Dr. Xu: A Chinese Medicine Novel

The morning’s consultations take Evan back to the wards.

Simon pulled Evan along, and the two headed back to the inpatient building.

Afraid they might come to blows, Leo followed close behind. Why was Simon being so stubborn again? What was he going to do now?

Leo was worried sick. He had never worried this much about his own son.

Back in the inpatient building, they went up to the fifth floor.

Leo paused in surprise. Now he knew whom Simon was taking Evan to see. That child!

Simon led Evan inside.

“Dr. Liu.” A tired-looking man stood to greet him.

Simon nodded. “How is Evie? Any better than she was this morning?”

Evie’s father rubbed his face. He looked exhausted, his eyes bloodshot. He shook his head. “No. Her fever’s worse. It’s up to 40 degrees.”

Their faces fell.

Evan turned to look at the little girl on the hospital bed. She lay with her eyes closed in her mother’s arms, her tiny face like a porcelain doll’s.

Her mother wore a mask. She kept wiping away tears; her eyes were swollen from crying.

Simon’s brows drew tightly together. “Her name is Evie. She’s a year and six months old. Four days of fever, with coughing and shortness of breath. She’s had two convulsions. Her temperature is now 40°C.

“White blood cell count, 12.9. Neutrophils, 68 percent; lymphocytes, 32 percent. Patchy shadows in both the upper and lower right lung, with indistinct lung markings. She’s been diagnosed with adenovirus pneumonia.

“Since she was admitted, Chinese and Western medicine doctors have assessed her together. We’ve treated her with antibiotics, Ma Xing Shi Gan Tang, and a modified Yinqiao San. There’s been no improvement.”[1]

Leo, standing behind them, gave a small sigh. He knew about this child too, but there was nothing he could do either. Simon might have been proved wrong in front of Dr. Xu, but what doctor had never made a mistake?

Simon was a capable physician. He had a master’s degree in integrated Chinese and Western medicine and specialized in combining the two in clinical practice. When the hospital’s conventional medicine doctors needed a consultation for their patients, it was often Simon they called, not Leo.

Leo knew he was no match for him clinically. He was good at maneuvering, finding the right connections and the right openings. That was how he had secured a deputy head’s position in obstetrics and gynecology so early.

Simon, meanwhile, was about to become deputy head of Chinese internal medicine. Internal medicine! And he was getting there on ability.

Yet even Simon had no good answer for this child. This was adenovirus pneumonia. Adenovirus pneumonia!

The illness usually lasted one to two weeks and most often affected children under two. This girl’s fever had already reached 40°C on the fourth day. If the high fever persisted, her condition would soon become severe.

The fatality rate in severe cases was 10 percent. Even children who recovered had a poor prognosis and were very likely to be left with lasting complications.[2]

Leo’s heart sank further. She was barely more than a year old!

Simon turned to Evan. He spoke with complete sincerity. “I’m not trying to test you or challenge you now. I know how good you are. Please help this child.”

Everyone nearby was startled.

Who was this young man? Why was Dr. Liu speaking to him like that?

Evie’s parents exchanged a look, both surprised and uncertain.

Leo sighed inwardly. Simon really had run out of options. And it wasn’t just Simon. Conventional medicine had no good answer either. There was still no specific drug for the illness; all they could do was try to control it, modulate the immune response, and manage complications.

In fact, conventional medicine doctors often sought Chinese medicine consultations for this illness, since herbal treatment often produced good results in adenovirus pneumonia. This time, though, it seemed to have done nothing.[3]

Evan didn’t answer at once. Instead, he asked Simon, “You came to see her this morning?”

“Yes.” Simon nodded.

Evan understood a little more. No wonder Simon had been hiding in the inpatient stairwell so early, smoking. He must have been worried about her.

Evan grew serious. “I’ll do everything I can.”

“Please,” Simon said emphatically.

Evan put on a mask and went over to examine her.

Evie’s father looked bewildered. “Dr. Liu… who is…?”

“A… Chinese medicine specialist I’ve brought to see her,” Simon explained.

He himself was already considered a specialist. Dr. Xu was better than he was, so of course Dr. Xu was a specialist too.

“Him?” Evie’s father was taken aback. Weren’t Chinese medicine specialists supposed to be gray-haired? Could someone this young really be one? He hesitated. “But he’s so young. I mean…”

Evie’s mother looked over with a frown too.

Simon paused. “He’s the disciple of one of the country’s greatest physicians of Chinese medicine!”[4]

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Both parents drew in a sharp breath.

A disciple of a nationally eminent master!

Someone like that had come to their little county town?

Leo was confused. He turned, astonished. “What did you say?”

Simon sighed. “You don’t have to hide it from me. I know everything.”

Now Leo was even more confused. Everything? What exactly did he know? But with the patient’s family right there, he couldn’t very well press the matter.

Hearing that Evan was the disciple of a nationally eminent physician, Evie’s parents looked at him differently.

“Thank you. Thank you,” her father hurried to tell Simon.

“You’re welcome. It’s what I should do.”

Evan had reached Evie’s bedside. He found a small stool and sat beside the bed.

Her little porcelain-doll face was drawn with illness. Every so often her large eyes opened, full of distress and exhaustion. She kept coughing, struggling to catch her breath.

Evan’s heart ached for her.

A hospital was a hospital, all right. He had already encountered two difficult cases in a single morning.

As Evan looked at the girl, the Chinese medicine patterns associated with adenovirus pneumonia sprang into his mind, classified by the course of the illness.

In the early stages, it was often wind-heat or summerheat blocking the Lung. As the illness progressed and the external pathogenic influence sank inward, exterior and interior could be affected together: exterior cold with interior heat, or an exterior excess pattern with diarrhea. In the most severe cases, phlegm-heat or toxic heat blocked the Lung.[5]

If it was wind-heat or summerheat blocking the Lung, the earlier treatment shouldn’t have been far wrong. Was it the combination of medicines, or the dosage? Or had something been overlooked?

“No!” Evan caught himself with a start. He had almost let a preconception take hold too.

He still lacked experience with many kinds of severe illness. During those years in the System, he had indeed been a well-known physician in the capital, but his reputation had been in gynecology. He had treated severe gynecological cases.

Beijing had so many renowned Chinese medicine physicians. For severe illnesses in other specialties, people weren’t going to seek out a gynecologist specifically for a consultation.

That was why the earlier patient who could pass neither urine nor stool after giving birth hadn’t unsettled him much, serious though her condition was. This child was different. This wasn’t gynecology. In Chinese medicine, children’s illnesses were the hardest to treat.

His composure had wavered, and facts he had memorized had immediately rushed into his mind, nearly fixing his judgment in advance.

But Evan was, after all, a true practitioner of Chinese medicine. He steadied himself at once and murmured, “Examine the pulse and signs, understand what has gone wrong, and treat according to the pattern.” Those twelve Chinese characters expressed a guiding principle of Chinese medicine.[6]

Evan slowly let out a breath. He cleared every preconception from his mind. For now, he set aside the child’s diagnosis of adenovirus pneumonia.

Reader Notes

Reader Notes

↩︎ Two named formulas. Ma Xing Shi Gan Tang is the shortened name of a formula combining mahuang (ephedra), xingren (bitter apricot kernel), shigao (gypsum), and gancao (licorice). Its traditional purpose includes clearing Lung heat and easing labored breathing. Yinqiao San, named for honeysuckle and forsythia, is associated with the early stages of wind-heat illness. These are formula names, rather than isolated drugs. Simon reports that both have been used, with modifications to Yinqiao San; the passage supplies no ingredient quantities or precise dosing sequence. Sources: Hong Kong Baptist University — Ma Huang Xing Ren Gan Cao Shi Gao Tang; Hong Kong Baptist University — Yin Qiao San.↩︎ Adenovirus pneumonia and prognosis. Adenoviruses can cause several kinds of illness, including pneumonia. Severe childhood pneumonia can leave lasting airway or lung damage, but a single mortality figure does not describe every outbreak, age group, or level of care. The 10 percent figure and the account of the usual course are retained from the novel’s narration; the source below does not establish them as universal estimates. China’s 2019 pediatric guideline identifies children from six months to five years, especially those under two, as the most commonly affected group. It also emphasizes possible lasting damage in severe cases. Source: National Health Commission — Pediatric Adenovirus Pneumonia Guideline, 2019, pp. 1–2 and 14–15 (in Chinese).↩︎ Treatment in the story. Antibiotics treat bacterial infections; they do not themselves target adenoviruses. The chapter reports antibiotics among Evie’s treatments without specifying a bacterial coinfection or the doctors’ reason for prescribing them. Current CDC guidance describes care directed at symptoms and complications and states that there is no FDA-approved antiviral treatment for adenovirus infection. The narration’s claim that Chinese herbal treatment often works well is part of the novel’s medical account. Neither the formula descriptions nor this CDC guidance establishes that efficacy claim for Evie’s illness. Sources: CDC — Clinical Overview of Adenovirus, Treatment and Recovery; National Health Commission — 2019 guideline, treatment section (in Chinese).↩︎ A master’s disciple. In a traditional teacher–disciple relationship, the teacher passes on learning and practical skills. Here Simon invokes the standing of Evan’s teacher to reassure the parents about a very young doctor. “One of the country’s greatest physicians” renders da guoshou, a term of exceptional professional esteem in this passage. It does not give Evan a new license, an academic degree, or a newly awarded government title. The claim is Simon’s explanation to the family, and Leo’s confusion remains unresolved. Source: Ministry of Education dictionary — shifu, teacher of learning or skills (in Chinese).↩︎ Patterns across an illness. These labels belong to Chinese medicine’s account of changing presentations. Wind-heat and summerheat describe pathogenic influences; “blocking the Lung” describes impaired function within that framework. Exterior and interior refer to the relative depth of a pattern. An exterior excess pattern can coexist with diarrhea; “excess” does not mean constipation. Phlegm-heat and toxic heat name further pattern categories, rather than laboratory findings. The 2019 guideline lists the same progression discussed here. Evan is recalling possible patterns, without yet deciding which the child has; the biomedical diagnosis alone does not supply that decision. Sources: National Health Commission — 2019 guideline, pp. 15–16 (in Chinese); WHO — Traditional Chinese Medicine Terminologies, eight-principle pattern definitions.↩︎ Treat according to the pattern. The saying comes from the Shanghan Lun, in a passage about an illness altered by inappropriate treatment. It calls for examining the present pulse and signs, understanding what has gone awry, and choosing treatment accordingly. The English here is a fresh translation of the twelve Chinese characters quoted in the novel. Evan uses the maxim to stop himself fitting the child to a remembered classification before examining her. Setting aside the disease label at this moment does not establish that the reported viral diagnosis is false. Sources: Chinese Text Project — Shanghan Lun, Taiyang disease, upper section (in Chinese); Ke Qin — Shanghan Lun Zhu Lai Su Ji, discussion following the Guizhi Tang presentations (in Chinese).