Dr. Xu: A Chinese Medicine Novel

Evan tries to explain Iris’s illness in terms her family can understand.

Seeing that none of them had understood, Evan brought the explanation down to kindergarten level.

“What I mean is, when a healthy person contracts wind-cold, it starts at the surface. The surface of the body has a first line of defense.

“But if your qi and blood are weak, that first line fails and the pathogenic factor gets straight through. This is where the second line comes in. Your healthy qi begins fighting the pathogenic qi to keep it from passing directly from the exterior into the interior. The struggle becomes lodged beneath the ribs, producing that distressing fullness in the chest and rib area.

“Shaoyang is associated with the Gallbladder channel. When the external pathogenic factor reaches the Gallbladder system, cold moves inward and transforms into heat. In shaoyang, this becomes pathogenic heat invading the Gallbladder. Gallbladder heat flares upward, causing a bitter taste and a dry throat.

“As the two sides fight, the Gallbladder is affected and its qi cannot flow freely. It can no longer clear the stagnation in the Stomach, which belongs to earth, so you don’t want to eat. The Liver and Gallbladder are an interior-exterior pair, too. A disorder of the Gallbladder can constrain Liver qi, causing fullness beneath the ribs.

“Constrained Liver and Gallbladder qi turns into fire. Wood becomes too strong and overacts on earth, attacking the Stomach. The Stomach loses its normal downward action, and its qi rises instead, causing vomiting or dry retching, as well as abdominal pain. That’s what the passage means by ‘the pathogenic factor above, the pain below.’ These are the symptoms of a shaoyang pattern. The pathogenic factor is half exterior, half interior.”[1]

Iris’s husband still didn’t understand.

Iris had grasped a little of it. “What does that have to do with my period?”

Evan answered, “When a woman contracts wind, and seven or eight days later develops recurring chills and fever at intervals just as her menstrual flow stops, this is heat entering the blood chamber. The blood must have become bound, producing episodes like malaria, recurring at intervals.”[2]

“I mentioned weak blood and depleted qi. When is that likely to happen to a woman? During her period, or after childbirth. At those times the blood chamber is empty and vulnerable to an external pathogenic factor. That’s why I asked whether you’d caught a cold during an earlier period.”

“Oh.” Iris nodded. “But I don’t have any abdominal pain, or that fullness in my chest or under my ribs.”

Her husband still looked completely lost.

“When a woman’s blood chamber is empty, an external pathogenic factor can invade it,” Evan said. “With blood weak and qi depleted, heat enters the blood chamber, which is also connected with the shaoyang channel. In your case, the heat has entered the blood chamber rather than becoming lodged beneath the ribs.

“But this is still a shaoyang pattern. The pathogenic factor is half exterior, half interior, so you have some of those other symptoms.”

“Then why do I get cold, then have a fever, then have it go away?” Iris asked.

“Alternating chills and fever are one of the features of a shaoyang pattern. Why? Because pathogenic qi and healthy qi are fighting, and they’re fairly evenly matched. Each wins in turn. When the pathogenic qi wins, the illness moves inward, and you develop a fever.

“When healthy qi wins, the pathogenic factor makes its way out through the exterior and you feel chilled. Aversion to cold occurs in taiyang patterns. That’s why the chills and fever alternate. When the two sides are evenly balanced, there are no symptoms. That’s what ‘coming and going at intervals’ means.”

Iris’s husband hadn’t believed in Evan. But as he listened… Well, he still didn’t understand, but it sounded impressive. It seemed to make sense. One classical quotation after another—the feng shui masters he’d met had sounded just like this.[3]

“I think I’m starting to understand.”

“No, you’re not,” Evan said.

“Huh?” He stared. Suddenly Evan seemed even more punchable. This time it had nothing to do with his good looks.

“When heat enters the blood chamber during menstruation, the illness can flare just as the flow begins or stops,” Evan explained. “At other times, your healthy qi is strong enough to hold the pathogenic qi in check, so you have no symptoms. But once menstruation weakens your qi and blood, the pathogenic factor starts causing trouble. That’s why you keep getting fevers that come and go during your period, with recurring chills and fever like malaria.”

“So that’s it,” Iris said. She understood now.

“Yours is still a mild case. If it became more severe, it could reach the stage described as ‘clear-headed by day, delirious at dusk, as though seeing ghosts.’ You’d be lucid in the daytime, then talk nonsense at night as though you’d seen a ghost.”[4]

Iris’s expression stiffened. Goose bumps rose across her cool, beautiful face. She had always felt as though she were possessed. Could the illness really produce something like that?

Her husband was startled too. “Is… is that true?”

“Don’t worry,” Evan reassured them. “You generally wouldn’t get that far.”

“Can you treat it?”

“Yes. They could treat it more than two thousand years ago.”

“Oh.” Only then did the couple relax.

Iris swallowed. “Then why does my fever start in the evening and go away in the second half of the night? It’s like that every day.”

“Uh…” Evan faltered.

“You don’t know either?” she asked cautiously.

Evan frowned…

Her husband looked troubled too. “Could it really be possession? Otherwise, why would the fever go away on its own after midnight?”

Iris looked worse at that. Even the goose bumps on her face seemed to tremble.

“Should we find someone who can drive out spirits?” her husband asked.

Clara was watching Evan. Could he explain this too?

Ben looked just as baffled. He didn’t know what caused it either.

“I…” Iris was beginning to lose her composure.

Evan absently scratched his hand, his mind racing.

“Fan told me about a very good feng shui master,” her husband said. “Why don’t we go and see him?”

“There’s no need. This isn’t possession,” Evan suddenly called out.

Everyone turned to him again.

He looked at the couple. “The shaoyang Gallbladder channel lies inward of nutritive and defensive qi, between the zang and fu organ systems. Shaoyang is the pivot through which yin and yang change into one another. Inward is yin; outward is yang. When this channel is affected, yin and yang fall out of harmony. Constrained yin produces chills; constrained yang produces fever.

“Yin and yang wax and wane over the year, and they do so over a single day as well. During the zi hour, around midnight, yin is at its strongest. But that’s also when the first yang is born. After that, yang grows stronger and yin weaker. So your fever gradually subsides after the zi hour, going away on its own in the second half of the night.

“At the wu hour, around noon, yang is strongest, but the first yin is born. Yin then grows stronger and yang weaker. After evening comes, you begin to have a fever, and it lasts until around the zi hour.”[5]

Having said all that, Evan breathed more easily too. This was knowledge from classical Chinese medicine. These days, the waxing and waning of yin and yang and the five movements and six qi were all regarded as feudal superstition. Many schools no longer taught them.[6]

He had read Circular Movement in Classical Chinese Medicine outside class. Bringing that together with more than a year’s study at Xiyuan Hospital, he had been able to work out the precise cause.[7]

“It’s that amazing?” Iris’s husband sounded dazed.

Clara quietly breathed a sigh of relief.

Ben was surprised too.

“There’s nothing magical about Chinese medicine,” Evan said. “These are simply patterns in the human body and in nature. There was a case of a boy who sneaked off to an internet café and paid for all-night sessions three or four nights in a row. Shaoyang is the pivot between yin and yang. His sleep schedule damaged it, and the pivot stopped working properly.

“After that, whenever the zi and wu hours came around, when yin and yang changed over, he’d lose consciousness. Right on time, for no apparent reason. Even his teachers stopped checking the clock during class. They just watched him. When he passed out, it was time for class to end.

“His family took him to major hospitals. They checked everything, but they couldn’t find anything.

“Everyone called it a strange illness. With nothing else to try, his family took a chance on Chinese medicine. Two or three doses of Xiao Chaihu Tang, and he was well again.

“Some science and education programs even used the story. They turned it into several episodes of a spooky serial. Some people get toothache during the wu hour, and it goes away afterward. Others grind their teeth during the zi hour. Some become dizzy for no apparent reason at the change from one solar term to the next. That, too, comes from the pivot failing to work properly.”[8]

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Hearing that she wasn’t possessed, Iris relaxed a little. “Then how do you treat it?”

“The principle is the same. When the pathogenic factor is half exterior, half interior, the treatment is to harmonize. When the pivot isn’t working and yin and yang are out of balance, that also calls for harmonizing. Xiao Chaihu Tang is the main formula for both.”[9]

“Is that what I’ll be taking too?”

Evan nodded. “Yes. Liu Hejian says in the Suwen Bingji Qiyi Baoming Ji: ‘For a woman whose menstrual flow has just begun or stopped, with alternating chills and fever, first give Xiao Chaihu Tang to remove the chills and fever, then regulate with Siwu Tang. If the chills and fever have not subsided, do not give Siwu Tang. This is a changed pattern: the exterior pathogenic factor remains, and the formula cannot work.’”[10]

Evan recalled the principles for treating heat entering the blood chamber. The sea of blood was already depleted. Whether heat had become trapped by stagnant blood or pathogenic heat was obstructing the womb, one could not recklessly use methods that forcefully broke up blood stasis.

Even if heat was forcing blood to move, simply clearing heat and cooling blood would not do. Those medicines could clear the heat and cool the blood, but they could not vent the pathogenic factor outward. The urgent task was to find a way out for the pathogenic heat.

That was why the medicines Iris had taken before had done nothing. Simply clearing heat and bringing down the fever wasn’t enough.

The foot jueyin Liver channel lay around the blood chamber. Working through it could allow the pathogenic heat to vent outward. Since the Liver and Gallbladder were an interior-exterior pair, treating jueyin also required treating shaoyang: resolving the pathogenic heat in jueyin through shaoyang.

On one hand, the sunken pathogenic factor had to be lifted and vented, and the heat trapped inside cleared. Clearing and venting had to work together. On the other, healthy qi needed support so it could drive the pathogenic factor out.

Chinese medicine had never been about confronting and annihilating. It was about supporting healthy qi and expelling pathogenic factors—driving them out without damaging the body’s sustaining functions.

The pathogenic factor needed a way out. The way it had come in was also its way out.

Once it was driven out, the body would naturally be healthy again. And because healthy qi was supported throughout treatment, patients would not be left with their vital qi badly depleted after being cured. Recovery would be quick too.[11]

Evan began considering the prescription.

“Chaihu decoction harmonizes; banxia, renshen, and gancao follow. Add huangqin, fresh ginger, and jujube: for all shaoyang disorders, this is the guiding formula.

“Chaihu and huangqin clear and drain the half-exterior, keeping the illness from entering yangming. Renshen and gancao warm and supplement the half-interior, keeping it from entering taiyin. The pathogenic factor is then resolved within its own division, without the danger of passing into either yin or yang. That’s what harmonizing the exterior and interior means.

“I’ll add a few more herbs. Danpi to cool the blood. Zhuru and chenpi to clear the Stomach and direct its qi downward, treating your dry retching. Qinghao uses its aromatic action to dispel foulness and resolve your malaria. Danggui invigorates blood and regulates qi. Baishao calms the Liver and nourishes the nutritive aspect. Yujin relieves Liver constraint. Yes, that should do it.”[12]

“How long will I need to take it?” Iris asked.

“How many days until your period?”

“Three.”

“Then I’ll prescribe three doses for now. One a day. Come back when you’ve finished them, and I’ll see how you’re doing.”

Iris nodded, turned to her husband, and suddenly asked, “Honey, could you stay with me for the next few days? I’m… a little scared…”

Everyone paused in surprise. Even Evan stopped as he was about to write the prescription.

Her husband frowned, looking torn.

Iris turned her face away. “I was only joking,” she added at once.

Everyone looked at her husband.

He sighed softly and took out his phone.

“Hello, it’s me. About that project… I won’t be coming to the talks.”

Reader Notes

↩︎ Shaoyang, the Gallbladder, and the Stomach. Here shaoyang names both a traditional diagnostic division and a channel associated with the Gallbladder. “Half exterior, half interior” describes an intermediate functional pattern, not a point halfway through the body. Capitalized organ names refer to Chinese medicine’s functional systems. The Liver and Gallbladder correspond to wood, the Stomach to earth; “wood overacting on earth” describes an excessive restraining relationship. Stomach qi normally descends in this framework, so its reversal helps explain Evan’s account of retching. Source: Hong Kong Baptist University — Xiao Chai Hu Tang, “Pathogenesis” (in Chinese).↩︎ Heat entering the blood chamber. The “blood chamber” is a traditional term interpreted as the womb, the Chong Vessel, or the Liver. Its “emptiness” during menstruation is theoretical language, not a claim that the body has lost all its blood. Evan’s quotation comes from the Shanghan Lun, the Treatise on Cold Damage. “Contracting wind” here means an externally contracted illness, not a cerebrovascular stroke. “Like malaria” compares recurring chills and fever; it does not establish a parasitic infection. The quotation supplies a traditional category for Evan’s explanation. Sources: WHO — Chinese medicine terminology, entries 532 and 1349; Shidian Guji — Shanghan Lun Sanzhu, “When a woman contracts wind” (in Chinese).↩︎ Feng shui. Feng shui traditionally concerns the placement and surroundings of buildings and graves, interpreted in relation to fortune and misfortune. A “master” here is someone claiming expertise in that practice. The comparison with Evan’s impressive classical language belongs to Iris’s husband. It is part of his reaction to the consultation, rather than a classification of Chinese medicine as feng shui. In the medical explanation, “pathogenic qi” refers to factors thought to cause illness, not a possessing demon. Source: Taiwan Ministry of Education — Concise Mandarin Dictionary, “Feng shui” (in Chinese).↩︎ “As though seeing ghosts.” The classical expression describes a disturbed state in which the patient is clear-headed by day but speaks deliriously toward evening. Evan presents this as a more severe possibility; Iris has not reported experiencing it. The comparison frightens her because it resembles her fear of possession. The line does not introduce a supernatural diagnosis, and his reassurance is not an observed treatment result. Source: Shanghan Shuoyi — “Heat entering the blood chamber,” classical text (in Chinese).↩︎ The zi and wu hours. Traditional Chinese timekeeping divides the day into twelve periods of roughly two modern hours. Zi spans about 11 p.m. to 1 a.m.; wu spans about 11 a.m. to 1 p.m. “Around midnight” and “around noon” locate those periods without reducing them to single clock strikes. Evan interprets them as turning points in a daily yin-yang cycle. The time conversion explains his vocabulary; it does not independently establish why Iris’s fever follows that schedule. Source: Academia Sinica — Taiwan Social Change Survey, third phase, fifth survey report, PDF p. 96, question 101 coding table (in Chinese).↩︎ Five movements and six qi. This traditional framework relates patterns in climate and time to human life and illness. The five movements are wood, fire, earth, metal, and water; the six qi describe climatic influences. “Movements” does not mean bodily exercise, and the Chinese term yunqi here does not mean luck. The surrounding statement about schools and “feudal superstition” is retained from the novel. It should not be taken as a description of every medical school: Beijing University of Chinese Medicine, for example, reported a dedicated lecture series in 2021. Sources: WHO — terminology, entries 466–468; BUCM — Five Movements and Six Qi lecture series (in Chinese).↩︎ The book Evan studied.Circular Movement in Classical Chinese Medicine is this edition’s descriptive rendering of Yuan Yundong de Gu Zhongyixue, a work by Peng Ziyi. The title refers to a medical theoretical framework, not a book of mechanics. A library catalog records a Chinese edition published in 2007, with a 2016 reprint; those are publication details, not dates assigned to this scene. Evan’s hospital study remains part of the novel’s account of his learning. Source: Guangzhou Library — Catalog record for Yuan Yundong de Gu Zhongyixue (in Chinese).↩︎ The anecdote and the solar terms. Evan tells the boy’s story without naming a patient, clinician, case report, or television program. Its provenance and reported cure have not been independently established. The “solar terms” are twenty-four seasonal markers based on the Sun’s position along its annual apparent path. They belong to the Chinese calendar and are different from the twelve daily time periods. The source below explains that calendar system; it does not verify the boy’s story or the proposed cause of anyone’s dizziness. Source: Hong Kong Observatory — The 24 Solar Terms.↩︎ Xiao Chaihu Tang and harmonizing. Xiao Chaihu Tang, often translated “Minor Bupleurum Decoction,” is a classical formula associated with harmonizing shaoyang. “Harmonizing” names a traditional treatment method, distinct from simply forcing sweating or purging. The standard formula contains chaihu, huangqin, renshen, gancao, banxia, fresh ginger, and jujube. Traditional formula verses serve as mnemonics for ingredients and uses. A named formula, a prescription portion, and a single swallow of prepared medicine are different things; the novel supplies no gram weights or preparation instructions here. Source: Hong Kong Baptist University — Xiao Chai Hu Tang, “Composition,” “Explanation,” and formula verse (in Chinese).↩︎ The quotation and Siwu Tang. Evan attributes this passage to Liu Hejian and the Suwen Bingji Qiyi Baoming Ji, here left under its Chinese title. Its exact wording and attribution have not been independently established in the consulted transcription. The sequence within his quotation matters: first address the chills and fever, then consider Siwu Tang, the blood-nourishing formula encountered earlier. He is not prescribing both formulas to Iris at once. The quotation’s conditional warning is retained, as is his earlier claim about treatment more than two thousand years ago. Text consulted: Suwen Bingji Qiyi Baoming Ji, “Disorders of pregnancy and childbirth,” section 29 (in Chinese).↩︎ Supporting healthy qi and expelling pathogenic factors. This treatment principle combines sustaining the body’s functions with removing what traditional theory identifies as harmful. “Pathogenic” is not a supernatural label, and “supporting” does not automatically mean stimulating a measurable immune response. The blood chamber, the sea of blood, and the Liver–Gallbladder channel relationship supply the framework for Evan’s reasoning here. The statements about recovery describe the novel’s therapeutic rationale. They are not an observed result for Iris: she has not taken the medicine, and no response has yet been shown. Source: WHO — Chinese medicine terminology, entry 2258, “Reinforce healthy qi to eliminate pathogenic factors”.↩︎ Medicinal names and the prescription. The pinyin names identify traditional medicinal materials rather than ordinary food ingredients. Danpi is tree peony bark; zhuru is bamboo shavings. Renshen is ginseng, gancao licorice, and baishao white peony root; fresh ginger and jujube are named in English. The roles listed in the dialogue remain Evan’s explanation of his chosen additions. In particular, his word “malaria” follows earlier malaria-like comparisons and is not a newly reported laboratory diagnosis. Three ji means three prescription portions; “one a day” is stated separately. The novel gives no weights, processing details, or number of drinks per portion. Sources: HKBU — Tree Peony Bark; HKBU — Tangerine Peel and Bamboo Shavings Decoction (in Chinese); HKBU — White Peony Root.