Dr. Xu: A Chinese Medicine Novel

The family waits through the long vigil. Evan watches the patient—and wonders where he stands with Dr. Li.

Dawn came.

The patient was still alive.

His condition was much the same. He had not finished the medicine either. He was, after all, at death’s door; getting that much decoction down him in a short time was difficult. They were still feeding it to him as daylight came.

His family was bewildered. They had brought him here without any expectation that he could be saved. Taking him to the hospital had only been for their own peace of mind.

Yet here it was, broad daylight, and he was still with them.

They had not expected that.

They waited and waited. Evening came, and he was still alive.

More than a dozen hours had passed since they brought him in at four in the morning. Still alive.

They were stunned.

It was late that night before he finally finished the entire first batch of medicine.

Dr. Li had come to check on him several times.

In the early hours of the morning, Evan had told Dr. Li that he wanted to become his apprentice. Dr. Li had not agreed, leaving Evan dejected.

After another examination, Dr. Li faced Evan and his gossiping roommate.

“Keep watching him,” he told them. “Whether he really gets out of danger depends on whether he makes it through the zi hour.”[1]

Both nodded.

Dr. Li’s eyes rested on Evan a moment longer. Then he turned and left.

Evan gave a small sigh.

The young doctor waggled his eyebrows at him. “Evan, I’ve noticed the director treats you differently.”

“What are you talking about?”

“Just now. After he gave us our instructions, he looked at me once. But he looked at you twice.”

Evan rolled his eyes. “Have you really got nothing better to do?”

“I’m serious. I definitely saw it. I’m quite sure of that.”

“Couldn’t you be sure of something useful? All this gossip—you should change jobs and be a gouzai, chasing celebrity stories all day.”

The young doctor looked utterly confused. “A what? What’s a celebrity? Why do you want me to be a puppy?”[2]

Evan rolled his eyes again and ignored him.

Then the fellow came running up to ask again.

Evan kept watching the patient until midnight. His condition had not deteriorated. It had stabilized.

After the zi hour, the first yang returned. The cold sweat that had coated him like oil slowly subsided, and his labored breathing grew steadier. The icy cold in his limbs began to retreat too. It had extended above his elbows and knees; now it had receded below them.

Evan was heartened. It had taken the patient more than twenty hours to finish this single, powerful batch of medicine, but at last his condition had stabilized. There seemed to be hope of saving him.

His family was even more bewildered, astonished, and overjoyed.

At six the next morning, Dr. Li came for the second consultation. The patient’s ashen face had turned sallow. The bluish discoloration had eased a little, and the wet rattle of phlegm in his throat was much less pronounced.

When Dr. Li called his name, the patient could open his eyes, though he was still not fully alert. Dr. Li examined his pulse again. At all six positions, it was slow, fine, weak, and regularly interrupted, with a rate of 48 beats per minute. The sparrow-pecking and roof-leak qualities were gone.[3]

The doctor trained in Western medicine who had first received him came over too. After observing the patient, he gave Dr. Li a thumbs-up.

“Doctor, how’s my dad?” a family member asked anxiously. “Can he still be saved?”

Dr. Li nodded slightly. “The first day and night were the most dangerous. Only now can we say there’s some hope he’ll live. We’ll have to see how he does. We still can’t let our guard down.”

They were beside themselves with relief and joy.

Dr. Li glanced back at Evan and the young doctor, then turned to the family.

“The patient is still hemmed in by layers of yin cold. We preserved his last thread of yang qi. That’s what gave him a thread of hope.

“The struggle between the body’s sustaining forces and the forces of illness turns on whether yang qi advances or retreats, grows or dwindles. When yang is deficient, illness follows. When it declines, life is in danger. When it returns, there is life. When it leaves, there is death. His yang qi has only just returned. His hold on life is still very slight. All the more reason to support yang vigorously now. Only when yang returns and yin retreats can he survive.”[4]

The family looked at one another. Not one of them understood what he meant.

Behind Dr. Li, Evan listened in surprise.

The young doctor glanced cautiously from Evan to Dr. Li.

Dr. Li turned. “If a prescription is working, don’t change it. Keep the same formula. Increase only the fuzi to 200 g; leave everything else as it is. Make up three batches. He is to take all three within one day and night.”

Evan winced. That meant 600 g of fuzi, plus 90 g of raw banxia and 90 g of raw tiannanxing, all in twenty-four hours. That was a formidable amount![5]

Having given his instructions, Dr. Li looked at them and left.

The young doctor nudged Evan’s shoulder and whispered, “The director gave you another couple of extra looks just now.”

“Get lost!” Evan was getting thoroughly fed up with him.

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Three powerful batches of medicine, one after another, in a day and a night!

Far from taking a dangerous turn, his condition grew more stable.

The next day came the third consultation.

The patient was conscious now, though his breathing was weak and his voice scarcely louder than a mosquito’s whine. His limbs were warm again, and he could lie flat. He even said he was hungry and ate a little.

His family was too overjoyed to speak. The coffin and burial clothes they had prepared at home were no longer needed. They had notified all their relatives and friends for nothing.

Dr. Li examined him. His pulse was deep and fine at the chi position, with no more interruptions. It was now 58 beats per minute.

The rattle that had been in his throat for years was gone too.

The doctor who had first received him came to look again, then walked away calmly, showing no particular astonishment. This was hardly the first time he had seen Dr. Li bring someone back from death’s door with Chinese medicine. After enough times, it ceased to be a surprise.

The patient’s wife said he had lost bladder control during the night and soaked more than half the bed. Yet his legs, once so swollen that the flesh was soft as mud, were no longer swollen.

“That is what a large dose of fuzi does: breaks through yin cold and restores yang,” Dr. Li said. “Once genuine yang flourishes, the darkness clears of itself.”

Evan nodded slightly behind him.

The young doctor’s eyes darted about.

After two days, the patient was finally out of immediate danger. Dr. Li modified the formula, removing several ingredients, reducing the fuzi to 150 g, and adding Shen Si Wei to warm and nourish the essence and qi of the Liver and Kidney and prevent collapse. He prescribed three more batches, one a day, each decoction to be taken in three portions.[6]

Once the prescription was written, Dr. Li gave Evan and the young doctor instructions about the medicines and left.

Evan turned to look at the young doctor.

The young doctor stared at the ceiling without a word.

Evan waited a long time. When the fellow still said nothing, he could not help asking, “How many times did the director look at me this time?”

The young doctor could barely hold back his laughter.

“You’re a pain,” Evan said.

After three days on the medicine, the patient was out of bed, walking around the hospital with a crutch.

At last, Dr. Li had saved him: a man conventional medicine had given up trying to resuscitate, sent home to wait for death. In his final moments, with his whole body through the gates of the underworld and only one foot still outside, he had been brought back.

Five days. A total of 1.1 kilograms of fuzi.

The formula was Dr. Li’s own Poge Jiuxin Tang, developed from the work of earlier physicians. He had used it to treat more than a thousand severe cases of heart failure. Every one had been cured.[7]

Among them were more than a hundred patients whom conventional medicine had given up trying to save. Dr. Li had brought them back from the brink and kept them alive.

His treatment was not only far more effective than conventional medicine; the prognosis was far better too.

And that was just Poge Jiuxin Tang.

By one rough count, Dr. Li had treated more than ten thousand severely ill patients in his lifetime. Over a thousand of them had been sent home to die after hospitals failed to save them, only to be saved by him. He had given countless people back their lives.[7]

Evan wanted to tell those people: Who said Chinese medicine couldn’t treat acute and critical illness? Who the hell said it couldn’t?

What left Evan dejected was that here was a man with an almost miraculous command of medicines, yet he still could not study under him. It was deeply frustrating.

Then, a few days later, Dr. Li was leaving to see a patient.

“I have a call to make. It’s some distance away. Evan, come with me.”

“All right,” Evan said.

The young doctor immediately waggled his eyebrows at him.

Reader Notes

Reader Notes

↩︎ The zi hour and returning yang. Zi is the traditional double-hour around midnight, approximately 11 p.m. to 1 a.m. The chapter continues the previous night’s reasoning about yang beginning to return when yin reaches its height. Here it supplies a period of anxious waiting and a traditional explanation for the change in symptoms. The references explain the time system and its medical associations; they do not establish midnight as a clinically verified threshold for this patient’s survival. Sources: Academia Sinica — traditional time coding, PDF p. 96 (in Chinese); Beijing University of Chinese Medicine — channel and double-hour correspondences (in Chinese).↩︎ Gouzai. Evan uses the Chinese slang word for paparazzi, literally “dog pups.” His companion takes the animal meaning literally and also fails to understand “celebrity.” The Chinese word is retained at this one point so the reply about a puppy has something to respond to. The joke depends on the gap between Evan’s everyday vocabulary and the historical setting; it does not establish when each word entered popular use. The literal dog reference comes from the source dialogue. Source: Cambridge English–Chinese Dictionary — paparazzi.↩︎ Six pulse positions and interruptions. The six positions are the cun, guan, and chi on each wrist, not six separate hearts or arteries. Slow, fine, weak, and interrupted describe different aspects of the pulse felt by the examiner. A dai pulse has pauses at regular intervals; the numerical heart rate is reported separately. The sparrow-pecking and roof-leak images recall the ominous traditional qualities described in the previous chapter. These are traditional palpation terms, not a new electrocardiographic diagnosis. Source: WHO — International Standard Terminologies on Traditional Chinese Medicine, entries 856, 883, 891, 896, 910, and 915.↩︎ Supporting yang. Dr. Li interprets the crisis through yang’s warming and activating functions and the opposition between the body’s sustaining capacity and pathogenic factors. “Yin cold” here is his traditional pattern language, rather than a measured substance surrounding the organs. His aim is to restore yang and prevent collapse. The dialogue’s life-and-death sequence expresses his treatment rationale; the terminology source does not validate that sequence as a universal prognosis or establish that these doses produced the patient’s recovery. Source: WHO — International Standard Terminologies on Traditional Chinese Medicine, entries 274, 365, and 2845.↩︎ The increased prescription. The amounts are weights of medicinal material across three prescriptions, not weights of purified toxins. Fuzi is an aconite-root medicine; raw banxia is unprocessed pinellia tuber, and raw tiannanxing is unprocessed arisaema tuber. “Raw” distinguishes the latter two from processed preparations. Their traditional names are retained rather than replaced with the name of a modern cardiac drug. Official material documents aconite toxicity and cautions about preparation, dosing, and combinations; botanical identification does not establish that the novel’s regimen is safe. Sources: CMRO — Aconitum Alkaloids (in Chinese); Hong Kong Baptist University — Banxia, specimen D00190; HKBU — Tiannanxing, specimen B00106.↩︎ Shen Si Wei. The name means “four Kidney medicines,” a group used in Li’s practice, rather than a reference to the taste of four kidneys. An account of his prescribing identifies the group as buguzhi, gouqizi, tusizi, and yinyanghuo. The novel names the group without giving its individual amounts; none are added to the prescription here. Liver and Kidney, capitalized in this edition, refer to traditional functional systems. Nourishing their essence and qi is the stated purpose after the immediate crisis, not a newly established anatomical diagnosis. Source: Journal of Tianjin University of Traditional Chinese Medicine — Li Ke’s prescribing experience, section 3 (in Chinese).↩︎ Formula background and cure claims. A published account identifies Poge Jiuxin Tang as Li’s formula, originally developed for heart failure. It does not supply the underlying case records, a definition of cure, follow-up data, or a controlled comparison establishing the novel’s outcome claims. The assertion that every case was cured remains the narrator’s statement. Saving a patient from immediate danger and curing an underlying disease are distinct claims in the translation; background information about a formula does not verify the narration’s statistics. Source for the formula’s background: Journal of Tianjin University of Traditional Chinese Medicine — section 2.1.3 (in Chinese). ↩︎