Chapter 4: Ephedra, Coptis, Red Bean Decoction

“Mm.” Li Yu nodded slightly and continued, “The four diagnostic examinations are complete. Simeng, you go ahead and differentiate the syndrome. According to the Three Yin and Three Yang system, what disease and pattern does the patient present? And which formula should be used?”

Three Yin and Three Yang?

Upon hearing these words, Zhang Jing suddenly understood.

The Three Yin and Three Yang system is the six-channel syndrome differentiation method discussed in the Treatise on Cold Damage Disorders.

He really should have thought of this earlier.

Li Yu is the academic successor of Master Liu, a renowned expert in classical prescriptions, who certainly follows the diagnostic and treatment principles of the Medical Sage Zhang Zhongjing.

No wonder during the initial inquiry, Li Yu emphasized syndrome differentiation rather than getting entangled in the so-called Western or Chinese medical disease names.

Before he could ponder further, Li Simeng began to analyze with a rhythmic nodding.

“The skin corresponds to the exterior, and the pulse is floating, indicating the disease is in the Taiyang channel. There is no nasal congestion, and symptoms of marked aversion to cold suggest the exterior pathogenic factor is not severe. Therefore, the diagnosis is a mild exterior constraint. The formula should be Guizhi Mahuang Decoction in equal parts.”

“On what textual basis?”

“In Taiyang disease, after eight or nine days, resembling intermittent fever, with fever predominant over chills, the person does not vomit and has clear stools that tend toward naturalness… the complexion shows a flush of heat… the body must itch. Therefore, Guizhi Mahuang Decoction in equal parts is suitable.”

She then added, “This formula is also the most commonly used classical prescription for treating urticaria.”

After speaking, a faint smile of satisfaction appeared on Li Simeng’s face, clearly confident in her answer.

Li Yu, however, neither confirmed nor denied, turning back to Zhang Jing.

“Doctor Zhang, what’s your diagnosis?”

“My senior sister and I might have differing views,” Zhang Jing said thoughtfully and solemnly.

“Hmm?” Li Simeng furrowed her brows, feeling a twinge of unease.

“Go on,” Li Yu’s eyes gleamed with anticipation.

“I think that although the patient has a floating pulse indicating unresolved exterior syndrome, there is also evidence of Yangming damp-heat. Because… because a wiry pulse can indicate phlegm-fluid retention. Moreover, the tongue coating is yellow and greasy, the stool is sticky, and the urine is somewhat dark yellow, all further indicating internal damp-heat.”

Zhang Jing spoke somewhat haltingly, as it was his first serious clinical syndrome differentiation, leaving him with a bit of uncertainty.

Unexpectedly, Li Yu nodded repeatedly after hearing this.

“Your differentiation is very accurate. So, what formula would you use?”

“Article 262 in the Treatise on Cold Damage Disorders: For cold damage with blood stasis heat internally, the body will be yellow, and the formula Mahuang Lianqiao Chixiaodou Decoction is the main treatment.”

“Do you remember the prescription and dosages?”

“Mahuang (ephedra) two liang (about 75 grams), Lianqiao (forsythia) two liang, Xingren (apricot kernels) forty pieces (peeled and tip removed), Chixiaodou (red adzuki bean) one sheng (about 1 liter), twelve large dates (split), fresh Zibaipi (catalpa bark) one sheng (cut), fresh ginger two liang (cut), licorice two liang (honey-fried).”

“The eight herbs are decocted in one sheng of water: first boil the Mahuang until foaming, remove the foam, add the remaining herbs, cook down to three sheng, strain, and divide into three warm doses to be taken within half a day.”

Reciting the original text from the Treatise on Cold Damage Disorders was Zhang Jing’s forte, so he spoke fluently.

As soon as he finished, Li Yu felt a sudden surprise: originally, he thought it impressive enough that Zhang Jing could recall the ingredients, but unexpectedly, he recited every dosage, preparation method, decoction, and administration instruction perfectly.

This level of mastery was something even Li Yu himself struggled to achieve.

He nodded repeatedly again.

“Very good! Very good! You truly are a promising disciple of classical prescriptions, solid foundation and high aptitude.”

Before Zhang Jing could respond, Li Simeng frowned and muttered, “I think he’s just a lucky cat stumbling upon a dead mouse. I’m not convinced; we’ll have to have a rematch next time.”

Unexpectedly, Li Yu did not reprimand her but smiled and said, “Alright, I look forward to it.”

Observing this, Zhang Jing found Li Simeng’s temper somewhat odd—always loud and brash, hardly endearing.

Moreover, the relationship between the master and disciple seemed a little peculiar.

Before he could ponder further, Li Yu spoke again.

“Doctor Zhang, you write the prescription for the patient, paying attention to dosage conversions. Do not simply use one liang as 15 grams. For this patient, calculate one-fifth of the original formula’s dosage. Just write the herbs and quantities; I will add the rest.”

He handed Zhang Jing a blank prescription sheet.

“Master Li, isn’t it true that classical prescriptions emphasize using the original formula and dosage without arbitrary adjustments?” Zhang Jing asked curiously.

“Our master Zhang Zhongjing’s method mainly teaches syndrome differentiation and treatment principles. Using classical prescriptions is primarily about learning their rigorous compatibility principles. However, one must not be rigidly bound to the ancient texts. Take this formula, for example. If you are treating a burly man versus a nursing infant, can you really use the same dosage?”

Upon hearing this, Zhang Jing’s cheeks flushed slightly. He quickly picked up his pen and began to write: fresh Mahuang 6 grams, Lianqiao 6 grams… When finished, he handed it to Li Yu for review.

Li Yu examined it carefully.

“Mm, the handwriting is good, but next time try to write neater. This way, the pharmacist can dispense the herbs without error.”

Zhang Jing nodded somewhat embarrassed. He was used to writing in a flamboyant cursive style and had not seriously written in standard script for a long time.

Still, he wondered why such a large traditional medicine clinic didn’t have computers in the consulting rooms.

Even Mingde Hall, a small clinic, used electronic prescriptions. After all, it saves a lot of writing time, and printed fonts are certainly easier to read.

Before he could ask, Li Yu had already begun instructing the male patient on decoction and administration.

“Take this prescription to the herbal dispensary downstairs and get three doses. When you bring the herbs back, decoct three bowls of water down to one bowl. Don’t drink during the day; only take it once every night before bed while it is still hot. Then, drink some extra hot water, cover yourself with a blanket to induce sweating, and do this for three consecutive days.”

“Only three days of medicine? I’ve seen many Chinese doctors before and taken lots of Chinese medicine with little effect. Western medicine worked somewhat, but as soon as I stopped, it flared up again,” the male patient said skeptically.

This was also Zhang Jing’s thought.

Urticaria persisting for two months, cured with just three doses? Was Li Yu overconfident?

Looking at Li Yu again, he remained composed and confident.

He replied, “Although this illness has lasted some time, the patient’s original Yang energy has not declined. Three doses are sufficient! Rest assured! After taking the medicine, you’ll sleep well tonight.”

The patient was somewhat confused at the first half of the explanation but clearly understood the latter.

Thinking, since the doctor is so confident, it must be reliable.

He quickly thanked them and happily took the prescription downstairs.

Now only the master and two disciples remained in the consulting room.

“Master Li, why don’t you use electronic prescriptions here?” Zhang Jing asked eagerly as soon as the patient left.

“Typing on a computer is indeed fast and convenient, but it tends to cultivate a restless and impatient character. Chinese medicine diagnosis requires calmness, attention, and seriousness, especially when taking the pulse,” Li Yu replied calmly.

Zhang Jing pondered silently and found it increasingly reasonable.

With technological advances and especially the proliferation of smartphones, society’s atmosphere has become increasingly impatient.

“Also, may I ask why you instructed the patient to take the medicine only once at night instead of following the original method of taking three warm doses throughout the half day?” he asked.

Li Yu smiled.

“That’s easy to understand. Think about when his symptoms usually flare up.”

“Oh…” Zhang Jing slapped his forehead, instantly realizing.

He had been foolish.

If dosages can be tailored to the individual, then the decoction and administration methods can be even more flexible.

At that thought, Zhang Jing couldn’t help but feel a deep admiration—this was truly the living and practical application of classical prescriptions.