It was already afternoon by the ti Li Xu returned to the clinic.
"Boss, you're back."
Song Sisi glanced up before lowering her head again to focus on identifying acupoints.
"Mhm. What did you have for lunch?"
"Hehe, Dr. Hu treated to barbecue."
"And him?"
"He left. He said he got enough footage, so he wouldn't be staying for the afternoon."
"I see."
Li Xu washed his hands and went back to his book.
He hadn't been reading for long when Captain Jia arrived.
"Oh, Doctor Li, you're back! Hiss… Get another bottle of Waterlon Frost." Captain Jia said, covering his mouth. "Your Waterlon Frost works great. It stops the pain as soon as I use it, but it doesn't solve the root problem."
Li Xu glanced at Song Sisi.
Song Sisi opened her mouth, wanting to say sothing, but she didn't know what.
Li Xu gestured for Captain Jia to sit down and said, "It's not supposed to solve the root problem. Canker sores are a symptom. Waterlon Frost can treat the symptom, but a complete cure requires analyzing the underlying cause."
"Open your mouth."
"Ahhh—"
Li Xu frowned as he looked into Captain Jia's open mouth.
The canker sores were even more severe than he had imagined. A dozen or so ulcers were densely scattered along the sides of the tongue and the inner lining of the mouth, looking as if soone had sprinkled a handful of coarse salt inside.
"So many ulcers. No wonder you're in so much pain." Li Xu leaned closer, carefully observing the shape of the ulcers.
The small ones were the size of millet grains, while the large ones were comparable to soybeans. Their edges were slightly raised, but the central depressions were an unhealthy pale white, and the surrounding mucous mbrane showed no obvious redness or swelling.
"Stick out your tongue for ," Li Xu said.
Captain Jia obediently stuck out his tongue.
Li Xu saw that the tongue was swollen and large, with clear teeth marks on its edges. The surface was coated with a thick, white, greasy layer, as if it had been brushed with cream.
"Hold out your hand. Let take your pulse."
Captain Jia extended his right hand, and Li Xu placed three fingers on his cun, guan, and chi positions.
The pulse beneath his fingers was deep, fine, and weak. It felt as faint as a thin thread, requiring firm pressure to be felt at all.
Li Xu switched to the left hand and found it to be the sa.
A fine pulse indicates a deficiency of qi and blood, while a deep pulse suggests the illness is internal. Combined with its weakness, this was clearly the pulse of a cold stomach due to Yang deficiency.
Li Xu released his hand, recalling a passage from the *Golden Mirror of dicine: Mouth Section*: "In cases of deficiency-heat, the canker sores are pale red, with small white spots throughout the mouth… In cases of excess-heat, the color is bright red, with festering sores throughout the mouth…"
Captain Jia's canker sores were pale, not red, which was clearly not a case of excess-heat.
"How's your appetite usually?" Li Xu asked.
"Don't even ask," Captain Jia said with a pained expression. "I get full after just a few bites, and if I eat a little more, I feel uncomfortably bloated."
"Do you often feel tired and weak all over?"
"Yes, yes, exactly!" Captain Jia exclaid as if he'd found a kindred spirit. "When I wake up in the morning, it feels like I haven't slept at all. I have to take a break after just two hours of driving. It never used to be like this."
Li Xu continued, "And your bowel movents? Are they well-ford?"
"Loose. They're never well-ford." Captain Jia shook his head. "I just thought I had a bad stomach."
"Does your stomach feel upset after eating or drinking cold things?"
Captain Jia's eyes lit up. "Amazing! Doctor Li, how did you know? I get diarrhea from drinking cold water. In the sumr, I don't even dare to eat much waterlon."
Li Xu nodded. All the symptoms matched.
He turned to Song Sisi, who was standing by with a confused look on her face. "Sisi, have you figured out the problem?"
Song Sisi bit her lip. "Boss, I thought the Waterlon Frost would be enough to cure it."
Li Xu said gently, "It's not your fault. For ordinary canker sores, Waterlon Frost is fine. But Captain Jia's condition is more complex. It's a classic case of transitioning from an excess condition to a deficiency one, shifting from accumulated heat in the heart and spleen to spleen deficiency with trapped dampness."
Captain Jia was completely bewildered. "Doctor Li, what exactly is going on with these canker sores? They've been recurring for months. They heal, then flare up again. I barely get a few days of peace."
He grew more agitated as he spoke. "You have no idea how miserable it is to have a mouth full of sores! My mouth hurts if I eat hot food; my stomach hurts if I eat cold food. I don't even dare to eat chicken eggs, for crying out loud! I switched to duck eggs, I drink Chrysanthemum tea every day, and I don't even dare to add Goji Berries!"
Li Xu gestured for him to calm down. "Easy now. Let's figure out the cause first. What were your canker sores like when they first started?"
"At first, it wasn't so bad. They'd flare up once every few months, and Huang Lian Shangqing Tablets worked wonders. I'd take them, and they'd clear up," Captain Jia recalled. "But then that stopped working. I went to a hospital and got vitamins and anti-inflammatory drugs. They'd help for a while, but the sores would co back soon after."
Li Xu understood. "And there's the problem. In Chinese dicine, we call these canker sores 'mouth sores,' and they're mainly related to three organs: the heart, spleen, and kidneys. Initially, it was indeed an excess-heat condition. Huang Lian Shangqing Tablets are bitter and cold, and they clear heat, which is why they were effective. But long-term use of bitter, cold dicine damages the Yang Qi of the spleen and stomach. Combined with your irregular diet, this caused your condition to transition from excess to deficiency."
Captain Jia looked lost. "But if the problem is heat, shouldn't you eat cooling foods?"
"That's a common misconception," Li Xu explained patiently. "There are two types of 'heat': excess and deficiency. Excess-heat is a genuine overabundance of pathogenic heat, which can be treated with cold and cooling dicines. Deficiency-heat, however, is an imbalance of yin and yang. It looks like excess heat on the surface, but it's actually caused by insufficient organ function. Your case is the latter."
Song Sisi suddenly interjected, "Boss, then why does spleen deficiency lead to canker sores?"
Li Xu replied, "Good question. The *Inner Canon of the Yellow Emperor* states that 'the spleen opens into the mouth,' aning the state of the spleen's function directly affects the oral cavity. When the spleen is deficient, it cannot transform and transport water and dampness. This damp turbidity then rises to the mouth, forming ulcers. Xue Ji of the Ming Dynasty also wrote in *Essentials of Stomatology*: 'Canker sores are caused by excess-heat in the upper burner, deficiency-cold in the middle burner, yin-fire in the lower burner, and pathogenic transmission through the various ridians.'"
He turned to Captain Jia. "Your white, greasy tongue coating, your deep and fine pulse, your poor appetite, loose stools, and aversion to cold are all signs of spleen Yang deficiency. Using cold and cooling dicines at this stage would only make things worse."
A look of sudden realization dawned on Captain Jia's face. "No wonder it got worse the more heat-clearing dicine I took! So, how should it be treated?"
Li Xu picked up a pen to write a prescription. "I'll write you a formula based on Fuzi Lichong Decoction. It will warm and supplent the spleen Yang, with a small amount of heat-clearing dicine to treat the symptoms."
He explained as he wrote, "The Aconite and dried ginger will warm the Yang and dispel cold. The Codonopsis and Atractylodes will strengthen the spleen and boost qi. The Poria Cocos and Alisma promote urination to drain dampness, and we'll add a small amount of Huang Lian to clear any residual heat."
"Continue using the Waterlon Frost spray externally to relieve the pain, but the key is internal regulation." After finishing the prescription, Li Xu added, "You must avoid raw and cold foods. Eat more foods that warm and supplent the spleen and stomach, like Mountain Yam, red dates, and ginger."
Captain Jia slapped his thigh in regret. "Actually, the day before yesterday, my canker sores were almost healed. But yesterday I indulged myself—plenty of alcohol, at, and spicy food—and they suddenly got much worse."
Li Xu shook his head. "This is why you have to watch what you eat. If you can't control your diet, no amount of dicine will help."
All things can be dicine.
And food is no exception.
Li Xu had prescribed him Fuzi Lichong Decoction to warm and supplent his spleen Yang.
But if he were to drink iced beer and eat spicy food again, it would neutralize the effects of the Fuzi Lichong Decoction.
Captain Jia took the prescription. "Doctor Li, how long do I need to take this dicine?"
"Start with seven doses, then co back for a follow-up so we can adjust it," Li Xu said. "Rember, during the treatnt, you absolutely must not have any cold drinks or cold-natured foods. Soak your feet in hot water at night, and try to be in bed before ten."
Captain Jia nodded repeatedly. After paying the consultation fee, he left, thanking Li Xu profusely.
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