Dr. Xu: A Chinese Medicine Novel

A family waits for answers as the doctors review a difficult case.

Evan and Professor He came out of the ICU.

The professor looked deeply troubled.

Evan seemed a little more at ease.

Everyone turned toward them.

Only the patient’s wife remained slumped wearily against the wall.

Marcus came over. “Professor He, how is he?”

The professor’s face darkened. “Let’s talk in the office…”

At those words, Marcus’s heart sank.

The group returned to the office.

The patient’s wife leaned back in a chair, pale, silent, and utterly worn out.

Marcus stood ramrod straight.

The department heads from both Chinese and Western medicine had come too. The younger Chinese medicine doctors crowded into the corners and around the doorway.

Dr. Qi brought over a thick stack of documents. “Professor He, have a look at these first. They’re the records of his previous diagnoses and treatment.”

The professor nodded and began reading.

Evan stood behind him, reading over his shoulder.

After a while, the professor finished and passed the records to Evan.

He turned to the family, his voice heavy. “His illness is very difficult. From our Chinese medicine perspective, he suffered severe frostbite years ago. It seemed to have healed, but it never truly did.

“The pathogenic cold has remained hidden inside him all this time. When he was young, his qi and blood may have been strong, with no deficiency in his healthy qi, so he could withstand it. It didn’t do him too much harm then.

“Over time, though, the cold gradually entered the internal organs. Now it has penetrated deep into the blood level. That’s a technical term we use.

“In the wei, qi, ying, and xue framework, the blood level means the pathogenic factor has reached the deepest level. In other words, the illness is already very serious.[1]

“The cold lodged deep at the blood level is blocking his blood vessels. That is what has caused his tuoju and true Heart pain. His condition is very serious now, worse than when he was hospitalized in the provincial capital. It could threaten his life.”

The younger doctors behind them scribbled furiously.

Evan was going through the previous doctors’ records too. Their pattern differentiation was correct. They were provincial specialists, after all. They knew what they were doing.

Some Chinese medicine practitioners, though, treated illness in a quite absurd way. They didn’t know how to differentiate patterns. They looked only at test reports and Western diagnostic names, particularly names containing the Chinese character yan, “inflammation.” This patient’s thromboangiitis was one example.

They saw yan, written as two “fire” characters stacked together, and thought: how could there be inflammation without fire and heat? So they went straight to clearing heat and draining fire. There—now they’d reduced the inflammation![2]

In a patient like this, with cold lodged deep at the blood level and the illness already critical, giving bitter, cold, purgative medicines might leave him dead before the day was out.

That was why a Chinese medicine practitioner couldn’t treat from test reports alone. It wasn’t a rejection of modern science. The problem was that those reports couldn’t provide the basis for Chinese medicine treatment. With luck, the disease name and the pattern would agree, and the treatment would work. But what if luck wasn’t on your side…?

Marcus spoke bluntly from where he stood. “Professor He, tell us straight. We can take it. Can this illness still be treated?”

The professor shook his head. “It’s very serious. It would be extremely difficult.”

Marcus frowned. “Can you at least keep it under control?”

The professor shook his head again. “Very difficult.”

Marcus grew agitated. “So nothing can be done? You’re saying it’s untreatable?”

“Marcus, what are you shouting for?” Leo cut in. “Mind your attitude and your tone.”

Marcus turned toward him. “Are you telling me what to do?”

“I…” His obnoxious younger brother had left Leo speechless. He gave up on him and turned to Professor He. “I’m sorry, Professor. My brother’s a rough sort. He raised his voice. Please don’t take it to heart.”

The professor waved it off with a faint smile. “It’s all right. I understand. But I can’t make any promises about this patient. I can’t guarantee his condition won’t deteriorate. All I can say is that I’ll do everything I can.”

Everyone’s heart sank.

The younger doctors at the door sighed. For a doctor, few things hurt more, or left more regret, than being helpless in the face of illness.

Dr. Shi, the head of the ICU, spread his hands toward Dr. Zhong. There, hadn’t he said it would be useless? So many provincial specialists had failed. What difference would another one make?

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Dr. Zhong sighed helplessly too. He had examined this patient himself. With his abilities, he had even less chance of curing him. The illness was too serious. There was simply no way to save him.

“Qingyan… please don’t cry,” Leo said at once, trying to comfort the patient’s wife. He really did seem to know everyone.

Everyone looked toward her.

She leaned back in her chair, tears running ceaselessly down her face. Her features barely moved. She was so still, so numb, that there wasn’t a trace of expression.

Like a puppet with tears streaming down its face.

No expression.

No sound.

This was despair at its deepest.

Her husband’s illness had begun ten years ago. Ten full years of treatment, and he still wasn’t better. This year alone, he had spent seven months in hospitals in the provincial capital. She had spent all seven months at his side, all seven months afraid, all seven months in despair…

For a moment, everyone felt as though a great stone were lodged in their chest, making it hard to breathe.

Marcus punched the wall. Grief and anger filled his voice. “My mentor’s a hero! He ended up like this because he was saving people! Goddamn it, why do good people get treated like this?”

Dr. Qi sighed. “Perhaps you should accept the hospital’s recommendation and agree to the amputation…”

Marcus’s lips moved, but he only let out another heavy sigh. He knew his mentor’s temper. The man would rather die. Who could possibly persuade him?

“Actually, it isn’t incurable. There’s still hope.”

Everyone turned toward the speaker in astonishment.

Even the patient’s wife, still as a puppet, lifted her eyes a little.

“Evan, don’t say things like that carelessly,” Professor He warned at once.

Seeing that it was the young doctor speaking, Marcus felt a surge of anger too.

Dr. Shi frowned at him.

“I’m not speaking carelessly,” Evan said. “His illness is serious. He’s suffered from deep-seated, stubborn cold for more than thirty years, and the cold is lodged deep in his blood vessels. But that doesn’t make it incurable.

“He is severely ill, yes, but he hasn’t reached the point where his life hangs by a thread. If we use strongly acrid, hot-natured medicines now to break through the ice and thaw it, replenish qi and break up blood stasis, they will work.”[3]

Professor He frowned. “Evan, take a good look at what the previous doctors did.”

“I have. Their approach was the same as mine. There was nothing wrong with their formulas, either.”

The professor was more puzzled than ever. They had already tried that approach, and it hadn’t worked. Why was Evan still going down the same road?

Everyone else looked baffled too.

Evan opened the records in his hands. He shook his head slightly, his brow deeply furrowed. Displeasure slowly appeared on his face, and his voice grew grave.

“Their diagnoses and treatment were correct. The doses were simply too low. This patient has had a deep-seated cold illness for thirty-five years. He’s like an old iceberg that’s been frozen for thirty-five years.

“Throw three to five glowing coals onto it, and you won’t melt it. Look—the highest dose of fuzi they used was only 30 g, and the highest dose of chuanwu was only 9 g.

“For cold this deep and stubborn, only fierce medicines like wutou and fuzi can defeat it. They’re strongly acrid and hot, reaching all twelve channels, inside and out, from the surface to the interior. But the previous doctors deployed these powerful generals in doses too small to break through the ice and thaw it.”[4]

The Western medicine doctors and the family stared at him, lost.

The Chinese medicine doctors were all astounded.

Professor He’s expression darkened at once. “Do you know the doses specified in the pharmacopoeia?”

“I do,” Evan said. “No more than 15 g for fuzi and 3 g for chuanwu. The previous doctors were already using several times the specified doses.”

“Then how can you say that?” the professor demanded.

Evan shook his head. “It still wasn’t enough.”

The professor stared. “How many grams do you want to use?”

“We need 30 g of chuanwu.”

An uproar broke out. He wanted to go straight to ten times the specified dose!

Professor He’s face turned grim. “Don’t forget what got you into trouble before!” he snapped.

Evan lowered his head and let out a small breath. Then he looked at the professor calmly.

“I haven’t forgotten. But I haven’t forgotten that I’m a doctor, either.”

Reader Notes

↩︎ Cold and the blood level. Pathogenic cold is a traditional explanation for illness; healthy qi describes the body’s capacity to sustain and defend its functions. Neither term names a microbe or a measured immune value. Wei, qi, ying, and xue mean the defensive, qi, nutritive, and blood levels. This four-level framework is associated with warm or febrile diseases and describes their depth and progression. The professor applies its language to deeply lodged cold here. “Blood level” therefore belongs to his account of the illness; it does not establish a bloodstream infection. Sources: WHO — TCM Terminologies, entries 274–276, 365, 429, 951, and 965; Beijing University of Chinese Medicine — the four-level framework in warm-disease theory (in Chinese).↩︎ A disease name and a pattern. Pattern differentiation groups symptoms and examination findings within Chinese medicine’s diagnostic frameworks. It is distinct from identifying a biomedical disease. The narrator’s criticism hinges on a Chinese word: yan, 炎, used in names for inflammatory conditions, is formed from two 火, “fire,” components. The passage mocks treating that written resemblance as sufficient reason to select heat-clearing medicine. The sweeping comments about test reports and treatment are the novel’s argument, rather than a conclusion established by the terminology source. Sources: WHO — TCM Terminologies, entry 949; Ministry of Education — character analysis of 炎 (in Chinese).↩︎ Thawing the ice. “Hot” and “acrid” describe traditional medicinal properties; they do not mean a drink’s serving temperature. Replenishing qi and breaking up blood stasis name treatment aims in that system. Blood stasis concerns blood described as obstructed or failing to move normally; it is not automatically identical to a modern finding of a blood clot. The twelve channels are the traditional network associated with the organ systems. Evan’s thawing metaphor connects these ideas, while his confidence about the treatment remains his own judgment. Source: WHO — TCM Terminologies, entries 428, 2429, 2639–2643, and 2909.↩︎ Fuzi, chuanwu, and the dose dispute. These are related aconite medicines, rather than interchangeable names: chuanwu comes from the plant’s main root, while fuzi comes from its lateral roots, prepared for medicinal use. The novel uses wutou for aconite root and chuanwu in its dose discussion. Aconite alkaloids can cause severe poisoning, including dangerous heart effects. The health authority’s dose table distinguishes processed chuanwu from processed fuzi. This chapter does not specify the pharmacopoeia edition or the exact preparation of chuanwu. Its quantities are retained as dialogue in a disputed fictional case. Sources: Hong Kong Department of Health — root distinctions, “Chuanwu, Fuzi and Caowu” (in Chinese); Department of Health — aconite medicines and dose table (in Chinese).