Dr. Xu: A Chinese Medicine Novel

Evan begins his first lesson with Instructor Cheng.

Outside, the commotion was in full swing. Inside the acupuncture training room, Evan stood speechless.

He knew the man before him well. There were photographs and a statue of him at Evan’s university: he had been the first president of Nanjing University of Chinese Medicine.

Evan had never imagined he would have the good fortune to study acupuncture with Instructor Cheng.

Cheng was more than a great acupuncturist. He was a great educator. More than half the living acupuncture masters in China had studied under him, and his Chengjiang school had spread throughout China and overseas.[1]

Cheng nodded to Evan. “Comrade Evan Xu, from now on, you’ll do all your acupuncture practice on him.”

Evan turned to the other man. He stood perfectly straight, his eyes vacant and his face expressionless. He said nothing. He looked like a wax figure.

“Who is…?” Evan was confused.

“A simulated patient for you to practice on. He isn’t a real person!”

Evan was amazed. The things this system could do kept getting more impressive.

“Let’s begin,” Cheng said. “The patient has stomach pain. Diagnose and treat him.”

The moment he finished speaking, the simulated patient clutched his belly.

Evan’s eyes lit up. Hey, that was clever. He went over and began his examination: inspection, listening and smelling, inquiry, and palpation. Acupuncture treated illness too. Before you could treat an illness, you had to understand its underlying mechanism.[2]

He worked through the examination, weighing the findings from all four methods. His conclusion was that the patient had just had an angry outburst. Liver constraint had turned into fire; Wood had grown too strong and was overwhelming Earth. Liver fire had invaded the Stomach, causing distending pain in the upper abdomen.[3]

“Well?” Cheng asked. “How would you diagnose and treat him?”

Evan thought for a moment. “The illness lies in the Liver. The Liver is an unyielding organ, so it is best soothed by promoting its free flow. The Stomach is one of the six hollow organs. They convey and discharge rather than store, so keeping things moving is the way to strengthen the Stomach.[4]

“The treatment should soothe the Liver, regulate the middle, and open the hollow organs. I would use the Liver’s front-mu point and the Metal jing-river point of the Hand Jueyin Pericardium channel to soothe and soften Liver qi. The yuan-source and he-sea points of the Hand and Foot Yangming channels, together with the Stomach’s front-mu point, would regulate the middle and open the hollow organs.[5]

“I would needle Qimen, Zhongwan, Jianshi, Hegu, Zusanli, and Liangqiu. Qimen is the Liver’s front-mu point and can soothe and soften Liver Wood. Since Liver constraint inevitably produces heat, I would use Jianshi on the Fire-associated Hand Jueyin Pericardium channel to soothe the Liver and clear fire.

“Zhongwan is the Stomach’s front-mu point, and Zusanli is the he-sea point of the Foot Yangming Stomach channel. These are key points for treating every kind of stomach illness, harmonizing the middle and restoring the Stomach’s free passage.

“To open the Stomach, you must also clear the intestines. That is why I would use Hegu on the Hand Yangming Large Intestine channel. Liangqiu is the xi-cleft point of the Foot Yangming Stomach channel. It relieves pain and is particularly good for acute stomach pain.”

Cheng nodded approvingly. “Good, good. Go ahead and insert the needles.”

“All right.”

Evan was excited too. He had the simulated patient take off his clothes and lie on the treatment bed.

After inserting a needle, Evan asked, “Do you feel soreness or fullness?”

Before the patient could answer, Cheng said, “Wrong.”

Evan looked up in surprise.

“When we needle an acupuncture point, we judge by deqi, obtaining qi,” Cheng explained. “It isn’t simply a matter of asking the patient whether he feels soreness or fullness. A practitioner should rely mainly on what he feels through his own fingers—whether the needle feels heavy and tight, or there is a sense of slowness beneath it.[6]

“If you rely only on the patient’s sensations, you can easily go wrong. A patient can feel soreness and fullness even when you haven’t located the point accurately. You have to consider everything together.”

Evan nodded earnestly. “I’ll remember that.”

“The art of acupuncture depends on practice. Ordinary practitioners don’t have a training room like this. You must study seriously and practice diligently.”

“Yes,” Evan replied.

Cheng went on teaching him how to handle the needle, carefully, one detail at a time. The patient lying there was a simulation, after all. He had no temper and no feelings.

Acupuncture had always had practice stand-ins of one sort or another. Bronze figures had been made for teaching it as far back as the Song dynasty. And any student of Chinese medicine knew who suffered most when acupuncture classes began: your roommates. After-class practice meant sticking needles in each other.[7]

Neither method could compare with Evan’s setup, though. This was the system’s impossible technology.

As he demonstrated, Cheng said, “The term deqi first appears in the Neijing: ‘Insert the needle on the in-breath; do not make qi flow against its course. Retain it quietly for a long time; do not let the pathogenic influence spread. Turn the needle on the in-breath, seeking to obtain qi.’

“It means that after inserting a needle into a point, you use methods such as rotating, lifting, and thrusting to produce particular sensations and responses at the site. This is called deqi, or needle sensation. Both the patient and the practitioner feel something.

“You must also distinguish deqi from the arrival of qi. They aren’t the same. The Neijing says, ‘The essential thing in needling is that when qi arrives, an effect follows. The certainty of that effect is like wind parting the clouds, clear as the open sky. That completes the way of needling.’

“It is the arrival of qi that tells you when to withdraw the needle. But practitioners of our generation confused the two concepts. Most came to believe that the arrival of qi and deqi meant the same thing.”[8]

Cheng sighed softly, his expression growing sad.

Evan’s heart tightened. “Are you… all right?”

Cheng gave a bitter smile. “I crossed mountains and rivers and sailed all the way to Japan to study their new acupuncture theories. I used the Western theory of nerves to explain our ancient channels and acupuncture points.

“I worked tirelessly for it. But in clinical practice, that theory was difficult to make work. With particularly complicated, difficult illnesses, I still often had to turn to the old methods.

“Only when I had grown old did I realize I had taken the wrong road.”

He raised his head and looked at Evan. Carefully, he asked, “You younger practitioners… you haven’t been led too far astray, have you?”

It hurt Evan to hear him. He was almost in tears. “Please don’t say that. Without you, Chinese acupuncture would have died out long ago.”

But Cheng waved a hand and shook his head.

Acupuncture had been handed down for a thousand years. It had always been one of Chinese medicine’s greatest strengths, flourishing across the centuries. Then, in the second year of the Daoguang reign, the Qing government suddenly ordered it abolished.

The reason was simple. The Daoguang Emperor said acupuncture required exposing the chest and back, which was no way to treat a sovereign. He also feared that a doctor might use a needle to assassinate him.[9]

Acupuncture had reached its height during the Ming dynasty. Under the Qing, that development came to an abrupt halt, and the art plunged into decline.

Then came the Republican era, when wholesale adoption of Western culture was in fashion. Prominent intellectuals demanded the abolition of traditional culture. Chinese medicine, one of its foremost representatives, was among the first targets.

Several policies to abolish Chinese medicine entirely were introduced during the Republican era. Acupuncture, which diagnosed and treated through channels and acupuncture points, fared even worse.[10]

In those darkest years, it came close to extinction. No one wanted to learn it anymore.

It was at that desperate moment that Cheng stepped forward, turning the tide and saving a tradition on the brink. He founded China’s first acupuncture correspondence institution, its first specialist acupuncture school, and its first acupuncture journal.

Building on earlier theories, he actively sought connections with Western medicine. He even crossed the sea to Japan and translated Japanese works on acupuncture.

Japan had once learned Chinese medicine too, calling it kanpō. But after the Meiji Restoration, its medical system was reformed as well. It too suppressed Chinese medicine in favor of Western medicine, bringing the traditional art close to extinction.

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Acupuncture faced the same pressure. To survive, practitioners actively changed its guiding theories, connecting the channels with Western theories of nerves. That was how it was recast in scientific terms, and at last it survived.[11]

Working from that foundation, Cheng combined the two systems, testing one against the other. He forced a step forward on a road that could not succeed, preserving acupuncture and lifting the spirits of Chinese medicine practitioners of his time.

Through his work, the art that had nearly disappeared finally began to flourish again.

And that was not all. He trained a great many acupuncturists, improved needling methods and instruments, and developed acupuncture’s clinical practice. All of these were valuable advances.

You could say that no one in modern times had contributed more to acupuncture than Cheng. No one!

Yet he was still worrying that his work might have harmed the practitioners who came after him!

That was why Evan felt such an ache.

In those days, there had been no other choice. If you did not make Chinese medicine scientific, government policy would wipe it out. The leaders of the school that sought to reconcile Chinese and Western medicine had all been formidable Chinese physicians: Tang Rongchuan, Zhang Xichun, and Cheng himself.

In old age, every one of them, without exception, discovered that the road he had taken was wrong.

And so they turned back from that attempt to reconcile the two systems.[12]

Later practitioners often criticized that school harshly. But that was hardly an objective judgment. You hadn’t lived through those times.

In an era when everything was expected to conform to Western science, refusing to reform meant waiting to die. These were the people who had struggled to hold on through Chinese medicine’s most desperate years.

Every one of them deserved respect!

After the founding of the People’s Republic, acupuncture’s guiding theory changed back. The theory of nerves was replaced once more by channel theory.

It had been the neurological approach that caused deqi and the arrival of qi to be confused.

But the confusion had never been corrected. Put simply, deqi meant that the needle had found the point, and treatment through needle manipulation could begin. The arrival of qi meant that the treatment had worked, and the needle could be withdrawn, ending the treatment.

With the two concepts merged, the arrival of qi meant nothing more than deqi. There was no longer a sign that treatment was complete. That was why the general clinical standard now was to retain the needles for thirty minutes.[13]

Cheng sighed. “The questions we couldn’t resolve will be yours to explore. The future of Chinese medicine belongs to your generation, after all.”

Evan nodded seriously.

Cheng glanced up at Evan, slowly lowered his eyes, then looked up again. Carefully, he asked, “In your time… do they still insist that Chinese medicine be validated by Western medicine’s methods?”

Evan’s expression froze for an instant. Then he immediately put on a smile.

“Of course not! Chinese medicine did… just fine.”

Reader Notes

↩︎ Cheng’s university and school. Nanjing University of Chinese Medicine traces its beginnings to the Jiangsu school whose first head was Cheng. Chengjiang names his acupuncture teaching lineage, rather than another university or a separate medical profession. The institution’s history records correspondence teaching, a specialist school, and an acupuncture journal among his educational work. The novel’s claim that more than half of China’s living masters came from his school is an emphatic estimate; the source does not supply that census. Source: Nanjing University of Chinese Medicine — Cheng Dan’an (in Chinese).↩︎ The four diagnostic methods. These are the examinations described in earlier chapters: looking, listening and smelling, asking questions, and palpating, including pulse examination. “Considering all four together” means bringing their findings into a single assessment, rather than performing four additional tests. Pathomechanism names the traditional explanation of how an illness arises and develops. Here the system supplies a simulated patient; neither the term nor the examination makes him a robot doctor or a real volunteer. Source for the four methods: Hong Kong Polytechnic University — Four Diagnostic Methods.↩︎ Liver fire and Wood overwhelming Earth. Earlier chapters introduced Liver qi constraint and the five phases. This passage combines them: anger is interpreted through the Liver’s Wood association, constraint becomes fire, and excessive Wood disturbs Earth-associated digestion. “Overwhelming” means excessive restraint, rather than the ordinary balanced relationship between phases. Liver and Stomach are capitalized for their traditional functional meanings. Fire is a pattern description, not a measured rise in temperature or proof of anatomical liver injury. Evan’s particular diagnosis belongs to the fictional exercise. Source for the terminology: WHO — Chinese medicine terminology, entries 35–39 and 1317.↩︎ The hollow organs and the middle. The fu are a traditional group of six organs concerned with receiving, transforming, and passing material onward. In this framework, the Stomach benefits from unobstructed passage, while the Liver is associated with the free flow of qi. “The middle” refers here to digestive functions, particularly those of the Spleen and Stomach. “Opening” these organs describes a treatment principle; it does not mean surgery. These distinctions explain Evan’s reasoning without making his point prescription a general treatment rule. Source: WHO — Chinese medicine terminology, entries 56, 136, and 140–141.↩︎ Point categories. Front-mu points lie on the chest or abdomen and correspond to organs. Jing-river and he-sea belong to the five transport-point categories; yuan-source and xi-cleft are other traditional classifications. The water imagery describes qi in that framework. Hand and Foot, Jueyin and Yangming identify channel groupings, rather than six additional treatment sites. A point’s phase assignment and its channel’s phase association are different classifications, so “Metal point” and “Fire-associated channel” are not automatically contradictory. Qimen through Liangqiu are the six points Evan actually names. Sources: WHO — Chinese medicine terminology, entries 2969 and 2973–2979; Great Compendium of Acupuncture and Moxibustion, volume 5, point tables (Chinese transcription).↩︎ Deqi and the feel beneath the needle. Descriptions of deqi can include the patient’s soreness or fullness and resistance felt by the practitioner through the needle. The teacher emphasizes the latter, while warning against relying on a single sensation. One phrase in the Chinese manuscript, zhen xia you xu, is unclear: xu ordinarily means “slow.” “A sense of slowness” is a provisional literal rendering, not an established technical definition. The wording needs the author’s review. Source for the broader discussion of practitioner and patient sensations: Chen and colleagues — Appraisal of the Deqi Concept, §3.2.↩︎ Bronze teaching figures. Song-dynasty acupuncture models marked channels and points on a human-shaped figure. They served as aids to instruction and examination. The National Museum of China describes that tradition while identifying its own displayed example as a later Qing reproduction. The historical models help explain the narrator’s comparison, but they were not responsive simulated people. The roommates passage is a joke about students practicing on one another, rather than a claim that the system’s patient is human. Source: National Museum of China — Bronze acupuncture figure (in Chinese).↩︎ The Neijing and two readings of qi. Neijing abbreviates the Yellow Emperor’s Inner Canon, including the Suwen and Lingshu. The breathing passage is in Suwen chapter 27; the wind-and-clouds passage is in Lingshu chapter 1. Both are translated here for this edition. Cheng distinguishes obtaining qi from a later response signaling effectiveness. That is the teaching in this scene; historical and modern writers have also used the terms interchangeably. The novel’s second quotation has an unclear character in the cloud image; the translation retains its general simile. Sources: Suwen, chapter 27 (Chinese transcription); Lingshu, chapter 1 (Chinese transcription); Zhao and colleagues — Deqi in ancient medical books, abstract.↩︎ The 1822 order. Daoguang’s second regnal year was 1822. The order quoted in the Palace Museum’s historical material stopped the acupuncture department of the Imperial Medical Academy, the institution serving the court. That is narrower than a prohibition of all acupuncture throughout China. Its stated objection concerns the suitability of needling and moxibustion for serving the ruler. The novel’s additional explanations about exposed skin and assassination have not been established by this quoted order. The translation preserves the narrator’s account. Source: Palace Museum — Historical account of the Imperial Medical Academy, printed p. 50 (in Chinese).↩︎ Republican-era abolition campaigns. The Republican period brought disputes over the future of Chinese medicine, including attempts to restrict or abolish it. An Academia Historica archival description records petitions seeking withdrawal of abolition measures and disputes over schools, hospitals, and administration in 1929–1930. Such records document political conflict; a proposed measure, an adopted resolution, and a nationwide prohibition actually enforced are different things. The chapter compresses these conflicts into a sweeping narrative. Its wording does not establish that traditional practice ceased everywhere. Source: Academia Historica — Proposals to withdraw the Chinese-medicine abolition measure, archival description (in Chinese).↩︎ Medicine after the Meiji Restoration. The reforms beginning in 1868 favored Western medicine in Japan’s medical education and professional system. Acupuncture and other inherited practices faced restrictions and adapted through changing institutions, training, and research. Kanpō means medicine of the Chinese or Han tradition; the passage uses it broadly. Connecting acupuncture with anatomy or nerves was one response to that setting. The narrator’s claim that this alone preserved the art is a compressed explanation, rather than the full history of Japanese acupuncture. Source: Kobayashi, Uefuji, and Yasumo — History and Progress of Japanese Acupuncture, “The Meiji Period”.↩︎ Reconciling Chinese and Western medicine. The historical movement called zhongxi huitong sought connections between two medical traditions. Tang Rongchuan and Zhang Xichun are historical physicians, so their names remain Chinese. The narrator’s tribute, including the claim that every leader later rejected his earlier path, is an interpretation retained from the novel. Research on Cheng instead describes a continuing combination of traditional theory with selected modern knowledge. It does not establish a single late-life reversal shared by all three men. Source for Cheng’s position: Zhang Jianbin — Study of Cheng Dan’an’s academic thought, §2.3 (in Chinese).↩︎ When treatment ends. The narrator uses the distinction just taught to explain when a needle should be removed. This is the chapter’s particular interpretation of deqi and qi’s arrival. Published discussions describe several views of those terms and of retention time; they do not establish one duration for every patient and condition. The thirty-minute statement and its proposed historical cause remain the narrator’s generalization. No elapsed practice time or successful outcome for the simulated patient is supplied here. Source: Chen and colleagues — Appraisal of the Deqi Concept, §§3.2.2 and 3.4.3.