Dr. Xu: A Chinese Medicine Novel

Evan wants to become a doctor who can help his patients. For now, he is struggling to hold on.

Both patients had left, and Mingxin Clinic was quiet again.

Ben was playing Dou Dizhu, a card game, on his computer.

Evan leafed through gynecology textbooks and case records, trying to work out the underlying pattern behind his patient’s illness. He felt ashamed that he hadn’t been able to help her. He read for a long time without finding an answer.

He sighed dejectedly. He had always wanted to be a doctor of Chinese medicine who could actually treat illness. Nearly half the profession seemed unable to do that these days, but he didn’t want to become one of them.

If he hadn’t been fired from the hospital of Chinese medicine, he would probably be in standardized residency training by now, learning clinical diagnosis and treatment under a mentor. With his talent and grounding in theory, he was sure he would soon distinguish himself among the other residents.

But… there was no point in ifs.

No hospital would take a young doctor who had been fired, lacked solid clinical skills and had no connections. Even to get into a little place like Mingxin, he had concealed his history. They thought he was just a graduate whose grades had been too poor to get him a hospital job.

A student of Chinese medicine needed the right mentor to become a doctor who could treat illness. Without one, a master’s or a doctorate was no help. However well you knew the theory, you were lost as soon as you faced a patient.

To a large extent, a mentor’s skill set the limits of a student’s ability. The person you learned from could determine your entire future in Chinese medicine.

Ye Tianshi, a founding figure of the warm-disease school, came from a family of renowned physicians stretching back generations. Besides learning his family’s medicine, he studied under seventeen mentors over six years. By thirty, his name was known throughout the country.

If Evan ever had another chance to learn under a clinical mentor, he would fight for it with everything he had.

But he probably wouldn’t get that chance. No one would take him anymore. Except perhaps Dr. Song behind him… Oh, forget it.

The thought made the aching pressure in his chest and along his ribs worse again.

He knew what caused it: his low spirits had constrained his Liver qi, leaving it stagnant.[1]

“Hello, Mr. Pan…” The girl with the ponytail by the counter answered her phone and stepped outside to talk.

Her name was Clara Zhang, and she was the daughter of the owner, Adam Zhang. Since her father had fallen ill, she had come back to manage everything at Mingxin.

She soon returned from the call, looking furious.

Still playing cards, Ben spared her a glance. “What’s wrong, Clara? Who upset you?”

“The landlord,” she snapped. “He’s raised the rent again. Keep this place open much longer and my family will go broke!”

Both men’s hearts sank. Mingxin’s business was poor; the clinic had been losing money for years. Now it was emptier than ever, often seeing only three to five patients a week. And the landlord had chosen this moment to raise the rent.

Clara glared at them and planted her hands on her hips. “You two had better start making me some money! If Mingxin goes, so do your jobs!”

She pointed at Evan. “Especially you. Stop prescribing Siwu Tang every single day! Are you getting kickbacks from a drug rep or something?”

Evan was mortified.

Ben covered his mouth and chuckled. As if anyone would bother offering them kickbacks.

Clara turned on him at once. “And you! What are you laughing at? Go find some more customers. Your tuina and fire cupping don’t bring in as many people as a massage parlor!”

“They offer different services, you know,” Ben protested.

“Then put on a bunny-girl outfit yourself!”

“Oh, hell.” Ben shuddered.

Evan was startled too. Ben’s broad back, thick waist and rough face in that outfit… That would be quite a sight.

“If you can’t bring in more money, I’ll have to cut staff!” Clara declared, her hands still on her hips.

Ben and Evan exchanged an unhappy look. Doctors made their living by their skills, and neither of them could treat illness. If they were laid off, they really wouldn’t know where to go.

Ben frowned and thought it over. Even if she did cut staff, Evan would be first. Nearly all of Mingxin’s income came from Ben’s work these days.

He would be there as long as the clinic lasted. Reassured, he returned to his card game with renewed concentration.

Evan sighed softly, looking miserable. He might soon be out of work again…

Clara glanced at him too, her brows drawing together slightly. Then she let out a heavy breath and fumed to herself.

After that, none of them felt like working. It was already early evening, and there probably wouldn’t be any patients that night. Clara sent the doctors home early and went back to look after her father.

Back in his small rented room, Evan tidied the medical books scattered across his table, then got up to make dinner.

A little later, he brought a small bowl of noodles to the table. The portion wasn’t small because he was trying to save money. He simply couldn’t eat much.

He knew his own condition. The Liver thrived on free flow and suffered under constraint, so his low spirits were bound to constrain his Liver qi. The Liver regulated the flow of qi, blood and body fluids throughout the body. Constraint prevented it from doing that properly.

In the five-phase framework, the Liver belonged to wood and the Spleen to earth. Wood restrained earth: the Liver’s regulation of qi flow kept the Spleen from becoming congested.[2] But his Liver qi wasn’t flowing freely. His Spleen had become congested and could no longer transport and transform food properly.[3] He had indigestion, bloating and loose stools. Food wouldn’t digest; a couple of mouthfuls filled him up.

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He had barely eaten two mouthfuls of noodles when he felt a belch stuck in his stomach. It would neither come up nor go down. The discomfort stopped him from eating at once.

He knew why. His Liver wasn’t regulating qi flow, and that had affected his Stomach qi too, preventing its flow and downward movement. This was disharmony between the Liver and Stomach, with a failure of Stomach qi to descend.[4]

Stomach qi should move downward. His was moving upward instead, which explained the belching—the belch that wouldn’t come up after just a couple of mouthfuls.

A hospital workup for stomach disease wouldn’t turn up anything to explain his belching, bloating and indigestion. He was certain of that: the source lay in his constrained Liver qi.

Often, problems with the Spleen and Stomach weren’t caused by those systems themselves, but by the Liver affecting them. There was a plain saying in Chinese medicine: treat the Spleen without treating the Liver, and all your work is wasted.

Evan sighed and set down his bowl and chopsticks. Where could he go if he lost this job too? Who would take in a doctor who’d been fired?

He remembered the cold, mocking looks he’d seen the day he left the hospital of Chinese medicine. The memory was like a needle driven hard into his heart, making it difficult to breathe.

With a bitter smile, he rubbed his belly.

He knew what could happen if the constraint in his Liver grew worse. It would turn into fire and attack the Stomach even more severely. Besides belching, he could develop hiccups, dry heaving and lower abdominal pain. Liver yang could rise to the crown of his head, causing dizziness and headaches. There would be plenty of trouble.

And there was that mess inside his head. He still had no idea what it was!

But he didn’t want to treat himself. He couldn’t get past himself.

A beep sounded inside his head.

“Huh?” Evan froze. He closed his eyes. The display in his mind had changed:

System loading complete!

He tensed.

Beep.

System starting.

The view before him shifted, and several large lines of text slowly appeared.

Chinese Medicine Inheritance System

Inheritor: Evan Xu

Age: 28

Medical skill level: Apprentice

Medical ethics rating: Excellent

Evan stared. The Chinese Medicine Inheritance System?

“What is this thing?” he murmured. “Doesn’t look like Android. Am I hallucinating?”

Tap, tap, tap… More lines slowly appeared before him.

Everyone says Chinese medicine is useless. Yet what has protected our people in China for thousands of years? The practice of Chinese medicine depends on passing it down. Inheritor, faithfully carry forward its medical knowledge and skills, and revive the lost learning of past sages. Treat illness, heal disease, and relieve the people’s suffering.

Yet those who disparage Chinese medicine are everywhere. Countless people know nothing about it; countless more deceive and swindle in its name. Inheritor, use the major online platforms to promote authentic Chinese medicine. Tell the world what Chinese medicine is!

Show the world through your actions: can Chinese medicine treat illness? How does it treat illness? Inheritor, become a prominent online blogger who can treat and heal patients. Promote Chinese medicine and restore the good name of China’s medical tradition!

Evan was bewildered. “Isn’t that… just telling me to become a Chinese medicine influencer?”

He was getting nervous. He wouldn’t even know how to shout, “You guys are awesome!”

He frowned at the status panel. “Why me?”

The system didn’t answer. A new line appeared instead.

Beep.

Starter task: Register an account on an online platform to promote Chinese medicine. Manage it conscientiously. Once your follower count reaches 1,000, the Renowned Physician Mentorship module will unlock.

“An account? A thousand followers?” Evan muttered, puzzled.

He took out his phone and felt lost. He didn’t know how to do any of this. Couldn’t he just be a proper doctor of Chinese medicine? Why did he have to chase followers?

After thinking it over for a while, he tried sending Clara a text. She understood this stuff. She ran Mingxin’s WeChat public account and its Weibo microblog.

Clara was stir-frying dinner at home when her phone chimed. Still moving the spatula, she took out her phone and glanced at it.

Evan the Blockhead: “Clara, can I ask you something? How do you get a thousand followers on an online account quickly?”

She read it and sent back two brisk words:

Clara: “Buy followers.”

Then she slipped the phone into her pocket and went on cooking.

Evan stared at the message, stunned. Was it that easy?

He looked up at the status panel. It didn’t seem to say he couldn’t buy them.

After a moment’s hesitation, he registered an account on Weibo, found a shop selling followers and picked a discounted package. It cost him over two hundred yuan. His follower count shot up. Within minutes, it had reached a thousand.

He still felt a little uneasy…

Beep.

Inheritor’s Weibo account detected: “DrXuChineseMedicine.”

Follower count detected: 1,004.

Verification complete! Task complete. Distributing reward!

Evan was dumbfounded. Seriously? That worked? This system didn’t seem very bright.

Beep.

Which school do you wish to study under first, Inheritor?

Evan paused. His first thought was of the patient with menstrual cramps from earlier.

Beep.

Chinese medicine gynecology. Inheritance begins!

Reader Notes

↩︎ Liver qi stagnation. In Chinese medicine, qi describes the activity and movement that sustain bodily functions. The Liver is understood to help this movement remain smooth, with emotional distress closely connected to disruptions in that flow. “Constraint” and “stagnation” describe a loss of this smooth movement. Here, Evan interprets his frustration and the aching pressure around his chest and ribs as parts of the same pattern. Capitalized organ names in this edition denote Chinese medicine’s functional systems, whose meanings extend beyond the anatomical organs. “Liver qi stagnation” does not by itself mean liver damage or a diagnosis of clinical depression. Source: WHO — International Standard Terminologies on Traditional Chinese Medicine, entry 1240, p. 149.↩︎ The Five Phases: Wood and Earth. The Five Phases—Wood, Fire, Earth, Metal and Water—form a traditional Chinese framework for describing relationships and change in nature and the body. In its medical application, the Liver corresponds to Wood and the Spleen to Earth. “Wood restrains Earth” describes one relationship in a cycle of mutual regulation. Restraint can be part of normal balance; excessive restraint describes a different, disruptive relationship. In this passage, Evan uses the Wood–Earth relationship to explain how disturbed Liver function can affect digestion. The names express correspondences within the framework, rather than the physical materials of the organs. Source: Beijing University of Chinese Medicine — Five-Phase relationships (in Chinese).↩︎ The Spleen’s “transportation and transformation.” Chinese medicine assigns the Spleen a central role in turning food and drink into nourishment and distributing that nourishment through the body. “Transformation” concerns making what is consumed usable; “transportation” concerns conveying it onward. A failure of this function describes impaired digestive processing within that framework. Evan connects it here with his poor appetite, bloating and loose stools. The technical phrase therefore carries a broader meaning than the everyday English word “spleen” would suggest. Source: The Chinese Medicine Hospital of Hong Kong — Zang-xiang (Visceral Manifestation).↩︎ Liver–Stomach disharmony and descending Stomach qi. Chinese medicine describes healthy Stomach activity as having a downward direction, associated with receiving food and passing it onward. “Failure to descend” means that this normal movement is disrupted; movement in the opposite direction is called counterflow. “Liver–Stomach disharmony” describes disturbed coordination between the Liver’s regulation of qi and the Stomach’s digestive activity. Evan uses these connected ideas to explain why his emotional distress, difficulty eating and troublesome belching belong to one chain of reasoning. Source: Huang et al. — Quantifying Liver-Stomach Disharmony Pattern (2020), Discussion.