Although some of the six rookies came across as a bit arrogant, they were still quite humble and polite with one another.
A staff member brought over a box with lots. After a bit of polite back-and-forth, each of them stepped forward and drew a slip of paper from the box.
Xu Ze went up third and drew a slip. When he opened it, all he saw was a single name written on it: Yang Liming.
He paused for a moment, then understood. This had to be the name of one of the patients. It looked like this practical exam really was going to test their true skills. They weren’t spelling anything out for you—just handing you a patient to treat, exactly like a real clinical situation. No shortcuts whatsoever.
Xu Ze looked at the name in his hand, then at the six patients in front of him. He honestly couldn’t tell which one was his.
The six patients were all male, ranging in age from their thirties to their sixties. Logically speaking, a name like that was more likely to belong to someone between thirty and forty.
But among these six, at least three fit that description. One was clutching his belly with a deep frown—clearly an abdominal pain patient.
Another had a pale face and was breaking out in a cold sweat—his condition wasn’t very clear.
And then there was a third who looked like nothing much was wrong with him at all.
Xu Ze had hoped to figure out which patient was his early on, but now he wasn’t so sure anymore.
He wasn’t afraid of examining patients. But if he had to treat this patient using Traditional Chinese Medicine… well, that was a bit… dicey.
Xu Ze felt that “dicey” was actually a very fitting word for his situation right now. If he had to treat the patient with Western medicine, he wouldn’t be worried at all—that was what he’d studied.
But to be tested on TCM diagnosis in front of all these people? He really didn’t have much confidence. Sure, his family practiced TCM, and he’d taken a year of TCM classes in school, but when it came to actually seeing patients, he had never really used it.
So now, with a grimace on his face and his heart hanging by a thread, he waited for the exam to start, looking rather peculiar.
Seeing that everyone had finished drawing their lots, Old Dean Guo stroked his white beard and nodded. “Alright, the practical assessment now begins.”
“First: Li Bolin.”
At Old Dean Guo’s call, the oldest patient among the group walked up and sat down at the central diagnostic table, waiting for the doctor to examine him.
“Who drew this lot? You may begin,” Old Guo said, taking a light sip of tea and speaking slowly.
A young man with a buzz cut stood up, nodded in acknowledgment, and walked over to take the main seat at the table.
“Oh, Wu Lin. Yes, you may begin,” Old Guo said, nodding at the young man.
“Yes, Elder Guo,” the young man named Wu Lin replied and got to work.
Watching Wu Lin methodically go through the four diagnostic techniques—inspection, listening and smelling, inquiry, and palpation—Xu Ze nodded to himself with admiration. These people who qualified for this assessment were truly remarkable.
Wu Lin finished his examination quickly and respectfully addressed the veteran masters at the front. “Esteemed teachers, I have completed the patient examination.”
Old Dean Guo nodded slightly and then asked slowly, “Very well. Please state this patient’s diagnosis, your basis for it, and the treatment method.”
“Patient Li Bolin, male, sixty-two years old. Primary symptoms include upper abdominal pain for six months, worsening again over the past three days, accompanied by acid reflux and a burning pain. Signs and symptoms: burning pain in the stomach and abdomen, dry mouth and bitter taste, red tongue with yellow coating, wiry and rapid pulse. Diagnosis: Gastric ulcer with Liver-Stomach Heat Accumulation pattern. Treatment principle: soothe the liver and regulate qi, clear heat and harmonize the stomach. Formula: Modified Danzhi Xiaoyao Powder. Acupuncture points: Zhongwan, Neiguan, Zusanli. Needling method: reducing technique,” Wu Lin answered carefully.
Hearing Wu Lin’s responses, the several nationally renowned TCM masters all nodded approvingly. In particular, Wang Yibo, a famous doctor from Jiangnan, smiled with great satisfaction. Wu Lin was his disciple, and seeing him answer so smoothly naturally made Wang Yibo very happy—because this wasn’t just about whether his disciple passed; it also reflected on him as the teacher.
Old Dean Guo stroked his beard and gave a slight nod, then said with a smile, “Not bad at all. Your stated pattern, treatment principle, and formula are all quite good.”
Hearing Old Dean Guo’s words, Wu Lin breathed a huge sigh of relief and smiled, nodding.
Old Guo continued, “Alright, the TCM assessment is passed. Next is the Western clinical assessment. Do you need to perform any further examinations?”
“Western clinical assessment? They really do test that!” Wu Lin’s expression changed slightly. He wasn’t worried about the TCM portion at all, but being tested on Western medicine was a serious challenge. Still, he felt a bit relieved. The Western medical treatment for this patient wasn’t too complicated. If it had been a heart disease patient, that would have been trouble. Heart disease was complex, and he didn’t know much about it.
There was no need for further examination. After thinking for a moment and organizing his words, Wu Lin said, “Western medical diagnosis: suspected gastric or duodenal ulcer. Medication: Amoxicillin for infection, Cimetidine and Pectin Bismuth to protect the stomach. For severe abdominal pain, 654-2 can be used to relieve spasms and pain.”
After he finished, Wu Lin thought for a moment to see if there was anything else to add, then looked up at the masters, waiting for their evaluation.
Hearing that Wu Lin seemed to have finished, Old Dean Guo turned to Professors Tang Wuyou and Jiang Lingyun from Capital Medical University, who were sitting nearby.
These two professors were specially invited by Old Guo as Western medicine experts, so naturally they would do the evaluating.
The two old professors exchanged a glance, and then Professor Tang Wuyou nodded. “The diagnosis is largely fine. The medication choices are standard, but the drugs used to treat gastric and duodenal ulcers have been updated. Generally, we now use Clarithromycin, which is more effective against infection, and Omeprazole to protect the stomach. Overall, it’s acceptable.”
“Good. Thank you, Old Tang,” Old Dean Guo said, nodding to Professor Tang to express his thanks, and then continued, “Wu Lin, overall evaluation: Excellent.”
“Next: Lin Dongping.”
Watching the assessments of the first few patients—two passed, one received an excellent—Xu Ze could see that the assessment was extremely strict. Even a small deviation would only earn a passing grade at best.
So Xu Ze was sweating a little. The veteran masters sitting up there were all experts. He himself was only a half-trained TCM practitioner at best. If he really got stumped and made one or two mistakes, he’d probably be sent packing.
With his heart in his throat, he watched the other rookies go up one by one to take the exam. In the end, only he and Guo Yujian, who had come in first on the theory portion, were left. The other four had barely scraped by. Now Xu Ze was even more nervous.
Old Dean Guo then called the fifth patient’s name: “Hu Jiang.”
Hearing that name, Xu Ze couldn’t help but sigh again. Still not his turn. This waiting was pure torture.
The rookie assigned to Hu Jiang was Guo Yujian.
Watching Guo Yujian’s smooth examination technique, Xu Ze couldn’t help but feel envious. Guo Yujian had dedicated over ten years to focused TCM training, and it really showed.
For Guo Yujian, this patient was ridiculously easy. He quickly laid out the diagnosis, the basis for it, and the treatment plan. He also clearly explained the patient’s Western medical diagnosis and treatment to the two professors from Capital Medical University, making them nod frequently. Only at the very end did Professor Jiang Lingyun correct a small deviation.
In the end, Guo Yujian received an evaluation of “Outstanding,” which made Old Dean Guo stroke his beard and smile with great satisfaction.
With Guo Yujian’s assessment finished, everyone turned their attention to the last rookie—the one they were most curious about: Xu Ze.
The several nationally renowned masters sitting up there already knew some of Xu Ze’s background through Old Master Wang, so they were also very curious to see just how skilled this young man—whom Old Master Wang had so exceptionally recommended—really was.
Xu Ze, meanwhile, had already been observing the last patient for a while. Without a doubt, this patient had to be Yang Liming, the one he’d been waiting for all this time.
Xu Ze had already started preparing for his upcoming exam. From the way the patient was clutching his belly, he could tell the main symptom was upper abdominal pain.
The most common causes of upper abdominal pain are usually problems with the stomach, gallbladder, liver, or pancreas. In rare cases, heart problems can also cause it.
So Xu Ze had already begun his preliminary examination of the patient. On his command, his level-three system’s functional color ultrasound had been activated.
Even from two meters away, thanks to the system’s powerful capabilities, the patient’s upper abdominal area quickly appeared before Xu Ze’s eyes in his dimmed field of vision.
Looking at the patient’s slightly swollen gallbladder and the small, bright spot inside it surrounded by a whitish glow, Xu Ze was already certain that the patient’s abdominal pain was caused by gallstones.
Having basically confirmed the cause, Xu Ze immediately used Xiao Dao’s encyclopedia to search for information on the TCM diagnosis and treatment principles for gallstones, even though he vaguely remembered some of it from before. He wanted to be prepared for anything.
In TCM, gallstones are classified into several types: Liver-Qi Stagnation type, Damp-Heat Internally Accumulated type, Toxic Heat Blazing type, Blood Stasis Internal Obstruction type, and so on.
Treatment principles: 1) Liver-Qi Stagnation type: soothe the liver and relieve stagnation, regulate qi and stop pain. 2) Damp-Heat Internally Accumulated type: clear heat and resolve dampness, unblock the interior and purge downward. 3) Toxic Heat Blazing type: clear heat and resolve toxicity, unblock downward and drain fire. 4) …
Xu Ze quickly started reviewing this information and reinforcing his memory of it. This was exactly what he would need for the upcoming assessment. He had to deepen his understanding now to minimize the chance of making mistakes.
“Yang Liming,” Old Dean Guo called out, and the last patient took the stage. Up above, Old Master Wang’s expression also started to show a hint of tension.
As Xu Ze walked slowly to the front, the veteran masters all looked at this handsome young man with mild smiles tinged with anticipation. They wanted to see just how skilled this Western-medicine-focused student really was in TCM. Was he truly as impressive as Old Master Wang had claimed?
Xu Ze felt reasonably confident by now, so he was able to maintain the same calm composure as before. He sat down at the diagnostic table and began the familiar process of examining the patient.
He had already essentially confirmed what the illness was, so when he examined the patient with that in mind, his actions flowed very smoothly.
Watching Xu Ze’s skilled questioning techniques and diagnostic methods—even though many of them leaned toward Western-style examination—the masters still noticed from the accurate and practiced way he took the pulse that this young man was indeed quite familiar with TCM diagnosis. He wasn’t just a Western medicine guy. They all nodded approvingly.
But although everyone saw the confidence and calm on Xu Ze’s face, none of them could see the anxiety churning inside him. He had already confirmed that the patient had gallstones—called “gallstone disease” in TCM—but TCM required pattern differentiation. Based on symptoms, pulse, tongue coating, and so on, the treatment approach would differ.
Xu Ze had some understanding of pulse diagnosis, but when had he ever really used it in real life? Back when he treated patients at home and took their pulses, it was mostly just for show, because he never actually needed to rely on herbal medicine for treatment.
But now, it was time to test real skill. He had to determine what this patient’s pulse was. If he made a mistake on something this important, there was no way he would pass.
While taking the patient’s pulse, Xu Ze reviewed the knowledge about gallstones he had just studied. Gallstone pulse patterns fall into only a few categories: wiry, wiry and rapid, wiry and slippery, wiry and thready, and wiry and hesitant.
These patterns correspond to Liver-Qi Stagnation type, Damp-Heat Internally Accumulated type, Toxic Heat Blazing type, Blood Stasis Internal Obstruction type, and so on.
Poor Xu Ze—when had he ever delved into such advanced pulse study? But now there was no turning back. He had to do everything he could to figure out what this pulse was.
He took the pulse for a long time but could only identify it as wiry. As for whether it was rapid, slippery, or anything else, he really couldn’t tell.
“Xiao Dao… is there any way you can help with this?” Xu Ze frowned and thought for a long time before finally, helplessly, asking Xiao Dao for help. But he wasn’t even sure—as a futuristic medical assistance system, would Xiao Dao know this?
Sure enough, Xiao Dao replied, sounding very frustrated. “Well… there’s no corresponding virtual data in my database for this. Just based on the text I just searched, I can’t make an accurate judgment.”
Hearing that, Xu Ze had no choice but to sigh and keep trying.
The masters watching from the side saw Xu Ze frowning slightly, taking the patient’s pulse without letting go for a long time. They all knew this young man had likely run into trouble.
But they also sighed quietly to themselves. Although this young man had done well on TCM theory, he was, after all, trained in Western medicine. How could he be expected to master pulse study—the most difficult part of TCM—so easily?
And the rookies who had already passed were watching Xu Ze with a mix of curiosity and confusion. They really couldn’t figure it out. This guy had performed pretty well on the written exam, so why was he stuck on the pulse for so long? Could it be that he studied TCM without actually mastering pulse study? Or was this patient’s pulse truly so strange that it was nearly impossible to read?
The other rookies were skeptical, but none of them dared to assume the first reason was true. The annual Rookie Assessment, with only a handful of spots each year, wasn’t something to be taken lightly. The veteran masters would never recommend someone to take this exam unless they had full confidence in their disciple’s abilities.
If he hadn’t even mastered pulse study, how could the elder who taught him possibly have let him come? So the patient’s pulse must really be that hard to read. That was why Xu Ze was hesitating.
Thinking this, the other rookies quietly counted their blessings that they hadn’t drawn this patient. If his pulse was really that difficult to determine, they might have embarrassed themselves.
Poor things—they were making excuses for Xu Ze without realizing that he genuinely didn’t know pulse study well, which was why he was struggling.
But after thinking it over for a long time, Xu Ze did come up with a clever workaround.
Gallstone disease only has a few types, and each type has its own unique pulse patterns, symptoms, and signs to help identify it. Since he couldn’t determine the pulse, he could use the other symptoms and signs to figure out which type this patient had.
Once he knew the type, all he had to do was report the pulse pattern that matched that type according to the documentation. That would likely be correct.
So Xu Ze quickly changed tack and began diagnosing the patient’s type classification without relying on the pulse.
Besides upper abdominal pain, this patient also had a bitter taste in the mouth, an aversion to fatty foods, and a fever. Looking at his tongue coating, it was slightly yellow but not thick—so it should be thin and yellow.
Bitter taste, aversion to fats, fever, thin yellow coating. No symptoms like constipation or thick, greasy yellow coating. Comparing this with the data Xiao Dao had sent earlier, it matched the Liver-Qi Stagnation type best. The other types all had some differences.
This had to be the type. Xu Ze was overjoyed. He had finally confirmed the type, and according to the data, the pulse pattern for this type was simply wiry—no slippery, no rapid, nothing else. So now it was easy. He would just answer “wiry pulse.” That shouldn’t be wrong.
With the TCM diagnosis, basis, and treatment principles all sorted out once he completed the pattern differentiation, there were no more problems. As long as he answered according to those standard references, nothing major should go wrong.
Xu Ze was just about to stand up and indicate that he had finished his examination when suddenly his heart jolted. A thought hit him. He had been so focused on getting through the TCM portion that he had forgotten about the Western medicine side. Besides gallstones causing abdominal pain, there were other conditions he needed to rule out.
Even though he was already certain this patient had gallstones and that they were likely the cause of the pain, he couldn’t be one hundred percent sure there weren’t other conditions contributing to it, like gastritis or pancreatitis.
