Dr. Xu: A Chinese Medicine Novel

Iris waits for an answer while her husband watches the clock.

Clara hadn’t expected this woman’s strange illness to have defeated so many specialists. Now the problem had landed in Evan’s lap.

Could he solve it?

She wasn’t confident. She didn’t think he could treat an illness like this. So many specialists had failed, and even antibiotics hadn’t worked. Was Evan somehow better than antibiotics?

He was only a young doctor just starting out.

But all Mingxin Clinic’s hopes now rested on him. Clara desperately wanted him to be able to cure cases like this. He had been so capable once.

She clasped her hands tightly together.

She knew it was unlikely. Still, she couldn’t help hoping.

“Go on, then. Examine her. Treat her.” The middle-aged man folded his arms and stared at Evan.

Evan slowly let out a breath. The pressure was getting to him a little. He had been studying the treatment of gynecological conditions lately, and naturally he had treated menstrual fever too.

Menstrual fever meant recurring fever during, just before, or just after a woman’s period. It generally went away on its own once the period ended. There were no headaches or body aches of the kind associated with an externally contracted illness.[1]

In Chinese medicine, menstrual fever could fall into either an excess or a deficiency pattern: excess heat or yin deficiency, for instance. Drain excess; supplement deficiency. But this patient’s chills and fever alternated within a single day during her period. Simple yin deficiency or an excess of yang might not explain it.[2]

Besides distinguishing excess from deficiency by whether the fever came before or after menstruation, there were other guides: “For fever with no fixed hour, look for heat from an external cause”; “For tidal fever in the afternoon, consider yin deficiency.” Yin deficiency wasn’t the only possibility. Qi stagnation and blood stasis could also cause fever. Then there was heat entering the blood chamber.[3]

Evan reviewed what he knew, frowning slightly. “How long has this been happening?”

“About four months,” Iris replied. “It’s like this every time I have my period.”

“When you have the fever, do you have any other symptoms?”

“I retch and feel sick. I can’t eat.”

Evan paused.

Her husband turned to her too, his brow deeply furrowed.

Evan’s gaze shifted slightly. “Do you have a bitter taste in your mouth?”

“Yes. A bitter taste.”

“I see.” He gave a slight nod. He was beginning to suspect something. “Any fullness in your chest or under your ribs? Any pain in your abdomen?”

“A little, I suppose. Not much.”

“Let me see your tongue.”

Iris stuck it out.

Evan examined it carefully. The tongue was dark, with a thin yellow coating. Its body was firm and compact, its texture coarse, its color dull. In tongue diagnosis, these were signs of invading pathogenic factors, with the body’s healthy qi still holding its own: a struggle between the two.

The thin yellow coating indicated mild pathogenic heat, often seen in an exterior wind-heat pattern, or when wind-cold transformed into heat and moved inward.[4]

Evan frowned. “Ms. Gao, give me your hand. I’ll check your pulse.”

Iris held out her hand, and he began the examination.

Everyone watched curiously. Even Little Octopus had stayed.

Iris’s husband gave Evan a dissatisfied look but said nothing.

Evan took great care over pulse examinations. As Dr. Qian had said, a doctor should proceed as though walking on thin ice, consider what came before and what lay ahead, and never examine or treat a patient rashly.

Another ten minutes or more went by.

Iris’s husband was almost out of patience. He kept checking the time, his anger building. He wanted to swear. Why on earth was she wasting her time in this little clinic?

But looking at her, so miserable, he couldn’t quite bring himself to do it. He knew that in a few days she would be going through those fevers again, as though possessed.

It was sheer torment.

And there was nothing he could do.

For now, he had to swallow his anger.

At last Evan finished examining both wrists. The pulse was wiry.[5] His eyes brightened a little. He knew what was causing this strange illness.

Her husband saw him finally let go, then caught that glimmer of excitement. He wanted to curse. What the hell was he so pleased about?

“Finished? Good. Let’s go home.” He didn’t believe Evan could treat it.

But Iris looked at Evan. “How does it look?”

“How does what look?” her husband snapped. “Do you really think he can treat this?”

Evan nodded. “This can be treated.”

“What a load of crap. All those specialists couldn’t do it, but you can? Do you even know what’s causing it?”

“The disorder is in shaoyang.”

Her husband almost laughed. “Shaoyang? What do you think you’re using, the Six-Meridian Divine Sword? Shaoyang, huh? I’ll stab you to death with my Shaoshang Sword in a minute.”[6]

Evan was speechless.

“A shaoyang pattern?” Ben was puzzled, trying to work it out.

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Iris was getting angry too. “Could you let him finish?”

“Fine, fine. Let him talk.” Her husband waved impatiently and kept checking the time.

“I’m sorry, Dr. Xu,” Iris said. “Please don’t mind him.”

Evan smiled gently. “It’s all right. Back to your illness. Did you catch a cold about four months ago? Particularly during your period, or after giving birth…”

Iris thought back.

Her husband didn’t know what to say. Now he was dragging things back four months. What a stretch.

After a moment Iris said, “Yes. Yes, I did have a cold!”

“When?” her husband asked, startled. “Why didn’t I know?”

“When have you ever paid any attention to me?”

“How am I supposed to know if you don’t tell me?” he demanded, as though that settled it.

“Some things…” Her voice was cold. “Once you have to say them, there’s no point…”

“Damn it,” he muttered.

Evan ignored their argument. “Ms. Gao, what happened when you had that cold?”

She thought back. “Nothing much, really. I got caught in a little rain while I was on my period. I had a bit of a fever, then took some cold medicine and felt fine, so I didn’t think any more of it. Are you saying this strange illness has something to do with that cold?”

“Exactly.” Evan nodded firmly.

“What?” Iris was taken aback. “Why?”

“When blood is weak and qi depleted, the spaces in the body’s surface open. Pathogenic qi enters and contends with healthy qi, binding beneath the ribs. As the two struggle, chills and fever alternate, coming and going at intervals. The patient is subdued and has no desire to eat or drink. The zang-fu organ systems are connected, so the pain must descend. With the pathogenic factor above and the pain below, vomiting results.”[7]

Iris and her husband looked at each other.

“What does that mean?” he asked blankly.

Evan explained. “Normally, when external wind-cold attacks the body, it first reaches the skin and the spaces beneath it. Defensive qi at the surface resists it. Wind-cold binds the exterior, healthy and pathogenic qi contend, and nutritive and defensive qi lose their harmony. The main signs are aversion to cold, neck pain, headache, and a floating pulse. In Chinese medicine, this is called a taiyang pattern.[8]

“This is six-division pattern differentiation. If the pathogenic factor hasn’t been cleared, it continues inward, passing from taiyang into yangming. If it still isn’t released through the exterior, it continues into shaoyang. A shaoyang pattern is half exterior, half interior. Any farther inward, and it will have passed from the exterior to the interior. Your illness is in the shaoyang division. It’s a shaoyang pattern.”[9]

Iris and the others looked completely lost. They hadn’t understood a word.

Little Octopus looked admiring. She hadn’t understood either, but it sounded impressive.

Reader Notes

↩︎ Menstrual fever. Chinese medicine uses jingxing fare, “fever during menstruation,” for fever associated with the menstrual cycle. Traditional teaching distinguishes this recurring pattern from a cold or other externally contracted illness that happens to coincide with a period. The timing, accompanying symptoms, and whether the fever stops after menstruation matter to that distinction. The label describes the traditional clinical category Evan is considering; it does not settle the cause of Iris’s illness. Source: Singapore College of Traditional Chinese Medicine — Clinical Differential Diagnosis, p. 64, sections 25–26 (in Chinese).↩︎ Different kinds of heat. In traditional pattern differentiation, excess describes a predominance of pathogenic factors, while deficiency describes inadequate sustaining functions or resources. Yin deficiency can produce relative heat when cooling and moistening functions are insufficient; it is therefore different from excess heat. “Drain” and “supplement” name contrasting treatment principles. A tidal fever recurs or worsens at a regular time, like a tide. Evan is weighing these traditional distinctions against Iris’s alternating chills and fever, rather than equating every heat pattern with a measured high temperature. Source: WHO — Chinese medicine terminology, entries 734–737, 994–995, 1096, 2264, and 2267.↩︎ Stagnation and the blood chamber. Qi stagnation means impaired movement in the traditional functional system; blood stasis means blood no longer moving as it should, rather than an automatically confirmed clot. Evan is recalling possible heat-producing patterns, not diagnosing all of them at once. The “blood chamber” is an older term with several traditional interpretations, including the uterus and the Chong Vessel, which is associated with menstruation. Heat entering it is a distinct traditional pattern. Its appearance in this list does not establish that Iris has it. Source: WHO — Chinese medicine terminology, entries 532, 1106, 1113, and 1349.↩︎ Reading the tongue. Traditional tongue examination considers the tongue body and its coating separately. The firm, coarse, dark appearance described here corresponds to lao she, conventionally translated “tough tongue”; the Chinese word for “old” describes texture, not the patient’s age. A thin coating leaves the underlying surface partly visible, while yellow is associated with heat in this system. “Healthy qi” means the body’s sustaining and resisting functions; “pathogenic qi” refers broadly to factors causing illness. The interpretation remains Evan’s traditional assessment. Source: WHO — Chinese medicine terminology, entries 274, 365, 653, 674, and 696.↩︎ A wiry pulse. As in earlier chapters, this is a description of how the pulse feels under the fingers, not simply its speed. Xian, “wiry,” compares its taut, sustained feel to a tightened musical string. Different pulse qualities can combine with different symptoms in traditional pattern differentiation. The term alone does not establish a biomedical diagnosis; here Evan interprets it alongside Iris’s history, tongue, bitter taste, and difficulty eating. Source: WHO — Chinese medicine terminology, entry 904.↩︎ The sword joke. The Six-Meridian Divine Sword is a fictional martial art from Jin Yong’s Tianlong Babu. It sends invisible sword force from the fingers. Hearing “shaoyang,” Iris’s husband switches to martial-arts language and threatens a “Shaoshang Sword.” The similar sounds help the mockery, but shaoyang and Shaoshang are different terms. He produces no weapon; the retort is part of his scorn for the consultation. Source: National Museum of Natural Science — Newsletter 318, p. 7, opening of “Six-Meridian Mirror: Types of Leaf Veins” (in Chinese).↩︎ The classical passage. Evan recites language from the Shanghan Lun, the Treatise on Cold Damage. The passage describes a struggle between sustaining functions and pathogenic influences, using the surface spaces and the area beneath the ribs as traditional locations. Zang-fu means the interconnected functional organ systems, not just anatomical organs. The Chinese novel’s heihei here means subdued or withdrawn, not laughter. This translation renders the classical wording afresh and ends where Evan ends; the longer source passage is not an additional prescription in this scene. Source: Shidian Guji — Shanghan Lun Zhijie, passage beginning “Blood weak, qi depleted” (in Chinese).↩︎ Nutritive and defensive qi. Traditional theory distinguishes ying, the nourishing aspect associated with circulation within the vessels, from wei, the protective aspect associated with activity outside them. Their harmony is part of the explanation of the body’s response at its surface. “Wind-cold” and “wind-heat” name traditional pathogenic patterns, not identified microorganisms. “Exterior” describes a functional location, and a floating pulse is felt most readily with light pressure. Evan is explaining the taiyang category in that vocabulary. Source: WHO — Chinese medicine terminology, entries 237, 240, 889, and 1397–1400.↩︎ Six divisions and shaoyang. The six-division framework classifies patterns associated with taiyang, yangming, shaoyang, taiyin, shaoyin, and jueyin. “Division” distinguishes this diagnostic use from a simple map of acupuncture channels. Evan gives the sequence taiyang → yangming → shaoyang; his wording is retained here. The categories themselves do not establish a compulsory route through illness. “Half exterior, half interior” is a familiar literal expression for an intermediate functional pattern, not an anatomical halfway point; WHO prefers “neither exterior nor interior.” No treatment outcome has yet been shown. Source: WHO — Chinese medicine terminology, entries 969–971, 1008, and 1397–1405.