Chapter 54: Excessive Menstrual Bleeding in Women and Yellow Earth Decoction

Zhang Jing said with quiet confidence, "Director Huang, it's settled. The diagnosis is clear. Xiao Cui, please get me a new medical record book so I can write up the case history in my consulting room."

"Also, Xiao Cui, go buy some portable herbal decoction equipment nearby—the kind of mini gas stoves we use for small hot pots at restaurants, along with a ceramic medicinal pot."

"What do we need those for? Don't we have an automatic herbal decoction machine?" Gui Cui handed him an outpatient record book, looking at him in puzzlement.

"I'm only prescribing a single dose first, which the machine probably can't handle properly. Besides, traditional decoction methods yield better therapeutic results," Zhang Jing explained.

"Oh, I see!" Gui Cui suddenly understood and quickly said, "Alright, alright, I'll ride the electric scooter right now. I saw those two items being sold at the vegetable market ahead just a few days ago. I'll definitely be back within ten minutes."

With that, she rushed off in a flurry of activity.

Zhang Jing took the medical record book and quickly returned to his consulting room, with Huang Biao following closely behind.

As soon as they entered, Huang Biao couldn't help asking, "Dr. Zhang, is one dose really enough? And brewing it right here on the spot to be taken immediately—what if it doesn't work? What should we do then?"

Zhang Jing furrowed his brow slightly. "Director Huang, as physicians, we must have absolute confidence in our own medical skills. If you don't even believe in yourself, how can you expect the patient to trust you?"

"Don't get me wrong, Dr. Zhang. I'm not doubting your medical skills. It's just that this whole situation started because of me, and no matter what, it shouldn't implicate you," Huang Biao hastily explained.

Seeing the sincere look on Huang Biao's face, Zhang Jing knew the words came straight from the heart.

He therefore said solemnly, "Director Huang, time is a bit tight, so I'll write the prescription first. Since Xiao Cui is out, could I trouble you to take the prescription to the dispensary and fill it while I write the medical record? Would that be alright?"

Hearing this, Huang Biao nodded eagerly like pounding garlic. "Of course, of course, I can do that, absolutely."

Zhang Jing nodded slightly and began writing on the prescription pad.

Prepared Licorice Root 15 grams, Rehmannia Root 15 grams, White Atractylodes Rhizome 15 grams, Prepared Aconite 15 grams, Donkey-Hide Gelatin 15 grams (melted separately), Scutellaria Root 15 grams, Furnace Yellow Earth 40 grams (wrapped in cloth for decoction)—one dose.

Take these seven ingredients, add 1,000 milliliters of water, boil down to 300 milliliters, and administer in two warm doses.

Once finished, he handed it directly to Huang Biao. "Director Huang, I'll have to trouble you with this."

Huang Biao glanced over it briefly, frowned, and asked, "I recognize this as the Yellow Earth Decoction, but aconite is toxic, and you've used as much as 15 grams. Furthermore, we're dealing with a current medical dispute patient. Dr. Zhang, aren't you worried at all that if something goes wrong, it will escalate directly into a medical malpractice incident?"

Zhang Jing also frowned, his expression turning serious. "Director Huang, let's put the discussion of case histories and prescriptions aside for a moment. As a doctor, I believe we shouldn't just focus on protecting ourselves."

In truth, he very much wanted to give Huang Biao a lecture on "medical ethics" right then and there. But considering he was facing a senior predecessor nearing sixty years of age, being too direct would inevitably wound his self-esteem.

Therefore, Zhang Jing decided to quote a passage from *The Great Physician's Purity of Sincerity* to offer a tactful admonition.

"When a great physician treats a disease, they must calm their spirit and settle their will, devoid of desires and cravings. First, they must generate a great heart of compassion and mercy, vowing to relieve the suffering of all living creatures. If someone comes seeking help for illness or affliction, one must not inquire whether they are noble or base, poor or rich, young or old, beautiful or ugly, enemy or friend, foolish or wise. All should be treated as equal, regarded just like one's closest kin. Nor should one hesitate, calculating personal fortune or misfortune, or guarding one's own life and limb..."

Hearing this, Huang Biao clutched the prescription, turned around in shame, and hurried away.

Of course, Zhang Jing knew that Huang Biao was ultimately worried on his account.

Yet, as a veteran traditional Chinese medicine practitioner with nearly forty years of experience, to fear aconite like a tiger or wolf was truly shameful!

After steadying his mind, Zhang Jing began writing the medical record conscientiously.

Patient: Female, 38 years old. Came in presenting with flooding and spotting (uterine bleeding) for one day. Due to irregular menstruation, a previous doctor prescribed seven doses of Peach Kernel and Safflower Four-Substance Decoction (including 6 grams of peach kernel and 3 grams of safflower). Yesterday, coinciding with the onset of her menstrual period, she ate several Chinese mitten crabs, after which she experienced lower abdominal pain and a massive menstrual blood flow. This morning, she already received symptomatic intravenous infusion treatment at the hospital. She usually has a marked aversion to winter cold and frequently consumes cold and raw foods.

Current symptoms: Mental fatigue, reluctance to speak, low and faint voice, obvious aversion to cold, poor appetite, loose stools. Examination reveals a pale tongue body with tooth marks along the edges, a thin white coating, grade I stasis under the tongue, and a minute, thready pulse.

Diagnosis: Combined Lesser Yin and Greater Yin Syndrome (Syndrome of Qi and Blood Deficiency).

Prescription: Yellow Earth Decoction (one-third the dosage of the original formula).

After finishing the medical record, Zhang Jing walked out to the clinic's waiting hall.

At that moment, Huang Biao was walking out of the dispensary holding a package of Chinese herbs.

"Director Huang, are they all filled?" Zhang Jing asked.

"Yes, yes, yes. I carefully checked them three times, there won't be any mistakes," Huang Biao replied quickly.

After a brief pause, he added, "Dr. Zhang, I noticed your prescription didn't specify pre-boiling for the aconite. You must have accidentally omitted it, so I went ahead and packaged it separately."

Zhang Jing shook his head slightly. It seemed that without giving him a quick lecture on the usage of aconite, there was no getting through.

He slowly explained, "Director Huang, because you haven't used aconite regularly, you might not be very familiar with its toxic effects. When I was studying under my mentor, I often saw him use aconite. Of course, except for special circumstances where raw aconite is strictly required, prepared aconite is generally used."

"As we know, raw aconite contains a large amount of aconitine, which can exert toxic effects on the human nervous system and cardiovascular system. In severe cases, it can even lead to death. Therefore, when raw aconite is used clinically, it needs to be pre-boiled for over an hour to minimize its toxicity."

"However, aconite slices that have undergone standardized processing—which are the prepared aconite slices in our pharmacy—are extremely safe to use. As long as the dosage isn't exceptionally massive, toxic reactions are virtually nonexistent. I am absolutely certain of this."

"Oh, so that's how it is! I've learned something new, truly enlightened!" Huang Biao nodded repeatedly, looking as though he had genuinely taken it to heart.

Just then, the two of them heard an electric scooter's prompt sound from outside:

"Please check if your beloved vehicle is locked."

"Beep ~ Your beloved vehicle is locked. Welcome to use it again."

Looking up, they saw Gui Cui had returned and was waving at them from outside.

Zhang Jing and Huang Biao hurried out together, each taking either the gas stove or the medicinal pot from the electric scooter.

"That was fast, Xiao Cui! You're back just as the herbs were finished filling, and it hasn't even been ten minutes," Huang Biao praised.

"Of course! Knowing you guys were waiting anxiously, I rode at full speed," Gui Cui said proudly as she removed her helmet.

Zhang Jing had no time for pleasantries. Carrying the medicinal pot, he walked briskly to the sink and filled the pot about halfway with tap water.

Understanding his intention, Huang Biao quickly set down the gas stove, followed him over, and handed the packet of herbs to Zhang Jing.

Zhang Jing opened the medicine packet and picked out the donkey-hide gelatin, which required separate melting.

As for the remaining herbs, including the prepared aconite slices, he dumped them all into the medicinal pot in one go.

Immediately afterward, Zhang Jing picked up the medicinal pot and said to Huang Biao, "Director Huang, could you please take the gas stove into the decoction room, find a suitable spot, and start brewing the medicine right now?"

Feeling a bit perplexed, Huang Biao couldn't help asking, "Don't we need to soak it for half an hour first?"

"Extenuating circumstances call for urgent measures. If we wait too long, the patient and her family will grow anxious. Besides, I suspect the hemostatic injection the patient received at the hospital won't hold for long. It's very likely she'll start bleeding again shortly," Zhang Jing said with a stern expression.

Hearing this, Huang Biao dared not delay any further and hurried off to set up the gas stove.