Chapter 706: Ten-Jujube Decoction

Chapter 706: Chapter 706: Ten-Jujube Decoction

"It’s severe bilateral tuberculous exudative pleurisy, with a serious pleural effusion."

Xu Yuan’cai answered anxiously, pulling a stack of test reports from the bedside table and handing them to Li Xu. "The respiratory specialist at the city hospital looked at the scans. He said that for my mother’s lungs, on both sides, everything below the first to third ribs is completely white. It’s all submerged in fluid."

"The hospital insisted she needed an immediate puncture to drain the fluid, or she would suffocate. But my mother absolutely refused. She’s afraid of pain and afraid of the cost. She cried and made a scene at the hospital, even pulling out her IV needle. We couldn’t convince her, so we had to sign the discharge papers, thinking we could just let her recover slowly at home... Oh, what do we do now? How did it suddenly get so serious?"

Xu Yuan’cai was sweating with anxiety. "The medicine we brought back from the city hospital—that anti-tuberculosis drug, streptomycin—we haven’t missed a single day for the past ten days or so. We even had Dr. Han come over to give her the injections."

Standing to the side, Han Weimin nodded quickly. "I was the one who gave them. I administered the injections on time and with the correct dosage every day; there’s no way I made a mistake. But... although she was coughing and wheezing the last few days, it was nowhere near as severe as it is today. She could still drink a little congee on her own."

Han Weimin’s heart was now pounding with panic.

He prayed silently, ’Please don’t let them pin this on me.’

After all, his clinic had already been investigated once for secretly decocting traditional Chinese medicine.

If this old woman died because of the injections, his clinic would be shut down for good.

Li Xu ignored Han Weimin’s attempt to pass the buck.

He walked to the bedside and observed the old woman.

The old woman’s lips had turned a purplish-blue. It was a sign of extreme oxygen deprivation—cyanosis.

She was completely unable to speak and couldn’t even lie flat. She had to sit upright to breathe, as the fluid in her chest cavity was compressing her lungs, preventing them from expanding.

Li Xu quickly questioned Xu Yuan’cai to understand the full history of the illness.

He learned that when the old woman first fell ill, it just seemed like a common cold, with fever and chills.

Because the family was poor, they didn’t pay much attention at first. She didn’t take any medicine and continued to work in the fields.

As a result, after dragging on for over half a month, it developed into chest tightness, incessant night sweats, a violent cough, and even coughing up blood-streaked phlegm.

Only then did her family force her to go to the city hospital for an examination.

The diagnosis was "severe bilateral tuberculous exudative pleurisy with pleural effusion."

After the patient insisted on being discharged and returning home, her condition had suddenly and rapidly worsened in the last few days, despite continuously receiving streptomycin injections.

It had reached the point where she now struggled to breathe and couldn’t take a deep breath at all. Each breath sent a sharp, stabbing pain through her chest, like being pricked by needles.

Moreover, due to the intense pain and stuffiness, she ate very little each day, and her stomach Qi was already extremely weak.

"Stick out your tongue for me, let me have a look."

Li Xu said gently to the old woman.

The old woman struggled to open her mouth, her tongue trembling slightly as she extended it.

Li Xu leaned in for a closer look and was instantly alarmed.

The edges and tip of the old woman’s tongue were covered in dark purple ecchymosis spots of various sizes.

The color of her lips and tongue was also a purplish-blue.

Li Xu mused, ’There is a saying in Chinese medicine: "When the tongue’s color resembles the blue veins visible on the skin and lacks redness, it is called a blue tongue, also known as a water buffalo tongue."’

’A blue tongue indicates cold coagulation, stagnation of Yang Qi, and Qi stagnation with blood stasis.’

’Her tongue is also covered in stasis spots, which indicates not only cold coagulation and Qi stagnation, but also the formation of severe blood stasis obstructing the meridians.’

’The accumulation of fluid in the chest and hypochondrium is compressing the heart and lungs, leading to poor Qi flow. Qi stagnation then causes blood stasis.’

’This fluid and blood stasis have become intertwined, forming the deadly root of this disease.’

"Doctor Li, please, you have to come up with a plan! How are we going to treat this?"

Xu Yuan’cai’s face was etched with anxiety.

Just as Li Xu was about to speak, another set of footsteps was heard from outside the door.

"Oh my, what’s happened to her? I’m late!"

As the voice spoke, a middle-aged man in his fifties walked in.

It turned out that Xu Yuan’cai’s wife, having found Li Xu’s clinic closed earlier, had grown anxious. Fearing that Li Xu wouldn’t be able to come and the treatment would be delayed, she had run to the next street over to fetch another TCM doctor—Liu Quanshan.

Liu Quanshan also ran a small clinic in the area. He was decent at treating minor ailments like headaches, fevers, and back pain, and was a familiar face to the neighbors.

The moment he entered, he saw Li Xu and froze.

"Oh, Doctor Li, you’re here too."

Liu Quanshan breathed a sigh of relief. "With a Divine Physician like you here, there’s no need for me to show off my amateur skills."

In the TCM circles of Feng City, who didn’t know Li Xu’s name by now?

He was someone even the City Hospital of Traditional Chinese Medicine had to treat with reverence. Moreover, his medical skills were famously uncanny, specializing in all sorts of difficult and complex cases.

Although he, Liu Quanshan, was a good two decades older than Li Xu, he felt ashamed of his inferior medical skills.

"Doctor Liu, since you’re already here, don’t be in such a hurry to leave," Li Xu said, stopping him. "This is actually a very typical case. Let’s discuss it together. Looking at the old woman’s condition, how would you plan to treat her?"

Li Xu wasn’t intentionally putting him on the spot; rather, he sincerely wanted to mentor these local, grassroots doctors.

If the skill level of grassroots TCM doctors improved, ordinary people would suffer less.

Seeing how polite Li Xu was, and that he had no intention of shooing him away, Liu Quanshan felt a desire to learn from the situation.

He walked to the bedside, carefully observing the old woman’s complexion and breathing, then took her pulse.

After a moment, Liu Quanshan frowned in thought and said, "The old woman has pleural effusion, her breathing is so labored, and her pulse is deep and thready... In TCM, this would fall into the category of ’suspended fluid,’ wouldn’t it?"

"’Suspended fluid’: water accumulated beneath the ribs, causing pain upon coughing and spitting."

Recalling a passage from a medical text, Liu Quanshan said tentatively, "The *Essential Prescriptions of the Golden Cabinet* says, ’For the disease of suspended fluid, prescribe Ten Jujube Decoction.’ Doctor Li, what do you think... should we first try to purge the fluid with Ten Jujube Decoction and see if we can drain the pleural effusion?"

After listening, Li Xu shook his head. "No. The window of opportunity to use Ten Jujube Decoction has already passed."

Liu Quanshan was confused and asked humbly, "Why not? Isn’t pleural effusion a case of suspended fluid? And if it is, Zhang Zhongjing’s *Essential Prescriptions of the Golden Cabinet* clearly states that Ten Jujube Decoction should be used. It’s the classic, symptomatic formula."

Li Xu explained patiently, "Doctor Liu, you can’t just read half a sentence, and you certainly can’t just memorize books without understanding them. When the *Treatise on Cold Pathogenic and Warm Pathogenic Diseases* discusses the indications for Ten Jujube Decoction, it explicitly states a prerequisite for its use: ’It can only be used to purge after the exterior condition has been resolved.’"

"In other words, this kind of harsh, purgative medicine can only be used after the patient’s exterior syndrome is fully resolved. On top of that, there must be other signs, such as ’epigastric focal distention, hardness, and fullness,’ which indicate an unresolved interior condition with fluid accumulation. Crucially, the patient’s vital Qi must still be strong—a case where both the symptoms and the patient’s constitution are strong enough to handle it."

"Ten Jujube Decoction is an extremely potent medicine, a ferocious remedy designed to expel fluid. Its application is very strictly defined; you absolutely cannot use it for just any case of suspended fluid."

Liu Quanshan nodded, a look of understanding dawning on his face.