Chapter 451: Chapter 451: Schools of Thought
The Warm Disease School?
Li Xu was taken aback by the question.
He was a ’Wild Doctor’, unaffiliated with any school of thought.
However, his current solution was straight out of the Warm Disease School’s playbook.
The patient’s condition meant that simply using the Xinwen Method to induce sweating and expel the pathogen was out of the question.
Seeing Li Xu hesitate, Tang Changchun asked curiously, "Dr. Li, what prescription are you planning to use?"
Li Xu already had a plan. "A modified Ma Xing Gan Shi Tang Extract Decoction."
Tang Changchun was stunned for a moment, his face a mask of confusion. "Ma Xing Gan Shi Tang Extract Decoction? Isn’t... isn’t that a prescription for Typhoid? The Warm Disease School uses Typhoid formulas?"
Li Xu countered with a question, "What school are you from?"
Tang Changchun answered honestly, "In school, my teacher was from the Typhoid School, so I suppose I am too."
Li Xu then turned to Lin Guorui and asked, "Dr. Lin, what about you? Which school are you from?"
Lin Guorui stated frankly, "I studied under the Plague School, and my main research is in warm diseases."
Li Xu shook his head and said, "I don’t belong to any school."
He fell silent.
In the world of Chinese medicine, disputes between schools of thought were long-standing. There were sectarian biases, centuries of bitter conflict, and mutual disdain.
For example, the ’winter warmth’ Tang Changchun had just mentioned was a concept from the Warm Disease School, a type of seasonal illness.
The so-called ’winter warmth’ basically meant that during winter, which should be cold, one instead experiences warm weather. When people are affected by this unseasonal warmth and fall ill, it is called a winter warmth illness.
Chinese medicine emphasizes harmony between heaven, earth, and humanity. There is a time for autumn harvest and winter storage; winter is supposed to be a time of cold and preservation.
When a winter day is warm instead of cold, people are actually more susceptible to illness.
It’s like in years with mild winters; when the winter is unusually warm, epidemics are more likely to occur.
This is a seasonal illness. The Warm Disease School’s standard prescriptions for winter warmth are Sang Ju Yin and Yin Qiao San, which primarily use acrid-cool methods to release the exterior.
Li Xu pointed to the child. "This child’s condition can’t be simply categorized by the theory of any single school. He has both exterior cold and interior heat, with severely constrained lung qi. A simple acrid-warm method to induce sweating would likely worsen the interior heat, while a simple acrid-cool method to release the exterior would hinder the dispersal of the exterior cold. Therefore, we must take a comprehensive approach and not be constrained by the disputes between schools."
Li Xu continued his analysis, "The acrid-cool methods of the Warm Disease School, like Sang Ju Yin and Yin Qiao San, are not mutually exclusive with the acrid-cool methods from the Typhoid tradition, like the Ma Xing Gan Shi Tang Extract Decoction. Both have their strengths and should coexist, to be selected as the situation demands. The key is an accurate pattern differentiation."
"For example, if a patient has contracted a cold pathogen that has sealed the exterior, we might use a modified San Ao Tang, applying an acrid-warm method to release the exterior.
"If it’s a warm pathogen stagnating in the exterior, we would choose a modified Sang Ju Yin for its acrid-cool properties to promote dispersal and outward diffusion.
"But for this child, his condition is one of interior heat and exterior cold—lung heat and surface cold—which prevents the lung heat from venting and causes the lung qi to become constrained. Using the Ma Xing Gan Shi Tang Extract Decoction at this moment is precisely to leverage its ability to use an acrid-cool method to permeate the exterior and urgently open the constrained lungs."
After hearing Li Xu’s explanation, Lin Guorui felt it made sense, but he was still worried.
He said hesitantly, "Dr. Li, the child’s illness progressed rapidly with dangerous symptoms, and the condition is volatile. Your prescription... while the choice of herbs is brilliant, the child is still suffering from severe pneumonia. I’m still not entirely certain."
Li Xu saw through Lin Guorui’s concerns.
He knew Lin Guorui was worried about the child’s safety and also about the risks he would bear as the attending physician.
But the child was in a perilous state, and they couldn’t afford to delay.
He took the initiative and said, "Dr. Lin, this is an emergency. The medicine must be timely and target the correct pattern to stop the disease’s progression. I’ll write the prescription."
Generally speaking, whoever writes the prescription bears the responsibility.
Li Xu was voluntarily shouldering the responsibility.
Seeing this, Lin Guorui was deeply moved.
Li Xu was a man who took charge.
Since that was the case, he no longer hesitated and nodded. "Alright, Dr. Li. We’ll do everything as you say."
Li Xu didn’t even go back to his office. He got a piece of paper from a nurse, turned around, and began to draft the prescription.
"Ephedra, almond, gypsum, licorice... and add some scallion whites. Scallion whites are acrid and warm, able to unblock the yang and disperse cold, assisting the ephedra in releasing the exterior. At the same time, they can guide the herbs into the lungs, enhancing the effect of opening the constrained lungs."
He specified the dosage: "Decoct to 120 milliliters. Administer warm in three doses, one every four hours."
This combination of herbs reflected the principles of being light, nimble, and pure.
It used small doses, typically employing six or seven herbs—sometimes as few as one or two, and at most no more than twelve—striving for elegant simplicity and effectiveness.
He had recently read a medical text and come across a viewpoint he strongly agreed with.
Prescribing medicine is like commanding troops: precision is more valuable than numbers.
Furthermore, the highest art of pharmacology was being able to substitute inexpensive herbs for costly ones.
This ensures the medicinal effect while also saving the patient money.
Lin Guorui took the prescription and studied it carefully.
Li Xu’s formula was rigorous and the combination of herbs appropriate, but looking at the light dosage and remembering the child had severe pneumonia, Lin Guorui had his doubts.
’Is the dosage too gentle?’
’Will it even be effective?’
But on second thought, since he had already agreed to let Li Xu take the lead, he ought to trust him.
Besides, the prescription was very safe. Even if it didn’t work, it wouldn’t make the patient’s condition worse.
In the end, he decided to use Li Xu’s prescription.
Tang Changchun, who had been standing to one side, also saw the prescription. He was astonished when he heard Li Xu predict that the child’s "fever will break after midnight, and he’ll be mostly fine by tomorrow morning."
He had always heard that Dr. Li was a brilliant physician, but he had never personally witnessed him turn a desperate situation around.
Though filled with doubt, he said nothing and quietly committed the prescription to memory.
"Administer the medicine according to the prescription."
Li Xu gave the instruction and left the treatment area with Tang Changchun.
On the way, he reminded him, "Dr. Tang, you asked me about the disputes between schools earlier. I want you to remember this: don’t get caught up in those kinds of arguments in the future."
Tang Changchun replied, "Yes, Dr. Li."
Li Xu continued, "The diagnostic methods of Chinese medicine—be it the ’Six Meridians,’ the ’Triple Burner,’ or ’Wei-Qi-Ying-Xue’—are all just explanations of the body’s functions and pathological changes. They can be used interchangeably and integrated; they are not mutually exclusive. You can’t rigidly adhere to one school. You have to learn to be flexible and apply them according to the specific illness."
"As for Typhoid, warm diseases, and plagues, they are more like three branches from a single root, not competing schools of thought. They are simply different treatment methods that developed in response to different eras, regions, climates, and causes of disease. The theories of warm diseases also grew out of the study of Typhoid and cannot be separated from the principles, methods, prescriptions, and herbs that originated there. So, you must master all of these. In the future, you’ll be less likely to make mistakes when treating externally-contracted febrile diseases. Even with severe, acute febrile illnesses, your treatments will be very effective."
Tang Changchun voiced the question that had been on his mind. "Dr. Li, was your diagnosis that the patient was suffering from a ’winter warmth’ illness based on these principles?"
Li Xu explained in detail, "The *Inner Jing* states, ’One must first consider the atmospheric influences of the year and not disrupt the harmony of nature.’ When we treat illness and prescribe medicine, we must adapt to the individual, the location, and the time. All externally-contracted diseases are caused by the forces of heaven and earth. We are born between heaven and earth, and our lives should follow their rhythms. If we fall ill, it is only natural that we should be treated according to their laws."
