Chapter 12: Yangming Organ Excess Syndrome with Recurrent High Fever

Entering Huang Biao’s internal medicine consultation room, Zhang Jing chose not to draw back the blinds but instead turned on the lights. In his view, traditional Chinese medical consultations were not for show, nor a display behind glass windows. Moreover, exposing patients to passersby would infringe upon their privacy rights.

Huang Biao’s desk was sparse; besides the pulse pillow, tongue depressor, blood pressure cuff, stethoscope, and telephone, there was only a ceramic teacup. Remarkably, there wasn’t a single medical book in sight. This was hardly surprising, as his sole secret weapon, the “Song of Decoctions,” was engraved in his memory, rendering any physical book unnecessary. As for other medical texts, he had no intention of studying them, so bringing them along would have been pointless. Zhang Jing also guessed that Huang Biao might worry that having books on the desk would give patients the impression that his skills were incomplete.

In one corner of the room stood a computer, originally intended for electronic medical records and prescriptions. However, Huang Biao neither knew how to operate it nor could he type, so it remained idle.

Zhang Jing was aware that, apart from occasional busyness on weekends, Huang Biao’s daily caseload on regular workdays rarely exceeded three to five patients. Hence, Zhang Jing did not expect to see many patients during his one-day stint covering for him. Even if only one patient came, he was determined to prove his worth.

Unfortunately, the entire morning passed without a single sound at the door. During lunch break, Gui Cui informed Zhang Jing that, apart from two patients seeking massage therapy from Wang Sen, there had been one woman wanting to consult for gynecology. However, upon learning that Huang Biao was off today and only Zhang Jing was available, she refused to register no matter how much Gui Cui recommended him.

Zhang Jing knew Gui Cui had done her best. There was no way around it—in the popular belief among the common folk, the older the traditional Chinese doctor, the more trustworthy. Thus, they still preferred seeing seasoned practitioners.

Soon, the afternoon shift was already halfway through. Zhang Jing shook his head helplessly, thinking that short-term hopes of seeing internal medicine patients were slim; he would have to adopt a more circuitous approach.

After all, his acupuncture skills had already reached a modest level of renown—not high, but distinctly superior to Wang Sen’s. Although Wang Sen claimed over twenty years of experience, his medical expertise was extremely limited; frankly, he hadn’t even mastered the basics of traditional Chinese medicine. The only reason he retained some regular patients was his single massage service. As for acupuncture and cupping, those were mere formalities to charge extra fees.

Zhang Jing had long noticed that Wang Sen couldn’t accurately identify many common acupoints. It had to be admitted that Wang Sen’s massage technique had some foundation. Yet, without understanding yin and yang or point selection, he was no different from a professional blind masseur.

In a sense, Wang Sen wasn’t really treating illnesses; he was merely providing health maintenance massage.

…

While Zhang Jing was planning how to introduce warm needle acupuncture to patients in the acupuncture and massage room to gain his first clinical experience, a sudden knock came from outside the consultation room.

His heart leapt. Finally, a patient?

“Please come in,” Zhang Jing whispered promptly.

Unexpectedly, it was Gui Cui from the herbal pharmacy who entered.

“Is there something wrong?” Zhang Jing asked, a hint of disappointment in his tone.

“Doctor Zhang, a patient has arrived. Please take a look,” Gui Cui said.

“Where? Please invite them in.”

“She… she’s in the lobby but hasn’t registered. Her child has a high fever. Could you… see him first?”

Gui Cui seemed a little hesitant, perhaps feeling this was disrespectful to the doctor.

Zhang Jing paid no mind and immediately rose from his chair.

“Let’s go and take a look.”

In the lobby, there sat a middle-aged woman holding a five- or six-year-old boy. Though it was late autumn and the indoor temperature was below 20 degrees Celsius, the boy wore only a thin vest and was barefoot. Yet, beads of sweat intermittently glistened on his palms and soles.

His vest remained mostly dry, so the sweating was not obvious.

“This is Dr. Zhang from our clinic—a graduate of a reputable university with a practicing physician’s license,” Gui Cui introduced.

The woman eyed Zhang Jing skeptically, finding him too young and untrustworthy.

“Let Dr. Zhang take a look first. It won’t cost anything, right?” Gui Cui urged.

By then, Zhang Jing had already formed a preliminary diagnosis. The child’s high fever, clammy hands and feet in the mid-afternoon—what traditional Chinese medicine called the “daily tide fever”—and the timing corresponding to the Yangming meridian were classic signs of a Yangming fu organ excess pattern.

“Yes, ma’am, I can treat your child’s illness,” Zhang Jing said calmly.

“Really? Young man, don’t make empty promises,” the woman shot him a few more doubtful glances.

“Yes, really,” Zhang Jing reiterated.

“I originally planned to buy some fever-reducing medicine and take him to the hospital for an IV drip tonight,” the woman said, pointing to Gui Cui. “But this young lady said there’s no fever medicine sold here and insisted you could treat the illness so the child wouldn’t have to suffer through IV treatment.”

“Hmm, she didn’t lie to you. Ma’am, bring the child into the consultation room so I can make a proper diagnosis,” Zhang Jing said earnestly.

Hesitating, the woman stood and, still uncertain, followed Zhang Jing into the internal medicine consultation room.

“Please have a seat.”

Once the woman was seated, Zhang Jing began taking the boy’s pulse. As expected, it was extremely large and forceful, like surging waves—a typical flooding pulse.

“Little one, open your mouth,” he gently instructed.

The boy resisted slightly, clamping his mouth shut.

Seeing this, his mother sternly warned, “Open up quickly, or you’ll have to get a shot again.”

This coaxing worked immediately; the boy opened his mouth wide.

“Excellent. Now stick out your little tongue,” Zhang Jing said softly, leaning in.

Pleased by the praise, the boy cooperated further.

Using a medical flashlight, Zhang Jing illuminated the entire throat clearly, obviating the need for a tongue depressor. This was not merely to save the use of a small tool but because many patients, especially children, feared the tongue depressor, which often triggered gag reflexes.

Upon examining the tongue, Zhang Jing observed a red body with a thick, yellow, slightly dry coating—also characteristic of the Yangming fu excess pattern.

Next came the inquiry.

“Ma’am, please briefly describe your child’s illness and treatments over the past few days.”

“Well, last Wednesday evening, I was playing with my child in the community square. It was windy and he sweated a lot, so he probably caught a chill.”

“In the middle of the night, he suddenly developed a high fever. My husband and I took him to the hospital emergency room.”

“After blood tests, the doctor said it was nothing serious—just a common cold—and gave him two anti-inflammatory injections. After the IV, his temperature dropped somewhat, and the doctor prescribed oral anti-inflammatory medicine and a red fever-reducing syrup.”

“The next morning, the fever had indeed subsided. We continued the anti-inflammatory medicine, but the fever returned that night. So we gave him the syrup again, which quickly made him sweat heavily, and the fever gradually went down.”

“Unexpectedly, on the third day, the pattern repeated: fine during the day, fever at night. Thinking this wasn’t sustainable, I took him back to the hospital.”

“The doctor ordered blood tests and an X-ray. The results showed no major problem—just an unresolved cold—and said the child needed a few more days of IV fluids.”