I am currently in a translation workshop, led by Stephen Boyanton, with Lorraine Wilcox and others. The quirky cases Lorraine shares are a constant delight for the participants. Recently, she shared a case in which the doctor spun the patient on a home-made wheel until he vomited to obtain a cure for the patient’s insanity. In another case, the patient had a lump due to grief, and the doctor successfully treated him by teasing him until he laughed so hard he could barely stand it. These cases are wonderful and will hopefully find their way into a book for all to enjoy and learn from.

Today, Lorraine posted this case in our new White Pine Circle Translation Support Group. It is from Volume 2 of 俞弁《續醫說》 Xù Yī Shuō by Yú Biàn (1522, Míng):

宋蔡元長苦大便秘，國醫用藥，俱不能通利，蓋元長不肯服大黃故也。時史載之未知名，往謁之閽者，齟齬久之，乃得見既而診脈，史欲出奇曰：請求二十文錢。元長問何為，曰：欲市紫菀耳。

(Northern Sòng dynasty prime minister) Cài Yuánzhǎng suffered constipation. The Imperial Doctors used herbs, but nothing could free his stool. It was probably because Cài Yuánzhǎng was not willing to take dàhuáng. At the time, Shǐ Zàizhī was not a well-known doctor. He called on Cài, but the gatekeeper argued with him for a long time. Eventually, Shǐ got to see Cài and took his pulse. Shǐ was about to leave and strangely asked for 20 coins. Cài asked why. Shǐ replied: “I want to buy zǐwǎn.”

史遂以紫菀末之，而進須臾，大便遂通。元長驚異詢其故，曰：大腸肺之傳送，今之秘結無他以肺氣濁耳。紫菀能清肺氣，是以通也。自此醫名大著，元長深敬服之。

Shǐ then powdered the zǐwǎn. The moment Cài took it, his stool was freed. Cài Yuánzhǎng was astonished and inquired about the reason. Shǐ said: “The large intestine is the [downward] conductor of the lungs. The constipation you have today is simply lung qì turbidity. Zǐwǎn clears lung qì, so it freed the stool.” The doctor became famous from this, and Cài greatly admired him.

We can surmise that the gatekeeper argued with Dr. Cái because he was not a well-known doctor, saying something like “who do you think you are to think YOU can treat him when the Imperial Doctors have already tried and failed?!”  We can perhaps assume that the herbs given to this patient by the Imperial doctors were herbs that directly attempted to purge the large intestine. With his thoughtful approach, Dr. Cái shows us the importance of understanding physiology when diagnosing and treating patients. Physiology gives us the whole-body context as to why a particular symptom, involving a specific organ, occurs. He obviously asked the question, “What is going on with this patient that explains why his stool does not move?”

Using the image of a straw, maybe we can understand the physiology of this case a bit. Substance can be held in a straw by keeping our finger on the top of it.

When we open the top of the straw by removing our finger, the bottom opens, and the contents can flow out. Through the lungs being able to open and close above, urine and stool can flow out below.

Dr. Cái leaves us with questions. He does not tell us what signs and symptoms told him that this patient’s lungs were “turbid,” focusing instead on sharing the treatment. What did he see, hear, feel or ask?