Chapter 671: Explanation

Chapter 671: Chapter 671: Explanation

Li Xu didn’t blame Tang Changchun. On the contrary, he nodded. "A CT scan is fine. It’s to rule out any organic lesions, to see if there’s really a tumor or something growing in there. That’s part of being responsible for the patient.

"As for the liver function test, it’s optional.

"Because for us practitioners of Chinese medicine, we can’t formulate a prescription based solely on the numbers from a lab report.

"Do I just prescribe something to clear the liver and promote bile flow if his transaminase levels are high?

"And if they’re low, do I just ignore it?

"That’s not Chinese medicine."

Tang Changchun nodded and quietly breathed a sigh of relief. ’Good, I didn’t get chewed out,’ he thought. ’Looks like the Dean is in a good mood today.’

Li Xu brought the topic back around, patiently explaining, "You all heard him just now. The patient said he was working on a construction site, lifting something heavy. He might have overexerted himself or used poor posture and somehow injured his side. He felt pain right away, and it hurt continuously for several days."

"A few days later, the pain subsided, but his breathing became labored. He said he felt useless.

"When did the illness begin?

"It began right at the moment of the ’injury.’

"So, what exactly happened in his right flank to trigger this series of seemingly unrelated chain reactions?"

The interns all fell into deep thought.

"He injured it?"

A TCM intern named Zhou Ning muttered under his breath.

Li Xu looked at him, encouraging him. "Zhou Ning, keep going. Where was he injured? And what was the nature of the injury?"

The young man wasn’t normally nervous around Li Xu. After all, he’d been working with him for a while and knew that while Dean Li was strict, he was also easygoing.

But the problem was the titan sitting right there!

Professor Wang Wenbo’s presence was overwhelming. He sat there with a stony expression, not saying a word, like a proctor overseeing an exam.

It was like being in a fun, relaxed class when the principal suddenly walks in to observe, and then the teacher calls on you to answer a question. How could he not be nervous?

Zhou Ning quickly steadied his nerves, took a deep breath, and said, "The patient stated that he was doing heavy labor on a construction site, which caused pain in his right flank, so it was likely an external injury. It’s even possible... that there’s some congealed blood stagnating in the meridians, which might cause the sensation of a foreign object. It’s just... as for the shortness of breath, I think... I still think it’s Qi deficiency? After all, ’a long illness will inevitably lead to deficiency.’"

Li Xu nodded, affirming part of his explanation before pointing out the problem. "But can you find any other evidence to support a diagnosis of Qi deficiency? The pulse diagnosis showed the pulse was moderate and slightly weak, not the ’vacuous, large, and forceless’ or ’thready and weak’ pulse typical of Qi deficiency. Right?"

The others nodded in agreement.

Indeed, that was the sticking point for them as well.

Li Xu said, "So, you deduced that there was likely still congealed blood in the Liver meridian of his right flank, causing a blockage. However, you couldn’t understand the direct connection between the ’Liver’ and ’respiration,’ so you had to fall back on explaining it as Qi deficiency."

Again, the others nodded,

like a group of students whose teacher had just seen right through them.

Li Xu smiled, stood up, and walked over to a model of the human meridians. He pointed to a few lines and began to explain:

"When we talk about respiration, we’re talking about the Lungs. From the perspective of modern anatomy, in particular, respiration is just gas exchange—a matter for the alveoli and capillaries. It really has nothing to do with the Liver."

"However, according to the Meridian Science of Chinese medicine and the theory of Qi’s ascent and descent, human respiration can reach the Chong and Ren meridians and involves all the Zang-Fu organs. The *Nan Jing* states: ’Exhalation is governed by the Heart and Lungs; inhalation is received by the Kidneys and Liver.’"

"The Kidneys are responsible for grasping Qi, and the Liver is responsible for ensuring its free flow. You all know that. But you overlooked the pathway of the Liver meridian."

Li Xu’s finger traced a path on the model. "The Foot Jueyin Liver Meridian passes up through the diaphragm, spreads across the ribs and flank, runs along the back of the throat, and enters the nasopharynx. In other words, the Liver meridian passes directly through the diaphragm, is distributed throughout the flank, and extends all the way up to the throat."

"So, if we imagine the Lungs as an engine, the meridians are the intake and exhaust manifolds. Qi moves up and down the meridians, one in, one out. When you inhale, the Qi must descend along the meridians to be grasped by the Kidneys. When you exhale, it must ascend back up the meridians."

"Therefore, regardless of whether the Qi is ascending or descending during respiration, it must pass through the flank, where the Liver meridian is distributed. Because of the injury, the patient’s Liver meridian has congealed blood, creating a blockage. It’s like a pipe stuffed with a ball of cotton. The flow of Qi is naturally obstructed, and he naturally feels like he ’can’t catch his breath.’"

"This is a case of ’Liver Qi Stagnation causing Lung Qi to fail to descend,’ or you could call it ’Blood Stasis Obstructing the Collaterals, Impeding the Flow of Qi.’"

"Oh!"

Understanding dawned on everyone at once, like a sudden enlightenment.

This time, even the patient himself understood, nodding his head again and again.

Li Xu sat back down at the computer and began typing up a prescription. "Regarding the Qi deficiency you mentioned, if he were truly so deficient that he couldn’t even speak, his pulse would be an absolute mess. It could never be this moderate."

"By the way, Senior Brother Wang, what are your thoughts?"

Li Xu asked casually as he typed.

Wang Wenbo didn’t rush to look at the prescription. Instead, he began to speak slowly and deliberately about another matter.

"I’ve read some of your case studies. They are indeed brilliant, and some of your lines of reasoning are things even I hadn’t considered. But your prescriptions... they are often exceptionally bold. You favor swift and powerful formulas, like an army storming cities and seizing territory. Especially when you prescribe single-herb or emergency formulas, your dosages are massive—often tens of grams, sometimes even over a hundred."

"Of course, I’m not denigrating your style. For a doctor, results are the only thing that matters. Black cat, white cat—as long as it catches mice, it’s a good cat."

"But since you are a disciple of our Master, it is my duty as the eldest disciple—your Senior Brother—to come and see how you are doing. After all, our lineage has an orderly tradition of succession."

The others looked at Wang Wenbo in surprise.

His words... sounded a little... like he was about to lay down the law.

Li Xu, however, had already finished writing the prescription. The printer whirred and spat out a prescription slip.

Wang Wenbo tilted his head up slightly and said with a touch of pride, "Our lineage emphasizes an ’elegant and nimble’ approach, the principle of ’moving a thousand pounds with just a few ounces.’ We value concise formulas and ingenious combinations, using just a few herbs and a mere few grams to move a great wheel, bring order from chaos, and harmonize Yin and Yang."

"Using medicine is like deploying troops: victory lies not in numbers, but in precision. I think it’s imperative that you..."

He had been about to say, "...imperative that you rein in your grand, sweeping style and learn how to treat serious illnesses with light-handed formulas."

However, he never got to finish his sentence.

Li Xu had already handed the printed prescription to the patient’s family, instructing them clearly and concisely, "Go get this filled. Sanqi powder, 5g per dose, mixed with water. Raw malt, 9g, to be decocted. Just these two. Nothing else."

"Huh?"

Wang Wenbo’s words caught in his throat.

He was stunned.

’Sanqi powder, 5g?’

’Raw malt, 9g?’

’This is the prescription Li Xu wrote?’