Chapter 707: Same Treatment for Different Diseases

Chapter 707: Chapter 707: Same Treatment for Different Diseases

Li Xu continued, "If this were over a month ago, when she first fell ill and the suspended fluid was just starting to accumulate, using the Ten Jujubes Decoction to purge the fluid after resolving the exterior symptoms would have likely had good results. It might have even been a complete success."

"But now, too much time has passed. After all the back-and-forth at the city hospital and the rounds of antibiotics, her condition has become severe. Look at her. She can’t eat, meaning the qi of her spleen and stomach is extremely weak. She’s struggling to breathe, indicating a major deficit in her pectoral qi. She’s as thin as a rail—her vital qi is all but gone."

"In her current state, using a harsh purgative like the Ten Jujubes Decoction would only make things worse. She would likely die of exhaustion before any fluid could be expelled."

Liu Quanshan broke out in a cold sweat. He still asked, a little uncertain, "Doctor Li, how did you determine that her vital qi is too depleted to withstand an aggressive treatment? Is there a specific passage about this in the *Treatise on Cold Pathogenic and Warm Pathogenic Diseases*?"

Li Xu answered with a solemn expression, "Her pulse. Right now, it’s fine, rapid, and erratic."

"A fine pulse indicates dampness and weak Yang Qi, which fits her condition of suspended fluid and chronic debility. But a rapid pulse indicates a heat pattern. When a fine and rapid pulse appear together, it often points to a critical situation of yin deficiency with blazing fire, where yin can’t restrain yang. This completely contradicts the patient’s overall presentation of cold congealing the blood and Yang Qi on the verge of collapse."

"As we say in Chinese medicine, ’A match between pulse and symptoms is auspicious; a mismatch is dire.’ Add to that her erratic pulse—like a pecking sparrow or a leaking roof—and it’s clear the True Qi of her five major organs is failing and her pulse qi is about to give out. She’s on death’s door. To use a violent formula like the Ten Jujubes Decoction at this stage... the consequences would be unthinkable."

Hearing this, Liu Quanshan’s heart seized, and he subconsciously clenched his sphincter.

The books were perfectly clear about how powerful the Ten Jujubes Decoction was. It was a violent purgative capable of causing such severe vomiting and diarrhea that it could lead to dehydration and shock.

A wave of fear washed over him in hindsight.

’Thank goodness Li Xu came today.’

’Otherwise, if I had been on my own and prescribed the Ten Jujubes Decoction strictly by the book... if she had died after drinking it, my clinic’s reputation would have been destroyed. No one would ever have dared to come to me for treatment again.’

He wiped the cold sweat from his forehead and asked Li Xu, "So... what should we be prescribing in a situation like this?"

Li Xu gave his answer. "The Gualou Xiebai Baijiu Decoction..."

Liu Quanshan froze, interrupting in confusion, "The Gualou Xiebai Baijiu Decoction? Isn’t that a formula for chest impediment? Why would you use it for pleurisy and pleural effusion?"

Listening on the side, a thoroughly confused Xu Yuan Cai couldn’t help but cut in. "You two doctors... what’s ’chest impediment’?"

Doctor Liu explained to the patient’s son, "Chest impediment, in layman’s terms, is a stuffy, stabbing pain in the chest and back. It’s primarily a heart issue, like what Western medicine calls coronary artery disease or angina."

This made Xu Yuan Cai even more anxious. He turned to Li Xu. "But my mom was checked at the city hospital! It’s not her heart, it’s pleurisy from tuberculosis! Doctor Li, are you sure you haven’t made a mistake?"

Li Xu frowned slightly at his words.

He was quite familiar with Liu Quanshan.

A few years ago, whenever Doctor Liu encountered a case he wasn’t sure about, he would often go and consult Li Xu’s father.

’To be honest,’ Li Xu thought, ’Doctor Liu is just your average, run-of-the-mill TCM practitioner. He’s memorized a few of the classic song-poems for prescriptions and can handle common ailments like colds and stomachaches just fine.’

’But as soon as he runs into a complicated or critical case, his rigid way of thinking falls apart.’

’His thinking is too rigid—he’s a classic case of someone who studies the books without truly understanding them. He doesn’t know how to adapt.’

Instead of answering Xu Yuan Cai directly, Li Xu turned to Liu Quanshan. "Doctor Liu, since you know the Gualou Xiebai Baijiu Decoction is for chest impediment, why don’t you tell me: what is the core disease mechanism of chest impediment?"

Liu Quanshan answered without hesitation. "The disease mechanism... the books describe it as ’deficient yang and ascendant yin.’ That means the yang in the chest is weak, allowing yin-cold to congeal, which leads to qi stagnation and blood stasis that blocks the heart’s vessels."

Li Xu nodded. "Exactly. The chest is supposed to be a ’clear and open space,’ full of Yang Qi. It’s only because the Yang Qi is weak that pathogenic yin-cold can invade, gather, and cause qi stagnation and blood stasis. That’s when you use the Gualou Xiebai Baijiu Decoction. The trichosanthes fruit resolves phlegm and breaks up masses. The Chinese scallion unblocks the yang and scatters cold. The white wine is pungent and warm, coursing through the body to move qi and invigorate the blood. With these three ingredients, the chest yang is restored, and the pathogenic yin-cold naturally scatters. Correct?"

Liu Quanshan nodded again and again. "Yes, yes, that is indeed the theory."

Li Xu pointed to the old woman gasping for breath on the bed, then patted his own chest and declared, his voice ringing with conviction:

"Western medicine calls the old woman’s condition severe pleurisy and pleural effusion. But in Chinese medicine, no matter what you call it, the essence is the same: this area, the chest cavity, is full of fluid."

"And fluid—is it yin in nature?"

Startled, Liu Quanshan answered instinctively, "It is. Water and fluids are considered yin pathogens."

"Then isn’t that just pathogenic yin-cold gathering in the chest?"

Li Xu’s voice rose, each word landing like a hammer blow. "And why would so much fluid accumulate? It’s because her chest Yang Qi is deficient! The qi transformation process is powerless, so fluids can’t be metabolized properly. They stagnate and become ’suspended fluid’!"

"In essence, how is that any different from the disease mechanism of ’chest impediment’—’weak chest yang and congealed yin-cold’? It’s the exact same pathology!"

"So tell me: in a situation where the chest yang is being suffocated by cold yin-fluid, should we or should we not use a decoction that can ’unblock the yang, break up stagnation, resolve phlegm, and redirect qi downward’?"

"Oh!!!"

It was a moment of sudden enlightenment for Liu Quanshan.

His mind might have been rigid, but he was by no means a fool.

With Li Xu’s prompting, he felt a wave of clarity wash over him, like a fog suddenly lifting.

He muttered to himself, "’Different diseases, same treatment’... So this is what it means. You ignore the name of the disease and treat the underlying mechanism directly. Brilliant... absolutely brilliant!"

It was like a paper screen.

Once it was punctured,

everything became clear.

Li Xu began to write out the prescription.

"We’ll use the Gualou Xiebai Baijiu Decoction as the main formula. This will bolster the chest yang and warm and transform the cold fluids. This treats the root of the problem."

"We’ll combine it with the Danshen Drink. Her lips and tongue are bluish-purple, a clear sign of blood stasis. We have to invigorate the blood to break up the stasis, regulate qi, and stop the pain. This will drive out the stagnation."

"Finally, we’ll add the Thousand Gold Reeds Decoction. That formula is originally for lung abscesses with coughing of pus and blood, but I’m borrowing its ability to ’clear the lungs, transform phlegm, expel stasis, and drain pus.’ We’ll use it to open the water pathways and drain the pleural effusion. The results should be excellent."

To this powerful combination of formulas, Li Xu carefully added or removed a few more herbs based on the old woman’s weak constitution, aiming to support her vital qi and promote fluid drainage.

When he finished writing, Li Xu handed the prescription to Xu Yuan Cai.

"Get on your bike and go to my clinic right now. Have Sisi prepare these herbs."

The herbs at his clinic were all high-quality and thus more effective. Li Xu didn’t trust ingredients from any other source. The patient was in critical condition; he couldn’t allow the outcome to be compromised by the quality of the herbs.

"Okay, yes, I’ll go right now."

Xu Yuan Cai took the prescription and bolted out the door.