Hearing this, Lu Xuan thought for a moment and said, "I’d like to take a look at the patient first before I say anything."

From the situation described by Lv Xuming and Zhang Guangli, Lu Xuan already had some rough ideas in mind, but that was only their judgment and had nothing to do with his own. He still hoped to see the patient’s condition with his own eyes before deciding how to formulate a treatment plan.

Faced with this request from Lu Xuan, Lv Xuming naturally agreed readily. The four of them went to the ICU. Lu Xuan took the patient’s pulse and examined the tongue coating. After observing the patient’s condition for a while, he then left the ICU.

"Dr. Lu, how is the situation?"

Once they were outside, the previously silent Zhang Guangli asked anxiously.

Although he didn’t really think Lu Xuan would have any unique insights, remembering how highly Huang Beishan regarded him, he felt that Lu Xuan must have some skills. Maybe not better than Huang Beishan, but at least not too far off, and certainly much better than most of his peers.

Besides, all their hopes were now pinned on Lu Xuan.

All Zhang Guangli could do was inwardly hope that Lu Xuan really would be as capable as Huang Beishan had said, and have a corresponding treatment plan for Li Dali’s condition.

The others also turned their eyes toward Lu Xuan.

Lu Xuan thought for a moment and said, "In TCM there’s no corresponding disease name for chronic renal failure. Judging from its clinical evolution, it falls under such categories as ’urine toxin,’ ’guange,’ ’long bi,’ ’kidney wind,’ ’edema,’ ’deficiency taxation,’ ’kidney taxation,’ and so on.

Modern TCM’s understanding of the disease name of chronic renal failure mainly has two viewpoints. One holds that chronic renal failure falls under multiple TCM disease categories—for example, classifying chronic renal failure under ’guange,’ ’edema,’ ’long bi,’ ’deficiency taxation,’ ’urine toxin,’ ’kidney wind,’ ’water qi disease,’ ’uremia,’ and so on. The other advocates summarizing chronic renal failure with a single TCM disease name, such as calling it ’deficiency-consumption renal failure,’ and some believe it belongs to the category of ’kidney taxation’ in TCM.

If you consult the national standard ’TCM Clinical Diagnostic and Therapeutic Terminology’ compiled some years ago, chronic renal failure in modern medicine is named ’chronic renal failure’ in TCM as well.

But having seen the patient’s condition and combined it with the test results, I think his edema can be considered as caused by spleen–kidney Yang deficiency."

"Spleen–kidney Yang deficiency..."

Zhang Guangli kept murmuring these four words.

Most of what Lu Xuan had just said, he basically knew. Even if he didn’t know it as systematically and in such detail as Lu Xuan, his overall understanding wasn’t too far off; it was just that his memory wasn’t good enough to recall it as clearly as Lu Xuan did.

But when Lu Xuan mentioned edema due to spleen–kidney Yang deficiency, he had hit the nail squarely on the head.

In TCM, treatment hinges on syndrome differentiation. Only after differentiating the syndrome clearly can one prescribe properly and treat the disease.

If the syndrome differentiation is correct, then the prescription will not be too far off overall.

One can say that the most critical aspect of TCM treatment is syndrome differentiation.

If the differentiation is off, the herbs prescribed will naturally fail to achieve much effect.

"So spleen–kidney Yang deficiency is the key to his edema?" After thinking for a bit, Zhang Guangli still voiced the doubt in his heart.

Although Lu Xuan had said the patient had spleen–kidney Yang deficiency, Zhang Guangli still wasn’t sure. He had no way to judge whether Lu Xuan’s differentiation was accurate, so he could only use this way to probe and see whether Lu Xuan’s medical skills were really as formidable as Huang Beishan claimed.

After he asked, a faint look of expectation appeared on his face.

From their earlier conversation, he had learned that Lu Xuan was from Anjiang County. If Lu Xuan really was as skilled as Huang Beishan said, then Anjiang would have produced a top-tier TCM master.

For the Traditional Chinese Medicine Circle in Anjiang, that would absolutely be something to celebrate.

Facing Zhang Guangli’s questioning and probing, Lu Xuan didn’t expose it. Instead, he thought for a moment and said, "As for the etiology of chronic renal failure, I think it can generally be divided into three aspects. The first is invasion of external pathogenic factors, entering from the exterior to the interior, with the condition recurring and worsening;

The second is psychological trauma or excessive worrying and overthinking, unrestrained sexual life, and irregular daily habits;

And the third is pre-existing deficiency of lung, spleen, and kidney. When this is further triggered by exterior pathogens, or by excessive fatigue, or improper treatment, the imbalance of the viscera, Yin and Yang, and Qi and blood is further aggravated, giving rise to substantial pathogens like wind, cold, damp-heat, stasis, and toxin.

Su Wen·Ju Teng Lun says, ’Overstrain leads to Qi depletion’; Suwen Shengqi Tongtian Lun also states, ’Exerting undue strength injures the kidney Qi.’ The medical classic ’On the Spleen and Stomach’ likewise mentions, ’Overexertion of the body leads to spleen disease’;

I wonder if Dean Zhang has heard of Old Mr. Zheng?"

"Which Old Mr. Zheng?" Zhang Guangli’s eyes moved slightly.

Seeing that Zhang Guangli had heard of him, Lu Xuan nodded slightly and said, "Old Mr. Zheng divides the etiology of chronic renal insufficiency into root causes, branch causes, and triggers. The root cause is spleen–kidney deficiency and damage; the branch cause is that prolonged kidney disease impairs the function of separating the clear from the turbid, causing damp-turbidity to be retained in the body, diffusing through the triple burner and affecting other organs, thereby inducing this disease.

This damp-turbidity is what Old Mr. He Lianchen calls ’urine toxin’; he further says, ’Urine toxin enters the blood, blood toxin invades the brain.’

The trigger is sudden invasion of external pathogens: lung Qi fails to disseminate, its governing function is impaired, the water pathways of the triple burner become obstructed, damp-turbidity accumulates. Coupled with the pre-existing spleen–kidney deficiency, an acute attack of external pathogens further worsens spleen–kidney damage; or irregular diet, or overexertion injuring the spleen and stomach, thereby aggravating spleen–kidney deficiency.

Among all this—whether in ancient medical texts, or in the work of Old Mr. Zheng and Old Mr. He Lianchen—one point is repeatedly mentioned: spleen–kidney deficiency and damage. It can be seen from this that chronic renal failure is greatly related to spleen–kidney deficiency, and it can even be said that this deficiency leads to the patient’s edema and the series of symptoms throughout the body.

Judging from the classics and relevant discussions, most physicians believe this disease mainly results from dysfunction of ascent and descent of the zang–fu organs, confusion and reversal of clear and turbid. It is a pattern of root deficiency with branch excess, with the disease location primarily in the spleen and kidney.

Deficiency of the upright Qi and excess of the pathogenic factors run throughout the course. The pathomechanism is spleen–kidney dual deficiency as the root, damp-turbidity retention as the branch. There exist four major pathological mechanisms: deficiency, excess, stasis, and toxin. Among them, deficiency is the fundamental mechanism, centered on kidney deficiency, which over time extends to heart, liver, spleen, and lung.

In this disease, kidney Yang deficiency manifests as soreness and pain of the lower back, aversion to cold and cold limbs, and a deep, fine pulse—typical signs of Yang deficiency. TCM believes that ’chronic disease enters the kidney,’ and ’chronic disease must involve deficiency.’ Formation of kidney disease mostly stems from congenital insufficiency, emotional stagnation, and improper diet leading to spleen–kidney deficiency and Yang deficiency with water flooding.

The disease is rooted in spleen–kidney dual deficiency, with water-damp retention in the middle burner as the branch. In summary, it belongs to the pattern of root deficiency with branch excess, and the treatment principle is to warm Yang and promote urination—that is, to warm and tonify spleen and kidney, promote water metabolism, and reduce edema."

Inwardly, Zhang Guangli was utterly astonished. He had originally intended to probe Lu Xuan through this line of questioning, to see whether he really had the skills and ability that Huang Beishan claimed, but he had not expected that this probing would yield such a result.

These things are not something you can memorize by rote alone.

Moreover, everything had happened so suddenly. From the time Lu Xuan received the call to the moment he rushed over, barely a dozen minutes had passed; he had had no time to review anything related to nephrology. Yet he could explain everything concerning the kidney so thoroughly.

From the basic to the profound, layer upon layer—this was not him explaining casually, but more like a top-tier TCM master, a Master of Medicine, expounding the true principles of TCM nephrology to his student.

Just moments ago, Zhang Guangli had still been unsure whether Lu Xuan’s syndrome differentiation was accurate.

But now, that last shred of doubt in his heart had completely vanished without a trace.

This young man in his twenties really did have great skill.

Huang Beishan had said that his own medical skill was inferior to Lu Xuan’s. Previously, Zhang Guangli had thought that might be a joke, but now he had a different feeling.

What Huang Beishan had said might very well be true.

At this moment, Zhang Guangli was truly filled with admiration.

He no longer cared about maintaining the demeanor of the dean of the First Hospital. With the expression of a student, he asked humbly, "Dr. Lu, you mentioned ’warming and tonifying spleen and kidney, promoting water metabolism and reducing edema’ as the treatment method. If we are to prescribe herbs, which ones should we use?"

"Use a modified prescription of Wuling San combined with Jinkui Shenqi."

Lu Xuan smiled slightly and said, "Polyporus 1 qian, Fuling, Polygonum, White Atractylodes, Gui Zhi, Rehmannia Glutinosa, prepared Aconite, Cornelian Cherry, Peony Bark, Dioscorea. Seven doses, decocted in water. If after taking it the patient’s urine output increases, lower limb edema is relieved, and urinary protein decreases, then we can continue with the original formula with appropriate modifications."