Hu Qiming didn't leave after giving his report. Instead, like a student, he pulled up a chair and sat down next to Li Xu.
He had nothing else scheduled for the day, so it was a perfect opportunity to learn from Li Xu.
A short while later, the consultation room door was pushed open.
A young man and woman walked in.
The man was about twenty-seven or twenty-eight, dressed head to toe in brand-name casual wear. Although Li Xu didn't recognize the Patek Philippe on his wrist, he could tell it was incredibly valuable.
His companion was young and beautiful, holding the man's arm with a look of concern.
Judging by their clothes, style, and demeanor, their family had to be quite well-off.
"Have a seat."
Li Xu gestured.
The young man sat in the chair before the desk. He seemed fidgety and ill at ease, twitching his shoulders from time to time as if in great discomfort.
"Dr. Li."
The young man spoke before Li Xu could, his tone polite. "A friend recommended me. He said you're a Divine Physician who specializes in difficult and unusual cases."
"What seems to be the problem?"
Li Xu asked with a smile.
"Dr. Li, look at this."
The young man wasted no time and lifted his shirt.
HISS—
Hu Qiming, who was sitting nearby, couldn't help but suck in a sharp breath, goosebumps breaking out all over his skin.
The young man's fair skin was densely covered in red wheals, the kind commonly known as hives.
They formed vast, connected patches, some shaped like maps, others like islands. The sight alone was unsettling.
Worse, many areas had been scratched raw, leaving behind long, bloody marks and scabs.
"And here."
The young man pulled up his pant legs and sleeves.
Holy cow!
Except for his face, which was relatively clear, his arms and legs were completely covered in the same red spots and wheals. There wasn't a single patch of intact skin.
"How long has it been like this?"
Li Xu asked, his expression still calm.
"Over two years now."
The young man said with a pained expression, "Dr. Li, you have to help me. This condition is torture. Seriously, it's worse than being punished. When it gets itchy, I wish I could just take a knife and scrape this whole layer of skin off."
As Hu Qiming listened from the side, his mind couldn't help but wander. 'Rich people really are something else. Even with his skin like this, he can still find such a beautiful girlfriend. If I had skin like a toad, I'd probably be doomed to die alone.'
It was a good thing Li Xu couldn't read his mind, or he would have kicked him for sure.
At a time like this, instead of focusing on the diagnosis, his mind was on that?
Letting his thoughts stray like that showed a lack of professionalism and discipline.
In Traditional Chinese Medicine, a diagnosis is made by synthesizing the four examinations: observation, listening and smelling, inquiry, and palpation.
A skilled physician performs all of these simultaneously.
Observation is listed first precisely because it is the most direct and fastest way to gather information.
The moment a doctor first sees a patient, the diagnosis has already begun.
They observe the patient's complexion, physique, and expression—even the way they walk and the tone of their voice.
A less skilled doctor can only go through the steps one by one.
But a doctor who can take the pulse, ask questions, and observe the patient's demeanor all at the same time is truly a master among masters.
"Is it very itchy?"
Li Xu continued his questions.
"Yes, incredibly itchy. A deep, boring itch."
The young man said through gritted teeth, "All the doctors tell me not to scratch, that it'll only make it worse, but I can't help it. Scratching it feels so good. Even though it hurts when the skin breaks, it's still better than the itching!"
"Let me take your pulse."
Li Xu gestured for the young man to rest his arm flat, then placed three fingers on the man's radial artery.
As he took the pulse, he continued to observe the young man's tongue.
The tongue itself was pale red with a thin, white coating.
The pulse was floating and slow.
After finishing the pulse diagnosis, Li Xu turned to Hu Qiming, intending to test him. "What do you think?"
Hu Qiming quickly reined in his wandering thoughts and said seriously, "It's urticaria. In TCM, we refer to it as 'hidden rash' or 'wind rash.' The main symptoms are bright red or pale wheals that appear and disappear, accompanied by intense itching."
"Generally, it's caused by an external contraction of wind evil. Wind is the leader of the hundred diseases; it moves swiftly and changes often, which is why the wheals appear in different places."
"There is also a type caused by blood deficiency and wind-dryness. However, patients with that condition usually also present with a pale complexion, heart palpitations, insomnia, and pale lips and tongue."
Hu Qiming paused for a moment before continuing his analysis. "Although this patient has had the condition for a long time, his complexion is ruddy, his spirits seem fine, and his tongue is pale red, so it's likely not blood deficiency. Therefore, I believe it's a wind rash caused by wind evil lodging in the skin and creating a disharmony between the nutritive and defensive qi."
Li Xu nodded slightly, acknowledging his basic assessment.
But he immediately followed up with a deeper question. "Then tell me, why do these wheals itch? What is the pathogenesis?"
"Well..."
Hu Qiming froze, opening and closing his mouth, momentarily at a loss for words.
'That's right, why does it itch?'
Although the books say "an abundance of wind causes itching," that's just a conclusion.
What's the actual mechanism?
As a medical school graduate, he had a solid theoretical foundation.
But the theories of TCM are vast and profound. He had studied and memorized much of it for exams in school, but if it wasn't repeatedly verified and deeply understood in a clinical setting, it would eventually be forgotten—returned to the teachers, so to speak.
This was the principle of "applying what you learn."
If you used something you'd read just once, it would leave a deep impression. If you only relied on rote memorization, you would quickly forget it.
"Itching is the release of wind."
Li Xu looked at the medical record and spoke slowly. "After the wheals are scratched open, even though the skin is damaged, the qi and blood are temporarily unblocked. The wind evil is expelled with the blood, which is why the patient feels a 'perverse' sense of relief. This indicates that the root of the problem is stagnant qi and blood, trapping the wind evil inside."
"So that's it..."
Realization dawned on Hu Qiming, and he slapped his thigh. "No wonder they say, 'Itching is the beginning of pain, and pain is the extreme of itching.' It's all an issue of qi and blood."
"Since it's caused by stagnant qi and blood, what method should be used to treat it?"
Li Xu asked again, patiently guiding him.
"Then we need to promote the smooth flow of qi and blood in the superficial layers of the skin and muscle, allowing the wind evil to be expelled. The itching will naturally disappear," Hu Qiming replied, following the line of reasoning.
"Correct."
Li Xu nodded in approval. "Since the qi and blood are obstructed, we unblock them and give the wind evil a way out."
With that, Li Xu posed another test question. "Think about it. What medicinal herb, or formula, can both enter the blood aspect and move through the qi aspect, while also venting wind evil?"
"Schizonepeta?"
Hu Qiming answered with some hesitation, not entirely certain.
"That's right, Schizonepeta."
Li Xu confirmed with a nod.
"Schizonepeta has the effects of releasing the exterior, dispelling wind, venting rashes, and resolving sores. It's not just an exterior-releasing herb; it's a blood-regulating herb."
Li Xu explained further, "In *Fu Qingzhu's Gynecology*, Schizonepeta is considered 'a qi-mover within the blood.' It excels at entering the blood aspect and can draw out the wind qi latent in the blood vessels, making it a sacred herb for treating wind evil in the blood."
As he spoke, Li Xu typed the patient's symptoms into the computer and then wrote out a prescription.
The printer whirred, and a prescription slip slid out.
Li Xu handed it to the young man covered in red welts.
The young man took the prescription, and his eyes widened in surprise as he looked at it.
Because on Li Xu's prescription, there was only a single herb.
It was—Schizonepeta.
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