The patient’s na was Liu Ping, a 31-year-old woman.
According to her dical records and her own account, Liu Ping had missed her period six months ago.
She thought she was pregnant.
Overjoyed, Liu Ping waited patiently for a while before going to the hospital for a check-up.
But at the hospital, both the urine and blood tests ca back negative. Liu Ping was not pregnant.
If she wasn’t pregnant, a missed period ant she was sick.
Liu Ping started by visiting the obstetrics and gynecology departnt at her local county hospital.
The doctors ran so gynecological exams and prescribed a lot of dication, but her condition didn’t improve.
Later, soone told Liu Ping about an old traditional Chinese dicine doctor in a certain village, a master whose family had specialized in treating gynecological diseases for generations.
Many people had supposedly been cured there and had their wishes fulfilled.
Liu Ping went to see the old doctor and received a large amount of traditional Chinese dicine with unknown ingredients, which she took for over three consecutive months.
However, after several months of this herbal treatnt, not only had her period not returned, but her complexion worsened, her skin quality declined, her energy levels dropped, and she had lost a noticeable amount of weight.
Sensing sothing was wrong, Liu Ping went to a Class A Grade 3 hospital in the city for another check-up.
After a series of detailed examinations, the gynecology specialist at the city hospital diagnosed her with secondary anorrhea.
Having a normal nstrual cycle that later stops is called secondary anorrhea.
The causes of secondary anorrhea are nurous and complex.
Yan Feifan recalled that the establishnt and maintenance of a normal nstrual cycle depended on an extrely complex neuroendocrine regulatory system.
Problems with any part of this system, from the hypothalamus, pituitary gland, and ovaries to the endotrium, could all lead to anorrhea.
For so people, prolonged psychological stress, tension, anxiety, environntal changes, overexertion, or even emotional shifts could also cause anorrhea.
So people developed it while trying to lose weight.
Others developed it from long-term intense exercise, like dancing.
This might sound far-fetched, but they were real cases Yan Feifan had read about in dical journals and magazines.
For others still, anorrhea was caused by long-term use of certain dications, such as so antipsychotics or antihypertensives.
The gynecologist at the Class A Grade 3 city hospital determined that the cause of Liu Ping’s secondary anorrhea was liver cirrhosis.
Yan Feifan quickly filtered and analyzed the data from all the tests and lab work Liu Ping had undergone at that city hospital in his mind.
In all her examination and lab data, every indicator was normal except for her liver function transaminases... they were abnormal!
Her liver function transaminase data showed an ALT of 80 U/L and an AST of 78 U/L.
These numbers were clearly elevated.
Subsequent ultrasound and CT scans did indeed confirm that Liu Ping had liver cirrhosis.
The gynecology specialist gave her final diagnosis.
Long-term use of traditional Chinese dicine with unknown ingredients had led to liver damage, which in turn caused liver cirrhosis.
In patients with liver cirrhosis, many hormone levels change, especially a decreased ability to inactivate estrogen.
This would then trigger a series of secondary endocrine problems, resulting in anorrhea.
Yan Feifan ntally reconstructed the patient’s entire clinical course, as well as the doctor’s diagnostic process.
Yan Feifan didn’t find any major flaws in the process. The doctor’s diagnosis was well-reasoned and evidence-based, seeming quite perfect.
But if the story had ended there, he wouldn’t be involved.
In the one or two months of follow-up treatnt, Liu Ping’s symptoms did not improve in the slightest.
According to that doctor’s diagnosis, if the liver damage and cirrhosis were caused by taking large amounts of traditional Chinese dicine, then after stopping the dicine and undergoing one to two months of targeted treatnt, Liu Ping’s condition should have shown significant improvent.
The problem was, Liu Ping’s condition seed to have gotten even worse.
This made Liu Ping and her family lose faith in that doctor, and they decided to co to Binhai and pull so strings to find a better hospital and doctor.
’It wasn’t the traditional dicine that caused the cirrhosis!’ Yan Feifan deduced.
’But then, what was the real cause?’
According to her dical records, Liu Ping didn’t smoke or drink, and her blood tests showed she was not a patient with hepatitis B or C.
This ruled out the most common causes of liver cirrhosis in our country: viral hepatitis, alcoholic hepatitis, and cholestatic hepatitis.
’Could it be autoimmune liver disease?’
’Or cirrhosis caused by a parasite?’
’Could it be Budd-Chiari syndro?’
...
As he drove, Wang Chuan had been secretly observing Yan Feifan.
He noticed that after looking at the nurous images sent to his phone, the young man’s eyes took on a distant, unfocused look.
Yet, his brow would occasionally furrow with small wrinkles.
Wang Chuan understood. The young man was deep in thought, clearly analyzing the patient file his sister had sent him.
This scene further solidified Wang Chuan’s confidence in Yan Feifan.
As a wily old fox who had seen it all, he could clearly tell that Yan Feifan had gotten into the car with a certain degree of unease.
After all, the trouble Yan Ziruo had caused was still unresolved, and Wang Chuan had been deliberately vague and confusing.
It would be impossible for Yan Feifan not to be nervous.
But this guy, upon seeing a complex case, would quickly beco engrossed in his thoughts, forgetting everything else.
This showed that the kid truly, genuinely loved dicine.
There was no greater motivator for success and achieving world-shocking results than this kind of heartfelt passion.
’Talent, plus a passion that cos from the heart. Perhaps that’s the reason this kid has beco so outstanding.’
Wang Chuan mused to himself and subconsciously slowed the car down a bit to avoid jostling Yan Feifan and breaking his concentration.
A short while later, Wang Chuan heard Yan Feifan’s voice.
"Sis, can you have that colleague of yours tell the patient to call back now?"
"I have so questions for her."
"What questions? Cirrhosis has a chance of developing into liver cancer, and liver cancer has a hereditary component."
"In the family history report, the patient said her paternal aunt died at forty-five from a high fever."
"That part made a little suspicious, so I want to ask her about it over the phone."
Yan Feifan hung up and noticed the car was driving on an overpass.
But the direction they were heading...
"Mr. Wang, are we leaving the city?"
Wang Chuan replied softly, "Our destination is Phoenix Tail Mountain in the southern suburbs. It’s about another hour’s drive."
"Is that enough ti for you to solve a difficult case?"
Yan Feifan said matter-of-factly, "The current clinical data isn’t enough for to make an accurate diagnosis."
"I hope the upcoming phone call will give enough information..."
After waiting patiently for about ten minutes, Yan Feifan finally received a call from an unfamiliar out-of-province number.
"Mr. Yan, this is Liu Ping. What did you want to know?"
Recognizing the heavily accented and weak-sounding Mandarin, Yan Feifan spoke slowly, "Ms. Liu, I’d like to ask about the exact cause of your aunt’s death."
"My aunt... she took her clothes off in the middle of winter, caught a bad cold, her fever hit forty degrees, and she died from it."
Yan Feifan asked doubtfully, "With modern dicine being so advanced, even at forty degrees, that shouldn’t have been fatal, should it?"
"Doctor, we live in the countryside. It’s not very convenient to see a doctor."
"Doctor, is my aunt’s death related to my illness?"
Yan Feifan said, a little disappointed, "If she really died because of a high fever and delayed treatnt, then there’s no connection."
"But if it was for so other reason..."
Yan Feifan’s tone grew heavier, and he paused deliberately.
He waited for only ten seconds before Liu Ping’s voice ca through the phone again.
"Doctor, actually... well, the thing is, my aunt developed a ntal illness before she died..."
Yan Feifan’s spirits lifted, and he cut in, "A ntal illness?"
"What were her symptoms?"
"She slept a lot, shouted and scread, um... she would also relieve herself anywhere, and she hated wearing clothes."
"That’s what happened in the winter. We weren’t watching her for a mont, and she took off her clothes and caught a cold."
Hearing this, Yan Feifan asked, "Before your aunt’s ntal state beca abnormal, did she experience a prolonged period of fatigue, loss of appetite, or jaundice—that is, yellowing of the eyes and skin?"
A mont later, Liu Ping’s weak voice ca through the phone again. "Doctor, I’m not sure about the others, but I do know her face was very yellow."
"Doctor, my aunt’s illness... it couldn’t be..."
At that mont, Yan Feifan knew what it was.
He organized his thoughts and said, "Ms. Liu, I highly suspect your aunt didn’t have a ntal illness."
"She had a liver disease called hepatolenticular degeneration."
Yan Feifan explained, "Hepatolenticular degeneration is a rare inherited disorder caused by a defective gene that leads to impaired copper tabolism in the body."
"It primarily affects liver and nervous system function."
"Copper deposits in the liver lead to cirrhosis. Deposits in the lenticular nucleus of the brain cause brain dysfunction, resulting in psychiatric abnormalities, lethargy, and abnormal behavior."
"Ms. Liu, it’s very likely you have this disease as well."
Liu Ping’s anxious voice imdiately ca over the line. "Doctor, am I going to end up like my aunt?"
"No," Yan Feifan reassured her.
"This is one of the few genetic diseases that can be treated. With systematic and proper copper chelation therapy, most patients can live and work like normal people."
Yan Feifan advised, "Ms. Liu, don’t co to Binhai just yet. Go back to that Class A Grade 3 hospital in your hotown and get a serum copper and liver copper test. Also, have them check your eyes for K-F rings."
Liu Ping’s panicked voice ca through the phone again. "Doctor, Doctor, I don’t understand what you’re saying."
Yan Feifan continued, "I’ll send you a text ssage. Just show it to the doctors, and they’ll understand."
After a pause, Yan Feifan added a warning, "Ms. Liu, in the future when you see a doctor, don’t hide things from them."
"Whatever there is, just say it..."
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