The tongue is dark with a white coating. There are generally three reasons for this tongue sign: food accumulation, liver stagnation with blood stasis, and internal retention of dampness.

Food accumulation refers to irregular eating habits or the spleen and stomach failing to receive, digest, and transport food properly, causing food to stagnate in the gastrointestinal tract after eating. This can lead to bloating and pain, belching sour gas, vomiting sour and decayed food, and other symptoms, resulting in a purple-dark tongue with a white greasy coating.

For food accumulation, medications like Baohe Pill and Citrus Peel Rhubarb Pill can be taken to aid digestion and relieve symptoms.

Liver stagnation with blood stasis is due to liver qi stagnation and impeded qi and blood flow, which manifests as a purple-dark tongue with a white greasy coating.

As for internal retention of dampness, it indicates a deficiency of healthy qi in the body, leading to blocked muscles, joints, and meridians.

Li Yuquan's condition is quite severe, as he has all three reasons mentioned above.

"Take a look."

Lu Xuan gave his position to Su Kenan.

To this, Li Yuquan was not surprised, but Li Jueying frowned slightly, although she opened her mouth, she said nothing.

This kind of mentor-apprentice training is seen everywhere, as new doctors need to accumulate clinical experience, but this is the first time she's seen it at the Health Center.

Su Kenan nodded obediently, switched positions with Lu Xuan, took the pulse, and looked at Li Yuquan's tongue sign, contemplating silently.

Meanwhile, Lu Xuan listened to Heart's Voice, comparing if his judgment was correct.

After a while, Lu Xuan returned to himself and asked, "How is it?"

Su Kenan blinked: "His pulse seems a bit complex."

Lu Xuan chuckled; with a pulse that's deep, thin, and sluggish, how could it not be complex?

"This old gentleman's pulse has three types," Lu Xuan reminded.

"Three types..."

Su Kenan thought for a moment and said, "Thin pulse..."

After a pause, Su Kenan looked at Lu Xuan for help.

Lu Xuan realized that asking Su Kenan to assess Li Yuquan's pulse was indeed difficult, so he directly said, "The pulse is deep, thin, and sluggish. Assessing a thin pulse is relatively simple, but deep and sluggish pulses are relatively difficult to assess without certain experience."

Su Kenan looked disheartened.

"Actually, if it were a single type of pulse, whether thin, deep, or sluggish, assessing it wouldn't be too difficult. It's just that the old gentleman's pulse combines all three, so not being able to assess it is quite normal."

Lu Xuan comforted her. If everyone could easily assess such a complex pulse, traditional Chinese medicine wouldn't need clinical experience; it could be mastered through self-study alone.

The difficulty in learning traditional Chinese medicine compared to Western medicine lies in these areas.

Without certain experience, wanting to assess accurately is simply impossible.

Lu Xuan was able to assess it mainly because he had encountered these three pulse types recently; otherwise, half a month ago, he might not have been any better than Su Kenan.

Hearing this, Su Kenan nodded slightly.

Lu Xuan continued, "Once you know the pulse, many things can be diagnosed. I believe you understand this, but before discussing Old Mr. Li's condition, let me first explain how to differentiate and treat bile reflux gastritis after gastrectomy."

As he spoke, Lu Xuan looked at Li Yuquan: "Old gentleman, this might take some of your time."

After all, it's necessary to seek the patient's opinion.

If the patient is in a hurry, then he won't discuss it and will bring it up with Su Kenan later when there's time.

Fortunately, Old Mr. Li was not bothered by this; not only did he not oppose it, but he also showed a strong interest: "No problem, I might as well listen."

"Thank you, old gentleman."

Lu Xuan expressed gratitude and then organized his thoughts before continuing: "Generally, after gastrectomy and gastroenterostomy, patients have a high probability of developing acidic bile reflux gastritis. The incidence after Billroth II gastrectomy is two to three times that of Billroth I."

The main reason for bile reflux is the loss of pyloric function or incomplete pyloric closure in patients after the aforementioned surgeries.

At this point, Li Yuquan thought for a moment and asked, "Dr. Lu, when I was in the hospital, I heard that some people have bile reflux without having undergone these surgeries. Why is that?"

Lu Xuan didn't expect Li Yuquan to ask about this aspect, but since the other party was curious, he explained without reservation: "Actually, it's quite simple. Some patients have no surgical history, but if their pylorus is not fully closed, duodenal contents can still reflux into the stomach, causing reflux gastritis.

If the gallbladder is removed, its function as a bile reservoir is lost, and bile continues to flow into the duodenum. Bile reflux into the stomach is the most common postoperative complication after gastrectomy."

"I see."

Li Yuquan suddenly realized, then looked at Lu Xuan: "Thank you for the knowledge."

If it were other doctors, they wouldn't explain so much to him.

They would at most tell him what would happen if the surgery wasn't done, rarely explaining what postoperative complications might occur after the surgery.

Lu Xuan nodded slightly and continued, "Generally, patients with bile reflux gastritis experience abdominal gastric distension, burning sensation, and pain, which worsen after eating. Taking alkaline antacid drugs cannot relieve these symptoms and may aggravate them. A few patients may experience chest pain, loss of appetite, distension, and burning discomfort."

"For example, after eating greasy food, they feel nauseated, and vomit bile. Post-vomiting, the stomach feels somewhat relieved. Due to impaired gastric emptying, vomiting often occurs after eating or later at night, with the vomit containing undigested food or occasionally small amounts of blood streaks.

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