Dr. Xu: A Chinese Medicine Novel

A signature stands between Dr. Li’s prescription and the dispensary. Evan stays to watch what follows.

As soon as Dr. Li had heard that this was a severe acute myocardial infarction, he had sent someone to fetch the hospital director. The reason was simple: without the director’s signature, the dispensary would not release the medicine.

The pharmacopoeia then in force set a maximum of 9 g for fuzi; the 2005 revision would change the range to 3–15 g. Dr. Li was starting with 150 g, more than ten times the limit. Who would dare dispense that without a signature?[1]

The hospital director had been a soldier. He acted quickly and decisively, was not afraid of taking responsibility, and was stubborn enough to stand his ground. If Dr. Li needed a signature, he would give it at once.

After finishing the prescription, Dr. Li checked the patient again and nodded. “Add 2,000 mL of cold water. Simmer over gentle heat until 600 mL remains. Divide it into three portions, one every two hours.”

Had the situation been desperate enough, there would have been no time to wait for a slow decoction. They would have added boiling water, cooked the medicine rapidly over high heat, and given it as it was being prepared.

But Evan’s emergency treatment had stabilized the patient’s condition. He was not out of danger, but the chest pain had stopped, buying time for further treatment.

Rapid decoction over high heat was a last resort. To get the best effect from the herbs, they still needed cold water and a slow simmer over gentle heat.[2]

The hospital director arrived quickly and signed without delay. The woman from the dispensary had already weighed the ingredients and was only waiting for his signature. As soon as it came, she sent them off to have the medicine prepared.

Dr. Li stayed at the patient’s side. It was his habit to remain with any critically ill patient he took on until that patient was out of danger.

He was not much of a talker. He simply sat there quietly.

When the family asked a few questions, he gave a few short answers. Then there was silence again.

Evan was in the treatment room too. Dr. Li did not speak to him, and he did not dare speak to Dr. Li.

Instead, a young Chinese medicine doctor beside him asked, “Evan, was that you doing the emergency treatment earlier?”

Evan nodded slightly.

“Impressive!” the young doctor said.

At that, Dr. Li turned and looked at Evan again, but still said nothing.

“It went all right,” Evan said. The rescue had been so tense that exhaustion was now settling through his whole body. He did not feel like saying much either.

The hospital director was there as well, observing the patient. The man was a veteran local government official.

He had only just retired and was getting on in years. His Kidney yang had long been depleted in the lower body. Over the Lunar New Year holiday, he had visited relatives every day, playing cards and drinking late into the night. The excessive exertion had injured him internally. On top of that, he had eaten far too much rich, fatty food.

As a result, turbid phlegm and stagnant blood had obstructed his chest and diaphragm: a severe case of true Heart pain. He had already been diagnosed with coronary heart disease, yet even when the chest pain came, he ignored it and let his condition become critical. Only then had he been brought to the hospital.[3]

The Western medicine doctors had taken one look, doubted they could manage it, and sent for Dr. Li.

Dr. Li had only joined the county hospital in 1978. Before that, he had been a barefoot doctor.[4] Since he arrived, the Western medicine doctors had not even had a turn at treating acute or critical cases. Emergencies were the Chinese medicine department’s business, and Dr. Li was its unshakable anchor.

It was like the Jade Emperor in Journey to the West crying, “Quick! Fetch the Buddha!”[5]

Before long, the decoction was ready. It was brought over and given to the patient.

A quarter of an hour passed. It was now after eight in the evening.

The man’s drenching sweat had subsided. His breathing had settled, and warmth had returned to his limbs. Evan’s earlier treatment with needles and medicine had only eased the chest pain and kept him alive; it had not brought him out of danger.

But after this medicine from Dr. Li, all his symptoms rapidly receded. Now he was lying in bed, sleeping peacefully!

He had only taken it once.

What did “as prompt as a drum answering a strike” mean? This was what it fucking meant![6]

Evan could only stare. He had just seen with his own eyes how the man had looked as though he were in hell.

“Director Li, how is my dad?” a family member asked anxiously.

Dr. Li checked again. “He’s stable now. Give the other two portions at two-hour intervals, day or night. We have it under control, but we can’t be careless.”

“Yes, of course.” The family member nodded hurriedly.

Seeing that the patient’s condition had stabilized, the hospital director said, “Good. That’s what matters. Director Li, I’ll leave him in your care. I have other things to attend to, so I’ll be going.”

Readers may support the author on NovelPhoenix, where this chapter is published. The copy here was not approved by them.

Dr. Li quickly stopped him. “Wait, Director. We need another batch of the same prescription. I’ll need your signature again.”

The director smiled. “Another 150 g of fuzi? You’ll land me in prison one of these days.”

Dr. Li shook his head and smiled, but said nothing. Talking was not his habit.

The director said no more either. He signed again.

Another batch of the same prescription was dispensed.

Evan’s eyelids twitched. Another 150 g of fuzi. That made 300 g altogether.

“Prepare it the same way,” Dr. Li told Evan and the young doctor. “Again, divide it into three portions and give one every two hours, day or night. Six portions in all.”

Evan sucked air through his teeth. Dr. Li really did prescribe with a heavy hand. From the first portion to the sixth would be ten hours, with 300 g of fuzi in total.

Compared with the pharmacopoeia’s 9 g limit, the difference was frightening.

No wonder people described Dr. Li’s way of saving lives as thunder and lightning!

Two more hours passed. It was after ten, and the patient took the second portion.

“Director Li, why don’t you get some rest?” Evan said. “We can watch him here.”

“Yes, Director Li, please do,” the family member said earnestly. “You’ve done so much today. When Dad’s better, we’ll bring him to visit you and thank you properly for saving his life.”

Dr. Li shook his head slightly. “No need to thank me.”

Seeing that the man was stable, he told Evan, “Stay here and watch the patient. I’ll rest upstairs for a while. If anything changes, come and tell me at once.”

“All right,” Evan said.

Dr. Li left.

The young doctor gave Evan a friendly punch. “You’re pretty good, you know.”

“What do you mean?” Evan asked.

“Has our director been giving you private lessons? You can really handle an emergency. You’ve got something of his style!”

The family hurried to thank Evan again.

He kept telling them there was no need.

Evan looked outside. There was so much he wanted to ask Dr. Li, so much he did not understand. But this was not the time. He could only keep it all to himself for now.

The patient was stable and sleeping soundly.

Evan and the young doctor went to the duty room. They could return to watch him when it was time for the medicine.

The young doctor fell asleep with his head on the desk.

Evan gazed out into the darkness, his expression wistful.

The night passed. By a little after six the next morning, the patient had taken all six portions from the two batches of modified Poge Jiuxin Tang. He was awake now, able to sit up and talk normally with everyone, and in good spirits.

Dr. Li returned to examine him. All his symptoms were gone; even the bruised patches on his tongue had disappeared. In one night—ten hours—this critically ill heart attack patient was no longer in any immediate danger.

The patient and his family thanked Dr. Li at length again.

Finally, Dr. Li prescribed Peiyuan Guben San to treat the root of the illness.[7]

Evan let out a long breath of relief. They had saved the man. He was safe at last. Even a major hospital could not promise to save someone this sick, much less achieve results this good, this quickly.

In a small northwestern county town with the limited medical resources of 1981, the man might well have died.

Yet Dr. Li had used Chinese medicine alone to bring him completely out of danger in ten hours. He could even be discharged.

For a moment, Evan’s eyes began to sting…

Reader Notes

Reader Notes

↩︎ Fuzi and the prescription amounts. Fuzi is an aconite lateral-root medicine. The passage contrasts a historical 9 g limit with a later 3–15 g range; its reference to 2005 looks forward from the 1981 setting. Here 150 g belongs to each prescribed batch, divided into three portions, while 300 g is the total across two batches. These are ingredient weights, not amounts of purified aconitine. Aconite alkaloids can cause severe poisoning and abnormal heart rhythms; preparation and dose matter. Source: Hong Kong Department of Health — Safe use of medicines containing aconitum alkaloids (in Chinese).↩︎ Decoction and heat. A decoction extracts medicinal materials by heating them in water; the liquid is then separated from the solid residue. Wenhuo means gentle heat and wuhuo strong heat, rather than specified temperatures. Preparation can vary with the materials and the situation. The narration’s preference for cold water and slow cooking belongs to this account; the emergency method is conditional. General preparation guidance does not establish that the methods or quantities in this scene are suitable for other prescriptions, particularly those containing toxic ingredients. Source: Hong Kong Department of Health — Preparing Herbal Decoctions.↩︎ Kidney yang, phlegm, and blood stasis. In traditional theory, Kidney yang concerns warming and supporting bodily functions; the Kidney system is associated with the lower body. Phlegm can name a pathological accumulation in traditional theory, beyond mucus that is coughed up; blood stasis describes impaired movement of blood within that framework. The passage links these concepts to overexertion, rich food, and severe chest pain. This is its traditional explanation of the case, separate from the biomedical diagnosis of coronary disease and myocardial infarction. Source: WHO — Standard TCM terminologies, entries 1072 and 1276.↩︎ A former barefoot doctor. This historical title refers to rural community health workers, many of whom combined agricultural work with basic medical duties after relatively brief training. Their work could include both Chinese and Western medicine. The term is not a description of footwear or a synonym for a specialist in Chinese medicine. Dr. Li’s move to the hospital in 1978 is the novel’s account of this particular doctor. Source: WHO Bulletin — China’s village doctors take great strides.↩︎ Calling in the Buddha.Journey to the West is the Chinese novel of the Monkey King’s adventures. In chapter 7, Heaven’s forces cannot subdue him, so the Jade Emperor sends for the Buddha. Here Dr. Li is the person everyone calls when ordinary efforts fail. The original also calls him dinghai shenzhen, the “sea-steadying needle,” an allusion to the Monkey King’s magical staff, rendered here as an “unshakable anchor.” Both images make him indispensable. Sources: Wikisource — Journey to the West, chapter 7 (in Chinese); chapter 3, the staff (in Chinese).↩︎ The answering drum. The Chinese expression xiao ru fu gu likens a treatment’s response to a drum sounding as soon as the beater strikes it. Fu is the beater and gu the drum; together they also suggest things answering one another. The title and the abrupt, profane repetition celebrate the speed of the change Evan has just witnessed. The metaphor expresses the novel’s claim about this case, rather than a promise about every use of the medicine. Source: Ministry of Education — Dictionary entry for fugu (in Chinese).↩︎ Treating the root after the emergency. In Chinese medicine, the “root” is the underlying basis of an illness, contrasted with its more immediate manifestations. The shift to Peiyuan Guben San marks that distinction in Dr. Li’s treatment. San names a powder preparation, but the chapter supplies neither its ingredients nor its directions. The overnight improvement and possible discharge are the narrative’s reported outcome; they do not by themselves establish that coronary disease has disappeared. Source: WHO — Standard TCM terminologies, entries 2252–2253 and 2785.