The Physician of Traditional Medicine Returns from Murim - Chapter 123

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This chapter was translated by Lunox Team. To support us and help keep this series going, visit our website: LunoxScans.com
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Chapter 123

“So when did your shoulder start hurting, and how?”

While Grandmother Heo Sunnam was connecting the call, I asked Seong Myeongin.

“Ah, it’s been about two months. As for how… I’m not sure what to tell you. I didn’t hear the details from the doctor.”

“Haven’t you received any other tests or treatments?”

“Oh, yes I have. I think the first oriental medicine clinic said it was frozen shoulder, but later when they took an MRI, I remember them saying it was a rotator cuff tear.”

“Ah. Neither of those are diseases that heal quickly.”

Even though he wasn’t the patient or guardian, Seong Myeongin knew quite a lot of details.

Frozen shoulder and rotator cuff tear.

They’re completely different conditions, but misdiagnosis is surprisingly common because they share the symptom of not being able to raise the arm.

Since he later got a confirmed diagnosis of rotator cuff tear through MRI, the first oriental medicine clinic he went to probably made the wrong diagnosis.

The rotator cuff refers to four muscles that work to lift the shoulder.

A rotator cuff tear is simply when these muscles and ligaments are torn and become tattered, which naturally means there’s no strength to support and lift the arm by oneself.

But what if someone else lifts that arm for you?

Though it would hurt, there’s no reason it wouldn’t go up.

Frozen shoulder is different from this.

This condition, called frozen shoulder or adhesive capsulitis, is literally when the joint capsule hardens and becomes firmly adhered, so even if a doctor tries to lift the arm from the side, it won’t budge at all.

Of course, this diagnostic method isn’t 100% accurate.

Frozen shoulder patients can sometimes have their arms lifted if forced before it becomes severely stiff, and rotator cuff tear patients sometimes make such a fuss about the pain that accurate diagnosis becomes impossible.

Sometimes misdiagnosis occurs even after seeing an ultrasound.

“Yes… He’s been receiving physical therapy and continues getting acupuncture at an oriental medicine clinic, but it’s not healing easily, so he’s very worried.”

“Clinic Director~. Should I tell Author Cheon to come this way?”

While I was talking with Seong Myeongin, Grandmother Heo Sunnam had succeeded in persuading Cheonwon-il.

Should I call it persuading? It was closer to scolding him into submission.

“No. If it’s a rotator cuff tear, it would be good to have thread embedding needles. If it’s alright with you, let’s meet at Seongsuhaneui Clinic Seoul Songpa Branch in a little while.”

I had regular acupuncture needles with me, but I didn’t carry all the treatment tools like herbal injections, knife needles, and thread embedding needles.

Of course, consistent treatment with regular needles would also help, but since there had been no improvement for two months, I wanted to try more aggressive treatment.

“Oh, what’s troublesome about that! Our clinic director said that would be convenient!”

Perhaps Cheonwon-il was worried about causing more trouble over the phone, as Grandmother Heo Sunnam’s scolding echoed loudly through the meeting room.

“Is he coming?”

“Yes~! He says it’s close and good.”

“I was originally planning to finish business here and go there anyway, but he’s apologizing so much that I feel sorry. He’s not being forced to come out when he doesn’t really want treatment from me, is he?”

“That’s absolutely not the case. After hearing about how you treated Representative Heo’s spinal stenosis, he’s been curious about it.”

“This man is just overly polite by nature, so don’t worry about it~.”

Well, if that’s what they say, then that’s how it is.

I concluded the conversation and stepped back for a moment.

It was time for Seong Myeongin to explain the paintings to the Couple at Clinic 4.

“You have an excellent eye! That dragon painting was actually inspired by Haedong Yonggungsa…!”

“Ooooh!”

While he lacked confidence when talking about his master’s condition, when it came to his own work, he seemed ready to talk all night.

Every time Seong Myeongin said something, the Couple at Clinic 4 chimed in saying how wonderful it was.

But isn’t Yonggungsa the temple in Busan?

Is it okay to use such a painting as a symbol of Cheonma?

“Interpretation is up to the individual, so it doesn’t matter at all.”

Right, this too… if both the person who drew it and the people living with it like it, then it’s good, yeah.

“If you like dragons, there are also works like this. You said the Namgung Family’s image color is blue, right? This isn’t my work, but this friend draws a lot of skies.”

Seong Myeongin showed them all the works he had drawn on his tablet, along with paintings by other artists who draw oriental paintings.

“Wow, this one and this one would also fit the atmosphere.”

Perhaps because Seong Myeongin and his close acquaintances were emerging artists, the painting prices weren’t as expensive as expected.

That seemed to move the couple’s hearts even more. Their shoulders perked up at every painting they saw.

“We must have been wandering around all this time to meet these paintings…”

It’s good that they like them, but is it okay for them to buy so many?

They purchased just one large-sized painting for each examination room, and chose several small ones to hang in the corridor.

“Clinic Director, you should buy one too. I recommend this one.”

In the midst of this, Grandmother Heo Sunnam pointed to a small dragon painting.

“Even though Artist Seong isn’t very famous yet, in about 20 years he’ll be a great master like his name suggests. I’m confident he’ll surpass his teacher.”

…Didn’t she say Cheonwon-il’s paintings cost tens of millions of won?

Hmm, well!

It’s not exactly for investment purposes! I was originally planning to buy one or two anyway!

I should hang one in my clinic too.

I chose the chipmunk painting that Grandmother Heo Sunnam’s son had drawn, along with Artist Seong Myeongin’s small dragon painting.

‘So you like dragons.’

But somehow, unlike the big dragon the couple bought, this one looked like a snake.

Is it an imugi?

Holding it together with the chipmunk, it somehow reminds me of the spiritual creatures I saw on the rear mountain.

* * *

Having finished our business with the painting, we moved to the 3rd branch.

“Oh my, Clinic Director~ My shoulder is hurting so much again that I came~.”

“Oh dear~ You must be suffering a lot. Since you do hard work, you need proper treatment too. I’ll loosen it up well for you today. Even if you’re busy, please make time twice a week~.”

In the past, he would have gotten angry, saying did you hear me with your nostrils when I told you to come twice a week.

Seeing Kim Chunsik speaking with a bright smile, I was deeply moved.

“You’ve become very skilled at kind responses now too.”

“Haha, isn’t it thanks to you? I was reborn through financial therapy.”

Kim Chunsik grinned.

…Did I corrupt someone who was only sincere about treatment?

No, no. Speaking kindly to make them come more than twice a week is good for the patient too, so anyway, let’s consider it a good thing.

“I was just going to greet you and leave, but somehow I ended up with a patient. Thank you for letting me use the facilities so readily.”

“Hey, it’s not like it wears out, so use it as much as you want. What mm thread lifting needles will you use? I’ll tell them to prepare some.”

“I’ll see after looking at the patient’s condition.”

Just as I was finishing my greeting with Kim Chunsik, Cheonwon-il also arrived at the clinic.

“Teacher! Over here.”

“Myeongin, why do you bring up unnecessary topics and bother the doctors?”

Cheonwon-il was an oriental painter exactly as I had imagined, unlike Seong Myeongin.

This meant he had ambiguously grown out his hair and beard, and wore modified hanbok.

Since Grandmother Heo Sunnam, who had forcibly called him out, said she had remaining business at the gallery and didn’t accompany him to the clinic, only poor Seong Myeongin got severely scolded by his teacher.

“Representative Heo did call me to come, but I’m very sorry for causing trouble on a holiday.”

“You don’t need to worry about that. I mentioned it because I wanted to see you quickly. I’m the one who should be sorry for suddenly calling you out while you were resting.”

These polite exchanges would be endless if continued.

After quickly exchanging a few words with Cheonwon-il, I immediately checked his shoulder’s range of motion.

“I heard from Writer Seong that your shoulder isn’t good. Could you try lifting your arm forward first?”

Hmm, flexion is 100 degrees.

“Let’s try lifting it to the side too.”

Abduction is 90 degrees.

This was the limit of the active range of motion for lifting his arm by himself.

“I’ll try lifting it once. Please relax and release the tension.”

Next was the passive range of motion.

When I lifted his arm, as expected, Cheonwon-il’s arm went up to the end without problem.

“Ugh.”

“Does it hurt?”

“A little.”

Though he showed pain, it didn’t feel like the joint capsule was stiff as in frozen shoulder.

It would be pain caused by the torn rotator cuff rubbing.

“Make a fist with your thumb down, and spread both arms.”

“Ah, yes.”

“I’ll press down, so try to resist.”

I also conducted the Empty Can Test as a supplement.

This was to confirm whether it was indeed a rotator cuff problem, and specifically whether damage to the supraspinatus muscle was the cause.

Thud.

As I expected, Cheonwon-il’s right arm couldn’t resist the pressing force from above at all and dropped.

“You probably had an MRI and received an explanation, but among the four muscles used to lift the shoulder, the supraspinatus muscle is the problem. Here, it’s the long muscle located above the scapular spine.”

When I mentioned the supraspinatus muscle, Cheonwon-il lightly clapped his hands.

“Ah, that’s right. It was the supraspinatus muscle. It was slightly torn, but since it wasn’t severe, they said to avoid using the shoulder and try physical therapy. They said to consider surgery if there’s no improvement after 6 months of conservative treatment, but it’s been over 2 months now and it hasn’t healed at all, so I was troubled.”

It wasn’t much different from what Seong Myeongin had told me earlier.

However, one part bothered me.

“You said it was slightly torn?”

“Yes, the MRI showed damage about the size of a fingernail.”

The size of a fingernail?

If they judged it as a partial tear of less than 1cm, the diagnosis of doing physical therapy while monitoring progress would be appropriate.

But…

‘That’s not right? It’s torn much larger?’

From what I confirmed by subtly flowing energy with my hand when examining the shoulder, the damage definitely exceeds 1cm. It seems like it would exceed 2cm too.

I slightly frowned.

How should I convey this?

“Let me also take a look with ultrasound first.”

Rotator cuff tears can be seen with both ultrasound and MRI, but they’re generally clearly visible on MRI.

Sure enough, when I scanned Cheonwon-il’s shoulder with ultrasound, the tear didn’t appear very large.

Why is this happening? Are the muscle fibers overlapping? Are they attached? I’m sure the damage seems larger?

‘Ah.’

Suddenly, a good idea came to mind.

If it’s hard to see, just make it visible.

Unlike MRI which requires staying in the machine for 20 minutes and is expensive, using ultrasound had the advantage of being able to better observe changes after treatment.

“Please prepare 1cc of 38mm herbal acupuncture diluted with 4cc of NS (Normal Saline) for a total of 5cc.”

“Are you planning to use herbal acupuncture instead of thread embedding?”

Kim Chunsik, who had apparently finished seeing his own patients, entered the examination room with gleaming eyes.

“I’ll prepare it for you!”

As soon as the 3rd branch staff brought out the syringe needle and herbal acupuncture, Jeon Minji prepared the dilution and handed it to me.

“I’ll do thread embedding too, but I want to use herbal acupuncture for treatment and to see the rupture more accurately.”

I inserted the syringe needle toward the location where the rupture was visible on the ultrasound.

Then I injected all of the diluted herbal acupuncture solution into one location.

Normal saline doesn’t cause problems even if a considerable amount enters the muscle. In fact, saline alone is sometimes injected for therapeutic purposes to relax tense muscles and relieve nerve compression.

“Ugh…”

Perhaps feeling pain from the procedure, Cheonwon-il squeezed his eyes shut.

“Huh?”

Yu Gyeonghun, who was watching the ultrasound screen, was startled.

As I injected the herbal acupuncture solution, the black line that appeared as a rupture on the ultrasound became thicker and deeper.

“It seems the torn part looked small because the muscles overlapped in their ruptured state. When we injected water, it opened up like this.”

“Wow, you can see it like this by injecting herbal acupuncture?”

“I’ve never tried this method before either.”

Not only Yu Gyeonghun but also Kim Chunsik found it fascinating.

I smiled with satisfaction.

Phew, I’ve finally adapted to modern civilization!

“It’s over 2cm. The rupture isn’t small.”

If I had said it was quite large based on sensing the energy flow, no one would have believed me, but by showing it like this, everyone looking at the screen, including Cheonwon-il, nodded in agreement.

“Is it very serious?”

Seong Myeongin, who had been quietly observing the examination, asked worriedly.

I wanted to say no, but it wasn’t a mild situation.

I nodded.

“Typically, a 3cm rupture warrants immediate surgery recommendation, and 2-2.5cm cases often end up requiring surgery as well. It’s inevitable if it involves the infraspinatus muscle or becomes a full-thickness tear. …Looking at it now, it appears to be a partial tear limited to the supraspinatus muscle.”

I pondered the treatment plan.

Given the severity, regular acupuncture would indeed have limitations.

In fact, there had been little improvement despite two months of treatment.

“We’ll continue acupuncture treatment while doing thread embedding three times at 2-week intervals. If there’s no improvement in both subjective symptoms and ultrasound results after the procedures, I recommend surgery without waiting the full 6 months.”

“…I understand.”

Cheonwon-il nodded.

While it was relieving to finally know why he hadn’t been getting better, no patient would be happy to hear their condition was serious.

“But don’t be discouraged. I only mentioned the standard treatment plan in case there’s no improvement. I’ve treated quite a few 2cm partial ruptures.”

I’ve treated many of them.

Really, many of them.

How many times had I seen warriors who swung swords and threw daggers until their arms nearly fell off?

“Let’s do the thread embedding right now.”

I confidently opened the thread embedding needle package.

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This chapter was translated by Lunox Team. To support us and help keep this series going, visit our website: LunoxScans.com
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