In the dean’s office at the Guanghe District Hospital of Traditional Chinese dicine, Dean Sun rubbed his temples, an application report spread out before him.
"Old Guo, are you sure this golden toad skin will work?" He looked up at Guo Yu. "Fifty thousand yuan is no small sum. If it all goes down the drain..."
Guo Yu stood ramrod straight. "Dean, I can’t guarantee it, but the *Supplent to the Compendium of Materia dica* clearly records that golden toad skin has a miraculous effect on ’Water Gu.’ Compared to the half-million yuan the family is demanding in compensation, it’s worth a shot."
Dean Sun sighed deeply and signed the application form. "Go on, then. Let’s hope it works... By the way, where’s the patient who’s causing all this trouble?"
"Still in the outpatient lobby..." Guo Yu gave a bitter smile. "His son brought a few relatives and they’re holding up a banner..."
In the outpatient lobby, the patient, fifty-sothing Zhao Daqiang, was slumped on a bench. His abdon was severely swollen, and his face had a sallow, waxy complexion.
His son, Zhao Lei, held up a sign that read "QUACK DOCTORS KILL," surrounded by several relatives who occasionally shouted curses.
The security guards stood at a distance, not daring to get closer.
"Everyone, you be the judge!" Zhao Lei shouted at the top of his lungs. "Half a year ago, my dad could still work in the fields! It’s because he took this hospital’s dicine that he can’t even walk now!"
The crowd of patients whispered among themselves, and so took photos to post on social dia.
Guo Yu walked over quickly, and Zhao Lei imdiately rushed forward. "Guo! If you don’t give us an explanation today, I’m not done with you people!"
"Zhao Lei, calm down." Guo Yu held up his hands. "We’ve found a highly effective dicine. It’s a rare golden toad skin, specifically for your father’s condition..."
"What toad skin? Trying to fool us again?" Zhao Lei sneered. "Today, you either pay up, or I’m calling the TV stations to expose you!"
Guo Yu suppressed his anger. "How about this: the hospital will pay for the dicine. If it doesn’t work, we can discuss compensation then. How does that sound?"
Zhao Daqiang weakly tugged on his son’s arm. "Son... why don’t we... give it a try..."
...
That afternoon, Guo Yu went to the clinic to pick up the dicine.
Li Xu handed him the golden toad skin, hesitated for a mont, then finally spoke up. "Director Guo, this golden toad skin is good, but I’m afraid it might not be enough to cure his ascites from liver cirrhosis."
Guo Yu was taken aback. "What do you an?"
Li Xu explained, "From a TCM perspective, the pathogenesis of ascites from liver cirrhosis is essentially liver depression and blood stasis, spleen-kidney yang deficiency, and the internal retention of water and dampness. The main effects of golden toad skin are clearing heat, detoxifying, promoting diuresis, and reducing swelling. It’s suitable for damp-heat type ascites, like that caused by late-stage liver cancer or acute hepatitis. But this patient’s situation is different—"
The day before, Guo Yu had described the patient’s condition in detail.
Li Xu had committed it to mory and was now using it for comparison.
He opened his notebook and drew a simple diagram:
Liver Depression and Blood Stasis: The patient has suffered from prolonged emotional distress, leading to liver qi stagnation. This impedes blood circulation, resulting in blood stasis.
Spleen-Kidney Yang Deficiency: Post-cirrhosis, the spleen has lost its transportive function and the kidney yang is insufficient. The body is unable to tabolize water and dampness, which then accumulate as ascites.
Yin-Blood Deficiency: With a long-term liver disease, the liver yin is depleted, causing hyperactivity of liver yang. This further exacerbates the blood stasis and water retention.
"The golden toad skin can promote diuresis, but it can’t solve the core problems of liver yin deficiency and internal obstruction from blood stasis," Li Xu concluded. "So even if you use it, it will likely only provide temporary relief, not a complete cure."
Guo Yu frowned. "So what you’re saying is...?"
Li Xu handed him a slip of paper. "I ca across an ancient formula this morning called Turtle Garlic Soup. It might be a better fit for his condition."
Guo Yu took it and glanced at it, his frown deepening. "Soft-shelled turtle stewed with garlic? This... isn’t this just a folk redy?"
Li Xu shook his head. "It’s not an ordinary folk redy. It’s a modified formula from the *Essential Prescriptions of the Golden Cabinet*, specifically for ascites from liver cirrhosis. The turtle nourishes yin and softens hardness, while the garlic breaks up stasis and clears the collaterals. The combination directly targets the patient’s liver yin deficiency, internal obstruction from blood stasis, and accumulation of water and dampness."
Guo Yu was still uneasy. "But the patient’s condition worsened precisely because he was using unproven folk redies. What if sothing goes wrong again..."
Li Xu understood his concern but insisted, "TCM emphasizes treatnt based on syndro differentiation. Not all folk redies are bad. This formula is well-founded and worth a try."
Guo Yu hesitated for a mont, then finally sighed. "I’ll try the golden toad skin first. If it doesn’t work... I’ll consider your proposal."
...
On the third floor of the inpatient departnt at the Guanghe District Hospital of Traditional Chinese dicine, Guo Yu stood by the window, staring at the prescription in his hand with a deep frown.
He had just completed the admission procedures for Zhao Daqiang and now needed to formulate a detailed treatnt plan.
He went to Dean Sun’s office.
Dean Sun had just hung up the phone. "There can’t be any more problems this ti. I’ve swallowed my pride and specially invited liver disease experts from other hospitals for a joint consultation."
"Even so, he’s our hospital’s patient. When the ti cos, you’ll still need to decide on the final plan."
Guo Yu felt an imnse weight of pressure. He took a deep breath. "Dean, I understand."
「That afternoon.」
In the video conference room, a remote consultation for the liver cirrhosis and ascites case began.
In attendance were Xue Shuheng, an internal dicine expert from the City Hospital of Traditional Chinese dicine; Chen Ming, the Director of the Hepatobiliary Departnt at the City People’s First Hospital; and others.
Dean Sun also attended, his expression grave.
Guo Yu stood before the projector screen, giving a detailed report on Zhao Daqiang’s condition.
"The patient, Zhao Daqiang, 56, has post-hepatitis B cirrhosis that has now progressed to ascites, accompanied by an enlarged spleen and portal hypertension. He was treated at our hospital six months ago. At that ti, the diagnosis was liver depression and spleen deficiency with internal obstruction from blood stasis. He was prescribed a treatnt to soothe the liver, strengthen the spleen, activate blood, and resolve stasis. However, the patient did not follow dical advice and took folk redies on his own, which led to a deterioration of his condition..."
The projector screen displayed the patient’s various test results: abnormal liver function, low albumin, massive fluid accumulation, and an abdon distended like a drum.
"Currently, the patient’s ascites is severe..." Guo Yu paused. "The family has refused Western dical intervention like paracentesis and is demanding TCM treatnt."
A low murmur of discussion filled the conference room.
Chen Ming, the Director of the Hepatobiliary Departnt at the City People’s First Hospital, pushed up his glasses and was the first to speak. "In a situation like this, what can TCM possibly do? The ascites is this severe; we have to drain the fluid as soon as possible, supplented with albumin and diuretics. Otherwise, he could slip into a hepatic coma at any mont!"
"Director Chen is right," an expert from another hospital chid in. "Once cirrhosis reaches this stage, TCM conditioning is too slow. The focus should be on Western dical intervention."
Guo Yu didn’t imdiately argue. Instead, he brought up another set of data. "The patient previously received treatnts like diuretics and albumin supplents at a top-tier hospital, but the results were poor, and the ascites kept recurring. Moreover, his constitution is weak. After multiple fluid drainages, he developed an electrolyte imbalance, which actually worsened his condition."
The conference room fell silent for a mont.
Just then, Xue Shuheng, the internal dicine expert from the City Hospital of Traditional Chinese dicine, spoke slowly. "Director Guo, what is your current proposed treatnt plan?"
Guo Yu took a deep breath and clicked to the next slide. "We plan to use a modified Lower Rib Trauma Decoction, combined with golden toad skin for both internal and external treatnt."
"Golden toad skin?" Several experts looked surprised.
"Yes." Guo Yu nodded. "Golden toad skin has a special therapeutic effect on ascites from liver cirrhosis. It can promote diuresis, reduce swelling, activate blood, and resolve stasis. We plan to apply half of it externally over the liver region and grind the other half into a powder for the patient to take orally, in conjunction with the herbal decoction for overall conditioning."
Xue Shuheng mulled this over for a mont. "Golden toad skin is indeed rare, but can it alone control such severe ascites?"
"That’s why it needs to be combined with a modified Lower Rib Trauma Decoction." Guo Yu displayed the prescription:
Chaihu, Peach Kernel, Red Flower, Danggui, red peony, Chuan Xiong, Nutgrass Rhizo, Agrimonia Pilosa, Yanhusuo, Danshen, Ligusticum Chuanxiong, Trogopterus Dung, licorice, and Astragalus Root.
"This formula soothes the liver and regulates qi, activates blood, and resolves stasis. Combined with the diuretic effect of the golden toad skin, it should be able to alleviate the ascites and improve liver function."
The conference room once again broke out in discussion.
Chen Ming shook his head. "Director Guo, your plan is too risky! For ascites this advanced, TCM conditioning is likely to be a drop in the bucket."
"But it’s also the only plan the patient will accept," Guo Yu said.
After so discussion, Dean Sun spoke slowly. "Experts, since the patient’s family insists on TCM treatnt, we might as well give it a try. If there are no results within three days, we will consider other options."
In the end, the committee decided to proceed with Guo Yu’s plan.
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