The patient’s name was Liu Ping, a 31-year-old woman.
According to her medical 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 came back negative. Liu Ping was not pregnant.
If she wasn’t pregnant, a missed period meant she was sick.
Liu Ping started by visiting the obstetrics and gynecology department at her local county hospital.
The doctors ran some gynecological exams and prescribed a lot of medication, but her condition didn’t improve.
Later, someone told Liu Ping about an old traditional Chinese medicine 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 medicine with unknown ingredients, which she took for over three consecutive months.
However, after several months of this herbal treatment, 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 something 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 amenorrhea.
Having a normal menstrual cycle that later stops is called secondary amenorrhea.
The causes of secondary amenorrhea are numerous and complex.
Yan Feifan recalled that the establishment and maintenance of a normal menstrual cycle depended on an extremely complex neuroendocrine regulatory system.
Problems with any part of this system, from the hypothalamus, pituitary gland, and ovaries to the endometrium, could all lead to amenorrhea.
For some people, prolonged psychological stress, tension, anxiety, environmental changes, overexertion, or even emotional shifts could also cause amenorrhea.
Some 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 medical journals and magazines.
For others still, amenorrhea was caused by long-term use of certain medications, such as some antipsychotics or antihypertensives.
The gynecologist at the Class A Grade 3 city hospital determined that the cause of Liu Ping’s secondary amenorrhea 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 medicine 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 amenorrhea.
Yan Feifan mentally 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 treatment, 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 medicine, then after stopping the medicine and undergoing one to two months of targeted treatment, Liu Ping’s condition should have shown significant improvement.
The problem was, Liu Ping’s condition seemed to have gotten even worse.
This made Liu Ping and her family lose faith in that doctor, and they decided to come to Binhai and pull some strings to find a better hospital and doctor.
’It wasn’t the traditional medicine that caused the cirrhosis!’ Yan Feifan deduced.
’But then, what was the real cause?’
According to her medical 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 syndrome?’
...
As he drove, Wang Chuan had been secretly observing Yan Feifan.
He noticed that after looking at the numerous images sent to his phone, the young man’s eyes took on a distant, unfocused look.