The Leg That Wouldn't Move
Newbie doctors always struggle with this question: "How's the patient's complexion? Does the patient look sick?"
Of course they're sick—that's why they came to the clinic. And if they're in pain, their face is naturally going to look rough.
You might think it's a silly question, but it's actually pretty important. It's a way of gauging how urgent the patient's condition is.
Someone might look fine on the outside but have a major issue brewing. Or they might seem like they're dying but it's really nothing serious.
Figuring out how quickly a patient needs intervention is part of a doctor's job. And as an internal medicine specialist, even I have an eye for that. In that sense, the guy in front of me... yeah.
He looks bad. Dragging his left leg, sweat pouring down, face all scrunched up in pain. If this were a university hospital, he'd be admitted on the spot.
"What happened?"
"I don't know. I was using lightfoot skill when suddenly my left leg just gave out..."
There's an exam bed in the clinic. I help him over and lay him down for now.
"How long exactly? One hour? Two?"
"About one hour... on my way to Yeongchang... ugh!"
The man winces and grabs his left calf. Must be hurting bad. Not a good sign.
"Does it hurt? Here?"
"Ugh... yeah. It's been like this since earlier..."
"What kind of pain? Throbbing? Or numb?"
"...More like throbbing. The whole calf..."
"Yeah? What if I press like this?"
I press down pretty hard. He flinches, scared, but doesn't jerk away or anything. Okay. No tenderness.
"Did you bump into something? Any trauma?"
"No, nothing like that. Just suddenly while using lightfoot skill..."
"Let's try lifting the good leg first. There you go. Good. Now the left? Oh, it lifts. Try straightening the knee. Hmm, that's not happening."
Lifting the left leg is fine. But he can't extend the knee. Issue with knee joint extension.
Sudden weakness in one limb? First thing to rule out is stroke.
But strokes usually affect the whole side. Isolated like this is rare. Plus, upper limb strength on both sides and cranial nerve exam are normal. Stroke probability low!
Whew, diagnosing stroke without a CT. Scary stuff.
"Sensation okay? If I stroke down both legs, any difference?"
"No difference... More importantly, doctor, my calf hurts so much..."
He grabs his calf again. No Tylenol or NSAIDs in this world. What do they even use for pain?
Anyway, sensation normal, no numbness. Not peripheral neuropathy. I rule out other differentials one by one.
What's left with possibility...
"Hold on, let me check your pulse."
I feel the pulse on the top of his left foot. It's pounding strong. Peripheral vascular disease, out.
Then the qi pulse?
I focus. Using Pulse-Probing Hand on his left foot... hmm?
No qi pulse flow.
Where's it cut off? Ankle? No. Calf? Still nothing. Below the knee? Still no qi pulse.
I probe above the knee.
'Oh!'
There it is. The qi pulse starts above the knee. Blocked below the knee.
Call it acute qi meridian occlusion?
For regular folks, lots of possibilities, but this guy... he had dantian fibrillation earlier today, right? Stagnant qi from that probably clogged the meridian.
"Your qi meridian below the knee is blocked."
"W-what?"
The man startles and rubs his left leg.
"No wonder my lightfoot skill failed. Damn, damn...!"
"Kang Mu-sa, calm down. Doctor, what do we do...?"
The woman who came with him chimes in. She's taken off her sedge hat sometime, brown hair matted with sweat against her cheeks. Her voice trembles slightly—she's anxious.
"The standard way to treat qi meridian occlusion is injecting inner power. Pouring qi to blast open the blockage. Do you have that level of inner power?"
"N-no. Not at that realm yet..."
This world's treatments for qi meridian occlusion fall into two categories.
One: Patient circulates their own qi steadily to slowly clear it.
Two: An expert pumps in massive inner power to force it open.
Patient's pain is too severe for option one right now. Option two needs a passing expert. My realm's second-rate at best. She's no expert either. Option two out.
Murim-standard treatments impossible.
"Isn't there... another way?"
The anxious woman asks. Perfect.
Blasting with qi? That's like jacking up blood pressure to unclog an artery. Never sat right with me.
So, the remaining option...
"We could try medicine..."
"Medicine?"
"Yes. A decoction to break down and dissolve the hardened stagnant qi. Wait here a sec."
I tell them and head to the pharmacy. Cho Hyang and I prepped some herbs earlier that should work.
Modern medicine has thrombolytics. Drugs that literally bust up blood clots.
For clot-related issues, if symptoms are recent—within 4.5 hours for stroke, ideally 3 for acute limb ischemia—you can try them. Past that, bleeding risk too high.
So for stagnant qi blocking a meridian? Should work with a dissolver.
No idea on exact time window for qi clots, but it's only been two hours. Should be fine.
"Where'd I put it..."
I rummage in the pharmacy corner. We'd sorted herbs for dantian fibrillation and complications.
"Ah, found it. Peach kernel, rhizome of atractylodes, turmeric rhizome..."
Peach seed, poria root, turmeric tuber. All dissolve hardened stagnant qi. Qi meridian thrombolytic, basically.
I grab those three plus opium poppy and head back.
Opium poppy's for pain. Friend of morphine.
Opioids are last resort, but you can't skimp on severe pain.
"Doctor, that medicine?"
"To dissolve the stagnant qi. It'll take time to boil, so this first."
"Ah... opium poppy! Quick, give it here!"
The man snatches the poppy. Must hurt like hell. He chews it messily, and his face relaxes as it kicks in.
Meanwhile, I boil water, add the three herbs, and simmer. With stagnant qi dissolvers, call it Blockage-Breaking Decoction?
Self-pity hits. No instant meds in emergency—instead, brewing from scratch. Makes you appreciate pharmacists.
Anyway, after a while, I pour the well-boiled decoction and hand it to him.
"Blockage-Breaking Decoction. Half bowl first. We'll adjust based on progress."
"Ugh... can't I just drink it all?"
"Absolutely not."
Now, problems with this treatment? (3 points)
One: Side effects.
These three herbs dissolve clots effectively, but overdose means bleeding out.
Bleeding might not sound bad, but brain hemorrhage changes your mind.
Two: Dosage.
No such thing as Blockage-Breaking Decoction in medieval murim medicine. I mixed based on properties. No clue on exact amount to clear it.
Feed till improvement, but with bleeding risk? Nerve-wracking.
Three: Administration.
Emergencies need IV. Oral takes time, lower absorption.
But this is beautiful medieval murim. No IV lines. No compatible herbs anyway.
IV the decoction? Disaster.
So, every 30 minutes, I dosed Blockage-Breaking Decoction and monitored.
After three rounds, two bowls in, faint qi pulse returns at left ankle. Man and woman finally relax into sleep.
Not me. Pulled an all-nighter, wide-eyed.
Of course. I was terrified.
Blind-dosing strong meds without dosage info. Who wouldn't freak?
Checked every 30 minutes. Left leg qi pulse improving? No brain bleed signs?
Time passes. Dawn breaks outside.
* * *
"Doctor, good morn—huh?"
Cheerful voice jolts me from dozing. Cho Hyang.
Cold decoction pot on floor, strange man passed out on exam bed.
Brown-haired woman leaning against wall, sedge hat in lap, asleep.
"Cho Hyang, you're here?"
"What's all this? Why're they back?"
"Why whisper?"
"They're sleeping!"
I explain last night briefly. Her eyes go wide.
"Qi meridian occlusion? Don't experts have to blast it with inner power?"
"What expert in Namgye Village? Had to improvise with meds."
"Medicine works for that?"
From progress so far, seems like it? Working pretty well, actually.
Man half-opens eyes at voices. I check left foot with Pulse-Probing Hand. Qi pulse clearer than yesterday.
"Patient, try moving your left leg?"
He wiggles toes. Fine. Bending and extending knee much smoother.
"Doctor, my leg... it's moving!"
"Pain?"
"Much better...! Thank you, thank you...!"
Man bows deeply. Woman wakes from corner nap, approaches.
"Truly grateful, doctor. Without you, who knows what would've happened to Kang Mu-sa..."
"Just did what I could. You must be exhausted from last night. Rest and head out when ready. Oh, and."
I hand over a medicine pouch. Pills I prepped sleeplessly. What a grind.
"Pills for Kang Mu-sa. One daily."
"Treatment not done? Like yesterday's decoction?"
"That was emergency. This is different. Stagnant qi from irregular pulse blocked it. This keeps qi pure to prevent future stagnant qi."
In modern medicine, afib patients get anticoagulants to prevent clots.
So for dantian fibrillation, preventing qi clotting... call it Vital Qi Powder. Keeps qi fresh and lively.
Woman takes it, bows with clasped hands.
"I'm Eun So-ryeong, second daughter of Silver Peak Manor in Hakgyeong. On urgent business, we hit this snag, but your grace got us through."
Silver Peak Manor? Heard of it. Famous silversmith family in Hakgyeong, big city near Namgye Village.
"Neither I nor Kang Mu-sa will forget this grace. Modest treatment fee."
Eun So-ryeong pulls a money pouch from her sleeve.
"Gasp!"
Who sucked in breath so eagerly? Cho Hyang? Anyway, pouch looks heavy.
"Just did my job. I'm embarrassed."
I humbly accept it.
Clink.
Rich coin jingle. Couldn't help smiling.
"Long way from Namgye Village to Hakgyeong... If you're ever in Hakgyeong, visit Silver Peak Manor. As our benefactor, we'll treat you right."
"Benefactor? Too kind. If chance arises."
I nod, pass pouch to Cho Hyang. She's thrilled, stuffing it away.
Silver Peak duo rests briefly, then departs. Kang Mu-sa bows till his back nearly snaps.
And the earnings from this...
"Doctor...! Jackpot! Know how much in the pouch?"
"Look at those sparkling eyes. Pretty good, huh."
"Pretty good? Five silver taels!"
"Five taels?"
Is that a lot? Medieval murim money sense still fuzzy.
"Why that reaction? Covers three months' herbs!"
"Three months?"
Whoa. Three months? For one consult?
"Doctor! So, wanna grab something tasty later?"
"We? I did the treatment."
"Huh? Stingy! You don't even know good spots!"
"What good food in Namgye Village?"
"Never been to Song Manor?"
Song Manor? Heard the name. Mansion across the river.
Widow lives alone there, cooks for folks. Not free. Village's only restaurant, basically.
Come to think—since possessing Hong Yak, no eating out. Always tight budget, cooked with basics.
Pouch fat now. Time for dine-out?
"Never have, Cho Hyang. Lead the way."
"Yay, doctor. This way!"
Cho Hyang's as polite as the pouch is full. We leave clinic, head deeper into village.