The Physician of Traditional Medicine Returns from Murim

Unlike Park Seon-yun, who had arrived dressed in a suit and was addressed as “young master,” Chairwoman Choi Gwi-jae came to the Korean medicine clinic quietly.

A middle-aged woman, presumably her driver, accompanied her. However, it wasn’t unusual for someone of her age to be escorted by a child or caregiver, so it didn’t draw much attention.

Sensing her desire for discretion, I refrained from informing my staff about her identity.

After a considerable wait, Chairwoman Choi entered my consultation room.

“Chairwoman, how have you been? I see your adductor muscle has improved significantly!”

Her improved gait was evident just from watching her walk in.

When we first met, she struggled to even rise from the bed. Even after acupuncture, her walk remained hesitant. Now, her gait was completely stable.

“Yes, thanks to you, Doctor. Until yesterday, I felt some stiffness when spreading my legs, but now it’s no longer an issue.”

“Please lie down here. I’ll apply some pressure to check.”

I pressed firmly, using palpation to assess the muscle condition.

There was still slight tension, but I believed one more treatment today would sufficiently relax the muscle.

The ligament recovery was also progressing much faster than expected.

“After today’s treatment, you should be fine for walking. However, please refrain from running for another week.”

“That long? I hardly feel any pain now.”

“Even a sprained ankle requires a week of rest. This injury involved larger muscles and ligaments.”

“Ah, I understand. It’s frustrating, but I’ll follow your instructions, Doctor.”

Chairwoman Choi nodded slowly.

“It seems you have another concern besides this pain. Am I correct?”

I broached the subject, recalling something she had wanted to discuss during my house call three days ago.

Chairwoman Choi let out a deep sigh.

“It’s nothing major, but I suppose it is a concern.”

“Is it a chronic condition? Please tell me; I might be able to help.”

After a moment’s hesitation, Chairwoman Choi placed her hand on her lower abdomen and spoke.

“Actually… I experience some urinary leakage when I run.”

Oh my.

I wondered what the issue might be, and it turned out to be urinary incontinence.

Urinary incontinence is a condition where urine leaks involuntarily. While it may seem trivial, it’s quite a bothersome ailment.

Incontinence is more common in women than men, and its prevalence increases with age. Nearly 40% of women experience this symptom.

“It mainly occurs during activities that put pressure on your abdomen, like running, jumping rope, or sneezing, correct?”

“Yes.”

“And you don’t often experience sudden urges to urinate that lead to leakage before reaching the bathroom?”

“I don’t think that’s happened.”

“Do you wake up at night needing to urinate, or find your underwear wet in the morning?”

“…I wake up occasionally? But it’s not common.”

“Then we can diagnose this as stress urinary incontinence.”

There are primarily two types of urinary incontinence: stress incontinence and urge incontinence.

I explained stress incontinence to Chairwoman Choi.

“You’ve probably heard of this, but when urine leaks during activities that put pressure on your abdomen, like running, it’s called stress urinary incontinence. It happens because the urethral sphincter can’t withstand the pressure.”

“I see.”

This type accounts for most cases of incontinence in middle-aged women.

In contrast, urge incontinence involves a sudden, overwhelming need to urinate that results in leakage and is related to the central nervous system.

There are also rare cases like overflow incontinence, where the bladder becomes overfull due to a blockage in the urinary tract, such as from urethritis.

“There are various causes, including childbirth, aging, and inflammation. Damage to the tissues below the bladder or pelvic floor muscles can alter the bladder’s position and weaken the urethral sphincter. It’s a more common condition than you might think, but it’s embarrassing to discuss and significantly impacts quality of life.”

“Indeed. I suppose it’s inevitable as we age.”

“While muscle weakness due to aging might be a factor if there are no other underlying causes, that doesn’t mean nothing can be done.”

Chairwoman Choi’s eyes brightened at this.

I hadn’t said a word about treatment being impossible.

“Before we proceed, I need to ask about any underlying conditions. You don’t have a history of neurological diseases like stroke, meningitis, or myelitis, correct?”

“No, I don’t.”

“Please let me know if you’ve had any other surgeries or if you’re taking any medications. And your kidney function tests are normal, right?”

Chairwoman Choi shook her head.

“I’ve had two C-sections, and I’m not taking any medications. I was once cautioned about my blood sugar, but I’m managing it through diet without diabetes medication.”

No metabolic diseases at her age?

I couldn’t help but be impressed. She was extraordinary in many ways.

Diabetes, hypertension, and hyperlipidemia are usually a package deal, often accompanied by arthritis medication, but not in her case.

“I recommend a combination of herbal medicine and acupuncture, with acupuncture being the primary treatment. We’ll stimulate the Foot Taiyang Bladder Meridian to improve bladder function while balancing the tension and relaxation of the lower abdominal muscles. We’ll use electroacupuncture to strengthen stretched muscles and relax those that are overly tense from exercise.”

“Does the herbal medicine also work to strengthen bladder function?”

“It’s similar. We’ll use tonic herbs and channel-guiding herbs. ‘Channel-guiding’ means directing energy to specific meridians. You can think of it as your body currently lacking the energy to supply nutrients to the pelvic floor muscles and urethral sphincter. The herbs and acupuncture will help provide energy and direct it to the bladder.”

After pondering my words, Chairwoman Choi spoke up.

“So you’re saying the herbal medicine isn’t essential since my energy levels aren’t that low?”

“Correct. You’re also exercising diligently.”

“How long would it take to see improvement with this treatment?”

“Ideally, you’d receive acupuncture every other day, take the herbal medicine regularly, and perform Kegel exercises. In my experience, patients following this regimen have seen at least a 50% improvement.”

“So it was ineffective for half of the patients?”

“Ah, I apologize for the confusion. All patients experienced at least a 50% reduction in discomfort. This is specifically for stress urinary incontinence.”

While it can be a challenging condition, the clear cause means that consistent treatment invariably yields results.

Particularly, I can precisely target weakened muscles with acupuncture, providing immediate temporary relief.

To maintain the effects, muscle-building exercises are necessary… but usually, after 3 or 4 treatments showing results, patients become motivated to diligently perform Kegel exercises, not wanting to revert to their previous state.

“You’ve heard of Kegel exercises, right?”

“Yes, I’ve been dealing with incontinence for quite some time. But I haven’t been consistent with them.”

“Let’s take this opportunity to address it properly. If you have time, set aside 30 minutes in the morning for stretching and these exercises. You can do them intermittently too, but it’s easy to forget.”

Kegel exercises are the only method to independently strengthen the pelvic floor muscles by consciously contracting and relaxing them. Any Korean suffering from incontinence who’s searched the internet has likely come across this exercise.

It seems obvious now that strengthening the urethral sphincter involves exercising those muscles, but surprisingly, this method wasn’t developed until the 1900s.

It was quite innovative for people in the martial arts world… When I taught it to a disciple for therapeutic purposes, it became popular after they reported improved sexual sensitivity.

Some expressed their gratitude with blushing faces, which was rather embarrassing.

Anyway, Chairwoman Choi seemed to already know the method without needing further explanation.

“I’ll try as you’ve suggested.”

“Herbal medicine, acupuncture, and exercises. All together, right?”

“Yes. Sigh… At first, I thought it would pass on its own, and later I wondered if it was worth treating at my age, but it seems I have more years ahead than I expected. I really need to fix this.”

With the patient so determined, there were no obstacles.

“Excellent. I’ll ensure you see significant improvement.”

After a few more inquiries, I decided on the prescription.

Bojungikgi-tang with modifications.

Chairwoman Choi smiled happily upon hearing it would boost her energy and help with marathon running.

I passed the prescription to An Ju-hee and headed to the treatment room.

Ah, An Ju-hee would now explain the herbal medicine through the medication guide.

Of course, I explain the basic principles when recommending the medication, but some patients might want to know the specific effects of each herb.

◆◇◆◇◆

Chairwoman Choi lay face down on the treatment room bed, waiting for the doctor.

The Foot Taiyang Bladder Meridian diagram the doctor had shown her marked points from the buttocks to the lower back and up the spine.

Could acupuncture in those areas really improve her incontinence?

Judging by how effectively she had treated her hip adductor muscle three days ago, she seemed highly skilled, but her incontinence had persisted for well over 30 years.

‘I’ll give it a month, just to see,’ she thought.

When she wasn’t thinking about it, it was manageable, but once she became conscious of it, it was incredibly bothersome.

How frustrating it had been during her recent half marathon, with the constant small leaks!

Her throat was parched, but she couldn’t avoid drinking water, and even after using the restroom, the slight leakage was unavoidable.

“Choi Gwi-jae-nim, I’m coming in,” the doctor said, carefully drawing the curtain as she entered.

She began disinfecting with an alcohol swab, not just her buttocks but up to her neck.

Was she planning to insert needles that far up?

“I’ll start with quick needling. Like when we treated your adductor muscle, the needle will go in and out quickly. It will sting a bit.”

“Alright, I understand.”

The doctor pressed near her hip bone with her left hand.

Now, just like last time, she’ll slowly insert the needle here…

Swish swish swish swish swish swish swish swish swish!

“?!”

Swish swish swish swish swish swish swish swish swish!

“Ah! Ugh!?”

Before Chairwoman Choi could even cry out, the needles swept across her skin at an unbelievably rapid pace.

Unlike three days ago when the needles were used to relax specific muscles, this felt like quick jabs at particular points.

Is this correct?

Despite never having hesitated to speak her mind for at least half her life, Chairwoman Choi found herself unable to voice a single protest to the acupuncturist rapidly needling her.

“Well done.”

Before she could properly open her mouth, the dozens of pricks were over in just a few seconds.

“Is… is it finished?”

“The quick needling of the Bladder Meridian is. Now, please turn over. Was it bearable?”

“It happened so quickly, I…”

“If we did each one slowly, it would be too painful, so this treatment is always done this way. The needles on your abdomen won’t hurt much.”

The doctor discarded the thick needles he had been holding into a container.

Then she unwrapped a long needle… A long needle?

“You’re going to put that in my abdomen?”

It was different from the needles she had experienced three days ago.

No, even in her previous acupuncture experiences, she had never encountered needles longer than a finger.

But this long needle the doctor held was nearly as long as her hand span.

“I won’t insert it vertically into your abdomen. I’ll lay it along your rectus abdominis muscle. It won’t touch any internal organs, so there’s no need to worry.”

“Ah, I see.”

She nodded in understanding.

According to his earlier explanation, the needle would be inserted along the muscle fibers to strengthen them.

If it wasn’t piercing through her abdomen, it shouldn’t be too painful.

But still.

The needle’s length was undeniably intimidating.

It seemed to be over 10cm long… Was she really going to use that?

“Alright, here we go.”

Contrary to Chairwoman Choi’s concerns, the doctor remained completely calm.

“Relax your abdominal muscles… and there.”

The doctor tapped her abdomen lightly.

“…Ugh!”

Finally, the long needle began to penetrate Chairwoman Choi’s lower abdomen.

She squeezed her eyes shut.

“Hah!”

This treatment was so different from what she had vaguely imagined.

And she wanted her to do this every other day?

It wasn’t just inconvenient; it was a whole new challenge.

Would it be effective?

It really, absolutely had to be!