Dr. Xu: A Chinese Medicine Novel

The family waits for an answer as the doctors argue over the proposed dose.

“What’s wrong? Can’t you use this medicine?” Marcus asked anxiously.

No one knew how to answer.

Marcus singled out his brother. “Leo, you tell me.”

“Well…” Leo didn’t know what to say either. “You… don’t get worked up. Hear them out first.”

Professor He’s face was dark. “Nonsense!” he snapped.

He stopped there. To say more would embarrass Evan in front of everyone.

Evan plainly had no intention of letting it go. He frowned. “Professor, at a critical moment like this, saving the patient’s life has to come first!”

The professor glared at him.

“Wait, wait. What exactly is going on? Can you treat him or not?” Marcus was growing agitated.

Professor He remained silent, his face grim.

Dr. Zhong considered for a moment. “Well… there’s nothing wrong with Dr. Xu’s approach. It’s the same approach the provincial specialists used. He just wants to increase the dose.

“Perhaps the family could wait outside for a while? We need to discuss this carefully and weigh our options. We’ll give you a treatment plan afterward. Would that be all right?”

Marcus stared. “What, we’re not even allowed to listen?”

“You wouldn’t understand it anyway,” Leo said impatiently. “There’s no point in your staying here.”

Marcus was immediately offended.

“I’m not going anywhere. I’m staying right here.” The patient’s wife lightly wiped the corner of her eye. Her face was expressionless, her voice very calm.

For a moment, no one knew what to say.

She raised her head a little and looked at Evan. “It’s been so long. There’s nothing left that I can’t bear. Doctor, whatever you have to say, please say it.”

Evan gave a slight nod. “I’ve already explained it. It’s as if your husband has an iceberg inside him that’s been frozen for thirty-five years. That’s why he’s so ill. Only potent medicines with strongly acrid, hot properties can break through that ice and thaw it. That’s the treatment he needs.”

“Can you cure him?” Marcus asked anxiously.

“His illness has been left to develop into something this serious. No one can guarantee a cure. What I can guarantee is that after he takes the medicine, his condition won’t get worse.”

“Evan!” Professor He shouted, slapping the desk. Now he was truly angry.

Marcus looked bewildered. “If it works, why won’t you let him use it?”

The others’ expressions varied.

“Leo.” Marcus called on his older brother again.

Leo frowned deeply. “Do you know why the pharmacopoeia says no more than 3 g of chuanwu?”

“Why?”

Leo’s brow tightened further. “Because chuanwu is poisonous.”[1]

“What?” Marcus was shocked. Only now did he remember that this young doctor had just proposed using more than ten times the specified dose. “You… how could you?”

Evan frowned even more deeply. He glanced again at the stack of treatment records in his hands, and his displeasure grew.

“That’s not the point. For an intractable illness caused by such deep, stubborn cold, small doses of wutou and fuzi aren’t enough to have any effect, let alone save a life.

“Yes, chuanwu is poisonous. But Zhongjing dared to use it this way more than eighteen hundred years ago. Wutou Tang in the Jinkui contains five aconite roots—about 25 g in today’s terms.”[2]

Evan stared at them. “Zhongjing could use it. Why can’t you?”

No one could answer him.

Marcus looked from one person to another. “So can it be used or can’t it?”

Leo forced himself to explain. “The ancients did use it that way. But now… modern pharmacological research shows we can’t use such large doses… And the pharmacopoeia has specified the doses for years.

“Exceeding them by that much really isn’t appropriate.”

Before Marcus could speak, Evan fixed his eyes on Leo. “What’s inappropriate about it? You say the dose is far too high, that it isn’t appropriate. Have you ever used it?”

Leo was at a loss for words.

Evan’s tone was becoming aggressive. “You read a pharmacology report and don’t dare use it? Have you tested it yourself?”

Leo looked to either side and licked his lips. “Well… they all say it’s poisonous. How could I dare give a patient more than the specified dose?”

Evan raised his voice another notch. “If you don’t dare give it to a patient, have you tried it yourself?”

Leo froze. He wanted to say, Am I out of my damn mind? Why the hell would I drink something poisonous?

“I have,” Evan said.

Leo was stunned again. Damn. There really was someone out of his mind here.

Everyone stared in astonishment.

Even Professor He looked at Evan in surprise.

NovelPhoenix’s publication carries the author’s chapter, and this copy was taken without consent.

The patient’s wife stared at him too.

Evan looked around at them. “It’s because I’ve drunk it that I know what I’m dealing with. How could Zhongjing use such a large dose of Wutou Tang without poisoning anyone? The secret lies in the combination of ingredients, their processing, and the way the medicine is prepared and taken.

“Zhongjing first simmered the chuanwu in honey. Why? Because honey is the essence of a hundred flowers. It counteracts all manner of poisons, and chuanwu in particular.

“Simmering chuanwu gently in thick honey must affect how its toxins break down. Its fierce, drying, intensely hot nature can no longer do harm.

“Next, Wutou Tang contains three liang of prepared licorice root. One Han-dynasty liang equals 15.625 g today. Round it to 16 g, and that makes exactly 48 g—twice the dose of chuanwu.

“Licorice counteracts all manner of poisons. With twice as much licorice restraining the chuanwu’s toxicity and tempering its fierce, drying nature, why worry about harm? As for the preparation, Zhongjing first simmered the chuanwu in two sheng of honey, equivalent to 200 mL today.

“Once the honey had reduced to one sheng, he removed the chuanwu. He boiled the five medicinal ingredients in Wutou Tang in three sheng of water until one sheng remained, strained out the dregs, then added the one sheng of honey from before and simmered it again. He reduced it to seven ge, about 140 mL, two-thirds of the original amount.[3]

“After its toxicity has been moderated repeatedly like this, and after prolonged simmering, the chuanwu can no longer do harm. Yet its strongly acrid, hot action remains. That is the secret of how Chinese medicine controls potent, toxic drugs like these.

“You read two or three pages of test results. Does that mean you can control it? Do you understand how to use it? How can a Chinese medicine practitioner look only at the toxicity of a single drug and ignore its processing, the other ingredients, and the way it’s simmered?”[4]

Again, Evan challenged them.

Everyone looked rather embarrassed.

Marcus looked from one to another. How had this young doctor managed to leave everyone here without an answer?

As he spoke, Evan was growing angry himself. He looked again at the stack of treatment records in his hands.

“The Shanghan Lun is a clinical manual for rescuing patients from acute, critical illness. It can save someone on the brink of death in an instant. Cold-damage epidemics strike suddenly and progress quickly. They can easily turn into life-threatening illness.[5]

“The Shanghan Lun was forged in the struggle to save people during those epidemics. That’s why Zhongjing’s formulas use large doses and few ingredients, with focused, powerful effects. Only then can they halt the progression of illness in time to save the patient’s life.

“The previous doctors failed this patient because their doses were too small to break through the ice and thaw it. Make a habit of prescribing small doses, and of course everything looks safe and steady. The doctor doesn’t have to take any risks or bear any responsibility.

“But what about the patient?”

The more he spoke, the angrier Evan became.

“Only when you’ve actually tried them will you know that Zhongjing’s formulas are never wrong. If you don’t dare give them to a patient, why don’t you dare try them yourselves first?

“Have you tasted chuanwu’s toxicity yourselves? If you don’t dare follow Shennong’s example and taste the hundred herbs, why practice Chinese medicine at all?”[6]

Evan stared at them, his tone growing harsher.

“If you don’t understand how to control these potent poisons, and don’t even dare try, how can you save a patient’s life when every moment counts? This patient has suffered for ten years without a cure. The doctors are to blame! Seven months in hospital, and instead of improving, he’s deteriorated to the point of death. The doctors are to blame! Chinese medicine is to blame!”

With an angry shout, Evan slammed the treatment records down on the desk. He had lost his temper completely.

Reader Notes

↩︎ Chuanwu and toxicity. Chuanwu is an aconite root medicine; fuzi is a related medicine from the plant’s lateral root, rather than another name for the same material. Both can contain toxic aconitum alkaloids. The pharmacopoeial limit is part of the characters’ argument; the chapter does not identify an edition or specify whether the chuanwu is raw or processed. Sources: Hong Kong Department of Health — Safe Use of Chinese Medicines Containing Aconitum Alkaloids (in Chinese); Nanjing University of Chinese Medicine — Aconite, “Harvesting and Processing” (in Chinese).↩︎ Wutou Tang and the Jinkui. Jinkui is short for Jinkui Yaolue, Essentials from the Golden Cabinet, a classical medical work associated with Zhang Zhongjing. Tang means a decoction: a liquid preparation, rather than a modern packet of “soup.” Wutou Tang is a particular formula containing aconite; it is distinct from other aconite formulas discussed earlier. A university transcription of its classical recipe specifies five roots. A count of roots does not establish a fixed modern weight; “about 25 g” is Evan’s conversion here. Source: Nanjing University of Chinese Medicine — Aconite, “Supplementary Formulas,” item 1 (in Chinese).↩︎ Ancient measures and this account. Liang measures weight; sheng and ge measure volume, with ten ge to a sheng. Research discusses several reconstructions of a Han liang, including 15.625 g, and commonly estimates a Han sheng at about 200 mL. This makes Evan’s “two sheng… 200 mL” inconsistent with his later “seven ge… 140 mL.” His “twice” and “two-thirds” are also approximations. The classical transcription specifies four ingredients in the water stage and seven ge to be taken, whereas Evan describes five ingredients and reduction to that volume. His account is preserved here. Sources: Nanjing University of Chinese Medicine — Historical Formula Measures, §§2.2–2.3 and 3, pp. 555–557 (in Chinese); University Aconite Entry — Classical Formula, item 1 (in Chinese).↩︎ Processing, combinations, and toxicity. Paozhi means processing medicinal materials before their use; it is distinct from preparing a decoction. Zhigancao is prepared licorice root, while gancao is licorice root without that processing specified. Traditional accounts describe ingredients as restraining or moderating one another. Hong Kong’s regulator notes that processing, prolonged boiling, and some combinations can reduce aconite toxicity; reduction does not mean elimination. Evan’s claims that honey counters all poisons, that this preparation cannot cause harm, and that his own tasting establishes control remain his assertions. Sources: Hong Kong Department of Health — GMP Premises FAQ, question 12 (in Chinese); Department of Health — Aconitum Alkaloids, “Precautions” (in Chinese).↩︎ Shanghan Lun.Treatise on Cold Damage is a medical classic associated with Zhang Zhongjing, whose work is traditionally situated amid epidemics of the late Eastern Han. “Cold damage” belongs to that historical medical vocabulary; it is not automatically the modern diagnosis of typhoid fever. Evan invokes the classic’s authority in this dispute. His claim that its formulas are never wrong, and his explanation of why the earlier treatment failed, are his judgments. Source: Beijing University of Chinese Medicine Museum — Zhang Zhongjing (in Chinese).↩︎ Shennong tasting the herbs. Shennong, the Divine Farmer, is a legendary figure associated with discovering medicinal plants by tasting them himself. “The hundred herbs” evokes that tradition, rather than a precisely counted experiment. Evan uses the story as a challenge to the other doctors; the legend does not establish that tasting a poisonous medicine is safe. Source: Beijing University of Chinese Medicine Museum — Shennong and the Heartbreak Herb (in Chinese).