Dr. Xu: A Chinese Medicine Novel

A dispute over treatment turns personal in the consulting room.

Evan was truly angry.

He was usually good-tempered. He rarely lost his temper, but this time he had, and he had made no effort to spare Simon’s feelings.

He could tolerate a doctor like Leo, whose clinical skills were lacking. You couldn’t expect every practitioner of Chinese medicine to match a provincial-level specialist, or every one of them to be a nationally eminent master.

Every profession had its levels. With someone at a lower level, Evan could be patient, teach him, and share his hard-earned experience.

There was nothing fundamentally wrong with Leo’s approach. At least he could still be considered a competent practitioner of Chinese medicine.

If Evan could help him improve a little, he would. He wasn’t that ungenerous.

But someone like Simon—he couldn’t tolerate that.

You practiced Chinese medicine without using its way of thinking at all. All you did was read pharmacology reports, send patients for one test after another, and write prescriptions based on lab results. You ignored pattern differentiation, threw the four examinations and eight principles out the window, and prescribed recklessly![1]

This patient had grown worse because of the Chinese medicine he had taken!

And when he wasn’t cured, what would he blame? Chinese medicine. But what the hell kind of Chinese medicine doctor were you?

Evan kept telling himself to stay calm. Anger damaged the Liver. But he really couldn’t stand this anymore.[2]

The atmosphere in the consulting room turned icy.

Leo was the most embarrassed of all. He had seen doctors argue before, but like this, in front of a patient… That was taking the gloves off completely.

One was an old friend; the other was a new friend he had invited!

What a mess.

The patient was bewildered too, though he thought he was beginning to understand. This doctor had given him the wrong medicine. That was why he hadn’t merely failed to improve—he had grown worse.

He ought to be angry now. He was the one who had suffered, after all. But the young doctor had already done the getting angry. Now he was stuck. Getting angry himself didn’t seem right; neither did staying quiet.

This was miserable for him too.

Simon looked awful. He wanted to insist he hadn’t been wrong, but the patient’s symptoms really had grown worse. He looked at Evan. “Then what formula would you prescribe?”

Evan was no longer bothering to be pleasant either. “Do you even need to ask? It’s deficiency in the middle with sinking qi. Naturally, you need to strengthen the middle and replenish qi. Buzhong Yiqi Tang should be the main formula.”[3]

Leo was taken aback. Buzhong Yiqi Tang again? Hadn’t they just used that?

Simon looked startled too.

Seeing his expression, Evan asked, “You find it hard to believe you can treat damp-heat pouring downward by tonifying?”

Simon actually gave a slight nod. “Please write the prescription.”

Evan sat down to write it.

“Perhaps we don’t need an actual prescription,” Leo put in. “We can just discuss it.”

“No,” Simon said. “I have to see whether it works.”

Leo was speechless. He had offered the man a way out, and he wouldn’t take it.

Evan modified Buzhong Yiqi Tang. Chinese medicine had always tailored a prescription to the individual patient and the particular illness. Only that way could it achieve the best results.[4]

He finished writing and handed the prescription to Simon.

“Wait here.” Simon took it and hurried out. He was in such a rush as he opened the clinic door and ran through it that he stumbled and nearly fell.

Watching him go, Leo couldn’t help sighing.

“Actually… Simon is a very responsible doctor.” He still felt he had to explain.

Evan looked at him.

Leo gave a rueful smile. “If he weren’t, none of this would have happened today.

“Everyone at our hospital knows that his favorite thing to do is call his patients.

“Every day, he checks their records to see whether they should have finished their medicine. If they have, he calls to follow up and asks how they’re doing.”

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Evan was taken aback too.

Leo pointed at the patient sitting nearby. “Ask him if you don’t believe me. I’m sure he came back because Simon called him.”

Evan looked at the man.

The patient quickly nodded. “He prescribed three doses of herbal medicine last time. He called yesterday, and I said I wasn’t any better. He told me to come back so he could have another look. He even booked the appointment for me.”

Evan’s expression softened a little.

Rubbing his hands, Leo went on awkwardly. “Simon isn’t really trying to pick a fight with you. He has doubts of his own. He’s been in clinical practice all these years. He came to you for proof because he’s begun to question himself.

“If he were completely sure of himself, he wouldn’t have come to you. Even if he argued you into silence, he wouldn’t gain any fame or money from it. If he did nothing at all, he’d be getting a promotion and a raise before long.

“Ah, Simon… He really does take his responsibilities seriously. Perhaps he’s been a little careless with his prescribing. But we’re doctors. Who among us can promise a cure with one dose? So… please let him keep a little of his dignity.”

Evan pressed his lips together, his brow furrowed. At last, he too sighed and shook his head slightly.

Before long, Simon returned with the prepared decoction.

“Here. Drink this,” he told the patient.

The man didn’t take it at once. He glanced at Evan and Leo.

Both nodded.

Only then did he accept the medicine. He blew on it, tipped his head back, and drank.

Simon kept his eyes fixed on him.

The patient was so uncomfortable under that stare that he didn’t even dare use his phone.

Simon was watching for his reaction to the medicine.

After a while, the patient put a hand on his belly. It felt a little more comfortable.

“What is it? How do you feel?” Simon asked quickly.

“My stomach feels quite comfortable. And I don’t feel so dizzy now.”

Simon was a little surprised. Looking at the man’s face again, he saw that it wasn’t as red as before. He fetched a thermometer and took his temperature. It had come down.

The fever had gone!

A warming, tonifying medicine had brought down his fever—and worked this well![5]

The patient went to urinate again. The pain was much less, and so was the burning.

For a moment, Simon felt a little panicked.

If Evan hadn’t come today, he would still have prescribed medicines to clear heat and drain fire. Wouldn’t that have made the man even worse?

Simon’s face grew grimmer.

“Simon… Ah…” Leo didn’t know what to say either.

“Do you need to take him for another urinalysis and complete blood count?” Evan asked.

“Er…” Leo started to speak, then stopped. Why bring that up again?

“Why?” Simon looked at Evan in disbelief.

One dose. Just one dose! Evan hadn’t used any medicine to clear heat or drain fire. He’d used tonics instead, and one dose had eased every symptom. Surely even antibiotics didn’t work this well? He had already tried those!

“Because this is Chinese medicine!” Evan replied.

Simon and Leo both froze.

Simon’s lips trembled slightly. “You… you… Come with me.” He grabbed Evan’s hand and ran out with him.

“Hey, what are you doing?” Leo hurried after them.

The patient sat there, bewildered. “Hey! Has everyone forgotten about me again? Am I supposed to keep taking the medicine or not?”

Reader Notes

Reader Notes

↩︎ Four examinations and eight principles. The four examinations are inspection, listening and smelling, inquiry, and palpation, including pulse examination. The eight principles organize traditional diagnostic findings by yin/yang, exterior/interior, cold/heat, and deficiency/excess. They are ways of gathering and interpreting findings within Chinese medicine. Evan’s complaint is that Simon is abandoning that framework when choosing a prescription. His angry assessment of Simon’s practice belongs to the scene; these definitions do not decide whether the patient’s earlier treatment was appropriate. Sources: Hong Kong Department of Health — Diagnostic Methods and Features of Chinese Medicine Practice; WHO — Traditional Chinese medicine terminologies, entry 931 and section on the eight principles.↩︎ Anger and the Liver. This is Evan recalling a familiar traditional health-preservation idea, also encountered in Chapter 22. Chinese medicine associates the emotions with its functional organ systems, and excessive anger is linked with disruption of Liver qi. The capitalized “Liver” follows this edition’s convention for that theoretical system. The sentence is his rueful attempt to restrain himself, rather than a new finding that the argument has injured his anatomical liver. Source: Hong Kong Department of Health — Maintaining a Healthy Mental State in Chinese Medicine (in Chinese).↩︎ Buzhong Yiqi Tang and tonification. The formula’s name means replenishing the middle and supplementing qi. Its traditional actions include supporting Spleen and Stomach qi and raising what has sunk. It appeared in the earlier case in Chapter 62; Leo’s surprise is at using the same named formula in a different case. Here Evan chooses it for his interpretation of the underlying deficiency, despite the damp-heat signs. That is his treatment reasoning, rather than a claim that any urinary complaint calls for a tonic. Source: Hong Kong Baptist University — Bu Zhong Yi Qi Tang, Action, Indication, and Application.↩︎ A formula adapted to the case. A named formula can serve as a starting structure, with ingredients or amounts adjusted to the presentation. Traditional discussions call this jiajian, adding and subtracting. The Piwei Lun gives examples of changing a prescription according to accompanying signs. This chapter says that Evan modifies Buzhong Yiqi Tang but gives neither the changes nor the quantities; the earlier case’s prescription is not silently carried over. The narrator’s statement about obtaining the best results retains the original’s account of this prescribing ideal. Source: Piwei Lun — discussions of adjusting medicines to accompanying patterns (in Chinese).↩︎ Warming medicine and a falling fever. “Warming” describes a traditional medicinal property, distinct from the temperature of the liquid. In the framework discussed in the previous chapter, heat signs can accompany an underlying deficiency, so the traditional treatment need not be a cooling formula. The Piwei Lun discusses replenishing qi in such a context. Simon’s astonishment, the patient’s improvement, and the comparison with antibiotics are events and judgments in this fictional case. The passage supplies no repeat laboratory results or new numerical temperature. Sources: WHO — Traditional Chinese medicine terminologies, entry 2639; Piwei Lun — heat arising from dietary and exertional injury (in Chinese).