Chapter 63: Pediatric Bronchitis

Zhang Jing sat inside his new consultation room and prepared to welcome his first patient.

"Knock, knock, knock..." A gentle rapping sound echoed.

"Please come in," Zhang Jing called out softly toward the door.

To his slight surprise, three people walked in all at once.

An elderly woman, a middle-aged mother, and a little girl around three or four years old.

Judging by the appearance, they seemed to be three generations of a family.

Before Zhang Jing could speak, the middle-aged woman immediately handed over the medical record booklet.

"Hello, Dr. Zhang," she said. "I was referred here by Huanhuan's mother. She said you are exceptionally skilled at treating children's ailments. We had originally agreed to come together, but she temporarily mentioned she had something to take care of later, so we came ahead of time."

Zhang Jing nodded and looked closely at the little girl, noticing that her skin was very fair yet lacked luster, carrying a somewhat pale complexion.

Her eyes were large, clear, and very lively, completely devoid of any shyness around strangers.

Therefore, he bent down slightly and spoke softly directly to her, "Little girl, shall we shake hands?"

"I am not a little girl, my name is Xuanxuan," Liu Zixuan immediately corrected him in a childish, tender voice, much to his surprise.

Just as her voice trailed off, it was followed by a bout of severe coughing.

"Dr. Zhang, my little darling has been coughing for a long time now..." Xuanxuan's mother hurriedly began describing the symptoms.

Zhang Jing raised a hand to signal, "Xuanxuan's mother, please hold your words for a moment. Let me take her pulse first."

Then, he turned to the little girl with a gentle tone, "Come, Xuanxuan, let's shake hands and be quiet for a moment, alright?"

Liu Zixuan nodded her little head and extended both of her tiny hands.

"Wonderful!" Zhang Jing said as he gently grasped her small hands, placing his index, middle, and ring fingers respectively over the three pulse regions of the radial artery.

After a short moment, the feedback from his fingertips indicated: the pulse was easily felt with a light touch, but the pushing force was relatively weak, and pressing down firmly revealed a distinct deficiency.

It was undoubtedly a floating and weak pulse.

"Xuanxuan, now open your mouth wide and make an 'ah' sound, okay?" Zhang Jing continued softly.

Liu Zixuan cooperated remarkably well, executing the action with practiced ease, as if she did it frequently at kindergarten.

Holding a small medical flashlight, Zhang Jing carefully inspected her tongue and pharynx.

He noticed that her tongue coating was slightly white and greasy, while the condition of her pharynx was acceptable, showing no obvious congestion or tonsillar enlargement.

"Mhm, excellent. Now roll your little tongue upward slightly, alright?"

This time, Liu Zixuan looked a bit bewildered, moving her tongue a few times without successfully managing it.

Seeing this, Xuanxuan's mother quickly demonstrated from the side, "Xuanxuan, look at Mommy, you do it like this."

"Oh," Liu Zixuan tried a few more times and finally succeeded.

Accordingly, Zhang Jing quickly observed the sublingual area.

The conclusion drawn was: the tongue body was pale, and sublingual stasis was not prominent.

Afterward, Zhang Jing produced a stethoscope and said to Liu Zixuan, "Next, Doctor Uncle is going to talk on the telephone with you. However, you aren't allowed to speak for a little while; you can only take a deep breath, and then let it out. Do you understand?"

Liu Zixuan nodded again.

Zhang Jing began the auscultation process with meticulous care.

Some might ask: isn't the stethoscope an invention of modern medicine? How come a practitioner of pure traditional Chinese medicine is using it too?

That is correct. The stethoscope is the most commonly used diagnostic tool for physicians across internal medicine, surgery, obstetrics, and pediatrics, and modern medicine effectively began with its invention.

Therefore, the stethoscope can be said to be the symbol of the modern physician.

According to historical records, the inventor of the stethoscope was René Laënnec, whose full name was René Théophile Hyacinthe Laënnec.

On September 13, 1816, Laënnec rolled a thin notebook into a cylinder, solving a diagnostic puzzle that had troubled him for a long time. Through continuous improvements thereafter, he invented the most primitive stethoscope.

Traditional Chinese medicine has "looking, listening, asking, and pulse-taking," while Western medicine also has its four diagnostic steps, namely "inspection, palpation, percussion, and auscultation."

The concept of auscultation was already formed as early as the era of Hippocrates, where physicians would place their ears directly close to a patient's chest wall to examine the sounds of the heart and lungs for diagnosis.

This diagnostic method continued to be used well into the early 19th century, prior to Laënnec's invention of the stethoscope.

Ancient Chinese physicians, constrained by traditional ethical codes regarding physical contact between men and women, could never follow the Western practice of placing their ears directly against a patient's chest wall for auscultation.

Consequently, in the diagnosis of cardiopulmonary diseases, auscultation constituted a major shortcoming.

Although Zhang Jing aspired to become a highly skilled practitioner of pure traditional Chinese medicine, he was by no means pedantic or inflexible.

He deeply respected the achievements of modern Western medicine and harbored no aversion to necessary auxiliary diagnostic equipment, especially the stethoscope.

Just as he had once told Bai Bing, there is no inherent superiority or inferiority between traditional Chinese and Western medicine; they simply possess their respective strengths.

To put it simply, while Zhang Jing revered traditional Chinese medicine, he was definitely not a brainless detractor of Western medicine.

...

After carefully listening to the anterior chest and lungs, Zhang Jing proceeded to listen to the back.

He discovered distinct moist rales in the right anterior chest region, interspersed with wheezing sounds.

As soon as Zhang Jing removed the stethoscope, Xuanxuan's mother could no longer hold back.

She anxiously asked, "Dr. Zhang, how is it? Is it bronchitis? Is it serious?"

Zhang Jing nodded slightly. "There are distinct moist rales in the lungs. Western medicine would diagnose it as bronchitis, or even bronchopneumonia, but that is not important. Traditional Chinese medicine does not focus on these Western disease names during diagnosis."

"Based on the current situation, Xuanxuan has a constitution leaning toward coldness, and cold-phlegm in the lungs is quite pronounced. Has she had any nasal symptoms in the past few days? Specifically, symptoms like a runny nose, nasal congestion, and sneezing?"

Xuanxuan's mother thought for a moment and replied, "I only know that during the day her runny nose isn't very noticeable, it should be quite minimal. Sneezing... um, also rare, and nasal congestion doesn't seem to have been noticed either. However, at night she sleeps with her grandmother..."

At this point, she turned her head and glanced at the elderly woman standing silently behind her.

She asked in a chilly tone, "Grandma, when Xuanxuan sleeps at night, does she have a runny nose, a stuffy nose, or does she sneeze?"

The elderly woman spoke with a heavy local accent and replied evasively, "Yes... there's nasal discharge, and by the middle of the night... it... it also gets completely stuffed up. As for sneezing... not so much."

Fortunately, Zhang Jing's hometown was in a rural area located at the tri-provincial border, where the local dialect blended the major features of three provincial dialects, making it extremely obscure and difficult to understand.

This unintentionally granted Zhang Jing a special skill: he could more or less make out the general meaning of dialects from all over the country.

Therefore, without needing Xuanxuan's mother to translate, he had already understood.

Zhang Jing continued to question Xuanxuan's mother about the course of Xuanxuan's current illness.

Xuanxuan's mother cleared her throat and slowly recounted, "Dr. Zhang, it's like this. Our Xuanxuan was quite healthy before she started kindergarten, and she rarely even caught a cold."

"However, ever since she started kindergarten this September, she has caught colds and coughs every other day, though fevers haven't been very frequent. We've always seen Western doctors at the children's hospital. At first, Western medicine could control it with pills, but later on, the medicine stopped working altogether, and she had to be put on intravenous drips for a few days."

"And look, she had just recovered a few days ago, but the night before yesterday, she started catching a cold and coughing again. When we checked at the hospital, they said it was bronchitis again and told us to do IV drips, or it might quickly turn into pneumonia. But we are really worried; she is so young, and constantly getting IV drips is so harmful to her body. So, we wanted her to take some anti-inflammatory and cough medicine first to see if she could pull through."

"Yesterday, while chatting with Huanhuan's mother at the residential square, I heard that you are exceptionally good at treating children's illnesses. So, we wanted to give traditional Chinese medicine a try. After all, drinking herbal medicine has fewer side effects than IV drips, right?"