile. ”It’s not that there’s been no effect. The erythema on both sides of the patient’s nostrils has lessened somewhat, and it’s not as itchy as before.”

Du Heng paused slightly.

How much is ’somewhat’?