Chapter 17: Observing the Consultation
In the main auditorium.
Professor Gao continued discussing the case study.
"The prescription I wrote included Cinnamon Bark, red peony, spatholobus stem, pangolin scales, and motherwort..."
"Among them, the Cinnamon Bark was the most crucial... it was the primary ingredient in the formula. What’s more, Cinnamon Bark is very affordable, not expensive at all. But what I never expected was that the Cinnamon Bark the patient got from the pharmacy was actually fake..."
"I recognized it at a glance. It wasn’t Cinnamon Bark, but small, dried apple twigs being passed off as it. Real Cinnamon Bark has a reddish-brown surface with distinct vertical ridges, its bark peels off easily, and it’s brittle and hard. It has a rich, fragrant aroma... which does share some similarities with apple twigs, but its medicinal effects are completely different."
"It wasn’t just the Cinnamon Bark; the spatholobus stem was also fake. The ’spatholobus stem’ from the pharmacy was actually sarsaparilla stem. They look similar to the real thing, but you can still tell them apart with careful observation..."
The audience members looked at each other in dismay.
’If the herbs are all fake, it doesn’t matter how good the prescription is. It’s completely useless!’
Professor Gao grew angrier as he spoke on stage. "I went straight to the pharmacy and checked everything one by one. It turned out that of the more than one hundred commonly used herbs, over twenty were fakes, and the quality of the rest wasn’t great either..."
"...Of course, I reported it afterward. The head of the pharmacy department, who was in charge of procuring herbs, was arrested. The investigation found he was deeply involved in corruption..."
"This sort of thing happens even at our Provincial Hospital of Traditional Chinese Medicine. I’m sure it’s just as common, if not more so, in city and county hospitals, and some small clinics..."
"So, we TCM doctors must not only know how to diagnose illnesses but also understand medicinal herbs. The root of this patient’s problem was the quality of the herbs. Once the patient switched to genuine herbs, the effect was immediate... And that is what I want to talk about today: the decisive role of Chinese medicinal herbs in the development of TCM..."
The auditorium erupted in fervent applause.
Professor Gao gestured for Li Xu to sit down. "Young man, report to the internal medicine clinic at 1:30 this afternoon."
Li Xu breathed a sigh of relief. ’I guessed right!’
Although today’s intelligence didn’t give a direct answer, it was still very useful.
’Being able to observe Professor Gao’s consultations this afternoon will be a huge opportunity for my development!’
The students around him cast envious glances his way.
Hu Qiming gave him a friendly punch on the arm. "Not bad, kid! You actually guessed it!"
Li Xu whispered, "Just a blind squirrel finding a nut."
After that, the lecture officially began. Gao Guanghui gave a fascinating and easy-to-understand explanation covering every aspect of medicinal herbs, from cultivation and processing to distribution.
Li Xu focused all his attention on taking notes, and everyone else listened intently as well.
During the lunch break, the students gathered around Li Xu, hoping to learn from his experience.
Li Xu told them about his trip to the herb market. "...The market is flooded with fakes. If you don’t have a sharp eye, you’ll never get the real thing. I almost got burned myself."
At 1:20 p.m., Li Xu arrived early at the internal medicine clinic.
Hu Qiming and another middle-aged doctor were already waiting there.
"Li Xu, let me introduce you. This is Director Lin, an associate chief physician at our City Hospital of Traditional Chinese Medicine," Hu Qiming said, making the introduction.
Associate chief physicians are the backbone of a hospital.
While not on the same level as a chief physician, they are still highly skilled.
"Director Lin, hello. I’m Li Xu from Li’s Traditional Chinese Medicine Clinic."
Li Xu took the initiative to greet him.
Lin Guorui nodded and added, "This is a rare opportunity. Pay close attention."
A moment later, Professor Gao walked in wearing a white coat and offered a simple greeting.
The first patient was an elderly woman in her sixties, whose chief complaint was insomnia and excessive dreaming.
After taking her pulse, Professor Gao didn’t give a diagnosis right away. Instead, he turned to Li Xu and the other two and asked, "The patient’s pulse is floating but slightly deep, with flourishing heart-fire. What formula should be prescribed?"
The three of them thought it over. Lin Guorui, living up to his title of associate chief physician, was the first to think of a solution. "A modified Sour Jujube Seeds Soup?"
Sour Jujube Seeds Soup nourishes the blood to calm the spirit and clears heat to relieve vexation.
The ingredients can be adjusted to target the symptoms more precisely.
Professor Gao shook his head. "The line of thinking is correct, but it’s not precise enough."
He explained as he wrote the prescription, "The root cause is the old woman’s insufficient liver-blood, but there’s also heart-fire. We need to address both by clearing heart-fire and nourishing liver-blood."
"We should use Calming Soup to address the problem at its source. To use an analogy, if insomnia is like boiling water, the Sour Jujube Seeds Soup works by reducing the firewood or extinguishing the flame. The Calming Soup, on the other hand, removes the firewood entirely. The boiling water quickly cools down, or the cold water never even gets a chance to boil."
"I see."
The three of them had a moment of realization and felt they had learned a great deal.
For the subsequent cases, Professor Gao didn’t ask any more questions and focused all his attention on treating the patients.
His various techniques and insights were a great revelation to Li Xu.
It was like a math problem where he had only known the answer from a book, but not the process to get there.
Now, watching Professor Gao diagnose patients was like learning the entire process.
He gained a much deeper understanding of the four diagnostic methods: observation, listening and smelling, inquiry, and palpation.
A little after 3:00 p.m., a young woman in her early twenties entered the clinic, her face as pale as paper, slowly walking in with her mother’s support.
Professor Gao gestured for her to sit down and asked gently, "Young lady, what seems to be the trouble?"
"I’ve had irregular periods for over half a year, and recently I’ve been feeling dizzy all the time and can’t sleep well at night..." the young woman’s voice was as faint as a mosquito’s buzz.
Professor Gao took her pulse, his brow gradually furrowing. "A thin and weak pulse, seems like a deficiency of both qi and blood..."
Then he had the young woman stick out her tongue.
A pale, swollen tongue with teeth marks is a sign of spleen deficiency and excessive dampness.
However, Professor Gao had a feeling there was something else wrong with her.
’I need to diagnose this carefully.’
The young woman’s mother added from the side, "A previous doctor prescribed her a lot of tonics, but the more she took, the worse she felt."
Professor Gao explained, "TCM emphasizes treatment based on pattern differentiation. Just because there’s a deficiency doesn’t mean you must tonify. Prescribing herbs is like deploying troops; it requires strategy."
"Come a little closer. I want to look at your eyes."
"Okay."
The young woman moved her stool, accidentally bumping the table.
It made a harsh, strange noise.
No one else in the consultation room seemed to notice.
But the young woman’s body was suddenly wracked by violent convulsions. Her eyes rolled back in her head, and she slid from her chair to the floor, her limbs spasming uncontrollably.
The clinic was instantly thrown into chaos.
"Xiao Ya! Xiao Ya!" her mother cried in a panic, kneeling on the floor and trying to hold her daughter down.
Professor Gao leaped forward. "Don’t hold her down! Turn her onto her side!"
He quickly slid a soft cushion under the young woman’s head to prevent her from biting her tongue.
Li Xu, Hu Qiming, and Lin Guorui immediately came forward to help.
𝑓𝑟ℯ𝘦𝓌𝘦𝘣𝑛𝑜𝓋𝑒𝓁.𝑐ℴ𝓂
After about a minute, the convulsions gradually stopped, but the young woman’s face was even paler than before. Her eyes were unfocused, and white foam flecked the corners of her mouth.
The mother, her face streamed with tears, cried out, "Professor, my daughter has had this illness for three years. Western medicine diagnosed it as epilepsy, and she’s taken so much medication, but nothing has helped... I was afraid you wouldn’t treat her if I told you earlier, so I..."
Professor Gao waved his hand to show he understood and began taking the young woman’s pulse again.
This time, his expression was much more grave, and he took her pulse for a much longer time than before.
A case of seizures and epilepsy would be transferred to the neurology department in a Western hospital.
However, this was a Hospital of Traditional Chinese Medicine.
Most Hospitals of Traditional Chinese Medicine don’t have a neurology department.
Instead, such cases are handled by the internal medicine department.
As a renowned expert in TCM internal medicine, Gao Guanghui was also accomplished in treating neurological disorders. After a moment of thought, he said, "The situation isn’t too severe. I’ll write you a prescription."