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Dr. Xu: A Chinese Medicine Novel

Chapter 64 Deficiency in the Middle, Sinking Qi · Nov 09, 2026

↩︎ White cells in urine and blood. Neutrophils and lymphocytes are types of white blood cell. The figures here are their percentages in a blood differential, distinct from the total white blood cell count. “Pus cells” in urine is a term associated with urinary white cells; the Chinese text lists both labels, and both are retained. It supplies no absolute counts or full differential. The worsening described here belongs to this fictional case; these figures alone do not establish Evan’s traditional diagnosis. Sources: MedlinePlus — Blood differential test; National Library of Medicine — Pyuria.↩︎ Heat strangury and Bazheng San. As in the previous chapter, “heat strangury” names a traditional pattern involving urinary discomfort and heat signs. Bazheng San is a multi-ingredient formula traditionally used for damp-heat strangury. Simon equates that pattern with an acute urethral infection here; the traditional category and the biomedical diagnosis use different frameworks. His statements about effectiveness and antibacterial action remain his claims. Source: Hong Kong Baptist University — Ba Zheng San, Action, Indication, and Application.↩︎ Patterns, mechanisms, and the eight principles. Pattern differentiation brings findings together into a traditional diagnostic pattern; the mechanism explains how the illness develops. The eight principles organize findings by yin/yang, exterior/interior, cold/heat, and deficiency/excess. Evan’s spoken list names six of these, leaving cold/heat unstated. “Lower burner” refers to the lower functional region of the three-burner framework, which includes urinary functions. The terms describe traditional classifications, rather than results measured by a blood or urine test. Source: WHO — International standard terminologies on traditional Chinese medicine, entries 210, 364, 548–550, and 931.↩︎ Zhongjing’s twelve characters. Zhongjing is the historical physician Zhang Zhongjing; “Sage of Medicine” is an honorific. The twelve characters are those of the Chinese maxim, not twelve words in English. In its classical context in the Shanghan Lun, the instruction follows a discussion of illness altered by earlier treatments. “What has gone wrong” preserves that context without adding a particular treatment error to the quotation. The English is translated here from the Chinese, using the wording established in Chapter 5. Source: Shidian Guji — Maxim and its source in the annotated Shanghan Lun (in Chinese).↩︎ Middle qi and sinking. “Middle qi” is the qi of the Spleen and Stomach, the traditional functional systems involved in transforming food and supplying nourishment. “Sinking” describes failure of its upward and supporting functions; it does not mean that a measurable substance has fallen inside the body. This is a new application of the middle-qi discussion in Chapter 62. Evan connects the patient’s weakness, breathlessness, and urinary leakage within that framework. His case interpretation remains distinct from the laboratory findings. Source: WHO — International standard terminologies on traditional Chinese medicine, entries 243, 1195–1196.↩︎ Yin fire and original qi. Yin fire is a traditional term for pathogenic fire associated with causes that can include qi or yang deficiency. It should not automatically be read as the heat of yin deficiency, or as literal combustion. Li Dongyuan’s Piwei Lun links weakened Spleen and Stomach qi, depleted original qi, and upward-surging yin fire. This supplies the background to Evan’s explanation, rather than independently confirming his diagnosis. “Original qi” is another traditional functional concept, not a laboratory value. Sources: WHO — Terminologies, entries 235 and 362; Piwei Lun — section on heat arising from dietary and exertional injury (in Chinese).↩︎ Bitter and cold. These are traditional medicinal properties: bitter refers to a flavor category, and cold to a cooling tendency within the theory, not the temperature at which a medicine is swallowed. The Piwei Lun passage just cited warns that bitter, cold medicines can further damage a deficient Spleen and Stomach. That explains the reasoning Evan invokes. His accusation that Bazheng San caused this patient’s deterioration is the character’s conclusion, rather than an adverse-effect determination established by these sources. Sources: WHO — Terminologies, entries 2638 and 2644; Piwei Lun — section on heat arising from dietary and exertional injury (in Chinese).↩︎ Bringing Chinese and Western medicine together. Zhongxi huitong refers to efforts to bring the two medical traditions into conversation; the physician Zhang Xichun is associated with this current. Evan’s wording plays on zhong Zhong can Xi: remaining rooted in Chinese medicine while consulting Western medicine. He reverses “Chinese” and “Western” to criticize Simon’s priorities. The exchange concerns which framework leads the treatment, rather than simply whether a doctor uses both kinds of medicine. It does not define every present-day approach to integrated care. Source: Tianjin University of Traditional Chinese Medicine — Visit to the Zhongxi Huitong Medical Society (in Chinese).

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