Dr. Xu: A Chinese Medicine Novel

Alex examines a pulse, and Evan questions what he thinks he knows.

“Go and examine the patient’s pulse,” Evan told Alex.

“Yes.” Alex hurried over to Adam.

Adam glanced at him and made a contemptuous sound through his crooked mouth. “Tch.”

Alex froze. What an arrogant patient!

He frowned, forced down his irritation, and took Adam’s hand to feel his pulse.

Adam kept still and let him.

Clara came out too.

After a while, Alex finished examining both wrists.

“What did you find?” Evan asked.

“A floating, rapid pulse on the left… I think?” Alex said hesitantly.

“Your pulse examination still needs work. Pay attention to the details. At the left cun and guan positions, the pulse is floating, slightly tight, and rapid.”[1]

Alex looked puzzled again. “A floating pulse at the left cun indicates wind invasion. Tightness indicates cold. A floating, tight pulse means cold is at the exterior, so we should use pungent, warming medicines to release the exterior and disperse the pathogenic influence. That calls for the sweating method.

“But it’s rapid too, and a rapid pulse indicates heat. So he has cold and heat together? The Shanghan Lun says, ‘With a floating, rapid pulse, recovery should come through sweating.’ The sweating method again? To treat wind stroke?”[2]

At that, Adam finally lost his contemptuous look and gave Evan a serious glance.

Clara, meanwhile, was gazing at Evan like an adoring fan.

Seeing her, Adam was annoyed all over again.

“Then what formula should we use?” Evan asked.

“Something from the Xuming Tang family?” Alex ventured.[3]

Evan was amused. “Why so uncertain?”

Alex didn’t dare answer.

“Is it because hardly anyone dares use Xuming formulas for wind stroke these days?”

Alex gave an embarrassed smile and nodded.

“Why don’t they dare?” Clara asked from beside them.

“That’s a long story,” Evan said. “Before the Tang and Song dynasties, Xuming formulas were the mainstay of treatment for wind stroke. The Jinkui Yaolue mentions Xuming Tang for wind stroke with paralysis: the patient cannot control the body or speak, is confused and unable to identify where it hurts, or is so stiff and contracted that turning over is impossible.

“Later, Sun Simiao of the Tang dynasty included it in the Beiji Qianjin Yaofang—Essential Prescriptions Worth a Thousand Gold for Emergencies. He placed Xiao Xuming Tang first among the formulas for wind and listed several other Xuming prescriptions.

“He recorded Xiao Xuming Tang as treating sudden wind stroke when the patient is close to death, the body slack or contracted, the eyes and mouth distorted, the tongue stiff and unable to form words, breathing faint, and the mind confused and distressed. He said it proved effective for all wind disorders without depleting the patient.

“He also said, ‘Following the ancient method, the major and minor Xuming decoctions treat wind affecting the five zang organs, paralysis on one side, and harmful wind, with marvelous results.’ So before the Tang and Song, when a case was identified as true wind stroke through pattern differentiation, Xuming Tang was used.

“After the Tang and Song, however, theories of internal wind and of these illnesses not being wind at all began to gain ground. Gradually, people abandoned the method of expelling wind.

“The Four Masters of the Jin and Yuan dynasties were especially influential, each advancing a different view. Liu Hejian emphasized a sudden surge of Heart fire; Zhang Congzheng, internal stirring of Liver wind; Li Dongyuan, a robust body with declining qi, the body’s own qi becoming disordered; and Zhu Danxi, phlegm-dampness generating heat.

“Later physicians accepted their views. Treatment came to focus on calming the Liver and anchoring yang, clearing heat, and transforming phlegm.

“Zhang Jingyue, in particular, held that wind stroke ‘arises entirely from internal damage, with no externally contracted cause.’ He thought using Xuming Tang would only hasten the patient’s decline.[4]

“More recently, Zhang Shanlei was harsher still. He said treating wind stroke with Xuming Tang was inconceivable—merely gambling on a lucky success.

“So after the Song dynasty, Xuming formulas gradually fell out of use. And once modern pharmacology found that mahuang, guizhi, and fuzi could all raise blood pressure, people were even more reluctant to use them in patients who already had cerebral thrombosis.[5]

“There have always been physicians who continued to use Xuming Tang since the Song. But on the whole, it became rare.”

Clara nodded. “I see.”

Evan turned back to Alex. “Ever since Wang Qingren developed Buyang Huanwu Tang for wind stroke, physicians have praised it. But it treats qi deficiency with blood stasis.

“It can work very well when the pulse is deep and weak, or large but empty. If the pulse is wiry, large, and rapid, though, it won’t help. It’s a formula for deficiency. You have to learn to differentiate the pattern.”[6]

Alex nodded earnestly and wrote down the point.

“Quite a few practitioners today have carried out controlled studies of Xiao Xuming Tang,” Evan continued. “Yu Xiaoping, for instance, used it in 60 cases of acute ischemic stroke and reported an overall response rate of 96.7%.

“Zhang Huiwu, a renowned physician in Henan, used it in 88 cases of wind stroke with one-sided paralysis and reported an overall response rate of 98.86%.[7] And then… the veteran physician Li Ke… He had three strokes in two years from overwork. He treated himself with Xuming formulas too, with very good results.”

His voice grew a little heavier at the mention of Dr. Li.

After his stroke, Dr. Li had resolved to restore Xuming Tang’s reputation. Following the second stroke, he had even mailed Evan scholarly materials on a revised Xuming prescription to help him understand it more deeply.

Evan composed himself a little.

“The patient’s pulse and signs have already given us our answer. You’ve just worked it out yourself: wind-cold at the exterior, with cold and heat mixed together.

“After examining the pulse and signs, you have to understand what has gone wrong. Then you treat according to the pattern. With wind-cold at the exterior and cold mixed with heat, we need to open the exterior and reach the interior—to open the door and drive out the pathogenic influence.

“Look at the reasoning behind Xiao Xuming Tang. Mahuang, guizhi, fangfeng, and fangji enter the Taiyang channel to expel wind and dispel dampness, opening the exterior. When the pathogenic influence is lodged at the exterior, the qi within cannot move freely. That constraint generates heat, so xingren frees its movement and huangqin clears the heat.

“Where pathogenic influences gather, qi must be deficient, so renshen replenishes qi. Shaoyao and chuanxiong protect the nutritive aspect and invigorate blood. Fuzi strengthens the action of the tonics, generates yang, and helps mahuang act at the exterior.

This text was taken from the author’s publishing page without consent; the chapter there is a way to support its creator.

“So Xiao Xuming Tang both disperses with pungent warmth and replenishes qi and blood. It uses cooling medicines to clear heat alongside warming medicines to support yang in the interior. An unusual combination, but a clever one—and particularly well suited to this patient’s pattern.[8]

“That’s why you must follow Zhongjing’s twelve-character rule when treating illness. Don’t allow yourself the slightest preconception. Remember those twelve characters and treat according to the pattern. You won’t go wrong.”

Alex nodded earnestly and hurried to write it down.

Clara had long since grown used to Evan’s extraordinary abilities.

A hint of surprise had entered Adam’s eyes too.

When Alex had finished his notes, he asked, “So we can use the sweating method to treat wind stroke?”

“Of course. Sweating comes first among the eight methods of internal treatment in Chinese medicine. Don’t underestimate it. The Neijing says, ‘Pathogenic wind arrives as swiftly as wind and rain. The best practitioner therefore treats the skin and body hair; next comes the skin itself, then the sinews and vessels, then the six fu organs, and finally the five zang organs.’

“Sun Simiao also said, ‘When a patient suffering from wind takes a decoction, the wind will not leave without profuse sweating. That is why all wind formulas contain mahuang.’ Sweating is an appropriate way to treat pathogenic wind. Open the skin and its interstices, guide the pathogenic influence to the exterior, and release it through sweat.”[9]

Alex nodded, feeling that he finally understood. He’d learned so much in just this short time.

Then he asked one final question. “But why did we have to shut all the doors and windows?”

Evan couldn’t help rolling his eyes. “I’ve told you we’re using Xiao Xuming Tang, and I’ve spent all this time talking about Sun Simiao. In the Qianjin Yaofang, he says, ‘When someone is suddenly struck by wind and abruptly afflicted in body and mind, perhaps unable to speak—when signs such as these appear…

“‘Give the major or minor Xuming Tang, Xizhou Xuming Tang, Paifeng Tang, or Yuebi Tang in a closed room free of drafts. Administer four or five doses over the day and night, without counting how many batches are needed or worrying about depletion. It is best to keep the head and face, hands and feet, abdomen and back sweating continuously.’”[10]

Alex was immediately embarrassed.

Evan shook his head. “Your grounding in theory is far too weak. Go home and copy out the Qianjin Yaofang once.”

“What?”

Alex was dumbfounded.

Reader Notes

Reader Notes

↩︎ Positions and qualities. Cun and guan are two adjacent positions used in wrist-pulse examination. “Floating” concerns how readily a pulse is felt with light pressure; “tight” describes a taut, rope-like sensation; “rapid” concerns speed. They describe different aspects of the same pulse. Evan specifies the left wrist and adds slight tightness to Alex’s description. The associations with cold, heat, and the exterior belong to traditional pattern differentiation; they are not blood-pressure readings or findings from a brain scan. Source: WHO — TCM terminology, entries 856–857, 889, 892, and 906.↩︎ The sweating method. Here sweating means a traditional treatment method intended to release an exterior pattern, rather than exercise or sweating as a symptom. Alex is testing whether that principle can apply to this wind-stroke case. His quotation comes from the Shanghan Lun, or Treatise on Cold Damage. The passage continues with conditions under which sweating should not be induced after inappropriate purging. Alex quotes its opening principle, rather than the whole discussion. Source: Shidianguji — Annotated Shanghan Lun, passage beginning “With a floating, rapid pulse” (in Chinese).↩︎ A family of formulas. Xuming is conventionally understood as “continuing life”; it is a prescription name, rather than a promise of extended life. Tang denotes a decoction, and xiao and da distinguish minor and major forms. These are related prescriptions, not interchangeable names for one fixed recipe. The Qianjin Yaofang records several forms under wind disorders. The Jinkui Yaolue contains a Xuming prescription in the appended formulas to its wind-stroke chapter, attributed there to the Gujin Luyan. Sources: Qianjin Yaofang — volume 8, “Various Wind Disorders” (Chinese transcription); Jinkui Yaolue — chapter 5, appended formulas (Chinese transcription).↩︎ Internal wind and “non-wind.” These terms mark a disagreement within traditional medicine. Internal-wind explanations locate the disturbance in bodily processes; a “non-wind” account challenges treating the illness as an externally contracted wind disorder. It does not deny that the patient is ill. Evan’s Four Masters are historical physicians associated with the Jin and Yuan periods, rather than four stages of treatment. The capitalized Heart and Liver name traditional functional systems. Zhang Jingyue’s criticism of dispersing treatment appears alongside a qualification that cases with an accompanying exterior influence still require consideration of the old formulas. Source: Jingyue Quanshu — “Non-wind” and the discussion following Xiao Xuming Tang (Chinese transcription).↩︎ Three different medicines. Mahuang is ephedra; guizhi is cinnamon twig; fuzi is the aconite lateral-root medicine discussed earlier. Their risks are not identical. NCCIH describes high blood pressure among the adverse effects linked to ephedra, particularly in its discussion of ephedrine-containing supplements. Hong Kong’s health authority describes aconite poisoning with heart-rhythm disturbances and possible low blood pressure. These sources do not establish Evan’s broader claim that all three medicines raise blood pressure in the same way. Sources: NCCIH — Ephedra, safety; Hong Kong Department of Health — Aconitum alkaloids (in Chinese); HKBU — Cassia Twig, D00380.↩︎ Why the pattern matters. Buyang Huanwu Tang was Alex’s proposal in the previous chapter. Its traditional rationale is to supplement qi, invigorate blood, and unblock the collaterals in a qi-deficiency-and-blood-stasis pattern. Evan is distinguishing that rationale from choosing a prescription by the disease name alone. His contrast between deep or empty pulses and a wiry, large, rapid pulse is his clinical explanation here; the formula database does not establish his prediction for this patient. Source: HKBU — Bu Yang Huan Wu Tang, F00116, “Action,” “Indication,” and “Pathogenesis”.↩︎ “Overall response rate.” This renders the source’s zong youxiaolü, literally “total effective rate.” It preserves the reported outcome label without changing it to “cure rate.” Evan supplies the two percentages and case counts, but does not give the original outcome definitions, follow-up periods, or methods of assigning patients to groups. The complete original reports behind these particular figures have not been verified for this edition. The numbers remain part of his account, rather than independently established estimates of the likelihood of recovery.↩︎ Several aims in one prescription. Taiyang names a traditional channel or division, rather than sunlight. The exterior and interior describe levels within that framework. The “nutritive aspect” translates ying, associated with nourishment; it does not mean a measured nutrient level. Evan explains why he combines dispersing, clearing, warming, and replenishing actions instead of treating cold and heat as mutually exclusive labels. This is the formula rationale in his lecture, rather than an account of observed drug action inside Adam’s body. Source: WHO — TCM terminology, entries on ying qi, exterior/interior patterns, and Taiyang.↩︎ The eight methods. These are broad treatment categories: sweating, harmonizing, purging, reducing accumulations, inducing vomiting, clearing, warming, and replenishing. They are not eight steps every patient undergoes. Cheng Guopeng’s Yixue Xinwu lists them and begins its discussion with sweating, while also distinguishing situations in which sweating is inappropriate. The Neijing passage Evan cites describes progressively deeper levels of involvement; the zang and fu are traditional organ groupings. Sun’s statement about mahuang belongs to his historical discussion of wind prescriptions. Sources: Yixue Xinwu — “Eight Methods” (Chinese transcription); Suwen — chapter 5 (Chinese transcription); Qianjin Yaofang — volume 1, “Taking Medicines” (Chinese transcription).↩︎ The room and the doses. The cited passage describes giving wind prescriptions in a closed room protected from drafts, with sustained sweating. It explains Evan’s earlier instruction to shut the doors and windows. Its “four or five” refers to administrations over the day and night; the separate word for batches concerns how much medicine is prepared. Neither is a gram quantity. This is an account of Sun’s historical regimen and Evan’s reasoning; the chapter has not yet shown Adam drinking a dose or responding to treatment. Source: Qianjin Yaofang — volume 1, “Taking Medicines,” passage beginning “When someone suddenly encounters wind” (Chinese transcription).