Chinese Medicine: Starting with Daily Intelligence

Chapter 519: Chapter 519: The Examination

Hu Qiming laid out his analysis.

Li Xu nodded, indicating his approval.

Hu Qiming’s fundamentals were solid. His ability to analyze the pathogenesis so thoroughly showed he already had the makings of a qualified TCM doctor.

But the subtlety of Chinese medicine often lies in seemingly insignificant details and the grasp of "time and space."

Li Xu looked back at the couple.

The husband’s brow was still furrowed, his face a mask of bitterness.

"Give me your hand. I’m going to take your pulse."

Li Xu gestured.

The middle-aged man hesitantly extended his hand.

A moment later, Li Xu had finished reading the pulses in both wrists.

The left pulse was wiry, hard, and deep.

Wiry indicates the liver, hard indicates stagnation, and deep indicates an internal condition.

This indicated his liver meridian was deficient in blood and his liver qi was very deeply stagnated. It was no longer a superficial qi stagnation, but a stagnation that had penetrated to the blood level.

The right pulse, on the other hand, was wiry and weak.

The right *guan* position corresponds to the spleen and stomach. A wiry pulse is fundamentally a liver pulse, so its appearance in the right *guan* position indicated that Liver Wood was overacting on Spleen Earth. The weakness, meanwhile, represented a deficient spleen and stomach.

Just as Hu Qiming had said, the wiry and weak pulse was indeed proof that Earth had been damaged by Wood. The spleen and stomach had been excessively suppressed and had lost their function of transport and transformation.

That was why he felt pain, and why food wouldn’t digest, getting stuck in his stomach.

Li Xu examined his tongue. The tongue body was pale and dark, and the sublingual veins were somewhat crooked.

He withdrew his hand and asked, "How long has it been hurting?"

The patient himself seemed to lack the energy to speak, or perhaps didn’t want to, and just let out a muffled grunt.

His wife quickly answered, "About three months now. It started right after... after his business went bankrupt and we had to mortgage the house and car. That’s when he became like this. Sigh. At first, it was just a bloating pain around his ribs on both sides, but then his stomach started hurting. Now it hurts every day. He’s never comfortable."

As the woman spoke, her eyes reddened. "He used to be so busy with work, always out entertaining clients, drinking and smoking. I always told him to take care of his health. And now? He’s not busy anymore, just sitting at home all day, and he ends up with all these health problems. At first, the pain only came in the evenings, but now it’s all day long."

Li Xu was flipping through the previous medical records. Hearing this, he caught the key detail about the timing and asked, "It started with pain in the evenings, right? Around what time?"

His wife thought for a moment. "Around five or six o’clock, right around dinnertime. That’s why I’ve always said it’s because he didn’t eat properly in the past. He ruined his stomach."

The patient, who had been silent, suddenly spoke up, his tone aggressive. "When did I ever not eat properly? I was busy, sure, but I still ate three meals a day, didn’t I? Now I’m free all day and I can’t even take a single bite. Just looking at food makes me want to puke."

His wife didn’t back down. "Then why does it hurt specifically at mealtimes? Aren’t stomach problems caused by not eating properly?"

The patient retorted, "Then why doesn’t it hurt at breakfast or lunchtime? Why only around dinner?"

"Huh?" His wife was clearly taken aback. She opened her mouth but didn’t know how to respond.

That was a good point. If it were a stomach problem from hunger, the pain should have come before all three meals. Why only in the evening?

Li Xu smiled, turned to Hu Qiming, and tested him, "Qiming, why don’t you explain it to them? Why does it hurt specifically in the evening?"

Hu Qiming was also startled. He scratched his head as his mind started racing.

’Evening... five or six o’clock... the You hour...’

Chinese medicine emphasizes the "Zi Wu Meridian Flow," where each two-hour period corresponds to a different meridian and organ.

The You hour, from 5 PM to 7 PM, is when the Kidney Meridian is dominant.

’What does that have to do with the liver and stomach?’

’Could it be...’

Hu Qiming was lost in thought.

While Hu Qiming was thinking, Li Xu finished reading the patient’s previous medical records.

The prescriptions were indeed all for soothing the liver and strengthening the spleen.

Chaihu Shugan San, Carefree Powder, and even Banxia Xiexin Tang had all been used.

The line of thinking was correct.

But in terms of grasping the "degree,"

or rather, the point of entry, they all fell just short.

Li Xu closed the medical record book, looked at the still-puzzled Hu Qiming, and said, "Qiming, if you can figure out the patient’s condition completely, understand why the previous formulas were ineffective, and know how to treat him, then you could be considered a relatively mature TCM doctor. I can recommend to Director Lin that you be allowed to see patients independently."

Hu Qiming’s heart leaped with joy, and a fierce fighting spirit ignited in his eyes.

’This is a "final exam" from Li Xu.’

As soon as Li Xu said this, everyone else in the clinic looked at Hu Qiming.

Even Song Sisi, who was grabbing herbs from the medicine cabinet, glanced over curiously.

For Hu Qiming, it was both pressure and an opportunity.

He took a deep breath and re-organized the information he had just gathered.

’Evening pain... liver stagnation and spleen deficiency... a chronic illness that won’t heal...’

Suddenly, an idea flashed in his mind, and he recalled a line from the *Inner Canon of the Yellow Emperor*.

"Li Xu, I’ve got it."

Hu Qiming’s eyes lit up. "Is it related to the principle of ’late afternoon tidal fever’? Or... the manifestation of the five elements’ generation and restriction cycles in relation to the time of day?"

Li Xu nodded slightly, gesturing for him to continue. "Be more specific."

Hu Qiming organized his thoughts and explained to the patient and his wife, "In the evening, during the period from the Shen hour to the You hour, although the Bladder and Kidney meridians are dominant according to the meridian flow, in the grand cycle of the five elements, evening is when ’Metal’ qi is at its most exuberant."

"And in the five elements, Metal restricts Wood."

"The patient is already suffering from liver qi stagnation, and the liver belongs to Wood. When evening comes and Metal qi flourishes, it further restricts Liver Wood. This causes the liver qi to become even more suppressed and the stagnation to worsen. Once the liver qi is constrained, it lashes out and attacks Spleen Earth even more fiercely, which is why the stomach pain intensifies in the evening."

"The liver-soothing medicines prescribed by the previous doctors, while capable of soothing the liver, ignored this temporal pattern of ’Metal restricting Wood.’ Also... their effects were probably not focused enough to break this vicious cycle."

After he finished, Hu Qiming looked at Li Xu with some trepidation. "Is my analysis correct?"

Li Xu’s eyes showed his approval. He nodded. "Your analysis is very logical. You’ve grasped the key point of the five elements’ generation and restriction. But that’s only the first part."

"There’s a second part?"

Hu Qiming was stunned.

"The second part," Li Xu said, holding up two fingers, "lies in the transformation between ’deficiency and excess.’"

"The patient has been ill for a long time. His condition has transformed from a simple excess pattern to a mixed pattern of deficiency and excess. The liver blood is deficient, so it cannot nourish the liver, making the liver qi even more stagnant. The spleen qi is deficient, so it cannot transport and transform, making the dampness and stagnation even more severe."

"The previous formulas mostly focused on soothing the liver and regulating qi, but they neglected to nourish the blood and soften the liver. Herbs like Chaihu and Fructus Aurantii, while able to unblock the qi mechanism, will deplete the liver yin with prolonged use. This, in turn, makes the liver even more ’dry’ and agitated, so naturally, the pain not only doesn’t decrease but actually increases."

Li Xu turned to the patient. "Therefore, the treatment can no longer be purely about unblocking."

He picked up a pen and wrote on the prescription pad with swift, flowing strokes.

While writing, he explained, "Since we’ve identified it as a ’mixed deficiency and excess’ pattern with a focus on strengthening the spleen, we can use a large dose of Mountain Yam as the ’monarch’ herb. Mountain Yam is white and enters the lungs, sweet and returns to the spleen, and its thick fluid benefits the kidneys. It strengthens the spleen, tonifies the lungs, secures the kidneys, and boosts the essence. A single herb that takes care of the upper, middle, and lower jiaos. It is an excellent harmonizing tonic. We’ll add Atractylodes, malt, Chicken Gallbladder, Magnolia Bark, and licorice to fortify the spleen and stomach, promote digestion, and resolve accumulation."

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