On the way to the Yang household, Xu Yi asked Madam Yang whether Official Yang had any other symptoms besides thirst.
Madam Yang pondered for a long while, recalling her time with her husband over the past two days. After a moment, not daring to hide anything, she said, “Besides the thirst, my husband has been going to the privy quite frequently these past two days. He can’t sleep well at night either. He has to get up to use the privy several times.”
Upon hearing this, Xu Yi furrowed his brow slightly in thought. If someone was thirsty, drinking water didn’t help, and they also had frequent urination, the first thing that came to his mind was a certain illness.
A disease called wasting-thirst would present with exactly such symptoms.
However, wasting-thirst caused by different pathologies required different treatment prescriptions. He needed to prescribe medicine based on each patient’s specific condition and cause.
Before seeing Official Yang himself, Xu Yi couldn’t say much.
The two lanes were close to each other. After walking for a while, they saw the Yang family’s gate.
After Madam Yang opened the door, she invited Xu Yi into the main hall, then went to the inner room to find Official Yang.
However, she didn’t see Official Yang in the room. When she turned around to look for him, she saw that Official Yang had already started talking with Xu Yi in the main hall.
While waiting for Madam Yang to fetch Xu Yi, Official Yang had made two more trips to the privy. Just as he returned, he saw Xu Yi sitting composedly in the main hall with his medicine chest.
Seeing him return, Xu Yi stood up, set down his medicine chest, and bowed in greeting, “Official Yang.”
Official Yang returned the courtesy and sat in the chair opposite Xu Yi. His expression was bitter as he said, “These past two days, I suddenly felt my body was strange. Clearly I just finished drinking tea, but after only a moment I’m thirsty and uncomfortable again, with a vague pain in my lower abdomen. I thought it was because I’d been eating too much rich food during my recent trip to the prefectural city on official business, so I had the medical hall prepare Minor Bupleurum Decoction and took it with digestive pills. Who would have thought it not only didn’t cure it, but got even worse? Today I’ve gone to the privy many times. I want to go even when I haven’t been drinking water…”
This wasn’t exactly a glorious matter, but it was causing inconvenience in his daily life. If this situation wasn’t resolved, he’d probably be afraid to leave the house in the future.
He feared that the moment he stepped out, he’d immediately need to find a place to relieve himself.
How strange, how strange! He’d never heard his friends mention having this illness before. How had he contracted this peculiar disease?
Little did he know that among the differential diagnoses of wasting-thirst, one category was caused by excessive consumption of mineral medicines and frequent, unrestrained sexual activity. If someone got the disease for these reasons, how would they dare tell others? They would naturally keep it hidden, not letting anyone know.
And physicians usually kept their medical cases confidential, how would they casually spread such information?
Like Xu Yi, after coming to the Northern Song, all the medical cases he handled were written in patient record books and rarely shared with others.
Even if he wanted to discuss them, it would only be with other physicians, bringing them out for academic discussion when both parties were exploring medical knowledge, not gossiping about them.
After listening to his explanation, Xu Yi had him open his mouth for inspection.
Official Yang’s complexion was pale, his tongue coating light. He showed signs of deficiency taxation.
Looking at his palms again, though they were sweaty due to summer, it was more severe than in ordinary people.
Xu Yi asked, “Do you sweat at night too?”
Official Yang nodded, “When I wake from dreams at night, my palms are also sweaty.”
Xu Yi silently recalled discussions about medical cases he’d had with his older brother and the others back home, particularly about wasting-thirst syndrome. Among them was one differential diagnosis that matched Official Yang’s condition.
He didn’t dare draw conclusions immediately. Having Official Yang extend his hand, he needed to take his pulse first.
However, in Official Yang’s pulse, the large pulse showed expansion, the pulse was unstable, and from time to time it was slightly rough. This was a manifestation of qi depletion from exhaustion and depletion of primordial qi.
In the pathology of deficiency taxation, there was yin deficiency, yang deficiency, and combined yin-yang deficiency, with the essence, qi, and blood of the five organs as the focus. To put it plainly, all five organs and six bowels were interconnected. As long as there was a problem with “liver, lungs, kidneys, or spleen,” symptoms would often appear in other organs as well.
In clinical medicine, many times you couldn’t look at just one factor alone, nor could you classify two different patients together just because they showed the same symptoms.
Like Official Yang’s situation. It closely resembled thirst-diarrhea disease among wasting-thirst conditions, a syndrome caused by serious kidney deficiency from excessive sexual activity.
But judging from the pulse, it was actually caused by the “seven taxations and five injuries,” with excessive thinking, worry, and fatigue all present.
Combined with the other symptoms, Xu Yi could basically determine what was primarily causing Official Yang’s wasting-thirst disease.
Official Yang raised his hand to wipe the sweat beading on his forehead, “Doctor Xu, how is my condition?”
Deficiency taxation was a general term for weakness and exhaustion from overwork; not a single disease, but a collective name. Official Yang’s primary problem lay in spleen qi deficiency, and because of irregular living habits and constant mental and physical fatigue accumulated over a long time, these symptoms had manifested.
Xu Yi looked at him and said, “Official Yang, this is spleen-kidney imbalance, causing the yin and yang of the five organs to be unable to maintain mutual balance. This is a yang deficiency syndrome.”
Hearing him say this, Official Yang’s expression relaxed slightly. He opened his mouth, wanting to say something to Xu Yi, but seeing Xu Yi’s age, he really didn’t know how to broach the subject.
Xu Yi saw his hesitation and smiled, saying, “Is Official Yang trying to say he hasn’t been excessive in the rites of Duke Zhou (sexual activities)?”
Official Yang: “…” Was he that obvious?
Xu Yi spoke without hesitation, “I’m a physician. I need to know about such matters. If Official Yang has doubts, speak freely.”
Studying medicine meant that shame about sexual matters was actually somewhat reduced.
Especially when examining patients. If he was too embarrassed, how could he clearly explain conditions related to sexual activity to patients?
Besides, there was nothing to be ashamed of about this.
Xu Yi’s expression was frank, making Official Yang look at him with new respect. He couldn’t help but feel he had underestimated Xu Yi.
Official Yang first had Madam Yang take Rong’er to play in the outer courtyard.
Only then did he lean over and say quietly to Xu Yi, “Actually, when I went to the prefectural city this time, I also drank quite a bit of wine. That wine came from Bianjing. They said it was only interesting if you heated it before drinking. I couldn’t help being greedy and had several cups.”
Xu Yi glanced sideways at him: “…”
Under his gaze, Official Yang felt somewhat guilty and no longer met his eyes.
Xu Yi understood inwardly. It seemed he’d also done things he couldn’t let Madam Yang know about.
He knew he couldn’t judge people of this era by modern standards. Even those who usually loved their wives and children wouldn’t let that interfere with seeking pleasure in pleasure houses or taking concubines and keeping mistresses.
No wonder he’d been somewhat uncertain before. It seemed the problem lay here.
Wine’s nature was intensely hot. After drinking, a person’s apparent body temperature was higher than usual. If one engaged in that sort of activity at such times, pathogenic qi could easily invade, causing certain undesirable conditions.
Official Yang’s main pathology wasn’t this matter. The excessive drinking and sexual activity were merely triggers. From the pulse alone, it was difficult to diagnose.
He was still not skilled enough, had handled too few medical cases, and his diagnostic abilities were limited.
However, this was Official Yang’s private matter. Xu Yi had no right to interfere. Still, when he looked at Official Yang again, his gaze held something slightly different.
He paused, but still adhered to medical ethics, saying, “In that case, Official Yang should avoid greasy food, alcohol, and sexual activity in the coming days to prevent worsening of the condition.”
Official Yang hastily agreed.
Xu Yi said, “I’ll prescribe two formulas for you. One is Three Yellows Pill, to be made into medicinal pills and taken. The other is Donkey-Hide Gelatin Decoction.”
Three Yellows Pill could treat men’s five taxations and seven injuries, wasting-thirst, and so on.
This Three Yellows Pill was quite interesting. Depending on the season of use, the dosage of each medicinal ingredient varied.
It was currently summer, so he would need to take six taels of huangqin, one tael of rhubarb, and seven taels of huanglian, pound them together, and use honey to make them into pills the size of soybeans.
As for the Donkey-Hide Gelatin Decoction, it would treat another symptom.
Official Yang had deficiency with internal heat, frequent and copious urination. The Donkey-Hide Gelatin Decoction should omit the aconite and use only four ingredients: hemp seed, donkey-hide gelatin, dried ginger, and polygala. Grind them into fine powder, boil with water, reducing seven liters to two and a half liters, then filter out the dregs and dissolve the donkey-hide gelatin into the medicinal soup, taking it in three doses.
The herb polygala could treat many conditions.
But Official Yang didn’t understand pharmacology. Xu Yi didn’t say much more, simply explaining what these two prescriptions primarily treated.
Hearing that donkey-hide gelatin would be needed, Official Yang’s expression changed slightly. Donkey-hide gelatin was a superior tonic, and its price was not cheap.
It cost the same as ginseng. One stick of donkey-hide gelatin cost over two strings of cash, and Xu Yi’s prescription required two sticks.
Just this one ingredient would cost several strings of cash.
Xu Yi gave him a meaningful glance and wrote down the prescription for Donkey-Hide Gelatin Decoction. But the Three Yellows Pill needed to be prepared by Xu Yi and would be delivered to the Yang household tomorrow.
Holding this prescription, Official Yang let out a deep sigh, full of regret. If he’d known this would happen, he should have left after the banquet that day. Why did he have to stay and do that sort of thing?
Xu Yi said nothing more. After collecting the consultation fee and medicine payment, he said he would come by tomorrow at this time to deliver the medicine.
When he emerged with his medicine chest, he saw Madam Yang standing in the courtyard with a worried expression. Beside her, Yang Rong was happily playing with mud, completely unaware of what had happened.
Seeing Xu Yi, Madam Yang hurried over to ask, “Doctor Xu, what illness does my husband have?”
Xu Yi looked at her and said calmly, “It’s wasting-thirst disease caused by yang deficiency with pathogenic invasion. I’ve already prescribed medicine. After taking it for twenty days, he should recover.”
Twenty days meant two treatment courses. If taking Three Yellows Pill for twenty days didn’t cure it, another course would need to be added.
After briefly explaining, seeing how Madam Yang worried herself to death for her child and husband, he hesitated for a few seconds but ultimately didn’t voice the improper words to Madam Yang.
Perhaps without his knowledge, Madam Yang understood Official Yang’s character better than he did.
…
Leaving the Yang household, Xu Yi headed toward the medical hall.
After greeting the medical hall apprentice, he bought the medicinal ingredients for making Three Yellows Pill but didn’t rush to leave. Instead, he asked the apprentice, “How long have you been an apprentice?”
The apprentice was startled. After thinking for a moment, he said, “Doctor Xu, I’ve been an apprentice for three years.”
Xu Yi asked again, “During these years as an apprentice, what have you learned?”
The apprentice was even more confused after hearing this. Thinking Xu Yi wanted to poach him, he looked around somewhat anxiously. Seeing the attending physician wasn’t in the front hall, he quietly asked, “Doctor Xu, what do you mean by asking this?”
Xu Yi blinked and said, “I’ve taken in a young child these past few days. I think he has quite some talent, so I’m considering whether to train him as a student. But I’ve never taught anyone before, so I thought I’d ask you.”
The apprentice: “…”
So he’d been mistaken.
For some reason, he suddenly felt somewhat disappointed, but still told Xu Yi, “I spent a year selecting medicinal ingredients first before the physician let me dispense medicine for patients. He said I needed to memorize and thoroughly understand the ingredients first so I wouldn’t confuse similar herbs…”
The apprentices in medical halls were vastly different from the students at the Imperial Medical Bureau. Medical apprentices in this era had hierarchical distinctions.
For example, the Imperial Medical Bureau selected students from medical families as prospects. Some, wanting to change their family’s status, would actively take exams to enter the Imperial Medical Bureau. Without five years, you were hardly allowed to practice.
Apprentices in ordinary medical halls were mostly children from common families, sent over as free labor after studying for two years. The physicians responsible for teaching them medical principles didn’t take it very seriously.
Therefore, there were also some apprentices who studied for half their lives yet struggled to complete their training.
Of course, there were also those with exceptional talent, such as Pang Anshi, known as the “Medical King of the Northern Song.” Born into a medical family, he was intelligent from childhood with a photographic memory. Before turning twenty, he was already well-versed in the Yellow Emperor’s and Bian Que’s pulse texts and could apply his learning to develop new interpretations. Later, he specialized in many medical texts and compiled works of great academic research value such as the Comprehensive Treatise on Cold Damage and Various Diseases and Annotations on the Classic of Difficult Issues.
Even without entering the Imperial Medical Bureau, he could still become renowned throughout history in his field of study, his name passed down through the ages.
Though he wasn’t as universally famous as Sun Simiao or Zhang Zhongjing, Xu Yi still had to acknowledge that Pang Anshi was truly excellent. Whether as a physician or as a scholar researching medicine, he was worthy of being known and respected.
Unfortunately, he was currently in the Chunhua era. It would be several more decades before Pang Anshi was born. By the time Pang Anshi was born, Xu Yi didn’t even know if he could live that long.
Xu Yi shook his head, casting aside this fanciful thought.
–
When he returned home with his medicine chest, Xu Yi looked at the simple house and let out an imperceptible soft sigh.
No matter what he thought, life had to go on. Thinking so far ahead served no purpose now.
In the courtyard, Ah Jin was feeding Little Huang flatbread. Hearing the sound of the door opening, she immediately dropped Little Huang and ran over to see who had arrived.
Seeing it was Xu Yi, her eyes brightened. Her little face bloomed like a flower as she called out, “Young master, you’re home! Young master, I’ll carry your chest for you. Young master, do you want tea? I’ll brew tea for you. Young master…”
“Stop.” Xu Yi couldn’t help laughing.
Just a few days ago, this child was still timid and pitiful. After becoming familiar, Xu Yi discovered he’d been wrong.
This child had been beaten and scolded too much before, which made her fearful and timid. But after meeting Xu Yi and knowing that Xu Yi treated the siblings well, she gradually returned to her natural disposition.
She was a little chatterbox.
Little chatterbox Ah Jin didn’t know why Xu Yi was laughing. She grinned along, her sweet voice continuing, “Young master, I’ll carry your chest for you.”
Xu Yi didn’t give her the medicine chest. Though it didn’t look large, it was made of solid wood and contained ceramic jars for storing medicine. It wasn’t light.
It was only a few steps to the house. He didn’t need a child to carry his chest for him.
“No need. You…” Xu Yi paused and asked, “Where’s your brother?”
Ah Jin answered, “Brother went to buy the evening meal.”
Xu Yi: “…”
Oh?
Well then, the idle hand who frequently took jobs from his household would probably lose a long-term customer.
Learning that Ah Xu had gone to buy food, Xu Yi didn’t concern himself further. Taking the medicinal ingredients he’d bought, he went into the kitchen.
The kitchen was now divided into two stove areas: one for cooking, one for preparing medicine.
Xu Yi poured the huangqin, rhubarb, and huanglian separately into the mortar and pounded them, then poured them into the grinding trough to grind into powder. Next came adding honey, kneading the medicinal powder into pills the size of soybeans.
After finishing, Xu Yi heard Ah Xu return with food.
As soon as Ah Xu came back, he asked his sister, “Has the young master returned?”
Ah Jin nodded, “The young master is busy in the kitchen. He said he doesn’t need my help. Brother, am I too useless? Every day I can only feed Little Huang and water the little grass in the courtyard.”
Xu Yi, who had just stepped out of the kitchen door: “…”
Thanks, but that’s mint.
“Young master.”
Seeing Xu Yi, Ah Xu put his sister behind him, walked over carrying the food, and proactively reported where he’d been today and what food he’d bought.
“I asked Madam He. Madam He said the young master likes eating noodles, so I bought noodles.”
He spoke much more than before, clearly and logically. As Xu Yi listened, he couldn’t help smiling.
He nodded.
Actually, eating anything was fine, as long as it wasn’t the same thing every day.
Looking at the noodles Ah Xu brought back, they were knife-cut into willow-leaf shapes, tossed with fragrant oil boiled with scallions, topped with sliced pork stir-fried with zanthoxylum, giving off a slightly spicy aroma.
After looking, Xu Yi frowned slightly, “Why did you only buy one portion?”
Ah Xu said, “Young master, this was bought for you.”
Xu Yi: “What about yours?”
Ah Xu answered honestly, “My sister and I can just eat the leftover flatbread from noon. That flatbread is very delicious. We can’t waste it.”
Xu Yi fell silent: “…”
He couldn’t change these two children’s way of thinking overnight. Forcing it wouldn’t work either. He’d finally gotten them to seem more lively. He feared if he spoke too harshly, it would make them anxious and uneasy again.
He helplessly pinched the bridge of his nose. Knowing it would be difficult to correct this, he didn’t plan to force the issue.
However, he still said dutifully, “You can eat flatbread if you want, but I can’t stand seeing children like this. If I find out you’re going hungry and not eating, don’t blame me for punishing you.”
When he spoke of punishment, he wasn’t just saying it. That evening when he returned to his room, he lit the oil lamp, bent over his desk, and wrote a “Xu Household Survival Rules.”
There were three rules.
One: You must not wake up too early. Two: You must not kneel at the drop of a hat. Three: You must not eat overnight food.
…
The next day, he posted this rule written in large characters in the kitchen. He didn’t post it in the main hall because guests would be received there. It wasn’t appropriate.
Then Xu Yi held a disciplinary ruler in his hand and called the siblings to stand in a row in the kitchen.
Neither sibling could read large characters, so Xu Yi read each character to them one by one.
After finishing, he asked, “Do you remember?”
Seeing this, Ah Xu hastily nodded, saying he remembered.
Beside him, Ah Jin was stunned for a moment, secretly glancing at Ah Xu. She wanted to say she remembered but didn’t dare.
Xu Yi cleared his throat twice, “Ah Jin, do you have something to say?”
Xu Yi looked at the little bean standing before him. Though eight years old, her height and appearance looked only about six. Thin and scrawny, even wearing the jacket and skirt of decent fabric couldn’t hide the emaciation caused by long-term hunger.
Ah Jin’s dark eyes looked at Xu Yi somewhat helplessly.
Xu Yi’s heart nearly melted under those eyes. Sighing, he said, “If you can’t answer, I’ll read it again.”
In fact, he didn’t really want to punish them.
He just wanted them to know that he didn’t simply regard them as servants.
After the noon meal, Xu Yi took Ah Xu out to the Yang household to familiarize him with the route.
He also told Madam Yang how to take the Three Yellows Pill.
Take it after each meal, three times daily. Start by taking five pills, gradually increasing to seven pills, and take them with warm water, no cold water.
During the medication period, besides avoiding rich food, one should also avoid raw and cold foods. It would be better if Madam Yang made more light, stomach-nourishing porridge.
Madam Yang noted everything down and asked Xu Yi, “I’ve looked at the prescription. Is it acceptable not to drink the Donkey-Hide Gelatin Decoction?”
Xu Yi raised an eyebrow.
Madam Yang asked again, “We’re truly short of funds. My husband’s monthly salary hasn’t come yet, and just the donkey-hide gelatin in this prescription costs several strings of cash. If he must drink it, could we delay a few days?”
Hearing this was the reason, Xu Yi said slowly, “If this decoction isn’t taken, there’s another method. Acupuncture and moxibustion at acupoints. It’s just somewhat more troublesome, requiring consecutive acupoint treatment for a week.”
Madam Yang was delighted and hastily said, “That’s no trouble at all. I just don’t know if Doctor Xu has these stone needles?”
Xu Yi nodded, saying he’d just acquired a set of stone needles.
Setting aside his improper private behavior, Official Yang was still Xu Yi’s patient. If the patient couldn’t afford medicine, then another method had to be used.
As it happened, Xu Yi also wanted to know whether he could master treating illness with stone needles.
Both parties reached an agreement. Xu Yi said he would bring the stone needles over later and have Official Yang start taking the Three Yellows Pill first.
In the room.
How could Official Yang know that Madam Yang would ask Xu Yi whether they could skip the Donkey-Hide Gelatin Decoction?
After learning this, when he looked at Madam Yang again, his gaze unconsciously became somewhat guilty. If his wife learned that his illness was induced because he went to the prefectural city that day, greedily drank heated wine, and also… He wiped the nervous sweat beading on his forehead, wondering whether he should personally tell his wife.
At this moment, Madam Yang didn’t know what he was thinking. She sat on the long bench under the eaves, head bowed, embroidering the frame in her hands.
Back when she gave birth to Brother Rong, her body was severely depleted. She’d taken medicinal soups for many years but still couldn’t conceive again.
Later, when Brother Rong’s health was poor, they didn’t dare put their minds elsewhere, worrying about Brother Rong day after day. They even sold their house and moved to South Street.
These past few months, Rong’er’s health had greatly improved. After several years of worry was resolved, Official Yang no longer stayed home every day. He went out to do other business, sometimes leaving for five or six days at a time. Madam Yang had long known. He sometimes let things slip. When he returned, the clothes he wore carried the scent of rouge and powder.
Madam Yang had been frugal these past years. She hadn’t applied face cream or worn makeup for many years, so she knew that when he went out on business, he visited those filthy places.
Now that he’d contracted this disease, she actually hadn’t suspected whether it was caused by such matters.
Until yesterday, when Xu Yi’s gaze toward her was different, she knew—it was indeed because of this…
But what could she do knowing this? She couldn’t do anything to Official Yang. The household’s living expenses all depended on Official Yang’s monthly salary. Without him, her days with Rong’er would be even harder.
Madam Yang didn’t want to think about it anymore. She set down her embroidery frame and stood up, beckoning Rong’er over. Her expression gentle with a smile, she said, “You’re about to become a mud person. If I’d known you’d be this naughty, I’d have had your father send you to private school.”
Yang Rong hastily tried to please her, “Mother, I’ll be good, I’ll be good! Don’t send me to private school.”
Madam Yang covered her mouth and laughed, “Why are you so afraid?”
Yang Rong shrank his shoulders and said quietly, “I heard the teacher at private school beats people with a ruler. It really hurts. I don’t want to be beaten.”
Madam Yang said, “But if you don’t study, you won’t recognize characters in the future. You’ll be an idiot your whole life, unable to understand when others deceive and fool you with their words, not knowing anything, just being a useless person for nothing.”
As Yang Rong listened, he suddenly said, “Mother, why are you crying?”
Madam Yang wiped the corners of her eyes, saying, “I’m not crying. I’m just thinking about what Rong’er should do in the future.”
Yang Rong didn’t want his mother to worry about him anymore. He stood on tiptoe to wipe the tears from Madam Yang’s face, saying earnestly, “Mother, don’t cry. I’ll go tell Father right now. I want to study.”