Dr. Xu: A Chinese Medicine Novel

Evan and Dr. Li return to the village patient the next morning.

Early the next morning, Evan and Dr. Li went back to examine the patient.

She was already out of bed and had even made breakfast for them. The red, swollen lump over her appendix had disappeared, though pressing her abdomen still caused some pain.

The black coating on her tongue had completely cleared. Her pulse was calm and unhurried at all six positions, and her temperature was normal again.[1]

The village’s barefoot doctor kept calling it a miracle. He had seen for himself how ill she had been. Who would have imagined she could be well again after a single night?[2]

He no longer dared say he had studied Chinese medicine. He felt he knew nothing, that he was nothing.

Dr. Li prescribed three batches of Qingchang Yin, from the Bianzheng Qilu, to clear the remaining pathogenic influence. He left the prescription with the family and told them to have it filled in town.[3]

For breakfast, the family ladled out two big bowls of thick millet porridge for the doctors. There were also huangtiaotiao—“yellow strips”—and two eggs.[4]

But neither doctor ate there. On his way to the latrine, Evan had passed the kitchen and seen the patient drinking porridge so thin he could almost see the bottom of the bowl. Even that was reserved for her because she was ill. The others were drinking something dark.

Their staple food was huangtiaotiao too. Strictly speaking, though, these weren’t yellow strips at all. They were black. There was very little grain in them, just a mixture of all sorts of things. Plant fibers and bits of vegetable leaf were plainly visible.

When Evan returned and looked at his own bowl, so thick with millet it was almost a bowl of cooked grain, he could not bring himself to eat.

Dr. Li left his porridge untouched too. He put two yellow strips in Evan’s hand.

“Just say your stomach caught a chill last night. You had diarrhea a few times and can’t eat.”

Evan held the strips and nodded.

Dr. Li took two for himself.

As they said goodbye, the family tried to press a fee on Dr. Li. He refused it.

Dr. Li had four children, but none had studied medicine. They all thought it was a profession that brought nothing but trouble. He had spent almost everything he owned on his patients.

The farmers were so poor, their lives so hard, that he kept helping them out of his own pocket. Apart from the house on the family plot, he had given away almost everything.

He also spent his days treating severe and critical illnesses. Only a god could succeed every time. Disputes with patients and their families were common.

After he became famous, he traveled to Southeast Asia and places such as Taiwan to lecture and treat patients. He earned a considerable sum—more than 600,000 yuan. He had barely brought it home before he donated it all.

Who would have thought that a physician of his stature had lived so frugally all his life?

Evan and Dr. Li returned to the county hospital and resumed seeing patients.

As they had expected, the discovery of the Eastern Han tomb caused little stir in Chinese medicine. Practitioners were still content to take a long time to get results. They were still enthusiastic about combining Chinese and Western medicine.

Even the classical-formula school showed little interest. The Fire Spirit school, however, was rather excited. At last, they had something to support their position.[5]

They too followed Zhang Zhongjing and the Shanghan Lun. But their doses, particularly of fuzi, exceeded those in Zhongjing’s original formulas.

So did Dr. Li’s. Zhongjing’s basic doses were already high, but Dr. Li went beyond even those limits.

There were benefits to using such heavy doses, but the drawbacks were clear. A wrong diagnosis or the wrong treatment could cause serious trouble. So could combining the medicines improperly.

As the Fire Spirit school grew more popular, it gained a large following among the public. Yet many of its followers got poor results. They were Fire Spirits in name only.

Prescribing heavy doses was like wielding the Green Dragon Crescent Blade. It looked magnificent in motion, but a clumsy swing could cause disaster.

A true master of prescribing had to be able to carve tofu with that blade![6]

Evan now tasted toxic medicines such as fuzi, chuanwu, and mubiezi every day, increasing the quantity day by day. The poisoning often left his face and lips numb. He vomited, had diarrhea, and suffered abdominal cramps.

He kept antidote decoctions ready as well. He suffered, but he enjoyed it.[7]

Professor Ke Xuefan in Shanghai was the only person in the Chinese medicine community who kept campaigning over the Eastern Han discovery and promptly began clinical research.

Dr. Li was consulting the ancient texts too. He compiled the classical formulas for the six channels, the important, commonly used prescriptions from the Jinkui, and formulas found effective in practice before the Tang and Song dynasties.

Using the new findings, he recalculated their doses in modern units for reference and research. In the process, he found that people as far back as the Song dynasty had already questioned the doses of classical formulas.[8]

The transmission of Chinese medicine had broken down several times. The errors in dosage had begun not in the Ming, but as early as the Tang.

Even so, it was still Li Shizhen whom Dr. Li cursed most often.

…

In July 1982, after twenty-eight years under an unjust judgment and two terms in prison, Dr. Li’s name was finally cleared.[9]

The night the official notice arrived, he got drunk.

…

In 1983, Dr. Li was instructed to establish Lingshi Hospital of Chinese Medicine.

He became its director.

Evan went with him.

This page copied a chapter from the author’s official posting without approval; the published version is where readers support the writer.

As director, Dr. Li was even busier. Besides treating the patients who came every day, he had administrative matters to handle and meetings to attend.

Fortunately, Evan’s clinical skills were now quite good. When Dr. Li had more work than he could manage, Evan could take over for him.

Dr. Li often attended meetings and exchanged views with colleagues in Chinese medicine. But every time he returned, he was furious. He could smoke an entire pack of cigarettes in one angry evening.

In 1992, he retired as director and opened a small clinic in his home. Word spread through various channels, and patients gradually began coming from across the country.

They went home and told others. His reputation grew and eventually reached practitioners of Chinese medicine in other places.

Only then did people discover, to their astonishment, that a genuine practitioner who could treat severe and critical illnesses had been hidden away in this remote little county town in northwestern China.

It was only in his later years that Dr. Li finally ventured beyond Lingshi.

Later, his writings were published.

His writings caused a sensation in Chinese medicine. And in the wider medical community. And among the public!

Media outlets began interviewing him, reporting on his life, and spreading his medical ideas. Soon his name was known throughout the country.

When circumstances hold you back, cultivate your own character. When you have the means, help the world.[10]

Perhaps Dr. Li’s outlook had changed long before. It had probably changed when the Eastern Han tomb was discovered. Otherwise, he would not have spent so much of his time as hospital director going out to argue with other practitioners.

Now he was finally famous, with so many people recognizing his work. He accepted the invitation of the senior physician Deng Tietao and spent years traveling south to lecture, teach his skills, and explain his medical thinking.

He kept urging practitioners not to settle for taking so long to get results, or for being subordinate to Western medicine. Old, middle-aged, and young alike had to strive to catch up, to improve their ability to treat severe and critical illnesses. Taking so long to get results, he said, was a disgrace to Chinese medicine.

Evan, meanwhile, continued seeing patients at the county hospital of Chinese medicine. His teacher’s name might be known everywhere, but he himself remained content with obscurity. He never left Lingshi.

He saw patients by day, and villagers often came seeking help for urgent illnesses at night. In the middle of the night, he crossed mountains and ridges to treat them. In time, he knew the mountain paths so well he could find his way with his eyes shut.

His reputation never spread beyond the county. Many people did not even know he was Dr. Li’s disciple. But everyone locally knew there was an excellent practitioner named Evan Xu at the hospital of Chinese medicine.

In his declining years, Dr. Li kept traveling for the future of Chinese medicine. He crossed provinces, lecturing and teaching without pause. Patients came from all over the country, even following him from province to province just to seek treatment. He could not bear to turn them away.

For years, despite his advanced age, he never went to sleep before two in the morning.

At last he fell ill.

He had a stroke.

Reader Notes

Reader Notes

↩︎ The six pulse positions. These are the three traditional wrist-pulse positions, cun, guan, and chi, examined on each arm. They are not six separate heartbeats or six arteries elsewhere in the body. The description concerns the quality felt at those positions; the return to a normal temperature is a separate observation. As in the preceding chapters, this is the novel’s account of a traditional examination, rather than a newly supplied laboratory or imaging result. Source: WHO — International Standard Terminologies on Traditional Chinese Medicine.↩︎ A barefoot doctor. This historical term refers to a rural health worker trained to provide basic medical care, often while also doing agricultural work. It does not mean the man is literally barefoot, nor does it describe every village doctor in every period. This is the same local practitioner encountered during the village visit. His astonishment and loss of confidence belong to this particular scene, rather than a general assessment of rural medical workers. Source: WHO Bulletin — China’s village doctors take great strides.↩︎ Qingchang Yin and its cited book. Yin is part of this formula’s name; the three ji are three batches of prescription material, not necessarily three single drinks. “Remaining pathogenic influence” expresses the traditional rationale for continuing treatment. The manuscript calls the source book Bianzheng Qilu. A surviving text titled Bianzheng Lu contains Qingchang Yin in volume 13; this difference in titles remains visible here instead of being silently corrected. The historical prescription does not establish this patient’s outcome. Source: Bianzheng Lu, volume 13 — Qingchang Yin (in Chinese).↩︎ The yellow strips. Huangtiaotiao literally means “yellow strips,” the local name retained here for the grain-based staple. The contrast in this scene is between what the family offers its guests and what it can afford to eat itself: thick millet porridge for the doctors, watery porridge for the patient, and dark food for everyone else. The novel does not identify the plant fibers or give a recipe, so no particular grain mixture or plant species is supplied.↩︎ Classical formulas and the Fire Spirit school. Classical-formula practitioners look to the early medical prescriptions associated with Zhang Zhongjing. The Fire Spirit school is a medical tradition emphasizing the warming and support of yang, not a religious order or a supernatural ability. These categories can share classical sources without using identical doses. The passage also distinguishes an original formula’s quantity from later high-dose prescribing, and dose from the way ingredients are combined. The tomb’s reception and the judgments about practitioners remain the narrator’s account. Source: Nanjing University of Chinese Medicine — lecture on the Fire Spirit tradition (in Chinese).↩︎ A great blade, delicate work. The Green Dragon Crescent Blade is the famous long-handled blade associated with Guan Yu in literature and popular imagery. Its scale and martial force make it a deliberately extravagant comparison for powerful prescribing. Tofu supplies the opposite quality: something soft that demands very fine control. The point is precision as well as strength. This is a metaphor, with no weapon or tofu actually present in the clinical scene. Source: Romance of the Three Kingdoms, chapter 1 — Guan Yu’s blade (in Chinese).↩︎ Three distinct toxic medicines. Fuzi is the aconite lateral-root medicine discussed earlier; chuanwu denotes a different aconite-root material. Mubiezi is Momordica seed, not another name for aconite. The manuscript does not specify processing, amounts, or the ingredients of Evan’s antidote decoctions. Aconitum poisoning can include numbness, vomiting, diarrhea, and dangerous heart-rhythm disturbances. Keeping a decoction ready does not establish that poisoning can be reliably reversed; the self-tasting and its effects are events in the story. Sources: Hong Kong Department of Health — aconitum-containing medicines (in Chinese); Department of Health — medicinal-material schedule, Momordica seed and aconite entries (in Chinese).↩︎ The six channels and the Jinkui. The six channels here are the traditional diagnostic divisions associated with the Shanghan Lun, rather than six anatomical tubes. Jinkui abbreviates Jinkui Yaolue, “Essentials from the Golden Cabinet,” another classical medical text associated with Zhang Zhongjing. Compiling old prescriptions and converting their weights are distinct tasks: a historical weight conversion alone does not determine an appropriate clinical dose. The account’s claims about interrupted transmission and when dose errors began have not been established by these terminology and text sources. Sources: WHO — Chinese medicine terminology; Jinkui Yaolue, text (in Chinese).↩︎ Having one’s name cleared. Pingfan means reversing or redressing an unjust judgment. It is distinct from simply being released from prison. Here the novel explicitly supplies July 1982, twenty-eight years of injustice, and two imprisonments; the dictionary explains the term but does not independently verify those biographical details. No political campaign, charge, responsible official, or court procedure is added. The scene gives only the arrival of the notice and Dr. Li’s response that night. Source: Ministry of Education — pingfan, Revised Mandarin Chinese Dictionary.↩︎ Cultivating oneself and helping the world. This familiar saying echoes Mengzi, “Jin Xin I,” section 9. Its contrast concerns limited circumstances and the opportunity to put one’s principles into wider action. The novel uses the common variant jian ji tianxia, “help the world,” where the classical text has jian shan tianxia. The English follows the novel’s wording. Here the saying connects personal conduct with public service; it is not a new line of dialogue or a promise about the outcome of Dr. Li’s work. Source: Chinese Text Project — Mengzi, Jin Xin I, section 9 (in Chinese).