Dr. Xu: A Chinese Medicine Novel

Still dizzy after the resuscitation, Evan has something to tell the young doctors.

The young Chinese medicine doctors hurried forward to support Evan.

“Dr. Xu, are you all right?” Alex asked anxiously.

“I’m fine. Help me over there so I can sit for a while.”

A young nurse hurried to the nurses’ station and brought out a more comfortable chair.

Once Evan was seated, he reminded them, “Make sure she finishes the remaining third of the medicine. Get the other two batches brewing right away, too. Start with cold water and boil the herbs to release their medicinal strength.

“From now on, give her 100 mL of decoction every half hour, day and night. The medicine’s effect mustn’t be allowed to lapse. She has to take all three batches within 24 hours. Only then can we truly break through the yin cold, restore yang, and save her life.”[1]

“All right. I’ll go and brew it now,” Alex said at once.

“I’ll go.” Another young Chinese medicine doctor volunteered and hurried away.

The doctor who had been directing the resuscitation was astonished to hear this, though he still had his doubts. He went into the resuscitation room to check the patient’s readings. The monitors showed that her vital signs really were improving, recovering at an incredible rate.

The doctor stared. “Extraordinary!”

Evan sat in the chair, breathing wearily.

“Dr. Xu, you’re clearly unwell,” Alex said, deeply worried. “Since we’re already at the hospital, why don’t you get checked?”

Evan looked at him and gave an exasperated laugh. “What do I need a checkup for? You’re a doctor, aren’t you? Diagnose me and treat me.”

“What?” Alex was dumbfounded. “I… I…”

“Forgotten how to treat a patient?” Evan asked.

Alex waved his hands. “It’s just… you’re such a good doctor, Dr. Xu. If you haven’t managed to cure yourself, I’m afraid I won’t be able to either.”

“A doctor facing an illness is like an army facing an enemy. How can you let your morale collapse before you’ve even begun? You’ve weakened yourself before the first encounter. That won’t do.”

Alex looked thoroughly embarrassed.

“Any Chinese medicine doctor who wants to improve needs a solid grounding in theory,” Evan said. “But even more important is enough clinical experience.

“Treating a patient is like walking on thin ice. You must be cautious at every step. But whatever the illness, you mustn’t lose your nerve. Examine it. Find out what’s happening. Identify the pattern carefully and be cautious with your medicines. Once you’ve identified the pattern correctly, you can prescribe with confidence.”

Alex nodded firmly. “I understand, Dr. Xu. Let me feel your pulse.”

He took Evan’s hand and began a careful examination.

The other young doctors looked thoughtful too.

Evan was still dizzy and exhausted, but he had at last brought the patient largely out of immediate danger. That lifted his spirits. He asked the young doctors, “Did you see the prescription I wrote?”

They all nodded.

“It’s Dr. Li’s Poge Jiuxin Tang,” Evan said. “Once he’d worked out the question of dosage, he began using large amounts of fuzi. At first, he treated heart failure with high-dose Renshen Sini Tang. Eight out of ten severely ill patients could recover, and even among those at death’s door, he could save about half.

“Those were very good results, but he still wasn’t satisfied. A patient dying of heart failure isn’t suffering only from heart failure, or perhaps respiratory failure. The whole body is failing. Throughout the five zang and six fu organ systems, yin, yang, qi, and blood are all beginning to disperse.[2]

“Using Renshen Sini Tang alone meant seeing only one part and missing the whole. Later, Dr. Li drew on Zhang Xichun’s Laifu Tang. It has a very powerful action in preventing collapse. The shanyurou in it is even more effective at checking collapse than ginseng, baizhu, or huangqi. The formula gathers and secures yin, yang, qi, and blood when they are on the verge of dispersing.

“So Laifu Tang supplies exactly what Sini Tang lacks. It helps fuzi hold on to the yang that has been restored. In a critical case like this, life hangs by a thread. If yang returns, the patient lives. If it goes, the patient dies. That was the basis on which Dr. Li developed Poge Jiuxin Tang.”[3]

“Dr. Xu, that’s enough talking for now,” Leo urged him. “Get some rest first.”

Evan shook his head. “It’s all right. I feel much better. They’ve just seen Poge Jiuxin Tang save a life with their own eyes. This is the best possible moment for them to learn.”

For a moment, Leo had no answer.

The others didn’t know what to say either.

Du looked at Guo again.

Guo had been watching Evan all this time. His gaze was somber.

The young Chinese medicine doctors listened intently.

“This formula can restore yang when it’s all but extinguished and rescue yin from sudden collapse,” Evan continued. “Critical cases in any specialty can reach this point: severe vomiting and diarrhea; vomiting blood, blood in the stool, or massive uterine bleeding; externally contracted cold or warm disease with incessant sweating; or a long illness that has exhausted qi and blood.

“These can lead to the exhaustion of yin, the loss of yang, and a sudden collapse of original qi, with heart failure and shock leaving the patient close to death. The signs include drenching cold sweat, icy limbs, a very pale face or a sallow, ashen complexion, and bluish-purple nails, lips, and tongue. The patient gasps with shoulders heaving, loses control of urine and stool, and barely draws breath. For critical signs of yang collapse like these, a large dose of this formula, given urgently, can work wonders.”

Evan looked hard at the young doctors before him.

“Remember this. Chinese medicine isn’t just for treating chronic illnesses slowly. It has always had strengths in treating serious and critical illness. You must keep honing your skills. You have to know how to treat a patient, and you have to dare to do it.

“Zhang Cigong once gave Zhu Liangchun a seal engraved with sixteen characters: ‘A tender nature, a hero’s courage, an immortal’s skill, a bodhisattva’s heart.’ Those are the principles by which a Chinese medicine doctor should practice. Once we recognize what’s driving an illness, we must act decisively. We must dare to treat it, and dare to use the medicines it requires. We mustn’t let the chance slip away.[4]

No permission was given for this copy of the author’s chapter; reading the version on their official page supports their work.

“Sometimes a patient’s life is decided in an instant. Hesitate, and they’re gone. However close to death a patient may be, you must never give up. Chinese medicine can take the lead—and it should!”

The young doctors were stunned.

Even Alex, who had been feeling Evan’s pulse throughout, looked up and stared at him.

When Evan called this the best moment for them to learn, he wasn’t simply thinking of teaching them how to treat a patient. He wanted to plant a seed in their minds: Chinese medicine could treat critical emergencies. These young doctors had to learn how to treat patients, but they also had to dare!

And this was the best possible time to plant that seed.

A subtle change came over all the young doctors, in both their bearing and their outlook. For a while, they were all lost in thought.

Leo looked shaken too.

Du’s eyes lit up. Looking at the young doctors, he knew Evan had planted that seed. One day, it would sprout and grow.

This was exactly what he had always wanted to achieve. He looked at Evan again. He had chosen the right man after all. Evan really could do it!

Guo, too, was deeply shaken. At that moment, his earlier opposition seemed as though it might truly have been a mistake. Perhaps Chinese medicine wasn’t what he’d thought it was…

The patient was now largely out of immediate danger. What remained was to continue the medicine; there probably wouldn’t be any new developments for the time being.

But Evan made a point of stressing one thing to Du. Her yang had only just begun to return. Nothing with cold or cooling properties could be used now. That meant no more IV drips or antibiotics, which he regarded as cooling medicines.[5]

Du agreed. The Western medicine team would take no further part in her treatment and would hand her care entirely over to Chinese medicine. Only the necessary monitoring of her vital signs would continue. Guo approved the arrangement too.

For the first time, the hospital’s Chinese medicine department had taken sole charge of a critically ill patient.

Marcus took a more direct approach: he posted a police officer beside the human trafficker.

He hurried over to Evan. “Dr. Xu, when will the suspect wake up?”

Still tired, Evan replied, “In my experience, she’ll certainly regain consciousness once she’s finished these three batches. She’ll feel hungry too. Whether she’ll be able to speak remains to be seen.”

Marcus brightened at once. “Can we interrogate her tomorrow, then?”

“Hard to say. It depends on her condition after she wakes. Her qi and blood are utterly depleted, and her lung tissue has withered. Her incurable illness is already in its final stage. Even if we manage to save her and bring her round, I’m afraid she won’t have the stamina for intensive interrogation.”

Marcus’s expression tightened. “Then what can we do? When will she be strong enough?”

“I can’t say yet. Her condition is extremely complicated. A pathogenic influence is entrenched in her Lungs, a severe excess pattern that calls for draining. But her body is so weak that it can’t withstand aggressive treatment. The Lung is a delicate organ. Both draining and tonifying pose difficulties.[6]

“I need to go back and think carefully about the medicines. For now, we’ve only kept her alive. To see whether her condition can improve, I’ll have to come back tomorrow morning, after she’s finished the medicine, and examine her again.”

Marcus nodded firmly and held out his hand. “All right. Thank you for your hard work, Dr. Xu.”

Evan shook it. “You’re welcome.”

Reader Notes

Reader Notes

↩︎ A batch and a serving. A batch here means one complete set of prescribed medicinal ingredients, from which a decoction is brewed. It is different from the 100 mL served at a time. Evan’s directions carry forward the partly consumed first batch and add two more; the novel gives no total volume for each batch. Starting with cold water describes preparation, not the temperature at which the medicine is swallowed. General preparation guidance also distinguishes brewing a decoction from taking it. Source: Hong Kong Department of Health — Preparing Herbal Decoctions.↩︎ Yin, yang, and collapse. Yin and yang describe complementary aspects of bodily function in Chinese medicine; qi concerns activity and function, while blood also has a traditional nourishing role. The five zang and six fu are functional organ systems. Their names do not map exactly onto anatomical organs. “Dispersing” describes Evan’s account of failing bodily resources. “Original qi,” mentioned below, refers to fundamental qi. Restoring yang and securing yin name different aspects of his proposed response to collapse. The terminology explains his reasoning, rather than supplying laboratory measurements. Source: WHO — TCM terminology, entries 3–7, 54–56, 235, 247, 413–416 and 2561–2562.↩︎ The formulas in Evan’s explanation. Renshen Sini Tang is Sini Tang with ginseng. Laifu Tang is a different formula described by Zhang Xichun, whose discussion emphasizes gathering and securing what is being lost, particularly through shanyurou, medicinal cornel fruit flesh. This is the traditional rationale Evan draws on. A clinical-experience article also identifies Poge Jiuxin Tang as a formula originally developed for heart failure within a yang-restoring framework. Neither that background nor Zhang’s historical account establishes the recovery proportions quoted in Evan’s speech. Sources: Zhang Xichun — Yixue Zhongzhong Canxi Lu, “Laifu Tang,” transcription (in Chinese); Journal of Tianjin University of Traditional Chinese Medicine — clinical-experience article, section 2.1.3 (in Chinese).↩︎ The sixteen-character maxim. The Chinese inscription consists of four phrases of four characters each; the English wording preserves their parallel form. Zhu Liangchun’s daughter recalled the gift and the maxim in a published interview. The first phrase evokes tenderness toward patients, the second courage, and the third exceptional powers of observation and practical skill. A bodhisattva is a Buddhist figure whose path is motivated by compassion for others. Here the final phrase expresses a physician’s compassionate intent. The supernatural imagery describes ideals of medical character and skill. Sources: Yangtse Evening Post — interview with Zhu Liangchun’s family (in Chinese); Smithsonian National Museum of Asian Art — Bodhisattva.↩︎ “Cooling” medicines. Cold, cool, warm, and hot are traditional descriptions of medicinal properties. Here they concern a medicine’s attributed action, rather than its measured temperature. Evan extends that framework to IV treatment and antibiotics, and the hospital accepts his decision in this case. Modern antibiotic use is classified by the bacterial infections being treated, not by a universal cooling property. The passage gives no new infection findings or explanation of what the IV fluids contain. Sources: WHO — TCM terminology, entries 2639–2642; CDC — Antibiotic Use and Antimicrobial Resistance Facts.↩︎ Excess in a depleted patient. In pattern differentiation, excess refers to the strength or accumulation of pathogenic factors, while deficiency concerns depleted bodily resources. They can coexist. “Draining” aims to reduce the excess; “tonifying” aims to support what is deficient. The traditional description of the Lung as delicate helps explain Evan’s difficulty choosing between them. Capitalized “Lung” marks this functional concept. His description of withered lung tissue remains his clinical account; it does not add a new scan result or show that the underlying illness has resolved. Sources: WHO — TCM terminology, entries 994–995; Zhu Yimin — discussion of cold and heat in lung disease, section 1, p. 508 (in Chinese).