As a doctor treating patients, the most important thing is to learn to see through the surface to grasp the essence…
When a patient comes in with abdominal pain, you must clearly distinguish exactly which area hurts. From there, you can use the location to determine the cause.
For instance, Xu Ze had already discovered via color ultrasound that this patient had obvious gallstones, and the gallbladder was also swollen. At this point, one could basically confirm that the patient’s abdominal pain was primarily caused by these gallstones.
But being a doctor is not an easy profession, and diagnosis is never that simple. Xu Ze had only been focused on passing this assessment and had momentarily forgotten something crucial for any physician.
That is, beyond identifying the main condition, one must also analyze and rule out other potential diseases. Abdominal pain like this, aside from gallstones, can also be caused by gastritis or even pancreatitis.
Xu Ze had now confirmed the primary issue was gallstones, but he still needed to eliminate other corresponding possibilities… Although the likelihood of comorbid conditions was small, as a doctor, one cannot simply ignore a possibility just because it’s small. Often, it is precisely the tiny overlooked details that lead to severe consequences.
Xu Ze suddenly recalled this crucial point. Although it was unlikely to be a major issue, for someone as meticulous and deeply responsible for his patients as he was, this was absolutely something he could not afford to neglect.
Therefore, he steadied his mind once more, activated the color B‑mode ultrasound, and began scanning the patient’s stomach and pancreas.
Color ultrasound can effectively assess macroscopic changes in the pancreas and stomach. Through this examination, one can roughly determine if there are any abnormalities.
The scan results gave him a slight sense of relief. The patient’s stomach showed no significant problems, and the surface of the pancreas appeared quite smooth, with no obvious anomalies.
At this point, Xu Ze was almost entirely reassured. However, recalling the newly unlocked blood amylase function within the Level‑3 system, he decided to run that test on the patient as well.
A blood amylase test is the gold‑standard lab assay for ruling out pancreatitis. Running this test would provide absolute confirmation, even more accurately than a color ultrasound scan alone.
Following his mental command, a hair‑thin needle swiftly extended from the ring on his right index finger—the finger resting against the patient’s pulse—and lightly pricked the patient’s wrist. Unbeknownst to the patient, a tiny amount of blood was drawn for analysis.
“1200 U/L.” Xu Ze frowned at the red numerical value displayed on his lenses. The blood amylase level was significantly elevated. This patient actually had concurrent pancreatitis!
Nevertheless, the primary diagnosis remained gallstones, with pancreatitis as the secondary diagnosis. As for the Traditional Chinese Medicine (TCM) diagnosis, the assessment of cholelithiasis should not be problematic.
He slowly stood up, nodded toward the increasingly impatient senior experts at the front, and said, “Dean Guo, I have completed my examination.”
Hearing Xu Ze’s words, the senior masters all nodded slightly. Elder Wang, observing Xu Ze’s expression—serious yet still exuding confidence—felt a wave of relief.
Earlier, seeing Xu Ze’s hesitation, Elder Wang had deduced that Xu Ze’s foundation in TCM was indeed somewhat weaker than that of the other rising stars. He had been genuinely worried about whether Xu Ze would pass. But now, although Xu Ze had taken extra time, his confidence appeared unwavering, which naturally set Elder Wang’s mind at ease.
At this stage, Elder Wang was less concerned about the impact on his own reputation if Xu Ze failed; what he cared about was this young man’s undeniable talent. It would be a terrible shame if Xu Ze couldn’t obtain his license due to failing this assessment.
Dean Guo looked at the earnest young man across from him and nodded gently. “Very well… Since the examination is complete, Xu Ze, please present the diagnostic basis and treatment plan for this patient.”
“The patient primarily presents with upper abdominal pain, a bitter taste in the mouth, and an aversion to greasy food. TCM signs include a thin yellow tongue coating and a wiry pulse… Western physical examination reveals mild tenderness in the right upper quadrant and a positive Murphy’s sign… Therefore, the TCM diagnosis is: Cholelithiasis (Gallstones), classified as Liver Qi Stagnation type. The treatment principle is to soothe the liver and regulate Qi. The recommended herbal formula is: Chaihu Shugan Powder… Acupuncture points: Riyue, Qimen, Dannangxue, supplemented with Zusanli and Zhongwan…”
As he reached this point, Xu Ze narrowed his eyes slightly, glancing at the expressions of the senior masters seated before him. Seeing Elder Wang nodding gently with a smile, Xu Ze finally breathed a huge sigh of relief internally. As long as this part is correct, I have nothing else to worry about.
The subsequent discussion of Western diagnosis and treatment was, for Xu Ze, the easy part. Feeling much more at ease, he continued with a calm smile: “Western diagnosis considerations: Acute cholecystitis, cholelithiasis; acute pancreatitis cannot be ruled out… Recommend hepatobiliary ultrasound, complete blood count (CBC), and blood amylase tests. Initial treatment should include cephradine and ofloxacin for anti‑infection, along with cimetidine for acid suppression and anisodamine (654‑2) for spasmolysis and pain relief…”
“If relevant tests confirm gallstones and given the patient’s acceptable physical condition, surgical intervention is recommended following effective anti‑infection measures and gastric acid/pancreatic protection.”
Upon hearing this, Dean Guo’s brow furrowed slightly. A lifelong devotee of TCM, he had gradually come to accept Western medicine over the years, yet he remained deeply resistant to the Western reliance on surgery.
In his view, conservative treatment using herbal medicine to assist in expelling stones was the superior path. Western surgery, while decisive, was a matter of “killing a thousand enemies but losing eight hundred of your own men”—it did not align with the Tao of Chinese medicine.
However, although he was not entirely satisfied with the treatment plan Xu Ze proposed, surgery fell strictly under the domain of Western medicine. He was not in a position to easily refute it. He turned to the two professors from Capital Medical University beside him, awaiting their evaluation.
When Dean Guo looked at Professors Tang Wuyou and Jiang Lingyun, he found them staring at Xu Ze with a hint of surprise in their eyes.
Dean Guo was taken aback and asked the two professors quizzically, “Professors, your comments, please?”
Tang Wuyou and Jiang Lingyun exchanged a glance. Then, Professor Jiang Lingyun nodded with a smile. “Dean Guo… this young man’s diagnostic reasoning is extremely thorough… His analysis regarding acute cholecystitis and gallstones is crystal clear, and the treatment plan is flawless.”
Hearing Professor Jiang’s words, Dean Guo was stunned. Could this young man Xu Ze truly possess such advanced proficiency in Western medicine?
Beside him, Elder Wang stroked his chin and smiled. Xu Ze had not let him down after all.
Meanwhile, the other rising stars, especially Guo Yujian, looked at Xu Ze with newfound respect. They were all TCM practitioners, yet Xu Ze’s grasp of Western medicine was something they could hardly match.
Guo Yujian, in particular, had shed his earlier arrogance.
Just as they were marveling, Professor Jiang suddenly added, “However…”
“‘However’ what?” Dean Guo was caught off guard again, though he didn’t find it unusual. While Xu Ze’s Western medical skills appeared remarkably refined, his youth might still mean some gaps in experience.
Secretly, Dean Guo felt a hint of satisfaction. If Xu Ze had passed this round with absolute perfection, it would have meant a Western‑trained doctor had outperformed the finest TCM talents—a scenario that would have been rather embarrassing for everyone present. It would also have meant Xu Ze tying with his own grandson, Guo Yujian, whom he had meticulously trained for over a decade. Naturally, that wouldn’t sit well with him.
Assuming Xu Ze had indeed missed something, Dean Guo relaxed a bit and chuckled. “Professor Jiang, you hold the gavel today—please speak freely. If there are any shortcomings in Xu Ze’s diagnosis, it is your duty to enlighten us.”
Jiang Lingyun smiled and nodded, then turned to Xu Ze with a look of intrigued curiosity. “Dr. Xu, is it?”
“Professor Jiang… yes, I’m Xu Ze.” Seeing Jiang Lingyun’s expression, Xu Ze’s heart skipped a beat. Did I get something wrong?
“Dr. Xu… your diagnosis of acute cholecystitis and gallstones was well‑founded and accurate. But how can you be so certain about the possibility of comorbid acute pancreatitis?” Professor Jiang asked, his tone filled with genuine curiosity and surprise.
Hearing this, Xu Ze felt a jolt of surprise himself. Could it be that these two professors weren’t aware of the pancreatitis? Judging by the professor’s demeanor, Xu Ze gathered that they must have examined the patient beforehand but had not performed comprehensive lab tests or checks, thus missing this conclusion.
Of course, Xu Ze couldn’t reveal that he’d run a blood amylase test on the spot. He had anticipated this question and prepared his explanation.
He replied with a smile, “Professor Jiang, the patient reported consuming a large amount of greasy fried rice and beer shortly before the onset of pain. Abdominal pain triggered by such overindulgence—binge eating and alcohol consumption—while certainly a known trigger for cholecystitis, also necessitates consideration of acute pancreatitis. In fact, the very first point in the internal medicine textbook regarding this scenario warns that binge eating combined with alcohol intake can lead to this rather serious condition.”
“Therefore, although a positive Murphy’s sign strongly indicates cholecystitis and gallstones, the possibility of pancreatitis cannot be excluded; in fact, the probability is not insignificant. That’s why I listed it as a potential comorbidity.”
Upon hearing this analysis, Professors Jiang Lingyun and Tang Wuyou exchanged another glance of astonishment. They hadn’t expected Xu Ze to recall such a minor footnote from the textbooks with such clarity, let alone apply it so incisively.
It was a detail they themselves had overlooked in their cursory pre‑assessment, yet this young man had identified and articulated it within minutes. Truly remarkable.
Professor Jiang sighed with admiration, smiled at Xu Ze, and turned to Dean Guo. “Dean Guo… these young people of yours are simply extraordinary. To deduce such a complex condition using such basic methods… Most impressive. Most impressive.”
Dean Guo’s expression stiffened. He hadn’t anticipated that the “however” would only serve to boost Xu Ze’s score further, earning him praise even from these veteran Western medicine experts.
He could only stroke his beard and force a dry laugh. “Seeing such talent among the younger generation brings us old folks great comfort… great comfort indeed.”
Left with little choice, he concluded with a smile, “Xu Ze has performed exceptionally well today, graded as Excellent. All candidates have passed successfully… Director Lin, please announce the overall results for this assessment.”
Director Lin Zhikui from the National Medical Examination Center, seated nearby, smiled and nodded, about to speak, when an elderly voice suddenly interjected with a chuckle.
“Dean Guo, earlier Brother Wang mentioned that Xu Ze’s acupuncture skills are quite remarkable. Might we have the pleasure of witnessing them today? What does everyone think?”
Hearing this, Xu Ze frowned inwardly. It seems my success as a Western‑trained doctor in this TCM assessment has indeed ruffled some feathers.
The surrounding senior masters, however, nodded eagerly in agreement. After all, Elder Wang Yibo had been singing Xu Ze’s praises. They were naturally curious to see for themselves. Moreover, this young upstart had just outperformed most of their own disciples—if they could see his skills for themselves and perhaps temper the hype, it would save them some face.
Seeing the consensus, Elder Wang could only smile wryly. He could hardly object to the crowd testing Xu Ze further.
Dean Guo smiled warmly at Xu Ze. “Xu Ze, Brother Wang speaks very highly of your acupuncture technique. We are all quite curious. Would you mind giving us a demonstration on this patient?”
Surrounded by the smiling yet unyielding gazes of the elders, Xu Ze could only sigh internally. My license is in your hands. Do I have a choice?
He nodded in resignation. “Since the esteemed masters wish to test me, I am at your disposal.”
The elders, hearing the subtle hint of reluctance in his compliance, exchanged smug, satisfied glances. “Excellent. Then let us begin.”
Xu Ze took a light breath. He knew that if he didn’t show them something real today, he wouldn’t be able to leave this room gracefully. These men were the top authorities in the field; it wouldn’t do to disregard their request entirely. He reached into his pocket and pulled out the silver needles he always carried, ready to begin.
