BFDNS 066

Chapter 66: Congenital Heart Disease

A pair of dark, bright eyes looked over as Fang Qiaoci asked in the most childlike manner, “Why do you want to see the prescriptions? Can medical prescriptions be casually shown to others?”

The medicinal decoction prescriptions a patient took were considered a form of privacy. When Xu Yi made this request, there was a possibility of being refused.

Yet he spoke frankly. “Congenital deficiency of natural endowment has caused insufficient qi, blood, yin, and yang of the heart. This is a chest impediment syndrome caused by constitutional deficiency and weakness of yang and wiry yin.” 

That Xu Yi could diagnose the cause of Fang Qiaoci’s illness earned him a great deal of Fang Chuliang’s trust.

Last time, after examining his son, a doctor had said it was a syndrome of “heat binding and blood stasis,” and was directly driven out of the estate. If he had at least said “in heart impediment, the pulse is blocked,” it wouldn’t have angered him to the point of losing composure.

Speaking of which, Fang Chuliang had also read through quite a few ancient medical texts.

As an instructor who read extensively, he possessed many medical books that ordinary people couldn’t access. In fact, precisely because he had read so much, he understood all too well why few doctors could treat chest impediment, it was truly difficult to cure, which made him even more afraid of losing Ci’er.

Few people could understand this torment. Night after night, he would wake from dreams, startled by visions of Ci’er leaving him.

Fang Chuliang asked, “Doctor Xu, you may look at the previous prescriptions, but why?”

Xu Yi said, “My initial diagnosis of your son’s condition is more like insufficient heart yang, a congenital sign. However, considering various factors, this is not the only cause. I want to know what kinds of medicinal decoctions the doctors who previously took his pulse used.”

Although the Essential Prescriptions from the Golden Cabinet contained discussions on constitutional deficiency differentiation, in the Song period, there was no such thing as the term “congenital heart disease.”

It was said that the term “heart disease” originated in the mid-to-late Ming Dynasty, when the famous physician Gong Tingxian cured the chest impediment of the Princess Consort of Lu, thus giving rise to the term “heart disease.”

However, before cardiologists appeared, ancient Chinese medicine already had numerous clinical cases for various differentiations and treatments of chest impediment. Simply flipping through ancient medical texts, one could see various methods for differentiating “chest impediment.”

There were also many treatment plans, such as “blood-activating and stasis-dissolving method,” “aromatic warming and unblocking method,” “phlegm-transforming and fluid-expelling method,” “qi-supplementing and yin-nourishing method,” and so on.

By modern times, in the Chinese medicine Xu Yi had encountered, there were already new differentiations and classifications for treating chest impediment.

Therefore, Xu Yi very much wanted to know how doctors of this era used medicine in clinical practice.

Fortunately, Xu Yi’s explanation moved Fang Chuliang.

He called out, and soon Steward Fang entered. Fang Chuliang instructed him, “Go fetch all the medicinal decoction prescriptions that Ci’er has taken in the past.”

After Steward Fang withdrew, Xu Yi turned his attention to the child.

The child looked like a porcelain doll with a fair complexion. Looking more closely, he was excessively pale, with colorless lips tinged with a faint trace of purple.

However, his fingernails were smooth and rounded. Though not quite pink, they hadn’t turned purple either.

Seeing Xu Yi continuously watching him, Fang Qiaoci asked, “Doctor Xu, why do you keep looking at me?”

“I wanted to ask, do you become short of breath when walking?” Xu Yi followed up on his words with a question.

“No, except that I can’t run, everything else is normal.” To make Xu Yi believe what he was saying, Fang Qiaoci pulled him close and said quietly, “I only feel uncomfortable when I cry secretly, but I rarely cry. It’s all those doctors’ fault, they said I can’t run around, so I haven’t been down the mountain in a long time.”

His eyes looked at Xu Yi with anticipation. “Will you let me go out?”

Xu Yi smiled and said, “With your condition, going out won’t affect your illness.”

Fang Qiaoci’s eyes brightened after hearing this, and he quickly said, “Tell Father quickly, then Father will allow me to go out and play.”

“Alright.” Xu Yi nodded.

They hadn’t chatted for long when footsteps sounded outside.

More than just Steward Fang returned. There was also a beautiful young woman wearing a light purple silk jacket and skirt. She wore her hair in a round bun with minimal ornaments, only a silver comb and two silver hairpins. Without makeup, her brow carried a trace of unresolvable melancholy.

Behind her stood an old woman. Xu Yi remembered her, it was Old Lady Qin he had seen on the way over.

Old Lady Qin glared at him twice with an unfriendly expression, her face seeming to say, “With the mistress here, don’t think you can deceive the master.”

Xu Yi was bewildered. “…”

He didn’t recall knowing any Old Lady Qin.

Could this person have mistaken him for some kind of fraudulent con man?

Fang Chuliang stood up and looked at the young woman, asking, “Why have you come, wife?”

Before his words had finished, Fang Qiaoci, who had been sitting in the chair beside them, slipped down and walked to his mother’s side, nuzzling against the hem of her skirt as he called out softly, “Mother.”

Tenderness appeared in Qi Xiuniang’s eyes. She stroked his face and asked gently, “Ci’er, are you tired today? Should you go to your room to rest?”

Fang Qiaoci’s eyes darted around, glancing at Old Lady Qin beside him, and said sweetly, “Mother, I’m not tired.”

Then, right in front of everyone, he asked with innocent naivety, “Mother, did you come because you knew Doctor Xu was coming to see me?”

Qi Xiuniang fell silent.

Old Lady Qin stepped forward with a beaming smile and said to him, “Ci’er, the mistress and master have things to discuss. Shall we return to your room first?”

“What is there to say that can’t be said in front of me?” Fang Qiaoci pouted unhappily.

Old Lady Qin was stumped. She really couldn’t tell whether Ci’er knew or didn’t know.

Everyone said Ci’er was clever. Everyone in the Fang household dared not casually deceive him. Any lie was difficult to hide from him.

Even the master wouldn’t conceal everything from him.

With Fang Qiaoci saying this, Qi Xiuniang dismissed Old Lady Qin and turned to look at Fang Chuliang.

“Won’t my husband say a few words?”

Fang Chuliang said, “Ci’er has already spoken with Doctor Xu. Let him stay and listen together.”

He understood this son of his very well. He had heard their earlier conversation and knew that Ci’er quite liked this young doctor.

Qi Xiuniang’s expression remained unchanged. She led Ci’er to sit in a chair by the table, her gaze falling on Xu Yi as she slowly began to speak.

“Doctor Xu, I speak plainly so please don’t take offense. Over these years, we’ve searched far and wide for medicine to treat my Ci’er’s chronic illness. He hasn’t stopped drinking medicinal decoctions, yet his condition has never been cured. As Ci’er’s birth mother, I cannot bear to see him suffer like this constantly. You are truly too young, unlike the elderly doctors who have examined him before. To entrust Ci’er’s life to you makes my heart panic, I truly cannot do it.”

Xu Yi lowered his eyes. “Madam speaks too seriously. Just now during the examination, I have not yet written a prescription. If Madam does not trust me, I shall take my leave now.”

After speaking, he bowed to Fang Chuliang and began packing up his medicine chest.

Fang Chuliang frowned slightly and immediately stopped Xu Yi. “Doctor Xu, please wait.”

After speaking, he turned to look at Qi Xiuniang and explained, “Wife, you cannot judge only by appearances. Though Doctor Xu looks young, the Chen’s Digestive Pills you took last time came from his hands.”

Qi Xiuniang was surprised to hear this. Weren’t the Chen’s Digestive Pills made by someone surnamed Chen?

She had always thought they were prepared by Doctor Chen from Miracle Hands Hall, and had been very respectful toward Doctor Chen. But when Doctor Chen came to examine Ci’er, he said he couldn’t treat him and didn’t even write a prescription.

Could this young man possibly be better than Doctor Chen?

Where others weren’t paying attention, Fang Qiaoci shuffled over in small steps, tugged at Xu Yi’s sleeve, and asked in confusion, “Are you really leaving?”

Xu Yi looked at him, smiled faintly, and said nothing.

This child was indeed clever.

Soon, Qi Xiuniang was persuaded by Fang Chuliang to let Xu Yi write a prescription first and see.

Xu Yi knew where his disadvantages lay. Some patients were unwilling to be treated by young physicians, believing that doctors of this age lacked sufficient clinical experience and were certainly less reliable than older physicians.

Of course, this thinking wasn’t necessarily wrong. Indeed, in Chinese medicine, older practitioners’ medical skills carried more authority.

However, there were exceptions. In ancient times, there were quite a few famous physicians who gained renown at a young age.

Xu Yi wondered, might he be added to their number in the future?

But these were matters for later. Right now, the most pressing issue was deciding which prescription to give Fang Qiaoci.

Fang Chuliang said, “These are the medicinal decoction prescriptions Ci’er has taken in the past. Doctor Xu, please review them first.”

Xu Yi thanked him and took the stack of papers from his hand.

There were a full twenty or thirty sheets.

This Fang Qiaoci had truly grown up steeped in medicine. Though only eight years old, he had already drunk so many Chinese medicinal decoctions.

Xu Yi flipped through them one by one. Among them was the “Four Gentlemen Decoction” he had heard mentioned earlier. Besides baizhu, poria, and licorice, it contained ginseng. However, using this for Ci’er was inappropriate.

There was also “Danggui Sini Decoction,” “Cinnamon Twig Decoction,” “Trichosanthes, Chinese Chive, and Pinellia Decoction,” and so on. Looking through this stack of prescriptions, several doctors had written prescriptions of quite good quality.

For example, the modified “Danggui Sini Decoction” used cinnamon twig, asarum, and others to reduce internal cold qi. It was effective for cold limbs and could also alleviate chest impediment and heart pain.

However, in the new prescriptions this doctor later wrote, the channel-guiding medicine was wrong. The main focus was on qi and blood deficiency, but there was no yang supplementation.

Additionally, in the prescriptions written by other doctors, there were more or less issues of correct syndrome differentiation but incorrect medicine selection.

Xu Yi finished reading silently without saying much. He took out the brush, ink, paper, and inkstone from his medicine chest and began grinding ink.

The prescription he gave Fang Qiaoci was Baoyuan Decoction. This medicinal decoction came from the Bo’ai Xinjian (Heart Mirror of Universal Love) written by Wei Zhi of the Ming Dynasty.

This medicinal decoction mainly treated insufficient primordial qi, shortness of breath and fear of cold, yang deficiency and sunken vertex, and so on. It had good efficacy for chest impediment caused by insufficient heart qi.

Because its medicinal properties were sweet and warm, Xu Yi felt it was most suitable to use it first to regulate Ci’er’s body.

“In this prescription: ginseng one qian, huangqi one and a half fen, licorice five fen, cinnamon three fen, plus danggui one qian and danshen five fen. Decoct in water. When decocting the medicine, add an extra slice of fresh ginger.” (1 fen = 3mm, 1 qian = 5g)

Modified Baoyuan Decoction used two additional ingredients, danggui and danshen, one to supplement qi and harmonize blood, one to benefit the lungs and calm the heart. Both were good for the heart.

After Xu Yi finished writing, he handed the prescription to Fang Chuliang and said, “Among the medicines I brought today, I happen to have these four ingredients. If Instructor Fang agrees with my prescription, we can first decoct one bowl and have your son take it.”

“Good, good.”

Fang Chuliang took the prescription and looked at it. The medicines used in this prescription were all familiar, yet different from the prescriptions written by previous doctors.

He didn’t hesitate further and had the steward take the medicine to the kitchen, personally supervising the decoction of the medicinal soup.

Qi Xiuniang came from an educated family. In her boudoir days, a female tutor had taught her the Book of Poetry, the Classic of Filial Piety, and other texts. She could read, but after seeing the prescription, she wondered, could such a simple prescription really cure Ci’er’s illness?

She held the prescription and asked Xu Yi.

“Can this medicinal decoction truly cure Ci’er’s chronic illness?”

Xu Yi shook his head. “Your son’s illness is congenital, it was already present as a fetus. Having him drink this Baoyuan Decoction first is to supplement and nourish heart qi, and invigorate heart yang. After your son’s qi and blood deficiency is replenished, other prescriptions will still be needed for regulation.”

In Chinese medical pulse diagnosis, there were first consultations, second consultations, third consultations, or even fourth consultations. Each pulse diagnosis differed, and the medicinal decoctions taken also needed to be retained or modified accordingly.

Each doctor had their own insights regarding what medicines to use for the patients they received. Xu Yi wanted to start by addressing insufficient heart qi and lack of chest yang, so the prescription he wrote had to be different from others.

“Thank you, Doctor Xu.” Qi Xiuniang’s attitude softened considerably.

The time to decoct medicine was not short. During the wait, Qi Xiuniang asked Xu Yi idly, “Since Chen’s Digestive Pills were prepared by you, why aren’t they called ‘Xu’s Digestive Pills’?”

Xu Yi replied, “Though I prepared them, the prescription for these Digestive Pills did not come from my own hand. I merely borrowed the prescription and dared not change the name.”

Qi Xiuniang hadn’t expected to hear such an answer and couldn’t help but look at him a few more times.

“Doctor Xu, who was your teacher?”

“I did not formally take a master. In the past, I happened to encounter an elderly doctor traveling…”

To say he had learned medicine through self-study would sound too boastful. It was better to fabricate a nonexistent “elderly doctor,” which could bring Xu Yi many conveniences.

Indeed, after he spoke of receiving guidance from an elderly doctor and being given several medical texts, Qi Xiuniang’s impression of him improved considerably, no longer showing the complete distrust of the beginning.

As they were discussing how only he now sold the Digestive Pills, Steward Fang entered carrying a bowl of steaming medicinal decoction.

Qi Xiuniang anxiously stood up and had Steward Fang give her the medicinal soup so she could personally feed Ci’er.

The medicinal soup smelled both sour and bitter. Fang Qiaoci frowned. After Qi Xiuniang blew on it until it cooled, he drank it into his stomach, mouthful by mouthful.

After finishing, Fang Qiaoci said coquettishly, “Mother, my mouth is so bitter.”

“Open your mouth. Mother brought candies. Have one.” Qi Xiuniang was well prepared. From her sleeve pocket, she took out a wrapped handkerchief containing several candies.

Fang Qiaoci held the sugar bean in his mouth, his lips curving upward as he said, “Mother’s candies are the most delicious.”

“Sweet-talker.” These words were very gratifying to Qi Xiuniang.

Every time Fang Qiaoci complained after drinking medicinal soup that it was bitter and unpleasant, the candies he ate were made by her own hands.

…

Not long after drinking the medicinal decoction, Fang Qiaoci started saying he felt hot.

“My palms are even sweating.”

He pulled out his hands to show his mother and father.

When Qi Xiuniang touched his palms, they were warm, unlike the icy cold she used to feel.

She exclaimed joyfully, “Ci’er has warmed up!”

“I see it too!” Fang Chuliang was equally delighted. He removed the scarf his son was wearing. The scarf made of fluffy white rabbit fur was very warm. In the past, even when Ci’er wore it, there wasn’t much difference.

Now, the neck beneath the scarf was also sweating from warmth.

Xu Yi let out a breath of relief. The medicine had taken effect. It seemed the prescription he had written was correct and could treat the symptoms with the right medicine.

“Doctor Xu, your medicinal decoction is truly effective. Look at Ci’er’s warmth, is this a good thing?” Fang Chuliang was both excited and worried that this sweating might be wrong, so he asked again to be reassured.

Xu Yi nodded. “This sweating is not illness sweating, it truly is treating the symptoms with the right medicine.”

The melancholy on Fang Chuliang and Qi Xiuniang’s faces instantly dispersed considerably. If they could truly cure Ci’er’s illness, they would certainly reward Xu Yi handsomely.

Xu Yi said they could discuss this later.

Seeing the family of three so affectionate and warm together, the scene was truly heartwarming. Xu Yi felt it was time for him to return home.

When Fang Chuliang heard that Xu Yi was leaving, he immediately called for Steward Fang to fetch money.

He said, “This is a token of my sincere appreciation. Please accept it, Doctor Xu.”

Xu Yi looked at the silver ingot of good quality before him and accepted it without any burden. “Then I shall take my leave. After a ten-day period, Instructor Fang can have the steward seek me out on South Street again.”

“Understood.” Fang Chuliang nodded and had the steward see Xu Yi off.

After Steward Fang received the order, he quietly reminded, “Master, Doctor Xu doesn’t like riding in sedan chairs.”

How could Fang Chuliang not understand the meaning? He immediately said, “Prepare a carriage.”

This time when Xu Yi left the estate, he didn’t return on foot but rode in a donkey carriage.

The Fang family’s donkey carriage was no inferior to the Xing family’s. Though the interior decoration of the carriage wasn’t as luxurious as the Xing family’s, it was more elegant. On the pear wood bench sat a gilt bronze hand warmer, with burning incense inside that smelled refined and elegant. Xu Yi couldn’t help but hold it in his hands, closing his eyes and smelling it for a long time.

When he got out of the carriage, the clothes he wore had been permeated with the fragrance from the carriage.

When Ah Jin saw him, her first words were, “Young master, you smell so nice!”

Xu Yi was speechless.

Ah Xu tugged at Ah Jin and corrected her. “It’s not that the young master is fragrant, it’s the clothes the young master is wearing that are fragrant.”

Xu Yi fell silent. This explanation was worse than no explanation.

He coughed twice and asked what they had done during the time he was away.

Ah Xu and Ah Jin first reported what they had done, then ran into the main hall and came out with an invitation.

“Young master, this is an invitation delivered by a servant from Young Master Xing’s household. He said he wanted to invite you to go out tomorrow.”

Xu Yi raised an eyebrow. Taking the invitation and opening it, he remembered it was the gathering they had arranged previously.

Because the weather had turned cold, Xing Yuesen had changed the location of the gathering. Instead of going to a teahouse, they would go to the eastern suburb estate.

This eastern suburb estate wasn’t the Xin family’s horse ranch, but one of the Xing family’s vacation estates, filled with flowers, grass, and fruit trees. At this time, the peaches in the estate had ripened, so he wanted to invite Xu Yi and the others to pick peaches together.

A group of wealthy young masters whose limbs knew no labor ordinarily did no work. Now, seeing the peaches had ripened, they also wanted to learn how farmers picked peaches.

After reading the invitation, Xu Yi set it aside and said to Ah Xu, “Tomorrow, you and Ah Jin will stay home. If there’s an emergency, go to the brokerage and hire a carriage to find me at the eastern suburb estate.”

…

The next day at dawn, after Xu Yi finished practicing his boxing forms, he wiped the sweat from his body, changed into fresh robes, and a donkey carriage stopped outside.

Xing Yuesen was more thoughtful than he had imagined, he had even prepared transportation to the estate for Xu Yi.

Xu Yi had originally planned to take Old Liu’s ox cart, but it seemed he wouldn’t need to now.

“You two stay home. If a stranger comes looking for me, tell them to come back the next day.”

Ah Xu and Ah Jin nodded repeatedly. After Xu Yi left in the donkey carriage, they locked the courtyard gate.

Just as Xu Yi set out, at the Xin household on the other side:

In the western wing garden.

Xin Shengyuan lay sprawled on the warm bed, unwilling to get up. Xuelian, the personal maid serving outside, quietly entered and lifted the bed curtain. Seeing his sleeping posture, she covered her mouth and laughed. “Young Master Xin, if you don’t wake up soon, you’ll be late for the trip to the estate.”

“Mm… mm…” Hearing the voice, Xin Shengyuan responded unconsciously and continued sleeping.

Xuelian was helpless. She could only hang up all the curtains and call two maids in. One prepared the clothes Young Master Xin would wear out with incense, while another readied the washing basin with flower dew added to the water, giving off a floral fragrance.

“Young Master Xin, wake up quickly, wake up.”

Others didn’t dare rush him, but as his personal maid, Xuelian dared to. If nothing unexpected happened, she would later be promoted to become Xin Shengyuan’s concubine.

It was just that Xin Shengyuan still had a childish temperament and hadn’t yet touched her.

With Xuelian urging him again and again, Xin Shengyuan could no longer continue sleeping. Displeased, he puffed out his cheeks and got up.

“Noisy, noisy, noisy. You’re too noisy. I finally get a ten-day rest period, why can’t I sleep a bit longer?”

Xuelian attentively helped him change his undergarments, explaining in a soft voice, “Young Master Xin, when you returned yesterday, you specifically instructed me to call you early, saying you were going to the Xing family estate to pick peaches today.”

As she spoke, she pulled him up, wrung out a cloth to wipe his face, and continued, “You also said you wouldn’t bring servants today, only me, so I could also meet that Doctor Xu. Has Young Master Xin forgotten?”

Xin Shengyuan said dryly, “I haven’t forgotten.”

“Since you haven’t forgotten, does Young Master Xin want to eat breakfast before going out?” Xuelian asked him.

Xin Shengyuan looked at the timing hourglass for a moment and exclaimed, “There’s no time! Hurry, hurry, hurry, I need to leave.”

“Ah! Young Master Xin, don’t rush, put your clothes on properly first.” Seeing him in such a hurry, Xuelian had no choice but to tell a maid to bring over the pastries prepared in advance. How could he not eat breakfast? He should at least eat some pastries on the road to tide himself over.

Not only that, Xuelian also prepared a cloak. The two of them left the courtyard one after the other. Outside the side gate, a donkey carriage waited with a servant and driver standing beside it.

Xin Shengyuan jumped onto the carriage and called for Xuelian to hurry.

As a young lady, how could Xuelian dare to be so casual like him? She had to step on a stool to climb up.

After lowering the carriage curtain, Xuelian tied the cloak in her hands around Xin Shengyuan and said softly, “Young Master Xin, eat two pieces of pastry first.”

“You should have called me earlier. That way, even if I wanted to stay in bed, calling me a few more times would have woken me up.” Xin Shengyuan sighed. He was probably going to be the last one to arrive at the estate.

Yesterday he had even bet with Tao Qinghao that he definitely wouldn’t be the last to arrive.

Xuelian fell silent.

“If Young Master Xin says that, then Xuelian won’t go. I’ll return to the courtyard right now and won’t be an eyesore here.”

Xin Shengyuan twitched his lips. Knowing he had no reason to blame her, he asked with feigned indifference, “What pastries did you bring me?”

Hearing this, Xuelian covered her mouth and smiled, saying, “All your favorites, jujube-filled and sesame-filled square cakes, crispy spiral pastries, mung bean cakes, and lamb pastries.”

Hearing this, Xin Shengyuan swallowed. Xuelian was the best, she knew what he liked to eat, unlike his mother who wouldn’t let him eat these things.

“Here, you eat a piece of mung bean cake too.”

He took a piece and stuffed it into Xuelian’s hand, signaling her to eat quickly.

Xuelian looked at the piece of mung bean cake, hesitated with a sigh, but seeing Xin Shengyuan still urging her, she had to eat it in small bites.

As she ate, her throat felt as if something was blocking it, and she felt vaguely uncomfortable.