Dr. Xu: A Chinese Medicine Novel

Clara’s family faces mounting pressure. In another time, Evan’s clinical training continues.

Sunshine Residential Community.

“Dad, dinner’s ready.” Clara Zhang set the food on the dining table, then went to wheel her father over.

Adam Zhang sat in his wheelchair, his eyes uneven and his mouth crooked. His hands wouldn’t obey him either: one was stuck in the Chinese hand sign for six, the other in the sign for seven.[1]

Clara pushed him up to the table, picked up a bowl and a spoon, and brought a spoonful of rice to his mouth. “Eat.”

He struggled to open his mouth. She fed him a mouthful of rice and some of the other food, and he chewed slowly, staring ahead with tired eyes.

She wiped the corner of his mouth with a tissue. Her father had suffered a stroke four months earlier and still hadn’t recovered. His face remained crooked, one side of his body was paralyzed, and he had to use a wheelchair. He couldn’t even eat without someone feeding him.

“Dad, Mr. Pan, the landlord, called today,” she said as she fed him. “He’s raising the rent again.”

Adam said nothing. He simply stared into space, his face expressionless.

Clara looked at him and sighed helplessly. She brought another spoonful of rice to his mouth, but this time he refused to eat.

“What’s wrong?”

His eyes were dull. His lips moved faintly as he struggled to speak. “Close… close Mingxin Clinic… shut… shut it down.”

Clara jabbed the spoon into the bowl. “Have you lost your mind? Mom put her whole life into that place. You can’t just decide to close it!”

His neck tilted to one side, and a bitter sneer appeared at the corner of his mouth. “Chinese medicine… couldn’t save… your mother… What… what do I… need the clinic… for?”

Clara took several heavy breaths before she could get her anger under control. “You don’t need to worry about the clinic. Just concentrate on getting better.”

“I… don’t want… treatment… anymore…”

Her voice rose. “Then what do you want?”

His head tilted to one side. His crooked mouth twitched several times, and he grew agitated. “I… I should’ve… died long ago… You… shouldn’t have saved me! Should’ve… let me die…”

Clara’s chest heaved. “Don’t be ridiculous. You’re staying alive. If you die, who’s going to pay the mortgage? Who’s going to pay the rent?”

He seemed not to hear her. Sadness filled his eyes, and his hands trembled slightly. “I… miss… your mother…”

Clara’s chest tightened too.

His eyes reddened, moisture shining in them, and his voice shook. “I… want… to go… see your mother…”

Clara rubbed her stinging nose and slammed the bowl onto the table. “Stop talking nonsense. You’re going to stay alive. If you die, who’s supposed to sort out this mess?

“Hurry up and get better. Then start earning the money for my dowry! I’m telling you, if I can’t get married, let’s see how you explain that to Mom when you go down there to see her!”[2]

“Eat!” she shouted, picking up the bowl again and bringing a heaped spoonful of rice to his mouth.

Only then did Adam slowly open his mouth again.

As the night grew late, Clara stood on the balcony, looking out into the darkness, then up at the stars. While her mother was alive, Mingxin had been the best Chinese medicine clinic in the county. Business had been very good.

But after her mother died four years ago, Adam had never pulled himself together. Business had plummeted, until hardly anyone came to the clinic at all. Over those years, the family’s savings had been exhausted.

When her father fell ill a few months earlier, Clara had hurried home from university to care for him. Now the clinic faced trouble from every direction and could close at any moment. Her father could no longer get around and wanted to die. The family was in serious financial trouble.

All of it rested on this young woman’s shoulders, pressing down until she could hardly breathe.

She sighed softly and looked at the brightest star in the sky.

“Mom… I miss you too.”

Meanwhile, Evan Xu had spent more than seven months in the gynecology department of Xiyuan Hospital in 1978, studying under a clinical mentor all that time.

As he’d said before, if he hadn’t been fired from the Chinese medicine hospital, if he’d been able to study under a mentor along with the others, his talent and theoretical grounding would soon have made him stand out among the doctors in standardized residency training.[3]

And he had proved it.

He had made the fastest progress of any doctor in their cohort. Everyone who knew him knew how hard he worked and how seriously he studied.

For more than half a year, his life had been almost nothing but study. Apart from eating and sleeping, he studied. Every day he went to the hospital’s doctors with questions, especially those practicing Chinese medicine in gynecology.

His hunger for clinical experience in Chinese medicine had become almost frantic.

The senior doctors were moved. They remembered what he’d said on the day the mentorship assignments were announced.

He really had meant it. He worked so hard, with such a sense of collective pride!

But anyone who hadn’t lived through those six dark months of his couldn’t understand. At one point he’d thought his life was over, that he was finished.

Now there was hope in front of him again. He had another chance, a better one. How could he give it up? Even if he had to sink his teeth into it, he’d hang on for dear life.

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He was improving quickly. His skills had caught up with those of doctors who’d arrived a year or two before him. He’d even pulled ahead of Oliver Liu.

That was what thrilled him most.

“Evan, the department head wants you in his consulting room,” someone called from the dormitory doorway.

“Coming.” Evan closed his medical book and hurried out.

He jogged to the consulting room. Oliver was there too, along with a married couple seated in the room.

Dr. Qian sat behind the desk. When Evan came in, he beckoned him over. “Evan, come and examine this comrade.[4] She has edema during pregnancy. No other questions.”[5]

“Yes, sir,” Evan answered at once. These were Dr. Qian’s routine assessments, and he and Oliver were the ones being tested. They were the two outstanding doctors in this cohort.

Evan went over and gave Oliver a slight nod.

Oliver smiled back.

They now shared a dormitory room and got along quite well.

Evan didn’t sit down straight away. He first stood and looked at the patient. Her pregnant belly was already large; she looked to be seven or eight months along.

Chinese medicine had four diagnostic methods: inspection, listening and smelling, inquiry, and palpation. Strictly speaking, the findings from all four had to be considered together. None could be neglected.[6]

But this was a test, so Dr. Qian had deliberately removed inquiry to make it harder. These days, plenty of Chinese medicine doctors knew only how to ask questions. Without that, they couldn’t do a thing!

“Comrade, please roll up your trouser legs so I can have a look,” Evan told the woman.

“All right,” her husband answered. He crouched and rolled up his wife’s loose trouser legs. The problem was immediately apparent: her legs were badly swollen.

The difficulty in Chinese medicine lay in identifying patterns. A pattern was the underlying mechanism of illness. Chinese medicine held that a person in balance was free of illness. When illness occurred, something in the body must have gone out of balance. That deviation was the mechanism of illness—the pattern.[7]

Put simply, identifying the pattern meant understanding what had caused the illness and where the body had gone wrong.

If the pattern was right, the choice of medicines wouldn’t be far wrong.

Dr. Qian wanted Evan and Oliver to work out the patient’s pattern, and identify its underlying mechanism accurately, without asking her about her symptoms or history.

Evan crouched to inspect her swollen legs and feet. He pressed with a finger and found that it sank deeply into the swelling.

He stood and studied her face, which was puffy too. “Comrade, please stick out your tongue so I can have a look.”

She did.

After examining her tongue, Evan took her pulse. His pulse examination had improved enormously over these months of clinical training. By now, his assessments were usually accurate.

After about ten minutes, having carefully examined the pulses at both wrists, he nodded to Dr. Qian. “Director, I’m finished.”

Dr. Qian nodded slightly. “Tell me your conclusions.”

“Edema during pregnancy,” Oliver said. “The pattern is Kidney yang deficiency.”

“Edema during pregnancy,” Evan said instead. “The pattern is Spleen deficiency.”[8]

Dr. Qian gave a slight smile.

Reader Notes

↩︎ Number gestures. A common Chinese system uses one hand to signal numbers up to ten. Numbers above five have distinctive shapes that can be recognized without counting raised fingers. Six extends the thumb and little finger; seven gathers the fingertips against the thumb, as though holding something small. Here the narrator compares Adam’s uncontrolled hand positions to those shapes. The resemblance describes his hands after the stroke, rather than a deliberate attempt to count. Source: The Open University — Basic numbers, hand gestures, Figure 6.↩︎ Dowry. Jia zhuang refers to money or property provided from the bride’s side of the family for her marriage. It differs from cai li, gifts or payments coming from the groom’s side, although the two can be connected in practice. The forms and amounts vary between families and communities. Clara invokes her father’s future responsibility toward her as she insists he stay alive; this exchange does not announce an engagement or an agreed marriage payment. Source: Fudan University — The circulation of dowry: a gift perspective (in Chinese).↩︎ Mentorship and residency training. “Studying under a clinical mentor” means learning through supervised clinical work with an experienced doctor. Standardized residency training is a modern Chinese system of medical education after graduation, intended to develop clinical competence. The sentence compares Evan’s lost opportunity in his own time with the training he has now received in the historical setting. It does not identify the 1978 cohort as part of the later national residency program, or give Evan a new qualification. Source: National Health Commission — Residency training management measures, 2014, articles 2–3 (in Chinese).↩︎ Comrade. Tongzhi was a familiar respectful form of address in the social and political language of this period. It could be used in an ordinary encounter, including a doctor’s conversation with a patient. Retaining it gives the hospital dialogue its period register. Dr. Qian’s and Evan’s use of the word does not establish the patient’s occupation or political affiliation. “Director” in Evan’s later reply addresses Dr. Qian as the department head, rather than assigning him an academic title. Source: Laishan District Government — Etiquette and social forms of address (in Chinese).↩︎ Edema in pregnancy. Edema is swelling caused by fluid accumulating in body tissues; pregnancy is one of its possible settings. The phrase here describes the woman’s swelling, while the test asks the trainees to interpret it within Chinese medicine. It does not by itself identify a particular biomedical cause. The novel has supplied no blood pressure measurement, laboratory results, or other biomedical findings at this point. Those should not be inferred from the name of the condition. Source: US National Library of Medicine — Edema.↩︎ Using the four methods together. As in the previous chapters, inspection includes observing the tongue, listening and smelling attend to sounds and odors, inquiry gathers symptoms and medical history, and palpation includes feeling the pulse. Their findings normally inform one another. Dr. Qian removes the history-taking part for this assessment; Evan’s requests to uncover the legs and show the tongue enable examination. The restriction belongs to this teaching exercise. Source: Hong Kong Polytechnic University — Four Diagnostic Methods.↩︎ Pattern and pathomechanism. A pattern is an interpretation of clinical findings within Chinese-medicine theory at a particular stage of illness. Pattern differentiation means analyzing those findings to identify the pattern. Pathomechanism concerns how an illness arises and develops in that framework. The narrator brings these related terms together in a simplified account of bodily balance; standard terminology distinguishes them. The explanation is the novel’s account of traditional reasoning, not a new laboratory finding. Source: WHO — Chinese medicine terminology, entries 364 and 548–550.↩︎ Two explanations for the same swelling. Zizhong is a traditional name for swelling during pregnancy. Oliver and Evan agree on that label but offer different patterns. Kidney yang deficiency concerns inadequate activating and warming functions in the traditional Kidney system; Spleen deficiency concerns weakened functions of the traditional Spleen, including transformation and transport. These capitalized names denote functional systems, not simply the anatomical organs, and “deficiency” is a traditional category. Evan’s broader wording has not yet specified a subtype. Dr. Qian’s smile supplies no verdict on either answer, and the chapter gives no treatment or outcome. Source: WHO — Chinese medicine terminology, entries 156, 1195, 1276, and 2002.